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Published on: April 6, 2017
Real-world comparison of inhaled corticosteroid monotherapy versus fixed-dose inhaled corticosteroid/long-acting
Muhammet Kaya1, Hülya Anıl1, Niyazi Onur Şapci1
1Department of Pediatric Allergy and Immunology, Faculty of Medicine, Eskisehir Osmangazi University, Meselik, Turkey.
Insights
In children with persistent asthma, inhaled corticosteroid monotherapy and combination therapies showed similar effectiveness in preventing exacerbations. No single controller therapy was clearly superior for this age group.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Pharmacotherapy
Background:
- Persistent asthma in children aged 6-11 years requires effective management.
- Evidence on early use of inhaled corticosteroid (ICS)-long-acting beta-2 agonist (LABA) combination therapies in this age group is limited.
- Comparing ICS monotherapy with fixed-dose ICS/LABA is crucial for treatment optimization.
Purpose of the Study:
- To compare the effectiveness of ICS monotherapy, fixed-dose ICS/salmeterol, and fixed-dose ICS/formoterol in preventing asthma exacerbations in children aged 6-11 years.
- To assess the need for systemic corticosteroids as a primary outcome for asthma exacerbations.
- To evaluate emergency department visits and hospitalizations as secondary outcomes.
Main Methods:
- Retrospective study of children aged 6-11 years with persistent asthma, followed for at least 1 year.
- Patients were grouped by inhaled therapy: ICS monotherapy, fixed-dose ICS/salmeterol, or fixed-dose ICS/formoterol (GINA steps 2-4).
- Asthma exacerbations were defined by systemic corticosteroid use, emergency visits, or hospitalization.
Main Results:
- A total of 296 children were analyzed: 184 on ICS monotherapy, 47 on ICS/salmeterol, and 65 on ICS/formoterol.
- No significant differences were observed in the rate of asthma exacerbations requiring systemic corticosteroids among the three treatment groups (p=0.93).
- Emergency department visits (p=0.805) and hospital admissions (p=0.383) were also comparable across groups.
Conclusions:
- In children aged 6-11 years with persistent asthma, ICS monotherapy, ICS/salmeterol, and ICS/formoterol showed similar efficacy in preventing exacerbations.
- Current controller therapies do not demonstrate clear superiority for preventing asthma exacerbations in this pediatric population.
- Further research may be needed to identify optimal treatment strategies for pediatric persistent asthma.
Abstract:
In children aged 6-11 years with persistent asthma, earlier use of inhaled corticosteroid (ICS)-long-acting beta-2 agonist combination therapies has become a topic of increasing interest in recent years; however, available evidence in this age group remains limited. This study aimed to compare ICS monotherapy, fixed-dose ICS/salmeterol, and fixed-dose ICS/formoterol therapies regarding asthma exacerbations requiring systemic corticosteroids.
Methods:
This retrospective study included children aged 6-11 years with persistent asthma who were followed for at least 1 year while receiving regular inhaled therapy between January 2021 and August 2024. Patients classified as The Global Initiative for Asthma (GINA) steps 2-4 were grouped according to treatment with ICS monotherapy, fixed-dose ICS/salmeterol, or fixed-dose ICS/formoterol. Asthma exacerbations were assessed based on the need for systemic corticosteroids, emergency department visits, and/or hospitalization.
Results:
A total of 296 children aged 6-11 years with persistent asthma met the inclusion criteria: 184 received fluticasone propionate (FP), 47 received fluticasone propionate/salmeterol (FP/SAL), and 65 received budesonide/formoterol (BUD/FOR). The groups differed in age at initiation of inhaled therapy (p < 0.001) and duration of follow-up (p = 0.014). Overall, 113 patients (38.2%) experienced at least one asthma exacerbation during follow-up, with no significant difference among FP, FP/SAL, and BUD/FOR groups (p = 0.93). Rates of emergency department visits and hospital admissions were also comparable between groups (p = 0.805 and p = 0.383, respectively), and no significant differences were found regarding systemic corticosteroid-requiring asthma exacerbations.
Conclusions:
In children aged 6-11 years with persistent asthma, no single controller therapy demonstrated clear superiority in preventing asthma exacerbations.
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