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AAAAI: Step-Up Therapy for Children With Asthma Studied

Best response most likely to occur with LABA step-up; some respond better to other types

TUESDAY, March 2 (HealthDay News) -- Although many children with uncontrolled asthma have a differential response to step-up therapy, many respond better to one approach than others, emphasizing the need to consistently monitor and appropriately adjust asthma therapy prior to further step-up, according to a study published online March 2 in the New England Journal of Medicine to coincide with a presentation at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 28 to March 2 in New Orleans.

Robert F. Lemanske Jr., M.D., of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues randomized 182 children, aged 6 to 17 years, with uncontrolled asthma undergoing treatment with 100 µg of fluticasone twice daily to receive each of three step-up approaches in random order for 16 weeks: 250 µg of fluticasone twice daily (ICS step-up), 100 µg of fluticasone plus 50 µg of a long-acting beta agonist twice daily (LABA step-up), or 100 µg of fluticasone twice daily plus 5 or 10 mg of a leukotriene-receptor antagonist daily (LTRA step-up).

The researchers showed that the LABA step-up was most likely to provide the best response as compared to the LTRA step-up (relative probability, 1.6) and ICS step-up (relative probability, 1.7). Caucasian race and higher Asthma Control Test scores prior to randomization predicted a better response to LABA step-up, while African-American individuals were least likely to have the best response to LTRA step-up.

"The study by Lemanske et al shows that the practitioner must stay closely tuned to the patient's condition. For the patient whose asthma is hard to control, there is simply no substitute for attentive individual follow-up," write the authors of an accompanying editorial.

Several authors reported receiving consulting fees, lecture fees or grant funding from various pharmaceutical companies.

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