May 11, 2006

Early drug therapy doesn’t prevent asthma: studies

By Gene Emery

BOSTON (Reuters) - Using inhaled steroids to treat asthma
in young children does not alter the course of the disease and
should not be used for that purpose, according to two studies
in the New England Journal of Medicine.

Inhaled steroids such as Pulmicort and Flovent reduce
swelling and inflammation in the airways and help control the
wheezing and breathlessness associated with asthma, which
affects nearly 9 million children in the United States.

But some doctors prescribe them to very young children
considered at risk of developing asthma in the hope of
preventing the disease from developing. That strategy won't
work and should be discouraged because there could be risks
associated with the drugs, researchers said in Thursday's
edition of the journal.

Concerns about inhaled steroids emerged after some studies
found that the drugs slowed physical growth.

"Inhaled corticosteroids do not alter the natural history
of the disease," Harvard Medical School's Diane Gold and Anne
Fuhlbrigge said in an editorial. "The risk of wheezing will
persist beyond the first years of life."

One of the latest studies tested 285 children aged 2 and 3,
with symptoms of asthma. During the two years they were
treated, those taking the inhaled drugs had more symptom-free

But the following year, when treatment was suspended, those
who had received the drugs fared no better than those who had
received a placebo.

A separate study, conducted at Copenhagen University
Hospital in Denmark by Hans Bisgaard and his colleagues, found
that it made no difference whether the 411 1-month-old infants
who had experienced a three-day episode of wheezing received a
corticosteroid or a placebo. The chance of developing a
persistent wheeze -- believed to be an early sign of asthma --
was the same.

"Such drugs should not be used in the hope of altering the
course of asthma in childhood," said Gold and Fuhlbrigge.
"Given the potential risks of therapy in early life, prolonged
treatment for toddlers under the age of 2 years should be
highly selective."