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Green S. Climate-conscious inhaler prescribing for family physicians. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:381-387. [PMID: 38886092 PMCID: PMC11280715 DOI: 10.46747/cfp.7006381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To provide family physicians with prescribing and diagnostic strategies that can reduce carbon emissions associated with inhalers. SOURCES OF INFORMATION This review is based on the authors' experience developing the climate-conscious inhaler prescribing playbooks and courses for CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis). The approach was refined through patient and provider feedback since the first playbook was published in 2021. PubMed was also searched for relevant publications on inhaler use, asthma management, and chronic obstructive pulmonary disease (COPD) management. Current asthma and COPD guidelines were also reviewed. MAIN MESSAGE There is growing acknowledgment of the substantial impact that inhalers have on climate emissions generated by the health sector. Recent surveys indicate that most Canadian patients care about climate change and would be willing to opt for less carbon-intensive treatment and care delivery options where available. Beyond inhaler choice, there are many opportunities to address the climate impacts of respiratory care and enhance quality of care. Working with patients to ensure they are using the right medications in the right ways will produce both carbon savings and better health outcomes. The climate crisis can therefore serve as a catalyst for improving treatment of patients with respiratory conditions. Family physicians may reduce carbon emissions associated with inhalers by reducing unnecessary inhaler prescribing; ensuring patients' control of asthma and COPD is optimized; considering whether a more sustainable inhaler may be appropriate; optimizing dosing technique to reduce emissions and waste; and disposing of inhalers appropriately if possible. CONCLUSION Family physicians may reduce carbon emissions associated with inhalers through the following strategies: confirming diagnosis, controlling disease, considering inhaler type, optimizing dosing technique, and encouraging appropriate disposal.
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Affiliation(s)
- Samantha Green
- Family physician at Unity Health in Toronto, Ont, and Assistant Professor at the University of Toronto
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2
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Masson V, Kier C, Chandran L. Cough Conundrums: A Guide to Chronic Cough in the Pediatric Patient. Pediatr Rev 2022; 43:691-703. [PMID: 36450640 DOI: 10.1542/pir.2021-005398] [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: 12/03/2022]
Affiliation(s)
- Vicki Masson
- Division of Pediatric Pulmonology and Sleep Medicine
| | - Catherine Kier
- Division of Pediatric Pulmonology, Stony Brook University, Stony Brook, NY
| | - Latha Chandran
- Department of Medical Education and Pediatrics, University of Miami, Miller School of Medicine, Miami, FL
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3
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Kantar A, Marchant JM, Song WJ, Shields MD, Chatziparasidis G, Zacharasiewicz A, Moeller A, Chang AB. History Taking as a Diagnostic Tool in Children With Chronic Cough. Front Pediatr 2022; 10:850912. [PMID: 35498777 PMCID: PMC9051232 DOI: 10.3389/fped.2022.850912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic cough is a common symptom of many underlying respiratory and non-respiratory disorders and may be associated with less serious causes, such as gastroesophageal reflux and nasal diseases. Chronic cough in children differs from that in adults with respect to its etiologies and management since it can indicate a symptom of an underlying disease in children. Guidelines for managing chronic cough in children are based on recording the history, followed by physical examination, chest radiography, and spirometry. Thus, taking accurate respiratory history for coughing helps delineate the pathophysiological basis of the cause of chronic cough. Detailed history taking enhances the evaluation and treatment, and facilitates a tailored diagnostic identification of likely diagnoses. While studies have described evidence-based red flags in children with chronic cough, the value of skilled physicians regarding history taking has received less attention for the best patient care. In the present article, we outline the major questions comprising a detailed history taking for chronic cough in children.
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Affiliation(s)
- Ahmad Kantar
- Paediatric Asthma and Cough Centre, Gruppo Ospedaliero San Donato, Bergamo, Italy.,Department of Paediatrics, University Vita Salute San Raffaele, Milano, Italy
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Center for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Michael D Shields
- Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, United Kingdom.,Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
| | | | - Angela Zacharasiewicz
- Department of Pediatrics, Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring, Vienna, Austria
| | - Alexander Moeller
- Division of Respiratory Medicine and Childhood Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Center for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
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Balamurali BT, Hee HI, Kapoor S, Teoh OH, Teng SS, Lee KP, Herremans D, Chen JM. Deep Neural Network-Based Respiratory Pathology Classification Using Cough Sounds. SENSORS (BASEL, SWITZERLAND) 2021; 21:5555. [PMID: 34450996 PMCID: PMC8402243 DOI: 10.3390/s21165555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
Intelligent systems are transforming the world, as well as our healthcare system. We propose a deep learning-based cough sound classification model that can distinguish between children with healthy versus pathological coughs such as asthma, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). To train a deep neural network model, we collected a new dataset of cough sounds, labelled with a clinician's diagnosis. The chosen model is a bidirectional long-short-term memory network (BiLSTM) based on Mel-Frequency Cepstral Coefficients (MFCCs) features. The resulting trained model when trained for classifying two classes of coughs-healthy or pathology (in general or belonging to a specific respiratory pathology)-reaches accuracy exceeding 84% when classifying the cough to the label provided by the physicians' diagnosis. To classify the subject's respiratory pathology condition, results of multiple cough epochs per subject were combined. The resulting prediction accuracy exceeds 91% for all three respiratory pathologies. However, when the model is trained to classify and discriminate among four classes of coughs, overall accuracy dropped: one class of pathological coughs is often misclassified as the other. However, if one considers the healthy cough classified as healthy and pathological cough classified to have some kind of pathology, then the overall accuracy of the four-class model is above 84%. A longitudinal study of MFCC feature space when comparing pathological and recovered coughs collected from the same subjects revealed the fact that pathological coughs, irrespective of the underlying conditions, occupy the same feature space making it harder to differentiate only using MFCC features.
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Affiliation(s)
- B T Balamurali
- Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372, Singapore; (S.K.); (J.M.C.)
| | - Hwan Ing Hee
- Department of Paediatric Anaesthesia, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
- Anaesthesiology and Perioperative Sciences, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Saumitra Kapoor
- Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372, Singapore; (S.K.); (J.M.C.)
| | - Oon Hoe Teoh
- Respiratory Medicine Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
| | - Sung Shin Teng
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore 229899, Singapore; (S.S.T.); (K.P.L.)
| | - Khai Pin Lee
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore 229899, Singapore; (S.S.T.); (K.P.L.)
| | - Dorien Herremans
- Information Systems, Technology, and Design, Singapore University of Technology and Design, Singapore 487372, Singapore;
| | - Jer Ming Chen
- Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372, Singapore; (S.K.); (J.M.C.)
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5
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Teoh L, Chatfield MD, Acworth JP, McCallum GB, Chang AB. Determinants of cough and caregivers' quality of life in pediatric asthma exacerbations. Pediatr Pulmonol 2021; 56:371-377. [PMID: 33179390 DOI: 10.1002/ppul.25168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES In hospitalized and nonhospitalized children with asthma exacerbations, we evaluated the determinants of (a) prolonged cough on day-14 and (b) asthma quality of life (QoL) questionnaires for parents (PACQLQ) on day-21. We hypothesized that children with more severe acute asthma are more likely to have prolonged cough and/or poorer PACQLQ during the recovery phase. DESIGN Prospective cohort study performed during 2009-2011. METHODOLOGY Two hundred and forty-four children aged 2-16 years presenting with acute asthma to the Emergency Departments of two hospitals were recruited. Clinical history, examination, baseline asthma severity, and acute asthma severity on presentation were documented. Validated daily cough diaries and weekly PACQLQ were recorded for 14 and 21 days, respectively. RESULTS 34.4% and 32.2% of children who returned the daytime and nighttime cough diaries respectively had a prolonged cough. Those on regular inhaled corticosteroids (ICS) were significantly more likely to have a daytime or nighttime cough score of ≥1 on day-14 (odds ratio [ORadjusted ] = 4.70, 95% confidence interval [CI] 1.65, 13.35, p = .004 and ORadjusted = 2.65, 95% CI 1.05, 6.69, p = .040, respectively). PACQLQ on day-21 was significantly poorer in younger children (mean difference [MD] = -0.04 per year, 95% CI -0.08, -0.01, p = .016), those on ICS (MD = -0.31, 95% CI -0.52, -0.09, p = .005), leukotriene antagonists (MD = -0.42, 95% CI -0.83, -0.02, p = .040) and in those who had an unplanned visit for asthma on day-21 (MD = -1.20, 95% CI -1.61, -0.78, p = .0001). CONCLUSIONS Post an acute asthma exacerbation, children on regular ICS were more likely to have prolonged cough and poorer QoL. While this may be reflective of asthma severity or control, its association deserves further evaluation.
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Affiliation(s)
- Laurel Teoh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason P Acworth
- Department of Emergency Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital and Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
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Coker E, Katamba A, Kizito S, Eskenazi B, Davis JL. Household air pollution profiles associated with persistent childhood cough in urban Uganda. ENVIRONMENT INTERNATIONAL 2020; 136:105471. [PMID: 32044526 PMCID: PMC8772432 DOI: 10.1016/j.envint.2020.105471] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Most household air pollution (HAP) interventions in developing countries of sub-Saharan Africa have focused on a single source, such as replacing polluting cooking sources with cleaner burning cooking stoves. Such interventions, however, have resulted in insufficient reductions in HAP levels and respiratory health risks in children. In this study we determined how multiple HAP combustion sources and exposure-mitigation factors in the home environment influence child respiratory health alone and in combination. METHODS We carried out a case-control study to determine associations between multiple indicators of HAP and persistent cough among children (<15 years of age) seeking care at three primary-care clinics in Kampala, Uganda. HAP indicators included self-report of combustion sources inside the home (e.g., stove type, fuel type, and smoking); housing characteristics and cooking practices that mitigate HAP exposure (e.g., use of windows, location of cooking, location of children during cooking) and perceptions of neighborhood air quality. To explore joint associations between indicators of HAP, we applied a Bayesian clustering technique (Bayesian profile regression) to identify HAP indicator profiles most strongly associated with persistent cough in children. RESULTS Most HAP indicators demonstrated significant positive bivariate associations with persistent cough among children, including fuel-type (kerosene), the number of hours burning solid fuels, use of polluting fuels (kerosene or candles) for lighting the home, tobacco smoking indoors, cooking indoors, cooking with children indoors, lack of windows in the cooking area, and not opening windows while cooking. Bayesian cluster analysis revealed 11 clusters of HAP indicator profiles. Compared to a reference cluster that was representative of the underlying study population cough prevalence, three clusters with profiles characterized by highly adverse HAP indicators resulted in ORs of 1.72 (95% credible interval: 1.15, 2.60), 4.74 (2.88, 8.0), and 8.6 (3.9, 23.9). Conversely, at least two clusters of HAP indicator-profiles were protective compared to the reference cluster, despite the fact that these protective HAP indicator profiles used solid fuels for cooking in combination with an unimproved stove (cooking was performed predominantly outdoors in these protective clusters). CONCLUSIONS In addition to cooking fuel and type of cook stove, multiple HAP indicators were strongly associated with persistent cough in children. Bayesian profile regression revealed that the combination of HAP sources and HAP exposure-mitigating factors was driving risk of adverse cough associations in children, rather than any single HAP source at the home.
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Affiliation(s)
- Eric Coker
- University of Florida, Department of Environmental and Global Health, 1225 Center Dr., Rm 4160, Gainesville, FL 32610, United States; Center for Environmental Research and Children's Health (CERCH), University of California, Berkeley, School of Public Health, 1995 University Avenue, Suite 265, Berkeley, CA 94720-7392, United States.
| | - Achilles Katamba
- Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, New Mulago Hill Rd, Kampala, Uganda.
| | - Samuel Kizito
- Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, New Mulago Hill Rd, Kampala, Uganda.
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health (CERCH), University of California, Berkeley, School of Public Health, 1995 University Avenue, Suite 265, Berkeley, CA 94720-7392, United States.
| | - J Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT 06510, United States; Pulmonary Critical Care and Sleep Medicine Section, Department of Internal Medicine, Yale School of Medicine, 300 Cedar Street TAC - 441 South, New Haven, CT 06520-8057, United States.
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7
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Antibiotic exposure and 'response failure' for subsequent respiratory tract infections: an observational cohort study of UK preschool children in primary care. Br J Gen Pract 2019; 69:e638-e646. [PMID: 31405831 PMCID: PMC6692084 DOI: 10.3399/bjgp19x705089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/21/2019] [Indexed: 01/21/2023] Open
Abstract
Background Childhood antibiotic exposure has important clinically relevant implications. These include disruption to the microbiome, antibiotic resistance, and clinical workload manifesting as treatment ‘failure’. Aim To examine the relationship between the number of antibiotic courses prescribed to preschool children for acute respiratory tract infections (RTI), in the preceding year, and subsequent RTIs that failed to respond to antibiotic treatment (‘response failures’). Design and setting A cohort study using UK primary care data from the Clinical Practice Research Datalink, 2009 to 2016. Method Children aged 12 to 60 months (1 to 5 years) who were prescribed an antibiotic for an acute RTI (upper and lower RTI or otitis media) were included. One random index antibiotic course for RTI per child was selected. Exposure was the number of antibiotic prescriptions for acute RTI up to 12 months before the index antibiotic prescription. The outcome was ‘response failure’ up to 14 days after index antibiotic prescription, defined as: subsequent antibiotic prescription; referral; hospital admission; death; or emergency department attendance within 3 days. The authors used logistic regression models to estimate the odds between antibiotic exposure and response failure. Results Out of 114 329 children who were prescribed an antibiotic course for acute RTI, children who received ≥2 antibiotic courses for acute RTIs in the preceding year had greater odds of response failure; one antibiotic course: adjusted odds ratio (OR) 1.03 (95% confidence interval [CI] = 0.88 to 1.21), P = 0.67, n = 230 children; ≥2 antibiotic courses: adjusted OR 1.32 (CI = 1.04 to 1.66), P = 0.02, n = 97. Conclusion Childhood antibiotic exposure for acute RTI may be a good predictor for subsequent response failure (but not necessarily because of antibiotic treatment failure). Further research is needed to improve understanding of the mechanisms underlying response failure.
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8
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Development of Machine Learning for Asthmatic and Healthy Voluntary Cough Sounds: A Proof of Concept Study. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9142833] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
(1) Background: Cough is a major presentation in childhood asthma. Here, we aim to develop a machine-learning based cough sound classifier for asthmatic and healthy children. (2) Methods: Children less than 16 years old were randomly recruited in a Children’s Hospital, from February 2017 to April 2018, and were divided into 2 cohorts—healthy children and children with acute asthma presenting with cough. Children with other concurrent respiratory conditions were excluded in the asthmatic cohort. Demographic data, duration of cough, and history of respiratory status were obtained. Children were instructed to produce voluntary cough sounds. These clinically labeled cough sounds were randomly divided into training and testing sets. Audio features such as Mel-Frequency Cepstral Coefficients and Constant-Q Cepstral Coefficients were extracted. Using a training set, a classification model was developed with Gaussian Mixture Model–Universal Background Model (GMM-UBM). Its predictive performance was tested using the test set against the physicians’ labels. (3) Results: Asthmatic cough sounds from 89 children (totaling 1192 cough sounds) and healthy coughs from 89 children (totaling 1140 cough sounds) were analyzed. The sensitivity and specificity of the audio-based classification model was 82.81% and 84.76%, respectively, when differentiating coughs from asthmatic children versus coughs from ‘healthy’ children. (4) Conclusion: Audio-based classification using machine learning is a potentially useful technique in assisting the differentiation of asthmatic cough sounds from healthy voluntary cough sounds in children.
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9
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Korppi M. Review shows paediatric protracted bacterial bronchitis needs an accurate diagnosis and strictly targeted extended antibiotics. Acta Paediatr 2019; 108:823-827. [PMID: 30580451 DOI: 10.1111/apa.14705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
Abstract
AIM In 2017, the European Respiratory Society task force stated that protracted bacterial bronchitis (PBB) was a distinct clinical entity and outlined the diagnostic criteria and principles for treatment. However, this guidance was based on data from Australia and the USA. This mini review evaluated the data and addressed the lack of research-based data from Europe. METHODS We supplemented the 2017 report by conducting a nonsystematic review of the literature on prolonged wet or productive cough and on PBB in children up to September 2018. RESULTS Our review confirmed the lack of European data on PBB. Based on the available literature, and the 2017 European guidance, PBB is a wet or productive cough that lasts for four or more weeks, with no signs or symptoms, known as specific cough pointers, which suggest an underlying illness. PBB usually recovers with appropriate antibiotics for two weeks. Failing that radiological investigations or lung function measurements are needed. If PBB occurs three times over 12 months, then computerised tomography can diagnose bronchiectasis and determine other permanent changes. CONCLUSION More data are needed on PBB, especially in Europe. The implementation of PBB may help clinicians to prescribe antibiotics more effectively and reduce their inappropriate use.
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Affiliation(s)
- Matti Korppi
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
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10
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Liu M, Li Z, Wang S, Liu Y, Zhong X, He R, Li F. Application via mechanical dropper alleviates sufentanil-induced cough: a prospective, randomized, single-blinded trial. Trials 2019; 20:170. [PMID: 30876430 PMCID: PMC6420750 DOI: 10.1186/s13063-019-3274-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/01/2019] [Indexed: 12/20/2022] Open
Abstract
Background It was reported that prolonging the injection time or diluting administration can reduce the incidence of opioid-induced cough. However, the incidence of sufentanil-induced cough (SIC) via a standardized infusion rate is unclear. A mechanical dropper is an infusion filtering device commonly used for intravenous degassing; it can also be used to administer special drugs due to its temporary storage and dilution effect. This study assesses the effectiveness of administration via mechanical dropper on SIC. Methods Two hundred patients undergoing general anesthesia were enrolled. Patients received sufentanil at a strength of 0.3 μg·kg− 1 either via T-connector (group C) or by mechanical dropper (group M) at 1 ml·s− 1. Cough severity was graded as none (0), mild (1–2), moderate (3–5), or severe (> 5), and the incidence of SIC was evaluated for 5 min after the start of sufentanil injection. Other adverse reactions such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration during the induction period of general anesthesia were also observed. The primary outcome was the incidence of SIC. The secondary outcomes were the severity of SIC and other adverse reactions. Results The incidence of SIC in group M was significantly lower than that in group C (2% versus 21%, P = 0.000), and the prevalence of moderately severe coughing was also statistically different (none in group M versus 11% in group C, P = 0.001). However, there were no statistical differences in the incidence of other adverse reactions between two groups (P > 0.05). Conclusion Sufentanil application via mechanical dropper can significantly alleviate the occurrence of SIC during the induction phase of total intravenous general anesthesia. This method is simple, safe, and reliable, and has wide prospective application for clinical use. Trial registration Chinese Clinical Trial Register, ChiCTR-IOR-17011561. Registered on 3 June 2017.
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Affiliation(s)
- Minqiang Liu
- Department of Anesthesiology, Shenzhen Third People's Hospital, No. 29 Bulan Road, Longgang district, Shenzhen, 518112, Guangdong, China
| | - Zhichao Li
- Department of Anesthesiology, Shenzhen Third People's Hospital, No. 29 Bulan Road, Longgang district, Shenzhen, 518112, Guangdong, China
| | - Song Wang
- Department of Anesthesiology, Shenzhen Third People's Hospital, No. 29 Bulan Road, Longgang district, Shenzhen, 518112, Guangdong, China
| | - Yong Liu
- Department of Anesthesiology, Shenzhen Third People's Hospital, No. 29 Bulan Road, Longgang district, Shenzhen, 518112, Guangdong, China
| | - Xiangpeng Zhong
- Department of Anesthesiology, Shenzhen Third People's Hospital, No. 29 Bulan Road, Longgang district, Shenzhen, 518112, Guangdong, China
| | - Renliang He
- Department of Anesthesiology, Shenzhen Third People's Hospital, No. 29 Bulan Road, Longgang district, Shenzhen, 518112, Guangdong, China.
| | - Fengxian Li
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, No. 253 Middle Industrial Avenue, Haizhu district, Guangzhou, 518112, Guangdong, China
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Krishnan S, Ianotti V, Welter J, Gallagher MM, Ndjatou T, Dozor AJ. Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough. Glob Pediatr Health 2019; 6:2333794X19831296. [PMID: 30828592 PMCID: PMC6390215 DOI: 10.1177/2333794x19831296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 01/16/2023] Open
Abstract
Real-world management decisions for acute cough in children in primary care
practice are not well understood. This study is an analysis of 560 encounters
for children with cough, 19 days to 18 years of age, seen in a predominantly
suburban academic pediatric practice, over 1 year. Past history, cough duration,
and cough characteristics significantly affected treatment decisions. Children
with cough frequently had a history of preterm birth, allergies, asthma, and
neurological conditions. Most common therapies were bronchodilators,
antibiotics, and oral corticosteroids. Children prescribed antibiotics were
older, more likely to have a wet or productive cough, history of sinusitis,
pneumonia or dysphagia, and longer cough duration. Children prescribed oral
corticosteroids were younger, less likely to be wet or productive and more
likely to have history of asthma or dysphagia. Children prescribed
bronchodilators were more likely to have fever, nasal congestion, and wheezing
and history of previous asthma, pneumonia, or dysphagia.
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Affiliation(s)
| | | | | | | | - Tatiana Ndjatou
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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12
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de Benedictis FM, Carloni I, Comberiati P, Shields MD, Bush A, Chang AB. Wet Cough and Nasal Symptoms in Children: Can We Do Better? Front Pediatr 2019; 7:459. [PMID: 31956642 PMCID: PMC6949513 DOI: 10.3389/fped.2019.00459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
The causes of chronic cough in children are mainly dependent on the setting and age of the child. Protracted bacterial bronchitis is a frequent cause of morbidity in childhood, and antibiotic treatment is beneficial. Prompt recognition and early treatment is important both to prevent inappropriate use of asthma medications and also progression to bronchiectasis, but the diagnosis should not be made uncritically, because chronic wet cough is not necessarily due to lower airway disease. Upper Airway Cough Syndrome (UACS) is considered by some to cause chronic cough in childhood. Underlying UACS are many common conditions, including allergic rhinitis, adenoiditis and rhinosinusitis. Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific. The role of nasal endoscopy in children with chronic cough and signs suggesting UACS is unclear. Nasal saline solution irrigation is commonly used in UACS, but most studies have methodological biases, and efficacy data are scanty. Randomized controlled trials are urgently required. However, if saline washes, rather than oral antibiotics, can effectively treat some children with wet cough associated with upper airway conditions, antibiotic resistance could potentially be reduced. There is a need to further study wet cough and not to assume it to be equivalent to lower airway infection in all children.
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Affiliation(s)
| | - Ines Carloni
- Department of Child and Mother Health, Salesi Children's Hospital, Ancona, Italy
| | - Pasquale Comberiati
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michael D Shields
- Centre for Experimental Medicine, Royal Belfast Hospital for Sick Children, Queen's University of Belfast, Belfast, United Kingdom
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Imperial School of Medicine, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
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Abstract
Chronic cough in children is increasingly defined as a cough that lasts more than four weeks. It is recognized as a different entity than cough in adults. As a result, the diagnostic approach and management of chronic cough in children are no longer extrapolated from adult guidelines. These differences are attributed to the various characteristics of the respiratory tract, immunological system and nervous system in children. Specific paediatric guidelines and algorithms for chronic cough are now widely applied. Post-infectious cough, asthma, bronchiectasis, malacia and protracted bacterial bronchitis (PBB) appear to be the major causes of cough in young children. By adolescence, the causes of cough are more likely to be similar to those in adults, namely, gastroesophageal reflux, asthma, and upper airway syndrome. In a primary setting, it is essential to investigate the underlying disease entity that initiates and sustains chronic cough. The use of cough management protocols or algorithms improves clinical outcomes and should differ depending on the associated characteristics of the cough and the child's clinical history. Performing a thorough history and physical examination is crucial to starting an individualised approach. A correct interpretation of the phenotypic presentation can be translated into guidance for workup. This approach will be helpful for adequate management without the risk of inappropriate investigations or inadequate treatment.
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Affiliation(s)
- Ahmad Kantar
- Paediatric Asthma and Cough Centre, University and Research Hospitals, Gruppo Ospedaliero San Donato, Bergamo, Italy
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Blake K, Raissy H. Management of Acute Cough in Children: Where Do We Go From Here? PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2016; 29:155-158. [PMID: 35923051 DOI: 10.1089/ped.2016.0686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The safety of cough and cold products for pediatric use has been a concern of regulatory agencies and advocacy groups for decades. Most recently, the Food and Drug Administration requested input from Pulmonary-Allergy Drugs and Drug Safety and Risk Management advisory committees on the safety of codeine for cough in children aged 18 years and younger. There is little evidence of efficacy for codeine in the treatment of acute cough in children, but mounting evidence for risks of respiratory depression and death. Similarly, dextromethorphan, benzonatate, antihistamines, guaifenesin, and mucolytics lack efficacy in controlled trials or there are no data with which to evaluate efficacy, and dextromethorphan may cause respiratory depression. Honey and topical use of aromatic oils (camphor, menthol, and eucalyptus) have limited evidence of efficacy, but may have the greatest margin of safety for treatment of acute cough in children.
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Affiliation(s)
- Kathryn Blake
- Department of Biomedical Research, Center for Pharmacogenomics and Translational Research, Nemours Children's Specialty Care, Jacksonville, Florida
| | - Hengameh Raissy
- Department of Pediatrics, Health Sciences Center, School of Medicine, University of New Mexico, Albuquerque, New Mexico
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Cunningham S, Rodriguez A, Boyd KA, McIntosh E, Lewis SC. Bronchiolitis of Infancy Discharge Study (BIDS): a multicentre, parallel-group, double-blind, randomised controlled, equivalence trial with economic evaluation. Health Technol Assess 2016; 19:i-xxiii, 1-172. [PMID: 26364905 DOI: 10.3310/hta19710] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are no randomised trials of peripheral capillary oxygen saturation (SpO2) targets in acute respiratory infection. Two national guidelines recommended different targets for the management of acute viral bronchiolitis. OBJECTIVES To compare the American Academy of Pediatrics guideline target of SpO2 ≥ 90% with the Scottish Intercollegiate Guidelines Network target of SpO2 ≥ 94%. DESIGN A multicentre, parallel-group, double-blind, randomised controlled, equivalence trial with economic evaluation. SETTING Eight paediatric hospital departments in the UK. PARTICIPANTS Infants > 6 weeks and ≤ 12 months of age (corrected for prematurity) with physician-diagnosed bronchiolitis admitted to hospital from a paediatric emergency assessment area. Follow-up for 6 months by standardised telephone contacts. INTERVENTION Infants were randomised to a target oxygen saturation of ≥ 94% (standard care) or ≥ 90% (modified care) displayed by a pulse saturation oximeter (Masimo Corporation Limited, CA, USA). ROUTINE CARE All infants received routine care in addition to the study intervention. Infants were eligible for discharge when they exhibited a SpO2 of ≥ 94% in room air for 4 hours including a period of sleep and were also feeding adequately (≥ 75% usual volume). PRIMARY OUTCOME A total of 615 infants were recruited, of whom 308 were allocated to the standard care group and 307 to the modified care group. The primary outcome was time to cough resolution. There was equivalence at the prespecified variance of ± 2 days [time to cough resolution: standard care group, 15 days; modified care group, 15 days; median difference 1 day (benefit modified), 95% confidence interval (CI) -1 to 2 days]. SECONDARY RESULTS Return to adequate feeding occurred sooner in infants in the modified care group than in those in the standard care group (19.5 vs. 24.1 hours). This difference was non-equivalent [median difference 2.7 hours (95% CI -0.3 to 7.0 hours) versus prespecified ± 4 hours; post-hoc hazard ratio 1.22 (95% CI 1.04 to 1.44 (p-value = 0.015)]. Parent perspective of the time taken to return to normal was not equivalent, being 12 days in the standard care group compared with 11 days in the modified care group [median difference 1.0 day (95% CI 0.0 to 3.0 days) versus prespecified ± 2 days; post-hoc hazard ratio 1.19 (95% CI 1.00 to 1.41); p-value = 0.043]. At 28 days, SpO2 was equivalent [mean difference 0.11% (95% CI -0.35% to 0.57%), within the 1% prespecified]. The modified care group (55.6%) required oxygen less than the standard care group (73.1%), and for a shorter period (5.7 hours vs. 27.6 hours). Infants in the modified care group were fit for discharge (30.2 hours vs. 44.2 hours, hazard ratio 1.46, 95% CI 1.23 to 1.73; p-value < 0.001) and were discharged (40.9 hours vs. 50.9 hours; hazard ratio 1.28, 95% CI 1.06 to 1.50; p-value < 0.003) sooner than those in the standard care group. There were 35 serious adverse events in the standard care group, compared with 25 in the modified care group. Eight infants in the standard care group and 12 in the modified care group were admitted to a high-dependency unit. By 28 days, 23 infants had been readmitted to hospital in the standard care group and 12 infants in the modified care group. Parents of infants in the modified care group did not experience higher levels of anxiety and, by 14 days, had lost 28% fewer hours to usual activities. NHS costs were £290 lower in the modified care group than in the standard care group, with additional societal costs also being lower in the modified care group. CONCLUSIONS Management of infants to a SpO2 target of ≥ 90% is as clinically effective as ≥ 94%, gives rise to no additional safety concerns, and appears to be cost-effective. Future work could focus on the safety and effectiveness of using intermittent oxygen saturation monitoring in secondary care, and to consider what are safe and effective oxygen saturation targets for children with bronchiolitis managed in primary care. TRIAL REGISTRATION This trial is registered as ISRCTN28405428. FUNDING This project was funded by the NIHR Health Technology Assessment programme. Masimo Corporation Limited, CA, USA, kindly provided oxygen saturation monitors with standard and altered algorithms.
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Affiliation(s)
- Steve Cunningham
- Department of Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | - Aryelly Rodriguez
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Steff C Lewis
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Oren E, Rothers J, Stern DA, Morgan WJ, Halonen M, Wright AL. Cough during infancy and subsequent childhood asthma. Clin Exp Allergy 2016; 45:1439-46. [PMID: 26011047 DOI: 10.1111/cea.12573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/25/2015] [Accepted: 05/15/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Wheezing in infancy has been associated with subsequent asthma, but whether cough similarly influences asthma risk has been little studied. We sought to determine whether prolonged cough and cough without cold in the first year of life are associated with childhood asthma. METHODS Participants in the Infant Immune Study, a non-selected birth cohort, were surveyed 7 times in the first 9 months of life regarding the presence of wheeze and cough. Cough for more than 28 days was defined as prolonged. Parents were asked at 1 year if the child ever coughed without a cold. Asthma was defined as parental report of physician diagnosis of asthma, with symptoms or medication use between 2 and 9 years. Logistic regression was used to assess adjusted odds for asthma associated with cough characteristics. RESULTS A total of 24% (97) of children experienced prolonged cough and 23% (95) cough without cold in the first 9 months, respectively. Prolonged cough was associated with increased risk of asthma relative to brief cough (OR 3.57, CI: 1.88, 6.76), with the risk being particularly high among children of asthmatic mothers. Cough without cold (OR 3.13, 95% CI: 1.76, 5.57) was also independently associated with risk of childhood asthma. Both relations persisted after adjustment for wheeze and total IgE at age 1. CONCLUSIONS AND CLINICAL RELEVANCE Prolonged cough in infancy and cough without cold are associated with childhood asthma, independent of infant wheeze. These findings suggest that characteristics of cough in infancy are early markers of asthma susceptibility, particularly among children with maternal asthma.
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Affiliation(s)
- E Oren
- Division of Epidemiology and Biostatistics, College of Public Health, University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - J Rothers
- College of Nursing, University of Arizona Health Sciences Center, Tucson, AZ, USA.,Arizona Respiratory Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - D A Stern
- Arizona Respiratory Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - W J Morgan
- Arizona Respiratory Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - M Halonen
- Arizona Respiratory Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, AZ, USA.,Department of Pharmacology, College of Medicine, University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - A L Wright
- Arizona Respiratory Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, AZ, USA.,Department of Pediatrics, College of Medicine, University of Arizona Health Sciences Center, Tucson, AZ, USA
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Cunningham S, Rodriguez A, Adams T, Boyd KA, Butcher I, Enderby B, MacLean M, McCormick J, Paton JY, Wee F, Thomas H, Riding K, Turner SW, Williams C, McIntosh E, Lewis SC. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet 2015; 386:1041-8. [PMID: 26382998 PMCID: PMC4673090 DOI: 10.1016/s0140-6736(15)00163-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The American Academy of Pediatrics recommends a permissive hypoxaemic target for an oxygen saturation of 90% for children with bronchiolitis, which is consistent with the WHO recommendations for targets in children with lower respiratory tract infections. No evidence exists to support this threshold. We aimed to assess whether the 90% or higher target for management of oxygen supplementation was equivalent to a normoxic 94% or higher target for infants admitted to hospital with viral bronchiolitis. METHODS We did a parallel-group, randomised, controlled, equivalence trial of infants aged 6 weeks to 12 months of age with physician-diagnosed bronchiolitis newly admitted into eight paediatric hospital units in the UK (the Bronchiolitis of Infancy Discharge Study [BIDS]). A central computer randomly allocated (1:1) infants, in varying length blocks of four and six and without stratification, to be clipped to standard oximeters (patients treated with oxygen if pulse oxygen saturation [SpO2] <94%) or modified oximeters (displayed a measured value of 90% as 94%, therefore oxygen not given until SpO2 <90%). All parents, clinical staff, and outcome assessors were masked to allocation. The primary outcome was time to resolution of cough (prespecified equivalence limits of plus or minus 2 days) in the intention-to-treat population. This trial is registered with ISRCTN, number ISRCTN28405428. FINDINGS Between Oct 3, and March 30, 2012, and Oct 1, and March 29, 2013, we randomly assigned 308 infants to standard oximeters and 307 infants to modified oximeters. Cough resolved by 15·0 days (median) in both groups (95% CI for difference -1 to 2) and so oxygen thresholds were equivalent. We recorded 35 serious adverse events in 32 infants in the standard care group and 25 serious adverse events in 24 infants in the modified care group. In the standard care group, eight infants transferred to a high-dependency unit, 23 were readmitted, and one had a prolonged hospital stay. In the modified care group, 12 infants were transferred to a high-dependency unit and 12 were readmitted to hospital. Recorded adverse events did not differ significantly. INTERPRETATION Management of infants with bronchiolitis to an oxygen saturation target of 90% or higher is as safe and clinically effective as one of 94% or higher. Future research should assess the benefits and risks of different oxygen saturation targets in acute respiratory infection in older children, particularly in developing nations where resources are scarce. FUNDING National Institute for Health Research, Health Technology Assessment programme.
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Affiliation(s)
- Steve Cunningham
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
| | - Aryelly Rodriguez
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Tim Adams
- Department of Paediatrics, Crosshouse Hospital, Kilmarnock, UK
| | - Kathleen A Boyd
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Isabella Butcher
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Morag MacLean
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Jonathan McCormick
- Department of Paediatrics, Ninewells Hospital and Medical School, Dundee, UK
| | - James Y Paton
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Fiona Wee
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Huw Thomas
- Department of Respiratory Medicine, Bristol Children's Hospital, Bristol, UK
| | - Kay Riding
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | | | | | - Emma McIntosh
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Steff C Lewis
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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18
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Zanasi A, Cazzato S, Mazzolini M, Ierna CMS, Mastroroberto M, Nardi E, Morselli-Labate AM. Does additional antimicrobial treatment have a better effect on URTI cough resolution than homeopathic symptomatic therapy alone? A real-life preliminary observational study in a pediatric population. Multidiscip Respir Med 2015; 10:25. [PMID: 26251722 PMCID: PMC4527103 DOI: 10.1186/s40248-015-0022-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/27/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The effectiveness of a homeopathic syrup on cough has been demonstrated in an adult population in a previous double-blind randomized study. The present prospective observational study investigated children affected by wet acute cough caused by non-complicated URTIs, comparing those who received the homeopathic syrup versus those treated with the homeopathic syrup plus antibiotic. OBJECTIVES The aims were: 1) to assess whether the addition of antibiotics to a symptomatic treatment had a role in reducing the severity and duration of acute cough in a pediatric population, as well as in improving cough resolution; 2) to verify the safety of the two treatments. METHODS Eighty-five children were enrolled in an open study: 46 children received homeopathic syrup alone for 10 days and 39 children received homeopathic syrup for 10 days plus oral antibiotic treatment (amoxicillin/clavulanate, clarithromycin, and erythromycin) for 7 days. To assess cough severity we used a subjective verbal category-descriptive (VCD) scale. RESULTS Cough VCD score was significantly (P < 0.001) reduced in both groups starting from the second day of treatment (-0.52 ± 0.66 in the homeopathic syrup group and -0.56 ± 0.55 in children receiving homeopathic syrup plus oral antibiotic treatment). No significant differences in cough severity or resolution were found between the two groups of children in any of the 28 days of the study. After the first week (day 8) cough was completely resolved in more than one-half of patients in both groups. Two children (4.3 %) reported adverse effects in the group treated with the homeopathic syrup alone, versus 9 children (23.1 %) in the group treated with the homeopathic syrup plus antibiotics (P = 0.020). CONCLUSIONS Our data confirm that the homeopathic treatment in question has potential benefits for cough in children as well, and highlight the strong safety profile of this treatment. Additional antibiotic prescription was not associated with a greater cough reduction, and presented more adverse events than the homeopathic syrup alone.
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Affiliation(s)
- Alessandro Zanasi
- />Italian Association for Cough Study (AIST), Via Mazzini, 12, 40138 Bologna, Italy
| | - Salvatore Cazzato
- />Department of Pediatrics, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Massimiliano Mazzolini
- />Respiratory Medicine and Intensive Care Unit, Sant’Orsola Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Carla Maria Sofia Ierna
- />Respiratory Medicine and Intensive Care Unit, Sant’Orsola Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Marianna Mastroroberto
- />Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Elena Nardi
- />Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Bidiwala A, Krilov LR, Pirzada M, Patel SJ. Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children. Pediatr Ann 2015; 44:329-36. [PMID: 26312591 DOI: 10.3928/00904481-20150812-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pro: Children with chronic cough present a diagnostic challenge. Protracted bacterial bronchitis (PBB) is a chronic, persistent bacterial infection of conducting airways defined by the presence of cough for longer than 4 weeks that resolves with antimicrobial therapy and without an alternative diagnosis. The diagnosis is made by the findings of increased bronchial secretions and edema of the lower airways on flexible bronchoscopy and positive cultures on bronchoalveolar lavage. It is speculated that an initial respiratory insult such as viral infection disrupts normal surface morphology and ciliary function, which leads to chronic self-perpetuating inflammation with the formation of bacterial biofilms, leading to PBB. PBB is often misdiagnosed as asthma, leading to inappropriate and excessive use of steroids. The importance of timely diagnosis should be emphasized due to the potential that PBB may be a precursor to chronic suppurative lung disease or bronchiectasis if left untreated; however, every patient should be adequately assessed to exclude other causes of chronic cough. Con: Clinical criteria for the diagnosis of PBB are nonspecific and may not distinguish it from other known causes of chronic cough, including viral infections. Benefits from antibiotic therapy (particularly prolonged therapy) have not been demonstrated. Respiratory conditions are the most common reason for antibiotic prescriptions during ambulatory visits in the United States, and many of these prescriptions are inappropriate and/or unnecessary. The proposed diagnostic criteria and recommendations for the treatment of PBB will lead to unnecessary overuse of antibiotics.
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20
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Zacharasiewicz A, Eber E, Riedler J, Frischer T. Evaluation und Therapie des chronischen Hustens bei Kindern. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zacharasiewicz A, Eber E, Riedler J, Frischer T. Konsensuspapier zur Evaluation und Therapie des chronischen Hustens in der Pädiatrie. Wien Klin Wochenschr 2014; 126:439-50. [DOI: 10.1007/s00508-014-0554-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/13/2014] [Indexed: 01/11/2023]
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Canciani M, Murgia V, Caimmi D, Anapurapu S, Licari A, Marseglia GL. Efficacy of Grintuss® pediatric syrup in treating cough in children: a randomized, multicenter, double blind, placebo-controlled clinical trial. Ital J Pediatr 2014; 40:56. [PMID: 24917119 PMCID: PMC4066701 DOI: 10.1186/1824-7288-40-56] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cough is an extremely common problem in pediatrics, mostly triggered and perpetuated by inflammatory processes or mechanical irritation leading to viscous mucous production and increased sensitivity of the cough receptors. Protecting the mucosa might be very useful in limiting the contact with micro-organisms and irritants thus decreasing the inflammation and mucus production. Natural molecular complexes can act as a mechanical barrier limiting cough stimuli with a non pharmacological approach but with an indirect anti-inflammatory action. OBJECTIVE Aim of the study was to assess the efficacy of a medical device containing natural functional components in the treatment of cough persisting more than 7 days. METHODS In this randomized, parallel groups, double-blind vs. placebo study, children with cough persisting more than 7 days were enrolled. The clinical efficacy of the study product was assessed evaluating changes in day- and night-time cough scores after 4 and 8 days (t4 and t8) of product administration. RESULTS In the inter-group analysis, in the study product group compared with the placebo group, a significant difference (t4 study treatment vs. t4 placebo, p = 0.03) was observed at t4 in night-time cough score.Considering the intra-group analysis, only the study product group registered a significant improvement from t0 to t4 in both day-time (t0 vs. t4, p = 0.04) and night-time (t0 vs. t4, p = 0.003) cough scores.A significant difference, considering the study product, was also found in the following intra-group analyses: day-time scores at t4 vs. t8 (p =0.01) and at t0 vs. t8 (p = 0.001); night-time scores at t4 vs. t8 (p = 0.05), and at t0 vs. t8 (p = 0.005). Considering a subgroup of patients with higher cough (≥ 3) scores, 92.9% of them in the study product group improved at t0 vs. t4 day-time. CONCLUSIONS Grintuss® pediatric syrup showed to possess an interesting profile of efficacy and safety in the treatment of cough persisting more than 7 days.
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Affiliation(s)
| | | | | | | | | | - Gian Luigi Marseglia
- Department of Pediatrics, Immuno-Pneumo-Allergy Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Lamas A, Ruiz de Valbuena M, Máiz L. Cough in children. Arch Bronconeumol 2014; 50:294-300. [PMID: 24507905 DOI: 10.1016/j.arbres.2013.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 12/27/2022]
Abstract
Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing "normal cough", but all children with persistent cough, i.e. a cough lasting more than 4-8weeks or "chronic cough", must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of "nonspecific chronic cough", in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children.
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Affiliation(s)
- Adelaida Lamas
- Sección de Neumología Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España; Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España.
| | - Marta Ruiz de Valbuena
- Sección de Neumología Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España; Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - Luis Máiz
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
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