Preventing Common Cold from Causing Asthma Emergencies

For people with asthma, the viral infections that cause the common cold are a major cause of health emergencies, including hospitalizations. Children age 5 and younger with asthma have more than twice the number of hospitalizations than do older children with asthma and five times the number than do adolescents and adults with the condition.

However, an oral anti-inflammatory medication, used at home when cough from a cold first appears, is highly effective in preventing asthma-related urgent care visits and hospitalizations, especially for pre-schoolers. That is the health- and cost-saving message a University of Iowa Health Care pediatrician is getting out to colleagues and families.

Miles Weinberger, M.D., UI professor of pediatrics, was guest editor for "Treatment for Viral Respiratory Infection-Induced Asthma in Young Children," a supplement to the February 2003 issue of the Journal of Pediatrics, and author of two of the supplement articles.

"Findings over the past 15 years have contributed to a strategy to prevent the viral respiratory illnesses that cause the common cold from progressing to acute asthma episodes requiring urgent care," Weinberger said. "By instructing parents and giving them an oral corticosteroid to have on hand at home, in addition to the usual albuterol aerosol used for temporary quick relief, we can help parents begin the appropriate treatment for their child. This approach greatly reduces the need for an urgent care visit or hospitalization."

Children under age 5 average five to eight colds each year, and 15 percent of children in that age group get as many as 12 colds annually. In addition, children younger than 5 are more likely to have asthma that is triggered by a common cold than to have chronic asthma.

"Inhaled corticosteroids are very useful preventative medications for patients with chronic asthma, but studies included in the Journal of Pediatrics supplement convincingly demonstrate that they do not prevent acute flare-ups from the common cold," Weinberger said. "However, beginning a short course of an oral corticosteroid at the right time is a highly effective treatment for these acute episodes."

The oral corticosteroids most commonly used in these treatments are prednisone and prednisolone, which are available by prescription only. For a child whose previous colds trigged asthma episodes that required urgent physician visits or hospitalization, the medication is administered at home after the child shows cold symptoms of runny nose and cough, but before actual difficulty breathing develops. It is critical to begin the medication before breathing is severely affected because the steroid requires a half to a full day to take maximal effect. Children with severe breathing problems need to be cared for in a hospital or other acute care setting.

"When a child develops severe difficulty breathing, they need to be in a place where they can be clinically observed because they may progress to requiring assisted ventilation or intensive care," Weinberger said. "But if a child with a history of recurrent severe asthma episodes develops the usual runny nose and cough that would otherwise progress to a severe episode, there is a window of opportunity for treatment at home."

Parents are told, and receive in writing, guidelines about when to start the course of treatment and are asked to report to their physician if they actually administer the dose.

"It is essential that the family have the medication on hand so that, for example, on a Sunday night when the pharmacies are closed and their 3-year-old with recurrent acute episodes of asthma begins to cough, they can start the treatment," Weinberger said. "It is an especially important factor in states like Iowa, where many people live in areas without 24-hour pharmacies."

Previous studies by UI and other investigators showed that specialty care programs that offer instruction for this at-home treatment can help eliminate up to 90 percent of asthma-related hospitalizations and urgent care visits.

To promote the at-home treatment approach, Weinberger spoke in January at a national conference attended by nearly 700 general pediatricians. He also has met with HMO and pharmacy benefit managers to show how improving asthma outcomes can decrease costs.

"Nearly 75 percent of all medical care expenses for asthma in children under age 5 are for hospitalizations. Preventing acute asthma attacks triggered by the common cold could have a significant impact not only on children's health but also on health care costs," Weinberger said.

In people with asthma, the airways are more sensitive to different triggers, including colds, allergies and irritants such as cigarette smoke. These triggers can restrict breathing by causing inflammation and muscle spasms in the airway.

As with all medical care, it is best to consult with your family physician before making any changes to your or your child's health care routine.

For more information about asthma treatment in children, contact the UI Pediatric Allergy and Pulmonary Clinic at (319) 356-1828, or visit the clinic online at http://www.uihealthcare.com/depts/med/pediatrics/divisions/allergy.html. A brochure on "Managing Asthma for Patients and Families" is also available online at http://www.vh.org/pediatric/patient/pediatrics/asthma/.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at http://www.uihealthcare.com.

PHOTO: An image of Miles Weinberger is available for downloading at http://www.uihealthcare.com/depts/med/pediatrics/pedsmds/weinberger.html