Preschool-aged children with high-risk asthma had substantially fewer severe asthma attacks after starting combination inhaler therapy, according to a new Indiana University School of Medicine study published in Pediatric Allergy and Immunology.
Using real-world health records from 249 children in the Indiana Network for Patient Care, researchers found that repeat severe asthma attacks requiring emergency department care or hospitalization were 68% lower after children began inhaled corticosteroid plus long-acting beta-agonist therapy, known as ICS+LABA. The largest improvements were seen in children who started controller treatment early and those with more early-life asthma risk factors, including eczema, allergies, wheezing, bronchiolitis, pneumonia or a parent with asthma.
“This work could help move childhood asthma care toward a more personalized approach,” said Arthur Owora, PhD, associate professor of pediatrics at the IU School of Medicine and research scientist at the Regenstrief Institute, who led the study. “Rather than treating all young children the same, clinicians may eventually use early-life risk profiles from health records to decide who might benefit from earlier treatment escalation.”
Asthma is a chronic lung disease that can cause coughing, wheezing and shortness of breath. When poorly controlled, childhood asthma can lead to emergency department visits, hospitalizations and major disruptions for families.
Current treatment guidance remains cautious about ICS+LABA use in children younger than 5 because evidence in this age group has been limited. Owora said the new findings suggest that age alone may not be enough to guide treatment decisions for children with severe or recurrent asthma symptoms.
“What is exciting is that the children at highest risk seemed to experience the greatest improvement,” Owora said. “That suggests we may be able to do better by identifying high-risk children early instead of relying mainly on age-based treatment rules.”
The researchers emphasized that the study was observational, meaning it cannot prove that ICS+LABA therapy directly caused the reduction in severe asthma attacks. Families should not change a child’s asthma medications without consulting their clinician.
“Our findings do not mean every preschool child with asthma should receive combination therapy,” Owora said. “They suggest that selected high-risk children deserve closer study and may benefit from a more individualized approach.”
The team plans to build on this work by studying whether ICS+LABA directly reduces severe asthma attacks and by developing better tools to help clinicians identify young children most likely to benefit from earlier, risk-based treatment.
IU School of Medicine’s Bowen Jiang and Yash Shah are co-authors on the study. The research was supported by funding from the National Institutes of Health.
