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What drives pediatric pulmonologists when adjusting asthma treatment?

Published: October 22, 2021

Guidelines recommend adjusting asthma treatment regularly in children. Asthma treatment is stratified in steps, and it should be kept the same, stepped-up or down to optimize control of daily symptoms and reduce risk of asthma attacks, with the minimum possible treatment. Many factors may affect a doctor’s decision when modifying asthma treatment, such as comorbidities, personal preferences, treatment adherence, and environmental exposures. Little is known about what drives doctors to adjust asthma treatment in children in routine care.

In a clinical cohort study in The Journal of Allergy and Clinical Immunology: In Practice, Ardura-Garcia et al. collected information on treatment adjustments during consultations, to study factors that drive pediatric pulmonologists to step-up or step-down asthma treatment. The Swiss Paediatric Airway Cohort (SPAC) is a multicenter clinical cohort embedded in routine care, of children seen by pediatric pulmonologists. The authors collected information on treatments and on diagnostic tests (lung function tests, and measurement of fraction of exhaled nitric oxide, FeNO) from hospital records, and on symptoms, sociodemographic, and environmental factors from a questionnaire to parents. They used multivariable logistic regression to study which factors were linked to treatment changes by doctors (step-up or down).

The authors found that during the visit to the pediatric pulmonologist, most children remained on the same step of treatment, or were stepped-up, while only few were stepped down. Asthma treatment adjustment practices differed broadly between clinics; some clinics were more prone to stepping up, and others to stepping down. Main drivers for treatment step-up were the patient being a girl rather than a boy, uncontrolled asthma, and lower lung function (lower Forced Expiratory Volume in the 1st second, FEV1). The main driver for treatment step-down was low levels of lung inflammation (low FeNO). Understanding how asthma treatment is adjusted in routine care may help to improve monitoring of asthma control in children and to better implement recommendations.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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