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Increasing Steroid Doses Does Not Prevent Sudden Asthma Attack, May Stunt Growth In Children

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A study published in the New England Journal of Medicine advises on the safety and efficacy of increased doses of inhaled steroids to address sudden attacks or flare-ups of asthma.

High doses of inhaled steroids in children diagnosed with mild to moderate asthma will not help reduce the rate of severe asthma attacks nor improve the patient's other symptoms of the illness.

"These findings suggest that a short-term increase to high-dose inhaled steroids should not be routinely included in asthma treatment plans for children with mild-moderate asthma who are regularly using low-dose inhaled corticosteroids," says Daniel Jackson, M.D., study lead author and an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health, Madison.

In fact, high doses of inhaled steroids may be associated with stunted growth in children.

Steroids For Asthma

Without proper management, asthma can result in frequent emergency department visits, hospitalizations, and premature deaths. The use of steroids and other anti-inflammatory drugs is considered as a key long-term treatment for asthma.

Steroids are known to help control or prevent asthma attacks. Anti-inflammatory drugs such as steroids or corticosteroids and anti-inflammatory treatments like leukotriene modifiers, anticholinergics, and immunomodulators can help control asthma.

Inhaled steroids or inhalers are commonly used for asthma control, fewer symptoms, and flare-ups. It can also help reduce the need for hospitalization.

To help prevent asthma attacks, inhalers are used daily in regularly spaced doses. Among the commonly inhaled steroids include Asmanex, Alvesco, Flovent, Pulmicort, and Qvar.

"However, a recent Cochrane review concluded that there was no evidence indicating that doubling the dose of inhaled glucocorticoids in response to increasing symptoms decreased the likelihood of asthma exacerbations among children or adults," adds Dr. Jackson.

Stunted Growth

For the research, Jackson's team studied 254 children between ages 5 and 11 who are diagnosed with mild-to-moderate asthma for almost a year. All patients in the study were placed on low-dose inhaled steroids or two puffs from a steroid inhaler two times a day.

For the study's final trial, researchers placed 94 children with asthma in the high-dose group while 98 children were included in the low-dose group. Those in the high-dose group inhaled steroids five times more than the standard dose. They puffed from an inhaler twice every day for seven days during an asthma attack.

Children who were randomly assigned to the high-dose group were observed to have slower growth in height than the other group. The dose-response relationship was observed in children age 8 years and below.

The results of the study raised the concern that more frequent and long-time use of high-dose inhaled steroids could lead to greater adverse effects.

Burden Of Asthma

Asthma is a chronic disease of the lungs. It affects adults and children of all ages and is characterized by repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing.

According to the Centers for Disease Prevention and Control, asthma is a significant health and economic burden to patients, their families, and society. Asthma affects 25.7 million people in the United States, including 7 million children under 18.

Most people with asthma can control their symptoms by avoiding things that trigger an asthma attack and by receiving appropriate medical care.

The study was funded by the National Heart, Lung, and Blood Institute. It was presented at a meeting of the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology, and the World Allergy Organization in Orlando, Florida.

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