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Centre de recherche
Tuesday, April 17 2018
Press release

Asthma in preschoolers: perhaps not for their lifetime!

A Canadian research team demonstrates a significant breakthrough regarding asthma control.

MONTREAL, April 17, 2018 – While it was long assumed that evolution of asthma in children was predetermined, there seems to be a new hope for improving the chance of remission and perhaps even a complete cure. Asthma symptoms in young children disappear around school age in 50 to 60% of patients. However, many children already present an irreversible lung function limitation by 6 years of age. These irreversible effects are associated with a higher risk of developing a chronic obstructive pulmonary disease in adulthood. For the very first time, results from a research led by Dr. Francine Ducharme, presented at the Canadian Respiratory Conference in Vancouver on April 13th, are bringing a significant change of perspective. “Compared with children who achieved a rapid and sustained control of their asthma, children who took longer to achieve control or who never achieved control in the two years following the diagnosis, present a much lower chance of remission of their disease. Importantly, the worse the control, the lower the chance of remission,” explains Dr. Francine Ducharme, clinician and researcher at Sainte-Justine University Hospital Center and professor at the University of Montreal. “Our study suggests a window of opportunity to increase the chance of asthma remission and the chance to change the course of the disease. By aiming for a rapid and sustained control of asthma from the time of diagnosis, we could make a significant difference in children’s future and health.”

Importance of Rapid and Sustained Control

Asthma persistence in childhood has been associated with several non-modifiable risk factors such as sex, child allergies, and parental history of asthma. Chances of remission have also been associated with modifiable factors such as frequency and severity of asthma exacerbations, raising a key question among the research team: Could an early control of asthma influence the chance of remission?

The current study shown that, in the two years following the diagnosis, the level of asthma control is a major determinant of the chances of remission. To reach this conclusion, the research team studied a cohort of 113 588 Canadian children born between 1990 and 2013 who had received a diagnosis of asthma before the age of 5 years. The researchers evaluated the stability of disease control throughout the two years following its diagnosis. A child was considered in remission when he/she had had no use of asthma medication, no asthma-related medical or emergency visits and no hospitalization for asthma for two consecutive years.

“Our results are striking and support a strong association between asthma control in the two years following the diagnosis in children younger than 5 years of age and their chance of remission. Our results suggest that asthma remission may not be entirely predetermined by non-modifiable factors”, underlines Dr. Ducharme.  Indeed, children who had very poor control of the disease throughout the two years following diagnosis saw their chance of remission reduced by 78%, whereas those who started poorly controlled but reached good control by the end of two years, had their chance of remission reduced by 35%. “We need to focus our clinical and research efforts on this important period of lung growth. A shift in the usual medical's practice believes is crucial.”

For more than 20 years, the use of preventive treatment and the research efforts tended to concentrate on children with risk factors of persistent asthma (parental history of asthma and child allergies), assuming that in other children who were believed to eventually outgrow asthma anyway, the relief of symptoms and treatment of exacerbations was probably sufficient. In 2015, the joint recommendations of Thoracic Canadian Society and Canadian Pediatric Society regarding the diagnosis and management of asthma in preschoolers proposed to abandon this approach and aim instead for optimal control in all children, with a personalized preventive treatment depending on the control level. Because of a lack of access to lung function tests specific to preschool-aged children as well as scientific data on the optimal period to initiate the preventive treatment of asthma, there was still a lot of hesitation among health-care professionals regarding which child to treat preventively and when to initiate treatment. This study confirms that, to improve chances of remission, health care professionals and parents must work together not only to treat asthma exacerbations when they occur, but mostly to prevent both flare-ups and symptoms between exacerbations, to hope changing the evolution of the disease and ensure a healthy future.  

Asthma is the most common chronic disease among children and generally occurs before the age of 5 years. Asthma affects predominantly preschool age children. In fact, asthma-related visit rates to emergency departments are two or three times higher than all other groups’ age. Nowadays, almost 2.5 million Canadians suffer from asthma, with more than 600 000 in Quebec. The economic burden approaches 1 billion dollars in Canada. Improving asthma control in the early life could result in reduced health care costs not only in young children but also throughout their life.

The research team is now focusing on promising approaches to improve asthma control in preschool-aged children, by testing the utility of lung function tests designed specifically for young children to identify early those with asymptomatic narrowing of their bronchi; by testing innovative interventions to prevent asthma exacerbations triggered by colds; and by examining the long-term impact of controller medications, such as inhaled corticosteroids, to prevent lung function sequelae and improve the chances of remission of the disease.

About this study

This study was funded by the Canadian Respiratory Research Network, which receives funding from the Canadian Institutes of Health Research, the Canadian Lung Association, the Canadian Thoracic Society, the British Columbia Lung Association and from industrial partners Boehringer-Ingelheim Canada Ltd., AstraZeneca Canada Inc., and Novartis Canada Ltd. This research study relies partly on anonymous data retrieved from the Ministries of Health of British Columbia, Saskatchewan, Manitoba and Quebec. Donors did not play a role in the study conception, in data collection and analyses nor in the preparation of the study summary. Scientific inferences, interpretations, conclusions and implications of the results in the present document have been formulated by the authors of the study.

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About the CHU Sainte-Justine Research Center

CHU Sainte-Justine Research Center is a leading mother-child research institution affiliated with Université de Montréal. It brings together more than 200 research investigators, including over 90 clinician-scientists, as well as 450 graduate and postgraduate students focused on finding innovative prevention means, faster and less invasive treatments, as well as personalized approaches to medicine. The Center is part of CHU Sainte-Justine, which is the largest mother-child center in Canada and second pediatric center in North America. More on research.chusj.org

Source
CHU Sainte-Justine
Contact

Source:
Maude Hoffmann
Communications, CHU Sainte-Justine Research Center
communications@recherche-ste-justine.qc.ca

Media contact:
Mélanie Dallaire
Executive advisor – External communications
CHU Sainte-Justine
Office: 514-345-7707 / Pager: 514-415-5727
melanie.dallaire.hsj@ssss.gouv.qc.ca

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Updated on 4/19/2018
Created on 4/17/2018
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