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Cha JH, Hwang JK, Na JY, Ryu S, Oh JW, Choi YJ. Association between preterm birth and asthma and atopic dermatitis in preschool children: a nationwide population-based study. Eur J Pediatr 2024:10.1007/s00431-024-05747-5. [PMID: 39394496 DOI: 10.1007/s00431-024-05747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/30/2024] [Accepted: 08/26/2024] [Indexed: 10/13/2024]
Abstract
Asthma and atopic dermatitis (AD) are representative chronic diseases in childhood. This study aimed to investigate the impact of preterm birth on the incidence and severity of asthma and AD in children, as well as to identify neonatal risk factors for asthma and AD. We used health claims data recorded between 2007 and 2014 in the Korean National Health Insurance Service database. We recruited 2,224,476 infants born between 2007 and 2014 and divided them into three groups: 3518 of extremely preterm (EP) infants (< 28 weeks of gestational age (GA)), 82,579 of other preterm (OP) infants (28-36 weeks of GA), and 2,138,379 of full-term (FT) infants (> 37 weeks of GA). We defined asthma as > 3 episodes of clinical visits in a year before 6 years of age, early asthma as onset at < 2 years of age, and severe asthma as > 1 event of status asthmaticus or admission to a hospital via an emergency room. AD was defined as ≥ 3 diagnoses in a year before 6 years of age, early AD as onset at < 2 years of age, and severe AD as prescription of high-potency topical steroids or immunosuppressants. An association of preterm birth with asthma and AD was assessed using inverse probability of treatment-weighted multivariable Cox regression analysis. Cardiorespiratory conditions, such as respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, and pulmonary hypertension, significantly increased the risk of asthma. Specifically, bronchopulmonary dysplasia emerged as a significant risk factor for both severe and early-onset asthma (odds ratio (OR) 1.36, 95% CI 1.21-1.37 for severe asthma; OR 1.55, 95% CI 1.30-1.85 for early asthma), while it was associated with a decreased risk of AD (OR 0.86, 95% CI 0.80-0.92). Neonatal sepsis, jaundice, and retinopathy of prematurity were also identified as significant risk factors for later asthma. A stepwise increase in the risk of asthma with an increasing degree of prematurity was observed, with the OP group showing an adjusted hazard ratio (aHR) of 1.24 (95% CI: 1.22-1.26) and the EP group showing an aHR of 1.51 (95% CI: 1.41-1.63). Conversely, preterm birth was inversely associated with the risk of AD, with aHRs of 0.73 (95% CI: 0.67-0.79) for the OP group and 0.88 (95% CI: 0.87-0.89) for the EP group. Conclusion Preterm children have a significantly higher risk of asthma and lower risk of AD, with cardiorespiratory conditions significantly increasing the risk of asthma. Thus, we highlight the need for targeted respiratory management strategies for this high-risk population. What is Known: •Asthma and atopic dermatitis are prevalent chronic diseases in childhood, reducing the quality of life of children. •Preterm birth was associated with an increased risk of asthma, but few large nationwide studies. •Research on the relationship between preterm birth and pediatric atopic dermatitis is controversial, with few large nationwide studies. What is New: • Preterm children, especially born before 28 weeks of gestational age, had a significantly higher risk of asthma and lower risk of atopic dermatitis. • Cardiorespiratory comorbidities such as RDS, BPD, PDA, and pulmonary hypertension in neonatal period are prominent risk factors for asthma. • Preterm children are vulnerable to both early-onset and severe asthma.
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Affiliation(s)
- Jong Ho Cha
- Department of Pediatrics, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Kyoon Hwang
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
| | - Soorak Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
| | - Young-Jin Choi
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea.
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2
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Titus AR, Terlizzi K, Conderino S, Ðoàn LN, Kim B, Thorpe LE. Patterns and drivers of disparities in pediatric asthma outcomes among Medicaid-enrolled children living in subsidized housing in NYC. Prev Med 2024; 185:108023. [PMID: 38908569 DOI: 10.1016/j.ypmed.2024.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE There are persistent disparities in pediatric asthma morbidity in the U.S. We linked claims data with information on neighborhood-level risk factors to explore drivers of asthma disparities among Medicaid-enrolled children in New York City subsidized housing. METHODS We constructed a cohort of Medicaid-enrolled children living in public or other subsidized housing, based on residential address, in NYC between 2016 and 2019 (n = 108,969). We examined claims-derived asthma prevalence across age and racial and ethnic groups, integrating census tract-level information and using the Bayesian Improved Surname Geocoding (BISG) algorithm to address high rates of missing data in self-reported race and ethnicity. We used inverse probability weighting (IPW) to explore the extent to which disparities persisted when exposure to asthma risk factors - related to the built environment, neighborhood poverty, and air quality - were balanced across groups. This analysis was conducted in 2022-2023. RESULTS Claims-derived asthma prevalence was highest among children <7 years at baseline and among non-Hispanic Black and Hispanic children. For example, among children aged 3-6 years at baseline, claims-derived prevalence was 17.3% and 18.1% among non-Hispanic Black and Hispanic children, respectively, compared to 9.3% and 9.0% among non-Hispanic White and non-Hispanic Asian American/Pacific Islander children. Using IPW to balance exposure to asthma risk factors across racial and ethnic groups attenuated, but did not eliminate, disparities in asthma prevalence. CONCLUSIONS We found high asthma burden among children living in subsidized housing. Modifiable place-based characteristics may be important contributors to pediatric asthma disparities.
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Affiliation(s)
- Andrea R Titus
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America.
| | - Kelly Terlizzi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sarah Conderino
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Lan N Ðoàn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
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Makkad H, Saini A, Manning ER, Duan Q, Colegate S, Brokamp C. Racial Fairness of Individual- and Community-Level Proxies of Socioeconomic Status Among Birthing Parent-Child Dyads. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02050-9. [PMID: 38918321 DOI: 10.1007/s40615-024-02050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/17/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND While precision medicine algorithms can be used to improve health outcomes, concerns have been raised about racial equity and unintentional harm from encoded biases. In this study, we evaluated the fairness of using common individual- and community-level proxies of pediatric socioeconomic status (SES) such as insurance status and community deprivation index often utilized in precision medicine algorithms. METHODS Using 2012-2021 vital records obtained from the Ohio Department of Health, we geocoded and matched each residential birth address to a census tract to obtain community deprivation index. We then conducted sensitivity and specificity analyses to determine the degree of match between deprivation index, insurance status, and birthing parent education level for all, Black, and White children to assess if there were differences based on race. RESULTS We found that community deprivation index and insurance status fail to accurately represent individual SES, either alone or in combination. We found that deprivation index had a sensitivity of 61.2% and specificity of 74.1%, while insurance status had a higher sensitivity of 91.6% but lower specificity of 60.1%. Furthermore, these inconsistencies were race-based across all proxies evaluated, with greater sensitivities for Black children but greater specificities for White children. CONCLUSION This may explain some of the racial disparities present in precision medicine algorithms that utilize SES proxies. Future studies should examine how to mitigate the biases introduced by using SES proxies, potentially by incorporating additional data on housing conditions.
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Affiliation(s)
| | - Amisha Saini
- University of Cincinnati College of Medicine, Cincinnati, USA
| | - Erika Rasnick Manning
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45219, USA
| | - Qing Duan
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45219, USA
| | - Stephen Colegate
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45219, USA
| | - Cole Brokamp
- University of Cincinnati College of Medicine, Cincinnati, USA.
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45219, USA.
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4
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Al-Moamary MS, Alhaider SA, Allehebi R, Idrees MM, Zeitouni MO, Al Ghobain MO, Alanazi AF, Al-Harbi AS, Yousef AA, Alorainy HS, Al-Hajjaj MS. The Saudi initiative for asthma - 2024 update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2024; 19:1-55. [PMID: 38444991 PMCID: PMC10911239 DOI: 10.4103/atm.atm_248_23] [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: 10/01/2023] [Accepted: 10/31/2023] [Indexed: 03/07/2024] Open
Abstract
The Saudi Initiative for Asthma 2024 (SINA-2024) is the sixth version of asthma guidelines for the diagnosis and management of asthma for adults and children that was developed by the SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up-to-date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA Panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is aligned for age groups: adults, adolescents, children aged 5-12 years, and children aged <5 years. SINA guidelines have focused more on personalized approaches reflecting a better understanding of disease heterogeneity with the integration of recommendations related to biologic agents, evidence-based updates on treatment, and the role of immunotherapy in management. The medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and the current situation at national and regional levels. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan.
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Affiliation(s)
- Mohamed Saad Al-Moamary
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami A. Alhaider
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riyad Allehebi
- Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majdy M. Idrees
- Department of Medicine, Respiratory Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed O. Al Ghobain
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah F. Alanazi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Adel S. Al-Harbi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah A. Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan S. Alorainy
- Department of Respiratory Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Paediatrics, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Donath H, Klenner H, Hutter M, Meoli A, Trischler J, Schulze J, Blumchen K, Zielen S. Severe bronchial hyperresponsiveness along with house dust mite allergy indicates persistence of asthma in young children. Pediatr Allergy Immunol 2023; 34:e14047. [PMID: 38146109 DOI: 10.1111/pai.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Significant risk factors for persistence of asthma later in life are family history of allergies, early allergic sensitization and bronchial hyperresponsiveness (BHR). The evolution of BHR in young children without allergic sensitization and with house dust mite allergy (HDM) was investigated. METHODS In this retrospective analysis, electronic charts of 4850 young children with asthma and wheezy bronchitis between 2005 and 2018 were reviewed in order to study all patients ≤6 years with BHR assessed by methacholine provocation tests (MCT) at least once (n = 1175). Patients with more than two follow-up measurements were divided in group 1 (no allergic sensitization; n = 110) and group 2 (HDM allergy; n = 88). Additionally, skin prick test, exhaled nitrite oxide (eNO), and asthma treatment were analyzed. RESULTS Forty-seven patients of group 1 aged median 4.3 years and 48 patients of group 2 aged median 4.7 years showed initially severe BHR <0.1 mg. At follow-up, patients with HDM were more likely to show persistence of severe BHR than non-sensitized patients (severe BHR group 1: n = 5 (10.6%) vs. group 2: n = 21 (43.8%), p < .001). In addition, 89.4% of group 1 had mild to moderate or no BHR, compared to only 56.2% of group 2. There was a significant difference in eN0 (median group 1: 9 ppb vs. group 2: 26 ppb, p < .001), at last follow-up. Age, sex, and asthma therapy had no effect on BHR. CONCLUSION In young children without sensitization BHR normalizes, whereas HDM allergy indicates a persistence of asthma beyond infancy.
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Affiliation(s)
- Helena Donath
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Hans Klenner
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Martin Hutter
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Aniello Meoli
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Jordis Trischler
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Johannes Schulze
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Katharina Blumchen
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Zielen
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Institute for Respiratory Diseases, Medaimun GmbH, Frankfurt, Germany
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Farhan AJ, Kothalawala DM, Kurukulaaratchy RJ, Granell R, Simpson A, Murray C, Custovic A, Roberts G, Zhang H, Arshad SH. Prediction of adult asthma risk in early childhood using novel adult asthma predictive risk scores. Allergy 2023; 78:2969-2979. [PMID: 37661293 PMCID: PMC10840748 DOI: 10.1111/all.15876] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Numerous risk scores have been developed to predict childhood asthma. However, they may not predict asthma beyond childhood. We aim to create childhood risk scores that predict development and persistence of asthma up to young adult life. METHODS The Isle of Wight Birth Cohort (n = 1456) was prospectively assessed up to 26 years of age. Asthma predictive scores were developed based on factors during the first 4 years, using logistic regression and tested for sensitivity, specificity and area under the curve (AUC) for prediction of asthma at (i) 18 and (ii) 26 years, and persistent asthma (PA) (iii) at 10 and 18 years, and (iv) at 10, 18 and 26 years. Models were internally and externally validated. RESULTS Four models were generated for prediction of each asthma outcome. ASthma PredIctive Risk scorE (ASPIRE)-1: a 2-factor model (recurrent wheeze [RW] and positive skin prick test [+SPT] at 4 years) for asthma at 18 years (sensitivity: 0.49, specificity: 0.80, AUC: 0.65). ASPIRE-2: a 3-factor model (RW, +SPT and maternal rhinitis) for asthma at 26 years (sensitivity: 0.60, specificity: 0.79, AUC: 0.73). ASPIRE-3: a 3-factor model (RW, +SPT and eczema at 4 years) for PA-18 (sensitivity: 0.63, specificity: 0.87, AUC: 0.77). ASPIRE-4: a 3-factor model (RW, +SPT at 4 years and recurrent chest infection at 2 years) for PA-26 (sensitivity: 0.68, specificity: 0.87, AUC: 0.80). ASPIRE-1 and ASPIRE-3 scores were replicated externally. Further assessments indicated that ASPIRE-1 can be used in place of ASPIRE-2-4 with same predictive accuracy. CONCLUSION ASPIRE predicts persistent asthma up to young adult life.
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Affiliation(s)
- Abdal J. Farhan
- The David Hide Asthma and Allergy Research CentreSt. Mary's HospitalIsle of WightUK
- Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Dilini M. Kothalawala
- NIHR Biomedical Research CentreUniversity Hospital SouthamptonSouthamptonUK
- Human Development and Health, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Ramesh J. Kurukulaaratchy
- The David Hide Asthma and Allergy Research CentreSt. Mary's HospitalIsle of WightUK
- Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- NIHR Biomedical Research CentreUniversity Hospital SouthamptonSouthamptonUK
| | - Raquel Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological SciencesThe University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation TrustManchesterUK
| | - Clare Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological SciencesThe University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation TrustManchesterUK
| | - Adnan Custovic
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Graham Roberts
- The David Hide Asthma and Allergy Research CentreSt. Mary's HospitalIsle of WightUK
- Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- NIHR Biomedical Research CentreUniversity Hospital SouthamptonSouthamptonUK
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - S. Hasan Arshad
- The David Hide Asthma and Allergy Research CentreSt. Mary's HospitalIsle of WightUK
- Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- NIHR Biomedical Research CentreUniversity Hospital SouthamptonSouthamptonUK
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Seddon PC, Willson R, Olden C, Symes E, Lombardi E, Beydon N. Bronchodilator response by interrupter technique to guide management of preschool wheeze. Arch Dis Child 2023; 108:768-773. [PMID: 37258055 DOI: 10.1136/archdischild-2022-324496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We examined relationships between clinical features and pulmonary function before and after inhaled corticosteroid (ICS) treatment in wheezy preschool children, and specifically, whether measuring bronchodilator response (BDR) could predict benefit from ICS. DESIGN Clinical non-randomised intervention study SETTING: Secondary care. PATIENTS Preschool children (2 years to <6 years) with recurrent wheeze. INTERVENTIONS Inhaled beta-agonist, ICS. OUTCOME MEASURES We measured prebronchodilator and postbronchodilator interrupter resistance (Rint) and symptom scores at 0 (V1), 4 (V2) and 12 (V3) weeks. At V2, those with a predetermined symptom level commenced ICS. Modified Asthma Predictive Index (mAPI) and parental perception of response to bronchodilator were recorded. Response to ICS was defined as a reduction in daily symptom score of >0.26. Positive BDR was defined as fall in Rint of ≥0.26 kPa.s/L, ≥35% predicted or ≥1.25 Z Scores. RESULTS Out of 138 recruited children, 67 completed the full study. Mean (SD) prebronchodilator Rint at V2 was 1.22 (0.35) kPa.s/L, and fell after starting ICS (V3) to 1.09 (0.33) kPa.s/L (p<0.001), while mean (SD) daily symptom score fell from 0.56 (0.36) to 0.28 (0.36) after ICS (p<0.001). Positive Rint BDR before ICS (at V1 and/or V2), using all three threshold criteria, was significantly associated with response to ICS on symptom scores at V3 (p<0.05). mAPI was not significantly associated with response to ICS, and parents' perception of response to bronchodilator was not related to measured Rint BDR . CONCLUSIONS Rint BDR may be helpful in selecting which wheezy preschool children are likely to benefit from ICS.
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Affiliation(s)
- Paul C Seddon
- Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Rhian Willson
- Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Catherine Olden
- Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Elizabeth Symes
- Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Enrico Lombardi
- Paediatric Pulmonary Unit, Ospedale Pediatrico Meyer, Firenze, Toscana, Italy
| | - Nicole Beydon
- Unité Fonctionnelle de Physiologie Explorations Fonctionnelles Respiratoires, Armand-Trousseau Childrens' Hospital, Paris, Île-de-France, France
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Kienhorst S, van Aarle MHD, Jöbsis Q, Bannier MAGE, Kersten ETG, Damoiseaux J, van Schayck OCP, Merkus PJFM, Koppelman GH, van Schooten FJ, Smolinska A, Dompeling E. The ADEM2 project: early pathogenic mechanisms of preschool wheeze and a randomised controlled trial assessing the gain in health and cost-effectiveness by application of the breath test for the diagnosis of asthma in wheezing preschool children. BMC Public Health 2023; 23:629. [PMID: 37013496 PMCID: PMC10068201 DOI: 10.1186/s12889-023-15465-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The prevalence of asthma-like symptoms in preschool children is high. Despite numerous efforts, there still is no clinically available diagnostic tool to discriminate asthmatic children from children with transient wheeze at preschool age. This leads to potential overtreatment of children outgrowing their symptoms, and to potential undertreatment of children who turn out to have asthma. Our research group developed a breath test (using GC-tof-MS for VOC-analysis in exhaled breath) that is able to predict a diagnosis of asthma at preschool age. The ADEM2 study assesses the improvement in health gain and costs of care with the application of this breath test in wheezing preschool children. METHODS This study is a combination of a multi-centre, parallel group, two arm, randomised controlled trial and a multi-centre longitudinal observational cohort study. The preschool children randomised into the treatment arm of the RCT receive a probability diagnosis (and corresponding treatment recommendations) of either asthma or transient wheeze based on the exhaled breath test. Children in the usual care arm do not receive a probability diagnosis. Participants are longitudinally followed up until the age of 6 years. The primary outcome is disease control after 1 and 2 years of follow-up. Participants of the RCT, together with a group of healthy preschool children, also contribute to the parallel observational cohort study developed to assess the validity of alternative VOC-sensing techniques and to explore numerous other potential discriminating biological parameters (such as allergic sensitisation, immunological markers, epigenetics, transcriptomics, microbiomics) and the subsequent identification of underlying disease pathways and relation to the discriminative VOCs in exhaled breath. DISCUSSION The potential societal and clinical impact of the diagnostic tool for wheezing preschool children is substantial. By means of the breath test, it will become possible to deliver customized and high qualitative care to the large group of vulnerable preschool children with asthma-like symptoms. By applying a multi-omics approach to an extensive set of biological parameters we aim to explore (new) pathogenic mechanisms in the early development of asthma, creating potentially interesting targets for the development of new therapies. TRIAL REGISTRATION Netherlands Trial Register, NL7336, Date registered 11-10-2018.
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Affiliation(s)
- Sophie Kienhorst
- Department of Paediatric Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Moniek H D van Aarle
- Department of Paediatric Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Quirijn Jöbsis
- Department of Paediatric Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michiel A G E Bannier
- Department of Paediatric Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Elin T G Kersten
- Department of Paediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, and GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Peter J F M Merkus
- Department of Paediatric Pulmonology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerard H Koppelman
- Department of Paediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, and GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederik-Jan van Schooten
- Department Pharmacology and Toxicology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Agnieszka Smolinska
- Department Pharmacology and Toxicology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Edward Dompeling
- Department of Paediatric Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands
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9
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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. INDIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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10
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Shapiro DJ, Wu AC. Intermittent Tiotropium for Episodic Wheezing. Pediatrics 2022; 150:188735. [PMID: 35942819 DOI: 10.1542/peds.2022-057926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Daniel J Shapiro
- Divisions of Emergency Medicine.,Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ann Chen Wu
- General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
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11
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Development and validation of an RNA-seq-based transcriptomic risk score for asthma. Sci Rep 2022; 12:8643. [PMID: 35606385 PMCID: PMC9126925 DOI: 10.1038/s41598-022-12199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Recent progress in RNA sequencing (RNA-seq) allows us to explore whole-genome gene expression profiles and to develop predictive model for disease risk. The objective of this study was to develop and validate an RNA-seq-based transcriptomic risk score (RSRS) for disease risk prediction that can simultaneously accommodate demographic information. We analyzed RNA-seq gene expression data from 441 asthmatic and 254 non-asthmatic samples. Logistic least absolute shrinkage and selection operator (Lasso) regression analysis in the training set identified 73 differentially expressed genes (DEG) to form a weighted RSRS that discriminated asthmatics from healthy subjects with area under the curve (AUC) of 0.80 in the testing set after adjustment for age and gender. The 73-gene RSRS was validated in three independent RNA-seq datasets and achieved AUCs of 0.70, 0.77 and 0.60, respectively. To explore their biological and molecular functions in asthma phenotype, we examined the 73 genes by enrichment pathway analysis and found that these genes were significantly (p < 0.0001) enriched for DNA replication, recombination, and repair, cell-to-cell signaling and interaction, and eumelanin biosynthesis and developmental disorder. Further in-silico analyses of the 73 genes using Connectivity map shows that drugs (mepacrine, dactolisib) and genetic perturbagens (PAK1, GSR, RBM15 and TNFRSF12A) were identified and could potentially be repurposed for treating asthma. These findings show the promise for RNA-seq risk scores to stratify and predict disease risk.
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12
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Lin CH, Cerrone DA. Shifts in Asthma Evaluation and Management During COVID-19. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:42-51. [PMID: 35582628 PMCID: PMC9099326 DOI: 10.1007/s40521-022-00304-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/03/2022]
Abstract
Purpose of Review The comprehensive management of asthma has historically relied on in-person visits to obtain a detailed history, thorough physical exam, and diagnostic and monitoring tools such as pulmonary function testing. The COVID-19 pandemic has posed numerous challenges to adequately utilizing these strategies. Despite these limitations, telemedicine has provided an important means to deliver asthma care. In this review, we discuss how these challenges have created paradigm shifts in not only the clinical aspects of asthma management, but also in patient attitudes and physician-patient relationships. Recent Findings Different strategies have been suggested to address asthma during COVID-19. Telemedicine has taken on an important role during the pandemic. The emphasis on asthma questionnaire use, education regarding lapsed asthma control, and as-needed oral corticosteroid courses have proven to be important instruments in the remote management of asthma. Overall, asthma exacerbations have decreased during this time. This is thought to be due to a variety of factors such as decreased exposure to common triggers. Summary Although the COVID-19 pandemic significantly limited an allergist's ability to provide conventional comprehensive asthma management, we also found that patient outcomes have actually improved. In addition to the decreased exposure to asthma triggers, this may also be an effect of increased patient ownership of their asthma, and subsequent improved therapeutic alliance.
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Affiliation(s)
- Connie H. Lin
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Allergy and Clinical Immunology, University of California, Los Angeles, 1245 16th Street, Suite 303, Santa Monica, CA 90404 USA
| | - Daniel A. Cerrone
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, University of California, Davis, Davis, CA USA
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13
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Ezmigna D, Brown M, Daines C, Morgan W. Bronchoalveolar lavage profiles in uncontrolled wheezy children compared by asthma predictive index. Pediatr Pulmonol 2022; 57:293-299. [PMID: 34609079 DOI: 10.1002/ppul.25716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The asthma predictive index (API) predicts later asthma in preschoolers with frequent wheeze. We hypothesized that airway cytology differs between API positive (API+)/negative (API-) children with uncontrolled/recurrent wheezing with dominance of eosinophils in API+ and neutrophils in API- groups respectively. The main objective of this study is to compare bronchoalveolar lavage (BAL) cell profiles in API+/API- children with recurrent wheezing unresponsive to inhaled corticosteroids (ICS). DESIGN Retrospective analysis of BAL in 43 children, 3-36 months (median: 14 months) receiving ICS (31 API+, 12 API-). BAL cell differential counts, bacterial/viral cultures, and lipid-laden macrophage percentages were analyzed. Cell counts presented as median (range). RESULTS Neutrophil percentages were increased in both groups (API- 16% [1%-76%]; API+ 42% [1%-95%]; p = NS). Cell percentages were similar for lymphocytes (API- 12% [1%-30%]; API+ 7% [1%-37%]), and macrophages (API- 67.5% [12%-97%]; API+ 41% [2%-94%]). Eosinophil percentages were low in both groups (API- 1% [1%-2%]; API+ 1% [1%-11%]). There was no difference in cellular distributions using absolute cell counts comparing API groups. Bacterial cultures were positive in 18 (60%) API+ and 5 (41%) API- patients (p = 0.10). CONCLUSION Cell profiles do not differ between API groups in children ≤36 months with recurrent wheezing unresponsive to ICS. Neutrophil percentages and total granulocyte count correlate with positive bacterial cultures independent of API status. Persistent bacterial bronchitis likely plays an important role in the persistence of symptoms unresponsive to ICS therapy regardless of API status with a trend to more positive cultures in API positive children.
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Affiliation(s)
- Dima Ezmigna
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Mark Brown
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cori Daines
- Department of Pediatrics, The University of Arizona, Tucson, Arizona, USA
| | - Wayne Morgan
- Department of Pediatrics, The University of Arizona, Tucson, Arizona, USA
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14
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Watkinson RL, Looi K, Laing IA, Cianferoni A, Kicic A. Viral Induced Effects on a Vulnerable Epithelium; Lessons Learned From Paediatric Asthma and Eosinophilic Oesophagitis. Front Immunol 2021; 12:773600. [PMID: 34912343 PMCID: PMC8666438 DOI: 10.3389/fimmu.2021.773600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/05/2021] [Indexed: 01/07/2023] Open
Abstract
The epithelium is integral to the protection of many different biological systems and for the maintenance of biochemical homeostasis. Emerging evidence suggests that particular children have epithelial vulnerabilities leading to dysregulated barrier function and integrity, that resultantly contributes to disease pathogenesis. These epithelial vulnerabilities likely develop in utero or in early life due to various genetic, epigenetic and environmental factors. Although various epithelia are uniquely structured with specific function, prevalent allergic-type epithelial diseases in children potentially have common or parallel disease processes. These include inflammation and immune response dysregulation stemming from atypical epithelial barrier function and integrity. Two diseases where aetiology and pathogenesis are potentially linked to epithelial vulnerabilities include Paediatric Asthma and Eosinophilic Oesophagitis (EoE). For example, rhinovirus C (RV-C) is a known risk factor for paediatric asthma development and is known to disrupt respiratory epithelial barrier function causing acute inflammation. In addition, EoE, a prevalent atopic condition of the oesophageal epithelium, is characterised by similar innate immune and epithelial responses to viral injury. This review examines the current literature and identifies the gaps in the field defining viral-induced effects on a vulnerable respiratory epithelium and resulting chronic inflammation, drawing from knowledge generated in acute wheezing illness, paediatric asthma and EoE. Besides highlighting the importance of epithelial structure and barrier function in allergic disease pathogenesis regardless of specific epithelial sub-types, this review focuses on the importance of examining other parallel allergic-type disease processes that may uncover commonalities driving disease pathogenesis. This in turn may be beneficial in the development of common therapeutics for current clinical management and disease prevention in the future.
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Affiliation(s)
- Rebecca L Watkinson
- Division of Paediatrics, Medical School, The University of Western Australia, Nedlands, WA, Australia.,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Kevin Looi
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia.,School of Public Health, Curtin University, Bentley, WA, Australia
| | - Ingrid A Laing
- Division of Paediatrics, Medical School, The University of Western Australia, Nedlands, WA, Australia.,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Antonella Cianferoni
- Pediatrics Department, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Anthony Kicic
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia.,School of Public Health, Curtin University, Bentley, WA, Australia.,Centre for Cell Therapy and Regenerative Medicine, School of Medicine, The University of Western Australia, Nedlands, WA, Australia
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15
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Teijeiro A, Gómez RM. Wheezing-Related Relevant Factors and the Role of Viral Bronchiolitis. FRONTIERS IN ALLERGY 2021; 2:726972. [PMID: 35387057 PMCID: PMC8974738 DOI: 10.3389/falgy.2021.726972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022] Open
Abstract
Bronchiolitis is a virus-associated infection of the lower respiratory tract exhibiting signs and symptoms of airway obstruction. Respiratory Syncytial Virus (RSV) is responsible in most cases; however, different rhinoviruses have also been implicated. Specific viruses and time until the first infection, severity of the respiratory condition, and atopic status have a determinant role in the recurrence of wheezing and asthma development. Genetics, lung function, atopic condition, the role of microbiota and environment, pollution, and obesity are considered in the present review. Emergency room visits and hospitalizations because of severe wheezing and smoking during pregnancy among others were identified as risk factors for significant morbidity in our population. Approaching determinant conditions like genetics, allergy, antiviral immunity, and environmental exposures such as farm vs. urban and viral virulence provides an opportunity to minimize morbidity of viral illness and asthma in children.
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Affiliation(s)
- Alvaro Teijeiro
- Respiratory Department, Children's Hospital, Córdoba, Argentina
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16
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The First 1000 Days: Impact of Prenatal Tobacco Smoke Exposure on Hospitalization Due to Preschool Wheezing. Healthcare (Basel) 2021; 9:healthcare9081089. [PMID: 34442226 PMCID: PMC8391353 DOI: 10.3390/healthcare9081089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/26/2022] Open
Abstract
Preschool wheezing and related hospitalization rates are increasing. Prenatal tobacco smoke exposure (PTSE) increases the risk of wheezing, yet >20% of French women smoke during pregnancy. In this observational retrospective monocentric study, we assessed the link between PTSE and hospital admissions. We included infants <2 years of age admitted for acute wheezing. A phone interview with mothers was completed by electronic records. The primary endpoint was the ratio of cumulative duration of the hospitalization stays (days)/age (months). 129 children were included (36.4% exposed to PTSE vs. 63.6% unexposed). There was a significant difference in the duration of hospitalization/age: 0.9 days/month (exposed) vs. 0.58 days/month (unexposed) (p = 0.008). Smoking one cigarette/day during pregnancy was associated with an increase in hospitalization duration of 0.055 days/month (r = 0.238, p = 0.006). In the multi-variable analysis, this positive association persisted (β = 0.04, p = 0.04; standardized β = 0.27, p = 0.03). There was a trend towards a dose-effect relationship between PTSE and other important parameters associated with hospital admissions. We have demonstrated a dose-effect relationship, without a threshold effect, between PTSE and duration of hospitalization for wheezing in non-premature infants during the first 2 years of life. Prevention campaigns for future mothers should be enforced.
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17
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Just J, Saf S, Guiddir T, Cottel N, Amat F, Lambert N, Saint-Pierre P, Bourgoin-Heck M. Determinants of blood eosinophilia in moderate and severe asthmatic patients during childhood: Evidence from the severe asthma molecular phenotype (SAMP) cohort. Pediatr Allergy Immunol 2021; 32:1217-1225. [PMID: 33760279 DOI: 10.1111/pai.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Asthma is a heterogeneous disease in which the interaction between genetic and environmental factors plays a major role. The significance of blood eosinophil is unclear. The aim of the study was to determine the significance of blood eosinophil count in moderate-to-severe asthmatic children of preschool age and school age. METHODS This was a prospective cross-sectional study performed from 2011 to 2015 including children from the severe asthma molecular phenotype (SAMP) cohort at Trousseau Hospital (Paris, France). We included children with severe and moderate asthma, or severe and moderate recurrent wheeze, aged from 1 to 15 years at the time of exploration. RESULTS We analyzed data from 402 children: 248 of preschool age and 154 of school age. Blood eosinophil count third quartile thresholds were 322 and 600 cells/μL for the preschool- and school-age groups, respectively. In multivariate analysis, a blood eosinophil count over this threshold was associated with elevated total IgE (OR = 5.33, P < .01), multiple hospitalizations for asthma attacks (OR = 4.96, P = .03), and a maternal history of asthma (OR = 4.91, P = .01) in preschool children; and with staphylococcal toxin-specific IgE (OR = 2.75, P = .03) in children of school age. Random forest analysis reinforced these results. CONCLUSION High blood eosinophil count is linked to both atopic features and control of asthma with different parameters associated with these features depending on age.
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Affiliation(s)
- Jocelyne Just
- Department of Allergology, Hôpital d'Enfants Armand Trousseau, APHP, Paris, France.,Sorbonne Universités, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | - Sarah Saf
- Department of Allergology, Hôpital d'Enfants Armand Trousseau, APHP, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | - Tamazoust Guiddir
- Department of Allergology, Hôpital d'Enfants Armand Trousseau, APHP, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | - Nathalie Cottel
- Department of Allergology, Hôpital d'Enfants Armand Trousseau, APHP, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | - Flore Amat
- Department of Allergology, Hôpital d'Enfants Armand Trousseau, APHP, Paris, France.,Sorbonne Universités, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France.,Laboratory of Biochemistry and Molecular Biology- Laboratoire de Biochimie et Biologie Moléculaire, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Lambert
- Department of Allergology, Hôpital d'Enfants Armand Trousseau, APHP, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | | | - Mélisande Bourgoin-Heck
- Department of Allergology, Hôpital d'Enfants Armand Trousseau, APHP, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
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18
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Severcan EU, Bal CM, Tanac R, Gulen F, Demir E. Retrospective Cross-sectional Analysis of Factors Associated with Asthma in a Pediatric Cohort from Turkey. KLINISCHE PADIATRIE 2021; 234:14-19. [PMID: 34331302 DOI: 10.1055/a-1500-8264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND It is difficult to identify young children at increased risk of developing asthma amongst those with recurrent wheezing. In this study, we aimed to determine factors associated with asthma in Turkish children. METHODS We performed a retrospective cross-sectional analysis on factors associated with asthma in 651 children (200 girls, 451 boys) admitted for recurrent wheezing. RESULTS Amongst all included children, asthma frequency was 57.7%. Maturity, consanguinity, family income, passive smoking, father's, siblings' asthma were not found to be associated with asthma. Factors associated with asthma were: family's, parents', siblings' atopy, family's, mother's asthma, allergic rhinitis and atopic dermatitis, respiratory symptoms between wheezing attacks. The sensitivity (SN) of the modified asthma predictive index (mAPI) was 59.2% with a specificity (SP) of 91.3%, positive predictive index (PPI) of 65.1% and negative predictive index (NPI) of 82.3%. The SN of the modified Prevention and Incidence of Asthma and Mite Allergy (PIAMA) score was 22.9% with a SP of 89.2%, PPI of 84.6%, and NPI of 42.2%. Adjusted odds ratio for mAPI was 12.9, and for the modified PIAMA score 4. CONCLUSION Our analysis confirmed previously described factors associated with asthma. Although the SN is limited, the mAPI and PIAMA risk scores can be used to predict asthma in Turkish children. Differential diagnoses and overlaps with other chronic pediatric diseases such as immunodeficiencies need to be carefully excluded when confirming the diagnosis asthma.
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Affiliation(s)
- Ezgi Ulusoy Severcan
- Department of Pediatric Immunology and Allergy, Ege University Faculty of Medicine, Izmir, Turkey
| | - Cem Murat Bal
- Department of Pediatric Pulmonology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Remziye Tanac
- Department of Pediatric Immunology and Allergy, Ege University Faculty of Medicine, Izmir, Turkey
| | - Figen Gulen
- Department of Pediatric Immunology and Allergy, Ege University Faculty of Medicine, Izmir, Turkey
| | - Esen Demir
- Department of Pediatric Immunology and Allergy, Ege University Faculty of Medicine, Izmir, Turkey
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19
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Raita Y, Camargo CA, Liang L, Hasegawa K. Big Data, Data Science, and Causal Inference: A Primer for Clinicians. Front Med (Lausanne) 2021; 8:678047. [PMID: 34295910 PMCID: PMC8290071 DOI: 10.3389/fmed.2021.678047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/07/2021] [Indexed: 12/20/2022] Open
Abstract
Clinicians handle a growing amount of clinical, biometric, and biomarker data. In this “big data” era, there is an emerging faith that the answer to all clinical and scientific questions reside in “big data” and that data will transform medicine into precision medicine. However, data by themselves are useless. It is the algorithms encoding causal reasoning and domain (e.g., clinical and biological) knowledge that prove transformative. The recent introduction of (health) data science presents an opportunity to re-think this data-centric view. For example, while precision medicine seeks to provide the right prevention and treatment strategy to the right patients at the right time, its realization cannot be achieved by algorithms that operate exclusively in data-driven prediction modes, as do most machine learning algorithms. Better understanding of data science and its tasks is vital to interpret findings and translate new discoveries into clinical practice. In this review, we first discuss the principles and major tasks of data science by organizing it into three defining tasks: (1) association and prediction, (2) intervention, and (3) counterfactual causal inference. Second, we review commonly-used data science tools with examples in the medical literature. Lastly, we outline current challenges and future directions in the fields of medicine, elaborating on how data science can enhance clinical effectiveness and inform medical practice. As machine learning algorithms become ubiquitous tools to handle quantitatively “big data,” their integration with causal reasoning and domain knowledge is instrumental to qualitatively transform medicine, which will, in turn, improve health outcomes of patients.
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Affiliation(s)
- Yoshihiko Raita
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Carlos A Camargo
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Liming Liang
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kohei Hasegawa
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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20
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Izadi N, Baraghoshi D, Curran-Everett D, Zeiger RS, Szefler SJ, Covar RA. Factors Associated with Persistence of Severe Asthma from Late Adolescence to Early Adulthood. Am J Respir Crit Care Med 2021; 204:776-787. [PMID: 34029510 PMCID: PMC8528529 DOI: 10.1164/rccm.202010-3763oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Asthma severity in children generally starts mild but may progress and stay severe for unknown reasons. OBJECTIVES Identify factors in childhood that predict persistence of severe asthma in late adolescence and early adulthood. METHODS The Childhood Asthma Management Program is the largest and longest asthma trial in 1041 children aged 5-12 years with mild to moderate asthma. We evaluated 682 participants from the program with analyzable data in late adolescence (age 17-19) and early adulthood (age 21-23). MEASUREMENTS Severe asthma was defined using criteria from the American Thoracic Society and the National Asthma Education and Prevention Program to best capture severe asthma. Logistic regression with stepwise elimination was used to analyze clinical features, biomarkers, and lung function predictive of persistence of severe asthma. MAIN RESULTS In late adolescence and early adulthood 12% and 19% of the patents had severe asthma, respectively; only 6% were severe at both time periods. For every 5% decrease in post bronchodilator FEV1/FVC in childhood, the odds of persistence of severe asthma increased 2.36-fold (95% CI: 1.70-3.28; p <0.0001), for participants with maternal smoking during pregnancy odds of persistence of severe asthma increased 3.17-fold (95% CI: 1.18-8.53, p=0.02). Reduced growth lung function trajectory was significantly associated with persistence of severe asthma compared to normal growth. CONCLUSIONS Lung function and maternal smoking during pregnancy were significant predictors of severe asthma from late adolescence to early adulthood. Interventions to preserve lung function early may prevent disease progression.
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Affiliation(s)
- Neema Izadi
- Children's Hospital Los Angeles Department of Pediatrics, 337885, Division of Clinical Immunology & Allergy, Los Angeles, California, United States;
| | | | | | | | - Stanley J Szefler
- University of Colorado Denver School of Medicine, 12225, Pediatrics, Aurora, Colorado, United States
| | - Ronina A Covar
- National Jewish Health, 2930, Pediatrics, Denver, Colorado, United States
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21
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Severcan EU, Bal CM, Gülen F, Tanaç R, Demir E. Identifying wheezing phenotypes in a pediatric Turkish cohort. J Asthma 2021; 59:1298-1304. [PMID: 33906564 DOI: 10.1080/02770903.2021.1922916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Characterization of wheezing phenotypes in children might help to identify the underlying mechanisms through which asthma occurs. In our study, we aimed to describe wheezing phenotypes in Turkish children and to identify risk factors according to phenotypes. METHODS 651 wheezy children were evaluated and 5 wheezing phenotypes were described according to age of onset, atopy and persistence at 6 years of age and risk factors were identified. RESULTS Distribution of wheezing phenotypes was transient early wheeze (TEW)(34.9%) non-atopic wheeze (NAW) (18%), atopic wheeze (AW) (22.3%), intermediate onset wheeze (IOW) (11.1%), late onset wheeze (LOW) (11.7%). LOW, AW, and IOW were associated with, father's, sibling's and family's atopy (p:0.001) whereas LOW and AW were associated with mother's asthma and atopy as well as family's asthma (p < 0.05). Atopic dermatitis and allergic rhinitis were common of patients with LOW, AW, and IOW (p < 0.05). İnfection was the major trigger for TEW and NAW whereas multiple triggers were common of AW, LOW, and IOW. Allergens were mostly associated with AW, IOW and LOW. Aeroallergen-specific IgE positivity was mostly with AW, IOW, and LOW phenotype. Skin prick tests showed multiple allergen sensitivity in IOW, LOW groups and mostly single allergen in AW phenotype. Modified asthma predictive index (mAPI) positivity was high in all groups except TEW and NAW. CONCLUSIONS With this study we classified five wheeze phenotypes and found that atopy and family's atopy history, maternal asthma were strongly associated with AW, LOW, and IOW phenotypes which were usually effected by allergens or multiple triggers.
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Affiliation(s)
- Ezgi Ulusoy Severcan
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cem Murat Bal
- Department of Pediatrics, Division of Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Figen Gülen
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Remziye Tanaç
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Esen Demir
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ege University Faculty of Medicine, İzmir, Turkey
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22
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Turi KN, McKennan C, Gebretsadik T, Snyder B, Seroogy CM, Lemanske RF, Zoratti E, Havstad S, Ober C, Lynch S, McCauley K, Yu C, Jackson DJ, Gern JE, Hartert TV. Unconjugated bilirubin is associated with protection from early-life wheeze and childhood asthma. J Allergy Clin Immunol 2021; 148:128-138. [PMID: 33434532 DOI: 10.1016/j.jaci.2020.12.639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Wheeze and allergic sensitization are the strongest early-life predictors of childhood asthma development; the molecular origins of these early-life phenotypes are poorly understood. OBJECTIVES We sought to identify metabolites associated with early-life wheeze, allergic sensitization, and childhood asthma. METHODS We conducted a nested case-control study using Environmental influences on Child Health Outcomes Program cohorts for discovery and independent replication. Wheeze and allergic sensitization were defined by number of wheeze episodes and positive specific IgE at age 1 year, respectively. Asthma was defined as physician diagnosis of asthma at age 5 or 6 years. We used untargeted metabolomics, controlling for observed and latent confounding factors, to assess associations between the plasma metabolome and early-life wheeze, allergy, and childhood asthma. RESULTS Eighteen plasma metabolites were associated with first-year wheeze in the discovery cohort (n = 338). Z,Z unconjugated bilirubin (UCB) and its related metabolites exhibited a dose-response relationship with wheeze frequency; UCB levels were 13% (β = 0.87; 95% CI, 0.74-1.02) and 22% (β = 0.78; 95% CI, 0.68-0.91) lower in children with 1 to 3 and 4+ wheeze episodes compared with those who never wheezed, respectively. UCB levels were also associated with childhood asthma (β = 0.82; 95% CI, 0.68-0.98). Similar trends were observed in 2 independent cohorts. UCB was significantly negatively correlated with eicosanoid- and oxidative stress-related metabolites. There were no significant associations between metabolites and allergic sensitization. CONCLUSIONS We identified a novel inverse, dose-dependent association between UCB and recurrent wheeze and childhood asthma. Inflammatory lipid mediators and oxidative stress byproducts inversely correlated with UCB, suggesting that UCB modulates pathways critical to the development of early-life recurrent wheeze and childhood asthma.
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Affiliation(s)
- Kedir N Turi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Brittney Snyder
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | | | - Edward Zoratti
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Mich
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Susan Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, Calif
| | - Kathyrn McCauley
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, Calif
| | - Chang Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - James E Gern
- Department of Pediatrics, University of Wisconsin, Madison, Wis.
| | - Tina V Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
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Li Y, Li X, Zhou W, Yu Q, Lu Y. ORMDL3 modulates airway epithelial cell repair in children with asthma under glucocorticoid treatment via regulating IL-33. Pulm Pharmacol Ther 2020; 64:101963. [PMID: 33035699 DOI: 10.1016/j.pupt.2020.101963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Study found that glucocorticoids, as first-line treatments for asthma, fails to prevent asthma recurrence. Orosomucoid-like (ORMDL) 3 is associated to childhood asthma onset and involved in the inflammation and repair of airway epithelium. We explored the functional role of ORMDL3 in glucocorticoid treatment for childhood asthma. METHODS Mice were sensitized with Ovalbumin (OVA) and treated with Dexamethasone (Dex), followed by OVA challenge to establish a mouse model of asthma. Histopathological changes in lung tissues were observed by hematoxylin-eosin and masson staining. Human bronchial epithelial (16HBE-14°) cells were transfected with ORMDL3 overexpression plasmid and siRNA-interleukin (IL)-33 alone or in combination, followed by Dex. Cell viability was measured by MTT assay. Cell migration was evaluated by wound healing assay. The expressions of E-cadherin and Vimentin and the activation of NF-κB and MAPK/ERK in 16HBE-14° cells were assessed by Western blot. The expressions of ORMDL3 and IL-33 in lung tissues and 16HBE-14° cells were analyzed by qRT-PCR or Western blot. RESULTS Dex treatment alleviated the histopathological abnormality and reversed the overexpressions of ORMDL3 and IL-33 in the lung tissues of asthmatic mice. Overexpressed ORMDL3 enhanced migration and viability, decreased E-cadherin level, increased the levels of IL-33 and Vimentin, and promoted the phosphorylation of NF-κB and MAPK/ERK in Dex-treated 16HBE-14° cells, thus reversing the effect of Dex treatment. However, siRNA-IL-33 inhibited viability and migration, increased E-cadherin level, decreased Vimentin level, and suppressed the phosphorylation of NF-κB and MAPK/ERK, thus reversing the effect of overexpressed ORMDL3 in Dex-treated 16HBE-14° cells. CONCLUSION ORMDL3 overexpression helped airway epithelial cellrepairin asthma via regulating IL-33 expression.
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Affiliation(s)
- Yaqin Li
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No.2000, Jiangyue Road, Pujiang, Minhang District, Shanghai, 201112, China
| | - Xiaoyan Li
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No.2000, Jiangyue Road, Pujiang, Minhang District, Shanghai, 201112, China
| | - Wenjing Zhou
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No.2000, Jiangyue Road, Pujiang, Minhang District, Shanghai, 201112, China
| | - Qing Yu
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No.2000, Jiangyue Road, Pujiang, Minhang District, Shanghai, 201112, China
| | - Yanming Lu
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No.2000, Jiangyue Road, Pujiang, Minhang District, Shanghai, 201112, China.
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Matsumoto K, Iikura K, Morita H, Saito H. Barrier dysfunction in the atopic march-how does atopic dermatitis lead to asthma in children? J Allergy Clin Immunol 2020; 145:1551-1553. [PMID: 32344057 DOI: 10.1016/j.jaci.2020.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
| | - Katsuhito Iikura
- Department of Pediatrics, National Hospital Organization Nishisaitama-chuo National Hospital, Saitama, Japan
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hirohisa Saito
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
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25
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Kim BS. Is the predictive model for asthma development useful as a tool for diagnosing pediatric asthma? Clin Exp Pediatr 2020; 63:102-103. [PMID: 32023399 PMCID: PMC7073385 DOI: 10.3345/cep.2019.01557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/29/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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26
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Lee DH, Kwon JW, Kim HY, Seo JH, Kim HB, Lee SY, Jang GC, Song DJ, Kim WK, Jung YH, Hong SJ, Shim JY. Asthma predictive index as a useful diagnostic tool in preschool children: a cross-sectional study in Korea. Clin Exp Pediatr 2020; 63:104-109. [PMID: 32024332 PMCID: PMC7073380 DOI: 10.3345/kjp.2019.00640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is challenging to diagnose asthma in preschool children. The asthma predictive index (API) has been used to predict asthma and decide whether to initiate treatment in preschool children. PURPOSE This study aimed to investigate the association between questionnaire-based current asthma with API, pulmonary function, airway hyperreactivity (AHR), fractional expiratory nitric oxide (FeNO), and atopic sensitization in preschool children. METHODS We performed a population-based cross-sectional study in 916 preschool children aged 4-6 years. We defined current asthma as the presence of both physician-diagnosed asthma and at least one wheezing episode within the previous 12 months using a modified International Study of Asthma and Allergies in Childhood questionnaire. Clinical and laboratory parameters were compared between groups according to the presence of current asthma. RESULTS The prevalence of current asthma was 3.9% in the study population. Children with current asthma showed a higher rate of positive bronchodilator response and loose and stringent API scores than children without current asthma. The stringent API was associated with current asthma with 72.2% sensitivity and 82.0% specificity. The diagnostic accuracy of the stringent API for current asthma was 0.771. However, no intergroup differences in spirometry results, methacholine provocation test results, FeNO level, or atopic sensitization rate were observed. CONCLUSION The questionnaire-based diagnosis of current asthma is associated with API, but not with spirometry, AHR, FeNO, or atopic sensitization in preschool children.
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Affiliation(s)
- Dong Hyeon Lee
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gwang-Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Dae-Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Young-Ho Jung
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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27
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Kenyon CC, Maltenfort MG, Hubbard RA, Schinasi LH, De Roos AJ, Henrickson SE, Bryant-Stephens TC, Forrest CB. Variability in Diagnosed Asthma in Young Children in a Large Pediatric Primary Care Network. Acad Pediatr 2020; 20:958-966. [PMID: 32044466 PMCID: PMC8628349 DOI: 10.1016/j.acap.2020.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Our objectives were to 1) quantify the frequency of wheezing episodes and asthma diagnosis in young children in a large pediatric primary care network and 2) assess the variability in practice-level asthma diagnosis, accounting for common asthma risk factors and comorbidities. We hypothesized that significant variability in practice-level asthma diagnosis rates would remain after adjusting for associated predictors. METHODS We generated a retrospective longitudinal birth cohort of children who visited 1 of 31 pediatric primary care practices within the first 6 months of life from 1/2005 to 12/2016. Children were observed for up to 8 years or until the end of the observation window. We used multivariable discrete time survival models to evaluate predictors of asthma diagnosis by 3-month age intervals. We compared unadjusted and adjusted proportions of children diagnosed with asthma by practice. RESULTS Of the 161,502 children in the cohort, 34,578 children (21%) received at least 1 asthma diagnosis. In multivariable modeling, male gender, minority race/ethnicity, gestational age <34 weeks, allergic rhinitis, food allergy, and prior wheezing episodes were associated with asthma diagnosis. After adjusting for variation in these predictors across practices, the cumulative incidence of asthma diagnosis by practice by age 6 years ranged from 11% to 47% (interquartile range: 24%-29%). CONCLUSIONS Across pediatric primary care practices, adjusted incidence of asthma diagnosis by age 6 years ranged widely, though variation gauged by the interquartile range was more modest. Potential sources of practice-level variation, such as differing diagnosis thresholds and labeling of different wheezing phenotypes as "asthma," should be further investigated.
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Affiliation(s)
- Chén C. Kenyon
- PolicyLab, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | | | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Leah H. Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University,Urban Health Collaborative, Dornsife School of Public Health, Drexel University
| | - Anneclaire J. De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University,Urban Health Collaborative, Dornsife School of Public Health, Drexel University
| | - Sarah E. Henrickson
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania,Division of Allergy and Immunology, Children’s Hospital of Philadelphia and Institute for Immunology, Perelman School of Medicine, Philadelphia, PA
| | | | - Christopher B. Forrest
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania,Applied Clinical Research Center, Children’s Hospital of Philadelphia
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28
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Merckx J, Kraicer-Melamed H, Gore G, Ducharme FM, Quach C. Respiratory pathogens and clinical outcomes in children with an asthma exacerbation: A systematic review. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2019; 4:145-168. [PMID: 36340656 PMCID: PMC9603032 DOI: 10.3138/jammi.2019-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/15/2019] [Indexed: 06/16/2023]
Abstract
BACKGROUND In asthmatic children, respiratory pathogens are identified in 60%-80% of asthma exacerbations, contributing to a significant burden of illness. The role of pathogens in the clinical evolution of exacerbations is unknown. OBJECTIVE We systematically reviewed the association between the presence of pathogens and clinical outcomes in children with an asthma exacerbation. METHOD PubMed, EMBASE, BIOSIS, and the Cochrane Central Register of Controlled Trials were searched up to October 2016 for studies reporting on respiratory pathogen exposure and clinical outcome. The Risk of Bias in Non-Randomized Studies of Interventions tool was used for quality assessment. RESULTS Twenty-eight observational studies (N = 4,224 children) reported on 112 different associations between exposure to any pathogen (n = 45), human rhinovirus (HRV; n = 34), atypical bacteria (n = 21), specific virus (n = 11), or bacteria (n = 1) and outcomes of exacerbation severity (n = 26), health care use (n = 38), treatment response (n = 19), and morbidity (n = 29). Restricting the analysis only to comparisons with a low to moderate risk of bias, we observed an association between HRV and higher exacerbation severity on presentation (regression p = .016) and between the presence of any pathogen and emergency department treatment failure (odds ratio [OR] = 1.57; 95% CI 1.04% to 2.37%). High-quality evidence for effect on morbidity or health care use is lacking. CONCLUSIONS Further research on the role of pathogen-treatment interaction and outcomes is required to inform the need for point-of-care, real-time testing for pathogens. Studies with a sufficiently large sample size that address selection bias, correctly adjust for confounding, and rigorously report core patient-centred outcomes are necessary to improve knowledge.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Division of Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Québec, Canada
| | - Hannah Kraicer-Melamed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Genevieve Gore
- Life Sciences Library, McGill University, Montreal, Québec, Canada
| | - Francine M Ducharme
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Caroline Quach
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Québec, Canada
- Infection Prevention and Control Unit, Division of Infectious Disease and Medical Microbiology, CHU Sainte-Justine, Montreal, Québec, Canada
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29
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Levine H, Leventer-Roberts M, Hoshen M, Mei-Zahav M, Balicer R, Blau H. Healthcare utilization in infants and toddlers with asthma-like symptoms. Pediatr Pulmonol 2019; 54:1567-1577. [PMID: 31298808 DOI: 10.1002/ppul.24429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/07/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recurrent asthma-like symptoms are common in infants, but few population studies describe diagnostic and treatment practice. METHODS Using the electronic data repository of Clalit Health Services, the largest integrated health care provider in Israel, we evaluated children born 2005-2012, who before 3 years of age had >3 episodes of asthma-like symptoms and/or >2 bronchodilator purchases within a year. We described health care utilization and the odds ratio for subsequent utilization after 3 and 12 months' controller therapy. The primary outcome measure was respiratory-related doctor visits. Linear and categorical regression analysis measured overall effectiveness of therapy. RESULTS Among 689 171 infants, 262 900 (38.1%) had > 3 asthma-like episodes/year during at least 1 year. Of those, 26 108 (10%) purchased controller therapy: 20 316 (77.8%) inhaled corticosteroids (ICS) with or without leukotriene receptor antagonists (LTRA), and 5792 (22.2%) LTRA alone. For these 26 108 over 3 months there were 93 845 respiratory-related doctor visits, 3110 hospital admissions, 5568 diagnoses of pneumonia, 9960 chest X-rays, 37 127 purchases for oral steroids, and 45 142 for antibiotics courses. Healthcare utilization decreased following ICS ± LTRA and LTRA alone, respectively, as follows: doctor visits 7% and 3%, chest X-rays 16% and 17%, bronchodilators 20% and 11%, systemic steroids 17% and 12%, and antibiotics by 35% and 22%, (P < .001 for all). Twelve months' therapy remained effective. CONCLUSIONS Asthma-like symptoms are common in infants. Health care utilization is very high and physician practices should be reassessed. Following controller therapy, health care utilization decreased. Yet controllers were prescribed in only a minority of eligible children.
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Affiliation(s)
- Hagit Levine
- Schneider Children's Medical Center of Israel, Pulmonary Institute, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Moshe Hoshen
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Schneider Children's Medical Center of Israel, Pulmonary Institute, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Balicer
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Hannah Blau
- Schneider Children's Medical Center of Israel, Pulmonary Institute, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Li Y, Cao L, Yu Q, Xue H, Lu Y. Association between peripheral blood mononuclear cell ORMDL3 expression and the asthma predictive index in preschool children. J Int Med Res 2019; 47:3727-3736. [PMID: 31342811 PMCID: PMC6726768 DOI: 10.1177/0300060519862674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Yaqin Li
- 1 Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lanfang Cao
- 2 Department of Pediatrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Yu
- 1 Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Xue
- 2 Department of Pediatrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanming Lu
- 1 Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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31
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Trivedi M, Denton E. Asthma in Children and Adults-What Are the Differences and What Can They Tell us About Asthma? Front Pediatr 2019; 7:256. [PMID: 31294006 PMCID: PMC6603154 DOI: 10.3389/fped.2019.00256] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/06/2019] [Indexed: 12/30/2022] Open
Abstract
Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.
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Affiliation(s)
- Michelle Trivedi
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Eve Denton
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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32
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Al-Shamrani A, Bagais K, Alenazi A, Alqwaiee M, Al-Harbi AS. Wheezing in children: Approaches to diagnosis and management. Int J Pediatr Adolesc Med 2019; 6:68-73. [PMID: 31388550 PMCID: PMC6676316 DOI: 10.1016/j.ijpam.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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Rivera N, Flores C, Morales M, Padilla O, Causade S, Brockmann PE, Castro-Rodriguez JA. Preschoolers with recurrent wheezing have a high prevalence of sleep disordered breathing. J Asthma 2019; 57:584-592. [PMID: 30950302 DOI: 10.1080/02770903.2019.1599385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Sleep-disordered breathing (SDB) is highly prevalent in school children with poorly-controlled asthma. However, this association has not been assessed in preschoolers with recurrent wheeze, nor in those at risk for asthma. We hypothesized that preschoolers with asthma risk (positive asthma predictive index [API]) have a higher prevalence of SDB and higher inflammatory biomarkers (blood-hsCRP and urinary-LTE4) levels than those with negative API.Method: Children 2 to 5 years of age with recurrent wheezing were classified as positive or negative API. SDB was determined by the pediatric sleep questionnaire (PSQ) and its subscale (PSQSub6). Demographic characteristics, spirometry, blood hsCRP and urinary LTE4 were assessed.Results: We enrolled 101 preschoolers: 70 completed all measurements, 55.4% were males, mean age 4.07 ± 0.87 years, 45% overweight or obese, 70% had positive API, 87.5% had rhinitis. The prevalence of SDB measured by PSQ was 40.8% and by PSQSub6 was 29.6%. However, the proportion of SDB was similar between positive and negative API groups. The hsCRP (mean ± SD) was higher in the positive than in negative API (3.58 ± 0.58 and 1.32 ± 0.36 mg/L, p = 0.69, respectively); moreover, no differences in urinary LTE4 were found between groups. No correlation of PSQ (+) or PSQSub6 (+) with hsCRP and uLTE4 was found. However, preschoolers with positive API had significantly more post-bronchodilator percentage change in FEF25-75 than negative API (24.14 ± 28.1 vs. 4.13 ± 21.8, respectively, p = 0.01).Conclusions: In preschoolers with recurrent wheezing, we should be investigating for the coexistence of SDB, using early screening methods for detecting those conditions.
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Affiliation(s)
- Natalia Rivera
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Flores
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maureen Morales
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oslando Padilla
- Division of Public Health, School of Medicine, Pontificia Universidad Católica de Chile
| | - Solange Causade
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo E Brockmann
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Hallit S, Raherison C, Malaeb D, Hallit R, Waked M, Kheir N, Salameh P. Development of an asthma risk factors scale (ARFS) for risk assessment asthma screening in children. Pediatr Neonatol 2019; 60:156-165. [PMID: 29983338 DOI: 10.1016/j.pedneo.2018.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/16/2018] [Accepted: 05/30/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The study objective was to create asthma risk factors scale (ARFS) score that would be correlated with the increased risk of asthma in Lebanese children. This scale would eventually be used both to identify children at risk and assess early diagnosis of asthma. METHODS A case-control study (study 1) of 1276 children (976 controls and 300 cases) and a cross-sectional study (study 2) of 1000 children were conducted using a parental questionnaire. Children aged between 3 and 16 years were screened for possible enrollment. The ARFS was created by combining the following risk factors: child's exposure to pesticides, detergent mixing, alcohol, smoking and drug intake during pregnancy and breastfeeding, the actual paternal and maternal smoking status and history of asthma, and the types of food the child consumes. RESULTS There was a significant increase in the risk assessment screening for asthma per 15 points increments of ARFS (p < 0.001 for trend). The score category 0-14.99 best-represented control individuals (88.8% controls), while a score higher than 45 represented asthmatic children best (98.4% asthmatics). The positive predictive value (disease positive/all positive by scale) came out as 94.02%, whereas the negative predictive value (disease negative/all negative by scale) was found to be 90.47%. These results were confirmed in the second study sample. CONCLUSION The ARFS is a simple and easy-to-use tool, composed of 15 questions, for the clinician risk assessment of asthma in children, taking into account the environmental exposure, parental history of asthma and dietary habits of the child. Its value for asthma diagnosis remains to be confirmed in future prospective studies, especially in children with chronic respiratory symptoms.
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Affiliation(s)
- Souheil Hallit
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Kaslik, Lebanon; Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon; Occupational Health Environment Research Team, U1219 BPH Bordeaux Population Health Research Center, Inserm - Université de Bordeaux, Bordeaux, France; INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University, Beirut, Lebanon.
| | - Chantal Raherison
- Occupational Health Environment Research Team, U1219 BPH Bordeaux Population Health Research Center, Inserm - Université de Bordeaux, Bordeaux, France; Department of Pneumology, University Hospital, Bordeaux, France
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Kaslik, Lebanon
| | - Mirna Waked
- Faculty of Medicine, Balamand University, Koura, Lebanon
| | - Nelly Kheir
- Faculty of Science II, Lebanese University, Fanar, Lebanon
| | - Pascale Salameh
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University, Beirut, Lebanon; Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Moral L, Vizmanos G, Torres-Borrego J, Praena-Crespo M, Tortajada-Girbés M, Pellegrini F, Asensio Ó. Asthma diagnosis in infants and preschool children: a systematic review of clinical guidelines. Allergol Immunopathol (Madr) 2019; 47:107-121. [PMID: 30193886 DOI: 10.1016/j.aller.2018.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The definition and diagnosis of asthma are the subject of controversy that is particularly intense in the case of individuals in the first years of life, due to reasons such as the difficulty of performing objective pulmonary function tests or the high frequency with which the symptoms subside in the course of childhood. Since there is no consensus regarding the diagnosis of asthma in preschool children, a systematic review has been carried out. MATERIALS AND METHODS A systematic search was made of the clinical guidelines published in the last 10 years and containing information referred to the concept or diagnosis of asthma in childhood - including the first years of life (infants and preschool children). A series of key questions were established, and each selected guide was analyzed in search of answers to those questions. The review protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42017074872. RESULTS Twenty-one clinical guidelines were selected: 10 general guides (children and adults), eight pediatric guides and three guides focusing on preschool children. The immense majority accepted that asthma can be diagnosed from the first years of life, without requiring pulmonary function tests or other complementary techniques. The response to treatment and the exclusion of other alternative diagnoses are key elements for establishing the diagnosis. Only one of the guides denied the possibility of diagnosing asthma in preschool children. CONCLUSIONS There is generalized although not unanimous agreement that asthma can be diagnosed in preschool children.
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Abstract
Pediatric asthma is a common chronic condition with wide-ranging implications for children's health, their families, and the health care system. The diagnosis may be relatively straightforward for the child with characteristic symptoms, triggers, and response to therapy, but there are other less common presentations that can make the diagnosis challenging. Diagnosing asthma in a toddler with recurrent wheezing can be particularly difficult. Treating asthma in a step-wise fashion usually reduces symptom frequency and improves asthma control. Asthma exacerbations and poor outcomes from acute exacerbations remain an area in which we have room for improvement. This article provides an overview of the diagnosis and management of childhood asthma for the primary care provider. [Pediatr Ann. 2019;48(3):e103-e109.].
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Al-Moamary MS, Alhaider SA, Alangari AA, Al Ghobain MO, Zeitouni MO, Idrees MM, Alanazi AF, Al-Harbi AS, Yousef AA, Alorainy HS, Al-Hajjaj MS. The Saudi Initiative for Asthma - 2019 Update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2019; 14:3-48. [PMID: 30745934 PMCID: PMC6341863 DOI: 10.4103/atm.atm_327_18] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This is the fourth version of the updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up to date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is now more aligned for different age groups. The guidelines have focused more on personalized approaches reflecting better understanding of disease heterogeneity with integration of recommendations related to biologic agents, evidence-based updates on treatment, and role of immunotherapy in management. The medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and current situation at national and regional levels. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan.
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Affiliation(s)
- Mohamed S Al-Moamary
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami A Alhaider
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah A Alangari
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed O Al Ghobain
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed O Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Majdy M Idrees
- Respiratory Division, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah F Alanazi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Adel S Al-Harbi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah A Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan S Alorainy
- Department of Respiratory Care, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed S Al-Hajjaj
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Biagini Myers JM, Schauberger E, He H, Martin LJ, Kroner J, Hill GM, Ryan PH, LeMasters GK, Bernstein DI, Lockey JE, Arshad SH, Kurukulaaratchy R, Khurana Hershey GK. A Pediatric Asthma Risk Score to better predict asthma development in young children. J Allergy Clin Immunol 2018; 143:1803-1810.e2. [PMID: 30554722 DOI: 10.1016/j.jaci.2018.09.037] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Asthma phenotypes are currently not amenable to primary prevention or early intervention because their natural history cannot be reliably predicted. Clinicians remain reliant on poorly predictive asthma outcome tools because of a lack of better alternatives. OBJECTIVE We sought to develop a quantitative personalized tool to predict asthma development in young children. METHODS Data from the Cincinnati Childhood Allergy and Air Pollution Study (n = 762) birth cohort were used to identify factors that predicted asthma development. The Pediatric Asthma Risk Score (PARS) was constructed by integrating demographic and clinical data. The sensitivity and specificity of PARS were compared with those of the Asthma Predictive Index (API) and replicated in the Isle of Wight birth cohort. RESULTS PARS reliably predicted asthma development in the Cincinnati Childhood Allergy and Air Pollution Study (sensitivity = 0.68, specificity = 0.77). Although both the PARS and API predicted asthma in high-risk children, the PARS had improved ability to predict asthma in children with mild-to-moderate asthma risk. In addition to parental asthma, eczema, and wheezing apart from colds, variables that predicted asthma in the PARS included early wheezing (odds ratio [OR], 2.88; 95% CI, 1.52-5.37), sensitization to 2 or more food allergens and/or aeroallergens (OR, 2.44; 95% CI, 1.49-4.05), and African American race (OR, 2.04; 95% CI, 1.19-3.47). The PARS was replicated in the Isle of Wight birth cohort (sensitivity = 0.67, specificity = 0.79), demonstrating that it is a robust, valid, and generalizable asthma predictive tool. CONCLUSIONS The PARS performed better than the API in children with mild-to-moderate asthma. This is significant because these children are the most common and most difficult to predict and might be the most amenable to prevention strategies.
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Affiliation(s)
- Jocelyn M Biagini Myers
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Eric Schauberger
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hua He
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - John Kroner
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gregory M Hill
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Patrick H Ryan
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Grace K LeMasters
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - David I Bernstein
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio; Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - James E Lockey
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - S Hasan Arshad
- David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, United Kingdom
| | - Ramesh Kurukulaaratchy
- David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, United Kingdom
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
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Daley MF, Shoup JA, Newcomer SR, Jackson ML, Groom HC, Jacobsen SJ, McLean HQ, Klein NP, Weintraub ES, McNeil MM, Glanz JM. Assessing Potential Confounding and Misclassification Bias When Studying the Safety of the Childhood Immunization Schedule. Acad Pediatr 2018; 18:754-762. [PMID: 29604461 PMCID: PMC6445249 DOI: 10.1016/j.acap.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/13/2018] [Accepted: 03/17/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Some parents are concerned the childhood immunization schedule could increase risk for allergic disorders, including asthma. To inform future safety studies of this speculated association, a parent survey was conducted to examine the risk of misclassification of vaccination status in electronic health record data, and to assess the potential for confounding if asthma risk factors varied by vaccination status. METHODS A survey was conducted among parents of children 19 to 35 months old at 6 medical organizations within the Vaccine Safety Datalink. Parents of children in 4 vaccination groups were surveyed: 1) no vaccines by 12 months of age and a diagnosis of parental vaccine refusal; 2) consistent vaccine limiting (≤2 vaccines per visit); 3) not consistently vaccine limiting but otherwise undervaccinated with a vaccine refusal diagnosis; and 4) fully vaccinated with no delays and no vaccine refusal. Parents were surveyed about their child's vaccination status and whether asthma risk factors existed. RESULTS Among a survey sample of 2043 parents, 1209 responded (59.2%). For receiving no vaccines, the observed agreement between parent report and electronic health record data was 94.0% (κ = 0.79); for receiving all vaccines with no delays, the observed agreement was 87.3% (κ = 0.73). Although most asthma risk factors (allergic rhinitis, eczema, food allergies, family asthma history) reported by parents did not differ significantly between children in the vaccination groups studied, several factors (aeroallergen sensitivity, breastfeeding) differed significantly between groups. CONCLUSIONS Measurement and control of disease risk factors should be carefully considered in observational studies of the safety of the immunization schedule.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo
| | - Sophia R Newcomer
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Wash
| | | | | | | | | | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo
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Schapheer C, Sandoval G, Villagra CA. Pest Cockroaches May Overcome Environmental Restriction Due to Anthropization. JOURNAL OF MEDICAL ENTOMOLOGY 2018; 55:1357-1364. [PMID: 29889262 DOI: 10.1093/jme/tjy090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
Our species have altered their surroundings since its early dispersion on Earth. Unfortunately, thanks to human-modified habitats, several pest organisms such as domiciliary insects have expanded their distributions. Moreover, pest-related microorganisms may also be aided by anthropization. Pest cockroaches are globally distributed and capable of carrying several diseases. We explored if urbanization may buffer environmental conditions allowing pest insects to expand their distribution. Specifically, we suggest that human settlements may generate suitable microhabitats for synanthropic cockroaches, helping them to survive and establish with disregard to overall climatic restrictions. To test this idea we studied the distribution of pest cockroaches spanning the length of Chilean territory. Chile, along its 4270 km length north to south extent, is a country offering a formidable sampling of Earth's climatic diversity accompanied by dense urbanizations. We studied entomological collections and spatially analyzed pest cockroach distribution found in Chile and discovered that synanthropic cockroach populations are consistently concentrated near most urban developed zones of the country and not limited by overall temperature. Furthermore, health-concern pest cockroach species were widely distributed in Chilean territory, found even in its most southern urban centers as well as Easter Island. Therefore, these disease vectors could exist even in isolated and extreme climatic zones as long as urbanization provides the adequate microhabitat. We discuss the need for further research in order to assess if these distributions can be extrapolated to the pathogenic strains these pest insects may be carrying as reported in other regions of the planet.
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Affiliation(s)
- Constanza Schapheer
- Laboratorio de Sistemática y Evolución de Plantas, Departamento de Silvicultura y Conservación de la Naturaleza, Universidad de Chile, Avenida Santa Rosa, La Pintana, Santiago, Chile
| | - Gino Sandoval
- Departamento de Historia y Geografía, Facultad de Historia, Geografía y Letras, Universidad Metropolitana de Ciencias de la Educación, Ñuñoa, Santiago de Chile
| | - Cristian A Villagra
- Instituto de Entomología, Facultad de Ciencias Básicas, Universidad Metropolitana de Ciencias de la Educación, Ñuñoa, Santiago de Chile
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Merckx J, Ducharme FM, Martineau C, Zemek R, Gravel J, Chalut D, Poonai N, Quach C. Respiratory Viruses and Treatment Failure in Children With Asthma Exacerbation. Pediatrics 2018; 142:peds.2017-4105. [PMID: 29866794 DOI: 10.1542/peds.2017-4105] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5771275574001PEDS-VA_2017-4105Video Abstract OBJECTIVES: Respiratory pathogens commonly trigger pediatric asthma exacerbations, but their impact on severity and treatment response remains unclear. METHODS We performed a secondary analysis of the Determinants of Oral Corticosteroid Responsiveness in Wheezing Asthmatic Youth (DOORWAY) study, a prospective cohort study of children (aged 1-17 years) presenting to the emergency department with moderate or severe exacerbations. Nasopharyngeal specimens were analyzed by RT-PCR for 27 respiratory pathogens. We investigated the association between pathogens and both exacerbation severity (assessed with the Pediatric Respiratory Assessment Measure) and treatment failure (hospital admission, emergency department stay >8 hours, or relapse) of a standardized severity-specific treatment. Logistic multivariate regressions were used to estimate average marginal effects (absolute risks and risk differences [RD]). RESULTS Of 958 participants, 61.7% were positive for ≥1 pathogen (rhinovirus was the most prevalent [29.4%]) and 16.9% experienced treatment failure. The presence of any pathogen was not associated with higher baseline severity but with a higher risk of treatment failure (20.7% vs 12.5%; RD = 8.2% [95% confidence interval: 3.3% to 13.1%]) compared to the absence of a pathogen. Nonrhinovirus pathogens were associated with an increased absolute risk (RD) of treatment failure by 13.1% (95% confidence interval: 6.4% to 19.8%), specifically, by 8.8% for respiratory syncytial virus, 24.9% for influenza, and 34.1% for parainfluenza. CONCLUSIONS Although respiratory pathogens were not associated with higher severity on presentation, they were associated with increased treatment failure risk, particularly in the presence of respiratory syncytial virus, influenza, and parainfluenza. This supports influenza prevention in asthmatic children, consideration of pathogen identification on presentation, and exploration of treatment intensification for infected patients at higher risk of treatment failure.
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Affiliation(s)
- Joanna Merckx
- Division of Infectious Diseases, Department of Pediatrics.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Francine M Ducharme
- Departments of Pediatrics and.,Social and Preventive Medicine, CHU Sainte-Justine, University of Montreal, Quebec, Canada
| | - Christine Martineau
- Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Quebec, Canada.,Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; and
| | | | - Dominic Chalut
- The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Naveen Poonai
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Caroline Quach
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; .,Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Quebec, Canada.,Infection Prevention and Control Unit, Division of Infectious Disease and Medical Microbiology, CHU Sainte-Justine, Montreal, Quebec, Canada
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Hatziagorou E, Kouroukli E, Galogavrou M, Papanikolaou D, Terzi DD, Anagnostopoulou P, Kirvassilis F, Panagiotakos DB, Tsanakas J. Efficacy and safety of the combination fluticasone propionate plus salmeterol in asthmatic preschoolers: An observational study. J Asthma 2018; 56:573-580. [PMID: 29958011 DOI: 10.1080/02770903.2018.1474923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Inhaled Corticosteroids (ICS) are the cornerstone of asthma management in pediatric patients. However, in some cases, asthma is not adequately controlled on ICS alone. Long-acting beta2-agonists (LABA) are one of the available additional therapies but their use has rarely been studied among children younger than 5 years. OBJECTIVE The aim of this observational study was to evaluate the efficacy and safety of the combination of fluticasone propionate and salmeterol (FP/SA) in asthmatic children younger than 5 years of age. METHODS A retrospective study of 796 children under the age of 5 years (2.87 ± 1.22 years, 64.2% males), who were treated with FP/SA was conducted. Hospitalization rates, frequency of wheezing, exercise induced asthma, nocturnal wheeze and drug-related side-effects were recorded through children's medical records. RESULTS The children had previously received short-acting β2-agonists (73%), ICS (17%), montelukast (1%), and ICS with montelukast (2%). Mean duration of therapy with FP/SA was 12.45 ± 9.14 months. After adjusting for age, gender, and duration of treatment, a 89% reduction was recorded in annual hospitalization rates (from 27.13% before treatment to 3.01% after FP/SA therapy, p < 0.001), a 71% reduction in incidence of exercise-induced asthma (36.8% vs. after 10.6%, p < 0.001), a 81% reduction in nocturnal asthma (33.7% vs. after: 6.4%, p < 0.001), as well as in frequency of wheezing (p < 0.01),. No previous treatment carry-on effect was observed. No major drug-related side-effects occurred in the study group. CONCLUSIONS Combination therapy (FP/SA) is well-tolerated and highly effective in asthmatic children under the age of 5 years.
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Affiliation(s)
- Elpis Hatziagorou
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Eleana Kouroukli
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Maria Galogavrou
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Dafni Papanikolaou
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Dr Despoina Terzi
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Pinelopi Anagnostopoulou
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | - Fotios Kirvassilis
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
| | | | - John Tsanakas
- a Aristotle University of Thessaloniki , Greece, Paediatric Pulmonology Unit, Hippokration Hospital , Thessaloniki , Greece
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Zhou Y, Lu Y, Zhu H, Zhang Y, Li Y, Yu Q. Short-term effect of a smart nebulizing device on adherence to inhaled corticosteroid therapy in Asthma Predictive Index-positive wheezing children. Patient Prefer Adherence 2018; 12:861-868. [PMID: 29849453 PMCID: PMC5965382 DOI: 10.2147/ppa.s162744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To explore the effect of a smart nebulizing device on the rate of adherence to inhaled corticosteroid (ICS) in children with positive Asthma Predictive Index. METHODS In total, 65 children with positive Asthma Predictive Index and under the age of 5 years who visited our hospital from October 2015 through October 2016, were randomly assigned to receive conventional nebulization or smart nebulization. The smart nebulizer was connected to smart phones via an App. The following information was collected: rate of adherence to ICS, frequency of emergency visits or hospitalizations, application of antibiotics or oral steroids, and wheezing progression or improvement. RESULTS The rate of adherence to ICS was 86.67% (26/30), 76.67% (23/30), and 67.33% (20/30) in the smart nebulization group, and 62.86% (22/35), 51.42% (18/35), and 40.00% (14/35) in the conventional nebulization group after 4-, 8-, and 12-week therapy, respectively. There were significant differences between the 2 groups at all of the time points (P<0.05). Both day- and night-time wheezing scores were significantly lower in the smart nebulization group than those of the conventional nebulization group after 4-, 8-, and 12-week therapy (P<0.05). The frequency of emergency visits, comorbidity of respiratory infection, antibiotics or systemic steroid usage, and therapeutic cost for additional treatment during the 12-week study period, was significantly lower in the smart nebulization group than that in the conventional nebulization group (P<0.05). CONCLUSION A smart electronic nebulization device could significantly improve the rate of adherence to ICS in children under the age of 5 years, and thus could significantly reduce the frequency of emergency visits and respiratory infections as well as the usage of antibiotics or systemic steroids.
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Affiliation(s)
- Yuan Zhou
- Department of Pediatrics, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201112, People’s Republic of China
| | - Yanming Lu
- Department of Pediatrics, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201112, People’s Republic of China
| | - Haojin Zhu
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 201112, People’s Republic of China
| | - Yanhan Zhang
- Department of Pediatrics, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201112, People’s Republic of China
| | - Yaqin Li
- Department of Pediatrics, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201112, People’s Republic of China
| | - Qing Yu
- Department of Pediatrics, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201112, People’s Republic of China
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Arikoglu T, Batmaz S, Yildirim D, Tezol Ö, Bozlu G, Kuyucu S. Asthma predictive index in relation to respiratory mechanics by impulse oscillometry in recurrent wheezers. Allergol Immunopathol (Madr) 2018; 46:190-195. [PMID: 29331617 DOI: 10.1016/j.aller.2017.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The identification of children who will have persistent asthma has become a focus of recent research. The aim of this study was to assess whether impulse oscillometry (IOS) has a diagnostic value to predict modified API (asthma predictive index) in pre-schoolers with recurrent wheezing. METHODS Pre-school children aged 3-6 years with recurrent wheezing were enrolled. The study population was divided into two groups based on mAPI criteria. Lung function was assessed by IOS. RESULTS 115 children were assessed; 75 (65.2%) of them were male. The median age was 39 months (min: 36, max: 68 months). 64 (55.6%) of the children were mAPI positive. The R5-R20% levels of children with positive mAPI were significantly higher compared to negative mAPI. Also, R5-R20% levels of children with parental asthma and R20% pred and resonant frequency (Fres) levels of children with inhalant sensitization were higher than those without. No significant differences were found in IOS indices between groups based on the presence of atopic dermatitis, food sensitization, eosinophilia, inhaled corticosteroid usage or wheezing without colds. R5-R20% and total IgE values were found to be significantly related to positive mAPI (aOR: 1.40, p=0.022 and aOR: 1.02, p=0.001, respectively). In the ROC analysis, R5-R20% levels >14.4 had a sensitivity of 75% and specificity of 53% for predicting a positive mAPI (p=0.003). CONCLUSION IOS may help clinicians to identify the pre-school wheezers with a high risk of asthma.
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Pruikkonen H, Tapiainen T, Kallio M, Dunder T, Pokka T, Uhari M, Renko M. Intravenous magnesium sulfate for acute wheezing in young children: a randomised double-blind trial. Eur Respir J 2018; 51:51/2/1701579. [PMID: 29437941 DOI: 10.1183/13993003.01579-2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/19/2017] [Indexed: 01/17/2023]
Abstract
Magnesium sulfate has been shown to be an effective treatment in older children with asthma exacerbations, but it has not been investigated in acute severe virus-induced wheezing in young children.The study enrolled 61 children aged 6 months to 4 years. Inclusion criteria were severe wheezing, classified as a score of ≥6 points as assessed by the Respiratory Distress Assessment Instrument (RDAI) after initial treatment with salbutamol, and the symptoms of acute viral infection. The children were randomly allocated to receive either an infusion of magnesium sulfate (40 mg·kg-1) or 0.9% sodium chloride as a placebo infusion for 20 min. Primary outcome measure was mean change in RDAI scores from baseline to 6 h after the treatment.Change in the severity of wheezing from baseline to 6 h after the treatment, as measured by mean±sd RDAI scores, was 4.7±2.6 in the magnesium sulfate group and 4.2±4.2 in the placebo group (difference 0.5, 95% CI -1.3 to 2.3, p=0.594).Intravenous magnesium sulfate was ineffective in treating acute severe virus-induced wheezing in young children, in contrast to the previous efficacy demonstrated in older children.
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Affiliation(s)
- Hannele Pruikkonen
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Terhi Tapiainen
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Dept of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Merja Kallio
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Dept of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Teija Dunder
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Dept of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Dept of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Matti Uhari
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Dept of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Marjo Renko
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Dept of Children and Adolescents, Oulu University Hospital, Oulu, Finland
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46
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Mallol J, Solé D, Aguirre V, Chong H, Rosario N, García-Marcos L. Changes in the prevalence and severity of recurrent wheezing in infants: The results of two surveys administered 7 years apart. J Asthma 2017; 55:1214-1222. [PMID: 29231772 DOI: 10.1080/02770903.2017.1403625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To identify changes in the prevalence and severity of recurrent wheezing (RW) in infants using data obtained from two surveys administered seven years apart. METHODS A cross-sectional, international, population-based study in infants aged 12-15 months was conducted. Data were obtained from two surveys (S1 and S2, in 2005 and 2012, respectively) using the same methodology in three large Latin American cities: Curitiba (Brazil), São Paulo (Brazil), and Santiago (Chile). RESULTS A decrease in the overall prevalence of RW was identified between S1 (23.3%) and S2 (20.4%), p = 0.004, but it was mainly driven by the reduction observed in São Paulo; in Curitiba and Santiago, this change was not significant. The mean prevalence of the following RW severity indicators remained high and stable: severe wheezing episodes (56.9% in S1 and 54.2% in S2, p = 0.32) and emergency department (ED) visits for wheezing (S1 = 68.1%, S2 70.9%, p = 0.21). A significant increase in admissions for wheezing (21.1% to 26.7%, p = 0.004) was observed. In Curitiba and São Paulo, there were significant increases in the prevalence of physician-diagnosed asthma and in the use of inhaled corticosteroids and oral antileukotrienes. CONCLUSIONS The prevalence and severity of RW during the first year of life remained high over time, with remarkably high rates of ED visits, admissions for wheezing and use of asthma medications. This study suggests the need for considering early asthma diagnosis and to establish an appropriate treatment in infants with recurrent and severe asthma-like symptoms.
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Affiliation(s)
- Javier Mallol
- a Department of Pediatric Respiratory Medicine , Hospital El Pino, University of Santiago de Chile (USACH) , Santiago , Chile
| | - Dirceu Solé
- b Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Viviana Aguirre
- a Department of Pediatric Respiratory Medicine , Hospital El Pino, University of Santiago de Chile (USACH) , Santiago , Chile
| | - Herberto Chong
- c Department of Pediatric Allergy , Federal University of Paraná , Curitiba , Brazil
| | - Nelson Rosario
- c Department of Pediatric Allergy , Federal University of Paraná , Curitiba , Brazil
| | - Luis García-Marcos
- d University of Murcia and Arrixaca Bio-Health Research Institute of Murcia (IMIB) , Murcia , Spain
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Sacchetti M, Baiardini I, Chini L, Moschese V, Bruscolini A, Lambiase A. Development and preliminary validation of a new screening questionnaire for identifying atopic children. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:99-105. [PMID: 29388629 PMCID: PMC5774591 DOI: 10.2147/phmt.s142271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Allergic diseases represent a frequent and increasing condition affecting children. A screening questionnaire allowing an easy identification of children with symptoms of allergic diseases may improve management and clinical outcome. The aim of this study was to develop and validate an easy-to-use screening questionnaire to detect children requiring further allergological evaluations. Methods A 10-item questionnaire, evaluating the presence and the history of the most frequent allergic conditions affecting children, including allergic asthma, allergic rhinitis and conjunctivitis, food allergy, and atopic dermatitis, was developed and administered to 214 parents of children from 5 to 10 years of age (163 with allergic disease and 51 healthy, nonallergic children). Validation was performed by Pearson’s correlation between the clinical diagnosis and the responses to the questionnaire. Internal consistency was computed by Cronbach’s alpha correlation coefficient. Sensitivity and specificity of the novel questionnaire were assessed by the receiver operating characteristic (ROC) curve. Results Validation analysis of the new children atopy (ChAt) questionnaire showed good internal consistency with a Cronbach’s alpha of 0.757. Responses to the items evaluating the presence of individual allergic conditions significantly correlated with the clinical diagnosis (p<0.001). The ROC curve showed an area of 0.956 and identified a cutoff value >2 of the ChAt questionnaire total score for detection of allergy (sensitivity =0.92 and specificity =0.902). Conclusion The novel ChAt questionnaire represents a simple tool able to detect the presence of all major allergic diseases in a pediatric population allowing an early identification of allergic multimorbidity and potentially facilitating clinical management.
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Affiliation(s)
- Marta Sacchetti
- Cornea and Ocular Surface Unit, IRCCS-Ospedale San Raffaele di Milano, Milan.,Department of Sense Organs, Sapienza University, Rome
| | - Ilaria Baiardini
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa
| | - Loredana Chini
- Pediatric Allergology and Immunology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Viviana Moschese
- Pediatric Allergology and Immunology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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Hesselmar B, Saalman R, Wennergren G, Åmark M, Wold AE, Adlerberth I, Åberg N. An index to predict asthma in wheezing young children produced promising initial results. Acta Paediatr 2017; 106:1532-1533. [PMID: 28503824 DOI: 10.1111/apa.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bill Hesselmar
- Department of Paediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Robert Saalman
- Department of Paediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Göran Wennergren
- Department of Paediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Mainor Åmark
- Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Agnes E. Wold
- Department of Infectious Diseases; Institute of Biomedicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Ingegerd Adlerberth
- Department of Infectious Diseases; Institute of Biomedicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Nils Åberg
- Department of Paediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Kamalaporn H, Chawalitdamrong P, Preutthipan A. Thai pediatricians' current practice toward childhood asthma. J Asthma 2017; 55:402-415. [PMID: 28696803 DOI: 10.1080/02770903.2017.1338724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Childhood asthma is a substantial health burden in Thailand. Due to a lack of pediatric respiratory specialists (pediatric pulmonologists and allergists; RS), most Thai children are cared for by general pediatricians (pediatric primary care providers (PCP)). OBJECTIVES We investigated whether current practices of Thai pediatricians complied with asthma guidelines and compared practices (diagnosis and treatments) provided by PCP and RS. METHODS A cross-sectional study was conducted using electronic surveys including four case scenarios of different asthma phenotypes distributed to Thai pediatricians. Asthma diagnosis and management were evaluated for compliance with standard guidelines. The practices of PCP and RS were compared. RESULTS From 800 surveys distributed, there were 405 respondents (51%). Most respondents (81%) were PCP, who preferred to use clinical diagnosis rather than laboratory investigations to diagnose asthma. For acute asthmatic attacks, 58% of the pediatricians prescribed a systemic corticosteroid. For uncontrolled asthma, 89% of the pediatricians prescribed at least one controller. For exercise-induced bronchospasm, 55% of the pediatricians chose an inhaled bronchodilator, while 38% chose a leukotriene receptor antagonist (LTRA). For virus-induced wheeze, 40% of the respondents chose an LTRA, while 15% chose inhaled corticosteroids (ICS). PCP prescribed more oral bronchodilators (31% vs. 18%, p = 0.02), antibiotics (20% vs. 6%, p < 0.001), and antihistamines (13% vs. 0%, p = 0.02) than RS for the management of an acute asthmatic attack. CONCLUSIONS Most of the Thai pediatricians' practices toward diagnosis and treatment of acute asthmatic attack and uncontrolled asthma conform to the guidelines. PCP prescribed more oral bronchodilators, antibiotics, and antihistamines than RS.
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Affiliation(s)
- Harutai Kamalaporn
- a Division of Pulmonology, Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
| | - Pongpan Chawalitdamrong
- a Division of Pulmonology, Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
| | - Aroonwan Preutthipan
- a Division of Pulmonology, Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand
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50
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Mallol J. ASMA DEL LACTANTE: ACTUALIZACIÓN. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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