The phenotype of severe preschool asthmatics and their response to add-on therapy
CPS ePoster Library. Seaton C. Jun 1, 2017; 176656
Dr. Claire Seaton
Dr. Claire Seaton
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Abstract
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Background: The largest burden of asthma disease in British Columbia is in pre-school aged children, accounting for 50% of hospital admissions and 44% of Emergency Room (ER) visits. Diagnosis and management of asthma in this age group is controversial, with limited evidence and no guidelines addressing treatment beyond moderate-dose inhaled corticosteroids (ICS).

Objectives: The aim of this study was to describe the phenotype of preschool children who continued to have exacerbations despite moderate doses of ICS, and assess their response to treatment escalation.

Methods: Retrospective chart review of 1-6 year old children seen at an asthma clinic between August 2014 and April 2015. Children were included if they had ≥3 clinic visits to enable comparison between data before and after escalation of therapy. Data were entered into electronic charts using standardized data forms, including asthma phenotype, medication use and health care utilization before and after addition of high dose ICS, leukotriene receptor antagonists (LRTA) or long acting beta agonists (LABA) (groups 1-3). A control group on low to moderate dose ICS therapy alone was identified for comparison (group 4). The Mann-Whitney U test was used to compare non-normally distributed continuous variables.

Results: 167 patients were identified - baseline characteristics including age, sex, atopic status and asthma trigger were similar between groups. The escalation of therapy groups (groups 1-3) were similar to the control group (group 4) with the majority of children in all groups being male, having a known history of atopy, and exclusively triggered by viruses (Table 1). Baseline severity in the 3 therapy escalation groups was similar with regards to ER visits, steroid use and hospitalizations in the previous 12 months, although as expected, these groups had more courses of systemic steroids than the control group.Adding LABA to ICS resulted in a significant reduction in ER visits (median 0.5 courses/month reduced to 0, p=0.015) and steroid use (median 0.4 courses/month reduced to 0, p=0.013) over a median follow-up period of 1.8 months. There was no statistically significant difference in steroid use or ER visits following either high dose ICS or LTRA add on therapy, or in hospitalization rate following any add-on therapy.

Conclusion: The majority of severe preschool asthmatics are exclusively triggered by viruses. The addition of LABA to ICS shows a significant reduction in severe exacerbations over this short follow-up period and warrants further study in the pre-school age group.

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