ASTHMA

Recombinant human deoxyribonuclease for the treatment of acute asthma in children

R Boogaard¹, F Smit², R Schornagel³, A A P H Vaessen-Verberne⁴, J M Kouwenberg⁵, M Hekkelaan⁶, T Hendriks⁷, S W W Feith⁸, W C J Hop⁹, J C de Jongste¹ and P J F M Merkus^1,10

¹ Department of Pediatric Pulmonology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
² Department of Pediatrics, Medisch Centrum Rijnmond Zuid, Rotterdam, The Netherlands
³ Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands
⁴ Department of Pediatrics, Amphia Hospital, Breda, The Netherlands
⁵ Department of Pediatrics, HagaTeaching Hospital/Juliana Children’s Hospital, The Hague, The Netherlands
⁶ Department of Pediatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
⁷ Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands
⁸ Department of Pediatrics, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
⁹ Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, The Netherlands
¹⁰ Department of Pediatrics, Division of Respiratory Medicine, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands

Correspondence to:
Dr R Boogaard, Room Sb-2666, Department of Pediatric Pulmonology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, P O Box 2060, 3000 CB Rotterdam, The Netherlands; r.boogaard{at}erasmusmc.nl

Background: Airway obstruction in acute asthma is the result of airway smooth muscle contraction, inflammation and mucus plugging. Case reports suggest that mucolytic therapy might be beneficial in acute asthma. The aim of this study was to determine the efficacy of the mucolytic drug recombinant human deoxyribonuclease (rhDNase) in addition to standard treatment at the emergency department in children with an asthma exacerbation.

Methods: In a multicentre randomised double-blind controlled clinical trial, 121 children brought to the emergency room for a moderate to severe asthma exacerbation were randomly assigned to receive either a single dose of 5 mg nebulised rhDNase or placebo following the second dose of bronchodilators. An asthma score (scale 5–15) was assessed at baseline and at 1, 2, 6, 12 and 24 h. The primary outcome variable was the asthma score 1 h after the study medication.

Results: One hour after the study medication the asthma score in the rhDNase group showed an adjusted mean decrease from baseline of 1.0 (95% CI 0.5 to 1.6) points compared with 0.7 (95% CI 0.3 to 1.2) points in the placebo group (mean difference 0.4 (95% CI –0.2 to 1.0) points; p = 0.23). The asthma score over the study period of 24 h also did not differ significantly between the rhDNase and placebo group (mean difference 0.2 (95% CI –0.3 to 0.7) points, p = 0.40). The duration of oxygen supplementation and number of bronchodilator treatments in the first 24 h were similar in both groups.

Conclusion: Adding a single dose of nebulised rhDNase to standard treatment in the emergency room has no beneficial effects in children with moderate to severe acute asthma.

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