Corticosteroid Use Higher in Children With Bronchiectasis Who Have Asthma

Corticosteroid Use Higher in Children With Bronchiectasis Who Have Asthma

Children with non-cystic fibrosis (CF) bronchiectasis are more likely be prescribed inhaled corticosteroids — medications normally used to treat asthma — to manage their disease when they have certain asthma-like features, according to a recent study.

The study highlights the importance of additional research focused on the coexistence of asthma and bronchiectasis, investigators said, as well as on establishing clear clinical criteria to help physicians identify children with bronchiectasis who are more likely to benefit from these medications.

The study, “Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis,” was published in the Journal of Clinical Medicine and was conducted by scientists from Greece.

Bronchiectasis and asthma are lung diseases that can cause wheezing, shortness of breath, and cough. The similarity of their symptoms, combined with the lack of simple diagnostic tests for asthma and the fact that both disorders can coexist in the same patient, makes their distinction challenging. This in turn may also make it harder for physicians to prescribe treatments for these patients.

Treatment for bronchiectasis usually consists of a combination of antibiotics and chest physiotherapy. In turn, asthma is usually managed with inhaled corticosteroids, sometimes given in combination with long-acting beta-agonists.

“Nevertheless, in daily practice, inhaled corticosteroids, with or without long-acting beta-agonists (LABA), are frequently prescribed in patients with bronchiectasis even when there is no clear evidence of coexisting asthma,” the researchers wrote, adding that in most cases the reasons driving physicians to make this decision are unclear.

Here, the investigators reported the findings of a study that aimed to document the real-life use of inhaled corticosteroids in children with bronchiectasis, as well as pinpoint the reasons leading up to their prescription.

The study was based on data from 65 children, ages 1–16, with a diagnosis of non-CF bronchiectasis, who had been followed at the Pediatric Pulmonology Unit of the Attikon University Hospital in Athens, Greece, from 2013 to 2018.

All children underwent blood and lung function tests, CT chest scans, and skin prick tests to the most common airborne agents that can cause allergies (e.g. grass, house dust mite, cat and dog dander). In addition, the investigators analyzed patient-reported data about the frequency of shortness of breath and wheezing episodes.

From the 65 children included in the study, 46 (70.7%) had been referred to the hospital as difficult cases of asthma. More than half (39 or 60%) of the children had been referred by general pediatric practitioners, and the remaining 40% by other pediatric departments and clinics.

About a third of the children reported experiencing episodes of shortness of breath (33.8%) or wheezing (35.4%), and approximately a fourth (15 participants, 23%) were allergic to a common aeroallergen. Most (56.9%) of the patients had a mosaic pattern, indicative of airway obstruction, on chest CT scans.

In total, 28 children (43%) started daily treatment with inhaled corticosteroids, with or without LABA.

Statistical analyses found that shortness of breath, the presence of a mosaic pattern on chest CT scans, and a positive result on skin prick and bronchodilator response tests were all associated with the prescription of inhaled corticosteroids.

Notably, bronchodilator response tests assess lung function immediately after the use of a bronchodilator agent, which includes salbutamol, and are common in people with asthma. Following the administration of these agents, an improvement in lung function parameters above a defined threshold means a positive test result.

“The prescription of ICS [inhaled corticosteroids] in children with bronchiectasis is more likely when there are certain asthma-like characteristics,” the investigators wrote. “The difficulty to set the diagnosis of real asthma in cases of bronchiectasis may justify the decision of clinicians to start an empirical trial with ICS in certain cases.”

They added that the findings indirectly highlight the importance of addressing “the issue of asthma and bronchiectasis coexistence and define the clinical characteristics of children with bronchiectasis who could benefit from the use of ICS.”