Individualized therapy for persistent asthma in young children

被引：207

作者：

Fitzpatrick, Anne M. ^{[1
]}

Jackson, Daniel J. ^{[2
]}

Mauger, David T. ^{[3
]}

Boehmer, Susan J. ^{[3
]}

Phipatanakul, Wanda ^{[5
]}

Sheehan, William J. ^{[5
]}

Moy, James N. ^{[7
]}

Paul, Ian M. ^{[4
]}

Bacharier, Leonard B. ^{[8
,9
]}

Cabana, Michael D. ^{[10
]}

Covar, Ronina ^{[18
]}

Holguin, Fernando ^{[11
]}

Lemanske, Robert F., Jr. ^{[12
]}

Martinez, Fernando D. ^{[13
]}

Pongracic, Jacqueline A. ^{[14
]}

Beigelman, Avraham ^{[8
,9
]}

Baxi, Sachin N. ^{[5
]}

Benson, Mindy ^{[15
]}

Blake, Kathryn ^{[16
]}

Chmiel, James F. ^{[17
]}

Daines, Cori L. ^{[13
]}

Daines, Michael O. ^{[13
]}

Gaffin, Jonathan M. ^{[6
]}

Gentile, Deborah Ann ^{[19
]}

Gower, W. Adam ^{[20
]}

Israel, Elliot ^{[21
]}

Kumar, Harsha Vardhan ^{[22
]}

Lang, Jason E. ^{[23
]}

Lazarus, Stephen C. ^{[10
]}

Lima, John J. ^{[16
]}

Ly, Ngoc ^{[24
]}

Marbin, Jyothi ^{[15
]}

Morgan, Wayne ^{[13
]}

Myers, Ross E. ^{[25
]}

Olin, J. Tod ^{[18
]}

Peters, Stephen P. ^{[20
]}

Raissy, Hengameh H. ^{[26
]}

Robison, Rachel G. ^{[14
]}

Ross, Kristie ^{[17
]}

Sorkness, Christine A. ^{[27
]}

Thyne, Shannon M. ^{[28
]}

Szefler, Stanley J. ^{[29
,30
]}

机构：

[1] Emory Univ, Dept Pediat, Atlanta, GA 30322 USA

[2] Univ Wisconsin, Sch Med & Publ Hlth, Sect Allergy Immunol & Rheumatol, Pediat, Madison, WI 53706 USA

[3] Penn State Univ, Coll Med, Dept Publ Hlth Sci, Hershey, PA USA

[4] Penn State Univ, Coll Med, Dept Pediat, Hershey, PA USA

[5] Harvard Med Sch, Boston Childrens Hosp, Div Allergy Immunol, Boston, MA USA

[6] Harvard Med Sch, Boston Childrens Hosp, Div Resp Dis, Boston, MA USA

[7] Rush Univ, Med Ctr, Dept Pediat, Stroger Hosp Cook Cty, Chicago, IL 60612 USA

[8] Washington Univ, Sch Med, Dept Pediat, St Louis, MO 63130 USA

[9] St Louis Childrens Hosp, St Louis, MO 63178 USA

[10] Univ Calif San Francisco, Med, San Francisco, CA 94143 USA

[11] Univ Pittsburgh, Asthma Inst, UPMC, UPSOM, Pittsburgh, PA USA

[12] Univ Wisconsin, Sch Med & Publ Hlth, Pediat, Madison, WI 53706 USA

[13] Univ Arizona, Arizona Resp Ctr, Tucson, AZ USA

[14] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA

[15] Univ Calif San Francisco, Benioff Childrens Hosp Oakland, Oakland, CA USA

[16] Nemours Childrens Hlth Syst, Jacksonville, FL USA

[17] Case Western Reserve Univ, Sch Med, Rainbow Babies & Childrens Hosp, Dept Pediat, Cleveland, OH 44106 USA

[18] Natl Jewish Hlth, Pediat, Denver, CO USA

[19] Allegheny Gen Hosp, Dept Pediat, Pittsburgh, PA 15212 USA

[20] Wake Forest Sch Med, Winston Salem, NC USA

[21] Harvard Med Sch, Brigham & Womens Hosp, Boston, MA USA

[22] Univ Illinois, Chicago, IL USA

[23] Univ Cent Florida, Coll Med, Nemours Childrens Hosp, Orlando, FL 32816 USA

[24] Univ Calif San Francisco, Airway Clin Res Ctr, San Francisco, CA 94143 USA

[25] Rainbow Babies & Childrens Hosp, 2101 Adelbert Rd, Cleveland, OH 44106 USA

[26] Univ New Mexico, Pediat Pulm, Albuquerque, NM 87131 USA

[27] Univ Wisconsin, Madison, WI 53706 USA

[28] Univ Calif Los Angeles, David Geffen Sch Med, Olive View UCLA Med Ctr, Dept Pediat, Los Angeles, CA 90095 USA

[29] Childrens Hosp Colorado, Breathing Inst, Aurora, CO USA

[30] Univ Colorado, Sch Med, Aurora, CO USA

来源：

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY | 2016年 / 138卷 / 06期

关键词：

Asthma; asthma treatment; asthma biomarkers; asthma phenotype; inhaled corticosteroid; leukotriene receptor antagonist; personalized medicine; treatment response; 1ST; 6; YEARS; PRESCHOOL-CHILDREN; CHILDHOOD ASTHMA; INHALED CORTICOSTEROIDS; HIGH-RISK; LUNG-FUNCTION; NITRIC-OXIDE; MONTELUKAST; MANAGEMENT; DIAGNOSIS;

D O I：

10.1016/j.jaci.2016.09.028

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

Background: Phenotypic presentations in young children with asthma are varied and might contribute to differential responses to asthma controller medications. Methods: The Individualized Therapy for Asthma in Toddlers study was a multicenter, randomized, double-blind, double-dummy clinical trial in children aged 12 to 59 months (n = 300) with asthma necessitating treatment with daily controller (Step 2) therapy. Participants completed a 2- to 8-week run-in period followed by 3 crossover periods with daily inhaled corticosteroids (ICSs), daily leukotriene receptor antagonists, and as-needed ICS treatment coadministered with albuterol. The primary outcome was differential response to asthma medication based on a composite measure of asthma control. The primary analysis involved 2 stages: determination of differential response and assessment of whether 3 prespecified features (aeroallergen sensitization, previous exacerbations, and sex) predicted a differential response. Results: Seventy-four percent (170/230) of children with analyzable data had a differential response to the 3 treatment strategies. Within differential responders, the probability of best response was highest for a daily ICS and was predicted by aeroallergen sensitization but not exacerbation history or sex. The probability of best response to daily ICS was further increased in children with both aeroallergen sensitization and blood eosinophil counts of 300/mL or greater. In these children daily ICS use was associated with more asthma control days and fewer exacerbations compared with the other treatments. Conclusions: In young children with asthma necessitating Step 2 treatment, phenotyping with aeroallergen sensitization and blood eosinophil counts is useful for guiding treatment selection and identifies children with a high exacerbation probability for whom treatment with a daily ICS is beneficial despite possible risks of growth suppression.

引用

页码：1608 / +

页数：23

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