Adult asthma meds not suited for kids

CHARLIE FIDELMAN, "Adult asthma meds not suited for kids", Montreal
Gazette, July 11, 2006,
Link:
http://www.canada.com/montrealgazett...5fad5a&k=38838

Asthmatic children are not simply mini-adults with breathing disorders,
a leading pediatric pneumologist told an international conference in
Montreal yesterday.

Treating children with adult medication can be a grave mistake because
steroid therapy doesn't work for them and can lead to more
hospitalization, said Hans Bisgaard, professor of pediatrics at
Copenhagen University Hospital and head of the Danish Pediatric Asthma
Centre, in Copenhagen, Denmark.

"Asthma is the No. 1 cause of hospitalization of our children in the
Western world," Bisgaard said.

But inhaled corticosteroids that adults use are not efficient with
children and infants. Unfortunately, the disorder is researched in
adults and results are extrapolated to children, he noted.

"But it's just not the same disease as you see in the adult," Bisgaard
said. "This is very much a big problem."

In particular, Bisgaard was referring to steroid treatments of viral
infections that can produce asthma-like symptoms, including wheezing
and feelings of tightness in the chest, plus shortness of breath.

"Doctors have been arguing for decades about what to call this asthma,"
he said.

Infants and children with severe asthma should and do get a short
course of steroids to control the condition, but mild, intermittent
attacks need something else because that's where steroids fail, he
said.

"It's a major mistake thinking that one size fits all."

Diagnosing asthma in early childhood has always been difficult, said
Malcolm Sears, professor in the department of medicine at McMaster
University, and research director of the Firestone Institute for
Respiratory Health at St. Joseph's Healthcare in Hamilton, Ont.

Most childhood asthma starts as occasional wheezing.

"Is the wheezing viral or the first indication of persistent asthma?
Only follow-up will show the evolution of the disease," Sears said.

A large proportion of children who show those symptoms don't go on to
develop asthma, he said.

"How to treat them, if at all, is the kind of questions being answered
by Dr. Bisgaard's studies and others," Sears said.

The right treatment is crucial because asthma goes on to alter lung
function.

"Chronic inflammation can lead to permanent changes in the airway wall,
which makes the asthma irreversible," Sears said.

High doses of inhaled steroids are extremely effective in controlling
the condition, but the treatment is controversial and it's not a cure,
said Francine Ducharme, professor in the department of pediatrics at
McGill University Health Centre and head of asthma research at the
Montreal Children's Hospital.

"It works beautifully to control symptoms," Ducharme said of a major
study on children with a family history of asthma who took steroids
daily for three years.

"It had a preventative effect. But once you stop, it doesn't alter the
progression of the disease. Everyone came back to the same number of
episodes and severity," she said.

Asthma is now the most common chronic disease of childhood. Between 10
and 20 per cent of children in Canada have it, and about 20 children
and 500 adults die each year from asthma, according to the Lung
Association.

The seventh International Congress on Pediatric Pneumology, held in
Montreal, ends today.