Host: Dr. Ronald Teufel - Pediatrics
Guest: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Ron Teufel who is a pediatric hospitalist. We are talking about the treatment of asthma. Dr. Teufel, you mentioned that one of the strategies to prevent asthma attacks is the use of corticosteroids. What are the names of some of those steroids?
Dr. Ron Teufel: Some of the more common inhaled corticosteroids that are used in children to prevent asthma exacerbations and improve their disease condition are Flovent, one of the most common ones, and advair. Both of those are the majority of the treatments for older children. Younger children can be on a medicine called Pulmicort which is given by a nebulizer that is easier to deliver to young children.
Dr. Linda Austin: There has been a lot in the press recently, actually, about long term consequences of prolonged steroid use. Does this prove to be a problem for kids who are on these medications?
Dr. Ron Teufel: One of the concerns with steroids in general is avoiding the frequent exposure of the body to high-dose steroids. For example, if a child is frequently getting IV steroids over the long term and oral steroids long term, you worry about consequences such as height and other sequelae from having high exposure to corticosteroids. One of the advantages of asthma is that the condition is primarily focused in the lungs. So, what children with asthma get is a little bit different than the systemic corticosteroids, intravenous or taken by mouth, in that it is very targeted toward the lung itself, where the disease is. Now, these medicines are inhaled usually twice a day. The majority of the drug stays in the lung where it needs to, so it is very well focused.
There were previous studies that questioned if these medications taken by the lung have similar side effects to the medications taken by mouth or intravenous route. Most of them are showing a minimal consequence. There is not very much steroid getting in the blood and there is not very much of an effect from it. Some individuals question if there was a slight height differential. When they really started looking at the studies, it really came down to, long term, there was not much difference between the two groups. Some people question the study design. Studies have really assured individuals that the inhaled corticosteroids are safe. They are definitely safer than having a chronic uncontrolled condition like asthma.
Dr. Linda Austin: I know that one of your areas of interest has been in helping parents be more compliant or more disciplined, perhaps, more thoughtful about the reliable study treatment of their children to prevent major asthma attacks. What makes it difficult for parents to do that? What are some of the barriers to that kind of disciplined treatment that you have encountered?
Dr. Ron Teufel: There are many barriers to getting preventive care for asthma. It really can make it tough on families. Some of the barriers are just getting the medication and getting it into their child everyday. It is often times difficult to get to the pharmacy to get the medicine. Make sure you have a prescription for the medicine from your healthcare provider. Then, once you get it, there is also a matter of getting it into a young child.
My advice, to address those issues, is just to make it a part of everyday life. Children become very accustomed to things. So, if you give them a medicine everyday, eventually it is just part of their everyday life and they expect it and it is very easy for the child. As for getting medications and prescriptions, this [asthma] is a condition that I recommend keeping involved with physicians. Typically a child with asthma, especially when the condition is not completely controlled, need to be seen their physician every three months and if that is done, it’s easier to get prescriptions and get advice and help for further management.
Dr. Linda Austin: Thank you very much Dr. Teufel.
Dr. Ronald Teufel: Thank you.
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