Traditional asthma treatments center around inhaled steroids to soothe bouts of wheezing and coughing, with the dosage going up as symptoms worsen.
But a new study found that high doses of inhaled steroids may not be effective at reducing asthmatic exacerbations in some children and could even stunt their growth.
Published this week in The New England Journal of Medicine, the study examined the impact of high doses of inhaled steroids on children with mild-to-moderate asthma.
Asthma exacerbations are common events for children. About 1 in 10 children has asthma and that rate is growing, according to the U.S. Centers for Disease Control and Prevention (CDC).
These exacerbations can be bad enough that children need to be hospitalized. In 2016, one in six children with asthma ended up in the emergency department due to the condition.
To prevent children from ending up in the ER, doctors look for signs that a child’s asthma symptoms have changed.
These symptomatic changes are seen as the child moving from the “green zone” of asthma symptoms to the “yellow zone,” where coughing, wheezing, chest tightness, shortness of breath, waking at night, and limitation of usual activities become more prevalent.
When children hit the “yellow zone,” doctors often increase the inhaled steroid dosage to keep children from having a severe or dangerous exacerbation.
While this practice is fairly common, there’s been little robust research to test the effectiveness of increasing doses of inhaled steroids in kids who have mild-to-moderate asthma.
Treating asthma in the “yellow zone”
But the new study funded by the U.S. National Heart, Lung, and Blood Institute (NHLBI) looked at this issue by enrolling 254 children between 5 and 11 years old with mild-to-moderate asthma.
The study was conducted at 17 facilities throughout the Unites States over a one-year study period.
All of the enrolled children were given low-dose steroids daily or two puffs of a popular asthma medication, fluticasone or Flovent, twice a day.
When children started to show “yellow zone” symptoms, half of the children were maintained on the low-dose inhaled steroids while the other half were put on the high-dose inhaled steroids. This was done for seven days during each exacerbation.
The study found there were no major differences between the low-dose and the high-dose groups.
Despite more medication, those in the high-dose group had the same number of severe asthma exacerbations as those children in the low-dose group.
Researchers also found that it took the same amount of time for the first severe exacerbation to occur in both groups. Additionally, the number of emergency department and urgent care visits remained the same between both groups. They also had the same rate of medication failure.
Study leader Dr. Daniel Jackson, associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin said in a statement that the findings suggest “a short-term increase to high-dose inhaled steroids should not be routinely included in asthma treatment plans” for kids without severe asthma and who were already using low-dose inhaled steroids.
Jackson clarified that low-dose inhaled steroids should continue as the cornerstone daily treatment for children with asthma.
Jackson and his team also found signs that all those steroids could be impacting children negatively by stunting their growth.
They found the high-dose group grew 0.09 inches less than those who were in the low-dose group. This is despite the fact that these children only used higher dose steroids somewhat sparingly, during the week of an exacerbation.
While study authors acknowledged that this growth disparity is seemingly small, they warn that high steroid doses could lead to larger health implications.
Adding to the asthma ‘arsenal’
Dr. Sherry Farzan, attending allergy and immunology physician at Northwell Health in New York, told Healthline that the study could help doctors tailor treatment for patients.
“I think it is an important piece of information that we can add to our arsenal, especially because many physicians, including pediatricians, use this as a strategy in terms of increasing the dose of inhaled steroids in order to prevent a severe exacerbation,” Farzan told Healthline.
“That strategy may now not be helpful and it may actually be harmful,” Farzan continued.
She said that these rules would mainly affect kids older than preschool age and younger than teens or adults with severe asthma.
“It is a well-designed study with a very specific group of patients [in an] age range of 5 to 11 with mild-to-moderate persistent asthma,” said Farzan. “It is not your preschool ‘wheezers’ that may benefit from this kind of strategy.”
Farzan also said more research needs to be done in order to truly understand how to best personalize treatment plans for patients.
“It’s not the end of this strategy, it’s just perhaps we need to figure out what strategy is the best for each type of asthma patient,” she said.