Researchers have found that a long-acting ß-agonist (LABA) may be the most effective step-up treatment for children whose asthma is not well controlled. The study published in the New England Journal of Medicine compared the effectiveness of three different step-up treatments in 182 children ages 6 to 18 who had mild to moderate persistent asthma that was not controlled on low-dose inhaled corticosteroids.
The study, called Best Add on Therapy Giving Effective Responses (BADGER), showed that almost all the children responded differently to the three therapies. About 45% responded best to the long-acting ß-agonist salmeterol, 28% responded best to the leukotriene receptor antagonist montelukast, and 27% responded best to doubling the dose of the inhaled corticosteroid fluticasone.
"The study gives physicians confidence in using long-acting ß-agonist if a patient is not responding to steroid treatment alone," said Stanley Szefler, professor of pediatrics and pharmacology at National Jewish Health. "It also shows that children respond quite differently to different step-up therapies. Doctors need to monitor their patients closely to consider switching to a higher dose of inhaled corticosteroids or a leukotriene receptor antagonist if the long-acting ß- agonist does not improve asthma control."
Researchers also found that certain patient characteristics helped identify which step-up treatment would be most effective. African Americans were equally likely to respond best to LABA step-up or corticosteroid step-up, but not the montelukast. The addition of LABA step-up therapy was most likely to give the best response to white patients, with inhaled corticosteroid step-up the least favorable.