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Marguet C, Gregoire, Werner A, Cracco O, L'excellent S, Rhagani J, Tamalet A, Vrignaud B, Schweitzer C, Lejeune S, Giovannini-Chami L, Mortamet G, Houdouin V. [Management of asthma attack in children aged 6 to 12 years]. Rev Mal Respir 2024; 41 Suppl 1:e75-e100. [PMID: 39256115 DOI: 10.1016/j.rmr.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Affiliation(s)
- C Marguet
- Université de Rouen-Normandie Inserm 1311 Dynamicure, CHU Rouen Département de pédiatrie et médecine de l'adolescent, unité de pneumologie et allergologie et CRCM mixte, FHU RESPIRE, 76000 Rouen, France.
| | - Gregoire
- Service de pédiatrie-urgences enfants, CHU Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - A Werner
- Pneumologie pédiatrique, 30400 Villeneuve-les Avignon, France
| | - O Cracco
- Service de pédiatrie, centre hospitalier de Saint-Nazaire, 44600 Saint-Nazaire, France
| | - S L'excellent
- Service de pneumologie pédiatrique, CHU Femme-Mere-Enfant, 69500 Bron, France
| | - J Rhagani
- Service urgences pédiatriques, CHU de Rouen, 76000 Rouen, France
| | - A Tamalet
- Pneumologie pédiatrique, 92100 Boulogne-Billancourt, France
| | - B Vrignaud
- Service pédiatrie générale, urgences pédiatriques, CHU de Nantes, 44000 Nantes, France
| | - C Schweitzer
- Université de Lorraine DeVAH, CHRU de Nancy département de pédiatrie, 54000 Nancy, France
| | - S Lejeune
- Université de Lille Inserm U1019CIIL, CNRS UMR9017, CHRU de Lille hôpital Jeanne-de-Flandres, service de pneumologie et allergologie pédiatrique, 59000 Lille, France
| | - L Giovannini-Chami
- Service de pneumologie pédiatrique, hôpitaux pédiatriques, CHU de Lenval, 06000 Nice, France
| | - G Mortamet
- Université de Grenoble Inserm U1300, CHU de Grenoble-Alpes, service de soins critiques, 38000 Grenoble, France
| | - V Houdouin
- Université de Paris-Cité Inserm U1151, CHU Robert Debré, service de pneumologie allergologie et CRCM pediatrique, AP-HP, 75019 Paris, France
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2
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Weinberger M, Hendeles L, Abu-Hasan M. Oral corticosteroids should be available on-hand at home for the next asthma exacerbation! Ann Allergy Asthma Immunol 2018; 121:18-21. [PMID: 29653237 DOI: 10.1016/j.anai.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/30/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Miles Weinberger
- Pediatric Department, University of California-San Diego, Rady Children's Hospital, San Diego, California.
| | - Leslie Hendeles
- Pediatric Department, University of Florida, Gainesville, Florida
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3
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Sarzynski LM, Turner T, Stukus DR, Allen E. Home supply of emergency oral steroids and reduction in asthma healthcare utilization. Pediatr Pulmonol 2017; 52:1546-1549. [PMID: 29034999 DOI: 10.1002/ppul.23892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/01/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine if children with moderate-to-severe persistent asthma have decreased healthcare utilization after receiving a prescription and instructions to use an at home emergency supply of oral steroids during asthma exacerbations. METHODS A quasi-experimental design study with a historical control from retrospective chart review was performed for patients aged 2-18 years seen in a tertiary care pediatric pulmonary clinic for moderate to severe persistent asthma. Baseline utilization of the emergency department, inpatient hospital, and pediatric intensive care unit for asthma exacerbations was collected from 24 months prior to initial prescription for at home steroids and compared with 12 months post-intervention using Poisson Regression. A subgroup analysis was performed for ages 6-18 evaluating school age children alone. RESULTS Patients (N = 132) were averaged 10 years ± 3.9 years of age and 57% of patients were male. Emergency Department visit rates significantly declined in the 12 months after receiving a prescription and instructions for home emergency steroid supply compared with the 12 months prior to this intervention (0.39 visits/patient/year vs 0.67, P < 0.01). There was a trend for a decline in inpatient (0.27 visits/patient/year vs 0.11, P = 0.09) and pediatric intensive care unit stay rates (0.11 visits/patient/year vs 0.05, P = 0.06). A subgroup analysis of ages 6-18 found similar results. CONCLUSIONS Incorporation of home emergency oral steroids into the home management plan of children with moderate-to-severe asthma can reduce asthma related Emergency Department visits.
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Affiliation(s)
- Lisa M Sarzynski
- Nationwide Children's Hospital Division of Pulmonary Medicine, Columbus, Ohio.,The Ohio State University College of Medicine, Columbus, Ohio
| | - Tiffany Turner
- Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Department of Pulmonary, Allergy & Sleep Medicine, Indianapolis, Indiana
| | - David R Stukus
- The Ohio State University College of Medicine, Columbus, Ohio.,Nationwide Children's Hospital Division of Allergy and Immunology, Columbus, Ohio
| | - Elizabeth Allen
- Nationwide Children's Hospital Division of Pulmonary Medicine, Columbus, Ohio.,The Ohio State University College of Medicine, Columbus, Ohio
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4
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Smith N, Smith A, Wang A, Shaw K, Groeneweg G, Goldman RD, Wilkinson B, Jimenez R, Mwai L, Carleton B. Physician and parent barriers to the use of oral corticosteroids for the prevention of paediatric URTI-induced acute asthma exacerbations at home. Paediatr Child Health 2017; 22:190-194. [PMID: 29479212 DOI: 10.1093/pch/pxx047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives Administration of oral corticosteroids at the onset of an upper respiratory tract infection (URTI) can be effective in the management of acute asthma exacerbations in children. This study was designed to identify barriers to parent-initiated implementation of clinical practice guideline-recommended use of oral corticosteroids for prophylaxis against severe asthma exacerbations in children. Methods Twenty-seven children who presented to BC Children's Hospital with URTI-induced asthma exacerbations were recruited. Parents received a filled prescription for a course of oral corticosteroids to be used at the earliest onset of their child's next URTI. Each family was contacted monthly over a 1-year period to inquire about URTI events, asthma symptoms, medication use and health care utilization. Focus groups were held with family physicians, paediatricians and parents; transcripts were analyzed qualitatively to identify key themes. Results Incidence of URTI events among participants was high (85%). Uptake of study medication was low; 44% used the medication as directed at their first URTI event. Eleven per cent of the patients who used the study medication also visited the emergency department for an exacerbation. Focus groups identified four main barriers to the effective use of parent-initiated oral corticosteroids: physician resistance and conflicting messages from providers; parent uncertainty about oral corticosteroids; multiple caregivers and relative ease of access to an emergency department. Conclusion We have identified key barriers to the effective use of parent-administered oral corticosteroids as an asthma management strategy and gained important insights regarding the research that is required to enhance the applicability of the strategy.
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Affiliation(s)
- Neale Smith
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia
| | - Anne Smith
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Alice Wang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
| | - Kaitlyn Shaw
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Gabriella Groeneweg
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Ran D Goldman
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pediatric Research in Emergency Therapeutics (PRETx.org), Division of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia
| | - Bryan Wilkinson
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Ricardo Jimenez
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Leah Mwai
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Bruce Carleton
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
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5
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Kitazawa H, Yamaide A, Wada T, Arakawa H. CQ8 Are systemic corticosteroids for prevention of relapse following acute exacerbations of bronchial asthma in children effective? ACTA ACUST UNITED AC 2017. [DOI: 10.3388/jspaci.31.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hiroshi Kitazawa
- Department of general Pediatrics, Division of Allergy, Miyagi Children’s Hospital
| | - Akiko Yamaide
- Department of Allergy and Rheumatology, Chiba Children’s Hospital
| | - Takuya Wada
- Department of Pediatrics, University of Toyama
| | - Hirokazu Arakawa
- Department of Pediatrics, Gunma University Graduate School of Medicine
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6
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Ganaie MB, Munavvar M, Gordon M, Lim HF, Evans DJW. Patient- and parent-initiated oral steroids for asthma exacerbations. Cochrane Database Syst Rev 2016; 12:CD012195. [PMID: 27943237 PMCID: PMC6463969 DOI: 10.1002/14651858.cd012195.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Asthma is a chronic inflammatory disease of the airways affecting an estimated 334 million people worldwide. During severe exacerbations, patients may need to attend a medical centre or hospital emergency department for treatment with systemic corticosteroids, which can be administered intravenously or orally. Some people with asthma are prescribed oral corticosteroids (OCS) for self-administration (i.e. patient-initiated) or to administer to their child with asthma (i.e. parent-initiated), in the event of an exacerbation. This approach to treatment is becoming increasingly common. OBJECTIVES To evaluate the effectiveness and safety of patient- or parent-initiated oral steroids for adults and children with asthma exacerbations. SEARCH METHODS We identified trials from Cochrane Airways' Specialised Register (CASR) and also conducted a search of the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch). We searched CASR from its inception to 18 May 2016 and trial registries from their inception to 24 August 2016; we imposed no restriction on language of publication. SELECTION CRITERIA We looked for randomised controlled trials (RCTs), reported as full-text, those published as abstract only, and unpublished data; we excluded cross-over trials.We looked for studies where adults (aged 18 years or older) or children of school age (aged 5 years or older) with asthma were randomised to receive: (a) any patient-/parent-initiated OCS or (b) placebo, normal care, alternative active treatment, or an identical personalised asthma action plan without the patient- or parent-initiated OCS component. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results to identify any studies that met the prespecified inclusion criteria.The prespecified primary outcomes were hospital admissions for asthma, asthma symptoms at follow-up and serious adverse events. MAIN RESULTS Despite comprehensive searches of electronic databases and clinical trial registries, we did not identify any studies meeting the inclusion criteria for this review. Five potentially relevant studies were excluded for two reasons: the intervention did not meet the inclusion criteria for this review (three studies) and studies had a cross-over design (two studies). Two of the excluded studies asked the relevant clinical question. However, these studies were excluded due to their cross-over design, as per the protocol. We contacted the authors of the cross-over trials who were unable to provide data for the first treatment period (i.e. prior to cross-over). AUTHORS' CONCLUSIONS There is currently no evidence from randomised trials (non-cross-over design) to inform the use of patient- or parent-initiated oral corticosteroids in people with asthma.
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Affiliation(s)
| | - M Munavvar
- Lancashire Teaching Hospitals NHS Foundation TrustRespiratory MedicinePrestonUK
| | - Morris Gordon
- University of Central LancashireSchool of Medicine and DentistryPrestonUK
- Blackpool Victoria HospitalFamilies DivisionBlackpoolUK
| | - Hui F Lim
- National University Health System, Division of Respiratory & Critical Care MedicineSingapore CitySingapore
| | - David JW Evans
- Lancaster UniversityLancaster Health HubLancasterUKLA1 4YG
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7
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Ganaie MB, Munavvar M, Gordon M, Evans DJW. Patient- and parent-initiated oral steroids for asthma exacerbations. Cochrane Database Syst Rev 2016. [DOI: 10.1002/14651858.cd012195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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8
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Gaillard EA, McNamara PS, Murray CS, Pavord ID, Shields MD. Blood eosinophils as a marker of likely corticosteroid response in children with preschool wheeze: time for an eosinophil guided clinical trial? Clin Exp Allergy 2016; 45:1384-95. [PMID: 25809678 DOI: 10.1111/cea.12535] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Childhood wheezing is common particularly in children under the age of 6 years and in this age group is generally referred to as preschool wheezing. Particular diagnostic and treatment uncertainties exist in these young children due to the difficulty in obtaining objective evidence of reversible airways narrowing and inflammation. A diagnosis of asthma depends on the presence of relevant clinical signs and symptoms and the demonstration of reversible airways narrowing on lung function testing, which is difficult to perform in young children. Few treatments are available and inhaled corticosteroids are the recommended preventer treatment in most international asthma guidelines. There is, however, considerable controversy about its effectiveness in children with preschool wheeze and a corticosteroid responder phenotype has not been established. These diagnostic and treatment uncertainties in conjunction with the knowledge of corticosteroid side effects, in particular the reduction of growth velocity, have resulted in a variable approach to inhaled corticosteroid prescribing by medical practitioners and a reluctance in carers to regularly administer the treatment. Identifying children who are likely responders to corticosteroid therapy would be a major benefit in the management of this condition. Eosinophils have emerged as a promising biomarker of corticosteroid responsive airways disease, and evaluation of this biomarker in sputum has successfully been employed to direct management in adults with asthma. Obtaining sputum from young children is time consuming and difficult, and it is hard to justify more invasive procedures such as a bronchoscopy in young children routinely. Recently, in children, interest has shifted to assessing the value of less invasive biomarkers of likely corticosteroid response and the biomarker 'blood eosinophils' has emerged as an attractive candidate. The aim of this review was to summarize the evidence for blood eosinophils as a predictive biomarker for corticosteroid responsive disease with a particular focus on the difficult area of preschool wheeze.
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Affiliation(s)
- E A Gaillard
- Department of Infection Immunity and Inflammation, NIHR Leicester Respiratory Biomedical Research Unit, Institute for Lung Health, University of Leicester, Leicester, Leicestershire, UK
| | - P S McNamara
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | - C S Murray
- Respiratory and Allergy Centre, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - I D Pavord
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - M D Shields
- Centre for Infection and Immunity, Health Sciences, Queen's University Belfast, Belfast, UK
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9
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Hughes D. Treating asthma flareups at home - an opinion. Paediatr Child Health 2015; 20:429-431. [PMID: 26744554 PMCID: PMC4699526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 06/05/2023] Open
Affiliation(s)
- Daniel Hughes
- Correspondence: Dr Daniel Hughes, Department of Respirology, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, Nova Scotia B3K 6R8. Telephone 902-470-8218, e-mail
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10
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Franzese C. Management of acute asthma exacerbations. Int Forum Allergy Rhinol 2015; 5 Suppl 1:S51-6. [PMID: 26034013 DOI: 10.1002/alr.21554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acute asthma exacerbations are common events in the lives of asthmatics, and even the best-managed asthma patients will have acute asthma exacerbations. There are different levels of severity of exacerbations with corresponding management strategies the physician can use to treat acute events. These strategies, including some adjunctive therapies, are reviewed in this article. METHODS A review of the English-language scientific literature was performed regarding management of acute asthma exacerbations, focusing of published guidelines, meta-analyses, and database reviews. RESULTS Symptoms of exacerbations are reviewed with attention to determining the severity of the exacerbation and the place of management, either at home or in a more acute care setting. Medical therapies for the treatment of each severity level are reviewed as to their effectiveness. Post-exacerbation care is also discussed. CONCLUSION Asthma exacerbations will happen and both the provider and patient need to be educated on how to manage these occurrences. Whether the patient is managed at home or in a hospital setting will be determined by the level of severity. Regardless of the medical therapies employed, continued focus should be on further prevention of additional exacerbations.
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Affiliation(s)
- Christine Franzese
- Department of Otolaryngology, Eastern Virginia School of Medicine, Norfolk, VA
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11
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Oliver BGG, Robinson P, Peters M, Black J. Viral infections and asthma: an inflammatory interface? Eur Respir J 2014; 44:1666-81. [PMID: 25234802 DOI: 10.1183/09031936.00047714] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asthma is a chronic inflammatory disease of the airways in which the majority of patients respond to treatment with corticosteroids and β₂-adrenoceptor agonists. Acute exacerbations of asthma substantially contribute to disease morbidity, mortality and healthcare costs, and are not restricted to patients who are not compliant with their treatment regimens. Given that respiratory viral infections are the principal cause of asthma exacerbations, this review article will explore the relationship between viral infections and asthma, and will put forward hypotheses as to why virus-induced exacerbations occur. Potential mechanisms that may explain why current therapeutics do not fully inhibit virus-induced exacerbations, for example, β₂-adrenergic desensitisation and corticosteroid insensitivity, are explored, as well as which aspects of virus-induced inflammation are likely to be attenuated by current therapy.
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Affiliation(s)
- Brian G G Oliver
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, Australia Woolcock Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Paul Robinson
- Woolcock Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, Australia Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Mathew Peters
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia Dept of Thoracic Medicine, Concord General Hospital, Concord, Australia
| | - Judy Black
- Woolcock Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, Australia
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12
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Fu LS, Tsai MC. Asthma exacerbation in children: a practical review. Pediatr Neonatol 2014; 55:83-91. [PMID: 24211086 PMCID: PMC7102856 DOI: 10.1016/j.pedneo.2013.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/21/2013] [Accepted: 07/09/2013] [Indexed: 11/18/2022] Open
Abstract
Asthma is the most common chronic lower respiratory tract disease in childhood throughout the world. Despite advances in asthma management, acute exacerbations continue to be a major problem in patients and they result in a considerable burden on direct/indirect health care providers. A severe exacerbation occurring within 1 year is an independent risk factor. Respiratory tract viruses have emerged as the most frequent triggers of exacerbations in children. It is becoming increasingly clear that interactions may exist between viruses and other triggers, increasing the likelihood of an exacerbation. In this study, we provide an overview of current knowledge about asthma exacerbations, including its definition, impact on health care providers, and associated factors. Prevention management in intermittent asthma as well as intermittent wheeze in pre-school children and those with persistent asthma are discussed. Our review findings support the importance of controlling persistent asthma, as indicated in current guidelines. In addition, we found that early episodic intervention appeared to be crucial in preventing severe attacks and future exacerbations. Besides the use of medication, timely education after an exacerbation along with a comprehensive plan in follow up is also vitally important.
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Affiliation(s)
- Lin-Shien Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Pediatrics, National Yang-Ming University, Taipei, Taiwan; Institute of Technology, National Chi-Nan University, Nanto, Taiwan.
| | - Ming-Chin Tsai
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
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13
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Robinson PD, Van Asperen P. Update in paediatric asthma management: where is evidence challenging current practice? J Paediatr Child Health 2013; 49:346-52. [PMID: 21470328 DOI: 10.1111/j.1440-1754.2010.01975.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extrapolation of management strategies based on results from predominantly adult asthma studies frequently occurs in paediatric asthma despite increasing evidence that paediatric asthma and, in particular, pre-school recurrent wheeze are very different disease entities. Response to medications in paediatric subjects is often different from that seen in their older adolescent and adult counterparts. In this update, we discussed recent studies that have had important implications for future paediatric asthma management. The overuse of combination inhaled steroid and long-acting beta2 agonist inhalers in paediatric asthma despite ongoing safety concerns is an increasing trend in paediatric asthma, and recent evidence has helped clarify how they should be used in children. Other aspects discussed include the role of oral corticosteroids in pre-school viral-induced wheeze and the utility of leukotriene receptor antagonists in exercise-induced asthma.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, New South Wales, Australia.
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14
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Abstract
The principal aims of asthma management in childhood are to obtain symptom control that allows individuals to engage in unrestricted physical activities and to normalize lung function. These aims should be achieved using the fewest possible medications. Ensuring a correct diagnosis is the first priority. The mainstay of asthma management remains pharmacotherapy. Various treatment options are discussed. Asthma monitoring includes the regular assessment of asthma severity and asthma control, which then informs decisions regarding the stepping up or stepping down of therapy. Delivery systems and devices for inhaled therapy are discussed, as are the factors influencing adherence to prescribed treatment. The role of the pediatric health care provider is to establish a functional partnership with the child and their family in order to minimize the impact of asthma symptoms and exacerbations during childhood.
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Affiliation(s)
- André Schultz
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia
| | - Andrew C. Martin
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia
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15
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Okpapi A, Friend AJ, Turner SW. Asthma and other recurrent wheezing disorders in children (acute). BMJ CLINICAL EVIDENCE 2012; 2012:0300. [PMID: 24807832 PMCID: PMC3390594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Acute childhood asthma is a common clinical emergency presenting across a range of ages and with a range of severities. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute asthma in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 35 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta2 agonists (high-dose nebulised, metered-dose inhaler plus spacer device versus nebuliser, intravenous), corticosteroids (systemic, high-dose inhaled), ipratropium bromide (single- or multiple-dose inhaled), magnesium sulphate, oxygen, and theophylline or aminophylline.
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16
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de Benedictis FM, Bush A. Corticosteroids in respiratory diseases in children. Am J Respir Crit Care Med 2012; 185:12-23. [PMID: 21920920 DOI: 10.1164/rccm.201107-1174ci] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We review recent advances in the use of corticosteroids (CS) in pediatric lung disease. CS are frequently used, systemically or by inhalation. Their mechanisms of action in pulmonary diseases are ill defined. CS exert direct inhibitory effects on many inflammatory cells through genomic mechanisms. There is a time lag before clinical response, and the washout of effects is also prolonged. Prompt relief in some conditions, such as croup, may be related to airway mucosal vasoconstriction through a nongenomic mechanism. CS have proven beneficial roles in the treatment of asthma, croup, allergic bronchopulmonary aspergillosis, and subglottic hemangioma. In some conditions, such as bronchiolitis, cystic fibrosis, and bronchopulmonary dysplasia, their use is controversial and is not recommended routinely. In other conditions, such as tuberculosis, interstitial lung disease, acute lung aspiration, and acute respiratory distress syndrome, CS are often used empirically despite the lack of clear evidence of their benefit. New drug regimens, including the more flexible use of inhaled corticosteroids and long-acting β-agonists in asthma, the lack of efficacy of oral corticosteroids in preschool children with acute wheeze, the severe complications of systemic dexamethasone used to prevent bronchopulmonary dysplasia and thus more restricted use, and the beneficial effect of pulse high-dose intravenous methylprednisolone in patients with allergic bronchopulmonary aspergillosis or cystic fibrosis are among the major recent developments. There is concern about adverse effects, especially growth and adrenal suppression, induced by systemic CS in children. These have been reduced, but not eliminated, with the use of the inhaled route. The benefits must be weighed against the potential detrimental effects.
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17
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Lougheed MD, Lemiere C, Ducharme FM, Licskai C, Dell SD, Rowe BH, FitzGerald M, Leigh R, Watson W, Boulet LP. Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. Can Respir J 2012; 19:127-64. [PMID: 22536582 PMCID: PMC3373283 DOI: 10.1155/2012/635624] [Citation(s) in RCA: 209] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and⁄or gaps in the previous guidelines. METHODS Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations. RESULTS The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified. CONCLUSIONS The present clinical practice guideline is the first update of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee's new guideline development process. Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide updates reflecting new evidence.
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Schultz A, Brand PLP. Phenotype-directed treatment of pre-school-aged children with recurrent wheeze. J Paediatr Child Health 2012; 48:E73-8. [PMID: 21679334 DOI: 10.1111/j.1440-1754.2011.02123.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Wheeze in childhood may comprise different underlying diseases. Disease-specific treatment could potentially improve treatment efficacy. Various attempts have been made to differentiate between pre-school wheeze phenotypes. In this review, the results of clinical trials evaluating treatment of pre-school wheeze are discussed, with specific emphasis on the characteristics and phenotype of the study populations. Evidence suggests that systemic corticosteroids are not beneficial for the treatment of mild-to-moderate exacerbations of pre-school wheeze, irrespective of phenotype. The use of high-dose intermittent inhaled corticosteroid treatment cannot be recommended because of unacceptable side effects. Treatment with regular inhaled corticosteroids and leukotriene antagonists offer modest benefit, but neither treatment reduces hospitalisation rates. There is currently some evidence for a phenotype-specific effect of treatment. Phenotype-directed treatment of pre-school wheeze is currently limited by our ability to accurately differentiate between clinically useful phenotypes.
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Affiliation(s)
- André Schultz
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
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The role of parent-initiated oral corticosteroids in preschool wheeze and school-aged asthma. Curr Opin Allergy Clin Immunol 2011; 11:187-91. [PMID: 21464710 DOI: 10.1097/aci.0b013e3283461709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the theoretical background and current evidence regarding parent-initiated oral corticosteroid (PIOCS) therapy in preschool wheeze and asthma in school-aged children. RECENT FINDINGS In school-aged children with asthma PIOCS, given during acute episodes, has been associated with a modest reduction in asthma symptoms and health resource utilisation. In preschool wheeze, OCS (including PIOCS) therapy appears to be ineffective. SUMMARY PIOCS is associated with modest benefits among school-aged children with acute asthma but is not effective among children with preschool wheeze. In older children with asthma, the potential benefits of PIOCS must be balanced against potential adverse effects associated with increased OCS administration.
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:269-73. [PMID: 21516010 DOI: 10.1097/aci.0b013e3283473da8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pham Thi T, Scheinmann P, Karila C, Laurent J, Paty E, de Blic J. Syndrome dermorespiratoire : un phénotype sévère. REVUE FRANCAISE D ALLERGOLOGIE 2011. [DOI: 10.1016/j.reval.2011.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Davidson PM, De Geest S, Hill MN. Nurses addressing the challenges of chronic illness: From primary to palliative care. Collegian 2010; 17:43-5. [DOI: 10.1016/j.colegn.2010.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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