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Patterns of inhaled corticosteroid use and asthma control in the Childhood Asthma Management Program Continuation
Gregory S Sawicki1, Robert C Strunk, Brooke Schuemann
1Division of Respiratory Diseases, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. gregory.sawicki@childrens.harvard.edu
Insights
Many children with asthma do not achieve control despite using inhaled corticosteroids (ICS). Consistent ICS use was linked to poorer asthma control in this study, suggesting challenges in managing pediatric asthma effectively.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Clinical Observational Studies
Background:
- Daily controller medication, specifically inhaled corticosteroids (ICS), is recommended for persistent asthma in children.
- Achieving optimal asthma control remains a challenge for many pediatric patients.
Purpose of the Study:
- To investigate patterns of inhaled corticosteroid (ICS) use among children and adolescents with mild-to-moderate asthma.
- To evaluate the association between ICS usage patterns and asthma control status.
Main Methods:
- An observational study assessed ICS use patterns (consistent, intermittent, none) over 12 months.
- Asthma control was categorized as well-controlled or poorly controlled.
- Multivariate logistic regression analyzed the relationship between ICS use patterns and asthma control.
Main Results:
- Consistent ICS use decreased significantly over four years, while no ICS use increased.
- 18% of encounters reported poorly controlled asthma.
- Consistent ICS users were more likely to report poor asthma control compared to non-users, even after adjusting for covariates.
Conclusions:
- Most children and adolescents in the study did not maintain consistent ICS use.
- Consistent ICS use was paradoxically associated with poorer asthma control in this cohort.
- Findings suggest potential issues with ICS effectiveness or adherence in achieving well-controlled asthma in pediatric populations, warranting further investigation into residual confounding factors.
Background:
Daily controller medication use is recommended for children with persistent asthma to achieve asthma control.
Objective:
To examine patterns of inhaled corticosteroid (ICS) use and asthma control in an observational study of children and adolescents with mild-to-moderate asthma (the Childhood Asthma Management Program Continuation Study).
Methods:
We assessed patterns of ICS use during a 12-month period (consistent, intermittent, and none) and asthma control (well controlled vs poorly controlled). Multivariate logistic regression examined the association between pattern of ICS use and asthma control.
Results:
Of 914 patients enrolled, 425 were recommended to continue receiving ICS therapy in the Childhood Asthma Management Program Continuation Study. Of these patients, 46% reported consistent ICS use and 20% reported no ICS use during year 1. By year 4, consistent ICS use decreased to 20%, whereas no ICS use increased to 57%; poorly controlled asthma was reported in 18% of encounters. In multivariate models controlling for age, sex, forced expiratory volume in 1 second, and asthma severity assessment, patients reporting consistent ICS use during a 12-month period were more likely to report poor asthma control (odds ratio, 1.6; 95% confidence interval, 1.2-2.1) compared with those reporting no ICS use.
Conclusions:
In this observational study of children and adolescents with mild-to-moderate asthma, most did not report continued use of ICS. Patients recommended to continue receiving ICS therapy and reporting consistent ICS use were less likely to report well-controlled asthma even after controlling for markers of asthma severity. Although residual confounding by severity cannot be ruled out, many children and adolescents may not achieve well-controlled asthma despite consistent use of ICS.
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