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Weighing the risks of treatment versus nontreatment in pediatric asthma
Joseph D Spahn1, Ronina A Covar
1The Ira J. and Jacqueline Neimark Laboratory of Clinical Pharmacology and the Division of Allergy, and Clinical Immunology, Department of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson Street, Denver CO 80206, USA. spahnj@njc.org
Insights
Adhering to asthma management guidelines can significantly reduce healthcare costs and severe asthma exacerbations. Controller medications, particularly inhaled glucocorticoids, are crucial for managing persistent asthma in children.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Pediatric Medicine
Background:
- Asthma management has advanced significantly over the last decade with new medications.
- Despite advances, asthma continues to impose a substantial burden on society due to costs and morbidity.
- Current treatment options offer effective management for both acute and chronic asthma symptoms.
Purpose of the Study:
- To emphasize the importance of following the National Heart, Lung, and Blood Institute (NHLBI) guidelines for persistent asthma management.
- To highlight the benefits of controller agents, especially inhaled glucocorticoids, in managing childhood asthma.
- To address unanswered questions regarding the efficacy of leukotriene-modifying agents and combination therapies.
Main Methods:
- Review of current understanding and treatment guidelines for asthma.
- Analysis of the impact of inhaled glucocorticoids as first-line therapy for persistent asthma.
- Discussion of ongoing research into leukotriene-modifying agents and combination therapies.
Main Results:
- Following NHLBI guidelines can substantially reduce asthma-related healthcare expenditures.
- Effective asthma management, particularly with inhaled glucocorticoids, significantly decreases exacerbations, emergency visits, hospitalizations, and mortality.
- Inhaled glucocorticoids improve asthma control, lung function, and reduce overall morbidity and mortality.
Conclusions:
- Asthma is a chronic condition requiring consistent management with controller agents.
- Inhaled glucocorticoids are the recommended first-line treatment for persistent asthma.
- Further research is needed to determine the role of leukotriene-modifying agents and combination therapies in optimizing asthma control and reducing severe outcomes.
Abstract:
During the past dozen years, great strides have been made in the understanding of asthma. In addition, an excellent choice of effective and safe medications has become available for use in both the acute and chronic manifestations of this disease. Unfortunately, asthma continues to affect society adversely in terms of cost and morbidity. Following the NHLBI guidelines for the management of persistent asthma could substantially reduce the health care expenditures associated with asthma and, more importantly could significantly reduce asthma exacerbations, emergent care visits, hospitalizations, and even asthma deaths. All who care for children with asthma must continue to relay the message that asthma is a chronic condition that is best treated with controller agents. Inhaled glucocorticoids are considered first-line agents for all patients with persistent asthma. They have been shown to improve asthma control, improve lung function, and reduce morbidity and mortality. Whether the leukotriene-modifying agents will be shown to reduce morbidity and mortality significantly remains an important and unanswered question at present. Another important question is whether combination therapy and which combination (inhaled glucocorticoid plus LABA or inhaled glucocorticoid plus leukotriene-modifying agent) will provide even further improvement in asthma control and further reductions in hospitalizations and mortality than seen with the use of inhaled glucocorticoids alone.
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