Recently a randomised placebo controlled trial in a general practice setting showed that inhaler therapy with a spacer device in 218 1-4 year old children with moderate asthma is feasible, but that treatment with cromoglycate was no more effective than placebo. The lack of benefit from the treatment with cromoglycate may have resulted from several points discussed and refuted in this commentary. Major points are the degree of asthma of the children and uncertainty about the amount of medication that reached the lungs. The results of the trial support the intentions of national and international guidelines to withdraw the recommendation of cromoglycate as the first choice in prophylactic asthma treatment.
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