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Long-term outcomes in paediatric asthma
1University of Southern Denmark and Department of Pediatrics, Kolding Hospital, Kolding, Denmark.
Insights
Asthma management must prioritize long-term outcomes, as short-term studies on inhaled corticosteroids do not predict adult height or other lasting effects. More research is needed to guide effective, long-term pediatric asthma care.
Area of Science:
- Pediatric Pulmonology
- Evidence-Based Medicine
- Pharmacovigilance
Background:
- Asthma management has shifted from symptom relief to continuous prophylactic treatment, necessitating complex assessments of optimal control.
- Current asthma management relies heavily on short-term (<1 year) controlled studies, potentially oversimplifying long-term treatment goals and outcomes.
Discussion:
- Short-term studies on inhaled corticosteroids may not accurately predict long-term adverse effects, such as impacts on statural growth and adult height.
- Systemic effects observed in short-term trials, like changes in lower leg growth rates, do not reliably predict long-term statural growth or final adult height.
- Uncontrolled asthma itself can negatively impact attained adult height, highlighting the importance of effective disease management.
Key Insights:
- Long-term outcomes, including disease remission and prevention of complications like airway remodeling and impaired growth, should guide future asthma management strategies.
- Adverse effects of pharmacological management, particularly on adult height and peak bone mineral density, require careful consideration in treatment decisions.
- Asthma management in children must address potential impacts on growth, bone density, physical function, and psychosocial development.
Outlook:
- Future asthma management strategies require a greater emphasis on long-term outcomes for children.
- There is a critical need for more controlled, multi-year studies to understand how to best achieve long-term asthma control and prevent complications.
- Longitudinal research is essential to refine treatment protocols and ensure optimal lifelong health for individuals with asthma.
Abstract:
Over the years the aims of asthma management have changed markedly from effective prednisolone treatment of symptoms and exacerbations towards more use of continuous prophylactic treatment. With our new understanding of the disease and its management definition of the aims of treatment and assessment of optimal asthma control have become much more complex. Even in times of evidence-based medicine our asthma management is based upon findings of effects on various outcomes in somewhat short-term (<1 year) controlled studies. However, assumptions about long-term effects upon the basis of findings in such studies should be made with great caution. Good examples of this are studies which assess the risk of systemic effects and clinical adverse effects of inhaled corticosteroids. From such studies it has become clear that systemic effects detected in short-term trials may have no predictive value of long-term adverse effects. Thus steroid-induced changes in lower leg growth rates assessed by knemometry do not predict long-term statural growth. Moreover, steroid-induced changes in statural growth over 1 year are not predictive of effects upon attained adult height. In contrast, reduced growth caused by uncontrolled asthma disease also seems to affect attained adult height adversely. These findings suggest that long-term outcomes should play a larger role when future asthma management strategies are decided. Some important long-term outcomes of asthma management in children include cure or remission of the disease, prevention of complications of the disease (airway remodelling, adverse effects upon growth/adult height, peak bone mineral density, physical impairment and psychosocial development) or its pharmacological management (adverse effects upon adult height, peak bone mineral density). More controlled long-term studies (several years) are needed to provide a better understanding of how these outcomes are best achieved.