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Randomized Controlled Trial
. 2023 Sep;58(9):2583-2591.
doi: 10.1002/ppul.26556. Epub 2023 Jun 21.

Childhood asthma treatment based on indirect hyperresponsiveness test: Randomized controlled trial

Janusz Ciółkowski  1 , Paweł Hydzik  2 , Marta Rachel  3 , Zofia Mazurek-Durlak  4 , Renata Skalska-Izdebska  1   3 , Henryk Mazurek  5   6
Affiliations
Randomized Controlled Trial

Childhood asthma treatment based on indirect hyperresponsiveness test: Randomized controlled trial

Janusz Ciółkowski et al. Pediatr Pulmonol. 2023 Sep.

Abstract

Purpose: The purpose of this study was to assess the usefulness of indirect airway hyperresponsiveness (AHR) test using hypertonic saline in determining the dose of inhaled corticosteroids (ICS) to maintain asthma control in children.

Methods: A group of 104 patients (7-15 years) with mild-moderate atopic asthma were monitored for their asthma control and treatment for 1 year. Patients were randomly assigned to a symptom-only monitored group and a group with therapy changes based on the symptoms and severity of AHR. Spirometry, exhaled nitric oxide, and blood eosinophils (BEos) were assessed on enrollment and every 3 months thereafter.

Results: During the study period, the number of mild exacerbations was lower in the AHR group (44 vs. 85; the absolute rate per patient 0.83 vs. 1.67; relative rate 0.49, 95% confidence interval: 0.346-0.717 (p < 0.001)]. Mean changes from baseline in clinical (except asthma control test), inflammatory, and lung function parameters were similar between groups. Baseline BEos correlated with AHR and was a risk factor for recurrent exacerbation in all patients. There was no significant difference in the final ICS dose between AHR and symptoms group: 287 (SD 255) vs. 243 (158) p = 0.092.

Conclusions: Adding an indirect AHR test to clinical monitoring of childhood asthma reduced the number of mild exacerbations, with similar current clinical control and final ICS dose as in the symptom-monitored group. The hypertonic saline test appears to be a simple, cheap, and safe tool for monitoring the treatment of mild-to-moderate asthma in children.

Keywords: airway hyperresponsiveness; blood eosinophils; childhood asthma; exacerbations; inhaled corticosteroids.

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References

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