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 languageEnglish
Pages (from-to)721-731
Number of pages11
JournalThe Journal of Allergy and Clinical Immunology: In Practice
Volume3
Issue number5
Early online date29 May 2015
DOIs
Publication statusPublished - Sep 2015

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Adrenal Cortex Hormones
Asthma
Therapeutics
Particle Size
Odds Ratio
Population
Numbers Needed To Treat
Electronic Health Records
Respiratory Tract Infections
Observational Studies
Hospitalization
Emergencies
Cohort Studies
Randomized Controlled Trials

Keywords

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

Cite this

Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma. / van Aalderen, Willem M C; Grigg, Jonathan; Guilbert, Theresa W; Roche, Nicolas; Israel, Elliot; Martin, Richard J; Colice, Gene; Postma, Dirkje S; Hillyer, Elizabeth V; Burden, Anne; Thomas, Victoria; von Ziegenweidt, Julie; Price, David.

In: The Journal of Allergy and Clinical Immunology: In Practice, Vol. 3, No. 5, 09.2015, p. 721-731.

Research output: Contribution to journalArticle

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
van Aalderen, Willem M C ; Grigg, Jonathan ; Guilbert, Theresa W ; Roche, Nicolas ; Israel, Elliot ; Martin, Richard J ; Colice, Gene ; Postma, Dirkje S ; Hillyer, Elizabeth V ; Burden, Anne ; Thomas, Victoria ; von Ziegenweidt, Julie ; Price, David. / Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma. In: The Journal of Allergy and Clinical Immunology: In Practice. 2015 ; Vol. 3, No. 5. pp. 721-731.
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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

N1 - Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

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.

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KW - childhood

KW - small-particle beclomethasone

KW - fluticasone

KW - inhaled corticosteroid

KW - long-acting β2-agonist

KW - step-up therapy

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DO - 10.1016/j.jaip.2015.04.012

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VL - 3

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

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