Influence of anti-inflammatory therapy with glucocorticosteroids on the frequency and severity of respiratory infections in children with asthma

Asthma is a chronic inflammatory respiratory disease. Anti-inflammatory therapy with inhaled glucocorticosteroids is considered the most effective long-term therapy for moderate and severe forms of chronic asthma. Side-effects constitute the only limitation of this therapy. The purpose of our study was to find out whether long-term administration of inhaled glucocorticosteroids for asthma has an immunosuppressive side effect. We studied the frequency and severity of respiratory infections in asthmatic children treated with long-term inhaled glucocorticosteroids and in children with asthma receiving no such therapy. Our hypothesis was that long-term therapy with inhaled glucocorticosteroids for asthma has an imunosupressive side effect and that asthmatic children given long-term therapy with inhaled glucocorticosteroids suffer more frequent and more severe respiratory infections than children with asthma receiving no such
medication. This one-year prospective study included 20 children with mild and moderate asthma, aged 7 years 0 months to 14 years 11 months (average 9 years, 4 months. There were 7 girls and 13 boys. The children were divided into two groups (n = 10): one group receiving long-term therapy with inhaled glucocorticosteroids (fluticasone propionate) and another group given no such therapy. Because of moral, ethical and medical principles a non-random grouping of children was used in this study. The children, helped by their parents, kept a diary of symptoms and clinical signs of respiratory infection and asthma, and measured their peak expiratory flow rate and body temperature. In the event of occurrence of symptoms and clinical signs of respiratory infection, they were asked to visit the out-patient clinic for pulmonary diseases, Department of Paediatrics, for the evaluation of infection. Asthmatic children receiving no long-term therapy with inhaled glucocorticoids had a total of 26 respiratory infections (median- 2.5 respiratory infections/child/year), lasting for a total of 207 days (median- 6 days/respiratory infection), 9 of them were severity grade 1, 13 grade 2, and 4 grade 3. Children with asthma placed on long-term therapy with inhaled glucocorticosteroids had a total of 27 respiratory infections (median- 3 respiratory infections/child/year), lasting for a total of 198 days (median 7 days/respiratory infection), 12 of them severity grade 1, 13 grade 2, and 2 grade 3. There were no statistically significant differences between the two groups in the parameters studied. The Wilcoxon’s signed-rang test was used for the statistical analysis (p > 0,05). On the basis of the results of our study we are not able to conclude, that long-term administration of low-dose (200μg/day) inhaled glucocoticosteroids (fluticasone propionate) increases the frequency and severity of respiratory infections in children with asthma, and hence can’t conclude that it has clinically relevant imunosupresive effects.