Peak flow monitoring in pediatric asthma management: a clinical practice column submission

Burden of Asthma and Role of 2.5 µg Tiotropium Respimat® as an Add-On Therapy: A Systematic Review of Phase 2/3 Trials

Introduction

Tiotropium, a long-acting muscarinic antagonist, is approved for maintenance treatment of asthma in patients at least 6 years of age in the USA. We systematically reviewed published evidence on the efficacy and safety of 2.5 µg tiotropium Respimat^® add-on therapy to inhaled corticosteroid (ICS) with or without additional controller medication(s) in children, adolescents, and adults with asthma.

Methods

We searched PubMed from inception until October 3, 2018, for phase 2 and 3 randomized controlled trials (RCTs) evaluating the effects of 2.5 µg tiotropium Respimat^® on lung function parameters in patients with asthma. We extracted adjusted mean differences for lung function data and adverse events (AEs) from relevant articles.

Results

Overall, 11 RCTs (three phase 2 and eight phase 3 studies) including 3244 patients (2.5 µg tiotropium Respimat^®, n = 1642; placebo, n = 1602) met the predefined inclusion criteria. Once-daily 2.5 µg tiotropium Respimat^® improved lung function parameters, including peak and trough forced expiratory volume in 1 s and peak and trough forced vital capacity, versus placebo. Overall, the safety profile of 2.5 µg tiotropium Respimat^® was comparable to that of placebo, with the most commonly reported AEs being asthma worsening, reduction in peak expiratory rate, nasopharyngitis, and respiratory tract infections.

Conclusion

On the basis of the results of phase 2 and 3 studies, 2.5 µg tiotropium Respimat^® as add-on to ICS therapy was safe and associated with consistent improvements in lung function in patients with asthma of varying severities across different age groups.

Funding

Development of the manuscript was funded by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI).

Electronic supplementary material

The online version of this article (10.1007/s12325-019-01062-w) contains supplementary material, which is available to authorized users.

Efficiency of physiotherapy with Caycedian Sophrology on children with asthma: A randomized controlled trial

BACKGROUND

Asthma is the most common chronic disease in pediatrics. Along with the usual drug therapy using corticosteroids and bronchodilators, some interest has been shown for adjuvant therapies, such as sophrology. However, the level of evidence for non-pharmaceutical therapies in asthma remains low, especially in children. This study aimed to assess whether in children with asthma, peak expiratory flow (PEF) improved more after a sophrology session alongside standard treatment than after standard treatment alone.

METHODS

We carried out a prospective randomized controlled clinical trial among 74 children aged 6-17 years old, hospitalized for an asthma attack. Group 1: conventional treatment (oxygen, corticosteroids, bronchodilators, physiotherapy) added to one session of sophrology. Group 2: conventional treatment alone. The primary outcome was the PEF variation between the initial and final evaluations (PEF₂ -PEF₁ ).

RESULTS

Demographic and clinical characteristics were similar in both groups at baseline. Measures before and after the sophrology session showed that the PEF increased by mean 30 L/min in the sophrology group versus 20 L/min in the control group (P = 0.02). Oxygen saturation increased by 1% versus 0% (P = 0.02) and the dyspnea score with visual analogue scale improved by two points point (P = 0.01). No differences were observed between the two groups in terms of duration of hospitalization, use and doses of conventional medical treatment (oxygen, corticosteroids, and bronchodilators), and quality of life scores.

CONCLUSIONS

Sophrology appears as a promising adjuvant therapy to current guideline-based treatment for asthma in children.

Assessing asthma in the otolaryngologist's office

PURPOSE OF REVIEW

To familiarize otolaryngologists and other practitioners with basic diagnosis and treatment of asthma in adults and children based on current literature.

RECENT FINDINGS

Increased fractional excretion of nitrous oxide and sputum eosinophils have been identified in asthmatic patients being evaluated for chronic cough and appear to be more sensitive in diagnosis than traditional spirometry. Both sublingual and subcutaneous immunotherapy modalities are effective in decreasing symptoms and medication use in patients with allergic rhinitis and allergic asthma.

SUMMARY

Undiagnosed comorbid asthma is prevalent among patients with chronic rhinosinusitis and allergic rhinitis and control of all diseases processes greatly improves quality of life. Office spirometry is a helpful tool in the evaluation and management of asthma. Otolaryngologists should be able to recognize undiagnosed or poorly controlled asthma, initiate and improve medical therapy, and treat rhinosinusitis to improve asthma control.

A randomised dose-ranging study of tiotropium Respimat® in children with symptomatic asthma despite inhaled corticosteroids

BACKGROUND

A considerable number of children with asthma remain symptomatic despite treatment with inhaled corticosteroids, resulting in significant morbidity, reduced quality of life, increased healthcare costs and lost school days. The aim of our study was to assess the efficacy, safety and tolerability of once-daily tiotropium Respimat® 5 μg, 2.5 μg and 1.25 μg add-on to medium-dose inhaled corticosteroids, with or without a leukotriene modifier, in children aged 6-11 years with symptomatic asthma.

METHODS

In this Phase II, double-blind, placebo-controlled, incomplete-crossover, dose-ranging study, patients were randomised to receive three of the four treatments evaluated: once-daily tiotropium Respimat® 5 μg, 2.5 μg or 1.25 μg or placebo Respimat®, in the evening during the 12-week (three × 4-week) treatment period.

RESULTS

In total, 76, 74, 75 and 76 patients aged 6-11 years received tiotropium Respimat® 5 μg, 2.5 μg, 1.25 μg and placebo Respimat®, respectively. For the primary end point (peak forced expiratory volume in 1 second measured within 3 hours post-dosing), the adjusted mean responses with tiotropium Respimat® 5 μg (272 mL), 2.5 μg (290 mL) and 1.25 μg (261 mL) were significantly greater than with placebo Respimat® (185 mL; p = 0.0002, p < 0.0001 and p = 0.0011, respectively). The safety and tolerability of all doses of tiotropium Respimat® were comparable with those of placebo Respimat®, with no serious adverse events and no events leading to discontinuation.

CONCLUSIONS

Tiotropium Respimat® add-on to medium-dose inhaled corticosteroids, with or without a leukotriene modifier, was efficacious in paediatric patients with symptomatic asthma and had comparable safety and tolerability with placebo Respimat®.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT01383499.

Pediatric sedation and anesthesia for the oral surgeon

Even simple oral and maxillofacial surgical procedures can become challenging when the child patient has a high degree of fear and anxiety. This article reviews differences in anatomy and physiology between the adult and pediatric patient, preanesthetic assessment, fasting guidelines, and choices of sedation routes, and discusses equipment options for the management of pediatric anesthesia. After reflection on these topics and based on training and experience, oral and maxillofacial surgeons can decide the ages of patients, medical comorbidities, and techniques with which they are comfortable in performing surgery in their offices in a safe and effective manner.

Asthma self-management: a study in an emergency room of a chest hospital in delhi, India

OBJECTIVES

Poorly controlled asthma imposes a considerable burden and is a serious public health problem in the developing world. A key challenge for healthcare professionals is to help patients to engage in self-management behaviours with optimal adherence to appropriate treatment. The aim of the present study was to investigate the pattern of self-management in asthmatic patients enrolled as out-patients in a tertiary care referral public chest hospital, in Delhi, India.

METHODS

The study population was adult asthma patients (n=200) visiting the emergency room (December 2008-December 2009) of a chest hospital for asthma exacerbation. The data was collected through a questionnaire regarding the self-management of asthma.

RESULTS

Enrolled patients (64.0% female) were registered as asthma out-patients in the study hospital for a mean of 5.4±4.4 years. Patients visiting the emergency room (ER) and having an unscheduled visit to doctor at least twice in the previous 12 months were 86.5% and 91.0%. Patients were classified according to the disease severity as having intermittent (17.0%) or persistent (83.0%) asthma. Not all patients had metered dose inhalers at home. Only 2.0% of patients were prescribed peak flow meters and were keeping a diary of their readings. With one exception, patients did not have written action plans for treatment provided by doctor or health facility. No statistical difference was found in the pattern of self-management of patients having persistent or intermittent asthma.

CONCLUSIONS

Findings revealed poor self-management of asthma and poor communication from doctors regarding self-management to the patients. Suitable actions and interventions are needed by health professionals to implement patient self-management asthma programme for optimum asthma control.

Effect of peak flow monitoring on child asthma quality of life

The purpose of this study was to evaluate the effect of peak flow monitoring on asthma quality of life (QOL) for school-age children with asthma (N = 77) who participated in a 16-week asthma self-management program. QOL was measured using the Children's Health Survey for Asthma. Findings indicated significant improvement in asthma QOL from baseline to Week 16 and higher QOL scores for those with better asthma health outcomes.

Monitoring asthma status

PURPOSE

Asthma is a chronic disorder of the airways involving inflammation and airway hyper-reactivity. Clinical diagnosis and monitoring of asthma must incorporate the immunological, biochemical, and histological changes of a chronic disorder, while recognizing acute phenotypic changes in order to optimally tailor therapeutics to each individual.

RECENT FINDINGS

Articles published within the previous 18 months are summarized in this article in order to present an up to date review of the latest findings regarding the monitoring of asthma. The articles encompass a wide array of specialties from basic research and histology to clinical medicine as well as community medicine and nursing.

SUMMARY

Exciting new advancements in the monitoring of asthma continue to unfold. Potentially new diagnostic and monitoring tools are highlighted in this study. Continued investigations may enable a select few methodologies to reach clinical utility in the ongoing monitoring and treatment of patients with asthma.