Some asthma medicines overprescribed for children
One type of medicine used to treat asthma is being overprescribed to children while other possible treatments are being ignored, according to an Australian respiratory medicine expert.
Writing in the latest edition of Australian Prescriber, Professor Peter van Asperen of the Children’s Hospital at Westmead and the University of Sydney says there is limited evidence on the benefit and safety of medicines called long-acting beta2 agonists. These are usually used with a preventer medication, called inhaled corticosteroid, as a combination inhaler so people may be unaware that their child is using a long-acting beta2 agonist.
“There are very few trials of long-acting beta2 agonists in children and there have been none in children under four years of age," he says.
For children whose asthma is well controlled by other preventer medicines there is no need to use long-acting beta2 agonists.
“There are other treatment options apart from adding a long-acting beta2 agonist if the child’s asthma is not under control,” says Professor van Asperen.
Long-acting beta2 agonists are not recommended for pre-school children because no trials have been done in this age group. However the concern is that they are being overused in children of all ages.
“There is little current evidence that long-acting beta2 agonists reduce the risk of severe asthma attacks and some evidence that they may increase the risk. This issue is currently being investigated with further clinical safety trials in both children and adults. For children whose asthma is triggered by exercise, regular use of long-acting beta2 agonists may also reduce protection against exercise-induced asthma and make the inhaler they use for wheezing (short-acting beta2 agonists) less effective,” he says.
“Asthma needs to be well treated but not over-treated. I’d urge anyone with concerns or questions about their or their child’s asthma medication to speak with their doctor who can provide individualised advice.”
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Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published every two months and distributed to health professionals free of charge, and is also available online at www.australianprescriber.com