Severe Asthma & Your Child: 4 Treatment Steps

A little boy holding his teddy bear and wearing his pajamas in his bed(BlackDoctor.org)  — Asthma attacks are a scary thing for children and parents. When your child’s regular steroid inhaler fails to prevent asthma attacks you wonder what the best cause of action is. According to a study funded by the National Institutes of Health, every child’s asthma is different and different children do best with different step-up treatments.

Forty-five percent of children in the study had the best success with long-acting beta-agnoists, or LBAs, such as Serevent, Advair, Foradil and Symbicort. The drugs with the best chance of success — 45% — are long-acting beta-agonists (LABAs), the study suggests. Unfortunately, safety concerns plague these asthma treatments.
About 30 percent of kids in the study did best either with a leukotriene-receptor antagonist (brands include Accolate, Singulair, and Zyflo) or by doubling the dose of the child’s current inhaled steroid medication.

“Nearly all the children had a differential response to each step-up therapy,” said University of Wisconsin researcher Robert F. Lemanske Jr., MD.

Treating Tough Asthma

The study included 182 children age 6 to 17 years who have had recent asthma attacks despite using a steroid inhaler twice a day.

For three 16-week periods, each child continued to take the regular dose of inhaled corticosteroid and added a different step-up treatment. The step-up treatments include either a LABA such as Advair, a LTRA such as Singulair, or a double dose of their steroid inhaler.

The results were all over the board. Only a few clues point to which children were most likely to do best on which treatment. Hispanic and White children were most likely to respond best to LABAs such as Advair and least likely to respond to doubling steroid inhaler dosages. Black children were also most likely to respond well to LABA but also responded well to doubling inhaled sterioid doses and less likely to respond well to LTRAs such as Singulair.
Even with these few clues, there is still no way to predict which step-up treatment works best.

What Should Parents Do?

Erika von Mutius, MD, of University Children’s Hospital, Munich and Jeffrey M. Drazen, MD, editor of the New England Journal of Medicine say step-up therapy treatments should first be based on safety, then price and then convenience.

“Since we still have lingering concerns about the safety of LABAs in the treatment of asthma, in that they may promote severe exacerbations or fatal asthmatic events … our first choice would be either increasing the dose of an inhaled corticosteroid or adding an LTRA to the therapeutic regimen,” said Drazen and Mutius.

Whichever treatment a child’s doctor decides on it is important for parents to follow up with children’s doctors to make sure the chosen treatment is working for the child. It is especially important for Black children to follow up with doctors regarding asthma treatment. Statistics from the U.S. Department of Health and Human Services shows Black children have a 260% higher emergency room visit rate, a 250% higher hospitalization rate, and a 500% higher death rate from asthma, as compared with White children.

Once you and your child’s doctor have set up a plan for treating your child’s asthma, sticking to the plan and monitoring the progress of asthma is the most effective way of preventing asthma flare-ups.

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