Journal article
A Pragmatic Trial of Symptom-Based Inhaled Corticosteroid Use in African-American Children with Mild Asthma
The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.8(1), pp.176-185.e2
01/2020
DOI: 10.1016/j.jaip.2019.06.030
PMID: 31371165
Abstract
Symptom-based adjustment (SBA) of inhaled corticosteroids may be an alternative patient-centered approach in which day-to-day inhaled corticosteroid use is adjusted by symptoms and short-acting β-agonist need.
To evaluate the effectiveness of SBA in the primary care setting.
We conducted a randomized, open-label, pragmatic equivalence trial in African-American children (6-17 years old) with mild asthma managed by 12 primary care providers (PCPs). A total of 206 participants were randomized to SBA (as-needed beclomethasone 80 μg with rescue short-acting β-agonist) or provider-based guideline-directed adjustment (PBA): maintenance beclomethasone 80 μg/d (6-11 years old), 160 μg/d (12-17 years old), with subsequent guideline-based dose adjustment by PCPs. PCPs implemented both treatment assignments, with outcomes measured by blinded staff. All participants received symptom recognition and albuterol use education from peer educators. Primary outcome was change in asthma control (measured by Asthma Control Test [ACT]/childhood ACT [cACT]) over 12 months.
Participants had adequately controlled asthma (mean ACT or cACT score = 21.6 ± 2.8) at baseline. After 1 year, there was no significant between-group difference in change in ACT scores (SBA - PBA): ACT: -0.88 (95% CI, -2.19 to 0.42), cACT: -0.73 (-2.09 to 0.62), or combined ACT and cACT (P = .10), and was within the predefined statistical clinical equivalence. The proportion with an exacerbation and measures of lung function were similar between groups. Compared with PBA, SBA led to less beclomethasone use (SBA: 526 μg/mo [95% CI, 412-639 μg] vs PBA: 1961 μg/mo [95% CI, 1681-2241]; P < .0001). More parents in the SBA arm felt they were managing their child's asthma.
SBA in African-American children with mild asthma was similar to PBA in asthma control and events when implemented by PCPs with lower inhaled corticosteroid exposure.
Details
- Title: Subtitle
- A Pragmatic Trial of Symptom-Based Inhaled Corticosteroid Use in African-American Children with Mild Asthma
- Creators
- Kaharu Sumino - Washington University in St. LouisLeonard B Bacharier - Washington University in St. LouisJuanita Taylor - Washington University in St. LouisKelley Chadwick-Mansker - Washington University in St. LouisVanessa Curtis - Washington University in St. LouisAlison Nash - Washington University in St. LouisShawni Jackson-Triggs - Washington University in St. LouisJoseph Moen - Washington University in St. LouisKenneth B Schechtman - Washington University in St. LouisJane Garbutt - Washington University in St. LouisMario Castro - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.8(1), pp.176-185.e2
- DOI
- 10.1016/j.jaip.2019.06.030
- PMID
- 31371165
- ISSN
- 2213-2198
- eISSN
- 2213-2201
- Grant note
- DOI: 10.13039/100006093, name: Patient-Centered Outcomes Research Institute
- Language
- English
- Date published
- 01/2020
- Academic Unit
- Endocrinology and Diabetes; Stead Family Department of Pediatrics
- Record Identifier
- 9984354043902771
Metrics
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