'At first glance, asthma seems easy to treat, but under the surface, it's a complex disorder -- involving environment, the immune system, family history and the lungs.'

"We had a big hope that this would be it. In a certain sense we were disappointed, but now we can focus our attention on what will change the course of this disease," said senior author Fernando Martinez, professor of pediatrics at the University of Arizona.

On the other hand, the Prevention in Early Asthma in Kids multi-center clinical trial, or PEAK, reinforced the efficacy of corticosteroids -- a class of steroid hormones -- as the gold standard for asthma care. Children in the study who took inhaled steroids breathed easier and led overall healthier lives.

The study, which will appear May 11 in the New England Journal of Medicine, recruited 285 children age 2 to 3 who were at high risk for persistent asthma-like symptoms during their school years. The children had also not used inhaled steroids previously for more than four months.

Researchers randomly assigned them to either daily inhaled steroid treatment or a placebo group from 2002 to 2004. The children were then followed for an additional year to observe changes in their condition.

During the follow-up, Martinez and colleagues found the two groups had the same severity of asthma-related symptoms and lung function.

Altering Asthma's Course

Twenty million Americans suffer from asthma, and 9 million are under 18, making it the most common chronic condition in children, according to the Allergy and Asthma Foundation of America. A disease with no cure, asthma rates have been climbing steady since 1980.

Asthma usually develops when certain triggers in the body alter the way the lungs grow, which explains why the disease strikes the very young. These triggers -- or information, as Martinez calls them -- in the lungs also bring about symptoms such as frequent coughing, wheezing and shortness of breath. Steroids are able to control these symptoms by quelling the triggers.

A previous study had found steroids given to children older than 4 did not alter asthma's course, but it was thought that these kids were too old, as their lungs had already developed.

Thus, researchers thought giving young kids steroids might prevent damage to their lungs during the crucial period of lung growth.

Complex Disorder

Now, doctors are just as perplexed as to how to stop the process whereby a child becomes an asthmatic, Martinez said. Current asthma medication only treats the symptoms, and not the disease itself.

But future medicines that mediate the immune responses in the lungs may someday actually treat asthma the disease. For some reason, in children with the worst asthma cases, their immune systems delay responses to asthma triggers.

"One possibility for the immune-system delay is the hygiene hypothesis. Parents in recent decades have shielded their children from infectious and microbial agents, organisms that normally stimulate a child's immune system. For instance, past research has found kids who attend daycare in their first six months of life are significantly less likely to develop asthma in their school years," Martinez said.

"At first glance, asthma seems easy to treat, but under the surface, it's a complex disorder -- involving environment, the immune system, family history and the lungs," said Mike Tringale, director of communications for the Allergy and Asthma Foundation of America.

"With this in mind, parents should take their children to a specialist to treat asthma," Tringale said.

"The encouraging news in the study is that steroids work for younger children, but otherwise, there's really nothing new, and once again we're reminded there is no cure," Tringale said.