Inhaled steroids help asthmatic tots

Daily use of inhaled steroids can reduce breathing problems in toddlers at high risk for asthma, but the treatments do not prevent development of asthma in the children, according to a new study.

The research, being published today in The New England Journal of Medicine, sought to determine whether the intensive treatments for inflammation could thwart the onset of the most common chronic childhood illness in the United States.

"Asthma is an enormous public-health problem, and this study was designed to see if we could stop the development of asthma in its tracks, while the lungs are still developing, in young children known to be at high risk," said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, which sponsored the study.

The trial was carried out on 285 high-risk children ages 2 to 3 at five medical centers around the country. The youngsters were randomly selected to receive either a daily treatment of inhaled steroids (Flovent) using a metered-dose inhaler or a placebo, for two years. All the children received additional medications to treat frequent coughing or wheezing as symptoms occurred.

"High risk" was determined by using an index of symptoms that included having eczema, allergic reaction to airborne substances such as dust mites, a parent with asthma or a combination of two symptoms: food allergy, wheezing not related to colds or elevated levels of white blood cells called eosinophils associated with asthma.

When the treatment ended, all participants were observed for another year to see if the earlier treatment had any lasting effects. The researchers found no significant differences between the participants in the two groups during the follow-up period.

"After a year without treatment, the children who had received inhaled corticosteroids had roughly the same frequency and severity of asthma-related symptoms and similar levels of lung function as the children who had not been treated," said Dr. Theresa Guilbert, lead author of the study and an assistant professor of pediatrics at the Arizona Respiratory Center of the University College of Medicine in Tucson.

During the two-year treatment period, however, the children getting the active drug had significantly fewer and less severe asthma symptoms than their peers receiving the placebo.

For instance, those getting the drugs had two days of symptoms per month compared to four days of symptoms per month in the placebo group. They also had a lower rate of severe episodes requiring further drug treatment.