Viral infection in children can make routine asthma therapies fail

Asthma is a chronic disease affecting 235 million people worldwide and affecting 8.5% of all Canadians. The common symptoms include chest tightness, wheezing, coughing, and shortness of breath that can be sudden. Currently asthma is the most common childhood chronic disease, affecting 13% of Canadian children and accounting for 50% of all emergency department visits for children. Approximately 250,000 people die each year due to complications from asthma, in Canada, 20 children and 500 adults die yearly. For the majority of patients with asthma, treatment with inhaled steroids can control the inflammation in the lungs and the use of a bronchodilator is able to reverse the narrowing of the airways. Unfortunately, these medications do not work for around 20% of asthmatic patients who have what is known as severe steroid refractory asthma. These patients have a worse quality of life, end up in the hospital more, and are at greater risk of life threatening asthma attacks. We don’t fully understand why children with severe asthma are unresponsive to steroids.

To understand the nature of severe asthma attacks in children, a team of researchers based in Montreal recruited children between the ages of 1 and 17 years old who showed up to emergency departments in the area for treatment of moderate to severe asthma. In total 973 children were analyzed in the study. The researchers found that 17% of the patients (165 total) experienced treatment failure, that is to say that routine treatments didn’t help their symptoms. Failure of treatment was found to be associated with viral infection, fever, and the presence of asthma symptoms between severe attacks. In the children studied, viral infection and fevers occurred more often in pre-school children than older children and may account for why more cases of severe asthma attacks that are resistant to treatment occur in younger children. Interestingly, there was no association between treatment failure and a child’s age, meaning that aside from the fact that pre-school children are more likely to have colds, their younger age does not play a role in the failure of steroids to treat their disease. This last point goes against the findings of a paper published in 2009.

Overall the findings of this study highlight two key points. 1) Knowing how to manage asthma during cold and flu season could have a big impact on lowering the amount of hospital admissions a child will need. 2) The development of new, low cost treatments for asthma is needed to help treat those patients who have steroid refractory disease. There are treatments out there that can help control severe asthma but a year’s worth of medication can cost between $10,000 and $16,00. The burden asthma puts on patients lives cannot be understated and we need on going research to find appropriate treatments.

 

The worst part of living with asthma used to be that nobody believed me. It’s kind of an invisible illness. You don’t always want to say ‘I am not feeling well, I have asthma’ because there is still a stigma. Even when you go to the hospital, they ask, ‘Well, how bad is your asthma attack?’ What difference does it make? An asthma attack is an asthma attack and I need help, otherwise I wouldn’t be here.

A patient explaining the difficulty in getting treatment

 

Image Credit: Jessica Wilson Flickr

 

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