Jan 27

Canadian researchers have new insights in the treatment of severe asthma attacks in children with a cold. First of all, what causes asthma?

In healthy people, the muscles around the airways are relaxed and allow the airways to stay open. (a) The airways are swelling and mucus free. However, in people with asthma, the inside of the airways can become swollen and quickly fill with mucus (b). The muscles around the airways can spasm, squeezing the airways even tighter (c). This chain of reactions leaves less room for air to pass through. It becomes therefore more difficult to breath.

While asthma is mostly associated with allergies, exercise or are being developed at work, about one third of asthma is said to be “non-allergic”. A considerable number of children fall under that last category. Those infants have no respiratory disease when they are health, but can suddenly suffer from severe asthma attacks when they catch a cold. In children with a cold, this type of asthma is caused by viral infections. Asthma attacks associated with viral respiratory infections can begin rapidly and be quite severe. Hence, these young children end up spending a lot of time at the emergency when they catch a cold. However, Dr. Francine Ducharme, vice director of the clinical research department of Ste-Justine Hospital in Montreal and main investigator of this clinical study, may have find them a break.

The prophylactic treatment described by Dr. Ducharme and her collaborators to prevent cold-induced asthma uses high doses of corticosteroids, a class of steroid hormones with anti-inflammatory properties. The high dose corticosteroids treatment was shown to significantly reduce the duration as well as the intensity of asthma attacks in young children. Corticosteroids have the ability prevent to reduce the swelling and other mechanisms involved in asthma, such as reducing eosinophils action. A commonly used corticosteroids in the treatment of asthma is Flovent, marketed by GlaxoSmithKline, although there are now many other generic brands.

In a recent study published in January 2009 in the New England Journal of Medicine, Dr. Ducharme shows that inhalation of high doses of flucatisone, such as Flovent, at the very beginning of a cold, for a period of time up to 10 days, cut in half the number of asthma attacks in toddlers aged between 1 to 3 years old. These finding is a breakthrough for asthma diagnosis and treatment in young children. Indeed, 60% of children admitted in emergencies for asthma attacks are in that age group.

«We know well how to treat asthma attacks associated with viral respiratory infections. But we did not know how to prevent it. Children who attend daycare services tend to catch a cold once a month, on average. We needed to find a way to avoid those attacks», Dr Ducharme explains.

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And she adds that the preventive treatment using corticosteroids should only be used on children known to develop severe asthma attacks when they catch a cold. The use of this therapy on children that suffer from minor asthma attacks would lead to an overuse of corticosteroids.

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