Inhaled Steroids Still Most Effective Treatment for Asthma

Children who have been prescribed steroidal inhalers to control asthma symptoms should continue to use them, despite questions raised by a medical study concerning their long-term benefits.

The study, published in the New England Journal of Medicine in 2006, found strong evidence that steroidal inhalers effectively control symptoms in toddlers at high risk for chronic asthma. However, the study found, the treatment did not ultimately prevent children from developing the disease.

"Most experts agree inhaled steroids are the most effective treatment for chronic asthma," said Dr. Jamshed F. Kanga, a pediatric pulmonologist at Kentucky Children's Hospital and professor of pediatrics and chief of pediatric pulmonology in the University of Kentucky College of Medicine. "The question we don't yet know the answer to is whether treatment for a long period of time will result in the disease being cured."

Kanga says that although the study raised some interesting questions for further study, it has not changed treatment guidelines.

"Asthma is a serious disease and children with chronic asthma should be on controller therapy," Kanga said.

Diagnosing asthma

Kanga says diagnosing asthma in young children can be difficult because symptoms are often very similar to those of viral infection. However, if the symptoms become more chronic and persistent, then a diagnosis of asthma should be considered.

Treatment options

Once a diagnosis of asthma is made, Kanga says, the symptoms need to be controlled and treated to prevent damage to the airway. Asthma medication falls into two groups: rescue or reliever medication and controller medication.

Rescue medication is a temporary treatment and does not address inflammation in the airways. These medications are taken at the first sign of asthma symptoms, such as wheezing. Rescue medications work quickly to relax muscles surrounding the airways, making it easier to breathe almost immediately. If needed, rescue medications are sometimes taken before exercise to help prevent asthma symptoms. The most common rescue medication is albuterol, which is sold under many brand names.

The second type of medication, controller medication, addresses inflammation in the airways. These medications are used every day in an effort to keep asthma under control. When taken daily, controller medications reduce inflammation in the lungs, helping to reduce and even prevent symptoms of asthma. Inhaled corticosteroids, the same drug tested in the journal study, are a common controller medication. Leukotriene modifiers, mast cell stabilizers and long-acting bronchodilators are also examples of controller medications.

Inhaled corticosteroids: risks, benefits, alternatives

"The best medications we have to treat chronic asthma are inhaled steroids," said Kanga. "Although there is a lot of concern that in children long-term steroid use leads to a decrease in growth, most experts agree the benefits outweigh any potential short-term growth decrease. Most three- to five-year studies show only a slight growth difference. That difference often disappears as the child ages."

Minimizing side effects

Nonsteroidal controller medications such as Singulair (montelukast) are the latest drug treatment option to become available. There is not yet enough data to determine if they are better than corticosteroids, Kanga says, but they do provide an alternative for children with mild asthma. If growth is a concern, it is also possible to give a lower-dose steroid.

"In our clinic, all patient heights are monitored closely," Kanga said. "If a child is in good control, we always try to cut back the dose of their inhaled steroid. We attempt to optimize treatment by monitoring the inflammation of the airways with a regular lung function test, every three to six months."

Spirometry is a simple lung function test that can be performed on children 5 and older. A nitric oxide monitor is another way to measure inflammation in the airway to help ensure the patient is receiving the correct dose of steroids and thus the optimal treatment.

Future of asthma treatment

Doctors once thought children would 'outgrow' their asthma; however, long-term follow-up has shown that many childhood asthma patients continue to have asthma as adults. Longer studies are needed, Kanga says, to address the important question of whether treatment helps with long-term obstruction.

"It is important to remember asthma is still underdiagnosed and often inappropriately treated," Kanga said. "To optimize your treatment, talk with your doctor about appropriate medications. We want every child to be able to live a normal life and participate in sports. We have very good medications today and most children with asthma can lead a very normal life."



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