beclomethasone dipropionate in the control of mild childhood asthma

The effects of controlling childhood asthma of the same daily dose (400 pg) of beclomethasone dipropionate, given in two or four equal divided doses from a metered aerosol, were compared in a double blind crossover study. Thirty one children aged 6-14 years completed the study. They had previously been shown to need beclomethasone by showing either symptoms or reduced peak flow when the treatment was withdrawn. They recorded their daytime and night time symptoms on a visual analogue scale and their morning and evening peak expiratory flow (PEF), and recorded their symptomatic use of bronchodilator aerosols. Spirometry was performed at the end of each treatment period. Control of asthma was good on both regimens. There were small differences in both objective and subjective measurements in favour of the four times daily regimen, but none reached statistical significance, apart from patients' assessment of daytime wheeze (p < 0-05). In particular, the differences in the results of lung function tests were very small. Compliance was better for morning and evening doses. These results suggest that beclomethasone given as 200pg twice daily is effective in controlling mild childhood asthma. It may be preferable to lOO1g four times daily because of better compliance and because it is unnecessary to take medication to school. Inhaled beclomethasone dipropionate has been used for over 10 years in the treatment of childhood asthma.' 2 During that time many accounts of its usefulness and safety have been published.34 The recommended standard dose of 100 pg (two puffs from a metered dose inhaler) four times a day has been shown to be effective in controlling symptoms and it can successfully replace oral steroid treatment in a large proportion of steroid dependent patients. This standard dose has been shown not to suppress the pituitary-adrenal axis.56 Furthermore, it does not affect linear growth7 and has no long term deleterious effect on the bronchial mucosa.8 Problems with compliance are more frequent when drugs have to be taken several times a day.9 "'Treatment twice daily is easier to manage than treatment four times daily, especially in children as parental supervision can be more strict and it removes the inconvenience of having to take medication at school. Address for reprint requests: Dr J R Sibert, Liandough Hospital, Penarth, S Glam CF6 IXX. Accepted 5 February 1986 Results of a small study of the use of beclomethasone in adults" and experience with another inhaled steroid in children'2 have suggested that a twice daily regimen could be effective. This trial was conducted to compare the usefulness in children of twice daily treatment with beclomethasone with that of the previously recommended regimen of four times a day. Patients and methods Thirty nine asthmatic children of up to 14 years of age underwent a period of pretrial assessment. All had been using beclomethasone to control their asthma before the onset of the trial and were able to perform simple lung function tests. Patients who required oral steroids occasionally (more than twice a year) were not included in the study. Informed consent was obtained from the parents and children in each case. A pretrial period of assessment was considered necessary to prove that the children needed treatment with beclomethasone 100 pg four times a day and were therefore suitable for the study. During this three week pretrial period beclomethasone was 602 group.bmj.com on April 12, 2017 Published by http://thorax.bmj.com/ Downloaded from