Long-term comparison of 3 controller regimens for mild-moderate persistent childhood asthma: The Pediatric Asthma Controller Trial

Sorkness, Christine A.; Lemanske, Robert F.; Mauger, David T.; Boehmer, Susan J.; Chinchilli, Vernon M.; Martínez, Fernando D.; Strunk, Robert C.; Szefler, Stanley J.; Zeiger, Robert S.; Bacharier, Leonard B.; Bloomberg, Gordon R.; Covar, Ronina; Guilbert, Theresa W.; Heldt, Gregory P.; Larsen, Gary L.; Mellon, Michael; Morgan, Wayne J.; Moss, Mark H.; Spahn, Joseph D.; Taussig, Lynn M.

doi:10.1016/j.jaci.2006.09.042

Cited by 268 publications

(250 citation statements)

References 32 publications

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“…Inhaled corticosteroids (ICSs) improve lung function, decrease the number of asthma-related hospitalizations, reduce emergency department (ED) visits, and limit the use of oral corticosteroids (2)(3)(4)(5). Evidence-based guidelines recommend that ICSs should be the preferred first-line therapy for patients with persistent asthma, with leukotriene antagonists (LTRAs) as an alternate or add-on medication (6).…”

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confidence: 99%

Primary Adherence to Controller Medications for Asthma Is Poor

Butler

et al. 2015

Annals ATS

107

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Rationale: Few previous studies have evaluated primary adherence (whether a new prescription is filled within 30 d) to controller medications in individuals with persistent asthma.Objective: To compare adherence to the major controller medication regimens for asthma.Methods: This was a retrospective cohort study of enrollees from five large health plans. We used electronic medical data on patients of all ages with asthma who had experienced an asthma-related exacerbation in the prior 12 months. We studied adherence measures including proportion of days covered and primary adherence (first prescription filled within 30 d).Measurements and Main Results: Our population included 69,652 subjects who had probable persistent asthma and were prescribed inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting b-agonists (ICS/LABAs). The mean age was 37 years and 58% were female. We found that 14-20% of subjects who were prescribed controller medicines for the first time did not fill their prescriptions. The mean proportion of days covered was 19% for ICS, 30% for LTRA, and 25% for ICS/LABA over 12 months. Using multivariate logistic regression, subjects prescribed LTRA were less likely to be primary adherent than subjects prescribed ICS (odds ratio, 0.82; 95% confidence interval, 0.74-0.92) or ICS/LABA (odds ratio, 0.88; 95% confidence interval, 0.80-0.97). Black and Latino patients were less likely to fill the prescription compared with white patients.Conclusions: Adherence to controller medications for asthma is poor. In this insured population, primary adherence to ICSs was better than to LTRAs and ICS/LABAs. Adherence as measured by proportion of days covered was better for LTRAs and ICS/LABAs than for ICSs.

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confidence: 99%

Primary Adherence to Controller Medications for Asthma Is Poor

Butler

et al. 2015

Annals ATS

107

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“…The CARE trial was entitled the ''Pediatric Asthma Controller Trial'' (PACT) and enrolled children 6 to 14 years of age with mild to moderate persistent asthma (18). The children were treated for 48 weeks with one of three therapies: fluticasone monotherapy (100 mg twice daily), combination therapy (PACT combination therapy) (fluticasone 100 mg in the morning and salmeterol 50 mg twice daily), and montelukast (age-appropriate dose once daily).…”

Section: First-line Therapy For Mild Persistent Asthmamentioning

confidence: 99%

Asthma Therapies Revisited: What Have We Learned?

Lemanske

2009

Proceedings of the American Thoracic Society

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Asthma is a heterogenous disorder related to numerous biologic, immunologic, and physiologic components that generate multiple clinical phenotypes. Further, genetic and environmental factors interact in ways that produce variability in both disease onset and severity and differential expression based on both the age and sex of the patient. Thus, the natural history of asthma is complex in terms of disease expression, remission, relapse, and progression. As such, therapy for asthma is complicated and has been approached from the standpoints of primary, secondary, and tertiary prevention. Presently, asthma cannot be cured but can be controlled in most patients, an indication that most of the success clinical research strategies have realized has been in the area of tertiary prevention. Since for many adult patients with asthma their disease had its roots in early life, much recent research has focused on events during early childhood that can be linked to subsequent asthma development with the hopes of creating appropriate interventions to alter its natural history of expression. These research approaches can be categorized into three questions. Who is the right patient to treat? When is the right time to begin treatment? And finally, what is the appropriate treatment to prescribe?

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“…45 The guideline recommendations to date had largely relied on trials in adults with more moderate diseases, resulting in extrapolations to the pediatric population. Whereas, important data to manage childhood asthma was provided in CLIC, the trial was too short-term to adequately assess the important outcome of asthma exacerbations.…”

Section: Pediatric Asthma Controller Trial (Pact)mentioning

confidence: 99%

Guideline-defining asthma clinical trials of the National Heart, Lung, and Blood Institute's Asthma Clinical Research Network and Childhood Asthma Research and Education Network

Denlinger¹,

Sorkness²,

Chinchilli

et al. 2007

Journal of Allergy and Clinical Immunology

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Due to an increasing prevalence, morbidity and mortality associated with asthma, the National Heart, Lung and Blood Institute created the Asthma Clinical Research Network (ACRN) and the Childhood Asthma Research and Education (CARE) Network to improve public health. The objectives of these clinical research networks are to conduct multiple, well designed clinical trials for rapid evaluation of new and existing therapeutic approaches to asthma and to disseminate laboratory and clinical findings to the health care community. These trials comprise a large proportion of the data driving the treatment guidelines established and reviewed by the National Asthma Education and Prevention Program. This article will review the basic design and major findings of selected ACRN and CARE Network trials involving both adults and children with asthma. Collectively, these studies have helped refine the therapeutic role of existing controller medications, establish standard models for side effect evaluation and risk-benefit models, validate symptom based assessments for asthma control, and identify baseline characteristics that may predict individual patient responses. Remaining challenges include shaping the role of novel therapeutics in future guidelines, incorporating pharmacogenomic data in treatment decisions, and establishing better implementation strategies for translation to community settings, all with the goal of reducing the asthma burden on society.

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Long-term comparison of 3 controller regimens for mild-moderate persistent childhood asthma: The Pediatric Asthma Controller Trial

Cited by 268 publications

References 32 publications

Primary Adherence to Controller Medications for Asthma Is Poor

Primary Adherence to Controller Medications for Asthma Is Poor

Asthma Therapies Revisited: What Have We Learned?

Guideline-defining asthma clinical trials of the National Heart, Lung, and Blood Institute's Asthma Clinical Research Network and Childhood Asthma Research and Education Network

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