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Individualized therapy for persistent asthma in young children.

Publication ,  Journal Article
Fitzpatrick, AM; Jackson, DJ; Mauger, DT; Boehmer, SJ; Phipatanakul, W; Sheehan, WJ; Moy, JN; Paul, IM; Bacharier, LB; Cabana, MD; Covar, R ...
Published in: J Allergy Clin Immunol
December 2016

BACKGROUND: Phenotypic presentations in young children with asthma are varied and might contribute to differential responses to asthma controller medications. METHODS: The Individualized Therapy for Asthma in Toddlers study was a multicenter, randomized, double-blind, double-dummy clinical trial in children aged 12 to 59 months (n = 300) with asthma necessitating treatment with daily controller (Step 2) therapy. Participants completed a 2- to 8-week run-in period followed by 3 crossover periods with daily inhaled corticosteroids (ICSs), daily leukotriene receptor antagonists, and as-needed ICS treatment coadministered with albuterol. The primary outcome was differential response to asthma medication based on a composite measure of asthma control. The primary analysis involved 2 stages: determination of differential response and assessment of whether 3 prespecified features (aeroallergen sensitization, previous exacerbations, and sex) predicted a differential response. RESULTS: Seventy-four percent (170/230) of children with analyzable data had a differential response to the 3 treatment strategies. Within differential responders, the probability of best response was highest for a daily ICS and was predicted by aeroallergen sensitization but not exacerbation history or sex. The probability of best response to daily ICS was further increased in children with both aeroallergen sensitization and blood eosinophil counts of 300/μL or greater. In these children daily ICS use was associated with more asthma control days and fewer exacerbations compared with the other treatments. CONCLUSIONS: In young children with asthma necessitating Step 2 treatment, phenotyping with aeroallergen sensitization and blood eosinophil counts is useful for guiding treatment selection and identifies children with a high exacerbation probability for whom treatment with a daily ICS is beneficial despite possible risks of growth suppression.

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Published In

J Allergy Clin Immunol

DOI

EISSN

1097-6825

Publication Date

December 2016

Volume

138

Issue

6

Start / End Page

1608 / 1618.e12

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Recurrence
  • Precision Medicine
  • Male
  • Leukotriene Antagonists
  • Infant
  • Humans
  • Follow-Up Studies
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Fitzpatrick, A. M., Jackson, D. J., Mauger, D. T., Boehmer, S. J., Phipatanakul, W., Sheehan, W. J., … NIH/NHLBI AsthmaNet, . (2016). Individualized therapy for persistent asthma in young children. J Allergy Clin Immunol, 138(6), 1608-1618.e12. https://doi.org/10.1016/j.jaci.2016.09.028
Fitzpatrick, Anne M., Daniel J. Jackson, David T. Mauger, Susan J. Boehmer, Wanda Phipatanakul, William J. Sheehan, James N. Moy, et al. “Individualized therapy for persistent asthma in young children.J Allergy Clin Immunol 138, no. 6 (December 2016): 1608-1618.e12. https://doi.org/10.1016/j.jaci.2016.09.028.
Fitzpatrick AM, Jackson DJ, Mauger DT, Boehmer SJ, Phipatanakul W, Sheehan WJ, et al. Individualized therapy for persistent asthma in young children. J Allergy Clin Immunol. 2016 Dec;138(6):1608-1618.e12.
Fitzpatrick, Anne M., et al. “Individualized therapy for persistent asthma in young children.J Allergy Clin Immunol, vol. 138, no. 6, Dec. 2016, pp. 1608-1618.e12. Pubmed, doi:10.1016/j.jaci.2016.09.028.
Fitzpatrick AM, Jackson DJ, Mauger DT, Boehmer SJ, Phipatanakul W, Sheehan WJ, Moy JN, Paul IM, Bacharier LB, Cabana MD, Covar R, Holguin F, Lemanske RF, Martinez FD, Pongracic JA, Beigelman A, Baxi SN, Benson M, Blake K, Chmiel JF, Daines CL, Daines MO, Gaffin JM, Gentile DA, Gower WA, Israel E, Kumar HV, Lang JE, Lazarus SC, Lima JJ, Ly N, Marbin J, Morgan W, Myers RE, Olin JT, Peters SP, Raissy HH, Robison RG, Ross K, Sorkness CA, Thyne SM, Szefler SJ, NIH/NHLBI AsthmaNet. Individualized therapy for persistent asthma in young children. J Allergy Clin Immunol. 2016 Dec;138(6):1608-1618.e12.
Journal cover image

Published In

J Allergy Clin Immunol

DOI

EISSN

1097-6825

Publication Date

December 2016

Volume

138

Issue

6

Start / End Page

1608 / 1618.e12

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Recurrence
  • Precision Medicine
  • Male
  • Leukotriene Antagonists
  • Infant
  • Humans
  • Follow-Up Studies
  • Female