Small airways targeting of inhaled steroids for severe therapy resistant asthma in children

Abstract

Background: About 5% of all children with asthma have severe therapy resistant asthma (STRA) with decreased quality of life. Current devices for inhaled drugs do not effectively target small airways. The controlled-inhalation smart nebulizer Akita^® Jet has efficient deposition in the small airways.

Aim: Retrospective follow-up till 12 months of children with STRA treated with high dose ICS using the Akita^® Jet.

Methods: Fourteen children aged 4-17 years with STRA used the Akita^® Jet for high dose ICS (start dose either fluticasone 2mg bid or budesonide 1mg bid) and bronchodilators. ICS were tapered based on symptoms. Primary endpoints: FEV₁ and FEF₇₅. Data about lung function, asthma symptoms, exercise tolerance, exacerbations and hospital admissions were collected retrospectively from patient charts.

Results: Three patients discontinued treatment. Eleven of 14 patients used the Akita^® Jet 6 months or longer. Table 1 shows improvement in FEV₁ and FEF₇₅ in time. The children reported less asthma symptoms and increased exercise tolerance and there were less prednisone courses and admissions. However 3 children (27.3%) showed a deflection in length of ≥0.25 SDS.

Conclusion: Asthma symptoms and lung function improved substantially with high dose ICS with the Akita^® Jet in children with STRA, although with a risk of side effects. This retrospective study does not allow to conclude whether the improvement was due to the high dose ICS, improved targeting of ICS to the small airways, or both.