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Struiken STL, Lobée D, van Tuinen EL, Touw DJ, van der Vaart H, Bourgonje AR, Rottier BL, Koppelman GH, Mian P. Evaluation of Target Attainment for Tobramycin in Children and Adults with Cystic Fibrosis. J Clin Med 2024; 13:2641. [PMID: 38731170 PMCID: PMC11084493 DOI: 10.3390/jcm13092641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: Patients with cystic fibrosis (CF) commonly experience pulmonary exacerbations, and it is recommended by the TOPIC study to treat this with tobramycin at a dose of 10 mg/kg once daily. The aim of this study was to evaluate the target attainment of the current dosing regimen. Methods: A single-center retrospective cohort study of child and adult patients with CF who received tobramycin between 2019 and 2022 was conducted. Descriptive statistics and linear mixed models were used to assess target attainment for tobramycin. Results: In total, 25 patients (53 courses), of which 10 were children (12 courses) and 15 were adults (41 courses), were included. Those 25 patients all received 10 mg/kg/day. The tobramycin peak concentrations were supratherapeutic in 82.9% and therapeutic in 100.0% of adults and children, respectively. The trough concentrations were outside the target range in 0% and 5.1% of children and adults, respectively. We found lower tobramycin concentrations with the same dose in children compared to adults. Conclusions: This study illustrates the need to validate dosing advice in a real-world setting, as supratherapeutic concentrations of tobramycin were prevalent in adults with CF.
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Affiliation(s)
- Sheseira T. L. Struiken
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands; (S.T.L.S.); (D.L.); (E.L.v.T.); (D.J.T.)
| | - Danique Lobée
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands; (S.T.L.S.); (D.L.); (E.L.v.T.); (D.J.T.)
| | - Eline L. van Tuinen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands; (S.T.L.S.); (D.L.); (E.L.v.T.); (D.J.T.)
| | - Daniel J. Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands; (S.T.L.S.); (D.L.); (E.L.v.T.); (D.J.T.)
- Department of Pharmaceutical Analysis, Groningen Research Institute for Pharmacy, University of Groningen, 9712 GZ Groningen, The Netherlands
| | - Hester van der Vaart
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands;
| | - Arno R. Bourgonje
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands;
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bart L. Rottier
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Beatrix Children’s Hospital, University of Groningen, 9712 GZ Groningen, The Netherlands; (B.L.R.); (G.H.K.)
- Department of Pediatric Pulmonology, University Medical Center Groningen, University of Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), 9712 GZ Groningen, The Netherlands
| | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Beatrix Children’s Hospital, University of Groningen, 9712 GZ Groningen, The Netherlands; (B.L.R.); (G.H.K.)
- Department of Pediatric Pulmonology, University Medical Center Groningen, University of Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), 9712 GZ Groningen, The Netherlands
| | - Paola Mian
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands; (S.T.L.S.); (D.L.); (E.L.v.T.); (D.J.T.)
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Mian P, Maurer JM, Touw DJ, Vos MJ, Rottier BL. Pharmacy compounded pilocarpine: An adequate solution to overcome shortage of pilogel® discs for sweat testing in patients with cystic fibrosis. J Cyst Fibros 2024; 23:126-131. [PMID: 37775445 DOI: 10.1016/j.jcf.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
To respond to shortage of pilocarpine discs due to CE-licensing problems a pharmacy compounded pilocarpine HCL solution was developed and validated for use in CF diagnosis. The aim of this study was to compare the results from a pharmacy compounded pilocarpine HCL solution versus Pilogel® discs for the measurements of sweat chloride concentrations. Ten pediatric and adult patients with CF underwent a sweat test using both Pilogel® discs and pilocarpine HCL solution. The average difference between both methods was -3.25 mmol/L (95% Limits of Agreement: -7.19 [95% CI: -9.19;-5.19] and 0.69 [95% CI: -1.31;2.69] mmol/L. Passing-Bablok regression showed that zero was enclosed with the 95% CI of the calculated intercept (0.15 [95% CI: -1.70;1.42] mmol/L). These data show a good agreement in chloride concentrations obtained using the two pilocarpine products. Therefore, the pharmacy compounded pilocarpine HCL solution can be used as an alternative for Pilogel® discs during times of shortage.
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Affiliation(s)
- P Mian
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - J M Maurer
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - D J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands; Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - M J Vos
- Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - B L Rottier
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Akkerman-Nijland AM, Rottier BL, Holstein J, Winter RL, Touw DJ, Akkerman OW, Koppelman GH. Eradication of Burkholderia cepacia complex in cystic fibrosis patients with inhalation of amiloride and tobramycin combined with oral cotrimoxazole. ERJ Open Res 2023; 9:00055-2023. [PMID: 37377654 PMCID: PMC10291312 DOI: 10.1183/23120541.00055-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/20/2023] [Indexed: 06/29/2023] Open
Abstract
This case series suggests that successful eradication therapy of BCC in cystic fibrosis can be done with a combination of inhaled and oral medication, which in many cases may eliminate the need for intensive treatment with intravenous antibiotics https://bit.ly/40oOMIn.
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Affiliation(s)
- Anne M. Akkerman-Nijland
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Bart L. Rottier
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Joanne Holstein
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, Groningen, the Netherlands
| | - Rik L.J. Winter
- University of Groningen, University Medical Center Groningen, Department of Microbiology, Groningen, The Netherlands
| | - Daniel J. Touw
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Onno W. Akkerman
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, Groningen, the Netherlands
| | - Gerard H. Koppelman
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
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4
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Akkerman-Nijland AM, Möhlmann JE, Akkerman OW, Vd Vaart H, Majoor CJ, Rottier BL, Burgerhof JGM, Hak E, Koppelman GH, Touw DJ. The long-term safety of chronic azithromycin use in adult patients with cystic fibrosis, evaluating biomarkers for renal function, hepatic function and electrical properties of the heart. Expert Opin Drug Saf 2021; 20:959-963. [PMID: 34030570 DOI: 10.1080/14740338.2021.1932814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Azithromycin maintenance therapy is widely used in cystic fibrosis (CF), but little is known about its long-term safety. We investigated whether chronic azithromycin use is safe regarding renal function, hepatic cell toxicity and QTc-interval prolongation.Methods: Adult CF patients (72 patients using azithromycin for a cumulative period of 364.8 years and 19 controls, 108.8 years) from two CF-centers in the Netherlands with azithromycin (non)-use for at least three uninterrupted years were studied retrospectively.Results: There was no difference in mean decline of estimated glomerular filtration rate (eGFR), nor in occurrence of eGFR-events. No drug-induced liver injury could be attributed to azithromycin. Of the 39 azithromycin users of whom an ECG was available, 4/39 (10.3%) had borderline and 4/39 (10.3%) prolonged QTc-intervals, with 7/8 patients using other QTc-prolonging medication. Of the control patients 1/6 (16.7%) had a borderline QTc-interval, without using other QTc-prolonging medication. No cardiac arrhythmias were observed.Conclusion: We observed no renal or hepatic toxicity, nor cardiac arrythmias during azithromycin use in CF patients for a mean study duration of more than 5 years. One should be aware of possible QTc-interval prolongation, in particular in patients using other QTc-interval prolonging medication.
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Affiliation(s)
- A M Akkerman-Nijland
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - J E Möhlmann
- University Medical Center Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, The Netherlands
| | - O W Akkerman
- University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, Groningen, Netherlands
| | - H Vd Vaart
- University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, Groningen, Netherlands
| | - C J Majoor
- Amsterdam University Medical Centers, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - B L Rottier
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - J G M Burgerhof
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - E Hak
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, The Netherlands.,Department of Pharmacotherapy, -epidemiology and economics, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -epidemiology & -economics, University of Groningen, Groningen, The Netherlands
| | - G H Koppelman
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - D J Touw
- University Medical Center Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, The Netherlands
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5
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Akkerman-Nijland AM, Yousofi M, Rottier BL, Van der Vaart H, Burgerhof JGM, Frijlink HW, Touw DJ, Koppelman GH, Akkerman OW. Eradication of Pseudomonas aeruginosa in cystic fibrosis patients with inhalation of dry powder tobramycin. Ther Adv Respir Dis 2021; 14:1753466620905279. [PMID: 32046620 PMCID: PMC7016310 DOI: 10.1177/1753466620905279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Pseudomonas aeruginosa (Pa) is the predominant pulmonary pathogen in patients with cystic fibrosis (CF). Tobramycin nebulization is used for the eradication of Pa infection. Nowadays, tobramycin dry powder inhalation (DPI) is available as well. This study reports the results of eradicating Pa with tobramycin DPI versus nebulization. Methods: Adult CF patients with a Pa isolation between September 2010 and September 2017 from the University Medical Centre Groningen (UMCG), the Netherlands, were included in this retrospective study. Results: In total 27 Pa isolations were recorded. In 13 of these, eradication was attempted with tobramycin, 7 with DPI and 6 with nebulization. DPI eradicated Pa successfully in six isolations (85.7%). Of these, one patient received additional oral ciprofloxacin and one received intravenous ceftazidime. Nebulization eradicated three Pa isolations (50.0%), in two of these, additional oral ciprofloxacin was given. Conclusion: Eradication rates of DPI tobramycin are comparable with those for nebulized tobramycin reported in the literature. This study suggests that DPI tobramycin is an alternative to nebulized tobramycin for eradication of Pa. Trial registration: The Medical Ethics Committee of the UMCG granted a waiver (METC2017-349), as they concluded that this study was not subject to the Medical Research Involving Human Subjects Act. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Anne M Akkerman-Nijland
- Department of Paediatrics, University Medical Centre Groningen, Beatrix Children's Hospital, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Groningen, 9713 GZ, the Netherlands
| | - Mina Yousofi
- Department of Pulmonary Diseases and Tuberculosis, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Bart L Rottier
- Department of Paediatric Pulmonology and Paediatric Allergology, University Medical Centre Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands
| | - Hester Van der Vaart
- Department of Pulmonary Diseases and Tuberculosis, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands.,Department of Clinical Pharmacy & Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerard H Koppelman
- Department of Paediatric Pulmonology and Paediatric Allergology, University Medical Centre Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands
| | - Onno W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Akkerman-Nijland AM, Akkerman OW, Grasmeijer F, Hagedoorn P, Frijlink HW, Rottier BL, Koppelman GH, Touw DJ. The pharmacokinetics of antibiotics in cystic fibrosis. Expert Opin Drug Metab Toxicol 2020; 17:53-68. [PMID: 33213220 DOI: 10.1080/17425255.2021.1836157] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Dosing of antibiotics in people with cystic fibrosis (CF) is challenging, due to altered pharmacokinetics, difficulty of lung tissue penetration, and increasing presence of antimicrobial resistance. AREAS COVERED The purpose of this work is to critically review original data as well as previous reviews and guidelines on pharmacokinetics of systemic and inhaled antibiotics in CF, with the aim to propose strategies for optimization of antibacterial therapy in both children and adults with CF. EXPERT OPINION For systemic antibiotics, absorption is comparable in CF patients and non-CF controls. The volume of distribution (Vd) of most antibiotics is similar between people with CF with normal body composition and healthy individuals. However, there are a few exceptions, like cefotiam and tobramycin. Many antibiotic class-dependent changes in drug metabolism and excretion are reported, with an increased total body clearance for ß-lactam antibiotics, aminoglycosides, fluoroquinolones, and trimethoprim. We, therefore, recommend following class-specific guidelines for CF, mostly resulting in higher dosages per kg bodyweight in CF compared to non-CF controls. Higher local antibiotic concentrations in the airways can be obtained by inhalation therapy, with which eradication of bacteria may be achieved while minimizing systemic exposure and risk of toxicity.
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Affiliation(s)
- Anne M Akkerman-Nijland
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Onno W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Floris Grasmeijer
- Department of Pharmacy, PureIMS B.V , Roden, The Netherlands.,Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen, The Netherlands
| | - Paul Hagedoorn
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen, The Netherlands
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen, The Netherlands
| | - Bart L Rottier
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Daniel J Touw
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
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Koopman T, Rottier BL, Ter Elst A, Timens W. A case report of an unusual non-mucinous papillary variant of CPAM type 1 with KRAS mutations. BMC Pulm Med 2020; 20:52. [PMID: 32093717 PMCID: PMC7041291 DOI: 10.1186/s12890-020-1088-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background congenital pulmonary airway malformation (CPAM) is the most frequent congenital lung disorder. CPAM type 1 is the most common subtype, typically having a cystic radiological and histological appearance. Mucinous clusters in CPAM type 1 have been identified as premalignant precursors for mucinous adenocarcinoma. These mucinous adenocarcinomas and the mucinous clusters in CPAM commonly harbor a specific KRAS mutation. Case presentation we present a case of a 6-weeks-old girl with CPAM type 1 where evaluation after lobectomy revealed a highly unusual complex non-mucinous papillary architecture in all cystic parts, in which both mucinous clusters and non-mucinous papillary areas harbored the known KRAS mutation. Conclusions we found that a KRAS mutation thought to be premalignant in mucinous clusters only, was also present in the other cyst lining epithelial cells of this unusual non-mucinous papillary variant of CPAM type 1, warranting clinical follow-up because of uncertain malignant potential.
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Affiliation(s)
- Timco Koopman
- Department of Pathology, Pathologie Friesland, Leeuwarden, The Netherlands. .,Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Bart L Rottier
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arja Ter Elst
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim Timens
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Kroon MAGM, Akkerman-Nijland AM, Rottier BL, Koppelman GH, Akkerman OW, Touw DJ. Drugs during pregnancy and breast feeding in women diagnosed with Cystic Fibrosis - An update. J Cyst Fibros 2017; 17:17-25. [PMID: 29233472 DOI: 10.1016/j.jcf.2017.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/18/2017] [Accepted: 11/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M A G M Kroon
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - A M Akkerman-Nijland
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - B L Rottier
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC research institute, Groningen, The Netherlands
| | - G H Koppelman
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC research institute, Groningen, The Netherlands
| | - O W Akkerman
- University of Groningen, University Medical Center Groningen, Department of Pulmonary diseases and Tuberculosis, Groningen, The Netherlands
| | - D J Touw
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.
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van den Wijngaart LS, Roukema J, Boehmer ALM, Brouwer ML, Hugen CAC, Niers LEM, Sprij AJ, Rikkers-Mutsaerts ERVM, Rottier BL, Donders ART, Verhaak CM, Pijnenburg MW, Merkus PJFM. A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control. Eur Respir J 2017; 50:50/4/1700471. [PMID: 28982775 DOI: 10.1183/13993003.00471-2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/02/2017] [Indexed: 11/05/2022]
Abstract
eHealth is an appealing medium to improve healthcare and its value (in addition to standard care) has been assessed in previous studies. We aimed to assess whether an eHealth intervention could improve asthma control while reducing 50% of routine outpatient visits.In a multicentre, randomised controlled trial with a 16-month follow-up, asthmatic children (6-16 years) treated in eight Dutch hospitals were randomised to usual care (4-monthly outpatient visits) and online care using a virtual asthma clinic (VAC) (8-monthly outpatient visits with monthly web-based monitoring). Outcome measures were the number of symptom-free days in the last 4 weeks of the study, asthma control, forced expiratory volume in 1 s, exhaled nitric oxide fraction, asthma exacerbations, unscheduled outpatient visits, hospital admissions, daily dose of inhaled corticosteroids and courses of systemic corticosteroids.We included 210 children. After follow-up, symptom-free days differed statistically between the usual care and VAC groups (difference of 1.23 days, 95% CI 0.42-2.04; p=0.003) in favour of the VAC. In terms of asthma control, the Childhood Asthma Control Test improved more in the VAC group (difference of 1.17 points, 95% CI 0.09-2.25; p=0.03). No differences were found for other outcome measures.Routine outpatient visits can partly be replaced by monitoring asthmatic children via eHealth.
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Affiliation(s)
- Lara S van den Wijngaart
- Dept of Paediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jolt Roukema
- Dept of Paediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Marianne L Brouwer
- Dept of Paediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cindy A C Hugen
- Dept of Paediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Arwen J Sprij
- Dept of Paediatric Pulmonology, Juliana Children's Hospital, Haga Hospital, The Hague, The Netherlands
| | | | - Bart L Rottier
- Paediatric Pulmonology and Allergology, Groningen Research Institute for Asthma and COPD, Beatrix Children's Hospital, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Rogier T Donders
- Dept for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris M Verhaak
- Dept of Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mariëlle W Pijnenburg
- Dept of Paediatric Pulmonology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Peter J F M Merkus
- Dept of Paediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
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van den Wijngaart LS, Kievit W, Roukema J, Boehmer ALM, Brouwer ML, Hugen CAC, Niers LEM, Sprij AJ, Rikkers-Mutsaerts ERVM, Rottier BL, Verhaak CM, Pijnenburg MW, Merkus PJFM. Online asthma management for children is cost-effective. Eur Respir J 2017; 50:50/4/1701413. [PMID: 28982768 DOI: 10.1183/13993003.01413-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/23/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Lara S van den Wijngaart
- Dept of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jolt Roukema
- Dept of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Marianne L Brouwer
- Dept of Paediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cindy A C Hugen
- Dept of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Arwen J Sprij
- Dept of Paediatric Pulmonology, Haga Hospital, Juliana Children's hospital, Den Hague, The Netherlands
| | | | - Bart L Rottier
- Dept of Paediatric Pulmonology and Allergology, Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Chris M Verhaak
- Dept of Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mariëlle W Pijnenburg
- Dept of Paediatric Pulmonology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Peter J F M Merkus
- Dept of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
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11
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Grigg J, Balfour-Lynn IM, Everard M, Hall G, Karadag B, Priftis K, Roehr CC, Rottier BL, Midulla F. Key paediatric messages from the 2016 European Respiratory Society International Congress. ERJ Open Res 2017; 3:00127-2016. [PMID: 28154820 PMCID: PMC5279069 DOI: 10.1183/23120541.00127-2016] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022] Open
Abstract
In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
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Affiliation(s)
- Jonathan Grigg
- Centre for Paediatrics, The Blizard Institute, Queen Mary University of London, London, UK
| | - Ian M. Balfour-Lynn
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Mark Everard
- Princess Margaret Hospital for Children School of Paediatric and Child Health, University of Western Australia, Perth, Australia
| | | | - Bülent Karadag
- Dept of Paediatrics, Athens University Medical School, Attikon General Hospital, Athens, Greece
| | - Kostas Priftis
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Charles Christoph Roehr
- Dept of Paediatrics, Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bart L. Rottier
- Dept of Paediatric Respiratory Medicine, Groningen Research Institute of Asthma and COPD, University Medical Center Groningen, Beatrix Childrens’ Hospital, State University Groningen, Groningen, Netherlands
| | - Fabio Midulla
- Dept of Paediatrics, Sapienza University of Rome, Rome, Italy
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12
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Rottier BL, Eber E, Hedlin G, Turner S, Wooler E, Mantzourani E, Kulkarni N. Monitoring asthma in childhood: management-related issues. Eur Respir Rev 2016; 24:194-203. [PMID: 26028632 PMCID: PMC9487817 DOI: 10.1183/16000617.00003814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood. The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established. In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention. ERS review summarising and discussing the management-related issues regarding the monitoring of asthma in childhoodhttp://ow.ly/JfjGs
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Affiliation(s)
- Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Gunilla Hedlin
- Dept of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Eva Mantzourani
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
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van Adrichem EJ, Siebelink MJ, Rottier BL, Dilling JM, Kuiken G, van der Schans CP, Verschuuren EAM. Correction: Tolerance of Organ Transplant Recipients to Physical Activity during a High-Altitude Expedition: Climbing Mount Kilimanjaro. PLoS One 2015; 10:e0145566. [PMID: 26673221 PMCID: PMC4682962 DOI: 10.1371/journal.pone.0145566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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van Adrichem EJ, Siebelink MJ, Rottier BL, Dilling JM, Kuiken G, van der Schans CP, Verschuuren EAM. Tolerance of Organ Transplant Recipients to Physical Activity during a High-Altitude Expedition: Climbing Mount Kilimanjaro. PLoS One 2015; 10:e0142641. [PMID: 26606048 PMCID: PMC4659574 DOI: 10.1371/journal.pone.0142641] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/23/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND It is generally unknown to what extent organ transplant recipients can be physically challenged. During an expedition to Mount Kilimanjaro, the tolerance for strenuous physical activity and high-altitude of organ transplant recipients after various types of transplantation was compared to non-transplanted controls. METHODS Twelve organ transplant recipients were selected to participate (2 heart-, 2 lung-, 2 kidney-, 4 liver-, 1 allogeneic stem cell- and 1 small bowel-transplantation). Controls comprised the members of the medical team and accompanying family members (n = 14). During the climb, cardiopulmonary parameters and symptoms of acute mountain sickness were recorded twice daily. Capillary blood analyses were performed three times during the climb and once following return. RESULTS Eleven of the transplant participants and all controls began the final ascent from 4700 meters and reached over 5000 meters. Eight transplant participants (73%) and thirteen controls (93%) reached the summit (5895m). Cardiopulmonary parameters and altitude sickness scores demonstrated no differences between transplant participants and controls. Signs of hyperventilation were more pronounced in transplant participants and adaptation to high-altitude was less effective, which was related to a decreased renal function. This resulted in reduced metabolic compensation. CONCLUSION Overall, tolerance to strenuous physical activity and feasibility of a high-altitude expedition in carefully selected organ transplant recipients is comparable to non-transplanted controls.
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Affiliation(s)
- Edwin J. van Adrichem
- Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Transplant Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marion J. Siebelink
- Groningen Transplant Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart L. Rottier
- Department of Pediatric Pulmonology and Allergy, Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Transplant Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Janneke M. Dilling
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Greetje Kuiken
- Groningen Transplant Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Cees P. van der Schans
- Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erik A. M. Verschuuren
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Transplant Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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van Mastrigt E, Vanlaeken L, Heida F, Caudri D, de Jongste JC, Timens W, Rottier BL, Krijger RRD, Pijnenburg MW. The clinical utility of reticular basement membrane thickness measurements in asthmatic children. J Asthma 2015; 52:926-30. [PMID: 26367334 DOI: 10.3109/02770903.2015.1025409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Reticular basement membrane (RBM) thickness is one of the pathological features of asthma and can be measured in endobronchial biopsies. We assessed the feasibility of endobronchial biopsies in a routine clinical setting and investigated the clinical value of RBM thickness measurements for asthma diagnosis in children. METHODS We included all children who underwent bronchoscopy with endobronchial mucosal biopsies for clinical reasons and divided them into three subgroups: (1) no asthma, (2) mild-moderate asthma, and (3) problematic severe asthma. RESULTS In 152/214 (71%) patients, mean age 9.5 years (SD 4.6; range 0.1-18.7) adequate biopsies were retrieved in which RBM thickness could be measured. Mean (SD) RBM thickness differed significantly among children without asthma, with mild-moderate asthma, and with problematic severe asthma (p = 0.04), 4.68 (1.24) µm, 4.56 (0.89) µm, and 5.21 (1.10) µm respectively. This difference disappeared after adding exhaled nitric oxide to the multivariate model. CONCLUSIONS This study confirms the difference in RBM thickness between children with and without asthma and between asthma severities in a routine clinical care setting. However, quantifying the RBM thickness appeared to have no added clinical diagnostic value for asthma in children.
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Affiliation(s)
- Esther van Mastrigt
- a Department of Pediatric Pulmonology, Erasmus Medical Centre , Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Leonie Vanlaeken
- a Department of Pediatric Pulmonology, Erasmus Medical Centre , Sophia Children's Hospital , Rotterdam , The Netherlands .,b Department of Pathology , Erasmus Medical Centre , Rotterdam , The Netherlands
| | - Fardou Heida
- c Department of Pathology and Medical Biology , University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands , and.,d Department of Pediatric Pulmonology , University of Groningen, University Medical Centre, Beatrix Children's Hospital , Groningen , The Netherlands
| | - Daan Caudri
- a Department of Pediatric Pulmonology, Erasmus Medical Centre , Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Johan C de Jongste
- a Department of Pediatric Pulmonology, Erasmus Medical Centre , Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Wim Timens
- c Department of Pathology and Medical Biology , University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands , and
| | - Bart L Rottier
- d Department of Pediatric Pulmonology , University of Groningen, University Medical Centre, Beatrix Children's Hospital , Groningen , The Netherlands
| | - Ronald R de Krijger
- b Department of Pathology , Erasmus Medical Centre , Rotterdam , The Netherlands
| | - Mariëlle W Pijnenburg
- a Department of Pediatric Pulmonology, Erasmus Medical Centre , Sophia Children's Hospital , Rotterdam , The Netherlands
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16
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Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E, Frischer T, Hedlin G, Kulkarni N, Lex C, Mäkelä MJ, Mantzouranis E, Moeller A, Pavord I, Piacentini G, Price D, Rottier BL, Saglani S, Sly PD, Szefler SJ, Tonia T, Turner S, Wooler E, Lødrup Carlsen KC. Monitoring asthma in children. Eur Respir J 2015; 45:906-25. [PMID: 25745042 DOI: 10.1183/09031936.00088814] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised. Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Dept of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eugenio Baraldi
- Women's and Children's Health Dept, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Paul L P Brand
- Dept of Paediatrics/Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Kai-Håkon Carlsen
- Dept of Paediatrics, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - Gunilla Hedlin
- Depart of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Pediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Eva Mantzouranis
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, Oxford, UK
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, USA
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Karin C Lødrup Carlsen
- Dept of Paediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway Dept of Paediatrics, Faculty of Medicine, University of Oslo, Oslo, Norway
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Doorn J, Storteboom TTR, Mulder AM, de Jong WHA, Rottier BL, Kema IP. Ion chromatography for the precise analysis of chloride and sodium in sweat for the diagnosis of cystic fibrosis. Ann Clin Biochem 2014; 52:421-7. [PMID: 25128544 DOI: 10.1177/0004563214549642] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Measurement of chloride in sweat is an essential part of the diagnostic algorithm for cystic fibrosis. The lack in sensitivity and reproducibility of current methods led us to develop an ion chromatography/high-performance liquid chromatography (IC/HPLC) method, suitable for the analysis of both chloride and sodium in small volumes of sweat. METHODS Precision, linearity and limit of detection of an in-house developed IC/HPLC method were established. Method comparison between the newly developed IC/HPLC method and the traditional Chlorocounter was performed, and trueness was determined using Passing Bablok method comparison with external quality assurance material (Royal College of Pathologists of Australasia). RESULTS Precision and linearity fulfill criteria as established by UK guidelines are comparable with inductively coupled plasma-mass spectrometry methods. Passing Bablok analysis demonstrated excellent correlation between IC/HPLC measurements and external quality assessment target values, for both chloride and sodium. With a limit of quantitation of 0.95 mmol/L, our method is suitable for the analysis of small amounts of sweat and can thus be used in combination with the Macroduct collection system. CONCLUSIONS Although a chromatographic application results in a somewhat more expensive test compared to a Chlorocounter test, more accurate measurements are achieved. In addition, simultaneous measurements of sodium concentrations will result in better detection of false positives, less test repeating and thus faster and more accurate and effective diagnosis. The described IC/HPLC method, therefore, provides a precise, relatively cheap and easy-to-handle application for the analysis of both chloride and sodium in sweat.
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Affiliation(s)
- J Doorn
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - T T R Storteboom
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - A M Mulder
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - W H A de Jong
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - B L Rottier
- Department of Pediatric Pulmonology and Allergy, Beatrix Children's Hospital/University Medical Centre Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - I P Kema
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Lexmond AJ, Kruizinga TJ, Hagedoorn P, Rottier BL, Frijlink HW, de Boer AH. Effect of inhaler design variables on paediatric use of dry powder inhalers. PLoS One 2014; 9:e99304. [PMID: 24901338 PMCID: PMC4047113 DOI: 10.1371/journal.pone.0099304] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/13/2014] [Indexed: 11/18/2022] Open
Abstract
Age appropriateness is a major concern of pulmonary delivery devices, in particular of dry powder inhalers (DPIs), since their performance strongly depends on the inspiratory flow manoeuvre of the patient. Previous research on the use of DPIs by children focused mostly on specific DPIs or single inspiratory parameters. In this study, we investigated the requirements for a paediatric DPI more broadly using an instrumented test inhaler. Our primary aim was to assess the impact of airflow resistance on children’s inspiratory flow profiles. Additionally, we investigated children’s preferences for airflow resistance and mouthpiece design and how these relate to what may be most suitable for them. We tested 98 children (aged 4.7–12.6 years), of whom 91 were able to perform one or more correct inhalations through the test inhaler. We recorded flow profiles at five airflow resistances ranging from 0.025 to 0.055 kPa0.5.min.L−1 and computed various inspiratory flow parameters from these recordings. A sinuscope was used to observe any obstructions in the oral cavity during inhalation. 256 flow profiles were included for analysis. We found that both airflow resistance and the children’s characteristics affect the inspiratory parameters. Our data suggest that a medium-high resistance is both suitable for and well appreciated by children aged 5–12 years. High incidences (up to 90%) of obstructions were found, which may restrict the use of DPIs by children. However, an oblong mouthpiece that was preferred the most appeared to positively affect the passageway through the oral cavity. To accommodate children from the age of 5 years onwards, a DPI should deliver a sufficiently high fine particle dose within an inhaled volume of 0.5 L and at a peak inspiratory flow rate of 25–40 L.min−1. We recommend taking these requirements into account for future paediatric inhaler development.
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Affiliation(s)
- Anne J. Lexmond
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Tonnis J. Kruizinga
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | - Paul Hagedoorn
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | - Bart L. Rottier
- Division of Paediatric Pulmonology and Paediatric Allergology, Beatrix Children’s Hospital, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henderik W. Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | - Anne H. de Boer
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
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Abstract
Asthma is usually treated with inhaled corticosteroids (ICS) and bronchodilators generated from pressurized metered dose inhalers (pMDI), dry powder inhalers (DPI), or nebulizers. The target areas for ICS and beta 2-agonists in the treatment of asthma are explained. Drug deposition not only depends on particle size, but also on inhalation manoeuvre. Myths regarding inhalation treatments lead to less than optimal use of these delivery systems. We discuss the origin of many of these myths and provide the background and evidence for rejecting them.
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Affiliation(s)
- Bart L Rottier
- Department of Paediatric Pulmonology and Paediatric Allergology, Beatrix Children's Hospital, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, the Netherlands.
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20
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Abstract
BACKGROUND Inhaled corticosteroids (ICS) are the cornerstone of asthma maintenance treatment in children. Particularly among parents, there is concern about the safety of ICS as studies in children have shown reduced growth. Small-particle-size ICS targeting the smaller airways have improved lung deposition and effective asthma control might be achieved at lower daily doses.Ciclesonide is a relatively new ICS. This small-particle ICS is a pro-drug that is converted in the airways to an active metabolite and therefore with potentially less local (throat infection) and systemic (reduced growth) side effects. It can be inhaled once daily, thereby possibly improving adherence. OBJECTIVES To assess the efficacy and adverse effects of ciclesonide compared to other ICS in the management of chronic asthma in children. SEARCH METHODS We searched the Cochrane Airways Group Register of trials with pre-defined terms. Additional searches of MEDLINE (via PubMed), EMBASE and Clinical study results.org were undertaken. Searches are up to date to 7 November 2012. SELECTION CRITERIA Randomised controlled parallel or cross-over studies were eligible for the review. We included studies comparing ciclesonide with other corticosteroids both at nominally equivalent doses or lower doses of ciclesonide. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. MAIN RESULTS Six studies were included in this review (3256 children, 4 to 17 years of age). Two studies were published as conference abstracts only. Ciclesonide was compared to budesonide and fluticasone.Ciclesonide compared to budesonide (dose ratio 1:2): asthma symptoms and adverse effect were similar in both groups. Pooled results showed no significant difference in children who experience an exacerbation (risk ratio (RR) 2.20, 95% confidence interval (CI) 0.75 to 6.43). Both studies reported that 24-hour urine cortisol levels showed a statistically significant decrease in the budesonide group compared to the ciclesonide group.Ciclesonide compared to fluticasone (dose ratio 1:1): no significant differences were found for the outcome asthma symptoms. Pooled results showed no significant differences in number of patients with exacerbations (RR 1.37, 95% CI 0.58 to 3.21) and data from a study that could not be pooled in the meta-analysis reported similar numbers of patients with exacerbations in both groups. None of the studies found a difference in adverse effects. No significant difference was found for 24-hour urine cortisol levels between the groups (mean difference 0.54 nmol/mmol, 95% CI -5.92 to 7.00).Ciclesonide versus fluticasone (dose ratio 1:2) was assessed in one study and showed similar results between the two corticosteroids for asthma symptoms. The number of children with exacerbations was significantly higher in the ciclesonide group (RR 3.57, 95% CI 1.35 to 9.47). No significant differences were found in adverse effects (RR 0.98, 95% CI 0.81 to 1.14) and 24-hour urine cortisol levels (mean difference 1.15 nmol/mmol, 95% CI 0.07 to 2.23).The quality of evidence was judged 'low' for the outcomes asthma symptoms and adverse events and 'very low' for the outcome exacerbations for ciclesonide versus budesonide (dose ratio 1:1). The quality of evidence was graded 'moderate' for the outcome asthma symptoms, 'very low' for the outcome exacerbations and 'low' for the outcome adverse events for ciclesonide versus fluticasone (dose ratio 1:1). For ciclesonide versus fluticasone (dose ratio 1:2) the quality was rated 'low' for the outcome asthma symptoms and 'very low' for exacerbations and adverse events (dose ratio 1:2). AUTHORS' CONCLUSIONS An improvement in asthma symptoms, exacerbations and side effects of ciclesonide versus budesonide and fluticasone could be neither demonstrated nor refuted and the trade-off between benefits and harms of using ciclesonide instead of budesonide or fluticasone is unclear. The resource use or costs of different ICS should therefore also be considered in final decision making. Longer-term superiority trials are needed to identify the usefulness and safety of ciclesonide compared to other ICS. Additionally these studies should be powered for patient relevant outcomes (exacerbations, asthma symptoms, quality of life and side effects). There is a need for studies comparing ciclesonide once daily with other ICS twice daily to assess the advantages of ciclesonide being a pro-drug that can be administered once daily with possibly increased adherence leading to increased control of asthma and fewer side effects.
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Affiliation(s)
- Sharon Kramer
- Australasian Cochrane Centre, School of PublicHealth and PreventiveMedicine,Monash University,Melbourne, Australia.
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Raphael MF, Rottier BL, Boelens JJ. Fludarabine in paediatric steroid-refractory inflammatory lung injury after stem cell transplantation. Eur Respir J 2013; 41:479-83. [PMID: 23370805 DOI: 10.1183/09031936.00029312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Balink H, Collins J, Korsten-Meijer AGW, Rottier BL. Unilateral hyperlucent lung in a child caused by a foreign body identified with v/q scintigraphy. Clin Nucl Med 2012; 37:916-7. [PMID: 22889792 DOI: 10.1097/rlu.0b013e31825b20aa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 5-year-old girl presented with episodes of coughing, inspiratory stridor, and occasionally squeaking breath sounds. There was no history of a foreign body aspiration. Initially, she was diagnosed with allergic asthma. However, signs and symptoms continued despite a trial of inhaled corticosteroids. A chest radiograph showed a hyperlucent right lung, mainly in the upper lobe, with decreased vascular markings compatible with Swyer-James-MacLeod syndrome, or foreign body aspiration. V/Q imaging showed markedly diminished right lung ventilation and perfusion, especially in the upper lobe, with a hot spot in the area of the right bronchus. At bronchoscopy, a pistachio nutshell was removed from the right main bronchus.
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Affiliation(s)
- Hans Balink
- Departments of Nuclear Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
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Siersma CL, Rottier BL, Hulscher JB, Bouman K, van Stuijvenberg M. Jejunoileal atresia and cystic fibrosis: don't miss it. BMC Res Notes 2012; 5:677. [PMID: 23217263 PMCID: PMC3532316 DOI: 10.1186/1756-0500-5-677] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While an increased prevalence of cystic fibrosis (CF) in patients with jejunal atresia and ileal atresia (JIA) has been described previously, it still may not be a practice routine to indicate a sweat test or DNA test for CFTR mutations in newborns presenting with JIA. Leading textbooks do not mention JIA as a possible presenting clinical feature of CF. We describe two cases of JIA with a delayed diagnosis of CF (4 months [post mortem] and 19 months). This led to a retrospective review of all patients with JIA in our hospital. We hypothesised that also in the past although indicated further testing for CF had not always been performed. METHODS Over an 18-year period from January 1991 until December 2008, all cases of JIA in our centre were reviewed (n=50). We compared patients who have been tested for CF (n=18) with patients who have not been tested for CF (n=32), with respect to their patient characteristics, either by logistic regression analysis or a nonparametric test (p<0.05). RESULTS Of all 50 patients the proportion of infants actually tested for CF was 18 (36%). A statistical significant difference between the group of patients who were tested for CF versus the group of those who were not tested was found in a higher occurrence of postoperative bilious retention after 7 days (56% versus 25%, respectively), and postoperative complications (78% versus 34%, respectively). CF was confirmed in 4 (8%). CONCLUSION Testing for CF in newborns presenting with JIA does not appear to be common practice. A timely diagnosis of CF leads to presymptomatic treatment and has beneficial effects on morbidity and mortality. CF should be tested for in all children with JIA. We recommend a sweat test for term children and CFTR DNA testing as a first step for preterm infants. Medical professional awareness may be increased if future editions of leading text books in the relevant fields should include JIA as an indication to follow an appropriate CF-diagnostic algorithm. TRIAL REGISTRATION Statement on reporting of a clinical trial: This article is not based on a clinical trial.
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Affiliation(s)
- Carolien L Siersma
- Department of Pediatrics, Beatrix Children's Hospital, CA51 Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands
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Boluyt N, Rottier BL, de Jongste JC, Riemsma R, Vrijlandt EJLE, Brand PLP. Assessment of controversial pediatric asthma management options using GRADE. Pediatrics 2012; 130:e658-68. [PMID: 22926178 DOI: 10.1542/peds.2011-3559] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To develop explicit and transparent recommendations on controversial asthma management issues in children and to illustrate the usefulness of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in rating the quality of evidence and strength of recommendations. METHODS Health care questions were formulated for 3 controversies in clinical practice: what is the most effective treatment in asthma not under control with standard-dose inhaled corticosteroids (ICS; step 3), the use of leukotriene receptor antagonist for viral wheeze, and the role of extra fine particle aerosols. GRADE was used to rate the quality of evidence and strength of recommendations after performing systematic literature searches. We provide evidence profiles and considerations about benefit and harm, preferences and values, and resource use, all of which played a role in formulating final recommendations. RESULTS By applying GRADE and focusing on outcomes that are important to patients and explicit other considerations, our recommendations differ from those in other international guidelines. We prefer to double the dose of ICS instead of adding a long-acting β-agonist in step 3; ICS instead of leukotriene receptor antagonist are the first choice in preschool wheeze, and extra fine particle ICS formulations are not first-line treatment in children with asthma. Recommendations are weak and based on low-quality evidence for critical outcomes. CONCLUSIONS We provide systematically and transparently developed recommendations about controversial asthma management options. Using GRADE for guideline development may change recommendations, enhance guideline implementation, and define remaining research gaps.
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Affiliation(s)
- Nicole Boluyt
- Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Amsterdam, Netherlands.
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Boluyt N, Rottier BL. Transparent reporting of all GRADE criteria in clinical practice guidelines. Am J Respir Crit Care Med 2012; 185:1129; author reply 1129-30. [PMID: 22589316 DOI: 10.1164/ajrccm.185.10.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zijtregtop EAM, Pijnenburg MW, Rottier BL, Duijts L. [Bronchiolitis obliterans after Stevens-Johnson syndrome]. Ned Tijdschr Geneeskd 2012; 156:A4387. [PMID: 22571546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Bronchiolitis obliterans is a non-reversible lung disease in which the inflammatory process ultimately leads to obstruction of the bronchioles. This condition often occurs after a lung or bone marrow transplantation, and sometimes respiratory tract infection. Clinical presentation is that of persistent and increasing airway obstruction. The gold standard for diagnosis is open lung biopsy. Treatment is symptomatic and aimed at preventing further lung damage. CASE DESCRIPTION An 8-year-old girl was treated for a suspected pneumonia. Two weeks later she developed Stevens-Johnson syndrome followed by severe dyspnoea. A CT scan of the chest revealed findings consistent with bronchiolitis obliterans. Methylprednisone pulse therapy was ineffective. Due to respiratory insufficiency she underwent a lung transplantation, which to date has been successful. CONCLUSION Bronchiolitis obliterans after Stevens-Johnson syndrome should be considered in patients with recurrent and progressive respiratory symptoms with typical findings on a CT scan. Lung transplantation is often the only therapeutic option.
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Affiliation(s)
- Eline A M Zijtregtop
- Erasmus Medisch Centrum - Sophia Kinderziekenhuis, afd. Kindergeneeskunde, Rotterdam, the Netherlands
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Rottier BL, Janssens HM, de Jongste JC, Brouwer ML, Vrijlandt EJLE, Boluyt N. [Guideline "Treatment of asthma in children": 3 controversial approaches to treatment]. Ned Tijdschr Geneeskd 2012; 156:A4389. [PMID: 22727227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In context of the development of evidence-based guidelines by the Dutch Paediatric Society, the three most important controversies in asthma treatment in children were investigated by systematic literature review and assessed based on the quality of evidence according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Although the quality of evidence was low, this method did result in clear, although weak, recommendations, in which the considerations playing a role are made clear. In young children with severe and/or recurrent wheezing, maintenance treatment using an inhalation corticosteroid (ICS) is initially recommended. When inhalation technique is poor, a leukotriene receptor antagonist (LTRA) can be given instead. Inhalation corticosteroids with ultrafine particles are not specifically recommended as first line treatment in young children. If asthma is not controlled despite use of ICS, it is advised to double the dose of ICS after unfavourable environmental factors have been excluded. If the result is insufficient, a combination of ICS and a long acting bronchodilator is prescribed in children older than 4- 6 years of age.
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Affiliation(s)
- Bart L Rottier
- Beatrix Kinderziekenhuis/Universitair Medisch Centrum Groningen, afd. Kinderlongziekten en kinderallergologie, Groningen, the Netherlands.
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Boluyt N, Rottier BL, Langendam MW. [Guidelines are made more transparent with the GRADE method: considerations for recommendations are explicit in the new method]. Ned Tijdschr Geneeskd 2012; 156:A4379. [PMID: 22748366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
GRADE (Grading of Recommendations Assessment, Development and Evaluation) is a new method to represent the quality of evidence and strength of recommendations in guidelines more transparently. In this article, we describe the benefits of GRADE as applied to a recommendation from the guideline "Treatment of asthma in children". A new feature of GRADE is that the relevant outcome criteria are specified in advance and that the quality of evidence is assessed per outcome criterion. The quality is adjusted downwards in the case of limitations in the study design and in the case of four additional factors: inconsistency, indirectness of evidence, imprecision and publication bias. The strength of the recommendation depends not only on the quality of evidence, but also on considerations such as the balance between benefits and adverse effects, patient preferences and costs. When using GRADE to formulate guidelines, these considerations are made explicit. Using GRADE can lead to different recommendations than older methods and to improved acceptance and implementation in clinical practice.
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Affiliation(s)
- Nicole Boluyt
- Academisch Medisch Centrum, Amsterdam, the Netherlands.
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Rottier BL, de Boer AH. Authors' Responses. J Aerosol Med Pulm Drug Deliv 2010. [DOI: 10.1089/jamp.2009.cor3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bart L. Rottier
- Beatrix Children's Hospital University Medical Center Groningen University of Groningen Groningen, The Netherlands
| | - Anne H. de Boer
- Department of Pharmaceutical Technology and Biopharmacy University of Groningen Groningen, The Netherlands
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Abstract
Asthma is a disease with chronic inflammation of the airways and and-inflammatory treatment is a logical treatment. Inhaled corticosteroids [ICS] remain the cornerstone of anti-inflammatory therapy in recent international guidelines. Asthma cannot be cured by any medication: if the drug is discontinued, the disease manifestations return. This has been proven at all ages. In preschool children the diagnosis of asthma is difficult to establish. In this heterogeneous group ICS or leukotriene receptor antagonists [LTRA] are just as effective as placebo; in the future it will hopefully be possible to describe characteristics of responders. LTRA are an alternative in mild asthma, especially when mono-triggered viral related wheeze is present. Theophylline is effective and also has bronchodilatory properties, which need to be balanced against the relatively frequent side effects. The working mechanisms of anti-inflammatory asthma medications including ICS, LTRA, cromones, macrolides and theophylline are described.
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Affiliation(s)
- Bart L Rottier
- Department of Paediatric Pulmonology and Allergy, Beatrix Children's Hospital/University Medical Centre Groningen, RB Groningen, The Netherlands
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Rottier BL, van Erp CJ, Sluyter TS, Heijerman HG, Frijlink HW, de Boer AH. Changes in Performance of the Pari eFlow® Rapid and Pari LC Plus™ during 6 Months Use by CF Patients. J Aerosol Med Pulm Drug Deliv 2009; 22:263-9. [DOI: 10.1089/jamp.2008.0712] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bart L. Rottier
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Cyril J.P. van Erp
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, The Netherlands
| | | | | | - Henderik W. Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, The Netherlands
| | - Anne H. de Boer
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, The Netherlands
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de Vries TW, Rottier BL, Visserman H, Wilffert B, Weel J. The influence of inhaled corticosteroids and spacer devices on the growth of respiratory pathogenic microorganisms. Am J Infect Control 2009; 37:237-40. [PMID: 18922602 DOI: 10.1016/j.ajic.2008.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 04/28/2008] [Accepted: 05/01/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Guidelines advise weekly cleansing of spacers, with one of the reasons being to prevent the spacers from becoming colonized with respiratory pathogens. Earlier work in clinical settings showed conflicting results. METHODS Common respiratory pathogens and Candida albicans were applied on Petri dishes with and without inhaled corticosteroids and in 3 brands of spacer devices, with and without inhaled corticosteroids. Growth was measured. RESULTS After 24 hours, Staphylococcus aureus grew in 7 of 18 spacers (39%); Pseudomonas aeruginosa grew in 12 out of 18 spacers (67%); and C albicans survived in 5 of 18 spacers (28%). Microorganisms survived on Petri dishes with fluticasone and beclomethasone but not when budesonide was applied. One out of 30 metal Nebuhalers (3%) was colonized after 24 hours, whereas of 30 Volumatics 8 (27%) and Aerochambers, 17 (57%) still had viable microorganisms. Application of inhaled steroids did not affect growth in the spacers. CONCLUSION The colonization of metal spacers is lower than of spacers made of polycarbonate or polyethylene. C albicans can survive in spacers. The survival of microorganisms in spacers is not influenced by inhaled corticosteroids.
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Affiliation(s)
- Tjalling W de Vries
- Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
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de Vries TW, Rottier BL, Gjaltema D, Hagedoorn P, Frijlink HW, de Boer AH. Comparative in vitro evaluation of four corticosteroid metered dose inhalers: Consistency of delivered dose and particle size distribution. Respir Med 2009; 103:1167-73. [PMID: 19269801 DOI: 10.1016/j.rmed.2009.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 02/13/2009] [Accepted: 02/14/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recent developments concerning pressurized metered dose inhalers (pMDIs) with inhaled corticosteroids (ICS) are the introduction of ciclesonide and the replacement of propellants. As the results of in vivo studies depend on pMDIperformance, it is necessary to evaluate pMDIs in vitro for delivered dose and particle size distributions under different conditions. METHODS Fluticasone 125microg, budesonide 200microg, beclomethasone HFA100microg, and ciclesonide 160microg were compared for delivered dose and particle size using laser diffraction analysis with inspiratory flow rates of 10, 20 and 30l/s. RESULTS The volume median diameter of budesonide was 3.5microm, fluticasone 2.8microm, beclomethasone and ciclesonide both 1.9microm. The mouthpiece retention was up to 30% of the nominal dose for beclomethasone and ciclesonide, 11-19% for the other pMDIs. Lifespan, flow rate, and air humidity had no significant influence on particle size distribution. The delivered dose of beclomethasone, budesonide, and ciclesonide remained constant over the lifespan. The delivered dose of fluticasone 125 decreased from 106% to 63%; fluticasone 250 also decreased whereas fluticasone 50 remained constant. CONCLUSIONS There is a significant difference in median particle size distribution between the different ICS pMDIs. Air humidity and inspiratory flow rate have no significant influence on particle size distribution. Ciclesonide 160 and beclomethasone 100 deliver the largest fine particle fractions of 1.1-3.1microm. The changes in delivered dose during the lifespan for the fluticasone 125 and 250 may have implications for patient care.
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Affiliation(s)
- Tjalling W de Vries
- Department of Paediatrics, Medical Centre Leeuwarden, P.O. Box 888, 8901 BR Leeuwarden, The Netherlands.
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Boeve MM, Rottier BL, Mandema J, Ríngs EHHM, Kieboom JKW, Dubois AEJ. [Anaphylaxis in two children caused by peanut and nut allergies; recommendations for treatment]. Ned Tijdschr Geneeskd 2007; 151:602-6. [PMID: 17402653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Two girls aged 12 and 7 years with asthma and peanut and nut allergy developed anaphylactic shock after ingestion of peanuts and nuts from an unreported source. They were both given intramuscular epinephrine. The 12-year-old girl was treated clinically for shock and after two days was discharged from hospital. The 7-year-old girl died. Risk factors for life-threatening anaphylactic reactions are adolescent to young adult age, asthma, previous severe anaphylactic reactions to the food in question, previous reaction to small dose of the food in question and allergy to peanuts or tree nuts. A double-blind, placebo-controlled food challenge should be carried out to document the culprit food. The most important therapeutic intervention is the intramuscular administration of epinephrine. For patients with two or more risk factors the prescription of an epinephrine auto-injector should be considered.
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Affiliation(s)
- M M Boeve
- Universitair Medisch Centrum Groningen, Beatrix Kinderkliniek, Postbus 30.001, 9700 RB Groningen.
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Rottier BL, Cohen J, van der Mark TW, Douma WR, Duiverman EJ, ten Hacken NHT. A different analysis applied to a mathematical model on output of exhaled nitric oxide. J Appl Physiol (1985) 2005; 99:378-9; author reply 379-80. [PMID: 16036910 DOI: 10.1152/japplphysiol.00163.2005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The following is the abstract of the article discussed in the following letter: The relatively recent detection of nitric oxide (NO) in the exhaled breath has prompted a great deal of experimentation in an effort to understand the pulmonary exchange dynamics. There has been very little progress in theoretical studies to assist in the interpretation of the experimental results. We have developed a two-compartment model of the lungs in an effort to explain several fundamental experimental observations. The model consists of a nonexpansile compartment representing the conducting airways and an expansile compartment representing the alveolar region of the lungs. Each compartment is surrounded by a layer of tissue that is capable of producing and consuming NO. Beyond the tissue barrier in each compartment is a layer of blood representing the bronchial circulation or the pulmonary circulation, which are both considered an infinite sink for NO. All parameters were estimated from data in the literature, including the production rates of NO in the tissue layers, which were estimated from experimental plots of the elimination rate of NO at end exhalation (ENO) vs. the exhalation flow rate (V̇e). The model is able to simulate the shape of the NO exhalation profile and to successfully simulate the following experimental features of endogenous NO exchange: 1) an inverse relationship between exhaled NO concentration and V̇E, 2) the dynamic relationship between the phase III slope and V̇E, and 3) the positive relationship between ENO and V̇E. The model predicts that these relationships can be explained by significant contributions of NO in the exhaled breath from the nonexpansile airways and the expansile alveoli. In addition, the model predicts that the relationship between ENO and V̇E can be used as an index of the relative contributions of the airways and the alveoli to exhaled NO.
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de Vries TW, Duiverman EJ, Rottier BL. [When the treatment in children with asthma fails: first other reasons should be sought before prescribing more medication]. Ned Tijdschr Geneeskd 2005; 149:161-4. [PMID: 15702732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In 4 children with asthma symptoms increased. A 13-year-old girl suffered shortness of breath from fear of a man who was making indecent advances; an 8-year-old girl was allergic to the new cat at home; a 6-year-old boy was not inhaling the medication properly; and a 6-year-old girl had tracheomalacia and a vascular ring. After the appropriate treatment policy was implemented, the symptoms reduced or the extra doses of medication were no longer needed. If the treatment of asthma in children is unsuccessful, then therapy compliance and inhalation technique should be assessed first. After that causes of failure can be excluded. Only when this has been done can the dosage of inhalation corticosteroids be increased or other medicines added to the medication therapy.
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Affiliation(s)
- T W de Vries
- Medisch Centrum Leeuwarden, afd. Kindergeneeskunde, Postbus 888, 8901 BR Leeuwarden.
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Duiverman EJ, Brackel HJ, Merkus PJ, Rottier BL, Brand PL. [Guideline 'Treating asthma in children' for pediatric pulmonologists (2nd revised edition). II. Medical treatment]. Ned Tijdschr Geneeskd 2003; 147:1909-13. [PMID: 14560689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The second revision of the guidelines for the treatment of asthma in children is largely based on the evidence of comparative studies. Short-acting beta 2-sympathicomimetics are the medication of choice for acute exacerbations and should therefore be prescribed to each patient. Inhaled corticosteroids (ICS) are the medication of choice for maintenance treatment. Starting with a high dose of ICS which is then reduced to a lower but effective level on the basis of the complaints (step-down approach) is no longer recommended, as this strategy is not more effective than a constant dosage schedule. If asthmatic symptoms persist despite ICS maintenance treatment then 3 therapeutic options are available in the following order: doubling the ICS dose, the addition of a long-acting beta 2-sympathicomimetic, and the addition of a leukotriene receptor antagonist.
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Affiliation(s)
- E J Duiverman
- Academisch Ziekenhuis, Beatrix Kinderkliniek, afd. Kindergeneeskunde, sectie Kinderlongziekten, Postbus 30.001, 9700 RB Groningen.
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Rottier BL, Holl RA, Draaisma JM. [Acute pancreatitis in children]. Ned Tijdschr Geneeskd 1998; 142:385-8. [PMID: 9562770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis is probably commoner in children than was previously thought. In children it is most commonly associated with trauma or viral infection. The presentation may be subtler than in adults, requiring a high index of suspicion in the clinician. In three children, two boys aged 4 and 10 and a girl of 15 years, acute pancreatitis was suspected because of the findings at ultrasonography and endoscopic retrograde cholangiopancreatography performed when the disease recurred (the boy aged 4), apathy and immobility without dehydration or other obvious causes (the boy aged 10), and severe abdominal pain in combination with vomiting (the girl). All three patients had severely increased (urinary) amylase levels. Most often, acute pancreatitis in children tends to be a self-limiting disease which responds well to conservative treatment.
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Affiliation(s)
- B L Rottier
- St. Elisabeth Ziekenhuis, afd. Kindergeneeskunde, Tilburg
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