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Kennedy AA, Anne S, Hart CK. Otolaryngologic Management of Chronic Cough in School-aged Children: A Review. JAMA Otolaryngol Head Neck Surg 2020; 146:1059-1064. [PMID: 33022062 DOI: 10.1001/jamaoto.2020.2945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The causes of pediatric chronic cough are numerous and span across several medical subspecialties. In addition to the vast array of underlying causes, there are also several different ways to approach and evaluate chronic cough. Given the frequency with which children present to otolaryngology clinics with this problem, a review of common otolaryngologic causes and an algorithm for evaluation and treatment can be beneficial. Observations The primary 3 causes of pediatric chronic cough presenting to an otolaryngologist include infectious causes, reflux, and airway hyperreactivity. In these cases and other instances of specific cough, treatment should be directed at the underlying cause-which may include supportive care, antibiotics, antireflux medication, bronchodilators, inhaled steroids, or other intervention. Patients with nonspecific cough should be treated according to pediatric-specific cough algorithms. Conclusions and Relevance Appropriate workup and treatment of chronic cough can lead to higher cure rates, shorter cough duration, and improved quality of life for both patients and caregivers. A systematic approach using cough algorithms can help otolaryngologists effectively manage this common yet complex problem.
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Affiliation(s)
- Aimee A Kennedy
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Samantha Anne
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio.,Section Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Sessa M, Mascolo A, D'Agostino B, Casciotta A, D'Agostino V, Michele FD, Polverino M, Spaziano G, Andersen MP, Kragholm K, Rossi F, Torp-Pedersen C, Capuano A. Relationship Between Gender and the Effectiveness of Montelukast: An Italian/Danish Register-Based Retrospective Cohort Study. Front Pharmacol 2018; 9:844. [PMID: 30116192 PMCID: PMC6083053 DOI: 10.3389/fphar.2018.00844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/13/2018] [Indexed: 11/13/2022] Open
Abstract
Rationale: Gender-related differences in asthma prevalence, pathophysiology and clinical features induced by sex steroids have been investigated, however, how gender influences response to asthma treatments in routine clinical practice have not yet been elucidated fully. This aspect is crucial for montelukast considering the jeopardization of asthmatic patients that benefit from this treatment and the existence of evidence of gender differences in leukotriene levels. Therefore, to fulfill this medical need, we investigated the role of gender on a set of montelukast' effectiveness surrogates in adults and pediatric patients with asthma. Methods: The study settings were Napoli 2 Local Health Unit (southern Italy) and the entire Danish territory. The study population was composed of adult and pediatric patients with asthma. Cumulative incidence curves, unadjusted and adjusted Cox regression were used as statistical models to compare aforementioned outcomes between genders. Results: Adult Italian male users of montelukast had a statistically lower persistence in montelukast treatment compared to female users. In the adjusted analyses, they had a higher hazard of montelukast' withdrawal (Hazard Ratio [HR] 1.07; 95% Confidence Interval [CI] 1.01-1.14), add-on/switch to a long-term treatment for asthma following montelukast withdrawal (HR 1.72; 95%CI 1.39-2.12), and rescue therapy with short-acting β2 agonist (HR 1.24; 95%CI 1.04-1.47). In the adult Danish cohort, we also found that male users had higher a hazard of rescue therapy with oral corticosteroids (HR 1.10; 95%CI 1.04-1.16). In the pediatric cohorts, no statistically significant differences were observed between genders for aforementioned outcomes. Conclusions: In adults, male gender was associated with increased hazards of montelukast discontinuation, add-on/switch to a long-term treatment for asthma following montelukast withdrawal, and rescue therapy with oral corticosteroids or short-acting β2 agonist when compared to the female gender. As expected, these associations were reversed or absent in pediatric patients.
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Affiliation(s)
- Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Annamaria Mascolo
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Bruno D'Agostino
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Casciotta
- Local Health Unit Napoli Second, Department of Pharmaceutical, Naples, Italy
| | - Vincenzo D'Agostino
- Local Health Unit Napoli Second, Department of Pharmaceutical, Naples, Italy
| | | | - Mario Polverino
- Department of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati, Italy
| | - Giuseppe Spaziano
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Kristian Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Francesco Rossi
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.,Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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Bernstein DI, Schwartz G, Bernstein JA. Allergic Rhinitis: Mechanisms and Treatment. Immunol Allergy Clin North Am 2016; 36:261-78. [PMID: 27083101 DOI: 10.1016/j.iac.2015.12.004] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The prevalence of allergic rhinitis (AR) has been estimated at 10% to 40%, and its economic burden is substantial. AR patients develop specific immunoglobulin E (IgE) antibody responses to indoor and outdoor environmental allergens with exposure over time. These specific IgE antibodies bind to high-affinity IgE receptors on mast cells and basophils. Key outcome measures of therapeutic interventions include rhinitis symptom control, rescue medication requirements, and quality-of-life measures. A comprehensive multiple modality treatment plan customized to the individual patient can optimize outcomes.
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Affiliation(s)
- David I Bernstein
- Division of Immunology and Allergy, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Gene Schwartz
- Division of Immunology and Allergy, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan A Bernstein
- Division of Immunology and Allergy, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Lee QU. Fractional exhaled nitric oxide-guided algorithm for children with asthma. Pediatr Pulmonol 2015; 50:932-3. [PMID: 25327828 DOI: 10.1002/ppul.23115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/01/2014] [Indexed: 11/07/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) is a surrogate marker of eosinophilic airway inflammation in asthma. The randomized controlled parallel study published by Peirsman et al combined GINA guidelines and FeNO level in guiding drug treatment in children with mild to severe asthma. Their target was to control the FeNO level below 20 ppb. The FeNO group resulted in increasing the dosage of inhaled corticosteroid and the usage of leukotriene receptor antagonist. However, the study was not truly randomized and drug adherence was not reported. The FeNO-guided algorithm failed to improve the primary outcome, the symptom-free days, but did result in decreasing the number of acute exacerbations and unscheduled contacts. Unfortunately the authors did not demonstrate a persistent and significant difference in FeNO levels between both groups. As the final FeNO levels were not reported, it remains unclear whether their target was met.
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Affiliation(s)
- Qun Ui Lee
- Department of Paediatrics & Adolescent Medicine, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong
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Stelmach I, Ożarek-Hanc A, Zaczeniuk M, Stelmach W, Smejda K, Majak P, Jerzynska J, Anna J. Do children with stable asthma benefit from addition of montelukast to inhaled corticosteroids: randomized, placebo controlled trial. Pulm Pharmacol Ther 2015; 31:42-8. [PMID: 25640020 DOI: 10.1016/j.pupt.2015.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 12/02/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND To determine the effects of montelukast added to maintenance inhaled steroids (ICS) therapy during the school year in children with stable asthma on the ICS use, frequency of exacerbations, lung function, asthma symptoms, fractional exhaled nitric oxide (FeNO) level and exercise-induced bronchoconstriction (EIB). METHODS Seventy six asthmatic children aged 6-14 years, allergic to house dust mites were randomized to a double-blinded trial comparing montelukast therapy to a matching placebo. We studied following end-points: the reduction in the ICS dose, the frequency of exacerbations, lung function, asthma control test score, and the change from baseline in FEV1 during a standardized exercise treadmill challenge. ICS dose was adjusted in a stepwise fashion to determine the lowest dose necessary to control asthma symptoms. RESULTS We showed that children with baseline value of FeNO above 31 ppb and well controlled asthma symptoms on low doses of ICS, benefit the most from additive therapy with montelukast; their cumulative ICS dose is lower than in children treated with ICS only. Also, the addition of montelukast to regular treatment in asthmatic children resulted in a significant reduction in the frequency of exacerbations and EIB protection. CONCLUSION It is reasonable to add montelukast to ICS therapy in asthmatic children during the school year, to lower cumulative ICS dose in children with well controlled asthma symptoms, as well as to reduce number of exacerbations, and to achieve better control of EIB. TRIAL REGISTRATION NCT01266772.
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Affiliation(s)
- Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland.
| | - Agata Ożarek-Hanc
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Magdalena Zaczeniuk
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Wlodzimierz Stelmach
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Smejda
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Pawel Majak
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Joanna Jerzynska
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Janas Anna
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland; Institute of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Lodz, Poland
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