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Stefanidis C, Martineau AR, Nwokoro C, Griffiths CJ, Bush A. Vitamin D for secondary prevention of acute wheeze attacks in preschool and school-age children. Thorax 2019; 74:977-985. [PMID: 31278171 DOI: 10.1136/thoraxjnl-2019-213278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/13/2019] [Accepted: 06/01/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Vitamin D is best known for its role in bone health; however, the discovery of the vitamin D receptor and the expression of the gene encoding the vitamin D 1α-hydroxylase (CYP27B1) enzyme in a wide variety of tissues including immune cells and respiratory epithelium has led to the discovery of potential roles for vitamin D in the prevention of acute wheeze. METHODS We review here the literature concerning the relationships between circulating 25-hydroxyvitamin D (25(OH)D) concentration and secondary prevention of acute wheeze attacks in preschool and school-age children. RESULTS Epidemiological data suggest that vitamin D insufficiency (25(OH)D <75 nmol/L) is highly prevalent in preschool and school-age children with wheeze. Preschool age children with a history of wheeze attacks and circulating 25(OH)D <75 nmol/L are at increased risk and frequency of future acute wheeze. However, no consistent association between low vitamin D status and risk of acute wheeze is reported in school-age children. Seven randomised controlled trials (RCTs) with relatively small sample sizes (30-430) and variable quality showed inconsistent results regarding the effect of oral vitamin D supplementation during childhood on the risk of asthma attacks, asthma symptom control, inhaled corticosteroid requirements, spirometry and unscheduled healthcare attendances for wheeze. A RCT showed that vitamin D supplementation had no effect on the frequency of unplanned healthcare attendances due to acute wheeze in 22 preschool children. DISCUSSION An evidence-based recommendation for the use of vitamin D as a preventive therapy for wheeze attacks cannot be made until results of further trials are available. The assessment of circulating 25(OH)D concentration and the optimisation of vitamin D status to prevent acute respiratory tract infections, and to maintain skeletal and general health in preschool and school-age children with acute wheeze is worthwhile in its own right, but whether this will reduce the risk of acute wheeze attacks is unclear.
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Affiliation(s)
- Christos Stefanidis
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK .,Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R Martineau
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chinedu Nwokoro
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Christopher J Griffiths
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrew Bush
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Royal Brompton Hospital, Biomedical Research Unit at the Royal Brompton & Harefield NHS Foundation Trust, Imperial College London, London, UK
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2
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Burman A. Question 2: Is there a role for Montelukast in the management of viral-induced wheeze in preschool children? Arch Dis Child 2018; 103:519-520. [PMID: 29618481 DOI: 10.1136/archdischild-2018-314905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Alisha Burman
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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3
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Khetan R, Hurley M, Neduvamkunnil A, Bhatt JM. Fifteen-minute consultation: An evidence-based approach to the child with preschool wheeze. Arch Dis Child Educ Pract Ed 2018; 103:7-14. [PMID: 28667045 DOI: 10.1136/archdischild-2016-311254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/02/2016] [Accepted: 04/04/2017] [Indexed: 11/04/2022]
Abstract
Preschool wheeze is very common and its prevalence is increasing. It consumes considerable healthcare resources and has a major impact on children and their families due to significant morbidity associated with acute episodes.History taking is the main diagnostic instrument in the assessment of preschool wheeze. Diagnosis and management is complicated by a broad differential and associations with many other diseases and conditions that give rise to noisy breathing, which could be misinterpreted as wheeze. Several clinical phenotypes have been described but they have limitations and do not clearly inform therapeutic decisions. New insights in aetiopathogenesis modify treatment options and lay foundation for further research. An understanding of the approach and available evidence to assess and manage wheeze informs best patient care and use of resources.Our objective is to demonstrate a focused history, examination and management options in a preschool child with wheeze.
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Affiliation(s)
- Renu Khetan
- Department of Paediatrics, Nottingham Children's Hospital, Nottingham, UK
| | - Matthew Hurley
- Department of Paediatrics, Nottingham Children's Hospital, Nottingham, UK.,Division of Child Health, University of Nottingham, Nottingham, UK
| | | | - Jayesh Mahendra Bhatt
- Department of Paediatrics, Nottingham Children's Hospital, Nottingham, UK.,Nottingham Children's Hospital, National Paediatric Ataxia Telangiectasia Clinic, Nottingham, UK
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van Wonderen KE, Geskus RB, van Aalderen WMC, Mohrs J, Bindels PJE, van der Mark LB, Ter Riet G. Stability and predictiveness of multiple trigger and episodic viral wheeze in preschoolers. Clin Exp Allergy 2017; 46:837-47. [PMID: 26464237 DOI: 10.1111/cea.12660] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/10/2015] [Accepted: 10/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2008, the European Respiratory Society Task Force proposed the terms multiple-trigger wheeze (MTW) and episodic (viral) wheeze (EVW) for children with wheezing episodes. We determined MTW and EVW prevalence, their 24-month stability and predictiveness for asthma. METHODS In total, 565 preschoolers (1-, 2- and 3-year-olds) in primary care with respiratory symptoms were followed until the age of 6 years when asthma was diagnosed. MTW status and EVW status were determined using questionnaire data collected at baseline and after one and 2 years. We distinguished 3 phenotypes and determined their 24-month stability, also accounting for treatment with inhaled corticosteroids (ICS). Logistic regression was used to analyse the phenotypes' associations with asthma. RESULTS Two hundred and eighty-one children had complete information. MTW and EVW were stable in 10 of 281 (3.6%) and 24 of 281 (8.5%), respectively. The odds of developing asthma for children with stable MTW and stable EVW were 14.4 (1.7-119) and 3.6 (1.2-11.3) times greater than those for children free of wheeze (for at least 1 year). ICS was associated with increased stability of MTW and EVW. CONCLUSIONS Stable multiple-trigger and stable episodic viral wheeze are relatively uncommon. However, 1- to 3-year-olds with stable MTW are at much increased risk of asthma.
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Affiliation(s)
| | - R B Geskus
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - W M C van Aalderen
- Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - J Mohrs
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | - P J E Bindels
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L B van der Mark
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | - G Ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
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5
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Perucci LO, Sugimoto MA, Gomes KB, Dusse LM, Teixeira MM, Sousa LP. Annexin A1 and specialized proresolving lipid mediators: promoting resolution as a therapeutic strategy in human inflammatory diseases. Expert Opin Ther Targets 2017; 21:879-896. [PMID: 28786708 DOI: 10.1080/14728222.2017.1364363] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The timely resolution of inflammation is essential to restore tissue homeostasis and to avoid chronic inflammatory diseases. Resolution of inflammation is an active process modulated by various proresolving mediators, including annexin A1 (AnxA1) and specialized proresolving lipid mediators (SPMs), which counteract excessive inflammatory responses and stimulate proresolving mechanisms. Areas covered: The protective effects of AnxA1 and SPMs have been extensively explored in pre-clinical animal models. However, studies investigating the function of these molecules in human diseases are just emerging. This review highlights recent advances on the role of proresolving mediators, and pharmacological opportunities of promoting resolution pathways in preclinical models and patients with various human diseases. Expert opinion: Dysregulation or 'failure' in proresolving mechanisms might be involved in the pathogenesis of chronic inflammatory diseases. Altered levels of proresolving mediators were found in a wide range of human diseases. In some cases, AnxA1 and SPMs are up-regulated in human blood and tissues but fail to engage in proresolving signaling and, hence, to regulate excessive inflammation. Thus, the new concept of 'resolution pharmacology' could be applied to compensate deficiency of endogenous proresolving mediators' generation and/or possible failures in the engagement of resolution pathways observed in many chronic inflammatory diseases.
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Affiliation(s)
- Luiza Oliveira Perucci
- a Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil.,b Programa de Pós-Graduação em Análises Clínicas e Toxicológicas , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Michelle Amantéa Sugimoto
- a Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil.,c Programa de Pós-Graduação em Ciências Farmacêuticas , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Karina Braga Gomes
- a Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil.,b Programa de Pós-Graduação em Análises Clínicas e Toxicológicas , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Luci Maria Dusse
- a Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil.,b Programa de Pós-Graduação em Análises Clínicas e Toxicológicas , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil.,c Programa de Pós-Graduação em Ciências Farmacêuticas , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Mauro Martins Teixeira
- d Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
| | - Lirlândia Pires Sousa
- a Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil.,b Programa de Pós-Graduação em Análises Clínicas e Toxicológicas , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil.,c Programa de Pós-Graduação em Ciências Farmacêuticas , Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil
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Busi LE, Restuccia S, Tourres R, Sly PD. Assessing bronchodilator response in preschool children using spirometry. Thorax 2016; 72:367-372. [PMID: 27742871 DOI: 10.1136/thoraxjnl-2015-207961] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Measuring lung function, including bronchodilator response (BDR), is an integral part of asthma management in older children. While spirometry is possible in preschool-aged children, the question remains whether measuring BDR aids in asthma diagnosis in this age group. METHODS 431 healthy children and 289 children with asthma, aged 3-5 years, were recruited from kindergartens and the pulmonology clinic in Trelew, Argentina. Spirometry was performed at visit 1 and repeated after 15 min, with children randomised to placebo or salbutamol (400 µg). Spirometry was again performed within 8 weeks at visit 2. Within-session repeatability from visit 1 and between-session reproducibility were calculated using baseline spirometry. The within-session repeatability and receiver operating characteristic curve analyses were used to determine the optimal threshold values for BDR for spirometry outcome variables measured at the first visit, and sensitivity, specificity and diagnostic accuracy were determined. RESULTS As a group, children with asthma had lower lung function (FVC 1.11±0.12 L vs 1.01±0.15 L; FEV0.75 1.01±0.10 L vs 0.91±0.15 L) and a greater BDR (FEV0.75 group difference 8.6 (95% CI -5.0 to 14.3)%) than healthy children. BDR was best defined by change in FEV0.75; an increase of 11% showed the best balance between sensitivity (51%), specificity (88%), positive predictive value (47%) and negative predictive value (89%) for discriminating healthy from preschool-aged children with asthma. CONCLUSIONS A negative BDR in a child suspected of having asthma makes a diagnosis of asthma less likely.
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Affiliation(s)
- Luciano E Busi
- Pulmonology Committee of the Argentinean Pediatric Society, Trelew, Argentina.,Trelew Hospital, Trelew, Argentina
| | | | | | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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7
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Kittana N, Hattab S, Ziyadeh-Isleem A, Jaradat N, Zaid AN. Montelukast, current indications and prospective future applications. Expert Rev Respir Med 2016; 10:943-56. [PMID: 27485393 DOI: 10.1080/17476348.2016.1207533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Montelukast is recommended for the treatment of asthma, exercise -induced bronchospasm and allergic rhinitis. Several trials demonstrated potential therapeutic effects in other respiratory conditions, and different animal-model-based studies explored potential pharmacological actions in non-respiratory conditions. AREAS COVERED Clinical investigations on the pharmacotherapeutic effects of montelukast, in addition to in-vivo studies on animal models of non-respiratory diseases. The data discussed in this review were mainly obtained from clinical randomized trials, real-life studies, and studies based on animal models as approve of concept. As a condition, all of the discussed articles were published in journals cited by Pubmed. Expert commentary: The current clinical data are in favor of montelukast use in the management of chronic asthma as an add-on or alternative therapy to the inhaled corticosteroids. Further clinical trials are required to confirm the effectiveness and feasibility of montelukast for the treatment of conditions other than the current clinical indications.
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Affiliation(s)
- Naim Kittana
- a Division of Pharmacology and Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences , An-Najah National University , Nablus , Palestine
| | - Suhaib Hattab
- a Division of Pharmacology and Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences , An-Najah National University , Nablus , Palestine
| | - Azza Ziyadeh-Isleem
- a Division of Pharmacology and Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences , An-Najah National University , Nablus , Palestine
| | - Nidal Jaradat
- b Division of Pharmaceutical Chemistry and Technology, Department of Pharmacy, Faculty of Medicine and Health Sciences , An-Najah National University , Nablus , Palestine
| | - Abdel-Naser Zaid
- b Division of Pharmaceutical Chemistry and Technology, Department of Pharmacy, Faculty of Medicine and Health Sciences , An-Najah National University , Nablus , Palestine
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8
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Sugimoto MA, Sousa LP, Pinho V, Perretti M, Teixeira MM. Resolution of Inflammation: What Controls Its Onset? Front Immunol 2016. [PMID: 27199985 DOI: 10.3389/fimmu.2016.00.00160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
An effective resolution program may be able to prevent the progression from non-resolving acute inflammation to persistent chronic inflammation. It has now become evident that coordinated resolution programs initiate shortly after inflammatory responses begin. In this context, several mechanisms provide the fine-tuning of inflammation and create a favorable environment for the resolution phase to take place and for homeostasis to return. In this review, we focus on the events required for an effective transition from the proinflammatory phase to the onset and establishment of resolution. We suggest that several mediators that promote the inflammatory phase of inflammation can simultaneously initiate a program for active resolution. Indeed, several events enact a decrease in the local chemokine concentration, a reduction which is essential to inhibit further infiltration of neutrophils into the tissue. Interestingly, although neutrophils are cells that characteristically participate in the active phase of inflammation, they also contribute to the onset of resolution. Further understanding of the molecular mechanisms that initiate resolution may be instrumental to develop pro-resolution strategies to treat complex chronic inflammatory diseases, in humans. The efforts to develop strategies based on resolution of inflammation have shaped a new area of pharmacology referred to as "resolution pharmacology."
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Affiliation(s)
- Michelle A Sugimoto
- Laboratório de Sinalização Inflamação, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lirlândia P Sousa
- Laboratório de Sinalização Inflamação, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vanessa Pinho
- Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Laboratório de Resolução da Resposta Inflamatória, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mauro Perretti
- William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London , London , UK
| | - Mauro M Teixeira
- Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
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9
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Sugimoto MA, Sousa LP, Pinho V, Perretti M, Teixeira MM. Resolution of Inflammation: What Controls Its Onset? Front Immunol 2016; 7:160. [PMID: 27199985 PMCID: PMC4845539 DOI: 10.3389/fimmu.2016.00160] [Citation(s) in RCA: 395] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/12/2016] [Indexed: 12/12/2022] Open
Abstract
An effective resolution program may be able to prevent the progression from non-resolving acute inflammation to persistent chronic inflammation. It has now become evident that coordinated resolution programs initiate shortly after inflammatory responses begin. In this context, several mechanisms provide the fine-tuning of inflammation and create a favorable environment for the resolution phase to take place and for homeostasis to return. In this review, we focus on the events required for an effective transition from the proinflammatory phase to the onset and establishment of resolution. We suggest that several mediators that promote the inflammatory phase of inflammation can simultaneously initiate a program for active resolution. Indeed, several events enact a decrease in the local chemokine concentration, a reduction which is essential to inhibit further infiltration of neutrophils into the tissue. Interestingly, although neutrophils are cells that characteristically participate in the active phase of inflammation, they also contribute to the onset of resolution. Further understanding of the molecular mechanisms that initiate resolution may be instrumental to develop pro-resolution strategies to treat complex chronic inflammatory diseases, in humans. The efforts to develop strategies based on resolution of inflammation have shaped a new area of pharmacology referred to as “resolution pharmacology.”
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Affiliation(s)
- Michelle A Sugimoto
- Laboratório de Sinalização Inflamação, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lirlândia P Sousa
- Laboratório de Sinalização Inflamação, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vanessa Pinho
- Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Laboratório de Resolução da Resposta Inflamatória, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mauro Perretti
- William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London , London , UK
| | - Mauro M Teixeira
- Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
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10
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Sayão LB, de Britto MCA, Burity E, Rattes C, Reinaux CMA, Fink J, Dornelas de Andrade A. Exhaled nitric oxide as a diagnostic tool for wheezing in preschool children: A diagnostic accuracy study. Respir Med 2016; 113:15-21. [PMID: 27021575 DOI: 10.1016/j.rmed.2016.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Airways inflammation may precede pulmonary dysfunction in wheezing individuals. The fraction of exhaled nitric oxide (FENO) has been described as a useful method for wheezing diagnosis in children, however, its application requires evidence. This study aimed to determine the accuracy of FENO in identifying wheezing in preschoolers. METHODS A cross-sectional study was carried out with children from 3 to 5 years old, from Brazilian day care centers and public schools. They were evaluated by FENO measurement through the single breath method, and by ATS-DLD-78-C questionnaire that is used as a gold standard to phenotype wheezing patterns. RESULTS The sample consisted of 243 non-wheezing children, 118 non-recurrent wheezing and 62 recurrent wheezing. The means of FENO and confidence intervals of 95%, were 5.4 (CI 95%, 5.2-5.6); 7.5 (CI 95%, 6.9-8.2) and 11.2 (CI 95%, 9.6-12.7), respectively. The sensitivity, specificity, positive and negative predictive FENO values in the 6 parts per billion (ppb) cut-off point that best diagnosed wheezing of non-wheezing children, were: 65.5%, 84.3%, 75.6% and 76.7%, respectively, with an area under the curve (AUC) = 0.77. At 10 ppb, the best cut-off points for differentiating recurrent wheezing of non-recurrent wheezing were: 56.4%, 81.3%, 61.4%, 78.0%, respectively, with an AUC = 0.69. The post-test probability for each FENO cut-off points was increased by 33% for wheezing and 20% for recurrent wheezing diagnosis when associated with clinical examination. CONCLUSION FENO can provide a reliable and accurate method to discriminate the presence and type of wheezing in preschoolers with 92% of acceptable in this study population.
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Affiliation(s)
| | | | - Edjane Burity
- Department of Pediatric Pneumology, Instituto de Medicina Integral Fernando Figueira - IMIP, Recife, Brazil
| | - Catarina Rattes
- Department of Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - James Fink
- Rush University Medical Center, Georgia State University, USA
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Abstract
Leukotrienes (LTs) are a family of inflammatory mediators including LTA4, LTB4, LTC4, LTD4, and LTE4. By competitive binding to the cysteinyl LT1 (CysLT1) receptor, LT receptor antagonist drugs, such as montelukast, zafirlukast, and pranlukast, block the effects of CysLTs, improving the symptoms of some chronic respiratory diseases, particularly bronchial asthma and allergic rhinitis. We reviewed the efficacy of antileukotrienes in upper airway inflammatory diseases. An update on the use of antileukotrienes in upper airway diseases in children and adults is presented with a detailed literature survey. Data on LTs, antileukotrienes, and antileukotrienes in chronic rhinosinusitis and nasal polyps, asthma, and allergic rhinitis are presented. Antileukotriene drugs are classified into two groups: CysLT receptor antagonists (zafirlukast, pranlukast, and montelukast) and LT synthesis inhibitors (5-lipoxygenase inhibitors such as zileuton, ZD2138, Bay X 1005, and MK-0591). CysLTs have important proinflammatory and profibrotic effects that contribute to the extensive hyperplastic rhinosinusitis and nasal polyposis (NP) that characterise these disorders. Patients who receive zafirlukast or zileuton tend to show objective improvements in, or at least stabilisation of, NP. Montelukast treatment may lead to clinical subjective improvement in NP. Montelukast treatment after sinus surgery can lead to a significant reduction in eosinophilic cationic protein levels in serum, with a beneficial effect on nasal and pulmonary symptoms and less impact in NP. Combined inhaled corticosteroids and long-acting β-agonists treatments are most effective for preventing exacerbations among paediatric asthma patients. Treatments with medium- or high-dose inhaled corticosteroids, combined inhaled corticosteroids and LT receptor antagonists, and low-dose inhaled corticosteroids have been reported to be equally effective. Antileukotrienes have also been reported to be effective for allergic rhinitis.
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12
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Dharmalingam V, Ramesh S. Preschool Wheeze is Not Asthma: A Clinical Dilemma - Correspondence. Indian J Pediatr 2015; 82:969-70. [PMID: 25990593 DOI: 10.1007/s12098-015-1750-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/16/2015] [Indexed: 11/24/2022]
Affiliation(s)
| | - Shanthi Ramesh
- Department of Pediatrics, Sree Balaji Medical College & Hospital, Chennai, Tamil Nadu, 600044, India.
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Krawiec M, Strzelak A, Krenke K, Modelska-Wozniak I, Jaworska J, Kulus M. Fluticasone or montelukast in preschool wheeze: a randomized controlled trial. Clin Pediatr (Phila) 2015; 54:273-81. [PMID: 25246602 DOI: 10.1177/0009922814550158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Approximately 30% of children younger than 3 years experience at least 1 episode of wheezing. Antiasthmatic medication is routinely prescribed, but its effectiveness remains unclear. Our study was aimed to evaluate the effect of anti-inflammatory treatment on frequency and severity of preschool wheeze episodes (PWEs). METHODS Children aged 6 to 36 months with the first up to the third PWE were randomly assigned to receive montelukast, fluticasone, or no treatment for 12 weeks. The outcome measures were the number of PWEs, the number of hospitalizations due to PWE, and the severity of respiratory symptoms. results: There were no significant differences in outcome measures between the groups. However, tobacco-exposed children treated with fluticasone had significantly fewer PWEs (P = .01). CONCLUSION Neither montelukast nor fluticasone has proven effective in the prevention of PWE recurrence. Children of smoking parents may benefit from fluticasone treatment after PWE. This observation requires confirmation in larger studies.
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Affiliation(s)
| | | | | | | | | | - Marek Kulus
- The Medical University of Warsaw, Warsaw, Poland
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Paul SP, Bhatt JM. Preschool wheeze is not asthma: a clinical dilemma. Indian J Pediatr 2014; 81:1193-5. [PMID: 24920441 DOI: 10.1007/s12098-014-1500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022]
Abstract
Recurrent wheezing is common in preschool children and often gets labelled as asthma. It is important to differentiate preschool wheeze from asthma through focused history, examination and exclusion of other serious conditions that may present as wheeze. Two different pragmatic clinical phenotypes viz. episodic viral wheeze (EVW) and multi-trigger wheeze (MTW) have been described although categories do not remain fixed and cross over is often seen in clinical practice. Episodic use of inhaled bronchodilators such as salbutamol when wheezy, is the mainstay of treatment along with non-pharmacological measures such as avoidance of environmental tobacco smoke and parental education. Inhaled corticosteroids are the first choice for maintenance therapy in MTW whereas montelukast may be useful when maintenance therapy is considered in EVW. Any maintenance therapy should be viewed as a trial and need to be discontinued in cases where no benefit has been demonstrated. Short term systemic steroid therapy should be reserved for excaerbation of wheezy symptoms where hospitalization is necessary. Prognosis is good in recurrent mild EVW although remission in atopic MTW is often not achieved and the children in the latter group go on to develop asthma.
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Affiliation(s)
- Siba Prosad Paul
- Department of Neonatal Medicine, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, Avon BS10 5NB, UK,
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Esposito S, Principi N. Pharmacological approach to wheezing in preschool children. Expert Opin Pharmacother 2014; 15:943-52. [PMID: 24611506 DOI: 10.1517/14656566.2014.896340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Wheezing disorders are very common during childhood (particularly among preschool children), and represent a significant burden for patients, their families, the healthcare system, and society as a whole. Identifying wheezing phenotypes, and recognizing the risk factors associated with each, may help to predict long-term outcomes, distinguish high-risk children who may benefit from secondary prevention measures, and ensure that the most effective therapy is prescribed for each case. AREAS COVERED The main aim of this review is to analyze the characteristics of the drugs currently used to treat wheezing in preschool children, and discuss the results obtained in children with different wheezing phenotypes. EXPERT OPINION The continuous or intermittent administration of various oral or inhaled drugs could theoretically be effective in preventing or controlling wheezing in preschool children. However, the optimal management of acute preschool wheezing episodes has not yet been determined mainly because of their phenotypical heterogeneity.
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Affiliation(s)
- Susanna Esposito
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Pediatric High Intensity Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Via Commenda 9, 20122 Milano , Italy +39 02 55032498 ; +39 02 50320206 ;
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Eke Gungor H, Tahan F, Gokahmetoglu S, Saraymen B. Decreased levels of lipoxin A4 and annexin A1 in wheezy infants. Int Arch Allergy Immunol 2014; 163:193-7. [PMID: 24525704 DOI: 10.1159/000358490] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/08/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Wheezing is a common and challenging health issue in infancy and early childhood. Asthma diagnosis is frequent in patients with a history of recurrent wheezing. A relationship has been reported between asthma and anti-inflammatory mediators such as lipoxin A4 and annexin A1. However, this remains uncertain in wheezy infants. The aim of the present study was to determine lipoxin A4 and annexin A1 levels in wheezy infants. MATERIALS AND METHODS Eighty-seven patients aged 6-36 months were included in this study. Demographic characteristics, clinical features, laboratory data, clinical diagnoses, and treatments, if present, were recorded. Patients were divided into 2 groups: patients with wheezing (n = 59) and healthy controls (n = 28). Blood samples were taken and lipoxin A4 and annexin A1 levels were evaluated by ELISA. RESULTS Lipoxin A4 and annexin A1 levels were significantly lower in the wheezing group than in the control group (p < 0.05). A significant correlation was found between the serum total immunoglobulin E (IgE) level and the percentage and absolute number of eosinophils (p < 0.05). No significant correlation was found in terms of lipoxin A4 and annexin A1 levels, the serum total IgE level, and the percentage and absolute number of eosinophils among groups (p > 0.05). CONCLUSION This is the first study to assess lipoxin A4 and annexin A1 levels in wheezy infants. The levels of lipoxin A4 and annexin A1 were found to be low in wheezy infants. We hope that these results will lead to novel therapeutic options for asthma in cases where an optimal treatment modality is lacking.
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Affiliation(s)
- Hatice Eke Gungor
- Department of Pediatric Allergy, Erciyes University School of Medicine, Kayseri, Turkey
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Abstract
Wheezing is a common condition in pediatric practice, it can be defined as a musical sound, high-pitched and continuous, emitting from the chest during breath exhalation. Although almost 50% of children experiences wheeze in the first 6 years of life, only 40% of them will report continued wheezing symptoms after childhood. The classification of wheeze in preschool children is more difficult compared to school aged children. It is based on the onset and duration of symptoms and divided children in three categories: transient early wheezing, non-atopic wheezing and atopic wheezing/asthma. History and physical examination, skin prick test, exhaled nitric oxide, lung function test are the parameter to evaluate children with wheezing. The aim of management of wheezing is to finalize the control of symptoms, reduce exacerbations and improve the quality of life. All guidelines underline the complexity in making a diagnosis of asthma under five years and the need to identify phenotypes that may help paediatricians in the therapeutic choices.
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The role of inhaled corticosteroids in management of asthma in infants and preschoolers. Curr Opin Pulm Med 2013; 19:54-9. [PMID: 23143197 DOI: 10.1097/mcp.0b013e32835b1165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review analyses published data on the treatment of wheezing in infants and preschoolers with inhaled corticosteroids (ICS), including the effect in subgroups of patients such as 'multiple trigger wheeze' and 'episodic viral wheeze'. RECENT FINDINGS Therapy with ICS at daily doses of 100-200 μg results in significant clinical improvements in several outcomes in preschoolers and infants suspected of having asthma (multiple trigger wheeze). Such treatment is normally considered well tolerated. Although not well studied, higher daily doses may be associated with measurable effects on growth, which are not cumulative with continued treatment. In children who only wheeze in association with viral infections (episodic viral wheeze), preemptive treatment with high doses of ICS has demonstrated significant clinical effects on several outcomes, whereas lower doses seem to have little effect. Intermittent use of high doses of ICS has been associated with significant reductions in height and weight gain over 1 year. SUMMARY The review illustrates the complexity of treating wheezing in infants and preschoolers and interpreting the study results. It emphasizes the need for more studies in clinical subgroups, more long-term studies and dose-response studies to assess the optimal doses and safety of intermittent as well as regular ICS treatment.
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Savenije OE, Kerkhof M, Koppelman GH, Postma DS. Predicting who will have asthma at school age among preschool children. J Allergy Clin Immunol 2012; 130:325-31. [DOI: 10.1016/j.jaci.2012.05.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
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