Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma

Willem M C van Aalderen; Jonathan Grigg; Theresa W Guilbert; Nicolas Roche; Elliot Israel; Richard J Martin; Gene Colice; Dirkje S Postma; Elizabeth V Hillyer; Anne Burden; Victoria Thomas; Julie von Ziegenweidt; David Price

doi:10.1016/j.jaip.2015.04.012

Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma

Willem M C van Aalderen, Jonathan Grigg, Theresa W Guilbert, Nicolas Roche, Elliot Israel, Richard J Martin, Gene Colice, Dirkje S Postma, Elizabeth V Hillyer, Anne Burden, Victoria Thomas, Julie von Ziegenweidt, David Price

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Abstract

BACKGROUND: Because randomized controlled trials of established pediatric asthma therapies are expensive and difficult to perform, observational studies may fill gaps in the evidence base.

OBJECTIVES: To compare the effectiveness of representative small-particle inhaled corticosteroid (ICS) with that of standard size-particle ICS for children initiating or stepping up ICS therapy for asthma (analysis 1) and to compare the effectiveness of ICS dose step-up using small-particle ICS with adding long-acting β2-agonist (LABA) to the ICS (analysis 2).

METHODS: These historical matched cohort analyses drew on electronic medical records of children with asthma aged 5 to 11 years. Variables measured during 2 consecutive years (1 baseline year for confounder definition and 1 outcome year) included risk-domain asthma control (no hospital attendance for asthma, acute oral corticosteroids, or lower respiratory tract infection requiring antibiotics) and rate of severe exacerbations (asthma-related emergency, hospitalization, or oral corticosteroids).

RESULTS: In the initiation population (n = 797 in each cohort), children prescribed small-particle ICS versus standard size-particle ICS experienced greater odds of asthma control (adjusted odds ratio, 1.49; 95% CI, 1.10-2.02) and lower severe exacerbation rate (adjusted rate ratio, 0.56; 95% CI, 0.35-0.88). Step-up outcomes (n = 206 in each cohort) were also significantly better for small-particle ICS, with asthma control adjusted odds ratio of 2.22 (95% CI, 1.23-4.03) and exacerbations adjusted rate ratio of 0.49 (95% CI, 0.27-0.89). The number needed to treat with small-particle ICS to achieve 1 additional child with asthma control was 17 (95% CI, 9-107) for the initiation population and 5 (95% CI, 3-78) for the step-up population. Outcomes were not significantly different for stepped-up small-particle ICS dose versus ICS/LABA combination (n = 185 in each cohort).

CONCLUSIONS: Initiating or stepping up the ICS dose with small-particle ICS rather than with standard size-particle ICS is more effective and shows similar effectiveness to add-on LABA in childhood asthma.

Original language	English
Pages (from-to)	721-731
Number of pages	11
Journal	The Journal of Allergy and Clinical Immunology: In Practice
Volume	3
Issue number	5
Early online date	29 May 2015
DOIs	https://doi.org/10.1016/j.jaip.2015.04.012
Publication status	Published - Sep 2015

Keywords

asthma
childhood
small-particle beclomethasone
fluticasone
inhaled corticosteroid
long-acting β2-agonist
step-up therapy

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10.1016/j.jaip.2015.04.012Licence: CC BY-NC-ND

Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial-No Derivs (CC BY-NC-ND 4.0) license, which permits others to distribute this work non-commercially provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc-nd/4.0/
Final published version, 1.66 MBLicence: CC BY-NC-ND

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van Aalderen, W. M. C., Grigg, J., Guilbert, T. W., Roche, N., Israel, E., Martin, R. J., Colice, G., Postma, D. S., Hillyer, E. V., Burden, A., Thomas, V., von Ziegenweidt, J., & Price, D. (2015). Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma. The Journal of Allergy and Clinical Immunology: In Practice, 3(5), 721-731. https://doi.org/10.1016/j.jaip.2015.04.012

van Aalderen, WMC, Grigg, J, Guilbert, TW, Roche, N, Israel, E, Martin, RJ, Colice, G, Postma, DS, Hillyer, EV, Burden, A, Thomas, V, von Ziegenweidt, J & Price, D 2015, 'Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma', The Journal of Allergy and Clinical Immunology: In Practice, vol. 3, no. 5, pp. 721-731. https://doi.org/10.1016/j.jaip.2015.04.012

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title = "Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma",

abstract = "BACKGROUND: Because randomized controlled trials of established pediatric asthma therapies are expensive and difficult to perform, observational studies may fill gaps in the evidence base.OBJECTIVES: To compare the effectiveness of representative small-particle inhaled corticosteroid (ICS) with that of standard size-particle ICS for children initiating or stepping up ICS therapy for asthma (analysis 1) and to compare the effectiveness of ICS dose step-up using small-particle ICS with adding long-acting β2-agonist (LABA) to the ICS (analysis 2).METHODS: These historical matched cohort analyses drew on electronic medical records of children with asthma aged 5 to 11 years. Variables measured during 2 consecutive years (1 baseline year for confounder definition and 1 outcome year) included risk-domain asthma control (no hospital attendance for asthma, acute oral corticosteroids, or lower respiratory tract infection requiring antibiotics) and rate of severe exacerbations (asthma-related emergency, hospitalization, or oral corticosteroids).RESULTS: In the initiation population (n = 797 in each cohort), children prescribed small-particle ICS versus standard size-particle ICS experienced greater odds of asthma control (adjusted odds ratio, 1.49; 95% CI, 1.10-2.02) and lower severe exacerbation rate (adjusted rate ratio, 0.56; 95% CI, 0.35-0.88). Step-up outcomes (n = 206 in each cohort) were also significantly better for small-particle ICS, with asthma control adjusted odds ratio of 2.22 (95% CI, 1.23-4.03) and exacerbations adjusted rate ratio of 0.49 (95% CI, 0.27-0.89). The number needed to treat with small-particle ICS to achieve 1 additional child with asthma control was 17 (95% CI, 9-107) for the initiation population and 5 (95% CI, 3-78) for the step-up population. Outcomes were not significantly different for stepped-up small-particle ICS dose versus ICS/LABA combination (n = 185 in each cohort).CONCLUSIONS: Initiating or stepping up the ICS dose with small-particle ICS rather than with standard size-particle ICS is more effective and shows similar effectiveness to add-on LABA in childhood asthma.",

keywords = "asthma, childhood, small-particle beclomethasone, fluticasone, inhaled corticosteroid, long-acting β2-agonist, step-up therapy",

author = "{van Aalderen}, {Willem M C} and Jonathan Grigg and Guilbert, {Theresa W} and Nicolas Roche and Elliot Israel and Martin, {Richard J} and Gene Colice and Postma, {Dirkje S} and Hillyer, {Elizabeth V} and Anne Burden and Victoria Thomas and {von Ziegenweidt}, Julie and David Price",

year = "2015",

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doi = "10.1016/j.jaip.2015.04.012",

language = "English",

volume = "3",

pages = "721--731",

journal = "The Journal of Allergy and Clinical Immunology: In Practice",

issn = "2213-2198",

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T1 - Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma

AU - van Aalderen, Willem M C

AU - Grigg, Jonathan

AU - Guilbert, Theresa W

AU - Roche, Nicolas

AU - Israel, Elliot

AU - Martin, Richard J

AU - Colice, Gene

AU - Postma, Dirkje S

AU - Hillyer, Elizabeth V

AU - Burden, Anne

AU - Thomas, Victoria

AU - von Ziegenweidt, Julie

AU - Price, David

PY - 2015/9

Y1 - 2015/9

N2 - BACKGROUND: Because randomized controlled trials of established pediatric asthma therapies are expensive and difficult to perform, observational studies may fill gaps in the evidence base.OBJECTIVES: To compare the effectiveness of representative small-particle inhaled corticosteroid (ICS) with that of standard size-particle ICS for children initiating or stepping up ICS therapy for asthma (analysis 1) and to compare the effectiveness of ICS dose step-up using small-particle ICS with adding long-acting β2-agonist (LABA) to the ICS (analysis 2).METHODS: These historical matched cohort analyses drew on electronic medical records of children with asthma aged 5 to 11 years. Variables measured during 2 consecutive years (1 baseline year for confounder definition and 1 outcome year) included risk-domain asthma control (no hospital attendance for asthma, acute oral corticosteroids, or lower respiratory tract infection requiring antibiotics) and rate of severe exacerbations (asthma-related emergency, hospitalization, or oral corticosteroids).RESULTS: In the initiation population (n = 797 in each cohort), children prescribed small-particle ICS versus standard size-particle ICS experienced greater odds of asthma control (adjusted odds ratio, 1.49; 95% CI, 1.10-2.02) and lower severe exacerbation rate (adjusted rate ratio, 0.56; 95% CI, 0.35-0.88). Step-up outcomes (n = 206 in each cohort) were also significantly better for small-particle ICS, with asthma control adjusted odds ratio of 2.22 (95% CI, 1.23-4.03) and exacerbations adjusted rate ratio of 0.49 (95% CI, 0.27-0.89). The number needed to treat with small-particle ICS to achieve 1 additional child with asthma control was 17 (95% CI, 9-107) for the initiation population and 5 (95% CI, 3-78) for the step-up population. Outcomes were not significantly different for stepped-up small-particle ICS dose versus ICS/LABA combination (n = 185 in each cohort).CONCLUSIONS: Initiating or stepping up the ICS dose with small-particle ICS rather than with standard size-particle ICS is more effective and shows similar effectiveness to add-on LABA in childhood asthma.

AB - BACKGROUND: Because randomized controlled trials of established pediatric asthma therapies are expensive and difficult to perform, observational studies may fill gaps in the evidence base.OBJECTIVES: To compare the effectiveness of representative small-particle inhaled corticosteroid (ICS) with that of standard size-particle ICS for children initiating or stepping up ICS therapy for asthma (analysis 1) and to compare the effectiveness of ICS dose step-up using small-particle ICS with adding long-acting β2-agonist (LABA) to the ICS (analysis 2).METHODS: These historical matched cohort analyses drew on electronic medical records of children with asthma aged 5 to 11 years. Variables measured during 2 consecutive years (1 baseline year for confounder definition and 1 outcome year) included risk-domain asthma control (no hospital attendance for asthma, acute oral corticosteroids, or lower respiratory tract infection requiring antibiotics) and rate of severe exacerbations (asthma-related emergency, hospitalization, or oral corticosteroids).RESULTS: In the initiation population (n = 797 in each cohort), children prescribed small-particle ICS versus standard size-particle ICS experienced greater odds of asthma control (adjusted odds ratio, 1.49; 95% CI, 1.10-2.02) and lower severe exacerbation rate (adjusted rate ratio, 0.56; 95% CI, 0.35-0.88). Step-up outcomes (n = 206 in each cohort) were also significantly better for small-particle ICS, with asthma control adjusted odds ratio of 2.22 (95% CI, 1.23-4.03) and exacerbations adjusted rate ratio of 0.49 (95% CI, 0.27-0.89). The number needed to treat with small-particle ICS to achieve 1 additional child with asthma control was 17 (95% CI, 9-107) for the initiation population and 5 (95% CI, 3-78) for the step-up population. Outcomes were not significantly different for stepped-up small-particle ICS dose versus ICS/LABA combination (n = 185 in each cohort).CONCLUSIONS: Initiating or stepping up the ICS dose with small-particle ICS rather than with standard size-particle ICS is more effective and shows similar effectiveness to add-on LABA in childhood asthma.

KW - asthma

KW - childhood

KW - small-particle beclomethasone

KW - fluticasone

KW - inhaled corticosteroid

KW - long-acting β2-agonist

KW - step-up therapy

U2 - 10.1016/j.jaip.2015.04.012

DO - 10.1016/j.jaip.2015.04.012

M3 - Article

C2 - 26032474

VL - 3

SP - 721

EP - 731

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

IS - 5

ER -

Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma

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Keywords

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