Cromoglicate

The mode of action of sodium cromoglicate and nedocromil is not completely understood.

They may be of value in asthma with an allergic basis, but in practice it is difficult to predict who will benefit.

• They could probably be given for 4 to 6 weeks to assess response.
• Dose frequency is adjusted according to response but is usually 3 to 4 times a day initially.
• This may subsequently be reduced.

For people above the age of 5 years, whose asthma is inadequately controlled on level 2 treatment of the BTS/SIGN guidelines, sequential trials of one additional add-on therapy is indicated:¹

• Stop inhaled long-acting beta2-agonist and consider:
  • Either leukotriene receptor antagonist, modified-release theophylline, oral modified-release/long-acting beta2-agonist
  • Or cromoglicate (in adults) and nedocromil in children aged 5 to 12 years

In general prophylaxis with sodium cromoglicate is less effective than prophylaxis with corticosteroid inhalations. There is evidence of efficacy of nedocromil in children aged 5 to 12 years:

• Two RCTs in children aged 6 to 12 years taking usual medication found that, compared with placebo, adding inhaled nedocromil reduced asthma symptom scores, asthma severity, bronchodilator use and improved lung function.^2,3
• Two long-term trials have not shown consistent effects on lung function outcomes. Although nedocromil may have advantages over inhaled corticosteroids in terms of side effects, it is not yet clear where nedocromil should sit in relation to other therapies in the treatment of asthma in children.⁴

Sodium cromoglicate can prevent exercise-induced asthma. However, exercise-induced asthma may reflect poor overall control and the patient should be reviewed.

Sodium cromoglicate is of no value in the treatment of acute attacks of asthma.

Sodium cromoglicate

• By aerosol inhalation - Intal®pincaps®⁵
• By inhalation of nebulised solution

Necrodomil sodium

• By aerosol inhalation - Tilade®

Patients should be counselled that regular use is necessary.

• Inhalation of the dry powder form of sodium cromoglicate may cause bronchospasm.⁵
• A selective beta2-adrenoceptor stimulant, e.g. salbutamol or terbutaline, should be inhaled a few minutes beforehand.
• The nebuliser solution is an alternative means of delivery for children who cannot manage the dry powder inhaler or the aerosol.