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Short-chain fatty acid acetate triggers antiviral response mediated by RIG-I in cells from infants with respiratory syncytial virus bronchiolitis. EBioMedicine 2022; 77:103891. [PMID: 35220042 PMCID: PMC8871125 DOI: 10.1016/j.ebiom.2022.103891] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 12/31/2022] Open
Abstract
Background Gut microbiota-derived short-chain fatty-acid (SFCA) acetate protects mice against RSV A2 strain infection by increasing interferon-β production and expression of interferon-stimulated genes (ISGs). However, the role of SFCA in RSV infection using strains isolated from patients is unknown. Methods We first used RSV clinical strains isolated from infants hospitalized with RSV bronchiolitis to investigate the effects of in vitro SCFA-acetate treatment of human pulmonary epithelial cells. We next examined whether SCFA-acetate treatment is beneficial in a mouse model of RSV infection using clinical isolates. We sought to investigate the relationship of gut microbiota and fecal acetate with disease severity among infants hospitalized with RSV bronchiolitis, and whether treating their respiratory epithelial cells with SCFA-acetate ex-vivo impacts viral load and ISG expression. We further treated epithelial cells from SARS-CoV-2 infected patients with SCFA-acetate. Findings In vitro pre-treatment of A549 cells with SCFA-acetate reduced RSV infection with clinical isolates and increased the expression of RIG-I and ISG15. Animals treated with SCFA-acetate intranasally recovered significantly faster, with reduction in the RSV clinical isolates viral load, and increased lung expression of IFNB1 and the RIG-I. Experiments in RIG-I knockout A549 cells demonstrated that the protection relies on RIG-I presence. Gut microbial profile was associated with bronchiolitis severity and with acetate in stool. Increased SCFA-acetate levels were associated with increasing oxygen saturation at admission, and shorter duration of fever. Ex-vivo treatment of patients’ respiratory cells with SCFA-acetate reduced RSV load and increased expression of ISGs OAS1 and ISG15, and virus recognition receptors MAVS and RIG-I, but not IFNB1. These SCFA-acetate effects were not found on cells from SARS-CoV-2 infected patients. Interpretation SCFA-acetate reduces the severity of RSV infection and RSV viral load through modulation of RIG-I expression. Funding FAPERGS (FAPERGS/MS/CNPq/SESRS no. 03/2017 - PPSUS 17/2551-0001380-8 and COVID-19 20/2551-0000258-6); CNPq 312504/2017-9; CAPES) - Finance Code 001.
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Xu H, Tong L, Gao P, Hu Y, Wang H, Chen Z, Fang L. Combination of ipratropium bromide and salbutamol in children and adolescents with asthma: A meta-analysis. PLoS One 2021; 16:e0237620. [PMID: 33621253 PMCID: PMC7901745 DOI: 10.1371/journal.pone.0237620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A combination of ipratropium bromide (IB) and salbutamol is commonly used to treat asthma in children and adolescents; however, there has been a lack of consistency in its usage in clinical practice. OBJECTIVE To evaluate the efficacy and safety of IB + salbutamol in the treatment of asthma in children and adolescents. METHODS The MEDLINE, Embase, and Cochrane Library as well as other Chinese biomedical databases (including China Biological Medicine Database, Chinese National Knowledge Infrastructure, Chongqing VIP, and Wanfang Chinese language bibliographic database) were systematically searched from the earliest record date to September 2020 for randomized controlled trials in children and adolescents (≤18 years) with asthma who received IB + salbutamol or salbutamol alone. The primary outcomes included hospital admission and adverse events. A random effects model with a 95% confidence interval (CI) was used. Subgroup analysis was performed according to age, severity of asthma, and co-interventions with other asthma controllers. This study was registered with PROSPERO. RESULTS Of the 1061 studies that were identified, 55 met the inclusion criteria and involved 6396 participants. IB + salbutamol significantly reduced the risk of hospital admission compared with salbutamol alone (risk ratio [RR] 0.79; 95% CI 0.66-0.95; p = 0.01; I2 = 40%). Subgroup analysis only showed significant difference in the risk of hospital admission in participants with severe asthma exacerbation (RR 0.73; 95% CI 0.60-0.88; p = 0.0009; I2 = 4%) and moderate-to-severe exacerbation (RR 0.69; 95% CI 0.50-0.96; p = 0.03; I2 = 3%). There were no significant differences in the risk of adverse events between IB + salbutamol group and salbutamol alone group (RR 1.77; 95% CI 0.63-4.98). CONCLUSION IB + salbutamol may be more effective than salbutamol alone for the treatment of asthma in children and adolescents, especially in those with severe and moderate to severe asthma exacerbation. The very low to high quality of evidence indicated that future well-designed double-blind RCTs with large sample are needed for research on evaluating the effectiveness of IB + salbutamol treatment for asthma in children and adolescents.
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Affiliation(s)
- Hongzhen Xu
- Department of Pulmonology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Lin Tong
- Department of Pulmonology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Peng Gao
- Department of Pharmacy, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yan Hu
- Department of Pharmacy, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Huijuan Wang
- Department of Pharmacy, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Zhimin Chen
- Department of Pulmonology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Luo Fang
- Department of Pharmacy, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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Aralihond A, Shanta Z, Pullattayil A, Powell C. Treating acute severe asthma attacks in children: using aminophylline. Breathe (Sheff) 2020; 16:200081. [PMID: 33664832 PMCID: PMC7910032 DOI: 10.1183/20734735.0081-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Aminophylline does have a role in treating severe asthma attacks in children with asthma. Clinicians just need to be aware of the toxic side-effects of the drug and manage the drug carefully. https://bit.ly/3o7IJV1.
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Affiliation(s)
- A. Aralihond
- Sidra Medicine, Doha, Qatar
- Weill Cornell Medical College, Doha, Qatar
| | | | | | - C.V.E. Powell
- Sidra Medicine, Doha, Qatar
- Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Craig SS, Dalziel SR, Powell CV, Graudins A, Babl FE, Lunny C. Interventions for escalation of therapy for acute exacerbations of asthma in children: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2020; 8:CD012977. [PMID: 32767571 PMCID: PMC8078579 DOI: 10.1002/14651858.cd012977.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Asthma is an illness that commonly affects adults and children, and it serves as a common reason for children to attend emergency departments. An asthma exacerbation is characterised by acute or subacute worsening of shortness of breath, cough, wheezing, and chest tightness and may be triggered by viral respiratory infection, poor compliance with usual medication, a change in the weather, or exposure to allergens or irritants. Most children with asthma have mild or moderate exacerbations and respond well to first-line therapy (inhaled short-acting beta-agonists and systemic corticosteroids). However, the best treatment for the small proportion of seriously ill children who do not respond to first-line therapy is not well understood. Currently, a large number of treatment options are available and there is wide variation in management. OBJECTIVES Main objective - To summarise Cochrane Reviews with or without meta-analyses of randomised controlled trials on the efficacy and safety of second-line treatment for children with acute exacerbations of asthma (i.e. after first-line treatments, titrated oxygen delivery, and administration of intermittent inhaled short-acting beta2-agonists and oral corticosteroids have been tried and have failed) Secondary objectives - To identify gaps in the current evidence base that will inform recommendations for future research and subsequent Cochrane Reviews - To categorise information on reported outcome measures used in trials of escalation of treatment for acute exacerbations of asthma in children, and to make recommendations for development and reporting of standard outcomes in future trials and reviews - To identify relevant randomised controlled trials that have been published since the date of publication of each included review METHODS: We included Cochrane Reviews assessing interventions for children with acute exacerbations of asthma. We searched the Cochrane Database of Systematic Reviews. The search is current to 28 December 2019. We also identified trials that were potentially eligible for, but were not currently included in, published reviews. We assessed the quality of included reviews using the ROBIS criteria (tool used to assess risk of bias in systematic reviews). We presented an evidence synthesis of data from reviews alongside an evidence map of clinical trials. Primary outcomes were length of stay, hospital admission, intensive care unit admission, and adverse effects. We summarised all findings in the text and reported data for each outcome in 'Additional tables'. MAIN RESULTS We identified 17 potentially eligible Cochrane Reviews but extracted data from, and rated the quality of, 13 reviews that reported results for children alone. We excluded four reviews as one did not include any randomised controlled trials (RCTs), one did not provide subgroup data for children, and the last two had been updated and replaced by subsequent reviews. The 13 reviews included 67 trials; the number of trials in each review ranged from a single trial up to 27 trials. The vast majority of comparisons included between one and three trials, involving fewer than 100 participants. The total number of participants included in reviews ranged from 40 to 2630. All studies included children; 16 (24%) included children younger than two years of age. Most of the reviews reported search dates older than four years. We have summarised the published evidence as outlined in Cochrane Reviews. Key findings, in terms of our primary outcomes, are that (1) intravenous magnesium sulfate was the only intervention shown to reduce hospital length of stay (high-certainty evidence); (2) no evidence suggested that any intervention reduced the risk of intensive care admission (low- to very low-certainty evidence); (3) the risk of hospital admission was reduced by the addition of inhaled anticholinergic agents to inhaled beta2-agonists (moderate-certainty evidence), the use of intravenous magnesium sulfate (high-certainty evidence), and the use of inhaled heliox (low-certainty evidence); (4) the addition of inhaled magnesium sulfate to usual bronchodilator therapy appears to reduce serious adverse events during hospital admission (moderate-certainty evidence); (5) aminophylline increased vomiting compared to placebo (moderate-certainty evidence) and increased nausea and nausea/vomiting compared to intravenous beta2-agonists (low-certainty evidence); and (6) the addition of anticholinergic therapy to short-acting beta2-agonists appeared to reduce the risk of nausea (high-certainty evidence) and tremor (moderate-certainty evidence) but not vomiting (low-certainty evidence). We considered 4 of the 13 reviews to be at high risk of bias based on the ROBIS framework. In all cases, this was due to concerns regarding identification and selection of studies. The certainty of evidence varied widely (by review and also by outcome) and ranged from very low to high. AUTHORS' CONCLUSIONS This overview provides the most up-to-date evidence on interventions for escalation of therapy for acute exacerbations of asthma in children from Cochrane Reviews of randomised controlled trials. A vast majority of comparisons involved between one and three trials and fewer than 100 participants, making it difficult to assess the balance between benefits and potential harms. Due to the lack of comparative studies between various treatment options, we are unable to make firm practice recommendations. Intravenous magnesium sulfate appears to reduce both hospital length of stay and the risk of hospital admission. Hospital admission is also reduced with the addition of inhaled anticholinergic agents to inhaled beta2-agonists. However, further research is required to determine which patients are most likely to benefit from these therapies. Due to the relatively rare incidence of acute severe paediatric asthma, multi-centre research will be required to generate high-quality evidence. A number of existing Cochrane Reviews should be updated, and we recommend that a new review be conducted on the use of high-flow nasal oxygen therapy. Important priorities include development of an internationally agreed core outcome set for future trials in acute severe asthma exacerbations and determination of clinically important differences in these outcomes, which can then inform adequately powered future trials.
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Affiliation(s)
- Simon S Craig
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- Emergency Research, Murdoch Children's Research Institute, Parkville, Australia
- Paediatric Emergency Department, Monash Medical Centre, Monash Emergency Service, Monash Health, Clayton, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia
| | - Stuart R Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Colin Ve Powell
- Department of Emergency Medicine, Sidra Medciine, Doha, Qatar
- School of Medicine, Cardiff University, Cardiff, UK
| | - Andis Graudins
- Department of Medicine, Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia
- Monash Emergency Service, Monash Health, Dandenong Hospital, Dandenong, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Parkville, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia
- Emergency Department, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics and Centre for Integrated Critical Care, University of Melbourne, Parkville, Australia
| | - Carole Lunny
- Cochrane Hypertension Group, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Andrews AL, Williams DC, Hogan AH. Clinical Progress Note: Care of Children Hospitalized for Acute Asthma Exacerbation. J Hosp Med 2020; 15:416-418. [PMID: 32118556 DOI: 10.12788/jhm.3382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Daniel C Williams
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Alexander H Hogan
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
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Iramain R, Castro-Rodriguez JA, Jara A, Cardozo L, Bogado N, Morinigo R, De Jesús R. Salbutamol and ipratropium by inhaler is superior to nebulizer in children with severe acute asthma exacerbation: Randomized clinical trial. Pediatr Pulmonol 2019; 54:372-377. [PMID: 30672140 DOI: 10.1002/ppul.24244] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/07/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In moderate-severe asthma exacerbation, salbutamol by inhaler (MDI) is superior to salbutamol delivered by nebulizer (NEB); however, to our knowledge, no studies in children with exclusively severe exacerbations were performed. OBJECTIVE To compare the efficacy of salbutamol and ipratropium bromide by MDI versus by NEB in severe asthma exacerbations. METHODS We performed a clinical trial enrolling 103 children (2-14 years of age) with severe asthma exacerbations (defined by the Pulmonary Score ≥ 7) seen at the emergency room in Asuncion, Paraguay. One group received salbutamol and ipratropium (two puff every 10 min for 2 h and then every 30 min for 2 h more) by MDI with a valved-holding chamber and mask along with oxygen by a cannula separately (MDI-SIB); and the other received nebulization with oxygen (NEB-SIB) of salbutamol and ipratropium (1 every 20 min for 2 h and then every 30 min for 2 h more). Primary outcome was the rate of hospitalization (Pulmonary Score ≥ 7) after 4 h and secondary outcome was oxygen saturation. RESULTS Fifty two children received MDI-SIB and 51 NEB-SIB. After the 4th hour, children on MDI-SIB had significantly (P = 0.003) lower rate of hospital admission than on NEB-SIB (5.8% vs 27.5%, RR: 0.21 [0.06-0.69], respectively). Similarly, a significant improved clinical score after 60 min and increase in oxygen saturation after 90 min of treatment was observed in MDI-SIB versus NEB-SIB group (4.46 ± 0.7 vs 5.76 ± 0.65, P < 0.00001; and 90.5 ± 1.7 vs 88.43 1 ± 1, P < 0.00001, respectively). CONCLUSION Even in severe asthma exacerbations administration of salbutamol and ipratropium by MDI with valved-holding chamber and mask along with oxygen by a cannula separately was more effective than by a nebulizer.
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Affiliation(s)
- Ricardo Iramain
- Division of Pediatrics, Emergency Department, Clinical Hospital, National University of Asunción, Asunción, Paraguay.,Emergency Department, Private Childreńs Institute Asunción, Asunción, Paraguay
| | - Jose A Castro-Rodriguez
- Division of Pediatrics, Department of Pediatric Respiratory and Cardiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfredo Jara
- Division of Pediatrics, Emergency Department, Clinical Hospital, National University of Asunción, Asunción, Paraguay
| | - Laura Cardozo
- Division of Pediatrics, Emergency Department, Clinical Hospital, National University of Asunción, Asunción, Paraguay
| | - Norma Bogado
- Division of Pediatrics, Emergency Department, Clinical Hospital, National University of Asunción, Asunción, Paraguay
| | - Rocío Morinigo
- Division of Pediatrics, Emergency Department, Clinical Hospital, National University of Asunción, Asunción, Paraguay
| | - Raúl De Jesús
- Division of Pediatrics, Emergency Department, Clinical Hospital, National University of Asunción, Asunción, Paraguay
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Abuabat F, AlAlwan A, Masuadi E, Murad MH, Jahdali HA, Ferwana MS. The role of oral magnesium supplements for the management of stable bronchial asthma: a systematic review and meta-analysis. NPJ Prim Care Respir Med 2019; 29:4. [PMID: 30778086 PMCID: PMC6379356 DOI: 10.1038/s41533-019-0116-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 01/18/2019] [Indexed: 01/24/2023] Open
Abstract
Asthma is a chronic lung disease characterized by airway inflammation and hyper-responsiveness of airway smooth muscles. There is growing evidence that magnesium may have a role in managing asthma through its dual effect as an anti-inflammatory and bronchodilating agent. To assess the efficacy of oral magnesium supplements in chronic asthmatic patients. In addition to searching through Clinicaltrials.gov/ and references for oral magnesium supplement studies, we performed a database search in Medline, CINAHL, CENTRAL, and Embase. We contacted the authors of the included trials to ask for additional information. We included randomized controlled trials that compared oral magnesium supplements versus placebo, in addition to standard asthma treatment in mild-moderate asthmatic adults and children (older than 6 years). Two reviewers independently performed the study selection, data abstraction, and the assessment of the risk of bias. Eight trials at moderate risk of bias enrolling a total of 917 patients were included. Oral magnesium improved FEV1 at week 8 (5.69 (L/min); 95% CI: 1.92, 9.46; I2: 45%). There was no significant improvement in FEV1 at other follow up periods. There was no significant change in FVC, Methacholine challenge test, the frequency of bronchodilator use, or symptoms score. There were no data on mortality or quality of life. Oral magnesium supplements may lead to improvement in FEV1 that was only demonstrated at eight weeks; but no effect on any other outcome. Until future evidence emerges, oral magnesium cannot be recommended as adjuvants to standard treatment for mild to moderate asthmatic individuals.
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Affiliation(s)
- Faisal Abuabat
- Family Medicine Residency Program, King Abdulaziz Medical City, National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz AlAlwan
- Family Medicine Residency Program, King Abdulaziz Medical City, National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Emad Masuadi
- Department of Medical Education, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Hamdan Al Jahdali
- King Saud bin Abdulaziz University for Health Sciences, King Adulaziz Medical City, National Guard Health Affairs, King Abdullah International Medical Research Center, Riyadh, 11665, Saudi Arabia
| | - Mazen Saleh Ferwana
- King Saud bin Abdul-Aziz University for Health Sciences; National & Gulf Center for Evidence Based Health Practice, King Abdullah International Medical Research Center, Family Medicine & Primary Healthcare Department, King Abdul-Aziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
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Abstract
Shared decision-making (SDM) is a well-established component of patient-centered care, and yet, its application in pediatrics is poorly understood. Common features of pediatric decision-making are not completely addressed in current SDM models, such as the fact that the principal SDM participant is the patient's surrogate, who, unlike competent adult patients deciding for themselves, has limitations on decision-making authority. To address this gap and improve the practice of SDM in pediatrics, a practical 4-step framework is presented. In step 1, physicians are posed the following question for any discrete decision: does the decision include >1 medically reasonable option? If the answer is no, SDM is not indicated. If the answer is yes, physicians proceed to step 2 and answer the following question: does 1 option have a favorable medical benefit-burden ratio compared with other options? If yes, physician-guided SDM is appropriate. If no, parent-guided SDM is appropriate. For each SDM approach, the physician proceeds to step 3 and answers the following question: how preference sensitive are the options? This helps to determine the specific SDM approach in step 4, which ranges from a strong or weak version of physician-guided SDM to a strong or weak version of parent-guided SDM. Several decisional characteristics, if present, can also help calibrate the version of SDM used. Additional analyses are needed to consider the inclusion of adolescents into this SDM framework.
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Affiliation(s)
- Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute; and Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
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Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Cost Effectiveness of Pharmacological Treatments for Asthma: A Systematic Review. PHARMACOECONOMICS 2018; 36:1165-1200. [PMID: 29869050 DOI: 10.1007/s40273-018-0668-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The objective of this article was to summarize the findings of all the available studies on alternative pharmacological treatments for asthma and assess their methodological quality, as well as to identify the main drivers of the cost effectiveness of pharmacological treatments for the disease. METHODS A systematic review of the literature in seven electronic databases was conducted in order to identify all the available health economic evidence on alternative pharmacological treatments for asthma published up to April 2017. The reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. RESULTS A total of 72 studies were included in the review, classified as follows: medications for acute asthma treatment (n = 5, 6.9%); inhaled corticosteroids (ICS) administered alone or in conjunction with long-acting β-agonists (LABA) or tiotropium for chronic asthma treatment (n = 38, 52.8%); direct comparisons between different combinations of ICS, ICS/LABA, leukotriene receptor antagonists (LTRA), and sodium cromoglycate for chronic asthma treatment (n = 14, 19.4%); and omalizumab for chronic asthma treatment (n = 15, 20.8%). ICS were reported to be cost effective when compared with LTRA for the management of persistent asthma. In patients with inadequately controlled asthma taking ICS, the addition of long-acting β-agonist (LABA) preparations has been demonstrated to be cost effective, especially when combinations of ICS/LABA containing formoterol are used for both maintenance and reliever therapy. In patients with uncontrolled severe persistent allergic asthma, omalizumab therapy could be cost effective in a carefully selected subgroup of patients with the more severe forms of the disease. The quality of reporting in the studies, according to the CHEERS checklist, was very uneven. The main cost-effectiveness drivers identified were the cost or rate of asthma exacerbations, the cost or rate of the use of asthma medications, the asthma mortality risk, and the rate of utilization of health services for asthma. CONCLUSIONS The present findings are in line with the pharmacological recommendations for stepwise management of asthma given in the most recent evidence-based clinical practice guidelines for the disease. The identified reporting quality of the available health economic evidence is useful for identifying aspects where there is room for improvement in future asthma cost-effectiveness studies.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Carrera 45 No. 26-85, Bogota, Colombia.
- Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Av. Cra 9 No. 131A-02, Bogota, Colombia.
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Carrera 45 No. 26-85, Bogota, Colombia
| | - Jose A Castro-Rodriguez
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Av Libertador Bernardo O'Higgins 340, Santiago, Región Metropolitana, Chile
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A Randomized Trial Comparing Metered Dose Inhalers and Breath Actuated Nebulizers. J Emerg Med 2018; 55:7-14. [PMID: 29716819 DOI: 10.1016/j.jemermed.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/19/2018] [Accepted: 03/03/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite little evidence for its effectiveness, the breath-actuated nebulizer (BAN) is the default albuterol delivery method in our pediatric emergency department. OBJECTIVE We compared the clinical efficacy of BAN and the metered-dose inhaler (MDI) in treating subjects patients 2 to 17 years of age who presented with mild to moderate asthma exacerbations. METHODS This is a randomized, nonblinded, noninferiority study conducted at a single pediatric tertiary care emergency department. Subjects presenting with a Pediatric Asthma Score ranging from 5 to 11 received albuterol by BAN or MDI via standard weight-based and symptom severity dosing protocols. Aerosolized ipratropium (via BAN) and intravenous magnesium sulfate were given when clinically indicated. The primary outcome was patient disposition. The noninferiority margin for the primary outcome was an admission rate difference ≤10%. Analyses were adjusted for confounders that were significant at p ≤ 0.10. RESULTS We enrolled 890 subjects between October 2014 and April 2015. BAN and MDI groups were comparable for age, gender, and race but not for pretreatment symptom severity; 51% in the MDI group had a Pediatric Asthma Score of moderate severity (8-11) vs. 63% in the BAN group (p < 0.003). Unadjusted admission rates were 11.9% for MDI and 12.8% for BAN, for an unadjusted risk difference of -0.9% (95% confidence interval -5% to 3%). After adjusting for baseline confounder severity, the risk difference was 2% (95% confidence interval -4% to 7%), which met the criteria for noninferiority. CONCLUSIONS Albuterol therapy by MDI is noninferior to BAN for the treatment of mild to moderate asthma exacerbations in children 2 to 17 years of age.
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Mathew JL. Systematic Review on Efficacy of Magnesium (Intravenous or Nebulized) for Acute Asthma Episodes in Children: Evidence-based Medicine Viewpoint. Indian Pediatr 2017; 54:133-136. [PMID: 28285284 DOI: 10.1007/s13312-017-1016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Cutrera R, Baraldi E, Indinnimeo L, Miraglia Del Giudice M, Piacentini G, Scaglione F, Ullmann N, Moschino L, Galdo F, Duse M. Management of acute respiratory diseases in the pediatric population: the role of oral corticosteroids. Ital J Pediatr 2017; 43:31. [PMID: 28335827 PMCID: PMC5364577 DOI: 10.1186/s13052-017-0348-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/02/2017] [Indexed: 12/27/2022] Open
Abstract
Respiratory diseases account for about 25% of all pediatric consultations, and 10% of these are for asthma. The other main pediatric respiratory diseases, in terms of incidence, are bronchiolitis, acute bronchitis and respiratory infections. Oral corticosteroids, in particular prednisolone, are often used to treat acute respiratory diseases given their anti-inflammatory effects. However, the efficacy of treatment with oral corticosteroids differs among the various types of pediatric respiratory diseases. Notably, also the adverse effects of corticosteroid treatment can differ depending on dosage, duration of treatment and type of corticosteroid administered — a case in point being growth retardation in long-course treatment. A large body of data has accumulated on this topic. In this article, we have reviewed the data and guidelines related to the role of oral corticosteroids in the treatment and management of pediatric bronchiolitis, wheezing, asthma and croup in the attempt to provide guidance for physicians. Also included is a section on the management of acute respiratory failure in children.
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Affiliation(s)
- Renato Cutrera
- Pediatric Pulmonology and Sleep & Long Term Ventilation Unit, Academic Department Pediatric Hospital "Bambino Gesù", Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padua, Via Giustiniani 3, 35128, Padova, Italy
| | - Luciana Indinnimeo
- Department of Maternal and Child Care and Urology, Gender Medicine Polyclinic, University of Rome "Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Via Luigi De Crecchio 4, 80138, Naples, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Via Vanvitelli 32, 20129, Milan, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology and Sleep & Long Term Ventilation Unit, Academic Department Pediatric Hospital "Bambino Gesù", Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Laura Moschino
- Women's and Children's Health Department, University of Padua, Via Giustiniani 3, 35128, Padova, Italy
| | - Francesca Galdo
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Via Luigi De Crecchio 4, 80138, Naples, Italy
| | - Marzia Duse
- Department of Maternal and Child Care and Urology, Gender Medicine Polyclinic, University of Rome "Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
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Van Ginderdeuren F, Vandenplas Y, Deneyer M, Vanlaethem S, Buyl R, Kerckhofs E. Effectiveness of airway clearance techniques in children hospitalized with acute bronchiolitis. Pediatr Pulmonol 2017; 52:225-231. [PMID: 27254132 DOI: 10.1002/ppul.23495] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/05/2016] [Accepted: 05/13/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of two airway clearance techniques (ACT's) in children <24 months hospitalized with mild to moderate bronchiolitis. DESIGN One hundred and three children were randomly allocated to receive one 20-min session daily, either assisted autogenic drainage (AAD), intrapulmonary percussive ventilation (IPV), or bouncing (B) (control group), ninety-three finished the study. OUTCOME MEASURES Mean time to recovery in days was our primary outcome measure. The impact of the treatment and the daily improvement was also assessed by a validated clinical and respiratory severity score (WANG score), heart rate (HR), and oxygen saturation (SaO2 ). RESULTS Mean time to recovery was 4.5 ± 1.9 days for the control group, 3.6 ± 1.4 days, P < 0.05 for the AAD group and 3.5 ± 1.3 days, P = 0.03 for the IPV group. Wang scores improved significantly for both physiotherapy techniques compared to the control group. CONCLUSION Both ACT's reduced significantly the length of hospital stay compared to no physiotherapy. Pediatr Pulmonol. 2017;52:225-231. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- F Van Ginderdeuren
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels 1090, Belgium.,Department of Physiotherapy, UZ Brussel, Brussels, Belgium
| | - Y Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Deneyer
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Vanlaethem
- Department of Physiotherapy, UZ Brussel, Brussels, Belgium
| | - R Buyl
- Information Research Group, Department of Public Health, Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - E Kerckhofs
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels 1090, Belgium
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