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Asthma affects one in eight children in the UK. New research projects commissioned by the National Institute for Health Research's Health Technology Assessment (NIHR HTA) programme, costing more than £1million, will investigate the best treatments for children with both long-term asthma and severe acute attacks of asthma. Researchers at the British Paediatric Respiratory Society, led by Professor Warren Lenney, will assess the best ways to manage asthma in children for whom inhaled low dose steroids (the standard first line treatment) are not working. The trial will investigate the clinical and cost-effectiveness of the three alternative treatment strategies that are outlined in the National Asthma Guidelines: a steroid inhaler, an inhaler containing a steroid combined with a long-acting reliever, or a steroid inhaler combined with a leukotriene receptor antagonist tablet. The research will involve 900 children aged seven -15. To measure response to the different treatments, the children and their parents will fill in questionnaires which reflect asthma symptom control. "Much of the available research evidence about treatments for asthma involves trials of adults. But children experience very different asthma symptoms than adults so it is vital that research involving children is carried out," says Professor Lenney. "What matters to children is how they feel, and whether they are able to run around and play with friends and go to school. We aim to identify which of these treatments is best to achieve this." The second trial funded by the HTA programme will investigate whether nebulised magnesium is a clinical and cost-effective addition to standard treatment, nebulised salbutamol and ipratropium, in children with acute severe asthma. The Magnesium Nebuliser Trial In Children (MAGNETIC) trial, led by Dr Colin Powell of the Children's Hospital for Wales, involves 500 children aged two -16. "A number of studies examining nebulised magnesium have found it to be effective for treating acute asthma in adults, but evidence about its effectiveness for children is limited," says Dr Powell. "Current guidelines require that, if inhaled treatment is unsuccessful, the next step is to start intravenous treatment. If this study shows that children respond to nebulised magnesium at this stage, invasive intravenous treatment could be avoided."
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