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BMC Medical Research Methodology
Published in: BMC Medical Research Methodology 1/2020

Open Access 01-12-2020 | Bronchial Asthma | Research article

Long-term effects of asthma medication on asthma symptoms: an application of the targeted maximum likelihood estimation

Authors: Carolin Veit, Ronald Herrera, Gudrun Weinmayr, Jon Genuneit, Doris Windstetter, Christian Vogelberg, Erika von Mutius, Dennis Nowak, Katja Radon, Jessica Gerlich, Tobias Weinmann

Published in: BMC Medical Research Methodology | Issue 1/2020

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Abstract

Background

Long-term effectiveness of asthma control medication has been shown in clinical trials but results from observational studies with children and adolescents are lacking. Marginal structural models estimated using targeted maximum likelihood methods are a novel statistiscal approach for such studies as it allows to account for time-varying confounders and time-varying treatment. Therefore, we aimed to calculate the long-term risk of reporting asthma symptoms in relation to control medication use in a real-life setting from childhood to adulthood applying targeted maximum likelihood estimation.

Methods

In the prospective cohort study SOLAR (Study on Occupational Allergy Risks) we followed a German subsample of 121 asthmatic children (9–11 years old) of the ISAAC II cohort (International Study of Asthma and Allergies in Childhood) until the age of 19 to 24. We obtained self-reported questionnaire data on asthma control medication use at baseline (1995–1996) and first follow-up (2002–2003) as well as self-reported asthma symptoms at baseline, first and second follow-up (2007–2009). Three hypothetical treatment scenarios were defined: early sustained intervention, early unsustained intervention and no treatment at all. We performed longitudinal targeted maximum likelihood estimation combined with Super Learner algorithm to estimate the relative risk (RR) to report asthma symptoms at SOLAR I and SOLAR II in relation to the different hypothetical scenarios.

Results

A hypothetical intervention of early sustained treatment was associated with a statistically significant risk increment of asthma symptoms at second follow-up when compared to no treatment at all (RR: 1.51, 95% CI: 1.19–1.83) or early unsustained intervention (RR:1.38, 95% CI: 1.11–1.65).

Conclusions

While we could confirm the tagerted maximum likelihood estimation to be a usable and robust statistical tool, we did not observe a beneficial effect of asthma control medication on asthma symptoms. Because of potential due to the small sample size, lack of data on disease severity and reverse causation our results should, however, be interpreted with caution.
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Metadata
Title
Long-term effects of asthma medication on asthma symptoms: an application of the targeted maximum likelihood estimation
Authors
Carolin Veit
Ronald Herrera
Gudrun Weinmayr
Jon Genuneit
Doris Windstetter
Christian Vogelberg
Erika von Mutius
Dennis Nowak
Katja Radon
Jessica Gerlich
Tobias Weinmann
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2020
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/s12874-020-01175-9

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