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Problematic severe asthma in children treated at high altitude: tapering the dose while improving control
Erik-Jonas van de Griendt1, Marieke Verkleij, J Menno Douwes
1Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Center , Amsterdam , The Netherlands .
Summary
High altitude multidisciplinary treatment may help children with problematic severe asthma (PSA) reduce inhaled corticosteroids (ICS). However, patient health status at the start of treatment does not predict ICS tapering success.
Area of Science:
- Pediatric Pulmonology
- Environmental Medicine
- Asthma Management
Background:
- Problematic severe asthma (PSA) in children often requires high medication doses.
- Multidisciplinary treatment at high altitude is explored as an option to reduce medication, including inhaled corticosteroids (ICS).
Purpose of the Study:
- To evaluate the efficacy of high-altitude multidisciplinary treatment for pediatric PSA.
- To determine if pre-treatment variables predict the ability to taper ICS.
- To assess changes in lung function, inflammation, asthma control, and quality of life.
Main Methods:
- Prospective cohort study of 43 children (aged 8-17) with PSA.
- Evaluated lung function (FEV1, FEV1/VC), FeNO, ICS dosage, asthma control (ACT), and quality of life (PAQLQ(S)) at admission and discharge.
- Analyzed demographic data, disease control, and quality of life for prediction of ICS tapering.
Main Results:
- 74% of children met PSA criteria; 7% used oral steroids.
- Mean ICS dosage reduced significantly after ~72 days.
- All patients discontinued oral steroids; FeNO, asthma control, and quality of life improved significantly (p<0.001).
- No pre-treatment variables predicted ICS reduction, except for initial ICS levels.
Conclusions:
- High-altitude treatment offers a potential therapeutic option for children with PSA.
- Pre-treatment health status variables are not reliable predictors for successful ICS tapering in this population.
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