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Inhaled Corticosteroids Could Be Killing Your Asthmatic Child

By Dr Nick Freezer

Posted  May 7 2017 | 0 Shares

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Inhaled corticosteroids have been so effective at controlling asthma that many in the medical industry have considered them “revolutionary” in treating the disease. According to the Monash Children’s Hospital, however, side effects of the medication are starting to show up more often in children: Many are being sent to intensive care, becoming lethargic, and even comatose.

According to Dr. Nick Freezer of the Department of Paediatrics, many asthmatic children are being overdosed with inhaled corticosteroids. “We were seeing higher and higher doses of corticosteroids and starting to see side effects,” he says. “These children are very unwell.”

How Inhaled Corticosteroids Work

Steroids (short for inhaled corticosteroids) closely resemble cortisol, a hormone that the body produces naturally and whose function is to control inflammation. Asthma causes the airways to become inflamed, narrow, and swollen, making breathing difficult. Steroids control this inflammation so that not only do airways relax, they also become less susceptible to asthma triggers.

Read: Treatments for easing kids’ asthma

Research has shown, however, that high doses of steroids are affecting the body’s ability to fight disease. The medication tricks the adrenal system, responsible for producing natural steroids to fight infections, into thinking that it didn’t need to add to the body’s steroid load. As a result, the immune system finds it harder to fight off infections. Children are especially susceptible as their immune system is still underdeveloped and therefore does not function as well as an adult’s does.

The researchers also found restricted growth in highly dosed children; later research at Monash showed enough reduction in bone density to increase the risk of fractures. The good news is that children overcome these side effects when their doses of inhaled corticosteroids are reduced.

Dr. Freezer’s research team was one of the first to warn about this danger. The work of his team at Southampton University in the early 1990s was confirmed by other researchers and led to a complete overhaul of corticosteroid use.

In his battle against the overuse of corticosteroids, the Monash team also found that children who had infrequent asthma attacks didn’t need to be on the treatment all the time, as suggested by some European doctors. National guidelines in the UK, Australia and elsewhere now ask doctors to consider non-steroid asthma treatments before trying corticosteroids.

The guidelines also suggest that doctors lower the dose once they’ve controlled asthma, using them until they find a minimum effective amount. Packaging instructions now recommend mouth-rinsing after inhaling corticosteroids as well, to get rid of any excess that would otherwise enter the bloodstream.

Read: Treating eczema naturally

Why We’ll Continue to Depend on Inhaled Corticosteroids

According to Dr. Freezer, the most likely cause of the growing incidence of asthma in children in the developed world is our success at fighting bacterial infections, which has left us more vulnerable to virus infections – the main cause of asthma attacks.

“If you grow up in a first world country, you have ready access to antibiotics and don’t get the chronic bacterial infections found in the developing world,” he says. “But your immune system is skewed toward the allergic spectrum of reactions, especially to virus infections, which cause 85 per cent of asthma attacks.”

Dr. Freezer says we’ll continue to rely on inhaled corticosteroids because our best virus vaccines only protect against influenza and not rhinovirus – the common cold – which is the most common asthma trigger, especially in winter and spring. When infected by a virus, asthma sufferers have an allergic reaction as their airways become inflamed and narrow and their mucous production increases.

Attacks can occur often and prove very distressing in children, which is why they’re the main cause of child hospital admissions. However, they become less frequent for most children as they mature. “About 70 per cent of children have infrequent, episodic asthma, and so aren’t on regular treatment,” Dr. Freezer says. “About 20 per cent have frequent, episodic asthma and about five per cent have persistent asthma with symptoms most days.”

This means about 25 per cent of children need a corticosteroid preventer, particularly in winter, exposing them to possible side effects without a proper asthma management plan. “That age group hasn’t really been studied much in the world literature, and their immune system is so undeveloped and sensitive that even if we give them the lowest possible dosage we don’t know if that’s causing side effects.”

Before making any changes to your child’s asthma treatment or medication, it’s always best to consult your GP, paediatrician, or asthma specialist.

Reviewed by Dr Nick Freezer 7 May 2017 references
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This document has been developed and peer reviewed by a KIDS HEALTH Advisory Board Representative and is based on expert opinion and the available published literature at the time of review. Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

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Inhaled Corticosteroids Could Be Killing Your Asthmatic Child

AILMENTS

Inhaled corticosteroids have been so effective at controlling asthma that many in the medical industry have considered them “revolutionary” in treating the disease. According to the Monash Children’s Hospital, however, side effects of the medication are starting to show up more often in children: Many are being sent to intensive care, becoming lethargic, and even comatose.

According to Dr. Nick Freezer of the Department of Paediatrics, many asthmatic children are being overdosed with inhaled corticosteroids. “We were seeing higher and higher doses of corticosteroids and starting to see side effects,” he says. “These children are very unwell.”

How Inhaled Corticosteroids Work

Steroids (short for inhaled corticosteroids) closely resemble cortisol, a hormone that the body produces naturally and whose function is to control inflammation. Asthma causes the airways to become inflamed, narrow, and swollen, making breathing difficult. Steroids control this inflammation so that not only do airways relax, they also become less susceptible to asthma triggers.

Read: Treatments for easing kids’ asthma

Research has shown, however, that high doses of steroids are affecting the body’s ability to fight disease. The medication tricks the adrenal system, responsible for producing natural steroids to fight infections, into thinking that it didn’t need to add to the body’s steroid load. As a result, the immune system finds it harder to fight off infections. Children are especially susceptible as their immune system is still underdeveloped and therefore does not function as well as an adult’s does.

The researchers also found restricted growth in highly dosed children; later research at Monash showed enough reduction in bone density to increase the risk of fractures. The good news is that children overcome these side effects when their doses of inhaled corticosteroids are reduced.

Dr. Freezer’s research team was one of the first to warn about this danger. The work of his team at Southampton University in the early 1990s was confirmed by other researchers and led to a complete overhaul of corticosteroid use.

In his battle against the overuse of corticosteroids, the Monash team also found that children who had infrequent asthma attacks didn’t need to be on the treatment all the time, as suggested by some European doctors. National guidelines in the UK, Australia and elsewhere now ask doctors to consider non-steroid asthma treatments before trying corticosteroids.

The guidelines also suggest that doctors lower the dose once they’ve controlled asthma, using them until they find a minimum effective amount. Packaging instructions now recommend mouth-rinsing after inhaling corticosteroids as well, to get rid of any excess that would otherwise enter the bloodstream.

Read: Treating eczema naturally

Why We’ll Continue to Depend on Inhaled Corticosteroids

According to Dr. Freezer, the most likely cause of the growing incidence of asthma in children in the developed world is our success at fighting bacterial infections, which has left us more vulnerable to virus infections – the main cause of asthma attacks.

“If you grow up in a first world country, you have ready access to antibiotics and don’t get the chronic bacterial infections found in the developing world,” he says. “But your immune system is skewed toward the allergic spectrum of reactions, especially to virus infections, which cause 85 per cent of asthma attacks.”

Dr. Freezer says we’ll continue to rely on inhaled corticosteroids because our best virus vaccines only protect against influenza and not rhinovirus – the common cold – which is the most common asthma trigger, especially in winter and spring. When infected by a virus, asthma sufferers have an allergic reaction as their airways become inflamed and narrow and their mucous production increases.

Attacks can occur often and prove very distressing in children, which is why they’re the main cause of child hospital admissions. However, they become less frequent for most children as they mature. “About 70 per cent of children have infrequent, episodic asthma, and so aren’t on regular treatment,” Dr. Freezer says. “About 20 per cent have frequent, episodic asthma and about five per cent have persistent asthma with symptoms most days.”

This means about 25 per cent of children need a corticosteroid preventer, particularly in winter, exposing them to possible side effects without a proper asthma management plan. “That age group hasn’t really been studied much in the world literature, and their immune system is so undeveloped and sensitive that even if we give them the lowest possible dosage we don’t know if that’s causing side effects.”

Before making any changes to your child’s asthma treatment or medication, it’s always best to consult your GP, paediatrician, or asthma specialist.

Reviewed by Lisa Kelly 7 May 2017
references
  • current version

  • PEER REVIEWER

  • Doc id

  • next review

This document has been developed and peer reviewed by a KIDS HEALTH Advisory Board Representative and is based on expert opinion and the available published literature at the time of review. Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

make a comment

0 comments

latest articles

view more

MEET THE EXPERTS

view more