Long-term asthma treatment guided by airway hyperresponsiveness in children. a randomized controlled trial

¹ Juliana Children's Hospital, Dept of paediatric Respiratory Medicine, The Hague, The Netherlands
² Erasmus University Medical Center, Dept of Epidemiology and Biostatistics, Rotterdam, The Netherlands
³ Leiden University Medical Center, Dept of Pulmonology, Leiden, The Netherlands
⁴ University Medical Center Groningen, Dept of paediatric Respiratory Diseases, Groningen, The Netherlands
⁵ Erasmus University Medical Center/Sophia Children's Hospital, Dept of paediatric Respiratory Medicine, Rotterdam, The Netherlands

^* To whom correspondence should be addressed. E-mail: j.c.dejongste{at}erasmusmc.nl.

	Abstract

Management plans for childhood asthma have limited success in optimizing asthma control. We assessed, in asthmatic children, whether a treatment strategy guided by airway hyperresponsiveness (AHR) increases the number of symptom-free days and improves lung function, as compared to a symptom driven reference strategy.

In a multi-centre, double blind, parallel group randomized 2-year intervention trial, we studied 210 children (6-16y) with moderate atopic asthma, selected on the basis of symptom scores and/or presence of AHR. At 3-monthly visits symptom scores, FEV₁ and methacholine challenges were obtained and medication (5 levels of fluticasone with or without salmeterol) adjusted according to algorithms based on symptom score (reference strategy, n=104), or AHR and symptom score (AHR strategy, n=102).

After 2 years, we found no difference in % symptom-free days between the treatment strategies. Prebronchodilator FEV₁ was higher in the AHR strategy (2·3% predicted, p=0·046). This was entirely explained by a gradual worsening of FEV₁ in a subgroup of 91 hyperresponsive children enrolled with low symptom scores (final difference between study arms: 6%, p=0.017).

Two years of asthma treatment guided by AHR had no benefits in terms of symptom free days, but produced a better outcome of pre-bronchodilator FEV₁ in allergic asthmatic children, especially those characterized by low symptom scores despite AHR.

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