Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

Jonathan Grigg (Corresponding Author), Anjan Nibber, James Y. Paton, Alison Chisholm, Theresa W. Guilbert, Alan Kaplan, Steve Turner, Nicolas Roche, Elizabeth V. Hillyer, David B. Price, Respiratory Effectiveness Group

Research output: Contribution to journalArticle

4 Citations (Scopus)
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Abstract

Background: An inhaled corticosteroid (ICS) or leukotriene receptor antagonist (LTRA) may prevent wheezing/asthma attacks in preschoolers with recurrent wheeze when added to short-acting β-agonist (SABA).
Objective: The aim of this historical matched cohort study was to assess the effectiveness of these treatments for preventing wheezing/asthma attacks.
Methods: Electronic medical records from the Optimum Patient Care Research Database were used to characterize a UK preschool population (1–5 years old) with two or more episodes of wheezing during 1 baseline year before first prescription (index date) of ICS or LTRA, or repeat prescription of SABA. Children initiating ICS or LTRA on the index date were matched 1:4 to those prescribed only SABA for age, sex, year of index prescription, mean baseline SABA dose, baseline attacks, baseline antibiotic prescriptions, and eczema diagnosis. Wheezing/asthma attacks (defined as asthma-related emergency attendance, hospital admission, or acute oral corticosteroid prescription) during 1 outcome year were compared using conditional logistic regression.
Results: Matched ICS and SABA cohorts included 990 and 3,960 children, respectively (61% male; mean [SD] age 3.2 [1.3] years), and matched LTRA and SABA cohorts included 259 and 1,036 children, respectively (65% male; mean [SD] age 2.6 [1.2] years). We observed no significant difference between matched cohorts in the odds of a wheezing/asthma attack: ICS vs SABA, OR (95% CI) 1.01 (0.85–1.19) and LTRA vs SABA, OR (95% CI) 1.28 (0.96–1.72).
Conclusion: We found no evidence that initiation of ICS or LTRA therapy is associated with fewer attacks during 1 outcome year than SABA alone for a heterogeneous group of preschool children with recurrent wheeze in the real-life clinical setting.
Original languageEnglish
Pages (from-to)309-321
Number of pages13
JournalJournal of Asthma and Allergy
Volume11
DOIs
Publication statusPublished - 11 Dec 2018

Keywords

  • electronic medical records
  • inhaled corticosteroids
  • leukotriene receptor antagonists
  • observational study
  • ICS particle size
  • short-acting β-agonist

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