Medication use in uncontrolled pediatric asthma: Results from the SysPharmPediA study.

BACKGROUND

Uncontrolled pediatric asthma has a large impact on patients and their caregivers. More insight into determinants of uncontrolled asthma is needed. We aim to compare treatment regimens, inhaler techniques, medication adherence and other characteristics of children with controlled and uncontrolled asthma in the: Systems Pharmacology approach to uncontrolled Paediatric Asthma (SysPharmPediA) study.

MATERIAL AND METHODS

145 children with moderate to severe doctor-diagnosed asthma (91 uncontrolled and 54 controlled) aged 6-17 years were enrolled in this multicountry, (Germany, Slovenia, Spain, and the Netherlands) observational, case-control study. The definition of uncontrolled asthma was based on asthma symptoms and/or exacerbations in the past year. Patient-reported adherence and clinician-reported medication use were assessed, as well as lung function and inhalation technique. A logistic regression model was fitted to assess determinants of uncontrolled pediatric asthma.

RESULTS

Children in higher asthma treatment steps had a higher risk of uncontrolled asthma (OR (95%CI): 3.30 (1.56-7.19)). The risk of uncontrolled asthma was associated with a larger change in FEV

CONCLUSION

This study showed that children with uncontrolled moderate-to-severe asthma were treated in higher treatment steps compared to their controlled peers, but still showed a higher reversibility response to salbutamol. Self-reported adherence and inhaler technique scores did not differ between controlled and uncontrolled asthmatic children. Other determinants, such as environmental factors and differences in biological profiles, may influence the risk of uncontrolled asthma in this moderate to severe asthmatic population.

Informations de copyright

Copyright © 2022. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of Competing Interest AHAB, EMAS, LDB, SB, PC, SiH, AMH, JK, ADK, OSP, SJHV, and CW have no conflicts of interest to disclose. MG has received the SysPharmPedia and PERMEABLE grants, co-financed by the Ministry of Education, Science and Sport Slovenia (MIZS), and he was also funded by Slovenian Research Agency. SuH has received honoraria from Nutricia. MK has received the ERACoSysMed grant. He was funded by the European Union, the German ministry of education and research, the German research foundation, and Infectopharm and received consulting fees from Bionorica, Sanofi, Novartis, and Bencard. He also received honoraria from ERS, EAACI, ATS, Novartis, Glaxo, Chiesi, Sanofi, Nutricia, Hipp, and Allergopharma. GHK has received grants for his institution outside this study from the Lung Foundation of the Netherlands, The Netherlands Organization of Scientific Research, GSK, TEVA, Vertex, and Ubbo Emmius Foundation. He also received financial support for his institute as membership of scientific advisory boards to GSK and to PURE IMS. AHN has received the ZonMW grant. MWP has received research grants for her institute from Netherlands Lung Foundation and Netherlands Organisation for Health Research and Development and received consulting fees as an advisory board from Sanofi Genzyme. She also received speaker fees from AbbVie and Novartis. She is also chair of the pediatric assembly European Respiratory Society. MPY was funded by ISCIII through AES and EC within the AAL framework, and the SysPharmPedia grant from the ERACoSysMed 1st Joint Transnational Call from the European Union under the Horizon 2020. She was funded by the Ramón y Cajal Program by the Spanish Ministry of Science and Innovation and by the European Social Fund “ESF Investing in your future”. She was funded by the Spanish Ministry of Science and Innovation and the European Regional Development Fund “ERDF A way of making Europe” by the European Union grant [SAF2017–83417R], and by MCIN/AEI/10.13039/501,100,011,033 [grant PID2020–116274RB-I00] (Outside of the submitted work). She was also funded by the Allergopharma Award 2021, Instituto de Salud Carlos III (ISCIII) [CB06/06/1088], and received support from GlaxoSmithKline S.A. (Outside of the submitted work). UP has received the SysPharmPedia grant, co-financed by the Ministry of Education, Science and Sport Slovenia (MIZS), and funded by the Slovenian Research Agency and the Ministry of Education, Science and Sport of the Republic of Slovenia for the PERMEABLE grant. MIA was funded by a full PhD scholarship from the Ministry of Higher Education of the Arab Republic of Egypt during the conduct of the study and was funded by a grant from Stichting Asthma Bestrijding. AHM has received ERANET Systems Medicine and ZonMW grant [project number: 9,003,035,001], SysPharmPediA grant from the ERACoSysMed 1st Joint Transnational Call from the European Union under the Horizon 2020 (AC15/00,015) and she is the PI of P4O2 (Precision Medicine for more Oxygen) public-private partnership sponsored by Health Holland involving many private partners who contribute in cash and/or in kind (Boehringer Ingelheim, Breathomix, Fluidda, Ortec Logiqcare, Philips, Quantib-U, Smartfish, SODAQ, Thirona, TopMD, and Novartis) and received Unrestricted research grant Boehringer Ingelheim and Vertex Innovation Award paid to her institution. She also received consulting fees paid to her institution from Astra Zeneca and Boehringer Ingelheim and received honoraria for lectures paid to her institution from GSK. She is chair of the DSMB SOS BPD study, advisory board member of the CHAMP study, president federation of innovative drug research in the Netherlands (FIGON), and the president European association of systems medicine (EASYM).