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Spirometry to manage asthma in children: study protocol for a randomised controlled trial (SPIROMAC)
Victoria Bell1, Nicole Sergenson2, Seonaidh Cotton1
1Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK.
Insights
This study investigates if lung function tests (spirometry) can help prevent asthma attacks in children. Using spirometry alongside symptom monitoring may reduce exacerbations compared to symptom monitoring alone.
Area of Science:
- Pediatric Pulmonology
- Clinical Trials
- Respiratory Medicine
Background:
- Childhood asthma affects over 1 million UK children, with treatment relying on subjective symptom assessment.
- Current guidelines lack clear protocols for adjusting asthma treatment based on objective lung function (spirometry) changes.
- Spirometry offers an objective measure of lung function, valuable for guiding pediatric asthma management.
Purpose of the Study:
- To evaluate the efficacy of spirometry-guided asthma treatment in reducing asthma attacks in children.
- To determine if objective lung function measurements can improve asthma management strategies.
- To assess the impact of spirometry on pediatric asthma exacerbation rates.
Main Methods:
- Multi-centre randomized controlled trial involving children aged 6-15 years with a recent asthma exacerbation.
- Participants randomized to asthma treatment guided by spirometry plus symptoms or by symptoms alone.
- Primary outcome: number of asthma attacks requiring oral/intravenous corticosteroids over 12 months.
Main Results:
- The study is designed to evaluate the effectiveness of spirometry in reducing asthma attacks.
- Results will quantify the difference in exacerbation rates between the intervention and standard care groups.
- Secondary outcomes include time to first attack, asthma control, and quality of life.
Conclusions:
- This trial will determine if spirometry-guided asthma management reduces future asthma attacks in children.
- Findings may inform and update national and international pediatric asthma treatment guidelines.
- Objective lung function monitoring shows potential for improving asthma care outcomes.
Background:
Asthma affects over 1 million children across the UK, and preventative treatment is guided subjectively by patient symptoms. Spirometry is an objective test of lung function and can be used in children to guide treatment. However, current guidelines do not indicate how asthma treatment should change in the context of changing spirometry results. This study will evaluate how spirometry can be used to guide asthma treatment and reduce the risk for asthma attacks in children.
Methods:
This is a multi-centre, randomised controlled trial. Children aged 6-15 years, who have a diagnosis of asthma and have had an exacerbation requiring oral or intravenous corticosteroids in the previous 12 months, will be eligible. Exclusion criteria include being unable to provide spirometry measurement at baseline assessment, having another chronic respiratory condition and being currently treated with maintenance oral steroids or biologicals. Participants will be recruited in both primary and secondary care settings and will be randomised to either receive asthma treatment guided by spirometry plus symptoms (intervention group) or asthma treatment guided by symptoms only (standard care group). Within the spirometry group, treatment recommendations will be dependent on changes in spirometry measurements. Participants will attend assessments 3, 6, 9 and 12 months post-randomisation, where treatment recommendations will be made. The primary outcome is the number of asthma attacks per participant requiring treatment with 1-7 days of oral or intravenous corticosteroid over 12 months, as recorded by the participant or parent. Secondary outcomes include time to first attack, any asthma attack, adverse events, dose of inhaled corticosteroids, asthma control and quality of life. Adherence to inhaled corticosteroid treatment is measured by an electronic logging device.
Discussion:
This study will evaluate whether asthma treatment guided by spirometry will reduce future asthma attacks in children. Our findings may be relevant to national and international asthma guidelines.
Trial Registration:
ISRCTN, ISRCTN31849868. Registered on 01.07.2022. Prospectively registered.
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