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[Application of asthma predictive index-based group therapy in wheezing children under 5 years of age]
Ya-Qin Li1, Hai-Yan Xue, Wei Chen
1Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China. clf530417@126.com.
Insights
Asthma Predictive Index (API) guides therapy for wheezing children under 5. Montelukast sodium showed better outcomes than inhaled corticosteroids in API-positive children after 24 weeks.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Pharmacotherapy
Context:
- Wheezing in children under 5 is a common clinical challenge.
- Accurate diagnosis and effective treatment are crucial for long-term respiratory health.
- The Asthma Predictive Index (API) aids in identifying children at higher risk for persistent asthma.
Purpose:
- To evaluate the clinical utility of the Asthma Predictive Index (API) in guiding group therapy for young children with wheezing.
- To compare the efficacy of inhaled corticosteroids (ICS) and montelukast sodium (leukotriene receptor antagonist, LTRA) in different API-defined subgroups.
- To assess treatment outcomes based on API status and therapeutic strategy.
Summary:
- A study involving 239 wheezing children under 5 compared ICS and LTRA treatments stratified by API status.
- Both ICS and LTRA showed initial effectiveness. After 24 weeks, LTRA demonstrated superior outcomes in API-positive children, while no significant difference was observed in API-negative children.
- Therapeutic strategies tailored by API during stable disease periods can optimize wheezing control in young children.
Impact:
- Provides evidence for personalized asthma management in pediatric populations.
- Informs clinical decision-making regarding the choice between ICS and LTRA based on API risk stratification.
- Contributes to improved long-term asthma control and reduced healthcare burden in young wheezing patients.
Objective:
To study the application value of asthma predictive index (API)-based group therapy in wheezing children under 5 years of age.
Methods:
A total of 239 wheezing children under 5 years of age were divided into API-positive (n=126) and API-negative groups (n=113). Each group was randomly assigned to inhaled corticosteroids (ICS) subgroup and montelukast sodium (leukotriene receptor antagonist, LTRA) subgroup. The ICS and LTRA subgroups received the same drug therapy at the same dosage within the first four weeks of treatment. In the stable period of disease, the ICS subgroup only received aerosol inhalation of budesonide suspension, while the LTRA group was orally given montelukast sodium only. Asthma symptom scores were assessed and recorded at different time points.
Results:
In the first four weeks of treatment, ICS and LTRA were effective both in the API-positive and API-negative groups; the two groups showed significant improvements in asthma symptom scores, and the asthma symptom score showed no significant difference between the ICS and LTRA subgroups of each group. After 24 weeks of treatment, the two therapies were still effective; in the API-positive group, the LTRA subgroup had a better treatment outcome than the ICS subgroup, but there was no significant difference in treatment outcome between the LTRA and ICS subgroups of the API-negative group.
Conclusions:
For wheezing children under 5 years of age, therapeutic strategies can be chosen based on API in the stable period of disease, so as to better control wheezing.
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