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Ennadif B, Alaoui-Inboui FZ, Benmoussa AY, El Kettani A, Elmdaghri N, Slaoui B. Virological Profile of Asthma Exacerbation in Children: A Hospital-Based Retrospective Study. Cureus 2024; 16:e60261. [PMID: 38872674 PMCID: PMC11170309 DOI: 10.7759/cureus.60261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Viruses are the most common triggering factors for asthma exacerbation during the autumn and winter seasons. Viruses, such as influenza A and rhinovirus, play a major role in the occurrence of severe exacerbation of asthma. This association between viral infection and asthma exacerbation in children is a result of the antiviral response of the immune system and various anti-inflammatory phenomena. In this work, we aimed to identify the virological profile of asthma exacerbation in children and analyze the correlation between viral infection type and the severity of exacerbation. Materials and methods This retrospective study was conducted from January 2016 to January 2024. The study included children hospitalized for asthma exacerbation associated with signs of viral-like respiratory infection with positive virological testing by multiplex real-time polymerase chain reaction or rapid test in the case of influenza A or respiratory syncytial virus (RSV). Data analysis was performed with Microsoft Excel and SPSS software using a previously established data collection sheet Results Thirty cases were collected for the study period. The mean age of the patients was 4 years and 8 months, with a male-to-female ratio of 3.3. Eighteen patients were known to have asthma, of which nine had uncontrolled asthma, and exacerbation was inaugural in 12 patients. Viral shedding was found in 14 patients. A viral agent was found in all patients, with coinfection of two or more viruses in three patients. The viruses found were influenza A (18 cases), coupled rhinovirus/enterovirus (eight cases), RSV (eight cases), human metapneumovirus (three patients), and parainfluenza type IV in only one inaugural patient. Asthma exacerbation was severe in 20 patients, moderate in eight patients, and two patients had severe acute asthma requiring intensive care management. We noted a higher frequency of severe exacerbation among those with an influenza A viral infection. All patients with RSV infection exhibited moderate exacerbation. No other significant correlation between asthma severity and other types of viruses was found. Conclusions Our results demonstrate the major role played by viruses in triggering asthma exacerbation, primarily influenza virus, followed by enterovirus, rhinovirus, RSV, and metapneumovirus. Larger-scale studies should be carried out to establish a more complete virological profile and further investigate the viral factor in the management of asthma in children.
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Affiliation(s)
- Basma Ennadif
- Department of Pediatrics, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, MAR
- Pediatric Pneumo-Allergology Unit, Pediatric Department 2, Hôpital Mère-Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, MAR
| | - Fatima Zahra Alaoui-Inboui
- Department of Pediatrics, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, MAR
- Pediatric Pneumo-Allergology Unit, Pediatric Department 2, Hôpital Mère-Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, MAR
| | - AbdelHakim Youssef Benmoussa
- Department of Pediatrics, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, MAR
- Pediatric Pneumo-Allergology Unit, Pediatric Department 2, Hôpital Mère-Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, MAR
| | - Assiya El Kettani
- Department of Microbiology, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, MAR
- Department of Microbiology, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, MAR
| | - Naima Elmdaghri
- Department of Microbiology, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, MAR
- Department of Microbiology, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, MAR
| | - Bouchra Slaoui
- Department of Pediatrics, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, MAR
- Pediatric Pneumo-Allergology Unit, Pediatric Department 2, Hôpital Mère-Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, MAR
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Korematsu S, Fujisawa T, Saito N, Tezuka J, Miura K, Kobayashi I, Miyata I, Kosugi Y, Gohda Y, Koike Y, Suda A, Matsuo A, Sasaki M, Handa Y, Fujiwara M, Ono A, Koizumi S, Oishi T, Tanaka T, Ando Y, Taba N, Tsurinaga Y, Sato T, Kanai R, Yashiro M, Takagi T, Hida S, Harazaki M, Hoshina T, Okada S, Yasutomi M, Nakata S, Muto A, Tanabe S, Ueda Y, Hasegawa S, Kameda M, Tanaka‐Taya K, Fujimoto T, Okada K. Suppressed pediatric asthma hospitalizations during the COVID-19 pandemic in Japan, from a national survey. Clin Transl Allergy 2024; 14:e12330. [PMID: 38282201 PMCID: PMC10795717 DOI: 10.1002/clt2.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/06/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Acute asthma exacerbation in children is often caused by respiratory infections. In this study, a coordinated national surveillance system for acute asthma hospitalizations and causative respiratory infections was established. We herein report recent trends in pediatric acute asthma hospitalizations since the COVID-19 pandemic in Japan. METHODS Thirty-three sentinel hospitals in Japan registered all of their hospitalized pediatric asthma patients and their causal pathogens. The changes in acute asthma hospitalization in children before and after the onset of the COVID-19 pandemic and whether or not COVID-19 caused acute asthma exacerbation were investigated. RESULTS From fiscal years 2010-2019, the median number of acute asthma hospitalizations per year was 3524 (2462-4570), but in fiscal years 2020, 2021, and 2022, the numbers were 820, 1,001, and 1,026, respectively (the fiscal year in Japan is April to March). This decrease was observed in all age groups with the exception of the 3- to 6-year group. SARS-CoV-2 was evaluated in 2094 patients from fiscal years 2020-2022, but the first positive case was not detected until February 2022. Since then, only 36 of them have been identified with SARS-CoV-2, none of which required mechanical ventilation. Influenza, RS virus, and human metapneumovirus infections also decreased in FY 2020. In contrast, 24% of patients had not been receiving long-term control medications before admission despite the severity of bronchial asthma. CONCLUSION SARS-CoV-2 was hardly detected in children with acute asthma hospitalization during the COVID-19 pandemic. This result indicated that SARS-CoV-2 did not induce acute asthma exacerbation in children. Rather, infection control measures implemented against the pandemic may have consequently reduced other respiratory virus infections and thus acute asthma hospitalizations during this period. However, the fact that many hospitalized patients have not been receiving appropriate long-term control medications is a major problem that should be addressed.
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Sasada T, Hayashi K, Okafuji I, Miyakoshi C, Tsuruta S. Incidence and causative agent distribution of viral-induced paediatric asthma exacerbations under strict infection control measures: a single-centre retrospective study in Japan. BMC Pulm Med 2023; 23:480. [PMID: 38031001 PMCID: PMC10685531 DOI: 10.1186/s12890-023-02779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The prevalence of respiratory viruses in children changed under strict infection control measures during the coronavirus disease 2019 (COVID-19) outbreak. In this study, we investigated the frequency of viral detection in the nasopharynx of paediatric patients with asthma exacerbations requiring hospitalization during the COVID-19 pandemic, as well as the distribution of causative viruses. METHODS We included paediatric patients admitted for asthma exacerbations between November 2020 and December 2022 at a single centre in Kobe, Japan. Demographic, clinical, and laboratory data were collected from their medical records and using additional questionnaires. All patients enrolled in this study met the diagnostic criteria for asthma exacerbations outlined in the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma 2020. Statistical differences were calculated using univariate analyses (chi-square or Mann‒Whitney U test). RESULTS We enrolled 203 children hospitalized for asthma attacks and collected nasopharyngeal samples from 189 patients. The median patient age was 3.0 years. Asthma severity was classified as mild (4.0%), moderate (82.3%), or severe (13.8%). The proportion of viral respiratory infections was 95.2% (180/189). The rate of patients with multiple viral infections was 20.6% (39/189). The most frequently detected pathogens were rhinovirus and enterovirus (RV/EV) at 69.3% (131/189), allowing for duplicate detection, followed by respiratory syncytial virus (RSV) at 28.6% (54/189). We also detected RV/EV almost every month compared to RSV and other viruses. In addition, RV/EV-positive patients were significantly older (p = 0.033), exhibited higher WBC counts (p < 0.001) and higher Eos counts (p < 0.001), had elevated total IgE levels (p < 0.001) and house dust mite-specific IgE levels (p = 0.019), had a shorter duration of hospitalization (p < 0.001), and had a shorter duration of oxygen therapy (p < 0.001). In patients positive for RV/EV, the use of ICSs significantly reduced the severity of the condition (p < 0.001). CONCLUSION Even under strict infection control measures, respiratory viruses were detected in the nasopharynx of almost all paediatric patients who had asthma exacerbations requiring hospitalization.
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Affiliation(s)
- Tsuyoshi Sasada
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan.
| | - Ken Hayashi
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Ikuo Okafuji
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Satoru Tsuruta
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
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Gorina LG, Krylova NA, Rakovskaya IV, Geppe NA, Gamova NA, Barkhatova OI. Mechanisms of Long-Term Persistence of Mycoplasmas in Children with Asthma. Microorganisms 2023; 11:1683. [PMID: 37512855 PMCID: PMC10383847 DOI: 10.3390/microorganisms11071683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Improving the management of children with asthma associated with mycoplasma infection is important. Aim: To study the duration of the persistence of antigens, and DNA in a free state, in the structures of circulating immune complexes (CICs) and living cells of Mycoplasma pneumoniae (Mpn) and Mycoplasma hominis (Mh) in children with asthma. In total, 205 children with asthma from 1 to 14 years were observed. The reaction of aggregate-hemagglutination (AHAA), the direct immunofluorescence reaction (DIF), the reaction of the polymerase chain reaction (PCR), and the culture method were used. In addition, 47 children were re-examined 1.5 months after the treatment of mycoplasma infection with azithromycin. The number of samples positive for antigens and DNA in the free state and in the structures of CICs significantly decreased. Then, 50 blood serum samples containing Mh antigens, and 50 samples containing Mpn antigens were analyzed by culture method. Mh was isolated in 21 (65.5%) of 32 samples containing DNA. Mpn was isolated from antigen-positive samples in nine cases. The presented data indicate the long-term persistence of antigens, and DNA of mycoplasma cells in the free state, in the structure of CICs, as well as in the form of "microcolonies". A high level of CICs can be used to predict the course of the disease and the response to therapy.
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Affiliation(s)
- Luisa G Gorina
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Natalya A Krylova
- Department of Childhood Diseases Sechenov, First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Irina V Rakovskaya
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Natalia A Geppe
- Department of Childhood Diseases Sechenov, First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Natalia A Gamova
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Olga I Barkhatova
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
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Chou CC, Morphew T, Ehwerhemuepha L, Galant SP. COVID-19 infection may trigger poor asthma control in children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:1913-1915. [PMID: 35487371 PMCID: PMC9040415 DOI: 10.1016/j.jaip.2022.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/16/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
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6
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Pan X, Liu Y, Luo J, Li S, Diao S, Li H, Huang L, Jia Z, Chen L, Cheng G, Liu H, Zhang L. The efficacy and safety of azithromycin in treatment for childhood asthma: A systematic review and meta-analysis. Pediatr Pulmonol 2022; 57:631-639. [PMID: 34862766 DOI: 10.1002/ppul.25783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/02/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Azithromycin (AZI) is increasingly used for childhood asthma despite limited and inconsistent data. We aimed to evaluate the efficacy and safety of AZI in childhood asthma. METHODS We searched seven databases to include randomized controlled trials (RCTs) of AZI in the treatment of childhood asthma. Four reviewers independently screened the records. Risk of Bias 2 was used to assess the quality of RCTs. Risk ratios with 95% confidence interval (CI) from dichotomous outcomes, and mean difference (MD) with 95% CI from continuous outcomes were pooled. RESULTS We included 19 eligible reports from 17 studies. The prevalence of exacerbations in AZI + budesonide (BUD) + β2 agonist (BA) group was lower than BUD + BA group (four [13%] vs. 19 [63%], p < 0.05) in 6- 14 years old children with chronic persistent asthma. AZI plus antiasthma drugs (AADs) could improve the posttreatment childhood asthma control test score (MD = 2.97; 95% CI, 2.39-3.54) compared to AADs alone in children with chronic persistent asthma. AZI plus AADs could improve posttreatment forced expiratory volume in 1 s of predicted value/forced vital capacity % (MD = 10.24%; 95% CI, 6.44%-14.03%) and posttreatment peak expiratory flow % of predicted value (MD = 7.00%; 95% CI, 2.53%-11.47%) compared to AADs alone in children with chronic persistent asthma. The most common adverse reactions of AZI combined with other drugs were gastrointestinal reactions. CONCLUSIONS AZI may be beneficial in improving some clinical symptoms and lung functions in older asthma children (over 6 years old) with persistent asthma. But it still requires further research.
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Affiliation(s)
- Xiangcheng Pan
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Pharmacy, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yan Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Pharmacy, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jiefeng Luo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Pharmacy, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Siyu Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Sha Diao
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Liang Huang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zhijun Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Department of Biopharmaceutics, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lina Chen
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Pharmacy, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
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Saravanos GL, Hu N, Homaira N, Muscatello DJ, Jaffe A, Bartlett AW, Wood NJ, Rawlinson W, Kesson A, Lingam R, Britton PN. RSV Epidemiology in Australia Before and During COVID-19. Pediatrics 2022; 149:184564. [PMID: 35083489 DOI: 10.1542/peds.2021-053537] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
COVID-19 public health measures altered respiratory syncytial virus (RSV) epidemiology. We examined age-stratified trends in RSV-related disease in Australian children in 2020 compared with previous years.
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Affiliation(s)
- Gemma L Saravanos
- The University of Sydney, Camperdown, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Nan Hu
- University of New South Wales Sydney, Randwick, Australia
| | - Nusrat Homaira
- University of New South Wales Sydney, Randwick, Australia.,Sydney Children's Hospital, Randwick, Australia
| | | | - Adam Jaffe
- University of New South Wales Sydney, Randwick, Australia.,Sydney Children's Hospital, Randwick, Australia
| | - Adam W Bartlett
- University of New South Wales Sydney, Randwick, Australia.,Sydney Children's Hospital, Randwick, Australia
| | - Nicholas J Wood
- The University of Sydney, Camperdown, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, Australia.,The Children's Hospital at Westmead, Westmead, Australia
| | | | - Alison Kesson
- The University of Sydney, Camperdown, Australia.,The Children's Hospital at Westmead, Westmead, Australia
| | - Raghu Lingam
- University of New South Wales Sydney, Randwick, Australia
| | - Philip N Britton
- The University of Sydney, Camperdown, Australia.,The Children's Hospital at Westmead, Westmead, Australia
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8
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Nagasawa K, Ishiwada N. Disease burden of respiratory syncytial virus infection in the pediatric population in Japan. J Infect Chemother 2021; 28:146-157. [PMID: 34952776 DOI: 10.1016/j.jiac.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/22/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is one of the most common causes of lower respiratory tract infections in children aged <5 years and is associated with long-term respiratory morbidities such as recurrent wheezing and asthma, decreased lung function, and allergic sensitization. The objective of this review was to evaluate the epidemiology and burden of RSV infection in the pediatric population in Japan. METHODS Studies indexed in PubMed and ICHUSHI databases during January 2010-December 2020 were manually reviewed. Data on proportion of RSV infections, seasonality, length of stay (LoS), mortality, medical expenses, and palivizumab use were extracted from the selected articles. RESULTS Ninety-three articles were included (PubMed, 64; ICHUSHI, 29). The proportion of patients/samples with an RSV infection was 5.5%-66.7%, and 6.0%-29.9% in the inpatient and outpatient departments, respectively. RSV infections generally occurred during autumn/winter; however, recently the peak has shifted to summer. The LoS was variable and depended on factors such as age, infection severity, wheezing, and RSV subgroups. Mortality rates varied from <1% to 19% depending on the infection severity. The average daily hospitalization and intensive care unit cost was JPY 34,548 while intensive care unit incurred an additional cost of JPY 541,293. Palivizumab was indicated for high-risk infants and 0%-3% of patients required hospitalization despite palivizumab use. CONCLUSIONS RSV imposes a significant burden on the Japanese healthcare system, suggesting a need to create awareness among caregivers of children, pregnant women and healthcare professionals to ensure early recognition of infection and adequate treatment or prophylaxis.
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Affiliation(s)
- Koo Nagasawa
- Division of Infectious Diseases, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba 266-0007, Japan; Laboratory of Cancer Genetics, Chiba Cancer Center Research Institute, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717, Japan.
| | - Naruhiko Ishiwada
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba 260-8673, Japan
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9
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Hogan AH, Carroll CL, Iverson MG, Hollenbach JP, Philips K, Saar K, Simoneau T, Sturm J, Vangala D, Flores G. Risk Factors for Pediatric Asthma Readmissions: A Systematic Review. J Pediatr 2021; 236:219-228.e11. [PMID: 33991541 DOI: 10.1016/j.jpeds.2021.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To systematically review the literature on pediatric asthma readmission risk factors. STUDY DESIGN We searched PubMed/MEDLINE, CINAHL, Scopus, PsycINFO, and Cochrane Central Register of Controlled Trials for published articles (through November 2019) on pediatric asthma readmission risk factors. Two authors independently screened titles and abstracts and consensus was reached on disagreements. Full-text articles were reviewed and inclusion criteria applied. For articles meeting inclusion criteria, authors abstracted data on study design, patient characteristics, and outcomes, and 4 authors assessed bias risk. RESULTS Of 5749 abstracts, 74 met inclusion criteria. Study designs, patient populations, and outcome measures were highly heterogeneous. Risk factors consistently associated with early readmissions (≤30 days) included prolonged length of stay (OR range, 1.1-1.6) and chronic comorbidities (1.7-3.2). Risk factors associated with late readmissions (>30 days) included female sex (1.1-1.6), chronic comorbidities (1.5-2), summer discharge (1.5-1.8), and prolonged length of stay (1.04-1.7). Across both readmission intervals, prior asthma admission was the most consistent readmission predictor (1.3-5.4). CONCLUSIONS Pediatric asthma readmission risk factors depend on the readmission interval chosen. Prior hospitalization, length of stay, sex, and chronic comorbidities were consistently associated with both early and late readmissions. TRIAL REGISTRATION CRD42018107601.
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Affiliation(s)
- Alexander H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, CT; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT.
| | - Christopher L Carroll
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Division of Critical Care, Connecticut Children's Medical Center, Hartford, CT
| | | | - Jessica P Hollenbach
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Asthma Center, Connecticut Children's Medical Center, Hartford, CT
| | - Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, NY; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Katarzyna Saar
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Tregony Simoneau
- Boston Children's Medical Center, Boston, MA; Department of Pediatrics, Harvard University, Cambridge, MA
| | - Jesse Sturm
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Department of Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT
| | - Divya Vangala
- Department of Pediatrics, Duke University, Durham, NC
| | - Glenn Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, FL
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10
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Leung ASY, Tham EH, Li J, Pacharn P, Takizawa T, Lee E, Xing Y, Leung TF, Hong SJ, Wong GWK. The role of the environment in shaping the trends of childhood asthma - An Asian perspective. Pediatr Allergy Immunol 2021; 32:1152-1164. [PMID: 33760296 DOI: 10.1111/pai.13508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 12/15/2022]
Abstract
Asthma has now become one of the most common atopic disorders not only in developed countries but also in many developing countries. The etiology is likely due to a complex interaction between genetic and environmental factors. In many Asian countries, the prevalence of asthma has also been documented by validated instruments to be increasing rapidly over the past two decades. However, studies in rural areas in Asia with a traditional farming environment revealed markedly lower asthma prevalence when compared with residents in nearby cities despite having similar genetic background. Among the environmental factors implicated in the pathogenesis of asthma, air pollution, dietary patterns, viral infections, and early microbial exposure have been studied extensively around the world. Asia provides many opportunities to study these potential factors as there are many ethnic groups living in distinctly different environments. The understanding of the roles of these factors in affecting the early immune system and subsequent development of asthma will enable us to develop potential primary preventive strategies against a disease which affects millions worldwide.
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Affiliation(s)
- Agnes S Y Leung
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Elizabeth Huiwen Tham
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jing Li
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Punchama Pacharn
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Takumi Takizawa
- Department of Pediatrics, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Ting-Fan Leung
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Soo-Jong Hong
- Childhood Asthma and Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gary W K Wong
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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11
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Eigenmann P. Comments on vitamin D and sensitization, asthma treatment, and lung function development. Pediatr Allergy Immunol 2021; 32:1137-1140. [PMID: 34333802 DOI: 10.1111/pai.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Pediatrics Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
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12
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Federico MJ, Denlinger LC, Corren J, Szefler SJ, Fuhlbrigge AL. Exacerbation-Prone Asthma: A Biological Phenotype or a Social Construct. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2627-2634. [PMID: 34051392 DOI: 10.1016/j.jaip.2021.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022]
Abstract
Asthma is a complex syndrome with multiple phenotypes and endotypes. Asthma exacerbations are not only the clearest indictor of the morbidity of asthma and of the risk for mortality due to asthma, but also comprise a significant amount of the cost to care for poorly controlled asthma. There continues to be significant disparity in the prevalence, mortality, and morbidity due to asthma. Patients with asthma who suffer recurrent exacerbations are considered to have exacerbation-prone asthma (EPA). Efforts to characterize patients with frequent exacerbations show that the etiology is likely multifactorial. Research to determine the intrinsic risk factors for EPA include studies of both genetic and inflammatory biomarkers. External factors contributing to exacerbations have been extensively reviewed and include viral infection, environmental exposures, air pollution, and psychosocial and economic barriers to optimizing health. It is likely that EPA occurs when patients who have an increased underlying intrinsic/biological risk are placed in a given exposome (environments with a variety of exposures and triggers including allergens, pollution, stress, barriers, and occupational exposures). It is the social construct combined with underlying biology that frequently drives an EPA phenotype.
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Affiliation(s)
- Monica J Federico
- The Breathing Institute, Children's Hospital Colorado, and Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo.
| | - Loren C Denlinger
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jonathan Corren
- Departments of Medicine and Pediatrics, Divisions of Allergy and Clinical Immunology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif
| | - Stanley J Szefler
- The Breathing Institute, Children's Hospital Colorado, and Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Anne L Fuhlbrigge
- Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
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13
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Sada M, Watanabe M, Inui T, Nakamoto K, Hirata A, Nakamura M, Honda K, Saraya T, Kurai D, Kimura H, Ishii H, Takizawa H. Ruxolitinib inhibits poly(I:C) and type 2 cytokines-induced CCL5 production in bronchial epithelial cells: A potential therapeutic agent for severe eosinophilic asthma. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:363-373. [PMID: 33534941 PMCID: PMC8127547 DOI: 10.1002/iid3.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/18/2022]
Abstract
Rationale Severe eosinophilic asthma is characterized by airway eosinophilia and corticosteroid‐resistance, commonly overlapping with type 2 inflammation. It has been reported that chemokine (C‐C motif) ligand 5 (CCL5) is involved in the exacerbation of asthma by RNA virus infections. Indeed, treatment with a virus‐associated ligand and a T helper type 2 cell (Th2) cytokine can synergistically stimulate CCL5 production in bronchial epithelial cells. We aimed to evaluate the mechanisms underlying CCL5 production in this in vitro model and to assess the potential of Janus kinase 1 (JAK1) as a novel therapeutic target via the use of ruxolitinib. Methods We stimulated primary normal human bronchial epithelial (NHBE) cells and BEAS‐2B cells with poly(I:C) along with interleukin‐13 (IL‐13) or IL‐4, and assessed CCL5 production. We also evaluated the signals involved in virus‐ and Th2‐cytokine‐induced CCL5 production and explored a therapeutic agent that attenuates the CCL5 production. Results Poly(I:C) stimulated NHBE and BEAS‐2B cells to produce CCL5. Poly(I:C) and IL‐13 increased CCL5 production. Poly(I:C)‐induced CCL5 production occurred via the TLR3–IRF3 and IFNAR/JAK1–phosphoinositide 3‐kinase (PI3K) pathways, but not the IFNAR/JAK1–STATs pathway. In addition, IL‐13 did not augment poly(I:C)‐induced CCL5 production via the canonical IL‐13R/IL‐4R/JAK1–STAT6 pathway but likely via subsequent TLR3‐IRF3‐IFNAR/JAK1‐PI3K pathways. JAK1 was identified to be a potential therapeutic target for severe eosinophilic asthma. The JAK1/2 inhibitor, ruxolitinib, was demonstrated to more effectively decrease CCL5 production in BEAS‐2B cells than fluticasone propionate. Conclusion We have demonstrated that JAK1 is a possible therapeutic target for severe corticosteroid‐resistant asthma with airway eosinophilia and persistent Th2‐type inflammation, and that ruxolitinib has potential as an alternative pharmacotherapy.
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Affiliation(s)
- Mitsuru Sada
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Masato Watanabe
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Toshiya Inui
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Keitaro Nakamoto
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Aya Hirata
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Masuo Nakamura
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kojiro Honda
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Daisuke Kurai
- Division of Infectious Diseases, Department of General Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Hirokazu Kimura
- Department of Health Science, Graduate School of Health Science, Gunma Paz University, Gunma, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
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14
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Ariyoshi T, Tezuka J, Yasudo H, Sakata Y, Nakamura T, Matsushige T, Hasegawa H, Nakajima N, Ainai A, Oga A, Itoh H, Shirabe K, Toda S, Atsuta R, Ohga S, Hasegawa S. Enhanced airway hyperresponsiveness in asthmatic children and mice with A(H1N1)pdm09 infection. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:457-465. [PMID: 33470564 PMCID: PMC8127572 DOI: 10.1002/iid3.406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Severe asthma exacerbation is an important comorbidity of the 2009 HIN1 pandemic (A(H1N1)pdm09) in asthmatic patients. However, the mechanisms underlying severe asthma exacerbation remain unknown. In this study, airway hyperresponsiveness (AHR) was measured in pediatric asthma patients infected with A(H1N1)pdm09. We also evaluated AHR in asthmatic mice with A(H1N1)pdm09 infection and those with seasonal influenza for comparison. METHODS AHRs in asthmatic children were defined as the provocative acetylcholine concentration causing a 20% reduction in forced expiratory volume in 1 s (PC20 ). To investigate the pathophysiology using animal models, BALB/c mice aged 6-8 weeks were sensitized and challenged with ovalbumin. Either mouse-adapted A(H1N1)pdm09, seasonal H1N1 virus (1 × 105 pfu/20 μl), or mock treatment as a control was administered intranasally. At 3, 7, and 10 days after infection, each group of mice was evaluated for AHR by methacholine challenge using an animal ventilator, flexiVent. Lung samples were resected and observed using light microscopy to assess the degree of airway inflammation. RESULTS AHRs in the children with bronchial asthma were temporarily increased, and alleviated by 3 months after discharge. AHR was significantly enhanced in A(H1N1)pdm09-infected asthmatic mice compared to that in seasonal H1N1-infected mice (p < .001), peaking at 7 days postinfection and then becoming similar to control levels by 10 days postinfection. Histopathological examination of lung tissues showed more intense infiltration of inflammatory cells and severe tissue destruction in A(H1N1)pdm09-infected mice at 7 days postinfection than at 10 days postinfection. CONCLUSION Our results suggest that enhanced AHR could contribute to severe exacerbation in human asthmatic patients with A(H1N1)pdm09 infection.
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Affiliation(s)
- Taira Ariyoshi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Junichiro Tezuka
- Department of Allergy and Pulmonology, Fukuoka Children's Hospital, Fukuoka, Japan.,Department of Pediatrics, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Hiroki Yasudo
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasufumi Sakata
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tamaki Nakamura
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takeshi Matsushige
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hideki Hasegawa
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Noriko Nakajima
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Akira Ainai
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Atsunori Oga
- Department of Molecular Pathology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroshi Itoh
- Department of Molecular Pathology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Komei Shirabe
- Yamaguchi Prefectural Institute of Public Health and Environment, Yamaguchi, Japan
| | - Shoichi Toda
- Yamaguchi Prefectural Institute of Public Health and Environment, Yamaguchi, Japan
| | | | - Shouichi Ohga
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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15
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Eigenmann P. Improving asthma care in preschool children. Pediatr Allergy Immunol 2020; 31:597-600. [PMID: 32757337 DOI: 10.1111/pai.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/25/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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16
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Eigenmann P. COVID-19 and its impact on allergic and immunologic diseases in children. Pediatr Allergy Immunol 2020; 31:437-440. [PMID: 32779791 PMCID: PMC7404668 DOI: 10.1111/pai.13295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women‐Children‐TeenagersUniversity Hospital of GenevaGenevaSwitzerland
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17
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Lee EA, Johnson LR, Johnson EG, Vernau W. Clinical features and radiographic findings in cats with eosinophilic, neutrophilic, and mixed airway inflammation (2011-2018). J Vet Intern Med 2020; 34:1291-1299. [PMID: 32338397 PMCID: PMC7255660 DOI: 10.1111/jvim.15772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/16/2020] [Indexed: 01/01/2023] Open
Abstract
Background Idiopathic inflammatory airway disease (IAD) in cats often is described as asthmatic (eosinophilic) or bronchitic (neutrophilic), but this designation requires collection of airway fluid and it fails to consider cats with mixed airway inflammation. Objective To identify clinical features that would differentiate inflammatory disease types. Animals Forty‐nine cats with nonspecific airway inflammation identified by bronchoscopic bronchoalveolar lavage (BAL) between 2011 and 2018 were evaluated. Methods This is a retrospective study. Cats were categorized by BAL differential cytology as having eosinophilic (eosinophils >20% with neutrophils <14%, or eosinophils >50%), mixed (eosinophils 20%‐50% and neutrophils >14% or discordant inflammation from 2 BAL sites), or neutrophilic (neutrophils >14% and eosinophils <20%) inflammation. Type and duration of presenting complaints, signalment, body condition score, respiratory rate, CBC results, bronchoscopy, BAL results (% recovery, total nucleated cell count, differential cell count), and radiographic findings were compared among groups. Results Idiopathic IAD was diagnosed in 49 cats, with BAL eosinophilic inflammation in 23, mixed inflammation in 14, and neutrophilic inflammation in 12. Cough was the predominant presenting complaint with no difference in duration of signs among groups (median, 5.5 months). Respiratory rate and effort also did not differ. Cats with eosinophilic inflammation were significantly younger (4.4 ± 3.3 years) than those with neutrophilic (8.0 ±5.6 years) or mixed inflammation (7.5 ± 4.0 years; P = .03). Results of CBC and interpretation of radiographic findings did not differ among groups. Conclusions and Clinical Importance Substantial overlap exists in clinical and radiographic findings in cats with various forms of idiopathic airway inflammation.
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Affiliation(s)
- Elizabeth A Lee
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California School of Veterinary Medicine, Davis, California, USA
| | - Lynelle R Johnson
- Department of Medicine and Epidemiology, University of California School of Veterinary Medicine, Davis, California, USA
| | - Eric G Johnson
- Department of Surgical and Radiological Sciences, University of California School of Veterinary Medicine, Davis, California, USA
| | - William Vernau
- Department of Pathology, Microbiology and Immunology, University of California School of Veterinary Medicine, Davis, California, USA
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18
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Eigenmann P. Early wheeze progression to asthma, and insight into peri-operative anaphylaxis. Pediatr Allergy Immunol 2020; 31:5-6. [PMID: 31898367 DOI: 10.1111/pai.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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19
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Abe N, Yasudo H, Fukano R, Nakamura T, Okada S, Wakiguchi H, Okazaki F, Shirabe K, Toda S, Okamoto R, Ouchi K, Ohga S, Hasegawa S. Multi-season analyses of causative pathogens in children hospitalized with asthma exacerbation. Pediatr Allergy Immunol 2019; 30:724-731. [PMID: 31251831 PMCID: PMC7167852 DOI: 10.1111/pai.13102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Respiratory viral and mycoplasma infections are associated with childhood asthma exacerbations. Here, we explored epidemiologic profile of causative pathogens and possible factors for exacerbation in a single center over a three-year period. METHODS Hospitalized asthmatic children with attack aged 6 months-17 years were recruited between 2012 and 2015 (n = 216). Nasopharyngeal mucosa cell samples were collected from the participants and examined by reverse transcription-polymerase chain reaction to detect rhinovirus (RV), respiratory syncytial virus (RSV), enterovirus (EV), parainfluenza virus (PIV), Mycoplasma pneumoniae, and others. Clinical features, laboratory data, asthma exacerbation intensity, and asthma severity were compared among participants. Epidemiologic profile of causative pathogens and possible factors for exacerbation were explored. RESULTS Viruses and/or Mycoplasma pneumoniae were detected in 75% of the participants. Rhinovirus (48%) was the most commonly detected virus in the participants with single infection, followed by RSV (6%). The median age at admission in the RV group was significantly higher than that in the RSV group. Insufficient asthma control and allergen sensitization were significantly related to RV-associated asthma exacerbation. There was no seasonality of pathogen types associated with asthma exacerbation although a sporadic prevalence of EV-D68 was observehinovirud. Rhinovirus were repeatedly detected in multiple admission cases. CONCLUSION Our three-year analysis revealed that patients with RV infection were significantly prone to repeated RV infection in the subsequent exacerbation and good asthma control could prevent RV-associated asthma development and exacerbation. Multiple-year monitoring allowed us to comprehend the profile of virus- and/or mycoplasma-induced asthma exacerbation.
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Affiliation(s)
- Nozomi Abe
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroki Yasudo
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Reiji Fukano
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tamaki Nakamura
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroyuki Wakiguchi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Fumiko Okazaki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Komei Shirabe
- Yamaguchi Prefectural Institute of Public Health and Environment, Yamaguchi, Japan
| | - Shoichi Toda
- Yamaguchi Prefectural Institute of Public Health and Environment, Yamaguchi, Japan
| | - Reiko Okamoto
- Yamaguchi Prefectural Institute of Public Health and Environment, Yamaguchi, Japan
| | - Kazunobu Ouchi
- Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
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