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Dr. Healy's Comments on Steroids Treatment for Asthma

A new study published this week in the New England Journal of Medicine finds that inhaled steroids, a standard treatment for children with severe asthma, do not permanently stunt growth, as doctors had feared. Asthma afflicts some 17 million Americans--five million of them are children and teens under the age of 18. Dr. Bernadine Healy talks to us about the study, the effectiveness of steroids as treatment and what parents can do to minimize their child's asthma attacks.


Is This Good News for Parents of Asthmatic Children?


The news is promising. Doctors knew that steroids cut growth by about a third of an inch (7 millimeters) a year when children start using them. They had worried that youngsters' growth might continue to lag that much every year. But researchers of two studies--a five-year US study and a 10-year study in Denmark found the effect is temporary and children resume normal growth after about a year.


Why Have Doctors Been Prescribing Inhaled Steroids Without Knowing Whether They Could Stunt Growth?


Up to now, doctors knew that in children with severe cases of asthma, steroids' effectiveness outweighed any side effects. They would prescribe the steroid inhaler even though there is slight growth retardation.


Do These New Findings Mean That Young Children With Very Mild Asthma Should Be Treated With Inhaled Steroids?


While the results of the studies show the inhaled steroids won't stunt a child's height, it's still unclear whether the use of these drugs may interfere with the growth of the lungs and other organs. So until those questions are answered it may be prudent to avoid the use of inhaled corticosteroids in young children with very mild asthma.


There are Different Types of Inhalers-- What are They and How do They Differ?


There are basically three types of inhalers--two are for prevention: steroid and non-steroid anti-inflammatory inhalers and one for use during an attack such as albuterol. The steroid inhaler was found to be much better than other anti-inflammatory inhalers such as nedocromil, at reducing the heightened sensitivity that turns allergies into asthma. However, both medicines also cut down the number of emergency room and urgent doctor visits. But the steroid also had benefits the other drug did not such as less time spent in the hospital, less need for other asthma medicines and more days without asthma attacks. The study found asthmatic children who used corticosteroids had 45 percent less urgent-care health visits and 43 percent less hospitalization than asthmatic kids who used a placebo. Which to use should be determined by the parent and doctor based on that particular child.


How can Parents Minimize Their Child's Asthma Attacks?


Experts aren't sure why the asthma problem is getting worse. The rates of asthma, as well as deaths from the disease, are on the rise. But we do know what brngs on asthma attacks. Many asthma triggers have been identified and include tobacco smoke, air pollution, dust mites and cockroach droppings. So by eliminating these things, you can minimize the attacks. However, you should also practice good asthma management. When your child isn't getting the treatment he or she needs, they are likely to have more exacerbation and wind up in hospital emergency rooms more often.

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