Guidelines Are Issued on Asthma and Youths

By DENISE GRADY

Published: August 30, 2007

Children ages 5 to 11 with asthma require different treatment than do adults, guidelines issued yesterday by the National Heart, Lung and Blood Institute say.

The new guidelines are the first to recognize that this age group has distinct needs and should not be lumped together with adults, as has been done in the past.

Specifically, these children can often control their asthma with inhalers that contain only steroid drugs, whereas adults are more likely to need inhalers that combine steroids and other medicines.

(The steroids used to treat asthma are different from the ones that athletes take to bulk up their muscles.)

The new information is part of a 440-page report (http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm) that spells out details for diagnosing and treating the disease. The report emphasizes that every patient should have a treatment plan that considers not only current symptoms, but also the risk of future attacks. Someone with asthma can be feeling perfectly fine and yet still be at high risk of having a severe attack. The risk is based on the history of asthma attacks and related problems like allergies, and it is an important factor in determining the type of medicine needed and how often it should be used.

People with persistent asthma need to take medicine every day to prevent attacks, even when they are feeling well, and the report notes that educating patients and their families is an essential part of controlling the disease. Patients must be persuaded to take medicine even when they do not feel sick, and they need to be taught how to use inhalers properly, or the medicine will not reach their lungs.

During a telephone news conference yesterday, experts who drew up the guidelines said they expected hospital and doctor visits for asthma to rise sharply in the next few months, as they always do at this time of year, because children are going back to school and infecting one another with the common cold. Cold viruses are a notorious cause of attacks in children who have asthma.

But with the right treatment “asthma control is achievable for nearly every patient,” Dr. Elizabeth Nabel, head of the heart, lung and blood institute, said yesterday in a telephone news conference.

Dr. Nabel described asthma as a major public health problem and one of the most common chronic diseases in the United States. More than 22 million Americans have the disease, including 6.5 million children under 18, according to the Centers for Disease Control and Prevention. It creates a great deal of suffering and disability, causing people to miss work and school, and leaving them unable to exercise or to enjoy sports. Asthma kills about 4,000 people a year in the United States, mostly adults.

Asthma attacks are prolonged spells of wheezing, coughing and difficulty breathing that occur when air passages in the lungs constrict and begin to fill with mucus. Allergies, viruses, cigarette smoke, fumes, cold air and exercise are among the things that can bring on attacks. Inhaled drugs called bronchodilators can halt attacks by opening up the airways. But bronchodilators do not treat the underlying problem, which is inflammation in the airways.

To prevent attacks, the inflammation must also be treated, and that usually requires regular use of inhaled steroids, which experts describe as the foundation of therapy for asthma. The inhalers deliver low doses to the lungs, with minimal side effects unless they are used heavily. Severe attacks may require higher doses of steroids, taken in pills.

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