Inhaled Corticosteroids Won't Prevent Kids' Asthma

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.

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Eating Apples, Fish During Pregnancy Protects Kids From Allergies, Asthma

Filling up on apples and fish during pregnancy might protect your child from developing asthma and allergic diseases, a new study shows.

Researchers from the Netherlands and Scotland have found that eating apples throughout pregnancy may protect against wheezing and asthma in 5-year-old children, while fish consumption may lower the risk of eczema, an allergic skin condition. The findings were to be presented Sunday at the American Thoracic Society's International Conference in San Francisco.

"To our knowledge, we are one of the first studies evaluating the influence of maternal consumption of so many different foods and food groups during pregnancy on childhood asthma and allergic disease," said study author Saskia Willers, a doctoral student at Utrecht University in the Netherlands.
Previous studies in the same group of children, part of the SEATON birth cohort conducted at the University of Aberdeen in Scotland, found that maternal intake of vitamins E and D, and zinc during pregnancy may also lower the risk of asthma, wheezing and eczema. For this study, the researchers looked at how eating different foods, rather than individual nutrients, during pregnancy impacted these children.

The researchers studied 1,212 children born to women who had filled out food questionnaires 32 weeks into their pregnancy. When the children were 5, the mothers filled out another questionnaire about their child's respiratory symptoms and allergies, as well as a survey about their child's food consumption. The children were also given lung function and allergy tests.

The study found that children of women who ate more apples and fish during their pregnancy were less likely to develop asthma or allergic disease. Specifically, children of women who ate fish once or more a week were 43 percent less likely to have had eczema at age 5 than children of mothers who never ate fish. Those whose mothers ate more than four apples a week during pregnancy were 37 percent less likely to have ever wheezed, 46 percent less likely to have had asthma symptoms, and 53 percent less likely to have had doctor-confirmed asthma compared to children of mothers who ate one or no apples a week.

"We were quite surprised to see a protective effect of apples, because, to our knowledge, no other study had seen that before," said Willers. "For fish, there is an earlier study that found a protective effect of maternal fish intake during pregnancy on childhood asthma."

No protective effect was found against asthma or allergic diseases from many other foods, including vegetables, fruit juice, citrus or kiwi fruit, whole grain products, fat from dairy products or margarine or other low-fat spreads.

The study speculated that apples may be beneficial because they contain flavonoids, which have been associated with a reduced risk of asthma in other studies, while fish's protective effect may be due to their omega-3 fatty acids.

"The authors' explanations are plausible," said Dr. Carlos Camargo, an associate professor of medicine and epidemiology at Harvard Medical School. "It's curious, however, why only apples would be protective, since flavonoids are present in other foods. This will require further work. The first step, however, is to see if other investigators find the same associations in other birth cohorts."

Dr. Augusto A. Litonjua, an assistant professor at Harvard Medical School, said this study adds to the growing literature that prenatal factors, specifically maternal diet during pregnancy, can affect the development of wheezing illnesses, asthma and allergies in young children.

It's too early, though, to recommend how much fish and apples pregnant women should eat, Willers said. Rather, it's important for them to follow a healthy, balanced diet.

Connie Diekman, director of university nutrition at Washington University in St. Louis, added that pregnant women should be careful about not eating too much fish because of the potential mercury and other pollutants in fish.

"The study supports the health benefits of increased fruits, vegetables and fish, but pregnant women need to exercise caution with king mackerel, tilefish, shark and swordfish, and should limit albacore tuna to 6 ounces per week," she said.

Litonjua added that in addition to a healthy diet, pregnant women should also take prenatal vitamins with folic acid and abstain from smoking and drinking to maximize the health of their growing fetus, and subsequently their young child.

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Fear affects emergency care for child with asthma

Parents' psychological responses to asthma attacks are among the strongest motivators of seeking accident and emergency (A&E) services for their child, according to a study conducted in London.

In contrast, characteristics of the home environment, such as dampness, overcrowding, or living with a smoker, have little effect on use of emergency departments.

Children with asthma often use A&E services, Dr. Lindsay Forbes, from Springfield University Hospital, and associates note in their paper, published in the journal Thorax. To find out what triggers a visit to A&E, they studied children with asthma residing in south-east inner London, which has a high poverty rate.
The team identified 209 children ages 3 to 14 years old who were treated at an A&E for asthma over a 1-year period. Another 712 randomly chosen subjects who also had asthma but had not attended an A&E during the year prior to their enrollment. The data came from patients' records and questionnaires they were asked to completed.

The authors found that patients who had attended an outpatient clinic with a family doctor during the previous year were 13 times more likely to visit A&E.

Parents who reported feeling alone or experiencing panic or fear when their child's asthma got worse, or who believed they would get quicker service in an A&E, were 2- to 3-fold more likely to bring their child to the emergency department.

To reduce A&E use for asthma in children, Forbes and associates recommend that "health service planners should take a broader approach, considering what is the most appropriate setting for treating asthma attacks for children of different levels of attack severity, ensuring that services are accessible and address parents' concerns, and that the different parts of the health service communicate appropriate care pathways effectively and consistently to parents."

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