Inhaled corticosteroids helped preterms with decreased lung function

Corticosteroids improved lung function for premature children. A study suggests that bronchodilator responsiveness helps screening patients for this approach.

The study was based on 170 survivors of very preterm birth

Preterm associated lung disease is a common complication and evidence indicates that the lung function of these preterm patients worsens over time1,2. A randomised, clinical trial demonstrated that inhaled corticosteroids may be administered to improve lung function in preterm-born children3. The current Preterm Paediatric Inhaled Corticosteroids Intervention (PICSI) study, conducted by Prof. Shannon Simpson (Curtin University, Australia) and colleagues, randomised 170 survivors of very preterm birth (≤32 weeks gestation) to a 12-week course of the inhaled corticosteroid fluticasone propionate or to placebo.

A modest but significant difference in % FEV1-change was observed between the fluticasone arm (5.93) and the placebo arm (1.75; P=0.01). Changes in FEV1/FVC favoured the intervention arm over the placebo arm (3.69% vs -0.79%; P=0.013) and changes in FeNO (ppb) displayed an advantage for children receiving fluticasone (-4.92 vs 0.11; P=0.01). Prof. Simpson added that 21.3% of the patients had a clinically significant improvement in FEV1. Finally, multivariate analysis showed that BDR is an independent predictor of the efficacy of inhaled corticosteroids in these patients (P<0.001).

“Although our study observed only a modest improvement in lung function after a course of inhaled corticosteroids, a significant proportion of patients was highly responsive to this treatment,” according to Prof. Simpson. “BDR may be used to screen for these patients, but further studies are needed to predict which children are most likely to benefit from inhaled corticosteroids.”

  1. Kotecha SJ, et al. JAMA Pediatrics. 27 June, 2022. Doi: 10.1001/jamapediatrics.2022.1990.
  2. Simpson SJ, et al. Lancet Child Ado Health. 2018;2(5):350–359.
  3. Goulden N, et al. JAMA Pediatrics. 2022;176(2):133–141.
  4. Simpson S, et al. Inhaled corticosteroids to improve lung function in survivors of very preterm birth: PICSI RCT. ALERT 2, RCT2165, ERS International Congress 2022, Barcelona, Spain, 4–6 September.