Cenya Davis

Cenya Davis, 9, puffs on her inhaler in this 2018 file photo. A new Washington University study followed more than 200 African American children in St. Louis, a demographic that is 10 times more likely to visit the hospital for asthma than white children.

Some kids with mild asthma only need to use their inhalers when they have symptoms, according to research from Washington University. That’s a major departure from traditional guidelines that recommend patients use their inhalers every day, regardless of how they’re feeling. 

The study, which focused on African-American children in St. Louis, found no difference in symptoms or lung function between kids who used their steroid inhalers every day and those who used them as needed. Following an “as-needed” treatment strategy may help some patients cut down on the total amount of medicine they need to manage their asthma — and may reduce overall costs for low-income populations.

For the past three decades, the Global Initiative for Asthma has recommended asthma patients take a daily dose of inhaled corticosteroids, which reduce inflammation in the lungs. 

“It keeps those airways open, in case you’re exposed to a trigger,” said Reagan Nelson, program director for the St. Louis chapter of the Asthma and Allergy Foundation of America. “If you get a cold, it’s going to trigger your asthma, and you want to have all the cards stacked in your favor.”

But some low-income patients might not be able to afford the daily medication. Between 2008 and 2013, the annual per person cost of having asthma was about $3,200. Prescription drug costs account for more than half of that total.

There are also concerns about the potential side effects of inhaling steroids every day, including reduced growth rate and hormonal release. 

“Not everybody has symptoms every day, so it’s very hard for the patient to be motivated to take their medicine every day, especially if they’re feeling well,” said Kaharu Sumino, a pulmonologist and associate professor of medicine at Washington University.

A growing body of research shows “as-needed” inhaler use may be just as effective as daily preventative use in controlled clinical trials, but Sumino and her colleagues wanted to test whether these patterns held up in real-life settings.

They enrolled more than 200 African American kids with mild asthma in St. Louis. Not only are African American children more likely to have asthma than white children, according to the St. Louis Equity Indicators Report, they’re also 10 times more likely to visit the emergency room for asthma-related problems.

Half the kids in the study used their steroid inhalers daily — the traditional recommendation — while the rest only used inhalers when they had symptoms. A year later, the kids in the two groups were virtually indistinguishable in terms of their symptoms and lung function. 

What’s more, the kids who took asthma medication as needed used a quarter of the medicine as the daily users, potentially saving those families hundreds of dollars. 

Because the study focused on patients with mild asthma, Sumino cautioned this treatment may not be for everyone. 

“We’re not trying to say this is better; we’re trying to say it can be considered as an option,” she said.

Sumino and her colleagues hope to develop materials that doctors can use to educate their patients about this treatment strategy. 

Reagan Nelson, who was not affiliated with the study, called the results “exciting” and said symptom-based treatment may help the low-income patients her organization serves better manage their asthma.

“Inhaled corticosteroids are very expensive, and cost is a huge barrier for a lot of families,” Nelson said. “Hearing that they can use less of the most expensive medicine that they need is really meeting patients where they are.”

But she stressed that patients need to talk with their doctors before changing the way they manage their asthma.

“I think it’s exciting that after 30 years we’re starting to look at alternative therapies,” Nelson said. “But like with any new strategy, it needs to be a partnership with your physician to maintain that asthma control.”

Follow Shahla on Twitter: @shahlafarzan.

Reprinted with permission from news.stlpublicradio.org.

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