Inhaled corticosteroids are recommended as first-line therapy for children with persistent asthma; however, specific patient characteristics may modify the treatment response.
[Photo: Dr. Joe Gerald]
A study led by Dr. Joe Gerald, assistant professor at the University of Arizona Mel and Enid Zuckerman College of Public Health found that children with mild persistent asthma who have markers of atopic asthma or who have greater asthma burden may obtain greater benefit from beclomethasone therapy than those without such markers. The study was published recently in the Journal of Allergy and Clinical Immunology: In Practice.
The researchers looked at demographic, clinical and physiologic characteristics that may modify the inhaled corticosteroid treatment response among children enrolled in the Treating Children to Prevent Exacerbations of Asthma (TREXA) trial.
Children aged 6 to 18 years with mild persistent asthma were randomized to 44 weeks of combined, daily, or rescue treatment with an inhaled cortiocosteroid or placebo treatment. Daily treatment consisted of 40 μg of beclomethasone twice daily. Rescue treatment consisted of 40 μg of beclomethasone accompanying each symptom-driven albuterol actuation. Combined treatment consisted of both. Outcomes included time to first exacerbation and proportion of asthma control days. Fourteen baseline characteristics were selected for interaction testing on the basis of their clinical relevance.
Two hundred eighty-eight children were randomized. Seventy-five percent were White, and 55 percent were male. As measured by time to first exacerbation, four characteristics identified children who received greater benefit from treatment: non-Hispanic ethnicity, positive aeroallergen skin test result, serum immunoglobulin E level of 350 K/μL or more, and history of oral corticosteroid use in the year before enrollment. As measured by asthma control days, 4 characteristics identified children who received greater benefit from treatment: male sex, positive aeroallergen skin test result, serum immunoglobulin E level of 350 K/μL or more, and incomplete run-in asthma control.
When parents and physicians must decide when inhaled corticosteroids are needed, they can be most confident that children will benefit when there is a history of significant allergies, when asthma-specific antibodies are present in the blood, or when asthma symptoms are frequent or severe. Nevertheless, treatment should never be withheld simply because these markers are absent. Instead, parents and physicians should consider each child’s unique situation and decide when treatment is likely to improve the child’s ability to breathe well, participate fully in all of life’s activities, and reduce their risk of an asthma attack. Additional study is needed to confirm whether these markers can guide individualized therapy.
Link: Markers of differential response to inhaled corticosteroid treatment among children with mild persistent asthma. http://www.sciencedirect.com/science/article/pii/S2213219815000525