Treating young children at high risk for asthma for two years with an inhaled steroid continually decreased asthma-like symptoms but did not prevent the disease after the medication was stopped, a study involving researchers at the School of Medicine has shown.
The three-year, multicenter “Prevention of Early Asthma in Kids” (PEAK) study treated nearly 300 high-risk 2- and 3-year-olds for two years with inhaled fluticasone (Flovent), a corticosteroid, or with a placebo.
Eligible children had wheezing episodes in the year prior to the study and at least one additional risk factor for asthma, such as eczema, allergies or a parent with asthma. After the two-year treatment period, the patients were followed for one year while not taking any asthma medication.
The results of the PEAK study, performed by the Childhood Asthma Research and Education Network, were published in the May 11 issue of the New England Journal of Medicine.
The School of Medicine enrolled 62 patients who were evaluated at St. Louis Children’s Hospital over the three-year period.
The study found that while the children who were treated with fluticasone did much better than those on the placebo during the two-year period, there was no significant difference in the number of asthma-like symptoms between the two groups of children after the medication was stopped, said lead WUSTL investigator Robert C. Strunk, M.D., the Donald Strominger Professor of Pediatrics.
“The study results show that corticosteroids are good for treating symptoms, but not for prevention,” Strunk said. “The treatment had no impact on preventing the disease.”
Asthma is a chronic respiratory disorder characterized by swollen airways and recurrent episodes of bronchial constriction that severely obstruct airflow in and out of the lungs. Nearly 20 million Americans suffer from asthma, and about 75 percent of all asthmatics first develop the disease in childhood, making it the most common chronic childhood illness.
In 2004, nearly 9 million children were diagnosed with asthma. Fifty percent of children wheeze, or make a whistling or squeaky sound while breathing, before age 3. Of that 50 percent, about one-third develop asthma.
“Asthma is an enormous public health problem, and this study was designed to see if we could stop the development of asthma in its tracks — while the lungs are still developing — in young children known to be at high risk,” said Elizabeth G. Nabel, M.D., director of the National Heart, Lung, and Blood Institute, which funded the study.
“Although this study shows that inhaled corticosteroids do not prevent chronic asthma, it provides clear evidence that inhaled corticosteroids benefit even some of our youngest patients.”
The children who took the inhaled fluticasone had about 1 centimeter fewer growth in height at the end of the two-year treatment compared to those on the placebo. But by the end of the third year, the difference between the two groups was just 0.7 centimeter.
“It’s likely that the children’s growth will catch up by puberty,” Strunk said.
Researchers will now look at the impact of allergens, such as pet dander and mold, in homes of children with asthma.
“Children who are allergic to things in their homes have more asthma,” Strunk said.
“If the allergen is removed, they do better.”
The School of Medicine was one of six medical centers that participated in the PEAK study. The other participating medical centers were the University of Arizona; the University of California, San Diego; Pennsylvania State University; the National Jewish Medical and Research Center; and the University of Wisconsin.
The results of the PEAK study were similar to a large, five-year study of children ages 5-12, which showed that inhaled corticosteroids are generally safe and effective for children with mild to moderate asthma.
In that study, called the “Childhood Asthma Management Program,” the benefits of treatment stopped when it was discontinued.