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Asthma therapy: is it really effective?

Editor, The article by Chen et al. (1), provides the largest efficacy result of early interventions with inhaled corticosteroids in children with mild persistent asthma. As these findings are likely to direct public health interventions around the world; a detailed debate should follow the publication. It should be noted that the placebo group is inaccurately called usual care group . First, because second hand smoking was not discouraged; secondly, because environmental control measurements were not implemented according to allergen sensitivities; thirdly, because only pharmacotherapy was added to either intervention; and fourthly, because 77% of the placebo group did not receive inhaled corticosteroids. Therefore, it received less than usual care and it should be called placebo group . The authors concluded that the budesonide group was associated with a statistically significant increase in the time to first severe asthmarelated events (SARE). However, they fail to show a reduction of emergency room visits and hospitalizations. Probability (p) values for these two outcomes at the end of the trial must have been presented. It is of great interest that authors could compare their pulmonary function data with the one reported by CAMP (2). Similarly, they should allow us to compare both clinical outcomes by using the same units that CAMP did (number of events per 100 children treated per year); both at baseline and at the end of the trial. Some of these outcomes are: emergency room visits, hospitalizations, hospital days, oral/ systemic corticosteroids, among others. Until that information is provided, we could only conclude that chronic treatment with inhaled corticosteroids per 100 children for a 3-yr period could prevent one emergency room visit and two hospitalizations. Moreover, it could relieve chronic symptoms in 16 (1.5%) of the 1095 days that the medication is used.