Background:
Inhaled corticosteroids (ICS) are the recommended controller therapy of choice for pediatric patients suffering from mild persistent asthma. In this study, the goal was to identify which asthmatic children were more or less likely to respond to ICS, as defined by improvement in lung function, in the context of a pediatric pulmonology practice. We hypothesized that baseline bronchodilator response (BDR) is a significant predictor of an individual’s response to ICS.
Methods:
This retrospective study analyzed children between 5 and 18 years of age from the Rady Children’s Hospital San Diego pulmonary clinic from January 2019 to May 2022 who had been diagnosed with asthma. These patients had baseline pulmonary function tests (PFT) which were used to calculate a BDR before initiating ICS therapy. Follow-up PFTs obtained at least 3 weeks after initiating ICS were used to assess changes in lung function, indicating a response to therapy.
Results:
Among 16 patients, baseline BDR and change in FEV1% while on ICS were positively correlated, r(16) = .73, p < .05. The 6 patients who had high BDR at baseline (M = 15.7, SD = 12.8) compared to the 10 patients who had low BDR (M = 1.1, SD = 8) demonstrated significantly higher changes in FEV1%, t(16) = 2.8, p < .05, following ICS. Furthermore, patients with high BDR at baseline were 12 times more likely to have a notable lung function response to ICS.
Conclusion:
Baseline BDR is associated with response to ICS in pediatric patients with asthma. As baseline BDR increases so do the changes between FEV1% in follow up visits while on ICS therapy. Furthermore, patients who have high baseline BDR have significantly higher responses to ICS. Overall, BDR may be an adequate parameter in identifying asthmatic children who could be considered responders to ICS in the real-world clinical setting.
