Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

Area of Science:

• Pediatric Pulmonology
• Pharmacological Interventions
• Respiratory Health

Background:

• Recurrent wheezing in preschoolers is common, often managed with short-acting β-agonists (SABA).
• Inhaled corticosteroids (ICS) and leukotriene receptor antagonists (LTRA) are sometimes used to prevent asthma attacks in this population.
• The comparative effectiveness of ICS and LTRA versus SABA alone for preventing wheezing/asthma attacks in young children is not well-established in real-world settings.

Purpose of the Study:

• To assess the real-world effectiveness of inhaled corticosteroids (ICS) or leukotriene receptor antagonists (LTRA) in preventing wheezing/asthma attacks in preschoolers.
• To compare the outcomes of adding ICS or LTRA to short-acting β-agonist (SABA) therapy versus SABA monotherapy.

Main Methods:

• A historical matched cohort study utilizing UK electronic medical records.
• Included preschool children (1-5 years) with at least two wheezing episodes in a baseline year.
• Children initiating ICS or LTRA were matched 1:4 to those prescribed only SABA, controlling for baseline characteristics. Asthma attacks were defined as emergency attendance, hospital admission, or acute oral corticosteroid prescription.

Main Results:

• No significant difference in the odds of wheezing/asthma attacks was observed between the ICS and SABA groups (OR 1.01, 95% CI 0.85-1.19).
• Similarly, no significant difference was found between the LTRA and SABA groups (OR 1.28, 95% CI 0.96-1.72).
• The study included 990 children in the ICS vs. SABA comparison and 259 in the LTRA vs. SABA comparison.

Conclusions:

• Initiating inhaled corticosteroids (ICS) or leukotriene receptor antagonists (LTRA) therapy did not demonstrate a reduction in wheezing/asthma attacks compared to short-acting β-agonist (SABA) alone in preschool children with recurrent wheeze.
• These findings suggest that for a broad group of preschoolers with recurrent wheeze, adding ICS or LTRA to SABA may not provide additional benefit in preventing acute exacerbations in a real-world clinical setting.
• Further research may be needed to identify specific subgroups of preschool children who might benefit from ICS or LTRA therapy.