RT Journal Article
SR Electronic
T1 Comparative effectiveness of paediatric asthma step-up options: Increasing ICS dose vs adding separate LABA
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 434
VO 44
IS Suppl 58
A1 Clare S. Murray
A1 Stephen Turner
A1 Mike Thomas
A1 Kathryn Richardson
A1 Annie Burden
A1 Daniel West
A1 David Price
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/434.abstract
AB Aim: In children who remain symptomatic despite maintenance inhaled corticosteroid therapy (ICS), step-up options include addition of a long-acting beta-agonist (LABA) or increasing existing ICS dose (INC). We compared the effectiveness of adding a separate LABA (+LABA) vs INC in a real-life paediatric population.Method: Clinical records were selected from 2 UK databases for patients aged 5–12yrs with an asthma diagnosis who stepped up therapy as +LABA or INC, had 1 year of baseline data prior to, and 1 year of outcome data after, step up. Patients were matched on baseline age, step-up year, ICS dose, reliever usage & exacerbations (EXBs). Outcomes over the following year included EXBs: oral steroid courses with evidence of respiratory review, asthma-related hospital admission or emergency room attendance, and asthma control (AC), defined as absence of: exacerbations, asthma-related out patient appointments, and antibiotic prescription following respiratory review. Conditional logistic/negative binomial regression was used to adjust for residual confounders.Results: +LABA and INC patients were matched 1:1 (n=3129). 59% were boys, mean(standard deviation[SD]) age was 9(2)yrs. Mean(SD) exacerbations were 0.09(0.37) and 0.07(0.31) for +LABA and INC patients, respectively.View this table:Outcome summary: adjusted odds/rate ratio (AOR/ARR)Conclusion: Compared with addition of separate LABA therapy, increasing ICS dose achieved significantly lower exacerbation rates and similar attainment of AC. Further work will compare INC vs addition of LABA as part of a fixed dose combination.