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

Grigg, J., Nibber, A., Paton, J. Y. , Chisholm, A., Guilbert, T. W., Kaplan, A., Turner, S., Roche, N., Hillyer, E. V. and Price, D. B. (2018) Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks. Journal of Asthma and Allergy, 11, pp. 309-321. (doi: 10.2147/JAA.S178531)

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.

• Item Type: Articles
• Additional Information: This work was supported by the Respiratory Effectiveness Group (http://effectivenessevaluation.org/).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Paton, Dr James
• Authors: Grigg, J., Nibber, A., Paton, J. Y., Chisholm, A., Guilbert, T. W., Kaplan, A., Turner, S., Roche, N., Hillyer, E. V., and Price, D. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Asthma and Allergy
• Publisher: Dove Medical Press
• ISSN: 1178-6965
• ISSN (Online): 1178-6965
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in Journal of Asthma and Allergy 11:309-321
• Publisher Policy: Reproduced under a Creative Commons License