St. Louis, Oct. 12, 2000 - In the largest and longest childhood asthma study ever, researchers at Washington University School of Medicine in St. Louis helped determine that inhaled steroids are safe and effective for children with mild-to-moderate asthma.

The researchers and their colleagues in the national Childhood Asthma Management Program (CAMP) report their results today in The New England Journal of Medicine.

"There's no downside to inhaled steroids. Doctors should prescribe them, and children with asthma will do a lot better. There's so much evidence that they work," said Robert C. Strunk, M.D., professor of pediatrics and principal investigator at the Washington University site.

The six-year study, funded by the National Institutes of Health, involved eight clinical centers in the United States. It compared the effects of three asthma treatments in 1,041 children between ages 5 and 12. The St. Louis researchers recruited 135 participants.

The 1,041 children were divided randomly into three groups. All received a bronchodilator to open the lungs' air passages and relieve current asthma symptoms.

The first group also inhaled an anti-inflammatory steroid called budesonide twice daily. The second group inhaled a nonsteroidal anti-inflammatory called nedocromil. The third inhaled an inactive substance.

Compared with the last group, the budesonide group had 43 percent fewer hospitalizations, 45 percent fewer emergency room visits and used oral steroids (prednisone) 43 percent less during the four to six years they participated in the study.

They also had 62 percent fewer symptoms and 22 percent more days when they didn't need medication to control their asthma symptoms.

The children treated with nedrocromil had 27 percent fewer emergency room visits and used oral steroids 16 percent less. But they were not hospitalized fewer times than the children in the control group.

The study also determined whether long-term treatment of asthma improves lung growth in asthmatic children. The researchers concluded that neither budesonide nor nedocromil was better than the inactive substance in this respect. "We were surprised by these results," Strunk said. "We had hoped to show that if you treat children regularly through adolescence, their lungs function better by the time they reach adulthood."

For years, physicians have debated the long-term risks of treating children with inhaled steroids. Previous studies also have indicated that inhaled steroids stunt children's growth up to 1/2 inch in the first year. The CAMP results showed the same effect, but the growth was affected only in the first year. Children in the budesonide group had the same projected adult height - determined from wrist X-rays at the end of the study - as children in the other two groups.

"This suggests that the effect on growth in the first year only was a delay and not a permanent reduction," Strunk said.

Additionally, the CAMP researchers found no evidence of thin bones or cataracts, which in the past have been associated with inhaled steroids.

An estimated 3 million children in the United States have asthma, making this disease the most common chronic childhood illness. An asthma attack can be triggered by allergies, exercise, cigarette smoke and other lung irritants. During an attack, the lung's airways narrow, hampering breathing. Narrow air passages produce some of asthma's hallmark symptoms, including wheezing, coughing and shortness of breath.

As children with asthma become adolescents, symptoms often subside and in some cases disappear. That's because the lungs grow rapidly, allowing young adolescents to breathe easier. As a result, teens often discontinue regular asthma medications. But when they reach adulthood, their lungs are smaller and don't function as well as those of healthy people.

Decreased lung function may predispose asthmatics to a greater decline in lung function later in life and to chronic airway obstruction. Either condition can limit a person's ability to exercise and carry out daily physical activities.

Strunk hopes this study will encourage physicians to prescribe inhaled steroids for children with asthma. "These medications are not a cure," he said, "but they're a very good way to treat asthma."

The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. The New England Journal of Medicine, 343, 1054-1063.

Editor's note: Dr. Strunk wishes to thank more than 150 physicians in St. Louis who encouraged their patients to follow their CAMP study treatment plans.

The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC Health System.