Background Clinical experience suggests that asthmatic children in developing countries have a different phenotype and therapeutic response than in developed countries.
Objective To correlate therapeutic response in childhood asthma with phenotypic features.
Methods 180 children in the Childhood Asthma Phenotype (CAP) cohort (n = 600, age <12y, diagnosis based on NAEPR III Guidelines) underwent evaluation of phenotypic characteristics using a pre-tested semis-structured questionnaire. Classification of severity, treatment plan, follow-up protocol and monitoring of response were done as per GINA Guideline. Response to therapy was assessed 6 months after initiating treatment and modifying the drug/dose as required. Disease control was defined as per GINA.
Results The mean age of enrolled children was 81.4mo (range 3.0 to 144.0) with age distribution <12 months=9, 12–60 months = 111, 60–144 months =180. Severity classification: Mild intermittent=33, Mild persistent=61, Moderate persistent=181, Severe persistent=25. Children with persistent asthma received inhaled corticosteroid with (26%) or without (74%) long-acting-bronchodilator or Leukotriene-receptor-antagonist. Those with intermittent asthma received short course of bronchodilator. After 6mo, disease control could be assessed in150 children who had at least 90% adherence to the prescribed treatment. Table1 shows the distribution of demographic features, symptom profile, personal and family atopy, and exacerbating/triggering factors, in children with uncontrolled versus controlled disease.
Conclusion With the exception of night time symptoms at presentation, there are no specific features that can predict poor response to therapy in children with bronchialasthma.