March 17, 2009 (Washington, D.C.) -- Kids with severe asthma can breathe a lot easier than they could a decade ago.
Thanks in large part to better medications, children with severe asthma are less likely to wheeze and suffer full-blown asthma attacks today than 10 years ago, researchers report. They’re less likely to have to swallow steroid pills every day to calm airway inflammation, which means fewer side effects of long-term use, such as thinning bones or stunted growth.
The list goes on. Children are now less likely to have to reach for rescue inhalers for quick relief of worsening symptoms. And their lungs generally function better, says researcher Joseph Spahn, MD, a children’s asthma specialist at National Jewish Health in Denver.
“If your child has asthma and is suffering, he shouldn’t be,” Spahn says. “Even severe symptoms should be controlled, and the child should be able to go about most normal activities,” he tells WebMD.
Newer Asthma Medications Better and Safer
Spahn credits several types of newer medications with the dramatic improvement. Among them:
- Leukotriene-modifier pills such as Singulair, Accolate, and Zyflo. They help to control the inflammation of the airways that occurs in asthma.
- Second-generation inhaled steroids such as Pulmicort, Flovent, and Asmanex. They’re also anti-inflammatory medications.
“The second-generation steroids are much more potent than the first-generation drugs. In general, they also cause fewer adverse events, such as growth suppression or [brittle bones],” Spahn says.
- The highly popular Advair, which combines an inhaled steroid with a long-acting bronchodilator. Bronchodilators relieve the symptoms of asthma by temporarily relaxing the muscle bands that tighten around the airways.
- Xolair, which blocks proteins in the immune system from becoming activated, an underlying cause of allergic asthma symptoms.
Children With Severe Asthma Healthier Than in Years Past
For the study, Spahn and colleagues reviewed the medical records of 65 children 6 to 18 referred to their clinic for severe asthma between 2004 and 2007. They were compared to 163 children of the same ages treated for severe asthma between 1993 and 1997.
Among the findings, presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology:
- Only 28% of children in the latter time period took steroid pills regularly vs. 51% a decade before. “Those who do take them today require a lower dose and a shorter course of treatment,” Spahn says.
- 89% of children in the latter time period took inhaled steroids vs. 98% a decade earlier.
- 66% of children with severe asthma in the latter time period took Advair. It wasn’t on the market in the 1990s.
- Children in the latter time period were more likely to be on a second-generation inhaled steroid. For example, 16% were taking Pulmicort vs. 0% a decade before.
- Children in the latter time period were in the 53rd percentile of height for their age vs. the 39th percentile 10 years earlier.
- None of the kids in the latter time period had cataracts, a side effect of first-generation steroids. This compares with 21% in the earlier time period.
Has Natural History of Asthma Been Altered?
But not all the news is good. Children in the latter time period were just as likely to be overweight as in years past. About half suffered from the fragile, thinning bones of osteopenia, a comparable figure to a decade earlier.
And there was no difference in the proportion who suffered severe attacks that required the child to be placed on a ventilator to aid breathing.
“As good as the new medications are, we still need better ones for exacerbations,” Spahn says.
The big question, he says, is “whether these changes represent a permanent alteration. Have we actually taken the kids off the track toward severe impairment? Or are we just delaying the inevitable?”
Nancy Ostrom, MD, says that she has seen a dramatic drop in hospitalizations, even deaths, from severe asthma among children in her own practice. Ostrom, co-director of the Allergy and Asthma Medical Group and Research Center in San Diego, moderated the session at which the findings were presented.
In addition to new medications, she credits a greater awareness of the disorder among doctors and patients for the improvement.
“Still, too many children have uncontrolled asthma. There’s still a long way to go to control the disease and improve quality of life in as safe a manner as possible,” Ostrom tells WebMD.