1
|
Chacorowski ARP, Lima VDO, Menezes E, Teixeira JJV, Bertolini DA. Acute viral bronchiolitis phenotype in response to glucocorticoid and bronchodilator treatment. Clinics (Sao Paulo) 2024; 79:100396. [PMID: 38843677 PMCID: PMC11215958 DOI: 10.1016/j.clinsp.2024.100396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To analyze whether infants admitted to hospital with Acute Viral Bronchiolitis (AVB), who received glucocorticoids and bronchodilators, and who had an atopic phenotype, spent less time in hospital and/or less time on oxygen therapy when compared to those who did not have the phenotype. METHOD A cross-sectional, retrospective epidemiological study was developed with data from medical records of infants admitted to hospital due to AVB from 2012 to 2019 in a sentinel public hospital. It was verified that the frequency of prescription of glucocorticoids, bronchodilators and antibiotics. Length of stay and oxygen therapy duration were then compared in the group that used glucocorticoids and bronchodilators between those who had a personal or family history of atopy and those who did not. Subsequently, the length of hospital stay was compared among infants who received antibiotic therapy and those who did not. RESULTS Fifty-eight infants were included. Of these, 62.1 % received an antibiotic, 100 % a bronchodilator and 98.3 % a glucocorticoid. When comparing infants without a family history of atopy, those who received antibiotics had a longer hospital stay (p = 0.01). CONCLUSION The presence of an atopic phenotype did not interfere with the length of stay and/or oxygen therapy duration of those who received bronchodilators and glucocorticoids. Increased length of stay of infants without a family history of atopy, who used antibiotics without evidence of bacterial co-infection, and the high frequency of prescription of non-recommended drugs call attention to stricter protocol implementation and professional training in AVB diagnosis and care.
Collapse
|
2
|
Weis A, Hailey C. Bronchiolitis: Safely Doing Less Is the Next Big Thing. Pediatr Ann 2024; 53:e223-e228. [PMID: 38852076 DOI: 10.3928/19382359-20240407-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Bronchiolitis is a viral lower respiratory tract infection primarily affecting children younger than 2 years; a common cause of health care encounters, including hospitalization; and a considerable economic burden for health care systems in the United States and worldwide. The American Academy of Pediatrics (AAP) most recently updated its bronchiolitis guideline in 2014 and reaffirmed supportive care as the mainstay of treatment. Despite these recommendations, there is still significant variability in care provided for these children, especially in bronchodilator usage, radiography, and high-flow nasal cannula. Since the 2014 AAP guideline, many pediatric hospitalists have undertaken quality initiatives to improve the adherence to published guidelines, yet a large gap remains between what is recommended and what is practiced. This article presents research on the efficacy of common interventions as well as an introduction to diagnostics and treatments potentially on the horizon. [Pediatr Ann. 2024;53(6):e223-e228.].
Collapse
|
3
|
Buendía JA, Salazar AFZ. Genotype-driven asthma prescribing of inhaled corticosteroids and long-acting β2-agonist: A cost-effectiveness analysis. Pediatr Pulmonol 2024. [PMID: 38661231 DOI: 10.1002/ppul.27037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/17/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Predicting response to inhaled corticosteroids (ICSs) + long-acting β2-agonist (LABA) by previously detecting the presence of Arg16Gly ADRB2 genotype is a strategy that could reduce and optimize the management of asthmatic patients. There is a need for economic evaluations to facilitate the implementation of such tests. This research aims to evaluate the cost-effectiveness of Arg16Gly ADRB2 screening in children with asthma in Colombia. METHODS From the perspective of a third-party payer, we conducted a cost-effectiveness analysis to determine the cost and quality-adjusted life-years (QALYs) of genotype-driven asthma prescribing based on the Arg16Gly ADRB2 genotype versus current treatment based on no genetic testing. Using four state-transition models, we estimate cost and QALYs employing micro-simulation modeling with a time horizon of 10 years and a cycle length of 1 week. Cost-effectiveness was assessed at a willingness-to-pay (WTP) value of US$5180. RESULTS The mean incremental cost of strategy genetic testing versus no genetic testing is US$ -6809. The mean incremental benefit of strategy genetic testing is 16 QALYs. The incremental net monetary benefit of strategic genetic testing versus no genetic testing is US$ 88,893. Genetic testing is the strategy with the highest expected net benefit. The outcomes derived from our primary analysis remained robust when subjected to variations in all underlying assumptions and parameter values. CONCLUSION Genetic testing of Arg16Gly ADRB2 is a cost-effective strategy to address asthma management in asthmatic children requiring ICS+LABA. This result should encourage the generation of more evidence and the incorporation of such evidence into clinical practice guidelines for pediatric asthma.
Collapse
Affiliation(s)
- Jefferson Antonio Buendía
- Research Group in Pharmacology and Toxicology, Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Andrés Felipe Zuluaga Salazar
- Research Group in Pharmacology and Toxicology, Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
- Laboratorio Integrado de Medicina Especializada (LIME), Facultad de Medicina, IPS Universitaria, Universidad de Antioquia, Antioquia, Colombia
| |
Collapse
|
4
|
De Luca D, Pezza L, Vivalda L, Di Nardo M, Lepainteur M, Baraldi E, Piastra M, Ricciardi W, Conti G, Gualano MR. Critical care of severe bronchiolitis during shortage of ICU resources. EClinicalMedicine 2024; 69:102450. [PMID: 38333363 PMCID: PMC10850123 DOI: 10.1016/j.eclinm.2024.102450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Large seasonal outbreaks of bronchiolitis put pressure on healthcare systems and particularly on intensive care units (ICUs). ICU admission is necessary to provide respiratory support to the severest cases, otherwise bronchiolitis can result in substantial mortality. ICU resources are often insufficient and there is scant evidence to guide the ICU clinical management. Most available studies do not cover the ICU-admitted cases and do not consider the associated public health issues. We review this topic through a multidisciplinary approach from both the clinical and public health perspectives, with an analysis based on pathophysiology and cost-effectiveness. We suggest ways to optimise respiratory care, minimise ICU stay, "protect" ICU beds and, whenever possible, make them available for other critically ill children. We also provide guidance on how to prepare ICUs to work under stressful conditions due to outbreaks and to reduce the risk of nosocomial cross-contamination, particularly in ICUs caring for high-risk children. Funding None.
Collapse
Affiliation(s)
- Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, “A. Béclère” Hospital, APHP-Paris Saclay University, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Lucilla Pezza
- Division of Paediatrics and Neonatal Critical Care, “A. Béclère” Hospital, APHP-Paris Saclay University, Paris, France
| | - Laura Vivalda
- Division of Paediatrics and Neonatal Critical Care, “A. Béclère” Hospital, APHP-Paris Saclay University, Paris, France
| | - Matteo Di Nardo
- Paediatric Intensive Care Unit, “Bambino Gesù” Children's Hospital-IRCCS, Rome, Italy
| | - Margaux Lepainteur
- Division of Bacteriology-Hygiene, “A. Béclère” Hospital, APHP-Paris Saclay University, Paris, France
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
- Respiratory Syncytial Virus Network (RESVINET) Foundation, Zeist, the Netherlands
| | - Marco Piastra
- Paediatric Intensive Care Unit, “A. Gemelli” University Hospital Foundation-IRCCS, Rome, Italy
- Department of Biotechnological Sciences, Intensive and Perioperative Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Walter Ricciardi
- Leadership Research Centre, Catholic University of Sacred Heart, Rome, Italy
| | - Giorgio Conti
- Paediatric Intensive Care Unit, “A. Gemelli” University Hospital Foundation-IRCCS, Rome, Italy
- Department of Biotechnological Sciences, Intensive and Perioperative Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Rosaria Gualano
- UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| |
Collapse
|
5
|
Pittet LF, Glangetas A, Barazzone-Argiroffo C, Gervaix A, Posfay-Barbe KM, Galetto-Lacour A, Stollar F. Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study. PLoS One 2023; 18:e0285626. [PMID: 37200253 DOI: 10.1371/journal.pone.0285626] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/26/2023] [Indexed: 05/20/2023] Open
Abstract
The latest guideline from the American Academy of Pediatrics for the management of bronchiolitis has helped reduce unnecessary interventions and costs. However, data on patients still receiving interventions are missing. In patients with acute bronchiolitis whose management was assessed and compared with current achievable benchmarks of care, we aimed to identify factors associated with nonadherence to guideline recommendations. In this single-centre retrospective study the management of bronchiolitis pre-guideline (Period 1: 2010 to 2012) was compared with two periods post-guideline (Period 2: 2015 to 2016, early post-guideline; and Period 3: 2017 to 2018, late post-guideline) in otherwise healthy infants aged less than 1 year presenting at the Children's University Hospitals of Geneva (Switzerland). Post-guideline, bronchodilators were more frequently administered to older (>6 months; OR 25.8, 95%CI 12.6-52.6), and atopic (OR 3.5, 95%CI 1.5-7.5) children with wheezing (OR 5.4, 95%CI 3.3-8.7). Oral corticosteroids were prescribed more frequently to older (>6 months; OR 5.2, 95%CI 1.4-18.7) infants with wheezing (OR 4.9, 95% CI 1.3-17.8). Antibiotics and chest X-ray were more frequently prescribed to children admitted to the intensive care unit (antibiotics: OR 4.2, 95%CI 1.3-13.5; chest X-ray: OR 19.4, 95%CI 7.4-50.6). Latest prescription rates were all below the achievable benchmarks of care. In summary, following the latest American Academy of Pediatrics guideline, older, atopic children with wheezing and infants admitted to the intensive care unit were more likely to receive nonevidence-based interventions during an episode of bronchiolitis. These patient profiles are generally excluded from bronchiolitis trials, and therefore not specifically covered by the current guideline. Further research should focus on the benefit of bronchiolitis interventions in these particular populations.
Collapse
Affiliation(s)
- Laure F Pittet
- Division of General Pediatrics, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
| | - Alban Glangetas
- Division of Pediatric Emergency, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
| | - Constance Barazzone-Argiroffo
- Unit of Pediatric Pulmonology, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
| | - Alain Gervaix
- Division of Pediatric Emergency, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Division of General Pediatrics, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Pediatric Emergency, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
| | - Fabiola Stollar
- Division of General Pediatrics, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|
6
|
Bottau P, Liotti L, Laderchi E, Palpacelli A, Calamelli E, Colombo C, Serra L, Cazzato S. Something Is Changing in Viral Infant Bronchiolitis Approach. Front Pediatr 2022; 10:865977. [PMID: 35498813 PMCID: PMC9047867 DOI: 10.3389/fped.2022.865977] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Acute Viral Bronchiolitis is one of the leading causes of hospitalization in the first 12-24 months of life. International guidelines on the management of bronchiolitis broadly agree in recommending a minimal therapeutic approach, not recommending the use of bronchodilators. Guidelines, generally, consider bronchiolitis as a "unique disease" and this runs the risk of not administering therapy in some patients who could benefit from the use of bronchodilators, for instance, in those who will develop asthma later in their life and face first episode in the age of bronchiolitis. Today, there is growing evidence that bronchiolitis is not a single illness but can have different "endotypes" and "phenotypes," based on age, personal or family history of atopy, etiology, and pathophysiological mechanism. There is evidence that some phenotypes of bronchiolitis are more strongly associated with asthma features and are linked to higher risk for asthma development. In these populations, possible use of bronchodilators might have a better impact. Age seems to be the main feature to suggest a good response to a bronchodilator-trial, because, among children > 6 months old with bronchiolitis, the presence of a subset of patients with virus-induced wheezing or the first episode of asthma is more likely. While waiting for new research to define the relationship between therapeutic options and different phenotypes, a bronchodilator-trial (using short-acting β2 agonists with metered-dose inhalers and valved holding chambers) seems appropriate in every child with bronchiolitis and age > 6 months.
Collapse
Affiliation(s)
- Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, Imola, Italy
| | - Lucia Liotti
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Eleonora Laderchi
- Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy
| | - Alessandra Palpacelli
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Carlotta Colombo
- Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy
| | - Laura Serra
- Pediatric and Neonatology Unit, Imola Hospital, Imola, Italy
| | - Salvatore Cazzato
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| |
Collapse
|