NEW ORLEANS — Better asthma control in children can be achieved by either increasing inhaled corticosteroid (ICS) dose or by switching to a combination ICS plus long-acting beta agonist (LABA), with similar treatment outcomes, according to study results presented at the CHEST Annual Meeting, held October 19-23, 2019, in New Orleans, Louisiana.

Researchers conducted a prospective cohort study to compare the clinical effectiveness during the course of 1 year of either doubling ICS dose (n=106; 65%) or switching to ICS plus LABA combination therapy (n=57; 35%) in pediatric patients (N=163) referred from primary care to a tertiary care children’s hospital for “difficult to treat asthma.” Patients and families filled out questionnaires that included acute emergency department need since last visit, asthma control test (ACT), primary care physician visits, urgent care visits, mean symptom scores since last visit, and missed school days. Levels of improvement in indicators of asthma control over time between groups and for the total sample were compared using multivariable Poisson mixed model effects modeling.

Of the total 163 participants, the mean age was 5.62±3.6 years, and 59% (n=96) were boys. At the initial clinic visit, participants taking ICS were younger (4.4±2.6 vs 8.4±4 years), with less severe asthma (23% mild persistent asthma in ICS group vs 2% in ICS plus LABA group [P <.001 for both]). Participants in the ICS group had higher mean scores for ACT (16.38 vs 14.25), fewer school days missed, and fewer number of days per month with nighttime cough, wheezing, and exercise symptoms compared with the ICS plus LABA group (P <.05 for all). No significant between-group differences were observed in mean percent predicted forced expiratory volume in 1 second, presence of household pets, smoking exposure, and acute care need (oral steroid use, hospital admission, or emergency department, primary care physician, and urgent care visits).


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At the 3-month follow-up, significant improvements in ACT scores were seen in both groups, even after adjusting for age (16.38±5.5 and 14.25±5.14 to 20.78±4.85 and 18.51±5.62, respectively; P <.001). Similar patterns were seen with symptom scores (mean number of days per month with wheezing, nighttime cough, requiring albuterol) and acute care need (missed school days, oral steroid use, and emergency department and primary care physician visits), with both groups improving significantly over time (P <.05 for all). No significant between-group rates of improvement were seen in any variable.

The investigators concluded that better asthma control in children can be achieved by either an increased ICS dose or a switch to ICS plus LABA, with similar treatment outcomes.

Reference

Al-Turki A, Sheikh S. Comparison of two types of controller therapies on long term asthma control. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 1024.