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

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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

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Respiratory Sounds
Leukotriene Antagonists
Cohort Studies
Asthma
Steroid Receptors
Prescriptions
Adrenal Cortex Hormones
Therapeutics
3-(2-(4-azidobenzamidino)ethyl)-5-hydroxyindole
Electronic Health Records
Eczema
Preschool Children
Patient Care
Emergencies
Logistic Models
Databases
Anti-Bacterial Agents

Keywords

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

Cite this

Grigg, J., Nibber, A., Paton, J. Y., Chisholm, A., Guilbert, T. W., Kaplan, A., ... Respiratory Effectiveness Group (2018). Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks. Journal of Asthma and Allergy, 11, 309-321. https://doi.org/10.2147/JAA.S178531

Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks. / Grigg, Jonathan (Corresponding Author); Nibber, Anjan; Paton, James Y. ; Chisholm, Alison; Guilbert, Theresa W.; Kaplan, Alan; Turner, Steve; Roche, Nicolas; Hillyer, Elizabeth V.; Price, David B.; Respiratory Effectiveness Group.

In: Journal of Asthma and Allergy, Vol. 11, 11.12.2018, p. 309-321.

Research output: Contribution to journalArticle

Grigg, J, Nibber, A, Paton, JY, Chisholm, A, Guilbert, TW, Kaplan, A, Turner, S, Roche, N, Hillyer, EV, Price, DB & Respiratory Effectiveness Group 2018, 'Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks' Journal of Asthma and Allergy, vol. 11, pp. 309-321. https://doi.org/10.2147/JAA.S178531
Grigg, Jonathan ; Nibber, Anjan ; Paton, James Y. ; Chisholm, Alison ; Guilbert, Theresa W. ; Kaplan, Alan ; Turner, Steve ; Roche, Nicolas ; Hillyer, Elizabeth V. ; Price, David B. ; Respiratory Effectiveness Group. / Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks. In: Journal of Asthma and Allergy. 2018 ; Vol. 11. pp. 309-321.
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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.",
keywords = "electronic medical records, inhaled corticosteroids, leukotriene receptor antagonists, observational study, ICS particle size, short-acting β-agonist",
author = "Jonathan Grigg and Anjan Nibber and Paton, {James Y.} and Alison Chisholm and Guilbert, {Theresa W.} and Alan Kaplan and Steve Turner and Nicolas Roche and Hillyer, {Elizabeth V.} and Price, {David B.} and {Respiratory Effectiveness Group} and {van Aalderen}, {W. M. C.} and Murray, {C. S.} and W. Phipatanakul and S. Sonnappa and Hoe, {T. O.} and Martin, {R. J.} and A. Papi and Szefler, {S. J.} and D. Skinner and McQueen, {R. B.} and Usmani, {O. S.}",
note = "The authors gratefully acknowledge Ronan Ryan, PhD, and Jaco Voorham, PhD (Observational and Pragmatic Research Institute Pte Ltd, Singapore), for statistical expertise and assistance with the analyses. This work was supported by the Respiratory Effectiveness Group (http://effectivenessevaluation.org/). Access to data from the Optimum Patient Care Research Database (http://optimumpatientcare.org/opcrd/) was provided as an in-kind donation from Optimum Patient Care.",
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T1 - Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

AU - Grigg, Jonathan

AU - Nibber, Anjan

AU - Paton, James Y.

AU - Chisholm, Alison

AU - Guilbert, Theresa W.

AU - Kaplan, Alan

AU - Turner, Steve

AU - Roche, Nicolas

AU - Hillyer, Elizabeth V.

AU - Price, David B.

AU - Respiratory Effectiveness Group

A2 - van Aalderen, W. M. C.

A2 - Murray, C. S.

A2 - Phipatanakul, W.

A2 - Sonnappa, S.

A2 - Hoe, T. O.

A2 - Martin, R. J.

A2 - Papi, A.

A2 - Szefler, S. J.

A2 - Skinner, D.

A2 - McQueen, R. B.

A2 - Usmani, O. S.

N1 - The authors gratefully acknowledge Ronan Ryan, PhD, and Jaco Voorham, PhD (Observational and Pragmatic Research Institute Pte Ltd, Singapore), for statistical expertise and assistance with the analyses. This work was supported by the Respiratory Effectiveness Group (http://effectivenessevaluation.org/). Access to data from the Optimum Patient Care Research Database (http://optimumpatientcare.org/opcrd/) was provided as an in-kind donation from Optimum Patient Care.

PY - 2018/12/11

Y1 - 2018/12/11

N2 - 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.

AB - 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.

KW - electronic medical records

KW - inhaled corticosteroids

KW - leukotriene receptor antagonists

KW - observational study

KW - ICS particle size

KW - short-acting β-agonist

U2 - 10.2147/JAA.S178531

DO - 10.2147/JAA.S178531

M3 - Article

VL - 11

SP - 309

EP - 321

JO - Journal of Asthma and Allergy

JF - Journal of Asthma and Allergy

SN - 1178-6965

ER -