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Ha EK, Kim JH, Han B, Shin J, Lee E, Lee KJ, Shin YH, Han MY. Viral respiratory infections requiring hospitalization in early childhood related to subsequent asthma onset and exacerbation risks. J Med Virol 2024; 96:e29876. [PMID: 39233491 DOI: 10.1002/jmv.29876] [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: 03/24/2024] [Revised: 07/19/2024] [Accepted: 08/13/2024] [Indexed: 09/06/2024]
Abstract
Viral lower respiratory tract infections (LRTIs), including rhinovirus and respiratory syncytial virus during early childhood, have been linked to subsequent asthma. However, the impact of other respiratory viruses remains unclear. We analyzed nationwide Korean data from January 1, 2008, to December 31, 2018, utilizing the national health insurance database. Our study focused on 19 169 meticulously selected children exposed to severe respiratory infections requiring hospitalization with documented viral pathogens, matched with 191 690 unexposed children at a ratio of 1:10 using incidence density sampling. Our findings demonstrate that asthma exacerbation rates were higher among the exposed cohort than the unexposed cohort over a mean follow-up of 7.8 years. We observed elevated risks of asthma exacerbation and newly developed asthma compared to the unexposed cohort. Hospitalization due to rhinovirus, respiratory syncytial virus, influenza, metapneumovirus, and adenovirus was related to increased asthma exacerbations. Notably, we found a stronger association in cases of multiple LRTI hospitalizations. In conclusion, our study shows that early childhood respiratory viral infections are related to subsequent asthma exacerbations and new asthma diagnoses.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Boeun Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Jeewon Shin
- Department of Pediatrics, CHA Ilsan Medical Center, CHA University, Goyang, South Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Kee-Jae Lee
- Department of Information and Statistics, Korea National Open University, Seoul, South Korea
| | - Youn Ho Shin
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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Rivera-Sepulveda A, Hakim M, Aronson L, Glass TF, Blake K, Alexander K, Schrimshaw EW. A Community-Guided Approach to Bronchiolitis: A Needs Assessment and Illness Perception Study. J Patient Exp 2024; 11:23743735241257384. [PMID: 39050093 PMCID: PMC11268019 DOI: 10.1177/23743735241257384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
The factors influencing caregivers' understanding of pediatric respiratory diseases, such as bronchiolitis, can guide patient care and the acceptability of treatment methods within the healthcare system. This study aims to identify illness perceptions and perform a needs assessment among caregivers of children diagnosed with respiratory diseases. This is a prospective, cross-sectional, questionnaire-driven study of a representative sample of caregivers whose children had an acute respiratory illness. The telephone-administered questionnaire was comprised of (1) demographic items; (2) illness perception questionnaire-revised (IPQ-R); and (3) items about personal barriers, the latter 2 of which employed a 5-point Likert response. Cronbach's alpha (α) was used to measure the internal consistency reliability for each item within the IPQ-R. The Pearson 2-tailed correlation coefficient was used to correlate questionnaire items. We included 75 caregivers whose children have been diagnosed with bronchiolitis (51%), reactive airway disease (RAD) (35%), asthma (33%), and wheezing (44%). We found no significance between the child's diagnosis and the site of recruitment. The most important components of the illness perception were illness coherence (α=0.849), psychological attributions (α=0.903), and barriers to diagnosis (α=0.633). Understanding caregivers' perceptions of respiratory diseases will lead to better treatment acceptance. We must clarify the terms used to define bronchiolitis from viral-induced wheezing, RAD, and the first asthma episode in older infants. Identifying caregivers' gaps in knowledge will help establish a cohesive approach to personalized treatment of respiratory diseases in children and their diagnosis.
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Affiliation(s)
| | - Monica Hakim
- University of Central Florida College of Medicine, Nemours Children's Health Department of Pediatrics, Orlando, FL, USA
| | - Lauren Aronson
- University of Central Florida College of Medicine, Nemours Children's Health Department of Pediatrics, Orlando, FL, USA
| | - Todd F. Glass
- Division of Emergency Medicine and Urgent Care, Nemours Children's Health, Orlando, FL, USA
| | - Kathryn Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health, Jacksonville, FL, USA
| | - Kenneth Alexander
- Division of Infectious Disease, Nemours Children's Health, Orlando, FL, USA
| | - Eric W. Schrimshaw
- University of Central Florida College of Medicine, Nemours Children's Health Department of Pediatrics, Orlando, FL, USA
- Department of Population Health Sciences, University of Central Florida, Orlando, FL, USA
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Ukkonen RM, Renko M, Kuitunen I. Azithromycin for acute bronchiolitis and wheezing episodes in children - a systematic review with meta-analysis. Pediatr Res 2024; 95:1441-1447. [PMID: 38066246 PMCID: PMC11126380 DOI: 10.1038/s41390-023-02953-z] [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: 08/09/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 05/26/2024]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to analyse the efficacy of azithromycin in acute bronchiolitis and wheezing. METHODS PubMed, Scopus, and Web of Science databases were searched for randomized controlled trials comparing azithromycin to placebo in children <2 years of age. Main outcomes were progress of acute wheezing episode and recurrence of wheezing. We used random-effects model to calculate mean difference (MD) with 95% confidence interval (CI) or risk ratios (RR) with CI. RESULTS We screened 1604 abstracts and included 7 studies. Risk of bias was low in three and had some concerns in four studies. Need for intensive care unit treatment was assessed in four studies (446 children) and the risk difference was 0.0% (CI -2.0 to 2.0; low quality evidence). Hospitalization duration was -0.27 days shorter in the azithromycin group (MD-0.27, CI -0.47 to -0.07; three studies; moderate quality evidence). Azithromycin did not prevent recurrence of wheezing (RR 0.84, CI 0.45-1.56; three studies), hospital readmissions (RR 1.14, CI 0.82-1.60; four studies). CONCLUSIONS We found moderate quality evidence that azithromycin may reduce hospitalization duration. Low certainty evidence suggests that azithromycin does not reduce the need for intensive care unit treatment. Furthermore, azithromycin did not prevent wheezing recurrence. IMPACT Azithromycin may reduce hospitalization time in acute bronchiolitis and wheezing episodes among children aged less than two. Azithromycin administrated during the acute wheezing period, does not have preventive effect on wheezing recurrence. Azithromycin seemed to have similar adverse event profile than placebo. Future studies with clinically relevant outcomes, and sufficient sample sizes are needed, before implementing azithromycin into clinical use.
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Affiliation(s)
- Rosa-Maria Ukkonen
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Marjo Renko
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Ilari Kuitunen
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
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Shhada E, Nahle AA, Hamdar H, Jlailati A, Jawad A, Nahle Z, Ali S. Unveiling the complexity of right middle lobe syndrome: a case series highlighting the association with asthma. Ann Med Surg (Lond) 2024; 86:1836-1842. [PMID: 38576953 PMCID: PMC10990357 DOI: 10.1097/ms9.0000000000001848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Right middle lobe syndrome (MLS) is a rare lung disorder primarily affecting children with a history of asthma or atopy. It encompasses a range of pathological and clinical conditions, from recurrent collapses of the middle lobe to bronchiectasis. In this study, the authors present a case series featuring four individuals with MLS associated with asthma, aiming to deepen our understanding of this uncommon condition. Case presentation Four paediatric patients with right MLS exhibited symptoms of persistent cough, dyspnoea, and recurrent asthma exacerbations. Radiographic evaluations confirmed features consistent with right MLS, and bronchoscopy revealed mucus plugs and oedematous airways obstructing the right middle lobe bronchus. Treatment with bronchodilators, antibiotics, and corticosteroids led to symptom improvement and resolution of atelectasis. Clinical discussion MLS is a rare condition characterized by chronic collapse of the right middle lobe and bronchiectasis. It is challenging to diagnose MLS, but computed tomography (CT) scans provide detailed lung images for confirmation. Treatment focuses on addressing the underlying cause, such as infections or mucus obstruction. Lobectomy may be considered in severe cases. This case series emphasizes the need for further research on MLS, as its rarity and characteristics remain unclear. Conclusion These cases exhibited obstructive MLS with and without asthma. Accurate diagnosis is challenging, requiring imaging techniques. MLS has clinical implications, particularly in asthma patients. Future studies should focus on understanding the aetiology of non-obstructive MLS.
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Affiliation(s)
- Eman Shhada
- Department of Pediatric Intensive Care, Children’s Hospital, Faculty of Medicine
| | | | | | | | | | - Zeinab Nahle
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Sawssan Ali
- Department of Pulmonary Pediatrics, Children’s Damascus University Hospital, Damascus University, Damascus, Syria
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Zhu Z. Early-life airway microbiome and childhood asthma development. Eur Respir J 2024; 63:2302187. [PMID: 38238000 DOI: 10.1183/13993003.02187-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Zhaozhong Zhu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Steininger H, Moltzau-Anderson J, Lynch SV. Contributions of the early-life microbiome to childhood atopy and asthma development. Semin Immunol 2023; 69:101795. [PMID: 37379671 DOI: 10.1016/j.smim.2023.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
The rapid rise in atopy and asthma in industrialized nations has led to the identification of early life environmental factors that promote these conditions and spurred research into how such exposures may mediate the trajectory to childhood disease development. Over the past decade, the human microbiome has emerged as a key determinant of human health. This is largely due to the increasing appreciation for the myriad of non-mutually exclusive mechanisms by which microbes tune and train host immunity. Microbiomes, particularly those in early life, are shaped by extrinsic and intrinsic factors, including many of the exposures known to influence allergy and asthma risk. This has led to the over-arching hypothesis that such exposures mediate their effect on childhood atopy and asthma by altering the functions and metabolic productivity of microbiomes that shape immune function during this critical developmental period. The capacity to study microbiomes at the genetic and molecular level in humans from the pre-natal period into childhood with well-defined clinical outcomes, offers an unprecedented opportunity to identify early-life and inter-generational determinants of atopy and asthma outcomes. Moreover, such studies provide an integrative microbiome research framework that can be applied to other chronic inflammatory conditions. This review attempts to capture key studies in the field that offer insights into the developmental origins of childhood atopy and asthma, providing novel insights into microbial mediators of maladaptive immunity and chronic inflammatory disease in childhood.
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Affiliation(s)
- Holly Steininger
- Division of Gastroenterology, University of California, San Francisco, USA; Benioff Center for Microbiome Medicine, Department of Medicine, University of California, San Francisco, USA
| | - Jacqueline Moltzau-Anderson
- Division of Gastroenterology, University of California, San Francisco, USA; Benioff Center for Microbiome Medicine, Department of Medicine, University of California, San Francisco, USA
| | - Susan V Lynch
- Division of Gastroenterology, University of California, San Francisco, USA; Benioff Center for Microbiome Medicine, Department of Medicine, University of California, San Francisco, USA.
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Dearborn LC, Hazlehurst MF, Loftus CT, Szpiro AA, Carroll KN, Moore PE, Adgent MA, Barrett ES, Nguyen RHN, Sathyanarayana S, LeWinn KZ, Bush NR, Kaufman JD, Karr CJ. Role of Air Pollution in the Development of Asthma Among Children with a History of Bronchiolitis in Infancy. Epidemiology 2023; 34:554-564. [PMID: 37042935 PMCID: PMC10563986 DOI: 10.1097/ede.0000000000001613] [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: 01/13/2022] [Accepted: 03/12/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Infants experiencing bronchiolitis are at increased risk for asthma, but few studies have identified modifiable risk factors. We assessed whether early life air pollution influenced child asthma and wheeze at age 4-6 years among children with a history of bronchiolitis in the first postnatal year. METHODS Children with caregiver-reported physician-diagnosed bronchiolitis were drawn from ECHO-PATHWAYS, a pooled longitudinal cohort from six US cities. We estimated their air pollution exposure from age 1 to 3 years from validated spatiotemporal models of fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ). Caregivers reported children's current wheeze and asthma at age 4-6 years. We used modified Poisson regression to estimate relative risks (RR) and 95% confidence intervals (CI), adjusting for child, maternal, and home environmental factors. We assessed effect modification by child sex and maternal history of asthma with interaction models. RESULTS A total of 224 children had caregiver-reported bronchiolitis. Median (interquartile range) 2-year pollutant concentrations were 9.3 (7.8-9.9) µg/m 3 PM 2.5 , 8.5 (6.4-9.9) ppb NO 2 , and 26.6 (25.6-27.7) ppb O 3 . RRs (CI) for current wheeze per 2-ppb higher O 3 were 1.3 (1.0-1.7) and 1.4 (1.1-1.8) for asthma. NO 2 was inversely associated with wheeze and asthma whereas associations with PM 2.5 were null. We observed interactions between NO 2 and PM 2.5 and maternal history of asthma, with lower risks observed among children with a maternal history of asthma. CONCLUSION Our results are consistent with the hypothesis that exposure to modest postnatal O 3 concentrations increases the risk of asthma and wheeze among the vulnerable subpopulation of infants experiencing bronchiolitis.
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Affiliation(s)
- Logan C Dearborn
- From the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
| | - Marnie F Hazlehurst
- From the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
| | - Christine T Loftus
- From the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA
| | - Kecia N Carroll
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, NY
| | - Paul E Moore
- Division of Allergy, Immunology, and Pulmonology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret A Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Environmental and Occupational Health Sciences Institute, Rutgers School of Public Health, Piscataway, NJ
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Ruby HN Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Sheela Sathyanarayana
- From the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Nicole R Bush
- Department of Psychiatry and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Joel D Kaufman
- From the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Department of Medicine, School of Medicine, University of Washington; Seattle, WA
| | - Catherine J Karr
- From the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
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Teijeiro A, Gómez RM. Wheezing-Related Relevant Factors and the Role of Viral Bronchiolitis. FRONTIERS IN ALLERGY 2021; 2:726972. [PMID: 35387057 PMCID: PMC8974738 DOI: 10.3389/falgy.2021.726972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022] Open
Abstract
Bronchiolitis is a virus-associated infection of the lower respiratory tract exhibiting signs and symptoms of airway obstruction. Respiratory Syncytial Virus (RSV) is responsible in most cases; however, different rhinoviruses have also been implicated. Specific viruses and time until the first infection, severity of the respiratory condition, and atopic status have a determinant role in the recurrence of wheezing and asthma development. Genetics, lung function, atopic condition, the role of microbiota and environment, pollution, and obesity are considered in the present review. Emergency room visits and hospitalizations because of severe wheezing and smoking during pregnancy among others were identified as risk factors for significant morbidity in our population. Approaching determinant conditions like genetics, allergy, antiviral immunity, and environmental exposures such as farm vs. urban and viral virulence provides an opportunity to minimize morbidity of viral illness and asthma in children.
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Affiliation(s)
- Alvaro Teijeiro
- Respiratory Department, Children's Hospital, Córdoba, Argentina
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Honcoop AC, Poitevien P, Kerns E, Alverson B, McCulloh RJ. Racial and ethnic disparities in bronchiolitis management in freestanding children's hospitals. Acad Emerg Med 2021; 28:1043-1050. [PMID: 33960050 DOI: 10.1111/acem.14274] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Variation in bronchiolitis management by race and ethnicity within emergency departments (EDs) has been described in single-center and prospective studies, but large-scale assessments across EDs and inpatient settings are lacking. Our objective is to describe the association between race and ethnicity and bronchiolitis management across 37 U.S. freestanding children's hospitals from 2015 to 2018. METHODS Using the Pediatric Health Information System, we analyzed ED and inpatient visits from November 2015 to November 2018 of children with bronchiolitis 3 to 24 months old. Rates of use for specific diagnostic tests and therapeutic measures were compared across the following race/ethnicity categories: 1) non-Hispanic White (NHW), 2) non-Hispanic Black (NHB), 3) Hispanic, and 4) other. The subanalyses of ED patients only and children < 1 year old were performed. Mixed-effect logistic regression was performed to compare the adjusted odds of receiving specific test/treatment using NHW children as the reference group. RESULTS A total of 134,487 patients met inclusion criteria (59% male, 28% NHB, 26% Hispanic). Adjusted analysis showed that NHB children had higher odds of receiving medication associated with asthma (odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.22 to 1.32) and lower odds of receiving diagnostic tests (blood cultures, complete blood counts, viral testing, chest x-rays; OR = 0.78, 95% CI = 0.75 to 0.81) and antibiotics (OR = 0.58, 95% CI = 0.52 to 0.64) than NHW children. Hispanic children had lower odds of receiving diagnostic testing (OR = 0.94, 95% CI = 0.90 to 0.98), asthma-associated medication (OR = 0.92, 95% CI = 0.88 to 0.96), and antibiotics (OR = 0.74, 95% CI = 0.66 to 0.82) compared to NHW children. CONCLUSION NHB children more often receive corticosteroid and bronchodilator therapies; NHW children more often receive antibiotics and chest radiography. Given that current guidelines generally recommend supportive care with limited diagnostic testing and medical intervention, these findings among NHB and NHW children represent differing patterns of overtreatment. The underlying causes of these patterns require further investigation.
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Affiliation(s)
| | - Patricia Poitevien
- Hasbro Children's HospitalWarren Alpert Medical School Providence Rhode Island USA
| | - Ellen Kerns
- University of Nebraska Medical CenterChildren's Hospital Medical Center Omaha Nebraska USA
| | - Brian Alverson
- Hasbro Children's HospitalWarren Alpert Medical School Providence Rhode Island USA
| | - Russell J. McCulloh
- University of Nebraska Medical CenterChildren's Hospital Medical Center Omaha Nebraska USA
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Srinivasan M, Bacharier LB, Goss CW, Zhou Y, Boomer J, Bram S, Burgdorf D, Burnham CA, Casper T, Castro M, Coverstone A, Haslam M, Kanchongkittiphon W, Kuklinski C, Lian Q, Schechtman K, Storch GA, True K, Wallace MA, Yin-DeClue H, Ahrens E, Wang J, Beigelman A. The azithromycin to prevent wheezing following severe RSV bronchiolitis-II clinical trial: Rationale, study design, methods, and characteristics of study population. Contemp Clin Trials Commun 2021; 22:100798. [PMID: 34189338 PMCID: PMC8219746 DOI: 10.1016/j.conctc.2021.100798] [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: 09/06/2020] [Revised: 04/30/2021] [Accepted: 06/03/2021] [Indexed: 02/02/2023] Open
Abstract
Severe respiratory syncytial virus (RSV) bronchiolitis in early life is a significant risk factor for future recurrent wheeze (RW) and asthma. The goal of the Azithromycin to Prevent Wheezing following severe RSV bronchiolitis II (APW-RSV II) clinical trial is to evaluate if azithromycin treatment in infants hospitalized with RSV bronchiolitis reduces the occurrence of RW during the preschool years. The APW-RSV II clinical trial is a double-blind, placebo-controlled, parallel-group, randomized trial, including otherwise healthy participants, ages 30 days-18 months, who are hospitalized due to RSV bronchiolitis. The study includes an active randomized treatment phase with azithromycin or placebo for 2 weeks, and an observational phase of 18-48 months. Two hundred participants were enrolled during three consecutive RSV seasons beginning in the fall of 2016 and were randomized to receive oral azithromycin 10 mg/kg/day for 7 days followed by 5 mg/kg/day for an additional 7 days, or matched placebo. The study hypothesis is that in infants hospitalized with RSV bronchiolitis, the addition of azithromycin therapy to routine bronchiolitis care would reduce the likelihood of developing post-RSV recurrent wheeze (≥3 episodes). The primary clinical outcome is the occurrence of a third episode of wheezing, which is evaluated every other month by phone questionnaires and during yearly in-person visits. A secondary objective of the APW-RSV II clinical trial is to examine how azithromycin therapy changes the upper airway microbiome composition, and to determine if these changes are related to the occurrence of post-RSV RW. Microbiome composition is characterized in nasal wash samples obtained before and after the study treatments. This clinical trial may identify the first effective intervention applied during severe RSV bronchiolitis to reduce the risk of post-RSV RW and ultimately asthma.
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Key Words
- AE, Adverse events
- AESI, AEs of Special Interest
- APW, Azithromycin to Prevent Wheezing
- AZM, Azithromycin
- Asthma
- Azithromycin
- DSMB, Data safety and monitoring board
- ED, Emergency department
- ICS, Inhaled corticosteroids
- IL, Interleukin
- IRB, Institutional review board
- LRTI, Lower respiratory tract infection
- MMP-9, Matrix metallopeptidase-9
- Microbiome
- NHLBI, National Heart, Lung, and Blood Institute
- PC, Phone call
- RBEL, RSV Bronchiolitis in Early Life
- RSV, Respiratory syncytial virus
- RW, Recurrent wheezing
- RZ, Randomization
- Recurrent wheezing
- Respiratory syncytial virus (RSV) bronchiolitis
- SAE, serious adverse events
- SLCH, Saint Louis Children's Hospital
- V, visit
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Affiliation(s)
- Mythili Srinivasan
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Leonard B Bacharier
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Charles W Goss
- Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Yanjiao Zhou
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jonathan Boomer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Sarah Bram
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Dana Burgdorf
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Carey-Ann Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, CAB, USA
| | - Timothy Casper
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Andrea Coverstone
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Matthew Haslam
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Watcharoot Kanchongkittiphon
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Cadence Kuklinski
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Qinghua Lian
- Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Kenneth Schechtman
- Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Gregory A Storch
- Division of Pediatric Infectious Disease, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Kelly True
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Meghan A Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, CAB, USA
| | - Huiqing Yin-DeClue
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Elizabeth Ahrens
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Jinli Wang
- Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Avraham Beigelman
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
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11
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Gestational hypertension and childhood atopy: a Millennium Cohort Study analysis. Eur J Pediatr 2021; 180:2419-2427. [PMID: 33770273 PMCID: PMC8285347 DOI: 10.1007/s00431-021-04012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 11/16/2022]
Abstract
Gestational hypertension may confer risk of atopic disease in offspring through a direct biological mechanism, but another possibility is that risk is mediated through complications of pregnancy. To explore these associations, we conducted an analysis of a nationally representative birth cohort based in the UK involving children born 2000-2002. We included 12,450 mother-child pairs. We used logistic regression to estimate the association between hypertensive disease and asthma, hay fever, or eczema by age 5, and parentally reported early wheeze and severe wheeze. Mediation by gestation at delivery and caesarean delivery was explored using causal mediation analysis. Odds ratios (95% CI) for gestational hypertension and childhood asthma, hay fever, and eczema were 1.32 (1.09, 1.59), 1.22 (0.97, 1.55), and 1.12 (0.96, 1.32) respectively, adjusted for confounding. The population attributable fractions were 2.4% (1.0-3.8%), 0.9% (-0.3% to 2.1%), and 1.8% (0.0-3.7%), respectively. Accounting for mediation by gestational age and caesarean delivery, odds ratios (95% CI) for the potential direct effects of gestational hypertension were 1.21 (0.97, 1.50), 1.17 (0.91, 1.49), and 1.11 (0.94, 1.31) for the same.Conclusion: Gestational hypertension was weakly positively associated with asthma and this was partly mediated by earlier delivery. Only a small proportion of early childhood asthma was attributable to gestational hypertensive disease in this representative UK-based birth cohort. What is known: • Gestational hypertension has been shown to be an inconsistent risk factor for the atopic diseases. • The in utero immune environment may modify the risk of atopy in offspring; alternatively, complications of pregnancy including caesarean delivery and prematurity may explain an association between hypertensive disease and atopy. What is new: • Self-reported gestational hypertension was a weak risk factor for asthma and wheeze in the Millennium Cohort Study. • Part of the association between gestational hypertensive disease and asthma was explained by earlier delivery.
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12
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Sastre B, García-García ML, Cañas JA, Calvo C, Rodrigo-Muñoz JM, Casas I, Mahíllo-Fernández I, Del Pozo V. Bronchiolitis and recurrent wheezing are distinguished by type 2 innate lymphoid cells and immune response. Pediatr Allergy Immunol 2021; 32:51-59. [PMID: 32628310 PMCID: PMC7818223 DOI: 10.1111/pai.13317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recurrent wheezing (RW) is frequently developed in infants that have suffered bronchiolitis (BCH) during first months of life, but the immune mechanism underlying is not clear. The goal was to analyze the innate immune response that characterizes BCH and RW. METHODS Ninety-eight and seventy hospitalized infants with BCH or RW diagnosis, respectively, were included. Nasopharyngeal aspirate (NPA) was processed. Cellular pellet was employed to evaluate type 2 innate lymphoid cells (ILC2) by flow cytometry and mRNA expression assays by semi-quantitative real-time PCR (qRT-PCR). In supernatant, twenty-seven pro-inflammatory and immunomodulatory factors, as well as lipid mediators and nitrites, were evaluated by ELISA and Luminex. RESULTS Bronchiolitis patients showed higher ILC2 percentage compared with RW (P < .05). Also, ST2+ /ILC2 percentage was higher in the BCH group than in the RW group (P < .01). TLR3, IL33, IFNG, IL10, and FLG mRNA levels were significantly increased in BCH vs RW (P < .05). In supernatant, no significant differences were reached, observing similar levels of parameters linked to vascular damage, monocyte activation, and fibroblast growth. Prostaglandin E2 and cysteinyl leukotrienes C4 were evaluated; a significant difference was only found in their ratio. CONCLUSION Bronchiolitis is associated with elevated nasal percentage of ILC2. This cellular population could be the key element in the differential immune response between BCH and RW which share some mechanisms such us monocyte activation, vascular damage, and fibroblast repair. Lipid mediators could play a role in the evolution of the disease later in life through innate lymphoid cells.
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Affiliation(s)
- Beatriz Sastre
- Department of Immunology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - María Luz García-García
- Pediatrics Department, Severo Ochoa Hospital, Leganés, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Alfonso X El Sabio University, Madrid, Spain
| | - José Antonio Cañas
- Department of Immunology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Cristina Calvo
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Alfonso X El Sabio University, Madrid, Spain.,Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Fundación IdiPaz, Madrid, Spain.,TEDDY Network (European Network of Excellence for Pediatric Clinical Research), Madrid, Spain
| | - José Manuel Rodrigo-Muñoz
- Department of Immunology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Inmaculada Casas
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Respiratory Virus and Influenza Unit, National Microbiology Center (ISCIII), Madrid, Spain
| | | | - Victoria Del Pozo
- Department of Immunology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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13
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Bianchini S, Silvestri E, Argentiero A, Fainardi V, Pisi G, Esposito S. Role of Respiratory Syncytial Virus in Pediatric Pneumonia. Microorganisms 2020; 8:microorganisms8122048. [PMID: 33371276 PMCID: PMC7766387 DOI: 10.3390/microorganisms8122048] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
Respiratory viral infections represent the leading cause of hospitalization in infants and young children worldwide and the second leading cause of infant mortality. Among these, Respiratory Syncytial Virus (RSV) represents the main cause of lower respiratory tract infections (LRTIs) in young children worldwide. RSV manifestation can range widely from mild upper respiratory infections to severe respiratory infections, mainly bronchiolitis and pneumonia, leading to hospitalization, serious complications (such as respiratory failure), and relevant sequalae in childhood and adulthood (wheezing, asthma, and hyperreactive airways). There are no specific clinical signs or symptoms that can distinguish RSV infection from other respiratory pathogens. New multiplex platforms offer the possibility to simultaneously identify different pathogens, including RSV, with an accuracy similar to that of single polymerase chain reaction (PCR) in the majority of cases. At present, the treatment of RSV infection relies on supportive therapy, mainly consisting of oxygen and hydration. Palivizumab is the only prophylactic method available for RSV infection. Advances in technology and scientific knowledge have led to the creation of different kinds of vaccines and drugs to treat RSV infection. Despite the good level of these studies, there are currently few registered strategies to prevent or treat RSV due to difficulties related to the unpredictable nature of the disease and to the specific target population.
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Affiliation(s)
- Sonia Bianchini
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (S.B.); (E.S.)
- Pediatric Unit, ASST Santi Carlo e Paolo, 20142 Milan, Italy
| | - Ettore Silvestri
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (S.B.); (E.S.)
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.A.); (V.F.); (G.P.)
| | - Valentina Fainardi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.A.); (V.F.); (G.P.)
| | - Giovanna Pisi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.A.); (V.F.); (G.P.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.A.); (V.F.); (G.P.)
- Correspondence: ; Tel.: +39-0521-704790
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14
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Stokes JR, Bacharier LB. Prevention and treatment of recurrent viral-induced wheezing in the preschool child. Ann Allergy Asthma Immunol 2020; 125:156-162. [PMID: 32454096 DOI: 10.1016/j.anai.2020.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To summarize the recent evidence in the treatment of viral-induced wheezing in the infant and preschool aged child. DATA SOURCES Published literature obtained through PubMed database searches. STUDY SELECTIONS Studies relevant to phenotypes and treatment of wheezing illnesses in infants and preschool children were included. RESULTS Recurrent wheezing in preschool children is common and is frequently triggered by viral respiratory tract infections. Certain phenotypes may respond to treatments differently, depending on the risk factors identified. Inhaled corticosteroids, administered continuously or intermittently, reduce the risk of virus-induced wheezing episodes. The use of leukotriene modifying agents may have a role in wheezing episodes in a select group of preschool children. Early administration of azithromycin reduces the risk of severe lower respiratory tract illnesses in children. The effect of oral corticosteroids on wheezing episodes in young children varies by degree of episode severity. CONCLUSION Recurrent viral-induced wheezing illnesses has been the focus of many clinical trials, which now provide an increasingly robust evidence base for management. Additional research is needed to define optimal strategies, to best match therapies to specific phenotypes and endotypes, and will eventually begin to include therapies directed specifically at the viral triggers.
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Affiliation(s)
- Jeffrey R Stokes
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, St. Louis Children's Hospital, St. Louis, Missouri
| | - Leonard Benjamin Bacharier
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, St. Louis Children's Hospital, St. Louis, Missouri.
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15
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Symptom-based screening tool for asthma syndrome among young children in Uganda. NPJ Prim Care Respir Med 2020; 30:18. [PMID: 32376892 PMCID: PMC7203121 DOI: 10.1038/s41533-020-0175-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 04/09/2020] [Indexed: 11/08/2022] Open
Abstract
Under-diagnosis of asthma in ‘under-fives’ may be alleviated by improved inquiry into disease history. We assessed a questionnaire-based screening tool for asthma among 614 ‘under-fives’ with severe respiratory illness in Uganda. The questionnaire responses were compared to post hoc consensus diagnoses by three pediatricians who were guided by study definitions that were based on medical history, physical examination findings, laboratory and radiological tests, and response to bronchodilators. Children with asthma or bronchiolitis were categorized as “asthma syndrome”. Using this approach, 253 (41.2%) had asthma syndrome. History of and present breathing difficulties and present cough and wheezing was the best performing combination of four questionnaire items [sensitivity 80.8% (95% CI 77.6–84.0); specificity 84.7% (95% CI 81.8–87.6)]. The screening tool for asthma syndrome in ‘under-fives’ may provide a simple, cheap and quick method of identifying children with possible asthma. The validity and reliability of this tool in primary care settings should be tested.
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16
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Ng GYH, Ong C, Wong JJM, Teoh OH, Sultana R, Mok YH, Lee JH. Nutritional status, intake, and outcomes in critically ill children with bronchiolitis. Pediatr Pulmonol 2020; 55:1199-1206. [PMID: 32109353 DOI: 10.1002/ppul.24701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/14/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Optimal nutrition in children with severe bronchiolitis remains poorly described. We aimed to describe nutritional status and practices in children with severe bronchiolitis requiring admission to the pediatric intensive care unit (PICU), and explore their associations with outcomes. METHODS We conducted a retrospective study on patients with bronchiolitis requiring PICU stay from 2009 to 2014. Demographics, medical data, and baseline weight-for-length Z-scores (WLZ) were collected. In patients requiring more than 48 hours of PICU stay, nutritional intake data in the first 3 days of PICU stay were collected. Underfeeding and overfeeding were defined as the median energy intake of less than 80% and more than 120% of requirements, respectively. Protein adequacy was defined as intake of more than 1.5 g/kg/d. Primary and secondary outcomes of interest were the duration of PICU stay and mechanical ventilation (MV), respectively. RESULTS Seventy-four patients were included, with a median PICU stay of 4.9 days (interquartile range 2.0-8.2). Low WLZ at baseline was associated with longer duration of PICU stay (adjusted β: 4.33 [95% confidence interval [CI], 0.49-8.18]; P = .028) and MV days (adjusted β: 4.87 [95% CI, 1.56-8.18]; P = .008) compared to appropriate WLZ. In patients with ≥48 hours PICU stay, protein adequacy was significantly associated with greater PICU (adjusted β coefficient, 6.35 [95% CI, 1.66-11.0]; P = .009) and MV days (adjusted β coefficient, 5.22 [95% CI, 1.06-9.38]; P = .015). CONCLUSION Among bronchiolitis patients admitted to the PICU, low WLZ at admission was associated with a longer duration of PICU stay and MV. Protein adequacy was associated with longer PICU and MV days in children with ≥48 hours of PICU stay.
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Affiliation(s)
- Glenn Y H Ng
- Department of Pediatrics, General Paediatrics Service, KK Women's and Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Chengsi Ong
- Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Judith J M Wong
- Department of Pediatric Subspecialties, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Oon Hoe Teoh
- Department of Pediatrics, Respiratory Medicine Service, KK Women's and Children's Hospital, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Yee Hui Mok
- Department of Pediatric Subspecialties, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Jan Hau Lee
- Department of Pediatric Subspecialties, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
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17
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Lee E, Song DJ, Kim WK, Suh DI, Baek HS, Shin M, Yoo Y, Kim JT, Kwon JW, Jang GC, Lim DH, Yang HJ, Kim HS, Seo JH, Woo SI, Kim HY, Shin YH, Lee JS, Yoon J, Jung S, Han M, Eom E, Yu J. Associated Factors for Asthma Severity in Korean Children: A Korean Childhood Asthma Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:86-98. [PMID: 31743966 PMCID: PMC6875483 DOI: 10.4168/aair.2020.12.1.86] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 12/19/2022]
Abstract
Purpose Childhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity. Methods This study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity. Results Mild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma. Conclusions Modification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hey Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Jin Tack Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Ji Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Korea
| | - Hyeon Jong Yang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hwan Soo Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Ju Hee Seo
- Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Il Woo
- Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Ho Shin
- Department of Pediatrics, Gangnam CHA Medical Center CHA University School of Medicine, Seoul, Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jisun Yoon
- Department of Pediatrics, Mediplex Sejong Hospital, Incheon, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunjin Eom
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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18
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Zhang S, Zhao G, Su C, Li C, Zhou X, Zhao W, Zhong Y, He Z, Peng H, Dong A, Wang B. Neonatal priming and infancy boosting with a novel respiratory syncytial virus vaccine induces protective immune responses without concomitant respiratory disease upon RSV challenge. Hum Vaccin Immunother 2019; 16:664-672. [PMID: 31545125 PMCID: PMC7227690 DOI: 10.1080/21645515.2019.1671134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although respiratory syncytial virus (RSV) infection in infants and young children is a global public health issue, development of a safe RSV vaccine has been impeded by formalin-inactivated RSV-enhanced respiratory disease (ERD). In developing a safer yet effective RSV vaccine for children, a strategy to decrease over-reactive T cells and increase neutralizing anti-RSV antibodies should be considered. We previously demonstrated that adult mice immunized with RSV recombinant G protein plus low-dose Cyclosporine A (G+ CsA) could, upon subsequent RSV challenge, produce increased levels of antigen-specific T regulatory cells in lungs that overcame the ERD. Neutralizing anti-RSV antibodies that prevented viral infection were also elicited. In this study, we investigated if such a G+ CsA vaccine could provide infant mice with the same protection from RSV infection without ERD. The results showed that the G+ CsA vaccine could prevent RSV infection with only a mild loss of body weight. Importantly, there was nearly normal morphology and no mucus appearance in lung tissues after RSV challenge. These results demonstrate that the G+ CsA vaccine strategy achieved similar benefits in the neonatal prime and infancy boost model as in the adult mouse model. The G+ CsA immunization strategy is potentially safe and effective in neonates and infants because it suppresses the devastating ERD.
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Affiliation(s)
- Shuren Zhang
- Key Laboratory of Medical Molecular Virology of MOH and MOE and Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Gan Zhao
- Key Laboratory of Medical Molecular Virology of MOH and MOE and Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Caixia Su
- Key Laboratory of Medical Molecular Virology of MOH and MOE and Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Chaofan Li
- Key Laboratory of Medical Molecular Virology of MOH and MOE and Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Xian Zhou
- Key Laboratory of Medical Molecular Virology of MOH and MOE and Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Weidong Zhao
- Key Laboratory of Medical Molecular Virology of MOH and MOE and Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yiwei Zhong
- Key Laboratory of Medical Molecular Virology of MOH and MOE and Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | | | | | - Aihua Dong
- Advaccine Biotechnology Co. LTD, Beijing, China
| | - Bin Wang
- Key Laboratory of Medical Molecular Virology of MOH and MOE and Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai, China
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19
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Abstract
Antibiotics during infancy, delivery, and breastfeeding affect the intestinal microbiota in early life and is associated with allergic disease. Gastroenteritis (GE) during infancy also affects intestinal microbiota in early life, however, its relationship to allergic disease has not been investigated.Data of 45,499 males and 49,430 females, from birth to 5 years of age, were collected from a national database in Taiwan. Subjects were categorized into early GE (GE within 0-6 months) and non-early GE group (no GE within 0-6 months). The rates of asthma (AS), allergic rhinitis (AR), and atopic dermatitis (AD) over 5 years were evaluated and compared between the groups. In patients with AS, AR, and AD, the number of clinical visits and drug prescriptions for the allergic disease was also evaluated to assess the effect of early GE on allergic disease.After adjusting for the effect of GE in later life and other factors, the rates of AS [OR (odds ratio) 1.54, 95% confidence interval (CI) 1.48-1.60], AR [OR 1.49, 95% CI 1.45-1.54], and AD [OR 1.40, 95% CI 1.33-1.47] were higher in the early GE group than in the non-early GE group. The magnitude of the increase was higher in females than in males. In those with AS, AR, and AD, the number of clinical visits and drug prescriptions was not different between the early GE and non-early GE groups. In children with early GE, good control of GE in the following years lowered the rate of allergic disease.Early-life GE was associated with increased rates of AS, AR, and AD in later life and this was trend more prominent in females.
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Affiliation(s)
- Hui-Hsien Pan
- School of Medicine, Chung Shan Medical University
- Division of Allergy, Asthma and Rheumatology, Department of pediatrics, Chung Shan Medical University Hospital
| | - Ko-Huang Lue
- School of Medicine, Chung Shan Medical University
- University President, Chung Shan Medical University, Taichung, Taiwan
| | - Hai-Lun Sun
- School of Medicine, Chung Shan Medical University
- Division of Allergy, Asthma and Rheumatology, Department of pediatrics, Chung Shan Medical University Hospital
| | - Min-Sho Ku
- School of Medicine, Chung Shan Medical University
- Division of Allergy, Asthma and Rheumatology, Department of pediatrics, Chung Shan Medical University Hospital
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20
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Haahtela T. A biodiversity hypothesis. Allergy 2019; 74:1445-1456. [PMID: 30835837 DOI: 10.1111/all.13763] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 02/06/2023]
Abstract
Biodiversity hypothesis states that contact with natural environments enriches the human microbiome, promotes immune balance and protects from allergy and inflammatory disorders. We are protected by two nested layers of biodiversity, microbiota of the outer layer (soil, natural waters, plants, animals) and inner layer (gut, skin, airways). The latter inhabits our body and is colonized from the outer layer. Explosion of human populations along with cultural evolution is profoundly changing our environment and lifestyle. Adaptive immunoregulatory circuits and dynamic homeostasis are at stake in the newly emerged urban surroundings. In allergy, and chronic inflammatory disorders in general, exploring the determinants of immunotolerance is the key for prevention and more effective treatment. Loss of immunoprotective factors, derived from nature, is a new kind of health risk poorly acknowledged until recently. The paradigm change has been implemented in the Finnish allergy programme (2008-2018), which emphasized tolerance instead of avoidance. The first results are promising, as allergy burden has started to reduce. The rapidly urbanizing world is facing serious biodiversity loss with global warming, which are interconnected. Biodiversity hypothesis of health and disease has societal impact, for example, on city planning, food and energy production and nature conservation. It has also a message for individuals for health and well-being: take nature close, to touch, eat, breathe, experience and enjoy. Biodiverse natural environments are dependent on planetary health, which should be a priority also among health professionals.
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Affiliation(s)
- Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
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21
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Kim MJ, Shim DH, Cha H, Moon K, Yang CM, Hwang SJ, Kim KW, Park JH, Lee C, Elias JA, Sohn MH, Lee JM. Chitinase 3-like 1 protein plays a critical role in respiratory syncytial virus-induced airway inflammation. Allergy 2019; 74:685-697. [PMID: 30402955 PMCID: PMC7159489 DOI: 10.1111/all.13661] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 09/09/2018] [Accepted: 09/19/2018] [Indexed: 12/28/2022]
Abstract
Background Chitinase 3‐like 1 protein (CHI3L1) (YKL‐40 in humans and breast regression protein [BRP]‐39 in mice) is required for optimal allergen sensitization and Th2 inflammation in various chronic inflammatory diseases including asthma. However, the role of CHI3L1 in airway inflammation induced by respiratory viruses has not been investigated. The aim of this study was to investigate the relationship between CHI3L1 and airway inflammation caused by respiratory syncytial virus (RSV) infection. Methods We measured YKL‐40 levels in human nasopharyngeal aspirate (NPA) from hospitalized children presenting with acute respiratory symptoms. Wild‐type (WT) and BRP‐39 knockout (KO) C57BL/6 mice were inoculated with live RSV (A2 strain). Bronchoalveolar lavage fluid and lung tissue samples were obtained on day 7 after inoculation to assess lung inflammation, airway reactivity, and expression of cytokines and BRP‐39. Results In human subjects, YKL‐40 and IL‐13 levels in NPA were higher in children with RSV infection than in control subjects. Expression of BRP‐39 and Th2 cytokines, IL‐13 in particular, was increased following RSV infection in mice. Airway inflammation caused by RSV infection was reduced in BRP‐39 KO mice as compared to WT mice. Th2 cytokine levels were not increased in the lungs of RSV‐infected BRP‐39 KO mice. BRP‐39 regulated M2 macrophage activation in RSV‐infected mice. Additionally, treatment with anti‐CHI3L1 antibody attenuated airway inflammation and Th2 cytokine production in RSV‐infected WT mice. Conclusion These findings suggest that CHI3L1 could contribute to airway inflammation induced by RSV infection. CHI3L1 could be a potential therapeutic candidate for attenuating Th2‐associated immunopathology during RSV infection.
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Affiliation(s)
- Min Jung Kim
- Department of Microbiology and Immunology Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
- Department of Pediatrics Severance Hospital Institute of Allergy Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Doo Hee Shim
- Department of Microbiology and Immunology Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Hye‐Ran Cha
- Department of Microbiology and Immunology Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Kuk‐Young Moon
- Department of Microbiology and Immunology Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Chang Mo Yang
- Department of Microbiology and Immunology Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Su Jin Hwang
- Department of Microbiology and Immunology Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Kyung Won Kim
- Department of Pediatrics Severance Hospital Institute of Allergy Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Jeon Han Park
- Department of Microbiology and Immunology Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Chun Geun Lee
- Department of Molecular Microbiology and Immunology Brown University Providence Rhode Island USA
| | - Jack A. Elias
- Department of Molecular Microbiology and Immunology Brown University Providence Rhode Island USA
| | - Myung Hyun Sohn
- Department of Pediatrics Severance Hospital Institute of Allergy Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
| | - Jae Myun Lee
- Department of Microbiology and Immunology Brain Korea 21 PLUS Project for Medical Science Yonsei University College of Medicine Seoul Korea
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22
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Grunwell JR, Travers C, Fitzpatrick AM. Inflammatory and Comorbid Features of Children Admitted to a PICU for Status Asthmaticus. Pediatr Crit Care Med 2018; 19:e585-e594. [PMID: 30106766 PMCID: PMC6218278 DOI: 10.1097/pcc.0000000000001695] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine risk factors associated with admission to a PICU with or without endotracheal intubation for an asthma exacerbation. We hypothesized that children with critical and near-fatal asthma would have distinguishing clinical features but varying degrees of asthma severity and measures of type 2 inflammation. DESIGN Retrospective analysis of prospectively collected data of children with asthma recruited into outpatient asthma clinical research studies at Emory University between 2004 and 2015. SETTING Large, free-standing academic quaternary care children's hospital in Atlanta, GA. PATIENTS Children 6-18 years old with physician-diagnosed and confirmed asthma. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 579 children were analyzed with 170 children (29.4%) being admitted to the PICU for an asthma exacerbation in their lifetime. Of these 170 children with a history of critical asthma, 24.1% were classified as having mild-to-moderate asthma, and 83 of 170 children (48.8%) had been intubated and experienced near-fatal asthma. Multiple logistic regression was used to identify risk factors associated with increased odds of PICU admission with or without endotracheal intubation. Hospitalization within the prior 12 months of survey (odds ratio, 8.19; 95% CI, 4.83-13.89), a history of pneumonia (odds ratio, 2.56; 95% CI, 1.52-4.29), having a designation of increased chronic asthma severity on high-dose inhaled corticosteroids (odds ratio, 2.76; 95% CI, 1.62-4.70), having a father with asthma (odds ratio, 2.15; 95% CI, 1.23-3.76), living in a region with a higher burden of poverty (odds ratio, 1.28; 95% CI, 1.02-1.61), and being of black race (odds ratio, 2.01; 95% CI, 1.05-3.84) were all associated with increased odds of PICU admission with or without intubation. CONCLUSIONS Our findings suggest that there are factors associated with critical and near-fatal asthma, distinct from the chronic asthma severity designations, that should be the focus of future investigation.
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Affiliation(s)
- Jocelyn R Grunwell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA
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23
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Turi KN, Romick-Rosendale L, Gebretsadik T, Watanabe M, Brunwasser S, Anderson LJ, Moore ML, Larkin EK, Peebles RS, Hartert TV. Using urine metabolomics to understand the pathogenesis of infant respiratory syncytial virus (RSV) infection and its role in childhood wheezing. Metabolomics 2018; 14:135. [PMID: 30830453 PMCID: PMC6557166 DOI: 10.1007/s11306-018-1431-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection in infants causes significant morbidity and is the strongest risk factor associated with asthma. Metabolites, which reflect the interactions between host cell and virus, provide an opportunity to identify the pathways that underlie severe infections and asthma development. OBJECTIVE To study metabolic profile differences between infants with RSV infection, and human rhinovirus (HRV) infection, and healthy infants. To compare infant metabolic differences between children who do and do not wheeze. METHODS In a term birth cohort, urine was collected while healthy and during acute viral respiratory infection with RSV and HRV. We used 1H-NMR to identify urinary metabolites. Multivariate and univariate statistics were used to discriminate metabolic profiles of infants with either RSV ARI, or HRV ARI, and healthy infants. Multivariable logistic regression was used to assess the association of urine metabolites with 1st-, 2nd-, and 3rd-year recurrent wheezing. RESULTS Several metabolites in nicotinate and nicotinamide metabolism pathways were down-regulated in infants with RSV infection compared to healthy controls. There were no significant differences in metabolite profiles between infants with RSV infection and infants with HRV Infection. Alanine was strongly associated with reduced risk of 1st-year wheezing (OR 0.18[0.0, 0.46]) and 2nd-year wheezing (OR 0.31[0.13, 0.73]), while 2-hydroxyisobutyric acid was associated with increased 3rd-year wheezing (OR 5.02[1.49, 16.93]) only among the RSV infected subset. CONCLUSION The metabolites associated with infant RSV infection and recurrent-wheezing are indicative of viral takeover of the cellular machinery and resources to enhance virulence, replication, and subversion of the host immune-response, highlighting metabolic pathways important in the pathogenesis of RSV infection and wheeze development.
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Affiliation(s)
- Kedir N Turi
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, USA
| | - Lindsey Romick-Rosendale
- Department of Pathology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Miki Watanabe
- Department of Pathology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Steven Brunwasser
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, USA
| | | | - Martin L Moore
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Emma K Larkin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, USA
| | - Ray Stokes Peebles
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, USA
| | - Tina V Hartert
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, USA.
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24
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Caballero MT, Hijano DR, Acosta PL, Mateu CG, Marcone DN, Linder JE, Talarico LB, Elder JM, Echavarria M, Miller EK, Polack FP. Interleukin-13 associates with life-threatening rhinovirus infections in infants and young children. Pediatr Pulmonol 2018; 53:787-795. [PMID: 29665312 DOI: 10.1002/ppul.23998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 03/03/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Delineate risk factors associated with severe hypoxemia (O2 sat ≤87%) in infants and children younger than 2 years hospitalized with single pathogen HRV infection. STUDY DESIGN Prospective study in a yearly catchment population of 56 560 children <2 years old between 2011 and 2013 in Argentina. All children with respiratory signs and O2 sat <93% on admission were included. HRV infections were identified by reverse transcriptase-polymerase chain reaction. Epidemiologic, clinical, viral, and immunological risk factors were assessed. RESULTS Among 5012 hospitalized patients, HRV was detected as a single pathogen in 347 (6.92%) subjects. Thirty-two (9.2%) had life-threatening disease. Traditional risk factors for severe bronchiolitis did not affect severity of illness. HRV viral load, HRV groups, and type II and III interferons did not associate with severe hypoxemia. Interleukin-13 Levels in respiratory secretions at the time of admission (OR = 7.43 (3-18.4); P < 0.001 for IL-13 >10 pg/mL) predisposed to life-threatening disease. CONCLUSIONS Targeted interventions against IL-13 should be evaluated to decrease severity of HRV illness in infancy and early childhood.
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Affiliation(s)
| | - Diego R Hijano
- Fundación INFANT, Ciudad de Buenos Aires, Argentina.,St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Patricio L Acosta
- Fundación INFANT, Ciudad de Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad de Buenos Aires, Argentina
| | | | - Débora N Marcone
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad de Buenos Aires, Argentina.,Virology Unit and Clinical Virology Laboratory, Centro de Educación Médica e Investigaciones Clínicas "CEMIC", Ciudad de Buenos Aires, Argentina
| | | | - Laura B Talarico
- Fundación INFANT, Ciudad de Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad de Buenos Aires, Argentina
| | | | - Marcela Echavarria
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad de Buenos Aires, Argentina.,Virology Unit and Clinical Virology Laboratory, Centro de Educación Médica e Investigaciones Clínicas "CEMIC", Ciudad de Buenos Aires, Argentina
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25
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Turi KN, Romick-Rosendale L, Ryckman KK, Hartert TV. A review of metabolomics approaches and their application in identifying causal pathways of childhood asthma. J Allergy Clin Immunol 2018; 141:1191-1201. [PMID: 28479327 PMCID: PMC5671382 DOI: 10.1016/j.jaci.2017.04.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/08/2017] [Accepted: 04/13/2017] [Indexed: 12/20/2022]
Abstract
Because asthma is a disease that results from host-environment interactions, an approach that allows assessment of the effect of the environment on the host is needed to understand the disease. Metabolomics has appealing potential as an application to study pathways to childhood asthma development. The objective of this review is to provide an overview of metabolomics methods and their application to understanding host-environment pathways in asthma development. We reviewed recent literature on advances in metabolomics and their application to study pathways to childhood asthma development. We highlight the (1) potential of metabolomics in understanding the pathogenesis of disease and the discovery of biomarkers; (2) choice of metabolomics techniques, biospecimen handling, and data analysis; (3) application to studying the role of the environment on asthma development; (4) review of metabolomics applied to the outcome of asthma; (5) recommendations for application of metabolomics-based -omics data integration in understanding disease pathogenesis; and (6) limitations. In conclusion, metabolomics allows use of biospecimens to identify useful biomarkers and pathways involved in disease development and subsequently to inform a greater understanding of disease pathogenesis and endotypes and prediction of the clinical course of childhood asthma phenotypes.
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Affiliation(s)
- Kedir N Turi
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Lindsey Romick-Rosendale
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, College of Public Health and Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Tina V Hartert
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
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26
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Backman K, Ollikainen H, Piippo-Savolainen E, Nuolivirta K, Korppi M. Asthma and lung function in adulthood after a viral wheezing episode in early childhood. Clin Exp Allergy 2017; 48:138-146. [PMID: 29143374 DOI: 10.1111/cea.13062] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Viral aetiology of infection has a significant role in the long-term outcome of early-childhood wheezing. OBJECTIVE This study examines asthma and lung function in adulthood after early-childhood wheezing induced by respiratory syncytial virus (RSV) and rhinovirus (RV). METHODS A total of 100 children were hospitalized for a wheezing episode at less than 24 months of age from 1992 to 1993 in Kuopio University Hospital (Finland). Adenovirus, influenza A and B virus, parainfluenza (1-3) virus, and RSV were tested on admission using antigen detection and antibody assays, and RSV and RV were tested by polymerase chain reaction (PCR). In 2010, 49 cases and 60 population controls attended a follow-up study, which included spirometry with bronchodilation test and fractionally exhaled nitric oxide (FENO ) measurements. RESULTS Current asthma was present in 64% of the cases with RV-induced wheezing (OR 17.0 [95%CI 3.9-75.3] vs controls), in 43% of the cases with RSV-induced wheezing episode (6.1 [1.5-24.9] vs controls), and in 12% of the controls. The RV group showed significantly higher mean FENO values than the RSV group and controls. RV-positive cases had lower MEF50 before bronchodilation and higher MEF50, FEV1, and FEV1/FVC bronchodilation responses than controls. RSV-positive cases had lower FVC than controls before bronchodilation. CONCLUSION Cases with RV- and RSV-induced early-childhood wheezing had increased risk for asthma in adulthood, and RV-positive cases had significantly higher FENO values than RSV-positive cases and controls. Compared to controls, RV-positive cases showed more bronchial reactivity, and RSV-positive cases showed lower FVC before bronchodilation in lung function testing. CLINICAL RELEVANCE Children with RV- or RSV-induced wheezing in early childhood have an increased risk for asthma and lung function abnormalities in adulthood.
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Affiliation(s)
- K Backman
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - H Ollikainen
- Child Welfare Clinic and School Health Care, Health Care Center, Pediatrics, Kuopio, Finland
| | | | - K Nuolivirta
- Department of Pediatrics, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - M Korppi
- Pediatric Research Centre, Tampere University and Tampere University Hospital, Tampere, Finland
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27
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Early-life respiratory infections and asthma development: role in disease pathogenesis and potential targets for disease prevention. Curr Opin Allergy Clin Immunol 2016; 16:172-8. [PMID: 26854761 DOI: 10.1097/aci.0000000000000244] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW This article presents recent findings and perspectives on the relationship between early-life respiratory infections and asthma inception, and discusses emerging concepts on strategies that target these infectious agents for asthma prevention. RECENT FINDINGS Cumulative evidence supports the role of early-life viral infections, especially respiratory syncytial virus and human rhinovirus, as major antecedents of childhood asthma. These viruses may have different mechanistic roles in the pathogenesis of asthma. The airway microbiome and virus-bacteria interactions in early life have emerged as additional determinants of childhood asthma. Innovative strategies for the prevention of these early-life infections, or for attenuation of acute infection severity, are being investigated and may identify effective strategies for the primary and secondary prevention of childhood asthma. SUMMARY Early-life infections are major determinants of asthma development. The pathway from early-life infections to asthma is the result of complex interactions between the specific type of the virus, genetic, and environmental factors. Novel intervention strategies that target these infectious agents have been investigated in proof-of-concepts trials, and further study is necessary to determine their capacity for asthma prevention.
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28
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Ozdemir A, Dogruel D, Yilmaz O. Vitamin D Status in Infants with Two Different Wheezing Phenotypes. Indian J Pediatr 2016; 83:1386-1391. [PMID: 27345567 DOI: 10.1007/s12098-016-2184-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate vitamin D levels in patients with recurrent wheeze at early ages of childhood. METHODS In the present cross-sectional study, serum 25-hydroxy vitamin D [25 (OH)D], levels which is known as an indicator of vitamin D adequacy, was examined in infants with three or more wheezing attacks. RESULTS A total of 186 infants with recurrent wheezing were included in the study along with 118 healthy control peers. The recurrent wheezing study participants were classified into two groups according to Asthma Predictive Index (API) positivity and compared to control subjects regarding their serum vitamin D status. The API negative group had the lowest mean serum 25 (OH)D level (n = 121; 22.71 ± 10.76 ng/ml) followed by API positive group (n = 65; 24.08 ± 9.02 ng/ml) compared to healthy group (26.24 ± 11.88 ng/ml) (p < 0.05). In addition, higher vitamin D deficiency was observed in infants in API negative group (52.1 %; p < 0.01) and API positive group (38.5 %; p < 0.05) than control group (31.4 %). CONCLUSIONS Low levels of 25 (OH)D were detected in infants with two different phenotypes of recurrent wheeze. Vitamin D deficiency may play a role in the pathogenesis of infants with recurrent wheezing.
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Affiliation(s)
- Ali Ozdemir
- Pediatric Pulmonary Section, Department of Pediatrics, Mersin Children's Hospital, Halkkent, 33240, Mersin, Turkey.
| | - Dilek Dogruel
- Pediatric Allergy & Immunology Section, Department of Pediatrics, University of Baskent, Adana, Turkey
| | - Ozlem Yilmaz
- Pediatric Allergy & Immunology Section, Department of Pediatrics, Mersin Children's Hospital, Halkkent, Mersin, Turkey
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29
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Zhou Y, Bacharier LB, Isaacson-Schmid M, Baty J, Schechtman KB, Sajol G, Wylie K, Storch GA, Castro M, Beigelman A. Azithromycin therapy during respiratory syncytial virus bronchiolitis: Upper airway microbiome alterations and subsequent recurrent wheeze. J Allergy Clin Immunol 2016; 138:1215-1219.e5. [PMID: 27339392 PMCID: PMC5056860 DOI: 10.1016/j.jaci.2016.03.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 03/14/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Yanjiao Zhou
- The Jackson Laboratory for Genomic Medicine, Farmington, Conn
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Megan Isaacson-Schmid
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Jack Baty
- Division of Biostatistics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Geneline Sajol
- Department of Internal Medicine, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Kristine Wylie
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Gregory A Storch
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Mario Castro
- Department of Internal Medicine, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Avraham Beigelman
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo.
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30
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Sheen YH, Lee E, Kang MJ, Yu HS, Ahn K, Kim KW, Yang SI, Jung YH, Lee KJ, Chang HY, Shin HL, Choi KY, Kim HY, Seo JH, Kwon JW, Kim BJ, Kim HB, Lee SY, Suh DI, Yang HJ, Choi SJ, Oh SY, Kwon JY, Kim SH, Won HS, Kim EJ, Lee JK, Hong SJ. Interaction between 25-hydroxyvitamin D and variants at 17q12-21 on respiratory infections. Pediatr Pulmonol 2016; 51:958-67. [PMID: 27111254 DOI: 10.1002/ppul.23421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES 25-hydroxyvitamin D (25[OH]D) deficiency and genetic variants at the 17q12-21 locus are independent risk factors for respiratory tract infections (RTIs). We aimed to investigate whether the effect of 25(OH)D at birth and 1 year of age and the polymorphism at the 17q12-21 locus, or interactions between these two factors, increase susceptibility to RTIs in the first year of life. METHODS We tested cord-blood (CB) 25(OH)D at birth and 1 year of age and genotypes of a variant at the 17q12-21 locus for associations with RTIs, particularly lower respiratory tract infections (LRTIs), and determined whether there exist interactions between 25(OH)D and 17q12-21 genotypes in a birth cohort of 473 infants. RESULTS The levels of CB 25(OH)D inversely associate with development of RTIs and LRTIs during the first year of life. There exists an inverse association of 25(OH)D at birth, but not at 1 year, with the risk of acquiring LRTIs in early infancy (adjusted odds ratio [aOR], 2.37; 95% confidence interval [CI]: 1.23-4.60; P = 0.010 and aOR, 0.50; 95%CI: 0.23-1.12; P = 0.094). We have also found a significant interaction between CB 25(OH)D and a variant at the 17q12-21 locus with respect to the development of early LRTIs, such that associations between a variant at the 17q12-21 locus and LRTIs are restricted to infants with low CB 25(OH)D concentrations (P for interaction = 0.013). In addition, when infants with a variant at the 17q12-21 locus had been exposed to chronic 25(OH)D deficiency over the first year, their risk of LRTIs was increased. CONCLUSION CB 25(OH)D deficiency during fetal life contribute to the development of LRTIs in genetically susceptible infants. Pediatr Pulmonol. 2016; 51:958-967. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Mi-Jin Kang
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Sung Yu
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Young-Ho Jung
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Kyung-Ju Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyoung Yoon Chang
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Hye Lim Shin
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Kil Yong Choi
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Korea Cancer Center, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byoung-Ju Kim
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Hyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Jin Kim
- Division of Allergy and Chronic Respiratory Diseases, Center for Biomedical Science, Korea National Institute of Health, Cheongju, Korea
| | - Jeom Kyu Lee
- Division of Allergy and Chronic Respiratory Diseases, Center for Biomedical Science, Korea National Institute of Health, Cheongju, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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31
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Abstract
Human rhinovirus (HRV) and coronavirus (HCoV) infections are associated with both upper respiratory tract illness (“the common cold”) and lower respiratory tract illness (pneumonia). New species of HRVs and HCoVs have been diagnosed in the past decade. More sensitive diagnostic tests such as reverse transcription-polymerase chain reaction have expanded our understanding of the role these viruses play in both immunocompetent and immunosuppressed hosts. Recent identification of severe acute respiratory syndrome and Middle East respiratory syndrome viruses causing serious respiratory illnesses has led to renewed efforts for vaccine development. The role these viruses play in patients with chronic lung disease such as asthma makes the search for antiviral agents of increased importance.
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Affiliation(s)
- Stephen B Greenberg
- Department of Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, Texas
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32
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Garcia-Garcia ML, Calvo Rey C, Del Rosal Rabes T. Pediatric Asthma and Viral Infection. Arch Bronconeumol 2016; 52:269-73. [PMID: 26766408 PMCID: PMC7105201 DOI: 10.1016/j.arbres.2015.11.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 12/15/2022]
Abstract
Respiratory viral infections, particularly respiratory syncytial virus (RSV) and rhinovirus, are the most importance risk factors for the onset of wheezing in infants and small children. Bronchiolitis is the most common acute respiratory infection in children under 1year of age, and the most common cause of hospitalization in this age group. RSV accounts for approximately 70% of all these cases, followed by rhinovirus, adenovirus, metapneumovirus and bocavirus. The association between bronchiolitis caused by RSV and the development of recurrent wheezing and/or asthma was first described more than 40years ago, but it is still unclear whether bronchiolitis causes chronic respiratory symptoms, or if it is a marker for children with a genetic predisposition for developing asthma in the medium or long term. In any case, sufficient evidence is available to corroborate the existence of this association, which is particularly strong when the causative agent of bronchiolitis is rhinovirus. The pathogenic role of respiratory viruses as triggers for exacerbations in asthmatic patients has not been fully characterized. However, it is clear that respiratory viruses, and in particular rhinovirus, are the most common causes of exacerbation in children, and some type of respiratory virus has been identified in over 90% of children hospitalized for an episode of wheezing. Changes in the immune response to viral infections in genetically predisposed individuals are very likely to be the main factors involved in the association between viral infection and asthma.
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Affiliation(s)
- M Luz Garcia-Garcia
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - Cristina Calvo Rey
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
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33
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Luz Garcia-Garcia M, Calvo Rey C, del Rosal Rabes T. Pediatric Asthma and Viral Infection. ARCHIVOS DE BRONCONEUMOLOGÍA (ENGLISH EDITION) 2016. [PMID: 26766408 PMCID: PMC7105201 DOI: 10.1016/j.arbr.2016.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Respiratory viral infections, particularly respiratory syncytial virus (RSV) and rhinovirus, are the most importance risk factors for the onset of wheezing in infants and small children. Bronchiolitis is the most common acute respiratory infection in children under 1 year of age, and the most common cause of hospitalization in this age group. RSV accounts for approximately 70% of all these cases, followed by rhinovirus, adenovirus, metapneumovirus and bocavirus. The association between bronchiolitis caused by RSV and the development of recurrent wheezing and/or asthma was first described more than 40 years ago, but it is still unclear whether bronchiolitis causes chronic respiratory symptoms, or if it is a marker for children with a genetic predisposition for developing asthma in the medium or long term. In any case, sufficient evidence is available to corroborate the existence of this association, which is particularly strong when the causative agent of bronchiolitis is rhinovirus. The pathogenic role of respiratory viruses as triggers for exacerbations in asthmatic patients has not been fully characterized. However, it is clear that respiratory viruses, and in particular rhinovirus, are the most common causes of exacerbation in children, and some type of respiratory virus has been identified in over 90% of children hospitalized for an episode of wheezing. Changes in the immune response to viral infections in genetically predisposed individuals are very likely to be the main factors involved in the association between viral infection and asthma.
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34
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Luo G, Nkoy FL, Stone BL, Schmick D, Johnson MD. A systematic review of predictive models for asthma development in children. BMC Med Inform Decis Mak 2015; 15:99. [PMID: 26615519 PMCID: PMC4662818 DOI: 10.1186/s12911-015-0224-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 11/26/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Asthma is the most common pediatric chronic disease affecting 9.6 % of American children. Delay in asthma diagnosis is prevalent, resulting in suboptimal asthma management. To help avoid delay in asthma diagnosis and advance asthma prevention research, researchers have proposed various models to predict asthma development in children. This paper reviews these models. METHODS A systematic review was conducted through searching in PubMed, EMBASE, CINAHL, Scopus, the Cochrane Library, the ACM Digital Library, IEEE Xplore, and OpenGrey up to June 3, 2015. The literature on predictive models for asthma development in children was retrieved, with search results limited to human subjects and children (birth to 18 years). Two independent reviewers screened the literature, performed data extraction, and assessed article quality. RESULTS The literature search returned 13,101 references in total. After manual review, 32 of these references were determined to be relevant and are discussed in the paper. We identify several limitations of existing predictive models for asthma development in children, and provide preliminary thoughts on how to address these limitations. CONCLUSIONS Existing predictive models for asthma development in children have inadequate accuracy. Efforts to improve these models' performance are needed, but are limited by a lack of a gold standard for asthma development in children.
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Affiliation(s)
- Gang Luo
- Department of Biomedical Informatics, University of Utah, Suite 140, 421 Wakara Way, Salt Lake City, UT 84108 USA
| | - Flory L. Nkoy
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Bryan L. Stone
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Darell Schmick
- Spencer S. Eccles Health Sciences Library, 10 N 1900 E, Salt Lake City, UT 84112 USA
| | - Michael D. Johnson
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
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35
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Clinical Endpoints for Respiratory Syncytial Virus Prophylaxis Trials in Infants and Children in High-income and Middle-income Countries. Pediatr Infect Dis J 2015; 34:1086-92. [PMID: 26121204 DOI: 10.1097/inf.0000000000000813] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Respiratory syncytial virus (RSV) continues to cause significant clinical and economic burden around the world. Historically, RSV-associated hospitalization was used as a primary endpoint for RSV prophylaxis trials in infants. However, because of the changing epidemiology and healthcare system landscape, this endpoint has become a critical bottleneck on the pathway to licensure for new therapeutics. A panel of 7 RSV experts was convened (Chicago, IL, May 22, 2014) to evaluate the challenges of defining RSV prevention endpoints for clinical trials and to develop endpoints that are clinically meaningful while minimizing subjectivity and bias to achieve sufficient consistency of response for regulatory approval. Particular consideration was given to the ability to collect data systematically and consistently in countries with different healthcare practices and systems, while capturing the greatest proportion of disease impact. The group consensus was that a clinically meaningful primary endpoint could include medically attended RSV illness in settings beyond RSV-associated hospitalizations alone, in particular, a composite reduction in hospitalization, emergency room or urgent care center visits because of an RSV respiratory infection. Relevant secondary endpoints included reductions in RSV lower respiratory tract infection, RSV-related intensive care unit rates, subsequent recurrent wheezing or asthma and direct and indirect costs.
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36
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Henriksen RE, Thuen F. Marital Quality and Stress in Pregnancy Predict the Risk of Infectious Disease in the Offspring: The Norwegian Mother and Child Cohort Study. PLoS One 2015; 10:e0137304. [PMID: 26422017 PMCID: PMC4589358 DOI: 10.1371/journal.pone.0137304] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/16/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore the degree to which couples' relationship dissatisfaction and stressful life events during pregnancy predict the risk of infectious disease in the offspring during their first year of life. METHODS Data were obtained from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health. Pregnant women completed questionnaires in week 30 of pregnancy concerning the couples' relationship satisfaction and stressful life events. In follow-up questionnaires, the women reported whether their children (n = 74,801) had been subject to various categories of infectious disease: the common cold, throat infection, bronchitis, RS virus, pneumonia, pseudocroup, gastric flu, ear infection, conjunctivitis and urinary tract infection. Reports from two age groups of infants were used. Associations between the predictor and outcome variables were assessed via logistic regression and linear regression analyses. RESULTS Separate logistic regression analyses for each disease and age group showed that prenatal relationship dissatisfaction and stressful life events were significantly associated with all reported categories of infectious disease. After controlling for socioeconomic factors, social support, smoking, breastfeeding, maternal depression, the sex of the offspring, and use of child care, 29 out of 32 tested associations were statistically significant. Finally, multivariate linear regression analyses showed that prenatal relationship dissatisfaction and stressful life events were significantly associated with the frequency, as well as the variety, of infectious disease in the offspring.
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Affiliation(s)
| | - Frode Thuen
- Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
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37
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Lower respiratory tract infection caused by respiratory syncytial virus: current management and new therapeutics. THE LANCET RESPIRATORY MEDICINE 2015; 3:888-900. [PMID: 26411809 DOI: 10.1016/s2213-2600(15)00255-6] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 01/20/2023]
Abstract
Respiratory syncytial virus (RSV) is a major worldwide cause of morbidity and mortality in children under five years of age. Evidence-based management guidelines suggest that there is no effective treatment for RSV lower respiratory tract infection (LRTI) and that supportive care, ie, hydration and oxygenation, remains the cornerstone of clinical management. However, RSV treatments in development in the past decade include 10 vaccines and 11 therapeutic agents in active clinical trials. Maternal vaccination is particularly relevant because the most severe disease occurs within the first 6 months of life, when children are unlikely to benefit from active immunisation. We must optimise the implementation of novel RSV therapeutics by understanding the target populations, showing safety, and striving for acceptable pricing in the context of this worldwide health problem. In this Review, we outline the limitations of RSV LRTI management, the drugs in development, and the remaining challenges related to study design, regulatory approval, and implementation.
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38
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Beigelman A, Bacharier LB, Baty J, Buller R, Mason S, Schechtman KB, Sajol G, Isaacson-Schmid M, Castro M, Storch GA. Does azithromycin modify viral load during severe respiratory syncytial virus bronchiolitis? J Allergy Clin Immunol 2015. [PMID: 26215052 DOI: 10.1016/j.jaci.2015.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Avraham Beigelman
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo.
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Jack Baty
- Division of Biostatistics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Richard Buller
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Sheila Mason
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Geneline Sajol
- Department of Internal Medicine, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Megan Isaacson-Schmid
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Mario Castro
- Department of Internal Medicine, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Gregory A Storch
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
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39
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Aho VTE, Pereira PAB, Haahtela T, Pawankar R, Auvinen P, Koskinen K. The microbiome of the human lower airways: a next generation sequencing perspective. World Allergy Organ J 2015; 8:23. [PMID: 26140078 PMCID: PMC4468963 DOI: 10.1186/s40413-015-0074-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 06/01/2015] [Indexed: 12/22/2022] Open
Abstract
For a long time, the human lower airways were considered a sterile environment where the presence of microorganisms, typically revealed by culturing, was interpreted as an abnormal health state. More recently, high-throughput sequencing-based studies have led to a shift in this perception towards the notion that even in healthy conditions the lower airways show either transient presence or even permanent colonization by microorganisms. However, challenges related to low biomass and contamination in samples still remain, and the composition, structure and dynamics of such putative microbial communities are unclear. Here, we review the evidence for the presence of microbial communities in the human lower airways, in healthy subjects and within the context of medical conditions of interest. We also provide an overview of the methodology pertinent to high-throughput sequencing studies, specifically those based on amplicon sequencing, including a discussion of good practices and common pitfalls.
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Affiliation(s)
- Velma T. E. Aho
- DNA Sequencing and Genomics Laboratory, Institute of Biotechnology, University of Helsinki, P.O. Box 56 (Viikinkaari 4), 00014 Helsinki, Finland
| | - Pedro A. B. Pereira
- DNA Sequencing and Genomics Laboratory, Institute of Biotechnology, University of Helsinki, P.O. Box 56 (Viikinkaari 4), 00014 Helsinki, Finland
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Petri Auvinen
- DNA Sequencing and Genomics Laboratory, Institute of Biotechnology, University of Helsinki, P.O. Box 56 (Viikinkaari 4), 00014 Helsinki, Finland
| | - Kaisa Koskinen
- DNA Sequencing and Genomics Laboratory, Institute of Biotechnology, University of Helsinki, P.O. Box 56 (Viikinkaari 4), 00014 Helsinki, Finland
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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40
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Simões EAF, DeVincenzo JP, Boeckh M, Bont L, Crowe JE, Griffiths P, Hayden FG, Hodinka RL, Smyth RL, Spencer K, Thirstrup S, Walsh EE, Whitley RJ. Challenges and opportunities in developing respiratory syncytial virus therapeutics. J Infect Dis 2015; 211 Suppl 1:S1-S20. [PMID: 25713060 PMCID: PMC4345819 DOI: 10.1093/infdis/jiu828] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Two meetings, one sponsored by the Wellcome Trust in 2012 and the other by the Global Virology Foundation in 2013, assembled academic, public health and pharmaceutical industry experts to assess the challenges and opportunities for developing antivirals for the treatment of respiratory syncytial virus (RSV) infections. The practicalities of clinical trials and establishing reliable outcome measures in different target groups were discussed in the context of the regulatory pathways that could accelerate the translation of promising compounds into licensed agents. RSV drug development is hampered by the perceptions of a relatively small and fragmented market that may discourage major pharmaceutical company investment. Conversely, the public health need is far too large for RSV to be designated an orphan or neglected disease. Recent advances in understanding RSV epidemiology, improved point-of-care diagnostics, and identification of candidate antiviral drugs argue that the major obstacles to drug development can and will be overcome. Further progress will depend on studies of disease pathogenesis and knowledge provided from controlled clinical trials of these new therapeutic agents. The use of combinations of inhibitors that have different mechanisms of action may be necessary to increase antiviral potency and reduce the risk of resistance emergence.
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Affiliation(s)
- Eric A F Simões
- Department of Pediatrics, University of Colorado School of Medicine, and Colorado School of Public Health, Aurora
| | - John P DeVincenzo
- Department of Pediatrics, Division of Infectious Diseases, and Department of Microbiology, Immunology and Biochemistry, University of Tennessee School of Medicine Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis
| | - Michael Boeckh
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle
| | - Louis Bont
- Department of Pediatrics and Laboratory of Translational Immunology, University Medical Center Utrecht, The Netherlands
| | - James E Crowe
- Department of Pediatrics and the Vanderbilt Vaccine Center, Vanderbilt University, Nashville, Tennessee
| | - Paul Griffiths
- Centre for Virology, University College London Medical School
| | - Frederick G Hayden
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Richard L Hodinka
- Clinical Virology Laboratory, Children's Hospital of Philadelphia, Pennsylvania
| | - Rosalind L Smyth
- Department of Pediatrics, University College London Institute of Child Health
| | | | - Steffen Thirstrup
- NDA Advisory Services Ltd, Leatherhead, United Kingdom Department of Health Sciences, University of Copenhagen, Denmark
| | - Edward E Walsh
- Department of Medicine, Infectious Diseases Unit, Rochester General Hospital, New York
| | - Richard J Whitley
- Department of Pediatrics, Microbiology, Medicine and Neurosurgery, University of Alabama at Birmingham
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41
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Vitamin D as an adjunctive therapy in asthma. Part 1: A review of potential mechanisms. Pulm Pharmacol Ther 2015; 32:60-74. [PMID: 25732539 DOI: 10.1016/j.pupt.2015.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 12/24/2022]
Abstract
Vitamin D deficiency (VDD) is highly prevalent worldwide. The classical role for vitamin D is to regulate calcium absorption form the gastrointestinal tract and influence bone health. Recently vitamin D receptors and vitamin D metabolic enzymes have been discovered in numerous sites systemically supporting diverse extra-skeletal roles of vitamin D, for example in asthmatic disease. Further, VDD and asthma share several common risk factors including high latitude, winter season, industrialization, poor diet, obesity, and dark skin pigmentation. Vitamin D has been demonstrated to possess potent immunomodulatory effects, including effects on T cells and B cells as well as increasing production of antimicrobial peptides (e.g. cathelicidin). This immunomodulation may lead to asthma specific clinical benefits in terms of decreased bacterial/viral infections, altered airway smooth muscle-remodeling and -function as well as modulation of response to standard anti-asthma therapy (e.g. glucocorticoids and immunotherapy). Thus, vitamin D and its deficiency have a number of biological effects that are potentially important in altering the course of disease pathogenesis and severity in asthma. The purpose of this first of a two-part review is to review potential mechanisms whereby altering vitamin D status may influence asthmatic disease.
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42
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Jang GC, Shim JY, Ahn YM, Jung JA, Kim SW, Chung HL. Clinical characteristics related to onset age of wheeze in school-age children and adolescents with asthma. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.5.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jin-A Jung
- Department of Pediatrics, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Sung Won Kim
- Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea
| | - Hai Lee Chung
- Department of Pediatrics, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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43
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Strickland MJ, Marsh CA, Darrow LA. Gestational age-specific associations between infantile acute bronchiolitis and asthma after age five. Paediatr Perinat Epidemiol 2014; 28:521-6. [PMID: 25256755 PMCID: PMC4232988 DOI: 10.1111/ppe.12150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Infantile acute bronchiolitis (AB) is a risk factor for the development of paediatric asthma. The associations might differ according to gestational age. METHODS Data sets of emergency department (ED) visits (January 2002 to June 2010) and livebirth records (January 2002 to December 2004) from the state of Georgia were linked for all children who survived 1 year. Exposure was an ED visit for AB during infancy, and the outcome was an ED visit for asthma after age 5 years. The risk of asthma among children with AB (n = 11 564) was compared with the risk of asthma among children who did not have an ED visit for AB but who utilised the ED for another reason during infancy (n = 131 694). Associations were estimated using log-binomial regression models that controlled for several plausible confounders. Effect measure modification of the risk ratio by gestational age was investigated. RESULTS Unadjusted asthma risks (per 100 children) through June 2010 were 4.5 for children with AB and 2.3 for children without AB. The adjusted risk ratio for the overall association was 1.9 [95% confidence interval 1.7, 2.1]. We did not observe effect modification of the risk ratio by gestational age. CONCLUSION A positive association was observed between ED visits for AB and subsequent asthma ED visits after age 5; associations did not vary meaningfully by gestational age. Sensitivity analyses did not suggest large biases due to differences in ED utilisation across sociodemographic groups or loss to follow-up from residential migration.
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Affiliation(s)
- Matthew J. Strickland
- Department of Environmental Health, Rollins School of Public Health, Emory University,Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Caitlin A. Marsh
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Lyndsey A. Darrow
- Department of Epidemiology, Rollins School of Public Health, Emory University
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44
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The relationships between environmental bacterial exposure, airway bacterial colonization, and asthma. Curr Opin Allergy Clin Immunol 2014; 14:137-42. [PMID: 24451910 DOI: 10.1097/aci.0000000000000036] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Recent application of advanced culture-independent molecular techniques for the identification of microorganisms has contributed to our knowledge on the role of early-life microbial exposure and colonization in health and disease. The purpose of this review is to present the current perspectives regarding the role of microbial exposure and airway bacterial colonization on the development and the activity of asthma. RECENT FINDINGS Recent findings continue to support the protective role of early-life diverse microbial exposure against the development of atopic diseases. However, airway bacterial colonization early in life serves as a risk factor for the development of asthma. Culture-independent molecular techniques for the identification of microorganisms have challenged the traditional paradigm that the lower airway is a sterile compartment. Asthmatics, compared with nonasthmatics, appear to have a different lung microbiome composition and some of these differences might contribute to asthma activity, severity, and corticosteroid response. SUMMARY Bacterial presence in the airway appears to influence the inception and may affect the activity of asthma. Complex interactions between different types and routes of bacterial exposures, the airway, and the immune system early in life may determine whether these exposures augment or reduce the risk of asthma development.
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45
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Demirel S, Guner SN, Celiksoy MH, Sancak R. Is vitamin D insufficiency to blame for recurrent wheezing? Int Forum Allergy Rhinol 2014; 4:980-5. [PMID: 25175821 DOI: 10.1002/alr.21401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/04/2014] [Accepted: 07/08/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Vitamin D (VitD) and its metabolites play important roles in the regulation of the respiratory and immune systems. The aim of this study was to examine serum 25(OH) vitamin D [25(OH)D] levels and VitD deficiency on the development of wheezing and clinical features. METHODS This study was a prospective cross-sectional survey that included a total of 70 infants being followed in the Pediatric Immunology and Allergy Unit at Ondokuz Mayis University. Forty of these infants (patient group), ranging in age from 1 to 3 years, had been diagnosed as wheezy infants; 30 were age-and-gender matched healthy infants (control group). Prior to the study, blood samples were taken from both groups to determine their serum VitD, blood eosinophil, and serum immunoglobulin E (IgE) levels. RESULTS The duration of breastfeeding was similar for both groups. The serum 25(OH)D levels of the patient group were significantly lower than those of the control group. Although there was a negative relationship between 25(OH)D level and IgE(log10) values for the wheezy infants with VitD deficiency, the control group had a negative relationship between VitD level and IgE(log10) . CONCLUSION Serum 25(OH)D levels must be evaluated when following wheezy infants, and those with deficiency must be treated with VitD.
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Affiliation(s)
- Soner Demirel
- Division of Pediatric Allergy and Clinical Immunology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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46
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A systematic review of predictive modeling for bronchiolitis. Int J Med Inform 2014; 83:691-714. [PMID: 25106933 DOI: 10.1016/j.ijmedinf.2014.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/20/2014] [Accepted: 07/16/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Bronchiolitis is the most common cause of illness leading to hospitalization in young children. At present, many bronchiolitis management decisions are made subjectively, leading to significant practice variation among hospitals and physicians caring for children with bronchiolitis. To standardize care for bronchiolitis, researchers have proposed various models to predict the disease course to help determine a proper management plan. This paper reviews the existing state of the art of predictive modeling for bronchiolitis. Predictive modeling for respiratory syncytial virus (RSV) infection is covered whenever appropriate, as RSV accounts for about 70% of bronchiolitis cases. METHODS A systematic review was conducted through a PubMed search up to April 25, 2014. The literature on predictive modeling for bronchiolitis was retrieved using a comprehensive search query, which was developed through an iterative process. Search results were limited to human subjects, the English language, and children (birth to 18 years). RESULTS The literature search returned 2312 references in total. After manual review, 168 of these references were determined to be relevant and are discussed in this paper. We identify several limitations and open problems in predictive modeling for bronchiolitis, and provide some preliminary thoughts on how to address them, with the hope to stimulate future research in this domain. CONCLUSIONS Many problems remain open in predictive modeling for bronchiolitis. Future studies will need to address them to achieve optimal predictive models.
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Overeem MMA, Verhagen LM, Hermans PWM, del Nogal B, Sánchez AM, Acevedo NM, Murga RR, Roelfsema J, Pinelli E, de Waard JH. Recurrent wheezing is associated with intestinal protozoan infections in Warao Amerindian children in Venezuela: a cross-sectional survey. BMC Infect Dis 2014; 14:293. [PMID: 24885094 PMCID: PMC4045948 DOI: 10.1186/1471-2334-14-293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 05/14/2014] [Indexed: 12/11/2022] Open
Abstract
Background While in developed countries the prevalence of allergic diseases is rising, inflammatory diseases are relatively uncommon in rural developing areas. High prevalence rates of helminth and protozoan infections are commonly found in children living in rural settings and several studies suggest an inverse association between helminth infections and allergies. No studies investigating the relationship between parasitic infections and atopic diseases in rural children of developing countries under the age of 2 years have been published so far. We performed a cross-sectional survey to investigate the association of helminth and protozoan infections and malnutrition with recurrent wheezing and atopic eczema in Warao Amerindian children in Venezuela. Methods From August to November 2012, 229 children aged 0 to 2 years residing in the Orinoco Delta in Venezuela were enrolled. Data were collected through standardized questionnaires and physical examination, including inspection of the skin and anthropometric measurements. A stool sample was requested from all participants and detection of different parasites was performed using microscopy and real time polymerase chain reaction (PCR). Results We observed high prevalence rates of atopic eczema and recurrent wheezing, respectively 19% and 23%. The prevalence of helminth infections was 26% and the prevalence of protozoan infections was 59%. Atopic eczema and recurrent wheezing were more frequently observed in stunted compared with non-stunted children in multivariable analysis (OR 4.3, 95% CI 1.3 – 13.6, p = 0.015 and OR 4.5, 95% CI 0.97 – 21.2, p = 0.055). Furthermore, recurrent wheezing was significantly more often observed in children with protozoan infections than in children without protozoan infections (OR 6.7, 95% CI 1.5 – 30.5). Conclusions High prevalence rates of atopic eczema and recurrent wheezing in Warao Amerindian children under 2 years of age were related to stunting and intestinal protozoan infections respectively. Helminth infections were not significantly associated with either atopic eczema or recurrent wheezing.
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Affiliation(s)
- Marcella M A Overeem
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Nijmegen Medical Centre, PO Box 9101 (Internal Post 224), 6500 HB Nijmegen, The Netherlands.
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Beigelman A, Bacharier LB. Infection-induced wheezing in young children. J Allergy Clin Immunol 2014; 133:603-4. [PMID: 24636478 DOI: 10.1016/j.jaci.2013.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/26/2013] [Accepted: 12/04/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Avraham Beigelman
- Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, Mo
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, Mo.
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Hasegawa K, Mansbach JM, Camargo CA. Infectious pathogens and bronchiolitis outcomes. Expert Rev Anti Infect Ther 2014; 12:817-28. [PMID: 24702592 DOI: 10.1586/14787210.2014.906901] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bronchiolitis is a common early childhood illness and an important cause of morbidity, it is the number one cause of hospitalization among US infants. Bronchiolitis is also an active area of research, and recent studies have advanced our understanding of this illness. Although it has long been the conventional wisdom that the infectious etiology of bronchiolitis does not affect outcomes, a growing number of studies have linked specific pathogens of bronchiolitis (e.g., rhinovirus) to short- and long-term outcomes, such as future risk of developing asthma. The authors review the advent of molecular diagnostic techniques that have demonstrated diverse pathogens in bronchiolitis, and they review recent studies on the complex link between infectious pathogens of bronchiolitis and the development of childhood asthma.
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Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine (KH, CAC), Boston, MA, USA
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Øymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med 2014; 22:23. [PMID: 24694087 PMCID: PMC4230018 DOI: 10.1186/1757-7241-22-23] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/28/2014] [Indexed: 12/26/2022] Open
Abstract
Acute viral bronchiolitis is one of the most common medical emergency situations in infancy, and physicians caring for acutely ill children will regularly be faced with this condition. In this article we present a summary of the epidemiology, pathophysiology and diagnosis, and focus on guidelines for the treatment of bronchiolitis in infants. The cornerstones of the management of viral bronchiolitis are the administration of oxygen and appropriate fluid therapy, and overall a “minimal handling approach” is recommended. Inhaled adrenaline is commonly used in some countries, but the evidences are sparse. Recently, inhalation with hypertonic saline has been suggested as an optional treatment. When medical treatment fails to stabilize the infants, non-invasive and invasive ventilation may be necessary to prevent and support respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.
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Affiliation(s)
- Knut Øymar
- Department of Paediatrics, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway.
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