Childhood asthma and breaking SABA Over-reliance
REDUCING RISK OF ASTHMA ATTACKS IN CHILDREN
- Requires new approach to asthma management
Despite the fact that we have evidence-based medicines to treat asthma – an alarming number of adults and children still die from asthma every year. With the fifth highest annual asthma mortality rate in the world1 – South Africa desperately needs to reshape its approach to asthma management. The publication of updated global asthma treatment guidelines could not be more opportune or more important in the pursuit of better control.
Getting to Grips with the GINA Guidelines
The updated Global Initiative for Asthma (GINA) recommendations have overturned decades of asthma care and represent the most significant change in asthma management in over 30 years. GINA no longer recommends SABA blue reliever inhalers alone as the preferred reliever therapy, and instead recommends the use of a low dose inhaled corticosteroid (ICS)-formoterol therapy as needed as the preferred reliever therapy across all asthma severities.1 This combination inhaler contains an anti-inflammatory agent which reduces inflammation in the airways.
To fully comprehend the significance of the changes, it’s important to first understand the illness and how it presents in children.
Impact of Inflammation
An asthmatic child has a degree of inflammation present in their airways at all times. This inflammation causes the bronchial tubes to narrow – making it harder for air to get to the lungs – even when they they’re not having a flare-up from their triggers. Treatment goals should therefore focus on reducing inflammation.1
According to the Allergy Association of South Africa (ALLSA) chronic control relies on anti-inflammatory maintenance.2,21 This is true whether your child has mild, moderate or severe asthma. The approach to treatment and management of asthma is almost identical and reducing inflammation is at the heart of it.”3,21
The same applies for asthma attacks. Mild asthma doesn’t preclude children from having an asthma attack. The risk is equally high regardless of disease severity, adherence to treatment, or level of control.4,5,6 This is significant because mild asthmatic patients are regarded as the silent majority of asthmatics and in children, mild asthma is more frequent, symptomatic and less controlled than in adults.7,8
Break Over-Reliance on Relievers
Inflammation of their little lungs can be made worse when a child is continually overusing the short-acting beta2 agonists (SABA) or blue over-the-counter symptom reliever inhaler. Using a reliever inhaler three or more times a week is now considered over-reliant and increases a child’s risk of asthma attacks9-12 and asthma-related deaths.13-15
According to ALLSA patients often under-use their anti-inflammatory ‘preventer’ therapy and over-rely on their SABA reliever, which can mask symptom worsening10,16-19,21 and explain suboptimal control in children. Using a SABA inhaler alone does not address the underlying inflammation caused by asthma,2 leaving children at risk of an asthma flare up10,16-18,21 and potential exposure to frequent bursts of oral corticosteroids.16,19,21
ALLSA says that reducing asthma-induced airway inflammation with a combination maintenance inhaler has been shown to be more effective in controlling asthma symptoms and preventing attacks.1,21 This approach to treatment is in line with the latest GINA guidelines which have ushered in a new, more effective and safer approach to asthma management.
Establishing Control is Key
For parents concerned about their child’s treatment patterns, over-reliance can easily be established, thanks to a free, first-of-its-kind digital assessment tool.
By answering five short questions the online Reliever Reliance Test will confirm if there’s a pattern of over-reliance. The results are immediate and can be shared with your child’s doctor.
Asthma attacks can be emotionally traumatising and they keep kids from activities that matter – reducing their overall quality of life. There’s no cure for asthma but it can be controlled but you need an asthma treatment plan that prioritises reducing inflammation. Take the Reliever Reliance Test here: http://bit.ly/Yes2Breathe
- Global strategy for Asthma Management and prevention. Global initiative for Asthma (GINA)2021. Available from https://ginasthma.org/wp-content uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf. Accessed August 2021.
- P.M. O Byrne. How much is too much? The treatment of mild asthma. EUR RESPIR J. 2007(30):403-406.
- Global Initiative for Asthma. Updated 2018. www.ginasthma.org. Accessed March 2019.
- Papi A et al. J Allergy Clin Immunol Pract. 2018;6:1989-1998.
- Price D et al. NPJ Prim Care Respir Med. 2014;24:14009.
- Fitzgerald J, Branes J, Ghipps E, et al. The burden of exacerbations in mild asthma: a systematic review. ERJ Open Res. 2020;6:00359-2019.
- Dusser D, Montani D, Chanez P, et al. Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy.2007;62:591–604.
- O’Byrne. Daily inhaled corticosteroid treatment should be prescribed for mild persistent asthma. Am J Respir crit care med. 2005;172:410-416.
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2020 Update. Available at: https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf Last accessed July 2020.
- Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the asthma insights and reality in Europe (AIRE) study. Eur Respir J. 2000; 16: 802–807.
- Asthma UK: Asthma Attacks. Available at: https://www.asthma.org.uk/advice/asthma-attacks/ Last accessed July 2020.
- Asthma UK. Reducing prescribing errors in asthma care. Available at: https://www.asthma.org.uk/support-us/campaigns/publications/nrad-one-year-on/ Last accessed July 2020.
- Suissa S, et al. Am J Respir Crit Care Med 1994;149:604–10.
- Suissa S, et al. N Engl J Med 2000;343:332–6.
- Buhl R, et al. Respir Res 2012;13:59.
- Tattersfield AE, Postma DS, Barnes PJ, et al. on behalf of the FACET International Study Group. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. Am J Respir Crit Care Med. 1999; 160: 594–599.
- Adams RJ, Fuhlbrigge A, Guilbert T, et al. Inadequate use of asthma medication in the United States: results of the asthma in America national population survey. J Allergy Clin Immunol. 2002; 110: 58–64.
- Larsson, K., Kankaanranta, H., Janson, C. et al. Bringing asthma care into the twenty-first century. NPJ Prim. Care Respir. Med. 2020; 30, 25,
- Price DB, Trudo F, Voorham J, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018;11:193–204
- Mosler G, Oyenuga V, Addo-Yobo E, et al. Achieving Control of Asthma in Children in Africa (ACACIA): protocol of an observational study of children’s lung health in six sub-Saharan African countries. BMJ Open. 2020;10:e035885.
- ALLSA2021, Summary of childhood asthma guidelines 2021:A consensus document, viewed on 09 May 2022, https://doi.org/10.7196/SAMJ.2021.v111i5.15703
- Date 11 May 2022
- Tags Press-Release