Allercy and Asthma Health
The Official Publication of AAN - MA

Step-Up Therapy for Asthma

A respiratory therapist answers patient/parent questions about a new study

Your child has been to the doctor for his asthma and is taking his asthma medications as prescribed. But he’s still having problems. What now?

A new study supported by the National Institutes of Health (NIH)—the BADGER STUDY*—sheds some much-needed light on how to treat asthma in children who are not well controlled on their current medications. In the following interview, American Association for Respiratory Care member Rhonda Vosmus, RRT-NPS, AE-C, asthma education specialist for the AH! Program at Maine Medical Center in Portland, explains what the BADGER study found, and what it means for kids who need more help in bringing their asthma under control.

Allergy & Asthma Health: Why did the National Institutes of Health decide this study was needed?

Rhonda Vosmus: The NIH felt this study was necessary because evidence was lacking to guide step-up in therapy in children with uncontrolled asthma on low dose inhaled corticosteroids (ICS), the main controller medications used for asthma. With the recent FDA “Black Box” warning on medications containing long acting bronchodilators (LABAs), one type of step-up medication, there have been concerns about safety and efficacy, as well. 

Allergy & Asthma Health: What did the BADGER study find?

Rhonda Vosmus: Almost all the study participants had a different response to the three different treatment options, which were: doubling ICS, adding LABA, or adding leukotriene receptor antagonists. On the whole, children did the best on the LABA, leading researchers to conclude it was the best treatment option. However, many children responded best to the other two treatment options.

Allergy & Asthma Health: Why do you think different kids responded differently to the various step-up plans?

Rhonda Vosmus: There were some notable differences in response to step-up therapy options in certain races and ethnic groups. This has been noted in other studies conducted with beta agonists, the main rescue medications used for asthma. This tells us there is no one asthma therapy regimen to treat all people. Each care plan and the prescribed medications need to be tailored to the individual.

Allergy & Asthma Health: What are the implications of this study for kids whose asthma is not currently well controlled on low doses of ICS alone?

Rhonda Vosmus: The study shows there are treatment options for step-up in therapy. If one treatment plan does not achieve good asthma control, there are other medications your doctor can try. All the while, it is essential to develop and maintain good partnerships with all health care team members while managing a chronic illness like asthma.

Allergy & Asthma Health: Many parents are concerned that their children take too many medications as it is, and this study suggests some kids may need to add medications. What would you say to these parents?

Rhonda Vosmus: Though it does not always seem this way, we all have the same goals—for the child to receive the least amount of medication with no persistent symptoms and no side effects. Before adding medications, it is essential to establish adherence to the asthma care plan, identify any barriers to care, and make sure everyone knows how to correctly use the inhalers. But once all this has been established, and the doctor or respiratory therapist has taken a complete history and physical exam assessing risk and impairment, it may be necessary to step up therapy to achieve good asthma control.

*Best ADd-on Therapy Giving Effective Responses study, published in the New England Journal of Medicine, March 18, 2010.


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