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March 17, 2009

AAAAI 2009: Newer Medications Have Changed Presentation of Childhood Asthma

Martha Kerr

March 16, 2009 (Washington, DC) — Second-generation inhaled corticosteroids (ICS) and long-acting beta-2-agonist (LABA) bronchodilators, introduced into clinical practice in past decade, have significantly "changed the face of childhood asthma," investigators at National Jewish Health, in Denver, Colorado, announced here at the 2009 American Academy of Asthma, Allergy and Immunology Annual Meeting.
Two cohorts of children referred to the National Jewish Health Pediatric Day Program for the management of severe asthma were analyzed by Joseph Spahn, MD, and colleagues. The first cohort was a group of 164 children treated between 1993 and 1997, and the second was a group of 65 children treated between 2004 and 2007.
All children were between the ages of 6 and 18 years, although mean age of the recent cohort was younger than that of the earlier (historic) cohort (11.3±0.3 years vs 14.1±0.2 years; P < .001).
There was a higher proportion of boys in the recent cohort than in the historic cohort (59% vs 45; P = .05).
Chronic oral glucocorticoid therapy was used in only 28% of the recent cohort, compared with 51% of the historic cohort (P = .001). The average dose used was 3.7±2.4 mg in the recent cohort vs 16.7±1.4 mg in the historic cohort (P < .0001). Duration of oral glucocorticoid use was 17.8±8.6 months in the recent cohort and 33.7±3.5 months in the historic cohort (P = .09).
In addition, 76% of the recent cohort was taking a leukotriene-receptor antagonist and 66% was taking an ICS/LABA combination. None of the historic cohort received these medications because they were not on the market at that time.
The recent cohort had higher forced expiratory volume in 1 second than the historic cohort (84%±2.5% vs 76%±2% of predicted; P = .008), required less albuterol (33±9 vs 71±7 inhalations per week; P = .0007), and had undergone fewer intubations (mean, 13% vs 21%; P = .13).
Finally, the recent cohort had fewer glucocorticoid-induced adverse effects than the historic cohort, Dr. Spahn told meeting attendees.
Those in the recent cohort "were less likely to require chronic oral glucocorticoids, had better asthma control, and had fewer glucocorticoid-induced adverse effects compared with the cohort of severe asthmatic children studied a decade ago," Dr. Spahn said. "This is likely due to the use of more effective medications for asthma." Leukotriene-receptor antagonists and LABAs were not available 10 years ago, he noted.
"The whole approach to asthma has changed," Andy Nish, MD, a practitioner from the Allergy and Asthma Care Center, in Gainesville, Georgia, and a member of the American Board of Allergy and Immunology, told Medscape Allergy & Clinical Immunology after Dr. Spahn's presentation.
"Inhaled corticosteroids are now the gold standard . . . but patients can't just be given these prescriptions," Dr. Nish warned. "Most patients don't know how to use an inhaler. They need to be educated. We ask the patient to demonstrate how he uses it."
"We tell our patients that there is underlying inflammation present that they might not be able to feel, and that the medications are to control that," Dr. Nish pointed out. "We have to get them away from using rescue therapy on a PRN basis. That's one of the biggest hurdles we have to cross. Patients have to use maintenance therapy, even if they feel well.
"We tell our patients to think of their asthma like a diabetic treats his blood sugar or a patient with hypertension treats his blood pressure," Dr. Nish said. "You keep the exacerbations from starting with controller medications and try to keep rescue medications to a minimum."
Neither Dr. Spahn nor Dr. Nish report any relevant financial relationships.
2009 American Academy of Asthma, Allergy and Immunology (AAAAI) Annual Meeting: Oral abstract 242. Presented March 14, 2009.

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