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Journalism of Courage
Having an asthma attack can be scary for both children and their parents. Reducing the frequency of these bouts and their severity is a public health priority, say researchers of a new trial, published in The Lancet. Which is why a combination inhaler, which the researchers found can reduce such attacks in children by almost half, could redefine how children with asthma are treated.
In the first randomised controlled trial to investigate the use of a two-in-one inhaler as the sole reliever therapy for children aged between five and 15, an international team found the combined treatment (budesonide-formoterol) to be more effective than salbutamol, the current standard for asthma symptom relief in children, with no additional safety concerns.
The combined formulation is budesonide-formoterol. A budesonide is a corticosteroid that reduces inflammation and swelling in the airways. Formoterol relaxes and widens the muscles in the airways. Salbutamol is a medication used for quick relief.
Dr Sundeep Salvi, pulmonologist and member of Global Initiative for Asthma (GINA) told The Indian Express that this study has shown that treating asthmatic children between the ages of five and 15 with a combination of inhaled salbutamol and a steroid prevented the exacerbation of asthma by 45 per cent. “This landmark study will now help offer better treatments to asthmatic children,” he says.
The CARE study (Children’s Anti-inflammatory REliever) was designed and led by the Medical Research Institute of New Zealand (MRINZ) in collaboration with Imperial College London, University of Otago Wellington, Starship Children’s Hospital, and the University of Auckland. It recruited 360 children across New Zealand who were then randomly assigned to receive either budesonide-formoterol or salbutamol for on-demand symptom relief.
Over a year, the budesonide-formoterol reliever resulted in a lower rate of asthma attacks than salbutamol reliever, with rates of 0.23 versus 0.41 per participant per year. This means that for every 100 children with mild asthma who are switched from salbutamol to a 2-in-1 budesonide-formoterol inhaler, there would be 18 fewer asthma attacks per year.
Importantly, the study also confirmed the safety of the combined-inhaler approach, with no significant differences in children’s growth, lung function or asthma control between the two groups.
While the 2-in-1 budesonide-formoterol inhaler is widely recommended as the preferred reliever treatment for adults, children are still usually prescribed salbutamol. Dr Lee Hatter, lead author of the study and Senior Clinical Research Fellow at the MRINZ, said that this is a key step in addressing the evidence gap that exists between asthma management in adults and children. “For the first time, we have demonstrated that the budesonide-formoterol 2-in-1 inhaler, used as needed for symptom relief, can significantly reduce asthma attacks in children with mild asthma. This evidence- based treatment could lead to improved asthma outcomes for children worldwide,” Dr Hatter added
India contributes to 43 per cent of global asthma deaths, one of the major reasons being the low use of inhaled steroids. “The overuse of salbutamol without a steroid is rampant in our country and is causing more harm to children. Parents are reluctant to give steroids to their asthmatic child because of fear of side effects. However this fear is not warranted, because the benefit it offers far outweighs the side effects – which are few if the right dose is taken as prescribed by the doctor,” Dr Salvi says. “The GINA and Lancet Asthma Commissions too had earlier recommended replacing salbutamol inhalers with a combination of a drug containing a steroid for adolescents and adults with asthma. This new study has suggested to do the same in children with asthma between five and 15 years,” he explains.
