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Published on: November 4, 2010
Individualized therapy for persistent asthma in young children
Anne M Fitzpatrick1, Daniel J Jackson2, David T Mauger3
1Emory University, Department of Pediatrics, Atlanta, GA.
Insights
Identifying asthma phenotypes in young children is key. Aeroallergen sensitization and high eosinophil counts predict better response to daily inhaled corticosteroids (ICSs) for asthma control.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Trial Research
Background:
- Asthma presentations vary in young children, influencing treatment effectiveness.
- Step 2 asthma therapy in toddlers requires tailored approaches.
- Understanding differential medication responses is crucial for effective asthma management.
Purpose of the Study:
- To investigate differential responses to asthma controller medications in toddlers.
- To identify predictors of treatment response in pediatric asthma.
- To evaluate the efficacy of inhaled corticosteroids (ICSs) versus leukotriene receptor antagonists.
Main Methods:
- A multicenter, randomized, double-blind, double-dummy trial involving 300 children aged 12-59 months with asthma.
- Crossover design comparing daily ICS, daily leukotriene receptor antagonists, and as-needed ICS with albuterol.
- Primary outcome: composite measure of asthma control; secondary analysis: prediction of differential response by sensitization, exacerbations, and sex.
Main Results:
- 74% of children showed differential responses to the three treatment strategies.
- Daily ICS provided the best response probability, particularly in those with aeroallergen sensitization.
- Aeroallergen sensitization and blood eosinophil counts ≥300/μL identified children benefiting most from daily ICS.
Conclusions:
- Phenotyping young children with asthma using aeroallergen sensitization and eosinophil counts guides treatment selection.
- Daily ICS is beneficial for children with high exacerbation probability and specific biomarkers.
- This approach optimizes asthma control in toddlers, balancing efficacy and potential risks.
Background:
Phenotypic presentations in young children with asthma are varied and might contribute to differential responses to asthma controller medications.
Methods:
The Individualized Therapy for Asthma in Toddlers study was a multicenter, randomized, double-blind, double-dummy clinical trial in children aged 12 to 59 months (n = 300) with asthma necessitating treatment with daily controller (Step 2) therapy. Participants completed a 2- to 8-week run-in period followed by 3 crossover periods with daily inhaled corticosteroids (ICSs), daily leukotriene receptor antagonists, and as-needed ICS treatment coadministered with albuterol. The primary outcome was differential response to asthma medication based on a composite measure of asthma control. The primary analysis involved 2 stages: determination of differential response and assessment of whether 3 prespecified features (aeroallergen sensitization, previous exacerbations, and sex) predicted a differential response.
Results:
Seventy-four percent (170/230) of children with analyzable data had a differential response to the 3 treatment strategies. Within differential responders, the probability of best response was highest for a daily ICS and was predicted by aeroallergen sensitization but not exacerbation history or sex. The probability of best response to daily ICS was further increased in children with both aeroallergen sensitization and blood eosinophil counts of 300/μL or greater. In these children daily ICS use was associated with more asthma control days and fewer exacerbations compared with the other treatments.
Conclusions:
In young children with asthma necessitating Step 2 treatment, phenotyping with aeroallergen sensitization and blood eosinophil counts is useful for guiding treatment selection and identifies children with a high exacerbation probability for whom treatment with a daily ICS is beneficial despite possible risks of growth suppression.
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