Research by scientists at the Imperial College of London has found that testing the phlegm and breath of young children with severe asthma, could spare them from potentially damaging oral steroid drugs by over a third over a three year period.
The tests could help spot the early signs of the condition, allowing it to be brought back under control. A national guideline already recommends the use of sputum tests in adults.
With one in ten children in the UK suffering from asthma it is the most common medical condition of childhood. The majority of children have a steroid inhaler to help them control the condition, but if it is not working, then higher does are prescribed in tablet or medicine form to get it back under control, to reduce the risk from asthma attacks.
Doctors generally try to avoid using “rescue steroids” unless they really must, because if used to frequently, side effects can cause growth problems.
The scientific team’s tests involved looking for signs of increasing lung inflammation - the presence of cells called eosinophils in the sputum, and higher than usual levels of nitric oxide gas in the breath.
These signs can appear before the symptoms of asthma themselves changed.
The children’s progress was assessed using symptoms and lung function tests with a group given the sputum and breath tests. In each case, if doctors judged that the asthma was likely to be worsening, they increased the dose of the steroid inhalers used by the children. If this failed to improve matters, oral steroids were used.
The research found that, on average, there was a 29% reduction in the number of courses of oral steroids used by the children in the sputum and breath test group. A third of the children in that group did not need any courses of oral steroids, compared with 12.5% of those in the conventionally monitored group.
Professor Andrew Bush, who led the research, said: “It’s a much more efficient way of making sure children with severe asthma get the treatment they need.”
His colleague Dr Louise Fleming said that “the aim was not only to reduce the number of severe attacks, but to make sure that children were not on too high a dose of inhaled steroids all the time”.
Professor Chris Brightling, from the Institute of Lung Health at Leicester University, said a recent guideline had “suggested these techniques be used to help control severe asthma in adults”.
He said it was likely that children with severe asthma would also benefit.
“These are a measure of the control of inflammation, and this measurement can be an ‘early warning sign’ of an exacerbation of asthma.”
Dame Helena Shovelton, from the British Lung Foundation, which funded the research, said that “targeted treatment” was “good news” for children with asthma.