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Inhaled Corticosteroid-Long-Acting Beta-2 Agonist Fixed-Dose Combinations: Preferred Controller in 6- to 11-Year-Olds
Gizem Koken1, Sinem Polat Terece2, Ceren Varer Akpinar3
1Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey, kokengizem@gmail.com.
Insights
Inhaled corticosteroid-long-acting beta-2 agonist (ICS-LABA) combinations are more effective than ICS alone for preventing asthma exacerbations in children aged 6-11. These fixed-dose combinations are recommended as preferred controllers for persistent asthma.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Pharmacotherapy
Background:
- Persistent asthma in children aged 6-11 lacks direct comparative data between inhaled corticosteroid (ICS) monotherapy and ICS-long-acting beta-2 agonist (ICS-LABA) fixed-dose combinations.
- Current treatment guidelines place children in steps 2-4, with varying controller options.
Purpose of the Study:
- To compare the efficacy of ICS monotherapy versus ICS-LABA fixed-dose combination therapies in reducing asthma exacerbations requiring systemic corticosteroids (CS) in children aged 6-11.
- To evaluate controller medication effectiveness in managing persistent asthma in pediatric patients.
Main Methods:
- Retrospective analysis of electronic health records for children aged 6-11 with persistent asthma on ICS-containing treatments (fluticasone propionate [FP], fluticasone propionate/salmeterol [FP/SAL], budesonide/formoterol [BUD/F]) from January 2021 to January 2024.
- Data collected included asthma controller medication, frequency of exacerbations (requiring systemic CS, ED visits, or hospitalization), and pneumonia incidence.
Main Results:
- ICS-LABA fixed-dose combinations (FP/SAL, BUD/F) demonstrated significantly lower frequencies of all exacerbations, CS-requiring exacerbations, and ED visit/hospitalization exacerbations compared to ICS monotherapy (FP).
- No significant differences were observed between the FP/SAL and BUD/F groups for any exacerbation parameters.
- Pneumonia incidence was low in fixed-dose combination groups, precluding statistical comparison.
Conclusions:
- ICS-LABA fixed-dose combination therapies are more effective than ICS monotherapy in preventing asthma exacerbations in 6-11-year-old children.
- These combination therapies represent a preferred controller option for managing persistent asthma in this pediatric population.
Introduction:
So far, there is no direct comparison between inhaled corticosteroid (ICS) monotherapy and ICS-long-acting beta-2 agonists (LABA) fixed-dose combination therapies in 6- to 11-year-old children with persistent asthma. The primary objective of this study was to compare ICS monotherapy and ICS-LABA fixed-dose combination therapies for the frequency of exacerbations requiring systemic corticosteroids (CS).
Methods:
Patients aged 6-11 years diagnosed with persistent asthma during steps 2-4 of treatment, prescribed daily ICS-containing treatment (fluticasone propionate [FP], fluticasone propionate/salmeterol [FP/SAL], and budesonide/formoterol [BUD/F]), and followed for at least 1 year at our institution from January 2021 to January 2024 were included. The hospital's electronic database was used to retrospectively record asthma controller medication, frequency of asthma exacerbations (including those requiring systemic CS, emergency department [ED] visit and/or hospitalization) and pneumonia.
Results:
The frequency of all exacerbations, exacerbations requiring systemic CS, and exacerbations requiring ED visit/hospitalization were significantly higher in the FP group compared to the FP/SAL and BUD/F groups (p < 0.001, p = 0.003, p < 0.001, respectively). There were no significant differences between the FP/SAL and BUD/F groups concerning all exacerbation parameters (p > 0.05). The incidence of pneumonia was very low in the fixed-dose combination groups, making a statistical comparison unfeasible.
Conclusion:
ICS-LABA fixed-dose combination therapies have been found to be more effective than ICS monotherapy in preventing asthma exacerbations in 6-11-year-old children with persistent asthma and could be recommended as the preferred controllers.
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