Problematic severe asthma in children treated at high altitude: tapering the dose while improving control

Abstract

Background: Multidisciplinary treatment at high altitude is a possible treatment option for problematic severe asthma (PSA) in children. This management can result in the tapering of inhaled corticosteroids. Aim: Our aim was to analyze the effect of multidisciplinary treatment at high altitude, notably the ability to taper corticosteroids. To get an insight into possible factors influencing tapering, we examined whether demographic variables, disease control and quality of life at treatment entrance could predict the tapering of corticosteroids. Methods: This prospective open-phase cohort study analyzed the data of 43 children aged 8–17 years referred to a specialized high altitude treatment centre. Lung function (FEV₁, FEV₁/VC), inflammation (FeNO), medication level, asthma control (ACT) and quality of life [PAQLQ(S)] were evaluated on admission and at discharge. Results: Thirty-two (74%) children fulfilled PSA criteria. Three (7%) children used daily oral steroids. After 72 ± 30 (mean ± SD) days of treatment, the mean dosage of inhaled corticosteroids (ICS) could be significantly reduced from 1315 μg ± 666 budesonide equivalent to 1132 μg ± 514. Oral steroid maintenance therapy could be stopped in all patients. FeNO, asthma control and quality of life improved (p < 0.001) from admission to discharge; FEV₁ was in the normal range on both occasions. Apart from ICS levels at entrance, multiple regression analyses did not show any associated factor predicting the reduction of ICS dosage during treatment. Conclusion: The results indicate that high altitude treatment may be a treatment option for children with PSA, but it is not possible to predict ICS tapering off from health status variables at treatment entrance.

• Asthma control
• inhaled corticosteroids
• lung function
• problematic severe asthma
• tapering

Acknowledgements

The authors would like to thank Prof. Dr E. Bel, Academic Medical Center, Amsterdam and Dr A. Boehmer, Rotterdam, for their valuable advises and review of earlier versions of the manuscript.