Treatment of Aerosol Beclomethasone Dipropionate for Managing Exacerbations in Chronic Asthmatic Patients, ages 5-18, and those with Corticosteroid Dependence

Pediatric chronic asthma management often requires inhaled corticosteroid use, like beclomethasone dipropionate (BDP). While BDP has been a keystone in asthma treatment for decades, the research assessing its efficacy and safety, particularly in ages 5-18, were conducted between the 1970s to 2005, leaving a significant gap in recent studies. This systematic review evaluates the efficacy of BDP in improving pulmonary function and resolving corticosteroid dependence in chronic asthmatic children, while also assessing its potential side effects.

Out of 273 studies, 20 fit the inclusion criteria, encompassing 1495 children, ages 5-18, with chronic asthma and some with corticosteroid dependence. The trials compared the administration of BDP to a placebo, across different timeframes and doses. Pulmonary function metrics (FEV1, PEFR, PEF, and PFR), methacholine tests, and symptom scores, displayed significant improvement in children receiving BDP. Common observed side effects among majority of studies were oropharyngeal candidiasis, rhinitis, and eczema.

Though studies display BDP as a beneficial treatment option, advances in asthma treatments and inhaler technology since then have outpaced the available research, making it difficult to assess BDP’s current role in childhood chronic asthma management. Conflicting findings on growth suppression and adrenal dysfunction raise concerns about the reliability and certainty of existing data on BDP. This highlights the need for updated, comprehensive studies to resolve these contradictions and clarify BDP’s role in managing pediatric asthma, in order to update clinical guidelines.

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Article Contents 

23 min

Introduction Literature Review Methodology Results Discussion Conclusion FAQs

Introduction

Unmanaged chronic pediatric asthma must be managed as it carries possibilities of asthma attacks. It’s crucial to ensure normal growth, development, prevent frequent hospitalizations, and improve overall quality of life by reducing symptoms and enhancing daily functioning in children, where asthma is more prevalent. James W. defines asthma as a chronic, long-term, inflammatory condition caused by complex interactions between genes and environmental factors that are not completely understood.[1] He characterizes asthma by variable airway blockage and increased sensitivity of the bronchial tubes (narrowing of the airways) where asthmatics often experience recurrent episodes of wheezing, coughing, chest tightness, and difficulty in breathing.[1] For treatment, inhalers are used to transfer aerosol medications via inhalation allowing air to enter and exit the lungs more easily by opening its airways.

This device is specifically beneficial and manageable for children with chronic asthma.

Asthma is labelled severe or chronic when continuous asthma exacerbations are observed. It is the uncontrolled progressive increase in asthma symptoms despite treatment where inadequate control can’t be achieved, or when a therapeutic step down is attempted further leading to a change in treatment plan.[2] The primary goal of these treatments is to control asthmatic symptoms and prevent exacerbations. Such medications, to name a few, include beta-agonists, inhaled corticosteroids, beclomethasone dipropionate (BDP), albuterol, and theophylline. Although said medications provide benefits, some patients develop corticosteroid-dependency; an unusual but potential complication of corticosteroid use, requiring daily administration.[3] Its’ discontinuation results in withdrawal symptoms and recurring severe asthmatic episodes. Prednisone, a frequently implicated corticosteroid for asthmatic patients, is often associated with this dependency due to its euphoria-inducing effects, withdrawal syndrome, and direct influence on the reward circuitry.[3]

Asthma is one of the most common chronic conditions in children along with systematic corticosteroid use, such as prednisone. Consequently, sub