PHILADELPHIA - Early intervention in children with asthma is critical in preserving lung function. Intervention can begin in infancy or even in the prenatal period if the mother has asthma.
"However, if we treat all patients with asthma early on, then we are going to be treating patients who may not need long-term therapy, so we have risks to consider with that kind of approach. On the other hand, it has been shown that children who have frequent, severe episodes of asthma, are less likely to outgrow their asthma and have remission," said Robert Bush, MD, at the recent meeting of the American College of Allergy, Asthma and Immunology here.
Instituting anti-inflammatory therapy early in the disease process can prevent inflammatory effects in the airways. This can reduce the long-term consequences and many of the chronic irreversible airway changes.
"Among the factors that we know are important in long-term outcomes are the degree of frequency of episodes, the level of lung function at the time of diagnosis and the presence of bronchial hyperresponsiveness and atopy in childhood. Anything that we can do to impact upon those factors is critical in improving long-term outcomes," he explained.
Additionally, pharmacotherapy in remission can play an important role in treatment and reduced symptoms as well as perhaps impact on the long-term effect of asthma. "It has been shown that inhaled steroids can improve long-term lung function and that inhaled steroids in infants and children may improve symptoms and reduce exacerbations," said Bush, who is professor of medicine at the University of Wisconsin and chief of allergy at Wm. S. Middleton VA Hospital in Madison. Often, if patients are treated and improve, they will relapse when treatment is discontinued.
"The important thing is that inhaled steroids may, in fact, help reduce mortality from asthma. Clearly, inhaled steroids and other anti-inflammatory drugs do impact in early onset asthma. A recent study found that if patients were treated during the first two years of symptoms, their ongoing decline in lung function was less than if their symptoms had been present for a longer period. This indicates that early intervention is critical if one is attempting to preserve lung function," he added.
According to Bush, early intervention can begin during the prenatal period. Mothers-to-be should avoid tobacco smoke, and they can also institute environmental controls. "It is important to institute the environmental control measures before the birth of the child because many of these measures, especially animal avoidance, may take as long as six months before there is any impact," he said.
Public health measures need to reduce environmental pollutants, such as vehicle exhaust particles. Also, children should be encouraged to play outside.
"With our environmentally controlled homes where we have high levels of perennial allergens and with children spending more and more time indoors, we are actually reducing the capacity to develop complete lung function. Clearly, smaller lung capacity has been associated with asthma. Perhaps encouraging children to partake of outdoor activities may be helpful," Bush added.
"We also need to learn more about the genetic-environmental interaction, which is important in the development of the pathogenesis of asthma," he said.
For more information:
- Bush R. When is it appropriate to begin asthma therapy? Presented at the Gateway to the 21st Century, the annual meeting of the American College of Allergy, Asthma and Immunology. Nov. 6-11, 1998. Philadelphia.
- Martinex FD, Wright AL, Taussig LM, et. al. Asthma and wheezing in the first six years of life. N Engl J Med. 1995;332:133-38.
- Flangovan P, et. al. Treatment of severe steroid dependent preschool asthma with nebulized budesonide suspension. Arch Dis Child. 1993;68:356-59.
- Bisgard H, et al. Inhaled budesonide for treatment of recurrent wheezing in early childhood. Lancet. 1990;336:649-51.
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