By LEE BOWMAN
Scripps Howard News Service
Wednesday, September 05, 2007
New guidelines for asthma treatment focuses on day-to-day control of symptoms without having to limit activity.
But getting parents to make sure their asthmatic children take preventive drugs daily is not as simple as a doctor writing an "action plan."
The lung disease is caused by inflammation inside tiny airways, making them especially sensitive to irritants. Symptoms include wheezing, coughing, tightness in the chest and difficulty breathing.
About 22 million Americans have asthma, almost half of them children.
The new guidelines, issued in late August by the National Heart, Lung and Blood Institute, are intended to reinforce what pediatricians and lung specialists have been trying to do for some time -- treat asthma like the chronic condition it is.
That means keeping track of even little symptoms and taking preventive medications regularly, rather than just using "rescue" medications for severe flare-ups.
Daily medications -- which for most people are inhaled corticosteroids -- are effective in reducing inflammation and preventing most flare-ups. But for a variety of reasons -- from cost to forgetfulness to concern over side effects -- many patients don't stick to the preventive meds, doctors are finding.
Adults often need to take more than one drug. But for most 5- to 11-year-olds, for example, low doses of a corticosteroid are sufficient. Yet children are as least as likely to fall off the prevention program as adults.
A new study, out Tuesday from the University of Rochester Medical Center in New York, offers fresh insight.
The research, published in the journal Pediatrics, found that parents who are leery of side effects are particularly less likely to have their children adhere to a schedule for preventive drugs.
"Children today can be virtually symptom-free, thanks to the modern preventive medications," said Kelly Conn, a senior research coordinator at Rochester who led the study. "But kids rely on their parents to make their health decisions for them, so we need to know what parents are thinking."
Researchers used a questionnaire that probed beliefs about medicines among the parents of 622 children in southeast Michigan who were using at least one preventive medication.
Parents were asked about both how vital they thought it was for their child to take the medication as prescribed and how much they were concerned about possible risks associated with drugs, including side effects and possible dependency.
For 77 percent of the parents, the perceived necessity of the drug outweighed concern about possible risks; but another 17 percent were more concerned about potential harm from the drug than the consequences of asthma. The remaining 6 percent said they were evenly split in their concerns.
"We knew that parents often hold opposing attitudes on this issue, almost instinctively," Conn said. "It's only natural to be caught between worrying about possible dangers related to the medicine and worrying about risks posed by the asthma itself."
The parents also completed a second survey. It gauged how strictly they helped their children adhere to the drug regime. Not surprisingly, those who had a strong belief in the need for the drugs did more to help their children stick with them.
Even so, only 14 percent of parents said their children adhered to drug schedules perfectly.
The bottom line, Conn said, is that doctors, nurses and pharmacists can do a lot to control kids' symptoms just by taking a bit more time to explain to parents the need for their children to take the drugs consistently and alleviate worries about possible side effects.
Corticosteroids, while serious drugs, don't produce the monstrous side effects associated with anabolic steroids or growth hormones. Rather, they mimic the hormone cortisol, which is naturally produced by the adrenal gland. While side effects are possible, they usually occur when dosage is reduced too quickly.
"Some parents hear or read the word 'steroid,' and at once start worrying about long-term effects on their child," Conn said. "Physicians regard these medicines as quite safe, when used properly. The more parents hear that, the less room there is for anxiety."
On the Net: http://www.aap.org
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