AsthmaNet Step-up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) - Catalog

  • Name

    AsthmaNet Step-up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS)

  • Accession Number

    HLB02162020a

  • Acronym

    AsthmaNet-STICS

  • Related studies
  • BSI Study IDs

    AN7

  • Is public use dataset

    False

  • Keywords
  • Ingestion Status
    Released
  • Has Study Datasets

    True

  • Has Specimens

    True

  • Specimen ID Type
    Coded
  • Study Website
  • The Framingham Heart Study Group requires that the requestor must obtain full or expedited IRB/Ethics Committee review and approval to obtain these data. Waivers or a determination that the research is exempt from ethical regulations do not suffice.

    False

  • Clinical Trial URLs
  • Study type
    Clinical Trial
  • Collection Type
    Open BioLINCC Study
  • Cohort type
    Pediatric
  • Interventions

    Drug: Fluticasone 44 mcg

    Drug: Fluticasone 220 mcg

  • Study Open Date (Data)

    2020-02-04

  • Study Open Date (Specimens)

    2022-01-21

  • Date materials available

    2020-02-04

  • Last updated

    2022-01-21

  • Study period

    July 2014-April 2017

  • Study Contacts
  • NHLBI Division

    DLD

  • Classification
    Lung
  • HIV study classification
    non-HIV
  • COVID study classification
    non-COVID
  • Pre-Website # of Specimens Shipped

    None

  • # of Returned Specimens

    None

  • Primary Publication URLs
  • Conditions
    Asthma
  • Objectives

    To assess the efficacy and safety of increasing the dose of inhaled glucocorticoids by a factor of 5 for 7 days in school-age children with mild-to-moderate persistent asthma at the early signs of loss of asthma control (“yellow zone”).

  • Background

    Asthma exacerbations are common events, particularly in school-age children. Exacerbations are costly and are associated with considerable complications. In addition, asthma exacerbations may lead to progressive loss of lung function and greater asthma severity over time. Day-to-day asthma symptoms are traditionally controlled through conventional therapies, particularly the daily use of inhaled glucocorticoids; however, they have only partial efficacy in preventing exacerbations.


    There is limited evidence available to inform clinicians’ selection and implementation of strategies in the “yellow zone” (i.e., when there are signs of early loss of asthma control) to prevent these early symptoms from progressing to a full asthma exacerbation. Quadrupling the dose of inhaled glucocorticoids was identified as a potentially efficacious intervention in adult patients, but data on the safety or efficacy of an intervention that uses more than a doubled dose of inhaled glucocorticoids are limited in children. The objective of this study was to determine whether quintupling the dose of inhaled corticosteroids at the onset of “yellow zone” symptoms reduces the rate of severe asthma exacerbations treated with oral corticosteroids.

  • Participants

    A total of 254 participants (aged 5-11) underwent randomization with 127 participants assigned to the low-dose and high-dose group. A total of 192 participants, including 94 participants in the high-dose group and 98 in the low-dose group, completed the final trial visit.


    Eligible participants were required to have mild-to-moderate persistent asthma, at least one asthma exacerbation treated with systemic glucocorticoids in the previous year, and a prebronchodilator FEV1 >80% predicted. Participants were excluded if asthma was too severe (>5 exacerbations in the previous year that had been treated with systemic glucocorticoids), a history of life-threatening asthma and/or if they experienced more than two prednisone-treated exacerbations in the past 6 months.

  • Design

    Prior to randomization, participants were entered into a 4-week run-in period with maintenance low-dose inhaled glucocorticoids (fluticasone) at a dose of 44 μg per inhalation, two inhalations twice daily. Participants were treated for 48 weeks and were randomly assigned 1:1 to either continue the same dose or use a quintupled dose (fluticasone at a dose of 220 μg per inhalation, two inhalations twice daily) for 7 days at the early signs of loss of asthma control (“yellow zone”).


    Yellow-zone episodes were identified by the occurrence of any of the following: the use of two doses (four inhalations) of rescue albuterol in 6 hours, the use of three doses (six inhalations) of rescue albuterol in 24 hours, or one night awakening that was due to asthma that was treated with albuterol. Participants were provided with a written asthma action plan that instructed them not to wait for the yellow-zone alert from the electronic diary before starting the blinded yellow-zone inhaler.


    The green-zone low-dose inhaler was discontinued while the blinded yellow-zone inhaler was used. Conversely, if a participant did not experience a yellow zone episode, the low-dose inhaler was continued throughout the trial.


    An electronic diary was completed nightly that measured symptoms, medications, and peak expiratory flows. Participants were blinded to the results of the peak expiratory flow meter and there was no electronic link between the inhaler and the electronic diary. Clinical assessments during the course of the trial included: standing height measurements, spirometry, peripheral-blood eosinophil counts, total serum IgE level and the levels of IgE specific to aeroallergens.


    The primary outcome was the rate of severe asthma exacerbations treated with oral corticosteroids during the 48 week treatment period. Secondary outcomes included time to the first exacerbation, the rate of treatment failure, symptom scores, and albuterol use during yellow-zone episodes. Additionally, rates of exposure to inhaled glucocorticoids were assessed.

  • Conclusions

    In children with mild-to-moderate persistent asthma treated with daily inhaled glucocorticoids, quintupling the dose at the early signs of loss of asthma control did not reduce the rate of severe asthma exacerbations or improve other asthma outcomes and may be associated with diminished linear growth.


    Jackson DJ, Bacharier LB, Mauger DT, et al. Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations. N Engl J Med. 2018;378(10):891–901. doi:10.1056/NEJMoa1710988

  • Disease classification
  • Publications
  • Mat types
    DNA
    Plasma
  • Network
    AsthmaNet

The study population available in BioLINCC study data may be lower than total study enrollment due to Informed Consent restrictions and other factors.

  • Subjects

    254 randomized (127 fluticasone 220 ug, 127 fluticasone 44 ug) and 125 failed screening


    Last Modified: Feb. 1, 2022, 10:40 a.m.
  • Age
    AgeFlut 220Flut 44All
    5142539
    6212243
    7281644
    8242852
    9201333
    10111122
    1191221

    Last Modified: March 12, 2025, 11:16 a.m.
  • Sex
     Flut 220Flut 44All
    Male8380163
    Female444791

    Last Modified: March 12, 2025, 11:16 a.m.
  • Race
     Flut 220Flut 44All
    Black343569
    White574299
    Hispanic/Latino292958
    Other72128

    Last Modified: March 12, 2025, 11:16 a.m.

Please note that biospecimen availability is subject to review by the NHLBI, BioLINCC, and the NHLBI Biorepository. Certain biospecimens may not be made available for your request. PDF Section 3.0 of the BioLINCC Handbook describes the components of the review process.

  • Material Types

    Plasma
    DNA


    Last Modified: March 12, 2025, 11:16 a.m.
  • General Freeze/Thaw Status

    All plasma samples have 0 thaws
    66% of DNA samples have 0 thaw. The remaining 33% of DNA samples have 1-2 thaws.


    Last Modified: March 12, 2025, 11:16 a.m.
  • Visits (Vials)

    12 March 2025

     

    Plasma

    DNA

    Total

    Visit 2

    533

    1393

    1926

    Visit 3

    28

    27

    55

    Visit 4

    15

    9

    24

    Visit 6

    3

    3

    6

    Visit 7

    3

    .

    3


    Last Modified: March 12, 2025, 11:16 a.m.
  • Visits (Subjects)

    12 March 2025

     

    Plasma

    Total number of subjects

    Average volume (ml) per subject

    Visit 2

    178

    3.98

    Visit 3

    10

    3.64

    Visit 4

    5

    4.02

    Visit 6

    1

    4.10

    Visit 7

    1

    4.10

     

     

    DNA

    Total number of subjects

    Average mass (µg) per subject

    Average vials per subject

    Visit 2

    157

    35.86

    8.87

    Visit 3

    9

    87.89

    3.00

    Visit 4

    3

    272.13

    3.00

    Visit 6

    1

    43.45

    3.00


    Last Modified: March 12, 2025, 11:16 a.m.