The efficacy of inhaled steroids in spontaneously breathing infants with established bronchopulmonary dysplasia (BPD) is debatable. The inhaled steroid hydrofluoalkane-beclomethasone dipropionate (QVAR) is unique in its small particle size that results in higher lung deposition. Our objective was to determine if inhaled QVAR could decrease respiratory rehospitalizations of infants with established BPD.STUDY DESIGN:
Double-blind, randomized placebo-controlled, multicenter pilot study. Preterm infants with moderate-to-severe BPD were randomized to inhaled QVAR 100 μg per dose or placebo twice daily via Aerochamber with face mask. Treatment was administered daily from recruitment at 36 weeks post menstrual age until 3 months post discharge. Analysis was carried out by intention to treat.RESULTS:
The QVAR (n = 18) and placebo (n = 20) groups were comparable in birth and recruitment characteristics. Length of stay (108.5 ± 26.3 vs 108.7 ± 36.0 days) and infants requiring oxygen at discharge (5/17 vs 6/19) or at study end (0/17 vs 2/19) were comparable. Respiratory rehospitalizations/infant (0.1 ± 0.5 vs 0.4 ± 0.6), rehospitalization days (0.5 ± 1.5 vs 4.1 ± 10.3), and postdischarge additive inhaled (0.3 ± 0.9 vs 6.4 ± 21.5 days), systemic (0.7 ± 2.8 vs 1.0 ± 1.4 days) and combined (inhaled/systemic) steroids (1.0 ± 2.9 vs 7.8 ± 25.8 days) tended to be lower in the QVAR compared with the placebo group. Blood pressure, height and weight gain, and urine cortisol/creatinine ratio at study end were comparable between groups.CONCLUSIONS:
Our study was unable to detect a significant effect of inhaled QVAR on the respiratory course of established BPD. The study was underpowered. Possible benefits of QVAR could be masked by a tendency toward higher use of additional steroids in the placebo group.