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Książkiewicz A, Kwilosz E, Fornal R, Dworzańska E. Management and treatment of bronchial asthma in adults and children on the basis of new guidelines. POSTEP HIG MED DOSW 2020. [DOI: 10.5604/01.3001.0014.3290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bronchial asthma is the most common chronic disease in children and adults under 40 years of age. Characteristic symptoms include wheezing, shortness of breath, tightness of the chest and a cough varying in time and intensity. The disease usually begins in childhood and lasts a lifetime, with periods of exacerbation and remission. Asthma can occur at any age, but in approximately 80% of cases the first asthma attack occurs before the age of 5. Over the past
several years, progress in the diagnosis and monitoring of patients with asthma has been
made. In addition to the long-established objective assessment methods, such as functional
tests, rapid asthma control questionnaires recommended for use in daily practice and noninvasive
methods for assessing inflammation have been introduced. The availability of these
methods and their degree of use in routine practice are variable. Taking careful history with
the child and parents is very important. A detailed history is the first and primary step of
asthma recognition. While in the case of adults, the observation period and available methods
usually allow us to make reliable diagnosis of the disease, in younger children the diagnosis is
associated with difficulties resulting from the inability to use some diagnostic tools. The paper
discusses the currently available diagnostic methods and those used for monitoring the disease,
especially the most current ones used in the youngest children. Medications used in asthma
treatment have been characterized, including new therapeutic options, especially biological
treatment. Particular attention was paid to the education of the patient and caregivers, which,
apart from well-established treatment, determines good asthma control.
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Affiliation(s)
| | - Edyta Kwilosz
- Zakład Pielęgniarstwa, Państwowa Wyższa Szkoła Zawodowa w Krośnie
| | - Rafał Fornal
- Oddział Dziecięcy Wojewódzkiego Szpitala Podkarpackiego w Krośnie
| | - Ewa Dworzańska
- Klinika Neurologii Dziecięcej, Uniwersytet Medyczny w Lublinie
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Smit HA, Pinart M, Antó JM, Keil T, Bousquet J, Carlsen KH, Moons KGM, Hooft L, Carlsen KCL. Childhood asthma prediction models: a systematic review. THE LANCET RESPIRATORY MEDICINE 2015; 3:973-84. [PMID: 26597131 DOI: 10.1016/s2213-2600(15)00428-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/26/2022]
Abstract
Early identification of children at risk of developing asthma at school age is crucial, but the usefulness of childhood asthma prediction models in clinical practice is still unclear. We systematically reviewed all existing prediction models to identify preschool children with asthma-like symptoms at risk of developing asthma at school age. Studies were included if they developed a new prediction model or updated an existing model in children aged 4 years or younger with asthma-like symptoms, with assessment of asthma done between 6 and 12 years of age. 12 prediction models were identified in four types of cohorts of preschool children: those with health-care visits, those with parent-reported symptoms, those at high risk of asthma, or children in the general population. Four basic models included non-invasive, easy-to-obtain predictors only, notably family history, allergic disease comorbidities or precursors of asthma, and severity of early symptoms. Eight extended models included additional clinical tests, mostly specific IgE determination. Some models could better predict asthma development and other models could better rule out asthma development, but the predictive performance of no single model stood out in both aspects simultaneously. This finding suggests that there is a large proportion of preschool children with wheeze for which prediction of asthma development is difficult.
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Affiliation(s)
- Henriette A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Mariona Pinart
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - Josep M Antó
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Jean Bousquet
- WHO Collaborating Center for Asthma and Rhinitis, Montpellier, France; University Hospital of Montpellier, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Kai H Carlsen
- Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Dutch Cochrane Centre, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Dutch Cochrane Centre, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Karin C Lødrup Carlsen
- Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
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Abstract
Several population-based birth cohort studies documented that 30% of children suffer from wheezing during respiratory infections before their third birthday. Infants are prone to wheeze because of anatomic factors related to the lung and chest wall in addition to immunologic and molecular influences in comparison to older children. Viral infections lead to immunologic derangements that cause wheezing both in immunocompetent and immunodeficient infants. Anatomic causes of wheeze may be extrinsic or intrinsic to the airway. Not every wheeze is indicative of asthma but prediction of asthma in persistent wheezers is possible. Testing for allergy in these infants is worthwhile and can be of significant value in avoidable allergens. Treatment of an infant with wheezing depends on the underlying etiology. Response to bronchodilators is unpredictable and a trial of inhaled steroids may be warranted in a patient who has responded to multiple courses of oral steroids, has moderate to severe wheezing, or a significant history of atopy including food allergy or eczema. Ribavirin administered by aerosol, hyper-immune respiratory syncytial virus immunoglobulin (RSV IVIG), and intramuscular monoclonal antibody to an RSV protein have been used for RSV bronchiolitis in infants with congenital heart disease or chronic lung disease.
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Affiliation(s)
- Yehia M El-Gamal
- From the Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
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Leonardi NA, Spycher BD, Strippoli MPF, Frey U, Silverman M, Kuehni CE. Validation of the Asthma Predictive Index and comparison with simpler clinical prediction rules. J Allergy Clin Immunol 2011; 127:1466-72.e6. [DOI: 10.1016/j.jaci.2011.03.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 02/25/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
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Castro-Rodriguez JA. The Asthma Predictive Index: a very useful tool for predicting asthma in young children. J Allergy Clin Immunol 2010; 126:212-6. [PMID: 20624655 DOI: 10.1016/j.jaci.2010.06.032] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/20/2010] [Accepted: 06/22/2010] [Indexed: 12/14/2022]
Abstract
Recurrent wheezing is a common problem in young children: approximately 40% of children wheeze in their first year of life. However, only 30% of preschoolers with recurrent wheezing still have asthma at the age of 6 years. Nevertheless, asthma, the most prevalent chronic disease in children, is difficult to diagnose in infants and preschoolers. This article reviews the importance of determining at an early age which infants/preschoolers will have asthma later in life, analyzes the pros and cons of different predictive indices, and discusses the efficacy of the Asthma Predictive Index.
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Affiliation(s)
- Jose A Castro-Rodriguez
- Departments of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Papi A, Nicolini G, Baraldi E, Boner AL, Cutrera R, Rossi GA, Fabbri LM. Regular vs prn nebulized treatment in wheeze preschool children. Allergy 2009; 64:1463-1471. [PMID: 19772514 DOI: 10.1111/j.1398-9995.2009.02134.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND International guidelines recommend regular treatment with inhaled glucocorticoids for children with frequent wheezing; however, prn inhaled bronchodilator alone or in combination with glucocorticoid is also often used in practice. We aimed to evaluate whether regular nebulized glucocorticoid plus a prn bronchodilator or a prn nebulized bronchodilator/glucocorticoid combination is more effective than prn bronchodilator alone in preschool children with frequent wheeze. METHODS Double-blind, double-dummy, randomized, parallel-group trial. After a 2-week run-in period, 276 symptomatic children with frequent wheeze, aged 1-4 years, were randomly assigned to three groups for a 3-month nebulized treatment: (1) 400 microg beclomethasone bid plus 2500 microg salbutamol prn; (2) placebo bid plus 800 microg beclomethasone/1600 microg salbutamol combination prn; (3) placebo bid plus 2500 microg salbutamol prn. The percentage of symptom-free days was the primary outcome measure. Secondary outcomes included symptom scores, use of relief medication and exacerbation frequency. RESULTS As compared with prn salbutamol (61.0 +/- 24.83 [SD]), the percentage of symptom-free days was higher with regular beclomethasone (69.6%, SD 20.89; P = 0.034) but not with prn combination (64.9%, SD 24.74). Results were no different in children with or without risk factors for developing persistent asthma. The effect of prn combination was no different from that of regular beclomethasone on the primary and on several important secondary outcomes. CONCLUSIONS Regular inhaled glucocorticoid is the most effective treatment for frequent wheezing in preschool children. However, prn bronchodilator/glucocorticoid combination might be an alternative option, but it requires further study.
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Affiliation(s)
- A. Papi
- Department of Respiratory Diseases, Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - G. Nicolini
- Medical Department, Chiesi Farmaceutici, Parma, Italy
| | - E. Baraldi
- Department of Pediatrics, Unit of Allergy and Respiratory Medicine, University of Padova, Padova, Italy
| | - A. L. Boner
- Department of Pediatrics, University of Verona, Verona, Italy
| | - R. Cutrera
- Respiratory Unit, Department of Pediatrics, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - G. A. Rossi
- Department of Pediatrics, Ospedale Gaslini, Genova, Italy
| | - L. M. Fabbri
- Department of Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
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