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

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

Author information

1
Blizard Institute, Queen Mary University of London, London, UK, j.grigg@qmul.ac.uk.
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.

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

Conflict of interest statement

Disclosure JG has received honoraria from GSK and Vifor Pharmaceuticals for Advisory Board membership. AN is an employee of the Respiratory Effectiveness Group. TWG reports personal fees from American Board of Pediatrics/Pediatric Pulmonary Subboard, personal fees from Teva, personal fees from GSK, personal fees from Regeneron Pharmaceuticals, grants from the National Institutes of Health (NIH), other from UpTo-Date, personal fees from Merck, personal fees from Sanofi, personal fees from Novartis, and personal fees from Aviragen. AK reports board membership with Aerocrine, AstraZeneca, Boehringer Ingelheim, Novartis, and Teva Pharmaceuticals, consultancy agreements with AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Mylan, Novartis, Pfizer, Teva Pharmaceuticals, and Johsnson and Johnson, Purdue, grants and unrestricted funding for investigator-initiated studies from Novartis, payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Mylan, Merck, Novartis, Pfizer, Purdue Pharmaceuticals, and payment for the development of educational materials from Benton Dickinson. NR has received over the past 3 years fees for speaking, organising education, participation in advisory boards or consulting from 3M, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, MSD-Chibret, Mundipharma, Novartis, Pfizer, Sanofi, Sandoz, Teva, and Zambon, and research grants from Novartis, Boehringer Ingelheim, and Pfizer. EVH is a consultant to the Observational and Pragmatic Research Institute Pte Ltd (Singapore) and has received payment for medical writing work from Merck. DBP has board membership with Aerocrine, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals, reports consultancy agreements with Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Napp, Novartis, Pfizer, Teva Pharmaceuticals, and Theravance, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Aerocrine, AKL Research and Development Ltd, AstraZeneca, Boehringer Ingelheim, British Lung Foundation, Chiesi, Mylan, Mundipharma, Napp, Novartis, Pfizer, Respiratory Effectiveness Group, Teva Pharmaceuticals, Theravance, UK National Health Service, and Zentiva, payment for lectures/speaking engagements from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Merck, Mundipharma, Novartis, Pfizer, Skyepharma, and Teva Pharmaceuticals, payment for manuscript preparation from Mundipharma and Teva Pharmaceuticals, payment for the development of educational materials from Mundipharma and Novartis, payment for travel/accommodation/meeting expenses from Aerocrine, AstraZeneca, Boehringer Ingelheim, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals, funding for patient enrollment or completion of research from Chiesi, Novartis, Teva Pharmaceuticals, and Zentiva, and stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals, owns 74% of the social enterprise Optimum Patient Care Ltd (Australia, Singapore, and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore), and is a peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme and Health Technology Assessment. The other authors report no conflicts of interest in this work.

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