Treatment of mild-to-moderate asthma in childhood and adolescence in 2021

Abrams, Elissa M.; Shaker, Marcus; Greenhawt, Matthew; Fernandes, Ricardo M; Sinha, Ian

doi:10.1016/s2213-2600(21)00135-1

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…Participants receiving budesonide-formoterol will be escalated using a paediatric-dose-adjusted anti-inflammatory reliever regimen, transitioning from budesonide-formoterol as needed to maintenance and reliever therapy (MART), very-low-dose at step 2 and, if a further severe asthma attack occurs, low-dose at step 3. This is in line with the proposed children's [27] and adult [20,21] anti-inflammatory reliever therapy algorithms.…”

Section: Interventionssupporting

confidence: 85%

The Children's Anti-inflammatory Reliever (CARE) study: a protocol for a randomised controlled trial of budesonide-formoterol as sole reliever therapy in children with mild asthma

et al. 2021

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BackgroundAsthma is the most common chronic disease in children, many of whom are managed solely with a short-acting β2-agonist (SABA). In adults, the evidence that budesonide-formoterol as sole reliever therapy markedly reduces the risk of severe exacerbations compared with SABA alone has contributed to the Global Initiative for Asthma recommending against SABA monotherapy in this population. The lack of current evidence in children means it is unknown whether these findings are also relevant to this demographic. High-quality randomised controlled trials (RCTs) are needed.ObjectiveTo determine the efficacy and safety of as-needed budesonide-formoterol therapy compared with as-needed salbutamol in children aged five to 15 years with mild asthma, who only use a SABA.MethodsA 52-week, open-label, parallel group, phase III, RCT will recruit 380 children aged five to 15 years with mild asthma (ACTRN12620001091998). Participants will be randomised 1:1 to either budesonide-formoterol (Symbicort Rapihaler®) 50/3mcg, two actuations as needed or salbutamol (Ventolin®) 100mcg, two actuations as needed. The primary outcome is asthma attacks as rate per participant per year. Secondary outcomes assess asthma control, lung function, exhaled nitric oxide, and treatment step change. A cost-effectiveness analysis is also planned.ConclusionThis is the first RCT to assess the safety and efficacy of as-needed budesonide-formoterol in children with mild asthma. The results will provide a much-needed evidence base for the treatment of mild asthma in children.

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Section: Interventionssupporting

confidence: 85%

The Children's Anti-inflammatory Reliever (CARE) study: a protocol for a randomised controlled trial of budesonide-formoterol as sole reliever therapy in children with mild asthma

et al. 2021

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“…1,2 Since the introduction of inhaled corticosteroid (ICS) treatment for asthma in the 1970s, ICS treatment has provided an effective option for maintenance therapy in asthma. 3 However, in the past several years, we observed one of the greatest paradigm shifts, in which ICS was used not only for maintenance but also for symptom relief in the management of asthma among adults and adolescents. This paradigm shift in the treatment for adults and adolescents with asthma is changing from a fixed combination of ICS/formoterol (a long-acting b 2 -agonists [LABA] with rapid onset action) as a daily controller with as-needed short-acting b 2 -agonists (SABA) for symptom relief to the combination of ICS/formoterol as single inhaler maintenance and reliever therapy (SMART).…”

mentioning

confidence: 99%

“…This paradigm shift in the treatment for adults and adolescents with asthma is changing from a fixed combination of ICS/formoterol (a long-acting b 2 -agonists [LABA] with rapid onset action) as a daily controller with as-needed short-acting b 2 -agonists (SABA) for symptom relief to the combination of ICS/formoterol as single inhaler maintenance and reliever therapy (SMART). 3 Yet, uncertainties regarding the management of children with asthma still remain.…”

mentioning

confidence: 99%

“…9 This difference may be ascribed to the disparate guideline designs (ie, GINA is designed to improve asthma awareness and NAEPP is based on a systematic review of previous studies, which evaluated the evidence), differences in risk/benefit assessment in asthma management, and lack of high-quality studies unlike the evidence in adults and adolescents. 3 Despite these discrepancies, it is worth considering unifying the approach between the GINA and NAEPP guidelines and international integrative management for pediatric asthma. To achieve tailored asthma management in children, we need more sophisticated trials using ICS-SABA and several ICS-LABA devices; more data regarding the pharmacokinetics, pharmacodynamics, and adverse effects of LABA; and approval for the intermittent use of ICS/formoterol treatment by the US Food and Drug Administration.…”

mentioning

confidence: 99%

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Single Inhaler as Maintenance and Reliever Therapy (SMART) in Childhood Asthma in 2021: The Paradigm Shift in the Inhaled Corticosteroids Reliever Therapy Era

Shin

Lee

Yon

2021

The Journal of Allergy and Clinical Immunology: In Practice

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“…More recent evidence indicates that the use of ICS may be beneficial even for asthmatic children with mild disease that accounts for 30%–40% of severe attacks 29. Treatment recommendations for children and adolescents with mild disease are now shifting to use of ICS (plus long-acting beta-agonists in combination inhalers) as required 30 31. Despite such initiatives, access to ICS in many LMIC settings is limited within healthcare systems because of cost and a failure to recognise the public health impact of childhood asthma.…”

Section: Introductionmentioning

confidence: 99%

Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol

et al. 2022

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IntroductionAsthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities.Methods and analysisProspective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5–17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses.Ethics and disseminationEthical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.

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Treatment of mild-to-moderate asthma in childhood and adolescence in 2021

Cited by 10 publications

References 9 publications

The Children's Anti-inflammatory Reliever (CARE) study: a protocol for a randomised controlled trial of budesonide-formoterol as sole reliever therapy in children with mild asthma

The Children's Anti-inflammatory Reliever (CARE) study: a protocol for a randomised controlled trial of budesonide-formoterol as sole reliever therapy in children with mild asthma

Single Inhaler as Maintenance and Reliever Therapy (SMART) in Childhood Asthma in 2021: The Paradigm Shift in the Inhaled Corticosteroids Reliever Therapy Era

Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol

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