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Published on: November 4, 2010
Long-term effects of asthma medications in children
Grace P Tamesis1, Ronina A Covar
1Department of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA.
Insights
Controller asthma medications significantly improve symptoms in children but do not alter the disease
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Asthma Research
Background:
- Childhood asthma management relies on controller medications.
- Long-term outcomes of these treatments are crucial for understanding disease progression.
Purpose of the Study:
- To review recent studies on the long-term effects of controller asthma medications in children.
- To evaluate the impact of current asthma therapies on disease progression and airway damage.
Main Methods:
- Systematic literature review of recent studies.
- Analysis of clinical trial data and observational studies.
- Synthesis of evidence on inhaled corticosteroids and montelukast.
Main Results:
- Inhaled corticosteroids (ICS) improve symptom control and reduce morbidity but do not prevent asthma progression from recurrent wheeze.
- Limited evidence suggests ICS have minimal effect on lung function decline.
- Montelukast reduces asthma exacerbations and need for supplemental ICS.
- Combination therapy with ICS and long-acting beta-agonists shows no superiority over full-dose ICS alone for long-term efficacy or growth.
Conclusions:
- Current asthma medications substantially impact symptom control and quality of life in children.
- No available medication can alter the natural progression of childhood asthma.
- Progressive airway damage in susceptible children remains a challenge despite available treatments.
Purpose Of Review:
This review describes recent studies in children that evaluated long-term outcomes of controller asthma medications.
Recent Findings:
The literature is replete with studies demonstrating the immediate profound effects of inhaled corticosteroids on symptom control, reduction in morbidity and mortality rates, improvement in lung function, bronchial hyperresponsiveness, and inflammatory markers. Recent evidence supports that even this most effective class of medication does not alter the progression of recurrent wheeze to asthma, and that its effects on decline in lung function are limited. The lack of evidence supporting the superiority of lower dose inhaled corticosteroids combined with a long-acting beta-agonist over a full dose inhaled corticosteroid with respect to long-term efficacy measures and growth effects suggests that monotherapy with acceptable inhaled corticosteroid dose is the preferred treatment in children with mild to moderate persistent asthma. Montelukast has been shown to significantly reduce asthma exacerbations and lower use of supplemental inhaled corticosteroids compared with placebo.
Summary:
There is mounting evidence that the currently available medications for childhood asthma have a substantial impact on multiple dimensions of asthma control. No drug in our current armamentarium, however, has been found to alter the natural progression of childhood asthma nor halt progressive airway damage in the more susceptible children.
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