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Hamlington KL, Navanandan N. A step toward predicting recurrence in preschool-age severe wheeze. The Journal of Allergy and Clinical Immunology: In Practice 2024; 12:1071-1072. [PMID: 38583924 DOI: 10.1016/j.jaip.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Katharine L Hamlington
- Section of Pulmonary and Sleep Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colo
| | - Nidhya Navanandan
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colo.
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Akelma Z, Çetin S, Başkaya N, Bostancı İ, Özmen S. Preschool children with asthma during the Covid-19 pandemic: fewer infections, less wheezing. J Asthma 2023; 60:691-697. [PMID: 35696321 DOI: 10.1080/02770903.2022.2089994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A few studies have already investigated preschool children with asthma during the pandemic. The purpose of this research was to investigate how preschool children with asthma were affected by the precautionary measures adopted during the pandemic. METHODS Preschool children with asthma aged 18-60 months evaluated in our clinic in March-May 2019, before the Covid-19 pandemic, were included in the study. The lockdown continued during March, April, and May 2020. The questionnaires and asthma symptom control tests for preschool children with asthma in 2019 and 2020 were then evaluated. RESULTS Sixty-three preschool children with asthma, 37 boys and 26 girls, aged 18-60 months (median 47) were included in the study. The median number of upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs), and the use of antibiotics were significantly lower in 2020 than 2019 (p<.01). The median numbers of the pediatric emergency department (PED) visits and hospitalizations were also lower in 2020 than in 2019 (p<.05). In 2019, 31 children with asthma were well controlled, 28 were partly controlled, and 4 were uncontrolled, compared to 58 well controlled, four partly controlled, and one uncontrolled in 2020 (p<.01). CONCLUSIONS Preschool children with asthma have been positively affected in terms of PED admission, hospitalization, and asthma symptom control in association with the Covid-19 pandemic and the resulting lockdown measures. This study revealed that wheezing decreased significantly in the absence of respiratory infection in preschool children with asthma. Namely, fewer infections meant less wheezing.
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Affiliation(s)
- Zülfikar Akelma
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
- Division of Pediatric Allergy and Immunology, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Sema Çetin
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
| | - Nevzat Başkaya
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
| | - İlknur Bostancı
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
- Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara, Türkiye
| | - Serap Özmen
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
- Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara, Türkiye
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Li L, Zhang F, Sun P, Zheng J, Chen T, Huang T, Wang F, Li K. Efficacy of three different budesonide treatments in Chinese preschool children with recurrent wheezing. Sci Rep 2022; 12:17043. [PMID: 36220847 DOI: 10.1038/s41598-022-21505-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/28/2022] [Indexed: 12/29/2022] Open
Abstract
To explore and compare the clinical control of three atomized inhalation budesonide (BUD) regimens for Chinese preschool children with recurrent wheezing using Test for Respiratory and Asthma Control (TRACK) scores. A total of 474 preschool children with positive Modified Asthma Predictive Index (mAPI) were randomly assigned to a daily group (initially given inhaled BUD 1 mg once a day and assessed every 4 weeks; if symptom were well controlled for 12 weeks, the dose was reduced to 25-50% of the previous dose until afinal dose of 0.25 mg once a day, maintained until 52 weeks), an intermittent high-dose group (1 mg twice daily for 7 days starting early during a predefined respiratory tract illness) and an intermittent medium-dose group (0.5 mg twice daily as soon as they contacted allergens or experienced nasal congestion, a runny nose, cough or other suspicious respiratory symptoms and continuing until symptoms were reduced or risk factors were absent for 3 days) for 52 weeks of treatment. The TRACK questionnaire was administered every 4 weeks. When TRACK scores were ≥ 80, symptoms were considered to be controlled. The average TRACK scores of the three groups after treatment were significantly higher than those before treatment (P < 0.001). There were no significant differences in the average TRACK scores and control rate after treatment at every 4 weeks in the three groups (P > 0.05). Te number of systemic glucocorticoid courses, urgent care visits for wheezing, and wheezing episodes before and after treatment were significantly different within each of the three groups (P < 0.001), but not among the three groups (P > 0.05). In clinical treatment of children, one of the three treatment options can be selected according to the specific situation case of mAPI- positive recurrent wheezing children.
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Qin Y, Wang J, Qin J, Yang N, Li S, Xu L, Han Y. Correlation Meta-Analysis of the Efficacy of Inhaled Corticosteroids in Children with Asthma Based on Smart Medical Health. J Healthc Eng 2022; 2022:6220774. [PMID: 35463694 PMCID: PMC9020921 DOI: 10.1155/2022/6220774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Children are the reserve force for national construction, and children's health is now being paid more and more attention. In today's childhood asthma treatment, many are based on the treatment of common cough, and there is no strict division with asthma. Importantly, the efficacy of inhaled corticosteroids in the treatment of childhood asthma has been extensively studied in the medical community. However, there is no clear explanation for its specific efficacy and role. Research on childhood asthma has always been a key topic in medicine. This article aims to conduct a meta-analysis of the correlation between inhaled corticosteroids and asthma in children. This article proposes a more scientific literature screening strategy, which can achieve a higher accuracy rate for meta-analysis. It combines the intelligent medical health system in the analysis of children's asthma to assist in the analysis of curative effects. Such analysis also provides reference significance for related research. The experimental results indicate that inhaled corticosteroids have a good effect on childhood asthma. As the concentration of inhaled glucocorticoid increases, the effect will be better. Specifically, if the concentration is increased by 10%, the effect will be about 15% better, but there are corresponding side effects.
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Affiliation(s)
- Yu Qin
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Jing Wang
- Endocrine Department, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Jingmin Qin
- Neonatology, Handan Second Hospital, Handan 056001, Hebei, China
| | - Ning Yang
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Sha Li
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Lijia Xu
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
| | - Yanjun Han
- Pediatrics, Xingtai People's Hospital, Zhanjiang 054031, Hebei, China
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Affiliation(s)
- Patrick Holt
- Telethon Kids Institute The University of Western Australia Nedlands, Western Australia, Australia
| | - Deborah Strickland
- Telethon Kids Institute The University of Western Australia Nedlands, Western Australia, Australia
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Nieto A, Mazón A, Nieto M, Calderón R, Calaforra S, Selva B, Uixera S, Palao MJ, Brandi P, Conejero L, Saz-Leal P, Fernández-Pérez C, Sancho D, Subiza JL, Casanovas M. Bacterial Mucosal Immunotherapy with MV130 Prevents Recurrent Wheezing in Children: A Randomized, Double-Blind, Placebo-controlled Clinical Trial. Am J Respir Crit Care Med 2021; 204:462-472. [PMID: 33705665 PMCID: PMC8480240 DOI: 10.1164/rccm.202003-0520oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Rationale: Recurrent wheezing in children represents a severe public health concern. Wheezing attacks (WA), mainly associated with viral infections, lack effective preventive therapies. Objectives: To evaluate the efficacy and safety of mucosal sublingual immunotherapy based on whole inactivated bacteria (MV130) in preventing WA in children. Methods: A Phase 3 randomized, double-blind, placebo-controlled, parallel-group trial including a cohort of 120 children <3 years old with ⩾3 WA during the previous year was conducted. Children with a positive skin test to common aeroallergens in the area where the clinical trial was performed were excluded from the trial. Subjects received MV130 or placebo daily for 6 months. The primary endpoint was the number of WA within 1 year after the first dose comparing MV130 and placebo. Measurements and Main Results: There was a significant lower number of WA in MV130 versus the placebo group, 3.0 (interquartile range [IQR], 2.0-4.0) versus 5.0 (IQR, 3.0-7.0) (P < 0.001). As secondary outcomes, a decrease in the duration of WA and a reduction in symptoms and medication scores in the MV130 versus placebo group were found. No adverse events were reported related to the active treatment. Conclusions: Mucosal bacterial immunotherapy with MV130 shows safety and clinical efficacy against recurrent WA in children.Clinical trial registered with www.clinicaltrials.gov (NCT01734811).
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Affiliation(s)
- Antonio Nieto
- Unidad de Neumología y Alergia Pediátrica, Instituto de Investigaciones Sanitarias, Hospital Universitario La Fe, Valencia, Spain
| | - Angel Mazón
- Unidad de Neumología y Alergia Pediátrica, Instituto de Investigaciones Sanitarias, Hospital Universitario La Fe, Valencia, Spain
| | - María Nieto
- Unidad de Neumología y Alergia Pediátrica, Instituto de Investigaciones Sanitarias, Hospital Universitario La Fe, Valencia, Spain
| | | | - Susana Calaforra
- Unidad de Neumología y Alergia Pediátrica, Instituto de Investigaciones Sanitarias, Hospital Universitario La Fe, Valencia, Spain
| | - Blanca Selva
- Unidad de Neumología y Alergia Pediátrica, Instituto de Investigaciones Sanitarias, Hospital Universitario La Fe, Valencia, Spain
| | - Sonia Uixera
- Unidad de Neumología y Alergia Pediátrica, Instituto de Investigaciones Sanitarias, Hospital Universitario La Fe, Valencia, Spain
| | | | - Paola Brandi
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | | | | | - Cristina Fernández-Pérez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - David Sancho
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Mthembu N, Ikwegbue P, Brombacher F, Hadebe S. Respiratory Viral and Bacterial Factors That Influence Early Childhood Asthma. Front Allergy 2021; 2:692841. [PMID: 35387053 PMCID: PMC8974778 DOI: 10.3389/falgy.2021.692841] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
Asthma is a chronic respiratory condition characterised by episodes of shortness of breath due to reduced airway flow. The disease is triggered by a hyperreactive immune response to innocuous allergens, leading to hyper inflammation, mucus production, changes in structural cells lining the airways, and airway hyperresponsiveness. Asthma, although present in adults, is considered as a childhood condition, with a total of about 6.2 million children aged 18 and below affected globally. There has been progress in understanding asthma heterogeneity in adults, which has led to better patient stratification and characterisation of multiple asthma endotypes with distinct, but overlapping inflammatory features. The asthma inflammatory profile in children is not well-defined and heterogeneity of the disease is less described. Although many factors such as genetics, food allergies, antibiotic usage, type of birth, and cigarette smoke exposure can influence asthma development particularly in children, respiratory infections are thought to be the major contributing factor in poor lung function and onset of the disease. In this review, we focus on viral and bacterial respiratory infections in the first 10 years of life that could influence development of asthma in children. We also review literature on inflammatory immune heterogeneity in asthmatic children and how this overlaps with early lung development, poor lung function and respiratory infections. Finally, we review animal studies that model early development of asthma and how these studies could inform future therapies and better understanding of this complex disease.
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Affiliation(s)
- Nontobeko Mthembu
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Paul Ikwegbue
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Frank Brombacher
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Immunology, Health Science Faculty, International Centre for Genetic Engineering and Biotechnology (ICGEB) and Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Faculty of Health Sciences, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Sabelo Hadebe
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Sørensen KG, Mikalsen IB, Neven A, Øymar K. Half of children with recurrent or chronic wet cough before three years of age were symptom-free by age seven. Acta Paediatr 2020; 109:2664-2670. [PMID: 32271955 DOI: 10.1111/apa.15293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
AIM We aimed to study the natural course of recurrent episodic and chronic wet cough in preschool children, the proportion and age of resolution, and risk factors for persistent symptoms. METHODS Parents of children with recurrent or chronic wet cough who had attended the outpatient clinic before the age of three years during 2010-2013 at Stavanger University Hospital, Norway, answered a questionnaire regarding clinical symptoms and current medication at a follow-up in 2017-2018. RESULTS We invited 840 children to participate, and parents consented for 348 (41.4%) of the children. At the first outpatient visit, 171 children (58.8%) had recurrent episodic and 120 (41.2%) had chronic wet cough. At follow-up at a median age of 82 months, 57.0% in both groups were symptom-free, and 9.4% with episodic cough and 13.3% with chronic cough had more than mild symptoms. During the last 12 months prior to the survey, 27.2% with episodic cough and 18.6% with chronic cough had used inhaled corticosteroids. CONCLUSION Half of the preschool children with recurrent episodic or chronic wet cough outgrew their symptoms by the median age of seven years, but one in four still used inhaled corticosteroids.
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Affiliation(s)
- Karen Galta Sørensen
- Department of Paediatrics Stavanger University Hospital Stavanger Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Ingvild Bruun Mikalsen
- Department of Paediatrics Stavanger University Hospital Stavanger Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Axel Neven
- Department of Paediatrics Stavanger University Hospital Stavanger Norway
| | - Knut Øymar
- Department of Paediatrics Stavanger University Hospital Stavanger Norway
- Department of Clinical Science University of Bergen Bergen Norway
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9
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Tualzik L, Chandrasekaran V. Clinical Profile of Episodic Wheezing and Multiple Trigger Wheezing in Preschool Children: A Cross-Sectional Study. Journal of Child Science 2020. [DOI: 10.1055/s-0040-1717140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe objectives of our study were to identify the relative frequency of episodic viral wheeze (EVW) and multiple trigger wheeze (MTW) in preschool children of 1 to 5 years of age with recurrent wheezing and to compare the relevant clinical and sociodemographic parameters in the above phenotypes. This cross-sectional study included 165 children aged 1 to 5 years with recurrent wheeze. Participants were categorized into EVW and MTW based on history according to European Respiratory Society Task Force recommendations 2008. Symptom control was assessed by Global Initiative for Asthma guidelines 2015. Of the total participants, EVW was seen in 55% and MTW in 45%. Children with MTW were significantly older than those with EVW, more atopic, and had higher eosinophil counts. The dominant phenotype seen in our study was EVW. The absence of ocular/nasal allergy and exclusive breastfeeding predicted well-controlled symptoms in EVW and in all preschool wheezers, respectively.
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Affiliation(s)
- Lalsiama Tualzik
- Department of Pediatrics, District Hospital Mamit, Mizoram, India
| | - Venkatesh Chandrasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Lejeune S, Deschildre A, Le Rouzic O, Engelmann I, Dessein R, Pichavant M, Gosset P. Childhood asthma heterogeneity at the era of precision medicine: Modulating the immune response or the microbiota for the management of asthma attack. Biochem Pharmacol 2020; 179:114046. [PMID: 32446884 PMCID: PMC7242211 DOI: 10.1016/j.bcp.2020.114046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
Exacerbations are a main characteristic of asthma. In childhood, the risk is increasing with severity. Exacerbations are a strong phenotypic marker, particularly of severe and therapy-resistant asthma. These early-life events may influence the evolution and be involved in lung function decline. In children, asthma attacks are facilitated by exposure to allergens and pollutants, but are mainly triggered by microbial agents. Multiple studies have assessed immune responses to viruses, and to a lesser extend bacteria, during asthma exacerbation. Research has identified impairment of innate immune responses in children, related to altered pathogen recognition, interferon release, or anti-viral response. Influence of this host-microbiota dialog on the adaptive immune response may be crucial, leading to the development of biased T helper (Th)2 inflammation. These dynamic interactions may impact the presentations of asthma attacks, and have long-term consequences. The aim of this review is to synthesize studies exploring immune mechanisms impairment against viruses and bacteria promoting asthma attacks in children. The potential influence of the nature of infectious agents and/or preexisting microbiota on the development of exacerbation is also addressed. We then discuss our understanding of how these diverse host-microbiota interactions in children may account for the heterogeneity of endotypes and clinical presentations. Finally, improving the knowledge of the pathophysiological processes induced by infections has led to offer new opportunities for the development of preventive or curative therapeutics for acute asthma. A better definition of asthma endotypes associated with precision medicine might lead to substantial progress in the management of severe childhood asthma.
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Affiliation(s)
- Stéphanie Lejeune
- CHU Lille, Univ. Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, F-59000 Lille, France; Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France
| | - Antoine Deschildre
- CHU Lille, Univ. Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, F-59000 Lille, France; Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France
| | - Olivier Le Rouzic
- Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France; CHU Lille, Univ. Lille, Department of Respiratory Diseases, F-59000 Lille Cedex, France
| | - Ilka Engelmann
- Univ. Lille, Virology Laboratory, EA3610, Institute of Microbiology, CHU Lille, F-59037 Lille Cedex, France
| | - Rodrigue Dessein
- Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France; Univ. Lille, Bacteriology Department, Institute of Microbiology, CHU Lille, F-59037 Lille Cedex, France
| | - Muriel Pichavant
- Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France
| | - Philippe Gosset
- Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France.
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Kwong CG, Bacharier LB. Management of Asthma in the Preschool Child. Immunol Allergy Clin North Am 2019; 39:177-190. [PMID: 30954169 DOI: 10.1016/j.iac.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The management of asthma in the preschool population is challenging because disease phenotypes are heterogeneous and evolving. Available therapies aimed at preventing persistent symptoms and recurrent exacerbations include inhaled corticosteroids and leukotriene receptor antagonists; episodic use of inhaled corticosteroids and azithromycin may result in a decrease in exacerbations among children with intermittent disease. This article reviews an approach using patient characteristics for selecting initial treatment approaches based on disease phenotype, such as symptom patterns or evidence of atopic markers. Evidence for and against the use of oral corticosteroids during acute episodes and barriers to adherence and effective treatment are discussed.
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Affiliation(s)
- Christina G Kwong
- Department of Pediatrics, Washington University School of Medicine in St. Louis, Campus Box 8116, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine in St. Louis, Campus Box 8116, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Saglani S, Fleming L, Sonnappa S, Bush A. Advances in the aetiology, management, and prevention of acute asthma attacks in children. Lancet Child Adolesc Health 2019; 3:354-364. [PMID: 30902628 DOI: 10.1016/s2352-4642(19)30025-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/17/2022]
Abstract
Acute attacks of wheeze or asthma are among the most common reasons for paediatric hospital attendance, and the incidence of severe attacks in the UK is among the highest in Europe. Although most attacks are driven by infection, there are important differences in the underlying pathophysiology of asthma and wheeze between preschool and school-aged children. Allergen sensitisation, airway eosinophilia, and type 2 inflammation predominate in older children, whereas phenotypes in preschool children are variable, often including non-atopic episodes driven by neutrophilic infection. Currently, a universal approach is adopted towards management, but there is a need to make objective assessments of airway function, inflammation, and infection, both during the attack and during stable periods, to identify treatable traits and to target therapy if outcomes are to be improved. An assessment of the risk factors that led to the attack and early, focused follow-up are essential to ensure attacks never occur again.
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Affiliation(s)
- Sejal Saglani
- National Heart & Lung Institute, Imperial College London, London, UK; Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
| | - Louise Fleming
- National Heart & Lung Institute, Imperial College London, London, UK; Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Samatha Sonnappa
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Andrew Bush
- National Heart & Lung Institute, Imperial College London, London, UK; Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
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Grigg J, Nibber A, Paton JY, Chisholm A, Guilbert TW, Kaplan A, Turner S, Roche N, Hillyer EV, Price DB. Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks. J Asthma Allergy 2018; 11:309-321. [PMID: 30588038 PMCID: PMC6294169 DOI: 10.2147/jaa.s178531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background An inhaled corticosteroid (ICS) or leukotriene receptor antagonist (LTRA) may prevent wheezing/asthma attacks in preschoolers with recurrent wheeze when added to short-acting β-agonist (SABA). Objective The aim of this historical matched cohort study was to assess the effectiveness of these treatments for preventing wheezing/asthma attacks. Methods Electronic medical records from the Optimum Patient Care Research Database were used to characterize a UK preschool population (1–5 years old) with two or more episodes of wheezing during 1 baseline year before first prescription (index date) of ICS or LTRA, or repeat prescription of SABA. Children initiating ICS or LTRA on the index date were matched 1:4 to those prescribed only SABA for age, sex, year of index prescription, mean baseline SABA dose, baseline attacks, baseline antibiotic prescriptions, and eczema diagnosis. Wheezing/asthma attacks (defined as asthma-related emergency attendance, hospital admission, or acute oral corticosteroid prescription) during 1 outcome year were compared using conditional logistic regression. Results Matched ICS and SABA cohorts included 990 and 3,960 children, respectively (61% male; mean [SD] age 3.2 [1.3] years), and matched LTRA and SABA cohorts included 259 and 1,036 children, respectively (65% male; mean [SD] age 2.6 [1.2] years). We observed no significant difference between matched cohorts in the odds of a wheezing/asthma attack: ICS vs SABA, OR (95% CI) 1.01 (0.85–1.19) and LTRA vs SABA, OR (95% CI) 1.28 (0.96–1.72). Conclusion We found no evidence that initiation of ICS or LTRA therapy is associated with fewer attacks during 1 outcome year than SABA alone for a heterogeneous group of preschool children with recurrent wheeze in the real-life clinical setting.
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Affiliation(s)
- Jonathan Grigg
- Blizard Institute, Queen Mary University of London, London, UK,
| | | | - James Y Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Theresa W Guilbert
- Pulmonary Division, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada
| | - Steve Turner
- Department of Child Health, Royal Aberdeen Children's Hospital, University of Aberdeen, Aberdeen, UK
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital Group, AP-HP, University of Paris Descartes (EA2511), Paris, France
| | - Elizabeth V Hillyer
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - David B Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Academic Primary Care, University of Aberdeen, Aberdeen, UK
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14
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Hatziagorou E, Kouroukli E, Galogavrou M, Papanikolaou D, Terzi DD, Anagnostopoulou P, Kirvassilis F, Panagiotakos DB, Tsanakas J. Efficacy and safety of the combination fluticasone propionate plus salmeterol in asthmatic preschoolers: An observational study. J Asthma 2018; 56:573-580. [PMID: 29958011 DOI: 10.1080/02770903.2018.1474923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Inhaled Corticosteroids (ICS) are the cornerstone of asthma management in pediatric patients. However, in some cases, asthma is not adequately controlled on ICS alone. Long-acting beta2-agonists (LABA) are one of the available additional therapies but their use has rarely been studied among children younger than 5 years. OBJECTIVE The aim of this observational study was to evaluate the efficacy and safety of the combination of fluticasone propionate and salmeterol (FP/SA) in asthmatic children younger than 5 years of age. METHODS A retrospective study of 796 children under the age of 5 years (2.87 ± 1.22 years, 64.2% males), who were treated with FP/SA was conducted. Hospitalization rates, frequency of wheezing, exercise induced asthma, nocturnal wheeze and drug-related side-effects were recorded through children's medical records. RESULTS The children had previously received short-acting β2-agonists (73%), ICS (17%), montelukast (1%), and ICS with montelukast (2%). Mean duration of therapy with FP/SA was 12.45 ± 9.14 months. After adjusting for age, gender, and duration of treatment, a 89% reduction was recorded in annual hospitalization rates (from 27.13% before treatment to 3.01% after FP/SA therapy, p < 0.001), a 71% reduction in incidence of exercise-induced asthma (36.8% vs. after 10.6%, p < 0.001), a 81% reduction in nocturnal asthma (33.7% vs. after: 6.4%, p < 0.001), as well as in frequency of wheezing (p < 0.01),. No previous treatment carry-on effect was observed. No major drug-related side-effects occurred in the study group. CONCLUSIONS Combination therapy (FP/SA) is well-tolerated and highly effective in asthmatic children under the age of 5 years.
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Affiliation(s)
- Elpis Hatziagorou
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Eleana Kouroukli
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Maria Galogavrou
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Dafni Papanikolaou
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Dr Despoina Terzi
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Pinelopi Anagnostopoulou
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Fotios Kirvassilis
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | | | - John Tsanakas
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
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15
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Grigg J, Barben J, Everard ML, Hall G, Karadag B, Moeller A, Nenna R, Priftis KN, Rottier RJ, Terheggen-Lagro SWJ, Midulla F. Key paediatric messages from the 2017 European Respiratory Society International Congress. ERJ Open Res 2018; 4:00165-2017. [PMID: 29850468 PMCID: PMC5968195 DOI: 10.1183/23120541.00165-2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/08/2018] [Indexed: 12/31/2022] Open
Abstract
In this article, the group chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting findings presented at the 2017 ERS International Congress, which was held in Milan, Italy.
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Affiliation(s)
- Jonathan Grigg
- Centre for Child Health, The Blizard Institute, Queen Mary University of London, London, UK
| | - Jürg Barben
- Division of Paediatric Pulmonology, Children's Hospitals of Eastern Switzerland, St Gallen, Switzerland
| | - Mark L Everard
- Princess Margaret Hospital for Children School of Paediatric and Child Health, University of Western Australia, Perth, Australia
| | - Graham Hall
- Telethon Kids Institute and Curtin University, Perth, Australia
| | - Bülent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Raffaella Nenna
- Dept of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Kostas N Priftis
- 3rd Dept of Paediatrics, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece
| | | | | | - Fabio Midulla
- Dept of Paediatrics, Sapienza University of Rome, Rome, Italy
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16
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Perikleous E, Steiropoulos P, Nena E, Iordanidou M, Tzouvelekis A, Chatzimichael A, Paraskakis E. Association of Asthma and Allergic Rhinitis With Sleep-Disordered Breathing in Childhood. Front Pediatr 2018; 6:250. [PMID: 30255006 PMCID: PMC6141753 DOI: 10.3389/fped.2018.00250] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/24/2018] [Indexed: 11/20/2022] Open
Abstract
Objective: Asthma and allergic rhinitis (AR) are the most common chronic conditions in childhood and have previously been linked to sleep-related breathing disorder (SRBD). Aim of the study was to examine the association between SRBD risk and asthma control in children with asthma and with or without AR. Methods: The assessment of FeNO and pulmonary function tests were performed in 140 children (65 with asthma, 57 with both asthma, and AR, 18 with only AR). Children with asthma completed the childhood Asthma Control Test (c-ACT), and the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (PSQ). C-ACT scores ≤ 19 are indicative of poor asthma control whereas SRBD from PSQ scores ≥ 0.33 are suggestive of high risk for SRBD. Results: Mean age ± SD was 7.8 ± 3.1 years. Mean PSQ ± SD and c-ACT ± SD scores were 0.17 ± 0.14 and 24.9 ± 3.2, respectively. High risk for SRBD was identified in 26 children. Children at high risk for SRBD had significantly decreased c-ACT score (P = 0.048), verified by a negative association between c-ACT and PSQ-SRBD scores (r = -0.356, P < 0.001). Additionally a difference in diagnosis distribution between children at high or low risk for SRBD was observed. More specifically, among children at high risk, 88.5% were diagnosed with both atopic conditions, while this percentage among children at low risk was 29.8%. Asthma was mainly diagnosed in the latter group (P < 0.001). Conclusions: Poor asthma control is associated with SRBD. The presence of AR in children with asthma seems to increase the prevalence of SRBD in that particular population, requiring further investigation toward this direction.
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Affiliation(s)
- Evanthia Perikleous
- Master Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paschalis Steiropoulos
- Master Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Iordanidou
- Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Argyrios Tzouvelekis
- Division of Immunology, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Athanasios Chatzimichael
- Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Emmanouil Paraskakis
- Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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17
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Guiddir T, Saint-Pierre P, Purenne-Denis E, Lambert N, Laoudi Y, Couderc R, Gouvis-Echraghi R, Amat F, Just J. Neutrophilic Steroid-Refractory Recurrent Wheeze and Eosinophilic Steroid-Refractory Asthma in Children. J Allergy Clin Immunol Pract 2017; 5:1351-1361.e2. [PMID: 28363401 DOI: 10.1016/j.jaip.2017.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/21/2017] [Accepted: 02/03/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Little is known about inflammatory pathways of severe recurrent wheeze in preschool children and severe asthma in children. OBJECTIVES The aim of the Severe Asthma Molecular Phenotype cohort was to characterize phenotypes of severe recurrent wheeze and severe asthma during childhood in terms of triggers (allergic or not), involved cells (eosinophil or neutrophil), and corticoid responsiveness. METHODS Children with moderate-to-severe asthma and preschool children with moderate-to-severe recurrent wheeze were enrolled prospectively. They underwent standardized clinical and blood workup, and bronchoalveolar lavage (BAL) evaluation. Cluster analysis was applied to 350 children with 34 variables. RESULTS Three clusters were identified: cluster 1, Neutrophilic steroid-refractory recurrent wheeze phenotype, with 138 children uncontrolled despite high-dose inhaled corticosteroids (ICS) (92%, P < .001), with more history of pneumonia (31%, P < .001), more gastroesophageal reflux disease (37%, P < .001), and the highest blood neutrophil count (mean 4.524 cells/mm3, P = .05); cluster 2, Severe recurrent wheeze with sensitization to a single aeroallergen (12%, P = .002), with 104 children controlled with high-dose ICS (63%, P < .001); cluster 3, Eosinophilic steroid-refractory asthma phenotype, with 108 children uncontrolled despite high-dose ICS (76%, P < .001) with more allergic rhinitis, atopic dermatitis, and food allergies (82%, 40%, 31%, P < .001, respectively). They also had a higher blood eosinophil count and a higher percentage of BAL eosinophil (506/mm3, 2.6%, P < .001 respectively). CONCLUSIONS Inflammation pathway of asthma and recurrent wheeze are related to eosinophil cells in older children and neutrophil cells in younger children. These results could improve personalized treatments.
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Affiliation(s)
- Tamazoust Guiddir
- Allergology Department, Armand Trousseau Children Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; University Paris 06, Sorbonne University, Paris, France
| | | | - Elsa Purenne-Denis
- Allergology Department, Armand Trousseau Children Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Nathalie Lambert
- Allergology Department, Armand Trousseau Children Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; University Paris 06, Sorbonne University, Paris, France
| | - Yacine Laoudi
- Allergology Department, Armand Trousseau Children Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Rémy Couderc
- Biochemistry Laboratory, Armand Trousseau Children Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Rahelé Gouvis-Echraghi
- Allergology Department, Armand Trousseau Children Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Flore Amat
- Allergology Department, Armand Trousseau Children Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; University Paris 06, Sorbonne University, Paris, France
| | - Jocelyne Just
- Allergology Department, Armand Trousseau Children Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; University Paris 06, Sorbonne University, Paris, France.
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18
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Schatz M, Sicherer SH, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice - 2016 Year in Review. J Allergy Clin Immunol Pract 2017; 5:218-236. [PMID: 28143692 DOI: 10.1016/j.jaip.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/19/2023]
Abstract
As editors, we concluded that it would be helpful to our readers to write a Year in Review article that highlights the Review, Original, and Clinical Communication articles published in 2016 in The Journal of Allergy and Clinical Immunology: In Practice. We summarized articles on the topics of asthma, rhinitis/rhinosinusitis, food allergy, anaphylaxis, drug allergy, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Diagnostic tools described include history, skin tests, and in vitro tests. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help you, our readers, consolidate and use this extensive and practical knowledge for the benefit of your patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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19
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Lemanske RF. Asthma in Childhood: Expression, Exacerbation, and Progression. J Allergy Clin Immunol Pract 2016; 4:36-7. [PMID: 26772925 DOI: 10.1016/j.jaip.2015.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Robert F Lemanske
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
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20
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Abstract
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation and a variable course associated with various underlying mechanisms that can differ between individuals. Patients with asthma can therefore exhibit different phenotypes, a term used to define the observable characteristics of an organism resulting from the interaction between its genetic makeup and the environment. The heterogeneity of asthma has received a large amount of attention in the last few years in order to better tailor treatment according to the different clinical and biological phenotypes of the disease. Specific asthma phenotypes may require an approach to treatment sometimes different from that recommended by current guidelines, so a personalized approach to asthma pharmacotherapy is recommended. Growing evidence suggests that leukotrienes play an important role in the pathogenesis of bronchial asthma. The mechanisms of action of leukotriene-receptor antagonists theoretically predict a good response in some asthma “phenotypes”.In this article we have performed an analysis of the recent literature (controlled clinical trials and real-life studies) about a possible selective intervention with Montelukast in specific asthma phenotypes.
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Affiliation(s)
| | - Lombardi Carlo
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, Via Bissolati, 57, 25124 Brescia, Italy
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