Effect of inhaled budesonide on bronchial hyperresponsiveness in adolescents with clinical remission of asthma

Study objective: Many children with asthma go into long-term clinical remission at adolescence, but bronchial hyperresponsiveness (BHR) persists in some of these subjects. The regular use of inhaled corticosteroids improves BHR in patients with symptomatic asthma. The aim of this study was to determine whether BHR in adolescents with asthma remission could be reduced by prolonged treatment with inhaled corticosteroids. Design: A randomized, double-blind, placebo-controlled, parallel study. Patients: Thirty-seven adolescents with BHR and long-tern remission of their asthma (neither symptoms nor any medication use during the previous 2 years). Intervention: Subjects received inhaled budesonide (two 200-mug puffs bid; budesonide group, n = 19) or identical placebo (placebo group, n = 18) for 9 months. A separate group of patients with symptomatic asthma (symptomatic group, n = 19), using the same regimen of budesonide, was also studied. Measurements and results: The provocative concentration of methacholine producing a 20% fall in FEV1 (PC20) was measured before and every, 3 months during treatment. There was no significant difference among the three groups for the baseline PC20. In neither the placebo nor the budesonide group did the geometric mean of PC20 change significantly over the 9-month period. In contrast, a significant increase in PC20 was noted in the symptomatic group as a result of the budesonide treatment. Conclusion: Our data have shown that budesonide inhaled regularly for 9 months did not cause a significant improvement in the BUR of adolescents with long-term asthma remission. This suggests that the mechanism underlying BHR in this clinical setting may be different from that in symptomatic asthma.