Children with mild asthma can use inhalers as needed: Study

Researchers suggest that children with mild asthma can effectively manage the condition by using their two inhalers, one steroid, and the other bronchodilator when symptoms occur.

This is in contrast to the traditional method of using the steroid daily, regardless of symptoms, and the bronchodilator when symptoms occur. The as-needed use of both inhalers is just as effective for mild asthma as the traditional protocol, according to the study published in the journal -- Allergy and Clinical Immunology: In Practice'

The steroid inhaler lowers inflammation, and the bronchodilator, also known as a rescue inhaler, relaxes the airway during an asthma attack to quickly make breathing easier.

"We were pleased to find that as-needed treatment based on symptoms can deliver similar asthma control with less medication. Patients in the group that used both inhalers as needed to be used about one-fourth the steroid dose of the group that inhaled a prescribed daily amount," said Kaharu Sumino, associate professor of medicine.

"We also were pleased to see that the patients and families felt that they had more ownership over their asthma management when practicing as-needed treatment," added Prof Sumino, MD, also the first author of the research.

The study was conducted by primary care doctors at multiple pediatric practices throughout the St Louis area, suggesting the strategy is widely applicable in a primary care setting and not just effective when implemented by researchers at a single academic medical center.

Past clinical trials conducted in the highly controlled settings of academic medical centers had suggested that the medication-as-needed approach worked just as well as a traditional strategy of daily scheduled steroid treatments with a rescue inhaler as needed.

Not only is this alternative, as-needed, symptom-based strategy effective when administered by the children's primary care doctors, but the researchers also found that approach reduced the amount of steroid medication the children took monthly by almost 75 per cent.

The patients were randomly assigned to one of two groups. Each participant in one group was advised to take a dose from an inhaler containing the steroid beclomethasone as needed when symptoms arose, along with the rescue bronchodilator albuterol.

Symptoms that might prompt the use of medication include shortness of breath, tightness in the chest, coughing, wheezing and difficulty performing physical activities.

Each participant in the second group was advised to take a specific inhaled dose of the steroid beclomethasone daily, regardless of symptoms, plus the rescue bronchodilator as needed in response to symptoms, as has been the standard recommendation for almost 30 years by the Global Initiative for Asthma guidelines.

At the end of the one-year study, the researchers found no differences between groups in surveys of how well the patients' asthma was controlled, as well as no differences in breathing tests that measure lung function. There also were no differences in the number of participants who sought extra medical care such as office or emergency room visits for asthma attacks.

As might be expected, the group taking daily beclomethasone, an inhaled corticosteroid, used more of the medication per month than those in the symptom-based group.

The reduced amount is desirable, according to the investigators, because steroids have side effects that include stunted growth.

The researchers also noted that children and caregivers in the group taking medication as needed reported that they felt they were actively managing their asthma care rather than passively relying on doctors' orders.