An assessment of the predictive value of low risk criteria for children with intermittent asthma

Area of Science:

• Pediatric Pulmonology
• Clinical Asthma Management
• Health Outcomes Research

Background:

• Current asthma guidelines recommend concurrent use of short-acting beta-agonists (SABA) and inhaled corticosteroids (ICS) to mitigate severe exacerbations.
• This approach may not be optimal for all patients, particularly those at low risk for severe asthma events.

Purpose of the Study:

• To evaluate the association between SABA dispensing and severe asthma exacerbations in low-risk pediatric patients.
• To inform personalized treatment strategies for asthma management in children.

Main Methods:

• A retrospective cohort study utilized claims data from Texas Children's Health Plan (2016-2018).
• Inclusion criteria focused on children aged 1 to <18 years with asthma, limited SABA use (≤2 canisters), and no ICS, oral corticosteroids, hospitalizations, or ED visits in the baseline year.
• Outcomes assessed included asthma-related hospitalizations and emergency department visits in the subsequent follow-up year.

Main Results:

• The study included 45,230 eligible pediatric members.
• No significant difference in asthma hospitalization rates was observed between children with no SABA dispensing (1.1/1000) and those with limited SABA use (1.5/1000; p=0.3).
• Similarly, emergency department visit rates showed no significant difference (14/1000 vs. 17/1000; p=0.08). Adjusted analyses confirmed no difference in hospitalization rates (OR: 0.99, 95% CI: 0.54-1.81).

Conclusions:

• Low-risk pediatric asthma patients can be identified based on their baseline medication dispensing patterns.
• Findings suggest that the standard recommendation of combining SABA with ICS may not be necessary for all low-risk children, potentially allowing for tailored treatment approaches.