P90 Once daily inhaled corticosteroid prescribing in paediatric asthma: a single centre retrospective cohort study

Abstract

Introduction Children perceived to have difficult asthma often have poor treatment adherence.1 In asthma, long-term inhaled corticosteroids (ICS) are often abandoned by patients who feel little short-term benefit.2 Medication adherence often differentiates ‘difficult asthma’ from ‘difficult asthmatics’. Relvar (fluticasone furoate/vilanterol) is a once daily combined ICS/LABA preparation licensed for children aged >12 years. Relvar is considered in our centre for asthmatic patients reporting increased symptoms, demonstrating regular exacerbations or reduced lung function and those with reported/suspected poor adherence to twice daily combined ICS/LABA preparations. Methods Retrospective cohort study of patients prescribed Relvar. Data collected included FEV1 (percent predicted/absolute volumes), fraction of expired nitric oxide (FeNO), emergency department (ED)attendances and hospital/primary care prescriptions for rescue oral steroids (2 years before and after commencing Relvar). Data were analysed using paired t-test (Graphpad prism software). Results Thirty-nine patients (15 female) were studied with mean age of commencing Relvar 13 years. Mean (sd) baseline FEV1 of 84 (9.48)%predicted and FeNO 58.5 (43) ppb were noted prior to commencing Relvar. No statistical difference was in%FEV1 pre and post-Relvar (p=0.3652) was seen. FeNO was lower post-Relvar but did not reach statistical significance (p=0.21). Given the large confidence intervals (−5 to +25 ppb) statistical significance may have been achieved with a larger sample size. ED attendances were significantly reduced after commencing Relvar (p=0.004). 19/39 primary care teams responded, with no significant difference in prednisolone courses prescribed in primary care (p=0.1545 [95% CI −0.63 to 3.68]). However, hospital (p=0.0043 [95% CI 0.26 to 1.28]) and total (p=0.0087 [95% CI 0.27 to 1.77]) prednisolone courses were significantly reduced post Relvar. Conclusions In patients with poor adherence to ICS we found that once daily treatment with Relvar significantly reduced ED attendances and oral prednisolone use. Once daily medication may be more acceptable to patients, and in some instances it could be delivered within a school setting to ensure adherence. A prospective study including quality of life/asthma control test measures is planned. References Bracken M, et al. Arch Dis Child 2009;94:780–4. Klok T, et al. Ped All Imm 2015;26:197–205.