Asthma and lower airway diseaseIn utero smoke exposure and impaired response to inhaled corticosteroids in children with asthma
Section snippets
Methods
Details of the Childhood Asthma Management Program (CAMP) trial have been described elsewhere.15, 16 Briefly, CAMP is a multicenter, randomized, double-masked clinical trial to compare the long-term effectiveness and safety of 3 inhaled treatments for asthma: budesonide, nedocromil, and placebo. CAMP enrolled 1041 children age 5 to 12 years with mild-moderate asthma at 8 clinical centers between December 1993 and September 1995. Asthma was defined by the presence of asthma symptoms or the use
Results
All children with asthma in CAMP (n = 1041) had baseline methacholine challenge tests. Methacholine challenge testing was completed for 92%, 90%, 85%, and 82% of the cohort at 8, 20, 32, and 44 months after randomization, respectively. Baseline characteristics were generally similar between children with and without methacholine challenge data at 44 months. Children who were missing PC20 measurements were more likely to have been recruited from 3 of the clinical sites (Albuquerque, Boston,
Discussion
Inhaled corticosteroids are both commonly prescribed and efficacious for the treatment of asthma in children and adults. They have been shown to reduce airway responsiveness, asthma symptoms, need for breakthrough bronchodilator therapy, and exacerbation rates.14, 19 However, there is considerable between-subject variability in clinical response to inhaled corticosteroids, including patients who manifest partial to substantial steroid resistance necessitating escalation of treatment dose.20
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Cited by (53)
Allergenic and chemical pollutants of indoor environments and asthma: Characterization, assessment and eviction
2023, Revue des Maladies RespiratoiresFactors Associated with Asthma Severity in Children: Data from the French COBRAPed Cohort
2021, Journal of Allergy and Clinical Immunology: In PracticeNormal Lung Development in Relation to Clinical Practice and the Impact of Environment on Development
2021, Encyclopedia of Respiratory Medicine, Second EditionLife Cycle of Childhood Asthma: Prenatal, Infancy and Preschool, Childhood, and Adolescence
2019, Clinics in Chest MedicineCitation Excerpt :Beneficial effects of ICS do not last once therapy is discontinued, whereas small but significant reductions in height are sustained, particularly in girls.118 The CAMP investigators and others have shown that lack of response to ICS is predicted by prenatal smoke exposure,119 lack of bronchodilator reversibility,120,121 and overweight and obesity.122 Atopy123 and airway inflammation124 may predict better response to ICS in children with mild to moderate asthma.
Ambient air pollution
2016, Journal of Allergy and Clinical ImmunologyCitation Excerpt :The number of days from randomization was the time trend of the model. Potential for confounding factors was considered carefully, basing choice of covariates on prior CAMP experience.17,18 To estimate associations across all cities, we constructed a model including city as a covariate but also compared estimates of this model with study-wide estimates from meta-analyzing city-stratified models.
The Childhood Asthma Management Program is supported by contracts NO1-HR-16044, 16045, 16046, 16047, 16048, 16049, 16050, 16051, and 16052 with the National Heart, Lung, and Blood Institute and General Clinical Research Center grants M01RR00051, M01RR0099718-24, M01RR02719-14, and RR00036 from the National Center for Research Resources. B.A.R. is a recipient of a Mentored Clinical Scientist Development Award from NHLBI/NIH (K08 HL074193).
Disclosure of potential conflict of interest: R. T. Cohen has received research support from the National Institutes of Health, the National Heart, Lung, and Blood Institute, the Philadelphia Health and Education Corp, and Trustees of the Alumni/ae Association of the Women's Medical College of Pennsylvania. B. A. Raby is an editor for UpToDate. A. L. Fuhlbrigge was previously a consultant, advisory board member, and speaker for Merck and is currently a consultant for GlaxoSmithKline. B. A. Rosner has received research support from the National Institutes of Health. R. S. Zeiger is a consultant for Aerocrine, AstraZeneca, Genentech, GlaxoSmithKline, MedImmune, and Merck and has received research support (through Kaiser Permanente) from AstraZeneca, Aerocrine, Genentech, GlaxoSmithKline, and Merck. The rest of the authors have declared that they have no conflict of interest.