538 Long-term Follow Up Outcomes of Early Intervention with Anti-Inflammatory Therapy in Patients with Asthma Under 2 Year-old

BACKGROUND: To evaluate the 8- and 11-year follow up outcomes on the basis of various parameters including remission rate, pulmonary function, FeNO, IgE level and RAST in children with asthma who developed recurrent asthma attacks and started early intervention with anti-inflammatory treatment for active remission induction before 2 years of age. METHODS: This study investigated 63 children who presented with recurrent wheezing between October 1998 and September 2000 and were diagnosed with asthma in early childhood. After 3 to 5 episodes of recurrent asthma attacks were observed, administration of regular controller medications (ICS and LTRA) was started. Subjects were evaluated for the above parameters in 2008 and 2011. RESULTS: Subjects comprised 41 males and 22 females, with a mean age at symptom onset of 13.9 months, a mean age at treatment initiation of 18.2 months and a mean IgE level of 485.4 IU/mL at 2 years of age. Among the subjects, 68.3% and 85.7% were positive for specific IgE antibody against dermatophagoides pteronyssinus (Dp.) and egg white, respectively, at 2 years of age, and 87.3% were positive for specific IgE antibody against Dp. at 3 to 4 years of age. The severity of asthma at treatment initiation was intermittent in 9 children, mild persistent in 31, moderate persistent in 18 and severe persistent in 5. The prevalence of asthma symptoms among these children improved to 9.5% after 3 years and 1.6% after 6 years of treatment. The 8-year follow up outcome was evaluated in 53 children at a mean age of 10.2 years. The long-term remission ((3)a5 years) rate was 84.9% (100% for intermittent, 88.9% for mild persistent, 71.4% for moderate persistent and 75.0% for severe persistent cases). A mild decrease in pulmonary function was observed in 27.2% of cases while a mild increase in FeNO was observed in 48.8% of the children. CONCLUSIONS: Children who had undergone early intervention with anti-inflammatory therapy achieved higher long-term remission rates when compared with those in previous Japanese studies, although 65.1% of them had mild abnormalities in pulmonary function and/or FeNO levels. The 11-year follow up outcome of these children is also reported.