Treatment of Aerosol Beclomethasone Dipropionate for Managing Exacerbations in Chronic Asthmatic Patients, ages 5-18, and those with Corticosteroid Dependence

Introduction

Unmanaged chronic pediatric asthma must be managed as it carries possibilities of asthma attacks. It’s crucial to ensure normal growth, development, prevent frequent hospitalizations, and improve overall quality of life by reducing symptoms and enhancing daily functioning in children, where asthma is more prevalent. James W. defines asthma as a chronic, long-term, inflammatory condition caused by complex interactions between genes and environmental factors that are not completely understood.[1] He characterizes asthma by variable airway blockage and increased sensitivity of the bronchial tubes (narrowing of the airways) where asthmatics often experience recurrent episodes of wheezing, coughing, chest tightness, and difficulty in breathing.[1] For treatment, inhalers are used to transfer aerosol medications via inhalation allowing air to enter and exit the lungs more easily by opening its airways.

This device is specifically beneficial and manageable for children with chronic asthma.

Asthma is labelled severe or chronic when continuous asthma exacerbations are observed. It is the uncontrolled progressive increase in asthma symptoms despite treatment where inadequate control can’t be achieved, or when a therapeutic step down is attempted further leading to a change in treatment plan.[2] The primary goal of these treatments is to control asthmatic symptoms and prevent exacerbations. Such medications, to name a few, include beta-agonists, inhaled corticosteroids, beclomethasone dipropionate (BDP), albuterol, and theophylline. Although said medications provide benefits, some patients develop corticosteroid-dependency; an unusual but potential complication of corticosteroid use, requiring daily administration.[3] Its’ discontinuation results in withdrawal symptoms and recurring severe asthmatic episodes. Prednisone, a frequently implicated corticosteroid for asthmatic patients, is often associated with this dependency due to its euphoria-inducing effects, withdrawal syndrome, and direct influence on the reward circuitry.[3]

Asthma is one of the most common chronic conditions in children along with systematic corticosteroid use, such as prednisone. Consequently, substitutes have been explored to eliminate or significantly reduce this dependency, especially among children. Such alternatives include aerosol BDP.[4] Encouraging results have been observed with BDP, however, its effects are spread among countless papers dating back to late 1970s and early 2000s, making it difficult to gather up-to-date information regarding this medication. Additionally, very few refer to its effect on corticosteroid dependence.

This study will perform a recent review to evaluate the hypothesis that BDP significantly reduces asthmatic symptoms and the frequency of asthma exacerbations and if it alleviates corticosteroid dependency in children, ages 5-18, with chronic asthma or not; a modern understanding of BDP’s effects.

Literature Review

Multiple scholars have found BDP to be an effective medication for asthmatic patients in preventing asthma exacerbations and controlling its symptoms.[5-23] There have been various comparisons of BDP other asthmatic medications such as fluticasone propionate (FP), salbutamol, choline theophyllinate, and long-acting ß2 agonists (LABAs). Moreover, different BDP dosages and formulas have been tested to determine which combinations are most advantageous.

BDP vs. Fluticasone Proprionate (FP)

Wolthers and Pedersen compared growth velocity in FP to BDP, concluding BDP’s association by observing a statistically significant reduction.[5] In contrast, Fitzgerald et al. in long-term study, compared FP and BDP with more participants, reporting identical height gain velocities.[6] However, he noted these results may have been influenced by concurrent and previous systemic steroid usage, and possibly by effects of disease activity.[6] Additionally, they determined similar degrees of mild adrenal dysfunction, efficacy values, and symptom scores (cough, tachypnoea, wheeze, shortness of breath; means of night time scores) during the FP and BDP treatment phases.[6]

BDP vs. Salbutamol

Articles have also observed BDP in combination with medications, such as Salbutamol, in comparison to a placebo.[7] Bennati et al. found BDP alone was effective however greater improvement in bronchial hyperactivity was seen when combined with salbutamol.[7] This improvement was noted regardless of administration methods of a combined or two separate inhalers.[8] Furthermore, no significant difference was observed between peak expiratory flow rate (PEFR), symptom scores, additional symptomatic bronchodilator therapy, acute exacerbations of asthma, or incidence of adverse events, demonstrating that both treatments were similarly effective in managing the asthmatic symptoms.

[9] Study suggests further research although the drugs had greater improvement when combined than separate.[9] Concerns were raised about the potential effects on potassium levels from this combination, where Del et al. reported its untouched effect on serum potassium, QTc (heart rate), or ECG readings.[10] While both treatments led to a significant increase in CPK-MB levels, this alone does not confirm that BDP alone or with salbutamol have cardio-toxic side effects.[10] 

BDP vs. Theophylline

BDP and theophylline together improved the control of asthma in comparison with BDP alone.[11] Reduction in BDP use resulted in asthma exacerbations which were alleviated by resuming BDP. [11] Theophylline, however, was ineffective in preventing this deterioration. Similarly, Reed et al. determined BDP to be more effective than theophylline.[12] More patients discontinued theophylline treatment because it caused more headaches, nervousness, insomnia, and gastrointestinal distress.[12] For these reasons, theophylline’s inability to replace BDP for long-term treatment of asthmatic patients is displayed.

BDP vs ß2 Agonist (Salmeterol)

Verberne et al., in a one year study, found BDP to significantly increase FEV1 and PD20 methacholine, while salmeterol (a short-acting ß2 agonist) slightly reduced them.[13] Both groups improved in peak expiratory flow (PEF) and symptom scores, with BDP showing greater improvement, while exacerbations and withdrawals were more frequent in the salmeterol group.[13] Conversely, growth was significantly slower in the BDP group, aligning with the prior study.[13] Moreover, through measurements of CPK-MB, it was suggested that excessive use of beta agonists to treat lung conditions could be a possible cause for the increase of asthma morbidity and mortality and should not be used as monotherapy.[10,13] Overall, BDP ranks superior to salmeterol.[13]

Method of Administration

Some studies have focused on methods of BDP administration by comparing their functionality and effectiveness. Metered-dose inhaler (MDI) and breath-actuated inhaler (BAI) for BDP were given to participants with asthma. Both BDP BAI and MDI demonstrated significant improvements in pulmonary function, though, BAI was preferred due to its easy use.[14,15] The same occurred when comparing MDI and nebulization; both were equally effective and improvements were maintained, but as before, nebulization was preferred over MDI to simplify administration.[16] BDP can also be taken as a powder or aerosol, which are also equally effective[17]. Younger children preferred taking the powder via rotahaler device as compared to taking the aerosol, nonetheless, the method of administration does not affect efficacy.[18] In the end, it all came down to patient preference.

Formulas

BDP involves an original formula, chlorofluorocarbon BDP (CFC-BDP), and a newer one, hydrofluoroalkane-134a BDP (HFA-BDP).[19] Treatment with both versions at consistent dosages suggested no difference in their impacts.[20] Observations showed improvement in reducing asthma symptoms to a large degree, however quality of improvement was, on a minor scale, better in the HFA- BDP group.[19]

Dosage

BDP dosage among asthmatic children is dependent on severity. One paper determined a minimum of 200 micrograms a day was effective in controlling mild asthma.[21] Another study testing 1400 versus 1800 µg/d of BDP on individuals with severe chronic asthma, suggested the higher dosage had a greater efficacy than the lower dose.[22] Multiple studies testing various dosages came to the same conclusion.[19,21-23] Moreover, dosages were tested based on how the individuals split the daily dose throughout the day, such as a twice-daily or four-times-daily regimen. Greater compliance was noted with the twice daily regime as it was easier to manage.[23]

Methodology

A quantitative systematic study was performed adhering to the PRISMA guidelines to ensure a transparent and methodologically sound approach to selecting articles. A total of 20 articles sourced from PubMed were included in the final analysis; a reliable and peer-reviewed database holding a diverse range of scholarly papers that can be in the forms of reviews, books and documents, or experimental findings.

Search Strategy: To identify relevant articles, the MeSH terms “asthma”, “chronic”, “steroid dependent”, “children”, “BDP”, “beclomethasone dipropionate”, and “effects” were chosen to cover a broad yet focused range of studies. This ensures the review to be comprehensive and targeted towards addressing the impact of BDP on this particular patient population.

Eligibility Criteria: The PICO (Patient problem, Intervention, Comparison, and Outcome) framework was employed to narrow down papers to relevance and guide the formation of the inclusion and exclusion criteria. Studies included pediatric asthma patients, aged 5-18 years, diagnosed with chronic asthma, and some with corticosteroid dependence. The intervention of interest involved BDP typically compared to a placebo. Whether BDP improved or worsened their condition was the aim of their assessment. Articles were excluded if they included non-pediatric patients or non chronic asthma cases.

Sources: PubMed database was used for the literature search for its comprehensive collection of clinical studies and peer-reviewed articles. Only articles published in english were considered and limited to most recent studies.

Selection Process: Initially, titles and abstracts were screened based on the inclusion criteria and placed in the website, Covidence, for better organization. Studies meeting the eligibility criteria were subjected to a full-text review, some of which were found on Cochrane Library. Any doubt in the eligibility by reading the abstract, was either confirmed or denied by reading the full text which were then either added or removed from the set of included studies.

Data Collection Process: Data was extracted based on essential details such as study design, patient characteristics, intervention methods, comparison groups, and outcome measures. Data was collected on primary outcomes such as FEV1 (forced expiratory V/s), PEF, PFER scores, and symptom score

(including headaches, wheezing, shortness of breath, etc.) to display the drugs’ effectiveness while side effects such as adrenal function, growth rate, oropharyngeal effects, rhinitis, and prednisone discontinuation were assessed in relation to their severity and magnitude to the overall treatment.

Figure 1: PRISMA Diagram on selection process and screening

Results

The comprehensive systematic search yielded a total of 200 articles from PubMed, however, after removing duplicates, irrelevant references, and evaluating data and methodologies, 20 studies met the inclusion criteria for this review. Improvement in pulmonary function was showcased in almost all studies for which it was a focus. Occurrences of rhinitis, eczema, and candidiasis tended to be common across majority of studies while conflicting effects on growth and the adrenal gland were seen.

Table 1: Characteristics of included studies

* Sample ages not specified however categorized as children

Pulmonary Function

FEV1

Table 2 shows key findings for FEV1 where the percent increase in FEV1 varied with both dosage and trial length. Katz et al. Reported significant improvements in pulmonary function tests when compared to placebo groups.[24] Nathan et al. reported similar improvements when compared with patients taking salmeterol, with a mean increase in FEV1 of 0.23 L at week 26.[25] Observations analyzing non-corticosteroid-dependent patients with moderate airway obstruction showed appreciable responses to BDP, while steroid-dependent patients exhibited less improvement due to their already reduced airway obstruction from previous systemic steroid medications, such as prednisone.[26] Additionally, Chatterjee reported the greatest FEV1 improvements in children taking 800µg/d BDP of approximately 41%.[27] Nayak et al. noted 48.3% of patients demonstrated a clinically relevant improvement in lung function with an increase in FEV1 of ≥12% (a percentage indicating clinical significance).[28] Additional articles confirmed the beneficial and sustained impact of BDP on lung function in asthmatic children.[29,12,30]

Table 2 reveals a clear trend where the percent increase in FEV1 increases with dosage. Also, long-term BDP administration is associated with greater improvements in FEV1.

Table 2: Average percent increase in FEV1 values in asthmatic children through various studies and their respective dosages during trials.

**Number of children within the trial were excluded as it does not impact the results as they represent an average measure across patients

PEF, PEFR, and PFR

Both AM and PM PEF significantly improved compared to a placebo group during a 26-week study, with improvements in PM PEF becoming more pronounced at latter weeks.[25] These effects persisted even after treatment had ended.[1] Moreover, Nayak et al. found that children receiving 160 µg/d of BDP experienced a substantial mean increase in PEF of 30.8 L/min, compared to 9.2 L/min in the placebo group, highlighting the dose-dependent efficacy of BDP.[28] Godfrey and König confirmed these findings, observing notable improvements in PEF among children treated with BDP.[31] Younger patients often saw a dramatic doubling in their PEF values.[32] While long-term studies by Broder et al. report smoking could mitigate some of the drugs’ benefits, overall, the improvements in PEF were favourable when compared to the general population.[29]

The average PEFRs were measured over the course of a month.[12] During the evenings, children's PEFRs were between 97% and 100% of what is considered the predicted or normal value for their age, height, and gender.[12] In the morning, values were slightly lower (92%-96%), suggesting lung function to be generally close to normal in the evenings, but slightly reduced in the mornings.[12]

During a 12-month study where participants were treated with 300 µg/d of BDP, the observed peak flow rate (PFR) as a percentage of the predicted value increased significantly, rising from 63.8% at the start of the study, to 81% by the end.[33] Furthermore Francis RS. reported that 64.3% of participants experienced an improvement in their PFR over the course of the study.[33]

 Symptom Score

Over a 26-week period, a comparison between BDP and salmeterol revealed no significant differences in increasing the percentage of symptom-free days and nights.[25] However, during weeks 25 to 26, BDP-treated patients experienced significantly greater increases in symptom-free days and nights compared to placebo and salmeterol.[25] These improvements were sustained through the two-week post- treatment period, with an observed 14% increase in symptom-free nights by week 4.[25] Throughout BDP treatment, symptom scores (including reductions in wheezing and cough) improved consistently with a notable decline in its mean from baseline, leading to fewer days with moderately severe or worse symptoms.[12] Despite some mild side effects reported by 20% of patients, BDP effectively maintained symptom control without severe adverse reactions.[24-26,12,33]

Table 3: Average percent of symptom-free days and nights experienced by chronic asthmatic children.

Table 3 follows the same trends as FEV1, while there may be some variations based on factors such as oxygen tension and level of severity of asthma.[34] The discrepancy seen between the studies by Champion et al. and Springer et al. can be primarily attributed to the difference in sample size within the trial, where Chapiom et al. observed 41 children and Springer et al. observed only 10.[35] The overall trend, similar to budesonide reported in the study by Springer et al., highlights the association between higher doses and increased percentage of symptom-free days.[35]

 Methacholine Test

Treatment with BDP led to modest but statistically significant improvements in methacholine sensitivity, as evidenced by an increase in mean PD20, the dose of methacholine required to cause a 20% fall in FEV1.[12] The mean PD20 increased by approximately half of a doubling dilution, where improvements were sustained throughout the year.[12] Although the changes in PD20 were relatively small, ranging from 1.29 to 1.57 doubling doses, BDP significantly reduced bronchial hyper- responsiveness compared to placebo by week 14.[25] These findings suggest that higher doses correlate with better pulmonary function, as indicated by the reduced bronchial reactivity to methacholine. This is therapeutic benefit of BDP in managing asthma by enhancing lung function and reducing airway sensitivity to irritants.

Exacerbations

In a study comparing salmeterol and BDP for persistent asthma, 13 patients in the BDP group experienced asthma exacerbations and required oral corticosteroid treatment, with one case suspected to have an allergic component.[25] No significant differences were observed among treatment groups regarding the frequency of asthma exacerbations over time or those requiring oral corticosteroids, indicating stable asthma control across groups.[25] These findings are consistent with previous research showing salmeterol and BDP to maintain or slightly improve asthma stability over time.[25] However, in another extensive study, 1.3% of participants withdrew due to severe exacerbations and hospitalizations related to adverse events.[28]

Prednisone Use

Lovera et al. reported 33.3% of patients were able to discontinue or reduce prednisone therapy after starting BDP treatment.[34] Similarly, another study observed 71.4% of individuals reduced their prednisone use when converting from placebo to BDP while a marked decline in symptom-free days and pulmonary function was reported when switching from BDP to a placebo.[33]

Further supporting evidence found 82% of patients who were relieved from prednisone use, although 18% of those with a history of severe asthma exacerbations and significant allergic conditions had to revert to systemic steroids.[36] Additional findings noted 37.8% patients to discontinue prednisone, with greater success seen in those having a shorter duration of prior steroid therapy.[26]

Long-term studies reported 42% of children requiring no systemic steroids after 13-20 months on BDP, with 72% needing only one course of oral prednisone at most.[37] To elaborate, a small number of patients who successfully weaned off prednisone required short courses averaging 2-3 times a year due to occasional asthma exacerbations.[37] Brown et al. noted 77% of children withdrawing from oral corticosteroids, with a low failure rate of 4.5% while monitoring long-term withdrawal by gradually reducing prednisone dosages.[32]

Table 4: Average percent of steroid-dependent asthmatic children who discontinued or reduced prednisone use through multiple studies.

Side Effects

Pituitary Adrenal Gland Function

Adrenal function was measured through plasma cortisol levels and urinary steroid excretion.[34] Godfrey and König did not observe suppressed adrenal function in most patients before the trial, with no significant changes in cortisol levels noted through the study period.[37] Francis RS. reported that normal adrenal function was maintained during long-term BDP therapy in juvenile asthmatic patients.[33]

Further research indicated an improvement in adrenal function with BDP treatment, observing the hypothalamo-pituitary-adrenal axis returning to normal levels after stopping oral corticosteroids.[38] In contrast, Reed et al. found that while no change in cortisol levels was seen at the beginning of the study, at 6 and 12 months of BDP, a small but statistically significant reduction was noted in morning cortisol levels and maximum serum cortisol levels after cosyntropin stimulation, indicating a long-term effect.[12]

Other findings highlight moderate adrenal suppression where some patients experienced a slight drop in plasma cortisol levels after reducing or discontinuing prednisone following BDP therapy, although overall adrenal function was reported to be stable in most cases.[26,35] Furthermore, Yiallouros et al. noticed similar reduction in some children taking higher doses of BDP.[39]

Growth Rate

Francis RS. observed 90% of BDP-treated children maintained normal growth rates, with only one failing to meet expected growth rates.[33] Another study reported 60% of children able to regain the rate of growth lost during prior prednisone therapy after transitioning to BDP.[32]

A 13-20 month trial found no significant evidence of growth suppression, with most children continuing to grow along their previous height centiles.[37] Conversely, Reed et al. noted a reduction in growth velocity of 1.5 cm/year in children treated with BDP, though the long-term effects on final adult height were uncertain.[12] Rao et al. reported slower growth rates in BDP-treated prepubertal children, with an average growth of 4.94 cm/year.[40] Furthermore, Wolthers found a small reduction in children’s lower leg growth rate while using BDP, with a decrease of 0.10 mm/week.[20]

Camargos and Lasmar focused on prepubertal children’s sensitivity to the growth-suppressive effects of inhaled corticosteroids, concluding the slight impacts to not be clinically significant.[41]

Oropharyngeal Candidiasis

Francis RS., noted 7.1% of patients exhibiting symptoms of oropharyngeal candidiasis accompanied by slight to moderate Candida growth in the throat, and dry mouth.[33] Extensive studies by Broder et al. and Brown et al. observed lower doses (50g/d) having more incidences (34.4%) of candidiasis than higher doses (200-400µg/d) respectively.[29,32] Documentations by Broder et al. reported 34.4% patients developing candidiasis, with 27.3% also experiencing dysphonia.[29] Other studies show similar results for positive Candida throat cultures (table 5), where 400µg/d may seem the optimum dosage for avoidance.[26,27] Brown et al. emphasized this condition, along with hoarseness, to be more common in corticosteroid-dependent patients.[32]

Table 5 displays a trend of lower doses being associated with more prevalence in oropharyngeal candidiasis regardless of the patients’ treatment time on BDP.

Table 5: Percentage of individuals who developed oropharyngeal candidiasis

Eczema & Rhinitis

Corticosteroid-dependent asthmatic children with history of prednisone use were connected to an increase in eczema and rhinitis, though these side effects had minimal impact on BDP treatment and were as severe to reintroduce systemic steroids.[33,37] Dickson et al. observed 20% of children who experienced worsening eczema and developing nasal congestion, likely due to the unmasking of allergic rhinitis during BDP therapy.[36] Corticosteroid dependent patients reported development of rhinitis after reducing or discontinuing prednisone therapy upon BDP treatment; a theory supported by Webb.[26, 38] An extended study of 241 patients found 27% developed either rhinitis or eczema, with 8.3% experiencing eczema exacerbation and 15.4% showing signs of allergic rhinitis.[32]

Table 6: Percentage of individuals who developed rhinitis and/or eczema

Table 6 includes some unknowns as some studies provided quantitative data for one diagnosis while not the other. The trend here is similar to that seen with candidiasis, however, more occurrences of rhinitis is noted.

Additional Outcomes

Champion et al. detected the loss of weight gained with prednisone use when transitioning from prednisone to BDP, where prednisone doses was either discontinued or reduced.[26] The same study also observed 22.6% patients experiencing dry throat as a side effect of BDP therapy.[26] No significant improvement in airway obstruction observed with high doses of oral corticosteroids or BDP therapy in patients with irreversible allergic asthma (characterized by sputum containing abundant eosinophils).[32] Katz et al. observed that while no severe adverse reactions occurred, 20% of patients on BDP reported side effects such as headache, nausea, vomiting, dehydration, pyrexia, or hemoptysis, nonetheless, none discontinued BDP therapy.[24]

Discussion

Pulmonary Function

Several studies supported the effectiveness of BDP as a beneficial treatment option in managing chronic childhood asthma, particularly in non-steroid-dependent children. Godfrey and König reported a 96% clinical success rate in treating chronic childhood asthma with BDP with no effect on potassium levels, or neuropsychological and behavioural factors.[37] Katz et al. highlighted BDP's role as an effective additive agent for controlling chronic asthma with minimal withdrawal at higher doses.[24] As an additive agent, BDP was either as effective or better than the drug it was being compared with. Furthermore, BDP has shown to require lower doses compared to other drugs to maintain symptom control, emphasizing its efficacy and safety profile in pediatric asthma management.

Nayak et al. observed greater increases in PEF when given 160 µg/d of BDP as compared to 60µg/d, indicating a dose-dependent improvement in pulmonary function.[28] Improvement in pulmonary function and symptom score is gradual and observed and maintained in short-term administration, demonstrating both immediate and sustained benefits.[29,12] Brown et al. noted PEF doubling in younger patients suggesting BDP’s particularly effectiveness in this age group, especially when compared to inadequately dosed oral corticosteroids.[32]

Prednisone Use

BDP demonstrated substantial corticosteroid-sparing effects in pediatric patients previously reliant on prednisone, thereby reducing the risks linked with its long-term steroid use while maintaining asthma control. The studies show a significant percentage of patients either able to discontinue or considerably reduce their oral corticosteroid use when initiating BDP therapy; further supporting

BDP’s efficacy in improving lung function in chronic asthmatic children. Long-term studies affirm the sustainability of these benefits.[32,37] According to Brown et al., the primary cause of failure in transitioning from prednisone to BDP was infection and hypersecretion of airway mucous, likely preventing BDP aerosol from penetrating the bronchial mucosa.[32] Furthermore, Dickson et al. highlighted the need for cautious and gradual weaning in patients with more severe asthma phenotypes as a rapid course may cause patients to relapse back to systematic steroids.[36]

Side Effects

Side effects associated with BDP (exacerbations, candidiasis, rhinitis, and eczema) were common amongst studies but not severe enough to discontinue treatment. The prevalence of these outcomes, along with hoarseness, were dose-dependent and more noticeable in steroid-dependent children, indicating a potential area for caution in clinical practice.[32] Most cases of candidiasis responded rapidly to amphotericin B lozenges (though BDP had to be withdrawn in two cases), mouth washes, Nystatin, and simple treatments, not necessitating discontinuation of BDP therapy.[26,27,29,32] To mitigate the oral thrush, patients were advised to drink or gargle immediately after inhaling BDP to prevent aerosol deposition in the pharyngeal mucosa.[32]

BDP's impact on growth and adrenal function presented a mixed picture. While some studies report BDP to have a clinically irrelevant effect on growth in prepubertal children, the overall impact on final adult height and whether its effects are greater during puberty remains uncertain.[41]

Similarly contradictions were seen regarding BDP's effects on adrenal function, with literatures either reporting favourable outcomes, minimal impact, or potential adrenal suppression as a long-term effect. Nonetheless, normal to borderline cortisol levels were generally observed.[31,28] Suppression may be linked to corticosteroid-dependent children though no clear evidence is available. These inconsistencies emphasizes the need for more rigorous research in this area to confirm BDP's long-term effects since patients, prepubertal, pubertal, or post-pubertal, may experience different side effects.

Limitations

Despite promising outcomes, it is important to note the small sample sizes of the studies, ranging from 10-50 participants, implying that while the results are supportive, they may not be representative of the broader population. Larger-scale studies are necessary to further validate and generalize the efficacy of BDP in diverse pediatric populations. Additionally, future research should consider the impact of different socioeconomic factors on BDP treatment outcomes to provide a more comprehensive understanding of its effectiveness across various demographics. Other limitations that posed a challenge included the inability to access complete articles, and how the majority of papers were published between 1975-2005. The lack of recent research further stresses the need for updated studies to ensure that current clinical practices are based on the most reliable and comprehensive data available.

Conclusion

To summarize, BDP showed significant promise in the management of childhood asthma, particularly in reducing reliance on systemic corticosteroids and improving pulmonary function, with trivial side effects of eczema, rhinitis, and candidiasis. Future investigations should aim to include larger, more diverse populations and explore the long-term effects of BDP on growth, adrenal function, and other potential side effects to provide a deeper understanding of its safety and efficacy in pediatric asthma treatment.

Acknowledgements

This paper was completed within BeMo Academic Consulting’s Pre-Med Research Program’s framework. BeMo's contribution played a crucial role in enhancing the work’s quality. I extend my gratitude for their invaluable guidance and support.

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