Growing concerns about inhaled steroids?
ASTHMA MAGAZINE
By Pamela Appea
Starting your child on inhaled corticosteroids, asthma and allergy experts say, can be one of the most important steps in helping your child better manage his or her persistent asthma.
However, in 1998, the Food and Drug Administration (FDA) began to require inhaled corticosteroids, commonly referred to as steroids, to bear a label stating that kids who take the drug may experience delayed growth. Although parents may be concerned about giving their children these drugs, pediatric asthma and allergy specialists say this concern is unwarranted.
Allergy and asthma experts have found it challenging enough to get their young patients--around 5 million U.S. children have asthma--to use inhaled corticosteroids on a daily basis as recommended by national experts.So with the FDA-mandated labeling change, many experts fear parents are discouraged from choosing to give their children this medicine.
"There is a lot of steroid phobia," says Michael Blaiss, MD, vice president of the American Academy of Allergy, Asthma and Immunology and clinical professor of pediatrics and medicine at the University of Tennessee in Memphis.
Some older studies have shown that, when kids take these corticosteroids, they may experience a slowed rate of growth. The FDA thinks it is still unclear as to whether inhaled corticosteroids pose any long-term risks to a child's final height. These and other questions about corticosteroids are enough to make a parent ask: Are inhaled corticosteroids necessary? Among most pediatric asthma and allergy experts, the answer is a resounding yes.
Asthma experts say the first step is to know what inhaled corticosteroids are. For example, Blaiss explains that the steroids some athletes take to increase performance are in an entirely different class of medication than corticosteroids used for asthma.
When parents hear the doctor say inhaled steroids will be part of their child's asthma treatment, they may negatively associate that medicine with the kind of steroids athletes use.Parents often don't understand the difference and are afraid for no reason, Blaiss says.
"Estrogen is a steroid, yet there is no fear about taking estrogen," says William Berger, MD, president-elect of the American College of Allergy, Asthma and Immunology and clinical professor of pediatrics at the University of California in Irvine.
Taking their inhaled steroids may help children with asthma live fuller lives, he emphasizes, which is why it's important for parents to take their child's asthma seriously. It's important to understand the long-term benefits of inhaled corticosteroids, just as a diabetes patient knows that continuous treatment and medical care are essential.
How inhaled corticosteroids work.Inhaled corticosteroids, delivered through a small asthma inhaler (either a traditional metered dose inhaler or a newer dry powder inhaler), reduce and prevent swelling and inflammation in the bronchi, the airways of the lungs.
Specialists will prescribe specific medications so that kids can have better relief for long-term control of asthma symptoms.
Corticosteroids also come in a nasal inhaler preparation for the treatment of allergic rhinitis, commonly known as hay fever. Inhaled corticosteroids are preventive medicines.
They do not work like quick-relief inhalers and will not stop or relieve symptoms for a child in the middle of an asthma attack. They must be taken on a daily, long-term basis to be effective.
What research shows:Recent studies, including two published reports in The New England Journal of Medicine, found the definitive benefits of inhaled corticosteroids far outweigh the risks. Although children in the study did measure about 0.4 inches shorter than children on nonsteroid drugs after the first year of treatment, the researchers found that this growth lag disappeared in the following years.
So, as Finegold points out, the kids caught up and suffered no permanent loss from their adult height.
In addition, research from the Childhood Asthma Management Program funded by the National Institutes of Health's National Heart, Lung, and Blood Institute showed inhaled corticosteroids provided superior asthma control.
Compared with children on placebo, kids treated with corticosteroids had: 45% fewer urgent care visits 43% hospitalizations 45% less use of oral corticosteroids (used to treat severe exacerbations) 30% fewer days in which additional asthma medication was needed 22% more episode-free days.
Parents can take steps to ensure their child takes inhaled corticosteroids as safely as possible to minimize side effects. When taking these medicines with a traditional inhaler, it is important for the child to use a spacer attached to the inhaler. This device allows more medicine to be breathed into the lungs and less to end up in the mouth and throat, where it is swallowed and produces more systemic side effects. It is also important for the child to rinse, gargle, and spit after taking this medicine.
The focus on the inhaled steroid debate, Berger says, has approached the issue from the wrong angle."
Untreated asthma really hurts a child early growth," he says, a fact that physicians have known for years. Kids will be smaller and weaker if they don't take medications they need, he says.
Also, specialists most often prescribe inhaled corticosteroids to kids who have developed a moderate-to-severe chronic form of asthma, which means the asthma episodes are frequent, debilitating, and affecting quality of life. Most kids do extremely well when given low dosages of inhaled corticosteroids and regular check-ups.
"Five thousand people die from asthma every year," Berger says, including many children.
The best way parents should show their concern is to take the disease seriously and get their kids the treatment they need. Asthma specialists agree that research from the past 25 years has shown inhaled corticosteroids effectively help kids control asthma and lead a productive life in school, on the playground, at home, and beyond.
"These are lifesaving drugs," Berger emphasizes."As with all medications, there are some risks. However, the risks are minimal compared with the benefits."Guidelines to help your child use his or her medications.
Always give medicines as prescribed by your child's doctor.
Do not use medicines after the expiration date on the package.
Have your child rinse and gargle with water after each use to limit the amount of medication
that enters the body by being swallowed. This activity reduces the likelihood of side effects.
Keep medications out of the reach of children.
Understand that it may take a few weeks for these medicines to begin to work.
Using a spacer can help more medicine reach the lungs and less to collect in the mouth and throat, where it will be swallowed.
Source: The Children's Hospital Medical Center of Cincinnati
Copyright 2002 by Pamela Appea for Asthma Magazine.
Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350. Reprint no. 78/1/123558doi:10.1067/mas.2002.123558.http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=full&id=a123558
