Loss Of Asthma Control in Pediatric Patients After Discontinuation of Long-Acting Beta-Agonists

Authors

  • Hina Imtiaz
  • Zahid Rashid
  • Saadia Sharif
  • Qamar Uz Zaman Shahzad
  • Zafar Iqbal Bhatti
  • Zarmast Khan

DOI:

https://doi.org/10.1996/pjcm.v28i2.804

Keywords:

Asthma, Children, Long-acting Beta Agonist (LABAs)

Abstract

Background: Asthma poses a substantial worldwide health issue, particularly during childhood, where it stands as the most common chronic condition. Pulmonary function tests (PFT) have been designed to assess children’s tidal breathing may have limited cooperation due to their age or respiratory condition. Objective: The present study aimed to assess the pulmonary function in pediatric emergency department patients experiencing acute wheezing/asthma exacerbation. Methodology: This prospective observational study investigated 52 acute wheezing/asthma exacerbations in the Emergency Department of PIMS Hospital, Islamabad from November 2021 to October 2022. All patients aged 2-16 years presented with wheezing or asthma exacerbation as a chief complaint were enrolled. Pulmonary function tests were conducted initially, before initiating the standard care treatment (specifically, protocol-driven care for patients with asthma). The primary metrics evaluated included the feasibility of testing, patient compliance, and the tests' ability to predict whether the patient should be admitted to the hospital or discharged. Results: Of the total 52 patients, there were 33 (63.5%) male and 19 (36.5%) females. The overall mean age was 8.8±4.7 years. The incidence of mild, moderate, and severe asthma patients were 53.8% (n=28), 28.8% (n=15), and 17.3% (n=9) respectively. Admitted patients exhibited elevated heart rates, higher phase angle, labored breathing index, and asthma score. Based on prior history of patients, asthma/wheezing, allergic rhinitis, eczema, and smoke exposure were found in 18 (34.6%), 14 (26.9%), 9 (17.3%), and 4 (7.7%) respectively. Among 52 patients, the admitted and discharged patients were 19 (36.5%) and 33 (63.5%) respectively. Conclusion: The current study endorsed the use of Pulmonary Function Tests (PFTs) as an objective assessment tool for evaluating asthma/wheezing severity and exacerbation in an Emergency Department. Keywords: Acute Wheezing/Asthma; Pulmonary Function Test; Pediatric Patients

Author Biographies

Hina Imtiaz

Department of Paediatrics, King Abdullah Teaching Hospital, Mansehra – Pakistan

Zahid Rashid

Department of Paediatrics, Avicenna Medical College, Lahore – Pakistan

Saadia Sharif

Department of Paediatrics, East Surrey Hospital Redhill - UK

Qamar Uz Zaman Shahzad

Department of Paediatrics, Shalamar Medical College, Lahore – Pakistan

Zafar Iqbal Bhatti

Department of Paediatrics, Niazi Medical and Dental College, Sargodha – Pakistan

Zarmast Khan

Department of Paediatrics, Niazi Medical and Dental College, Sargodha - Pakistan  

References

Beasley R, Weatherall M, Shirtcliffe P, Hancox R, Reddel HK. Combination corticosteroid/β-agonist inhaler as reliever therapy: a solution for intermittent and mild asthma? J Allergy Clin Immunol. 2014;133(1):39-41.

Vogelberg C. Emerging role of long-acting anticholinergics in children with asthma. Curr Opin Pulm Med. 2016;22(1):74-9.

Reddel HK, FitzGerald JM, Bateman ED, Bacharier LB, Becker A, Brusselle G, et al. GINA 2019: a fundamental change in asthma management. Eur Respir J. 2019;53(6):1901046.

Ullmann N, Mirra V, Di Marco A, Pavone M, Porcaro F, Negro V, et al. Asthma: differential diagnosis and comorbidities. Front Pediatr. 2018;6:276. 2018.00276 DOI: 10.3389/fped.

Sharma A, Kerstjens HA, Aalbers R, Moroni-Zentgraf P, Weber B, Dahl R. Pharmacokinetics of tiotropium administered by Respimat R in asthma patients. Analysis of pooled data from phase II and III clinical trials. Pulm Pharmacol Ther. 2017;42:25–32. DOI: 10.1016/j.pupt.2016.12.003

Papi A, Fabbri LM, Kerstjens HAM, Rogliani P, Watz H, Singh D. Inhaled longacting muscarinic antagonists in asthma – a narrative review. Eur J Intern Med. 2021;85:14–22. DOI: 10.1016/j.ejim.2021.01.027.

Santamaria F, Borrelli M, Baraldi E. GINA 2021: the missing pieces in the childhood asthma puzzle. Lancet Respir Med. 2021; 9:e98. DOI: 10.1016/S2213-2600(21)00275-7

Porcaro F, Ullmann N, Allegorico A, Di Marco A, Cutrera R. Difficult and severe asthma in children. Children (Basel). 2020; 7:286. DOI: 10.3390/children7120286

Cazzola M, Calzetta L, Matera MG. Long-acting muscarinic antagonists and small airways in asthma: which link? Allergy. 2021; 76:1990–2001. DOI: 10.1111/all.14766.

Sharma A, Aalbers R, Hamelmann E, Goldstein S, Engel M, Moroni-Zentgraf P, et al. Pharmacokinetics of tiotropium in asthmatic children aged 6-11 years support its safety profile. Pediatr Allergy Immunol. 2018; 29:773–6. DOI: 10.1111/pai.12952.

Salpeter SR, Wall AJ, Buckley NS. Long-acting beta-agonists with and without inhaled corticosteroids and catastrophic asthma events. Am J Med. 2010; 123: 322–328.

Chowdhury BA, Dal Pan G. The FDA and safe use of long-acting beta-agonists in the treatment of asthma. N Engl J Med. 2010; 362: 1169–1171.

Brozek JL, Kraft M, Krishnan JA, Cloutier MM, Lazarus SC, Li JT, et al. Long-acting β2-agonist step-off in patients with controlled asthma: systematic review with meta-analysis. Arch Intern Med. 2012; 172:1365–75.

Kew KM, Beggs S, Ahmad S. Stopping long-acting beta2-agonists (LABA) for children with asthma well controlled on LABA and inhaled corticosteroids. Cochrane Database Syst Rev. 2015; 5: CD011316.

Reddel HK, Gibson PG, Peters MJ, Wark PA, Sand IB, Hoyos CM, et al. Down-titration from high-dose combination therapy in asthma: removal of long-acting β2-agonist. Respir Med 2010; 104(8): 1110–20.

Ducharme FM, Dell SD, Radhakrishnan D, Grad RM, Watson WT, Yang CL, et al. Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper. Can Respir J 2015; 20(7): 135-43.

Ducharme FM, Noya FJ, Allen-Ramey FC, Maiese EM, Gingras J, Blais L. Clinical effectiveness of inhaled corticosteroids versus montelukast in children with asthma: prescription patterns and patient adherence as key factors. Cur Med Res Opin. 2012;28(1):111-9.

Robinson PFM, Fontanella S, Ananth S, Martin Alonso A, Cook J, Kaya-de Vries D, et al. Recurrent severe preschool wheeze: from prespecified diagnostic labels to underlying endotypes. Am J Respir Crit Care Med. 2021; 204:523–35. DOI: 10.1164/rccm.202009-3696OC.

Vrijlandt EJ, El Azzi G, Vandewalker M, Rupp N, Harper T, Graham L, et al. Safety and efficacy of tiotropium in children aged 1–5 years with persistent asthmatic symptoms: a randomised, double-blind, placebo-controlled trial. Lancet Resp Med. 2018;6(2):127-37.

Zielen S, Reichert G, Donath H, Trischler J, Schulze J, Eickmeier O, et al. Tiotropium as an add-on treatment option for severe uncontrolled asthma in preschool patients. J Asthma Allergy. 2021; 14:23–30. DOI: 10.2147/JAA. S27454.

Szefler SJ, Murphy K, Harper T, Boner A, Laki I, Engel M, et al. A phase III randomized controlled trial of tiotropium add-on therapy in children with severe symptomatic asthma. J Allergy Clin Immunol. 2017; 140:1277–87. DOI: 10.1016/j.jaci.2017.01.01.

Hendaus MA, Jomha FA, Alhammadi AH. Is ketamine a lifesaving agent in childhood acute severe asthma?. Ther Clin Risk Manag. 2016:273-9.

Dima AL, Van Ganse E, Stadler G, de Bruin M. Does adherence to inhaled corticosteroids predict asthma-related outcomes over time? A cohort study. Eur Respir J. 2019;54(6).

Makhinova T, Barner JC, Richards KM, Rascati KL. Asthma controller medication adherence, risk of exacerbation, and use of rescue agents among Texas Medicaid patients with persistent asthma. Journal of managed care & specialty pharmacy. 2015;21(12):1124-32.

Chongmelaxme B, Chaiyakunapruk N, Dilokthornsakul P. Association between adherence and severe asthma exacerbation: a systematic review and meta-analysis. J Am Pharm Assoc. 2020; 60: 669–685.e662.

Lee LK, Ramakrishnan K, Safioti G, Ariely R, Schatz M. Asthma control is associated with economic outcomes, work productivity and health-related quality of life in patients with asthma.BMJ Open Respir Res 2020; 7: e000534.

Rangachari P. A framework for measuring self-management effectiveness and health care use among pediatric asthma patients and families. J Asthma Allergy 2017; 10: 111–122.

Downloads

Published

2022-06-02

How to Cite

Hina Imtiaz, Zahid Rashid, Saadia Sharif, Qamar Uz Zaman Shahzad, Zafar Iqbal Bhatti, & Zarmast Khan. (2022). Loss Of Asthma Control in Pediatric Patients After Discontinuation of Long-Acting Beta-Agonists. Pakistan Journal of Chest Medicine, 28(2), 155–160. https://doi.org/10.1996/pjcm.v28i2.804

Issue

Section

Original Article

Most read articles by the same author(s)