More than 90 percent of children with asthma are highly allergic and are reacting to allergens that are perennial, such as house dust mites, cockroaches, smoke and cat dander, rather than seasonal allergens such as ragweed. And if a child has even mild symptoms of asthma at age 3 or 4, has a parent with asthma, and lives with a smoker and/or a pet, he is considered at very high risk for developing the full-blown disease. About 50 percent of kids will "outgrow" their asthma at puberty, but for the other 50 percent it will be a lifelong problem.
Early diagnosis and an effective drug regimen are now recognized as essential because physiological changes to the airway, and the subsequent impact on function, in those with moderate to severe asthma can be progressive, with delays in treatment sometimes causing irreversible damage. The aim of drug therapy for asthma is no longer just to treat the symptoms, but also to stem the progress of the disease.
This raises serious challenges for those designing drug trials. As in the case of children needing psychiatric medication, asthma sufferers who get a placebo may, in fact, be in danger of suffering continuing damage.
At the current time, the asthma specialist says that Cromolyn is the number one drug for pediatric asthma. "It's a mild anti-inflammatory with minimal side effects which is used because there is such a phobia about steroids," explains Bielory. "Cromolyn is like a tricycle and steroids are like a car. You'll get there with cromylin but it has no power."
A concern is that some steroids -- which are really the drugs of choice in anti-inflammatory therapy -- seem to suppress growth in children when they are tested over a period of a few weeks. (It is not known if they have any permanent effect.) Research is also needed to study if all steroids suppress growth and at what dosages. In general, the higher amounts of drugs produce better results and also have more side effects. The flip side of this is that those with uncontrolled asthma also often experience slowed growth. So children of all ages are needed to participate in clinical trials of steroids and other asthma medications to answer many crucial questions. What is a safe and effective dose of a steroid for a toddler with severe asthma? How will these drugs affect a rapidly growing 6-year-old boy? Or a 12-year-old girl who has reached puberty? How long can a 3-year-old or a young boy or teenage girl take any asthma medication safely?
Also, during the last five years there's been an increase in the availability of nonsteroidal interventions, according to Bielory. These are drugs that have been in development for 15 years or more. Chief among them are leukotriene-inhibitors -- agents that block the activity of a group of substances that are part of the inflammatory response. They seem to work well for mild asthma -- although they are not as powerful as steroids -- and are sometimes used in combination with steroids for moderate disease. There is a lot of research activity using these agents for children since they do not have any of the side effects most steroids have. Bielory is currently involved in several of these clinical trials.
For more information, call (973)-972-2762 or 1-800-NJ1-2762 (ASMA).