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Chung HW, Hsieh HM, Lee CH, Lin YC, Tsao YH, Feng MC, Hung CH. Air pollution after acute bronchiolitis is a risk factor for preschool asthma: a nested case-control study. Environ Health 2023; 22:83. [PMID: 38044452 PMCID: PMC10694905 DOI: 10.1186/s12940-023-01035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Acute bronchiolitis and air pollution are both risk factor of pediatric asthma. This study aimed to assess subsequent exposure to air pollutants related to the inception of preschool asthma in infants with acute bronchiolitis. This study aimed to assess subsequent exposure to air pollutants related to the inception of preschool asthma in infants with acute bronchiolitis. METHODS A nested case-control retrospective study was performed at the Kaohsiung Medical University Hospital systems between 2009 and 2019. The average concentration of PM10, PM2.5, SO2, NO, NO2, and NOX was collected for three, six, and twelve months after the first infected episode. Adjusted regression models were employed to evaluate the association between asthma and air pollution exposure after bronchiolitis. RESULTS Two thousand six hundred thirty-seven children with acute bronchiolitis were included. Exposure to PM10, PM2.5, SO2, NO, NO2, and NOX in the three, six, and twelve months following an episode of bronchiolitis was found to significantly increase the risk of preschool asthma in infants with a history of bronchiolitis.(OR, 95%CI: PM10 = 1.517-1.559, 1.354-1.744; PM2.5 = 2.510-2.603, 2.148-3.061; SO2 = 1.970-2.040, 1.724-2.342; ; NO = 1.915-1.950, 1.647-2.272; NO2 = 1.915-1.950, 1.647-2.272; NOX = 1.752-1.970, 1.508-2.252) In a sensitive analysis of hospitalized infants, only PM10, PM2.5, SO2, and NO were found to have significant effects during all time periods. (OR, 95%CI: PM10 = 1.613-1.650, 1.240-2.140; PM2.5 = 2.208-2.286, 1.568-3.061; SO2 = 1.679-1.622, 1.197-2.292; NO = 1.525-1.557, 1.094-2.181) CONCLUSION: The presence of ambient PM10, PM2.5, SO2 and NO in the three, six, and twelve months following an episode of acute bronchiolitis has been linked to the development of preschool asthma in infants with a history of acute bronchiolitis.
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Affiliation(s)
- Hao-Wei Chung
- Department of Pediatrics, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao-Tung University, Hsinchu, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Community Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hsiang Lee
- Department of Pediatrics, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Lin
- Department of Medical Research, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Laboratory Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Doctoral Degree Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Laboratory Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Medical University, Kaohsiung, Taiwan
| | - Yu-Hsiang Tsao
- Department of Medical Research, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chu Feng
- Department of Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Chih-Hsing Hung
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Lirette MP, Conejero Müller MJ, Young J. Management of bronchiolitis in infants in primary care settings: What to do and what not to do. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:845-847. [PMID: 38092455 PMCID: PMC10949257 DOI: 10.46747/cfp.6912845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Marie-Pier Lirette
- Pediatric emergency physician at the Hospital for Sick Children in Toronto, Ont
| | - María José Conejero Müller
- Specialist in pediatric hospital medicine and Clinical Assistant Professor at Pontificia Universidad Católica de Chile in Santiago
| | - Jennifer Young
- Community family physician in Collingwood, Ont, Associate Clinical Professor at McMaster University in Hamilton, Ont, and a physician adviser at the College of Family Physicians of Canada
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Lirette MP, Conejero Müller MJ, Young J. Prise en charge de la bronchiolite chez les nourrissons en milieux de soins primaires. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e239-e242. [PMID: 38092452 PMCID: PMC10949261 DOI: 10.46747/cfp.6912e239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Marie-Pier Lirette
- Urgentologue pédiatrique au Hospital for Sick Children à Toronto (Ontario)
| | - María José Conejero Müller
- Spécialiste en médecine hospitalière pédiatrique et professeure adjointe de clinique à la Pontificia Universidad Católica de Chile à Santiago (Chili)
| | - Jennifer Young
- Médecin de famille communautaire à Collingwood (Ontario), professeure agrégée de clinique à l'Université McMaster à Hamilton (Ontario) et médecin conseillère auprès du Collège des médecins de famille du Canada
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Schuh S, Coates AL, Sweeney J, Rumantir M, Eltorki M, Alqurashi W, Plint AC, Zemek R, Poonai N, Parkin PC, Soares D, Moineddin R, Finkelstein Y. Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2337810. [PMID: 37856126 PMCID: PMC10587796 DOI: 10.1001/jamanetworkopen.2023.37810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/18/2023] [Indexed: 10/20/2023] Open
Abstract
Importance Although nasal suctioning is the most frequently used supportive management for bronchiolitis, its benefit remains unknown. Objective To evaluate the effectiveness of enhanced vs minimal nasal suctioning in treating infants with bronchiolitis after discharge from the emergency department (ED). Design, Setting, and Participants This single-blind, parallel-group, randomized clinical trial was conducted from March 6, 2020, to December 15, 2022, at 4 tertiary-care Canadian pediatric EDs. Participants included otherwise healthy infants aged 1 to 11 months with a diagnosis of bronchiolitis who were discharged home from the ED. Interventions Participants were randomized to minimal suctioning via bulb or enhanced suctioning via a battery-operated device before feeding for 72 hours. Main Outcomes and Measures The primary outcome was additional resource use, a composite of unscheduled revisits for bronchiolitis or use of additional suctioning devices for feeding and/or breathing concerns. Secondary outcomes included health care utilization, feeding and sleeping adequacy, and satisfaction. Results Of 884 screened patients, 352 were excluded for criteria, 79 declined participation, 81 were otherwise excluded, 372 were randomized (185 to the minimal suction group and 187 to the enhanced suction group), and 367 (median [IQR] age, 4 [2-6] months; 221 boys [60.2%]) completed the trial (184 in the minimal suction and 183 in the enhanced suction group). Additional resource use occurred for 68 of 184 minimal suction participants (37.0%) vs 48 of 183 enhanced suction participants (26.2%) (absolute risk difference, 0.11; 95% CI, 0.01 to 0.20; P = .03). Unscheduled revisits occurred for 47 of 184 minimal suction participants (25.5%) vs 40 of 183 enhanced suction participants (21.9%) (absolute risk difference, 0.04; 95% CI, -0.05 to 0.12; P = .46). A total of 33 of 184 parents in the minimal suction group (17.9%) used additional suctioning devices vs 11 of 183 parents in the enhanced suction group (6.0%) (absolute risk difference, 0.12; 95% CI, 0.05 to 0.19; P < .001). No significant between-group differences were observed for all bronchiolitis revisits (absolute risk difference, 0.07; 95% CI, -0.02 to 0.16; P = .15), ED revisits (absolute risk difference, 0.04; 95% CI, -0.03 to 0.12; P = .30), parental care satisfaction (absolute risk difference, -0.02; 95% CI, -0.10 to 0.06; P = .70), and changes from baseline to 72 hours in normal feeding (difference in differences, 0.03; 95% CI, -0.10 to 0.17; P = .62), normal sleeping (difference in differences, 0.05; 95% CI, -0.08 to 0.18; P = .47), or normal parental sleeping (difference in differences, 0.10; 95% CI, -0.02 to 0.23; P = .09). Parents in the minimal suction group were less satisfied with the assigned device (62 of 184 [33.7%]) than parents in the enhanced suction group (145 of 183 [79.2%]) (risk difference, 0.45; 95% CI, 0.36 to 0.54; P < .001). Conclusions and Relevance Compared with minimal suctioning, enhanced suctioning after ED discharge with bronchiolitis did not alter the disease course because there were no group differences in revisits or feeding and sleeping adequacy. Minimal suctioning resulted in higher use of nonassigned suctioning devices and lower parental satisfaction with the assigned device. Trial Registration ClinicalTrials.gov Identifier: NCT03361371.
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Affiliation(s)
- Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Allan L. Coates
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Judy Sweeney
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maggie Rumantir
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mohamed Eltorki
- Division of Pediatric Emergency Medicine, McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Amy C. Plint
- Department of Pediatrics and Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Naveen Poonai
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Children’s Health Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Patricia C. Parkin
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Diane Soares
- Department of Respiratory Therapy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Moore LE, Serrano-Lomelin J, Rosychuk RJ, Kozyrskyj AL, Chari R, Crawford S, Bakal J, Hicks A, Ducharme FM, Ospina MB. Perinatal and early life factors and asthma control among preschoolers: a population-based retrospective cohort study. BMJ Open Respir Res 2023; 10:e001928. [PMID: 37748808 PMCID: PMC10533801 DOI: 10.1136/bmjresp-2023-001928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Preventing poor childhood asthma control is crucial for short-term and long-term respiratory health. This study evaluated associations between perinatal and early-life factors and early childhood asthma control. METHODS This retrospective study used administrative health data from mothers and children born 2010-2012 with a diagnosis of asthma before age 5 years, in Alberta, Canada. The outcome was asthma control within 2 years after diagnosis. Associations between perinatal and early-life factors and risk of partly and uncontrolled asthma were evaluated by multinomial logistic regression. RESULTS Of 7206 preschoolers with asthma, 52% had controlled, 37% partly controlled and 12% uncontrolled asthma 2 years after diagnosis. Compared with controlled asthma, prenatal antibiotics (adjusted risk ratio (aRR): 1.19; 95% CI 1.06 to 1.33) and smoking (aRR: 1.18; 95% CI 1.02 to 1.37), C-section delivery (aRR: 1.11; 95% CI 1.00 to 1.25), summer birth (aRR: 1.16; 95% CI 1.00 to 1.34) and early-life hospitalisation for respiratory illness (aRR: 2.24; 95% CI 1.81 to 2.76) increased the risk of partly controlled asthma. Gestational diabetes (aRR: 1.41; 95% CI 1.06 to 1.87), C-section delivery (aRR: 1.18; 95% CI 1.00 to 1.39), antibiotics (aRR: 1.32; 95% CI 1.08 to 1.61) and hospitalisation for early-life respiratory illness (aRR: 1.65; 95% CI 1.19 to 2.27) were associated with uncontrolled asthma. CONCLUSION Maternal perinatal and early-life factors including antibiotics in pregnancy and childhood, gestational diabetes, prenatal smoking, C-section and summertime birth, and hospitalisations for respiratory illness are associated with partly or uncontrolled childhood asthma. These results underline the significance of perinatal health and the lasting effects of early-life experiences on lung development and disease programming.
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Affiliation(s)
- Linn E Moore
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Anne Hicks
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Maria B Ospina
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Long-term outcomes of preterm infants in the first 6 years of life: a nationwide population-based study in Korea. Eur J Pediatr 2023; 182:641-650. [PMID: 36445516 DOI: 10.1007/s00431-022-04728-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
UNLABELLED This study examined the relationship between gestational age and long-term outcomes up to 6 years of age using population-based big data from the National Health Insurance Service in Korea. This retrospective observational cohort study used data from the National Health Information Database (2011-2017). All children born in Korea during 2011 (January 1-December 31) were eligible and were followed up until 2017. Gestational age groups were divided into extremely preterm (< 28 weeks), very preterm (28-31 weeks), moderate-to-late preterm (32-36 weeks), and full-term (37-41 weeks). The survival rate, neurodevelopmental diseases, hearing or visual impairment, and respiratory morbidities were compared for each gestational age group. In total, 370,301 children were included in the analysis. The total survival rate increased with increasing gestational age. Furthermore, the risk of neurodevelopmental diseases (i.e., epilepsy, cerebral palsy, delayed development, mental retardation, language disorder, developmental coordination disorder, autism spectrum disorder), hearing or visual impairment, and asthma-related inhaler prescription increased with decreasing gestational age, despite adjustment for covariates. CONCLUSION Lower gestational age was associated with an increase in a wide spectrum of adverse neurodevelopmental and respiratory outcomes in the first 6 years of life. Although morbidities were highest at the earliest gestational ages, moderate-to-late preterm children were significantly associated with increased adverse outcomes compared with full-term children. Our findings prove this under-recognized group's long-term follow-up and policy support. WHAT IS KNOWN • Infants born preterm are at high risk for neurodevelopmental and various medical health problems. • Nationwide research on long-term outcomes for moderate-to-late preterm birth is sparse. WHAT IS NEW • In this nationwide cohort study, lower gestational age at birth was inversely associated with increased adverse neurodevelopmental and respiratory outcomes in the first 6 years of life. • Long-term follow-up and policy support are required for moderate-to-late preterm children who are at risk of increased adverse outcomes compared with full-term births.
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Chung HL. Diagnosis and management of asthma in infants and preschoolers. Clin Exp Pediatr 2022; 65:574-584. [PMID: 35436814 PMCID: PMC9742764 DOI: 10.3345/cep.2021.01746] [Citation(s) in RCA: 3] [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] [Received: 11/25/2021] [Accepted: 03/31/2022] [Indexed: 01/06/2023] Open
Abstract
Asthma is one of the most common chronic disease affecting children, and it often starts in infancy and preschool years. In previous birth cohorts, frequent wheezing in early life was associated with the development of asthma in later childhood and reduced lung function persisting into adulthood. Preschool wheezing is considered an umbrella term for distinctive diseases with different clinical features (phenotypes), each of which may be related to different underlying pathophysiologic mechanisms (endotypes). The classification of phenotypes of early wheezing is needed to identify children at high risk for developing asthma later who might benefit from early intervention. However, diagnosis of asthma in infants and preschoolers is particularly difficult because objective lung function tests cannot be performed and definitive biomarkers are lacking. Moreover, management of early asthma is challenging because of its different phenotypic presentations. Many prediction models and asthma guidelines have been developed to provide useful information for physicians to assess young children with recurrent wheezing and manage them appropriately. Many recent studies have investigated the application of personalized medicine for early asthma by identifying specific phenotypes and biomarkers. Further researches, including genetic and molecular studies, are needed to establish a clear definition of asthma and develop more targeted therapeutic approaches in this age group.
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Affiliation(s)
- Hai Lee Chung
- Department of Pediatrics, School of Medicine, Daegu Catholic University, Daegu, Korea
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Balanced Crystalloids versus Normal Saline in Children with Critical Asthma. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101480. [PMID: 36291416 PMCID: PMC9601181 DOI: 10.3390/children9101480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 01/03/2023]
Abstract
There is little known about the impact of maintenance fluid choice in children with critical asthma on clinical outcomes. Our primary study objectives were to determine the differences in the serum chloride and bicarbonate levels based on the receipt of 0.9% saline or a balanced solution. The secondary study objectives included differences in acute kidney injury (AKI) and intensive care unit (ICU)/hospital length of stay (LOS). In this retrospective cohort study, we included 1166 patients admitted to a quaternary children's hospital with critical asthma between 2017 and 2019. The patients were stratified based on if they received 0.9% saline or a balanced solution (Lactated Ringer's or Plasma-lyte) for maintenance therapy. The study outcomes were determined using independent sample t-tests, multivariable logistic regression, and negative binomial regression. The patients who received 0.9% saline maintenance therapy had a significantly higher increase in their serum chloride levels when compared to those who received balanced solutions (0.9% saline: +4 mMol/L, balanced: +2 mMol/L, p = 0.002). There was no difference in the decrease in the serum bicarbonate levels (0.9% saline: -0.4 mMol/L, balanced: -0.5 mMol/L, p = 0.830). After controlling for age, race, sex, and the Pediatric Logistic Organ Dysfunction (PELOD-2) score, there was no association between the type of fluid received and the development of AKI (OR 0.87, 95% CI: 0.46-1.63, p = 0.678). Additionally, there was no association between the type of fluid and hospital or ICU LOS. Thus, despite higher serum chloride levels in the patients that received 0.9% saline, the choice of fluid therapy did not have an impact on the serum bicarbonate values, the development of AKI or hospital and ICU LOS, suggesting there is little difference between 0.9% saline and balanced solutions as maintenance therapy in children with critical asthma.
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O'Toole D. Rapid recommendations: Updates from 2021 guidelines: part 1. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:664-666. [PMID: 36100372 PMCID: PMC9470190 DOI: 10.46747/cfp.6809664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Danielle O'Toole
- Practising family physician in Academic Family Medicine and Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont
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Just the facts: How to diagnose and manage acute preschool asthma in the ED. CAN J EMERG MED 2022; 24:688-690. [PMID: 36048408 DOI: 10.1007/s43678-022-00376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/09/2022] [Indexed: 11/02/2022]
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12
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Chung HW, Hsieh HM, Lee CH, Lin YC, Tsao YH, Wu HW, Kuo FC, Hung CH. Prenatal and Postnatal Exposure to Ambient Air Pollution and Preschool Asthma in Neonatal Jaundice Infants. J Inflamm Res 2022; 15:3771-3781. [PMID: 35832831 PMCID: PMC9271683 DOI: 10.2147/jir.s366336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Both air pollutant exposure and neonatal jaundice (NJ) have known effects on childhood asthma, but a higher total serum bilirubin (TSB) level has been associated with lung protection. This study aimed to assess whether prenatal/postnatal exposure to ambient air pollutants is related to the development of asthma in infants with NJ. Patients and Methods A nested case–control retrospective study was performed using the data of infants with NJ in the Kaohsiung Medical University Hospital Research Database. Data on average ambient air pollution concentrations within six months, the first year and second year after birth, and in the first, second and third prenatal trimesters were collected. NJ was defined as TSB levels ≥ 2 mg/dl with the diagnosis less than one-month-old. Asthma was defined as a diagnosis with medication use. We constructed conditional logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results Exposure to NO and SO2 at all six time points in the study was significantly associated with an increased risk of preschool asthma in infants with NJ. The overall peak OR (95% CI) of SO2, PM2.5, PM10, NO, NO2, and NOX were 1.277 (1.129–1.444), 1.057 (1.023–1.092), 1.035 (1.011–1.059), 1.272 (1.111–1.455), 1.168 (1.083–1.259) and 1.104 (1.051–1.161), respectively. Fetuses in the first and second trimester were most vulnerable to ambient air pollutant exposure such as SO2 PM2.5, NO, NO2 and NOX during the prenatal period. Exposure to all six ambient air pollutants during the first and second years after birth significantly affected preschool asthma in NJ infants. Conclusion In different time windows, prenatal and postnatal exposure to SO2, PM2.5, PM10, NO, NO2, and NOX were associated with preschool asthma in NJ infants. The relatively high impact of NO and SO2 exposure in infants with NJ requires further studies and prevention measures.
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Affiliation(s)
- Hao-Wei Chung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hsiang Lee
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Ching Lin
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Pharmacology and Toxicology, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Doctoral Degree Program of Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Hsiang Tsao
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Huang-Wei Wu
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Fu-Chen Kuo
- Department of Obstetrics & Gynecology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Hsing Hung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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13
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Greenky D, Goldman RD. Les β 2-agonistes pour la bronchiolite virale. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:431-433. [PMID: 35701199 PMCID: PMC9197290 DOI: 10.46747/cfp.6806431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Question Au mois de février, un bébé de 9 mois est amené à ma clinique d’urgence rurale après un épisode de 2 jours de toux et de congestion, et de 1 jour de difficultés respiratoires. Une auscultation des poumons révèle des sons diffus, de faibles sibilances et des crépitants. En tenant compte de l’âge du bébé, de la symptomatologie et de la saison hivernale, le diagnostic probable est une bronchiolite. Les β2-agonistes inhalés sont-ils un traitement approprié pour un tel patient? Réponse Il n’est pas indiqué d’utiliser des β2-agonistes inhalés chez les enfants de 2 ans et moins souffrant de bronchiolite. La sibilance fait le plus souvent partie des critères diagnostiques d’une bronchiolite, qui est une infection virale des voies respiratoires inférieures chez les jeunes enfants. Au contraire de l’asthme, la bronchiolite ne compte pas parmi ses symptômes la contraction des muscles lisses du poumon. Le traitement de la bronchiolite exige des soins de soutien, et il n’a pas été démontré que les interventions pharmacologiques, comme les β2-agonistes, les corticostéroïdes et les antibiotiques, raccourcissaient la durée de la maladie, diminuaient sa gravité ou réduisaient les taux d’hospitalisation. Il pourrait y avoir un sous-groupe de nourrissons souffrant de bronchiolite qui répondraient à un traitement aux β2-agonistes; toutefois, ce groupe n’a pas encore été entièrement défini dans la littérature jusqu’ici.
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14
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Greenky D, Goldman RD. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:429-430. [PMID: 35701205 PMCID: PMC9197272 DOI: 10.46747/cfp.6806429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Question A 9-month-old baby presented to my rural emergency department with 2 days of cough and congestion and 1 day of breathing difficulties in the month of February. An auscultation examination of the lungs indicated there were scattered, faint wheezes and coarse sounds. Based on the baby’s age, symptomatology, and the winter season, the likely diagnosis was bronchiolitis. Are inhaled β2-agonists an appropriate treatment for this patient? Answer The use of inhaled β2-agonists in children younger than 2 years of age with bronchiolitis is not indicated. Wheezing is most commonly part of the diagnosis of bronchiolitis, a lower respiratory viral infection in young children. Unlike with asthma, smooth muscle constriction in the lungs is not a symptom of bronchiolitis. Treatment of bronchiolitis requires supportive care, but pharmaceutical interventions such as β2-agonists, steroids, and antibiotics have not been shown to decrease length of illness, illness severity, or hospitalization rates. There may be a subgroup of infants with bronchiolitis who respond to β2-agonists treatment; however, this group has not been fully identified in the literature to date.
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15
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Adherence to inhaled corticosteroids prescribed once vs twice daily in children with asthma. Ann Allergy Asthma Immunol 2022; 128:423-431.e3. [PMID: 35077865 DOI: 10.1016/j.anai.2022.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suboptimal adherence to inhaled corticosteroids (ICS) is associated with poor asthma control. Adult studies suggest that simplification of ICS regimen leads to better adherence. OBJECTIVE We aimed to determine whether once-daily, compared with twice-daily, ICS dosing was associated with better adherence among children with asthma. METHODS We conducted a retrospective observational study of children with asthma prescribed with either once-daily or twice-daily ICS monotherapy between 2011 and 2019. Our primary adherence outcome was the proportion of prescribed days covered (PPDC)-that is, the number of days for which the drug was dispensed by the pharmacy divided by the number of days for which it was prescribed. The impact of once-daily vs twice-daily ICS regimen on adherence was evaluated using linear multivariable regression analysis adjusting for covariates. Secondary outcomes included the proportion of patients with greater than or equal to 75% adherence analyzed using logistic regression models. RESULTS A total of 232 children (61% boys; mean age of 5.8 [3.6] years) were included; 120 children were prescribed once-daily, and 112 twice-daily, ICS. The median PPDC was 66.8% for the once-daily and 57.9% for the twice-daily group (P = .03). Children prescribed once-daily ICS had a 7.2% (95% confidence interval, 1.3-13.1) greater mean PPDC compared with the twice-daily group and greater odds of having PPDC greater than or equal to 75% (71.4% vs 45.5%; odds ratio, 1.80; 95% confidence interval, 1.01-3.26). CONCLUSION Our findings suggest that once-daily dosing of ICS is associated with better medication adherence than twice-daily dosing. Whether the gain in adherence leads to better asthma control and health outcomes remains to be evaluated.
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16
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Biset N, Kestens W, Detemmerman D, Lona M, Karakaya G, Ceuppens A, Pochet S, De Vriese C. Analysis of the Consumption of Drugs Prescribed for the Treatment of Asthma in Belgian Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:548. [PMID: 35010808 PMCID: PMC8744625 DOI: 10.3390/ijerph19010548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 02/04/2023]
Abstract
(1) Asthma is one of the most common chronic diseases in the world among children. The main purpose of this study was to analyze the consumption of asthma medications in order to investigate asthma in children (2-18 years) and the association with health care consumption; (2) a retrospective study using anonymized administrative data for 2013-2018 from the third largest Belgian health insurer was conducted; (3) in 2018, 12.9% of children received at least one asthma medication and 4.4% received at least two packages with a minimum of 30 days between purchases. Preschool children (2-6 years) were three times more likely to take asthma medication than older children (7-18 years). ICS, in combination or not with LABA, were the most dispensed drugs among children. Children with asthma medications were almost twice as likely to receive antibiotics, more likely to end up in the emergency room, and twice as likely to be hospitalized; (4) most children took ICS, according to the GINA guidelines. High rates of nebulization in young children were observed, despite the recommendation to use an inhaler with a spacing chamber as much as possible. Finally, children who took asthma medications were more likely to end up in the ER or be hospitalized.
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Affiliation(s)
- Natacha Biset
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (N.B.); (S.P.)
| | - Wies Kestens
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Dominique Detemmerman
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Murielle Lona
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Güngör Karakaya
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Ann Ceuppens
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Stéphanie Pochet
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (N.B.); (S.P.)
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (N.B.); (S.P.)
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17
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Xue M, Dehaas E, Chaudhary N, O'Byrne P, Satia I, Kurmi OP. Breastfeeding and risk of childhood asthma: a systematic review and meta-analysis. ERJ Open Res 2021; 7:00504-2021. [PMID: 34912884 PMCID: PMC8666625 DOI: 10.1183/23120541.00504-2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To investigate the relationship between breastfeeding and the development of paediatric asthma. Methods A systematic review and meta-analysis was conducted with MEDLINE, Embase, CINAHL and ProQuest Nursing and Allied Health source databases. Retrospective/prospective cohorts in children aged <18 years with breastfeeding exposure reported were included. The primary outcome was a diagnosis of asthma by a physician or using a guideline-based criterion. A secondary outcome was asthma severity. Results 42 studies met inclusion criteria. 37 studies reported the primary outcome of physician-/guideline-diagnosed asthma, and five studies reported effects on asthma severity. Children with longer duration/more breastfeeding compared to shorter duration/less breastfeeding have a lower risk of asthma (OR 0.84, 95% CI 0.75–0.93; I2 = 62.4%). Similarly, a lower risk of asthma was found in children who had more exclusive breastfeeding versus less exclusive breastfeeding (OR 0.81, 95% CI 0.72–0.91; I2=44%). Further stratified analysis of different age groups demonstrated a lower risk of asthma in the 0–2-years age group (OR 0.73, 95% CI 0.63–0.83) and the 3–6-years age group (OR 0.69, 95% CI 0.55–0.87); there was no statistically significant effect on the ≥7-years age group. Conclusion The findings suggest that the duration and exclusivity of breastfeeding are associated with a lower risk of asthma in children aged <7 years. The findings of this systematic review and meta-analysis of cohort studies suggest that duration and exclusivity of breastfeeding are associated with a lower risk of asthma in children aged <7 yearshttps://bit.ly/3p804PG
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Affiliation(s)
- Mike Xue
- Dept of Family Medicine, Queen's University, Kingston, Canada
| | - Emily Dehaas
- Dept of Medicine, University of Toronto, Toronto, Canada
| | - Nagendra Chaudhary
- Dept of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Paul O'Byrne
- Dept of Medicine, Division of Respirology, McMaster University, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| | - Imran Satia
- Dept of Medicine, Division of Respirology, McMaster University, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| | - Om P Kurmi
- Dept of Medicine, Division of Respirology, McMaster University, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada.,Faculty Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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18
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Levivien C, Kendrick J, Carr R. Development and validation of the Pediatric Asthma kNowleDge and mAnagement (P.A.N.D.A) questionnaires. J Asthma 2021; 59:1940-1951. [PMID: 34503391 DOI: 10.1080/02770903.2021.1978482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess the validity, feasibility and reliability of the Pediatric Asthma kNowleDge and mAnagement (PANDA) questionnaires that we developed. METHODS We developed 3 questionnaires aimed for Children, Teenagers and Parents of children living with asthma. Experts in childhood asthma reviewed the questionnaires to evaluate face and content validity with a measure of the Scale-Content Validity Index (S-CVI). Children age 7 and up and their parents participated in the feasibility and reliability assessment. Reliability was assessed by doing a test re-test, using the Intraclass Correlation Coefficient (ICC), for each questionnaire topic. RESULTS Face validity was validated for the three PANDA questionnaires with a satisfactory length and comprehension level. Content validity, with a total S-CVI of 0.91, was found for the Children and Parents questionnaires. With 84 participants, the ICC were found to be higher than 0.7 with a 95%CI [0.5-0.9] for the total scores and higher than 0.5 for each topic for each questionnaire, indicating reliability. CONCLUSION Face and content validity and reliability of the PANDA questionnaires was established, with an appropriate comprehension level and length. Other types of validation like construct validity and responsiveness would need to be assessed to complete the validation of the questionnaires. The PANDA questionnaires could be used for research and in everyday practice.
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Affiliation(s)
- Clara Levivien
- Pharmacy Department, British Columbia Children's hospital and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Jennifer Kendrick
- Pharmacy Department, British Columbia Children's hospital and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Roxane Carr
- Pharmacy Department, British Columbia Children's hospital and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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19
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Ahmet A, Rowan-Legg A, Pancer L. Adrenal suppression from exogenous glucocorticoids: Recognizing risk factors and preventing morbidity. Paediatr Child Health 2021; 26:242-254. [PMID: 34630779 DOI: 10.1093/pch/pxab015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/08/2020] [Indexed: 11/12/2022] Open
Abstract
Adrenal suppression (AS), a potential side effect of glucocorticoid therapy (including inhaled corticosteroids), can be associated with significant morbidity and even death. In Canada, adrenal crisis secondary to AS continues to be reported in children. Being aware of symptoms associated with AS, understanding the risk factors for developing this condition, and familiarity with potential strategies to reduce risks associated with AS, are essential starting points for any clinician prescribing glucocorticoids.
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Affiliation(s)
- Alexandra Ahmet
- Canadian Paediatric Society, Community Paediatrics Committee and Canadian Pediatric Endocrine Group, Ottawa, Ontario, Canada
| | - Anne Rowan-Legg
- Canadian Paediatric Society, Community Paediatrics Committee and Canadian Pediatric Endocrine Group, Ottawa, Ontario, Canada
| | - Larry Pancer
- Canadian Paediatric Society, Community Paediatrics Committee and Canadian Pediatric Endocrine Group, Ottawa, Ontario, Canada
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20
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Li Q, Zhou Q, Li Y, Liu E, Fu Z, Luo J, Liu S, Liu F, Chen Y, Luo Z. The predictive role of small airway dysfunction and airway inflammation biomarkers for asthma in preschool and school-age children: a study protocol for a prospective cohort study. Transl Pediatr 2021; 10:2630-2638. [PMID: 34765487 PMCID: PMC8578752 DOI: 10.21037/tp-21-239] [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: 05/27/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Preschool children are at a high risk of developing asthma. Asthma in preschool children could remit in most cases, but could persist into school age, adolescence, or even adulthood in some cases. However, it is difficult to predict which children with preschool asthma will develop into school-age asthma. We present a cohort study protocol to explore the predictive role of small airway dysfunction and airway inflammation biomarkers of asthma in preschool and school-age children. METHODS A prospective cohort study will be conducted with at least 205 children with preschool asthma. All patients will be recruited when they consult a pediatric pulmonologist at the Children's Hospital of Chongqing Medical University and will be followed up to 6 years of age. Initially, patients' demographic information, medical history, physical findings, and questionnaire information will be collected, and baseline small airway function and inflammation biomarkers will be detected. During the follow-up period, medical history, physical findings, and the questionnaire results will be collected every 3 months, and small airway function will be tested by impulse oscillometry (IOS) every 6 months. At the final visit, a definite diagnosis of school-age asthma will be made by a pediatric pulmonologist based on the criteria of the Global Initiative for Asthma 2020. DISCUSSION The study will be the first to be conducted in preschool children assessing whether small airway dysfunction combined with airway eosinophilic biomarkers and club cell secretory protein is associated with school-age asthma. This study may provide new promising predictors of persistent asthma from preschool to school age. TRIAL REGISTRATION The study has been registered at the Chinese Clinical Trial Registry (ChiCTR2000039583). Registered on November 1, 2020. Protocol version: version 1.0, August 16, 2021.
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Affiliation(s)
- Qinyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Zhou
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yuanyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Sha Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Fangjun Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Lanzhou University Institute of Health Data Science, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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21
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Campisi ES, Reyna ME, Brydges M, Dubeau A, Moraes TJ, Campisi P, Subbarao P. Adenotonsillectomy, bronchoscopy and bronchoalveolar lavage in the management of preschool children with severe asthma: pilot study. Eur Arch Otorhinolaryngol 2021; 279:319-326. [PMID: 34542655 DOI: 10.1007/s00405-021-07084-x] [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: 07/05/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This is a pilot study that describes the feasibility and clinical course of a cohort of preschool children with severe asthma undergoing a combined adenotonillectomy (TA), bronchoscopy (B), and bronchoalveolar lavage (BAL) procedure. METHODS A retrospective cohort study of preschool patients with severe asthma who underwent a combined TA-B-BAL procedure between 2012 and 2019. Subjects were treated at a tertiary care asthma clinic and had a diagnosis of preschool asthma according to the Canadian Thoracic Society Guidelines. Data on demographics, clinical characteristics, medication use, virology and microbiology from bronchoalveolar lavage, and asthma control questionnaires were collected. Variables were analyzed using paired t test. RESULTS Eighteen preschool subjects (mean age 3.19 ± 1.13 years) with severe asthma were identified through the asthma clinic. Patients treated with standard asthma care and a combined TA-B-BAL procedure experienced a decrease in the number of oral steroid courses (p = 0.017), emergency department visits (p = 0.03) and wheezing exacerbations (p = 0.026) following the procedure. Ten patients experienced clinically meaningful improvements in TRACK scores after the procedure (p < 0.001). CONCLUSION This pilot study provides early evidence that a combined TA-B-BAL procedure is feasible in preschool children with severe asthma and that the procedure may reduce asthma medication use and hospital visits.
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Affiliation(s)
- Emma S Campisi
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Myrtha E Reyna
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - May Brydges
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Aimee Dubeau
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Paolo Campisi
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada.,Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, 27 King's College Circle, Toronto, Canada
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22
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洪 建. [Review of and Reflections on the Current Status of Childhood Asthma Diagnosis and Treatment in China]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2021; 52:725-728. [PMID: 34622583 PMCID: PMC10408880 DOI: 10.12182/20210960201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Indexed: 11/23/2022]
Abstract
Over the last decades, the overall prevalence of childhood asthma in China has been on the rise, and the level of diagnosis and treatment of asthma has also shown significant improvement. However, the overall control of childhood asthma in China has not yet reached the ideal level. The main causes are as follows: due to high social pressure and other factors, the accurate diagnosis of childhood asthma by clinicians is still insufficient; clinicians do not have sufficient understanding of environmental pollution and other controllable factors that may affect the rising prevalence of childhood asthma and poor asthma control; the standardization of clinical asthma treatment needs to be further improved. Clinicians should improve their understanding of childhood asthma, formulate therapeutic regimes based on the guidelines, and constantly improve the management of childhood asthma.
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Affiliation(s)
- 建国 洪
- 上海交通大学附属第一人民医院 儿内科 (上海 200080)Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China
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Czubaj-Kowal M, Kurzawa R, Mazurek H, Sokołowski M, Friediger T, Polak M, Nowicki GJ. Relationship Between Air Pollution and the Concentration of Nitric Oxide in the Exhaled Air (FeNO) in 8-9-Year-Old School Children in Krakow. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136690. [PMID: 34206247 PMCID: PMC8296872 DOI: 10.3390/ijerph18136690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/13/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
The consequences of air pollution pose one of the most serious threats to human health, and especially impact children from large agglomerations. The measurement of nitric oxide concentration in exhaled air (FeNO) is a valuable biomarker in detecting and monitoring airway inflammation. However, only a few studies have assessed the relationship between FeNO and the level of air pollution. The study aims to estimate the concentration of FeNO in the population of children aged 8–9 attending the third grade of public primary schools in Krakow, as well as to determine the relationship between FeNO concentration and dust and gaseous air pollutants. The research included 4580 children aged 8–9 years who had two FeNO measurements in the winter–autumn and spring–summer periods. The degree of air pollution was obtained from the Regional Inspectorate of Environmental Protection in Krakow. The concentration of pollutants was obtained from three measurement stations located in different parts of the city. The FeNO results were related to air pollution parameters. The study showed weak but significant relationships between FeNO and air pollution parameters. The most significant positive correlations were found for CO8h (r = 0.1491, p < 0.001), C6H6 (r = 0.1420, p < 0.001), PM10 (r = 0.1054, p < 0.001) and PM2.5 (r = 0.1112, p < 0.001). We suggest that particulate and gaseous air pollutants impact FeNO concentration in children aged 8–9 years. More research is needed to assess the impact of air pollution on FeNO concentration in children. The results of such studies could help to explain the increase in the number of allergic and respiratory diseases seen in children in recent decades.
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Affiliation(s)
- Marta Czubaj-Kowal
- Department of Paediatrics, Stefan Żeromski Specialist Hospital in Krakow, Na Skarpie 66 Str., PL-31-913 Krakow, Poland;
- Correspondence: ; Tel.: +48-604-433-428
| | - Ryszard Kurzawa
- Department of Alergology and Pneumonology, Institute of Tuberculosis and Lung Disorders, Prof. Jana Rudnika 3B Str., PL-34-700 Rabka-Zdrój, Poland;
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, Institute of Tuberculosis and Lung Disorders, Prof. Jana Rudnika 3B Str., PL-34-700 Rabka-Zdrój, Poland;
| | - Michał Sokołowski
- Department of Paediatrics, Stefan Żeromski Specialist Hospital in Krakow, Na Skarpie 66 Str., PL-31-913 Krakow, Poland;
| | - Teresa Friediger
- Faculty of Health, Catholic University in Ruzomberok, Námestie A. Hlinku 48 Str., SK-034 01 Ruzomberok, Slovakia;
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Grzegórzecka 20 Str., PL-31-531 Krakow, Poland;
| | - Grzegorz Józef Nowicki
- Department of Family Medicine and Community Nursing, Medical University of Lublin, Staszica 6 Str., PL-20-081 Lublin, Poland;
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Ahmet A, Rowan-Legg A, Pancer L. La suppression surrénalienne causée par les glucocorticoïdes exogènes : en reconnaître les facteurs de risque et en prévenir les effets. Paediatr Child Health 2021; 26:248-254. [PMID: 34136054 DOI: 10.1093/pch/pxab016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/08/2020] [Indexed: 11/14/2022] Open
Abstract
Résumé
La suppression surrénalienne, un effet secondaire potentiel du traitement aux glucocorticoïdes (y compris les corticostéroïdes inhalés), peut avoir des conséquences graves et même fatales. Au Canada, on continue de déclarer des poussées d’insuffisance corticosurrénalienne consécutives à une suppression surrénalienne chez les enfants. Avant de prescrire des glucocorticoïdes, le clinicien doit absolument connaître les symptômes de suppression surrénalienne, comprendre les facteurs de risque de cette affection et être au courant des stratégies susceptibles d’en réduire les risques.
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Affiliation(s)
- Alexandra Ahmet
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire et Groupe canadien d'endocrinologie pédiatrique, Ottawa (Ontario), Canada
| | - Anne Rowan-Legg
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire et Groupe canadien d'endocrinologie pédiatrique, Ottawa (Ontario), Canada
| | - Larry Pancer
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire et Groupe canadien d'endocrinologie pédiatrique, Ottawa (Ontario), Canada
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25
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Leung JS. Paediatrics: how to manage acute asthma exacerbations. Drugs Context 2021; 10:dic-2020-12-7. [PMID: 34113386 PMCID: PMC8166724 DOI: 10.7573/dic.2020-12-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
Background Asthma is the most common chronic disease of childhood and a major source of childhood health burden worldwide. These burdens are particularly marked when children experience characteristic ‘symptom flare-ups’ or acute asthma exacerbations (AAEs). AAE are associated with significant health and economic impacts, including acute Emergency Department visits, occasional hospitalizations, and rarely, death. To treat children with AAE, several medications have been studied and used. Methods We conducted a narrative review of the literature with the primary objective of understanding the evidence of their efficacy. We present this efficacy evidence in the context of a general stepwise management pathway for paediatric AAEs. This framework is developed from the combined recommendations of eight established (inter)national paediatric guidelines. Discussion Management of paediatric AAE centres around four major care goals: (1) immediate and objective assessment of AAE severity; (2) prompt and effective medical interventions to decrease respiratory distress and improve oxygenation; (3) appropriate disposition of patient; and (4) safe discharge plans. Several medications are currently recommended with varying efficacies, including heliox, systemic corticosteroids, first-line bronchodilators (salbutamol/albuterol), adjunctive bronchodilators (ipratropium bromide, magnesium sulfate) and second-line bronchodilators (aminophylline, i.v. salbutamol, i.v. terbutaline, epinephrine, ketamine). Care of children with AAE is further enhanced using clinical severity scoring, pathway-driven care and after-event discharge planning. Conclusions AAEs in children are primarily managed by medications supported by a growing body of literature. Continued efforts to study the efficacy of second-line bronchodilators, integrate AAE management with long-term asthma control and provide fair/equitable care are required.
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Affiliation(s)
- James S Leung
- McMaster University, Faculty of Health Sciences, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
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26
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Martin LJ, Murrison LB, Butsch Kovacic M. Building a Population Representative Pediatric Biobank: Lessons Learned From the Greater Cincinnati Childhood Cohort. Front Public Health 2021; 8:535116. [PMID: 33520904 PMCID: PMC7841396 DOI: 10.3389/fpubh.2020.535116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 12/15/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Biobanks can accelerate research by providing researchers with samples and data. However, hospital-based recruitment as a source for controls may create bias as who comes to the hospital may be different from the broader population. Methods: In an effort to broadly improve the quality of research studies and reduce costs and challenges associated with recruitment and sample collection, a group of diverse researchers at Cincinnati Children's Hospital Medical Center led an institution-supported initiative to create a population representative pediatric "Greater Cincinnati Childhood Cohort (GCC)." Participants completed a detailed survey, underwent a brief physician-led physical exam, and provided blood, urine, and hair samples. DNA underwent high-throughput genotyping. Results: In total, 1,020 children ages 3-18 years living in the 7 county Greater Cincinnati Metropolitan region were recruited. Racial composition of the cohort was 84% non-Hispanic white, 15% non-Hispanic black, and 2% other race or Hispanic. Participants exhibited marked demographic and disease burden differences by race. Overall, the cohort was broadly used resulting in publications, grants and patents; yet, it did not meet the needs of all potential researchers. Conclusions: Learning from both the strengths and weaknesses, we propose leveraging a community-based participatory research framework for future broad use biobanking efforts.
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Affiliation(s)
- Lisa J. Martin
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Liza Bronner Murrison
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Melinda Butsch Kovacic
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition, Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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27
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Ruszczyński M, Ambrożej D, Adamiec A, Ryczaj K, Elenius V, Cavkaytar O, Maggina P, Makrinioti H, Papadopoulos N, Hedlin G, Konradsen JR, Schaub B, H Smits H, Jartti T, Feleszko W. Preschool wheezing and asthma in children: A systematic review of guidelines and quality appraisal with the AGREE II instrument. Pediatr Allergy Immunol 2021; 32:92-105. [PMID: 32816386 DOI: 10.1111/pai.13334] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/26/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma-like symptoms in preschool children, such as wheezing and dyspnea, are common time- and resource-consuming diagnostic and management challenges. Quality of wheezing and asthma recommendations varies. The purpose of this study, carried out by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force for Preschool Wheeze, was to systematically review and assess the quality of guidelines for diagnosis and treatment of preschool wheezing and/or asthma. METHODS The Cochrane Library, MEDLINE, and EMBASE were searched until June 2018. The methodological rigor, quality, and transparency of relevant guidelines were assessed with the use of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. RESULTS We identified 26 guidelines. The quality scores for each domain varied. Of all domains, clarity and presentation had the highest mean score, whereas applicability and stakeholder involvement had the lowest. The scores (median) for individual domains were as follows: score and purpose 86%; stakeholder involvement 49%; rigor of development 54%; clarity of presentation 85%; applicability 51%; and editorial independence 63%. CONCLUSION Although several guidelines on asthma management in children are available, however, their quality varies. Additionally, there is a considerable gap in reliable recommendations on the management and treatment of non-asthmatic preschool wheeze.
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Affiliation(s)
- Marek Ruszczyński
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Ambrożej
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Aleksander Adamiec
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.,Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Klaudia Ryczaj
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Varpu Elenius
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - Ozlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Goztepe Training and Research Hospital, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Paraskevi Maggina
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | | | - Nikolaos Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jon R Konradsen
- Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Bianca Schaub
- Pediatric Allergology, Department of Pediatrics, German Center for Lung Research (DZL), Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Hermelijn H Smits
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland.,Department of Pediatrics, University of Oulu, Oulu, Finland
| | - Wojciech Feleszko
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
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28
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Kowalik K, Dai R, Safavi S, Reyna ME, Lou W, Lepine C, McDonald E, Schaap MJ, Brydges MG, Dubeau A, Boutis K, Narang I, Eiwegger T, Moraes TJ, Ratjen F, Subbarao P. Persistent ventilation inhomogeneity after an acute exacerbation in preschool children with recurrent wheezing. Pediatr Allergy Immunol 2020; 31:608-615. [PMID: 32160369 DOI: 10.1111/pai.13245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preschool children with recurrent wheezing suffer high morbidity. It is unclear whether objective measures of asthma control, such as pulmonary function tests (PFTs), provide additional information to the clinical assessment. METHODS We recruited children between 3 and 6 years old, with a history of recurrent wheezing in the preceding year and treated for acute wheezing exacerbation in the emergency department (ED) into an observational cohort study. Children attended two outpatient visits: the first study visit within five days of discharge from the ED and the second study visit 12 weeks after the ED visit. We performed standardized symptom score (test for respiratory and asthma control in kids (TRACK)), multiple breath washout (MBW), spirometry, and clinical assessment at both visits. RESULTS Seventy-four children, mean (standard deviation (SD)) age of 4.32 years (0.84), attended both visits. Paired FEV0.75 and lung clearance index (LCI) measurements at both time points were obtained in 37 and 34 subjects, respectively. Feasibility for all tests improved at visit 2 and was not age-dependent. At the second study visit, a third had controlled asthma based on the TRACK score, and the mean lung clearance index (LCI) improved from 9.86 to 8.31 (P = .003); however, 46% had an LCI in the abnormal range. FEV0.75 z-score improved from -1.66 to -1.17 (P = .05) but remained in the abnormal range in 24%. LCI was abnormal in more than half of the children with "well-controlled" asthma based on the TRACK score. There was no correlation between PFT measures and TRACK scores at either visit. CONCLUSIONS Lung clearance index demonstrates a persistent deficit post-exacerbation in a large proportion of preschoolers with recurrent wheezing, highlighting that symptom scores alone may not suffice for monitoring these children.
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Affiliation(s)
- Krzysztof Kowalik
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Ruixue Dai
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Shahideh Safavi
- Respiratory Medicine Department, Queen's Medical Centre, University of Nottingham School of Medicine, Nottingham, UK
| | - Myrtha E Reyna
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, Division of Biostatistics, University of Toronto, Toronto, Canada
| | - Claire Lepine
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Erica McDonald
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Mirjam J Schaap
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada.,Division of Respiratory Medicine and Allergy, Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - May G Brydges
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Aimee Dubeau
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Kathy Boutis
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Program in Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Thomas Eiwegger
- Division of Immunology & Allergy, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Paediatrics, Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada.,Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Canada
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29
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Buddala PK, Chandrasekaran V, Harichandrakumar KT. A 3-day course of 1 mg/kg versus 2 mg/kg bodyweight prednisolone for 1- to 5-year-old children with acute moderate exacerbation of asthma: a randomized double-blind noninferiority trial. Paediatr Child Health 2020; 26:e189-e193. [PMID: 34136056 DOI: 10.1093/pch/pxaa082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Even though the guidelines on the management of preschool asthma recommend early use of corticosteroids for acute moderate-to-severe exacerbations, considerable variation exists with regard to type and dose of steroids. Objectives To compare the clinical outcomes and side effect profile between 1 mg/kg/day and 2 mg/kg/day of oral prednisolone when administered for 3 days in preschool children with acute moderate asthma exacerbations. Study Design and Setting Randomized double-blind noninferiority trial was done in the paediatric emergency of a teaching hospital. Patients Interventions and Outcomes A total of 128 children aged 1 to 5 years who presented to the paediatric emergency with acute moderate exacerbation of asthma were enrolled. They were randomized into two groups. One group received 1 mg/kg/day and the other 2 mg/kg/day of oral prednisolone for 3 days. Severity of asthma exacerbation was measured by Pediatric Respiratory Assessment Measure (PRAM) score. The PRAM scores, wheeze recurrence, and side effect profile were compared and analyzed between the two groups. Results The difference in the PRAM scores at 1, 2, 3, and 4 hours after intervention between the two groups was statistically insignificant. Need for escalation of therapy, salbutamol nebulization, time for resolution of symptoms, and recurrence of wheeze were similar between the two groups. Vomiting was significantly less frequent in low-dose group with a relative risk of 0.19 to 0.99 compared to high-dose prednisolone. Conclusion Prednisolone at a dose of 1 mg/kg/day was not inferior to 2 mg/kg/day in terms of clinical improvement and recurrence of wheeze within 1 week and has less frequent vomiting compared to higher dose.
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Affiliation(s)
- Pavan Kumar Buddala
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Venkatesh Chandrasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K T Harichandrakumar
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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30
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Affiliation(s)
| | | | - Lamia Dahdah
- Bambino Gesù Childrens' Hospital IRCCS, Rome, Italy
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31
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Fiocchi A, Valluzzi R, Dahdah L. Zero tolerance for asthma deaths in children. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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32
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Douros K, Everard ML. Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That. Front Pediatr 2020; 8:218. [PMID: 32432064 PMCID: PMC7214804 DOI: 10.3389/fped.2020.00218] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. Terms such as "bronchiolitis," "reactive airways disease," "viral wheeze," and many more are used to describe the same condition and the same term is frequently used to describe illnesses caused by completely different dominant pathologies. This lack of clarity is due, in large part, to a failure to understand the basic underlying inflammatory and associated processes and, in part, due to the lack of a simple test to identify a condition such as asthma. Moreover, there is a lack of insight into the fact that the same pathology can produce different clinical signs at different ages. The consequence is that terminology and fashions in treatment have tended to go around in circles. As was noted almost 60 years ago, amongst pre-school children with a viral LRTI and airways obstruction there are those with a "viral bronchitis" and those with asthma. In the former group, a neutrophil dominated inflammation response is responsible for the airways' obstruction whilst amongst asthmatics much of the obstruction is attributable to bronchoconstriction. The airways obstruction in the former group is predominantly caused by airways secretions and to some extent mucosal oedema (a "snotty lung"). These patients benefit from good supportive care including supplemental oxygen if required (though those with a pre-existing bacterial bronchitis will also benefit from antibiotics). For those with a viral exacerbation of asthma, characterized by bronchoconstriction combined with impaired b-agonist responsiveness, standard management of an exacerbation of asthma (including the use of steroids to re-establish bronchodilator responsiveness) represents optimal treatment. The difficulty is identifying which group a particular patient falls into. A proposed simplified approach to the nomenclature used to categorize virus associated LRTIs is presented based on an understanding of the underlying pathological processes and how these contribute to the physical signs.
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Affiliation(s)
- Konstantinos Douros
- Third Department of Paediatrics, Attikon Hospital, University of Athens School of Medicine, Athens, Greece
| | - Mark L. Everard
- Division of Paediatrics and Child Health, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
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33
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Harel-Sterling M, Dai R, Moraes TJ, Boutis K, Eiwegger T, Narang I, Lepine C, Brydges MG, Dubeau A, Subbarao P, Schuh S. Test for respiratory and asthma control in preschool kids in the emergency department as a predictor of wheezing exacerbations. Pediatr Pulmonol 2020; 55:338-345. [PMID: 31909572 DOI: 10.1002/ppul.24601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/29/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The test for respiratory and asthma control in kids (TRACK score) is a standardized questionnaire tool validated to identify poor symptom control in children with stable preschool wheeze. This study determined if TRACK score measured within 5 days of an Emergency Department (ED) visit for acute wheezing predicts a subsequent wheezing exacerbation requiring an ED visit and/or treatment with systemic corticosteroids within 3 months. METHODS This was a single-center prospective cohort study of children aged 36 to 71 months who presented to the ED with an acute episode of wheezing and had TRACK score measured at a clinic visit within 5 days of the index ED encounter, focused on information about symptoms occurring before the onset of the current acute episode. The outcomes were the independent association of a repeat wheezing exacerbation with the overall TRACK score (primary) and with mutually uncorrelated TRACK items (secondary), adjusted for sex and atopy. RESULTS We enrolled 102 children; median age 52.3 (44.1, 59.9) months, 59% males. Of these, 33 (32.4%) had further wheezing exacerbations. For each 10 unit decrease in TRACK, the odds of a future exacerbation was 1.38 (95% CI, 1.10-1.75); male sex demonstrated OR, 5.13 (1.84-14.33). A model that included TRACK items reflecting more than equal to 1 awakenings for wheezing in the past 4 weeks, receipt of more than equal to 2 courses of corticosteroids in the last year and male sex was predictive of wheezing exacerbations: OR, 6.43 (2.18-19.00). CONCLUSION In preschoolers with acute wheezing episodes in the ED, we have identified the TRACK score components which, together with male sex, can be used to identify children at risk of future exacerbations requiring referral for specialized care. These results need to be confirmed and validated in other populations enrolled at multiple sites before they can be implemented in practice.
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Affiliation(s)
- Maya Harel-Sterling
- Division of Paediatric Emergency Medicine, Department of Paediatrics, and Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ruixue Dai
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Kathy Boutis
- Division of Paediatric Emergency Medicine, Department of Paediatrics, and Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Thomas Eiwegger
- Division of Immunology & Allergy, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Claire Lepine
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - May Grace Brydges
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Aimee Dubeau
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Suzanne Schuh
- Division of Paediatric Emergency Medicine, Department of Paediatrics, and Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Longo C, Bartlett G, Schuster T, Ducharme FM, MacGibbon B, Barnett TA. Weight status and nonadherence to asthma maintenance therapy among children enrolled in a public drug insurance plan. J Asthma 2019; 57:627-637. [PMID: 30912698 DOI: 10.1080/02770903.2019.1590593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: The pediatric obese-asthma phenotype is associated with poor control, perhaps because of medication nonadherence. This study aimed to assess whether weight status is associated with nonadherence in children prescribed new asthma maintenance therapies.Methods: A historical cohort was constructed from a clinical database linking individual patient and prescription data to Quebec's prescription claims registry. Children aged 2-18 years with specialist-diagnosed asthma who were newly prescribed one of the following maintenance controllers: leukotriene receptor antagonists (LTRA); low-dose inhaled corticosteroids (ICS); medium/high-dose ICS; or combination therapy (ICS with long-acting beta-2 agonists and/or LTRA), at the Asthma Center of the Montreal Children's Hospital from 2000-2007 were included. Primary nonadherence was defined as not claiming any prescriptions, whereas secondary nonadherence was measured with the proportion of prescribed days covered (PPDC ≤ 50%) among primary adherers over a 6-month follow-up period. A modified Poisson regression model served to estimate the effect of excess weight (BMI > 85th percentile) on primary and secondary nonadherence.Results: Approximately one third of patients were primary nonadherers and 60% took less than 50% of prescribed therapy. Excess weight was associated with a trend toward increased risk of primary nonadherence in children newly prescribed low-dose ICS (RR 1.53, 95%CI 0.94-2.49), and of secondary nonadherence in children initiating medium/high-dose ICS (RR 1.24; 95%CI 0.98-1.59).Conclusions: Excess weight status is a possible determinant of primary nonadherence in children initiating low-dose ICS and secondary nonadherence to higher-dose ICS regimens. This hypothesis-generating study suggests that nonadherence may be a potential contributor to higher morbidity in children with obese-asthma.
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Affiliation(s)
- Cristina Longo
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Francine M Ducharme
- Centre de recherche du CHU Sainte-Justine, Montréal, Québec, Canada.,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Brenda MacGibbon
- Département de Mathématiques, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Tracie A Barnett
- Centre de recherche du CHU Sainte-Justine, Montréal, Québec, Canada.,Unité d'Épidémiologie et Biostatistiques, INRS-Institut Armand-Frappier, Laval, Québec, Canada
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Papadopoulos NG, Čustović A, Cabana MD, Dell SD, Deschildre A, Hedlin G, Hossny E, Le Souëf P, Matricardi PM, Nieto A, Phipatanakul W, Pitrez PM, Pohunek P, Gavornikova M, Jaumont X, Price DB. Pediatric asthma: An unmet need for more effective, focused treatments. Pediatr Allergy Immunol 2019; 30:7-16. [PMID: 30312503 PMCID: PMC7380053 DOI: 10.1111/pai.12990] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite remarkable advances in our understanding of asthma, there are still several unmet needs associated with the management of pediatric asthma. METHODS A two-day, face-to-face meeting was held in London, United Kingdom, on October 28 and 29, 2017, involving a group of international expert clinicians and scientists in asthma management to discuss the challenges and unmet needs that remain to be addressed in pediatric asthma. RESULTS These unmet needs include a lack of clinical efficacy and safety evidence, and limited availability of non-steroid-based alternative therapies in patients <6 years of age. An increased focus on children is needed in the context of clinical practice guidelines for asthma; current pediatric practice relies mostly on extrapolations from adult recommendations. Furthermore, no uniform definition of pediatric asthma exists, which hampers timely and robust diagnosis of the condition in affected patients. CONCLUSIONS There is a need for a uniform definition of pediatric asthma, clearly distinguishable from adult asthma. Furthermore, guidelines which provide specific treatment recommendations for the management of pediatric asthma are also needed. Clinical trials and real-world evidence studies assessing anti-immunoglobulin E (IgE) therapies and other monoclonal antibodies in children <6 years of age with asthma may provide further information regarding the most appropriate treatment options in these vulnerable patients. Early intervention with anti-IgE and non-steroid-based alternative therapies may delay disease progression, leading to improved clinical outcomes.
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Affiliation(s)
- Nikolaos G. Papadopoulos
- Division of Infection, Inflammation & Respiratory MedicineThe University of ManchesterManchesterUK
- The Allergy Department, 2nd Pediatric Clinic, National & KapodistrianUniversity of AthensAthensGreece
| | - Adnan Čustović
- Department of PaediatricsImperial College LondonLondonUK
| | - Michael D. Cabana
- Departments of Pediatrics and Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCalifornia
| | - Sharon D. Dell
- Division of Respiratory Medicine, Department of Pediatrics, Child Health Evaluative Sciences, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Antoine Deschildre
- CHU Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de FlandreCHRU de Lille and Université Nord de FranceLilleFrance
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Lung and Allergy UnitKarolinska University HospitalStockholmSweden
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Elham Hossny
- Pediatric Allergy and Immunology UnitChildren's Hospital Ain Shams UniversityCairoEgypt
| | - Peter Le Souëf
- School of Paediatrics and Faculty of Child Health and Medical SciencesUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Paolo M. Matricardi
- Department of Pediatric Pneumology & ImmunologyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy UnitChildren's Hospital La FeValenciaSpain
| | - Wanda Phipatanakul
- Pediatric Allergy and ImmunologyBoston Children’s HospitalBostonMassachusetts
| | - Paulo M. Pitrez
- School of MedicinePontifícia Universidade Católica do Rio Grande do Sul (PUCRS)Porto AlegreBrazil
| | - Petr Pohunek
- Pediatric Department, 2nd Faculty of MedicineCharles University Prague, and University Hospital MotolPragueCzech Republic
| | | | | | - David B. Price
- Observational and Pragmatic Research InstituteSingaporeSingapore
- University of AberdeenAberdeenUK
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36
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Anderson-James S, Marchant JM, Chang AB, Acworth JP, Phillips NT, Drescher BJ, Goyal V, O'Grady KAF. Burden and emergency department management of acute cough in children. J Paediatr Child Health 2019; 55:181-187. [PMID: 30066972 DOI: 10.1111/jpc.14146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
AIM In children presenting to an emergency department (ED) with an acute coughing illness, the aims of this study were to: (i) describe the frequency of doctor visits and medication use; and (ii) describe management and relate it to current evidence-based guidelines. METHODS This was a cross-sectional study in ED of a major teaching hospital (Royal Children's Hospital, Brisbane, Australia). Participants included 537 children (<15 years) presenting with acute (<2 weeks) cough, with a median age of 2.2 years (interquartile range 1.0-4.0); 61.5% were boys. Hospitalised children and those with asthma, pneumonia or chronic illnesses were excluded. Main outcome measures were: (i) frequency of pre-ED doctor visits and medication use; and (ii) comparison of management to current evidence-based recommendations related to four discharge diagnoses: bronchiolitis, 'wheeze/reactive airway disease (RAD)', croup and 'non-specific acute respiratory illness'. RESULTS A total of 300 children (55.9%) had seen a doctor prior to their ED presentation, and use of medications pre-ED was high (53.4%). While 93.4% of children with croup were treated in accordance with guidelines, concordance was lower for children with bronchiolitis or 'wheeze/RAD'. The majority of children with a discharge diagnosis of 'wheeze/RAD' (95.6%) received bronchodilators, and 72.7% also received oral corticosteroids but were not diagnosed with asthma. More than half (55.1%) of the children with non-specific acute respiratory illness received medication(s) either prior to or during their ED presentation. CONCLUSIONS The burden of acute cough-related illnesses in children is high, and there is a need for improved uptake of evidence-based guidelines. In addition, the large number of children diagnosed with 'wheeze/RAD' suggests asthma is likely under-diagnosed in this setting.
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Affiliation(s)
- Sophie Anderson-James
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jason P Acworth
- Department of Emergency Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Natalie T Phillips
- Department of Emergency Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Benjamin J Drescher
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vikas Goyal
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
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Seol HY, Sohn S, Liu H, Wi CI, Ryu E, Park MA, Juhn YJ. Early Identification of Childhood Asthma: The Role of Informatics in an Era of Electronic Health Records. Front Pediatr 2019; 7:113. [PMID: 31001500 PMCID: PMC6454104 DOI: 10.3389/fped.2019.00113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
Emerging literature suggests that delayed identification of childhood asthma results in an increased risk of long-term and various morbidities compared to those with timely diagnosis and intervention, and yet this risk is still overlooked. Even when children and adolescents have a history of recurrent asthma-like symptoms and risk factors embedded in their medical records, this information is sometimes overlooked by clinicians at the point of care. Given the rapid adoption of electronic health record (EHR) systems, early identification of childhood asthma can be achieved utilizing (1) asthma ascertainment criteria leveraging relevant clinical information embedded in EHR and (2) innovative informatics approaches such as natural language processing (NLP) algorithms for asthma ascertainment criteria to enable such a strategy. In this review, we discuss literature relevant to this topic and introduce recently published informatics algorithms (criteria-based NLP) as a potential solution to address the current challenge of early identification of childhood asthma.
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Affiliation(s)
- Hee Yun Seol
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Miguel A Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, United States
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine and Internal Medicine, Mayo Clinic, Rochester, MN, United States
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38
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Wadden D, Allwood Newhook LA, Twells L, Farrell J, Gao Z. Sex-Specific Association between Childhood BMI Trajectories and Asthma Phenotypes. Int J Pediatr 2018; 2018:9057435. [PMID: 30631374 PMCID: PMC6304644 DOI: 10.1155/2018/9057435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Asthma and obesity are two common health problems in the pediatric population. Obesity is associated with several comorbidities which are of great consequence. Excess adipose tissue has been linked to asthma in a number of studies. However, little is known about childhood body mass index (BMI) trajectories and the development of asthma phenotypes. OBJECTIVE The current study aims to investigate the significance of BMI trajectories over childhood and the risk of asthma phenotypes. METHODS The current study is a prospective cohort of children aged 0-2 years who were followed every two years for eight years through cycles one to five in the National Longitudinal Survey of Children and Youths (NLSCY). Statistical analysis: a latent class growth modelling (LCGM) method was used to identify BMI trajectory patterns from cycles one to five. Multiple imputation (number of imputations=5) was carried out to impute children with missing values on height or weight information. Sampling weights and 1,000 bootstrap weights were used in SAS PROC SURVEYLOGISTIC to examine the association between BMI trajectory and asthma phenotypes (persistent or transient asthma) in a multivariate analysis. RESULTS The study consisted of 571,790 males and 549,230 females. Among them, 46% of children showed an increasing trajectory in terms of change in BMI percentile during childhood, followed by the stable-trajectory group (41%) and decreasing-trajectory group (13%). After controlling for confounding factors, females in the increasing BMI trajectory group were four times more likely to be associated with persistent asthma (OR = 4.09; 95% CI:1.04-16.15; p = 0.0442) than females in the stable BMI trajectory group. No such relationship was found in males. The BMI trajectory was not significantly associated with risk of transient asthma for either sex. CONCLUSION We report a female-specific association between increasing adiposity, measured by BMI, and persistent asthma.
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Affiliation(s)
- Danny Wadden
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Laurie Twells
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jamie Farrell
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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39
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Haw J, Cunningham S, O'Doherty KC. Epistemic tensions between people living with asthma and healthcare professionals in clinical encounters. Soc Sci Med 2018; 208:34-40. [PMID: 29758476 DOI: 10.1016/j.socscimed.2018.04.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/19/2018] [Accepted: 04/27/2018] [Indexed: 11/16/2022]
Abstract
RATIONALE Asthma is a common respiratory condition with high prevalence rates globally. While there are effective treatments, asthma remains an important health concern as people continue to die from severe attacks. Improving the experiences of, and health outcomes for, people with asthma depends heavily on their interactions with healthcare professionals. Understanding negative clinical encounters will benefit people with asthma and healthcare providers. OBJECTIVE To examine epistemic tensions in negative clinical encounters from a patient perspective, with an aim to better understand how patients respond to these tensions. Much of the scholarship on patient interactions with healthcare providers examines interpersonal or structural factors. Thus, focusing our analysis on tensions between lay and expert knowledge in negative clinical encounters provides a novel contribution to this body of scholarship. METHOD As part of a larger qualitative study (n = 70) examining the lived experiences of people who have asthma or a child with asthma, semi-structured interviews with 17 participants who described having negative clinical encounters were analyzed for themes. RESULTS Participants responded to epistemic tensions in two main ways: (1) by incorporating expert knowledge; and (2) by resisting/challenging expert knowledge. In both cases, participants also described feeling frustrated and uncertain about their or their child's clinical care. We analyze these responses by drawing on Lindström and Karlsson's (2016) conceptualization of epistemic tensions as arising from 3 characteristics of epistemic asymmetry: access, rights, and responsibility. CONCLUSION Based on this study, (1) a patient's confidence in claiming epistemic access and asserting epistemic rights when epistemic tensions arise are related to the context and their own history of living with asthma; and (2), epistemic tensions can make visible the power relations in the patient-clinician relationship, which can lead to the exertion of biomedical authority, or the taking up of patient's lay knowledge.
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Affiliation(s)
- Jennie Haw
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Shannon Cunningham
- Department of Medicine - Division of Nephrology, 3-063 Research Transition Facility, University of Alberta, Edmonton, AB T6G 2V2, Canada.
| | - Kieran C O'Doherty
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
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40
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FitzGerald JM, Lemiere C, Lougheed MD, Ducharme FM, Dell SD, Ramsey C, Yang MCL, Côté A, Watson W, Olivenstein R, Van Dam A, Villa-Roel C, Grad R. Recognition and management of severe asthma: A Canadian Thoracic Society position statement. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2017. [DOI: 10.1080/24745332.2017.1395250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J. Mark FitzGerald
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Catherine Lemiere
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - M. Diane Lougheed
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Francine M. Ducharme
- Departments of Pediatrics and of Social and Preventive Medicine, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Sharon D. Dell
- Department of Pediatrics and IHPME, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Clare Ramsey
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M. Connie L. Yang
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andréanne Côté
- Critical Care Department, University of Calgary, Calgary, Alberta, Canada
| | - Wade Watson
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ron Olivenstein
- Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Anne Van Dam
- Canadian Thoracic Society, Ottawa, Ontario, Canada
| | - Cristina Villa-Roel
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Risk Factors in Preschool Children for Predicting Asthma During the Preschool Age and the Early School Age: a Systematic Review and Meta-Analysis. Curr Allergy Asthma Rep 2017; 17:85. [DOI: 10.1007/s11882-017-0753-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fullmann K, Blackburn DF, Fenton ME, Mansell H. Readability and Suitability of COPD Consumer Information. Can Respir J 2017; 2017:2945282. [PMID: 28947874 PMCID: PMC5602649 DOI: 10.1155/2017/2945282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/12/2017] [Accepted: 07/25/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Information leaflets have been shown to positively or negatively impact adherence, depending on their content. The objective of this study was to perform an appraisal of the consumer information provided in COPD inhaler monographs. METHODS COPD inhalers were identified from the Health Canada Drug Product Database. Medication information and instructions for inhaler use were analyzed for readability by seven formulas, with an acceptability threshold of grades 6-8. Three researchers rated suitability using a modified Suitability Assessment of Materials (SAM) tool and assessed leaflets for explicit warnings. RESULTS Twenty-six inhalers with a COPD indication were evaluated. Medication information sections were rated as "difficult to read" or "hard," and 85% (22/26) had a reading level above grade 8. The instructions for inhaler use were rated as "easy" or "fairly easy" to read and 63% (16/26) met the threshold by all formulas. While all leaflets achieved superior suitability ratings, extreme warnings included risk of premature death (n = 12), risks of serious injury (n = 26), serious interactions (n = 26), and statements that convey a serious consequence to therapy (n = 26). CONCLUSION While COPD information leaflets in Canada performed well in terms of readability and suitability, overemphasis on side effects, warnings, and precautions may contribute to patient fear and nonadherence.
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Affiliation(s)
- Kathryn Fullmann
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - David F. Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mark E. Fenton
- Division of Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
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43
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Amirav I, Newhouse MT. Comment on the CTS 2015 guidelines for asthma in preschoolers. Paediatr Child Health 2017; 22:64-65. [PMID: 29479181 DOI: 10.1093/pch/pxx015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Israel Amirav
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Michael T Newhouse
- Firestone Institute for Respiratory Health, St. Joseph's Hospital, McMaster University, Hamilton, Ontario
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Pound CM, Gelt V, Akiki S, Eady K, Moreau K, Momoli F, Murchison B, Zemek R, Mulholland B, Kovesi T. Nurse-Driven Clinical Pathway for Inpatient Asthma: A Randomized Controlled Trial. Hosp Pediatr 2017; 7:204-213. [PMID: 28330941 DOI: 10.1542/hpeds.2016-0150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We examined the impact of a nurse-driven clinical pathway on length of stay (LOS) for children hospitalized with asthma. METHODS We conducted a randomized controlled trial involving children hospitalized with asthma. Nurses of children in the intervention group weaned salbutamol frequency using an asthma scoring tool, whereas physicians weaned salbutamol frequency for the control group patients as per standard care. The primary outcome was LOS in hours. Secondary outcomes included number of salbutamol treatments administered, ICU transfers, unplanned medical visits postdischarge, and stakeholders' pathway satisfaction. Research staff, investigators, and statisticians were blinded to group assignment, except for research assistants enrolling participants. Qualitative interviews were done to assess acceptability of intervention by physicians, nurses, residents, and patients. RESULTS We recruited 113 participants (mean age 4.9 years, 62% boys) between May 2012 and September 2015. Median LOS was 49 hours (21-243 hours) and 47 hours (22-188 hours) (P = .11), for the control and intervention groups, respectively. A post hoc analysis designed to deal with highly skewed LOS data resulted in a relative 18% (95% confidence interval 0.68-0.99) LOS reduction for the intervention group. There was no difference in secondary outcomes. No significant adverse events resulted from the intervention. The 14 participants included in the qualitative component reported a positive experience with the pathway. CONCLUSIONS This nurse-driven pathway led to increased efficiency as evidenced by a modest LOS reduction. It allowed for care standardization, improved utilization of nursing resources, and high stakeholder satisfaction.
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Affiliation(s)
- Catherine M Pound
- Children's Hospital of Eastern Ontario, Ontario, Canada; .,University of Ottawa, Ontario, Canada; and
| | - Victoria Gelt
- Children's Hospital of Eastern Ontario, Ontario, Canada.,University of Ottawa, Ontario, Canada; and
| | - Salwa Akiki
- Children's Hospital of Eastern Ontario, Ontario, Canada
| | - Kaylee Eady
- University of Ottawa, Ontario, Canada; and.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | - Katherine Moreau
- University of Ottawa, Ontario, Canada; and.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | - Franco Momoli
- University of Ottawa, Ontario, Canada; and.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | - Barbara Murchison
- Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario, Ontario, Canada.,University of Ottawa, Ontario, Canada; and.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | | | - Tom Kovesi
- Children's Hospital of Eastern Ontario, Ontario, Canada.,University of Ottawa, Ontario, Canada; and
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45
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Ducharme FM, Lamontagne AJ, Blais L, Grad R, Lavoie KL, Bacon SL, McKinney ML, Desplats E, Ernst P. Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma. Can Respir J 2016; 2016:4169010. [PMID: 27445537 PMCID: PMC4925971 DOI: 10.1155/2016/4169010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/10/2016] [Indexed: 11/18/2022] Open
Abstract
Objective. We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods. We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child and endorsement of enablers to prescribe long-term controllers. Results. With a 56% participation rate, 421 physicians participated. Most (86%) would prescribe a long-term controller (predominantly inhaled corticosteroids, ICS) to the patient in their clinical vignette. Determinants of intention were the recognition of persistent symptoms (OR 2.67), goal of achieving long-term control (OR 5.31), and high comfort level in initiating long-term ICS (OR 2.33). Decision tools, pharmacy reports, reminders, and specific training were strongly endorsed by ≥60% physicians to support optimal management. Physicians strongly endorsed asthma education, lung function testing, specialist opinion, accessible asthma clinic, and paramedical healthcare professionals to guide patients, as enablers to improve patient adherence to and physicians' comfort with long-term ICS. Interpretation. Tools and training to improve physician knowledge, skills, and perception towards long-term ICS and resources that increase patient adherence and physician comfort to facilitate long-term ICS prescription should be considered as targets for implementation.
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Affiliation(s)
- Francine M. Ducharme
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada H3T 1C5
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5
- Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada H3C 3J7
| | - Alexandrine J. Lamontagne
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5
| | - Lucie Blais
- Department of Pharmacology, University of Montreal, Montreal, QC, Canada H3T 1J4
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada H3T 1E2
| | - Kim L. Lavoie
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montreal, Montreal, QC, Canada H4J 1C5
- Department of Psychology, Université du Québec à Montreal, Montreal, QC, Canada H3C 3P8
| | - Simon L. Bacon
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montreal, Montreal, QC, Canada H4J 1C5
- Department of Exercise Science, Concordia University, Montreal, QC, Canada H4B 1R6
| | - Martha L. McKinney
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5
| | - Eve Desplats
- Research Centre, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5
| | - Pierre Ernst
- Divisions of Clinical Epidemiology and of Pulmonary Medicine, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada H3T 1E2
- Department of Medicine, McGill University, Montreal, QC, Canada H4A 3J1
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