Fall and winter can wreak havoc on asthma sufferers. Parents of asthmatics know this, perhaps, better than anyone.
Inhaled corticosteroids, which might have an impact on children’s growth, are often used to treat the condition. But, for some, the therapy may be unnecessary.
A new, noninvasive breath test called fractional exhaled nitric oxide, or FeNO, has taken away much of the guess work about whether a patient should be on inhaled corticosteroids. The test is helping to guide treatment decisions and is the first to measure airway inflammation - the major underlying cause of asthma.
“With one breath into a handheld device, physicians can measure the level of inflammation in a patient’s lungs,” said Dr. Stanley Fineman, an allergist at the Atlanta Allergy & Asthma Clinic. “If FeNO levels are high, that signals that the patient’s lungs are inflamed and the asthma is out of control.” By measuring airway inflammation, physicians can determine whether a steroid is the appropriate therapy and at what dose.
In 2010, Atlanta was the “asthma capital of the U.S.” and among the top 20 worst cities for air pollution, according to the Centers for Disease Control and Prevention. Twelve percent of Georgia children suffer from asthma compared to 9 percent of children nationally.
The culmination of pollution, pollen count and barriers to accessing medical care all contribute to the difficulty in managing patients with asthma.
Atlanta’s springs have been especially hard on Matt Brown’s 8-year-old daughter Hannah Claire.
Twice this past year, Fineman has had to resort to corticosteroids use so Hannah could breathe. And, each time, Brown said, he and his wife have worried about how long-term use might impact her growth.
“Taking any medicine can lead sometimes to another illness, which leads to something else, so you don’t always know if you’re better,” he said.
Although there is cause for concern, Fineman said, parents should talk to their doctors before starting or stopping steroid use.
“In general, inhaled steroids are much less risky than oral steroids,” he said. “A child is better off taking an inhaled steroid on a regular basis than taking an oral steroid every few months.”
This is because inhaled steroids go straight to the airway where the inflammation is and therefore have less systemic absorption with fewer potential long-term side effects.
“One of the things people need to understand is that the use of corticosteroids can be lifesaving,” Fineman said. “As long as you monitor the effects and the side effects, then you should be able to control any potential side effects and minimize them.”
We asked him to recall the three most common questions parents have about steroid use.
Q: How do I know whether inhaled corticosteroids are necessary?
A: A physician typically determines whether inhaled corticosteroids are the best course of treatment, based on the severity of the patient’s asthma. Traditionally, a physician will talk to patients about their history and symptoms (coughing or wheezing), perform a physical exam and testing - like lung function, to get a clearer picture of each patient’s individual asthma. By measuring FeNO levels, physicians can better determine if steroids are the appropriate course of treatment and if dosage might need to be increased or decreased.
Q: If my child isn’t taking his or her medication as directed, will my doctor be able to tell?
A: Sometimes, but not always. In general, it is very difficult to measure a patient’s adherence to medication because asthma is such a variable disease, meaning symptoms can wax and wane depending upon a patient’s exposures to triggers. Studies have shown, however, that FeNO levels can be helpful in determining whether patients have been taking their steroid medication as directed by their physician.
Q: How can I talk to my doctor about adjusting my child’s dosage?
A: The three most important pieces of information that a parent, caregiver or individual should share with their doctor are the types of symptoms that the child has been experiencing, how frequently the child needs to use their bronchodilator inhaler and what sort of physical limitations the asthma symptoms have been causing. If a patient’s asthma is under control, a physician may consider reducing the dose. If the asthma is not under control, you might want to adjust medication or treatment recommendations.