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Filipow N, Turner S, Petsky HL, Chang AB, Frischer T, Szefler S, Vermeulen F, Stanojevic S. Variability in forced expiratory volume in 1 s in children with symptomatically well-controlled asthma. Thorax 2024:thorax-2024-221755. [PMID: 39332902 DOI: 10.1136/thorax-2024-221755] [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: 04/03/2024] [Accepted: 09/09/2024] [Indexed: 09/29/2024]
Abstract
AIMS Spirometry is used by many clinicians to monitor asthma in children but relatively little is understood about its variability over time. The aim of this study was to determine the variability of forced expiratory volume in 1 s (FEV1) in children with symptomatically well-controlled asthma by applying three different methods of expressing change in FEV1 over 3-month intervals. METHODS Data from five longitudinal studies of children with asthma which measured FEV1 at 3-month intervals over 6 or 12 months were used. We analysed paired FEV1 measurements when asthma symptoms were controlled. The variability of FEV1% predicted (FEV1%), FEV1 z-score (FEV1z) and conditional z score for change (Zc) in FEV1 was expressed as limits of agreement. RESULTS A total of 881 children had 3338 FEV1 measurements on occasions when asthma was controlled; 5184 pairs of FEV1 measurements made at 3-month intervals were available. Each unit change in FEV1 z score was equivalent to a Zc 1.45 and an absolute change in FEV1% of 11.6%. The limits of agreement for change in FEV1% were -20 and +21, absolute change in FEV1 z were -1.7 and +1.7 and Zc were -2.6 and +2.1. Regression to the mean and increased variability in younger children were present for change in FEV1% and FEV1z comparisons, but not Zc. CONCLUSION Given the wide limits of agreement of paired FEV1 measurements in symptomatically well-controlled children, asthma treatment should primarily be guided by symptoms and not by a change in spirometry.
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Affiliation(s)
- Nicole Filipow
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Stephen Turner
- NHS Grampian, Aberdeen, UK
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Helen L Petsky
- School of Nursing and Midwifery, Griffith University Menzies Health Institute, Nathan, Queensland, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, Queensland, Australia
| | | | - Stanley Szefler
- Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Francoise Vermeulen
- Department of Integrated Paediatrics, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Sanja Stanojevic
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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2
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Drummond D, Mazenq J, Lezmi G, Cros P, Coutier L, Desse B, Divaret-Chauveau A, Dubus JC, Girodet PO, Kiefer S, Llerena C, Pouessel G, Troussier F, Werner A, Schweitzer C, Lejeune S, Giovannini-Chami L. [Therapeutic management and adjustment of long-term treatment]. Rev Mal Respir 2024; 41 Suppl 1:e35-e54. [PMID: 39181752 DOI: 10.1016/j.rmr.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Affiliation(s)
- D Drummond
- Service de pneumologie et d'allergologie pédiatrique, hôpital Necker, AP-HP, université Paris Cité, Paris, France
| | - J Mazenq
- Service de pneumologie pédiatrique, hôpital la Timone, AP-HM, université Aix-Marseille, Marseille, France
| | - G Lezmi
- Service de pneumologie et d'allergologie pédiatrique, hôpital Necker, AP-HP, université Paris Cité, Paris, France
| | - P Cros
- Service de pédiatrie, CHU Morvan, Brest, France
| | - L Coutier
- Unité Inserm U1028, CNRS, UMR 5292, université de Lyon 1, Lyon, France; Service de pneumologie pédiatrique, hospices civils de Lyon, hôpital Femme-Mère-Enfant, Bron, France
| | - B Desse
- Service de pédiatrie-néonatalogie, CH de Grasse, Grasse, France
| | - A Divaret-Chauveau
- Service de médecine infantile et explorations fonctionnelles pédiatriques, DeVAH EA 3450, hôpital d'enfants, faculté de médecine de Nancy, CHRU de Nancy, université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - J-C Dubus
- Service de pneumologie pédiatrique, hôpital la Timone, AP-HM, université Aix-Marseille, Marseille, France
| | - P-O Girodet
- CIC1401, service de pharmacologie médicale, CHU de Bordeaux, université de Bordeaux, Bordeaux, France
| | - S Kiefer
- Service de médecine infantile et explorations fonctionnelles pédiatriques, DeVAH EA 3450, hôpital d'enfants, faculté de médecine de Nancy, CHRU de Nancy, université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - C Llerena
- UTEP 38, hôpital Couple-Enfant, CHU de Grenoble Alpes, Grenoble, France
| | - G Pouessel
- ULR 2694 : METRICS, université de Lille, Lille, France; Service de pédiatrie, CH de Roubaix, Roubaix, France; Univ. Lille, Service de pneumologie et d'allergologie pédiatrique, hôpital Jeanne de Flandre, CHU de Lille, F-59000 Lille, France
| | - F Troussier
- Service de pédiatrie, CHU d'Angers, Angers, France
| | - A Werner
- Pôle pédiatrique, Association française de pédiatrie ambulatoire (AFPA) Ancenis Saint-Géreon, Villeneuve-lès-Avignon, France
| | - C Schweitzer
- Service de médecine infantile et explorations fonctionnelles pédiatriques, DeVAH EA 3450, hôpital d'enfants, faculté de médecine de Nancy, CHRU de Nancy, université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - S Lejeune
- Univ. Lille, Service de pneumologie et d'allergologie pédiatrique, hôpital Jeanne de Flandre, CHU de Lille, F-59000 Lille, France..
| | - L Giovannini-Chami
- Service de pneumologie et d'allergologie pédiatrique, hôpitaux pédiatriques de Nice CHU-Lenval, université Côte d'Azur, Nice, France
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3
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van Boven FE, Braunstahl GJ, Arends LR, van Maaren MS, Bramer WM, van Wijk RG, de Jong NW. House dust mite allergen avoidance strategies for the treatment of allergic asthma: A hypothesis-generating meta-analysis. World Allergy Organ J 2024; 17:100919. [PMID: 38966606 PMCID: PMC11223119 DOI: 10.1016/j.waojou.2024.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 07/06/2024] Open
Abstract
Background This study continues the review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187), aiming to systematically generate hypotheses on the effectiveness of (sub)strategies for house dust mite allergen avoidance in the treatment of allergic asthma. Methods We used the trials previously analysed by Gøtzsche and Johansen and searched recently published studies. Data on asthma symptom scores (ASS), ACQ, number of improved patients, AQLQ-scores, medication use, FEV1%, PC20, and FeNO levels were analysed. The effectiveness of strategies was assessed using Metafor in R. Results Thirty-five trials involving 2419 patients were included in the final study. The patient-reported outcome number of patients with improved condition following total bedroom control was RR = 3.39 (95% confidence interval: 1.04 to 11.04, P = 0.04). The mean differences in the ASS by nocturnal air purification was -0.7 (95% confidence interval: -1.08 to -0.32, P < 0.001). Other outcomes including partial bedroom control were non-significant or clinically not of importance. Conclusions Total bedroom control and nocturnal air purification of the breathing zone hypothetically provides clinical benefits in patients with house dust mite-induced allergic asthma. The number of patients with improvements in their condition respectively the asthma symptom score differences showed potential in small subgroups, consisting of single studies. Partial bedroom control is not recommended. Systematic Review Registration Prospero CRD42022323660.
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Affiliation(s)
- Frank E. van Boven
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, P.O. Box 10900, 3004 BA, Rotterdam, the Netherlands
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Lidia R. Arends
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
- Department of Biostatistics & Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Maurits S. van Maaren
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Wichor M. Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Nicolette W. de Jong
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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4
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Chen J, Xiao J, Liu L, Ali K, Wu S. Predictive Value of Impulse Oscillometry Combined with Fractional Expiratory Nitric Oxide Test for Asthma in Preschool Children. J Asthma Allergy 2024; 17:421-430. [PMID: 38736906 PMCID: PMC11088859 DOI: 10.2147/jaa.s460193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Objective Prediction of asthma in preschool children is challenging and lacks objective indicators. The aim is to observe and analyze the variances between impulse oscillometry (IOS) and fractional expiratory nitric oxide (FeNO) in preschool children with wheezing, establish a joint prediction model, and explore the diagnostic value of combining IOS with FeNO in diagnosing asthma among preschool children. Patients and methods This study enrolled children aged 3-6 years with wheezing between June 2021 and June 2022. They were categorized as asthmatic (n=104) or non-asthmatic (n=109) after a 1-year follow-up. Clinical data, along with IOS and FeNO measurements from both groups, underwent univariate regression and multiple regression analyses to identify predictive factors and develop the most accurate model. The prediction model was built using the stepwise (stepAIC) method. The receiver operating characteristic curve (ROC), calibration curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) were employed to validate and assess the model. Results During univariate analysis, a history of allergic rhinitis, a history of eczema or atopic dermatitis, and measures including FeNO, R5, X5, R20, Fres, and R5-R20 were found to be associated with asthma diagnosis. Subsequent multivariate analysis revealed elevated FeNO, R5, and X5 as independent risk factors. The stepAIC method selected five factors (history of allergic rhinitis, history of eczema or atopic dermatitis, FeNO, R5, X5) and established a prediction model. The combined model achieved an AUROC of 0.94, with a sensitivity of 0.89 and specificity of 0.88, surpassing that of individual factors. Calibration plots and the HL test confirmed satisfactory accuracy. Conclusion This study has developed a prediction model based on five factors, potentially aiding clinicians in early identification of asthma risk among preschool children.
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Affiliation(s)
- Junsong Chen
- Department of Pulmonology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China
| | - Jiying Xiao
- Department of Pulmonology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China
| | - Lingyue Liu
- Department of Pulmonology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China
| | - Kamran Ali
- Department of Oncology, the Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang, 322000, People’s Republic of China
| | - Suling Wu
- Department of Pulmonology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China
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5
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Au-Doung PLW, Chan JCH, Kui OYH, Ho MKY, Cheung YT, Lam JKW, Chan HK, Brannan J, Chan KCC, Li AM, Leung SSY. Objective monitoring tools for improved management of childhood asthma. Respir Res 2024; 25:194. [PMID: 38702779 PMCID: PMC11069259 DOI: 10.1186/s12931-024-02817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024] Open
Abstract
Asthma is a common chronic disease amongst children. Epidemiological studies showed that the mortality rate of asthma in children is still high worldwide. Asthma control is therefore essential to minimize asthma exacerbations, which can be fatal if the condition is poorly controlled. Frequent monitoring could help to detect asthma progression and ensure treatment effectiveness. Although subjective asthma monitoring tools are available, the results vary as they rely on patients' self-perception. Emerging evidence suggests several objective tools could have the potential for monitoring purposes. However, there is no consensus to standardise the use of objective monitoring tools. In this review, we start with the prevalence and severity of childhood asthma worldwide. Then, we detail the latest available objective monitoring tools, focusing on their effectiveness in paediatric asthma management. Publications of spirometry, fractional exhaled nitric oxide (FeNO), hyperresponsiveness tests and electronic monitoring devices (EMDs) between 2016 and 2023 were included. The potential advantages and limitations of each tool were also discussed. Overall, this review provides a summary for researchers dedicated to further improving objective paediatric asthma monitoring and provides insights for clinicians to incorporate different objective monitoring tools in clinical practices.
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Affiliation(s)
- Phillip L W Au-Doung
- School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C H Chan
- School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Oliver Y H Kui
- School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marco K Y Ho
- School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jenny K W Lam
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, WC1N 1AX, UK
| | - Hak-Kim Chan
- Sydney Pharmacy School, University of Sydney, Sydney, NSW, Australia
| | - John Brannan
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Kate C C Chan
- Department of Paediatrics, Prince of Wales Hospital, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert M Li
- Department of Paediatrics, Prince of Wales Hospital, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sharon S Y Leung
- School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
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6
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Isik E, Mack G, Sockrider MM, Fredland NM, Shegog R. Assessing Available Adolescent Self-Reported Measures for Asthma Management: A Systematic Literature Review. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:69-89. [PMID: 37669446 DOI: 10.1089/ped.2023.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Objective: Asthma is a common chronic disease and a substantial public health problem for children, adolescents, and adults. Adolescence, a period of increased independence and striving for autonomy, is an opportune time for youth transitioning to adulthood to assume more responsibility for their own asthma self-management. However, accurate measures of adolescent asthma outcomes are limited. The purpose of this systematic review is to identify self-reported asthma measures currently available in the empirical literature focused on adolescent populations. Methods: Search terms were based on the National Library of Medical Subject Headings and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases searched included CINAHL, Nursing Allied Health Prevention, Medline, ProQuest, and PubMed. Included studies were peer reviewed and published in English between 2010 and 2022. All studies reported on asthma measures for adolescents between 10 and 19 years old. Results: Nineteen studies were included, comprising 15 experimental and 4 quasi-experimental. This review revealed the following asthma measure domains: asthma knowledge, self-efficacy, attitudes, self-care, self-regulation, symptom prevention and management, medication adherence, asthma disease control, symptoms, and quality of life (QOL) for evaluating psychosocial, behavioral, clinical, and QOL outcomes. Conclusion: This review revealed the necessity of developing a comprehensive measure to assess the asthma self-management behaviors of adolescents. A comprehensive tool related to adolescent asthma self-management behavior would enhance the assessment and evaluation of adolescent asthma self-management behaviors and extend the science and clinical practice around adolescent self-management. Present measures for asthma self-management behavior for adolescents are limited; therefore, developing a valid and reliable measure is necessary not only to assess adolescents' asthma self-management behavior outcomes but also to identify and evaluate the essential components to include in educational interventions for adolescent self-management.
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Affiliation(s)
- Elif Isik
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Gardner Mack
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Marianna M Sockrider
- Pediatric Pulmonology, Texas Children's Hospital, Houston, Texas, USA
- Pediatric Pulmonology, Baylor College of Medicine, Houston, Texas, USA
| | - Nina M Fredland
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Ross Shegog
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas, Houston, Texas, USA
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7
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Onisor MO, Turner S. Routine FEV 1 measurement is essential in diagnosis and monitoring of childhood asthma: myth or maxim? Breathe (Sheff) 2023; 19:230048. [PMID: 37645020 PMCID: PMC10461742 DOI: 10.1183/20734735.0048-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/11/2023] [Indexed: 08/31/2023] Open
Abstract
Childhood asthma is a common condition in children. This review describes the evidence from seven asthma guidelines for using spirometry in the diagnosis and monitoring of childhood asthma. All guidelines recommend spirometry as the primary test to be performed for diagnosing asthma in children aged >5 years. Spirometry is often normal in children with asthma. Guidelines are not consistent with respect to whether forced expiratory volume in 1 s (FEV1) or FEV1/forced vital capacity (FVC) should be measured, or their threshold for "abnormal" spirometry, and we describe the sensitivity and specificity for these different cut-offs. The role of spirometry in monitoring asthma is less clear in the guidelines, and some do not suggest spirometry should be done. There is no consensus on what spirometric measurement should be used, how often it should be measured and what is a minimum clinically important change in spirometry. The role of spirometry in diagnosing asthma is more clearly established when compared to its role in monitoring asthma. The potential of spirometry to aid decision making for asthma diagnosis and monitoring in children remains to be fully evaluated. Educational aims To provide knowledge of the commonly used guidelines for asthma diagnosis and management.To give insight into the opportunities and challenges in using spirometry to diagnose and monitor asthma in children.To provide an understanding of the precision of spirometry for diagnosing asthma.
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Affiliation(s)
| | - Steve Turner
- Division of Women and Children, NHS Grampian, Aberdeen, UK
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8
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Papadopoulos NG, Mathioudakis AG, Custovic A, Deschildre A, Phipatanakul W, Wong G, Xepapadaki P. Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders. JAMA Netw Open 2023; 6:e2313120. [PMID: 37171821 PMCID: PMC10182430 DOI: 10.1001/jamanetworkopen.2023.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Childhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority. Objective To assess actual and perceived optimal childhood asthma monitoring practices used globally. Design, Setting, and Participants This international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies. Main Outcomes and Measures Outcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains. Results A total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest. Conclusions and Relevance These survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, Second Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty or Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Alexander G Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty or Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- North West Lung Centre, Wythenshawe Hospital, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Antoine Deschildre
- Center for Infection and Immunity of Lille, Institut Pasteur de Lille, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Université de Lille, Lille, France
| | - Wanda Phipatanakul
- Department of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Gary Wong
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Paraskevi Xepapadaki
- Allergy Department, Second Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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9
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Hopp RJ, Wilson MC, Pasha MA. Redefining biomarkers in pediatric asthma: A commentary. J Asthma 2023:1-7. [PMID: 36894331 DOI: 10.1080/02770903.2023.2189947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Russell J Hopp
- University of Nebraska Medical Center and Children's Hospital and Medical Center, Department of Pediatrics, Omaha, NE 68114
| | - Mark C Wilson
- University of Nebraska Medical Center and Children's Hospital and Medical Center, Department of Pediatrics, Omaha, NE 68114
| | - M Asghar Pasha
- Division of Allergy and Immunology, Albany Medical College, 176 Washington Avenue Extension, Suite 102, Albany, NY 12203
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10
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Xepapadaki P, Adachi Y, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, Filipovic I, Le Souef P, Morais-Almeida M, Miligkos M, Nieto A, Phipatanakul W, Pitrez PM, Wang JY, Wong GW, Papadopoulos NG. Utility of biomarkers in the diagnosis and monitoring of asthmatic children. World Allergy Organ J 2022; 16:100727. [PMID: 36601259 PMCID: PMC9791923 DOI: 10.1016/j.waojou.2022.100727] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Asthma imposes a heavy morbidity burden during childhood; it affects over 10% of children in Europe and North America and it is estimated to exceed 400 million people worldwide by the year 2025. In clinical practice, diagnosis of asthma in children is mostly based on clinical criteria; nevertheless, assessment of both physiological and pathological processes through biomarkers, support asthma diagnosis, aid monitoring, and further lead to better treatment outcomes and reduced morbidity. Recently, identification and validation of biomarkers in pediatric asthma has emerged as a top priority across leading experts, researchers, and clinicians. Moreover, the implementation of non-invasive biomarkers for the assessment and monitoring of paediatric patients with asthma, has been prioritized; however, only a proportion of them are currently included in the clinical practise. Although, the use of non-invasive biomarkers is highly supported in recent asthma guidelines for documenting diagnosis and supporting monitoring of asthmatic patients, data on the Pediatric population are limited. In the present report, the Pediatric Asthma Committee of the World Allergy Organization (WAO), aims to summarize and discuss available data for the implementation of non-invasive biomarkers in the diagnosis and monitoring in children with asthma. Information on the most studied biomarkers, including spirometry, oscillometry, markers of allergic sensitization, fractional exhaled nitric oxide, and the most recent exhaled breath markers and "omic" approaches, will be reviewed. Practical limitations and considerations based on both experts' opinion and critical review of the literature, on the utility of all "well-known" and newly introduced non-invasive biomarkers will be presented. A critical commentary on biomarkers' use in diagnosing and monitoring asthma during the COVID-19 pandemic, cost and availability of biomarkers in different settings and in developing countries, the differences on the biomarkers use between Primary Practitioners, Pediatricians, and Specialists and their role on the longitudinal aspect of asthma is provided.
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Affiliation(s)
- Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Corresponding author.
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of Toyam, Japan
| | | | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Ivana Filipovic
- University Hospital Center Dr Dragiša Mišović Hospital Pediatric Department, Serbia
| | - Peter Le Souef
- Faculty of Health and Medical Sciences, Dept of Respiratory Medicine, Child and Adolescent Health Service, University of Western Australia, Perth, Australia
| | | | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy Unit Children's. Health Research Institute. Hospital La Fe, 46026, Valencia, Spain
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo M. Pitrez
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jiu-Yao Wang
- Center for Allergy and Clinical Immunology Research, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Gary W.K. Wong
- Department of Paediatrics, The Chinese University of Hong Kong, China
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11
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Ojaniemi I, Salmivesi S, Tikkakoski A, Karjalainen J, Lehtimäki L, Schultz R. Are peanut oral food challenges still useful? An evaluation of children with suspected peanut allergy, sensitization to Ara h 2 and controlled asthma. Allergy Asthma Clin Immunol 2022; 18:100. [PMID: 36451230 PMCID: PMC9714138 DOI: 10.1186/s13223-022-00743-6] [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: 08/03/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Sensitization to Ara h 2 has been proposed as a promising biological marker for the severity of peanut allergy and may reduce the need for oral food challenges. This study aimed to evaluate whether peanut oral food challenge is still a useful diagnostic tool for children with suspected peanut allergy and an elevated level of Ara h 2-specific IgE. Additionally, we assessed whether well-controlled asthma is an additional risk for severe reactions. METHODS A retrospective analysis of 107 children with sensitization to Ara h 2-specific IgE (> 0.35 kU/l) undergoing open peanut challenges during 2012-2018 in the Tampere University Hospital Allergy Centre, Finland. RESULTS Of the 107 challenges, 82 (77%) were positive. Serum levels of Ara h 2 -sIgE were higher in subjects with a positive challenge than in those who remained negative (median 32.9 (IQR 6.7-99.8) vs. 2.1 (IQR 1.0-4.9) kU/l), p < 0.001) but were not significantly different between subjects with and without anaphylaxis. No correlation was observed between the serum level of Ara h 2-sIgE and reaction severity grading. Well-controlled asthma did not affect the challenge outcome. CONCLUSIONS Elevated levels of Ara h 2-specific IgE are associated with a positive outcome in peanut challenges but not a reliable predictor of reaction severity. Additionally, well-controlled asthma is not a risk factor for severe reactions in peanut challenges in children with sensitization to Ara h 2.
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Affiliation(s)
- Iida Ojaniemi
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland
| | - Susanna Salmivesi
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland
| | - Antti Tikkakoski
- grid.412330.70000 0004 0628 2985 Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Jussi Karjalainen
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lauri Lehtimäki
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Rüdiger Schultz
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland ,Pihlajalinna Medical Centre, Tampere, Finland
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12
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Alyami RA, Simpson R, Oliver P, Julious SA. TRial to Assess Implementation of New research in a primary care Setting (TRAINS): study protocol for a pragmatic cluster randomised controlled trial of an educational intervention to promote asthma prescription uptake in general practitioner practices. Trials 2022; 23:947. [PMCID: PMC9670052 DOI: 10.1186/s13063-022-06864-y] [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: 04/21/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background There is a marked increase in unscheduled care visits in school-aged children with asthma after returning to school in September. This is potentially associated with children not taking their asthma preventer medication during the school summer holidays. A cluster randomised controlled trial (PLEASANT) was undertaken with 1279 school-age children in 141 general practices (71 on intervention and 70 on control) in England and Wales. It found that a simple letter sent from the family doctor during the school holidays to a parent with a child with asthma, informing them of the importance of taking asthma preventer medication during the summer relatively increased prescriptions by 30% in August and reduced medical contacts in the period September to December. Also, it is estimated there was a cost-saving of £36.07 per patient over the year. We aim to conduct a randomised trial to assess if informing GP practices of an evidence-based intervention improves the implementation of that intervention. Methods/design The TRAINS study—TRial to Assess Implementation of New research in a primary care Setting—is a pragmatic cluster randomised implementation trial using routine data. A total of 1389 general practitioner (GP) practices in England will be included into the trial; 694 GP practices will be randomised to the intervention group and 695 control group of usual care. The Clinical Practice Research Datalink (CPRD) will send the intervention and obtain all data for the study, including prescription and primary care contacts data. The intervention will be sent in June 2021 by postal and email to the asthma lead and/or practice manager. The intervention is a letter to GPs informing them of the PLEASANT study findings with recommendations. It will come with an information leaflet about PLEASANT and a suggested reminder letter and SMS text template. Discussion The trial will assess if informing GP practices of the PLEASANT trial results will increase prescription uptake before the start of the school year. The hope is that the intervention will increase the implementation of PLEASANT work and then increase prescription uptake during the summer holiday prior to the start of school. Trial registration ClinicalTrials.gov ID: NCT05226091 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06864-y.
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Affiliation(s)
- Rami A. Alyami
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK ,grid.411831.e0000 0004 0398 1027Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Rebecca Simpson
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Phillip Oliver
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK ,grid.412937.a0000 0004 0641 5987Academic Unit of Primary Medical Care, Samuel Fox House Northern General Hospital, Herries Road, Sheffield, S5 7AU UK
| | - Steven A. Julious
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
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13
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Gunawardana S, Tuazon M, Wheatley L, Cook J, Harris C, Greenough A. Airwave oscillometry and spirometry in children with asthma or wheeze. J Asthma 2022; 60:1153-1161. [PMID: 36218195 PMCID: PMC9612926 DOI: 10.1080/02770903.2022.2134795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Lung function testing is used in diagnosing asthma and assessing asthma control. Spirometry is most commonly used, but younger children can find performing this test challenging. Non-volitional tests such as airwave oscillometry (AOS) may be helpful in that population. We compared the success of spirometry and AOS in assessing bronchodilator responsiveness in children. METHODS AOS was conducted alongside routine lung function testing. Resistance at 5 Hz (R5), the difference between the resistance at 5 and 20 Hz (R5-20) and the area under the reactance curve (AX) were assessed. Patients between 5 and 16 years old attending clinic with wheeze or asthma were assessed. Patients performed AOS, followed by spirometry and were then given 400 µg salbutamol; the tests were repeated 15 minutes later. RESULTS Lung function testing was performed in 47 children of whom 46 (98%) and 32 (68%) performed acceptable baseline oscillometry and spirometry, respectively (p < 0.001). Children unable to perform acceptable spirometry were younger (7.35, range: 5.4-10.3 years) than those who could (10.4, range: 5.5-16.9 years), p < 0.001. The baseline z-scores of AOS R5 correlated with FEV1 (r = 0.499, p = 0.004), FEF75 (r = 0.617, p < 0.001), and FEV1/FVC (r = 0.618, p < 0.001). There was a positive bronchodilator response assessed by spirometry (change in FEV1 ≥ 12%) in eight children which corresponded to a change in R5 of 36% (range: 30%-50%) and a change in X5 of 39% (range: 15%-54%). CONCLUSIONS Oscillometry is a useful adjunct to spirometry in assessing young asthmatic children's lung function. The degree of airway obstruction, however, might affect the comparability of the results of the two techniques.
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Affiliation(s)
- Shannon Gunawardana
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK;
| | - Mark Tuazon
- Chest Unit, King's College Hospital NHS Foundation Trust, DenmarkHill, London, UK;
| | - Lorna Wheatley
- Chest Unit, King's College Hospital NHS Foundation Trust, DenmarkHill, London, UK;
| | - James Cook
- Department of Pediatric Respiratory Medicine, King’s College Hospital NHS Foundation Trust, London, UK;
| | - Christopher Harris
- Neonatal Intensive Care Centre, King’s College Hospital NHS Foundation Trust, London, UK;
| | - Anne Greenough
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK; ,NIHR Biomedical Research Centre based at Guy’s and St Thomas NHS Foundation Trust and King’s College London, London, United Kingdom,Corresponding author: Professor Anne Greenough, Department of Women and Children’s Health, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, United Kingdom. Tel: +44 0203 299 3037; ORCID: 0000-0002-8672-5349
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14
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Bains KES, Färdig M, Gudmundsdóttir HK, Almqvist C, Hedlin G, Nordhagen LS, Rehbinder EM, Skjerven HO, Söderhäll C, Vettukattil R, Nordlund B, Lødrup Carlsen KC. Infant tidal flow-volume parameters and arousal state. ERJ Open Res 2022; 8:00163-2022. [PMID: 36267897 PMCID: PMC9574559 DOI: 10.1183/23120541.00163-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background Infant lung function can be assessed with tidal flow-volume (TFV) loops. While TFV loops can be measured in both awake and sleeping infants, the influence of arousal state in early infancy is not established. The aim of the present study was to determine whether TFV loop parameters in healthy infants differed while awake compared to the sleeping state at 3 months of age. Methods From the population-based Scandinavian Preventing Atopic Dermatitis and ALLergies in children (PreventADALL) birth cohort, 91 infants had reproducible TFV loops measured with Exhalyzer® D in both the awake and sleeping state at 3 months of age. The TFV loops were manually selected according to a standardised procedure. The ratio of time to peak tidal expiratory flow (t PTEF) to expiratory time (t E) and the corresponding volume ratio (V PTEF/V E), as well as tidal volume (V T) and respiratory rate were compared using nonparametric tests. Results The mean (95% CI) t PTEF/t E was significantly higher while awake compared to the sleeping state: 0.39 (0.37-0.41) versus 0.28 (0.27-0.29); with the corresponding V PTEF/V E of 0.38 (0.36-0.40) versus 0.29 (0.28-0.30). The V T was similar, while the respiratory rate was higher while awake compared to the sleeping state: 53 (51-56) breaths·min-1 versus 38 (36-40) breaths·min-1. Conclusion Higher t PTEF/t E, V PTEF/V E and respiratory rate, but similar V T while awake compared to the sleeping state suggests that separate normative TFV loop values according to arousal state may be required in early infancy.
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Affiliation(s)
- Karen Eline Stensby Bains
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- These authors contributed equally and share first authorship
| | - Martin Färdig
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- These authors contributed equally and share first authorship
| | - Hrefna Katrín Gudmundsdóttir
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Catarina Almqvist
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Dept of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Hedlin
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Eva M. Rehbinder
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Dept of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Håvard O. Skjerven
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Cilla Söderhäll
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Riyas Vettukattil
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Björn Nordlund
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Karin C. Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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15
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Burman J, Palosuo K, Pelkonen A, Malmberg P, Remes S, Kukkonen K, Mäkelä MJ. Bronchial hyperresponsiveness and asthma during oral immunotherapy for egg or peanut allergy in children. Clin Transl Allergy 2022; 12:e12203. [PMID: 36246730 PMCID: PMC9549178 DOI: 10.1002/clt2.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/25/2022] [Accepted: 09/17/2022] [Indexed: 11/08/2022] Open
Abstract
Background Bronchial hyperresponsiveness (BHR) and asthma are frequently present in children with food allergy. We assessed BHR in children receiving oral immunotherapy (OIT) for persistent egg or peanut allergy and examined whether OIT affects asthma control. Methods Methacholine challenge testing was performed in 89 children with persistent egg or peanut allergy diagnosed by double-blind, placebo-controlled food challenge and 80 control children without food allergy. Of the 89 food-allergic children, 50 started OIT for egg allergy and 39 for peanut allergy. Sensitization to aeroallergens was evaluated by skin prick testing. Forty of the 89 children with regular controller treatment for asthma underwent methacholine challenge testing and 34 measurement of exhaled nitric oxide (FeNO) at baseline and after 6-12 months of OIT. Results Methacholine challenge testing revealed significant BHR in 29/50 children (58%) with egg allergy, 15/39 children (38%) with peanut allergy, and 6/80 controls (7.5%). The mean cumulative dose of methacholine causing a 20% fall in FEV1 differed significantly between the egg and peanut-allergic versus the control children (1009 μg, 1104 μg, and 2068 μg, respectively, p < 0.001). Egg or peanut OIT did not affect lung function, the degree of BHR or FeNO levels in children with asthma and had no adverse effect on asthma control. Lung function or BHR did not associate with the OIT outcome. Conclusion BHR was significantly more frequent in children with persistent egg or peanut allergy than in children without food allergy. Oral immunotherapy did not increase BHR and was safe for children on regular asthma medication.
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Affiliation(s)
- Janne Burman
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Kati Palosuo
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Anna Pelkonen
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Pekka Malmberg
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Sami Remes
- Department of PediatricsKuopio University HospitalKuopioFinland
| | - Kaarina Kukkonen
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Mika J. Mäkelä
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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16
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Current Limitations and Recent Advances in the Management of Asthma. Dis Mon 2022:101483. [DOI: 10.1016/j.disamonth.2022.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Tsuneyoshi S, Kawayama T, Sasaki J, Kinoshita T, Yano C, Tokunaga Y, Matsuoka M, Imaoka H, Matsunaga K, Furukawa K, Hoshino T. Poor Asthma Control in Schoolchildren May Lead to Lower Lung Function Trajectory from Childhood to Early Adulthood: A Japanese Cohort Study. J Asthma Allergy 2022; 15:885-896. [PMID: 35795074 PMCID: PMC9252319 DOI: 10.2147/jaa.s366453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Although childhood asthma is a risk factor for adult lung function disorders, the correlation between childhood asthma control level and lung function growth remains unclear in Japan. The correlation between childhood asthma control and early adulthood lung function growth was investigated in this study. Patients and Methods We included 505 children with asthma from the Omuta City Air Pollution-Related Health Damage Cohort Program. The characteristics and lung function of girls and boys aged 6–11 years and 12–17 years were compared between poor and good asthma control groups. Results Among the 505 children, 214 (42.4%) showed poor asthma control. The mean percentage forced expiratory volume in 1 second predicted for girls and boys aged 6–11 years (80.2% and 79.2%, respectively) and 12–17 years (80.0% and 81.1%, respectively) in the poor control group was significantly lower than those of girls and boys aged 6–11 years (87.9% and 87.3%, respectively) and 12–17 years (88.1% and 87.8%, respectively) in the good control group. However, a linear regression model did not reveal between-group differences in the slopes of lung function growth for both sexes. Girls (24.6%, P < 0.0001) and boys (24.4%, P = 0.0026) in the poor control group had a significantly higher proportion of young adults with obstructive ventilatory patterns than girls (1.4%) and boys (8.1%) in the good control group. Conclusion Our findings revealed that poor childhood asthma control leaded to lung function disorders, which suggest the importance of early asthma control in school children.
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Affiliation(s)
- Shingo Tsuneyoshi
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Jun Sasaki
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Kinoshita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Chiyo Yano
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihisa Tokunaga
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Masanobu Matsuoka
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Haruki Imaoka
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kazuko Matsunaga
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kyoji Furukawa
- Biostatistics Center, Kurume University School of Medicine, Kurume, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
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18
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Atopic Status in Children with Asthma and Respiratory Allergies—Comparative Analysis of Total IgE, ImmunoCAP Phadiatop/fx5 and Euroimmun Pediatric Immunoblot. SINUSITIS 2021. [DOI: 10.3390/sinusitis6010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: An atopic status assessment (skin prick test or specific immunoglobulin (sIgE)) in asthmatic children is considered a milestone in identifying potential risk factors and triggers provoking loss of asthma control and asthma exacerbation. Objective: The study aims to perform a comparative analysis of different laboratory methods for a serological assessment of an atopic status in asthma and respiratory allergies in children. Material and methods: A total of 86 children were included, all of whom were diagnosed with bronchial asthma, aged from 5 to 17 years and screened for total IgE level using enzyme-linked immunosorbent assay (ELISA). In 48 randomly selected children, we performed a semi-quantitative serological in vitro assessment of the specific IgE antibodies against food and aeroallergen, using two different laboratory methods—Euroimmun Immunoblot and ImmunoCAP (Phadiatop/fx5). Results: In 70% of the children with a history of allergies, and 65.3% without clinically manifested allergies, multiscreen test ImmunoCAP Phadiatop/fx5 showed positivity and confirmed atopy. Our results showed a significant moderate to strong correlation between multiscreen ImmunoCAP Phadiatop/fx5, and Euroimmun specific IgE titers against aero-allergens—cats, mites, tree mix and food allergens—soy, wheat (р = 0.006), rice, р = 0.090), apple р = 0.007) and peanut. A sensitivity of 63% and specificity of 73.5% was observed for EUROIMMUN Pediatric (food allergens, IgE titer > 1) compared with the gold standard ImmunoCap/fx5. The mean value of total IgE is significantly higher in children with asthma and concomitant with allergic rhinitis compared to those without allergic rhinitis (mean 202.52 U/mL, IQR 102.50 (24.20–363.95) vs. 316.68, IQR 261.00 (109.20–552.50), p = 0.005). Conclusion: Establishing the spectrum of the most common respiratory and food allergens is an essential factor for maintaining asthma control, both through a strategy to avoid allergen exposure and by developing a recommendation plan. The immunoblotting technique is easily applicable in daily clinical and laboratory practice. It is also a cost-effective and reliable alternative to the “gold standard” ImmunoCAP Phadiatop/fx5 in diagnosing atopy in children.
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Khramova RN, Tush EV, Khramov AA, Ovsyannikov DY, Popov KS, Dolbin IV, Khaletskaya OV, Stroganov AB, Kubysheva NI, Eliseeva TI. Relationship of Nutritional Status and Spirometric Parameters in Children with Bronchial Asthma. Sovrem Tekhnologii Med 2021; 12:12-23. [PMID: 34795975 PMCID: PMC8596246 DOI: 10.17691/stm2020.12.3.02] [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] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 12/23/2022] Open
Abstract
The potential mechanisms of bronchial asthma (BA) negative modification under the influence of obesity are currently being actively studied. However, at present, the effect of nutritional status on bronchial obstruction in children with BA cannot be considered established. In this regard, the purpose of this work was to study the relationship of spirometric parameters reflecting bronchial patency with nutritional status in children with asthma.
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Affiliation(s)
- R N Khramova
- Medical Resident, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - E V Tush
- Associate Professor, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A A Khramov
- Medical Resident, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - D Yu Ovsyannikov
- Professor, Head of the Department of Children's Diseases; Peoples' Friendship University of Russia, 6 Miklukho-Maklaya St., Moscow, 117198, Russia
| | - K S Popov
- Medical Resident, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - I V Dolbin
- Consultant; City Clinical Hospital No.38, 22 Chernyshevskogo St., Nizhny Novgorod, 603000, Russia
| | - O V Khaletskaya
- Professor, Head of the Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A B Stroganov
- Associate Professor, Department of Faculty Surgery and Transplantology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - N I Kubysheva
- Senior Researcher, Research Laboratory "Clinical Linguistics"; Kazan Federal University, 18 Kremlyovskaya St., Kazan, Republic of Tatarstan, 420008, Russia
| | - T I Eliseeva
- Professor, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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20
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Development and equivalence of new faces for inclusion in the Childhood Asthma Control Test (C-ACT) response scale. J Patient Rep Outcomes 2021; 5:118. [PMID: 34743264 PMCID: PMC8572277 DOI: 10.1186/s41687-021-00390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate symptom monitoring is vital when managing pediatric asthma, providing an opportunity to improve control and relieve associated burden. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) has been validated for asthma control assessment in children; however, there are concerns that response option images used in the C-ACT are not culturally universal and could be misinterpreted. This cross-sectional, qualitative study developed and evaluated alternative response option images using interviews with children with asthma aged 4-11 years (and their parents/caregivers) in the United States, Spain, Poland, and Argentina. Interviews were conducted in two stages (with expert input) to evaluate the appropriateness, understanding and qualitative equivalence of the alternative images (both on paper and electronically). This included comparing the new images with the original C-ACT response scale, to provide context for equivalence results. RESULTS Alternative response option images included scale A (simple faces), scale B (circles of decreasing size), and scale C (squares of decreasing quantity). In Stage 1, most children logically ranked images using scales A, B and C (66.7%, 79.0% and 70.6%, respectively). However, some children ranked the images in scales B (26.7%) and C (58.3%) in reverse order. Slightly more children could interpret the images within the context of their asthma in scale B (68.4%) than A (55.6%) and C (47.5%). Based on Stage 1 results, experts recommended scales A (with slight modifications) and B be investigated further. In Stage 2, similar proportions of children logically ranked the images used in modified scales A (69.7%) and B (75.7%). However, a majority of children ranked the images in scale B in the reverse order (60.0%). Slightly more children were able to interpret the images in the context of their asthma using scale B (57.6%) than modified scale A (48.5%). Children and parents/caregivers preferred modified scale A over scale B (78.8% and 90.9%, respectively). Compared with the original C-ACT, most children selected the same response option on items using both scales, supporting equivalency. Following review of Stage 2 results, all five experts agreed modified scale A was the optimal response scale. CONCLUSIONS This study developed alternative response option images for use in the C-ACT and provides qualitative evidence of the equivalency of these response options to the originals.
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21
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Pijnenburg MW, Frey U, De Jongste JC, Saglani S. Childhood asthma- pathogenesis and phenotypes. Eur Respir J 2021; 59:13993003.00731-2021. [PMID: 34711541 DOI: 10.1183/13993003.00731-2021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/15/2021] [Indexed: 11/05/2022]
Abstract
In the pathogenesis of asthma in children there is a pivotal role for a type 2 inflammatory response to early life exposures or events. Interactions between infections, atopy, genetic susceptibility, and environmental exposures (such as farmyard environment, air pollution, tobacco smoke exposure) influence the development of wheezing illness and the risk for progression to asthma. The immune system, lung function and the microbiome in gut and airways develop in parallel and dysbiosis of the microbiome may be a critical factor in asthma development. Increased infant weight gain and preterm birth are other risk factors for development of asthma and reduced lung function. The complex interplay between these factors explains the heterogeneity of asthma in children. Subgroups of patients can be identified as phenotypes based on clinical parameters, or endotypes, based on a specific pathophysiological mechanism. Paediatric asthma phenotypes and endotypes may ultimately help to improve diagnosis of asthma, prediction of asthma development and treatment of individual children, based on clinical, temporal, developmental or inflammatory characteristics. Unbiased, data-driven clustering, using a multidimensional or systems biology approach may be needed to better define phenotypes. The present knowledge on inflammatory phenotypes of childhood asthma has now been successfully applied in the treatment with biologicals of children with severe therapy resistant asthma, and it is to be expected that more personalized treatment options may become available.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Urs Frey
- University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Johan C De Jongste
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College, London, UK
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22
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Oppelaar MC, van den Wijngaart LS, Merkus PJFM, Croonen EA, Hugen CAC, Brouwer ML, Boehmer ALM, Roukema J. It Is Not Just the FEV1 That Matters, but the Personal Goals We Reach Along the Way: Qualitative, Multicenter, Prospective, Observational Study. J Med Internet Res 2021; 23:e29218. [PMID: 34668868 PMCID: PMC8567151 DOI: 10.2196/29218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic has boosted the use of forced expiratory volume in 1 second (FEV1) telemonitoring in pediatric asthma, but a consensus on its most efficient and effective implementation is still lacking. To find answers, it is important to study how such an intervention is perceived, experienced, and used by both patients and health care professionals (HCPs). Objective The aim of this study was to provide perspectives on how FEV1 home monitoring should be used in pediatric asthma. Methods This is a qualitative, multicenter, prospective, observational study which included patients with asthma aged 6-16 and HCPs. Primary outcomes were results of 2 surveys that were sent to all participants at study start and after 3-4 months. Secondary outcomes consisted of FEV1 device usage during 4 months after receiving the FEV1 device. Results A total of 39 participants (26 patients and 13 HCPs) were included in this study. Survey response rates were 97% (38/39) at the start and 87% (34/39) at the end of the study. Both patients and HCPs were receptive toward online FEV1 home monitoring and found it contributive to asthma control, self-management, and disease perception. The main concerns were about reliability of the FEV1 device and validity of home-performed lung function maneuvers. FEV1 devices were used with a median frequency of 7.5 (IQR 3.3-25.5) during the 4-month study period. Conclusions Patients and HCPs are receptive toward online FEV1 home monitoring. Frequency of measurements varied largely among individuals, yet perceived benefits remained similar. This emphasizes that online FEV1 home monitoring strategies should be used as a means to reach individual goals, rather than being a goal on their own.
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Affiliation(s)
- Martinus C Oppelaar
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lara S van den Wijngaart
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ellen A Croonen
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Cindy A C Hugen
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marianne L Brouwer
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | | | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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23
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Arimova PS, Namazova-Baranova LS, Levina JG, Kalugina VG, Vishneva EA, Kharitonova EY. Mobile Technologies in Achieving and Maintaining Asthma Control in Children: First Results of MedQuizBot Chat Bot. PEDIATRIC PHARMACOLOGY 2021. [DOI: 10.15690/pf.v18i3.2279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background. Anti-inflammatory therapy is used to achieve and maintain asthma control, as well as respiratory function indicators monitoring. Telemedicine technologies can be used for this purpose, and it became particularly essential during the COVID-19 pandemic.Objective. The aim of the study is to analyze efficacy of the mobile technology MedQuizBot for asthma monitoring, to estimate patient compliance to use such instruments of self-control via the bot and without it, and bot's functioning satisfaction.Methods. 6-month prospective observational comparative study in patients with asthma from 4 to 17 years old was conducted. All patients were divided into two groups: patients who have used MedQuizBot and patients who have used any other self-control tools. Patients had to enter peakflowmetry data daily and undergo asthma control tests monthly. Patients were able to communicate with their doctor remotely via the chat bot. Main study indicators: determining the efficacy of MedQuizBot in patients with asthma by estimating the compliance to self-control tools at using the bot. Secondary study indicators: estimation of patients satisfaction on using the MedQuizBot and determination of level of asthma control due to the obtained data results.Results. 41 patients have used MedQuizBot, 27 patients were in the control group. Patients who used the bot more often answered asthma control test questions. Patients over 12 years old have completed the asthma control test less often than young children: ACT was filled on average in 1.5 times, САСТ — 1.8 times. 51% of patients filled in data on peakflowmetry via the new technology, patients from control group did not start the picflowmetry diary. Patients under 12 years old, who filled up the test with their parents, has entered picflowmetry data 7 times more often than adolescents. The asthma was under control in 70% of patients. The data was entered into the system 2.5 times more often during the lockdown period due to COVID-19 pandemic and during the tree flowering season in comparison to other periods of2020. Patients noted the usability of the MedQuizBot and agreed to use it in future.Conclusion. MedQuizBot is effective in achieving asthma control mainly during the period of need — in case of insufficient control over the disease itself (exposure to pollen allergens, acute respiratory diseases), during the limitations in medical care availability.
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Affiliation(s)
- Polina S. Arimova
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences
| | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences; Pirogov Russian National Research Medical University; Belgorod State National Research University
| | - J. G. Levina
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences; Pirogov Russian National Research Medical University
| | - V. G. Kalugina
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences
| | - E. A. Vishneva
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences; Pirogov Russian National Research Medical University
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24
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Abellard A, Pappalardo AA. Overview of severe asthma, with emphasis on pediatric patients: a review for practitioners. J Investig Med 2021; 69:1297-1309. [PMID: 34168068 DOI: 10.1136/jim-2020-001752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/03/2022]
Abstract
Asthma is the most common life-threatening chronic disease in children. Although guidelines exist for the diagnosis and treatment of asthma, treatment of severe, pediatric asthma remains difficult. Limited studies in the pediatric population on new asthma therapies, complex issues with adolescence and adherence, health disparities, and unequal access to guideline-based care complicate the care of children with severe, persistent asthma. The purpose of this review is to provide an overview of asthma, including asthma subtypes, comorbidities, and risk factors, to discuss diagnostic considerations and pitfalls and existing treatments, and then present existing and emerging therapeutic approaches to asthma management. An improved understanding of asthma heterogeneity, clinical characteristics, inflammatory patterns, and pathobiology can help further guide the management of severe asthma in children. More studies are needed in the pediatric population to understand emerging therapeutics application in children. Effective multimodal strategies tailored to individual characteristics and a commitment to address risk factors, modifiers, and health disparities may help reduce the burden of asthma in the USA.
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Affiliation(s)
- Arabelle Abellard
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea A Pappalardo
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA .,Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
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25
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Alam R, Peden DB, Lach JC. Wearable Respiration Monitoring: Interpretable Inference With Context and Sensor Biomarkers. IEEE J Biomed Health Inform 2021; 25:1938-1948. [PMID: 33147151 PMCID: PMC8238391 DOI: 10.1109/jbhi.2020.3035776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Continuous monitoring of breathing rate (BR), minute ventilation (VE), and other respiratory parameters could transform care for and empower patients with chronic cardio-pulmonary conditions, such as asthma. However, the clinical standard for measuring respiration, namely Spirometry, is hardly suitable for continuous use. Wearables can track many physiological signals, like ECG and motion, yet respiration tracking faces many challenges. In this work, we infer respiratory parameters from wearable ECG and wrist motion signals. We propose a modular and generalizable classification-regression pipeline to utilize available context information, such as physical activity, in learning context-conditioned inference models. Novel morphological and power domain features from the wearable ECG are extracted to use with these models. Exploratory feature selection methods are incorporated in this pipeline to discover application-driven interpretable biomarkers. Using data from 15 subjects, we evaluate two implementations of the proposed inference pipeline: for BR and VE. Each implementation compares generalized linear model, random forest, support vector machine, Gaussian process regression, and neighborhood component analysis as regression models. Permutation, regularization, and relevance determination methods are used to rank the ECG features to identify robust ECG biomarkers across models and activities. This work demonstrates the potential of wearable sensors not only in continuous monitoring, but also in designing biomarker-driven preventive measures.
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26
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Burman J, Malmberg LP, Remes S, Jartti T, Pelkonen AS, Mäkelä MJ. Impulse oscillometry and free-running tests for diagnosing asthma and monitoring lung function in young children. Ann Allergy Asthma Immunol 2021; 127:326-333. [PMID: 33819614 DOI: 10.1016/j.anai.2021.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Separating individuals with viral-induced wheezing from those with asthma is challenging, and there are no guidelines for children under 6 years of age. Impulse oscillometry, however, is feasible in 4-year-old children. OBJECTIVE To explore the use of impulse oscillometry in diagnosing and monitoring asthma in young children and evaluating treatment response to inhaled corticosteroid (ICS). METHODS A total of 42 children (median age 5.3 years, range 4.0-7.9 years) with physician-diagnosed asthma and lability in oscillometry were followed for 6 months after initiation of ICS treatment. All children performed the 6-minute free-running test and impulse oscillometry at 3 time points. After the baseline, they attended a second visit when they had achieved good asthma control and a third visit approximately 60 days after the second visit. A positive ICS response was defined as having greater than 19 points in asthma control test and no hyperreactivity on the third visit. RESULTS In total, 38 of 42 children responded to ICS treatment. Exercise-induced increases of resistance at 5 Hz decreased after ICS treatment (61% vs 18% vs 13.5%, P < .001), and running distance during the 6-minute test was lengthened (800 m vs 850 m vs 850 m, P = .001). Significant improvements in childhood asthma control scores occurred between the baseline and subsequent visits (21 vs 24 vs 24, P < .001) and acute physicians' visits for respiratory symptoms (1, (0-6) vs 0, (0-2), P = .001). Similar profiles were observed in children without aeroallergen sensitization and among those under 5 years of age. CONCLUSION Impulse oscillometry is a useful tool in diagnosing asthma and monitoring lung function in young children.
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Affiliation(s)
- Janne Burman
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Leo Pekka Malmberg
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sami Remes
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland; Department of Pediatrics, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anna S Pelkonen
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika J Mäkelä
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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27
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Lindenhofer M, Roth L, Mädel C, Götzinger F, Kainz K, Lex C, Frischer T, Reinweber M, Zacharasiewicz A. Wheeze and cough measurements at night in children with respiratory symptoms. BMC Pediatr 2020; 20:556. [PMID: 33308199 PMCID: PMC7733140 DOI: 10.1186/s12887-020-02455-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background Nocturnal cough and wheeze are important symptoms when diagnosing any respiratory disease in a child, but objective measurements of these symptoms are not performed. Methods The aim of our study was to analyze the use of an automated detection system to assess breath sounds objectively in comparison to cough and wheeze questionnaires and to evaluate its feasibility in clinical practice. Results Forty-nine recordings of thirty-nine children were processed (asthma n = 13; cystic fibrosis n = 2; pneumonia n = 5; suspicion of habit cough n = 7; prolonged, recurrent or chronic cough n = 13), and cough and asthma scores were compared to the objective nocturnal recordings. Time for audio-validation of recordings took between 2 and 40 min (mean: 14.22 min, (SD): 10.72). Accuracy of the automated measurement was higher for cough than for wheezing sounds. Nocturnal cough readings but not wheeze readings correlated with some of the corresponding scores. Conclusion To our knowledge this is the first study using a new device to assess nocturnal cough and obstructive breath sounds objectively in children with a wide variety of respiratory diseases. The assessment proved user friendly. We obtained additional information on nighttime symptoms, which would otherwise have remained obscure. Further studies to assess possible diagnostic and therapeutic benefits of this device are needed.
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Affiliation(s)
- Markus Lindenhofer
- Klinikum Favoriten, Wiener Gesundheitsverbund, Wien, Austria.,Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Lena Roth
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Clemens Mädel
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Florian Götzinger
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Katharina Kainz
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Christiane Lex
- Department for Pediatric Cardiology and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Thomas Frischer
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | | | - Angela Zacharasiewicz
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria.
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28
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Matsunaga NY, Gianfrancesco L, Mazzola TN, Oliveira MS, Morcillo AM, Ribeiro MÂGO, Ribeiro JD, Hashimoto S, Toro AADC. Differences between patients who achieved asthma control and those who remain uncontrolled after standardized severe asthma care strategy. J Asthma 2020; 59:418-425. [PMID: 33263446 DOI: 10.1080/02770903.2020.1852415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess clinical, functional, and inflammatory patterns of children and adolescents with severe uncontrolled asthma, and investigate the differences between patients who achieved asthma control and those who remain uncontrolled after standardized asthma care strategy. METHODS Screening all children and adolescents with asthma from the Pediatric Pulmonology Outpatient Clinic of Unicamp, Brazil, and included those with severe uncontrolled asthma according to GINA guidelines criteria. Patients were assessed at baseline and after by demographic and medication data, questionnaires (Asthma Control Test and Pediatric Asthma Quality of Life Questionnaire), Six-Minute Walk Test, skin prick test, spirometry, induced sputum, and blood collection (total immunoglobulin E and eosinophil count). Cytokine dosage was analyzed in sputum supernatant and serum by Cytometric Bead Array. RESULTS Thirty-three patients with severe uncontrolled asthma were included (median age 10.9 [7.00-17.60] years). All patients presented satisfactory adherence to treatment and 50% of them achieved good asthma control after six-month follow-up (p < 0.001). Patients who achieved asthma control reported higher intervals since their last exacerbation episode (p = 0.008) and higher quality of life scores (p < 0.001) as compared to patients who remained uncontrolled. We found no changes in lung function markers, inflammatory biomarkers, or cytokine levels between patients with uncontrolled and controlled asthma. CONCLUSION Participation of six months in a structured outpatient clinic for children with severe asthma had a notable improvement in control and quality of life of patients. This demonstrates the importance of a global assessment, focused on peculiarities presented by patients with severe uncontrolled asthma.
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Affiliation(s)
- Natasha Yumi Matsunaga
- Child and Adolescent Health Postgraduate Program, State University of Campinas, Campinas, São Paulo, Brazil.,Faculty of Medical Sciences, Laboratory of Pulmonary Physiology, Center for Investigation in Pediatrics, State University of Campinas, Campinas, São Paulo, Brazil
| | - Lívea Gianfrancesco
- Child and Adolescent Health Postgraduate Program, State University of Campinas, Campinas, São Paulo, Brazil.,Faculty of Medical Sciences, Laboratory of Pulmonary Physiology, Center for Investigation in Pediatrics, State University of Campinas, Campinas, São Paulo, Brazil
| | - Taís Nitsch Mazzola
- Faculty of Medical Sciences, Laboratory of Pulmonary Physiology, Center for Investigation in Pediatrics, State University of Campinas, Campinas, São Paulo, Brazil
| | - Marina Simões Oliveira
- Child and Adolescent Health Postgraduate Program, State University of Campinas, Campinas, São Paulo, Brazil.,Faculty of Medical Sciences, Laboratory of Pulmonary Physiology, Center for Investigation in Pediatrics, State University of Campinas, Campinas, São Paulo, Brazil
| | - André Moreno Morcillo
- Department of Paediatric Respiratory Medicine, Emma Children's hospital and Department of Respiratory Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Ângela Gonçalves Oliveira Ribeiro
- Faculty of Medical Sciences, Laboratory of Pulmonary Physiology, Center for Investigation in Pediatrics, State University of Campinas, Campinas, São Paulo, Brazil
| | - José Dirceu Ribeiro
- Faculty of Medical Sciences, Laboratory of Pulmonary Physiology, Center for Investigation in Pediatrics, State University of Campinas, Campinas, São Paulo, Brazil.,Department of Pediatrics, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Simone Hashimoto
- Department of Paediatric Respiratory Medicine, Emma Children's hospital and Department of Respiratory Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Adyleia Aparecida Dalbo Contrera Toro
- Faculty of Medical Sciences, Laboratory of Pulmonary Physiology, Center for Investigation in Pediatrics, State University of Campinas, Campinas, São Paulo, Brazil.,Department of Pediatrics, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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29
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Hopp RJ, Wilson MC, Pasha MA. Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary. Clin Rev Allergy Immunol 2020; 62:145-159. [PMID: 33241492 DOI: 10.1007/s12016-020-08818-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
Asthma affects all portions of the airways. Small airways, however, comprise a substantial component of the conducting lung air flow. In asthma, inflammatory processes can affect the whole respiratory tract, from central to peripheral/small airways. The emphasis in adult and pediatric respiratory disease clinics is to focus on large airway obstruction and reversibility. This information, although valuable, underemphasizes a large portion of the conduction airway of asthmatics. Standard descriptions of asthma management focus on a multiple medication approaches. We particularly focused on the management of asthma in the international guidelines for the Global Initiative for Asthma (GINA). Overall, however, minimal attention is placed on the small airway pool in asthma medical management. We took the opportunity to thoroughly review and present specific data from the adult asthma literature which supported the concept that small airway abnormalities may play a role in the pathogenesis and clinical expression of asthma. Based on the conclusions of the adult asthma literature, we here present a thorough review of the literature as it relates to small airway disease in children with asthma. We used, collectively, individual data sources of data to expand the information available from standard diagnostic techniques, especially spirometry, in the evaluation of small airway disease. As the pharmacological approaches to moderate to severe asthma are advancing rapidly into the realm of biologics, we sought to present potential pharmacological options for small airway dysfunction in pediatrics prior to biological modifier intervention.
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Affiliation(s)
- Russell J Hopp
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA.
| | - Mark C Wilson
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA
| | - M Asghar Pasha
- Division of Allergy and Immunology, Albany Medical College, 176 Washington Avenue Extension, Suite 102, Albany, NY, 12203, USA
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30
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van der Kamp MR, Klaver EC, Thio BJ, Driessen JMM, de Jongh FHC, Tabak M, van der Palen J, Hermens HJ. WEARCON: wearable home monitoring in children with asthma reveals a strong association with hospital based assessment of asthma control. BMC Med Inform Decis Mak 2020; 20:192. [PMID: 32795352 PMCID: PMC7427745 DOI: 10.1186/s12911-020-01210-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background Asthma is one of the most common chronic diseases in childhood. Regular follow-up of physiological parameters in the home setting, in relation to asthma symptoms, can provide complementary quantitative insights into the dynamics of the asthma status. Despite considerable interest in asthma home-monitoring in children, there is a paucity of scientific evidence, especially on multi-parameter monitoring approaches. Therefore, the aim of this study is to investigate whether asthma control can be accurately assessed in the home situation by combining parameters from respiratory physiology sensors. Methods Sixty asthmatic and thirty non-asthmatic children were enrolled in the observational WEARCON-study. Asthma control was assessed according to GINA guidelines by the paediatrician. All children were also evaluated during a 2-week home-monitoring period with wearable devices; a physical activity tracker, a handheld spirometer, smart inhalers, and an ambulatory electrocardiography device to monitor heart and respiratory rate. Multiple logistic regression analysis was used to determine which diagnostic measures were associated with asthma control. Results 24 of the 27 uncontrolled asthmatic children and 29 of the 32 controlled asthmatic children could be accurately identified with this model. The final model showed that a larger variation in pre-exercise lung function (OR = 1.34 95%-CI 1.07–1.68), an earlier wake-up-time (OR = 1.05 95%-CI 1.01–1.10), more reliever use (OR = 1.11 95%-CI 1.03–1.19) and a longer respiratory rate recovery time (OR = 1.12 95%-CI 1.05–1.20) were significant contributors to the probability of having uncontrolled asthma. Conclusions Home-monitoring of physiological parameters correlates with paediatrician assessed asthma control. The constructed multivariate model identifies 88.9% of all uncontrolled asthmatic children, indicating a high potential for monitoring of asthma control. This may allow healthcare professionals to assess asthma control at home. Trial registration Netherlands Trail Register, NL6087. Registered 14 February 2017.
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Affiliation(s)
- M R van der Kamp
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands. .,Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands. .,Roessingh Research and Development, Enschede, the Netherlands.
| | - E C Klaver
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - B J Thio
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - J M M Driessen
- OCON sport, Hengelo, Netherlands.,Department of Sports Medicine, Ziekenhuis Tjongerschans, Heerenveen, Netherlands
| | - F H C de Jongh
- Department of Pulmonology, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Engineering Fluid Dynamics, University of Twente, Enschede, Netherlands
| | - M Tabak
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Roessingh Research and Development, Enschede, the Netherlands
| | - J van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Netherlands
| | - H J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Roessingh Research and Development, Enschede, the Netherlands
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Chong YY, Mak YW, Loke AY. The role of parental psychological flexibility in childhood asthma management: An analysis of cross-lagged panel models. J Psychosom Res 2020; 137:110208. [PMID: 32798834 DOI: 10.1016/j.jpsychores.2020.110208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/24/2020] [Accepted: 07/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This is a secondary analysis of a previously reported randomized controlled trial, aimed at examining the mediating role of parental psychological flexibility (PF) in an Acceptance and Commitment Therapy (ACT)-based childhood asthma management program for parents. METHODS The participants were 168 parents (mean age (SD) = 38.40 (5.90) years; 88.1% mothers) and their children who had been diagnosed with asthma (mean age (SD) = 6.81 (2.50) years; 62% boys). They were randomly allocated to either the program composed of a four-session, group-based ACT plus asthma education (ACT Group) or to a group-based asthma education talk plus three telephone follow-ups (Control Group). The parents underwent assessments at baseline, and immediately, 3-months, and 6-months after the intervention for the following outcomes: PF (Acceptance and Action Questionnaire-II), psychological distress of the parents (Depression Anxiety Stress Scale-21); and the asthma symptoms and use of inhaled bronchodilators of their children. RESULTS Cross-lagged panel models showed that the improvement in parental PF at post-intervention mediated the effect of ACT on reducing parental psychological distress (all beta coefficients (βs) ranged from -2.20 to - 2.30, all Ps < 0.01) and childhood asthma symptoms in terms of daytime symptoms (β = -0.22, 95% CI [-0.52, -0.02], P = 0.04), nighttime symptoms (β = -0.17, 95% CI [-0.33, -0.02], P = 0.04), and the use of bronchodilators (β = -0.22, 95% CI [-0.48, -0.02], P = 0.03) at 6-months post-intervention. CONCLUSION ACT makes a unique contribution to improving the health outcomes of parents and their children diagnosed with asthma through fostering parental PF.
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Affiliation(s)
- Yuen Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Children with uncontrolled asthma and significant reversibility might show hypoxaemia. Eur J Pediatr 2020; 179:999-1005. [PMID: 32020332 DOI: 10.1007/s00431-020-03600-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
Asthmatic children free of exacerbation with airway obstruction may have low partial pressure of oxygen (PaO2) which can be a marker for future risk, but PaO2 is scarcely measured during pulmonary function testing. We prospectively included asthmatic children with airway obstruction referred for pulmonary function testing, including blood gas analysis (n = 51). Hypoxaemia, defined as a value lower than - 2 z-score, was present in 15 (29%) children, and 37 (72%) children had a significant reversibility after bronchodilator administration. The multivariable model showed a positive influence of baseline forced expiratory volume in 1 s (FEV1) on PaO2 (β coefficient 0.69, [95% CI: 0.07; 1.30]; P = 0.03), whereas uncontrolled asthma and FEV1 reversibility negatively influenced it (β coefficient - 1.59 [95% CI: - 2.74; - 0.44]; P = 0.01; and - 0.07 [95% CI: - 0.13; - 0.02]; P = 0.01, respectively). As a consequence, children with uncontrolled symptoms of asthma and FEV1 reversibility ≥ 12% were significantly more at risk of having hypoxaemia compared to children with well/partly controlled asthma or no significant reversibility of FEV1.Conclusion: Among obstructive asthmatic children without current exacerbation, hypoxaemia is more likely to be seen in children with uncontrolled asthma and a significant post-bronchodilator FEV1 reversibility, in favour of different pathophysiology and treatment requirements of their airway obstruction.What is Known:• Recommendations are to treat asthmatic children in order to control respiratory symptom and maintain normal pulmonary function.• Asthmatic children free of exacerbation may have different pathophysiology for airway obstruction (central, peripheral, inflammatory, spasticity, remodelling) and should be treated according the pathophysiology of their airway disease.What is New:• In obstructive asthmatic children free of current exacerbation, the presence of hypoxaemia (ventilation-perfusion mismatch) is influenced by asthma control and post-bronchodilator reversibility, independently of the level of baseline airway obstruction.• The presence of hypoxaemia in obstructive asthmatic children free of current exacerbation can be highly suspected by the composite index "uncontrolled asthma + FEV1reversibility ≥ 12%" which may guide treatment.
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Gerzon FL, Jöbsis Q, Bannier MA, Winkens B, Dompeling E. Discrepancy between Lung Function Measurements at Home and in the Hospital in Children with Asthma and CF. J Clin Med 2020; 9:jcm9061617. [PMID: 32466623 PMCID: PMC7355967 DOI: 10.3390/jcm9061617] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/24/2022] Open
Abstract
The Coronavirus pandemic stresses the importance of eHealth techniques to monitor patients at home. Home monitoring of lung function in asthma and cystic fibrosis (CF) may help to detect deterioration of lung function at an early stage, but the reliability is unclear. We investigated whether lung function measurements at home were comparable to measurements during clinical visits. We analysed prospectively collected data of two one-year observational cohort studies in 117 children (36 with CF and 81 with asthma). All patients performed forced expiratory volume in one second (FEV1) measurements with a monitor at home. Paired FEV1 measurements were included if the measurement on the home monitor was performed on the same day as the FEV1 measurement on the pneumotachometer during a two monthly clinical visit. Bland-Altman plots and linear mixed model analysis were used. The mean difference (home measurement was subtracted from clinical measurement) in FEV1 was 0.18 L in CF (95% confidence interval (CI) 0.08–0.27 L; p < 0.001) and 0.12 L in asthma (95%CI 0.05–0.19 L; p < 0.001). FEV1 measurements at home were significantly lower than clinically obtained FEV1 measurements, which has implications for the application of this technique in the daily clinical situation.
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Affiliation(s)
- Frederick L.G.R. Gerzon
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), 6202 AZ Maastricht, The Netherlands; (F.L.G.R.G.); (Q.J.); (M.A.G.E.B.)
| | - Quirijn Jöbsis
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), 6202 AZ Maastricht, The Netherlands; (F.L.G.R.G.); (Q.J.); (M.A.G.E.B.)
| | - Michiel A.G.E. Bannier
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), 6202 AZ Maastricht, The Netherlands; (F.L.G.R.G.); (Q.J.); (M.A.G.E.B.)
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, MUMC+, 6229 HA Maastricht, The Netherlands;
| | - Edward Dompeling
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), 6202 AZ Maastricht, The Netherlands; (F.L.G.R.G.); (Q.J.); (M.A.G.E.B.)
- Correspondence: ; Tel.: +31-43-387-7248
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Sleath B. Improving Youth Confidence in Using Asthma Medication Devices Correctly: An Important Step Toward Improving Health Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2031-2032. [PMID: 31279469 DOI: 10.1016/j.jaip.2019.03.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Hu LW, Yu S, Marks T, Zhang YT, Lodge CC, Dharmage SC, Gurram N, Bloom MS, Lin S, Zeeshan M, Yu HY, Zhou Y, Liu RQ, Yang BY, Zeng XW, Hu Q, Dong GH. The time window of pet ownership exposure modifies the relationship of Environmental Tobacco Smoke with lung function: A large population-based cohort study. ENVIRONMENTAL RESEARCH 2020; 183:109197. [PMID: 32058142 DOI: 10.1016/j.envres.2020.109197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/18/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
There is a large body of evidence linking Environmental Tobacco Smoke (ETS) exposure with impaired lung function. However, it is not known whether exposure to pets modifies this relationship. To investigate if pet ownership changes the association between ETS exposure and lung function, a population-based sample of 7326 children, 7-14 years old, were randomly recruited from 24 districts in northeast China. Lung function including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF) was measured by spirometry, while pet ownership time periods and ETS exposure were collected by questionnaire. Two-level regression analysis was done, with covariates controlled for. The results showed pet exposure in certain early lifetime windows modified the associations of ETS exposure on decreased lung function in children. Among children exposed to current ETS, those exposed to pets in utero had greater reductions in lung function (for instance: OR for reduced FVC (<85% predicted) = 10.86; 95% CI: 3.80-30.97) than those not exposed to pets in utero (OR = 2.32; 95% CI: 1.76-3.05) (pinteraction = 0.005). While, children exposed to current pet ownership reduced the lung function impairment induced by ETS exposure during the first 2 years of life and/or ETS exposure during pregnancy, especially for FVC impairment. For instance, OR (95%CI) for reduced FVC (<85% predicted) was 0.81 (0.56, 1.18) and 1.42 (1.15, 1.74), respectively, for children with or without current pet ownership exposed to ETS during the first 2 years of life (pinteraction = 0.010). Furthermore, pet type or number of pets did not significantly modify associations between ETS exposure and lung function. In conclusion, the timing of pet ownership modified associations between ETS exposure and lung function, pet ownership in utero and during the first 2 years of life significantly worsened the adverse impacts of passive smoking on lung function.
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Affiliation(s)
- Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Shu Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Tia Marks
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Departments of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Yun-Ting Zhang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Caroline C Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3052, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3052, Australia
| | - Namratha Gurram
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Departments of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Departments of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA; Departments of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Shao Lin
- Departments of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA; Departments of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Mohammed Zeeshan
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Hong-Yao Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yang Zhou
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ru-Qing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qiang Hu
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, 261041, China.
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Xing X, Hu L, Guo Y, Bloom MS, Li S, Chen G, Yim SHL, Gurram N, Yang M, Xiao X, Xu S, Wei Q, Yu H, Yang B, Zeng X, Chen W, Hu Q, Dong G. Interactions between ambient air pollution and obesity on lung function in children: The Seven Northeastern Chinese Cities (SNEC) Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 699:134397. [PMID: 31677469 DOI: 10.1016/j.scitotenv.2019.134397] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
Children are vulnerable to air pollution-induced lung function deficits, and the prevalence of obesity has been increasing in children. To evaluate the joint effects of long-term PM1 (particulate matter with an aerodynamic diameter ≤ 1.0 μm) exposure and obesity on children's lung function, a cross-sectional sample of 6740 children (aged 7-14 years) was enrolled across seven northeastern Chinese cities from 2012 to 2013. Weight and lung function, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF), were measured according to standardized protocols. Average PM1, PM2.5, PM10 and nitrogen dioxide (NO2) exposure levels were estimated using a spatiotemporal model, and sulphur dioxide (SO2) and ozone (O3) exposure were estimated using data from municipal air monitoring stations. Two-level logistic regression and general linear models were used to analyze the joint effects of body mass index (BMI) and air pollutants. The results showed that long-term air pollution exposure was associated with lung function impairment and there were significant interactions with BMI. Associations were stronger among obese and overweight than normal weight participants (the adjusted odds ratios (95% confidence intervals) for PM1 and lung function impairments in three increasing BMI categories were 1.50 (1.07-2.11) to 2.55 (1.59-4.07) for FVC < 85% predicted, 1.44 (1.03-2.01) to 2.51 (1.53-4.11) for FEV1 < 85% predicted, 1.34 (0.97-1.84) to 2.04 (1.24-3.35) for PEF < 75% predicted, and 1.34 (1.01-1.78) to 1.93 (1.26-2.95) for MMEF < 75% predicted). Consistent results were detected in linear regression models for PM1, PM2.5 and SO2 on FVC and FEV1 impairments (PInteraction < 0.05). These modification effects were stronger among females and older participants. These results can provide policy makers with more comprehensive information for to develop strategies for preventing air pollution induced children's lung function deficits among children.
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Affiliation(s)
- Xiumei Xing
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Liwen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY 12144, USA; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Gongbo Chen
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Steve Hung Lam Yim
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China
| | - Namratha Gurram
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Mo Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiang Xiao
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shuli Xu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Qi Wei
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hongyao Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Boyi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaowen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Qiang Hu
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang 261041, China.
| | - Guanghui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Parisi GF, Papale M, Tardino L, Nenna R, Midulla F, Leonardi S. Biomarkers in Pediatric Lung Diseases Including Cystic Fibrosis. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x15666190521112824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent decades, scientific studies of chemical processes involving metabolites have been
steadily increasing, indicating that we are well into the metabolomics era. This has resulted in
numerous studies that explore the field of biomarkers. One of the medical areas most concerned with
these innovations is certainly that of childhood respiratory disorders, including asthma and cystic
fibrosis. This current study is a review of the literature about biomarkers used or studied in the field
of pediatric pulmonology, including asthma and cystic fibrosis.
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Affiliation(s)
- Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria Papale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lucia Tardino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaella Nenna
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Fabio Midulla
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
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Felicio-Júnior EL, Barnabé V, de Almeida FM, Avona MD, de Genaro IS, Kurdejak A, Eller MCN, Vergani KP, Rodrigues JC, Tibério IDFLC, Martins MDA, Saraiva-Romanholo BM. Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents. Clinics (Sao Paulo) 2020; 75:e1512. [PMID: 31994616 PMCID: PMC6970279 DOI: 10.6061/clinics/2020/e1512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.
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Affiliation(s)
- Egberto Luiz Felicio-Júnior
- Hospital do Servidor Publico do Estado de Sao Paulo (IAMSPE), Sao Paulo, SP, BR
- Laboratorio de Terapeutica Experimental (LIM-20), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Viviani Barnabé
- Hospital do Servidor Publico do Estado de Sao Paulo (IAMSPE), Sao Paulo, SP, BR
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, SP, BR
| | - Francine Maria de Almeida
- Laboratorio de Terapeutica Experimental (LIM-20), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | | | - Miriam Cardoso Neves Eller
- Departamento de Pediatria e Pneumologia, Instituto da Criança, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Karina Pierantozzi Vergani
- Departamento de Pediatria e Pneumologia, Instituto da Criança, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Joaquim Carlos Rodrigues
- Departamento de Pediatria e Pneumologia, Instituto da Criança, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Milton de Arruda Martins
- Laboratorio de Terapeutica Experimental (LIM-20), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Beatriz Mangueira Saraiva-Romanholo
- Hospital do Servidor Publico do Estado de Sao Paulo (IAMSPE), Sao Paulo, SP, BR
- Laboratorio de Terapeutica Experimental (LIM-20), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Turner S, Cotton SC, Emele CD, Thomas R, Fielding S, Gaillard EA, de Jongste JC, Morgan H, Neilson AR, Norrie J, Pijnenburg M, Price D, Thomas M. Reducing Asthma Attacks in Children using Exhaled Nitric Oxide as a biomarker to inform treatment strategy: a randomised trial (RAACENO). Trials 2019; 20:573. [PMID: 31585544 PMCID: PMC6778366 DOI: 10.1186/s13063-019-3500-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Childhood asthma is a common condition. Currently there is no validated objective test which can be used to guide asthma treatment in children. This study tests the hypothesis that the addition of fractional exhaled nitric oxide (FENO) monitoring in addition to standard care reduces the number of exacerbations (or attacks) in children with asthma. Methods This is a multi-centre, randomised controlled study. Children will be included of age 6–16 years who have a diagnosis of asthma, currently use inhaled corticosteroids (ICSs) and have had an exacerbation in the previous 12 months. Exclusion criteria include being unable to provide FENO measurement at baseline assessment, having another chronic respiratory condition and being currently treated with maintenance oral steroids. Participants will be recruited in both primary and secondary care settings and will be randomised to either receive asthma treatment guided by FENO plus symptoms (FENO group) or asthma treatment guided by symptoms only (standard care group). Within the FENO group, different treatment decisions will be made dependent on changes in FENO. Participants will attend assessments 3, 6, 9 and 12 months post randomisation. The primary outcome is asthma exacerbation requiring prescription and/or use of an oral corticosteroid over 12 months as recorded by the participant/parent or in general practitioner records. Secondary outcomes include time to first attack, number of attacks, asthma control score and quality of life. Adherence to ICS treatment is objectively measured by an electronic logging device. Participants are invited to participate in a “phenotyping” assessment where skin prick reactivity and bronchodilator response are determined and a saliva sample is collected for DNA extraction. Qualitative interviews will be held with participants and research nurses. A health economic evaluation will take place. Discussion This study will evaluate whether FENO can provide an objective index to guide and stratify asthma treatment in children. Trial registration ISRCTN, ISRCTN67875351. Registered on 12 April 2017. Prospectively registered.
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Affiliation(s)
- S Turner
- Child Health, University of Aberdeen, Aberdeen, UK.
| | - S C Cotton
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - C D Emele
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - R Thomas
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - S Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - E A Gaillard
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - J C de Jongste
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - H Morgan
- Postgraduate Education Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A R Neilson
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - J Norrie
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - M Pijnenburg
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - D Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - M Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
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Korten I, Zacharasiewicz A, Bittkowski N, Hofmann A, Lex C. Asthma control in children: Body plethysmography in addition to spirometry. Pediatr Pulmonol 2019; 54:1141-1148. [PMID: 31172686 DOI: 10.1002/ppul.24320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is a lack of agreement among measures of asthma control in children. In Central Europe, body plethysmography is additionally used for asthma monitoring. However, its value is still unclear. OBJECTIVES We investigated the possible additional value of body plethysmographic measures (specific resistance, residual volume-total lung capacity ratio [RV/TLC]) compared with spirometric measures forced expiratory volume in 1 second (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC, forced expiratory flow at 25% to 75% of forced vital capacity (FEF 25-75 ), and fraction of exhaled nitric oxide (FeNO) for assessment of asthma control. METHODS One hundred and forty-five asthmatic children aged 5 to 17 were included. All children performed measurements of FeNO, spirometry, and body plethymography. Asthma control was assessed by the asthma control test (c-ACT/ACT) and a doctor's assessment of asthma control. RESULTS Investigating single lung function parameters, FEV1 , FEV 1 /FVC, FEF 25-75 and RV/TLC differed between controlled and partly controlled asthma. However, we found no differences between controlled and uncontrolled asthma with regard to single lung function parameters or for any parameter if investigated in a multivariable approach. This was also true if we combined obtained parameters from spirometry (comparing pathologic vs normal spirometry). Investigating the combination of body plethysmography and doctor's assessment of asthma control a significant association was found ( P = 0.02). Furthermore, combined spirometry and body plethysmography showed a significant association with both doctor's assessed asthma control ( P = 0.009) and the c-ACT/ACT ( P = 0.04). The addition of FeNO did not improve the results. CONCLUSIONS The combination of body plethysmography and spirometry shows best agreement with asthma control in children compared with spirometry or body plethysmography alone. Further studies are needed to find out whether additional measurements of body plethysmography improve the outcome of children in asthma monitoring.
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Affiliation(s)
- Insa Korten
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Teaching Hospital University of Vienna, Wilhelminenspital, Vienna, Austria
| | - Nina Bittkowski
- Department of Pediatric Cardiology and Intensive Care Medicine with Neonatology and Pediatric Pneumology, University Hospital Goettingen, Goettingen, Germany
| | - Alexander Hofmann
- Department of Pediatrics, University Hospital Halle (Saale), Halle, Germany
| | - Christiane Lex
- Department of Pediatric Cardiology and Intensive Care Medicine with Neonatology and Pediatric Pneumology, University Hospital Goettingen, Goettingen, Germany
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Malmberg LP. Shedding light on the breathing difficulties of children. Acta Paediatr 2019; 108:1380-1381. [PMID: 30916830 DOI: 10.1111/apa.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Leo Pekka Malmberg
- Allergology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
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Pappalardo MG, Parisi GF, Tardino L, Savasta S, Brambilla I, Marseglia GL, Licari A, Leonardi S. Measurement of nitric oxide and assessment of airway diseases in children: an update. Minerva Pediatr 2019; 71:524-532. [PMID: 31352766 DOI: 10.23736/s0026-4946.19.05513-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Nitric oxide (NO) is a gas synthesized by the inducible NO synthase enzyme in airway cells and it is thought to make important functions in the airway inflammation of several respiratory diseases. EVIDENCE ACQUISITION This current study is a review of the literature from 1990 to present about NO and its use in clinical practice. The databases used were PubMed, Scopus, and Cochrane Library. EVIDENCE SYNTHESIS At the respiratory level there are three different measurements sites of NO: nNO (nasal nitric oxide), FeNO (exhaled fraction of nitric oxide), CaNO (alveolar nitric oxide). Each of them is produced at different levels of the respiratory tract and is involved in various diseases. nNO finds its use, principally, in the allergic rhinitis in fact it can be used as a measure of therapeutic efficacy, but not for the evaluation of the severity; also in primary ciliary dyskinesia (PCD), where high levels exclude the disease, and in chronic rhinosinusitis, but it is not currently used as a diagnostic or prognostic marker. FeNO has a greatest use in bronchial asthma, particularly, it is considered a non-invasive biomarker to identify and to monitor airway inflammation but currently, there is not a consensus on the use of the FeNO in the management of asthma treatment. Finally, CaNO is the least used in clinical practice, because lack of standardization of measurement techniques. CONCLUSIONS Nitric oxide is a sensitive indicator of the presence of airway inflammation and ciliary dysfunction, although some studies have shown varying or conflicting results.
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Affiliation(s)
- Maria G Pappalardo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe F Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
| | - Lucia Tardino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Savasta
- Department of Pediatrics, San Matteo Polyclinic, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Ilaria Brambilla
- Department of Pediatrics, San Matteo Polyclinic, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Gian L Marseglia
- Department of Pediatrics, San Matteo Polyclinic, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Amelia Licari
- Department of Pediatrics, San Matteo Polyclinic, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Moustafa Y, El Nady HG, Saber MM, Dabbous OA, Kamel TB, Abel-Wahhab KG, Sallam SF, Zaki DA. Assessment of Allergic Rhinitis among Children after Low-Level Laser Therapy. Open Access Maced J Med Sci 2019; 7:1968-1973. [PMID: 31406538 PMCID: PMC6684433 DOI: 10.3889/oamjms.2019.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) represents one of the most common global health problems with seriously increasing incidence over the last decades. The goal of the treatment of rhinitis is to prevent or reduce the symptoms caused by the inflammation of affected tissues. Intranasal steroids and oral antihistamines are recommended as first lines of treatment. Acupuncture had reported a significant improvement in daily symptoms and an increase of symptom-free days in many studies enrolling adults' patients. AIM This study aimed to evaluate the laser acupuncture effect on the treatment of children AR in comparison to the effect of the medication and to assess the anti-inflammatory effect of laser acupuncture through measurement of serum inflammatory marker (hs-CRP). METHODS Sixty patients with allergic rhinitis their age group ranged from 4 to 18 years were divided randomly into two groups. Group 1 enrolled 30 patient that received AR in the form of intranasal steroids, antihistaminic, leukotriene antagonists while group2 thirty patients received 12 laser acupuncture sessions (2 sessions a \ week) on specific traditional Chinese acupuncture points. RESULTS There was a significant improvement in the severity score symptoms in both groups through and by the end of the study. High Significant improvement in the levels of the inflammatory marker in both groups, especially in the group which receive laser acupuncture sessions. CONCLUSION Laser acupuncture is a reliable, painless and non-invasive successful technique, which may be used as a complementary treatment for pediatric allergic rhinitis.
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Affiliation(s)
- Yousry Moustafa
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt
| | - Hala G. El Nady
- Child Health Department, National Research Centre, Cairo, Egypt
| | - Maha M. Saber
- Complementary Medicine Department, National Research Centre, Cairo, Egypt
| | - Ola A. Dabbous
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt
| | | | | | - Sara F. Sallam
- Child Health Department, National Research Centre, Cairo, Egypt
| | - Dina A. Zaki
- Child Health Department, National Research Centre, Cairo, Egypt
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Cheng JK, Faniyan A, Chan Yuen J, Myers T, Fleck M, Burgess J, Williams K, Wijeratne R, Webster R, Cox J, Ng MW. Changes in Oral Health Behaviors Associated With a Nursing Intervention in Primary Care. Glob Pediatr Health 2019; 6:2333794X19845923. [PMID: 31192280 PMCID: PMC6540475 DOI: 10.1177/2333794x19845923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/24/2019] [Accepted: 03/30/2019] [Indexed: 11/24/2022] Open
Abstract
Objective. To describe changes in oral health behaviors following implementation of a nursing intervention targeting children at risk for early childhood caries at an urban 2-site primary care practice. Methods. Nurses used a proprietary Nursing Caries Assessment Tool (N-CAT) to identify behaviors associated with early childhood caries risk, then provided brief focused dental education, fluoride varnish applications, and dental referrals to children without a dental home. We used generalized estimating equation logistic regression models, adjusted for age at visit, to analyze changes in oral health behaviors over time including the following: (1) tooth brushing frequency, (2) use of fluoride toothpaste, and (3) adult help with brushing among children younger than 5 years of age who had at least 2 N-CATs documented during well care visits between April 2013 and June 2015. We also evaluated dietary habits including going to bed with a bottle or sippy cup and sugar-sweetened beverage consumption, as secondary study outcomes during the same time frame. Results. A total of 2097 children with a mean age of 15.8 (SD 7.6) months at the initial visit were included in the analysis; 51% were boys; 28% were black, 36% Hispanic/Latino, 5% white, 2% Asian, and 19% other; 75% were publicly insured. During the study period, significant (P < .05) improvements were noted across the 3 oral health behaviors studied among children younger than 18 months. Conclusion. Nursing interventions show promise for promoting preventive dental care in primary care settings and deserve further study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Joanne Cox
- Boston Children’s Hospital, Boston, MA, USA
| | - Man Wai Ng
- Boston Children’s Hospital, Boston, MA, USA
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Lentferink YE, Boogaart NE, Balemans WAF, Knibbe CAJ, van der Vorst MMJ. Asthma medication in children who are overweight/obese: justified treatment? BMC Pediatr 2019; 19:148. [PMID: 31078144 PMCID: PMC6511208 DOI: 10.1186/s12887-019-1526-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/02/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The prevalence of asthma and obesity have increased over the last decades. A possible association between these two chronic illnesses has been suggested, since the prevalence of asthmatic symptoms rises with increasing Body Mass Index (BMI). However, asthma is only one of several possible causes of shortness of breath in obese children. The aim of this study is to evaluate the prevalence of overtreatment with asthma medication in a cohort overweight/obese children with respiratory symptoms visiting a pediatric outpatient clinic. METHODS Children referred to a pediatric outpatient clinic aged ≥4- ≤ 18 years with overweight/obesity (defined as BMI-sds > 1.1) and asthmatic symptoms were included. The diagnosis asthma was evaluated and classified in no, unlikely, probable and confirmed asthma, based on clinical parameters and/or spirometry results. Overtreatment was defined as asthma medication prescribed in participants classified as no or unlikely asthma. And undertreatment as probable or confirmed asthma without asthma medication prescribed . RESULTS Three hundred thirty-eight participants were included, of which 92.6% (313/338) had a prescription for asthma medication. Overtreatment was observed in 27.2% (92/338) participants. Nine participants were undertreated. CONCLUSION More than 25% overtreatment with asthma medication was observed in a cohort overweight/obese children with asthmatic symptoms. This finding emphasizes that the diagnosis of asthma must be confirmed before commencement of medication. The diagnosis of asthma should be based on standard questionnaires evaluating asthmatic symptoms, lung functions test and regular reassessments. Further studies concerning overtreatment with asthma medication in normal weight pediatric populations are warranted, to evaluate whether overtreatment is specific for overweight/obese children.
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Affiliation(s)
- Yvette E Lentferink
- Department of Pediatrics, St Antonius Hospital, P.O. Box 2500 3430, EM, Nieuwegein, The Netherlands
| | - Nienke E Boogaart
- Department of General Practitioners, Leiden University, P.O. 9600, 2300 RC, Leiden, The Netherlands
| | - Walter A F Balemans
- Department of Pediatrics, St Antonius Hospital, P.O. Box 2500 3430, EM, Nieuwegein, The Netherlands
| | - Catherijne A J Knibbe
- Department of Clinical Pharmacy, St Antonius Hospital, P.O. Box 2500 3430, EM, Nieuwegein, The Netherlands
| | - Marja M J van der Vorst
- Department of Pediatrics, St Antonius Hospital, P.O. Box 2500 3430, EM, Nieuwegein, The Netherlands.
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Lee WY, Suh DI, Song DJ, Baek HS, Shin M, Yoo Y, Kwon JW, Jang GC, Yang HJ, Lee E, Seo JH, Woo SI, Kim HY, Shin YH, Lee JS, Yoon J, Jung S, Han M, Eom E, Yu J, Kim WK, Lim DH, Kim JT, Chang WS, Lee JK, Kim HS. Asthma control test reflects not only lung function but also airway inflammation in children with stable asthma. J Asthma 2019; 57:648-653. [PMID: 30969134 DOI: 10.1080/02770903.2019.1599386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Various numerical asthma control tools have been developed to distinguish different levels of symptom control. We aimed to examine whether the asthma control test (ACT) is reflective of objective findings such as lung function, fractional exhaled nitric oxide (FeNO) and laboratory data in patients with stable asthma.Methods: We included patients who were enrolled in the Korean Childhood Asthma Study. ACT, spirometry, blood tests and FeNO were performed in patients after stabilization of their asthma. We examined differences among spirometry parameters, blood tests and FeNO according to control status as determined by ACT and investigated for any significant correlations.Results: The study population consisted of 441 subjects. Spirometry showed that forced expiratory volume in one second (FEV1), forced expiratory flow between 25% and 75% of forced vital capacity and FEV1/forced vital capacity were all significantly higher in the controlled asthma group. Likewise, FeNO and percent-change in FEV1 were both significantly lower in the controlled asthma group. In blood tests, the eosinophil fraction was significantly lower in the controlled asthma group while white blood cell count was significantly higher in the controlled asthma group. Lastly, among the various factors analyzed, only provocative concentration of methacholine causing a 20% fall in FEV1 significantly correlated with ACT score.Conclusion: ACT is useful as part of the routine evaluation of asthmatic children and should be used as a complement to existing tools such as spirometry and FeNO measurement.
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Affiliation(s)
- Woo Yeon Lee
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Ilsan, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Dankook University Hospital, Cheonan, Korea
| | - Sung-Il Woo
- Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Ho Shin
- Department of Pediatrics, Gangnam CHA Medical Center CHA University School of Medicine, Seoul, Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jisun Yoon
- Department of Pediatrics, Mediplex Sejong Hospital, Incheon, Korea
| | - Sungsu Jung
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Eunjin Eom
- Department of Statistics, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Korea
| | - Jin Tack Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's hospital, Uijeongbu, Korea
| | - Woo-Sung Chang
- Division of Allergy and Chronic Respiratory Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Jeom-Kyu Lee
- Division of Allergy and Chronic Respiratory Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Hwan Soo Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
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Biomarkers and asthma management: analysis and potential applications. Curr Opin Allergy Clin Immunol 2019; 18:96-108. [PMID: 29389730 DOI: 10.1097/aci.0000000000000426] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Asthma features a high degree of heterogeneity in both pathophysiology and therapeutic response, resulting in many asthma patients being treated inadequately. Biomarkers indicative of underlying pathological processes could be used to identify disease subtypes, determine prognosis and to predict or monitor treatment response. However, the newly identified as well as more established biomarkers have different applications and limitations. RECENT FINDINGS Conventional markers for type 2-high asthma, such as blood eosinophils, fraction of exhaled nitric oxide, serum IgE and periostin, feature limited sensitivity and specificity despite their significant correlations. More distinctive models have been developed by combining biomarkers and/or using omics techniques. Recently, a model with a positive predictive value of 100% for identification of type 2-high asthma based on a combination of minimally invasive biomarkers was developed. SUMMARY Individualisation of asthma treatment regimens on the basis of biomarkers is necessary to improve asthma control. However, the suboptimal properties of currently available conventional biomarkers limit its clinical utility. Newly identified biomarkers and models based on combinations and/or omics analysis must be validated and standardised before they can be routinely applied in clinical practice. The development of robust biomarkers will allow development of more efficacious precision medicine-based treatment approaches for asthma.
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Melgarejo González-Conde V, Pérez-Fernández V, Ruiz-Esteban C, Valverde-Molina J. Impact of Self-Efficacy on the Quality of Life of Children With Asthma and Their Caregivers. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.arbr.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Nishima S, Kozawa M, Milligan KL, Papadopoulos NG. Omalizumab and unmet needs in severe asthma and allergic comorbidities in Japanese children. Asia Pac Allergy 2019; 9:e7. [PMID: 30740355 PMCID: PMC6365659 DOI: 10.5415/apallergy.2019.9.e7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/17/2019] [Indexed: 01/20/2023] Open
Abstract
Childhood asthma is one condition within a family of allergic diseases, which includes allergic rhinitis, atopic dermatitis, and food allergy, among others. Omalizumab is an anti-IgE antibody therapy that was approved in Japan for children with asthma and added to the Japanese pediatric asthma guidelines in 2017. This review highlights the Japanese clinical perspectives in pediatric allergic asthma, and consideration for allergic comorbidities, and reflects on omalizumab clinical trials in progress to present comprehensive future opportunities.
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Affiliation(s)
- Sankei Nishima
- National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
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50
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Jung Y, Kim J, Park DA. [Effectiveness of Telemonitoring Intervention in Children and Adolescents with Asthma: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs 2018; 48:389-406. [PMID: 30206191 DOI: 10.4040/jkan.2018.48.4.389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE This review aimed to evaluate the effectiveness of telemonitoring (TM) in the management of children and adolescents with asthma. METHODS We searched Ovid-MEDLINE, Ovid-EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and 5 domestic databases to identify randomized controlled trials (RCTs) published through December 2017. Two reviewers independently selected relevant studies, assessed methodological quality and extracted data. We performed a meta-analysis of TM versus usual care and summarized the intervention characteristics of included studies. RESULTS Of the 3,095 articles identified, 8 RCTs (9 articles) were included in this review. The type of TM intervention of included studies was varying across studies (transmitted data, transmission frequency, data review, etc.). The pooled asthma control score was not significantly different between TM and usual care (standardized mean difference 0.04, 95% confidence interval (CI) -0.20~0.28). Another pooled analysis demonstrated no statistically significant difference in asthma exacerbation between TM and usual care (odds ratio 0.95, 95% CI 0.43~2.09). Overall, the pooled results from these studies revealed that TM did not lead to clinically significant improvements in health outcomes, but some studies in our analysis suggested that TM increased patient medication adherence and intervention adherence. CONCLUSION The current evidence base does not demonstrate any differences between TM intervention and usual care, but TM intervention might be considered a promising strategy for the delivery of self-management support for children and adolescents with asthma. Further well-designed studies are needed to assess the effects on clinical outcomes.
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Affiliation(s)
- Youjin Jung
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.,College of Nursing, Korea University, Seoul, Korea
| | - Jimin Kim
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong Ah Park
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
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