The inherent waxing and waning nature of asthma makes demonstrating benefits difficult. Furthermore, nedocromil tends to have an all-ornothing effect rather than a dose-response gradient. Unfortunately, none of these trials found useful predictors to help clinicians determine which patients respond.1,5
In a Cochrane Review, 20 RCTs involving 280 participants showed that 4 mg (2 puffs) of nedocromil inhaled 15 to 60 minutes prior to exercise significantly reduced the severity and duration of exercise-induced asthma for both adults and children. The maximum percentage fall in FEV1 improved significantly compared with placebo, with a weighted mean difference of 15.5% (95% confidence interval, 13.2–18.1). In addition, the time to complete recovery was shortened from 30 minutes with placebo to 10 minutes with nedocromil.6
TABLE
Classification of asthma
| Classification | Symptom frequency | Spirometry findings |
|---|---|---|
| Severe persistent | Continual symptoms | PEFR <60% Variability >30% |
| Moderate persistent | Daily symptoms, more than 1 night per week | PEFR >60% but <80% Variability >30% |
| Mild persistent | More than twice per week but less than daily; more than 2 nights per month | PEFR >80% Variability 20%–30% |
| Mild intermittent | Less than once per week; less than or equal to 2 nights per month | PEFR >80% Variability <20% |
| Source: Global Initiative for Asthma, National Heart, Lung and Blood Institute 2003.7 | ||
Recommendations from others
The Global Initiative for Asthma and the National Heart, Lung and Blood Institute Expert Panel Report list nedocromil as an option for the treatment of exercise-induced asthma and mild persistent asthma for adults and children. However, it is listed as a second choice to the use of inhaled steroids in the case of mild persistent asthma. It is not recommended for moderate or severe persistent asthma, or for mild intermittent asthma.7
CLINICAL COMMENTARY
Nedocromil and cromolyn sodium are safe but many patients do not respond
Ron Baldwin, MD
University of Wyoming Family Practice Residency at Casper
Inhaled nedocromil and cromolyn sodium have long been recognized as agents with an excellent safety profile. Unfortunately, as pointed about above, many patients do not respond to these agents. In addition, 4-times-daily dosing makes compliance difficult. Clinicians and parents must weigh the theoretical risk of inhaled corticosteroid-induced growth retardation with this potential differential in effectiveness.