American Academy of Pediatrics National Conference and Exhibition
American Academy of Pediatrics National Conference and Exhibition
October 26, 2016
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Guideline-based therapy not consistently followed by asthmatic children

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SAN FRANCISCO — Many children with asthma manage their symptoms with regimens inconsistent with the National Heart Lung and Blood Institute stepwise approach which poses potential health risks, suggesting a need for additional controller medications for children with asthma, according to recent research presented at the 2016 AAP National Conference and Exhibition.

“With asthma prevalence increasing globally, especially among children, we sought a better, real-world understanding of treatment patterns in pediatric patients with this condition,” Lindsay Bengtson, PhD, MPH, from the School of Public Health at the University of Minnesota, told Infectious Diseases in Children.

Lindsay Bengtson, MD
Lindsay Bengtson

Bengtson and colleagues obtained data from a US administrative claims database of patients with asthma aged 0 to 4 years (n = 10,309; mean ± SD age, 2.9 ±1.1 years; 64.4% male) and aged 5 to 11 years (n = 20,136; mean age, 8.4±2.0 years; 62.2% male) who began controller medication between January 1, 2011 and February 28, 2015. They defined asthma as the presence of ICD-9 codes 493.00-493.02, 493.10-493.12, 493.82 or 493.90-493.93 on 2 or more service dates. Following the initiation of controller medication, patients were enrolled in 2 or more years of a continuous health plan. Patients were excluded if they had any of the following conditions: cystic fibrosis, bronchitis, emphysema, chronic obstructive asthma or chronic airway obstruction.

ICS dose and the class of controller medication determined lines of therapy (LOTs). The addition or removal of a controller or the change in ICS dose caused patients to discontinue a LOT. The researchers reported that they classified regimens into a NHLBI Step according to the NHLBI Expert Panel Report 3 Stepwise Approach for Managing Asthma based on controller medications used within a LOT. If a regimen did not relate to a NHLBI Step, they were classified as “Other.”

Controller medication use and LOT at the beginning of year 2 was observed in 48.9% of patients aged 0 to 4 years and 60.1% of patients aged 5 to 11 years.

Patients were classified within each NHLBI Step for the LOT at the beginning of year 2. The proportion of patients aged 0 to 4 years and 5 to 11 years, respectively, for Step 2 was 48% and 59%, Step 3 was 16% and 13%, Step 4 was 3% and 3%, Steps 5 and 6 was 6% and 7% and “Other” was 27% and 18%. High-dose ICS monotherapy accounted for 78.4% and 73.4% of LOTs classified as “Other” with an average LOT duration (ALD) of 229 and 164 days among patients aged 0 to 4 years and 5 to 11 years, respectively. Combination regimens such as high-dose ICS accounted for 7.9% and 16.1% of LOTs with ALD of 117 and 180 days among patients aged 0 to 4 years and 5 to 11 years, respectively.

“A substantial proportion of pediatric asthma patients in the real-world population we studied were on regimens inconsistent with National Heart, Lung, and Blood Institute (NHLBI) recommendations,” Bengtson said. “Most of those not on an NHLBI-recommended regimen were on high-dose inhaled corticosteroid (HD-ICS) monotherapy.”

“Given the potential risks associated with long-term use of HD-ICS in children, these data highlight the need to maximize use of current guideline-based therapy and to add additional classes of controller medications if pediatric patients remain uncontrolled.” – by Alaina Tedesco

Reference:
Rosemas S, et al. Presented at: AAP National Conference and Exhibition; Oct. 22-25, 2016; San Francisco, California.

Disclosure: The researchers report funding by Novartis.