2025 Southeastern Residency Conference

Title: Evaluation of Maintenance-and-Reliever Therapy Utilization for Pediatric Asthma 

Authors: Chiara Huber, Christina Cox, Katie Rasmussen, Kimberly Grubbs, Logan Miller, Heather Staples

Background: Asthma is the most common pediatric chronic condition, affecting over 4.5 million children. Prior to guideline updates, the standard approach to moderate to severe asthma in children included a short acting beta agonist (SABA) inhaler for relief of asthma symptoms, plus a separate inhaled corticosteroid (ICS) or ICS/long-acting beta agonist (LABA) inhaler for maintenance therapy. In 2019-2020, the Global Initiative for Asthma (GINA) and National Heart Lung and Blood Institute (NHLBI) asthma guidelines were updated to recommend the use of combination ICS-formoterol as both maintenance and reliever therapy (MART) as a preferred regimen in moderate to severe asthma in adults and children ≥ 5 years old. Despite new recommendations, a recent evaluation of MART use in adults found low adoption rates among eligible patients. Factors associated with MART adoptions included baseline maintenance use of ICS-formoterol, private insurance, younger patients and newer clinicians. Since limited information exists for pediatric patients, this study aims to describe MART implementation in pediatric asthma patients and identify the factors associated with MART recommendations.   

Methods: This retrospective cohort study included patients aged 5-18 with asthma who were admitted to Prisma Health Children’s Hospital-Midlands for an asthma exacerbation between January 1, 2022, and July 1, 2023. The primary outcome was the proportion of patients who qualified for MART and received a MART recommendation. For the purposes of this study, patients qualified for MART if they were utilizing an ICS or ICS/LABA inhaler at time of admission and had received at least one course of non-inhaled corticosteroids in the last year. Secondary outcomes included asthma readmissions within one year and an evaluation of factors that may be associated with MART recommendations. Statistical analysis will involve descriptive statistics and a multivariate regression analysis to assess the relationship between demographic data and MART therapy. 

Results: 598 patients were screened for enrollment and 246 were included in the primary analysis. The median patient age was 8 years, 69.5% of patients were Black, and 63.5% of patients were on Medicaid. 102 patients qualified for MART based on study criteria, however only 4 patients (3.9%)  were discharged with MART recommendations. 36 patients were readmitted for asthma within one year. Compared to those who did not qualify, patients who qualified for MART were more likely to be readmitted for asthma (21.6% vs 9.7%) and have a high risk disease state (14.7% vs 9.7%).

Conclusions: MART utilization remained very long among qualifying patients. Patients who qualified for MART had high rates of asthma readmissions and more frequently had disease states associated with higher exacerbation risk.