Predictors of asthma control and lung function responsiveness to step 3 therapy in children with uncontrolled asthma.
J Allergy Clin Immunol
; 133(2): 350-6, 2014 Feb.
Article
em En
| MEDLINE
| ID: mdl-24084071
ABSTRACT
BACKGROUND:
Predictors of improvement in asthma control and lung function to step 3 therapy in children with persistent asthma have not been identified despite reported heterogeneity in responsiveness.OBJECTIVE:
We sought to evaluate potential predictors of asthma control and lung function responsiveness to step 3 therapy.METHODS:
A post hoc analysis from the Best Add-On Giving Effective Response (BADGER) study tested the association between baseline biological, asthma control, pulmonary function, and demographic markers and responsiveness to step-up to a higher dose of inhaled corticosteroid (ICS step-up therapy) or addition of leukotriene receptor antagonist (LTRA step-up therapy) or long-acting ß2-agonist (LABA step-up therapy).RESULTS:
In multivariate analyses higher impulse oscillometry reactance area was associated (P = .048) with a differential FEV1 response favoring LABA over ICS step-up therapy, whereas higher urinary leukotriene E4 levels were marginally (P = .053) related to a differential FEV1 response favoring LTRA over LABA step-up therapy. Predictors of differential responses comparing ICS with LTRA step-up therapy were not apparent, probably because of suppression of allergic markers with low-dose ICS treatment. Minimal overlap was seen across FEV1 and asthma control day predictors, suggesting distinct mechanisms related to lung function and asthma control day responses.CONCLUSION:
Levels of impulse oscillometry reactance area indicating peripheral airway obstruction and urinary leukotriene E4 levels indicating cysteinyl leukotriene inflammation can differentiate LABA step-up responses from responses to LTRA or ICS step-up therapy. Further studies with physiologic, genetic, and biological markers related to these phenotypes will be needed to predict individual responses to LABA step-up therapy.Palavras-chave
AACD; ACD; AX; Annualized asthma control day; Asthma; Asthma control day; BADGER; Best Add-On Giving Effective Response; FP; FVC; Feno; Fluticasone propionate; Forced vital capacity; Fraction of exhaled nitric oxide; ICS; IOS; Impulse oscillometry; Inhaled corticosteroids; Kilopascal per liter per second; LABA; LTRA; Leukotriene receptor antagonist; Long-acting ß(2)-agonist; R5; Reactance area; Resistance at 5 Hz; Urinary leukotriene E(4); children; fraction of exhaled nitric oxide; impulse oscillometry; inhaled corticosteroids; kPa/L/s; leukotriene E(4); leukotriene receptor antagonist; long-acting ß(2)-agonist; uLTE(4)
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
Base de dados:
MEDLINE
Assunto principal:
Asma
/
Broncodilatadores
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Agonistas Adrenérgicos beta
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Antiasmáticos
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Antagonistas de Leucotrienos
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
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Child
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Female
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Humans
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Male
Idioma:
En
Revista:
J Allergy Clin Immunol
Ano de publicação:
2014
Tipo de documento:
Article