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Morgan AD. Unravelling the obesity-asthma connection in childhood and adolescence: does body shape matter? Thorax 2024; 79:393-394. [PMID: 38453470 DOI: 10.1136/thorax-2023-221345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Ann D Morgan
- School of Public Health, Imperial College London Faculty of Medicine, London, UK
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2
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Sielinou Kamgang KH, Rhedin SA, Almqvist C, Wintzell V. Use of inhaled corticosteroids and the risk of hospitalisation for pneumonia in children with asthma: a nationwide cohort study. Thorax 2024; 79:395-402. [PMID: 38184370 DOI: 10.1136/thorax-2023-220742] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/01/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The potential association between the use of inhaled corticosteroids (ICS) and the risk of pneumonia among adults is disputed and paediatric-specific evidence is scarce. AIM To assess the potential association between ICS, use and the risk of hospitalisation for pneumonia among children (age 2-17 years) with asthma. METHODS This was a cohort study based on nationwide data from routine clinical practice in Sweden (January 2007 to November 2021). From 425 965 children with confirmed asthma, episodes of new ICS use and no use were identified using records of dispensed drugs. We adjusted for potential confounders with propensity score overlap weighting and the risk of a hospitalisation with pneumonia as primary diagnosis was estimated. Multiple subgroup and sensitivity analyses were also performed. RESULTS We identified 249 351 ICS (mean follow-up of 0.9 years) and 214 840 no-use (mean follow-up of 0.7 years) episodes. During follow-up, 369 and 181 events of hospitalisation for pneumonia were observed in the ICS and no-use episodes, respectively. The weighted incidence rates of hospitalisation for pneumonia was 14.5 per 10 000 patient-years for ICS use episodes and 14.6 for no-use episodes. The weighted HR for hospitalisation for pneumonia associated with ICS use was 1.06 (95% CI 0.88 to 1.28) and the absolute rate difference was -0.06 (95% CI -2.83 to 2.72) events per 10 000 patient-years, compared with no use. CONCLUSIONS In this nationwide cohort study, we found no evidence of an association between ICS use and the risk of hospitalisation for pneumonia among children with asthma, as compared with no use.
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Affiliation(s)
- Karl-Hermann Sielinou Kamgang
- Department of Medicine, Solna, Karolinska Institute, Solna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Stockholm, Sweden
| | - Samuel Arthur Rhedin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Stockholm, Sweden
| | - Viktor Wintzell
- Department of Medicine, Solna, Karolinska Institute, Solna, Sweden
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Koefoed HJL, Wang G, Gehring U, Ekstrom S, Kull I, Vermeulen R, Boer JMA, Bergstrom A, Koppelman GH, Melén E, Vonk JM, Hallberg J. Clinical implications of airway obstruction with normal or low FEV 1 in childhood and adolescence. Thorax 2024:thorax-2023-220952. [PMID: 38514183 DOI: 10.1136/thorax-2023-220952] [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] [Received: 09/07/2023] [Accepted: 01/30/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Airway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a low FEV1 (classic) or a normal FEV1 in combination with a large FVC (dysanaptic). The clinical implications of dysanaptic obstruction during childhood and adolescence in the general population remain unclear. AIMS To investigate the association between airway obstruction with a low or normal FEV1 in childhood and adolescence, and asthma, wheezing and bronchial hyperresponsiveness (BHR). METHODS In the BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology; Sweden) and PIAMA (Prevention and Incidence of Asthma and Mite Allergy; the Netherlands) birth cohorts, obstruction (FEV1:FVC ratio less than the lower limit of normal, LLN) at ages 8, 12 (PIAMA only) or 16 years was classified as classic (FEV1 RESULTS The prevalence of classic obstruction at ages 8, 12 and 16 in the two cohorts was 1.5%, 1.1% and 1.5%, respectively. Dysanaptic obstruction was slightly more prevalent: 3.9%, 2.5% and 4.6%, respectively. Obstruction, regardless of FEV1, was consistently associated with higher odds of asthma (dysanaptic obstruction: OR 2.29, 95% CI 1.40 to 3.74), wheezing, asthma medication use and BHR compared with the normal lung function group. Approximately one-third of the subjects with dysanaptic obstruction in childhood remained dysanaptic during adolescence. CLINICAL IMPLICATIONS Children and adolescents with airway obstruction had, regardless of their FEV1 level, a higher prevalence of asthma and wheezing. Follow-up and treatment at these ages should be guided by the presence of airway obstruction.
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Affiliation(s)
- Hans Jacob Lohne Koefoed
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
- Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, Groningen, The Netherlands
| | - Gang Wang
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra Ekstrom
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
- Pediatrics, Sachs' Children's Hospital, Stockholm, Sweden
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jolanda M A Boer
- Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anna Bergstrom
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Gerard H Koppelman
- Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Melén
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
- Pediatrics, Sachs' Children's Hospital, Stockholm, Sweden
| | - Judith M Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenny Hallberg
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
- Pediatrics, Sachs' Children's Hospital, Stockholm, Sweden
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Zhang L, Fu Z, Deng H, Xie Q, Wu W. Identification and treatment of persistent small airway dysfunction in paediatric patients with asthma: a retrospective cohort study. BMC Pulm Med 2024; 24:94. [PMID: 38395894 PMCID: PMC10893734 DOI: 10.1186/s12890-024-02907-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Asthma is a common respiratory disease. In asthma, the small airways have more intensive inflammation and prominent airway remodelling, compared to the central airways. We aimed to investigate the predictive value of risk factors and the fractional concentration of exhaled nitric oxide (FeNO) for persistent small airway dysfunction (p-SAD), and compare the effects of different treatment modalities. METHODS This retrospective cohort study included 248 children with asthma (aged 4-11 years). Binary logistic regression was used to analyse the risk factors for p-SAD. Correlations among FEV1/FVC, small airway function parameters, and FeNO levels in patients with asthma were analysed using Spearman's rank correlation. The receiver operating characteristic curve and the Delong test were used to analyse the predictive value of FeNO for p-SAD. Differences in the treatment effects of inhaled corticosteroids (ICS) and ICS with a long-acting beta-agonist (ICS/LABA) on p-SAD were analysed using Fisher's exact test. RESULTS Asthmatic children with older age of receiving the regular treatment (OR 1.782, 95% CI 1.082-2.935), with younger age at the time of onset of suspected asthma symptoms (OR 0.602, 95% CI 0.365-0.993), with longer duration of using ICS or ICS/LABA (OR 1.642, 95% CI 1.170-2.305) and with worse asthma control (OR 3.893, 95% CI 1.699-8.922) had increased risk for p-SAD. Significant negative correlations of small airway function parameters with FeNO at a 200 mL/s flow rate (FeNO200), and the concentration of nitric oxide in the alveolar or acinar region (CaNO) were observed. The areas under the curve of FeNO200 (cut-off:10.5ppb), CaNO (cut-off:5.1ppb), and FeNO200 combined with CaNO were 0.743, 0.697, and 0.750, respectively, for asthma with p-SAD. After using ICS or ICS/LABA, switching to ICS/LABA was easier than continuing with ICS to improve small airway dysfunction (SAD) in the 8th month. CONCLUSIONS Paediatric asthma with p-SAD is associated with older age at receiving regular treatment, younger age at the time of onset of suspected asthma symptoms, longer duration of using ICS or ICS/LABA, worse asthma control, and higher FeNO200 and CaNO levels, all of which can be combined with small airway function indicators to distinguish p-SAD from asthma. ICS/LABA improves SAD better than ICS alone.
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Affiliation(s)
- Lulu Zhang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, NO.136, Zhongshan Second Road, 400014, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, NO.136, Zhongshan Second Road, 400014, Chongqing, China
| | - Hua Deng
- Department of Pediatric Internal Medicine, Chongqing Youyoubaobei Women and Children's Hospital, NO.999, Jiarong Road, 401122, Chongqing, China
| | - Qin Xie
- Department of Pediatric Internal Medicine, Chongqing Youyoubaobei Women and Children's Hospital, NO.999, Jiarong Road, 401122, Chongqing, China
| | - Wenjie Wu
- Department of Pediatric Internal Medicine, Chongqing Youyoubaobei Women and Children's Hospital, NO.999, Jiarong Road, 401122, Chongqing, China.
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van den Bosch WB, Jacobs N, Tiddens H, van de Vathorst S. What if… your research is suddenly affiliated with a tobacco manufacturing company? BMJ Open Respir Res 2024; 11:e001505. [PMID: 38307629 PMCID: PMC10840048 DOI: 10.1136/bmjresp-2022-001505] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/10/2023] [Indexed: 02/04/2024] Open
Abstract
The tobacco industry is accountable for an annual global death toll of approximately 8 million people and cigarette smoking is the foremost risk factor for several types of cancer. In addition, the tobacco industry has a long and controversial history of trying to influence scientific research and of engaging in other morally problematic practices. In September 2021, the respiratory community was alarmed by the takeover of Vectura Group (Vectura) by Philip Morris International. As a reaction to this acquisition, strict measures were imposed by the International Respiratory Societies to prohibit the involvement of Vectura in respiratory research and its participation in societies' activities. International Respiratory Societies argued that Vectura had become part of the tobacco industry due to this takeover and is, therefore, subject to the same rules and restrictions. From a healthcare and historical perspective, the reaction and imposed measures are very understandable. However, for researchers that were already affiliated with Vectura through long-standing agreements and for research that was funded by Vectura, the imposed measures have serious consequences. With this article, we provide an example of these consequences. By reflecting on this issue, we would like to start a conversation regarding the current measures and to encourage the respiratory community to begin thinking of a way to avoid these consequences in the future. In addition, we hope that with this conversation the Respiratory Societies can set an example for other medical societies on how to cope with possible morally tainted affiliations (eg, fast food companies, alcohol manufacturing companies) in the future.
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Affiliation(s)
- Wytse Bastiaan van den Bosch
- Department of Paediatrics, division of Respiratory Medicine and Allergy, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Noortje Jacobs
- Department of Medical Ethics and Philosophy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Harm Tiddens
- Department of Paediatrics, division of Respiratory Medicine and Allergy, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Thirona BV, Nijmegen, Netherlands
| | - Suzanne van de Vathorst
- Department of Medical Ethics and Philosophy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Khalaf Z, Bush A, Saglani S, Bloom CI. Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma. Thorax 2024; 79:112-119. [PMID: 38071524 DOI: 10.1136/thorax-2023-220603] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/28/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Asthma trials and guidelines often do not distinguish between adolescents and younger children. Using a large English data set, we evaluated the impact of age on asthma characteristics, management and exacerbations. METHODS Primary care medical records, 2004-2021, were linked to hospital records. Children were categorised by age at diagnosis and followed until the next age bracket. Ages (based on management guidelines) were 5-8 years, 9-11 years and adolescents (12-16 years). Characteristics evaluated included body mass index, allergies and events before and after diagnosis (symptoms, medication). Exacerbation incidence was calculated. Multivariable Cox proportional hazards determined associations with exacerbations. RESULTS 119 611 children were eligible: 61 940 (51.8%) 5-8 years, 32 316 (27.7%) 9-11 years and 25 355 (21.2%) adolescents. Several characteristics differed by age; children aged 5-8 years had the highest proportion with eczema, food/drug allergy and cough, but adolescents had the highest proportion with overweight/obesity, aeroallergen sensitisation, dyspnoea and short-acting-beta-agonist only use. Exacerbation rates were highest in the youngest children (per 100 person-years (95% CI): 5-8 years =13.7 (13.4-13.9), 9-11 years =10.0 (9.8-10.4), adolescents =6.7 (6.5-7.0)). Exacerbation risk factors also differed by age; 5-8 years: male, eczema and food/drug allergy were strongly associated, but for children ≥9 years old, obesity and aeroallergen sensitisation were strongly associated. For all children, higher socioeconomic deprivation was significantly associated with having an exacerbation. Delayed diagnosis was most common in children aged 5-8 years and was associated with increased exacerbations across all ages. CONCLUSION Children's baseline characteristics and exacerbation rates varied according to their age group. Clinical guidelines should consider age at time of diagnosis more discretely than the broad range, 5-16 years, as this appears to impact on asthma severity and management.
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Affiliation(s)
- Zainab Khalaf
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, UK
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Kallis C, Maslova E, Morgan AD, Sinha I, Roberts G, van der Valk RJP, Quint JK, Tran TN. Recent trends in asthma diagnosis, preschool wheeze diagnosis and asthma exacerbations in English children and adolescents: a SABINA Jr study. Thorax 2023; 78:1175-1180. [PMID: 37524391 PMCID: PMC10715559 DOI: 10.1136/thorax-2022-219757] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Asthma-related burden remains poorly characterised in children in the UK. We quantified recent trends in asthma prevalence and burden in a UK population-based cohort (1‒17-year-olds). METHODS The Clinical Practice Research Datalink Aurum database (2008‒2018) was used to assess annual asthma incidence and prevalence in 1‒17-year-olds and preschool wheeze in 1‒5-year-olds, stratified by sex and age. During the same period, annual asthma exacerbation rates were assessed in those with either a diagnosis of preschool wheeze or asthma. RESULTS Annual asthma incidence rates decreased by 51% from 1403.4 (95% CI 1383.7 to 1423.2) in 2008 to 688.0 (95% CI 676.3 to 699.9) per 105 person-years (PYs) in 2018, with the most pronounced decrease observed in 1‒5-year olds (decreasing by 65%, from 2556.9 (95% CI 2509.8 to 2604.7) to 892.3 (95% CI 866.9 to 918.3) per 105 PYs). The corresponding decreases for the 6‒11- and 12‒17-year-olds were 36% (1139.9 (95% CI 1110.6 to 1169.7) to 739.9 (95% CI 720.5 to 759.8)) and 20% (572.3 (95% CI 550.4 to 594.9) to 459.5 (95% CI 442.9 to 476.4)) per 105 PYs, respectively. The incidence of preschool wheeze decreased over time and was slightly more pronounced in the 1‒3 year-olds than in the 4-year-olds. Prevalence of asthma and preschool wheeze also decreased over time, from 18.0% overall in 2008 to 10.2% in 2018 for asthma. Exacerbation rates increased over time from 1.33 (95% CI 1.31 to 1.35) per 10 PYs in 2008 to 1.81 (95% CI 1.78 to 1.83) per 10 PYs in 2018. CONCLUSION Paediatric asthma incidence decreased in the UK since 2008, particularly in 1-5-year-olds; this was accompanied by a decline in asthma prevalence. Preschool wheeze incidence also decreased in this age group. However, exacerbation rates have been increasing.
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Affiliation(s)
- Constantinos Kallis
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Ann D Morgan
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Ian Sinha
- Alder Hey Children's Hospital, Liverpool, UK
- Division of Child Health, University of Liverpool, Liverpool, UK
| | - Graham Roberts
- University of Southampton Faculty of Medicine, Southampton, UK
- NIHR Southampton, Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- David Hide Asthma and Allergy Centre, St Mary's Hospital, Isle of Wight, UK
| | | | - Jennifer K Quint
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Trung N Tran
- Biopharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Gaithersburg, Maryland, USA
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Moore LE, Serrano-Lomelin J, Rosychuk RJ, Kozyrskyj AL, Chari R, Crawford S, Bakal J, Hicks A, Ducharme FM, Ospina MB. Perinatal and early life factors and asthma control among preschoolers: a population-based retrospective cohort study. BMJ Open Respir Res 2023; 10:e001928. [PMID: 37748808 PMCID: PMC10533801 DOI: 10.1136/bmjresp-2023-001928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Preventing poor childhood asthma control is crucial for short-term and long-term respiratory health. This study evaluated associations between perinatal and early-life factors and early childhood asthma control. METHODS This retrospective study used administrative health data from mothers and children born 2010-2012 with a diagnosis of asthma before age 5 years, in Alberta, Canada. The outcome was asthma control within 2 years after diagnosis. Associations between perinatal and early-life factors and risk of partly and uncontrolled asthma were evaluated by multinomial logistic regression. RESULTS Of 7206 preschoolers with asthma, 52% had controlled, 37% partly controlled and 12% uncontrolled asthma 2 years after diagnosis. Compared with controlled asthma, prenatal antibiotics (adjusted risk ratio (aRR): 1.19; 95% CI 1.06 to 1.33) and smoking (aRR: 1.18; 95% CI 1.02 to 1.37), C-section delivery (aRR: 1.11; 95% CI 1.00 to 1.25), summer birth (aRR: 1.16; 95% CI 1.00 to 1.34) and early-life hospitalisation for respiratory illness (aRR: 2.24; 95% CI 1.81 to 2.76) increased the risk of partly controlled asthma. Gestational diabetes (aRR: 1.41; 95% CI 1.06 to 1.87), C-section delivery (aRR: 1.18; 95% CI 1.00 to 1.39), antibiotics (aRR: 1.32; 95% CI 1.08 to 1.61) and hospitalisation for early-life respiratory illness (aRR: 1.65; 95% CI 1.19 to 2.27) were associated with uncontrolled asthma. CONCLUSION Maternal perinatal and early-life factors including antibiotics in pregnancy and childhood, gestational diabetes, prenatal smoking, C-section and summertime birth, and hospitalisations for respiratory illness are associated with partly or uncontrolled childhood asthma. These results underline the significance of perinatal health and the lasting effects of early-life experiences on lung development and disease programming.
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Affiliation(s)
- Linn E Moore
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Anne Hicks
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Maria B Ospina
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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9
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Håkansson KEJ, Guerrero SC, Backer V, Ulrik CS, Rastogi D. Burden and unmet need for specialist care in poorly controlled and severe childhood asthma in a Danish nationwide cohort. Respir Res 2023; 24:173. [PMID: 37370052 PMCID: PMC10304602 DOI: 10.1186/s12931-023-02482-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/21/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Asthma is a common disease in childhood and adolescence with lifelong consequences particularly among those at risk of severe disease, poor control and/or frequent exacerbations. Specialist care is recommended for at-risk children and adolescents, yet access to specialist management in free-to-access healthcare settings remains poorly understood. METHODS A Danish nationwide cohort of children and adolescents aged 2-17 years with persistent asthma, defined as repeated redemption of inhaled corticosteroids (ICS) during 2015, were followed for two years, to identify at-risk children and adolescents comprising those with severe asthma (classified according to GINA 2020 guidelines), poor control (defined as use of 400/600 (ages 2-11/12 +) annual doses of short-acting bronchodilators), or frequent exacerbations (defined as use of oral steroids or hospitalization), and access to specialist care. The population is chosen due to detailed medical records in the setting of universal health care. RESULTS The cohort comprised of 29,851 children and adolescents (59% boys), with a median age of 9 years. While 17% of children were on high dose ICS, 22% were on daily ICS below GINA low dose cut-off. Prevalence of severe asthma (3.0-6.5%) was lower than poor asthma control (6.4-25%); both declined from childhood to adolescence. Exacerbations occurred in 7.1-9.0% of children, with median number of exacerbations being 1 (IQR 1-1). Despite being classified as having mild-to-moderate asthma, 15% had poor asthma control and 3.8% experienced exacerbation(s), respectively. While 61% of children with severe asthma and 58% with exacerbation-prone disease were in specialist care, only 24% with uncontrolled disease were receiving specialist care. Of children and adolescents using high-dose ICS, 71% were managed in primary care, while the use of additional controllers was more common in specialist care. CONCLUSIONS Throughout childhood and adolescence, there was a high prevalence of severe asthma and poor control, although their prevalence declined with age. We demonstrate a large unmet need for specialist care among children with at-risk asthma, particularly among those with poorly controlled asthma, even in a system with free-to-access, tax-funded healthcare.
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Affiliation(s)
- Kjell Erik Julius Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Silvia Cabrera Guerrero
- Division of Pulmonary and Sleep Medicine, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Vibeke Backer
- Department of Otorhinolaryngology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA.
- Pediatrics, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
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Mphahlele R, Lesosky M, Masekela R. Prevalence, severity and risk factors for asthma in school-going adolescents in KwaZulu Natal, South Africa. BMJ Open Respir Res 2023; 10:10/1/e001498. [PMID: 37192778 DOI: 10.1136/bmjresp-2022-001498] [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] [Received: 10/09/2022] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and risk factors for asthma in adolescents in an LMIC. METHODS A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021. RESULTS A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01. CONCLUSION Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.
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Affiliation(s)
- Reratilwe Mphahlele
- Paediatrics and Child Health, University of KwaZulu Natal, Durban, KwaZulu Natal, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, University of Cape Town, Rondebosch, South Africa
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Refiloe Masekela
- Paediatrics and Child Health, University of KwaZulu Natal, Durban, KwaZulu Natal, South Africa
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11
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Herrera-Luis E, Mak ACY, Perez-Garcia J, Martin-Gonzalez E, Eng C, Beckman KB, Huntsman S, Hu D, González-Pérez R, Hernández-Pérez JM, Mederos-Luis E, Sio YY, Poza-Guedes P, Sardón O, Corcuera P, Sánchez-Machín I, Korta-Murua J, Martínez-Rivera C, Mullol J, Muñoz X, Valero A, Sastre J, Garcia-Aymerich J, Llop S, Torrent M, Casas M, Rodríguez-Santana JR, Villar J, del Pozo V, Lorenzo-Diaz F, Williams LK, Melén E, Chew FT, Borrell LN, Burchard EG, Pino-Yanes M. Admixture mapping of severe asthma exacerbations in Hispanic/Latino children and youth. Thorax 2023; 78:233-241. [PMID: 36180068 PMCID: PMC9957797 DOI: 10.1136/thorax-2022-218755] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In the USA, genetically admixed populations have the highest asthma prevalence and severe asthma exacerbations rates. This could be explained not only by environmental factors but also by genetic variants that exert ethnic-specific effects. However, no admixture mapping has been performed for severe asthma exacerbations. OBJECTIVE We sought to identify genetic variants associated with severe asthma exacerbations in Hispanic/Latino subgroups by means of admixture mapping analyses and fine mapping, and to assess their transferability to other populations and potential functional roles. METHODS We performed an admixture mapping in 1124 Puerto Rican and 625 Mexican American children with asthma. Fine-mapping of the significant peaks was performed via allelic testing of common and rare variants. We performed replication across Hispanic/Latino subgroups, and the transferability to non-Hispanic/Latino populations was assessed in 1001 African Americans, 1250 Singaporeans and 941 Europeans with asthma. The effects of the variants on gene expression and DNA methylation from whole blood were also evaluated in participants with asthma and in silico with data obtained through public databases. RESULTS Genomewide significant associations of Indigenous American ancestry with severe asthma exacerbations were found at 5q32 in Mexican Americans as well as at 13q13-q13.2 and 3p13 in Puerto Ricans. The single nucleotide polymorphism (SNP) rs1144986 (C5orf46) showed consistent effects for severe asthma exacerbations across Hispanic/Latino subgroups, but it was not validated in non-Hispanics/Latinos. This SNP was associated with DPYSL3 DNA methylation and SCGB3A2 gene expression levels. CONCLUSIONS Admixture mapping study of asthma exacerbations revealed a novel locus that exhibited Hispanic/Latino-specific effects and regulated DPYSL3 and SCGB3A2.
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Affiliation(s)
- Esther Herrera-Luis
- Genomics and Health Group, Department of Biochemistry,
Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), La Laguna,
Tenerife, Spain
| | - Angel C. Y. Mak
- Department of Medicine, University of California San
Francisco, San Francisco, California, U.S.A
| | - Javier Perez-Garcia
- Genomics and Health Group, Department of Biochemistry,
Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), La Laguna,
Tenerife, Spain
| | - Elena Martin-Gonzalez
- Genomics and Health Group, Department of Biochemistry,
Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), La Laguna,
Tenerife, Spain
| | - Celeste Eng
- Department of Medicine, University of California San
Francisco, San Francisco, California, U.S.A
| | | | - Scott Huntsman
- Department of Medicine, University of California San
Francisco, San Francisco, California, U.S.A
| | - Donglei Hu
- Department of Medicine, University of California San
Francisco, San Francisco, California, U.S.A
| | - Ruperto González-Pérez
- Allergy Department, Hospital Universitario de Canarias,
Santa Cruz de Tenerife, Tenerife, Spain,Asthma Unit, Hospital Universitario de Canarias, La Laguna,
Tenerife, Spain
| | - José M. Hernández-Pérez
- Pulmonary Medicine, Hospital Universitario de N.S de
Candelaria, Santa Cruz de Tenerife, Spain,Pulmonary Medicine, Hospital General de La Palma, La Palma,
Santa Cruz de Tenerife, Spain
| | - Elena Mederos-Luis
- Allergy Department, Hospital Universitario de Canarias,
Santa Cruz de Tenerife, Tenerife, Spain
| | - Yang Yie Sio
- Department of Biological Sciences, National University of
Singapore, Singapore
| | - Paloma Poza-Guedes
- Allergy Department, Hospital Universitario de Canarias,
Santa Cruz de Tenerife, Tenerife, Spain,Asthma Unit, Hospital Universitario de Canarias, La Laguna,
Tenerife, Spain
| | - Olaia Sardón
- Division of Pediatric Respiratory Medicine, Hospital
Universitario Donostia, San Sebastián, Spain,Department of Pediatrics, University of the Basque
Country (UPV/EHU), San Sebastián, Spain
| | - Paula Corcuera
- Division of Pediatric Respiratory Medicine, Hospital
Universitario Donostia, San Sebastián, Spain
| | | | - Javier Korta-Murua
- Division of Pediatric Respiratory Medicine, Hospital
Universitario Donostia, San Sebastián, Spain,Department of Pediatrics, University of the Basque
Country (UPV/EHU), San Sebastián, Spain
| | - Carlos Martínez-Rivera
- CIBER de Enfermedades Respiratorias, Instituto de Salud
Carlos III, Madrid, Spain,Servicio de Neumología, Hospital Universitario
Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona,
Spain
| | - Joaquim Mullol
- CIBER de Enfermedades Respiratorias, Instituto de Salud
Carlos III, Madrid, Spain,Rhinology Unit & Smell Clinic, ENT Department;
Clinical & Experimental Respiratory Immunoallergy (IDIBAPS), Universitat de
Barcelona, Barcelona, Spain
| | - Xavier Muñoz
- CIBER de Enfermedades Respiratorias, Instituto de Salud
Carlos III, Madrid, Spain,Servicio de Neumología, Hospital Vall
d’Hebron, Barcelona, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias, Instituto de Salud
Carlos III, Madrid, Spain,Allergy Unit & Severe Asthma Unit, Pneumonology and
Allergy Department, Hospital Clínic; IDIBAPS; Universitat de
Barcelona.Barcelona, Spain
| | - Joaquín Sastre
- CIBER de Enfermedades Respiratorias, Instituto de Salud
Carlos III, Madrid, Spain,Allergy Department, Hospital Universitario
Fundación Jiménez Díaz, Madrid, Spain
| | - Judith Garcia-Aymerich
- Spanish Consortium for Research on Epidemiology and
Public Health (CIBERESP), Madrid, Spain,ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra, Barcelona, Spain
| | - Sabrina Llop
- Spanish Consortium for Research on Epidemiology and
Public Health (CIBERESP), Madrid, Spain,Epidemiology and Environmental Health Joint Research
Unit, FISABIO–Universitat Jaume I–Universitat de València,
Valencia, Spain
| | | | - Maribel Casas
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud
Carlos III, Madrid, Spain,Multidisciplinary Organ Dysfunction Evaluation Research
Network, Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran
Canaria, Spain
| | - Victoria del Pozo
- CIBER de Enfermedades Respiratorias, Instituto de Salud
Carlos III, Madrid, Spain,Immunology Department, Instituto de Investigación
Sanitaria Hospital Universitario Fundación Jiménez Díaz,
Madrid, Spain
| | - Fabian Lorenzo-Diaz
- Genomics and Health Group, Department of Biochemistry,
Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), La Laguna,
Tenerife, Spain,Instituto Universitario de Enfermedades Tropicales y
Salud Pública de Canarias (IUETSPC), Universidad de La Laguna (ULL), La
Laguna, Tenerife, Spain
| | - L. Keoki Williams
- Center for Individualized and Genomic Medicine Research,
Department of Internal Medicine, Henry Ford Health System, Detroit, MI, U.S.A
| | - Erik Melén
- Department of Clinical Sciences and Education,
Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Sachs’ Children’s Hospital, South General
Hospital, Stockholm, Sweden
| | - Fook Tim Chew
- Department of Biological Sciences, National University of
Singapore, Singapore
| | - Luisa N. Borrell
- Department of Epidemiology & Biostatistics, Graduate
School of Public Health & Health Policy, City University of New York, New York,
NY, U.S.A
| | - Esteban G. Burchard
- UMN Genomics Center, Minneapolis, Minnesota, U.S.A.,Department of Bioengineering and Therapeutic Sciences,
University of California San Francisco, San Francisco, California, U.S.A
| | - Maria Pino-Yanes
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology, and Genetics, Universidad de La Laguna (ULL), La Laguna, Spain .,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Tecnologías Biomédicas (ITB), Universidad de La Laguna (ULL), La Laguna, Spain
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12
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Gray CS, Xu Y, Babl FE, Dalziel S, Powell CVE, Chong SL, Roland D, Lyttle MD, Fernandes RM, Benito J, Johnson M, Yock-Corrales A, Santhanam I, Schuh S, Cheema B, Couper J, Craig S. International perspective on research priorities and outcome measures of importance in the care of children with acute exacerbations of asthma: a qualitative interview study. BMJ Open Respir Res 2023; 10:10/1/e001502. [PMID: 36849194 PMCID: PMC9972434 DOI: 10.1136/bmjresp-2022-001502] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Acute exacerbations of asthma are common in children, however, treatment decisions for severe exacerbations are challenging due to a lack of robust evidence. In order to create more robust research, a core set of outcome measures needs to be developed. In developing these outcomes, it is important to understand the views of clinicians who care for these children in particular, views that relate to outcome measures and research priorities. METHODS To determine the views of clinicians, a total of 26 semistructured interviews based on the theoretical domains framework were conducted. These included experienced clinicians from emergency, intensive care and inpatient paediatrics across 17 countries. The interviews were recorded, and later transcribed. All data analyses were conducted in Nvivo by using thematic analysis. RESULTS The length of stay in hospital and patient-focused parameters, such as timing to return to school and normal activity, were the most frequently highlighted outcome measures, with clinicians identifying the need to achieve a consensus on key core outcome measure sets. Most research questions focused on understanding the best treatment options, including the role of novel therapies and respiratory support. CONCLUSION Our study provides an insight into what research questions and outcome measures clinicians view as important. In addition, information on how clinicians define asthma severity and measure treatment success will assist with methodological design in future trials. The current findings will be used in parallel with a further Paediatric Emergency Research Network study focusing on the child and family perspectives and will contribute to develop a core outcome set for future research.
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Affiliation(s)
- Charmaine S Gray
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, South Australia, Australia .,Paediatric Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Yao Xu
- Zhuhai City People's Hospital, Zhuhai, Guangdong, China.,Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute; Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stuart Dalziel
- Children's Emergency Department, Starship Children's Health, Auckland, New Zealand.,Surgery and Paediatrics, The University of Auckland Faculty of Health and Medical Sciences, Auckland, New Zealand
| | - Colin V E Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Department of Emergency Medicine, Sidra Medicine, Doha, Ad-Dawhah, Qatar
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth Paediatrics Academic Clinical Programme, Singapore
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Mark D Lyttle
- Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Ricardo M Fernandes
- Department of Pediatrics, Hospital de Santa Maria, Lisboa, Portugal.,Clinical Pharmacology Unit, University of Lisbon, Lisboa, Portugal
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital. Biocruces Bizkaia Health Research Institute, Bilbao, Spain
| | - Mike Johnson
- Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Ninos "Dr Carlos Saenz Herrera", CCSS, San Jose, Costa Rica
| | - Indumathy Santhanam
- Regional Collaborative Center, Institute of Child Health, Madras Medical College, Egmore, Chennai, India
| | - Suzanne Schuh
- Hospital for Sick Children Research Institute, Univsersity of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Baljit Cheema
- Department of Paediatrics & Child Health, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jenny Couper
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Craig
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
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13
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Barclay M, Buderi S, Bush A, Daniel M, Jordan S, Rice A, Ruggins N, Semple T, Smyth AR. Wheeze in the time of COVID-19: overcoming obstacles to an unusual diagnosis. Thorax 2022; 77:1050-1053. [PMID: 35768197 DOI: 10.1136/thoraxjnl-2021-218526] [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] [Received: 12/01/2021] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
This case is an example of a rare cause of a common clinical presentation (persistent lobar collapse with wheeze). We describe patient management from primary care through to a national thoracic referral centre. We highlight the importance of objective testing to support an asthma diagnosis and the need to consider alternative or additional diagnoses if a patient does not respond to treatment or the clinical course is unexpected. We highlight the importance of follow-up X-ray to determine whether atelectasis has resolved, which was significantly delayed in this case due to COVID-19 restrictions. Though rare, an endobronchial tumour should be considered if atelectasis persists and when planning endoscopy for a presumed foreign body, especially if the clinical history and patient factors make a foreign body less likely. Greater awareness of this as a differential may expedite diagnoses for patients in future. We show how virtual, multicentre, multidisciplinary meetings can aid rapid diagnosis, surgical planning and coordination of follow-up across centres.
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Affiliation(s)
- Mhairi Barclay
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Silviu Buderi
- Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andrew Bush
- Imperial Centre for Paediatrics and Child Health, Imperial College, London, UK.,National Heart and Lung Institute, Imperial College, London, UK.,Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mat Daniel
- Ear, Nose & Throat Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Simon Jordan
- Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alexandra Rice
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Nigel Ruggins
- Derbyshire Children's Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Thomas Semple
- Imperial Centre for Paediatrics and Child Health, Imperial College, London, UK.,National Heart and Lung Institute, Imperial College, London, UK.,Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alan Robert Smyth
- Lifespan and Population Health, University of Nottingham School of Medicine, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK
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14
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Homaira N, Hu N, Owens L, Chan M, Gray M, Britton PN, Selvadurai H, Lingam R, Jaffe A. Impact of lockdowns on paediatric asthma hospital presentations over three waves of COVID-19 pandemic. Allergy Asthma Clin Immunol 2022; 18:53. [PMID: 35710455 DOI: 10.1186/s13223-022-00691-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Public health measures to mitigate the COVID-19 pandemic have altered health care for chronic conditions. The impact of the COVID-19 pandemic on paediatric asthma, the most common chronic respiratory cause of childhood hospitalisation, in Australia, remains unknown. In a multicentre study, we examined the impact of three waves of COVID-19 on paediatric asthma in New South Wales Australia. Time series analysis was performed to determine trends in asthma hospital presentations in children aged 2–17 years before (2015–2019) and during the COVID-19 pandemic (2020–2021) using emergency department and hospital admission datasets from two large tertiary paediatric hospitals. In this first report from Australia, we observed a significant decrease in asthma hospital presentations during lockdown periods including April (68.85%), May (69.46%), December (49.00%) of 2020 and August (66.59%) of 2021 compared to pre-pandemic predictions. The decrease in asthma hospital presentations coincided with the lockdown periods during first, second and third waves of the COVID-19 pandemic and was potentially due to reduced transmission of other common respiratory viruses from restricted movement.
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15
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Buelo A, McLean S, Julious S, Flores-Kim J, Bush A, Henderson J, Paton JY, Sheikh A, Shields M, Pinnock H. At-risk children with asthma (ARC): a systematic review. Thorax 2018; 73:813-824. [PMID: 29871982 PMCID: PMC6109248 DOI: 10.1136/thoraxjnl-2017-210939] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [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: 08/22/2017] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/15/2023]
Abstract
Introduction Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5–12 years) in order to inform and prioritise care. Methods We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop. Results From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk. Discussion Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives. Trial registration number CRD42016037464.
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Affiliation(s)
- Audrey Buelo
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Susannah McLean
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Steven Julious
- Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK
| | - Javier Flores-Kim
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Andy Bush
- Department of Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - John Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Y Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Michael Shields
- Centre for Experimental Medicine, Queen's University, Belfast, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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16
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Kivistö JE, Protudjer JLP, Karjalainen J, Bergström A, Korppi M. Trends in paediatric asthma hospitalisations - differences between neighbouring countries. Thorax 2017; 73:185-187. [PMID: 28373348 DOI: 10.1136/thoraxjnl-2016-209739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/23/2017] [Accepted: 03/12/2017] [Indexed: 11/04/2022]
Abstract
Paediatric asthma hospitalisation trends in Finland and Sweden over the past 10 years are unclear. We investigated the incidence of paediatric asthma hospitalisations in both countries from 2005 to 2014, using Finland's National Hospital Discharge Register and Sweden's National Patient Register which cover all hospitalisations in the respective countries. During the study period, the incidence of paediatric asthma hospitalisations decreased by 51% in Finland, but remained stable in Sweden. In both countries, asthma hospitalisations decreased over time among children aged 0-4 years, with unclear trends for older ages. The reasons for these intercountry differences are unclear, thus warranting future research.
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Affiliation(s)
- Juho E Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere, Finland.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Matti Korppi
- Tampere Center for Child Health Research, University of Tampere, Finland
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17
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Morton RW, Elphick HE, Rigby AS, Daw WJ, King DA, Smith LJ, Everard ML. STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma. Thorax 2016; 72:347-354. [PMID: 27815524 DOI: 10.1136/thoraxjnl-2015-208171] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 07/28/2016] [Accepted: 10/06/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Suboptimal adherence to inhaled steroids is common in children with asthma and is associated with poor disease control, reduced quality of life and even death. Previous studies using feedback of electronically monitored adherence data have demonstrated improved adherence, but have not demonstrated a significant impact on clinical outcomes. The aim of this study was to determine whether introduction of this approach into routine practice would result in improved clinical outcomes. METHODS Children with asthma aged 6-16 years were randomised to the active intervention consisting of electronic adherence monitoring with daily reminder alarms together with feedback in the clinic regarding their inhaled corticosteroid (ICS) use or to the usual care arm with adherence monitoring alone. All children had poorly controlled asthma at baseline, taking ICS and long-acting β-agonists. Subjects were seen in routine clinics every 3 months for 1 year. The primary outcome was the Asthma Control Questionnaire (ACQ) score. Secondary outcomes included adherence and markers of asthma morbidity. RESULTS 77 of 90 children completed the study (39 interventions, 38 controls). Adherence in the intervention group was 70% vs 49% in the control group (p≤0.001). There was no significant difference in the change in ACQ, but children in the intervention group required significantly fewer courses of oral steroids (p=0.008) and fewer hospital admissions (p≤0.001). CONCLUSIONS The results indicate that electronic adherence monitoring with feedback is likely to be of significant benefit in the routine management of poorly controlled asthmatic subjects. TRIAL REGISTRATION NUMBER NCT02451709; pre-result.
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Affiliation(s)
- Robert W Morton
- Academic Unit of Child Health, University of Sheffield, Sheffield, South Yorkshire, UK.,Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| | - Heather E Elphick
- Academic Unit of Child Health, University of Sheffield, Sheffield, South Yorkshire, UK.,Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| | - Alan S Rigby
- Hull York Medical School, University of Hull, Hull, Yorkshire, UK
| | - William J Daw
- Academic Unit of Child Health, University of Sheffield, Sheffield, South Yorkshire, UK.,Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| | - David A King
- Academic Unit of Child Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Laurie J Smith
- Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, Princess Margaret Hospital University of Western Australia, Perth, Western Australia, Australia
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18
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Affiliation(s)
- Liesbeth Duijts
- Divisions of Respiratory Medicine and Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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19
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Abstract
Asthma is a heterogeneous disease comprising a number of subtypes which may be caused by different pathophysiologic mechanisms (sometimes referred to as endotypes) but may share similar observed characteristics (phenotypes). The use of unsupervised clustering in adult and paediatric populations has identified subtypes of asthma based on observable characteristics such as symptoms, lung function, atopy, eosinophilia, obesity, and age of onset. Here we describe different clustering methods and demonstrate their contributions to our understanding of the spectrum of asthma syndrome. Precise identification of asthma subtypes and their pathophysiological mechanisms may lead to stratification of patients, thus enabling more precise therapeutic and prevention approaches.
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Affiliation(s)
- Matea Deliu
- />Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Matthew Sperrin
- />Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Adnan Custovic
- />Department of Paediatrics, Imperial College London, London, UK
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20
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Fina A, Baqué-Juston M, Guesmi M, Albertini M, Giovannini-Chami L. Symptomatic accessory cardiac bronchus in an infant. Thorax 2016; 71:962-3. [PMID: 27217520 DOI: 10.1136/thoraxjnl-2016-208407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/29/2016] [Indexed: 11/03/2022]
Affiliation(s)
- A Fina
- Paediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - M Baqué-Juston
- Paediatric Radiology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - M Guesmi
- Paediatric Radiology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - M Albertini
- Paediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France Université de Nice-Sophia Antipolis, Nice, France
| | - L Giovannini-Chami
- Paediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France Université de Nice-Sophia Antipolis, Nice, France
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21
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Czövek D, Shackleton C, Hantos Z, Taylor K, Kumar A, Chacko A, Ware RS, Makan G, Radics B, Gingl Z, Sly PD. Tidal changes in respiratory resistance are sensitive indicators of airway obstruction in children. Thorax 2016; 71:907-15. [PMID: 27178219 DOI: 10.1136/thoraxjnl-2015-208182] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/17/2016] [Indexed: 11/04/2022]
Abstract
RATIONALE Individual assessment of airway obstruction in preschool-age children requires sensitive and specific lung function methods with low demand of cooperation. Although the forced oscillation technique (FOT) is feasible in young children, conventional measurements of respiratory impedance (Zrs) have limited diagnostic power in individuals. OBJECTIVE To find descriptors of within-breath Zrs that are sensitive indicators of airway obstruction during tidal breathing in children. METHODS Zrs was measured with (i) a standard multifrequency FOT (4-26 Hz) to assess the mean values of resistance and reactance for whole breaths and (ii) a 10 Hz signal to track the within-breath changes. Various Zrs measures obtained in healthy children (n=75) and those with acute wheeze (n=31) were investigated with receiver operator characteristic (ROC) analysis. The cut-off values obtained for airway obstruction were then tested in children with recurrent wheeze (n=20) before and after administration of salbutamol. RESULTS The largest area under the ROC curve (0.95) was observed for the tidal changes of resistance between the zero-flow values (ΔR). The ΔR cut-off value of 1.42 hPa s/L detected airway obstruction with sensitivity of 92% and specificity of 89% in children with acute wheeze and distinguished children with recurrent wheeze (16/20 above the cut-off value) from healthy children (22/23 below the cut-off value). Furthermore, ΔR significantly decreased after salbutamol in wheezy children but remained unchanged in healthy children. CONCLUSIONS New lung function measure ΔR is able to detect airway obstruction with high sensitivity and specificity and is suitable for use in lung function testing in young children.
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Affiliation(s)
- Dorottya Czövek
- Children's Lung, Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Claire Shackleton
- Children's Lung, Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Zoltán Hantos
- Children's Lung, Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Kate Taylor
- Children's Lung, Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia
| | - Anushma Kumar
- Children's Lung, Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia
| | - Archana Chacko
- Children's Lung, Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Gergely Makan
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Bence Radics
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Zoltán Gingl
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Peter D Sly
- Children's Lung, Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
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22
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Beerthuizen T, Voorend-van Bergen S, van den Hout WB, Vaessen-Verberne AA, Brackel HJ, Landstra AM, van den Berg NJ, de Jongste JC, Merkus PJ, Pijnenburg MW, Sont JK. Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial. Thorax 2016; 71:607-13. [PMID: 27048197 DOI: 10.1136/thoraxjnl-2015-207593] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/27/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND In children with asthma, web-based monitoring and inflammation-driven therapy may lead to improved asthma control and reduction in medications. However, the cost-effectiveness of these monitoring strategies is yet unknown. OBJECTIVE We assessed the cost-effectiveness of web-based monthly monitoring and of 4-monthly monitoring of FENO as compared with standard care. METHODS An economic evaluation was performed alongside a randomised controlled multicentre trial with a 1-year follow-up. Two hundred and seventy-two children with asthma, aged 4-18 years, were randomised to one of three strategies. In standard care, treatment was adapted according to Asthma Control Test (ACT) at 4-monthly visits, in the web-based strategy also according to web-ACT at 1 month intervals, and in the FENO-based strategy according to ACT and FENO at 4-monthly visits. Outcome measures were patient utilities, healthcare costs, societal costs and incremental cost per quality-adjusted life year (QALY) gained. RESULTS No statistically significant differences were found in QALYs and costs between the three strategies. The web-based strategy had 77% chance of being most cost-effective from a healthcare perspective at a willingness to pay a generally accepted €40 000/QALY. The FENO-based strategy had 83% chance of being most cost-effective at €40 000/QALY from a societal perspective. CONCLUSIONS Economically, web-based monitoring was preferred from a healthcare perspective, while the FENO-based strategy was preferred from a societal perspective, although in QALYs and costs no statistically significant changes were found as compared with standard care. As clinical outcomes also favoured the web-based and FENO-based strategies, these strategies may be useful additions to standard care. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NTR1995).
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Affiliation(s)
- Thijs Beerthuizen
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Sandra Voorend-van Bergen
- Division Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hein J Brackel
- Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands
| | - Anneke M Landstra
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Johan C de Jongste
- Division Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Peter J Merkus
- Department of Pediatric Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mariëlle W Pijnenburg
- Division Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jacob K Sont
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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23
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Lang JE, Hossain J, Holbrook JT, Teague WG, Gold BD, Wise RA, Lima JJ. Gastro-oesophageal reflux and worse asthma control in obese children: a case of symptom misattribution? Thorax 2016; 71:238-46. [PMID: 26834184 DOI: 10.1136/thoraxjnl-2015-207662] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 01/04/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Obese children for unknown reasons report greater asthma symptoms. Asthma and obesity both independently associate with gastro-oesophageal reflux symptoms (GORS). Determining if obesity affects the link between GORS and asthma will help elucidate the obese-asthma phenotype. OBJECTIVE Extend our previous work to determine the degree of associations between the GORS and asthma phenotype. METHODS We conducted a cross-sectional study of lean (20%-65% body mass index, BMI) and obese (≥95% BMI) children aged 10-17 years old with persistent, early-onset asthma. Participants contributed demographics, GORS and asthma questionnaires and lung function data. We determined associations between weight status, GORS and asthma outcomes using multivariable linear and logistic regression. Findings were replicated in a second well-characterised cohort of asthmatic children. RESULTS Obese children had seven times higher odds of reporting multiple GORS (OR=7.7, 95% CI 1.9 to 31.0, interaction p value=.004). Asthma symptoms were closely associated with GORS scores in obese patients (r=0.815, p<0.0001) but not in leans (r=0.291, p=0.200; interaction p value=0.003). Higher GORS scores associated with higher FEV1-per cent predicted (p=0.003), lower airway resistance (R10, p=0.025), improved airway reactance (X10, p=0.005) but significantly worse asthma control (Asthma Control Questionnaire, p=0.007). A significant but weaker association between GORS and asthma symptoms was seen in leans compared with obese in the replicate cohort. CONCLUSION GORS are more likely to associate with asthma symptoms in obese children. Better lung function among children reporting gastro-oesophageal reflux and asthma symptoms suggests that misattribution of GORS to asthma may be a contributing mechanism to excess asthma symptoms in obese children.
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Affiliation(s)
- Jason E Lang
- Division of Pulmonary & Sleep Medicine, Nemours Children's Hospital, Orlando, Florida, USA
| | - Jobayer Hossain
- Department of Biomedical Research, Center for Pediatric Research, Alfred I. DuPont Hospital of Children, Wilmington, Delaware, USA
| | - Janet T Holbrook
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - W Gerald Teague
- Division of Pediatric Respiratory Medicine & Allergy, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Benjamin D Gold
- GI Care for Kids, Children's Center for Digestive Healthcare, Atlanta, Georgia, USA
| | - Robert A Wise
- Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John J Lima
- Center for Pharmacogenomics & Translational Research, Nemours Children's Clinic, Jacksonville, Florida, USA
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24
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de Groot EP, Kreggemeijer WJ, Brand PLP. Getting the basics right resolves most cases of uncontrolled and problematic asthma. Acta Paediatr 2015; 104:916-21. [PMID: 26033420 DOI: 10.1111/apa.13059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 05/06/2014] [Revised: 10/20/2014] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
AIM The prevalence of true therapy-resistant asthma among children whose asthma remains uncontrolled, despite daily controller therapy, is unknown. The aim of this study was to investigate the underlying causes in children with uncontrolled asthma. METHODS This was a retrospective chart review of 142 children aged from five to 17 years over a five-year period. The patients had uncontrolled asthma and were referred by general practitioners to a hospital-based paediatric asthma clinic. RESULTS An underlying cause for uncontrolled asthma was found in 138 children (97.2%). The causes were poor adherence (n = 53, 37.3%), ongoing exposure to environmental triggers (n = 40, 28.2%), comorbidities (n = 28, 19.7%), incorrect inhaler technique (n = 11, 7.7%) and incorrect diagnosis (n = 6, 4.2%). After properly addressing these basics in asthma management, the asthma was well controlled in all 138 patients and lung function was normal. Only four children (2.8%) fulfilled the criteria for true therapy-resistant asthma. CONCLUSION A remedial cause in the basics of asthma management could be found in 97% of children with uncontrolled asthma referred to a hospital-based asthma clinic. True therapy-resistant asthma was found to be very rare in children.
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Affiliation(s)
- Eric P. de Groot
- Princess Amalia Children's Centre; Isala Hospital; Zwolle The Netherlands
| | | | - Paul L. P. Brand
- Princess Amalia Children's Centre; Isala Hospital; Zwolle The Netherlands
- UMCG Postgraduate School of Medicine; University Medical Centre and University of Groningen; Groningen The Netherlands
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Dogaru CM, Narayanan M, Spycher BD, Pescatore AM, Owers-Bradley J, Beardsmore CS, Silverman M, Kuehni CE. Breastfeeding, lung volumes and alveolar size at school-age. BMJ Open Respir Res 2015; 2:e000081. [PMID: 26180638 PMCID: PMC4499711 DOI: 10.1136/bmjresp-2015-000081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/10/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 11/06/2022] Open
Abstract
Background Previous studies found larger lung volumes at school-age in formerly breastfed children, with some studies suggesting an effect modification by maternal asthma. We wanted to explore this further in children who had undergone extensive lung function testing. The current study aimed to assess whether breastfeeding was associated with larger lung volumes and, if so, whether all compartments were affected. We also assessed association of breastfeeding with apparent diffusion coefficient (ADC), which measures freedom of gas diffusion in alveolar-acinar compartments and is a surrogate of alveolar dimensions. Additionally, we assessed whether these effects were modified by maternal asthma. Methods We analysed data from 111 children and young adults aged 11–21 years, who had participated in detailed lung function testing, including spirometry, plethysmography and measurement of ADC of 3Helium (3He) by MR. Information on breastfeeding came from questionnaires applied in early childhood (age 1–4 years). We determined the association between breastfeeding and these measurements using linear regression, controlling for potential confounders. Results We did not find significant evidence for an association between duration of breastfeeding and lung volumes or alveolar dimensions in the entire sample. In breastfed children of mothers with asthma, we observed larger lung volumes and larger average alveolar size than in non-breastfed children, but the differences did not reach significance levels. Conclusions Confirmation of effects of breastfeeding on lung volumes would have important implications for public health. Further investigations with larger sample sizes are warranted.
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Affiliation(s)
- Cristian M Dogaru
- Institute of Social and Preventive Medicine, University of Bern , Switzerland ; Department of Children, Young People and Education , University Campus Suffolk , UK
| | - Manjith Narayanan
- Division of Child Health, Department of Infection , Immunity & Inflammation, University of Leicester , UK
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern , Switzerland
| | - Anina M Pescatore
- Institute of Social and Preventive Medicine, University of Bern , Switzerland
| | | | - Caroline S Beardsmore
- Division of Child Health, Department of Infection , Immunity & Inflammation, University of Leicester , UK
| | - Michael Silverman
- Division of Child Health, Department of Infection , Immunity & Inflammation, University of Leicester , UK
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern , Switzerland
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Forno E, Gogna M, Cepeda A, Yañez A, Solé D, Cooper P, Avila L, Soto-Quiros M, Castro-Rodriguez JA, Celedón JC. Asthma in Latin America. Thorax 2015; 70:898-905. [PMID: 26103996 DOI: 10.1136/thoraxjnl-2015-207199] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/02/2015] [Indexed: 12/20/2022]
Abstract
Consistent with the diversity of Latin America, there is profound variability in asthma burden among and within countries in this region. Regional variation in asthma prevalence is likely multifactorial and due to genetics, perinatal exposures, diet, obesity, tobacco use, indoor and outdoor pollutants, psychosocial stress and microbial or parasitic infections. Similarly, non-uniform progress in asthma management leads to regional variability in disease morbidity. Future studies of distinct asthma phenotypes should follow-up well-characterised Latin American subgroups and examine risk factors that are unique or common in Latin America (eg, stress and violence, parasitic infections and use of biomass fuels for cooking). Because most Latin American countries share the same barriers to asthma management, concerted and multifaceted public health and research efforts are needed, including approaches to curtail tobacco use, campaigns to improve asthma treatment, broadening access to care and clinical trials of non-pharmacological interventions (eg, replacing biomass fuels with gas or electric stoves).
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Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mudita Gogna
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alfonso Cepeda
- Fundación Hospital Universitario Metropolitano, Laboratorio de Alergia e Inmunología, Universidad Metropolitana, Barranquilla, Barranquilla, Colombia
| | - Anahi Yañez
- Division of Allergy and Immunology, Servicio de Alergia e Inmunología Clínica, Hospital Aeronáutico Central, Buenos Aires, Argentina
| | - Dirceu Solé
- Escola Paulista de Medicina, São Paulo, Brazil
| | - Philip Cooper
- Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas, Ecuador Institute of Infection and Immunity, St George's University of London, London, UK
| | | | | | - Jose A Castro-Rodriguez
- Departments of Pediatrics and Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Subbarao P, Anand SS, Becker AB, Befus AD, Brauer M, Brook JR, Denburg JA, HayGlass KT, Kobor MS, Kollmann TR, Kozyrskyj AL, Lou WYW, Mandhane PJ, Miller GE, Moraes TJ, Pare PD, Scott JA, Takaro TK, Turvey SE, Duncan JM, Lefebvre DL, Sears MR. The Canadian Healthy Infant Longitudinal Development (CHILD) Study: examining developmental origins of allergy and asthma. Thorax 2015; 70:998-1000. [PMID: 26069286 DOI: 10.1136/thoraxjnl-2015-207246] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/13/2015] [Indexed: 11/04/2022]
Abstract
The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study recruited 3624 pregnant women, most partners and 3542 eligible offspring. We hypothesise that early life physical and psychosocial environments, immunological, physiological, nutritional, hormonal and metabolic influences interact with genetics influencing allergic diseases, including asthma. Environmental and biological sampling, innate and adaptive immune responses, gene expression, DNA methylation, gut microbiome and nutrition studies complement repeated environmental and clinical assessments to age 5. This rich data set, linking prenatal and postnatal environments, diverse biological samples and rigorous phenotyping, will inform early developmental pathways to allergy, asthma and other chronic inflammatory diseases.
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Affiliation(s)
- Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Peter D Pare
- University of British Columbia, Vancouver, Canada
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Abstract
BACKGROUND The overlap between asthma and COPD is increasingly recognised. This review examines the new insights, treatment and remaining knowledge gaps for asthma-COPD overlap. METHOD A systematic literature review of cluster analyses of asthma and COPD was performed. Articles from 2009 to the present dealing with prevalence, morbidity and treatment of asthma-COPD overlap were identified and reviewed. RESULTS Asthma-COPD overlap was consistently recognised in studies using a variety of different study designs and sampling. The prevalence was approximately 20% in patients with obstructive airways diseases. Asthma-COPD overlap was associated with increased morbidity and possibly an increased mortality and comorbidity. There was evidence of a heterogeneous pattern of airway inflammation that included eosinophilic (in adult asthma), neutrophilic or mixed patterns (in severe asthma and COPD). Systemic inflammation was present in asthma-COPD overlap and resembled that of COPD. Within asthma-COPD overlap, there is evidence of different subgroups, and recognition using bronchodilator responsiveness has not been successful. Guidelines generally recommend a serial approach to assessment, with treatment recommendations dominated by an asthma paradigm. Research is needed into key clinical features that impact outcome, mechanisms and treatment approaches in asthma-COPD overlap. Identifying and treating disease components by multidimensional assessment shows promise. CONCLUSIONS Asthma-COPD overlap has drawn attention to the significant heterogeneity that exists within obstructive airway diseases. It should be replaced by novel approaches that identify and manage the components of this heterogeneity, such as multidimensional assessment and treatment. Future research is needed to test these novel and personalised approaches.
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Affiliation(s)
- Peter G Gibson
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle, Newcastle, New South Wales, Australia Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Vanessa M McDonald
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle, Newcastle, New South Wales, Australia Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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29
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Lee DCP, Walker SA, Byrne AJ, Gregory LG, Buckley J, Bush A, Shaheen SO, Saglani S, Lloyd CM. Perinatal paracetamol exposure in mice does not affect the development of allergic airways disease in early life. Thorax 2015; 70:528-36. [PMID: 25841236 PMCID: PMC4453715 DOI: 10.1136/thoraxjnl-2014-205280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 02/13/2014] [Accepted: 02/24/2015] [Indexed: 01/15/2023]
Abstract
Background Current data concerning maternal paracetamol intake during pregnancy, or intake during infancy and risk of wheezing or asthma in childhood is inconclusive based on epidemiological studies. We have investigated whether there is a causal link between maternal paracetamol intake during pregnancy and lactation and the development of house dust mite (HDM) induced allergic airways disease (AAD) in offspring using a neonatal mouse model. Methods Pregnant mice were administered paracetamol or saline by oral gavage from the day of mating throughout pregnancy and/or lactation. Subsequently, their pups were exposed to intranasal HDM or saline from day 3 of life for up to 6 weeks. Assessments of airway hyper-responsiveness, inflammation and remodelling were made at weaning (3 weeks) and 6 weeks of age. Results Maternal paracetamol exposure either during pregnancy and/or lactation did not affect development of AAD in offspring at weaning or at 6 weeks. There were no effects of maternal paracetamol at any time point on airway remodelling or IgE levels. Conclusions Maternal paracetamol did not enhance HDM induced AAD in offspring. Our mechanistic data do not support the hypothesis that prenatal paracetamol exposure increases the risk of childhood asthma.
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Affiliation(s)
- Debbie C P Lee
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, UK Immunology Programme, Centre for Life Sciences, National University of Singapore, Singapore, Singapore
| | - Simone A Walker
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam J Byrne
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Lisa G Gregory
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - James Buckley
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Bush
- Department of Respiratory Paediatrics, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, UK
| | - Seif O Shaheen
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Sejal Saglani
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, UK Department of Respiratory Paediatrics, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, UK
| | - Clare M Lloyd
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College London, London, UK
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30
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Voorend-van Bergen S, Vaessen-Verberne AA, Brackel HJ, Landstra AM, van den Berg NJ, Hop WC, de Jongste JC, Merkus PJ, Pijnenburg MW. Monitoring strategies in children with asthma: a randomised controlled trial. Thorax 2015; 70:543-50. [PMID: 25825006 DOI: 10.1136/thoraxjnl-2014-206161] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/17/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Asthma guidelines recommend monitoring of asthma control. However, in a substantial proportion of children, asthma is poorly controlled and the best monitoring strategy is not known. OBJECTIVES We studied two monitoring strategies for their ability to improve asthma outcomes in comparison with standard care (SC): web-based monthly monitoring with the (Childhood) Asthma Control Test (ACT or C-ACT) and 4-monthly monitoring of FENO. METHODS In this randomised controlled, partly blinded, parallel group multicentre trial with a 1-year follow-up, children aged 4-18 with a doctor's diagnosis of asthma treated in seven hospitals were randomised to one of the three groups. In the web group, treatment was adapted according to ACT obtained via a website at 1-month intervals; in the FENO group according to ACT and FENO, and in the SC group according to the ACT at 4-monthly visits. The primary endpoint was the change from baseline in the proportion of symptom-free days (SFD). RESULTS Two-hundred and eighty children (mean age 10.4 years, 66% boys) were included; 268 completed the study. Mean changes from baseline in SFD were similar between the groups: -2.1% (web group, n=90), +8.9% (FENO group, n=91) versus 0.15% (SC, n=87), p=0.15 and p=0.78. Daily dose of inhaled corticosteroids (ICS) decreased more in the web-based group compared with both other groups (-200 μg/day, p<0.01), while ACT and SFD remained similar. CONCLUSIONS The change from baseline in SFD did not differ between monitoring strategies. With web-based ACT monitoring, ICS could be reduced substantially while control was maintained. TRIAL REGISTRATION NUMBER NTR 1995.
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Affiliation(s)
- Sandra Voorend-van Bergen
- Department of Paediatrics, Division Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Hein J Brackel
- Department of Paediatrics, Catharina Hospital, Eindhoven, the Netherlands
| | - Anneke M Landstra
- Department of Paediatrics, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Wim C Hop
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Johan C de Jongste
- Department of Paediatrics, Division Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Peter J Merkus
- Department of Paediatric Pulmonology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mariëlle W Pijnenburg
- Department of Paediatrics, Division Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
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Custovic A, Ainsworth J, Arshad H, Bishop C, Buchan I, Cullinan P, Devereux G, Henderson J, Holloway J, Roberts G, Turner S, Woodcock A, Simpson A. The Study Team for Early Life Asthma Research (STELAR) consortium 'Asthma e-lab': team science bringing data, methods and investigators together. Thorax 2015; 70:799-801. [PMID: 25805205 PMCID: PMC4515979 DOI: 10.1136/thoraxjnl-2015-206781] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 12/27/2022]
Abstract
We created Asthma e-Lab, a secure web-based research environment to support consistent recording, description and sharing of data, computational/statistical methods and emerging findings across the five UK birth cohorts. The e-Lab serves as a data repository for our unified dataset and provides the computational resources and a scientific social network to support collaborative research. All activities are transparent, and emerging findings are shared via the e-Lab, linked to explanations of analytical methods, thus enabling knowledge transfer. eLab facilitates the iterative interdisciplinary dialogue between clinicians, statisticians, computer scientists, mathematicians, geneticists and basic scientists, capturing collective thought behind the interpretations of findings.
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Affiliation(s)
- Adnan Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Hasan Arshad
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Iain Buchan
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | | | - John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Holloway
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Graham Roberts
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK Human Developmental and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Ashley Woodcock
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
| | - Angela Simpson
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
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Bousquet J, Anto JM, Berkouk K, Gergen P, Antunes JP, Augé P, Camuzat T, Bringer J, Mercier J, Best N, Bourret R, Akdis M, Arshad SH, Bedbrook A, Berr C, Bush A, Cavalli G, Charles MA, Clavel-Chapelon F, Gillman M, Gold DR, Goldberg M, Holloway JW, Iozzo P, Jacquemin S, Jeandel C, Kauffmann F, Keil T, Koppelman GH, Krauss-Etschmann S, Kuh D, Lehmann S, Carlsen KCL, Maier D, Méchali M, Melén E, Moatti JP, Momas I, Nérin P, Postma DS, Ritchie K, Robine JM, Samolinski B, Siroux V, Slagboom PE, Smit HA, Sunyer J, Valenta R, Van de Perre P, Verdier JM, Vrijheid M, Wickman M, Yiallouros P, Zins M. Developmental determinants in non-communicable chronic diseases and ageing. Thorax 2015; 70:595-7. [PMID: 25616486 DOI: 10.1136/thoraxjnl-2014-206304] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 11/03/2022]
Abstract
Prenatal and peri-natal events play a fundamental role in health, development of diseases and ageing (Developmental Origins of Health and Disease (DOHaD)). Research on the determinants of active and healthy ageing is a priority to: (i) inform strategies for reducing societal and individual costs of an ageing population and (ii) develop effective novel prevention strategies. It is important to compare the trajectories of respiratory diseases with those of other chronic diseases.
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Affiliation(s)
- J Bousquet
- University Hospital, Montpellier, France Inserm U 1168, Paris, France Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands
| | - J M Anto
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - K Berkouk
- Deputy Head of Unit for Medical Research and the Challenge of Ageing, DG Research & Innovation, European Commission, Brussels, Belgium
| | - P Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - J Pinto Antunes
- European Commission, Directorate General for Health and Consumers, Brussels, Belgium
| | - P Augé
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France University Montpellier 1, France
| | - T Camuzat
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Région Languedoc Roussillon, France
| | - J Bringer
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Montpellier Medical School, France
| | - J Mercier
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Department of Physiology, Montpellier University Hospital, France University Montpellier 1, France
| | - N Best
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Nimes University Hospital, France
| | - R Bourret
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Montpellier University Hospital, France
| | - M Akdis
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Swiss Institute of Allergy and Asthma Research (SIAF), Davos and University of Zurich, Switzerland
| | - S H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - A Bedbrook
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France
| | - C Berr
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Inserm, Research Unit U1061, University Montpellier I, Montpellier, France
| | - A Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK
| | - G Cavalli
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Institute of Human Genetics, CNRS, Montpellier, France
| | - M A Charles
- Equipe 10 UMR Inserm-Université Paris-Sud (Centre de recherche en Epidémiologie et Santé des Populations, CESP), Villejuif, France
| | - F Clavel-Chapelon
- Nutrition, Hormones and Women's Health Team, INSERM UMR-S 1018, Paris-South University, Villejuif, France
| | - M Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - D R Gold
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, UK
| | - M Goldberg
- Population-Based Epidemiological Cohorts, INSERM-UVSQ UMS 011, Villejuif, France
| | - J W Holloway
- Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - P Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - S Jacquemin
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Horiba, Montpellier, France
| | - C Jeandel
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Department of Geriatrics, University Hospital, Montpellier, France
| | - F Kauffmann
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands CESP-Team of Respiratory and Environmental Epidemiology INSERM UMR-S1018, University Paris-Sud, Villejuif, France
| | - T Keil
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany Institute for Clinical Epidemiology and Biometry, Julius Maximilian University of Wuerzburg, Germany
| | - G H Koppelman
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - S Krauss-Etschmann
- Comprehensive Pneumology Center, Ludwig Maximilians University and Helmholtz Zentrum Muenchen, Member of the German Research Center for Lung Research, Großhadern, Germany
| | - D Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - S Lehmann
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Institut de Médecine Régénératrice et de Biothérapie (I.M.R.B.), University Hospital, INSERM U1040, Montpellier, France
| | - K C Lodrup Carlsen
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Department of Paediatrics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - D Maier
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Biomax Informatics AG, Planegg, Germany
| | - M Méchali
- Institute of Human Genetics, CNRS, Montpellier, France
| | - E Melén
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Institute of Environmental Medicine, Karolinska Institutet and Sachs' Children's Hospital, Stockholm, Sweden
| | - J P Moatti
- Aix-Marseille University (AMU), Research Unit 912 AMU/INSERM/IRD Social and Economic Sciences Applied to Health (SESSTIM), France
| | - I Momas
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Department of Public health and biostatistics, Descartes University, Paris, France Municipal Department of social action, childhood, and health, Paris, France
| | - P Nérin
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France SATT AxLR, Montpellier, France
| | - D S Postma
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Department of Pulmonology, University Medical Center Groningen, University of Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - K Ritchie
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Inserm U1061 Neuropsychiatry, Montpellier and Faculty of Medicine, Imperial College London, London, UK
| | - J M Robine
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Inserm Research Unit 988, Paris, France Inserm Research Unit 710, Montpellier, France Ecole Pratique des Hautes Etudes (EPHE), Paris, France
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - V Siroux
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, University Grenoble Alpes, IAB, Grenoble, France Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, INSERM, IAB, Grenoble, France Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, CHU de Grenoble, IAB, Grenoble, France
| | - P E Slagboom
- Section of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands Consortium for Healthy Aging, Leiden University Medical Center, Leiden, the Netherlands
| | - H A Smit
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - J Sunyer
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - R Valenta
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - P Van de Perre
- University Hospital and INSERM U 1058, Montpellier, France
| | - J M Verdier
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France EPHE, Section des Sciences de la Vie et de la Terre, Paris, France UMR S 710, University Montpellier 2, Montpellier, Paris, France Institut Transdisciplinaire d'Etudes du Vieillissement, Montpellier, France
| | - M Vrijheid
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - M Wickman
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Institute of Environmental Medicine, Karolinska Institutet and Sachs' Children's Hospital, Stockholm, Sweden
| | - P Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - M Zins
- Director of Population-Based Epidemiological Cohorts, INSERM-UVSQ UMS 011, Villejuif, France
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Morris I, Lyttle MD, O'Sullivan R, Sargant N, Doull IJM, Powell CVE. Which intravenous bronchodilators are being administered to children presenting with acute severe wheeze in the UK and Ireland? Thorax 2014; 70:88-91. [PMID: 25303945 DOI: 10.1136/thoraxjnl-2014-206041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
During a prospective 10-week assessment period, 3238 children aged 1-16 years presented with acute wheeze to Paediatric Emergency Research in the UK and Ireland centres. 110 (3.3%) received intravenous bronchodilators. Intravenous magnesium sulfate (MgSO4) was used in 67 (60.9%), salbutamol in 61 (55.5%) and aminophylline in 52 (47.3%) of cases. In 35 cases (31.8%), two drugs were used together, and in 18 cases (16.4%), all three drugs were administered. When used sequentially the most common order was salbutamol, then MgSO4, then aminophylline. Overall, 30 different intravenous treatment regimens were used varying in drugs, dose, rate and duration.
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Affiliation(s)
- I Morris
- Department of General Paediatrics, Children's Hospital for Wales, Cardiff, UK
| | - M D Lyttle
- Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK Academic Department of Emergency Care, University of the West of England, Bristol, UK
| | - R O'Sullivan
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - N Sargant
- Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - I J M Doull
- Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, UK
| | - C V E Powell
- Department of General Paediatrics, Children's Hospital for Wales, Cardiff, UK Institute of Molecular and Experimental Medicine, Cardiff University, School of Medicine, Cardiff, UK
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Turner S, Fielding S, Mullane D, Cox DW, Goldblatt J, Landau L, le Souef P. A longitudinal study of lung function from 1 month to 18 years of age. Thorax 2014; 69:1015-20. [PMID: 24891326 DOI: 10.1136/thoraxjnl-2013-204931] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Our hypothesis was that factors associated with wheeze will be associated with changes in lung function trajectory between 1 month and 18 years of age. METHODS Measurements of lung function were made in individuals aged 1, 6 and 12 months (V'maxFRC), and also at ages 6, 12 and 18 years (FEF(25-75)). Changes in lung function over time relative to sex, a history of asthma, maternal asthma and other factors were explored using random coefficient models. RESULTS Lung function (maximal flow at functional residual capacity in infants and FEF(25-75) in children) was determined in 241 individuals at 1 month, 192 at 6 months, 164 at 12 months, 106 at 6 years, 183 at 12 years and 141 at 18 years. In the multivariable model, maternal asthma (mean reduction in lung function 9.8%), flow limitation (mean reduction 17.4%), infant atopy (mean reduction 12.6%) and maternal smoking (mean reduction in lung function 8.1%) were acting independently. When interactions with time were sought, the reduction in lung function associated with maternal asthma and infant atopy were consistent over time, but % lung function increased in boys by a mean of 1%/year compared with girls, in flow-limited individuals by 3.0%/year and by 0.9%/year for those exposed to maternal smoking during pregnancy compared to other cohort members. CONCLUSIONS Decrements in lung function in 18-year-olds associated with maternal asthma and early onset atopy may be determined by 1 month of age. Low initial lung function in some individuals can 'recover' in some settings.
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Affiliation(s)
- Steve Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Dave Mullane
- School of Child Health, University of Western Australia, Perth, Australia
| | - Des W Cox
- School of Child Health, University of Western Australia, Perth, Australia
| | - Jack Goldblatt
- School of Child Health, University of Western Australia, Perth, Australia
| | - Lou Landau
- School of Child Health, University of Western Australia, Perth, Australia
| | - Peter le Souef
- School of Child Health, University of Western Australia, Perth, Australia
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Mattes J, Gibson PG. The early origins of COPD in severe asthma: the one thing that leads to another or the two things that come together? Thorax 2014; 69:789-90. [PMID: 24813191 DOI: 10.1136/thoraxjnl-2014-205401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Joerg Mattes
- Experimental & Translational Respiratory Medicine, University of Newcastle, Newcastle, New South Wales, Australia Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter G Gibson
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
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Petreschi F, Ullmann N, Bottero S, Tomà P, Inserra A, Francalanci P, Zicari AM, Cutrera R. A young girl with apparent treatment-resistant asthma treated at Bambino Gesù children's hospital. Thorax 2013; 69:396-8. [PMID: 24368714 DOI: 10.1136/thoraxjnl-2013-204880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shrikrishna D, Howard L, Coker RK. Authors' response to: how should we best determine the need for in-flight oxygen inpatients with pulmonary arterial hypertension. Thorax 2013; 68:680-1. [PMID: 23771948 DOI: 10.1136/thoraxjnl-2013-203936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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