Indirect airway hyperresponsiveness test may help ascertain correct ICS dose for better asthma control in kids

In a recent study, Janusz Ciolkowski and team found that indirect airway hyperresponsiveness (AHR) test using hypertonic saline in determining the appropriate dose of inhaled corticosteroids (ICS) increased asthma control in children. The findings were published in Pediatric Pulmonology.

The study involved 104 children aged 7 to 15 years with mild to moderate atopic asthma. These patients were closely monitored for asthma control and treatment over a period of one year. They were randomly divided into two groups: a symptom-only monitored group and a group where therapy adjustments were made based on both symptoms and the severity of AHR. Throughout the study, various parameters such as spirometry, exhaled nitric oxide, and blood eosinophils (BEos) were assessed every three months.

The results revealed a notable reduction in the number of mild exacerbations in the AHR group compared to the symptom-only group. The AHR group experienced 44 mild exacerbations, while the symptom-only group had 85 (absolute rate per patient: 0.83 vs. 1.67; relative rate: 0.49, 95% confidence interval: 0.346–0.717; p < 0.001). However, no significant differences were observed in the mean changes from baseline in clinical, inflammatory, and lung function parameters between the two groups.

The baseline BEos levels were found to correlate with AHR and were identified as a risk factor for recurrent exacerbations in all patients. Surprisingly, there was no significant difference in the final ICS dose between the AHR and symptom-only groups. The mean ICS dose in the AHR group was 287 (SD 255), while in the symptom-only group, it was 243 (SD 158) (p = 0.092).

These findings suggest that incorporating an indirect AHR test into the clinical monitoring of childhood asthma can effectively reduce the number of mild exacerbations without compromising current clinical control or necessitating higher ICS doses. The hypertonic saline test used in the study offers a simple, cost-effective, and safe tool for monitoring the treatment of mild-to-moderate asthma in children.

The results of this study have important implications for pediatric asthma management. By utilizing the indirect AHR test alongside traditional symptom monitoring, healthcare professionals can make more informed decisions about treatment adjustments, potentially leading to improved asthma control and reduced exacerbations in children.

Source:

Ciółkowski, J., Hydzik, P., Rachel, M., Mazurek-Durlak, Z., Skalska-Izdebska, R., & Mazurek, H. (2023). Childhood asthma treatment based on indirect hyperresponsiveness test: Randomized controlled trial. In Pediatric Pulmonology. Wiley. https://doi.org/10.1002/ppul.26556