Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma
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...
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| Veröffentlicht in: | The journal of allergy and clinical immunology in practice (Cambridge, MA) MA), 2015-09, Vol.3 (5), p.721-731.e16 |
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| creator | van Aalderen, Willem M.C., MD, PhD Grigg, Jonathan, MD Guilbert, Theresa W., MD, MS Roche, Nicolas, MD, PhD Israel, Elliot, MD Martin, Richard J., MD Colice, Gene, MD Postma, Dirkje S., MD, PhD Hillyer, Elizabeth V., DVM Burden, Anne, MSc Thomas, Victoria, MSc von Ziegenweidt, Julie Price, David, FRCGP |
| description | 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. |
| doi_str_mv | 10.1016/j.jaip.2015.04.012 |
| format | Article |
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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.</description><identifier>ISSN: 2213-2198</identifier><identifier>EISSN: 2213-2201</identifier><identifier>DOI: 10.1016/j.jaip.2015.04.012</identifier><identifier>PMID: 26032474</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Administration, Inhalation ; Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - adverse effects ; Adrenergic beta-2 Receptor Agonists - administration & dosage ; Adrenergic beta-2 Receptor Agonists - adverse effects ; Allergy and Immunology ; Asthma ; Asthma - drug therapy ; Child ; Child, Preschool ; Childhood ; Children & youth ; Clinical medicine ; Clinical trials ; Cohort Studies ; Drug Dosage Calculations ; Female ; Fluticasone ; Follow-Up Studies ; Humans ; Inhaled corticosteroid ; Internal Medicine ; Long-acting β2-agonist ; Male ; Microspheres ; Particle Size ; Small-particle beclomethasone ; Step-up therapy ; Studies ; Treatment Outcome</subject><ispartof>The journal of allergy and clinical immunology in practice (Cambridge, MA), 2015-09, Vol.3 (5), p.721-731.e16</ispartof><rights>The Authors</rights><rights>2015 The Authors</rights><rights>Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Sep 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c615t-1be304457c3d525d24de7d6661098eaaf97a8c0936fa603597050c201d7e40203</citedby><cites>FETCH-LOGICAL-c615t-1be304457c3d525d24de7d6661098eaaf97a8c0936fa603597050c201d7e40203</cites><orcidid>0000-0002-9728-9992</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26032474$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Aalderen, Willem M.C., MD, PhD</creatorcontrib><creatorcontrib>Grigg, Jonathan, MD</creatorcontrib><creatorcontrib>Guilbert, Theresa W., MD, MS</creatorcontrib><creatorcontrib>Roche, Nicolas, MD, PhD</creatorcontrib><creatorcontrib>Israel, Elliot, MD</creatorcontrib><creatorcontrib>Martin, Richard J., MD</creatorcontrib><creatorcontrib>Colice, Gene, MD</creatorcontrib><creatorcontrib>Postma, Dirkje S., MD, PhD</creatorcontrib><creatorcontrib>Hillyer, Elizabeth V., DVM</creatorcontrib><creatorcontrib>Burden, Anne, MSc</creatorcontrib><creatorcontrib>Thomas, Victoria, MSc</creatorcontrib><creatorcontrib>von Ziegenweidt, Julie</creatorcontrib><creatorcontrib>Price, David, FRCGP</creatorcontrib><title>Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma</title><title>The journal of allergy and clinical immunology in practice (Cambridge, MA)</title><addtitle>J Allergy Clin Immunol Pract</addtitle><description>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.</description><subject>Administration, Inhalation</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenal Cortex Hormones - adverse effects</subject><subject>Adrenergic beta-2 Receptor Agonists - administration & dosage</subject><subject>Adrenergic beta-2 Receptor Agonists - adverse effects</subject><subject>Allergy and Immunology</subject><subject>Asthma</subject><subject>Asthma - drug therapy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Childhood</subject><subject>Children & youth</subject><subject>Clinical medicine</subject><subject>Clinical trials</subject><subject>Cohort Studies</subject><subject>Drug Dosage Calculations</subject><subject>Female</subject><subject>Fluticasone</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Inhaled corticosteroid</subject><subject>Internal Medicine</subject><subject>Long-acting β2-agonist</subject><subject>Male</subject><subject>Microspheres</subject><subject>Particle Size</subject><subject>Small-particle beclomethasone</subject><subject>Step-up therapy</subject><subject>Studies</subject><subject>Treatment Outcome</subject><issn>2213-2198</issn><issn>2213-2201</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkkFr3DAQhU1paUKaP9BDEfTSi92RLFk2lEJYmjYQ6GHTs1CkWSxXtlzJDuy_r8wmLeRQqovE8L0Znt4UxVsKFQXafByqQbu5YkBFBbwCyl4U54zRumS59vLpTbv2rLhMaYB8WiqBw-vijDVQMy75eYH7UXtfzjouzngkN1OvPVqyC1shpAVjcJboRK5dTEvp3YQkRLJfcC7XOXPTEoP3GMldj1HPR-Imsuudt30IllylpR_1m-LVQfuEl4_3RfHj-svd7lt5-_3rze7qtjQNFUtJ77EGzoU0tRVMWMYtSts0DYWuRa0PndStga5uDjo7EJ0EASbbtRI5MKgvig-nvnMMv1ZMixpdMui9njCsSVHJm7ZjTHb_gVIqOGOCZfT9M3QIa5yykY0CqIHRbTY7USaGlCIe1BzdqONRUVBbZGpQW2Rqi0wBVzmyLHr32Hq9H9H-kTwFlIFPJwDztz04jCoZh5NB6yKaRdng_t3_8zO5yQk6o_1PPGL660MlpkDtt6XZdoYKAMahrX8DIae5dQ</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>van Aalderen, Willem M.C., MD, PhD</creator><creator>Grigg, Jonathan, MD</creator><creator>Guilbert, Theresa W., MD, MS</creator><creator>Roche, Nicolas, MD, PhD</creator><creator>Israel, Elliot, MD</creator><creator>Martin, Richard J., MD</creator><creator>Colice, Gene, MD</creator><creator>Postma, Dirkje S., MD, PhD</creator><creator>Hillyer, Elizabeth V., DVM</creator><creator>Burden, Anne, MSc</creator><creator>Thomas, Victoria, MSc</creator><creator>von Ziegenweidt, Julie</creator><creator>Price, David, FRCGP</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope><orcidid>https://orcid.org/0000-0002-9728-9992</orcidid></search><sort><creationdate>20150901</creationdate><title>Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma</title><author>van Aalderen, Willem M.C., MD, PhD ; Grigg, Jonathan, MD ; Guilbert, Theresa W., MD, MS ; Roche, Nicolas, MD, PhD ; Israel, Elliot, MD ; Martin, Richard J., MD ; Colice, Gene, MD ; Postma, Dirkje S., MD, PhD ; Hillyer, Elizabeth V., DVM ; Burden, Anne, MSc ; Thomas, Victoria, MSc ; von Ziegenweidt, Julie ; Price, David, FRCGP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c615t-1be304457c3d525d24de7d6661098eaaf97a8c0936fa603597050c201d7e40203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Administration, Inhalation</topic><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenal Cortex Hormones - adverse effects</topic><topic>Adrenergic beta-2 Receptor Agonists - administration & dosage</topic><topic>Adrenergic beta-2 Receptor Agonists - adverse effects</topic><topic>Allergy and Immunology</topic><topic>Asthma</topic><topic>Asthma - drug therapy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Childhood</topic><topic>Children & youth</topic><topic>Clinical medicine</topic><topic>Clinical trials</topic><topic>Cohort Studies</topic><topic>Drug Dosage Calculations</topic><topic>Female</topic><topic>Fluticasone</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Inhaled corticosteroid</topic><topic>Internal Medicine</topic><topic>Long-acting β2-agonist</topic><topic>Male</topic><topic>Microspheres</topic><topic>Particle Size</topic><topic>Small-particle beclomethasone</topic><topic>Step-up therapy</topic><topic>Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Aalderen, Willem M.C., MD, PhD</creatorcontrib><creatorcontrib>Grigg, Jonathan, MD</creatorcontrib><creatorcontrib>Guilbert, Theresa W., MD, MS</creatorcontrib><creatorcontrib>Roche, Nicolas, MD, PhD</creatorcontrib><creatorcontrib>Israel, Elliot, MD</creatorcontrib><creatorcontrib>Martin, Richard J., MD</creatorcontrib><creatorcontrib>Colice, Gene, MD</creatorcontrib><creatorcontrib>Postma, Dirkje S., MD, PhD</creatorcontrib><creatorcontrib>Hillyer, Elizabeth V., DVM</creatorcontrib><creatorcontrib>Burden, Anne, MSc</creatorcontrib><creatorcontrib>Thomas, Victoria, MSc</creatorcontrib><creatorcontrib>von Ziegenweidt, Julie</creatorcontrib><creatorcontrib>Price, David, FRCGP</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>The journal of allergy and clinical immunology in practice (Cambridge, MA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Aalderen, Willem M.C., MD, PhD</au><au>Grigg, Jonathan, MD</au><au>Guilbert, Theresa W., MD, MS</au><au>Roche, Nicolas, MD, PhD</au><au>Israel, Elliot, MD</au><au>Martin, Richard J., MD</au><au>Colice, Gene, MD</au><au>Postma, Dirkje S., MD, PhD</au><au>Hillyer, Elizabeth V., DVM</au><au>Burden, Anne, MSc</au><au>Thomas, Victoria, MSc</au><au>von Ziegenweidt, Julie</au><au>Price, David, FRCGP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma</atitle><jtitle>The journal of allergy and clinical immunology in practice (Cambridge, MA)</jtitle><addtitle>J Allergy Clin Immunol Pract</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>3</volume><issue>5</issue><spage>721</spage><epage>731.e16</epage><pages>721-731.e16</pages><issn>2213-2198</issn><eissn>2213-2201</eissn><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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26032474</pmid><doi>10.1016/j.jaip.2015.04.012</doi><orcidid>https://orcid.org/0000-0002-9728-9992</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Administration, Inhalation Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - adverse effects Adrenergic beta-2 Receptor Agonists - administration & dosage Adrenergic beta-2 Receptor Agonists - adverse effects Allergy and Immunology Asthma Asthma - drug therapy Child Child, Preschool Childhood Children & youth Clinical medicine Clinical trials Cohort Studies Drug Dosage Calculations Female Fluticasone Follow-Up Studies Humans Inhaled corticosteroid Internal Medicine Long-acting β2-agonist Male Microspheres Particle Size Small-particle beclomethasone Step-up therapy Studies Treatment Outcome |
| title | Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma |
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