The September Asthma Epidemic? Part 2 of 2

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Last time we discussed the timeing and the causes of the September Asthma Epidemic. Two bright researchers from Hamilton, Ontario, Malcom Sears and Neil Johston described how in many countries around the world, including Canada had an increase in the number of children hospitalized with asthma problems 2-3 weeks after the beginning of the new school year. We talked about how it was probably due to rhinoviruses and return to school stress. Rhinovirus infections increase in September. Suddenly cramming kids onto school buses and classrooms is a great way to spread these infections. But if it was just rhinovirus the timing of the hospitalization shouldn’t be as consistent as it has been from 1990 through 2004. So the researchers think that back to school stress may add to the problem. The last piece of the puzzle might be asthma medication usage.

When the researchers look in the Ottawa area, there were fewer fills of children’s asthma medications during the summer months. So the use of asthma controller medication may be at its lowest point just before school starts. Why does this matter? Let’s look at the two broad types of asthma medications.

Asthma medications are broadly classified as relievers or controllers. Relievers are medications like ventolin or salbutamol. These medications rapidly open airways when a patient has asthma symptoms. They work well during an asthma attack, but they don’t reduce inflammation in the lungs, so they don’t prevent future attacks. Controller medications have names like flovent, singulair, and pulmicort. These medications don’t work quickly enough to help someone if they are having an attack now. However, if controller medications are taken every day (even if the asthmatic is feeling well), they reduce inflammation in the lungs and prevent future attacks. So, if patients aren’t taking their controller medications over the summer, their lungs are going to be inflammed. So they will be primed and ready to have a full fledge, hospital-requiring asthma problem in September when they encounter the rhinoviruses and school stress.

So can we prevent the September Asthma Epidemic? Let’s look at the proposed causes: rhinovirus, school stress, and lack of controller medication at the beginning of school. Can we reduce rhinovirus exposure? There is no practical way to put all the kids in bubbles or filter the air on school buses. There might be a rhinovirus vaccine some time in the future. However, short of developing a vaccine, we can’t control rhinovirus. Can we get rid of school stress? Maybe brighter people than I can figure out how to teach children to handle the stress better, but I see no practical way. Also, as much as my daughter Emily might like it, we can’t banish school all together. Can we convince asthmatics to take their medications regularily? Asthmatic patient should keep taking controller medications in August to keep the inflammation down in September. The problem is that we have been telling patient that forever, and obviously in the years 1990 through 2004 (the years the researcher looked at in Canada), patient’s weren’t listening. So the researchers looked at another option. What if everyone took singulair for 6 weeks starting at the beginning of September?

The researchers ran an experiment. From September 1 to October 15, 2005 194 children aged 2 to 14 years took part in a randomized, placebo controlled trial with singulair (aka montelukast). They took the singulair in addition to whatever asthma medication they were regularily on. Guess what? The children who took the singulair had fewer days with worse asthma symptoms and fewer unscheduled doctor visits than those on the sugar pill! It didn’t matter if the children were regularily on other controller medications or not. It didn’t matter if the children had colds during the test period or not. Singulair seemed to help everyone in the first six weeks of school.

So should every school-aged asthmatic child go on Singulair from September 1st to October 15th every year? I’m not quite ready to say that yet. However, it is an intriguing option for my parents to consider. Do you buy less asthma medication over the summer? Does you child go on a drug-holiday in August? Have you every taken your asthmatic child to the emergency room in the third week of school? If you answered yes, ask you pharmacist which is your child’s controller medication. Talk to your doctor or pharmacist about having you child use his/her controller medication regularily in the summer. Ask your doctor if your child is a good candidate for being on Singulair for the first six week of school.

As always if you have any questions or concerns about these products, ask your pharmacist.