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Buendía JA, Acuña-Cordero R, Rodriguez-Martinez CE. Exploratory analysis of the economically justifiable price of nirsevimab for healthy late-preterm and term infants in Colombia. Pediatr Pulmonol 2024; 59:1372-1379. [PMID: 38358037 DOI: 10.1002/ppul.26920] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Respiratory syncytial virus infection is the leading cause of lower respiratory infection globally. Recently, nirsevimab has been approved to prevent respiratory syncytial virus (RSV) infection. This study explores the economically justifiable price of nirsevimab for preventing RSV infection in Colombia's children under 1 year of age. MATERIALS AND METHODS A static model was developed using the decision tree microsimulation to estimate the quality-adjusted costs and life years of two interventions: a single intramuscular dose of nirsevimab versus not applying nirsevimab. This analysis was made during a time horizon of 1 year and from a societal perspective. RESULTS The annual savings in Colombia associated with this cost per dose ranged from U$ 2.5 to 4.1 million. Based on thresholds of U$ 4828, U$ 5128, and U$ 19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices of U$ 21.88, U$ 25.04, and U$ 44.02 per dose of nirsevimab. CONCLUSION the economically justifiable cost for nirsevimab in Colombia is between U$ 21 to U$ 44 per dose, depending on the willingness to pay used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.
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Affiliation(s)
- Jefferson Antonio Buendía
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Grupo de Investigación en Farmacología y Toxicología, Universidad de Antioquia, Medellín, Colombia
| | - Ranniery Acuña-Cordero
- Departamento de Neumología Pediátrica, Hospital Militar Central, Departamento de Pediatría, Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
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2
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Prakash KJ, Gourishankar A. Asthma care: The need for evidence-based, equitable, and affordable approaches. Pediatr Pulmonol 2024; 59:798-800. [PMID: 38149486 DOI: 10.1002/ppul.26825] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/23/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Kavita Jyoti Prakash
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anand Gourishankar
- Pediatric Hospital Medicine, Children's National Hospital, Department of Pediatrics, George Washington University, Washington, District of Columbia, USA
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3
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Kuitunen I, Renko M. Inhaled nitric oxide in acute bronchiolitis: A systematic review and meta-analysis. Pediatr Pulmonol 2024; 59:426-432. [PMID: 37988259 DOI: 10.1002/ppul.26767] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Until date there is lack of effective therapies in acute bronchiolitis in infants. The aim was to analyze inhaled nitric oxide efficacy in acute bronchiolitis. DESIGN Systematic review and meta-analysis of randomized controlled trials. SETTING Pediatric specialized healthcare. PATIENTS All infants (age less than 2 years) having acute bronchiolitis, which requires emergency room visit or hospitalization. INTERVENTION Inhaled nitric oxide. MAIN OUTCOME MEASURES Need for intensive care unit admission. Secondary outcomes were length of hospital stay and adverse events. Risk ratios (RR) and mean differences with 95% confidence intervals (CI) calculated by random-effects DerSimonian and Laird inverse variance method. Peto Odds ratios were used for rare outcomes. Evidence certainty assessed according to GRADE. RESULTS 186 studies were screened and three included for analysis. Two had low risk of bias and one had some concerns. Three studies (166 infants) analyzed length of hospital stay and the duration was -11.3 h (CI: -26.8 to +4.2 h) shorter in the nitric oxide group. Evidence certainty was ranked as low. Overall adverse event rates were similar (3 studies, 166 infants, RR: 0.94, CI: 0.70-1.26), but treatment related harms were more common in nitric oxide group (2 studies, 98 infants, OR: 3.86, CI: 1.04-14.40). Evidence certainty in both was rated as low. CONCLUSIONS Low certainty evidence suggests that inhaled nitric oxide does not reduce length of hospital stay but may have higher rate of treatment associated harms. Future studies with larger sample sizes are needed to better estimate both the efficacy and adverse events.
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Affiliation(s)
- Ilari Kuitunen
- Department of Pediatrics, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Marjo Renko
- Department of Pediatrics, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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4
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Goth FEM, Green K, Hansen BM, Agertoft L, Jørgensen IM. From neonatal lung function to lung function and respiratory morbidity at 6-year follow-up. Pediatr Pulmonol 2023; 58:566-576. [PMID: 36349430 PMCID: PMC10098878 DOI: 10.1002/ppul.26240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/20/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lung function is traceable from infancy to adulthood. Only a few studies have examined lung function from birth to childhood longitudinally in children born moderate to late preterm. We aimed to investigate how prematurity and lung function in the neonatal period are related to lung function and respiratory morbidity at age 6 in former moderate to late preterm children compared with children born at term. METHODS Lung function was measured in a cohort of moderately to late preterm (n = 48) and term-born (n = 53) infants in the neonatal period by FeNO, and tidal breathing flow-volume loops (TBFVL) and at age 6 (n = 52) by spirometry, whole-body plethysmograph and impulse oscillation combined with a respiratory symptom questionnaire. RESULTS Moderate to late preterm children had a higher TPEF /TE ratio neonatally (42.6% vs. 33.7%, p = 0.02) and a lower % predicted orced expiratory volume in the first second at age 6 (94.4% vs. 101.9%, p = 0.01) compared to term-born children. We found a significant association between the variability of neonatal tidal volume and effective airway resistance at age 6 (β = -0.34, p = 0.03). No association between neonatal FeNO or TBFVL and respiratory morbidity at 6-year follow-up was shown. CONCLUSION Children born moderate to late preterm had lower lung function at age 6 than term-born children. We did not find evidence for the use of neonatal tidal breathing parameters as a predictor for subsequent respiratory morbidity or lung function, however sample size was small.
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Affiliation(s)
- Fanny E M Goth
- Department of Pediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kent Green
- Department of Pediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark
| | - Bo M Hansen
- Department of Pediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Inger M Jørgensen
- Department of Pediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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5
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Schroeder JC, Sharron MP, Wai K, Pillai DK, Rastogi D. Asthma as a comorbidity in COVID-19 pediatric ICU admissions in a large metropolitan children's hospital. Pediatr Pulmonol 2023; 58:206-212. [PMID: 36254734 PMCID: PMC9874824 DOI: 10.1002/ppul.26184] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/23/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2023]
Abstract
RATIONALE Children contribute to 5% of coronavirus disease of 2019 (COVID-19)-related hospitalizations in the United States. There is mounting evidence suggesting childhood asthma is a risk factor for severe disease. We hypothesized that asthma is associated with longer length of stay (LOS) and need for respiratory support among children admitted to pediatric intensive care unit (PICU) with COVID-19. METHODS We reviewed 150 charts of children and young adults with a positive severe acute respiratory syndrome coronavirus 2polymerase chain reaction test admitted to the PICU at Children's National Hospital, Washington, DC between 2020 and 2021. We recorded demographics, anthropometrics, past medical history, clinical course, laboratory findings, imaging, medication usage, respiratory support, and outcomes. Functional Status Scale (FSS), which measures an Intensive Care Unitpatient's physical function, was used to characterize children with multiple comorbidities; FSS and obesity were included as covariates in multivariate analysis. Statistical analysis was performed using SPSS v25.0. RESULTS Sixty-Eight patients ages 0-21 years met inclusion criteria. Median age was 14.9 years, 55.9% were female, median Body Mass Index percentile was 62, and 42.6% were African American. Compared with those without asthma, patients with asthma averaged longer LOS (20.7 vs. 10.2 days, p = 0.02), with longer PICU stay (15.9 vs. 7.6 days, p = 0.033) and prolonged maximum respiratory support (8.3 vs. 3.3 days, p = 0.016). Adjusted for obesity and poor physical function (FSS > 6), asthma remained a significant predictor of hospital LOS, PICU LOS, and days on maximum respiratory support. CONCLUSION Asthma can cause severe disease with prolonged need for maximum respiratory support among children with COVID-19.
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Affiliation(s)
- Jonathan C. Schroeder
- Division of Pulmonary and Sleep Medicine, Children's National HospitalGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Matthew P. Sharron
- Division of Critical Care Medicine, Children's National HospitalGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Kitman Wai
- Division of Critical Care Medicine, Children's National HospitalGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Dinesh K. Pillai
- Division of Pulmonary and Sleep Medicine, Children's National HospitalGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children's National HospitalGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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Hazan G, Orscheln RC, Kertz L, Rivera-Spoljaric K. A child with chronic cough and eosinophilia secondary to Strongyloides stercoralis infection. Pediatr Pulmonol 2022; 57:2562-2564. [PMID: 35778783 DOI: 10.1002/ppul.26048] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/26/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Guy Hazan
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel C Orscheln
- Division of Pediatric Infectious Diseases, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lila Kertz
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine Rivera-Spoljaric
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
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7
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McBride SC, McCarty K, Wong J, Baskin M, Currier D, Chiang VW. A pediatric hospital-wide asthma severity score: Reliability and effectiveness. Pediatr Pulmonol 2022; 57:1223-1228. [PMID: 35182050 DOI: 10.1002/ppul.25861] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 01/14/2022] [Accepted: 02/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Asthma is a leading cause of pediatric hospitalization in the United States. Children hospitalized with asthma are often managed in different care settings during hospitalization, posing challenges to accurate communication among care providers about illness severity. Our objective was to study the feasibility, reliability, and safety of a new pediatric hospital-wide asthma severity score (HASS) across different care units within a single tertiary-care pediatric center. METHODS 150 patients between the ages of 2 and 18 years hospitalized with a principal diagnosis of status asthmaticus were included in this study. Study patients were followed from the time of initial triage in the emergency department until the time of medical readiness for discharge. Rates of medical errors, early transfers to a higher level of care and medically indicated hospital length of stay (LOS) were compared between 75 patients before and 75 patients after widespread implementation of the HASS using retrospective chart review and anonymous staff reporting. Interrater reliability was determined by collecting independent HASS scores from blinded staff members after tandem or simultaneous patient assessment. RESULTS Interrater reliability among untrained staff members using the HASS was high. Hospital LOS, rates of adverse events, medical errors, and early transfer to a higher level of care were not significantly different before and after widespread HASS implementation. CONCLUSION The HASS is a reliable asthma severity tool that can be used throughout hospitalization and among multiple clinical providers to trend clinical progress and optimize communication, particularly during times of care handoffs.
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Affiliation(s)
- Sarah C McBride
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kendall McCarty
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jackson Wong
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Broward Health Medical Center, Fort Lauderdale, Florida, USA
| | - Marc Baskin
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Denise Currier
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vincent W Chiang
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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8
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Özer M, Başkaya N, Bostancı İ. Attitudes towards influenza and pneumococcal vaccines in parents of asthmatic children during the COVID-19 pandemic. Pediatr Pulmonol 2022; 57:871-877. [PMID: 34997997 DOI: 10.1002/ppul.25818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/06/2021] [Revised: 12/11/2021] [Accepted: 01/01/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to determine the differences in attitudes and views towards influenza and pneumococcal vaccines in parents of children with asthma during the COVID-19 pandemic. MATERIALS AND METHODS Asthmatic children in the 6-18 age group who were admitted to the pediatric allergy clinic of our hospital between October 1, 2020 and February 31, 2021 were included in the study. The parents were given a questionnaire asking about their demographics and medical history. Their attitudes and thoughts towards these two vaccines, both before and during the pandemic, and their COVID-19 stories were questioned. RESULTS A total of 78 patients diagnosed with asthma were included in this study. While the rate of influenza vaccination before the pandemic was 29.5%, the rate of those who received or wanted to receive influenza vaccine during the pandemic was 71.8% (p = 0.001). It was observed that the rate of influenza vaccination during the pandemic increased with the regular use of asthma medication, the presence of atopy, and a history of COVID-19 infection in the family/close environment. In total, 69.2% of the parents stated that their child's pneumococcal vaccination was incomplete or they were unaware of their child's vaccination status. CONCLUSION This study demonstrated that there was an increase in the rate and willingness of parents of asthmatic children to have their children vaccinated against influenza during the COVID-19 pandemic. As for the pneumococcal vaccine, the majority of the parents did not have enough information or they were unaware of the vaccination status of their children.
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Affiliation(s)
- Murat Özer
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nevzat Başkaya
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - İlknur Bostancı
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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9
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Wang Y, Hong X, Yao TC, Tsai HJ, Wang X. Interaction of maternal asthma history and plasma folate levels on child asthma risk in the Boston Birth Cohort. Pediatr Pulmonol 2021; 56:3728-3736. [PMID: 34607393 PMCID: PMC8629970 DOI: 10.1002/ppul.25680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/15/2021] [Revised: 07/28/2021] [Accepted: 08/13/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies on maternal folate status during pregnancy and child asthma risk yielded mixed results, and few considered maternal asthma history, a known risk factor of childhood asthma. This study examined whether the role of maternal folate in childhood asthma differs by maternal asthma history and whether there is an interaction between the two factors. METHODS This study included 1948 mother-child dyads from the Boston Birth Cohort. Childhood asthma was defined based on physician diagnosis documented in electronic medical records, and maternal asthma was based on standard questionnaire interview. Maternal plasma folate level within a few days of delivery was measured by chemiluminescent immunoassay. Logistic regression models were applied to examine individual and joint associations of maternal asthma history and plasma folate level with childhood asthma, adjusting for other covariables. RESULTS When stratified by maternal asthma history, an L-shaped relationship between maternal folate level and child asthma was observed in children born to mothers with asthma history (pinteraction = 0.03). The highest risk was found in children having maternal asthma history and low maternal folate level (odds ratio = 5.93; 95% confidence interval: 2.86-12.3) compared with children without maternal asthma history and with sufficient maternal folate levels. Sensitivity analyses using different definitions of asthma and stratified by major covariables yielded similar findings. CONCLUSION In this US prospective high-risk birth cohort, maternal asthma history and low folate level interactively increased the risk of child asthma. If further confirmed, optimizing maternal folate levels during pregnancy may mitigate child asthma risk in the setting of maternal asthma history.
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Affiliation(s)
- You Wang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hui-Ju Tsai
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Rázquin Arias M, Ventura Wichner PS, López-Escobar A, Díaz-Conradi A, Daoud Pérez Z. Letter from Spain. Respirology 2021; 26:1190-1191. [PMID: 34725891 DOI: 10.1111/resp.14178] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/23/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Paula Sol Ventura Wichner
- Pediatrics Department, HM Nens, HM Hospitals, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Alejandro López-Escobar
- Pediatrics Department, Hospital Vithas Madrid La Milagrosa, Madrid, Spain.,Clinical Research Unit, Fundación Vithas, Grupo Vithas, Madrid, Spain
| | | | - Zarife Daoud Pérez
- Pediatrics Pulmonology Department, HM Hospitals, Madrid, Spain.,Pediatrics Department, Emirates Speciality Hospital Dubai, Dubai, United Arab Emirates
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11
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Hurst JH, Zhao C, Fitzpatrick NS, Goldstein BA, Lang JE. Reduced pediatric urgent asthma utilization and exacerbations during the COVID-19 pandemic. Pediatr Pulmonol 2021; 56:3166-3173. [PMID: 34289526 PMCID: PMC8441648 DOI: 10.1002/ppul.25578] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has had a profound impact on healthcare access and utilization, which could have important implications for children with chronic diseases, including asthma. We sought to evaluate changes in healthcare utilization and outcomes in children with asthma during the COVID-19 pandemic. We used electronic health records data to evaluate healthcare use and asthma outcomes in 3959 children and adolescents, 5-17 years of age, with a prior diagnosis of asthma who had a history of well-child visits and encounters within the healthcare system. We assessed all-cause healthcare encounters and asthma exacerbations in the 12-months preceding the start of the COVID-19 pandemic (March 1, 2019-February 29, 2020) and the first 12 months of the pandemic (March 1, 2020-February 28, 2021). All-cause healthcare encounters decreased significantly during the pandemic compared to the preceding year, including well-child visits (48.1% during the pandemic vs. 66.6% in the prior year; p < .01), emergency department visits (9.7% vs. 21.0%; p < .01), and inpatient admissions (1.6% vs. 2.5%; p < .01), though there was over a 100-fold increase in telehealth encounters. Asthma exacerbations that required treatment with systemic steroids also decreased (127 vs. 504 exacerbations; p < .01). Race/ethnicity was not associated with changes in healthcare utilization or asthma outcomes. The COVID-19 pandemic corresponded to dramatic shifts in healthcare utilization, including increased telehealth use and improved outcomes among children with asthma. Social distancing measures may have also reduced asthma trigger exposure.
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Affiliation(s)
- Jillian H Hurst
- Department of Pediatrics, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA
| | - Congwen Zhao
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nicholas S Fitzpatrick
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Benjamin A Goldstein
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jason E Lang
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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Abstract
Pediatric asthma is a heterogeneous and common chronic condition with significant morbidity and burden on the healthcare system. Despite advances in the field, the disease has proven to be increasingly complex to diagnose and management strategies are constantly evolving. Studies from 2020 have advanced the field even further, particularly with regard to new methods of diagnosis and monitoring, treatment of severe asthma, modifiable risk factors like exercise and obesity, aerosol delivery, and viral respiratory infections contributing to the development of asthma. Continued studies are needed to improve our care for children with asthma and we look forward to future advances. This article is part of our 2020 "Year in Review" series, in which we summarize publications in major topic areas, in the context of selected literature from other journals relevant to our discipline.
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Affiliation(s)
- Andrew T Barber
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ceila E Loughlin
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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13
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Tomaz Barbosa RR, Monteiro KS, Cavalcanti Maciel ÁC, da Silva FEP, Jales LM, Santino TA, do Amaral CT, de Mendonça KMPP. Relationship between anxiety symptoms, clinical control and quality of life of children with asthma: A cross-sectional study. Pediatr Pulmonol 2021; 56:1906-1914. [PMID: 33789000 DOI: 10.1002/ppul.25377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/22/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the relationship between anxiety symptoms and factors related to clinical control and quality of life of children with asthma aged 7-12 years. METHODS A cross-sectional comparative study involving children recruited from a reference center for asthma treatment in the city of Natal-RN. Diagnosis, control and severity were performed following GINA recommendations (2019). Sociodemographic information and spirometry results from a bronchodilator test were collected. Modified Fisher's scale, clinical control questionnaires (c-ACT and ACT), quality of life assessment (PAQLQ) (total score and domains) and anxiety symptoms assessment (SCAS) (total score and domains) were applied. RESULTS The sample consisted of 42 children with asthma. Symptoms of social phobia (as identified by SCAS), and household head education were related to clinical asthma control (p = .006; R 2 = .19). Total SCAS score, guardian's education and physical activity were related to total PAQLQ (p < .0001; R 2 = .33). SCAS was related to the activity limitation domain of PAQLQ (p = .004; R 2 = .17). SCAS, gender, and physical activity were related to the PAQLQ symptoms domain (p = .003; R 2 = .32). The guardian's education, physical activity practice, and the symptoms of separation anxiety, panic attack and agoraphobia (as identified by SCAS) were related to the emotional domain of PAQLQ (p = .004; R 2 = .45). CONCLUSION The present study shows evidence of an association between anxiety symptoms, poorer clinical control, and health-related quality of life in children with asthma.
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Affiliation(s)
| | - Karolinne Souza Monteiro
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | | | - Lucas Menescal Jales
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil
| | - Thayla Amorim Santino
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil
| | - Cleia Teixeira do Amaral
- Department of Pediatric Pulmonology, Pediatric Hospital of the Federal University of Rio Grande do Norte- HOSPED, Rio Grande do Norte, Brazil
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14
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Gross Júnior M, Lago PM, Santana JCB, Biondo GF, Zandoná B, Chiaradia FDO, Carvalho PRA. Use of magnesium sulfate in continuous infusion in patients with severe acute asthma, in a pediatric emergency room. Pediatr Pulmonol 2021; 56:1924-1930. [PMID: 33831259 DOI: 10.1002/ppul.25393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/28/2020] [Revised: 02/01/2021] [Accepted: 03/08/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Asthma is a chronic disease, of high prevalence, with important morbidity and that can lead to death in childhood. The use of intravenous magnesium sulfate has been indicated in cases refractory to the initial management with inhaled bronchodilators and corticosteroids. OBJECTIVE To evaluate the use of magnesium sulfate in continuous infusion (50 mg/kg/h in 4 h) in children with severe acute asthma in a pediatric emergency room. LOCATION Ten-bed general pediatric emergency room, university hospital, tertiary, in southern Brazil. PATIENTS All children over 2 years old with severe acute asthma refractory to the initial treatment who received a continuous infusion of magnesium sulfate at a dose of 50 mg/kg/h in 4 h, from April 2017 to October 2019. CONCLUSION Based on this study, the use of continuous intravenous magnesium sulfate proved to be well tolerated, leading to improved respiratory status, and can be considered as a satisfactory adjunctive therapy in the management of severe acute asthma.
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Affiliation(s)
- Milton Gross Júnior
- Child and Adolescent Health from the Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patrícia Miranda Lago
- Pediatric Medicine and Child Health from the Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - João Carlos Batista Santana
- Child and Adolescent Health from the Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Bianca Zandoná
- Child and Adolescent Health from the Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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15
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Davidesko S, Wainstock T, Sheiner E, Landau D, Walfisch A. Maternal history of recurrent pregnancy loss increases the risk for long-term pediatric respiratory morbidity of the offspring. Pediatr Pulmonol 2020; 55:1765-1770. [PMID: 32426952 DOI: 10.1002/ppul.24813] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND While the etiology in many cases of recurrent pregnancy loss (RPL) is unclear, recent evidence suggests possible immunological dysfunction, which is also implicated in the pathophysiology of many pediatric respiratory diseases. OBJECTIVE We sought to investigate whether maternal history of RPL is associated with long-term respiratory morbidity of the offspring. STUDY DESIGN A population based cohort analysis was performed comparing the risk of long-term respiratory morbidity (up to the age of 18 years) of children born to mothers with and without a history of RPL (defined as two or more losses). Respiratory morbidity included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital medical records. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. A Kaplan-Meier survival curve was constructed to compare cumulative respiratory morbidity, and a Cox proportional hazards model was used to control for confounders. RESULTS During the study period, 242 187 newborns met the inclusion criteria; 5% (n = 12 182) of which were offspring to mothers with a history of RPL. Respiratory morbidity was significantly more common in the exposed group (6.0% vs 4.8%, P < .001). Specifically, offspring to mothers with a history of RPL had higher rates of obstructive sleep apnea and asthma (P < .05). The Kaplan-Meier survival curve exhibited a higher cumulative incidence of total respiratory morbidity in offspring of mothers with a history of RPL (Log rank P < .001). In the Cox regression, maternal history of RPL was independently associated with increased pediatric respiratory morbidity of the offspring with an adjusted hazard ratio of 1.24 (95 % confidence interval [95%CI], 1.15-1.34, P < .001). CONCLUSION Maternal history of RPL is associated with a higher risk of future pediatric respiratory morbidity of the offspring; possibly explained by a common immunological etiology.
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Affiliation(s)
- Sharon Davidesko
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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16
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Lu KD, Forno E, Radom-Aizik S, Cooper DM. Low fitness and increased sedentary time are associated with worse asthma-The National Youth Fitness Survey. Pediatr Pulmonol 2020; 55:1116-1123. [PMID: 32040886 PMCID: PMC7187732 DOI: 10.1002/ppul.24678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asthma is the most common chronic illness in children and is independently impacted by obesity and by fitness. The National Youth Fitness Survey collected data on aerobic fitness, body composition, and health outcomes in children 6 to 11 years old. The goal of this study is to test hypotheses regarding relationships between asthma, aerobic fitness, and sedentary time in this uniquely studied cohort of young children. METHODS A total of 665 children (6-11 years old; 49% male) were included in analyses. We explored relationships between asthma outcomes and aerobic fitness (measured by endurance time), self-reported sedentary time, and body mass index categories. Fitness was categorized as unfit (lowest 25% of endurance times) or fit. Multivariate logistic regression models were created for asthma outcomes and adjusted for race, age, sex, poverty status, and overweight/obesity. RESULTS Among the participants, 17.9% had a previous history of asthma and 11.4% had current asthma. Additionally, 37.3% of participants were overweight or obese. Low fitness was significantly associated with increased odds of past asthma, current asthma, asthma attacks, wheeze with exercise, and wheeze with activity limitations in multivariate models. Increased sedentary time was significantly associated with increased odds of previous asthma, current asthma, asthma attacks, and wheeze with activity limitations. CONCLUSION Decreased aerobic fitness and increased sedentary time were associated with worse asthma outcomes in this group of children (6-11 years old). This data suggest that fitness and sedentary time, both modifiable factors, each have an independent effect on asthma and should be included in assessments and management of asthma health.
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Affiliation(s)
- Kim D. Lu
- Pediatric Exercise and Genomics Research Center (PERC), Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, CA
| | - Erick Forno
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Pediatric Pulmonary Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center (PERC), Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, CA
| | - Dan M. Cooper
- Pediatric Exercise and Genomics Research Center (PERC), Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, CA
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17
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Hoch H, Kattan M, Szefler SJ. Challenges in managing difficult-to-treat asthma in children: Stop, look, and listen. Pediatr Pulmonol 2020; 55:791-794. [PMID: 31710161 DOI: 10.1002/ppul.24554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
It is recognized that asthma places a significant economic burden on the United States, with a total cost of $81.9 billion total costs including costs incurred by absenteeism and mortality. Severe asthma places a large burden of morbidity on children and their caregivers, including severe exacerbations, medication side effects, increased missed school days leading to impaired school performance, and lower caregiver quality of life. Therefore, we need to take a careful look at how we can make asthma care more efficient and cost effective, especially for those children with severe asthma. The 2019 American Thoracic Society symposium reported in this theme issue presented four aspects of managing severe asthma in children that merit attention including patient variables that affect severe asthma, understanding patient behaviors around medications, the appropriate use of bronchoscopy in diagnosis and management of severe asthma, and also the rational use of biologic therapy. This editorial will summarize key points in each of these reviews and prompt a more careful reading of each contribution.
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Affiliation(s)
- Heather Hoch
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Meyer Kattan
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado
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18
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De Keyser HH, Ramsey R, Federico MJ. They just don't take their medicines: Reframing medication adherence in asthma from frustration to opportunity. Pediatr Pulmonol 2020; 55:818-825. [PMID: 31944593 PMCID: PMC10187561 DOI: 10.1002/ppul.24643] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022]
Abstract
Assessing and addressing suboptimal adherence to asthma medications is a key component in the treatment of all children with asthma, particularly those with difficult-to-treat asthma. However, parents often overreport adherence to asthma medications. Increased medication adherence could lead to improved outcomes in the form of better asthma control and decreased asthma exacerbations, as well as decreased healthcare utilization costs. Yet there are many complex factors that affect medication adherence, and barriers are often different in each family. Social determinants of health, complex healthcare relationships, and patient-related factors may all affect medication adherence. Multicomponent patient-centered strategies, as well as strategies that utilize technology and habit formation strategies may be helpful in improving medication adherence. Further study is needed to reliably and sustainably improve medication adherence in children with asthma across the broader population; in some populations, alternate diagnoses, adjusting therapy, and other intervention may be required to improve asthma control and health.
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Affiliation(s)
- Heather Hoch De Keyser
- Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Monica J Federico
- Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
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19
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Abstract
Childhood obesity contributes to many diseases, including asthma. There is literature to suggest that asthma developing as a consequence of obesity has a nonallergic or non-T2 phenotype. In this review, obesity-related asthma is utilized as a prototype of non-T2 asthma in children to discuss several nonallergic mechanisms that underlie childhood asthma. Obesity-related asthma is associated with systemic T helper (Th)1 polarization occurring with monocyte activation. These immune responses are mediated by insulin resistance and dyslipidemia, metabolic abnormalities associated with obesity, that are themselves associated with pulmonary function deficits in obese asthmatics. As in other multifactorial diseases, there is both a genetic and an environmental contribution to pediatric obesity-related asthma. In addition to genetic susceptibility, differential DNA methylation is associated with non-T2 immune responses in pediatric obesity-related asthma. Initial investigations into the biology of non-T2 immune responses have identified the upregulation of genes in the CDC42 pathway. CDC42 is a RhoGTPase that plays a key role in Th cell physiology, including preferential naïve Th cell differentiation to Th1 cells, and cytokine production and exocytosis. Although these novel pathways are promising findings to direct targeted therapy development for obesity-related asthma to address the disease burden, there is evidence to suggest that dietary interventions, including diet modification, rather than caloric restriction alone, decrease disease burden. Adoption of a diet rich in micronutrients, including carotenoids and 25-OH cholecalciferol, a vitamin D metabolite, may be beneficial since these are positively correlated with pulmonary function indices, while being protective against metabolic abnormalities associated with the obese asthma phenotype.
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Affiliation(s)
- Deepa Rastogi
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
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20
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Gupta A, Pouliquen I, Austin D, Price RG, Kempsford R, Steinfeld J, Bradford ES, Yancey SW. Subcutaneous mepolizumab in children aged 6 to 11 years with severe eosinophilic asthma. Pediatr Pulmonol 2019; 54:1957-1967. [PMID: 31502421 PMCID: PMC6972599 DOI: 10.1002/ppul.24508] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/25/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES There are no published reports for anti-interleukin-5 therapy in children <12 years with asthma. The primary objective of this study was to characterize the pharmacokinetics and pharmacodynamics of mepolizumab following subcutaneous (SC) administration in children 6 to 11 years-of-age with severe eosinophilic asthma. HYPOTHESIS Mepolizumab SC pharmacokinetics and pharmacodynamics in children with severe eosinophilic asthma are comparable with adults. STUDY DESIGN Multinational, nonrandomised, open-label (NCT02377427). PATIENT SELECTION Children 6 to 11 years-of-age with severe eosinophilic asthma (blood eosinophil count ≥150 cells/µL at screening or ≥300 cells/µL <12 months of screening) and ≥2 exacerbations in the prior year. METHODOLOGY Children received mepolizumab SC 40 mg (bodyweight <40 kg) or 100 mg (≥40 kg) every 4 weeks for 12 weeks. RESULTS Thirty-six children received mepolizumab (40 mg, n = 26; 100 mg, n = 10). Mepolizumab exposures were higher and apparent clearance lower than predicted based on prior existing data. Derived mepolizumab exposures normalized to mean bodyweight for the 40 mg and 100 mg dose groups were 454 μg * day/mL and 675 μg * day/mL, respectively. At week 12, blood eosinophils were reduced by 89% and 83% from baseline to 42 and 55 cells/µL, respectively. Mepolizumab was well tolerated; no new safety signals were observed compared with previous adult/adolescent studies. CONCLUSION In children 6 to 11 years-of-age with severe eosinophilic asthma, mepolizumab SC 40 or 100 mg provided bodyweight-adjusted drug exposure within twofold of target adult exposure as well as marked reductions to blood eosinophil counts similar to adults, and although not designed to evaluate efficacy outcomes, demonstrated a positive clinical profile.
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Affiliation(s)
- Atul Gupta
- King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Isabelle Pouliquen
- Clinical Pharmacology Modelling and Simulation, GSK, Uxbridge, Middlesex, UK
| | - Daren Austin
- Clinical Pharmacology Modelling and Simulation, GSK, Uxbridge, Middlesex, UK
| | | | - Rodger Kempsford
- Clinical Pharmacology Modelling and Simulation, R&D Medicines Research Centre, GSK, Stevenage, Hertfordshire, UK
| | - Jonathan Steinfeld
- Respiratory TAU & Flexible Discovery Unit, GSK, Philadelphia, Pennsylvania
| | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, North Carolina
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, North Carolina
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21
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Lang JE, Bunnell HT, Lima JJ, Hossain MJ, Wysocki T, Bacharier L, Dempsey A, Ulrich L, Test MR, Forrest CB. Effects of age, sex, race/ethnicity, and allergy status in obesity-related pediatric asthma. Pediatr Pulmonol 2019; 54:1684-1693. [PMID: 31469258 DOI: 10.1002/ppul.24470] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 03/15/2019] [Accepted: 07/12/2019] [Indexed: 11/08/2022]
Abstract
RATIONALE Obesity in children increases the risk for new asthma. How age, sex, race/ethnicity, and allergy status affect the relationship between obesity and asthma is unclear. This study describes the relationship between high body mass index (BMI) and incident asthma. METHODS We conducted a retrospective cohort study to compare asthma incidence among normal weight, overweight, and obese 2 to 6, 7 to 11, and 12 to 17 year olds to define the effects of sex, race/ethnicity, and allergy status. Weight status was determined at baseline and asthma incidence was defined as ≥2 asthma encounters and ≥1 asthma prescriptions. We used multivariable Poisson regression to estimate adjusted incident asthma rates and risk ratios. RESULTS Data from 192 843 2 to 6 year olds, 157 284 7 to 11 year olds, and 157 369 12 to 17 year olds were included. The relative risks (95% confidence interval [CI]) of new asthma among obese children in 2 to 6 year olds, 7 to 11 year olds, and 12 to 17 year olds were 1.25 (1.15, 1.37), 1.49 (1.32, 1.69) and 1.40 (1.21, 1.63), respectively. Among children with underlying allergic rhinitis, obesity did not increase the risk of new asthma. In children without allergic rhinitis, the risk for obesity-related asthma was highest in 7 to 11 year olds (risk ratio = 1.50 95% CI, 1.33, 1.60). Before age 12, females had a higher risk for obesity-related asthma; but after age 12, obese males had a higher asthma risk (interaction P-value < .05). CONCLUSION Obesity is a major preventable risk factor for pediatric asthma that appears to vary along the pediatric age continuum and depends on sex, race/ethnicity and atopy status.
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Affiliation(s)
- Jason E Lang
- Division of Allergy/Immunology and Pulmonary Medicine, Duke University School of Medicine, Duke Children's Hospital and Health Center, Durham, North Carolina
| | - H Timothy Bunnell
- Department of Biomedical Research, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - John J Lima
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, Florida
| | - Md Jobayer Hossain
- Department of Biomedical Research, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Tim Wysocki
- Nemours Children's Health System, Jacksonville, Florida
| | - Leonard Bacharier
- Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Amanda Dempsey
- Department of Pediatrics, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Lisa Ulrich
- Section of Pulmonary Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew R Test
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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22
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Mikalsen IB, Dalen I, Karlstad Ø, Eide GE, Magnus M, Nystad W, Øymar K. Airway symptoms and atopy in young children prescribed asthma medications: A large-scale cohort study. Pediatr Pulmonol 2019; 54:1557-1566. [PMID: 31273956 DOI: 10.1002/ppul.24437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/15/2019] [Indexed: 11/09/2022]
Abstract
Diagnosing asthma and deciding treatment are difficult in young children. An inappropriate and too high prescription rate of inhaled corticosteroids (ICS) is suggested, but how airway symptoms are associated with prescriptions of asthma medication is less known. We studied how strongly wheeze, lower respiratory tract infections (LRTI), and atopic diseases are associated with dispensing of asthma medications during early childhood. We used data from the Norwegian Mother and Child Cohort Study and the Norwegian Prescription Database at four age-intervals (0-6, 6-18, 18-36 months, and 3-7 years). Primary outcomes were dispensed asthma medications (no medication, short-acting β-2 agonist, or ICS). Relative risks (RRs) and average attributable fractions (AAFs) were estimated. Both wheeze and LRTI were positively associated with both medication groups (0-6 months: no data on wheeze). The RRs and AAFs were higher for wheeze than LRTI. For ICS, the AAFs (95% CI) for wheeze vs LRTI were: 6 to 18 months: 69.2 (67.2, 71.2)% vs 10.4 (9.0, 11.8)%, 18 to 36 months: 33.0 (30.5, 35.5)% vs 10.0 (8.0, 12.0)%, and 3 to 7 years: 33.7 (31.0, 36.5)% vs 1.2 (0.5, 1.9)%. Except at 3 to 7 years of age, the AAFs were lower for atopic diseases than for LRTI and wheeze. Atopic diseases modified the associations between wheeze and ICS at 18 to 36 months and between LRTI or wheeze and ICS at 3 to 7 years. In conclusion, both wheeze and LRTI were associated with prescriptions of asthma medications in young children, with the strongest associations seen for wheeze. Atopic diseases contributed to these associations only in the oldest age groups.
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Affiliation(s)
- Ingvild Bruun Mikalsen
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Øystein Karlstad
- Department of Chronic Diseases and Aging, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Maria Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Wenche Nystad
- Department of Chronic Diseases and Aging, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Knut Øymar
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Norway
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23
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Pike KC, Griffiths LJ, Dezateux C, Pearce A. Physical activity among children with asthma: Cross-sectional analysis in the UK millennium cohort. Pediatr Pulmonol 2019; 54:962-969. [PMID: 30887727 PMCID: PMC6617805 DOI: 10.1002/ppul.24314] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/31/2019] [Accepted: 02/19/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although beneficial for health and well-being, most children do not achieve recommended levels of physical activity. Evidence for children with asthma is mixed, with symptom severity rarely considered. This paper aimed to address this gap. METHODS We analyzed cross-sectional associations between physical activity and parent-reported asthma symptoms and severity for 6497 UK Millennium Cohort Study 7-year-old participants (3321, [49%] girls). Primary outcomes were daily moderate-to-vigorous physical activity (MVPA, minutes) and proportion of children achieving recommended minimum daily levels of 60 minutes of MVPA. Daily steps, sedentary time, and total activity counts per minute (cpm) were recorded, as were parent-reported asthma symptoms, medications, and recent hospital admissions. Associations were investigated using quantile (continuous outcomes) and Poisson (binary outcomes) regression, adjusting for demographic, socioeconomic, health, and environmental factors. RESULTS Neither asthma status nor severity was associated with MVPA; children recently hospitalized for asthma were less likely to achieve recommended daily MVPA (risk ratio [95% confidence interval [CI]]: 0.67 [0.44, 1.03]). Recent wheeze, current asthma, and severe asthma symptoms were associated with fewer sedentary hours (difference in medians [95% CI]: -0.18 [-0.27, -0.08]; -0.14 [-0.24, -0.05]; -0.15, [-0.28, -0.02], respectively) and hospital admission with lower total activity (-48 cpm [-68, -28]). CONCLUSION Children with asthma are as physically active as their asthma-free counterparts, while those recently hospitalized for asthma are less active. Qualitative studies are needed to understand the perceptions of children and families about physical activity following hospital admission and to inform support and advice needed to maintain active lifestyles for children with asthma.
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Affiliation(s)
- Katharine C Pike
- Infection, Immunity and Inflammation Academic Programme, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Lucy J Griffiths
- Health Data Research UK, Wales and Northern Ireland, Swansea University Medical School, Swansea, UK
| | - Carol Dezateux
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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24
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Tang M, Zimmerman KO, Lang JE. Severe childhood asthma exacerbations: Is treatment response variability in the genes? Pediatr Pulmonol 2019; 54:680-682. [PMID: 30868766 PMCID: PMC9460636 DOI: 10.1002/ppul.24309] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 11/12/2022]
Abstract
Worldwide, asthma is one of the most common causes of medical emergency in children. Failed acute management events comprise a large part of the annual healthcare costs of asthma. These severe exacerbations requiring hospitalization likely also contribute to permanent remodeling and impaired lung function in later life. Various studies have uncovered clinical, environmental, and genetic risk factors for severe asthma and exacerbations that cannot be acutely managed and require hospitalization. Tse and colleagues extend their previous work by adding important new insights into the determinants of failed ED management of pediatric asthma. Using a candidate gene approach and stepwise regression, they identified three SNPs in two candidate genes: IL33, rs7037276, rs1342326 and SPATS2L, rs295137, which when aggregated together significantly increased the odds for ED management failure, with each risk allele increasing failure odds by 83% (95% CI, 36–145%). When these genes markers were combined with validated clinical predictors of acute asthma management failure (viral infection, poor baseline pediatric respiratory assessment measure score, oxygen saturation <92%, fever >38.3°C, and presence of symptoms between episodes) the resulting ability to predict acute management failure was significantly improved (ROC curve=0.82). As discussed in this editorial and the discussion by Tse et al, these novel genetic markers provide new avenues of research for management of acute exacerbations. As the syndrome of asthma continues to be better characterized into multiple endo-phenotypes, we are likely to find that personalized treatment is necessary not only for control of asthma but also for acute rescue of exacerbations.
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Affiliation(s)
- Monica Tang
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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25
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Jackson WM, O’Shea TM, Allred EN, Laughon MM, Gower WA, Leviton A. Risk factors for chronic lung disease and asthma differ among children born extremely preterm. Pediatr Pulmonol 2018; 53:1533-1540. [PMID: 30160065 PMCID: PMC6716602 DOI: 10.1002/ppul.24148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/11/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the hypothesis that chronic lung disease of prematurity (CLD) is a risk factor for asthma in children born extremely preterm, and the hypothesis that the risk factors for CLD are similar to those for asthma. METHODS A retrospective analysis was performed using data collected prospectively from 882 children born before the 28th week of gestation between 2002 and 2004 who returned for follow-up at ages 12 and 24 months and 10 years. We created time-oriented logistic regression models to compare risk factors for CLD, defined as need for supplemental oxygen at 36 weeks postmenstrual age, and parent-reported asthma at 10 years of age. RESULTS CLD diagnosed during neonatal admission was associated with bronchodilator use at 12 months and 24 months (P < 0.001), but not with an asthma diagnosis at 10 years (Odds Ratio 1.3; 95% confidence interval 0.98-1.8). While risk factors for CLD include lower gestational age (OR 2.7; 1.5-4.7) and fetal growth restriction (OR 2.3; 1.4-3.7), risk factors for asthma include mother's eligibility for public insurance (Medicaid) (OR 1.8; 1.1-2.8), and higher weight gain velocity during the first year (OR 1.5; 1.02-2.2) and between the 2nd and 10th year (OR 1.7; 1.2-2.4). CONCLUSIONS Among children born extremely preterm, the diagnosis of CLD and its antecedents were associated with transient preschool wheezing, but not with asthma. Post-NICU factors, such as growth velocity and socioeconomic disadvantage, appear to have stronger associations with asthma than exposures during NICU admission.
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Affiliation(s)
- Wesley M. Jackson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - T. Michael O’Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth N. Allred
- Departments of Neurology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Matthew M. Laughon
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - W. Adam Gower
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Alan Leviton
- Departments of Neurology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts
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Omole KO, Kuti BP, Oyelami OA, Adegbola AJ, Omole JO. Serum vitamin D profile of Nigerian children with asthma: Association with asthma severity and control. Pediatr Pulmonol 2018; 53:544-551. [PMID: 29461019 DOI: 10.1002/ppul.23969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 09/08/2017] [Accepted: 01/25/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Childhood asthma is a chronic inflammatory airway disorder with increasing prevalence even in Africa. Vitamin D, with anti-inflammatory and immune-modulatory properties, may have effects on the severity and level of symptoms control in childhood asthma. We aimed to assess the serum vitamin D levels in children with asthma as related to disease severity and control in a tropical region. METHODS A hospital based comparative cross sectional study was conducted in western Nigeria. Serum vitamin D (25-OH-D) levels of all the children, assayed using high-performance liquid chromatography (HPLC), were compared to the various disease severity and levels of asthma control as well as between the asthmatic and non-asthmatic children. RESULTS A total of 206 children (103 asthmatics and 103 non-asthmatics) were recruited with a mean (SD) age of 6.6 (3.7) years. The majority (82.5%) of the children with asthma had mild intermittent form, 63.1% had well controlled symptoms while 33.0% and 3.9% had partly controlled and uncontrolled symptoms, respectively. None of the children were deficient in vitamin D. The mean (SD) serum vitamin D levels of the children with asthma (49.2 [7.2] ng/mL) was significantly lower than those without asthma (51.2 [6.9] ng/mL, P = 0.043). Varying degrees of asthma severity and levels of symptoms control were not affected by serum vitamin D levels. CONCLUSION Children with asthma in Nigeria had marginally but significantly lower mean serum vitamin D levels when compared with their counterparts without asthma. However, serum vitamin D level does not seem to be associated with childhood asthma severity and control in these children with normal serum vitamin D levels.
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Affiliation(s)
- Kehinde O Omole
- Department of Paediatrics, Wesley Guild Hospital, Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ilesa, Nigeria
| | - Bankole P Kuti
- Department of Paediatrics, Wesley Guild Hospital, Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ilesa, Nigeria.,Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oyeku A Oyelami
- Department of Paediatrics, Wesley Guild Hospital, Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ilesa, Nigeria.,Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adebanjo J Adegbola
- Department of Pharmaceutical Chemistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - John O Omole
- Department of Physiotherapy, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
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Abstract
Wheezing is the most widely reported adventitious lung sound in the English language. It is recognized by health professionals as well as by lay people, although often with a different meaning. Wheezing is an indicator of airway obstruction and therefore of interest particularly for the assessment of young children and in other situations where objective documentation of lung function is not generally available. This review summarizes our current understanding of mechanisms producing wheeze, its subjective perception and description, its objective measurement, and visualization, and its relevance in clinical practice.
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Knihtilä H, Kotaniemi-Syrjänen A, Pelkonen AS, Kalliola S, Mäkelä MJ, Malmberg LP. Small airway oscillometry indices: Repeatability and bronchodilator responsiveness in young children. Pediatr Pulmonol 2017; 52:1260-1267. [PMID: 28834381 DOI: 10.1002/ppul.23794] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 02/20/2017] [Accepted: 08/01/2017] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The impulse oscillometry (IOS) indices absolute and relative difference between respiratory resistance at 5 and 20 Hz (R5-20 and R5-20%, respectively) and the area under the reactance curve (AX) are postulated to reflect small airway function. Data on their cutoff values to evaluate bronchodilator responsiveness (BDR) or between-visit changes after interventions are limited in young children. METHODS We evaluated the BDR of 103 healthy children aged 2-7 years, who received either salbutamol (n = 84) or placebo (n = 19) in order to determine cutoff values for BDR of R5-20, R5-20%, and AX. We then determined the repeatability within and between two IOS measurements 7-14 days apart in young children aged 4-8 years with asthmatic symptoms (n = 43), including cutoff values for significant between-visit changes. RESULTS The investigated IOS parameters showed marked BDR (fifth percentile cutoff of 75-110% of the baseline value) in healthy children, whereas no significant changes were seen after inhalation of placebo. The agreement within the triplicate IOS measurement was excellent (ICC > 0.80), and the agreement of results between visits was good (ICC > 0.60). A change in R5-20, R5-20%, and AX of 0.65, 1.08, and 0.84 z-scores, respectively, would exceed 95% confidence intervals for between-visit variability. CONCLUSION We introduce cutoff values for BDR of R5-20, R5-20%, and AX, and their repeatability indices and cutoff limits for significant between-visit changes. These IOS parameters may show greater variability than the conventional IOS indices during follow-up, but the between-visit agreement remains good, providing potentially useful endpoints for monitoring lung function in young children.
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Affiliation(s)
- Hanna Knihtilä
- Pediatric Unit of the Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Kotaniemi-Syrjänen
- Pediatric Unit of the Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna S Pelkonen
- Pediatric Unit of the Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Kalliola
- Pediatric Unit of the Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Pediatric Unit of the Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leo Pekka Malmberg
- Pediatric Unit of the Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Abstract
BACKGROUND The long-term respiratory characteristics of ex-preterm children with bronchopulmonary dysplasia (BPD) are not established. The objective of this study was to describe hallmarks of BPD at school age in comparison to children with atopic asthma. METHODS This study was a cross-sectional descriptive comparative study in a hospital-based setting. Thirty schoolchildren diagnosed with BPD (10.4 years/born at 26.6 weeks' gestation) and 30 age- and sex-matched children with asthma and sensitized to airborne allergens (IgE >0.35 kUA /L) were analyzed. Measurements included fraction of exhaled nitric oxide (FENO, ppb), dynamic and static lung function, and bronchial provocation with methacholine (PD:20) and mannitol (PD:15), as well as an evaluation of respiratory symptoms using the asthma control test (C-ACT). RESULTS Lung function measures (FEV1% 77 vs 84, FEV1/FVC% 85 vs 91, FEF50% 61 vs 80) and carbon monoxide diffusion capacity (DLCO%, 81 vs 88) were all reduced in children with BPD compared to asthma (P values <0.042). FENO values were also significantly lower in children with BPD (12 vs 23, P = 0.019). The proportion of positive methacholine tests (74% vs 93%, P = 0.14) was comparable between BPD and asthma. However, less responsiveness towards mannitol (19% vs 61%, P = 0.007) and fewer self-reported symptoms (C-ACT, median 26 vs 24, P = 0.003) were found in the BPD group. CONCLUSION Respiratory hallmarks of BPD at school-age were reduced lung function, limited responsiveness towards indirectly acting mannitol but hyper-responsiveness towards direct acting methacholine and impairment in diffusion capacity. Children with BPD displayed less evidence of airway inflammation compared with atopic asthma.
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Affiliation(s)
- Björn Nordlund
- Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna James
- Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christina Ebersjö
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eva B Broström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Das LT, Abramson EL, Stone AE, Kondrich JE, Kern LM, Grinspan ZM. Predicting frequent emergency department visits among children with asthma using EHR data. Pediatr Pulmonol 2017; 52:880-890. [PMID: 28557381 DOI: 10.1002/ppul.23735] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 12/08/2016] [Accepted: 04/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE For children with asthma, emergency department (ED) visits are common, expensive, and often avoidable. Though several factors are associated with ED use (demographics, comorbidities, insurance, medications), its predictability using electronic health record (EHR) data is understudied. METHODS We used a retrospective cohort study design and EHR data from one center to examine the relationship of patient factors in 1 year (2013) and the likelihood of frequent ED use (≥2 visits) in the following year (2014), using bivariate and multivariable statistics. We applied and compared several machine-learning algorithms to predict frequent ED use, then selected a model based on accuracy, parsimony, and interpretability. RESULTS We identified 2691 children. In bivariate analyses, future frequent ED use was associated with demographics, co-morbidities, insurance status, medication history, and use of healthcare resources. Machine learning algorithms had very good AUC (area under the curve) values [0.66-0.87], though fair PPV (positive predictive value) [48-70%] and poor sensitivity [16-27%]. Our final multivariable logistic regression model contained two variables: insurance status and prior ED use. For publicly insured patients, the odds of frequent ED use were 3.1 [2.2-4.5] times that of privately insured patients. Publicly insured patients with 4+ ED visits and privately insured patients with 6+ ED visits in a year had ≥50% probability of frequent ED use the following year. The model had an AUC of 0.86, PPV of 56%, and sensitivity of 23%. CONCLUSION Among children with asthma, prior frequent ED use and insurance status strongly predict future ED use.
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Affiliation(s)
- Lala T Das
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | - Erika L Abramson
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York.,Department of Pediatrics, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York
| | - Anne E Stone
- Department of Pediatrics, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York
| | - Janienne E Kondrich
- Department of Pediatrics, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York
| | - Lisa M Kern
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Zachary M Grinspan
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York.,Department of Pediatrics, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York
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Knihtilä H, Kotaniemi-Syrjänen A, Pelkonen AS, Kalliola S, Mäkelä MJ, Malmberg LP. Sensitivity of newly defined impulse oscillometry indices in preschool children. Pediatr Pulmonol 2017; 52:598-605. [PMID: 27736034 DOI: 10.1002/ppul.23627] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/27/2016] [Revised: 08/23/2016] [Accepted: 10/01/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Early origins of chronic obstructive pulmonary disease have been recognized. Impulse oscillometry (IOS) is suitable for assessment of lung function also in preschool children, and some novel indices have been connected to assessment of small airway function. However, limited data exist on the sensitivity of these new indices to detect lung function deficits in young symptomatic children. METHODS IOS measurements of 103 healthy preschool children were evaluated to establish reference equations for the difference between respiratory resistance at 5 and 20 Hz (R5-20), the relative difference of R5-20 (R5-20%), and area under the reactance curve (AX). Thereafter, IOS results of children with late-onset troublesome lung symptoms (n = 20), a history of early wheeze (n = 37), or a history of bronchopulmonary dysplasia (BPD, n = 8) were compared to healthy children. RESULTS None of the patient groups differed from healthy regarding respiratory resistance at 5 Hz (R5), and only children with a history of BPD differed from healthy regarding respiratory reactance at 5 Hz (X5). In contrast, z-scores of R5-20, R5-20%, and AX were significantly higher in all patient groups than in healthy children (P < 0.001), showing improved sensitivity (20-55%) compared to R5 and X5 (5-6%). CONCLUSION R5-20, R5-20%, and AX are superior to conventional IOS parameters in distinguishing children with current or past lower respiratory tract symptoms from healthy, and may prove valuable for screening early lung function deficits. Pediatr Pulmonol. 2017;52:598-605. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hanna Knihtilä
- Pediatric Unit of the Department of Allergology, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Kotaniemi-Syrjänen
- Pediatric Unit of the Department of Allergology, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna S Pelkonen
- Pediatric Unit of the Department of Allergology, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Kalliola
- Pediatric Unit of the Department of Allergology, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Pediatric Unit of the Department of Allergology, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - L Pekka Malmberg
- Pediatric Unit of the Department of Allergology, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Raywood E, Lum S, Aurora P, Pike K. The bronchodilator response in preschool children: A systematic review. Pediatr Pulmonol 2016; 51:1242-1250. [PMID: 27273556 DOI: 10.1002/ppul.23459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/05/2016] [Accepted: 04/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The bronchodilator response (BDR) is frequently used to support diagnostic and therapeutic decision-making for children who wheeze. However, there is little evidence-based guidance describing the role of BDR testing in preschool children and it is unclear whether published cut-off values, which are derived from adult data, can be applied to this population. METHODS We searched MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception-September 2015) for studies reporting response to a bronchodilator in healthy preschool children, response following placebo inhalation, and the diagnostic efficacy of BDR compared with a clinical diagnosis of asthma/recurrent wheezing. FINDINGS We included 14 studies. Thirteen studies provided BDR data from healthy preschool children. Two studies reported response to placebo in preschool children with asthma/recurrent wheezing. Twelve studies compared BDR measurements from preschool children with asthma/recurrent wheeze to those from healthy children and seven of these studies reported diagnostic efficacy. Significant differences between the BDR measured in healthy preschool children compared with that in children with asthma/recurrent wheeze were demonstrated in some, but not all studies. Techniques such as interrupter resistance, oscillometry, and plethysmography were more consistently successfully completed than spirometry. Between study heterogeneity precluded determination of an optimum technique. INTERPRETATION There is little evidence to suggest spirometry-based BDR can be used in the clinical assessment of preschool children who wheeze. Further evaluation of simple alternative techniques is required. Future studies should recruit children in whom airways disease is suspected and should evaluate the ability of BDR testing to predict treatment response. Pediatr Pulmonol. 2016;51:1242-1250. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Emma Raywood
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Sooky Lum
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Paul Aurora
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Katharine Pike
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom.
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
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Birnkrant DJ, Yilmaz O, Nicolai T, Black JB, Mhanna MJ, Noah TL. Pediatric pulmonology year in review 2015: Part 3. Pediatr Pulmonol 2016; 51:747-53. [PMID: 27105321 DOI: 10.1002/ppul.23413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/21/2016] [Revised: 03/03/2016] [Accepted: 03/12/2016] [Indexed: 12/21/2022]
Abstract
Our journal covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review (Part 3) covers articles on asthma, diagnostic testing/endoscopy, respiratory complications of neuromuscular disorders, and rare lung diseases. Pediatr Pulmonol. 2016;51:747-753. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- David J Birnkrant
- MetroHealth Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ozge Yilmaz
- Division of Pediatric Allergy and Pulmonology, Department of Pediatrics, Celal Bayar University, Manisa, Turkey
| | | | - Jane B Black
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Maroun J Mhanna
- MetroHealth Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, 450 Macnider Building, Campus Box 7217, Chapel Hill, North Carolina, 27599-7217
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Dawood FS, Fry AM, Goswami D, Sharmeen A, Nahar K, Anjali BA, Rahman M, Brooks WA. Incidence and characteristics of early childhood wheezing, Dhaka, Bangladesh, 2004-2010. Pediatr Pulmonol 2016; 51:588-95. [PMID: 26613245 DOI: 10.1002/ppul.23343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/08/2015] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early childhood wheezing substantially impacts quality of life in high-income countries, but data are sparse on early childhood wheezing in low-income countries. We estimate wheezing incidence, describe wheezing phenotypes, and explore the contribution of respiratory viral illnesses among children aged <5 years in urban Bangladesh. METHODS During 2004-2010, respiratory illness surveillance was conducted through weekly home visits. Children with fever or respiratory illness were referred for examination by study physicians including lung auscultation. During 2005-2007, every fifth referred child had nasal washes tested for human metapneumovirus, respiratory syncytial viruses, and influenza and parainfluenza viruses. RESULTS During April 2004-July 2010, 23,609 children were enrolled in surveillance. Of these, 11,912 (50%) were male, median age at enrollment was 20 months (IQR 5-38), and 4,711 (20%) had ≥1 wheezing episode accounting for 8,901 episodes (733 [8%] associated with hospitalization); 25% wheezed at <1 year of age. Among children aged <5 years, incidences of wheezing and wheezing hospitalizations were 2,335/10,000 and 192/10,000 child-years. Twenty-eight percent had recurrent wheezing. Recurrent versus non-recurrent wheezing episodes were more likely to be associated with oxygen saturation <93% (OR 6.9, 95%CI 2.8-17.3), increased work of breathing (OR 1.6, 95%CI 1.4-1.8), and hospitalization (OR 2.0, 95%CI 1.6-2.4). Respiratory viruses were detected in 66% (578/873) of episodes with testing. CONCLUSION In urban Bangladesh, early childhood wheezing is common and largely associated with respiratory virus infections. Recurrent wheezing is associated with more severe illness and may predict children who would benefit most from closer follow-up and targeted interventions. Pediatr Pulmonol. 2016;51:588-595. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta
| | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Amina Sharmeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kamrun Nahar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Bilkis Ara Anjali
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - W Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,The Bloomberg School of Public Health, Johns Hopkins University, Baltimore
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Krupp NL, Sehra S, Slaven JE, Kaplan MH, Gupta S, Tepper RS. Increased prevalence of airway reactivity in children with eosinophilic esophagitis. Pediatr Pulmonol 2016; 51:478-83. [PMID: 26509459 DOI: 10.1002/ppul.23327] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/20/2015] [Accepted: 08/28/2015] [Indexed: 01/08/2023]
Abstract
RATIONALE Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior studies versus 9% for the general population. However, pulmonary function and airway hyperresponsiveness (AHR) in children with EoE have not been previously defined. METHODS A cross-sectional prospective study was conducted of children ages 7-18 years with EoE and healthy controls. Methacholine bronchial challenge and exhaled nitric oxide were assessed. As measures of atopy and immune activation, peripheral blood was analyzed for total IgE, specific IgE to selected aeroallergens, eosinophil count, and serum cytokines including eotaxin. RESULTS EoE subjects (n = 33) and healthy controls (n = 37) demonstrated similar, normal baseline spirometry. AHR occurred in 33% of children with EoE and 11% of healthy controls (P = 0.04; 95% confidence intervals [19%, 52%] and [4%, 26%], respectively). The majority of EoE subjects with AHR had no prior diagnosis of asthma. Overall, 69.7% of EoE subjects had either asthma or AHR. For EoE subjects, total serum IgE was the only biomarker associated with a greater risk of AHR (OR = 9.643, 95%CI 1.633, 56.925). EoE subjects with and without asthma were similar to healthy controls in mean levels of serum cytokines (IL-5, IL-9, EGF, FGF-2, eotaxin). In exploratory analyses, the subgroup with EoE and asthma without asthma controller therapy had higher mean FGF-2 than EoE subjects without asthma (110 pg/ml vs. 65 pg/ml, P = 0.0426). CONCLUSIONS Asthma and AHR may be more prevalent than previous estimates in children with EoE. For subjects with EoE, elevation in serum IgE was associated with a greater risk of AHR.
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Affiliation(s)
- Nadia L Krupp
- Section of Pulmonology, Allergy and Sleep Medicine, Indiana University, Indiana
| | - Sarita Sehra
- Wells Center for Pediatric Research, Indiana University, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University, Indiana
| | - Mark H Kaplan
- Wells Center for Pediatric Research, Indiana University, Indiana
| | - Sandeep Gupta
- Section of Pediatric Gastroenterology, Indiana University, Indiana
| | - Robert S Tepper
- Wells Center for Pediatric Research, Indiana University, Indiana
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Gomersal T, Harnan S, Essat M, Tappenden P, Wong R, Lawson R, Pavord I, Everard ML. A systematic review of fractional exhaled nitric oxide in the routine management of childhood asthma. Pediatr Pulmonol 2016; 51:316-28. [PMID: 26829581 DOI: 10.1002/ppul.23371] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 02/26/2015] [Revised: 08/11/2015] [Accepted: 08/22/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic inflammation which may be used to guide the management of asthma in childhood. OBJECTIVES To synthesise the available evidence on the efficacy of FeNO-guided management of childhood asthma. METHODS Databases including MEDLINE and the Cochrane Library were searched, and randomised controlled trials (RCTs) comparing FeNO-guided management with any other monitoring strategy were included. Study quality was assessed using the Cochrane risk of bias tool for RCTs, and a number of outcomes were examined, including: exacerbations, medication use, quality of life, adverse events, and other markers of asthma control. Meta-analyses were planned if multiple studies with suitable heterogeneity were available. However, due to wide variations in study characteristics, meta-analysis was not possible. RESULTS Seven RCTs were identified. There was some evidence that FeNO-guided monitoring results in improved asthma control during the first year of management, although few results attained statistical significance. The impact on severe exacerbations was unclear. Similarly, the impact on use of anti-asthmatic drugs was unclear, and appears to depend on the step up/down protocols, and the clinical characteristics of patients. CONCLUSIONS The potential benefit of FeNO monitoring is equivocal. Trends toward reduced exacerbation and increased medication use were seen, but typically failed to reach statistical significance. There are a number of issues that complicate data interpretation, including differences in the likely severity of included cohorts and variations in treatment algorithms. Further work is needed to systematically explore the impact of these parameters.
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Affiliation(s)
- Tim Gomersal
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Sue Harnan
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Munira Essat
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Paul Tappenden
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Ruth Wong
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Ian Pavord
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mark Lloyd Everard
- School of Paediatrics and Child Health, Princess Margaret Hospital, Respiratory Medicine, University of Western Australia, Crawley, Australia
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Keemink YS, Klok T, Brand PLP. Long-term adherence to daily controller medication in children with asthma: The role of outpatient clinic visits. Pediatr Pulmonol 2015; 50:1060-4. [PMID: 25469915 DOI: 10.1002/ppul.23138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 06/18/2014] [Revised: 10/25/2014] [Accepted: 11/02/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program. STUDY DESIGN One-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit). RESULTS Overall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054). CONCLUSIONS There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence.
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Affiliation(s)
- Yvette S Keemink
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands
| | - Ted Klok
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands
| | - Paul L P Brand
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands.,UMCG Postgraduate School of Medicine, University Medical Center and University of Groningen, Groningen, The Netherlands
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Lauhkonen E, Koponen P, Nuolivirta K, Paassilta M, Toikka J, Saari A, Korppi M. Obesity and bronchial obstruction in impulse oscillometry at age 5-7 years in a prospective post-bronchiolitis cohort. Pediatr Pulmonol 2015; 50:908-14. [PMID: 25044353 DOI: 10.1002/ppul.23085] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 05/30/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Obesity has been linked with asthma symptoms, need for asthma treatment and reduced lung function but not with increased bronchial reactivity in children. The aim of this study was to evaluate the association between previous or current weight status and current lung function and bronchial reactivity to exercise at early school age. METHODS Ninety-nine children hospitalized for bronchiolitis at the age of less than 6 months were studied with impulse oscillometry (IOS) at the mean age of 6.3 years. Data on birth weight and weight gain in infancy before hospitalization were collected during hospitalization. Current weight and height data were transformed into age- and sex-specific height-related body mass index z scores (zBMI) using the Finnish national population-based weight and height data as reference. RESULTS Some significant though only low or modest correlations were found between current zBMI and baseline, post-exercise and post-bronchodilator IOS values in adjusted linear regression analysis. Seven obese children by zBMI had higher post-bronchodilator airway impedance (Zrs) and resistance (Rrs) at 5 Hz and lower post-bronchodilator frequency dependency of resistance (dRrs/df) than normal weight children. There were no significant differences in responses to exercise or to bronchodilators between currently obese or overweight children and normal weight children. Birth weight less than 3,000 g was associated with larger exercise-induced changes in Zrs and Rrs at 5 Hz, and in reactance (Xrs) at 5 Hz, than those with birth weight more than 3,000 g. CONCLUSIONS Preliminary evidence was found that obesity may be associated with airway obstruction, but not with bronchial hyper-reactivity.
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Affiliation(s)
- Eero Lauhkonen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Petri Koponen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | | | | | - Jyri Toikka
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland.,Department of Clinical Physiology, Turku University Hospital, Turku, Finland
| | | | - Matti Korppi
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
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Noah TL, Yilmaz O, Nicolai T, Birnkrant D, Praud JP. Pediatric Pulmonology year in review 2014: Part 1. Pediatr Pulmonol 2015; 50:621-9. [PMID: 25891206 DOI: 10.1002/ppul.23202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/29/2015] [Indexed: 11/08/2022]
Abstract
Our discipline and our journal cover an extremely broad range of research and scholarly topics related to children's respiratory disorders. To better meet the needs of our readership for updated perspectives on the rapidly expanding knowledge in our field, we here summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | | | - David Birnkrant
- MetroHealth Medical Center Department of Pediatrics, Cleveland, Ohio
| | - Jean-Paul Praud
- University Sherbrooke Pediatrics, Sherbrooke, Quebec, Canada
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