Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

Jonathan Grigg; Anjan Nibber; James Y Paton; Alison Chisholm; Theresa W Guilbert; Alan Kaplan; Steve Turner; Nicolas Roche; Elizabeth V Hillyer; David B Price; Respiratory Effectiveness Group

doi:10.2147/JAA.S178531

Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

J Asthma Allergy. 2018 Dec 11:11:309-321. doi: 10.2147/JAA.S178531. eCollection 2018.

Authors

Collaborators

Respiratory Effectiveness Group:
Willem M C van Aalderen¹⁰, Clare S Murray¹¹, Wanda Phipatanakul¹², Samatha Sonnappa¹³, Teoh Oon Hoe¹⁴, Richard J Martin¹⁵, Alberto Papi¹⁶, Stanley J Szefler¹⁷, Derek Skinner¹⁸, R Brett McQueen¹⁹, Omar S Usmani²⁰

Affiliations

¹ Blizard Institute, Queen Mary University of London, London, UK, [email protected].
² Respiratory Effectiveness Group, Cambridge, UK.
³ School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK.
⁴ Pulmonary Division, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
⁵ Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada.
⁶ Department of Child Health, Royal Aberdeen Children's Hospital, University of Aberdeen, Aberdeen, UK.
⁷ Respiratory Medicine, Cochin Hospital Group, AP-HP, University of Paris Descartes (EA2511), Paris, France.
⁸ Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.
⁹ Academic Primary Care, University of Aberdeen, Aberdeen, UK.
¹⁰ Department of Pediatric Respiratory Medicine and Allergy, Emma Children’s Hospital AMC, Amsterdam, the Netherlands.
¹¹ Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, The University of Manchester, University Hospital of South Manchester, and Royal Manchester Children’s Hospital, Manchester, UK.
¹² Division of Allergy and Immunology, Boston Children’s Hospital, and Harvard Medical School, Boston, MA, USA.
¹³ Department of Respiratory Paediatrics, Rainbow Children’s Hospital, Bengaluru, India, and Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.
¹⁴ Department of Paediatrics, Respiratory Medicine Service, KK Women’s and Children’s Hospital, Singapore, Singapore.
¹⁵ Department of Medicine, National Jewish Health, and University of Colorado Denver, Denver, CO, USA.
¹⁶ Department of Respiratory Medicine, University Hospital S. Anna, Ferrara, Italy.
¹⁷ Breathing Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
¹⁸ Optimum Patient Care, Cambridge, UK.
¹⁹ University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
²⁰ Airway Disease Section, National Heart and Lung Institute, Imperial College London, and Royal Brompton Hospital, London, UK.

Abstract

Background: An inhaled corticosteroid (ICS) or leukotriene receptor antagonist (LTRA) may prevent wheezing/asthma attacks in preschoolers with recurrent wheeze when added to short-acting β-agonist (SABA).

Objective: The aim of this historical matched cohort study was to assess the effectiveness of these treatments for preventing wheezing/asthma attacks.

Methods: Electronic medical records from the Optimum Patient Care Research Database were used to characterize a UK preschool population (1-5 years old) with two or more episodes of wheezing during 1 baseline year before first prescription (index date) of ICS or LTRA, or repeat prescription of SABA. Children initiating ICS or LTRA on the index date were matched 1:4 to those prescribed only SABA for age, sex, year of index prescription, mean baseline SABA dose, baseline attacks, baseline antibiotic prescriptions, and eczema diagnosis. Wheezing/asthma attacks (defined as asthma-related emergency attendance, hospital admission, or acute oral corticosteroid prescription) during 1 outcome year were compared using conditional logistic regression.

Results: Matched ICS and SABA cohorts included 990 and 3,960 children, respectively (61% male; mean [SD] age 3.2 [1.3] years), and matched LTRA and SABA cohorts included 259 and 1,036 children, respectively (65% male; mean [SD] age 2.6 [1.2] years). We observed no significant difference between matched cohorts in the odds of a wheezing/asthma attack: ICS vs SABA, OR (95% CI) 1.01 (0.85-1.19) and LTRA vs SABA, OR (95% CI) 1.28 (0.96-1.72).

Conclusion: We found no evidence that initiation of ICS or LTRA therapy is associated with fewer attacks during 1 outcome year than SABA alone for a heterogeneous group of preschool children with recurrent wheeze in the real-life clinical setting.

Keywords: ICS particle size; electronic medical records; inhaled corticosteroids; leukotriene receptor antagonists; observational study; short-acting β-agonist.