Summer "Drug Holidays" For Kids With Asthma: The Real Deal

Did you know that many kids with asthma might take “drug holidays”, or medication breaks, during summer when they are out of the classroom? I didn’t, until I read a timely Back-to-School tweet from Kingston, Ontario based allergist, Dr. Anne Ellis.

Well #asthma followers, it's back to school time, I do hope those who did a "drug Holliday" this summer have restarted controller therapies!

— Dr. Ellis (@DrAnneEllis) September 4, 2016

Well, I thought there might have been something to the “drug holiday” thing. It turns out, everything my research has lead me to, tells me that this holiday during summer holidays is not a good idea for kids.

One article, released in 2008, notes that a significant number of asthma exacerbations that occur in the early Fall, known as the September Asthma Peak, or September Peak, could be prevented if kids remained on asthma control therapy over the summer. ¹ This makes sense, as we know that asthma control medicines, either an inhaled corticosteroid alone, or paired with a long acting bronchodilator, are meant to prevent asthma symptoms—which is why we do not discontinue asthma medicines as soon as we feel better… because feeling better means medicines are doing their job of decreasing inflammation and constriction in the airways that cause asthma symptoms. Other contributors to the September Asthma Peak are fall allergens, weather changes, and kids returning to school—bringing a lot of different germs with them to cause a spike in colds… Not the kind of sharing we like to see in our classrooms!

The American Academy of Allergy, Asthma and Immunology (or AAAAI… and even some of the best asthma researchers can’t remember the number of As in there, so, don’t worry about it!) has also basically put its foot down on the topic of summer medicine breaks for kids, stating that there is no evidence supporting any benefit to taking breaks from controller therapy over summer—and echoes the risks of doing so. ² A child who does not take control medicines over summer is reported to have a 2% increase in visiting the emergency department for asthma symptoms (5.5% who did not take medicine over summer compared to 3.2% who did)¹. The statistics do not seem significant, but… why take the risk by getting out of the routine? It is also worth noting that if asthma meds are re-started only after symptoms begin, it may be more difficult to regain asthma control. ¹ Families who take medication breaks often rely more on short-acting inhalers through the summer months¹, meaning that children are probably experiencing more asthma symptoms—and, potentially needlessly as they could remain more symptom-free if maintained on controller medicines.

My suspicions behind why families started taking asthma medicine breaks stemmed from two things—one, being the higher dose medications of decades back, that could cause stunted growth, and two—backed up by the 2008 article ¹—that the landscape of ADHD treatment affected families with asthma. It is common for families of kids with ADHD to allow summer medication breaks³, to help with alleviating stunted growth caused by some ADHD medicines, or to help with appetite which is often suppressed by stimulant medications taken for ADHD ³. However, inhaled asthma medicines do not have these sorts of side effects, and, unlike stimulant medicines for ADHD, require time to reach their peak effectiveness. Where you can have a kid take an ADHD medicine for symptom management just after breakfast and have it working by the time the bell rings, you cannot start an inhaled steroid in the morning before school and expect it to be working by recess! (And, living with both asthma and ADHD, I can attest to this!)

A doctor should always be involved in any changes to your child’s asthma management plan—that includes taking summer breaks from inhaled steroids, combo inhalers, or any other asthma medicines used during the school year. And, if your child has been taking summer breaks from medicine as well as school, it might be worthwhile to reconsider that choice—you’ve got eight to ten more moths to weigh your options to make the best choice for your child!