Response of preschool children with asthma symptoms to fluticasone propionate

Background: Many uncertainties remain in the diagnosis and treatment of preschool children with asthma symptoms. Objective: We sought to determine the subgroups of preschool children (aged 12-47 months) with recurrent asthma symptoms most likely to respond to inhaled fluticasone propionate (200 mug/d). Methods: Subgroups of pooled data from 2 similar 12-week multicenter studies were analyzed. Results: Children with frequent symptoms (symptoms on greater than or equal to3 days per week and a total of greater than or equal to 75% days with symptoms during the 4-week run-in period; n = 169) showed a significantly greater increase in days without symptoms after fluticasone propionate treatment (0% to 45%) compared with after placebo treatment (0% to 25 %, P = .005). Children with a family history of asthma (n = 213) also had a significantly greater increase in days without symptoms after fluticasone propionate (11% to 54%) compared with after placebo (7% to 35%, P = .002) and a significantly higher proportion of exacerbation-free patients (61% to 76%, P = .02). Children with less frequent symptoms, no family history of asthma, or both showed no significant treatment effect. There seemed to be no association between response to fluticasone propionate and history of rhinitis or eczema or the number of previous exacerbations. Conclusions: Children with frequent symptoms, a family history of asthma, or both showed the greatest response to fluticasone propionate treatment. These findings may help to predict treatment outcome and guide the management of preschool children with recurrent asthma symptoms.