Parents, Breathe Easy: Asthma Inhalers Safe for Kids

Study finds they don't cause hyperactive behavior in children

THURSDAY, Feb. 21, 2002 (HealthDayNews) -- Do inhalers designed to stop asthma attacks send kids spinning out of control?

Not according to a new study from British researchers that found no such link, despite parental stories of hyperactivity and children "climbing the walls."

The study appears in the March issue of the journal Archives of Disease in Childhood.

People with asthma experience bouts of coughing, wheezing and difficulty breathing when their airways become narrowed or blocked. These attacks are triggered by a variety of factors, such as dust, smoke, allergens or exercise.

More than 17 million Americans have asthma, and roughly 3.8 million are under 18 years of age. While medications designed to provide long-term control exist, many people also need emergency "rescue" inhalers, designed to quickly open narrowed airways. Salbutamol is among the most common of these drugs.

Study co-author Peter Loader and his colleagues were struck by how parents of children with asthma consistently reported that using a salbutamol inhaler affected the child's behavior.

"Everyone in our study reported that they believed this to be the case," says Loader, a senior lecturer of child and adolescent psychiatry at Guy's, King's, St. Thomas's School of Medicine in London.

According to the parents, children "became excited and overactive," Loader says. "They were difficult to manage. Like ADHD [attention deficit hyperactivity disorder], they became hyperactive."

"When parents consistently report something, it is likely to have some basis," says Loader. "Parents are experts on their children."

So, he was surprised when the study failed to turn up any connection between the inhalers and hyperactive behavior.

The researchers studied 19 boys and girls, aged 2 to 5, who were taking salbutamol-based inhalers. All of the parents had reported hyperactivity in their children after they used the inhalers in everyday life.

The team scored each child on a rating scale for hyperactivity, then gave the child either a dose from a salbutamol inhaler or a placebo inhaler. A researcher and a parent monitored the child's behavior while playing, and rated the hyperactivity. The test was later repeated, with the child receiving the opposite inhaler.

Despite the parental belief that the inhalers affect behavior, the ratings revealed no significant effect on activity levels from the salbutamol dose.

The possibility exists that there is no link, says Loader. However, he points out the children were given salbutamol in a controlled experimental setting, not because they were having an asthma attack.

"[That's] slightly different … [from] a child at home, frightened, in an asthma attack, with parents who are quite often frightened, too," says Loader. "The situations are not comparable."

Dr. Anthony Montanaro, scientific advisor for the Asthma & Allergy Foundation of America, agrees the controlled setting may have played a role in the results.

"A lot of it has to do with parental expectations," he says. "When it becomes an issue, a lot of times the children behave in a way that they feel their parents think they are going to behave."

Loader points out that salbutamol is distantly related to amphetamine and Ritalin – the most common treatment for ADHD. In addition, the researchers did note the children became slightly more attentive following inhaler use, although the effect was not statistically significant.

Montanaro has heard the same complaints about hyperactivity from parents of asthmatic children.

"It's obviously a very important issue for most parents, particularly if they have younger children," he says. "There's always a great deal of concern about potential toxicity of drugs for use in asthma."

What To Do

You can find out more about asthma from the Asthma & Allergy Foundation of America or the National Institute of Allergy and Infectious Diseases.

The American Lung Association provides specific information on asthma and children.

SOURCES: Interviews with Peter Loader, M.D., senior lecturer, Department of Child & Adolescent Psychiatry, Guy's, King's, St. Thomas's School of Medicine, London; Anthony Montanaro, M.D., scientific advisor, Asthma & Allergy Foundation of America, and professor, head, Division of Allergy & Clinical Immunology, Oregon Health & Science University, Portland, Ore.; March 2002 Archives of Disease in Childhood
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