Asthma Research into Action
Talented “Tailors” Needed for Childhood Asthma Treatments
“There is no one-size-fits-all when it comes to childhood asthma treatment,” said Dr. Robert F. Lemanske, Jr., Professor of Pediatrics and Medicine at the University of Wisconsin School of Medicine and Public Health (Madison), and Head of the Division of Pediatric Allergy, Immunology, and Rheumatology.
Dr. Lemanske is the lead author of a recent NIH-funded study which revealed that while most children who have trouble controlling their asthma with low-dose inhaled corticosteroids show improvement by increasing the dose, or adding another medication, the best option differs for each child.
The multi-site trial followed 157 children who had mild to moderate asthma that was not well-controlled by low-dose corticosteroids alone. Each child received each of what were three step-up treatments (a long-acting beta-agonist [LABA]; a leukotriene receptor antagonist; or an additional dose of inhaled corticosteroid on top of their prescribed dosage) in random order, over a 16-week period.
Lemanske and his colleagues discovered that in more than 95% of the children, a best response to treatment varied from child to child among the three options. Nearly half of the children had the best response to the addition of LABA; about a quarter responded best to the addition of leukotriene receptor antagonist, and another quarter responded best to doubling the dosage of inhaled corticosteroids. View additional detail—including what role eczema and race played in predicting which treatment worked best—in the full study, published in the March 2, 2010, New England Journal of Medicine online edition.
“As a clinician, one of the most exciting and challenging things about taking care of people with asthma is that you have to really work with the patients and families to find the right approach,” said Dr. Lemanske. “Some people prefer pills; others prefer inhalers; and some don’t like to take medicine more than once a day: you have to take all of those things into consideration.”
Having been a pediatrician for more than 30 years; serving on expert panels for the development of guidelines for the diagnosis and management of asthma in the United States, and for the treatment of childhood asthma in Canada; and being a member of the National Asthma Education and Prevention Program’s (NAEPP) Guidelines Expert Panel in the U.S. for more than a decade, Dr. Lemanske is a recognized international expert in childhood asthma.
And, his excitement about the possibilities that the NAEPP’s asthma guidelines hold for improving the quality of life for children who have asthma (some 7 million in the U.S. alone) is almost electric.
“The latest set of guidelines has really put forward the concept of asthma control: now we have information to help us assess both current impairment (frequency and intensity of symptoms; functional limitations) and future risk (likelihood of exacerbation, adverse effects from medication, or progressive decline in lung function or, for children, lung growth),” said Dr. Lemanske. “Judging the two together is critical in determining an appropriate treatment regimen, because someone could be well controlled in terms of impairment, but the risk for future asthma attacks and/or side effects might not be predicted to be as well controlled.”
Assessing and monitoring asthma control is one of six critical actions that the National Asthma Control Initiative is encouraging healthcare professionals to use in order to improve asthma control and care, nationwide.
You can read about all six actions (known as the Guidelines Implementation Panel, or GIP, messages) here.
Last Updated February 2011