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 Washington University School of Medicine in St. Louis shows.
The three-year, multi-center Prevention of Early Asthma in Kids (PEAK) study treated nearly 300 high-risk two and three year olds for two years with inhaled fluticasone (Flovent), a corticosteroid, or with an inactive 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 additional year while not taking any asthma medication.
The results of the PEAK study, performed by the Childhood Asthma Research and Education (CARE) Network, are published in the May 11 issue of the New England Journal of Medicine.
Washington University 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 amount of asthma-like symptoms between the two groups of children after the medication was stopped, said Robert C. Strunk, M.D., the Donald Strominger Professor of Pediatrics at Washington University School of Medicine.
“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 less 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.”
Washington University 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; University of California, San Diego; Pennsylvania State University; 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 to 12 years, which showed that inhaled corticosteroids are generally safe and effective for children with mild to moderate asthma. In that study, the Childhood Asthma Management Program (CAMP), the benefits of treatment stopped when it was discontinued.
Guilbert T., Morgan W., Zeiger R., Mauger D., Boehmer S., Szefler S., Bacharier L., Lemanske Jr. R., Strunk R., Allen D., Bloomberg G., Heldt G., Krawiec M., Larsen G., Liu A., Chinchilli V., Sorkness C., Taussig L., Martinez F. Long-Term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma. New England Journal of Medicine, May 11, 2006. Volume 354, No. 19.
This research was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health.
Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.