Asthmatics Breathe a Sigh… of Exasperation
Glucocorticoids are a class of steroids patients with asthma use the world over by way of an inhaler. They are one of several drug classes that can reliably save a persons life in the event of an asthmatic exacerbation. But as many know all too well, severe asthmatic episodes can still persist despite the application of this drug. Conventional wisdom among parents and doctors has been to increase the dosage of administered glucocorticoids in patients with more serious symptoms.
But a new study on asthmatic children across the United States by the National Heart, Blood, and Lung institute finds that there is no significant differences in severity of asthma symptoms or frequency of episodes across average and quintuple doses of glucocorticoids. Further, the study even suggests high doses may stunt growth in children, revealing the possibility of more serious problems in childhood use. The article was published in The New England of Medicine.
The year long study consisted of over 250 asthma sufferers aged 5 to 11 years old, and divided them into 2 groups of continued low-level use, and quintupled use. The experiment was carried out such that neither the patients, their parents, nor the doctors knew which treatment they were receiving.
The results suggest no significant difference between the occurrence of asthmatic exacerbations or their intensity regardless of how much glucocorticoid is administered. The study also collected data on the childrens height and weight during the period and found that the patients taking the quintuple dose displayed slightly shorter stature when controlling for various differences. This may be an indicator of serious developmental problems caused by continuous high use of the drug, and should be a concern for anyone taking or prescribing it.
This study highlights a need for more effective medications in asthma sufferers, and a better understanding of how existing medications work. Glucocorticoids are self-administered in the form of an inhaler, often on an as needed basis. Add to this the fact that children are the most heavily afflicted by asthma, and it becomes extremely easy for a patient to take too much of their prescription. Granted, quintuple dose is a far cry from the average, but when double or triple dose does not lessen the symptoms, one can tend to take too much. In an age of ultra targeted and molecular approaches to medicine, a more precise asthma treatments should be available, given the low threshold of effectiveness on glucocorticoids, let alone its possible ill affects.
Jackson DJ, Bacharier LB, Mauger DT, Boehmer S, Beigelman A, et al., (2018) Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations. DOI: 10.1056/NEJMoa1710988