Treatment decisions in children with asthma in a real-life clinical setting: the Swiss Paediatric Airway Cohort (SPAC).

Abstract

BACKGROUND

Asthma treatment should be modified according to symptom control and future risk, but there is scarce data on what drives treatment adjustments in routine tertiary care.

OBJECTIVE

We studied factors that drive asthma treatment adjustment in paediatric outpatient clinics.

METHODS

We did a cross-sectional analysis of the Swiss Paediatric Airway Cohort (SPAC), a clinical cohort of 0-16-year-old children seen by paediatric pulmonologists. We collected information on diagnosis, treatment, lung function and Fractional exhaled Nitric Oxide (FeNO) from hospital records; and on symptoms, sociodemographic and environmental factors from a parental questionnaire. We used reported symptoms to classify asthma control and categorised treatment following the 2020 GINA guidelines. We used multivariable logistic regression to study factors associated with treatment adjustment (step-up or down vs. no change).

RESULTS

We included 551 children diagnosed with asthma (mean age 10 years, 37% female). At the clinical visit, most children were prescribed GINA Step 3 (35%). Compared to pre-visit treatment, 252 (47%) children remained on the same step, 227 (42%) were stepped-up and 58 (11%) were stepped-down. Female sex (aOR 1.61, 95% CI 1.05-2.47), poor asthma control (3.08, 1.72-5.54), and a lower Forced Expiratory Volume in the first second (FEV1) Z-score (0.70, 0.56-0.86 per 1 Z-score increase) were independently associated with treatment step-up, and low FeNO (2.34, 1.23-4.45) with treatment step-down, with a marked heterogeneity between clinics.

CONCLUSION

In this tertiary care real-life study, we identified main drivers for asthma treatment adjustment. These findings may help improve both asthma management guidelines and clinical practice.