Cutting childhood asthma relapses
Ireland has the fourth highest prevalence of asthma in the world, and the incidence is particularly high amongst children, where 1 in 5 suffers from the condition.
Some 800 children are treated for asthma attacks at Our Lady's Children's Hospital Crumlin (OLCHC) annually. Due to non-compliance with the standard 3-day course of medication – because of its bitter taste – relapse risk is high. Professor Ronan O’Sullivan, who led the study, said that research has shown that as many as one third of children prescribed prednisolone for 3 days do not finish the course of medication. This led him to look for equally effective alternatives. His study, funded by the NCRC, showed that prescribing another drug improved compliance and reduced asthma relapse.
Professor O’Sullivan’s comprehensive randomised controlled trial involved 226 children aged 2 to 16, and was set up to test whether – given the potential for increased compliance with medication and reduced risk of asthma attack relapse – clinicians could safely consider a single dose of oral dexamethasone, over a 3-day course of prednisolone, as the treatment for childhood asthma attack. If both drugs worked equally well, it was a safe, new option.
The study found that that both drugs did, in fact, work equally well. However, dexamethasone has many advantages over prednisolone; it does not have a bitter taste, it does not cause children to vomit, and it requires just a single dose versus the standard 3-day dose of prednisolone. This ensures high compliance rates.
This study has implications for the treatment of childhood asthma attacks in Emergency Departments everywhere. The subsequent research paper, published in the Annals of Emergency Medicine – one of the top Journals for emergency medicine in the world – was one of the top 3 downloads on the industry’s ScienceDirect website for October-December 2015 after its publication. To put that in context, hundreds of thousands of articles are downloaded from that website each year.
This research showed a new way for treating severe asthma attacks. The work has been of direct benefit to many Irish children with asthma – as well as children with asthma all around the world.
How this clinical research helped:
A single dose drug that is more easily tolerated by children was shown to be equally effective, and reduced the risk of relapse. This has influenced worldwide practice.