Source: Jpn J Clin Hematol  |  Posted 5 years ago

By Paula Moyer

MIAMI BEACH, FL -- March 12, 2006 -- Children and adolescents with severe and difficult-to-treat asthma could improve with targeted intervention programs and novel strategies, investigators said here at the 62[^]nd[] annual meeting of the American Academy of Allergy, Asthma, and Immunology (AAAAI).

The research, an update of The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens (TENOR) study, was presented in an oral session on March 6[^]th[].

The children and adolescents who were eligible to participate in the study were high users of healthcare resources and had loss of pulmonary function despite being on multiple long-term controllers.

"These findings are consistent with other TENOR analyses of data from adults," said principal investigator Bradley F. Chipps, MD, Pediatric Pulmonologist and Staff Physician, Capitol Allergy and Respiratory Disease Center, Sacramento, California, United States.

The targeted interventions referenced, such as medications that target immunoglobulin E (igE), may be necessary to ward off the high use of systemic corticosteroids n this population and the complications that come with their use, he said.

Among the 4756 participants in the TENOR study, 1261 were 6 to 17 years old. Of these subjects, 55% had moderate and 41% had severe asthma as determined by physician assessments.

Of the 369 children and 408 adolescents who used at least three long-term asthma controlling agents, 53% of children and 44% of adolescents reported a corticosteroid burst. In addition, 25% of children and 19% of adolescents had an emergency department visit. This group also had a high rate of intubation, with 10% of children and 25% of adults having had this experience.

In the overall group, 96% used short-acting beta-agonists, and 95% used inhaled corticosteroids. Other medications they used included long-acting beta-agonists (74%); anti-leukotrienes (73%), systemic corticosteroids on an ongoing basis (15%) anticholinergics (10%), methylxanthines such as theophylline (8%), and cromolyn or nedocromil (9%).

Participants tended to be shorter and heavier than their age- and gender-matched peers in the general population. In boys, the average weight ranged from the 65[^]th[] to the 67[^]th[] percentiles and height ranged from the 49[^]th[] to the 45[^]th[] percentile. In girls, their average weight for their ages ranged between the 67[^]th[] and70th percentiles. However, their height for their ages was between the 42[^]nd[] and the 54[^]th[] percentiles, which was statistically significant by the various age groups (P <.01).

Loss of lung function was directly associated with age. The ratio of pre-bronchodilator forced expiratory volume in 1 second (FEV[_]1[]) to forced vital capacity (FVC) went from 0.81 in boys 6 to 8 years old to 0.73 in boys 15 to 17 years old (P <.05). For girls, the pre-bronchodilator FEV[_]1[]/FVC ratio wend from 0.84 in girls 6 to 8 years old to 0.77 in girls 15-17 years (P <.05).

The researchers concluded that findings of this observational study show that pediatric patients with severe and difficult-to-treat asthma would benefit from asthma treatments that prevent loss of lung function and help reduce the need for systemic corticosteroids as well as unplanned uses of healthcare resources.

The study was funded by Genentech and Novartis Pharmaceuticals Corp., which partner in the manufacture of omalizumab (Xolair), an anti-IgE therapy used to treat refractory asthma.

[Presentation title: Demographic and Clinical Characteristics of Children and Adolescents with Severe or Difficult-to-Treat Asthma. Abstract 827]