Inhaled Corticosteroids Won't Prevent Kids' Asthma

THURSDAY, May 24 (HealthDay News) -- While inhaled corticosteroid medications are a mainstay of effective asthma treatment, they can't prevent the disease from occurring or recurring in high-risk children, new research found.

Two presentations Wednesday at the American Thoracic Society 2007 International Conference in San Francisco included an additional year of information from previous research. The studies confirmed that youngsters given inhaled corticosteroids may do well while they're taking the medications. But the drugs' beneficial effects wear off soon after they're stopped, and they don't appear to have any long-term effects on the progression of asthmatic disease.

"The good news is that you probably don't have to use steroids to prevent the progression of asthma, but inhaled corticosteroids do work when you need them," said one of the study's authors, Dr. Wayne Morgan, a professor of pediatrics and physiology and chief of pediatric pulmonary medicine at the University of Arizona at Tucson. "Inhaled corticosteroids control, but don't prevent, asthma."

Morgan's presentation, and that of his colleague Dr. Theresa Guilbert, assistant professor of pediatrics at the University of Wisconsin-Madison, revisited a clinical trial called PEAK (Prevention of Early Asthma in Kids). In this trial, 285 children at high risk of developing asthma were randomly selected to receive preventive treatment with an inhaled corticosteroid twice daily for two years, or a placebo. The third year of the study included no treatment. For the fourth year -- the year included in the new presentations -- the children's care was returned solely to their own physicians. Therefore, treatment varied and reflected what's going on in real-world clinical practice.

Morgan's presentation focused on specific physiological measures of lung function. During the study treatment period, these measures indicated that the children in the treatment arm were, in fact, taking the medication.

"At the end of the second observation period, there was no difference between the groups," Morgan said.

The information Guilbert presented focused on who responded most to the medications.

"There was a greater response to asthma medication in non-whites and in males. There was a better response in the somewhat older children and a better response in those with a parental history of asthma," said Morgan, who added that "when you use asthma medications, you can control the disease, but you can't cure it."

Pediatric asthma specialist Dr. Alan Khadavi, of New York University Medical Center, said the new findings won't "change my first-line asthma management. Inhaled corticosteroids may not prevent the development of asthma, but children with asthma still need it to decrease exacerbations."

But, another study presented at the same meeting found that inhaled corticosteroids don't help all children with asthma. Even when parents reported that their children consistently used inhaled corticosteroids, as many as one in five youngsters still didn't achieve good asthma control, this research found. The study included 914 children with mild to moderate asthma and compared those using inhaled corticosteroids on a regular basis to those who weren't prescribed an inhaled corticosteroid.

"It is possible that some children are genetically less responsive to steroids," the study's author, Dr. Gregory Sawicki, of Children's Hospital Boston, said in a prepared statement. He added that it was also possible that the children didn't use their medications as often as their parents reported or that the children who didn't respond to the inhaled corticosteroids may simply have been children with more severe asthma.

While the PEAK study failed to find a way to prevent childhood asthma, and there are no other known ways to prevent the development of the disease, Khadavi pointed out that if you have asthma, you can try to prevent exacerbations of the disease. Since most asthma has allergic triggers, he said, it's important to run an air conditioner or a HEPA air cleaner at times of the year when pollen counts are high. If dust mites trigger your child's symptoms, he recommended "removing carpeting and using dust-mite encasements on mattresses and pillows."

Khadavi also said that if you can't avoid allergens altogether, it's a good idea to give your child an antihistamine to lessen the allergy symptoms.

More information

To learn more about asthma prevention, visit the American Academy of Allergy, Asthma and Immunology.

SOURCES: Wayne J. Morgan, M.D., professor of pediatrics and physiology, and chief, pediatric pulmonary medicine, and associate head for academics, department of pediatrics, University of Arizona, Tucson; Alan Khadavi, M.D., board-certified pediatric asthma and allergy specialist, New York Univeristy Medical Center, pediatric asthma and allergy specialist, Allergy and Asthma Care of New York, New York City; May 23, 2007, presentations, American Thoracic Society 2007 International Conference, San Francisco

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