Children with asthma attacks triggered by colds less responsive to standard treatment

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A study conducted by Dr. Francine Ducharme confirms that it’s not child’s age, but a respiratory viral detection that explains the high rate of hospitalization.

The results of a study conducted by Dr. Francine Ducharme, Professor in the Departments of Pediatrics and Social and Preventive Medicine at the University of Montreal, published in the medical journal The Lancet Respiratory Medicine, confirm that respiratory viral detection, not child’s age, explains the high rate of hospitalization for asthma attacks in children under six.

The management of asthma attacks in preschoolers has been the subject of much recent debate. The results of a study published in 2009 had shaken the pediatric world. The study reported that preschool children with viral-triggered flare-ups did not respond to standard treatment and, suggesting that this was due to their young age. Such finding was particularly worrisome as the majority of asthma-related emergency room visits and hospitalizations involve preschool children.

However, the results of Dr. Ducharme and her team show that age does not come into play. Independently of attack severity and symptoms between attacks, it is rather the presence of respiratory viral infection or fever triggering the attack that is more often associated with treatment failure, i.e., higher hospitalization rates, more returns to the emergency room, and reduced speed of recovery over the 10 days after discharge. Viral detection occurred more frequently in preschoolers (67%) than in older children (46%) with asthma. Still, the results confirm the overall effectiveness of standard treatment, when adjusted to the severity of the attack assessed by the PRAM score and administered early, in the vast majority of children, regardless of age and viral detection.

“With the new school upon us and September being the busiest month of the year for emergency room visits for asthma attacks, the good news for parents is that standard treatment works well for the majority of children, regardless of their age,” said Dr. Ducharme, who is also Director of Clinical Research and Knowledge Translation at the Research Institute and Director of the Asthma Clinic of the Sainte-Justine University Health Centre.

The results of the study now open the door for exploring the best ways to prevent asthma attacks caused by viral infection in young children with asthma.

About the study

The study was conducted between February 14, 2011, and December 20, 2013, with 973 participants. Although a failure rate of nearly 40% was expected in this group of children with moderate to severe attack, only 17% of the participants did not respond to standard treatment. This rate was significantly higher (19%) in children with viral infection compared to uninfected children (13%). The study was funded by the Canadian Institutes of Health Research. The full article was published in The Lancet.

About the CHU Sainte-Justine Research Center

CHU Sainte-Justine Research Center is a leading mother-child research institution affiliated with the Université de Montréal. It brings together more than 200 research investigators, including over 90 clinicians, as well as 350 graduate and post-graduate students focused on finding innovative prevention means, faster and less invasive treatments, as well as personalized approaches to medicine. The Center is part of CHU Sainte-Justine, which is the largest mother-child center in Canada and second most important pediatric center in North America.

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