title: Markers of Differential Response to Inhaled Corticosteroid Treatment Among Children with Mild Persistent Asthma.
abstract: BACKGROUND
  Inhaled corticosteroids are recommended as first-line therapy for children with mild persistent asthma; however, specific patient characteristics may modify the treatment response.
  
  
  OBJECTIVE
  Identify demographic, clinical, and atopic characteristics that may modify the inhaled corticosteroid treatment response among children enrolled in the Treating Children to Prevent Exacerbations of Asthma trial.
  
  
  METHODS
  Children aged 6 to 18 years with mild persistent asthma were randomized to 44 weeks of combined, daily, rescue, or placebo treatment. Daily treatment consisted of 40 μg of beclomethasone twice daily. Rescue treatment consisted of 40 μg of beclomethasone accompanying each symptom-driven albuterol actuation. Combined treatment consisted of both. Outcomes included time to first exacerbation and proportion of asthma control days. Fourteen baseline characteristics were selected for interaction testing on the basis of their clinical relevance.
  
  
  RESULTS
  Two hundred eighty-eight children were randomized. Seventy-five percent were white, and 55% were male. As measured by time to first exacerbation, 4 characteristics identified children who received greater benefit from treatment: non-Hispanic ethnicity, positive aeroallergen skin test result, serum immunoglobulin E level of 350 K/μL or more, and history of oral corticosteroid use in the year before enrollment. As measured by asthma control days, 4 characteristics identified children who received greater benefit from treatment: male sex, positive aeroallergen skin test result, serum immunoglobulin E level of 350 K/μL or more, and incomplete run-in asthma control.
  
  
  CONCLUSIONS
  Children with mild persistent asthma who have markers of atopic asthma or who have greater asthma burden may obtain greater benefit from beclomethasone therapy. Additional study is needed to confirm whether these markers can guide individualized therapy.
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, Ariz, Tucson. Electronic address: geraldj@email.arizona.edu.
authors.forename: Joe K
authors.initials: JK
authors.lastname: Gerald
authors.affiliation: Mel and Enid Zuckerman College of Public Health and Arizona Respiratory Center, University of Arizona, Tucson, Ariz.
authors.forename: Lynn B
authors.initials: LB
authors.lastname: Gerald
authors.affiliation: Mel and Enid Zuckerman College of Public Health and Arizona Respiratory Center, University of Arizona, Tucson, Ariz.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Vasquez
authors.affiliation: Arizona Respiratory Center, College of Medicine, University of Arizona, Tucson, Ariz.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Morgan
authors.affiliation: Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pa.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Boehmer
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Lemanske
authors.affiliation: Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pa.
authors.forename: David T
authors.initials: DT
authors.lastname: Mauger
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, Mo.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
authors.affiliation: Department of Pediatrics, Pulmonary Section, The Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.affiliation: Department of Allergy, Kaiser Permanente Southern California, and Department of Pediatrics, University of California, San Diego, San Diego and La Jolla, Calif.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, Mo.
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Bacharier
authors.affiliation: University of Wisconsin, Aurora UW Medical Group, Milwaukee, Wis.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bade
authors.affiliation: Department of Pediatrics, National Jewish Health, Denver, Colo.
authors.forename: Ronina A
authors.initials: RA
authors.lastname: Covar
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Guilbert
authors.affiliation: Department of Pediatrics, University of New Mexico, Albuquerque, NM.
authors.forename: Hengameh
authors.initials: H
authors.lastname: Heidarian-Raissy
authors.affiliation: Department of Pediatrics, University of New Mexico, Albuquerque, NM.
authors.forename: H William
authors.initials: HW
authors.lastname: Kelly
authors.affiliation: Pediatric Associates, Miami, Fla.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Malka-Rais
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Sorkness
authors.affiliation: University of Denver, Denver, Colo.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Taussig
authors.affiliation: Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pa.
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.affiliation: Arizona Respiratory Center, College of Medicine, University of Arizona, Tucson, Ariz.
authors.forename: Fernando D
authors.initials: FD
authors.lastname: Martinez
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D001507:Beclomethasone / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D012882:Skin Tests; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D007073:Immunoglobulin E; D001507:Beclomethasone
keywords: Asthma; Inhaled corticosteroid; Pediatric; Stratified analysis