The changing face of severe childhood asthma: A comparison of two cohorts of children evaluated at National Jewish Health over the past 20 years
Novel asthma pharmacotherapy has changed the management of severe childhood asthma. This study determined whether the introduction and use of second-generation inhaled glucocorticoids (GCs), long-acting beta-agonists (LABAs), and combination inhaled GC/LABA (iGC/LABA) products and leukotriene
receptor antagonists (LTRAs) have impacted children with severe asthma. A retrospective review of children (aged 6‐18 years) referred to National Jewish Health for severe asthma between 2003 and 2007 (current cohort) was performed (n = 65); the results were compared with a published
cohort from 1993 to 1997 (historic cohort; n = 164). When comparing the current cohort to the historic cohort, the percentage requiring chronic oral GC therapy (28% versus 51%; p = 0.001), average dose (3.7 ± 2.4 mg/dose versus 16.7 ± 1.4 mg/dose; p < 0.0001), and duration
of oral GC use (17.8 ± 8.6 months versus 33.7 ± 3.5 months; p = 0.09) were less. Ninety-seven percent of the current cohort was on a second-generation iGC either alone or in combination with an LABA, 76% were on an LTRA, and 66% were on combination iGC/LABA product, while
none of the historic cohort received these medications. In addition, the current cohort had a higher forced expiratory volume in 1 second (84 ± 2.5% versus 76 ± 2% of predicted; p = 0.008), required less albuterol (33 ± 9 inhalations/week versus 71 ± 7 inhalations/week;
p = 0.0007), had fewer intubations in the past (13% versus 21%; p = 0.13) and had fewer GC-induced adverse effects compared with the historic cohort. The current cohort required less chronic oral GCs, had better asthma control, and had fewer GC-induced adverse effects compared with the historic
cohort studied 10 years ago. This is most likely because of the use of more effective medications for childhood asthma.
Keywords: Asthma controller medication; asthma pharmacotherapy; childhood asthma; combination inhaled glucocorticoid/long-acting bronchodilators; corticosteroid-related adverse effects; historical asthma; inhaled glucocorticoids; long-acting bronchodilators; morbidity in severe asthma; mortality in severe asthma; persistent asthma; severe asthma
Document Type: Research Article
Affiliations: Division of Clinical Pharmacology, Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
Publication date: 01 March 2014
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