WEDNESDAY, Jan. 21 (HealthDay News) -- Steroid medications that are commonly prescribed to improve asthma symptoms don't help ease wheezing associated with a virus in preschoolers, two new reports suggest.
One study, from British researchers, looked at the use of oral prednisolone and found no significant differences between the treated group of children and those who received a placebo. The second study, from Canadian doctors, assessed inhaled steroids for wheezing associated with a virus, and found that while preventive treatment did reduce the need for rescue medications, the benefits weren't strong enough to outweigh the potential side effects. The research was published in the Jan. 22 issue of the New England Journal of Medicine.
"These are kids who are at the brink. We're still trying to see if they're just having viral-induced wheezing or if they really have asthma, and we've always treated these kids like they have asthma," said Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital in Detroit. "These studies suggest that maybe we don't need to. Maybe we should treat viral-induced wheezing differently."
Part of the problem, she explained, is that it can be difficult to tell if small children actually have asthma, or if they're just wheezing from a cold or some other virus. Babies generally wheeze due to viruses, and in school-aged children, wheeze is often indicative of asthma, but it can be hard to tell the difference in toddlers and preschoolers.
The study of oral prednisolone included 700 children between the ages of 10 months and 60 months. All had virus-induced wheezing. The children were randomly assigned to receive either a five-day course of between 10 milligrams and 20 milligrams prednisolone depending on their age or a placebo for five days.
The researchers found no statistically significant differences between the two groups using measures such as the duration of hospitalization and the need for additional medications.
"Our study provides robust evidence that a short course of oral steroids has no clinical benefit, at least for children with mild to moderately severe [wheezing] attacks," said study senior author Dr. Jonathan Grigg, a professor of pediatric respiratory and environmental medicine at Queen Mary University London.
But, Grigg added, "doctors may still prescribe a course [of oral steroids] on a case-by-case basis, especially in severe attacks."
The second study included 129 children between the ages of 1 and 6 who were randomly assigned to receive 750 micrograms of inhaled fluticasone proprionate twice daily or a placebo. Fluticasone proprionate is an inhaled steroid and is often used as a preventive medication for people with asthma. In this study, the children were given the medication or placebo at the onset of any upper respiratory infection and asked to continue the medication for a maximum of 10 days. They did this over a period of six to 12 months.
Unlike the first study, the researchers did see a slight benefit from using the preventive inhaled steroid medication, but there were also side effects, such as a smaller gain in height and weight, that probably outweighed those benefits.
"These kids have intermittent wheezing with a respiratory virus, with no wheezing in between. Maybe viral-induced wheezing isn't so much inflammation, but an irritability of the airways, so anti-inflammatories [like steroids] don't work. Maybe it's a different pathophysiology with similar symptoms. Not all wheezing is asthma in kids," Appleyard suggested.
She did point out that the findings from these studies don't apply to children with asthma, and that these medications can be very helpful in children with asthma. Children with asthma will wheeze at other times, not just when they have a virus, Appleyard noted.
More information
To learn more about available asthma treatments and how they work, visit the U.S. National Heart, Lung, and Blood Institute.
TUESDAY, Jan. 20 (HealthDay News) -- Frequent exposure to hospital cleaning products and disinfectants greatly increases nurses' risk of asthma, according to a U.S. study that included 3,650 Texan health care professionals, including 941 nurses.
The researchers found that nurses regularly exposed to cleaning products and disinfectants were 72 percent more likely than other health care colleagues to report being diagnosed with asthma since starting their job, and 57 percent more likely to report symptoms similar to asthma.
Nurses who regularly cleaned medical instruments were 67 percent more likely to have newly diagnosed asthma, and those working with solvents and glues used in patient care were 51 percent more likely to report symptoms similar to asthma. Nurses who used powdered latex gloves before the year 2000 were 6 percent more likely to have newly diagnosed asthma.
The findings were published online in the journal Occupational and Environmental Medicine.
The researchers noted that products used by nurses in the study included a number known to be potentially strong respiratory irritants or sensitizers. These include: topical cleansers and antiseptics used for cleaning patients' skin; glutaraldehyde for cold sterilization of medical instruments; and all-purpose general cleaning products, such as bleach.
"Substituting cleaning agents with environmentally friendly 'green chemicals' and using appropriate personal care protection could help minimize occupational exposures in this professional group," wrote Ahmed Arif, of the University of North Carolina at Charlotte, and colleagues.
More information
The U.S. Centers for Disease Control and Prevention has more about asthma.