Determining the Best Tool Comparable with Global Initiative for Asthma Criteria for Assessing Pediatric Asthma Control

Lung Function and Asthma Clinical Control in N-ERD Patients, Three-Year Follow-Up in the Context of Real-World Evidence

Purpose

To describe the lung function and clinical control of asthma in patients with N-ERD during three years of medical follow-up using GINA guidelines.

Methods

We evaluated 75 N-ERD and 68 asthma patients (AG). Clinical control, lung function, and asthma treatment were evaluated according to GINA-2014. We compared all variables at baseline and one, two, and three years after treatment.

Results

At baseline, the N-ERD group had better basal lung function (LF) than the AG group (p<0.01), and the AG group used higher doses of inhaled corticosteroids than the N-ERD group (52.4% vs 30.5%, p=0.01) and short-term oral corticosteroid (OCS) use (52.4% vs 30.5%, p<0.01). Instead, N-ERD patients needed more use of leukotriene receptor antagonists (LTRA) (29.3% vs 5.9%, p<0.01). This group had better clinical control than the AG group (62.1% vs 34.1%, p<0.01). During the medical follow-up, the LF of the N-ERD group remained at normal values; however, these parameters improved in AG from one year (p<0.01). Likewise, there was a diminished use of high doses of ICS (52.4% vs 33%, p<0.05) and short-term OCS (67.6% vs 20.6%, p<0.01) in asthma patients. However, N-ERD patients still needed more use of LTRAs (p<0.02) during the study. In this context, one-third of N-ERD patients had to use a combination of two drugs to maintain this control. From the second year on, clinical control of asthma was similar in both groups (p>0.05).

Conclusion

According to GINA guidelines, only one-third of patients with N-ERD can gradually achieve adequate lung function and good asthma control with a high ICS dosage. Only a very small portion of patients will require the continued use of a second medication as an LTRA to keep their asthma under control.

Is It Time to Add Domains of Quality of Life to the Childhood Asthma Control Test and the GINA Criteria?

Objective: To measure the quality of life by using the Standardized Pediatric Asthma Quality of Life Questionnaire(PAQLQ(S)) in children with asthma and to determine the association of the Childhood Asthma Control Test(c-ACT) and Global Initiative for Asthma(GINA) criteria of asthma control with the PAQLQ(S) domains. Methods: This study was planned in a cross-sectional design. All consecutive children between the ages 7-11 years who had been followed up at least one year with a diagnosis of asthma were enrolled. Children filled out PAQLQ(S). The levels of asthma control were defined by c-ACT and GINA criteria of asthma control. Results: Of the total 120 children, the median(%25-75) PAQLQ(S) and c-ACT scores were 4.90(1.3) and 17.9(4.8). All children had quality of life impairments except four. According to c-ACT, 41.7% of children were controlled; 58.3% of them were uncontrolled. PAQLQ(S) scores were found to be correlated with both c-ACT scores(p&lt;0.001, r=0.612). The c-ACT score was more significantly correlated with the symptom domain of PAQLQ(S)(r=0,667, p&lt;0,001). A more significant positive correlation was found between c-ACT and the duet score of activity and emotional function(r=0.930; p&lt;0.001). Conclusion: Asthma affects the quality of life in children. PAQLQ(S) scores decrease significantly when asthma is out of control. PAQLQ(S) is more significantly associated with c-ACT than GINA criteria. It would be useful in clinical practice if c-ACT or GINA criteria can be improved to cover quality of life, at least the part of the quality of life related to the symptoms or the activity limitations and emotional functions.

Efficacy and Safety of Omalizumab for the Treatment of Severe or Poorly Controlled Allergic Diseases in Children: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the efficacy and safety of omalizumab in the treatment of severe or uncontrolled allergic diseases in children.

METHODS

We conducted a systematic search of the PubMed, Embase, CENTRAL, and clinicaltrials.gov databases up to 23rd July 2021, with no language limitations. Randomised controlled trials (RCTs) comparing omalizumab with other treatments or placebo in children with severe or inadequately controlled allergic diseases were considered. The primary outcomes of interest were asthma exacerbation rate, allergic symptom score, desensitisation achievement for food allergy (FA), and incidence of serious adverse events (SAEs). The study selection and data extraction were conducted independently by two researchers. Quality assessments were conducted using the Cochrane risk-of-bias tool, and data were pooled using a random-effects model if I ² was 50% or greater in the Cochrane Review Manager.

RESULTS

Overall, 10 RCTs [six on severe asthma, one on atopic dermatitis (AD), one on seasonal allergic rhinitis [SAR], and one on FA] consisting of 2,376 participants met the inclusion criteria. For severe asthma, omalizumab may reduce exacerbations at 12 weeks [risk ratio (RR), 0.52; 95% confidence interval (CI), 0.31-0.89], 24 weeks (RR, 0.69; 95% CI, 0.55-0.85; GRADE: moderate-quality evidence), and 52 weeks (RR, 0.62; 95% CI, 0.40-0.94; GRADE: moderate-quality evidence) and reduce the dose of inhalation corticosteroid compared with placebo. For severe AD, the association between omalizumab and allergic symptom improvement [i.e., SCORing Atopic Dermatitis or Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ)] was not confirmed. For severe SAR, omalizumab showed greater improvement in symptom load scores and saved rescue medication days. For FA, omalizumab demonstrated superiority in desensitisation compared with placebo. To date, no clinically significant drug-related SAEs have been reported.

CONCLUSION

For severe or uncontrolled asthma, AD, SAR, and FA, omalizumab may be associated with improved allergic symptoms and safety in children. Future studies should focus on the benefits and pharmacoeconomic evaluation of omalizumab in multiple allergic diseases compared with other treatments.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42021271863].