In children with severe asthma (SA), targeting small airways with high-dose inhaled corticosteroids (ICS) using a smart nebulizer resulted in a significant reduction in exacerbations requiring oral corticosteroid courses (OCS), according to Wyste B. van den Bosch, MD. “Small airways targeted treatment with smart nebulizer technology decreased the number of asthma-exacerbations and hospital admission after 1 year of treatment, compared to the year before,” he wrote.

For a paper published in the Journal of Asthma, Dr. van den Bosch and colleagues investigated whether targeting of high-dose ICS to small airways with a smart nebulizer could reduce exacerbation rates in children with SA. They conducted a retrospective study in children with SA using a smart nebulizer for the administration of high dose ICS in an outpatient clinic. Clinical data were collected before and after of treatment. The primary outcome was exacerbation rate, defined as: number of asthma exacerbations for which OCS were prescribed. The exacerbation rate 1 year before treatment was compared with the exacerbation rate 1 year after start of treatment. Secondary outcomes included changes in spirometry parameters, hospital admissions, and medication use.


Biologics May Not Be Suitable for All Patients

The researchers found that the median number of asthma exacerbations requiring OCS courses 1 year before decreased from 2 (interquartile range [IQR] 2) to 0.5 (IQR 3) 1 year after treatment. Hospital admissions decreased from 1 (IQR 3) to 0 (IQR 1). FEV1, FEF25-75, and FEF75 were not significantly improved after 1 year of treatment with the smart nebulizer.

“Due to the retrospective design of the study, however, we can only speculate on the causality of this difference,” the study authors wrote. “Notwithstanding these limitations, the results in this study may support the potential role of small airways targeted treatment with a smart nebulizer in SA. International guidelines currently indicate biologicals are the preferred and recommended treatment option for patients with SA and type 2 inflammation. However, various factors, such as prohibitive costs, limited eligibility for treatment, the need for use of injections or intravenous infusion and unresponsiveness of disease in certain patients, mean that biologicals are not a suitable treatment for all patients.”