Featured Research

from universities, journals, and other organizations

Daily wheezing treatment no different from intermittent in toddlers, study suggests

Date:
December 13, 2011
Source:
Washington University School of Medicine
Summary:
Pediatricians often treat young children who have frequent bouts of wheezing with a daily dose of an inhaled steroid to keep asthma symptoms at bay. But results of a recent study are likely to change that.

Pediatricians often treat young children who have frequent bouts of wheezing with a daily dose of an inhaled steroid to keep asthma symptoms at bay. But results of a recent study are likely to change that.

A group of pediatric asthma researchers nationwide, including at Washington University School of Medicine in St. Louis, found that daily inhaled steroid treatment was no different from preventing wheezing episodes than treating the child with higher doses of the drug at the first signs of a respiratory tract infection. They also found that daily treatment was comparable to use of the inhaled steroid intermittently at decreasing the severity of respiratory-tract illnesses, reducing the number of episode-free days or school absences, lowering the need for a "rescue" inhaler for acute asthma symptoms, improving quality of life or reducing visits to urgent care or the emergency room.

The researchers, who make up the National Institutes of Health (NIH)-funded Childhood Asthma Research and Education (CARE) Network, studied nearly 300 preschool-age children with frequent wheezing and at high risk for future persistent asthma in a trial called MIST (Maintenance and Intermittent Inhaled Corticosteroids in Wheezing Toddlers). Their findings are published in the Nov. 24, 2011, issue of The New England Journal of Medicine.

"We wanted to understand how to best treat young children who have repeated episodes of wheezing, most of whom appear symptomatic just when they have colds," says Leonard B. Bacharier, MD, a Washington University pediatric asthma and allergy specialist at St. Louis Children's Hospital. "Our goal was to start therapy at the first signs of a viral respiratory tract infection or cold to interrupt or slow the progression of symptoms. This trial was aimed to try to prevent wheezing severe enough that requires oral steroids and really gets in the way of children's lives."

A 2006 study by the same group of researchers, called the PEAK trial (Prevention of Early Asthma in Kids) found that daily treatment was effective in reducing episodes of wheezing requiring oral steroids. However, physicians and parents reported concerns about the drug's effects on growth and are often reluctant to follow the treatment plan, so the researchers began to look for an alternative.

Children in the yearlong MIST trial were between 12 months and 53 months old, had recurrent wheezing and were at high risk for a worsening of asthma-like symptoms that could require treatment with oral steroids and/or a visit to urgent care or emergency room. During the trial, the children received either a dose of budesonide once a day through a nebulizer or an inactive placebo. At the first signs of a respiratory tract illness, those children who received the inactive placebo received a higher dose of budesonide twice a day, while those who received daily budesonide received a placebo twice daily and kept taking their regular budesonide. Neither the patients nor the physicians knew who received the active drug until the trial was over.

During the study, parents were asked to keep a daily diary of symptoms, such as coughing, wheezing, difficulty breathing or other symptoms that interfered with normal activities, as well as a list of medications, visits to a health-care provider or absences from daycare or school.

Because previous studies had shown that daily inhaled corticosteroid therapy was more effective than placebo, the researchers expected to see the same in the MIST trial. But that's not what they found.

"The two groups were comparable in terms of episodes requiring oral steroids, symptom days, albuterol use and the time before oral steroids were needed," Bacharier says. "All of the relevant indicators of disease activity were comparable."

The results show there are a variety of treatments physicians can consider for children with frequent wheezing, Bacharier says.

"While daily therapy continues to be the recommended approach, in this group of children, whose disease is really evident only during respiratory tract illnesses with very few or no symptoms outside of that, instructing parents to treat them at the earliest signs of illness with a high dose of inhaled steroid diminishes the likelihood of an episode of illness requiring oral steroids comparable to giving them daily therapy," Bacharier says.

Washington University School of Medicine enrolled 75 children at St. Louis Children's Hospital. The other centers participating in the trial were the University of California, San Diego; University of Wisconsin-Madison; University of Arizona; National Jewish Health and University of Colorado School of Medicine; University of New Mexico School of Medicine; University of Wisconsin School of Medicine and Public Health, Milwaukee, Wis.


Story Source:

The above story is based on materials provided by Washington University School of Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Robert S. Zeiger, David Mauger, Leonard B. Bacharier, Theresa W. Guilbert, Fernando D. Martinez, Robert F. Lemanske, Robert C. Strunk, Ronina Covar, Stanley J. Szefler, Susan Boehmer, Daniel J. Jackson, Christine A. Sorkness, James E. Gern, H. William Kelly, Noah J. Friedman, Michael H. Mellon, Michael Schatz, Wayne J. Morgan, Vernon M. Chinchilli, Hengameh H. Raissy, Elizabeth Bade, Jonathan Malka-Rais, Avraham Beigelman, Lynn M. Taussig. Daily or Intermittent Budesonide in Preschool Children with Recurrent Wheezing. New England Journal of Medicine, 2011; 365 (21): 1990 DOI: 10.1056/NEJMoa1104647

Cite This Page:

Washington University School of Medicine. "Daily wheezing treatment no different from intermittent in toddlers, study suggests." ScienceDaily. ScienceDaily, 13 December 2011. <www.sciencedaily.com/releases/2011/11/111128115633.htm>.
Washington University School of Medicine. (2011, December 13). Daily wheezing treatment no different from intermittent in toddlers, study suggests. ScienceDaily. Retrieved July 25, 2014 from www.sciencedaily.com/releases/2011/11/111128115633.htm
Washington University School of Medicine. "Daily wheezing treatment no different from intermittent in toddlers, study suggests." ScienceDaily. www.sciencedaily.com/releases/2011/11/111128115633.htm (accessed July 25, 2014).

Share This




More Health & Medicine News

Friday, July 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Beatings and Addiction: Pakistan Drug 'clinic' Tortures Patients

Beatings and Addiction: Pakistan Drug 'clinic' Tortures Patients

AFP (July 24, 2014) A so-called drugs rehab 'clinic' is closed down in Pakistan after police find scores of ‘patients’ chained up alleging serial abuse. Duration 03:05 Video provided by AFP
Powered by NewsLook.com
Too Few Teens Receiving HPV Vaccination, CDC Says

Too Few Teens Receiving HPV Vaccination, CDC Says

Newsy (July 24, 2014) The Centers for Disease Control and Prevention is blaming doctors for the low number of children being vaccinated for HPV. Video provided by Newsy
Powered by NewsLook.com
New Painkiller Designed To Discourage Abuse: Will It Work?

New Painkiller Designed To Discourage Abuse: Will It Work?

Newsy (July 24, 2014) The FDA approved Targiniq ER on Wednesday, a painkiller designed to keep users from abusing it. Like any new medication, however, it has doubters. Video provided by Newsy
Powered by NewsLook.com
Doctor At Forefront Of Fighting Ebola Outbreak Gets Ebola

Doctor At Forefront Of Fighting Ebola Outbreak Gets Ebola

Newsy (July 24, 2014) Sheik Umar Khan has treated many of the people infected in the Ebola outbreak, and now he's become one of them. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

    Health News

      Environment News

        Technology News



          Save/Print:
          Share:

          Free Subscriptions


          Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

          Get Social & Mobile


          Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

          Have Feedback?


          Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
          Mobile: iPhone Android Web
          Follow: Facebook Twitter Google+
          Subscribe: RSS Feeds Email Newsletters
          Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins