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Emeryk A, Derom E, Janeczek K, Kuźnar-Kamińska B, Zelent A, Łukaszyk M, Grzywalski T, Pastusiak A, Biniakowski A, Szarzyński K, Botteldooren D, Kociński J, Hafke-Dys H. Home Monitoring of Asthma Exacerbations in Children and Adults With Use of an AI-Aided Stethoscope. Ann Fam Med 2023; 21:517-525. [PMID: 38012028 PMCID: PMC10681685 DOI: 10.1370/afm.3039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE The advent of new medical devices allows patients with asthma to self-monitor at home, providing a more complete picture of their disease than occasional in-person clinic visits. This raises a pertinent question: which devices and parameters perform best in exacerbation detection? METHODS A total of 149 patients with asthma (90 children, 59 adults) participated in a 6-month observational study. Participants (or parents) regularly (daily for the first 2 weeks and weekly for the next 5.5 months, with increased frequency during exacerbations) performed self-examinations using 3 devices: an artificial intelligence (AI)-aided home stethoscope (providing wheezes, rhonchi, and coarse and fine crackles intensity; respiratory and heart rate; and inspiration-to-expiration ratio), a peripheral capillary oxygen saturation (SpO2) meter, and a peak expiratory flow (PEF) meter and filled out a health state survey. The resulting 6,029 examinations were evaluated by physicians for the presence of exacerbations. For each registered parameter, a machine learning model was trained, and the area under the receiver operating characteristic curve (AUC) was calculated to assess its utility in exacerbation detection. RESULTS The best single-parameter discriminators of exacerbations were wheezes intensity for young children (AUC 84% [95% CI, 82%-85%]), rhonchi intensity for older children (AUC 81% [95% CI, 79%-84%]), and survey answers for adults (AUC 92% [95% CI, 89%-95%]). The greatest efficacy (in terms of AUC) was observed for a combination of several parameters. CONCLUSIONS The AI-aided home stethoscope provides reliable information on asthma exacerbations. The parameters provided are effective for children, especially those younger than 5 years of age. The introduction of this tool to the health care system might enhance asthma exacerbation detection substantially and make remote monitoring of patients easier.
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Affiliation(s)
- Andrzej Emeryk
- Department of Paediatric Pulmonology and Rheumatology, Faculty of Medicine, Medical University of Lublin, Lublin, Poland (A.E., K.J.)
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium (E.D.)
| | - Kamil Janeczek
- Department of Paediatric Pulmonology and Rheumatology, Faculty of Medicine, Medical University of Lublin, Lublin, Poland (A.E., K.J.);
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology, and Respiratory Oncology, Poznań University of Medical Sciences, Poznań, Poland (B.K.K.)
| | - Anna Zelent
- Department of Pediatric Pneumonology, Allergology, and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland (A.Z.)
| | - Mateusz Łukaszyk
- 1st Department of Lung Diseases and Tuberculosis, Faculty of Medicine, Medical University of Bialystok, Białystok, Poland (M.Ł.)
| | - Tomasz Grzywalski
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- WAVES Research Group, Department of Information Technology, Ghent University, Ghent, Belgium (T.G., D.B.)
| | - Anna Pastusiak
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
| | - Adam Biniakowski
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
| | | | - Dick Botteldooren
- WAVES Research Group, Department of Information Technology, Ghent University, Ghent, Belgium (T.G., D.B.)
| | - Jędrzej Kociński
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
| | - Honorata Hafke-Dys
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
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Abstract
PURPOSE OF REVIEW Asthma is a common chronic disease of the airways characterized by recurrent respiratory symptoms, bronchoreactivity, and airway inflammation. The high toll on quality of life has led to sustained efforts to understand the factors leading to asthma inception and poor disease control. Obesity is another increasingly common pediatric disease, which appears to increase the risk for incident asthma and worsened disease severity. Currently, our understanding of how obesity affects asthma risk and affects its phenotypic characteristics remains incomplete. The current review describes our current understanding of the epidemiology, clinical characteristics, and management considerations of obesity-related asthma in children. RECENT FINDINGS The epidemiologic relationship between obesity in children and incident asthma remains confusing despite numerous longitudinal cohort studies, and appears to be influenced by early life exposures, patterns of somatic growth and underlying familial risks of allergic disease. Children with comorbid obesity and asthma demonstrate diverse phenotypic characteristics which are still becoming clear. SUMMARY Like any child with asthma, a child with comorbid obesity requires an individualized approach adhering to current best-practice guidelines and an understanding of how obesity and asthma may interact.
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Horwitz D, Kestenbom I, Goldbart A, Chechik T, Dizitzer Y, Golan-Tripto I. The effect of a coaching program on asthma control and health care utilization in children with asthma. J Asthma 2019; 58:240-247. [PMID: 31591919 DOI: 10.1080/02770903.2019.1672721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSRACTObjective: Poor adherence to asthma therapy is a major problem in the management of asthma. We aimed to assess if a designed coaching program in children with asthma, coming from low socioeconomic background, will reduce respiratory morbidity and health care utilization.Methods: A prospective interventional pilot study enrolling children aged 3-18 years, admitted to Soroka University Medical Center (SUMC) between October 2015 and May 2016 due to asthma exacerbation. The intervention group was part of a coaching program, which was conducted by medical and paramedical personnel and included a diagnostic and personal educational office visit and a house visit by a nurse educator for asthma. The control group comprised of demographically matched children with asthma, who were admitted to the SUMC, but did not go through any intervention. Medications purchase and health care utilization were extracted from the participants' HMO databases, during 1-year of follow-up.Results: 41 children were enrolled to the intervention group, with 63 children as a control group. No differences were found in asthma-related drugs purchase, number of clinic visits, ER admissions and hospitalizations during the follow-up year, although the intervention group showed a trend towards having a shorter length of stay (2.3 vs. 4.5 days, Cohen's D = 0.44, p = 0.06). The intervention group demonstrated subjective improvement in asthma control, as reflected in Asthma Control Test questionnaires.Conclusions: In this pilot study of coaching program for children with asthma coming from low income families, no decrease in health care utilization was shown. Larger and longer intervention programs are needed.
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Affiliation(s)
- Dana Horwitz
- Department of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Inbal Kestenbom
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| | - Aviv Goldbart
- Faculty of Health Sciences, Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University, Beer Sheva, Israel.,Pediatric Pulmonology Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Tzila Chechik
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| | - Yotam Dizitzer
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Inbal Golan-Tripto
- Faculty of Health Sciences, Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University, Beer Sheva, Israel.,Pediatric Pulmonology Unit, Soroka University Medical Center, Beer Sheva, Israel
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4
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Dong X, Zhong N, Fang Y, Cai Q, Lu M, Lu Q. MicroRNA 27b-3p Modulates SYK in Pediatric Asthma Induced by Dust Mites. Front Pediatr 2018; 6:301. [PMID: 30406061 PMCID: PMC6204538 DOI: 10.3389/fped.2018.00301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 09/25/2018] [Indexed: 01/09/2023] Open
Abstract
The PI3K-AKT pathway is known to regulate cytokines in dust mite-induced pediatric asthma. However, the underlying molecular steps involved are not clear. In order to clarify further the molecular steps, this study investigated the expression of certain genes and the involvement of miRNAs in the PI3K-AKT pathway, which might affect the resultant cytokine-secretion. in-vivo and in-vitro ELISA, qRT-PCR and microarrays analyses were used in this study. A down-expression of miRNA-27b-3p in dust mite induced asthma group (group D) was found by microarray analysis. This was confirmed by qRT-PCR that found the miRNA-27b-3p transcripts that regulated the expression of SYK and EGFR were also significantly decreased (p < 0.01) in group D. The transcript levels of the SYK and PI3K genes were higher, while those of EGFR were lower in the former group. Meanwhile, we found significant differences in plasma concentrations of some cytokines between the dust mite-induced asthma subjects and the healthy controls. On the other hand, this correlated with the finding that the transcripts of SYK and its downstream PI3K were decreased in HBE transfected with miRNA-27b-3p, but were increased in HBE transfected with the inhibitor in vitro. Our results indicate that the differential expression of the miRNAs in dust mite-induced pediatric asthma may regulate their target gene SYK and may have an impact on the PI3K-AKT pathway associated with the production of cytokines. These findings should add new insight into the pathogenesis of pediatric asthma.
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Affiliation(s)
- Xiaoyan Dong
- Department of Pulmonary, Shanghai Children's Hospital, Shanghai, China
- Shanghai Institute of Medical Genetics, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
| | - Nanbert Zhong
- Shanghai Children's Hospital, Shanghai, China
- Department of Human Genetics, Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
- Chinese Alliance of Translational Medicine for Maternal and Children's Health, Beijing, China
- Peking University Center of Medical Genetics, Peking University Health Science Centre, Beijing, China
| | - Yudan Fang
- Shanghai Institute of Medical Genetics, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
| | - Qin Cai
- Shanghai Institute of Medical Genetics, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
| | - Min Lu
- Department of Pulmonary, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
| | - Quan Lu
- Department of Pulmonary, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
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5
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Kaur S, Singh V. Asthma and Medicines - Long-Term Side-Effects, Monitoring and Dose Titration. Indian J Pediatr 2018; 85:748-756. [PMID: 29306991 DOI: 10.1007/s12098-017-2553-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/22/2017] [Indexed: 01/30/2023]
Abstract
Asthma is a major pediatric respiratory morbidity requiring long-term management. A thorough knowledge of long-term medication side-effects in children is, thus, essential for every physician dealing with childhood asthma. Establishing diagnosis and initiating treatment is just a beginning of the journey. Ongoing monitoring is an essential component of comprehensive asthma management programme. Monitoring includes not only assessment of asthma control but also checking for adherence to treatment, technique of inhaler device use, associated co-morbities, if any, and potential environmental exposure. Various tools - both subjective and objective - are available for assessment of asthma control. However, evidence for their optimum use in different settings and patient groups is lacking and monitoring has to be customized depending on available resources and individual patient characteristics. Patient education is an important component of long-term asthma therapy. The ultimate aim is to achieve optimum asthma control i.e., achieve and maintain control of clinical symptoms, decrease future risk to patients (risk of exacerbations, progressive loss of lung function and development of fixed airflow obstruction, adverse effects of medications) and enabling the child to lead a life without restrictions, at lowest possible dose of drugs. This article reviews the side-effects of medications used for long-term management of asthma and discusses current literature on asthma monitoring and dose titration in pediatric population to help the asthma therapist not only prescribe the drugs rationally but also help the family make right choices for treatment.
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Affiliation(s)
- Satnam Kaur
- Department of Pediatrics, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.
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Licari A, Brambilla I, Marseglia A, De Filippo M, Paganelli V, Marseglia GL. Difficult vs. Severe Asthma: Definition and Limits of Asthma Control in the Pediatric Population. Front Pediatr 2018; 6:170. [PMID: 29971223 PMCID: PMC6018103 DOI: 10.3389/fped.2018.00170] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/24/2018] [Indexed: 01/14/2023] Open
Abstract
Evaluating the degree of disease control is pivotal when assessing a patient with asthma. Asthma control is defined as the degree to which manifestations of the disease are reduced or removed by therapy. Two domains of asthma control are identified in the guidelines: symptom control and future risk of poor asthma outcomes, including asthma attacks, accelerated decline in lung function, or treatment-related side effects. Over the past decade, the definition and the tools of asthma control have been substantially implemented so that the majority of children with asthma have their disease well controlled with standard therapies. However, a small subset of asthmatic children still requires maximal therapy to achieve or maintain symptom control and experience considerable morbidity. Childhood uncontrolled asthma is a heterogeneous group and represents a clinical and therapeutic challenge requiring a multidisciplinary systematic assessment. The identification of the factors that may contribute to the gain or loss of control in asthma is essential in differentiating children with difficult-to-treat asthma from those with severe asthma that is resistant to traditional therapies. The aim of this review is to focus on current concept of asthma control, describing monitoring tools currently used to assess asthma control in clinical practice and research, and evaluating comorbidities and modifiable and non-modifiable factors associated with uncontrolled asthma in children, with particular reference to severe asthma.
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Affiliation(s)
| | | | | | | | | | - Gian L. Marseglia
- Department of Pediatric, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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7
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Grigg J, Barben J, Everard ML, Hall G, Karadag B, Moeller A, Nenna R, Priftis KN, Rottier RJ, Terheggen-Lagro SWJ, Midulla F. Key paediatric messages from the 2017 European Respiratory Society International Congress. ERJ Open Res 2018; 4:00165-2017. [PMID: 29850468 PMCID: PMC5968195 DOI: 10.1183/23120541.00165-2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/08/2018] [Indexed: 12/31/2022] Open
Abstract
In this article, the group chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting findings presented at the 2017 ERS International Congress, which was held in Milan, Italy.
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Affiliation(s)
- Jonathan Grigg
- Centre for Child Health, The Blizard Institute, Queen Mary University of London, London, UK
| | - Jürg Barben
- Division of Paediatric Pulmonology, Children's Hospitals of Eastern Switzerland, St Gallen, Switzerland
| | - Mark L Everard
- Princess Margaret Hospital for Children School of Paediatric and Child Health, University of Western Australia, Perth, Australia
| | - Graham Hall
- Telethon Kids Institute and Curtin University, Perth, Australia
| | - Bülent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Raffaella Nenna
- Dept of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Kostas N Priftis
- 3rd Dept of Paediatrics, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece
| | | | | | - Fabio Midulla
- Dept of Paediatrics, Sapienza University of Rome, Rome, Italy
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8
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van den Wijngaart LS, Roukema J, Merkus PJFM. Monitoring asthma: no matter how? Eur Respir J 2018; 48:614-6. [PMID: 27581404 DOI: 10.1183/13993003.01217-2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Lara S van den Wijngaart
- Radboud University Medical Centre, Amalia Children's Hospital, Dept of Paediatrics, Division of Respiratory Medicine and Allergy, Nijmegen, The Netherlands
| | - Jolt Roukema
- Radboud University Medical Centre, Amalia Children's Hospital, Dept of Paediatrics, Division of Respiratory Medicine and Allergy, Nijmegen, The Netherlands
| | - Peter J F M Merkus
- Radboud University Medical Centre, Amalia Children's Hospital, Dept of Paediatrics, Division of Respiratory Medicine and Allergy, Nijmegen, The Netherlands
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Ali-Dinar T, Lang JE. Is impaired glucose metabolism the missing piece in the obesity-asthma puzzle? Pediatr Pulmonol 2017; 52:147-150. [PMID: 27749021 DOI: 10.1002/ppul.23625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/29/2016] [Indexed: 11/06/2022]
Abstract
Obesity is a major risk factor for several conditions including atherosclerotic disease, metabolic syndrome, and upper airway dysfunction. However, the purported link between obesity and asthma has remained more difficult to define, in part due to limitations in past epidemiologic studies and the inherent challenge in accurately defining asthma in children. It is possible that obesity leads to asthma only in the presence of a mediating variable such as an obesity-related conditions such as esophageal reflux or insulin resistance. The article by Karampatakis and colleagues in this week's edition of the journal is important because it addresses the hypothesis that altered glucose metabolism/insulin resistance associates with bronchial hyperresponsiveness (BHR), a central and objectively measured marker of asthma. They studied pre-pubertal children with and without asthma with a range of body mass indices and found for the first time in pre-pubertal asthmatic children that both insulin resistance and impaired glucose tolerance were more closely related to BHR than was obesity. Their work opens the way for directed mechanistic study of the effects of impaired glucose metabolism on airway development during childhood and airway responsiveness, and for the study of insulin sensitizing therapies in children to prevent lower airway disease. Pediatr Pulmonol. 2017;52:147-150. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tarig Ali-Dinar
- Division of Pulmonary and Sleep Medicine, Nemours Children's Hospital, Orlando, Florida
| | - Jason E Lang
- Division of Pulmonary Medicine, Duke Children's Hospital and Health Center, Duke University School of Medicine, Durham, North Carolina
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10
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Brouwer ML, Wijngaart LSVD, Hugen CAC, Gerrits GPJM, Roukema J, Merkus PJFM. Evaluation of monitoring strategies for childhood asthma. Expert Rev Respir Med 2016; 10:1199-1209. [PMID: 27666112 DOI: 10.1080/17476348.2016.1240034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The goal of monitoring pediatric asthma is to obtain and maintain asthma control, which is defined as minimizing asthma symptoms, restrictions to daily activities and the use of rescue medication. Long term goals include reducing the risk of fixed airflow limitation, and preventing asthma exacerbations and side effects of treatment. Several monitoring tools are available but no consensus exists on how to monitor patients in the most optimal way. Areas covered: In this review, we provide an overview of different tools and address general considerations on monitoring childhood asthma. Asthma care should be tailored to the individual patient. The health care professional should decide which monitoring strategy and frequency is optimal for the individual patient. Expert commentary: Personalized medicine should be the key issue in monitoring asthma in children. It is crucial to monitor disease activity and deterioration but there is no monitoring strategy that is clearly superior compared to others: The optimal strategy and frequency will vary between patients. Actually, both treatment and monitoring of pediatric asthma probably benefit from a personalized approach.
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Affiliation(s)
- M L Brouwer
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands
| | - L S van den Wijngaart
- b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - C A C Hugen
- c Department of pediatrics , University Centre for Chronic Diseases (Dekkerswald) , Nijmegen , The Netherlands
| | - G P J M Gerrits
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands
| | - J Roukema
- b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - P J F M Merkus
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands.,b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
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11
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Brand PLP, Mäkelä MJ, Szefler SJ, Frischer T, Price D. Monitoring asthma in childhood: symptoms, exacerbations and quality of life. Eur Respir Rev 2016; 24:187-93. [PMID: 26028631 DOI: 10.1183/16000617.00003614] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Monitoring asthma in children in clinical practice is primarily performed by reviewing disease activity (daytime and night-time symptoms, use of reliever medication, exacerbations requiring frequent use of reliever medication and urgent visits to the healthcare professional) and the impact of the disease on children's daily activities, including sports and play, in a clinical interview. In such an interview, most task force members also discuss adherence to maintenance therapy and the patients' (and parents') views and beliefs on the goals of treatment and the amount of treatment required to achieve those goals. Composite asthma control and quality of life measures, although potentially useful in research, have limited value in clinical practice because they have a short recall window and do not cover the entire spectrum of asthma control. Telemonitoring of children with asthma cannot replace face-to-face follow-up and monitoring because there is no evidence that it is associated with improved health outcomes.
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Affiliation(s)
- Paul L P Brand
- Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, CO, USA
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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12
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Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. However, to date there is limited evidence on how to monitor patients with asthma. Childhood asthma introduces specific challenges in terms of deciding what, when, how often, by whom and in whom different assessments of asthma should be performed. The age of the child, the fluctuating course of asthma severity, variability in clinical presentation, exacerbations, comorbidities, socioeconomic and psychosocial factors, and environmental exposures may all influence disease activity and, hence, monitoring strategies. These factors will be addressed in herein. We identified large knowledge gaps in the effects of different monitoring strategies in children with asthma. Studies into monitoring strategies are urgently needed, preferably in collaborative paediatric studies across countries and healthcare systems. Monitoring asthma in children is essential for disease control and should reflect age, triggers and disease activityhttp://ow.ly/J0k7f
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Affiliation(s)
- Karin C Lødrup Carlsen
- Dept of Paediatrics, Oslo University Hospital, Oslo, Norway Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mariëlle W Pijnenburg
- Dept of Paediatric/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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Moeller A, Carlsen KH, Sly PD, Baraldi E, Piacentini G, Pavord I, Lex C, Saglani S. Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation. Eur Respir Rev 2016; 24:204-15. [PMID: 26028633 DOI: 10.1183/16000617.00003914] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children. Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases.
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Affiliation(s)
- Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kai-Hakon Carlsen
- Dept of Paediatrics, Women and Children's Division, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Eugenio Baraldi
- Women's and Children's Health Department, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, NDM Research Building, Oxford, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Paediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
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14
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Cottin V. The European Respiratory Review: farewell from the editor with confidence for the future. Eur Respir Rev 2015; 24:547-9. [PMID: 26621968 PMCID: PMC9487622 DOI: 10.1183/16000617.0070-2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
As my third year as Chief Editor of the European Respiratory Review comes to an end, it is time for me to pass this responsibility onto a new team. It is also time to look back at what has been accomplished and what challenges are faced by the Review. The European Respiratory Review will continue to develop and to accompany respiratory physicians intheir practicehttp://ow.ly/TcDKh
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Affiliation(s)
- Vincent Cottin
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de pneumologie - Centre de référence national des maladies pulmonaires rares et Centre de compétences de l'hypertension artérielle pulmonaire, Lyon, France Université de Lyon, Université Claude Bernard Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France
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15
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Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E, Frischer T, Hedlin G, Kulkarni N, Lex C, Mäkelä MJ, Mantzouranis E, Moeller A, Pavord I, Piacentini G, Price D, Rottier BL, Saglani S, Sly PD, Szefler SJ, Tonia T, Turner S, Wooler E, Lødrup Carlsen KC. Monitoring asthma in children. Eur Respir J 2015; 45:906-25. [PMID: 25745042 DOI: 10.1183/09031936.00088814] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised. Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Dept of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eugenio Baraldi
- Women's and Children's Health Dept, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Paul L P Brand
- Dept of Paediatrics/Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Kai-Håkon Carlsen
- Dept of Paediatrics, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - Gunilla Hedlin
- Depart of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Pediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Eva Mantzouranis
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, Oxford, UK
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, USA
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Karin C Lødrup Carlsen
- Dept of Paediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway Dept of Paediatrics, Faculty of Medicine, University of Oslo, Oslo, Norway
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