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Thursday, 11 February 2016

Concern on long-term asthma treatment with inhaled corticosteroids in children



Many parents are worried about long-term usage of inhaled corticosteroids in their children. However, when they stop using the steroid inhalers, their children will get frequent asthma attacks.

According the researches done in the past decades, continuous long-term treatment is not associated with the development of tachyphylaxis and kids do not have an increased risk for broken bones (fractures) compared to those who are not using the medicine.
 

How It Works

All forms of corticosteroids reduce inflammation in the airways that carry air to the lungs (bronchial tubes) and reduce the mucus made by the bronchial tubes. This makes it easier for patients to breathe.
Inhaled corticosteroids treat inflammation in the airway, and only very small amounts of the medicine are absorbed into the body. Hence, these medicines don't cause serious side effects, such as weakening of the bones, which corticosteroids can cause when they are taken in liquid, pill, or injection form (systemic corticosteroids).
 

Why It Is Used

Inhaled corticosteroids are the preferred treatment for long-term control of mild persistent, moderate persistent, or severe persistent asthma symptoms in children, teens, and adults. They help control narrowing and inflammation in the bronchial tubes. In general, they are part of daily asthma treatment and are used daily.

Different types of medicines are often used together in the treatment of asthma. For example, inhaled corticosteroids are often used together with long-acting beta2-agonists for persistent asthma. Medicine treatment for asthma depends on a person's age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.
  • Children up to age 4 are usually treated a little differently from those 5 to 11 years old.
  • The least amount of medicine that controls the asthma symptoms is used.
  • The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
  • If the asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
  • Quick-relief medicine is used to treat asthma attacks. But if you or your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.
Do discuss with your GP for the number and dose of medicines that work best for you.

Journals Extracts:
Below are some of the journal extracts and information for your references:

1. Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children

Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children

L. Agertoft, S. Pedersen, doi: 10.1016/0954-6111(94)90044-2

CONCLUSION:
Inhaled budesonide in doses up to 400 μg per day does not stunt growth in children with asthma and that early intervention with this treatment may prevent the development of irreversible airway obstruction and reduce the risk of under-treatment. Finally, continuous long-term treatment is not associated with the development of tachyphylaxis.

2. Concerns for children

Inhaled corticosteroids and the risk of adult fractures in children and adolescents. (Pediatrics)
Schlienger RG, et al. (2004). Inhaled corticosteroids and the risk of adult fractures in children and adolescents. Pediatrics, 114(2): 469-473.

CONCLUSION:
Some parents worry that children who use inhaled corticosteroids may not grow as tall as other children. A very small difference in height and growth was found in children who were using inhaled corticosteroids compared to children not using them. And one study showed a very small difference in height [about 0.5 in. (1.3 cm)] in adults who used inhaled corticosteroids as children compared to adults who did not use inhaled corticosteroids. But the use of inhaled corticosteroids has important health benefits for children who have asthma. In nutshell, children who use inhaled corticosteroids do not have an increased risk for broken bones (fractures) compared to those who are not using the medicine.

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