0616. Does sodium cromoglycate lower the risk for asthma in school-age children?

Experience in various countries has been that hospital attendances for paediatric asthma have increased in respect of new cases (i.e. incidence and prevalence are increasing) whereas readmission rates and length of stay have decreased. The latter probably reflects improved management, much of which is the result of recognition of asthma as an inflammatory disease and the need for early anti-inflammatory medication. Inhaled steroids have assumed a prominent place, while cromoglycate and xanthines are used to a lesser extent. In a number of head-to-head studies of management and control of asthma in young children using inhaled budesonide vs cromoglycate, budesonide comes out on top in every case, with better control, fewer exacerbations, greater user satisfaction, etc. However there is also evidence from Japan and Finland that starting cromoglycate early has the potential to reduce the severity of asthma over time. The Finnish study again compared budesonide to cromoglycate in children who presented early with wheezing (<2 years of age). In contrast to other studies that compared the shorter term airway responses of one drug against the other, this study looked at risk for asthma at school age and found that cromoglycate was associated with a lowered risk (21% in the cromoglycate group vs 46% in those who had been treated with budesonide). Numbers are small and further studies are probably indicated to answer the question of whether the chronic effects of inflammation in early wheezers can be reduced through the use of anti-inflammatories other than steroids.

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