Young girl using asthma inhaler

National trial to investigative best treatment for childhood asthma

An innovative new £1.5m national clinical trial looking at finding the best treatment for childhood asthma has been funded by NIHR.

Led by researchers from the University of Liverpool and Alder Hey Children’s NHS Foundation Trust, the team will investigate whether taking a preventer inhaler only when a child has symptoms is as effective as taking it every day.

Over a million children in the UK are affected by asthma, with the main symptoms being a cough and difficulty breathing, as a result of swelling and irritation narrowing the airway. Every 20 minutes, a child with asthma is admitted to the hospital in the UK and approximately 20 children a year die from asthma attacks.

A preventer inhaler, containing steroids, is currently the main treatment for childhood asthma, preventing irritation of the airways. For many years, the guidance given by health professionals was for children with asthma to use their preventer inhaler every day to reduce symptoms and prevent attacks. However, new guidelines now recommend that taking a preventer inhaler every day might not be required in all children.

The new guidelines recommend that in mild asthma, inhalers could be taken only when symptoms occur. These changes are based on results of recent studies in adults, and some teenagers, with asthma. The results showed no difference in the risk of having an asthma attack if preventer inhalers were only taken when asthma symptoms occurred.

The newly-funded research study, directly aimed at childhood asthma, hopes to definitively answer if this is also true in children.

The study – called Assessing SYmptom-driven versus Maintenance Preventer Therapy for the Outpatient Management of AsThma in Children (ASYMPTOMATIC) – will involve around 250 GP practices across the UK. If their parents agree, children aged 6-16 will be randomly assigned to either use their preventer inhaler daily or only when they have asthma symptoms. Care for the children will then be as it would in routine practice, and the data required extracted from electronic health records, minimising the burden for participants.

Co-Chief Investigator, Associate Clinical Professor Ian Sinha, at Alder Hey Children’s NHS FT, said: “The trial will answer one of the most pressing and important questions about the fundamentals of managing childhood asthma.

“This is a condition which affects many millions of children, worldwide. We need a study to know the best way to control their inflammation – on the one hand we don’t want to put children at risk of asthma attacks, but on the other hand we don’t want to expose them to side effects of medications if we don’t need to.

“Given the differences between paediatric and adults asthma, it is right that we conduct studies in children”.

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