Treatment decisions in children with asthma in a real-life clinical setting: the Swiss Paediatric Airway Cohort (SPAC).

Ardura-Garcia, Cristina; Pedersen, Eva SL; Mallet, Maria Christina; de Jong, Carmen CM; Barben, Juerg; Jochmann, Anja; Jung, Andreas; Mueller-Suter, Dominik; Regamey, Nicolas; Singer, Florian; Kuehni, Claudia E (2022). Treatment decisions in children with asthma in a real-life clinical setting: the Swiss Paediatric Airway Cohort (SPAC). Journal of allergy and clinical immunology. In practice, 10(4), 1038-1046.e8. Elsevier 10.1016/j.jaip.2021.10.026

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BACKGROUND

Asthma treatment should be modified according to symptom control and future risk, but there is scarce data on what drives treatment adjustments in routine tertiary care.

OBJECTIVE

We studied factors that drive asthma treatment adjustment in paediatric outpatient clinics.

METHODS

We did a cross-sectional analysis of the Swiss Paediatric Airway Cohort (SPAC), a clinical cohort of 0-16-year-old children seen by paediatric pulmonologists. We collected information on diagnosis, treatment, lung function and Fractional exhaled Nitric Oxide (FeNO) from hospital records; and on symptoms, sociodemographic and environmental factors from a parental questionnaire. We used reported symptoms to classify asthma control and categorised treatment following the 2020 GINA guidelines. We used multivariable logistic regression to study factors associated with treatment adjustment (step-up or down vs. no change).

RESULTS

We included 551 children diagnosed with asthma (mean age 10 years, 37% female). At the clinical visit, most children were prescribed GINA Step 3 (35%). Compared to pre-visit treatment, 252 (47%) children remained on the same step, 227 (42%) were stepped-up and 58 (11%) were stepped-down. Female sex (aOR 1.61, 95% CI 1.05-2.47), poor asthma control (3.08, 1.72-5.54), and a lower Forced Expiratory Volume in the first second (FEV1) Z-score (0.70, 0.56-0.86 per 1 Z-score increase) were independently associated with treatment step-up, and low FeNO (2.34, 1.23-4.45) with treatment step-down, with a marked heterogeneity between clinics.

CONCLUSION

In this tertiary care real-life study, we identified main drivers for asthma treatment adjustment. These findings may help improve both asthma management guidelines and clinical practice.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Ardura Garcia, Cristina; Pedersen, Eva Sophie Lunde; Mallet, Maria Christina; de Jong, Carmen Cornelia Maria; Singer, Florian and Kühni, Claudia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2213-2198

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation ; [204] Swiss Lung Association = Lungenliga Schweiz

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

05 Nov 2021 19:33

Last Modified:

29 Apr 2022 08:58

Publisher DOI:

10.1016/j.jaip.2021.10.026

PubMed ID:

34695597

Uncontrolled Keywords:

asthma management children clinical practice

BORIS DOI:

10.48350/160667

URI:

https://boris.unibe.ch/id/eprint/160667

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