Asthma Symptoms in Toddlers Treatable without Inhalers

Children who present with symptoms of asthma, such as frequent wheezing, usually are treated by pediatricians with an inhaled steroid, but a recent study found that treating a wheezing child with a daily dose of an inhaler is no different than giving the child increased levels of the steroid at the beginning of a respiratory tract infection.

The double-blind study was performed on a national scale by pediatric asthma researchers who are a part of the National Institutes of Health (NIH)-funded Childhood Asthma Research and Education (CARE) Network.

They studied roughly 300 children between the ages of 12 months and 53 months who suffered from recurrent wheezing, all of whom were at an increased risk to develop persistent asthma in the future. The trial was known as MIST, or Maintenance and Intermittent Inhaled Corticosteroids in Wheezing Toddlers.

Throughout the trial, the children were either given a dose of budesonide once daily through a nebulizer or a placebo; at the first indication of a respiratory tract illness, a child on the placebo would be given a higher dose of budesonide twice per day, whereas children who were originally on a daily dose of budesonide received a placebo twice daily and kept taking budesonide.

The parents of the children were asked to submit a list of medications, visits to a health-care provider, or absences from daycare or school to the researchers. Also, they were asked to track symptoms (such as coughing, wheezing, and difficulty breathing) that got in the way of normal activities.

“We wanted to understand how to best treat young children who have repeated episodes of wheezing, most of whom appear symptomatic just when they have colds,” said Leonard B. Bacharier, MD, a Washington University pediatric asthma and allergy specialist at St. Louis Children’s Hospital.

“Our goal was to start therapy at the first signs of a viral respiratory tract infection or cold to interrupt or slow the progression of symptoms,” Bacharier continued. “This trial was aimed to try to prevent wheezing severe enough that requires oral steroids and really gets in the way of children’s lives.” The results, reported Bacharier, prove that there are many treatments physicians can consider for children with symptoms of asthma. “The two groups were comparable in terms of episodes requiring oral steroids, symptom days, albuterol use and the time before oral steroids were needed,” Bacharier said. “All of the relevant indicators of disease activity were comparable.”

“While daily therapy continues to be the recommended approach, in this group of children, whose disease is really evident only during respiratory tract illnesses with very few or no symptoms outside of that, instructing parents to treat them at the earliest signs of illness with a high dose of inhaled steroid diminishes the likelihood of an episode of illness requiring oral steroids comparable to giving them daily therapy,” Bacharier concluded.

These findings were published in the November 24 2011, issue of The New England Journal of Medicine.