A new study from St. Louis's Washington University School of Medicine supports evidence that children with mild asthma can effectively manage the condition using their two inhalers – one steroid and another bronchodilator – when symptoms appear. This is in contrast to the traditional method of using daily steroids regardless of symptoms, and bronchodilators when it comes to symptoms. According to investigators, the essential use of both inhalers is just as effective for asthma as is the traditional protocol.
The steroid inhaler reduces inflammation, and the bronchodilator – also known as a rescue inhaler – relaxes the airway to facilitate rapid breathing during asthma attacks.
This research focuses on African American children, who are disproportionately affected by asthma. The study appears Journal of Allergy and Clinical Immunology: In PracticeGeneral Chat Chat Lounge
"We are pleased to hear that the treatment required on the basis of symptoms provides the same degree of asthma control as using low drugs," said Kaharu Sumino, MD, MD, MD, first author. “In the group of patients who used both inhalers as needed, one-fourth of the group's steroid dose was used to inhale the prescribed daily dose. We were also pleased to see that patients and families felt that they had more control over asthma management while practicing the necessary treatments. "
In the US, approximately 6.2 million children under the age of 18 have asthma. Among white children, about 7.4 percent have asthma. Among African American children, that figure is almost double, which is 13.4 percent. According to the American Larger and Asthma Foundation, asthma visits 1.8 million emergency rooms every year, and African Americans are three times more likely than average to be hospitalized due to asthma.
The study was conducted by primary care doctors in several pediatric practice in the St. Louis area, indicating that the strategy is widely applied in primary care settings and is not effective only when implemented by researchers at a single academic medical center.
Former clinical trials conducted in the highly controlled settings of academic medical centers suggested that a drug-based approach as well as a daily routine with preservation inhaler serves as a traditional strategy for steroid treatment. But how well that strategy could be transferred to individual community medical practices was an open question. This alternative, symptom-based strategy is not effective only when administered by pediatric primary care doctors, researchers found. The approach reduced the dose of steroid medication taken by children approximately 75 percent monthly.
The study included 206 African American children aged 6 to 17 who had mild asthma who were adequately controlled with asthma-controlled steroid drugs. Participants saw their own pediatricians at 12 primary care providers throughout St. Louis. Patients were randomly assigned to one of two groups. Each participant in one group was advised to take an inhaler containing steroid baclomethasone, when necessary, when the symptoms arise, while also preserving bronchodilator albuterol. Symptoms that ask for drug use include shortness of breath, chest tightness, cough, difficulty with homework and physical activity.
Each participant in the other group was advised to take a specific inhaled dose of daily steroid baclomethasone, regardless of symptoms, in addition to the standard recommended for about 30 years by immune bronchodilators, such as Global Initiative, in response to symptoms. Asthma Guide.
At the end of the one-year study, the researchers surveyed how well they handled patients' asthma, found no differences between groups, as well as no difference in breathing tests measuring lung function. There was also no difference in the number of participants seeking additional medical care, such as a fee for an asthma attack or a visit to the emergency room.
As expected, the group taking daily beclomethasone consumes more drug per month than the symptomatic group. On average, children in the daily-use group used 1,961 micrograms per month, while the symptom-based group used 526 micrograms per month, reducing the drug volume by about three-fourths. According to investigators, a lower amount is desirable, as there are side effects of steroids that include stunt growth.
“Many families are concerned about the cost as well as the side effects of these drugs and stop taking their steroid medication together. So it's good to show that lesser drugs – used as needed – are as effective, Sumino said. As an alternative to the treatment of mild asthma, this essential steroid plus rescue albuterol strategy is now being recommended in the Global Initiative for Asthma. Given the results of our study and others, primary care doctors can tell their patients with mild asthma that they have an alternative effective strategy other than taking inhaled steroids daily, if they choose not to. "
Researchers also noted that children and caregivers in the group taking medication as needed stated that they felt they were actively pursuing their asthma care, rather than implicitly relying on expert doctors' orders. According to Sumino and his colleagues, the symptom-based strategy, in other words, gave them a sense of ownership over the management of their asthma, which is important in the long-term control of the disease.
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