Text Box: IS IT POSSIBLE TO STOP INHALED STEROID IN ASTHMATIC CHILDREN
Lam SY, Fong CM, So KT
Department of Paediatrics, Tuen Mun Hospital, Hong Kong SPR, China

Objective: To define the outcome of asthmatic children after cessation of inhaled steroid, and to identify factors predicting the failure of the cessation. 
Methods: The medical records of all asthmatic children scheduled to attend the respiratory clinic of Tuen Mun Hospital between 5/4/00 and 12/8/00 were reviewed. Inclusion criteria: 1) mild persistent to severe persistent asthma at initiation of inhaled steroid; 2) older than 1 year old when inhaled steroid was started; 3) inhaled steroid was initiated in Tuen Mun Hospital; 4) inhaled steroid had been stopped. Those who needed to be restarted on inhaled steroid were defined as failure of the cessation of steroid.
Results: 525 patients were recruited initially, while 12 patients were excluded because of missing data. The age at cessation of inhaled steroid was 7.96 ± 2.94 years old. The mean duration of follow up after steroid taken off was 24.72 ± 19.21 months. 252 (48%) patients needed to restart the inhaled steroid subsequently. The mean duration of symptoms free period before stopping steroid was 49 weeks among failure group vs 61 weeks in successful group (p = 0.01). There is no difference in failure rate among those who had their inhaled steroid stopped in different seasons. Gradual tailing down the dosage of inhaled steroid did not decrease the failure rate. 90 % of the failure occurred within 19 months.
Conclusion: About half of the asthmatic children had relapse of their symptoms and needed to be put back on their prophylactic medication after cessation of inhaled steroid. We recommend to follow-up these patients for at least 19 months after stopping their prophylactic medication.
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