Global Initiative for Asthma (GINA) guideline: achieving optimal asthma control in children aged 6-11 years

The Global Initiative for Asthma (GINA) 2021 guidelines for asthma have been set forth with some alterations in step 3, for children from the 6-11-year-old age group. The low-dose inhaled corticosteroid (ICS)-long-acting β-agonist (LABA), very low-dose formoterol-ICS, medium-dose ICS, and ICS-leukotriene receptor antagonist (LTRA) combination were recommended in the guideline. We organized this study to draw an effective comparison between these three combinations of controller therapies in the pediatric population. A retrospective study was conducted at the Aga Khan University Hospital (Karachi, Pakistan), which enrolled 114 children aged 6-11 years old from July 2021 to December 2022. These children were admitted with asthma exacerbations and were discharged on controller medications as per GINA guidelines on step 3 for control of asthma for 3 months. They were then followed for re-admission within 30 days of discharge, number of emergency room (ER) visits with asthma exacerbations for 1 year, number of admissions with asthma, including high dependency unit and pediatric intensive care unit (PICU) admissions, and length of stay per admission for all admissions in the subsequent year. The pulmonary function test was done at the 1-week follow-up in the clinic after discharge and at the 3-month visit post-discharge. A total of 114 pediatric patients from 6 to 11 years old were enrolled in the study period, out of which 36 (31.57%), 33 (28.9%), and 34 (29.82%) patients were categorized into ICS-LABA, ICS, and ICS-LTRA groups, respectively. ER visits were significantly low in the ICS-LABA group, followed by the ICS-LRTA group and then the ICS group (1.75±0.96 versus 2.93±1.412 versus 3.11±1.21, p<0.001). Similar statistically significant results were observed on the average number of admissions per year (1.52±1.02 versus 1.96±0.84 versus 2.06±1.07, p=0.047) and the number of patients needing PICU (13.88% versus 26.47% versus 39.39%, p=0.034) in these groups, respectively. ICS-LABA group patients had the best values of the forced expiratory volume in one second (FEV₁) and FEV₁/forced vital capacity ratio after pulmonary function tests at 3 months follow-up, followed by ICS-LTRA and ICS group. Amongst the three options for regimens for children managed at step 3 on GINA 2021 guidelines, ICS-LABA therapy helps attain optimal patient outcomes and lung functions in children with asthma, followed by ICS-LTRA and ICS group, respectively.