Children with Intermittent Asthma May Not Need Daily Inhaled Steroid Dosing

Children with intermittent asthma may not require a daily dose of inhaled corticosteroid (ICS) therapy, recent study results suggest.

Researchers from the University of California, San Francisco, analyzed 22 studies involving 4550 children aged 6 years and younger. Each child experienced at least 2 episodes of asthma or wheezing in the previous year.

In 15 of the studies, children with persistent asthma or wheezing had a 30% reduction in the risk of exacerbation with daily medium-dose ICS use. Another 5 studies focused on more sporadic use of the inhalers by children whose wheezing wasn’t recurrent and typically coincided with a cold, and the trials found a 35% reduction in exacerbations with high-dose intermittent ICS use compared with placebo.

The 2 remaining studies compared the effects of daily ICS with those of more sporadic ICS use in children with wheezing induced by common colds. Those studies found no difference in the number of exacerbations.

The study authors concluded that there’s “strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma,” and also “strong evidence to support intermittent ICS for preventing exacerbations” in preschool children with intermittent asthma or viral-triggered wheezing.

“It makes sense that…children with frequent symptoms require daily treatment, whereas those who wheeze just during viral illnesses may only need treatment during illnesses,” study lead author Sunitha Kaiser, MD, of the University of California, San Francisco, said in a university news release.

According to the CDC, 6.3 million children in the United States have asthma (8.6%), and parents are increasingly visiting physician assistants and nurse practitioners at retail clinics for convenient asthma treatment, especially because of the anticipatedphysician shortagein the near future.

Kristen Marjama, DNP, FNP-BC, education and training manager with Walmart Care Clinics in Fort Lauderdale, Florida, toldContemporary Clinicthat retail clinicians can play a key role in helping patients better understand how to use their asthma medications properly.

“Clinicians need to know the right medications to prescribe at the right time,” she explained. “An intermittent asthmatic patient is only [supposed] to use a short-acting beta agonist intermittently. The problem is, many times [patients] are using it way more than they should, and that goes unrecognized by a health care provider.”

Clinicians should take the time to ask patients and parents about both day and night symptoms so that they may start taking a controller medication at the proper dosage. Doing so can help reduce necessary scarring of the airways or permanent loss of lung function.

Because the researchers pointed to children who experience asthma flare-ups due to cold symptoms as prime candidates for reduced use of ICS, clinicians may only need a school calendar to pinpoint those kids.

Aseparate studyfound that the spread of cold viruses, which was greatly influenced by the school schedule, was the primary driver of asthma exacerbations in children.

The current study appeared inPediatricson May 26.