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Adamiec A, Cieślik M, Mączka K, Tarnoruda J, Jensen S, Chawes B, Bønnelykke K, Konradsen JR, Söderhäll C, Makrinioti H, Camargo CA, Hasegawa K, Ambrożej D, Jartti T, Ruszczyński M, Feleszko W. A systematic review and meta-analysis on absolute eosinophil counts and the risk of asthma in preschool children with wheezing: An EAACI Task Force Report. Pediatr Allergy Immunol 2024; 35:e14078. [PMID: 38339981 DOI: 10.1111/pai.14078] [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: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
Preschool children with wheezing disorders pose diagnostic and therapeutic challenges and consume substantial healthcare resources. Peripheral eosinophil blood count (EBC) has been proposed as a potential indicator for future asthma development. This review by the European Academy of Allergy and Clinical Immunology (EAACI) Preschool Wheeze Task Force aimed to provide systematic evidence for the association between increased EBC and the risk of future asthma, as well as to identify potential cutoff values. In February 2023, a search of PubMed, EMBASE, and Cochrane Library databases was conducted to identify studies comparing EBCs in preschool children with wheezing who continued to wheeze later in life and those who did not. Included observational studies focused on children aged <6 years with a wheezing disorder, assessment of their EBCs, and subsequent asthma status. No language or publication date restrictions were applied. Among the initial 3394 studies screened, 10 were included in the final analysis, involving 1225 patients. The data from these studies demonstrated that high EBC in preschool children with wheezing is associated with future asthma development, with odds ratios of 1.90 (95% CI: 0.45-7.98, p = .38), 2.87 (95% CI: 1.38-5.95, p < .05), and 3.38 (95% CI: 1.72-6.64, p < .05) for cutoff values in the <300, 300-449, and ≥450 cells/μL ranges, respectively. Defining a specific cutoff point for an elevated EBC lacks consistency, but children with EBC >300 cells/μL are at increased risk of asthma. However, further research is needed due to the limitations of the included studies. Future investigations are necessary to fully elucidate the discussed association.
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Affiliation(s)
- Aleksander Adamiec
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Maja Cieślik
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
| | - Katarzyna Mączka
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Tarnoruda
- Department of Paediatrics, Medical University of Warsaw Children's Hospital, Warsaw, Poland
| | - Signe Jensen
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Cilla Söderhäll
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Heidi Makrinioti
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominika Ambrożej
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Tuomas Jartti
- Department of Paediatrics, Turku University Hospital and Turku University, Turku, Finland
- PEDEGO Research Unit, Medical Research Centre, University of Oulu, Turku, Finland
- Department of Pediatrics, Oulu University Hospital, Turku, Finland
| | - Marek Ruszczyński
- Department of Paediatrics, Medical University of Warsaw Children's Hospital, Warsaw, Poland
| | - Wojciech Feleszko
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
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Graham ND, Graham ID, Vanderspank-Wright B, Varin MD, Nadalin Penno L, Fergusson DA, Squires JE. A systematic review and critical appraisal of guidelines and their recommendations for sedation interruptions in adult mechanically ventilated patients. Aust Crit Care 2023; 36:889-901. [PMID: 36522246 DOI: 10.1016/j.aucc.2022.10.011] [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: 01/25/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objectives of the review were to (i) assess the methodological quality of all accessible and published guidelines and care bundles that offer a recommendation related to sedation interruptions, using the AGREE-II instrument, to (ii) determine what is the recommended best practice for sedation interruptions from the available guidelines, and then to have (iii) a closer inspection of the overall credibility and applicability of the recommendations using the AGREE-REX instrument. This review will benefit the outcomes of critically ill patients and the multidisciplinary team responsible for the care of mechanically ventilated adults with continuous medication infusions by providing a synthesis of the recommended action(s), actor(s), contextual information, target(s), and timing related to sedation interruptions from current best practice. REVIEW METHOD USED We conducted a systematic review. DATA SOURCES We applied a peer-reviewed search strategy to four electronic databases from 2010 to November 2021-MEDLINE, CINAHL, Embase, and The Cochrane Database of Systematic Reviews-and included grey literature. REVIEW METHOD Findings are reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist. We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II and AGREE Recommendation Excellence tools. RESULTS We identified 11 clinical practice guidelines and care bundles comprising 15 recommendations related to sedation interruption. There are three key findings: (i) deficiencies exist with the methodological quality of included guidelines, (ii) sedation interruption is recommended practice for the care of adult mechanically ventilated patients, and (iii) the current evidence is of low quality, which impacts overall credibility and applicability of the recommendations. CONCLUSIONS Sedation interruptions are currently best practice for adult mechanically ventilated patients; however, the available guidelines and recommendations have several deficiencies. Future research is needed to further understand the role of the nurse and other actors to enact this practice.
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Affiliation(s)
- Nicole D Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada; Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Brandi Vanderspank-Wright
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Melissa Demery Varin
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Letitia Nadalin Penno
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada; Department of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada.
| | - Janet E Squires
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada.
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de Boer GM, Żółkiewicz J, Strzelec KP, Ruszczyński M, Hendriks RW, Braunstahl GJ, Feleszko W, Tramper-Stranders GA. Bacterial lysate therapy for the prevention of wheezing episodes and asthma exacerbations: a systematic review and meta-analysis. Eur Respir Rev 2020; 29:29/158/190175. [PMID: 33246991 DOI: 10.1183/16000617.0175-2019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/26/2020] [Indexed: 11/05/2022] Open
Abstract
Wheezing and asthma are a growing cause of morbidity in children and adults. Treatment is aimed at prevention of disease exacerbations and preservation of lung function. Respiratory viruses are involved in ∼40-60% of exacerbations. Bacterial lysates prevent recurrent respiratory tract infections and might reduce exacerbations. Moreover, immunomodulatory effects have been observed in human and animal studies. Here we aimed to assess the effects of bacterial lysate therapy on preschool wheezing episodes and asthma exacerbation frequency. We performed a systematic literature review based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement and a meta-analysis using Cochrane Review Manager. Out of 2016 retrieved articles, 22 studies were included, of which five provided sufficient data for a meta-analysis.The use of bacterial lysates showed a decrease of both wheezing episodes (mean difference -2.35 (-3.03- -1.67), p<0.001) and asthma exacerbations in children (mean difference -0.90 (-1.23- -0.57), p<0.001). Additionally, antibiotic use was reduced, and the duration of wheezing episodes was also decreased. No data for adults with asthma are currently available. The immunomodulatory effect seems to be dependent on increased T-helper (Th)1-cell activation and Th2-cell suppression.These favourable effects of bacterial lysates indicate that they show promise as add-on therapy in preschool wheezing and childhood asthma.
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Affiliation(s)
- Geertje Maria de Boer
- Dept of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Dept of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jakub Żółkiewicz
- Dept of Paediatric Allergy and Pulmonology, The Medical University of Warsaw, Warsaw, Poland.,Joint first authors
| | - Konrad Piotr Strzelec
- Dept of Paediatric Allergy and Pulmonology, The Medical University of Warsaw, Warsaw, Poland
| | - Marek Ruszczyński
- Dept of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Rudi W Hendriks
- Dept of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- Dept of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Dept of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Wojciech Feleszko
- Dept of Paediatric Allergy and Pulmonology, The Medical University of Warsaw, Warsaw, Poland
| | - Gerdien A Tramper-Stranders
- Dept of Paediatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Dept of Neonatology, Erasmus MC-Sophia, Rotterdam, The Netherlands
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Eigenmann P. Wheezing patterns, rhinitis, and the role of the environment in atopic dermatitis. Pediatr Allergy Immunol 2020; 31:875-878. [PMID: 33463776 DOI: 10.1111/pai.13370] [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: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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Jartti T, Papadopoulos NG, Feleszko W. Reply to: Medical algorithm: Diagnosis and treatment of preschool asthma. Allergy 2020; 75:2716-2717. [PMID: 33107631 DOI: 10.1111/all.14285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/01/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Tuomas Jartti
- Department of Pediatrics Turku University Hospital and University of Turku Turku Finland
- Department of Pediatrics University of Oulu and Oulu University Hospital Oulu Finland
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
- Division of Infection Immunity & Respiratory Medicine University of Manchester Manchester UK
| | - Wojciech Feleszko
- Department of Pediatric Pneumonology and Allergy Medical University of Warsaw Warsaw Poland
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Rossi GA, Pohunek P, Feleszko W, Ballarini S, Colin AA. Viral infections and wheezing-asthma inception in childhood: is there a role for immunomodulation by oral bacterial lysates? Clin Transl Allergy 2020; 10:17. [PMID: 32509272 PMCID: PMC7255835 DOI: 10.1186/s13601-020-00322-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022] Open
Abstract
Severe and recurrent infections of the respiratory tract in early childhood constitute major risk factors for the development of bronchial hyper-responsiveness and obstructive respiratory diseases in later life. In the first years of life, the vast majority of respiratory tract infections (RTI) leading to wheezing and asthma are of a viral origin and severity and recurrence are the consequence of a greater exposure to infectious agents in a period when the immune system is still relatively immature. Therefore, boosting the efficiency of the host immune response against viral infections seems to be a rational preventative approach. In the last decades it has been demonstrated that living in farm environments, i.e. early-life exposure to microbes, may reduce the risk of allergic and infectious disorders, increasing the immune response efficacy. These findings have suggested that treatment with bacterial lysates could promote a nonspecific immunomodulation useful in the prevention of recurrent RTIs and of wheezing inception and persistence. Experimental and clinical studies showing the reduction of RTI frequency and severity in childhood and elucidating the involved mechanisms can support this hypothesis.
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Affiliation(s)
- Giovanni A. Rossi
- Department of Pediatrics, Pulmonary and Allergy Disease Unit and Cystic Fibrosis Center, G. Gaslini University Hospital, Largo G. Gaslini, 4, 16148 Genoa, Italy
| | - Petr Pohunek
- Dept of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Stefania Ballarini
- Medical Affairs Lead, Infectious Diseases, OM Pharma, a Vifor Pharma Company, Meyrin, Geneva, Switzerland
| | - Andrew A. Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL USA
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Ullmann N, Di Marco A, Columbu F, Negro V, Chiarini Testa MB, Panetta V, Tripodi S, Potapova E, Allegorico A, Matricardi PM, Cutrera R. A Novel, Portable MESH Nebulizer-An Alternative to Metered Dose Inhaler: Efficacy and Usability in Preschool Wheezers. Front Pediatr 2020; 8:598690. [PMID: 33363063 PMCID: PMC7758231 DOI: 10.3389/fped.2020.598690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction and Objectives: Wheezing episodes are the first causes of doctor's consultation in preschool age. Treatment is usually administered with a metered dose inhaler (MDI) spacer. At variance, many parents and doctors prefer to use a compressor nebulizer, which cannot be easily carried. The study is aimed at testing whether a pocket mesh nebulizer has similar efficacy and acceptability than a standard MDI device. Materials and Methods: The IPAC study was a randomized, controlled, non-inferiority trial (number: 1616/2018, Ospedale Pediatrico Bambino Gesu'-IRCCS). The study had two arms: cases, using MicroAIR U100, and controls, using MDI+spacer device. Both devices were adopted for long-term treatment and for exacerbations. Follow-up was organized with clinical visits and a daily e-diary connected to an application for mobile phone. Results: One hundred patients were enrolled. The frequency of asthmatic symptoms showed a non-inferiority for MicroAIR U100 group vs. MDI. Accordingly, no significant difference was found in the average % of days with cough, wheezing, breathlessness after exercise, days lost at school, and not-programmed visits. Considering only patients with >1 day with symptoms, no significant sdifferences were found in the number of exacerbations nor in the cumulative days with symptoms. The acceptance and usability of both devices have been favorable. However, the MDI+AeroChamber® device showed better acceptability. Conclusions: Our study shows that MicroAIR U-100, a mesh nebulizer, has similar clinical efficacy but lower acceptance and usability than an MDI plus Aerochamber® in delivering therapy in preschool wheezers. Therefore, MicroAIR U-100 might be a valuable second choice, when the delivery of medication with an MDI plus Aerochamber® is not accepted, or wrongly used by the parents.
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Affiliation(s)
- Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Research Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Antonio Di Marco
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Research Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Fabiana Columbu
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Research Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Valentina Negro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Research Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Maria Beatrice Chiarini Testa
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Research Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy & Training, Biostatistics, Rome, Italy
| | | | - Ekaterina Potapova
- Department of Pediatric Pneumology & Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annalisa Allegorico
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Research Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Paolo Maria Matricardi
- Department of Pediatric Pneumology & Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Research Institute, Bambino Gesù Children Hospital, Rome, Italy
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