Skip to main content

Advertisement

SpringerLink
Log in

Probability of successful inhaled corticosteroids cessation in preschool wheezers: a predictive score

  • Research
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Nearly all asthma predictive tools estimate the future risk of asthma development. However, there is no tool to predict the probability of successful ICS cessation at an early age. Therefore, we aimed to determine the predictors of successful ICS cessation in preschool wheezers, and developed a simple predictive tool for clinical practice. This was a retrospective cohort study involving preschool wheezers who had undergone an ICS therapeutic trial during 2015–2020 at the University Hospital, Southern, Thailand. A predictive scoring system was developed using a nomogram to estimate the probability of successful ICS cessation. We calculated area under ROC curve and used a calibration plot for assessing the tool’s performance. A total of 131 medical records were eligible for analysis. Most of the participants were male (68.9%). More than half of the preschool wheezers had successful ICS cessation after an initial therapeutic trial regimen. The predictors of less successful ICS cessation were perinatal oxygen use [OR 0.10 (0.01, 0.70), P = 0.02], allergic rhinitis [OR 0.20 (0.08, 0.56), P = 0.002], blood eosinophil count > 500 cell/mm3 [OR 0.20 (0.06, 0.67), P = 0.008], and previous ICS use > 6 months [OR 0.30 (0.09, 0.72), P = 0.009].

Conclusions: Predictors of less successful ICS cessation were the following: perinatal oxygen use, allergic rhinitis, blood eosinophil count > 500 cell/mm3, and previous ICS use > 6 months. A simple predictive score developed in this study may help general practitioners to be more confident in making a decision regarding the discontinuation of ICS after initial therapeutic trials.

What is Known:

• Early allergic sensitization is associated with reduced chances of inhaled corticosteroid cessation at school age.

• Prolonged ICS is associated with the emergence of adverse effect and discontinuing too early can result in recurrence symptoms.

What is New:

• Requirement of oxygen support within 7 days after birth in term neonate is a postnatal factor associated with less successful ICS cessation.

• We propose a simple predictive tool with easily available clinical parameters (perinatal oxygen use, allergic rhinitis, blood eosinophil count, parental asthma history, and duration of previous ICS use) to determine the timing of inhalational corticosteroid cessation in preschool wheezers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AUC:

Area under the curve

GINA:

Global Initiative for Asthma

ICS:

Inhaled corticosteroids

ROC:

Receiver operating characteristics curve

SABA:

Short-acting beta-2-agonist

References

  1. Ozdogan S, Tabakci B, Demirel AS et al (2015) The evaluation of risk factors for recurrent hospitalizations resulting from wheezing attacks in preschool children. Ital J Pediatr 41:91. https://doi.org/10.1186/s13052-015-0201-z

    Article  CAS  Google Scholar 

  2. Mallol J, García-Marcos L, Solé D et al (2010) International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax 65:1004. https://doi.org/10.1136/thx.2009.115188

    Article  Google Scholar 

  3. Global Initiative for Asthma (2022) Global strategy for asthma management and prevention

  4. Fitzpatrick AM, Bacharier LB, Guilbert TW et al (2019) Phenotypes of recurrent wheezing in preschool children: Identification by latent class analysis and utility in prediction of future exacerbation. J Allergy Clin Immunol Pract 7:915-924.e7. https://doi.org/10.1016/j.jaip.2018.09.016

    Article  Google Scholar 

  5. Guilbert TW, Mauger DT, Lemanske RF (2014) Childhood asthma-predictive phenotype. J Allergy Clin Immunol Pract 2:664–670. https://doi.org/10.1016/j.jaip.2014.09.010

    Article  Google Scholar 

  6. Zeiger RS, Mauger D, Bacharier LB et al (2011) Daily or intermittent budesonide in preschool children with recurrent wheezing. N Engl J Med 365:1990–2001. https://doi.org/10.1056/NEJMoa1104647

    Article  CAS  Google Scholar 

  7. Guilbert TW, Boehmer SJ, Strunk RC et al (2006) Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med 13

  8. Fainardi V, Santoro A, Caffarelli C (2020) Preschool wheezing: trajectories and long-term treatment. Front Pediatr 8. https://doi.org/10.3389/fped.2020.00240

  9. Sitthisarunkul N, Sangsupawanich P, Anuntaseree W (2016) Negative skin prick test predicts asthma remission in preschool children. J Allergy Clin Immunol 4864:AB1. https://doi.org/10.1016/j.jaci.2015.12.011

  10. Longo C, Blais L, Brownell M et al (2021) Association between asthma control trajectories in preschoolers and disease remission. Eur Respir J 57:2001897. https://doi.org/10.1183/13993003.01897-2020

    Article  CAS  Google Scholar 

  11. Wanlapakorn N, Sritippayawan S, Deerojanawong J (2014) Prevalence of asthma, level of control and factors associated with asthma control in Thai elementary school students in Bangkok. Asian Pac J Allergy Immunol. 32:287–292. https://doi.org/10.12932/AP0464.32.4.2014

  12. Wang AL, Datta S, Weiss ST, Tantisira KG (2019) Remission of persistent childhood asthma: Early predictors of adult outcomes. J Allergy Clin Immunol 143:1752-1759.e6. https://doi.org/10.1016/j.jaci.2018.09.038

    Article  Google Scholar 

  13. Bao Y, Chen Z, Liu E et al (2017) Risk factors in preschool children for predicting asthma during the preschool age and the early school age: a systematic review and meta-analysis. Curr Allergy Asthma Rep 17:85. https://doi.org/10.1007/s11882-017-0753-7

    Article  Google Scholar 

  14. Andersson M, Hedman L, Sundberg S et al (2011) Remission of childhood asthma in adolescence – a longitudinal study. Eur Respir J 38:p317

    Google Scholar 

  15. To T, Gershon A, Wang C et al (2007) Persistence and remission in childhood asthma: a population-based asthma birth cohort study. Arch Pediatr Adolesc Med 161:1197–1204. https://doi.org/10.1001/archpedi.161.12.1197

    Article  Google Scholar 

  16. Becker A, Watson W, Ferguson A et al (2004) The Canadian asthma primary prevention study: Outcomes at 2 years of age. J Allergy Clin Immunol 113:650–656. https://doi.org/10.1016/j.jaci.2004.01.754

    Article  Google Scholar 

  17. Wen H-J, Chiang T-L, Lin S-J, Guo YL (2015) Predicting risk for childhood asthma by pre-pregnancy, perinatal, and postnatal factors. Pediatr Allergy Immunol 26:272–279. https://doi.org/10.1111/pai.12374

    Article  Google Scholar 

  18. Britt RD Jr, Faksh A, Vogel E et al (2013) Perinatal factors in neonatal and pediatric lung diseases. Expert Rev Respir Med 7:515–531. https://doi.org/10.1586/17476348.2013.838020

    Article  CAS  Google Scholar 

  19. Caudri D, Wijga AA, Schipper CM et al (2009) Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age. J Allergy Clin Immunol 124:903-910.e7. https://doi.org/10.1016/j.jaci.2009.06.045

    Article  Google Scholar 

  20. Rönmark E, Jönsson E, Platts-Mills T, Lundbäck B (2001) Incidence and remission of asthma in schoolchildren: Report from the obstructive lung disease in northern Sweden studies. Pediatrics 107:e37–e37. https://doi.org/10.1542/peds.107.3.e37

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Kittisakdi Choomalee, biostatistician, Department of epidemiology and the Office of International Affairs, Faculty of Medicine, Prince of Songkla University for their English editing services.

Author information

Authors and Affiliations

  1. Department of Pediatrics Pulmonology, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand

    Kantisa Sirianansopa, Kanokpan Ruangnapa, Pharsai Prasertsan, Kantara Saelim & Wanaporn Anuntaseree

  2. Department of Pediatrics Neurology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

    Utcharee Intusoma

Authors
  1. Kantisa Sirianansopa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kanokpan Ruangnapa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pharsai Prasertsan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kantara Saelim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Utcharee Intusoma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wanaporn Anuntaseree
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation was performed by Kanokpan Ruangnapa, Pharsai Prasertsan, and Kantara Saelim. Data collection, analysis, and first draft of manuscript were performed by Kantisa Sirianansopa. Utcharee Intusoma and Wanaporn Anuntaseree commented on previous version of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kantisa Sirianansopa.

Ethics declarations

Ethics approval

This research was approved by Human Research Ethic Committee (REC. 65-059-1-1), Faculty of Medicine, Prince of Songkla University, Thailand. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

The requirement for informed consents was waived because of the retrospective nature of the data.

Consent for publication

This paper did not include identifiable data or images.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Tobias Tenenbaum

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sirianansopa, K., Ruangnapa, K., Prasertsan, P. et al. Probability of successful inhaled corticosteroids cessation in preschool wheezers: a predictive score. Eur J Pediatr 182, 237–244 (2023). https://doi.org/10.1007/s00431-022-04679-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-022-04679-2

Keywords

Search

Navigation