G460(P) Interventions for autumn exacerbations of asthma in children: a systematic review

Aims Asthma exacerbations peak in school-aged children following the autumn school return. Modifiable factors, including poor treatment adherence during the summer months and increased allergen and viral exposure may underlie these observations. Interventions implemented in anticipation of the autumn school return might lessen the burden upon patients and healthcare resources. We undertook a Cochrane systematic review to assess the effectiveness of interventions aiming to reduce asthma exacerbations in children returning to school. Methods Randomised controlled trials (RCTs) were identified in searches of the Cochrane Airways Group Specialised Register (CAGR) and other supplementary sources. Eligibility criteria included study design (RCTs), intervention (intended to reduce autumn exacerbations) and population (participants aged 18 years or younger). We appraised the quality of trials using the Cochrane Risk of Bias tool. Results 520 records were retrieved. 4 studies met the inclusion criteria and together randomised 14 048 children to receive an intervention or usual care. Two studies employed the leukotriene receptor antagonist (LTRA) montelukast, one used omalizumab or an inhaled corticosteroids boost and the last analysed the impact of a reminder letter sent to caregivers from Primary Care Providers about asthma medication. Quality ratings in most domains were low risk. Risk of exacerbation were significantly reduced in single studies of omalizumab OR 0.48 (95% CI: 0.25 to 0.92) and montelukast OR 0.25 (0.08–0.79). Frequency of unscheduled contacts increased during September (OR 1.30 95% CI: 1.03 to 1.66) due to the reminder correspondence. The incidence of adverse events did not differ between trial arms. An updated search retrieved 25 further studies, including a randomised open trial of pranlukast. This un-blinded study was of poorer quality, relying largely upon subjective outcomes. Pranlukast was found to be superior to usual care in reducing worsening asthma symptoms only in boys aged 1–5 years. Conclusion Omalizumab treatment initiated 4–6 weeks in advance of the school return might reduce autumn asthma exacerbations. This review identified a need for coordinated research employing validated measurement tools to explore patient-important outcomes including the impact of interventions on asthma control or quality of life. We would recommend that exacerbation definition be standardised in future trials.