New Canadian study sheds light on reducing the risk of worsened asthma
symptoms during the month of September
MONTREAL, Sept. 6 /CNW/ - For the more than half million Canadian
children who have asthma, September can be a difficult month. Every year
during the back-to-school season, there is a significant spike in the number
of children requiring hospital treatment as a result of asthma attacks(1).
Epidemics of asthma exacerbations requiring hospital treatment occur
annually after school return after the summer vacation in both the Northern
and Southern Hemispheres(1). Approximately 20 to 25 per cent of annual
hospital admissions for asthma of children in Canada occur in September(1).
"Return to school in September is a signal event at which time the
epidemic begins, reaching its peak two and a half weeks later," says Neil
Johnston, an epidemiologist with the Firestone Institute for Respiratory
Health in Hamilton, Ontario and also a co-investigator on a Canadian study
just published this week in the peer-reviewed journal Pediatrics which looked
at this phenomenon.
What causes the 'September epidemic of asthma exacerbations'?
With the start of a new school year, children are in close contact with
each other and exposed to viruses, like the common cold. In fact, colds are
the most frequent asthma trigger in young children, and are associated with up
to 85 per cent of asthma exacerbations(4).
If a child is experiencing asthma symptom exacerbations, it may be a sign
that underlying inflammation is not adequately controlled and that their
maintenance or controller therapy (medications that keep symptoms and attacks
from starting) should be reassessed(5).
"Return to school in September is often a period of stress for children
and their families and a time when allergen levels in the environment may be
high. School classrooms often also contain allergens such as those from cats
and moulds. When you put youngsters in a crowded classroom or school bus, and
a few of them have colds, and may share food and drink it creates ideal
conditions for rapid transmission of cold viruses and a 'perfect storm' for
kids with asthma," says Johnston.
The latest research
The Attenuation of the September Epidemic of Asthma Exacerbations in
Children study, just published in this month's issue of Pediatrics
demonstrated that the addition of SINGULAIR(R) (montelukast sodium) to usual
asthma treatment in September, more than halved the number of days that
children experienced a worsening of their asthma symptoms during the September
asthma epidemic period. Even more striking, those given montelukast were four
times less likely than those receiving placebo to require unscheduled medical
interventions for asthma symptoms in September.
The randomized, double blind, placebo-controlled, 45 day study(*) compared
the effect of adding montelukast sodium or placebo to current therapy in 194
children aged two to 14 years of age with diagnosed asthma. A magnet backed
fridge calendar was used to record daily symptom data. The primary outcome was
the percentage of days in which the child experienced a worsening of their
"Use of asthma control medications may often be at their lowest levels in
September since some children with asthma often feel well over the summer
months and will have stopped or reduced their medication. They are not
well-protected to ride out the 'perfect storm,'" comments Dr. Malcolm Sears, a
respirologist with the Firestone Institute for Respiratory Health in Hamilton,
Ontario and a co-investigator on the study.
"The study results show that the addition of montelukast to usual
treatment makes a difference to these kids. It's additional asthma armor
during the back-to-school season," says Sears.
SINGULAIR(R) (10 mg) is a non-steroidal medication. It is the world's
first once-a-day leukotriene receptor antagonist and was discovered by
Canadian scientists at the Merck Frosst Centre for Therapeutic Research in
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(*) Funded by an unrestricted medical school grant from Merck Frosst
Canada Ltd. However, the study was conducted independent of Merck Frosst
Canada Ltd. influence or involvement.
(1) Neil W. Johnston, MSc, Piush J. Mandhane, MD, Jennifer Dai, MSc,
Joanne M. Duncan, BSc, Justina M. Greene, DipCompSys, Kim Lambert,
RN, MSc, Malcolm R. Sears, MB, ChB Firestone Institute for
Respiratory Health, St Joseph's Healthcare and McMaster University
Department of Medicine, Hamilton, Ontario, Canada: Attenuation of the
September Epidemic of Asthma Exacerbations in Children: A Randomized,
Controlled Trial of Montelukast Added to Usual Therapy
(2) Neil W. Johnston, MSc,a Sebastian L. Johnston, MD, PhD,b Geoff R.
Norman, PhD,c Jennifer Dai, MSc,a and Malcolm R. Sears, MB, ChBa
Hamilton, Ontario, Canada, and London, United Kingdom: The September
epidemic of asthma hospitalization: School children as disease
(3) Johnston NW, Sears MR. A national evaluation of geographic and
temporal patterns of hospitalization of children for asthma in Canada
(abstract). Am J Respir. Crit. Care Med. 2001; 163: A359.
(4) Johnston SL, Pattemore PK, Sanderson G, et al. Community study of
role of viral infections in exacerbations of asthma in 9-11 year old
children. BMJ. 1995;310:1225-1229.
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