Initial step-up treatment changes in asthmatic children already prescribed inhaled corticosteroids: a historical cohort study
Initial step-up treatment changes in asthmatic children already prescribed inhaled corticosteroids: a historical cohort study
Background:
When standard doses of inhaled corticosteroids (ICS) fail to control symptoms in children aged >4 years, guidelines recommend the addition of a long-acting ?2-agonist (LABA), with other treatment options being available if symptoms persist.
Aims:
To determine the proportion of initial ‘step-up’ episodes where LABAs were prescribed and to describe characteristics of individuals not stepped up with LABA.
Methods:
Between 1999 and 2011, initial step-up episodes from ICS monotherapy were identified in children aged 5–12 years with asthma and in receipt of ICS. Data sources were the Clinical Practice Research Datalink and Optimum Patient Care Research Database.
Results:
Initial step-up episodes were identified in 10,793 children. ICS dose was increased in 6,252 children (58%), LABA was introduced in 3,436 (32%; including 1,107 where fixed dose combination inhaler (FDC) replaced the ICS inhaler), and leukotriene receptor antagonist (LTRA) was added in 1,105 (10%). Compared with children stepped up to any LABA, others were younger and prescribed lower doses of ICS and reliever medication. ICS dose increase was more likely in obese children and LTRA prescribing was more likely in children with rhinitis and in receipt of antibiotics. Compared with FDC, step-up to separate LABA inhaler was more likely in younger, obese children who were using less oral steroids.
Conclusions:
One-third of initial step-up episodes in children with asthma treated with ICS are to add LABA. Different characteristics of children prescribed therapies other than LABA suggest that prescribers tailor treatment in some clinical settings.
materials and methods, results, discussion, references, acknowledgements, author information, supplementary information
1-8
Turner, Steve W.
3e17039b-88bd-42cc-ade2-83a069db640d
Richardson, Kathryn
d2a7c467-ecdb-4a61-bc07-c3367aca34a6
Burden, Annie
aad35ec4-4f56-4c4d-bf1f-bf3b07928413
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Murray, Clare
afa681f7-2a47-417e-b379-02cdf695e3ae
Price, David
4dee6753-83c4-4b65-aa9d-f4e915018b57
11 June 2015
Turner, Steve W.
3e17039b-88bd-42cc-ade2-83a069db640d
Richardson, Kathryn
d2a7c467-ecdb-4a61-bc07-c3367aca34a6
Burden, Annie
aad35ec4-4f56-4c4d-bf1f-bf3b07928413
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Murray, Clare
afa681f7-2a47-417e-b379-02cdf695e3ae
Price, David
4dee6753-83c4-4b65-aa9d-f4e915018b57
Turner, Steve W., Richardson, Kathryn, Burden, Annie, Thomas, Mike, Murray, Clare and Price, David
(2015)
Initial step-up treatment changes in asthmatic children already prescribed inhaled corticosteroids: a historical cohort study.
NPJ primary care respiratory medicine, 25 (15041), .
(doi:10.1038/npjpcrm.2015.41).
(PMID:26068328)
Abstract
Background:
When standard doses of inhaled corticosteroids (ICS) fail to control symptoms in children aged >4 years, guidelines recommend the addition of a long-acting ?2-agonist (LABA), with other treatment options being available if symptoms persist.
Aims:
To determine the proportion of initial ‘step-up’ episodes where LABAs were prescribed and to describe characteristics of individuals not stepped up with LABA.
Methods:
Between 1999 and 2011, initial step-up episodes from ICS monotherapy were identified in children aged 5–12 years with asthma and in receipt of ICS. Data sources were the Clinical Practice Research Datalink and Optimum Patient Care Research Database.
Results:
Initial step-up episodes were identified in 10,793 children. ICS dose was increased in 6,252 children (58%), LABA was introduced in 3,436 (32%; including 1,107 where fixed dose combination inhaler (FDC) replaced the ICS inhaler), and leukotriene receptor antagonist (LTRA) was added in 1,105 (10%). Compared with children stepped up to any LABA, others were younger and prescribed lower doses of ICS and reliever medication. ICS dose increase was more likely in obese children and LTRA prescribing was more likely in children with rhinitis and in receipt of antibiotics. Compared with FDC, step-up to separate LABA inhaler was more likely in younger, obese children who were using less oral steroids.
Conclusions:
One-third of initial step-up episodes in children with asthma treated with ICS are to add LABA. Different characteristics of children prescribed therapies other than LABA suggest that prescribers tailor treatment in some clinical settings.
Text
npjpcrm201541-2.pdf
- Accepted Manuscript
More information
Accepted/In Press date: 7 April 2015
Published date: 11 June 2015
Keywords:
materials and methods, results, discussion, references, acknowledgements, author information, supplementary information
Organisations:
Primary Care & Population Sciences
Identifiers
Local EPrints ID: 378236
URI: http://eprints.soton.ac.uk/id/eprint/378236
ISSN: 2055-1010
PURE UUID: 7b9b360a-e002-4333-9a27-f3cb28882f30
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Date deposited: 22 Jun 2015 15:52
Last modified: 14 Mar 2024 20:19
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Contributors
Author:
Steve W. Turner
Author:
Kathryn Richardson
Author:
Annie Burden
Author:
Clare Murray
Author:
David Price
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