Comparative Effectiveness of Therapies for Preschool Children with Recurrent Wheezing

Background: The additional benefit of either inhaled corticosteroids (ICS) or leukotriene receptor antagonists (LTRA) over short-acting beta 2 agonists (SABA) in real life condiitons is unclear in preschool children. Aim: To assess the effectiveness of current guideline-recommended treatment options in preschool children with asthma/wheeze. Methods: Electronic medical records from the Optimum Patient Care Research Database were used to characterise a UK population ≤5 y with asthma/wheeze. The study comprised 1-year baseline, index date (ID), date of first prescription (ICS, LTRA or repeat prescription of SABA), and 1-year outcome. We carried out two 2-way matched comparisons: (1) ICS vs. SABA and (2) LTRA vs. SABA. Children initiating ICS or LTRA were matched 1:4 to those prescribed only SABA, matching for age, sex, year of ID, baseline mean SABA usage, baseline exacerbations, baseline antibiotic prescriptions, and eczema diagnosis. We used conditional regression to compare outcome year rates of severe exacerbations, defined as any asthma-related emergency attendance, hospital admission, or acute course of oral steroids. Results: Matched ICS and SABA cohorts included 990 and 3960 children, respectively (39% female; mean (SD) age 3.2 (1.3) years) and matched LTRA and SABA cohorts included 259 and 1036 children, respectively (35% female; mean age 2.6 (1.2) years). We observed no significant difference between matched cohorts in exacerbation rate: ICS vs. SABA, rate ratio 1.01 (95% CI 0.85-1.19), LTRA vs. SABA, 1.28 (0.96-1.72). Conclusion: In this cohort of UK preschool children we found no evidence that ICS or LTRA therapy is associated with fewer exacerbations during 1 outcome year.