Inhaled corticosteroids useful in preterms with decreased lung function 

The use of inhaled corticosteroids (ICS) improved the lung function of prematurely born children in a randomised-controlled trial. The results suggest that bronchodilator responsiveness may be used to screen eligible infants for this approach.

Preterm-associated lung disease is a common complication and evidence indicates that the lung function of patients that were born preterm worsens over time [1,2]. A randomised, clinical trial demonstrated that ICS may be administered to improve lung function in preterm-born children [3]. The current 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 ICS fluticasone propionate or to placebo [4].

A modest but significant difference in % forced expiratory volume in 1 second (FEV₁)-change was observed between the fluticasone arm (5.93%) and the placebo arm (1.75%; P=0.01). Changes in FEV₁/forced vital capacity (FVC) also favoured the intervention arm over the placebo arm (3.69% vs -0.79%; P=0.013), as did changes in fractional exhaled nitric oxide (FeNO) (-4.92 vs 0.11; P=0.01). Prof. Simpson added that 21.3% of the participants had a clinically significant improvement in FEV₁. Finally, multivariate analysis showed that bronchodilator responsiveness was an independent predictor of the efficacy of ICS in these participants (P<0.001).

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

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.

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