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Efficacy of individualized homeopathy in bronchial asthma in adults: Double-blind, randomized, placebo-controlled, clinical trial in the context of usual care. ADVANCES IN INTEGRATIVE MEDICINE 2019. [DOI: 10.1016/j.aimed.2018.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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102
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Fu LS, Lin CC, Wei CY, Lin CH, Huang YC. Risk of acute exacerbation between acetaminophen and ibuprofen in children with asthma. PeerJ 2019; 7:e6760. [PMID: 31024768 PMCID: PMC6474393 DOI: 10.7717/peerj.6760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background Antipyretics are widely prescribed in pediatric practice. Some reports have mentioned that acetaminophen and non-steroid anti-inflammatory drugs may negatively affect asthma control by causing asthma exacerbation (AE). However, many confounding factors can also influence the risks. We assessed the impact of using acetaminophen or ibuprofen on AE in asthmatic children, especially those with strong risk factors. Methods We used the 2010 Taiwan National Health Insurance Research Database and identified 983 children with persistent asthma aged 1-5 years old; among them, 591 used acetaminophen alone and 392 used ibuprofen alone in 2010. Then, we analyzed the risk of AE over 52 weeks in the patients with and without severe AE in the previous year. Results The ibuprofen group had a higher risk of an emergency room (ER) visit or hospitalization for AE (odds ratio (OR) = 2.10, 95% confidence interval (CI) [1.17-3.76], P = 0.01). Among asthmatic children who had severe AE in the previous year, the risk of AE was higher in the ibuprofen group than in the acetaminophen group (OR = 3.28, 95% CI [1.30-8.29], P = 0.01), where as among those who did not, the risks of AE were similar between the acetaminophen and ibuprofen groups (OR = 1.52, 95% CI [0.71-3.25], P = 0.28). Conclusions Among young asthmatic children, use of ibuprofen was associated with a higher risk of AE than acetaminophen, if they had severe AE with ER visit or hospitalization in the previous year. Pediatricians should use antipyretics among children with asthma after a full evaluation of the risk.
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Affiliation(s)
- Lin-Shien Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Pediatrics, National Yang-Ming University, Taipei, Taiwan
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Yi Wei
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yung-Chieh Huang
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Pediatrics, Puli Branch, Taichung Veterans General Hospital, Nantou, Taiwan
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103
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Wang Q, Zhang W, Liu L, Yang W, Liu H. Effects of physical therapy on lung function in children with asthma: Study protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15226. [PMID: 30985726 PMCID: PMC6485752 DOI: 10.1097/md.0000000000015226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Morbidity of asthma in children is increasing, which is significantly affecting children's life quality. Despite the medication therapy, physical therapies, including breathing exercises, inspiratory muscle training and physical training, are widely used to improve children's condition. However, the effectiveness of physical therapy remains unclear. This systematic review and meta-analysis is aiming to evaluate the effects of physical therapy on lung function in children with asthma and to assess which physical therapy is more effective. METHODS Three main databases (PubMed, Embase, and the Cochrane Library) will be searched from inception to November 30, 2018 for randomized controlled trials investigating the effects of physical therapy on lung function in children (age < 18 years old) with asthma published in English. In addition, a manual search of the references of relevant published studies in English will also be considered.Two independent reviewers will conduct studies selection, data extraction, and risk of bias assessment. Outcome measures will be the Peak Expiratory Flow (PEF), the Forced Expiratory Volume in the first second (FEV1), and the Forced Vital Capacity (FVC). Subgroup analyses will be performed according to the physical therapy (breathing exercises, inspiratory muscle training, and physical training) and the outcome (PEF, FEV1, FVC). RESULTS The results will provide useful information about the effect of physical therapy on lung function in children with asthma and demonstrate which physical therapy is more effective. CONCLUSION The findings of this study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019121627.
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Affiliation(s)
- Qiu Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
| | - Weijian Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
| | - Lilong Liu
- Department of Gastrointestinal Surgery, People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Wenhao Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
| | - Hanmin Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
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104
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Abstract
Asthma is the most common chronic airway disease in children, with more than half the reported cases of persistent asthma starting in children below the age of 3 years. Asthma diagnosis in preschool children has proven to be challenging due to the heterogeneity of the disease, the continuing development of the immune system in such a young population, and lack of diagnostic options such as lung function measurement. Early diagnosis and treatment of asthmatic symptoms will improve patients' quality of life and help reduce disease morbidity. However, validated treatment options are scarce due to paucity of data and lack of conclusive studies in such a young patient population. Adjusting study design and endpoints to capture more reliable data with minimal risk of harm to patients is necessary. This thematic series review outlines the current position on preschool asthma, consolidates the current understanding of risk factors and diagnostic hurdles, and emphasizes the importance of early detection and management to help improve patients' quality of life, both present and future. Particular focus was given to anticholinergics and their emerging role in the treatment and control of asthma in pediatric patients.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatric Pulmonology and Allergy, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany,
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105
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Moral L, Vizmanos G, Torres-Borrego J, Praena-Crespo M, Tortajada-Girbés M, Pellegrini F, Asensio Ó. Asthma diagnosis in infants and preschool children: a systematic review of clinical guidelines. Allergol Immunopathol (Madr) 2019; 47:107-121. [PMID: 30193886 DOI: 10.1016/j.aller.2018.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The definition and diagnosis of asthma are the subject of controversy that is particularly intense in the case of individuals in the first years of life, due to reasons such as the difficulty of performing objective pulmonary function tests or the high frequency with which the symptoms subside in the course of childhood. Since there is no consensus regarding the diagnosis of asthma in preschool children, a systematic review has been carried out. MATERIALS AND METHODS A systematic search was made of the clinical guidelines published in the last 10 years and containing information referred to the concept or diagnosis of asthma in childhood - including the first years of life (infants and preschool children). A series of key questions were established, and each selected guide was analyzed in search of answers to those questions. The review protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42017074872. RESULTS Twenty-one clinical guidelines were selected: 10 general guides (children and adults), eight pediatric guides and three guides focusing on preschool children. The immense majority accepted that asthma can be diagnosed from the first years of life, without requiring pulmonary function tests or other complementary techniques. The response to treatment and the exclusion of other alternative diagnoses are key elements for establishing the diagnosis. Only one of the guides denied the possibility of diagnosing asthma in preschool children. CONCLUSIONS There is generalized although not unanimous agreement that asthma can be diagnosed in preschool children.
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106
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Allen ED, Montgomery T, Ayres G, Cooper J, Gillespie J, Gleeson SP, Groner J, Hersey S, McGwire G, Rowe C, Snyder D, Stukus D, Stukus KS, Timan C, Wegener N, Brilli RJ. Quality Improvement-Driven Reduction in Countywide Medicaid Acute Asthma Health Care Utilization. Acad Pediatr 2019; 19:216-226. [PMID: 30597287 DOI: 10.1016/j.acap.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study evaluates the impact of a coordinated effort by an urban pediatric hospital and its associated accountable care organization to reduce asthma-related emergency department (ED) and inpatient utilization by a large, countywide Medicaid patient population. METHODS Multiple evidence-based interventions targeting general pediatric asthma care and high health care utilizers were implemented using standardized quality improvement methodologies. Annual asthma ED and inpatient utilization rates by 2- to 18-year-old members of an accountable care organization living in the surrounding county (>140,000 eligible members in 2016), adjusted per 1000 children from 2008 through 2016, were analyzed using Poisson regression. We compared these ED utilization rates to national rates from 2006 to 2014. RESULTS Asthma ED utilization fell from 18.1 to 12.9 visits/1000 children from 2008 to 2016, representing a 28.7% reduction, with an average annual decrease of 3.9% (P < .001), during a time when national utilization was increasing. Asthma inpatient utilization did not change significantly during the study period. CONCLUSIONS Asthma-related ED utilization was significantly reduced in a large population of primarily urban, minority, Medicaid-insured children by implementing a multimodal asthma quality improvement program. With adequate support, a similar approach could be successful in other communities.
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Affiliation(s)
- Elizabeth D Allen
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio.
| | - Tricia Montgomery
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Gloria Ayres
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Jennifer Cooper
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Joshua Gillespie
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Sean P Gleeson
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio; Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Judith Groner
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Stephen Hersey
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Gerd McGwire
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Courtney Rowe
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Dane Snyder
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - David Stukus
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Kristin S Stukus
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Christopher Timan
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Neal Wegener
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
| | - Richard J Brilli
- Pediatric Pulmonology (ED Allen), Respiratory Therapy (G Ayres), The Center for Surgical Outcomes Research (J Cooper), Ambulatory Pediatrics (J Groner, S Hersey, and D Snyder), Hospital Pediatrics (G McGwire), Pediatric Allergy/Immunology (D Stukus), Pediatric Emergency Medicine (KS Stukus), Neonatology (C Timan), Data Resource Center (N Wegener), Chief Medical Officer (RJ Brilli), Nationwide Children's Hospital; Quality Improvement Services (T Montgomery), The Ohio State University Wexner Medical Center; Operations (J Gillispie), President (SP Gleeson), Children's Community Practices (C Rowe), Partners for Kids, Columbus, Ohio
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107
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Yoshihara S, Tsubaki T, Ikeda M, Lenney W, Tomiak R, Hattori T, Hashimoto K, Soutome T, Kato S. The efficacy and safety of fluticasone/salmeterol compared to fluticasone in children younger than four years of age. Pediatr Allergy Immunol 2019; 30:195-203. [PMID: 30556939 PMCID: PMC6850202 DOI: 10.1111/pai.13010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fluticasone propionate 50 μg/salmeterol xinafoate 25 μg (FP/SAL) is widely used in adults and children with asthma, but there is sparse information on its use in very young children. METHODS This was a randomized, double-blind, multicentre, controlled trial conducted in children aged 8 months to 4 years. During a 2-week run-in period, they all received FP twice daily. At randomization, they commenced FP/SAL or FP twice daily for 8 weeks. All were then given FP/SAL only, in a 16-week open-label study continuation. Medications were inhaled through an AeroChamber Plus with attached face mask. The primary end-point was mean change in total asthma symptom scores from baseline to the last 7 days of the double-blind period. Analyses were undertaken in all children randomized to treatment and who received at least one dose of study medication. RESULTS Three hundred children were randomized 1:1 to receive FP/SAL or FP. Mean change from baseline in total asthma symptom scores was -3.97 for FP/SAL and -3.01 with FP. The between-group difference was not statistically significant (P = 0.21; 95% confidence interval: -2.47, 0.54). No new safety signals were seen with FP/SAL. CONCLUSION This is the first randomized, double-blind study of this size to evaluate FP/SAL in very young children with asthma. FP/SAL did not show superior efficacy to FP; no clear add-on effect of SAL was demonstrated. No clinically significant differences in safety were noted with FP/SAL usage.
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Affiliation(s)
| | | | - Masanori Ikeda
- Department of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Warren Lenney
- Global Medical Expert, GSK, Brentford, London, UK.,Respiratory Child Health, Keele University, Staffordshire, UK
| | - Richard Tomiak
- Global respiratory franchise, GSK, Brentford, London, UK
| | - Takako Hattori
- Global respiratory franchise, GSK, Brentford, London, UK
| | - Kenichi Hashimoto
- Respiratory Medicines Development, GlaxoSmithKline K.K., Tokyo, Japan
| | - Toru Soutome
- Biomedical Data Sciences Department, GlaxoSmithKline K.K., Tokyo, Japan
| | - Shihona Kato
- Clinical Operations Department, GlaxoSmithKline K.K., Tokyo, Japan
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108
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Sol IS, Kim YH, Kim S, Kim JD, Choi SH, Kim KW, Sohn MH. Assessment of within-breath impulse oscillometry parameters in children with asthma. Pediatr Pulmonol 2019; 54:117-124. [PMID: 30536749 DOI: 10.1002/ppul.24201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 10/12/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Impulse oscillometry (IOS) measures respiratory resistance and reactance during tidal breaths and is a convenient tool for evaluation of lung function. Respiratory resistance and reactance can be measured separately during inspiration and expiration (inspiratory-expiratory analysis). OBJECTIVE We investigated the differences in inspiratory-expiratory measurements obtained using IOS between children with and without asthma. METHODS We analyzed 819 subjects aged 4-18 years, including asthmatic children (n = 600) and controls (n = 219). Asthma was diagnosed in accordance with the American Thoracic Society/European Respiratory Society guideline. Spirometry and IOS were performed in all subjects. RESULTS In whole-breath analysis, the asthma group had higher resistance at 5 Hz (R5) and reactance area (AX) and lower reactance at 5 Hz (X5) than the control groups. In inspiratory-expiratory analysis, the asthma group showed increased expiratory R5 and AX and decreased expiratory X5 when compared with the control group. The absolute changes in R5, X5, and AX values between inspiration and expiration were greater in children with asthma than those in controls (0.138 ± 0.195 vs 0.102 ± 0.162, P = 0.014; -0.106 ± 0.200 vs -0.086 ± 0.434, P < 0.001 and 0.460 ± 11.63 vs 0.398 ± 2.88, P = 0.002, respectively). CONCLUSIONS Inspiratory-expiratory IOS analysis differentiated asthmatic children from control subjects, reflecting airway narrowing on expiration in pediatric asthma. The changes in R5, X5, and AX between inspiration and expiration can be a useful index for diagnosis of asthma in children without assessment of the response to a bronchodilator.
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Affiliation(s)
- In Suk Sol
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - SooYeon Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Deok Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Sun Ha Choi
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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109
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Papadopoulos NG, Čustović A, Cabana MD, Dell SD, Deschildre A, Hedlin G, Hossny E, Le Souëf P, Matricardi PM, Nieto A, Phipatanakul W, Pitrez PM, Pohunek P, Gavornikova M, Jaumont X, Price DB. Pediatric asthma: An unmet need for more effective, focused treatments. Pediatr Allergy Immunol 2019; 30:7-16. [PMID: 30312503 PMCID: PMC7380053 DOI: 10.1111/pai.12990] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite remarkable advances in our understanding of asthma, there are still several unmet needs associated with the management of pediatric asthma. METHODS A two-day, face-to-face meeting was held in London, United Kingdom, on October 28 and 29, 2017, involving a group of international expert clinicians and scientists in asthma management to discuss the challenges and unmet needs that remain to be addressed in pediatric asthma. RESULTS These unmet needs include a lack of clinical efficacy and safety evidence, and limited availability of non-steroid-based alternative therapies in patients <6 years of age. An increased focus on children is needed in the context of clinical practice guidelines for asthma; current pediatric practice relies mostly on extrapolations from adult recommendations. Furthermore, no uniform definition of pediatric asthma exists, which hampers timely and robust diagnosis of the condition in affected patients. CONCLUSIONS There is a need for a uniform definition of pediatric asthma, clearly distinguishable from adult asthma. Furthermore, guidelines which provide specific treatment recommendations for the management of pediatric asthma are also needed. Clinical trials and real-world evidence studies assessing anti-immunoglobulin E (IgE) therapies and other monoclonal antibodies in children <6 years of age with asthma may provide further information regarding the most appropriate treatment options in these vulnerable patients. Early intervention with anti-IgE and non-steroid-based alternative therapies may delay disease progression, leading to improved clinical outcomes.
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Affiliation(s)
- Nikolaos G. Papadopoulos
- Division of Infection, Inflammation & Respiratory MedicineThe University of ManchesterManchesterUK
- The Allergy Department, 2nd Pediatric Clinic, National & KapodistrianUniversity of AthensAthensGreece
| | - Adnan Čustović
- Department of PaediatricsImperial College LondonLondonUK
| | - Michael D. Cabana
- Departments of Pediatrics and Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCalifornia
| | - Sharon D. Dell
- Division of Respiratory Medicine, Department of Pediatrics, Child Health Evaluative Sciences, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Antoine Deschildre
- CHU Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de FlandreCHRU de Lille and Université Nord de FranceLilleFrance
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Lung and Allergy UnitKarolinska University HospitalStockholmSweden
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Elham Hossny
- Pediatric Allergy and Immunology UnitChildren's Hospital Ain Shams UniversityCairoEgypt
| | - Peter Le Souëf
- School of Paediatrics and Faculty of Child Health and Medical SciencesUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Paolo M. Matricardi
- Department of Pediatric Pneumology & ImmunologyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy UnitChildren's Hospital La FeValenciaSpain
| | - Wanda Phipatanakul
- Pediatric Allergy and ImmunologyBoston Children’s HospitalBostonMassachusetts
| | - Paulo M. Pitrez
- School of MedicinePontifícia Universidade Católica do Rio Grande do Sul (PUCRS)Porto AlegreBrazil
| | - Petr Pohunek
- Pediatric Department, 2nd Faculty of MedicineCharles University Prague, and University Hospital MotolPragueCzech Republic
| | | | | | - David B. Price
- Observational and Pragmatic Research InstituteSingaporeSingapore
- University of AberdeenAberdeenUK
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Sensitivity of multiple breath washout to detect mild-to-moderate asthma in adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2052-2054.e5. [PMID: 30708145 DOI: 10.1016/j.jaip.2019.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/21/2022]
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Mallett LH, Soto A, Govande J, Ogborn C, Sagar M. Role of asthma camp in improving the overall health of children with asthma. Proc (Bayl Univ Med Cent) 2019; 32:54-57. [PMID: 30956581 DOI: 10.1080/08998280.2018.1533309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 01/27/2023] Open
Abstract
This study sought to evaluate the benefit of asthma camp for patients who attended Baylor Scott & White McLane Children's Medical Center's Camp Wheeze Away in July 2016. Data were collected on children aged 8 to 15 years who were diagnosed with asthma and attended asthma camp. Information on body mass index, hospital admissions, and emergency department visits was collected 1 year before and 1 year after camp. Asthma control tests, exhaled nitric oxide tests, and pulmonary function tests were administered at the beginning and end of camp. A total of 34 children with asthma (mean age 11 [±2] years) were included in this study. Postcamp asthma-related hospitalizations and emergency department visits decreased. Mean asthma control scores improved from 20.4 (±3.2) before camp to 23.4 (±2.8) after camp (P < 0.0001). Forced expiratory volume during the first breath and forced expiratory flow at 25% to 75% of the pulmonary volume improved during the weeklong camp (P = 0.04 and 0.0007, respectively). Forced expiratory volume during the first breath further improved 6 to 12 months after camp compared to values before camp (P = 0.047). Exhaled nitric oxide levels improved from the first to last day of camp by decreasing an average of 39% (P = 0.0009). This study showed the positive effect that a short-term educational intervention in a camp setting had on asthma control scores and asthma knowledge.
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Affiliation(s)
- Lea H Mallett
- Department of Pediatrics, Texas A&M Health Science Center, Baylor Scott & White McLane Children's Medical CenterTempleTexas
| | - Angela Soto
- Department of Pediatrics, Texas A&M Health Science Center, Baylor Scott & White McLane Children's Medical CenterTempleTexas
| | - Janhavi Govande
- Department of Pediatrics, Texas A&M Health Science Center, Baylor Scott & White McLane Children's Medical CenterTempleTexas
| | - Char Ogborn
- Department of Pediatrics, Texas A&M Health Science Center, Baylor Scott & White McLane Children's Medical CenterTempleTexas
| | - Malvika Sagar
- Department of Pediatrics, Texas A&M Health Science Center, Baylor Scott & White McLane Children's Medical CenterTempleTexas
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Fazlollahi MR, Najmi M, Fallahnezhad M, Sabetkish N, Kazemnejad A, Bidad K, Shokouhi Shoormasti R, Mahloujirad M, Pourpak Z, Moin M. Paediatric asthma prevalence: The first national population-based survey in Iran. CLINICAL RESPIRATORY JOURNAL 2019; 13:14-22. [PMID: 30472812 DOI: 10.1111/crj.12975] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/26/2018] [Accepted: 11/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The actual prevalence of paediatric asthma as a worldwide chronic disease has been surveyed in developed countries. However, no sufficient survey has been conducted in most of the eastern developing countries. Herein, we took measures to evaluate the prevalence of paediatric asthma in Iran. METHODS In this national cross-sectional study, the prevalence of asthma symptoms was estimated throughout the country using a randomized multistage stratified cluster sampling method in 16 410 and 16 850 individuals aged 6-7 and 13-14 years, respectively. A validated questionnaire including core questions of the International Study of Asthma and Allergies in Childhood (ISAAC) was applied between November 2015 and February 2016. RESULTS The total prevalence of asthma was 10.9% (n = 3624) (95% confidence interval [CI]: 10.6%-11.2%) which was significantly higher among 13- to 14-year olds compared to a younger age group (12.4% vs. 9.4%, P < 0.001), males versus females (12.1% vs. 9.8%, P < 0.001) and residents of urban compared to rural areas (P = 0.003). The prevalence of severe asthma was 3.9%, being significantly more prevalent in higher age groups and male individuals (P < 0.001). A significant relationship was found between asthma and passive smoking in both 6- to 7- and 13- to 14-year olds (P < 0.001). CONCLUSIONS The prevalence of asthma and severe asthma in the paediatric population of Iran was similar to other developing countries. It is recommended to pay special attention to urban regions, male individuals and higher age groups for better controlling of asthma. Nevertheless, further national surveys are necessary to determine the trend of paediatric asthma in Iran.
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Affiliation(s)
- Mohammad Reza Fazlollahi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Najmi
- Center of Non-communicable Diseases Management, Deputy for health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mojtaba Fallahnezhad
- Razi Science Researchers Institute, Tehran, Iran.,Health Department of Zanjan, University of Medical Sciences, Zanjan, Iran
| | - Nastaran Sabetkish
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Katayoon Bidad
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Mahloujirad
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Pourpak
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Moin
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Savary KW, Miller RL, Arteaga-Solis E, Hoepner L, Acosta LM, Perera FP, Rundle AG, Goldstein IF, Perzanowski MS. Infant rhinitis and watery eyes predict school-age exercise-induced wheeze, emergency department visits and respiratory-related hospitalizations. Ann Allergy Asthma Immunol 2018; 120:278-284.e2. [PMID: 29508714 DOI: 10.1016/j.anai.2017.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/26/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rhinitis and conjunctivitis are often linked to asthma development through an allergic pathway. However, runny nose and watery eyes can result from nonallergic mechanisms. These mechanisms can also underlie exercise-induced wheeze (EIW), which has been associated with urgent medical visits for asthma, independent of other indicators of asthma severity or control. OBJECTIVE To test the hypothesis that rhinitis or watery eyes without cold symptoms (RWWC) in infancy predict development of EIW and urgent respiratory-related medical visits at school age, independent of seroatopy. METHODS Within a prospective birth cohort of low-income, urban children (n = 332), RWWC was queried during the first year of life. Relative risks (RRs) for EIW, emergency department (ED) visits, and hospitalizations for asthma and other breathing difficulties at 5 to 7 years of age were estimated with multivariable models. Seroatopy was determined at 7 years of age. RESULTS Infant RWWC was common (49% of children) and predicted school-age EIW (RR, 2.8; P < .001), ED visits (RR, 1.8; P = .001), and hospitalizations (RR, 9.8; P = .002). These associations were independent of infant wheeze. They were also independent of birth order, an indicator of increased risk of exposure to viruses in infancy, and infant ear infections, an indicator of sequelae of upper airway infections. The association between infant RWWC and ED visits at 5 to 7 years of age was attenuated (RR, 1.2; P = .23) when EIW at 5 to 7 years of age was included in the model, suggesting EIW mediates the association. Adjustment for seroatopy did not diminish the magnitudes of any of these associations. CONCLUSION These findings suggest a nonallergic connection between infant nonwheeze symptoms and important consequences of urban respiratory health by school age through EIW.
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Affiliation(s)
- Khalil W Savary
- Division of Pulmonology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Rachel L Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Emilio Arteaga-Solis
- Division of Pulmonology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Lori Hoepner
- Data Coordinating Center, Mailman School of Public Health, New York, New York; Department of Environmental and Occupational Health Sciences, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Luis M Acosta
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Inge F Goldstein
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
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Wong L, Van Bever HP. Primary Prevention of Asthma: Will It Be Possible in the Future? CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fielding S, Pijnenburg M, de Jongste JC, Pike KC, Roberts G, Petsky H, Chang AB, Fritsch M, Frischer T, Szefler S, Gergen P, Vermeulen F, Vael R, Turner S. Change in FEV 1 and Feno Measurements as Predictors of Future Asthma Outcomes in Children. Chest 2018; 155:331-341. [PMID: 30359613 DOI: 10.1016/j.chest.2018.10.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/05/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Repeated measurements of spirometry and fractional exhaled nitric oxide (Feno) are recommended as part of the management of childhood asthma, but the evidence base for such recommendations is small. We tested the hypothesis that reducing spirometric indices or increasing Feno will predict poor future asthma outcomes. METHODS A one-stage individual patient data meta-analysis used data from seven randomized controlled trials in which Feno was used to guide asthma treatment; spirometric indices were also measured. Change in %FEV1 and % change in Feno between baseline and 3 months were related to having poor asthma control and to having an asthma exacerbation between 3 and 6 months after baseline. RESULTS Data were available from 1,112 children (mean age, 12.6 years; mean %FEV1, 94%). A 10% reduction in %FEV1 between baseline and 3 months was associated with 28% increased odds for asthma exacerbation (95% CI, 3-58) and with 21% increased odds for having poor asthma control (95% CI, 0-45) 6 months after baseline. A 50% increase in Feno between baseline and 3 months was associated with 11% increase in odds for poor asthma control 6 months after baseline (95% CI, 0-16). Baseline Feno and %FEV1 were not related to asthma outcomes at 3 months. CONCLUSIONS Repeated measurements of %FEV1 that are typically within the "normal" range add to clinical risk assessment of future asthma outcomes in children. The role of repeated Feno measurements is less certain because large changes were associated with small changes in outcome risk.
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Affiliation(s)
- Shona Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Marielle Pijnenburg
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Johan C de Jongste
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Katharine C Pike
- Clinical and Experimental Science Academic Unit, University of Southampton, Southampton, England; Respiratory Critical Care and Anaesthesia Group, Institute of Child Health, University College London, London, England
| | - Graham Roberts
- Clinical and Experimental Science Academic Unit, University of Southampton, Southampton, England
| | - Helen Petsky
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland University of Technology, Brisbane, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland University of Technology, Brisbane, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Maria Fritsch
- Department of General Paediatrics, University Children's Hospital, Vienna, Austria
| | - Thomas Frischer
- Department of General Paediatrics, University Children's Hospital, Vienna, Austria
| | - Stanley Szefler
- Breathing Institute, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Peter Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Francoise Vermeulen
- Pediatric Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Robin Vael
- Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Steve Turner
- Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen, Scotland.
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Ferguson L, Futamura M, Vakirlis E, Kojima R, Sasaki H, Roberts A, Mori R. Leukotriene receptor antagonists for eczema. Cochrane Database Syst Rev 2018; 10:CD011224. [PMID: 30343498 PMCID: PMC6517006 DOI: 10.1002/14651858.cd011224.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Eczema is a common, chronic, inflammatory skin condition that is frequently associated with atopic conditions, including asthma. Leukotriene receptor antagonists (LTRAs) have a corticosteroid-sparing role in asthma, but their role in eczema remains controversial. Currently available topical therapies for eczema are often poorly tolerated, and use of systemic agents is restricted by their adverse effect profile. A review of alternative treatments was therefore warranted. OBJECTIVES To assess the possible benefits and harms of leukotriene receptor antagonists for eczema. SEARCH METHODS We searched the following databases to September 2017: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and the GREAT database. We also searched five trial registries, and handsearched the bibliographies of all extracted studies for further relevant trials. SELECTION CRITERIA Randomised controlled trials of LTRAs alone or in combination with other (topical or systemic) treatments compared with other treatments alone such as topical corticosteroids or placebo for eczema in the acute or chronic (maintenance) phase of eczema in adults and children. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcome measures were change in disease severity, long-term symptom control, and adverse effects of treatment. Secondary outcomes were change in corticosteroid requirement, reduction of pruritis, quality of life, and emollient requirement. We used GRADE to assess the quality of the evidence for each outcome. MAIN RESULTS Only five studies (including a total of 202 participants) met the inclusion criteria, all of which assessed oral montelukast; hence, we found no studies assessing other LTRAs. Treatment ranged from four to eight weeks, and outcomes were assessed at the end of treatment; therefore, we could only report short-term measurements (defined as less than three months follow-up from baseline). Montelukast dosing was 10 mg for adults (age 14 years and above) and 5 mg for children (age 6 years to 14 years). One study included children (aged 6 years and above) among their participants, while the remaining studies only included adults (participant age ranged from 16 to 70 years). The participants were diagnosed with moderate-to-severe eczema in four studies and moderate eczema in one study. The study setting was unclear in two studies, multicentre in two studies, and single centre in one study; the studies were conducted in Europe and Bangladesh. Two studies were industry funded. The comparator was placebo in three studies and conventional treatment in two studies. The conventional treatment comparator was a combination of antihistamines and topical corticosteroids (plus oral antibiotics in one study).Four of the studies did not adequately describe their randomisation or allocation concealment method and were considered as at unclear risk of selection bias. Only one study was at low risk of performance and detection bias. However, we judged all studies to be at low risk of attrition and reporting bias.We found no evidence of a difference in disease severity of moderate-to-severe eczema after short-term use of montelukast (10 mg) when compared with placebo. The outcome was assessed using the modified EASI (Eczema Area and Severity Index) score and SASSAD (Six Area, Six Sign Atopic Dermatitis) severity score (standardised mean difference 0.29, with a positive score showing montelukast is favoured, 95% confidence interval (CI) -0.23 to 0.81; 3 studies; n = 131; low-quality evidence).When short-term montelukast (10 mg) treatment was compared with conventional treatment in one study, the mean improvement in severity of moderate-to-severe eczema was greater in the intervention group (measured using SCORAD (SCORing of Atopic Dermatitis) severity index) (mean difference 10.57, 95% CI 4.58 to 16.56; n = 31); however, another study of 32 participants found no significant difference between groups using the same measure (mean improvement was 25.2 points with montelukast versus 23.9 points with conventional treatment; no further numerical data provided). We judged the quality of the evidence as very low for this outcome, meaning the results are uncertain.All studies reported their adverse event rate during treatment. Four studies (136 participants) reported no adverse events. In one study of 58 participants with moderate eczema who received montelukast 10 mg (compared with placebo), there was one case of septicaemia and one case of dizziness reported in the intervention group, both resulting in study withdrawal, although whether these effects were related to the medication is unclear. Mild side effects (e.g. headache and mild gastrointestinal disturbances) were also noted, but these were fairly evenly distributed between the montelukast and placebo groups. The quality of evidence for this outcome was low.No studies specifically evaluated emollient requirement or quality of life. One study that administered treatment for eight weeks specifically evaluated pruritus improvement at the end treatment and topical corticosteroid use during treatment. We found no evidence of a difference between montelukast (10 mg) and placebo for both outcomes (low-quality evidence, n = 58). No other study assessed these outcomes. AUTHORS' CONCLUSIONS The findings of this review are limited to montelukast. There was a lack of evidence addressing the review question, and the quality of the available evidence for most of the measured outcomes was low. Some primary and secondary outcomes were not addressed at all, including long-term control.We found no evidence of a difference between montelukast (10 mg) and placebo on disease severity, pruritus improvement, and topical corticosteroid use. Very low-quality evidence means we are uncertain of the effect of montelukast (10 mg) compared with conventional treatment on disease severity. Participants in only one study reported adverse events, which were mainly mild (low-quality evidence).There is no evidence that LTRA is an effective treatment for eczema. Serious limitations were that all studies focused on montelukast and only included people with moderate-to-severe eczema, who were mainly adults; and that each outcome was evaluated with a small sample size, if at all.Further large randomised controlled trials, with a longer treatment duration, of adults and children who have eczema of all severities may help to evaluate the effect of all types of LTRA, especially on eczema maintenance.
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Affiliation(s)
- Leila Ferguson
- St Helier HospitalDepartment of DermatologyWrythe LaneCarshaltonSurreyUKSM5 1AA
| | - Masaki Futamura
- Nagoya Medical CenterDepartment of Pediatrics4‐1‐1 SannomaruNaka‐kuNagoyaJapan460‐0001
| | - Efstratios Vakirlis
- Aristotle University Medical SchoolA' Department of DermatologyKanari 13ThessalonikiGreece54644
| | - Reiji Kojima
- School of Medicine, University of YamanashiDepartment of Health SciencesYamanashiJapan
| | - Hatoko Sasaki
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 Okura, SetagayaTokyoTokyoJapan157‐8535
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with EczemaNottinghamUKNG5 4FG
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 Okura, SetagayaTokyoTokyoJapan157‐8535
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Papamichael MM, Katsardis C, Erbas B, Itsiopoulos C, Tsoukalas D. Urinary organic acids as biomarkers in the assessment of pulmonary function in children with asthma. Nutr Res 2018; 61:31-40. [PMID: 30683437 DOI: 10.1016/j.nutres.2018.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 10/05/2018] [Accepted: 10/05/2018] [Indexed: 12/14/2022]
Abstract
Childhood asthma prevalence continues to rise despite advancements in prevention and medical management strategies. The purpose of this study was to investigate correlations between urinary organic acids and pulmonary diagnostic tests, asthma control in Greek asthmatic children. We hypothesized that urinary organic acids are positively associated with poor pulmonary function in children with asthma. Seventy-two children, 5 to 12 years old with asthma were recruited from a pediatric asthma clinic in Athens, Greece. Pulmonary function was assessed using spirometry and exhaled nitric oxide analysis. Asthma control was measured qualitatively using the Asthma Control Questionnaire. Targeted metabolomic analysis of 34 urinary organic acids in children was conducted by gas chromatography-mass spectrometry. A statistically significant difference between girls and boys was found for asthma control score (P = .02), lactic acid (P = .03), but not for any other organic acids (P > .05). Statistically significant correlations were found between lactic acid and Forced Expiratory Volume in 1 second (FEV1) (P = .02), Forced Vital Capacity (FVC) (P = .03); 4- hydroxyphenylacetic acid and FEV1 (P = .01), FVC (P = .01); 5-hydroxyindoleacetic acid and FEV1/FVC (P = .03), eNO (P = .05); glycolic acid with Peak Expiratory Flow (PEF) (P = .03); and malic acid with asthma control (P = .02). In conclusion, metabolomics was used to determine correlations between urinary organic acids and conventional pulmonary diagnostic tests in Greek asthmatic children. Metabolomics could be a promising approach for asthma research and in detection of novel biomarkers for asthma monitoring and therapeutic targets for childhood asthma. This study contributes towards a better understanding of the biochemical pathways involved in asthma.
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Affiliation(s)
- Maria Michelle Papamichael
- La Trobe University, School of Allied Health, Department of Rehabilitation, Nutrition & Sport, Melbourne, Australia.
| | | | - Bircan Erbas
- La Trobe University, School of Psychology & Public Health, Department of Public Health, Melbourne, Australia.
| | - Catherine Itsiopoulos
- La Trobe University, School of Allied Health, Department of Rehabilitation, Nutrition & Sport, Melbourne, Australia.
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Ullmann N, Mirra V, Di Marco A, Pavone M, Porcaro F, Negro V, Onofri A, Cutrera R. Asthma: Differential Diagnosis and Comorbidities. Front Pediatr 2018; 6:276. [PMID: 30338252 PMCID: PMC6178921 DOI: 10.3389/fped.2018.00276] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022] Open
Abstract
Childhood asthma remains a multifactorial disease with heterogeneous clinical phenotype and complex genetic inheritance. The primary aim of asthma management is to achieve control of symptoms, in order to reduce the risk of future exacerbations and progressive loss of lung function, which results especially challenging in patients with difficult asthma. When asthma does not respond to maintenance treatment, firstly, the correct diagnosis needs to be confirmed and other diagnosis, such as cystic fibrosis, primary ciliary dyskinesia, immunodeficiency conditions or airway and vascular malformations need to be excluded. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Moreover, all possible risk factors or comorbidities (gastroesophageal reflux, rhinosinusitis, dysfunctional breathing and/or vocal cord dysfunction, obstructive sleep apnea and obesity) should be investigated. At the same time, the possible reasons for poor symptom control need to be find in all modifiable factors which need to be carefully assessed. Non-adherence to medication or inadequate inhalation technique, persistent environmental exposures and psychosocial factors are, currently, recognized as the more common modifiable factors. Based on these premises, investigation and management of asthma require specialist multidisciplinary expertise and a systematic approach to characterizing patients' asthma phenotypes and delivering individualized care. Moreover, since early wheezers are at higher risk of developing asthma, we speculate that precocious interventions aimed at early diagnosis and prevention of modifiable factors might affect the age at onset of wheezing, reduce the prevalence of persistent later asthma and determine long term benefits for lung health.
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Affiliation(s)
- Nicola Ullmann
- Paediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Department of Paediatrics, Paediatric Hospital “Bambino Gesù” Research Institute, Rome, Italy
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Tortajada-Girbés M, Bousquet R, Bosque M, Carrera Martínez JJ, Ibáñez MD, Moreira A, Nieto A, Plaza AM, Rivas C, Requena G, Sánchez-Solis M, Tabar A, Torres-Borrego J, Zapatero L. Efficacy and effectiveness of omalizumab in the treatment of childhood asthma. Expert Rev Respir Med 2018; 12:745-754. [PMID: 30141696 DOI: 10.1080/17476348.2018.1507740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Omalizumab is a monoclonal antibody that binds and inhibits free serum immunoglobulin E, a mediator involved in the clinical manifestations of allergic asthma. Evidence for its efficacy and safety in the treatment of moderate-to-severe allergic asthma is based primarily on studies in adolescents and adults. However, there is increasing evidence of its utility in children with allergic asthma aged 6-12 years. Areas covered: This article reviews efficacy, safety, and effectiveness of omalizumab in the treatment of moderate-to-severe allergic asthma in children aged 6-12 years in clinical trials and in studies in clinical practice. Pharmacoeconomic aspects of its use among this population and the positioning of omalizumab in pediatric asthma management guidelines are also discussed. Additionally, an algorithm for the management of poorly controlled severe pediatric asthma in children older than 6 years is proposed. Electronic databases, such as PubMed, were searched for terms Asthma and Omalizumab and for asthma management guidelines. Expert commentary: Add-on omalizumab is an effective maintenance therapy in children aged 6-12 years with poorly controlled moderate-to-severe allergic asthma treated with medium-high inhaled corticosteroids doses and inhaled long-acting β2-agonists. Omalizumab appears safe in children in both clinical trials and real-life setting and may be cost-effective.
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Affiliation(s)
- Miguel Tortajada-Girbés
- a Department of Pediatrics, Obstetrics and Gynecology , University of Valencia , Valencia , Spain.,b Pediatric Pulmonology and Allergy Unit , Dr. Peset University Hospital , Valencia , Spain
| | - Rosa Bousquet
- c Pediatric Pulmonology and Allergy Unit, Pediatric Service , Hospital del Mar , Barcelona , Spain
| | - Montserrat Bosque
- d Pediatric Allergy and Pulmonology Unit , Hospital Universitario Parc Taulí , Sabadell , Spain
| | | | | | - Ana Moreira
- g Medical Advisor Xolair-Asma, Novartis , Barcelona , Spain
| | - Antonio Nieto
- h Pediatric Pulmonology and Allergy Unit , Children's Hospital la Fe , Valencia , Spain
| | - Ana María Plaza
- i Allergy and Clinical Immunology Service , Hospital Sant Joan de Déu , Barcelona , Spain
| | - Cristina Rivas
- j Pediatric Service , Hospital de Sagunto , Valencia , Spain
| | - Gloria Requena
- k Allergy Department , Hospital Vithas-Xanit Internacional , Málaga , Spain
| | - Manuel Sánchez-Solis
- l Pediatric Pulmonology Unit, University Hospital Virgen de la Arrixaca , IMIB Bio-Health Research Institute , Murcia , Spain
| | - Ana Tabar
- m Allergology Service , Complejo Hospitalario de Navarra , Pamplona , Spain
| | - Javier Torres-Borrego
- n Pediatric Allergy and Pulmonology Unit , Children´s University Hospital Reina Sofía , Córdoba , Spain
| | - Lydia Zapatero
- o Pediatric Allergy Unit , Maternal and Child Hospital Gregorio Marañón , Madrid , Spain
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Tesse R, Borrelli G, Mongelli G, Mastrorilli V, Cardinale F. Treating Pediatric Asthma According Guidelines. Front Pediatr 2018; 6:234. [PMID: 30191146 PMCID: PMC6115494 DOI: 10.3389/fped.2018.00234] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/01/2018] [Indexed: 12/27/2022] Open
Abstract
Asthma is a common chronic inflammatory disorder of the lower respiratory airways in childhood. The management of asthma exacerbations and the disease control are major concerns for clinical practice. The Global Strategy for Asthma Management and Prevention, published by GINA, updated in 2017, the British Thoracic Society/Scottish Intercollegiate Guideline Network, revised in 2016, the National Institute for Health and Care Excellence asthma guideline consultation, available in 2017, are widely accepted documents, frequently implemented, with conflicting advices, and different conclusion on asthma definition and treatment. An International Consensus on Pediatric Asthma was carried out in 2012 by a Committee with expertise in the field, to critically review differences on current guidelines. In addition, the specific issue of treating severe and difficult asthma has been recently highlighted throughout the International European Respiratory Society/American Thoracic Society guidelines on severe asthma. The aim of this paper is to describe conventional treatments and some new therapeutic approaches to pediatric asthma according to guidelines, highlighting key aspects, and differences on proposed clinical recommendations for asthma management. Age specific therapy are proposed in steps, according to clinical severity and the level of disease control. If control is not achieved within 3 months, stepping-up should be considered; otherwise, if control is achieved after 3 months, stepping down may be considered. The most used drug classes of asthma medications are beta-2 adrenergic agonists, corticosteroids, and leukotriene modifiers. Intramuscolar triamcinolone has been used for severe asthma treatment. Chromones and xanthines have been extensively used in the past, but they have shown limits related to their efficacy and safety profile. Omalizumab, a monoclonal antibody against IgE, is an immunomodulatory biological agent, used as new drug in patients with confirmed IgE-mediated allergic asthma, only for patient's specific range of total IgE level. There are low evidences in the efficacy of metotrexate, as well as macrolide antibiotics in children with asthma. Antifungal agents are also not recommended in asthmatic patients. Non-pharmacological measures that may improve patient's quality of life should also be attempted. We conclude that treatment decisions on childhood asthma management should be critically made, pondering the differences suggested by agreed international consensus documents.
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Affiliation(s)
- Riccardina Tesse
- Allergy, Immunology and Pediatric Pulmonology Unit, Ospedale Pediatrico Papa Giovanni XXIII, Bari, Italy
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Young Muslim Women Living with Asthma in Denmark: A Link between Religion and Self-Efficacy. PHARMACY 2018; 6:pharmacy6030073. [PMID: 30041428 PMCID: PMC6165087 DOI: 10.3390/pharmacy6030073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/17/2022] Open
Abstract
Asthma is a chronic respiratory disease that can be controlled with appropriate medicinal treatment. Adherence to pharmacological treatment is therefore critical. Self-efficacy plays a key role in adherence to medicine in chronic diseases, including asthma. Additionally, ethnic minorities have poor adherence to medicines. However, the impact of religion on self-efficacy and adherence is understudied. Therefore, the aim of this study was to explore the role of self-efficacy in adherence to asthma medicine treatment and the influence of religion on self-efficacy among young, Muslim minority women. A focus group and individual interviews with 10 Muslim minority women (14–24 years of age) living in Denmark were conducted. Data analysis was deductive using Bandura’s theory of self-efficacy and modes of agency. Overall, religion was shown to affect self-efficacy. The women reported changes in self-perceived self-efficacy during the holy month of Ramadan. In addition, praying was used as an alternative to medicine for controlling asthma symptoms. However, the women did not perceive religion and treating asthma with medicine as mutually exclusive, but rather as coexisting for the shared goal of controlling asthma symptoms. It is important for healthcare professionals (HCPs) to be aware of the link between self-efficacy, religion and adherence to asthma medicine treatment. This awareness can aid HCPs in giving advice regarding adherence to asthma treatment, and when monitoring treatment to improve the quality of asthma care for young Muslim minority women.
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122
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Jović D, Petrović-Tepić S, Knežević D. Assessment of the quality of life in children and adolescents with asthma. OBZORNIK ZDRAVSTVENE NEGE 2018. [DOI: 10.14528/snr.2018.52.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Asthma is a global health problem that negatively affects various aspects of the quality of a person's life. The aim of the study was to examine the quality of life in children and adolescents with asthma and the correlation between the degree of asthma control and the quality of life.Methods: The cross-sectional study included 100 children and adolescents with asthma over a six-month period in 2015. The study used: Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ(S)) for the assessment quality of life and the questionnaires for the assessment of asthma control for two age groups: Asthma Control Test (ACT) for adolescents and Childhood Asthma Control Test (C-ACT).Results: 62 boys and 38 girls aged 7−17, whose average age was 11.2 (s = 2.7) years were included in the study. The overall PAQLQ(S) score ranged between 3.30 and 7.00 with an average mean value of 5.95. The findings have showed that most children with asthma estimated their overall PAQLQ(S) on the positive end of the scale. The children reported more impairment in the domain of 'Emotion' (x = 5.84) than in 'Activities' and 'Symptoms'. The percentage of adolescents in the category of poor control (12.5 %) was significantly lower than in the group of children (25.0 %). In both groups of children, the sub-scale 'Symptoms' was in highest correlation with the degree of asthma control (r = 0.915, p < 0.01).Discussion and conclusion: In this study the children and adolescents with asthma showed an overall good quality of life. Control of asthma symptoms in children and adolescents positively influenced their quality of life.
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123
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Mohammadi A, Mahjoub S, Ghafarzadegan K, Nouri HR. Immunomodulatory effects of Thymol through modulation of redox status and trace element content in experimental model of asthma. Biomed Pharmacother 2018; 105:856-861. [PMID: 30021378 DOI: 10.1016/j.biopha.2018.05.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022] Open
Abstract
Oxidative stress plays a key role in the immunopathogenesis of asthma. The objective of this study was to investigate the thymol effects on oxidative parameters along with trace elements in asthma experimental model. The Balb/c mice were sensitized by intraperitoneal injection of ovalbumin and thymol (8, 16 and 32 mg/kg) and dexamethasone (DEX) (2 mg/kg) were orally administered to sensitized mice. Oxidative stress parameters including protein carbonyl content, malondialdehyde (MDA), 8-hydroxy-2'-deoxyguanosine (8-OHdG) and total antioxidant capacity (TAC) besides trace element levels were evaluated. The protein carbonyl content, MDA and 8-OHdG in treated mice with 32 mg/kg of thymol significantly decreased compared to asthmatic mice (P < 0.01). Also, TAC significantly increased (P < 0.001) as well as zinc and selenium levels while copper level decreased. 16 mg/kg of thymol reduced the protein carbonyl content, MDA and 8-OHdG compared to asthmatic mice (P < 0.05). In addition, thymol improved the most prominent inflammation characteristics of asthma. The obtained results suggest that thymol has a protective effect against oxidative stress and it was also able to partially restore the defective trace element levels in asthma. Based on our observations, thymol may be used for alternative / complementary therapy in asthma.
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Affiliation(s)
- Akbar Mohammadi
- Student Research Committee, Babol University of Medical Sciences, Babol, I.R. Iran
| | - Soleiman Mahjoub
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran; Department of Clinical Biochemistry, School of Medicine, Babol University of MedicalSciences, Babol, I.R. Iran.
| | - Kamran Ghafarzadegan
- Research Center of Moayed Pathobiology Laboratory and Department of Razavi Hospital, Mashhad, I.R. Iran
| | - Hamid Reza Nouri
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran.
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Xepapadaki P, Bachert C, Finotto S, Jartti T, Konstantinou GN, Kiefer A, Kowalski M, Lewandowska-Polak A, Lukkarinen H, Roumpedaki E, Sobanska A, Sintobin I, Vuorinen T, Zhang N, Zimmermann T, Papadopoulos NG. Contribution of repeated infections in asthma persistence from preschool to school age: Design and characteristics of the PreDicta cohort. Pediatr Allergy Immunol 2018. [PMID: 29512854 DOI: 10.1111/pai.12881] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The PreDicta cohort was designed to prospectively evaluate wheeze/asthma persistence in preschoolers in association with viral/microbial exposures and immunological responses. We present the cohort design and demographic/disease characteristics and evaluate unsupervised and predefined phenotypic subgroups at inclusion. METHODS PreDicta is a 2-year prospective study conducted in five European regions, including children 4-6 years with a diagnosis of asthma as cases and healthy age-matched controls. At baseline, detailed information on demographics, asthma and allergy-related disease activity, exposures, and lifestyle were recorded. Lung function, airway inflammation, and immune responses were also assessed. Power analysis confirmed that the cohort is adequate to answer the initial hypothesis. RESULTS A total of 167 asthmatic children (102 males) and 66 healthy controls (30 males) were included. Groups were homogeneous in respect to most baseline characteristics, with the exception of male gender in cases (61%) and exposure to tobacco smoke. Comorbidities and number and duration of infections were significantly higher in asthmatics than controls. 55.7% of asthmatic children had at least one positive skin prick test to aeroallergens (controls: 33.3%, P = .002). Spirometric and exhaled nitric oxide values were within normal limits; only baseline FEV0.5 and FEV1 reversibility values were significantly different between groups. Viral infections were the most common triggers (89.2%) independent of severity, control, or atopy; however, overlapping phenotypes were also common. Severity and control clustered together in an unsupervised analysis, separating moderate from mild disease. CONCLUSIONS The PreDicta cohort presented no differences in non-asthma related measures; however, it is well balanced regarding key phenotypic characteristics representative of "preschool asthma".
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Affiliation(s)
- Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Claus Bachert
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
| | - Susetta Finotto
- Department of Molecular Pneumology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Alexander Kiefer
- Department of Pediatrics and Adolescent Medicine, Department of Allergy and Pneumology, Children's Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Marek Kowalski
- Department of Immunology, Rheumatology and Allergy, Central University Hospital, Lodz, Poland
| | - Anna Lewandowska-Polak
- Department of Immunology, Rheumatology and Allergy, Central University Hospital, Lodz, Poland.,Department of Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Heikki Lukkarinen
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - Eirini Roumpedaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Sobanska
- Department of Immunology, Rheumatology and Allergy, Central University Hospital, Lodz, Poland
| | - Ina Sintobin
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
| | - Tytti Vuorinen
- Department of Clinical Virology, Turku University Hospital, Department of Virology, Turku University, Turku, Finland
| | - Nan Zhang
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
| | - Theodor Zimmermann
- Department of Pediatrics and Adolescent Medicine, Department of Allergy and Pneumology, Children's Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
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125
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Westergren T, Berntsen S, Ludvigsen MS, Aagaard H, Hall EOC, Ommundsen Y, Uhrenfeldt L, Fegran L. Relationship between physical activity level and psychosocial and socioeconomic factors and issues in children and adolescents with asthma: a scoping review. ACTA ACUST UNITED AC 2018; 15:2182-2222. [PMID: 28800060 DOI: 10.11124/jbisrir-2016-003308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Asthma is a heterogeneous chronic airway disease which may reduce capability for physical activity. In healthy peers, physical activity is influenced by psychosocial and socioeconomic factors. Knowledge about the role of these factors has not been mapped in children and adolescents with asthma. OBJECTIVE The main objective of this scoping review was to identify psychosocial and socioeconomic factors associated with physical activity level in children and adolescents with asthma in the literature. The specific objectives were to map the instruments used to measure these factors, report on the construction and validation of these instruments, map psychosocial and socioeconomic issues related to physical activity level reported in qualitative studies, and identify gaps in knowledge about the relationship between psychosocial and socioeconomic factors and physical activity level in children and adolescents with asthma. INCLUSION CRITERIA TYPES OF PARTICIPANTS Children and adolescents with asthma aged six to 18 years. CONCEPT Psychosocial and socioeconomic factors related to physical activity level and participation. CONTEXT All physical activity contexts. TYPES OF SOURCES Quantitative and qualitative primary studies in English, with no date limit. SEARCH STRATEGY The databases searched included nine major databases for health and sports science, and five databases for unpublished studies. After screening and identification of studies, the reference lists of all identified reports were searched, and forward citation searches were conducted using four databases. EXTRACTION OF THE RESULTS The following data were extracted: (a) relevant study characteristics and assessment of physical activity level, (b) instruments used to assess psychosocial and socioeconomic factors, (c) association between physical activity level and these factors, (d) construction and validation of instruments, and (e) psychosocial and socioeconomic issues related to physical activity participation. PRESENTATION OF THE RESULTS Twenty-one quantitative and 13 qualitative studies were included. In cross-sectional studies, enjoyment, physical self-concept, self-efficacy, attitudes and beliefs about physical activity and health, psychological distress, health-related quality of life, and social support were more often reported as being correlated with physical activity level. In three studies, the construct validity was assessed by factor analysis and construct reliability tests for the study population. Qualitative studies reported 10 issues related to physical activity participation, and capability and being like peers were most commonly reported. There was no direct evidence that qualitative research informed the development or adjustment of instruments in quantitative studies. CONCLUSIONS Seven psychosocial factors correlated with physical activity level; capability and being like peers were the most commonly reported issues. Reports of the construction and validation of instruments were sparse.
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Affiliation(s)
- Thomas Westergren
- 1Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway 2Clinical Research Unit, Randers Regional Hospital, Randers, Denmark 3Department of Clinical Medicine, Aarhus University, Aarhus, Denmark 4Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark 5Section of Nursing, Department of Public Health, Health, Aarhus University, Aarhus, Denmark 6Department of Coaching and Psychology, Norwegian School of Sports Science, Oslo, Norway 7Danish Centre of Systematic Reviews: a Joanna Briggs Institute Center of Excellence, The Center of Clinical Guidelines - Clearing house, Aalborg University, Aalborg, Denmark 8Faculty of Nursing and Health Sciences, Nord University, Bodo, Norway 9Department of Pediatrics, Sørlandet Hospital, Kristiansand, Norway
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126
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Huo Y, Zhang HY. Genetic Mechanisms of Asthma and the Implications for Drug Repositioning. Genes (Basel) 2018; 9:genes9050237. [PMID: 29751569 PMCID: PMC5977177 DOI: 10.3390/genes9050237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 12/20/2022] Open
Abstract
Asthma is a chronic disease that is caused by airway inflammation. The main features of asthma are airway hyperresponsiveness (AHR) and reversible airway obstruction. The disease is mainly managed using drug therapy. The current asthma drug treatments are divided into two categories, namely, anti-inflammatory drugs and bronchodilators. However, disease control in asthma patients is not very efficient because the pathogenesis of asthma is complicated, inducing factors that are varied, such as the differences between individual patients. In this paper, we delineate the genetic mechanisms of asthma, and present asthma-susceptible genes and genetic pharmacology in an attempt to find a diagnosis, early prevention, and treatment methods for asthma. Finally, we reposition some clinical drugs for asthma therapy, based on asthma genetics.
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Affiliation(s)
- Yue Huo
- Hubei Key Laboratory of Agricultural Bioinformatics, College of Informatics, Huazhong Agricultural University, Wuhan 430070, China.
| | - Hong-Yu Zhang
- Hubei Key Laboratory of Agricultural Bioinformatics, College of Informatics, Huazhong Agricultural University, Wuhan 430070, China.
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127
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Lochte L, Petersen PE, Nielsen KG, Andersen A, Platts-Mills TAE. Associations of physical activity with childhood asthma, a population study based on the WHO - health behaviour in school-aged children survey. Asthma Res Pract 2018; 4:6. [PMID: 29736253 PMCID: PMC5925826 DOI: 10.1186/s40733-018-0042-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/05/2018] [Indexed: 11/11/2022] Open
Abstract
Background Asthma in paediatric populations is one of the highest public health concerns. In this study of children and adolescents, we hypothesized that low levels of physical activity (PA) would show associations with asthma that vary by asthma outcome. The objective was to assess whether PA was associated with ever asthma and/or current asthma. Methods Analyses were based on 4824 Danish schoolchildren aged 11–15 years old (48.7% boys) participating in the HBSC survey. The study variables were (1) physician-diagnosed asthma (ever asthma) and (2) physician-diagnosed asthma plus wheezing and/or physician or hospital consultation for wheezing (current asthma). Associations with PA by gender were analysed with multivariate logistic regression using the “variance covariance (vce) cluster” method. Results The prevalence of ever asthma was 14.3% (boys) and 12.8% (girls), and that of current asthma was 6.8% (boys) and 7.0% (girls). Boys with current asthma showed important differences in low and high PA. We found inverse associations between low PA and ever asthma, odds ratio [95% confidence interval] male: .55 [.30; .99] and female: .47 [.24; .93], and current asthma, male: .27 [.12; .60] (P linear trend = .007) and female: .32 [.11; .94]. Conclusions The lowest activity levels showed significant inverse associations with asthma, regardless of the definition. For boys, the more stringent (current asthma) of the two paediatric asthma definitions revealed a significant trend with PA, and the direction of associations shifted to positive as weekly PA increased. Electronic supplementary material The online version of this article (10.1186/s40733-018-0042-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lene Lochte
- 1Department of Odontology, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Poul Erik Petersen
- 1Department of Odontology, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Kim G Nielsen
- 2Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Anette Andersen
- 3National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark
| | - Thomas A E Platts-Mills
- 4Department of Medicine, Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, VA 22908 USA
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Abstract
PURPOSE OF REVIEW The progression of atopic disorders from atopic dermatitis in infants to allergic rhinitis and asthma in children, adolescents, and adults defines the allergy march. Allergen immunotherapy is the only causal treatment altering the immunological mechanism underlying the allergic diseases. The sublingual administration route is more acceptable than the subcutaneous one in pediatric age. RECENT FINDINGS Several studies show the efficacy and safety profile of sublingual immunotherapy (SLIT) for the treatment of respiratory allergy diseases, but few data are available on its effect of primary and secondary prevention of allergic disease. The purpose of this manuscript is to review the latest studies addressing the effect of SLIT on the development of new sensitizations in not sensitized or already sensitized patients and progression of the allergy march.
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Affiliation(s)
- Federica Porcaro
- Respiratory Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127, Palermo, Italy
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Paramesh H. Air Pollution and Allergic Airway Diseases: Social Determinantsand Sustainability in the Control and Prevention. Indian J Pediatr 2018; 85:284-294. [PMID: 29313309 DOI: 10.1007/s12098-017-2538-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
Abstract
Air pollution, global warming and climate change are the major contributing factors in causing the increase prevalence of allergic airway diseases like asthma and allergic rhinitis and they will be the defining issues for health system in the twenty-first century. Asthma is an early onset non-communicable environmental disease with global epidemic and contributes a greatest psycho socio economic burden. Nearly 8 million global deaths are from air pollution. Over one billion population are the sufferers during 2015 and will increase to 4 billion by 2050. Air pollution not only triggers the asthma episodes but also changes the genetic pattern in initiating the disease process. Over the years our concept of management of allergic airway disease has changed from control of symptoms to prevention of the disease. To achieve this we need positive development on clean air policies with standard norms, tracking progress, monitoring and evaluation, partnership and conventions with local and global authorities. We do have challenges to overcome like rapid urbanization, lack of multisectorial policy making, lack of finance for research and development and lack of monitoring exposure to health burden from air pollution. We need to prioritize our strategy by sustainable, safe, human settlement, cities, sustainable energy, industrialization, and research. The measures to be adopted are highlighted in this review article. With effective measures by all stake holders we can reduce air pollution and prevent the global warming by 2030, along with 194 countries as adopted by WHO in May 2015.
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Affiliation(s)
- H Paramesh
- Lakeside Center for Health Promotion, No: 535, 5th Main, 12th Cross, HIG Dollars Colony, RMV 2nd Stage, Bengaluru, Karnataka, 560094, India.
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130
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Zhang W, Lin C, Sampath V, Nadeau K. Impact of allergen immunotherapy in allergic asthma. Immunotherapy 2018; 10:579-593. [PMID: 29569506 DOI: 10.2217/imt-2017-0138] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although traditional pharmacological approaches improve outcomes in disease management for allergic asthma, these fail to modify the underlying immune responses. Allergen immunotherapy remains the only etiological therapy for the treatment of respiratory allergies for which clinical efficacy has been demonstrated through several well-controlled studies. In this review, we examine evidence from the past 5 years regarding the impact of allergen immunotherapy on allergic asthma to inform practitioners and stimulate further discussion and research.
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Affiliation(s)
- Wenming Zhang
- Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA 94305, USA
| | - Chunrong Lin
- Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA 94305, USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA 94305, USA
| | - Kari Nadeau
- Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA 94305, USA
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131
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Craig SS, Dalziel SR, Powell CVE, Graudins A, Babl FE, Lunny C. Interventions for escalation of therapy for acute exacerbations of asthma in children: an overview of Cochrane Reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd012977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Simon S Craig
- Monash University; Department of Medicine, Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences; Clayton Victoria Australia
- Monash Medical Centre, Monash Emergency Service, Monash Health; Paediatric Emergency Department; Clayton Australia
| | - Stuart R Dalziel
- The University of Auckland; Liggins Institute; Auckland New Zealand
| | - Colin VE Powell
- Cardiff University; Department of Child Health, The Division of Population Medicine, The School of Medicine; Cardiff UK
| | - Andis Graudins
- Monash University; Department of Medicine, Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences; Clayton Victoria Australia
- Dandenong Hospital; Monash Emergency Service, Monash Health; Dandenong Australia
| | - Franz E Babl
- Murdoch Children's Research Institute; Emergency Research; Flemington Road Parkville Victoria Australia 3052
- Royal Children's Hospital; Emergency Department; Parkville Australia
- University of Melbourne; Department of Paediatrics; Parkville Australia
| | - Carole Lunny
- School of Public Health & Preventive Medicine, Monash University; Cochrane Australia; 553 St Kilda Road Melbourne Victoria Australia 3004
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Lajunen K, Kalliola S, Kotaniemi-Syrjänen A, Sarna S, Malmberg LP, Pelkonen AS, Mäkelä MJ. Abnormal lung function at preschool age asthma in adolescence? Ann Allergy Asthma Immunol 2018. [PMID: 29522812 DOI: 10.1016/j.anai.2018.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Asthma often begins early in childhood. However, the risk for persistence is challenging to evaluate. OBJECTIVE This longitudinal study relates lung function assessed with impulse oscillometry (IOS) in preschool children to asthma in adolescence. METHODS Lung function was measured with IOS in 255 children with asthma-like symptoms aged 4-7 years. Baseline measurements were followed by exercise challenge and bronchodilation tests. At age 12-16 years, 121 children participated in the follow-up visit, when lung function was assessed with spirometry, followed by a bronchodilation test. Asthma symptoms and medication were recorded by a questionnaire and atopy defined by skin prick tests. RESULTS Abnormal baseline values in preschool IOS were significantly associated with low lung function, the need for asthma medication, and asthma symptoms in adolescence. Preschool abnormal R5 at baseline (z-score ≥1.645 SD) showed 9.2 odds ratio (95%CI 2.7;31.7) for abnormal FEV1/FVC, use of asthma medication in adolescence, and 9.9 odds ratio (95%CI 2.9;34.4) for asthma symptoms. Positive exercise challenge and modified asthma-predictive index at preschool age predicted asthma symptoms and the need for asthma medication, but not abnormal lung function at teenage. CONCLUSION Abnormal preschool IOS is associated with asthma and poor lung function in adolescence and might be utilised for identification of asthma persistence.
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Affiliation(s)
- Katariina Lajunen
- Department of Allergology, Skin and Allergy Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
| | - Satu Kalliola
- Pediatric Department, Lohja Hospital, Helsinki University Hospital, Lohja, Finland
| | - Anne Kotaniemi-Syrjänen
- Department of Allergology, Skin and Allergy Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Sarna
- Department of Allergology, Skin and Allergy Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - L Pekka Malmberg
- Department of Allergology, Skin and Allergy Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Anna S Pelkonen
- Department of Allergology, Skin and Allergy Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Department of Allergology, Skin and Allergy Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
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133
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Larenas-Linnemann D, Nieto A, Palomares O, Pitrez PM, Cukier G. Moving toward consensus on diagnosis and management of severe asthma in children. Curr Med Res Opin 2018; 34:447-458. [PMID: 29096551 DOI: 10.1080/03007995.2017.1400961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Children with severe asthma continue to experience symptoms despite long-term treatment with high doses of corticosteroids. Moreover, the heterogeneous nature of asthma and the presence of several phenotypes have limited our ability to develop an optimized management strategy for these patients. Adequate management of severe asthma in children necessitates a detailed understanding of what makes asthma difficult to control, knowledge of the causal factors, review of diagnosis for accurate identification of pediatric patients with severe asthma and a precise definition of the phenotypes to be able to better target the therapy. Advancement in all these aspects is likely to improve childhood asthma treatment in the future. Although our understanding of severe pediatric asthma has grown in recent years, there remains a lack of consensus and clarity around critical aspects of this condition. This review attempts to present a harmonized view on the definition of severe asthma in the pediatric age group, identification of phenotypes and diagnosis, the inflammatory cascade, pharmacological and non-pharmacological treatment strategies, considerations for follow-up and referral to specialists, and disease prevention strategies.
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Affiliation(s)
| | - Antonio Nieto
- b Pediatric Pulmonology and Allergy Unit , Children's Hospital La Fe, Instituto de Investigacion La Fe , Valencia , Spain
| | - Oscar Palomares
- c Department of Biochemistry and Molecular Biology, School of Chemistry , Complutense University of Madrid , Madrid , Spain
| | - Paulo Márcio Pitrez
- d School of Medicine , Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre/RS , Brazil
| | - Gherson Cukier
- e Pediatric Pulmonology , Hospital Materno Infantil José Domingo de Obaldía, Hospital Chiriquí , David , Panamá
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134
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Chong L, Zhang W, Yu G, Zhang H, Zhu L, Li H, Shao Y, Li C. High-fat-diet induces airway hyperresponsiveness partly through activating CD38 signaling pathway. Int Immunopharmacol 2018; 56:197-204. [PMID: 29414651 DOI: 10.1016/j.intimp.2018.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 01/05/2023]
Abstract
CD38 is a plasma membrane bound multifunctional enzyme. It can be activated by inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-13, inducing calcium responses to agonist in airway smooth muscle cells (ASMC). Previous studies have found that high-fat-diet (HFD) induced obesity exhibited innate airway hyperresponsiveness (AHR). This study aimed to detect the effect of CD38 signaling pathway on the AHR of overweight/obese mice. The HFD-fed mice exhibited a significantly higher baseline airway resistance (Rn), and the increasing rates of Rn responded to increasing doses of methacholine compared with the LFD-fed mice. High-fat-diet increased CD38 expressions both in lung tissues and primary cultured ASMCs. Besides, preincubation with TNF-α led to a higher expression of CD38 protein and increased intracellular calcium in ASMC of the HFD-fed mice. Furthermore, CD38 gene knockdown through transfection of CD38 siRNA decreased the concentration of intracellular calcium. Additionally, the upregulations of CD38 protein and CD38 mRNA were also found in the lung tissues of HFD-fed mice challenged by ovalbumin (OVA). Collectively, our findings demonstrated a role of CD38 signaling pathway on the AHR of obesity and might be a potential therapeutic target for treating difficult-to-control obese asthma phenotype.
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Affiliation(s)
- Lei Chong
- Institute of Pediatrics, National Key Clinical Specialty of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weixi Zhang
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Gang Yu
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hailin Zhang
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lili Zhu
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haiyan Li
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Youyou Shao
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Changchong Li
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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135
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Zeng Z, Lin X, Zheng R, Zhang H, Zhang W. Celastrol Alleviates Airway Hyperresponsiveness and Inhibits Th17 Responses in Obese Asthmatic Mice. Front Pharmacol 2018; 9:49. [PMID: 29445341 PMCID: PMC5797758 DOI: 10.3389/fphar.2018.00049] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 01/15/2018] [Indexed: 02/05/2023] Open
Abstract
Severe airway hyperresponsiveness (AHR) is a clinical feature of asthma, which has been associated with obesity and has shown a poor response to standard asthma treatments such as glucocorticoids. Numerous studies have shown that Interleukin (IL)-17 producing CD4+T cells (Th17 cells), which could be inhibited by celastrol, is essential in mediating steroid-resistant AHR. The following study investigates the impact of celastrol and its mechanism on the regulation of AHR in murine model of obesity and asthma. C57BL/6 mice were sensitized by intraperitoneal injection of ovalbumin (OVA) on day 1 and 13 starting from 12th week, which was followed by aerosol OVA challenge that lasted for 30 min per daily for 7 consecutive days starting from 16th week. Diet-induced obesity (DIO) mice were fed a high fat diet (HFD) for 16 weeks. Celastrol was administrated orally for 7 consecutive days, 30 min before every challenge in DIO-OVA-induced mice. Lung functions were analyzed by measuring the airway resistance (Rn) and methacholine (MCh) AHR, while H&E staining was used to examine histological changes in the lungs. Immunohistochemistry was used to observe IL-17A protein in lung tissues; flow cytometry to detect the proportion of Th17 cells in CD4+T cells. The concentration of cytokines IL-17A in serum was assessed by standardized sandwich ELISA, while the expression of IL-17A mRNA in lung was examined by quantitative real-time RT-PCR. Briefly, our data indicated that celastrol reduced body mass in DIO-OVA-induced obesity and asthma. Both baseline Rn and MCh AHR were significantly lower in celastrol group. Moreover, celastrol treatment decreased the frequency of Th17 cell expansion and reduced the production of IL-17A in both lung and serum. To sum up, our findings indicated that Th17 and its cytokine measured in the spleen and lung were closely associated with AHR. In addition, celastrol has shown the ability to suppress AHR through Th17 inhibition in obese asthmatic mice.
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Affiliation(s)
- Zeyu Zeng
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xixi Lin
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rongying Zheng
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui Zhang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weixi Zhang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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136
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Oktemer T, Altıntoprak N, Muluk NB, Senturk M, Kar M, Bafaqeeh SA, Bellussi L, Passali D, Cingi C. Clinical efficacy of immunotherapy in allergic rhinitis. Am J Rhinol Allergy 2018; 30:4-7. [PMID: 29025463 DOI: 10.2500/ajra.2016.30.4368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Aeroallergen immunotherapy (AIT) should be considered for patients who exhibit symptoms of allergic rhinitis (AR), rhinoconjunctivitis, and/or asthma after natural exposure to allergens and who also demonstrate specific immunoglobulin E antibodies against relevant allergens. METHODS In this paper, clinical efficacy of immunotherapy in allergic rhinitis is reviewed. RESULT Subcutaneous allergen immunotherapy (SCIT) is effective for seasonal and perennial AR. Sustained effectiveness requires several years of treatment. SCIT may prevent the development of allergic asthma in children with AR. Sublingual allergen immunotherapy (SLIT) is currently considered an alternative treatment to the subcutaneous route. The use of SLIT has been included in international guidelines for the treatment of AR with or without conjunctivitis. CONCLUSION Patients treated with SCIT are at risk of both local and systemic adverse reactions; however, in most cases, symptoms are readily reversible if they are recognized early and treated promptly. The safety profile of SLIT is good; therefore, SLIT can be self-administered by patients in their homes. In this article, we reviewed the efficacy and safety of allergen immunotherapy.
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Affiliation(s)
- Tugba Oktemer
- Ear, Nose and Throat (ENT) Department, Private Polatlı Can Hospital, Polatli-Ankara, Turkey
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137
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Sol IS, Kim YH, Park YA, Lee KE, Hong JY, Kim MN, Kim YS, Oh MS, Yoon SH, Kim MJ, Kim KW, Sohn MH, Kim KE. Relationship between sputum clusterin levels and childhood asthma. Clin Exp Allergy 2017; 46:688-95. [PMID: 26661728 DOI: 10.1111/cea.12686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/27/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a biomarker for inflammation-associated diseases. Clusterin levels in childhood asthma have not been evaluated. OBJECTIVES (1) To evaluate sputum clusterin levels in children with asthma compared to a control group. (2) To assess the relationships between sputum clusterin levels and airway inflammation, pulmonary function, and bronchial hyperresponsiveness. METHODS This study included 170 children aged 5-18 years with stable asthma (n = 91), asthma exacerbation (n = 29), or no asthma (healthy controls; n = 50). Induced sputum, pulmonary function, and methacholine challenge tests were performed. Stable asthma was classified into two groups according to the severity. Clusterin levels in sputum were measured using an enzyme-linked immunosorbent assay. RESULTS Children with stable asthma had a higher clusterin level than healthy controls [4540 (3872-5651) pg/mL vs. 3857 (1054-4369) pg/mL, P < 0.001]. The clusterin level was also more elevated in eosinophil-dominant sputum than in non-eosinophilic sputum in stable asthma [5094 (4243-6257) pg/mL vs. 4110 (1871-4839) pg/mL, P = 0.0017]. Clusterin levels were associated with asthma severity. Paradoxically, clusterin levels were lower during asthma exacerbation than in stable asthma [1838 (350-4790] pg/mL vs. 4540 (3872-5651) pg/mL, P < 0.001]. Clusterin levels were strongly correlated with the methacholine concentration that caused a 20% decrease in the forced expiratory volume in 1 s (r = -0.617, P < 0.001); there was no significant correlation between clusterin levels and other pulmonary function parameters. CONCLUSIONS AND CLINICAL RELEVANCE Clusterin levels were altered in children with stable asthma and asthma exacerbation because of its antioxidant and anti-inflammatory effects. Clusterin may be a marker that reflects airway inflammation and severity of symptoms, and it can be used in the assessment and management of childhood asthma.
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Affiliation(s)
- I S Sol
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y H Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y A Park
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K E Lee
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - J Y Hong
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M N Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M S Oh
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - S H Yoon
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M J Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K W Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M H Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K E Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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138
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Hong J, Bao Y, Chen A, Li C, Xiang L, Liu C, Chen Z, Zhao D, Fu Z, Shang Y. Chinese guidelines for childhood asthma 2016: Major updates, recommendations and key regional data. J Asthma 2017; 55:1138-1146. [PMID: 29227721 DOI: 10.1080/02770903.2017.1396474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE With increased industrialization and urbanization in China, pediatric asthma is becoming more prevalent. Despite a growing body of evidence, there remains a significant unmet need for adequate management of childhood asthma. The Subspecialty Group of Respiratory Diseases of the Society of Pediatrics, the Chinese Medical Association, and the editorial board of the Chinese Journal of Pediatrics have recently updated the "Guidelines for diagnosis and optimal management of asthma in children," first published in 2008. METHODS This article reviews the major updates to the guidelines and covers the main recommendations for diagnosis, assessment, and treatment of pediatric asthma in China. Key regional data on epidemiology, clinical features, disease burden, knowledge among children and parents, and risk factors including pollution are provided to contextualize the recommendations. RESULTS The major updates to the guidelines include: (1) A more practical definition of asthma; (2) assessment of asthma control that takes into account both current symptom control and future risk; (3) classification based on disease severity that corresponds with treatment step; (4) differentiation between difficult-to-treat and poorly controlled asthma; (5) an open-ended approach to pharmacological management; and (6) allergen immunotherapy (AIT) in mild- to moderate-persistent asthma. CONCLUSIONS The updated "Guidelines for the diagnosis and optimal management of asthma in children (2016)" combine the latest national and international clinical evidence and experience to provide practical and reliable recommendations to Chinese clinicians.
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Affiliation(s)
- Jianguo Hong
- a Department of Pediatrics , Shanghai General Hospital, Shanghai Jiaotong University , Shanghai , China
| | - Yixiao Bao
- b National Children's Medical Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China.,c Department of Pediatrics , Shanghai EverBetter Pubin Children's Hospital , Shanghai , China
| | - Aihuan Chen
- d Department of Pediatrics , The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease , Guangzhou , China
| | - Changchong Li
- e Department of Pediatrics , the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , China
| | - Li Xiang
- f Department of Allergy , Beijing Children's Hospital, Capital Medical University , Beijing , China
| | - Chuanhe Liu
- g Department of Pediatrics , Capital Institute of Pediatrics , Beijing , China
| | - Zhimin Chen
- h Department of Respiratory Diseases , the Children's Hospital, Zhejiang University School of Medicine , Hangzhou , China
| | - Deyu Zhao
- i Department of Respiratory Diseases , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Zhou Fu
- j Department of Respiratory Diseases , Children's Hospital of Chongqing Medical University , Chongqing , China
| | - Yunxiao Shang
- k Department of Pediatrics , Shengjing Hospital of China Medical University , Shenyang , China
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139
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Jiang C, Yu H, Zhu W, Xu J, Lou B, Sun Q, Yang X, Meng L, Lu S. Neutrophil-Lymphocyte Ratio in Children with Recurrent Wheezing. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2017; 30:227-231. [PMID: 35923022 DOI: 10.1089/ped.2017.0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pediatric recurrent wheezing is a common disorder with potential asthma risk; however, its diagnosis much relies on physician's subjective evaluation. Hence, efficient noninvasive biomarkers are in great need. In this retrospective study, blood routine test was analyzed in 143 wheezing children and 137 control individuals, and various cell types were discriminated and counted. Total IgE in plasma was detected using enzyme-linked immunosorbent assay. Receiver operating characteristic curve was plotted and area under curve (AUC) was calculated to evaluate the clinical potential of both indexes for diagnosing pediatric recurrent wheezing. The theoretical cutoff values for both indexes were also calculated using a Youden index. The results showed that neutrophil significantly increased in wheezing children, whereas lymphocyte decreased sharply. Total IgE, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were significantly elevated in wheezing patients. Besides, NLR and PLR were found unchanged in different genders. The results showed that NLR (AUC = 0.647) and PLR (AUC = 0.628) were able to discriminate recurrent wheezing. Cutoff for NLR was 0.98 (Youden index 24.8%) and cutoff for PLR was 116.4 (Youden index 19.4%). The mentioned evidence supported NLR and PLR as potential diagnostic indexes for pediatric recurrent wheezing.
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Affiliation(s)
- Congshan Jiang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, PR China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, PR China
| | - Hongchuan Yu
- Department of Respiratory Medicine, Xi'an Children Hospital, Xi'an, PR China
| | - Wenhua Zhu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, PR China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, PR China
| | - Jing Xu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, PR China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, PR China
| | - Bowen Lou
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, PR China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, PR China
| | - Qingzhu Sun
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, PR China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, PR China
| | - Xudong Yang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, PR China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, PR China
| | - Liesu Meng
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, PR China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, PR China
| | - Shemin Lu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, PR China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, PR China
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140
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The First 1000 Days of Life Factors Associated with "Childhood Asthma Symptoms": Brisa Cohort, Brazil. Sci Rep 2017; 7:16028. [PMID: 29167579 PMCID: PMC5700095 DOI: 10.1038/s41598-017-16295-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
This prospective study used data from the BRISA Cohort, São Luís, Brazil (n = 1140) and analyzed associations between environmental factors up to the first 1000 days of life and “Childhood Asthma Symptoms”. “Childhood Asthma Symptoms” was a latent variable based on the number of wheezing episodes, emergency care visit due to wheezing, diagnosis of asthma and diagnosis of rhinitis. A theoretical model that included prenatal factors (socioeconomic status, pregestational body mass index-BMI, soft drink and junk food consumption), birth factors (gestational age, smoking and diseases during pregnancy, birth weight and type of delivery), first year of life factors (breastfeeding, environmental aeroallergens and respiratory diseases) and BMI z-score in the second year of life, was analyzed by structural equation modeling. High pregestational BMI, high soft drink consumption, cesarean section without labor, chill in the first three months of life, carpeted floor and child’s exposure to tobacco were associated with higher values of “Childhood Asthma Symptoms”. In contrast, high birth weight, breastfeeding and infant’s age were associated with lower values of “Childhood Asthma Symptoms”. These findings support the hypothesis that environmental factors that are present before conception and up to the first 1000 days of life are associated with asthma.
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141
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Roxbury CR, Lin SY. Efficacy and Safety of Subcutaneous and Sublingual Immunotherapy for Allergic Rhinoconjunctivitis and Asthma. Otolaryngol Clin North Am 2017; 50:1111-1119. [PMID: 28964530 DOI: 10.1016/j.otc.2017.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Allergic rhinitis is often associated with asthma and has significant impacts on health care costs and productivity in the United States. Although allergen avoidance and pharmacotherapy are effective, allergen-specific immunotherapy is the only treatment that may lead to improved allergy symptoms even after treatment is discontinued. Subcutaneous immunotherapy has been the mainstay of allergen-specific immunotherapy in the United States for decades, but sublingual immunotherapy has recently become available. This review discusses the use of subcutaneous immunotherapy and sublingual immunotherapy in the treatment of allergic rhinitis and asthma and reviews the current evidence regarding the safety and efficacy of both formulations.
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Affiliation(s)
- Christopher R Roxbury
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA.
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142
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Zheng S, Yu Q, Zeng X, Sun W, Sun Y, Li M. The influence of inhaled corticosteroid discontinuation in children with well-controlled asthma. Medicine (Baltimore) 2017; 96:e7848. [PMID: 28858095 PMCID: PMC5585489 DOI: 10.1097/md.0000000000007848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Asthma is a chronic inflammatory disease that requires adherence to both preventative and therapeutic interventions in disease management. Children with asthma are likely to discontinue inhaled corticosteroids (ICS), especially when symptoms are under control. We aimed to investigate the impact of ICS adherence in children whose symptoms were under control.The study is cohort study; 35 children with controlled asthma that had undergone 3 years of follow-up were included. Serum eosinophil count, serum total IgE (tIgE), and lung function (FEV1, FEV1/FVC, PEF, FEF20-75%, and PC20) were evaluated at the beginning and end of the follow-up.At baseline, patients in both the adherent and nonadherent groups were similar. After 3 years, the nonadherent group who had discontinued ICS had a decrease in FEV1 (P < .05), FEV1/FVC (P < .05), PEF (P < .05), and FEF20-75% (P < .05). The nonadherent group had no significant improvement in PC20 compared with their values at the beginning of the follow-up, whereas the adherent group had improvement in PC20. Furthermore, there was an increase in serum eosinophil (P < .001) and tIgE (P < .05) in the nonadherent compared with the adherent group.Despite good asthma control, airway hyperresponsiveness (AHR) was detected in a large proportion of children with asthma. ICS discontinuation affected lung function, serum eosinophil count, tIgE, and AHR. Adequate adherence is important in asthma management. The benefits of ICS and the influence of drug discontinuation despite good asthma control may encourage better adherence from patients.
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143
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Mathioudakis AG, Eguiluz Gracia I, Bartel S, Tsilochristou O. ERS Early Career Members meet EAACI Junior Members: the launch of a strong, fruitful collaboration. Breathe (Sheff) 2017; 13:231-233. [PMID: 28894484 PMCID: PMC5584716 DOI: 10.1183/20734735.009017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Learn about the collaboration between @EarlyCareerERS and @EAACI_JM http://ow.ly/WUTO30d7dpC.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,All authors contributed equally
| | - Ibon Eguiluz Gracia
- Allergy Unit and Allergy Research Laboratory, Regional University Hospital of Malaga and Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain.,All authors contributed equally
| | - Sabine Bartel
- Priority Area Asthma and Allergy, Leibniz Center for Medicine and Biosciences, Research Center Borstel, Borstel, Germany.,Airway Research Center North, member of the German Center for Lung Research (DZL), Borstel, Germany.,All authors contributed equally
| | - Olympia Tsilochristou
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, Children's Allergy Service, King's College London, and Guy's and St Thomas' National Health Service Foundation Trust, London, UK.,All authors contributed equally
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144
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Chipps BE, Lanier B, Milgrom H, Deschildre A, Hedlin G, Szefler SJ, Kattan M, Kianifard F, Ortiz B, Haselkorn T, Iqbal A, Rosén K, Trzaskoma B, Busse WW. Omalizumab in children with uncontrolled allergic asthma: Review of clinical trial and real-world experience. J Allergy Clin Immunol 2017; 139:1431-1444. [PMID: 28477722 DOI: 10.1016/j.jaci.2017.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 02/04/2023]
Abstract
Asthma is one of the most common chronic diseases of childhood. Allergen sensitization and high frequencies of comorbid allergic diseases are characteristic of severe asthma in children. Omalizumab, an anti-IgE mAb, is the first targeted biologic therapeutic approved for the treatment of moderate-to-severe persistent allergic asthma (AA) that remains uncontrolled despite high-dose inhaled corticosteroids plus other controller medications. Since its initial licensing for use in adults and adolescents 12 years of age and older, the clinical efficacy, safety, and tolerability of omalizumab have been demonstrated in several published clinical trials in children aged 6 to less than 12 years with moderate-to-severe AA. These studies supported the approval of the pediatric indication (use in children aged ≥6 years) by the European Medicines Agency in 2009 and the US Food and Drug Administration in 2016. After this most recent change in licensing, we review the outcomes from clinical trials in children with persistent AA receiving omalizumab therapy and observational studies from the past 7 years of clinical experience in Europe. Data sources were identified by using PubMed in 2016. Guidelines and management recommendations and materials from the recent US Food and Drug Administration's Pediatric Advisory Committee meeting are also reviewed.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif.
| | - Bob Lanier
- Department of Pediatrics, University of North Texas, Fort Worth, Tex
| | | | - Antoine Deschildre
- Pneumologie Pédiatrique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Gunilla Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Stanley J Szefler
- Department of Pediatrics, Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Meyer Kattan
- Pediatric Pulmonary Division, Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | - William W Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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145
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Asamoah F, Kakourou A, Dhami S, Lau S, Agache I, Muraro A, Roberts G, Akdis C, Bonini M, Cavkaytar O, Flood B, Izuhara K, Jutel M, Kalayci Ö, Pfaar O, Sheikh A. Allergen immunotherapy for allergic asthma: a systematic overview of systematic reviews. Clin Transl Allergy 2017; 7:25. [PMID: 28775845 PMCID: PMC5539638 DOI: 10.1186/s13601-017-0160-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/17/2017] [Indexed: 12/20/2022] Open
Abstract
Background There is clinical uncertainty about the effectiveness and safety of allergen immunotherapy (AIT) for the treatment of allergic asthma. Objectives To undertake a systematic overview of the effectiveness, cost-effectiveness and safety of AIT for the treatment of allergic asthma. Methods We searched nine electronic databases from inception to October 31, 2015. Systematic reviews were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using the Critical Appraisal Skills Programme quality assessment tool for systematic reviews. Data were descriptively and thematically synthesized. Results We identified nine eligible systematic reviews; these focused on delivery of AIT through the following routes: subcutaneous (SCIT; n = 3); sublingual (SLIT; n = 4); and both SCIT and SLIT (n = 2). This evidence found that AIT delivered by SCIT and SLIT can improve medication and symptom scores and measures of bronchial hyper-reactivity. The impact on measures of lung function or asthma control was however less clear. We found no systematic review level evidence on the cost-effectiveness of SCIT or SLIT. SLIT had a favorable safety profile when compared to SCIT, particularly in relation to the risk of systemic reactions. Conclusions AIT has the potential to achieve reductions in symptom and medication scores, but there is no clear or consistent evidence that measures of lung function can be improved. Bearing in mind the limitations of synthesizing evidence from systematic reviews and the fact that these reviews include mainly dated studies, a systematic review of current primary studies is now needed to update this evidence base, estimate the effectiveness of AIT on asthma outcomes and to investigate the relative effectiveness, cost-effectiveness and safety of SCIT and SLIT.
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Affiliation(s)
- Felix Asamoah
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, London, UK.,Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Artemisia Kakourou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | | | - Ioana Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University Brasov, Brasov, Romania
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, University Hospital of Padua, Padua, Italy
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine, University of Southampton , Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cezmi Akdis
- Swiss Institute for Allergy and Asthma Research, Davos, Switzerland
| | | | - Ozlem Cavkaytar
- Department of Allergy and Clinical Immunology, Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Breda Flood
- European Federation of Allergy and Airways Diseases Patients Association, Brussels, Belgium
| | | | | | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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146
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Probiotics as an adjunct for the treatment of recurrent wheezing in infants and effects on expression of T-helper 1 and regulatory T cytokines. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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147
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Price D, Bjermer L, Bergin DA, Martinez R. Asthma referrals: a key component of asthma management that needs to be addressed. J Asthma Allergy 2017; 10:209-223. [PMID: 28794645 PMCID: PMC5536139 DOI: 10.2147/jaa.s134300] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Heterogeneity of asthma and difficulty in achieving optimal control are the major challenges in the management of asthma. To help attain the best possible clinical outcomes in patients with asthma, several guidelines provide recommendations for patients who will require a referral to a specialist. Such referrals can help in clearing the uncertainty from the initial diagnosis, provide tailored treatment options to patients with persistent symptoms and offer the patients access to health care providers with expertise in the management of the asthma; thus, specialist referrals have a substantial impact on disease prognosis and the patient's health status. Hurdles in implementing these recommendations include lack of their dissemination among health care providers and nonadherence to these guidelines; these hurdles considerably limit the implementation of specialist referrals, eventually affecting the rate of referrals. In this review, recommendations for specialist referrals from several key international and national asthma guidelines and other relevant published literature are evaluated. Furthermore, we highlight why referrals are not happening, how this can be improved, and ultimately, what should be done in the specialist setting, based on existing evidence in published literature.
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Affiliation(s)
- David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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148
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Tanno LK, Haahtela T, Calderon MA, Cruz A, Demoly P. Implementation gaps for asthma prevention and control. Respir Med 2017; 130:13-19. [PMID: 29206628 DOI: 10.1016/j.rmed.2017.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 12/22/2022]
Abstract
Asthma and allergic diseases can start in childhood and persist throughout life, but could also be manifested later, at any time for still misunderstood reasons. They are major chronic multifactorial respiratory diseases, for which prevention, early diagnosis and treatment is recognized as a priority for the Europe's public health policy and the United Nations. Given that allergy triggers (including infections, rapid urbanization leading to loss in biodiversity, pollution and climate changes) are not expected to change in a foreseeable future, it is imperative that steps are taken to develop, strengthen and optimize preventive and treatment strategies. Currently there are good treatments for asthma, several risk factors are known (e.g., allergies, rhinitis, tobacco smoke) and tools to control the disease have been developed. However, we are still uncertain how to prevent patients from developing asthma and allergic diseases. In this paper, we list the positive and negative experiences in this field as well as analyze the missing links in the process. This critical analysis will be the basis of setting-up an effective program for prevention and making, a process labeled as "implementation gaps".
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Affiliation(s)
- Luciana K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil; Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France.
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Central Hospital, FI-00029 Helsinki, Finland
| | - Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Alvaro Cruz
- ProAR-Núcleo de Excelência em Asma da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
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149
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Guarnaccia S, Pecorelli G, Bianchi M, Cartabia M, Casadei G, Pluda A, Quecchia C, Gretter V, Bonati M. IOEASMA: an integrated clinical and educational pathway for managing asthma in children and adolescents. Ital J Pediatr 2017. [PMID: 28646883 PMCID: PMC5483293 DOI: 10.1186/s13052-017-0374-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the lack of real life clinical and educational studies, "Io e l'Asma" Centre performed this implementation research (IR). Evaluate long-term effectiveness on bronchial asthma control of an integrated clinical and educational pathway for asthmatic children and adolescents. METHODS An observational retrospective pre-post intervention IR study was conducted among 262 children with asthma, ages 6-15 yrs. The intervention protocol included three clinical visits 8 weeks apart; an educational course at visit 1, post intervention consisted in two follow-up visits 6 months apart. The primary outcome was to verify the percentage of children who achieved bronchial asthma control at each visit. Secondary outcomes were based on daily therapy modulation, hospital admissions and the number of school days missed. An economic assessment was also included. RESULTS Two hundred sixty two children with bronchial asthma completed the pathway and were included in the analysis. The percentage of children who obtained disease control increased from 44% at visit 1 to 79% at visit 3 and at 1-year follow-up was 83%. Hospital admissions represent 11% of children: 8% before the intervention, 2% during the intervention, and 1% before and during the intervention; no hospitalizations related to bronchial asthma exacerbations were reported during the 2 follow-up visits. CONCLUSIONS The therapeutic-educational pathway was adapted according to the international guidelines and the primary performance indicators. Our findings confirmed that the clinical plus educational approach, shared between specialists and family physicians, is an effective template for asthma management. These findings also demonstrated a strong economic advantage.
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Affiliation(s)
- Sebastiano Guarnaccia
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy.
| | - Gaia Pecorelli
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marina Bianchi
- Laboratorio per la Salute Materno Infantile. Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Massimo Cartabia
- Laboratorio per la Salute Materno Infantile. Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gianluigi Casadei
- CESAV, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Ada Pluda
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Quecchia
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Valeria Gretter
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Bonati
- Laboratorio per la Salute Materno Infantile. Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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150
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Palomares Ó, Sánchez-Ramón S, Dávila I, Prieto L, Pérez de Llano L, Lleonart M, Domingo C, Nieto A. dIvergEnt: How IgE Axis Contributes to the Continuum of Allergic Asthma and Anti-IgE Therapies. Int J Mol Sci 2017. [PMID: 28635659 PMCID: PMC5486149 DOI: 10.3390/ijms18061328] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Asthma is an airway disease characterised by chronic inflammation with intermittent or permanent symptoms including wheezing, shortness of breath, chest tightness, and cough, which vary in terms of their occurrence, frequency, and intensity. The most common associated feature in the airways of patients with asthma is airway inflammation. In recent decades, efforts have been made to characterise the heterogeneous clinical nature of asthma. The interest in improving the definitions of asthma phenotypes and endotypes is growing, although these classifications do not always correlate with prognosis nor are always appropriate therapeutic approaches. Attempts have been made to identify the most relevant molecular and cellular biomarkers underlying the immunopathophysiological mechanisms of the disease. For almost 50 years, immunoglobulin E (IgE) has been identified as a central factor in allergic asthma, due to its allergen-specific nature. Many of the mechanisms of the inflammatory cascade underlying allergic asthma have already been elucidated, and IgE has been shown to play a fundamental role in the triggering, development, and chronicity of the inflammatory responses within the disease. Blocking IgE with monoclonal antibodies such as omalizumab have demonstrated their efficacy, effectiveness, and safety in treating allergic asthma. A better understanding of the multiple contributions of IgE to the inflammatory continuum of asthma could contribute to the development of novel therapeutic strategies for the disease.
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Affiliation(s)
- Óscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, 28040 Madrid, Spain.
| | - Silvia Sánchez-Ramón
- Department of Clinical Immunology and Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain.
- Department of Microbiology I, Complutense University School of Medicine, 28040 Madrid, Spain.
| | - Ignacio Dávila
- Allergy Service, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca (IBSAL), Biomedical and Diagnosis Science Department, Salamanca University School of Medicine, 37008 Salamanca, Spain.
| | - Luis Prieto
- Department of Allergy and Immunology, University of Valencia and Dr. Peset University Hospital, 46017 Valencia, Spain.
| | | | | | - Christian Domingo
- Pulmonary Service, Corporació Sanitària Parc Taulí, Department of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain.
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy Unit, Children's Hospital La Fe, 46026 Valencia, Spain.
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