Asthma Q&A With Dr. David Stempel

David A. Stempel, MD, is a board-certified allergist with 25 years of clinical practice. He is presently a Medical Director in Medical Affairs at GlaxoSmithKline

How many children have been diagnosed with asthma?

Over 6.5 million, or 9%, of US children under 18 years old had asthma in 2005. Nearly 2 of every 3 children had at least 1 asthma attack in the past year and missed an estimated 12.8 million school days due to asthma. There were 750,000 visits to emergency departments and 198,000 hospitalizations for asthma in 2004.

Is there a known cause of asthma?

Childhood asthma appears to run in families, but it is not clear exactly how it is inherited. Children with a history of allergies are more likely to develop asthma. Although many theories have been proposed, there is no easy explanation for how asthma develops.

Is asthma a condition that stops and starts? Or is it always there?

Asthma is a chronic illness, which means it is always there. Asthma causes changes in the airways of the lungs, and these changes are not reversible. Although the sudden symptoms of asthma may seem to start and stop, the disease is still there. Even after a long time without symptoms, asthma may be triggered again by common colds, exercise, or allergens. Preventative treatment appears to be the best way to reduce the effects of these triggers.

Is it possible to outgrow asthma, or is that a myth?

Most children with asthma do not outgrow their illness. Although the symptoms may decrease, the changes in the airways are still there. This makes children at greater risk of experiencing symptoms after a common cold or being around allergens. They might have colds that seem to last longer than those of their friends. They may cough more at night, or have a persistent cough that remains after getting over a cold. They may be unable to keep up with their friends when playing competitive sports.

If my child’s asthma remains untreated, will there be any long-term effects?

There is no easy answer to this question. What we do know is that children who use preventative medicines, such as inhaled corticosteroids, are less likely to need to go to the hospital or emergency room because of a severe asthma attack. We do not know yet whether long-term medication will change the lung health of children decades later. This is currently being studied.

Can you describe the common triggers of asthma symptoms?

Common triggers are viral infections, exercise, and allergens such as dust, pollen, cigarette smoke, and pet dander. In the fall, many school children get common cold viruses, which may trigger asthma symptoms in some children. Children who have asthma may feel more symptoms when they exercise, especially if their disease is not being treated adequately.

Are there any lifestyle changes that would help people with asthma feel better more
of the time?

Avoid triggers that you know will cause symptoms, such as places with excessive dust, pet dander, pollen, or cigarette smoke. Getting a flu shot may also help reduce the risk. Wash hands often with soap and hot water to reduce the chance of getting a common cold. It is important to exercise to stay healthy, even though exercise may sometimes worsen asthma symptoms. It is better for patients to use medication to keep their asthma under control, so that they are able to exercise.

Are there any dietary changes that a person with asthma can make?

Some children have asthma that is triggered by specific foods. These children should obviously avoid their trigger foods.

Can you talk to us about the role of preventative medications in treating asthma?

When you take your preventative medicine every day, you may reduce the chance that your asthma will get worse. You may be less likely to have to go to the hospital for your asthma. You may also be less likely to have nighttime symptoms, and less likely to need your rescue inhaler. You’re more likely to experience these benefits if you take your preventative medicine every day.

Can you talk about some of the reasons why people don’t take their medications as prescribed by their doctors?

Patients with asthma may have trouble understanding the benefit of preventative medications such as inhaled corticosteroids. These medicines do not work as fast as their rescue inhaler medicine. Until recently, many people thought that asthma only needed to be treated when there were symptoms. Now we know, from looking more closely at the airways, that asthma is a chronic disease. Because of this, we know that treating only the symptoms is the wrong approach.

Why should somebody on an inhaled corticosteroid, such as FLOVENT, continue to take it, even if this person is feeling fine and not having any asthma symptoms?

FLOVENT works best to reduce symptoms when it is used every day, even when the patient is feeling fine. Once a patient’s asthma has been triggered, and he or she starts to show symptoms, inhaled corticosteroids may not relieve those symptoms as well. That’s when a rescue inhaler is needed. The purpose of using an inhaled corticosteroid every day is to keep the disease in check, so that sudden symptoms will be less likely to occur.

I’ve heard that FLOVENT is an inhaled steroid. Should I be concerned about my child being on steroids?

Inhaled corticosteroids have been used for several decades, worldwide, for the treatment of persistent asthma. When used in recommended doses, medications like FLOVENT are well tolerated and effective.

If asthma is left untreated, patients may need to go to the hospital or emergency room more often, and their daily activities may be more limited. The benefit of these medicines for children with persistent asthma outweighs the risk.

The National Institutes of Health (a US government agency) recommends the use of inhaled corticosteroids for treating persistent asthma.

If my child is taking FLOVENT, how often should my child take the Childhood Asthma
Control Test?

The Childhood Asthma Control Test is a quick and simple way for you and your child to see whether his or her asthma is well controlled. Your child should take the test about once a month. If the score is 19 or less, contact your doctor and ask whether the treatment needs to be adjusted.

Can you explain the differences between the DISKUS and the metered-dose inhaler (MDI) devices?

Improved devices for taking the medicine, especially dry-powder devices, may make it easier for some children to properly inhale their medications. The DISKUS device is breath-activated, and most children over 4 years of age can use this device. This helps them achieve the benefits of treatment at the lowest recommended dose for children 4 to 11 years old.

Important Information About FLOVENT HFA and FLOVENT DISKUS
Prescription FLOVENT HFA and FLOVENT DISKUS are for patients with asthma 4 years of age and older. FLOVENT does not replace fast-acting (rescue) inhalers for sudden symptoms. Inhaled corticosteroids, as well as poorly controlled asthma, may cause a reduction in growth rate. The long-term effect on final adult height is unknown. People switching from an oral steroid, like prednisone, to FLOVENT need to be especially careful. While adjusting to the switch, your body is not as able to heal after surgery, infection, or serious injury. See your doctor if your asthma does not improve. The use of FLOVENT HFA in children 4 to 11 years old is based in part on results of studies in patients 12 years and older and other FLOVENT products.