Indirect Airway Hyperresponsiveness Test Shows Promise in Optimizing Asthma Treatment for Children

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Incorporating an indirect airway hyperresponsiveness (AHR) test using hypertonic saline into the monitoring and treatment of childhood asthma can lead to a reduction in mild exacerbations, new evidence showed.

A team of investigators led by Janusz Ciółkowski MD, from the Allergology Outpatient Clinic at the Regional Public Hospital in Lesko, conducted a study evaluating a group of 104 patients aged 7 to 15 years with mild-moderate atopic asthma. They aimed to examine the efficacy of this approach in maintaining asthma control in pediatric populations.

Over the course of a year, the patients were randomly divided into 2 groups: a symptom-only monitored group, and a group where therapy adjustments were made based on the severity of symptoms and AHR. Regular assessments were performed related to various parameters, including spirometry, exhaled nitric oxide levels, blood eosinophils (BEos), and asthma control, at the beginning of the study and every three months thereafter.

The results of the investigation revealed a lower number of mild exacerbations in the AHR group (44) compared with the symptom-only monitored group (85) which demonstrated significance (95% CI, .346 - 0.717; P < 0.001). Despite the reduction in exacerbations, the mean changes from baseline in clinical parameters, inflammatory markers, and lung function were similar between both groups.

These findings suggest the addition of the hypertonic saline test to clinical monitoring effectively curbed mild exacerbations without compromising other aspects of asthma management, investigators wrote. The data also demonstrated that baseline BEos levels correlated with AHR and served as a risk factor for recurrent exacerbations in all patients.

However, when comparing the final dose of inhaled corticosteroids (ICS) between the AHR (287; SD, 255) and symptom-monitored groups (243; SD, 158), no significant difference was observed. This relationship indicated the AHR test, when integrated into the treatment plan, enables the maintenance of asthma control using a comparable ICS dosage, the study stated.

The implications of this research propose a simple, cost-effective, and safe tool for managing mild-to-moderate asthma in children. Investigators emphasized the indirect approach offered by the hypertonic saline test as a way to assess airway hyperresponsiveness and provide valuable information that can guide treatment decisions.

By incorporating this test into routine clinical monitoring, healthcare providers may be better equipped to personalize asthma management plans for pediatric patients, according to the study.

"Our research demonstrates that the addition of the hypertonic saline test to symptom-based monitoring can significantly reduce the number of mild exacerbations in children with asthma," investigators wrote. "This simple and cost-effective method has the potential to enhance treatment outcomes and improve the quality of life for young asthma patients."

While the team acknowledged the need for further research to validate and expand upon these findings, this study presents a significant step forward in the quest for more effective and individualized asthma management in children.

References:

Ciółkowski, J, Hydzik, P, Rachel, M, Mazurek-Durlak, Z, Skalska-Izdebska, R, Mazurek, H. Childhood asthma treatment based on indirect hyperresponsiveness test: randomized controlled trial. Pediatr Pulmonol. 2023; 1- 9. doi:10.1002/ppul.26556