{
  "abstract": "Introduction Maintenance and Reliever Therapy (MART) with a combination inhaled corticosteroid (ICS)-formoterol inhaler is an alternative to conventional therapy (maintenance ICS plus a short-acting-beta-agonist (SABA) reliever) for children and young people (CYP) with asthma. While MART is effective in reducing asthma attacks in adults and adolescents, little is known about the impact on airway inflammation or real-life asthma control in CYP.Hypothesis In CYP with asthma, at GINA steps 3–5, MART is associated with improved inflammatory biomarkers (peripheral blood eosinophil count and fractional exhaled nitric oxide [FeNO]), lung function and symptom control, when compared to CYP on conventional therapy regimens.Methods Retrospective study of CYP (6–16 years) with confirmed asthma, attending a tertiary respiratory clinic. Participants on MART were prescribed treatment for a minimum of 12 months prior to testing. Blood eosinophil count, FeNO, spirometry, and Asthma Control Test (ACT)/childhood ACT (cACT) were assessed. Group comparisons were made using unpaired t-tests for normally distributed data (mean ± standard deviation), Mann-Whitney tests for non-normally distributed data (median and interquartile range) and chi-squared tests for categorical data.Results Data from 119 children were analysed (76 males; median age: 13.00 years, IQR – 11.00–15.00), 32 were prescribed MART and 87 were on conventional therapy ( table 1). Those prescribed MART had significantly lower blood eosinophil count (0.2×109/L, IQR: 0.1–0.5 vs. 0.4×109/L, IQR: 0.2–0.7, p<0.05). There was no significant difference in FeNO levels between the groups; MART 40ppb (IQR: 17–64) vs. 25ppb (IQR: 11–51, p=0.21). CYP using MART had significantly higher mean percent predicted FEV1; 91.3 ± 13.0% vs. 84.3 ± 16.4%, p<0.05). A higher proportion of CYP prescribed MART had good symptom control (65.6% (21/32), ACT/cACT score ≥ 20) compared to those prescribed conventional therapy (37.9% (33/87), p<0.05).Abstract S45 Table 1Participant Demographics and Clinical Characteristics. This table presents the baseline demographic and clinical characteristics of the entire study cohort, participants receiving MART, those on conventional asthma therapy and the p-value between the MART and conventional cohort (where applicable). Continuous variables are reported as the mean ± standard deviation (SD), when normally distributed or the median with the interquartile range, when non-parametric. Categorical variables are presented as number of participants (n) and percentage (%) of their respective cohorts. The sample size (n) for Blood Eosinophil Count and FeNO is specified where it differs from the total cohort or subgroup size All Subjects (n=119) MART (n=32) Conventional Therapy (n=87) P Value Age (years, median; IQR) 13.00; 11.00 - 15.00 14.84; 12.98 - 14.84 13.00; 10.44 - 15.00 N/A Gender Male - 76 (63.9%)Female - 43 (36.1%) Male - 21 (65.6%)Female - 11 (34.3%) Male - 56 (64.4%)Female - 31 (35.6%) N/A Ethnicity (GLI categories)CaucasianBlackNortheast AsianSoutheast AsianOther 56 (47.1%)12 (10.1%)0051 (42.9%) 17 (53.1%)4 (12.5%)0011 (34.4%) 39 (44.8%)8 (9.2%)0040 (46.0%) N/A Height (cm, mean ± SD) 153.31 ± 15.7 152.81 ± 15.8 150.42 ± 14.7 N/A Weight (kg, median; IQR) 47.1; 36.2 - 56.8 52.1; 46.1 - 52.1 46.0; 34.5 - 55.8 N/A Body Mass Index (median; IQR) 19.25; 17.23 - 22.14 19.82; 16.93 - 24.17 19.23; 17.32 - 22.06 N/A MedicationICSICS+LABAMontelukastAntihistamine 13 (10.9%)106 (89.1%)31 (26.1%)55 (46.2%) 032 (100.0%)6 (18.8%)15 (46.9%) 13 (14.9%)74 (85.1%)25 (28.7%)40 (46.0%) N/A Asthma attacks in the 12 months prior to test visit 0 - 50 (42.0%)1 - 28 (23.5%)2 - 18 (15.1%)3+ - 23 (19.3%) 0 - 13 (40.6%)1 - 7 (21.9%)2 - 5 (15.6%)3+ - 7 (21.9%) 0 - 36 (41.4%)1 - 22 (25.3%)2 - 13 (14.9%)3+ - 16 (18.4%) P = 0.63 Blood Eosinophil Count (x109/L, median; IQR) n=1090.3; 0.2 - 0.6 n=310.2; 0.1 - 0.5 n=780.4; 0.2 - 0.7 P < 0.05 FeNO (ppb, median; IQR) n=11029; 11 - 57 n=29 40; 17 - 64 n=81 25; 11 - 51 P = 0.21 SpirometryFEV1%Predicted(mean ± SD)FEV1/FVC (median; IQR) 88.57 ± 15.570.82; 0.76 - 0.87 91.3 ± 13.00.82; 0.77 - 0.87 84.3 ± 16.40.81; 0.75 - 0.87 P < 0.05 Symptom Score (ACT/cACT, ≥ 20 = good control) <20 – 65 (54.6%)≥ 20 - 54 (45.4%) < 20 - 11 (34.4%)≥ 20 - 21 (65.6%) <20 - 54 (62.1%)≥ 20 - 33 (37.9%) P < 0.05 Abbreviations: MART - Maintenance and Reliever Therapy, n – number of participants, IQR – interquartile range, SD – standard deviation, GLI - Global Lung Function Initiative, SABA – Short-acting beta 2-agonists, ICS – inhaled corticosteroids, LABA – Long-Acting Beta-Agonists, FeNO – fractional exhaled nitric oxide, FEV1 – forced expiratory volume in 1 second, FEV1/FVC – forced expiratory volume in 1 second/forced vital capacity, ACT – Asthma Control Test, cACT – childhood Asthma Control Test, N/A – not applicableDiscussion CYP prescribed MART had significantly lower blood eosinophil count, better lung function and better asthma control compared to those prescribed conventional therapy. However, there was no difference in FeNO for unclear reasons. This supports the benefit of MART on asthma pathophysiology in addition to the known impact on asthma attacks, in a real-life setting.",
  "authors": [
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "S Hay"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK"
      ],
      "name": "K Hillson"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "H Almeida"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "B Pavlou"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK"
      ],
      "name": "I Testa"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Y Bingham"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "K Mayoral Oritz"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "S Lacbay"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "M Gore"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Heraklion University Hospital, University of Crete Medical School, Crete, Greece"
      ],
      "name": "E Paraskakis"
    },
    {
      "affiliations": [
        "The Usher Insitute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "H Tibble"
    },
    {
      "affiliations": [
        "Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK"
      ],
      "name": "S Irving"
    },
    {
      "affiliations": [
        "Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK"
      ],
      "name": "S Sonnappa"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK"
      ],
      "name": "L Fleming"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK",
        "Centre for Paediatrics and Child Health, Imperial College London, London, UK"
      ],
      "name": "A Bush"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK",
        "Centre for Paediatrics and Child Health, Imperial College London, London, UK"
      ],
      "name": "S Saglani"
    }
  ],
  "title": "S45 Mart vs conventional therapy: impact on biomarkers, lung function and symptom control in children and young people with asthma",
  "uid": "2c038e3d-37c9-5c79-94ec-00417505d5fb"
}