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Krings JG, Gerald JK, Blake KV, Krishnan JA, Reddel HK, Bacharier LB, Dixon AE, Sumino K, Gerald LB, Brownson RC, Persell SD, Clemens CJ, Hiller KM, Castro M, Martinez FD. A Call for the United States to Accelerate the Implementation of Reliever Combination Inhaled Corticosteroid-Formoterol Inhalers in Asthma. Am J Respir Crit Care Med 2023; 207:390-405. [PMID: 36538711 PMCID: PMC9940146 DOI: 10.1164/rccm.202209-1729pp] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- James G. Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Joe K. Gerald
- Department of Community Environment and Policy, Mel and Enid Zuckerman College of Public Health
- Asthma & Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Kathryn V. Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children’s Health, Jacksonville, Florida
| | | | - Helen K. Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - Leonard B. Bacharier
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne E. Dixon
- Division of Pulmonary Critical Care, Department of Medicine, University of Vermont, Burlington, Vermont
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Lynn B. Gerald
- Population Health Sciences Program, University of Illinois Chicago, Chicago, Illinois
| | - Ross C. Brownson
- Department of Surgery, School of Medicine, and
- Prevention Research Center, Brown School, Washington University in Saint Louis, St. Louis, Missouri
| | - Stephen D. Persell
- Division of General Internal Medicine, Department of Medicine, and
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Katherine M. Hiller
- Department of Emergency Medicine, School of Medicine, Indiana University, Bloomington, Indiana; and
| | - Mario Castro
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Kansas, Kansas City, Kansas
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Hu W, Lu W, Li L, Zhang H, Lee YK, Chen W, Zhao J. Both living and dead Faecalibacterium prausnitzii alleviate house dust mite-induced allergic asthma through the modulation of gut microbiota and short-chain fatty acid production. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2021; 101:5563-5573. [PMID: 33709404 DOI: 10.1002/jsfa.11207] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Asthma is increasingly prevalent worldwide, and novel strategies to prevent or treat this disease are needed. Probiotic intervention has recently been reported to be effective for asthma prevention. Here, we explored the effects of Faecalibacterium prausnitzii on the development of allergic airway inflammation in a murine model of house dust mite (HDM)-induced allergic asthma. RESULTS Supplementation with living and dead F. prausnitzii blocked eosinophil, neutrophil, lymphocyte and macrophage influx and alleviated the pathological changes. Moreover, both living and dead F. prausnitzii administration decreased the levels of interleukin (IL)-4, IL-5, IL-13 and immunoglobulin G1, elevated regulatory T cell (Tregs) ratio, improved microbial dysbiosis and enhanced short-chain fatty acid (SCFA) production. Network correlation analysis revealed that the immune indicators were strongly associated with SCFA production. Based on the linear discriminant analysis effect size, Turicibacter was found to be the core genus related to HDM-induced asthma. Living F. prausnitzii treatment enriched Faecalibaculum, Dubosiella and Streptococcus, while dead F. prausnitzii treatment increased Muribaculaceae and Parabacteroides. Interestingly, both living and dead F. prausnitzii administration enriched Lachnoclostridium and normalized the pathways involving carbohydrate and lipid metabolism, which might be related to SCFA production. CONCLUSION Faecalibacterium prausnitzii exerts an anti-asthmatic effect partly by gut microbiota modulation and SCFA production, suggesting its potential as a probiotic agent for allergic asthma prevention. © 2021 Society of Chemical Industry.
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Affiliation(s)
- Wenbing Hu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Wenwei Lu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- School of Food Science and Technology, Jiangnan University, Wuxi, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou, China
| | - Lingzhi Li
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Hao Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- School of Food Science and Technology, Jiangnan University, Wuxi, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou, China
- Wuxi Translational Medicine Research Center and Jiangsu Translational Medicine Research Institute Wuxi Branch, Wuxi, China
| | - Yuan-Kun Lee
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- School of Food Science and Technology, Jiangnan University, Wuxi, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- School of Food Science and Technology, Jiangnan University, Wuxi, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
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Ethical considerations in pediatric chronic illness: The relationship between psychological factors, treatment adherence, and health outcomes. Paediatr Respir Rev 2021; 39:48-53. [PMID: 34246544 PMCID: PMC8448946 DOI: 10.1016/j.prrv.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
Children, adolescents, and young adults with chronic illnesses are often faced with complicated and burdensome treatments that not only require a great deal of time and energy to manage, but will also likely impact relationships with parents, siblings, and peers. Adolescents and young adults with chronic illness are often impacted by several unique and challenging factors that can ultimately impact health behaviors and treatment outcomes. Working with a psychologist can help to ameliorate these unique challenges, which will positively impact health behaviors and health outcomes. The present paper provides an overview of psychological interventions that were designed to target the unique challenges that are often associated with maladaptive health behaviors and ultimately poor health outcomes. As demonstrated in this commentary, when working with adolescents and young adults who have unique developmental challenges, it is important to deliver multi-faceted intervention approaches that utilize a number of different strategies and frameworks. These eclectic intervention approaches provide a unique opportunity to improve health behaviors during critical developmental periods, including the transition from childhood to adolescence to young adulthood.
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Asthma and COVID-19: Emphasis on Adequate Asthma Control. Can Respir J 2021; 2021:9621572. [PMID: 34457096 PMCID: PMC8397565 DOI: 10.1155/2021/9621572] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/18/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Asthmatics are at an increased risk of developing exacerbations after being infected by respiratory viruses such as influenza virus, parainfluenza virus, and human and severe acute respiratory syndrome coronaviruses (SARS-CoV). Asthma, especially when poorly controlled, is an independent risk factor for developing pneumonia. A subset of asthmatics can have significant defects in their innate, humoral, and cell-mediated immunity arms, which may explain the increased susceptibility to infections. Adequate asthma control is associated with a significant decrease in episodes of exacerbation. Because of their wide availability and potency to promote adequate asthma control, glucocorticoids, especially inhaled ones, are the cornerstone of asthma management. The current COVID-19 pandemic affects millions of people worldwide and possesses mortality several times that of seasonal influenza; therefore, it is necessary to revisit this subject. The pathogenesis of SARS-CoV-2, the virus that causes COVID-19, can potentiate the development of acute asthmatic exacerbation with the potential to worsen the state of chronic airway inflammation. The relationship is evident from several studies that show asthmatics experiencing a more adverse clinical course of SARS-CoV-2 infection than nonasthmatics. Recent studies show that dexamethasone, a potent glucocorticoid, and other inhaled corticosteroids significantly reduce morbidity and mortality among hospitalized COVID-19 patients. Hence, while we are waiting for more studies with higher level of evidence that further narrate the association between COVID-19 and asthma, we advise clinicians to try to achieve adequate disease control in asthmatics as it may reduce incidences and severity of exacerbations especially from SARS-CoV-2 infection.
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Junior RS, Scaranto WP, Falce VAGL. The Influence of Allergic Rhinitis Treatment on Asthma. Health (London) 2021. [DOI: 10.4236/health.2021.1311087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Koltermann V, Friedrich FO, Fensterseifer AC, Ongaratto R, Pinto LA. Cost-benefit impact of free asthma medication provision for the pediatric population. Respir Med 2020; 164:105915. [PMID: 32217290 DOI: 10.1016/j.rmed.2020.105915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/26/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Asthma is a common chronic disease in childhood, resulting in high costs for health care systems and society. As of June 2011, the Brazilian Unified Health System (SUS) provides free asthma medications for the population. This study evaluated the impact of this program on asthma admissions in the population aged 1-19 years. In addition, a cost-benefit analysis compared data before and after the introduction of the program. METHODS This descriptive study was based on information from SUS Information Technology Department (DATASUS). Admission rates and costs of patients aged 1-19 years with diagnosed asthma were compared before (2008-2010) and after (2012-2017) the provision of free inhaled corticosteroid. RESULTS The asthma admission rate reduced by 28.4% when comparing the two periods (OR 0.71; 95% CI 0.64-0.79). Children aged 1-4 years had a 27.3% reduction in asthma admissions (OR 0.72; 95% CI 0.63-0.82), while those aged 15-19 years had a 39.65% decrease (OR 0.59; 95% CI 0.37-0.95). Asthma admission costs decreased when comparing the two periods (OR 0.68; 95% CI 0.62-0.74). After the introduction of the program, mean cost savings reached US $27,865,905.08 in children aged 1-4 years and US $21,350,660.63 in those aged 5-19 years. CONCLUSION The economic burden of pediatric asthma on Brazil's public health care system is significant. From 2012 to 2015, free provision of inhaled corticosteroid was cost-effective in all age groups. In 2017, no cost-benefit effect was observed in this population, but asthma admission rate decreased.
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Affiliation(s)
- Vanessa Koltermann
- Department of Pediatrics, Infant Center, Pontificia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue 6690, Building 60, 2 nd floor, 90610-000, Porto Alegre, RS, Brazil.
| | - Frederico Orlando Friedrich
- Department of Pediatrics, Infant Center, Pontificia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue 6690, Building 60, 2 nd floor, 90610-000, Porto Alegre, RS, Brazil.
| | - Ana Carolina Fensterseifer
- Medical School, Pontificia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue 6690, Building 60, 90610-000, Porto Alegre, RS, Brazil.
| | - Renata Ongaratto
- Department of Pediatrics, Infant Center, Pontificia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue 6690, Building 60, 2 nd floor, 90610-000, Porto Alegre, RS, Brazil.
| | - Leonardo Araújo Pinto
- Department of Pediatrics, Infant Center, Pontificia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue 6690, Building 60, 2 nd floor, 90610-000, Porto Alegre, RS, Brazil.
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Inhaled corticosteroid-phobia and childhood asthma: Current understanding and management implications. Paediatr Respir Rev 2020; 33:62-66. [PMID: 31053357 DOI: 10.1016/j.prrv.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/20/2019] [Accepted: 03/31/2019] [Indexed: 02/04/2023]
Abstract
Asthma is the most prevalent chronic disease in children. Inhaled corticosteroids (ICS) is the first-line controller therapy for children with persistent asthma, however, suboptimal compliance to ICS therapy remains as a major obstacle in paediatric asthma management. Steroid-phobia, the fear of side-effects and subsequent aversion of ICS, has been widely reported in parents of asthmatic children. The reported prevalence of steroid-phobia varies widely from 19% to 67% in different populations. The concerns about ICS frequently raised by parents include growth suppression, weight gain, bone weakness, addiction and psychiatric disturbances. Outside of growth suppression, which is statistically significant yet mild in clinical studies, the other concerns are not evidence-based and are misconceptions. Conflicting results have been reported regarding the impact of steroid-phobia on ICS compliance. In contrast, steroid-phobia has consistent and negative effects on asthma control in children. While asthma educational programmes have demonstrable benefits in general paediatric populations, the generalisability of such programmes to steroid-phobic parents remains undetermined. There is a paucity of data on specific educational programmes to clear misconceptions and reduce steroid-phobia. Given the continually raising prevalence of paediatric asthma, high-quality studies are warranted to investigate the prevalence and impact of steroid-phobia, with an ultimate goal of developing effective strategies to tackle steroid-phobia and improve asthma care in children.
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Wu Z, Bian X, Hui L, Zhang J. Nebulized step-down budesonide vs. fluticasone in infantile asthma: A retrospective cohort study. Exp Ther Med 2019; 19:1665-1672. [PMID: 32104218 PMCID: PMC7027130 DOI: 10.3892/etm.2019.8401] [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: 01/11/2019] [Accepted: 09/04/2019] [Indexed: 11/08/2022] Open
Abstract
The United States Food and Drug Administration has approved budesonide in infantile asthma but nebulization of infants under budesonide has the risk of relapse of asthma. The objective of the present study was to compare the effectiveness and safety of fluticasone step-down treatment with budesonide step-down treatment in infantile asthma. The data of 778 infants with confirmed asthma were included in the analysis. Infants who had received nebulized 500 µg budesonide twice daily for 6 weeks followed by 250 µg budesonide twice daily for 6 weeks were included in the BS group (n=389), while infants who had received nebulized 250 µg fluticasone twice daily for 6 weeks followed by 125 µg fluticasone twice daily for 6 weeks were included in the FC group (n=389). The data of lung function tests and a safety study were collected and analyzed. Budesonide treatment achieved a reduced specific airway resistance (sRaw; 1.28±0.11 vs. 1.21±0.10 kPa/sec; P<0.0001, q=13.45) and improved forced expiratory volume in 1 sec (FEV1; 0.977±0.068 vs. 0.997±0.085 l/sec; P<0.0001, q=5.54). In addition, fluticasone treatment achieved a reduced sRaw (1.27±0.1 vs. 1.23±0.11 kPa/sec, P<0.0001, q=7.39) and improved FEV1 (0.971±0.069 vs. 0.992±0.085 l/sec; P=0.0003, q=5.46). Of note, the efficacy of budesonide to reduce sRaw (P=0.008, q=3.69) and improve FEV1 (P<0.0001, q=6.93) was greater than that of fluticasone. The budesonide treatment group had more post-treatment symptom-free days than the fluticasone treatment group (165.56±23.15 vs. 112.21±9.45 days; P<0.0001). The step-down approach of budesonide nebulization may better support the functional and clinical outcomes with an increased number of post-treatment symptom-free days compared with fluticasone in infantile asthma (level of evidence, 3).
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Affiliation(s)
- Zhimin Wu
- Department of Pediatrics, Shanghai University of Medicine and Health Science, Shanghai 201318, P.R. China
| | - Xiangli Bian
- Department of Pediatrics, Shanghai University of Medicine and Health Science, Shanghai 201318, P.R. China
| | - Lei Hui
- Department of Pediatrics, Shanghai University of Medicine and Health Science, Shanghai 201318, P.R. China
| | - Jinping Zhang
- Department of Pediatrics, Shanghai University of Medicine and Health Science, Shanghai 201318, P.R. China
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Trivedi M, Patel J, Lessard D, Kremer T, Byatt N, Phipatanakul W, Pbert L, Goldberg R. School nurse asthma program reduces healthcare utilization in children with persistent asthma. J Asthma 2018; 55:1131-1137. [PMID: 29206057 PMCID: PMC5988937 DOI: 10.1080/02770903.2017.1396473] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/03/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We examined the impact of a novel, school nurse-supervised asthma therapy program on healthcare utilization. METHODS We retrospectively reviewed charts of 84 children enrolled in this program in central Massachusetts between 2012 and 2015. Physicians identified children with persistent asthma and poor medication adherence. These children were enrolled in the program to receive daily-inhaled corticosteroid at school, supervised by their school nurse, with ongoing communication between physician's office and school nurse through the school year. This program relied on established family, provider and school resources rather than research staff. The primary outcome was change in the number of emergency department (ED) visits in the year before and after enrollment. Secondary outcomes were hospital admissions, school absences, and rescue medication use. RESULTS The study population was on average 10.5 years old, 63% male, 67% Hispanic, 19% black, 14% white with 95% using Medicaid insurance. Asthma-related ED visits over a 1-year period decreased 37.5%, from a pre-intervention mean of 0.8 visits to a post-intervention mean of 0.3 visits (p < 0.001). Asthma-related hospital admissions decreased from a pre-intervention mean of 0.3 admissions to post-intervention mean of 0 admissions (p < 0.001). Asthma rescue medication refills decreased by 46.3% from the pre- to post-intervention period (p = <.001). There were also non-significant declines in school absences and oral steroid use for children enrolled. CONCLUSIONS We demonstrate a significant reduction in healthcare utilization for children enrolled in this unique school nurse-supervised asthma program, which utilizes a clinical-school partnership to deliver preventative asthma medication to school-aged children under sustainable conditions.
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Affiliation(s)
- Michelle Trivedi
- Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Janki Patel
- Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Darleen Lessard
- Division of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ted Kremer
- Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Wanda Phipatanakul
- Division of Preventative and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lori Pbert
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Robert Goldberg
- Division of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Hogan AH, Rastogi D, Rinke ML. A Quality Improvement Intervention to Improve Inpatient Pediatric Asthma Controller Accuracy. Hosp Pediatr 2018; 8:127-134. [PMID: 29440128 DOI: 10.1542/hpeds.2017-0184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Our objective was to investigate if a rigorous quality improvement (QI) intervention could increase accuracy of pediatric asthma controller medications on discharge from an inpatient hospitalization. METHODS Our interprofessional QI team developed interventions such as improving documentation and creating standardized language to ensure patients were discharged on an appropriate asthma controller medication and improve assessment of asthma symptom control. Each week of 2015-2016, the first 5 patients discharged with status asthmaticus from the pediatric wards were reviewed for documentation of the 6 asthma control questions and accuracy of the discharge controller therapy. Correct discharge medication was defined as being prescribed the age-appropriate medication and dose on the basis of baseline controller therapy, compliance with baseline medication, and responses to asthma control assessment. The weekly proportion of control questions that were accessed and correct controller medications that were prescribed were analyzed by using Nelson rules and interrupted time series. RESULTS A total of 240 preintervention and 252 postintervention charts were reviewed. The primary outcome of the median proportion of patients discharged on appropriate controller therapy improved from 60% in preintervention data to 80% in the postintervention period. The process measure of proportion of asthma control questions that were assessed improved from 43% in the preintervention period to 98% by the final months of the intervention period. Both of these changes were statistically significant as per Nelson's rules and interrupted time series analyses (P = .02 and P < .001, respectively, for postintervention break). CONCLUSIONS An interdisciplinary QI team successfully improved the accuracy of asthma controller therapy on discharge and the inpatient assessment of asthma control questions.
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Affiliation(s)
- Alexander H Hogan
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut; and
| | - Deepa Rastogi
- Children's Hospital at Montefiore, Bronx, New York, New York
| | - Michael L Rinke
- Children's Hospital at Montefiore, Bronx, New York, New York
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Adams SN, Abel M, Fowler D, Braden J, Ebeling MD, Simpson AN, Titus MO, Andrews AL. Inhaled corticosteroid prescribing in a pediatric emergency department: Sustained success and prescription filling rates. J Asthma 2017; 55:252-258. [PMID: 28548868 DOI: 10.1080/02770903.2017.1323917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine if improvement in Inhaled Corticosteroid (ICS) prescribing in the pediatric emergency department (PED) can be sustained after transition from intense intervention to low-intervention phase, and to determine ICS fill rates. METHODS A Quality Improvement (QI) project began in Aug 2012. Results through Feb 2014 were previously published. In Feb 2014 interventions were scaled back to determine the sustainability of QI success. Eligible patients included children aged 2-17 seen in the PED for asthma between Feb 2014 and Sept 2016. The primary change when moving to the low-intervention phase was stopping monthly attending feedback. The primary outcome was the proportion of patients who were prescribed an ICS at the time of PED discharge. The secondary objective of this study was to determine the proportion of patients who filled their ICS prescription in the 6 months following Emergency Department (ED) visit. RESULTS The goal rate of ICS prescribing was 75%. After transition to the low-intervention phase, the ICS prescribing rate was maintained at a median of 79% through Sept 2016. ICS fill rate in the first 30 days following ED visit was 89%, although this quickly fell to below 40% for months 2-6. CONCLUSIONS The ICS prescribing rate remained the goal of 75% over a 2.5-year period after transition to a low-intervention phase. High ICS fill rates immediately after ED visit have been demonstrated. However, rapid decline in these rates over subsequent months suggests a need for future efforts to focus on long-term ICS adherence among children with ED visits for asthma.
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Affiliation(s)
| | - Mary Abel
- b Department of Pediatrics , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Dustin Fowler
- b Department of Pediatrics , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Jennifer Braden
- b Department of Pediatrics , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Myla D Ebeling
- b Department of Pediatrics , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Annie N Simpson
- b Department of Pediatrics , Medical University of South Carolina , Charleston , South Carolina , USA
| | - M Olivia Titus
- b Department of Pediatrics , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Annie Lintzenich Andrews
- b Department of Pediatrics , Medical University of South Carolina , Charleston , South Carolina , USA
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Andrews AL, Bundy DG, Simpson KN, Teufel RJ, Harvey J, Simpson AN. Inhaled Corticosteroid Claims and Outpatient Visits After Hospitalization for Asthma Among Commercially Insured Children. Acad Pediatr 2017; 17:212-217. [PMID: 28259341 PMCID: PMC5515358 DOI: 10.1016/j.acap.2016.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/13/2016] [Accepted: 10/28/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine rates of inhaled corticosteroid (ICS) claims and outpatient follow-up after asthma hospitalization among commercially insured children. METHODS We conducted a retrospective cohort analysis of children hospitalized for asthma using 2013 national Truven MarketScan data. Covariates included age, sex, region, length of stay, and having an ICS claim within 35 days before hospitalization. Outcome variables were a claim for any ICS-containing medication and outpatient visit within 30 days after discharge. Multivariable analysis used logistic regression. RESULTS A total of 5471 children aged 2 to 17 were included; 61% were boys, and mean age was 6.8 years. Forty-one percent had a claim for an ICS and 76% had an outpatient visit within 30 days after hospital discharge. In multivariable analysis, children who had an ICS claim within 35 days before the hospitalization were more likely to have an ICS claim within 30 days after discharge (relative risk [RR] 1.3, 95% confidence interval [CI] 1.2-1.5). The strongest predictor of an ICS claim within 30 days after discharge was attendance at an outpatient appointment (RR 1.4, 95% CI 1.3-1.6). Children aged 2 to 6 were more likely to attend an outpatient appointment (RR 1.1, 95% CI 1.1-1.2). Children with an ICS claim before admission were also more likely to attend an outpatient appointment (RR 1.1, 95% CI 1.004-1.1). CONCLUSIONS In this national sample of commercially insured children with asthma, rates of ICS claims after hospitalization are low despite high rates of outpatient visits. Both inpatient and outpatient physicians must play a role in increasing ICS adherence in this high-risk population of children with asthma.
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Affiliation(s)
- Annie Lintzenich Andrews
- Department of Pediatrics, Medical University of South Carolina College of Medicine, Medical University of South Carolina College of Medicine, Charleston, SC.
| | - David G. Bundy
- Medical University of South Carolina College of Medicine, Department of Pediatrics 135 Rutledge Ave MSC 561 Charleston, SC 29425
| | - Kit N. Simpson
- Medical University of South Carolina College of Health Professions, Department of Healthcare Leadership and Management 151B Rutledge Ave, MSC 962 Charleston, SC 29425
| | - Ronald J. Teufel
- Medical University of South Carolina College of Medicine, Department of Pediatrics 135 Rutledge Ave MSC 561 Charleston, SC 29425
| | - Jillian Harvey
- Medical University of South Carolina College of Health Professions, Department of Healthcare Leadership and Management 151B Rutledge Ave, MSC 962 Charleston, SC 29425
| | - Annie N. Simpson
- Medical University of South Carolina College of Health Professions, Department of Healthcare Leadership and Management 151B Rutledge Ave, MSC 962 Charleston, SC 29425
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Formenti AM, Maffezzoni F, Doga M, Mazziotti G, Giustina A. Growth hormone deficiency in treated acromegaly and active Cushing's syndrome. Best Pract Res Clin Endocrinol Metab 2017; 31:79-90. [PMID: 28477735 DOI: 10.1016/j.beem.2017.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Growth hormone deficiency (GHD) in adults is characterized by reduced quality of life and physical fitness, skeletal fragility, increased weight and cardiovascular risk. It may be found in (over-) treated acromegaly as well as in active Cushing's syndrome. Hypopituitarism may develop in patients after definitive treatment of acromegaly, although the exact prevalence of GHD in this population is still uncertain because of limited awareness, and scarce and conflicting data so far available. Because GHD associated with acromegaly and Cushing's syndrome may yield adverse consequences on similar target systems, the final outcomes of some complications of both acromegaly and Cushing's syndrome may be further affected by the occurrence of GHD. It is still largely unknown, however, whether GHD in patients with post-acromegaly or active Cushing's syndrome (e.g. pharmacologic glucocorticoid treatment) may benefit from GH replacement. We review the diagnostic, clinical and therapeutic aspects of GHD in adults treated for acromegaly and in those with active Cushing's syndrome.
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Affiliation(s)
| | | | - Mauro Doga
- Endocrinology, Univeristy of Brescia, Italy
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Vasbinder EC, Goossens LMA, Rutten-van Mölken MPMH, de Winter BCM, van Dijk L, Vulto AG, Blankman EIM, Dahhan N, Veenstra-van Schie MTM, Versteegh FGA, Wolf BHM, Janssens HM, van den Bemt PMLA. e-Monitoring of Asthma Therapy to Improve Compliance in children (e-MATIC): a randomised controlled trial. Eur Respir J 2016; 48:758-67. [PMID: 27230437 DOI: 10.1183/13993003.01698-2015] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/17/2016] [Indexed: 01/28/2023]
Abstract
Real-time medication monitoring (RTMM) is a promising tool for improving adherence to inhaled corticosteroids (ICS), but has not been sufficiently tested in children with asthma. We aimed to study the effects of RTMM with short message service (SMS) reminders on adherence to ICS, asthma control, asthma-specific quality of life and asthma exacerbation rate; and to study the associated cost-effectiveness.In a multicentre, randomised controlled trial, children (aged 4-11 years) using ICS were recruited from five outpatient clinics and were given an RTMM device for 12 months. The intervention group also received tailored SMS reminders, sent only when a dose was at risk of omission. Outcome measures were adherence to ICS (RTMM data), asthma control (childhood asthma control test questionnaire), quality of life (paediatric asthma quality of life questionnaire) and asthma exacerbations. Costs were calculated from a healthcare and societal perspective.We included 209 children. Mean adherence was higher in the intervention group: 69.3% versus 57.3% (difference 12.0%, 95% CI 6.7%-17.7%). No differences were found for asthma control, quality of life or asthma exacerbations. Costs were higher in the intervention group, but this difference was not statistically significant.RTMM with tailored SMS reminders improved adherence to ICS, but not asthma control, quality of life or exacerbations in children using ICS for asthma.
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Affiliation(s)
- Erwin C Vasbinder
- Dept of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Hospital Pharmacy, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - Lucas M A Goossens
- Erasmus University Institute for Medical Technology Assessment, Rotterdam, The Netherlands
| | | | - Brenda C M de Winter
- Dept of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Arnold G Vulto
- Dept of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Nordin Dahhan
- Division of Paediatric Respiratory Medicine, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands
| | | | | | - Bart H M Wolf
- Dept of Paediatrics, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands
| | - Hettie M Janssens
- Division of Paediatric Respiratory Medicine, Erasmus University Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
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Pouessel G, Gueorguieva I, Bernaczyk Y, Flammarion S, Thumerelle C, Deschildre A. [Inhaled corticosteroids and growth: should we be worried?]. Arch Pediatr 2015; 22:886-91. [PMID: 26142772 DOI: 10.1016/j.arcped.2015.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 02/13/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
Inhaled corticosteroids (ICSs) are the cornerstone and the first stage of asthma treatment. The objective of this study was to synthesize data on the potential effects of ICSs on growth in children. Studies on the short-term impact of ICSs on growth evaluated by knemometry cannot be extrapolated to the medium or long term and therefore have no utility in real life for a given person. In the medium term, the various ICSs given at the usual doses cause a small reduction in growth after 6 months of treatment. This slowdown occurs at the beginning of treatment, especially in younger children, and the growth velocity corrects itself later but without catching up. In the long term, the prolonged use of ICSs seems to induce a small reduction in the final size in adulthood (close to 1cm) occurring in the first 2 years of treatment without worsening over time. The impact of gender, age at onset of treatment, different ICSs, modes of inhalation, and severity of asthma should also be studied further. The benefit of ICSs in asthma treatment is greater than the risk of side effects, including on growth. The majority of the therapeutic effect is obtained for small to moderate doses of ICSs. Regular adjustment of ICS dose for optimal asthma control should also reduce ICS dose and the impact on growth.
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Affiliation(s)
- G Pouessel
- Service de pédiatrie, centre hospitalier de Roubaix, pavillon de pédiatrie médico-chirurgicale, 11-17, boulevard Lacordaire, BP 359, 59056 Lille, France; Unité de pneumologie et allergologie, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
| | - I Gueorguieva
- Unité d'endocrinologie pédiatrique, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Y Bernaczyk
- Service de pédiatrie, centre hospitalier de Roubaix, pavillon de pédiatrie médico-chirurgicale, 11-17, boulevard Lacordaire, BP 359, 59056 Lille, France
| | - S Flammarion
- Unité de pneumologie et allergologie, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - C Thumerelle
- Unité de pneumologie et allergologie, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - A Deschildre
- Unité de pneumologie et allergologie, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
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Giustina A, Mazziotti G. Impaired growth hormone secretion associated with low glucocorticoid levels: an experimental model for the Giustina effect. Endocrine 2014; 47:354-6. [PMID: 24798449 DOI: 10.1007/s12020-014-0278-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/18/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Andrea Giustina
- University of Brescia, Poliambulatori di Via Biseo,Via Biseo 17, 25123, Brescia, Italy,
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Beckhaus AA, Riutort MC, Castro-Rodriguez JA. Inhaled versus systemic corticosteroids for acute asthma in children. A systematic review. Pediatr Pulmonol 2014; 49:326-34. [PMID: 23929666 DOI: 10.1002/ppul.22846] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/18/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the effects of inhaled corticosteroids (ICS) against systemic corticosteroids (SC) in children consulting in emergency department (ED) or equivalent for asthma exacerbation. METHODS Electronic search in MEDLINE, CENTRAL, CINAHL, and LILACS databases and other sources. Study selection criteria: children 2-18 years of age, consulting in ED or equivalent for asthma exacerbation, comparison between ICS and SC, randomized controlled trials. PRIMARY OUTCOMES hospital admission rate, unscheduled visits for asthma symptoms, need of additional course of SC. SECONDARY OUTCOMES improvement of lung function, length of stay in ED, clinical scores, and adverse effects. RESULTS Eight studies met inclusion criteria (N = 797), published between 1995 and 2006. All used prednisolone as SC and budesonide, fluticasone, dexamethasone, and flunisolide were administered as ICS. No significant difference between ICS versus SC was found in terms of hospital admission (RR: 1.02; 95% CI: 0.41-2.57), unscheduled visits for asthma symptoms (RR: 9.55; 95% CI: 0.53-170.52) nor for need of additional course of SC (RR: 1.45; 95% CI: 0.28-7.62). The change in % of predicted FEV1 at fourth hour was significantly higher for SC group, but there was no significant difference between both groups after this time. There was insufficient data to perform meta-analysis of length of stay during first consult in ED and of symptom scores. Vomiting was similar among both groups. CONCLUSIONS There is no evidence of a difference between ICS and SC in terms of hospital admission rates, unscheduled visits for asthma symptoms and need of additional course of SC in children consulting for asthma exacerbations.
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Affiliation(s)
- Andrea A Beckhaus
- Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Shin IS, Ahn KS, Shin NR, Jeon CM, Kwon OK, Chin YW, Lee K, Oh SR. Homoegonol attenuates the asthmatic responses induced by ovalbumin challenge. Arch Pharm Res 2014; 37:1201-10. [PMID: 24424605 DOI: 10.1007/s12272-013-0327-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/29/2013] [Indexed: 12/26/2022]
Abstract
Homoegonol is a lignan derived from styraxlignolide A, which was isolated from Styrax japonica, a medicinal plant widely used for treatment of inflammatory diseases in Korea. We investigated the efficacy of homoegonol for the treatment of allergic asthma using an ovalbumin (OVA)-induced murine asthma model. The mice were sensitized through intraperitoneal injections of OVA on days 0 and 14. On days 21, 22 and 23 after the initial OVA sensitization, the mice were received OVA airway challenge. Homoegonol was administered by oral gavage at a dose of 30 mg/kg 1 h prior to the OVA challenge. The homoegonol-treated mice exhibited reduced inflammatory cell counts and Th2 cytokines in BALF, AHR, and IgE in the serum compared with the OVA-sensitized/challenged mice. The histological analysis of the lung tissue revealed that the administration of homoegonol attenuated the airway inflammation and the mucus overproduction in airway epithelial lesions induced by OVA through a reduction in expression of inducible nitric oxide synthase and matrix metalloproteinase-9. These findings indicate that homoegonol effectively suppresses the asthmatic responses induced by OVA challenge and suggests that homoegonol exhibits potential as therapeutic drug for allergic asthma.
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Affiliation(s)
- In-Sik Shin
- Natural Medicine Research Center, Korea Research Institute of Bioscience and Biotechnology, 30 Yeongudanji-ro, Ochang-eup, Cheongwon-gun, Chungbuk, 363-883, Republic of Korea,
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Asthma therapy in pediatric patients: a systematic review of treatment with montelukast versus inhaled corticosteroids. J Pediatr Health Care 2014; 28:51-62. [PMID: 23312367 DOI: 10.1016/j.pedhc.2012.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/14/2012] [Accepted: 11/23/2012] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Inhaled corticosteroids (ICS) are a first-line treatment for mild persistent asthma, but montelukast (MON) monotherapy also has been beneficial. The aim of this review is to evaluate current evidence comparing MON versus ICS monotherapy in pediatric patients. METHOD A systematic review was conducted of randomized controlled trials evaluating treatment of mild to moderate persistent asthma in which MON was compared with ICS monotherapy in children aged 2 to 18 years. PubMed, the Cumulative Index to Nursing and Allied Health Literature, and the Institute of Scientific Information's Web of Knowledge were searched using key words asthma, MON, and ICS. Studies that met inclusion criteria were appraised for quality. RESULTS Of 214 identified studies, eight met inclusion criteria and seven were deemed high quality. Study sample sizes ranged from 62 to 994, 88% were multi-site, and the average length of follow-up was 8.2 months. Asthma symptoms improved with both therapies. Four studies reported superiority of ICS compared with MON; the remaining studies showed no differences between therapies. DISCUSSION These results are consistent with the National Asthma Education and Prevention Program (2007) recommendation that ICS therapy should be first-line treatment in children with mild to moderate persistent asthma.
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Abstract
Glucocorticoids modulate the secretion of growth hormone (GH) by various and competing effects on the hypothalamus and pituitary gland. The final effects of this modulation depend on hormone concentrations and the duration of exposure. The traditional hypothesis is that chronically raised levels of glucocorticoids suppress the secretion of GH. However, a functional impairment of the GH reserve might also be observed in patients with low levels of glucocorticoids, such as those with secondary hypoadrenalism, which is consistent with the model of biphasic dose-dependent effects of glucocorticoids on the somatotropic axis. This Review updates our current understanding of the mechanisms underlying the effects of glucocorticoids on the secretion of GH and the clinical implications of the dual action of glucocorticoids on the GH reserve in humans. This Review will also address the potential diagnostic and therapeutic implications of GH for patients with a deficiency or excess of glucocorticoids.
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Affiliation(s)
- Gherardo Mazziotti
- Department of Medicine, Endocrine and Bone Unit, Azienda Ospedaliera Carlo Poma of Mantua, 46100 Mantua, Italy
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Lee T, Kwon HS, Bang BR, Lee YS, Park MY, Moon KA, Kim TB, Lee KY, Moon HB, Cho YS. Grape seed proanthocyanidin extract attenuates allergic inflammation in murine models of asthma. J Clin Immunol 2012; 32:1292-304. [PMID: 22836658 DOI: 10.1007/s10875-012-9742-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Antioxidants have been suggested to alleviate the pathophysiological features of asthma, and grape seed proanthocyanidin extract (GSPE) has been reported to have powerful antioxidant activity. PURPOSE This study was performed to determine whether GSPE has a therapeutic effect on allergic airway inflammation in both acute and chronic murine model of asthma. METHODS Acute asthma model was generated by intraperitoneal sensitization of ovalbumin (OVA) with alum followed by aerosolized OVA challenges, whereas chronic asthma model was induced by repeated intranasal challenges of OVA with fungal protease twice a week for 8 weeks. GSPE was administered by either intraperitoneal injection or oral gavage before OVA challenges. Airway hyperresponsiveness (AHR) was measured, and airway inflammation was evaluated by bronchoalveolar lavage (BAL) fluid analysis and histopathological examination of lung tissue. Lung tissue levels of various cytokines, chemokines, and growth factors were analyzed by quantitative polymerase chain reaction and ELISA. Glutathione assay was done to measure oxidative burden in lung tissue. RESULTS Compared to untreated asthmatic mice, mice treated with GSPE showed significantly reduced AHR, decreased inflammatory cells in the BAL fluid, reduced lung inflammation, and decreased IL-4, IL-5, IL-13, and eotaxin-1 expression in both acute and chronic asthma models. Moreover, airway subepithelial fibrosis was reduced in the lung tissue of GSPE-treated chronic asthmatic mice compared to untreated asthmatic mice. Reduced to oxidized glutathione (GSH/GSSG) ratio was increased after GSPE treatment in acute asthmatic lung tissue. CONCLUSION GSPE effectively suppressed inflammation in both acute and chronic mouse models of asthma, suggesting a potential role of GSPE as a therapeutic agent for asthma.
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Affiliation(s)
- Taehoon Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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Cataletto Guest Editor M. Commentary: The Importance of Certified Asthma Educators in Promoting Health Literacy for Children with Asthma and Their Families. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:127-128. [PMID: 35927874 DOI: 10.1089/ped.2011.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Mary Cataletto Guest Editor
- Division of Pediatric Pulmonology, Winthrop University Hospital, Mineola, New York
- Member, National Asthma Educator Certification Board, Grand Rapids, Michigan
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Asma na infância: tratamento medicamentoso. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Wu BH, Cabana MD, Hilton JF, Ly NP. Race and asthma control in the pediatric population of Hawaii. Pediatr Pulmonol 2011; 46:442-51. [PMID: 21194172 DOI: 10.1002/ppul.21387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 08/09/2010] [Accepted: 09/21/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The racially unique population of Hawaii has one of the highest prevalences of childhood asthma in America. We estimate the prevalence of impaired asthma control among asthmatic children in Hawaii and determine which factors are associated with impaired control. PATIENTS AND METHODS We analyzed data from 477 asthmatic children living in Hawaii participating in the 2006-2008 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-Back Surveys. Impaired asthma control was modeled after 2007 National Asthma Education and Prevention Program guidelines. Univariate and multivariate analyses were used to identify factors associated with impaired asthma control. RESULTS Children (53.8%) with asthma were either part or full Native Hawaiian/Pacific Islander. While 35.6% of asthmatic children met criteria for impaired asthma control, being part or full Native Hawaiian/Pacific Islander was not associated with impaired control. Only 31.1% of children with impaired control reported the use of inhaled corticosteroids despite >80% having had a routine checkup for asthma in the past year and receipt of asthma education from a healthcare provider. CONCLUSION A large proportion of asthmatic children in Hawaii have impaired asthma control that does not appear to be associated with race but may be associated with inadequate pharmacologic therapy. While a significant percentage reported receiving routine asthma care and asthma education, a minority reported using inhaled corticosteroids. Reasons for this discrepancy between asthma assessment and treatment are unclear. However, additional education on part of the physician, community, and healthcare system are likely to improve management and reduce morbidity in this population.
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Affiliation(s)
- Brian H Wu
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of California San Francisco, California.
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Urrusuno RF, Balosa MCM, de la Pisa BP, Mateos SJ, Calvo CB. Developing indicators of prescribing quality for primary care paediatricians. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2010. [DOI: 10.1111/j.1759-8893.2010.00031.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reply. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2010.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial. J Allergy Clin Immunol 2010; 126:942-9. [PMID: 20624650 DOI: 10.1016/j.jaci.2010.06.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 06/03/2010] [Accepted: 06/07/2010] [Indexed: 12/25/2022]
Abstract
BACKGROUND Asthma control is now recognized as the main goal of asthma therapy. Guidelines recommend finding the lowest effective dose of inhaled corticosteroids in children with persistent asthma. OBJECTIVE The aim of this study was to investigate the efficacy of an allergen-specific immunotherapy with a high-dose hypoallergenic mite preparation (allergoid) as steroid-sparing agent in children with allergic asthma. METHODS Sixty-five children with asthma (Global Initiative for Asthma treatment levels II and III; 6-17 years old), after reaching asthma control with inhaled steroids during a 5-month baseline period, were randomized for subcutaneous mite allergoid immunotherapy (SCIT) plus fluticasone propionate (FP) or FP therapy alone for 2 years. During 2 subsequent 5-month winter periods, steroid therapy was adjusted according to predefined dose steps, determining and comparing the changes in FP dosages and the lowest FP dose sufficient to maintain asthma control. Immunologic and functional investigations were also carried out. RESULTS Children treated with house dust mite SCIT plus FP were able to significantly reduce the FP dose by more steps (P < .05), compared with the control group on FP alone. The mean daily dose in the immunotherapy group decreased from 330.3 μg in the baseline period to 151.5 μg after 2 treatment years, whereas in the control group the dose decreased from 290.6 μg to 206.3 μg. Compared with the control group, significant improvement was also observed in morning peak expiratory flow (P = .0315). Significantly increased levels of specific IgG(1) (P = .0001) and IgG(4) (P < .0001) were also observed. CONCLUSION Adding a mite allergoid SCIT to pharmacologic treatment is an effective and safe strategy to reduce corticosteroid doses while maintaining disease control in children with mite-induced allergic asthma.
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Affiliation(s)
- Stefan Zielen
- Pediatric Clinic, Frankfurt University, Frankfurt, Germany
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Vaessen-Verberne AAPH, van den Berg NJ, van Nierop JC, Brackel HJL, Gerrits GPJM, Hop WCJ, Duiverman EJ. Combination therapy salmeterol/fluticasone versus doubling dose of fluticasone in children with asthma. Am J Respir Crit Care Med 2010; 182:1221-7. [PMID: 20622031 DOI: 10.1164/rccm.201002-0193oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE For children with symptomatic asthma despite low to moderate doses of inhaled corticosteroids, evidence is still lacking whether to add a long-acting bronchodilator or to increase the dose of inhaled corticosteroids. OBJECTIVE To evaluate whether salmeterol/fluticasone propionate (SFP), 50/100 μg twice a day, is noninferior regarding symptom control compared with fluticasone propionate (FP), 200 μg twice a day Diskus in children with symptomatic asthma. METHODS A multicenter, randomized, parallel-group, double-blind study was performed comparing SFP and FP treatment during 26 weeks on asthma control and lung function. MEASUREMENTS AND MAIN RESULTS A total of 158 children, 6-16 years old, still symptomatic on FP, 100 μg twice a day, during a 4-week run-in period, were included. Percentage of symptom-free days during the last 10 weeks of the treatment period did not differ between treatment groups (per protocol analysis: adjusted mean difference [FP minus SFP] 2.6%; 95% confidence interval, -8.1 to 13.4). Both groups showed substantial improvements of about 25 percent points in symptom-free days (both P < 0.001 from baseline). Lung function measurements (FEV(1), FVC, PEF rate, and maximal expiratory flow) did not differ between groups except for a slight advantage in maximal expiratory flow in the SFP group at 1 week. No differences were found between FP and SFP regarding exacerbation rates, adverse events, or growth. CONCLUSIONS In our study the efficacy on symptom control and lung function of the combination of a long-acting bronchodilator with inhaled corticosteroid is equal to doubling the dose of the inhaled corticosteroid in children still symptomatic on a moderate dose of inhaled corticosteroid.
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Pedersen S, Potter P, Dachev S, Bosheva M, Kaczmarek J, Springer E, Dunkel J, Engelstätter R. Efficacy and safety of three ciclesonide doses vs placebo in children with asthma: the RAINBOW study. Respir Med 2010; 104:1618-28. [PMID: 20619624 DOI: 10.1016/j.rmed.2010.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 06/14/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of three doses of ciclesonide (with or without spacer) in children with persistent asthma. PATIENTS AND METHODS This was a multicentre, double-blind, placebo-controlled, 12-week study of ciclesonide 40, 80 or 160 μg (once daily pm). Children (6-11 years) were randomised 1:1 to treatment via a metered dose inhaler (MDI) or MDI plus spacer. The primary variable was change from baseline in mean morning peak expiratory flow (PEF). Secondary variables included: time to first lack of efficacy (LOE), asthma control, forced expiratory volume in 1 s (FEV(1)), asthma symptom score and quality of life (QoL). Safety assessments included: adverse events (AEs), urinary cortisol excretion and body height. RESULTS In total, 1073 children received treatment. At endpoint, mean morning PEF significantly improved with all doses of ciclesonide vs. placebo. There was no difference over placebo in time to first LOE, but ciclesonide was superior to placebo on asthma control, symptom score, FEV(1) and QoL. There were no differences between the spacer or non-spacer subgroups. The incidences of AEs were comparable between treatment groups (approximately 35%) and there were no between-group differences in body height or urinary cortisol. CONCLUSIONS Ciclesonide 40-160 μg once daily is effective and well tolerated in children with persistent asthma; its efficacy and safety are unaffected by the use of a spacer. clinicaltrials.gov registration number: NCT00384189.
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Affiliation(s)
- Søren Pedersen
- University of Southern Denmark, Pediatric Research Unit, Kolding Hospital, Kolding, Denmark.
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Rohan J, Drotar D, McNally K, Schluchter M, Riekert K, Vavrek P, Schmidt A, Redline S, Kercsmar C. Adherence to pediatric asthma treatment in economically disadvantaged African-American children and adolescents: an application of growth curve analysis. J Pediatr Psychol 2010; 35:394-404. [PMID: 19710251 PMCID: PMC2858436 DOI: 10.1093/jpepsy/jsp074] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 07/18/2009] [Accepted: 07/26/2009] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The primary aims of the study were to: (a) describe the trajectories of adherence to daily inhaled corticosteroid (ICS) medication for a year in economically disadvantaged, African-American youth with asthma based on growth curve modeling; and (b) test the relationship of treatment adherence to symptom control, quick-relief medication, and healthcare utilization. METHODS This prospective study measured adherence to daily ICS treatment using electronic monitoring in 92 children and adolescents with moderate to severe asthma for 9-12 months and assessed clinical outcomes, including asthma-related symptoms, quick-relief medication, and healthcare utilization. RESULTS Youth showed a decrement in treatment adherence to less than half of prescribed corticosteroid treatment over the course of the study, which related to increased healthcare utilization (p < .04), but not to asthma symptoms or albuterol use. CONCLUSION Economically disadvantaged youth with asthma demonstrate high rates of chronic nonadherence that warrant identification and intervention to reduce asthma-related healthcare utilization.
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Affiliation(s)
- Jennifer Rohan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 7039, Cincinnati, OH 45229, USA.
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McNally KA, Rohan J, Schluchter M, Riekert KA, Vavrek P, Schmidt A, Redline S, Kercsmar C, Drotar D. Adherence to combined montelukast and fluticasone treatment in economically disadvantaged african american youth with asthma. J Asthma 2009; 46:921-7. [PMID: 19905919 DOI: 10.3109/02770900903229651] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
High rates of asthma treatment nonadherence have been reported, particularly in economically disadvantaged African American youth. The relationship between adherence to combined medication treatment and asthma outcomes has potential clinical significance but is not well understood. Using electronic monitoring, we describe the pattern of adherence to daily corticosteroid (fluticasone) and leukotriene receptor antagonist (montelukast) medication over the course of 1 year in a population of African American youth with moderate to severe asthma. On average, adherence to montelukast was higher than adherence to fluticasone (p < 0.01); however, for both medications, adherence rates significantly declined over the course of the study. After 1 year, participants took only 31% of prescribed doses of montelukast and 23% of prescribed doses of fluticasone. The decline in adherence to both fluticasone (p < 0.05) and montelukast (p < 0.001) was related to increased healthcare utilization. Furthermore, asthma symptom ratings were related montelukast (p < 0.001), but not fluticasone adherence. These results suggest that adherence promotion intervention strategies are warranted to improve health-related outcomes in families who are at-risk for treatment nonadherence.
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Affiliation(s)
- Kelly A McNally
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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Abstract
Nonadherence to treatment is an important influence on the health outcomes of children and adolescents with pediatric asthma, which is the most prevalent childhood chronic illness. Because the factors that influence treatment adherence for pediatric asthma are not well understood, a comprehensive review of relevant research is needed. To address this need, research concerning the correlates and predictors of adherence to inhaled corticosteroid treatment for pediatric asthma was reviewed. Significant predictors and correlates of treatment adherence identified in this review were consistent with a conceptual model that included family demographic characteristics and functioning, parent and child characteristics, health care system and provider characteristics, and child health outcomes. Family functioning and parental beliefs about asthma and medication treatment demonstrated consistent relationships with treatment adherence. Future research should test multivariate models of influences on treatment adherence in pediatric asthma in prospective studies using reliable and valid measures of predictors and outcomes. Intervention studies are also needed that target potentially modifiable, empirically supported influences to enhance treatment adherence. The clinical management of pediatric asthma would be enhanced by routine assessment of barriers to treatment adherence and anticipatory interventions that address them to prevent nonadherence.
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Warman K, Silver EJ, Wood PR. Modifiable risk factors for asthma morbidity in Bronx versus other inner-city children. J Asthma 2009; 46:995-1000. [PMID: 19995136 PMCID: PMC2892895 DOI: 10.3109/02770900903350481] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bronx children have higher asthma prevalence and asthma morbidity than other US children. OBJECTIVE To compare risk factors for asthma morbidity present in Bronx children with those of children from other US inner-city areas. METHODS Cross-sectional, multi-state study of 1772 children ages 5-11 yrs. old with persistent asthma. Parental responses to the Child Asthma Risk Assessment Tool for 265 Bronx children are compared with those of 1507 children from 7 other sites (1 Northeast, 2 South, 2 Midwest, 2 West). RESULTS Bronx children were significantly more likely to be sensitized to reported aeroallergens in their homes than were children from the other sites (86% vs. 58%; p < .001). More Bronx parents reported household cockroaches (65% v 20%; p < .001), mice (42% v 11%; p < .001), and rats (7% v 3%; p < .001); using a gas stove to heat the home (20% v 9%; p < .001); and visible mold (48% v 25%; p < .001). Bronx parents were more likely to report pessimistic beliefs about controlling asthma (63% v 26%; p < .001) and high parental stress (48% v 37%; p < .01). CONCLUSIONS Compared with other inner-city children with asthma, Bronx children are more likely to be exposed to household aeroallergens to which they are sensitized and have poor housing conditions. Their parents are more likely to report low expectations for asthma control and high levels of psychological stress. Interventions that address these identified needs may help to reduce the disproportionate burden of asthma morbidity experienced by Bronx children.
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Affiliation(s)
- Karen Warman
- Department of Pediatrics, Division of General Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York 10461, USA.
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Bloomberg GR. Recurrent wheezing illness in preschool-aged children: assessment and management in primary care practice. Postgrad Med 2009; 121:48-55. [PMID: 19820274 DOI: 10.3810/pgm.2009.09.2052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recurrent wheezing is common in preschool-aged children, with 1 in 3 children experiencing at least 1 acute wheezing illness before the age of 3 years. These children represent a diverse group, with some going on to present with asthma at school age and others experiencing complete resolution of symptoms. The primary care physician is faced with a dilemma of when to recommend daily therapy. He or she must also answer parents' concerns, often expressed as, "Does my child have asthma?" and "Will my child have to take medication the rest of his or her life?" This article presents recent studies and recommendations that can guide the physician in approaching the child and the parent with rational management. The emphasis is on viewing recurrent wheezing as a continuum requiring a plan of monitoring that starts with the very first episode. Using background information from the parents and a history of the child's allergic disposition, one can discuss with parents the risks of developing asthma and, together with planned monitoring, prescribe appropriate management. The primary care physician can plan management by using the Asthma Predictive Index and employing specific questions for features present during the intervals between acute episodes. Together with close monitoring, the physician will have a compass that effectively directs rational management.
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Affiliation(s)
- Gordon R Bloomberg
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO 63110, USA.
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