SAN FRANCISCO – Adding long-acting beta-agonists to a regimen consisting of inhaled corticosteroids did not increase the rate of admissions to the pediatric intensive care unit, results from a year-long study showed.
"This supports the guidelines from the National Asthma Education and Prevention Program," Dr. Tammy S. Jacobs said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "When you fail to have adequate control with inhaled corticosteroids alone, long-acting beta-agonists can be a very good medication to add."
Dr. Tammy S. Jacobs
While results from the U.K. Serevent Nationwide Surveillance study and the U.S. Salmeterol Multicenter Asthma Research Trial suggested that long-acting beta-agonists (LABAs) increase the risk of asthma-related mortality, neither trial was adequately powered to study the safety of LABAs when used in conjunction with inhaled corticosteroids (ICS), said Dr. Jacobs, a resident at Children’s Hospital of Pittsburgh. In an effort to evaluate the impact of LABA use in conjunction with inhaled corticosteroids on the risk of near-fatal asthma in children, she and her associates reviewed the medical charts of 363 children aged 4-18 years who were admitted for asthma exacerbations to Children’s Hospital of Pittsburgh in 2005.
Cases and controls were determined by pediatric intensive care (PICU) and floor admissions, respectively. Exposure was defined by LABA use in combination with ICS vs. ICS alone.
After excluding patients with non–asthma-indicated admissions, complicated pneumonias, debilitating comorbid disorders, and multiple admissions, 85 PICU admissions and 96 floor admissions were included in the final analysis. The mean age of patients was 9 years, 54% were male, and 51% were white.
Dr. Jacobs reported that the use of LABA in conjunction with ICS did not significantly increase the risk of PICU admissions (odds ratio, 1.07), compared with ICS alone. After the researchers adjusted for demographics, asthma severity, history of PICU admissions, and concurrent infection, they found that the use of LABA in conjunction with ICS may have decreased the risk of PICU admission, compared with ICS alone (OR, 0.85). No deaths occurred during the study period.
"Although this [study] does not directly evaluate increase in mortality (as in previous trials), risk of ICU admission may actually be a more clinically relevant outcome to evaluate LABA safety," the researchers concluded in their poster. "Findings are generalizable to a population of children with relatively higher-risk asthma/poorer asthma control since all subjects were admitted, and no outpatient subjects were included."
Dr. Jacobs acknowledged certain limitations of the study, including the fact that it was a retrospective chart review with the potential for missing data.
She said that she had no relevant financial conflicts to disclose.