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Major S, Vézina K, Tse SM. Lung Function of Children Following an Intensive Care Unit Admission for Asthma. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:1-6. [PMID: 33734876 DOI: 10.1089/ped.2020.1271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: To determine the lung function of children admitted to the intensive care unit (ICU) for a severe asthma exacerbation in the medium- to long-term following hospital discharge. Methods: We performed a retrospective chart review of children ≥6 years of age admitted to the ICU for a severe asthma exacerbation at a tertiary care center from January 1, 2000, to December 31, 2013. Lung function was ascertained during outpatient follow-up visits at 3-12 months and 12-24 months postdischarge. A total of 72 subjects met the inclusion criteria. Results: Subjects were predominantly boys (56.9%) and had a mean (standard deviation [SD]) age at admission of 10.3 years (3.4 years). The median (interquartile range) length of stay in the ICU was 1 day (1-3 days). Thirty-eight and 28 subjects performed pulmonary function tests with acceptable technique at the 3-12 months and 12-24 months postdischarge visits, respectively. At 3-12 months, the mean (SD) predicted forced expiratory volume in 1 s (FEV1) and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) percent were 95.9 (16.7) and 76.7 (25.8), respectively, and 97.4 (17.6) and 70.5 (24.9), respectively, at 12-24 months. FEV1/forced vital capacity (FEV1/FVC) was 81.7 (8.3) at 3-12 months and 79.3 (7.7) at 12-24 months. A paired t-test on 20 subjects who performed acceptable spirometry at both visits showed a significant intraindividual decrease in FEV1 (P = 0.008), FEF25-75 (P = 0.02), and FEV1/FVC (P = 0.01) between the 2 time points. Conclusion: Although prospective studies are required to confirm our findings, our study suggests that children admitted to the ICU for severe asthma exacerbations may be at risk for declining pulmonary function in the medium- to long-term postdischarge.
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Affiliation(s)
- Sandrine Major
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Kevin Vézina
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Canada
| | - Sze Man Tse
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Canada
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2
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Lee M, Bogdanova Y, Chan M, Owens L, Wales S, Gray M, Burns C, Briggs N, Jaffe A, Homaira N. Development and validation of a risk score to identify children at risk of life-threatening asthma. J Asthma 2020; 59:105-114. [PMID: 33086883 DOI: 10.1080/02770903.2020.1841224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To develop and validate a prediction risk score for identification of children at risk of developing life-threatening asthma (LTA). METHODS Our study utilized existing medical records and retrospective analysis to develop and validate a risk score. The study population included children aged 2-17 years, admitted with a primary diagnosis of asthma, to Sydney Children's Hospital between 2011-2016. Children admitted in the intensive care unit with asthma at risk of LTA (cases) and those admitted into general ward (comparison group), were randomly divided into a derivation and a validation cohort. Candidate predictors from derivation cohort were selected through multivariable regression, which were used to estimate each child's risk of developing LTA in the validation cohort. Predictive performance of the risk score was evaluated by the area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test. RESULTS The study population comprised of 1171 children; 586 in the derivation and 585 in the validation cohort. Four independent candidate variables from derivation cohort (age at admission, socioeconomic status, a family history of asthma/atopy and previous asthma hospitalizations) were retained in the predictive model (AUROC 0.759; 95% CI, 0.694-0.823), with a sensitivity of 78.5% and specificity of 46.6%. CONCLUSIONS Our risk algorithm based on routinely collected clinical data may be used to develop a user-friendly risk score for early identification and monitoring of children at risk of developing LTA.
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Affiliation(s)
- Menolly Lee
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Yulia Bogdanova
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Mei Chan
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Louisa Owens
- Respiratory Department, Sydney Children's Hospital, Randwick, Australia
| | - Sandy Wales
- Respiratory Department, Sydney Children's Hospital, Randwick, Australia
| | - Melinda Gray
- Respiratory Department, Sydney Children's Hospital, Randwick, Australia
| | - Christine Burns
- Respiratory Department, Sydney Children's Hospital, Randwick, Australia
| | - Nancy Briggs
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, Australia
| | - Nusrat Homaira
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, Australia
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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4
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Roncada C, Andrade J, Bischoff LC, Pitrez PM. COMPARISON OF TWO INHALATIONAL TECHNIQUES FOR BRONCHODILATOR ADMINISTRATION IN CHILDREN AND ADOLESCENTS WITH ACUTE ASTHMA CRISIS: A META-ANALYSIS. ACTA ACUST UNITED AC 2018; 36:364-371. [PMID: 29995144 PMCID: PMC6202895 DOI: 10.1590/1984-0462/;2018;36;3;00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/12/2017] [Indexed: 01/30/2023]
Abstract
Objective: To compare the efficacy of pediatric asthma treatment by nebulizer and
metered-dose inhaler with the use of a spacer (MDI-spacer) in rescue
techniques for asthmatic patients assisted at pediatric emergency units. Data sources: A systematic review was conducted to identify the most relevant randomized
controlled trials comparing the administration of a bronchodilator (β-2
agonist) by two inhalation techniques (nebulization and MDI-spacer) to treat
asthma in children at pediatric emergency units. The following databases
were searched: PubMed, Scientific Electronic Library Online (SciELO), and
ScienceDirect. Two researchers independently applied the eligibility
criteria, and only randomized controlled trials that compared both
inhalation techniques (nebulization and MDI-spacer) for asthma treatment at
pediatric emergency units were included. Data synthesis: 212 articles were pre-selected, of which only nine met the eligibility
criteria and were included in meta-analysis. Results show no differences
between inhalation techniques for any of the four outcomes analyzed: heart
rate (difference - Df: 1.99 [95% confidence interval - 95%CI -2.01-6.00]);
respiratory rate (Df: 0.11 [95%CI -1.35-1.56]); O2 saturation
(Df: -0.01 [95%CI -0.50-0.48]); and asthma score (Df: 0.06 [95%CI
-0,26-0.38]). Conclusions: The findings demonstrate no differences in cardiorespiratory frequency,
O2 saturation, and asthma scores upon administration of β-2
agonist by both inhalation techniques (nebulization and MDI-spacer) to
asthmatic patients assisted at pediatric emergency units.
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Affiliation(s)
- Cristian Roncada
- Centro Universitário da Serra Gaúcha, Caxias do Sul, RS, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Julia Andrade
- Centro Universitário da Serra Gaúcha, Caxias do Sul, RS, Brasil
| | | | - Paulo Márcio Pitrez
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
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5
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Nagarajan S, Ahmad S, Quinn M, Agrawal S, Manilich E, Concepcion E, Lee H. Allergic sensitization and clinical outcomes in urban children with asthma, 2013-2016. Allergy Asthma Proc 2018; 39:281-288. [PMID: 30095393 DOI: 10.2500/aap.2018.39.4147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study was to examine if food and/or aeroallergen sensitization was associated with worse asthma, pulmonary function tests (PFT), and laboratory markers. METHODS At our institution, 386 children with asthma were divided into allergic and nonallergic groups based on allergen-specific immunoglobulin E (IgE) testing classes 1-6 versus 0. Asthma severity and/or control, IgE level, eosinophil counts and/or percentages, forced vital capacity (FVC), forced expiratory volume in the first second of expiration (FEV1), and FEV1/FVC, were compared by using bivariate, regression, and subgroup analyses for children who were highly allergic (≥4 allergens). RESULTS A total of 291 subjects with asthma were allergic, significantly older, and had higher mean IgE levels and eosinophil counts and percentages (all p < 0.001). A total of 203 subjects who were highly allergic had worse obstruction on PFTs. Increasing age predicted allergen sensitization after confounder adjustment, odds ratio (OR) 1.54 (95% confidence interval [CI], 1.18-2.02). Similarly, PFT obstruction was associated with multiple allergen sensitization (OR 0.97 [95% CI, 0.93-1.02]). CONCLUSION Increasing age predicted allergic sensitization and multiple allergen sensitization. Worse obstruction on PFT also predicted multiple allergen sensitization. Continued surveillance of aeroallergen sensitization and PFT results may be beneficial in asthma management, particularly in older urban children.
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Affiliation(s)
- Sairaman Nagarajan
- From the Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Sabina Ahmad
- From the Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Markus Quinn
- From the Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Sabhyata Agrawal
- From the Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Elena Manilich
- Department of Biostatistics, John Carroll University, Cleveland, Ohio
| | - Emily Concepcion
- From the Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Haesoon Lee
- From the Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York
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Kim HJ, Lee J, Kim JH, Park SY, Kwon HS, Kim TB, Moon HB, Cho YS. Factors Affecting Recovery Time of Pulmonary Function in Hospitalized Patients With Acute Asthma Exacerbations. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:499-504. [PMID: 27582400 PMCID: PMC5011049 DOI: 10.4168/aair.2016.8.6.499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/15/2016] [Accepted: 03/25/2016] [Indexed: 12/26/2022]
Abstract
Purpose Prolonged recovery time of pulmonary function after an asthma exacerbation is a significant burden on asthmatics, and management of these patients needs to be improved. The aim of this study was to evaluate factors associated with a longer recovery time of pulmonary function among asthmatic patients hospitalized due to a severe asthma exacerbation. Methods We retrospectively reviewed the medical records of 89 patients who were admitted for the management of acute asthma exacerbations. The recovery time of pulmonary function was defined as the time from the date each patient initially received treatment for asthma exacerbations to the date the patient reached his or her previous best FEV1% value. We investigated the influence of various clinical and laboratory factors on the recovery time. Results The median recovery time of the patients was 1.7 weeks. Multiple linear regression analysis revealed that using regular inhaled corticosteroids (ICS) before an acute exacerbation of asthma and concurrent with viral infection at admission were associated with the prolonged recovery time of pulmonary function. Conclusions The prolonged recovery time of pulmonary function after a severe asthma exacerbation was not shown to be directly associated with poor adherence to ICS. Therefore the results indicate that an unknown subtype of asthma may be associated with the prolonged recovery of pulmonary function time after an acute exacerbation of asthma despite regular ICS use. Further prospective studies to investigate factors affecting the recovery time of pulmonary function after an asthma exacerbation are warranted.
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Affiliation(s)
- Hyo Jung Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaemoon Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hyun Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Young Park
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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7
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McDowell KM, Kercsmar CM, Huang B, Guilbert TW, Kahn RS. Medical and Social Determinants of Health Associated with Intensive Care Admission for Asthma in Children. Ann Am Thorac Soc 2016; 13:1081-8. [PMID: 27144510 PMCID: PMC5015749 DOI: 10.1513/annalsats.201512-798oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/27/2016] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Risk factors for severe asthma exacerbations in children requiring admission to the intensive care unit (ICU) may occur in variety of medical, environmental, economic, and socioeconomic domains. OBJECTIVES We sought to characterize medical and sociodemographic risk factors among children who required admission to the intensive care unit for asthma. METHODS Data were obtained from the Greater Cincinnati Asthma Risk Study, a population-based, prospective, observational cohort of children admitted for treatment of acute asthma or bronchodilator-responsive wheezing. Data collected on 774 children included race, socioeconomic status, allergen sensitization, environmental exposures, psychosocial strain, and financial hardship. Analyses compared children admitted to the ICU to those admitted to a medical inpatient unit. MEASUREMENTS AND MAIN RESULTS One hundred sixty-one (20.9%) children required admission to intensive care. There was no difference in sex, race, insurance status, caregiver educational level, income, financial strain, psychological distress, or marital status between the ICU and non-ICU cohorts. Risk for medication nonadherence assessed by parent report was not different between groups. Although previous hospital admission or emergency department visit history did not differ between the groups, prior ICU admission was more common among those admitted to the ICU at the index admission (27 vs. 16%, P = 0.002). Children requiring intensive care admission were more likely to be sensitized to multiple aeroallergens. Exposure to cigarette smoke (measured as salivary cotinine), although a risk factor for hospital admission, was negatively associated with risk of ICU admission. CONCLUSIONS Social and economic risk factors typically predictive of increased asthma morbidity, including exposure to tobacco smoke, were not associated with ICU admission among a population of children admitted to the hospital for treatment of acute asthma. Intrinsic disease factors, including allergic sensitization, may be more important predictors of ICU admission.
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Affiliation(s)
| | | | - Bin Huang
- Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Robert S. Kahn
- Division of General and Community Pediatrics, Department of Pediatrics, and
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8
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Ng CL, Wang DY. Latest developments in allergic rhinitis in Allergy for clinicians and researchers. Allergy 2015; 70:1521-30. [PMID: 26443244 DOI: 10.1111/all.12782] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 02/06/2023]
Abstract
Research efforts in allergic rhinitis have always been intense. Over the past 3 years, numerous breakthroughs in basic science and clinical research have been made, augmenting our understanding of this condition that afflicts a significant proportion of the global population. New epidemiological findings, novel insights into the molecular and cellular mechanisms of allergy, enhancement of current developmental theories, new concepts of the goals and endpoints of management, and latest therapeutic modalities that includes the harnessing of information technology and big data are some areas where important advances were made. We attempt to bring you a summary of the key research advances made in the field of allergic rhinitis from 2013 to 2015.
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Affiliation(s)
- C. L. Ng
- Department of Otolaryngology; Yong Loo Lin School of Medicine; National University of Singapore; National University Health System; Singapore City Singapore
| | - D. Y. Wang
- Department of Otolaryngology; Yong Loo Lin School of Medicine; National University of Singapore; National University Health System; Singapore City Singapore
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9
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Ramos MI, Cubillas JJ, Feito FR. Improvement of the Prediction of Drugs Demand Using Spatial Data Mining Tools. J Med Syst 2015; 40:6. [PMID: 26573643 DOI: 10.1007/s10916-015-0379-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 10/09/2015] [Indexed: 11/29/2022]
Abstract
The continued availability of products at any store is the major issue in order to provide good customer service. If the store is a drugstore this matter reaches a greater importance, as out of stock of a drug when there is high demand causes problems and tensions in the healthcare system. There are numerous studies of the impact this issue has on patients. The lack of any drug in a pharmacy in certain seasons is very common, especially when some external factors proliferate favoring the occurrence of certain diseases. This study focuses on a particular drug consumed in the city of Jaen, southern Andalucia, Spain. Our goal is to determine in advance the Salbutamol demand. Advanced data mining techniques have been used with spatial variables. These last have a key role to generate an effective model. In this research we have used the attributes that are associated with Salbutamol demand and it has been generated a very accurate prediction model of 5.78% of mean absolute error. This is a very encouraging data considering that the consumption of this drug in Jaen varies 500% from one period to another.
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Affiliation(s)
- M Isabel Ramos
- Department of Cartography, Geodesy and Photogrammetry Engineering, University of Jaen, Jaen, Spain
| | - Juan José Cubillas
- Department of Computer Science, TIC-144 Andalusian Research Plan (PAI), University of Jaen, Jaen, Spain.
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Barberi S, Ciprandi G, Verduci E, D'Auria E, Poli P, Pietra B, Incorvaia C, Buttafava S, Frati F, Riva E. Effect of high-dose sublingual immunotherapy on respiratory infections in children allergic to house dust mite. Asia Pac Allergy 2015; 5:163-9. [PMID: 26240793 PMCID: PMC4521165 DOI: 10.5415/apallergy.2015.5.3.163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/08/2015] [Indexed: 12/19/2022] Open
Abstract
Background Allergic rhinitis is characterized by eosinophil inflammation. Allergic inflammation may induce susceptibility to respiratory infections (RI). House dust mite (HDM) sensitization is very frequent in childhood. Allergen immunotherapy may cure allergy as it restores a physiologic immune and clinical tolerance to allergen and exerts anti-inflammatory activity. Objective This study investigated whether six-month high-dose, such as 300 IR (index of reactivity), HDM-sublingual immunotherapy (SLIT) could affect RI in allergic children. Methods Globally, 40 HDM allergic children (18 males; mean age, 9.3 years) were subdivided in 2 groups: 20 treated by symptomatic drugs (group 1) and 20 by high-dose HDM-SLIT (group 2), since September 2012 to April 2013. The daily maintenance dose of HDM-SLIT was 4 pressures corresponding to 24, 4.8, and 60 µg, respectively of the major allergens Dermatophagoides pteronyssinus (Der p) 1, Der p 2, and Dermatophagoides farinae (Der f) 1. RI was diagnosed when at least 2 symptoms or signs, and fever were present for at least 48 hours. A family pediatrician provided diagnosis on a clinical ground. Results SLIT-treated children had significantly (p = 0.01) less RI episodes (3.5) than control group (5.45). About secondary outcomes, SLIT-treated children had less episodes of pharyngo-tonsillitis (p < 0.05) and bronchitis (p < 0.005), and snoring (p < 0.05) than control group. In addition, SLIT-treated children had less fever (p < 0.01) and took fewer medications, such as antibiotics (p < 0.05) and fever-reducers (p < 0.01), than control group. Conclusion This preliminary study might suggest that also a short course (6 months) of high-dose SLIT, titrated in µg of major allergens, could reduce RI in allergic children.
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Affiliation(s)
| | - Giorgio Ciprandi
- Department of Medicine, IRCCS-Azienda Ospedaliera Universitaria San Martino, 16132 Genoa, Italy
| | - Elvira Verduci
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| | - Enza D'Auria
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| | - Piercarlo Poli
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| | - Benedetta Pietra
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| | | | - Serena Buttafava
- Medical and Scientific Department, Stallergenes Italy, 20155 Milan, Italy
| | - Franco Frati
- Medical and Scientific Department, Stallergenes Italy, 20155 Milan, Italy
| | - Enrica Riva
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
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11
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Okano M, Kariya S, Ohta N, Imoto Y, Fujieda S, Nishizaki K. Association and management of eosinophilic inflammation in upper and lower airways. Allergol Int 2015; 64:131-8. [PMID: 25838087 DOI: 10.1016/j.alit.2015.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 01/18/2023] Open
Abstract
This review discussed the contribution of eosinophilic upper airway inflammation includes allergic rhinitis (AR) and chronic rhinosinusitis (CRS) to the pathophysiology and course of asthma, the representative counterpart in the lower airway. The presence of concomitant AR can affect the severity of asthma in patients who have both diseases; however, it is still debatable whether the presence of asthma affects the severity of AR. Hypersensitivity, obstruction and/or inflammation in the lower airway can be detected in patients with AR without awareness or diagnosis of asthma, and AR is known as a risk factor for the new onset of wheeze and asthma both in children and adults. Allergen immunotherapy, pharmacotherapy and surgery for AR can contribute to asthma control; however, a clear preventive effect on the new onset of asthma has been demonstrated only for immunotherapy. Pathological similarities such as epithelial shedding are also seen between asthma and CRS, especially eosinophilic CRS. Abnormal sinus findings on computed tomography are seen in the majority of asthmatic patients, and asthmatic patients with CRS show a significant impairment in Quality of Life (QOL) and pulmonary function as compared to those without CRS. Conversely, lower airway inflammation and dysfunction are seen in non-asthmatic patients with CRS. Treatments for CRS that include pharmacotherapy such as anti-leukotrienes, surgery, and aspirin desensitization show a beneficial effect on concomitant asthma. Acting as a gatekeeper of the united airways, the control of inflammation in the nose is crucial for improvement of the QOL of patients with co-existing AR/CRS and asthma.
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Affiliation(s)
- Mitsuhiro Okano
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan.
| | - Shin Kariya
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Nobuo Ohta
- Department of Otolaryngology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yoshimasa Imoto
- Department of Otorhinolaryngology - Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology - Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
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Jacobs TS, Forno E, Brehm JM, Acosta-Pérez E, Han YY, Blatter J, Thorne P, Metwali N, Colón-Semidey A, Alvarez M, Canino G, Celedón JC. Mouse allergen exposure and decreased risk of allergic rhinitis in school-aged children. Ann Allergy Asthma Immunol 2014; 113:614-618.e2. [PMID: 25304339 DOI: 10.1016/j.anai.2014.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/30/2014] [Accepted: 09/03/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about exposure to mouse allergen (Mus m 1) and allergic rhinitis (AR). OBJECTIVE To evaluate the association between mouse allergen exposure and AR in children. METHODS We examined the relation between mouse allergen level in house dust and AR in 511 children aged 6 to 14 years in San Juan, Puerto Rico. Study participants were chosen from randomly selected households using a multistage probability sample design. The study protocol included questionnaires, allergy skin testing, and collection of blood and dust samples. AR was defined as current rhinitis symptoms and skin test reactivity to at least one allergen. RESULTS In the multivariate analyses, mouse allergen level was associated with a 25% decreased odds of AR in participating children (95% confidence interval, 0.62-0.92). Although endotoxin and mouse allergen levels were significantly correlated (r = 0.184, P < .001), the observed inverse association between Mus m 1 and AR was not explained by levels of endotoxin or other markers of microbial or fungal exposure (peptidoglycan and glucan). CONCLUSION Mouse allergen exposure is associated with decreased odds of AR in Puerto Rican school-aged children.
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Affiliation(s)
- Tammy S Jacobs
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John M Brehm
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joshua Blatter
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter Thorne
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, University of Iowa, Iowa City, Iowa
| | - Nervana Metwali
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, University of Iowa, Iowa City, Iowa
| | - Angel Colón-Semidey
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - María Alvarez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh, Pittsburgh, Pennsylvania.
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