title: Problematic severe asthma in children treated at high altitude: tapering the dose while improving control.
abstract: BACKGROUND
  Multidisciplinary treatment at high altitude is a possible treatment option for problematic severe asthma (PSA) in children. This management can result in the tapering of inhaled corticosteroids.
  
  
  OBJECTIVE
  Our aim was to analyze the effect of multidisciplinary treatment at high altitude, notably the ability to taper corticosteroids. To get an insight into possible factors influencing tapering, we examined whether demographic variables, disease control and quality of life at treatment entrance could predict the tapering of corticosteroids.
  
  
  METHODS
  This prospective open-phase cohort study analyzed the data of 43 children aged 8-17 years referred to a specialized high altitude treatment centre. Lung function (FEV1, FEV1/VC), inflammation (FeNO), medication level, asthma control (ACT) and quality of life [PAQLQ(S)] were evaluated on admission and at discharge.
  
  
  RESULTS
  Thirty-two (74%) children fulfilled PSA criteria. Three (7%) children used daily oral steroids. After 72 ± 30 (mean ± SD) days of treatment, the mean dosage of inhaled corticosteroids (ICS) could be significantly reduced from 1315 μg ± 666 budesonide equivalent to 1132 μg ± 514. Oral steroid maintenance therapy could be stopped in all patients. FeNO, asthma control and quality of life improved (p < 0.001) from admission to discharge; FEV1 was in the normal range on both occasions. Apart from ICS levels at entrance, multiple regression analyses did not show any associated factor predicting the reduction of ICS dosage during treatment.
  
  
  CONCLUSIONS
  The results indicate that high altitude treatment may be a treatment option for children with PSA, but it is not possible to predict ICS tapering off from health status variables at treatment entrance.
authors.affiliation: Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Center , Amsterdam , The Netherlands .
authors.forename: Erik-Jonas
authors.initials: EJ
authors.lastname: van de Griendt
authors.forename: Marieke
authors.initials: M
authors.lastname: Verkleij
authors.forename: J Menno
authors.initials: JM
authors.lastname: Douwes
authors.forename: Wim M C
authors.initials: WM
authors.lastname: van Aalderen
authors.forename: Rinie
authors.initials: R
authors.lastname: Geenen
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000531:Altitude; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D019819:Budesonide / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D062072:Patient Acuity; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D012959:Socioeconomic Factors
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D019819:Budesonide