Half of "untreatable" asthma cases may be treatable

NEW YORK (Reuters Health) - Good news for kids with treatment-resistant asthma: Their breathing troubles just might be treatable.

Approximately one in every 10 kids in the U.S. has asthma. And about one in 20 has a severe form that doesn't respond to standard therapies.

But after thoroughly evaluating the evidence to date, Drs. Andrew Bush and Sejal Saglani of the Imperial School of Medicine, in London, think that the true number of problematic asthma cases may be far lower. A lot of children, they say, carry a misdiagnosis of severe asthma or are simply not taking their medications correctly.

"These kids have a lot of problems," Bush told Reuters Health in an email, "but nurses, working with parents, lead to around half of children being able to manage their asthma better without intensifying medicines."

As the team reports in The Lancet, a lack of rigorous studies specific to this young treatment-resistant group of asthmatics limits a doctor's ability to optimally diagnose and treat them. So Bush and Saglani looked to research on mild-to-moderate cases of asthma in children and severe asthma in adults, as well as their own clinical experiences, to identify problems and develop an improved, multidisciplinary management plan.

They found that many cases of what appeared to be treatment-resistant asthma were really just the result of patients not taking their medicine correctly -- either they weren't using their inhaler properly or they weren't taking the right dose of medication each day.

They also found that less than half of patients picked up more than 80 percent of their prescriptions, and that many of the drugs sitting in patients' medicine cabinets were past their expiration dates.

About a quarter of the kids were exposed to tobacco smoke, which spells trouble for kids with asthma.

Simultaneous health problems in kids with asthma, such as food allergies, dysfunctional breathing and obesity, need to be evaluated too. "Severe asthma in early childhood predisposes them to obesity, as children get high doses of steroids and are inactive," Dr. Sally Wenzel, director of the University of Pittsburgh Asthma Institute who was not involved in the review, told Reuters Health in an email. She added that asthma could also be a potential driver of obesity in the teenage years.

To limit obstacles to proper asthma diagnosis and treatment, Bush and Saglani urge doctors to go back to the basics: first re-evaluate patients to confirm the diagnosis and ensure these fundamental management strategies are met. Symptoms should then be carefully assessed before a tailored therapy plan is made for each kid based on their individual patterns of airway inflammation, potentially utilizing new and future powerful options.

Promising new asthma treatments are currently in the works, the researchers say. Still, the evidence suggests that conventional therapies, if used correctly, would suffice for more than half of these kids.

"The most important aspects are distinguishing between 'asthma that is difficult to control' and severe asthma," noted Wenzel. "Anything beyond high-dose inhaled steroids for treatment should trigger a referral to an asthma center of some kind."

"If the asthma is bad," Bush added, "get referred to a multidisciplinary pediatric respiratory team who can reassess the whole problem from the beginning."

SOURCE: link.reuters.com/fud32p The Lancet, September 4, 2010.