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Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Direct medical costs of RSV-related bronchiolitis hospitalizations in a middle-income tropical country. Allergol Immunopathol (Madr) 2020; 48:56-61. [PMID: 31235183 DOI: 10.1016/j.aller.2019.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES With the objective of making informed decisions on resource allocation, there is a critical need for studies that provide accurate information on hospital costs for treating respiratory syncytial virus (RSV)-related bronchiolitis, mainly in middle-income countries (MICs). The aim of the present study was to evaluate the direct medical costs associated with bronchiolitis hospitalizations caused by infection with RSV in Bogota, Colombia. MATERIAL AND METHODS We reviewed the available electronic medical records (EMRs) for all infants younger than two years of age who were admitted to the Fundacion Hospital de La Misericordia with a discharge principal diagnosis of RSV-related bronchiolitis over a 24-month period from January 2016 to December 2017. Direct medical costs of RSV-related bronchiolitis were retrospectively collected by dividing the infants into three groups: those requiring admission to the pediatric ward (PW) only, those requiring admission to the pediatric intermediate care unit (PIMC), and those requiring to the pediatric intensive care unit (PICU). RESULTS A total of 89 patients with a median (IQR) age of 7.1 (3.1-12.2) months were analyzed of whom 20 (56.2%) were males. Overall, the median (IQR) cost of infants treated in the PW, in the PIMC, and in the PICU was US$518.0 (217.0-768.9) vs. 1305.2 (1051.4-1492.2) vs. 2749.7 (1372.7-4159.9), respectively, with this difference being statistically significant (p<0.001). CONCLUSIONS The present study helps to further our understanding of the economic burden of RSV-related bronchiolitis hospitalizations among infants of under two years of age in a middle-income tropical country.
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Affiliation(s)
- C E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia.
| | - M P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - J A Castro-Rodriguez
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Castro-Rodriguez JA, Atton I, Villarroel G, Serrano CA. Serum periostin is not related to asthma predictive index. Allergol Immunopathol (Madr) 2018; 46:235-240. [PMID: 29279258 DOI: 10.1016/j.aller.2017.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/19/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND In contrast to adult asthmatic patients, studies on the role of serum periostin levels in schoolchildren with asthma are still conflictive, and very few studies have been performed in pre-schoolers. The aim of this study was to compare serum periostin levels in recurrent wheezer pre-schoolers according to their asthma predictive index (API) condition. METHODS We performed a case-control study enrolling pre-schoolers with recurrent wheezing episodes (>3 episodes confirmed by physician) presented at one paediatric clinic in Santiago, Chile. The population was divided according to stringent API criteria into positive or negative. RESULTS In a one-year period, 60 pre-schoolers were enrolled. After excluding 12 (due to not fulfilment of inclusion criteria or refusal of blood sample extraction), 48 remaining pre-schoolers (27 males, age range from 24 to 71 months) completed the study; 34 were API positive and 14 were API negative. There were no significant differences in demographics between groups. The level of serum periostin levels for pre-schoolers with positive API and negative API were (median 46.7 [25.5-83.1] and 67.5 [20.5-131.8], p=0.9, respectively). The area under the curve for the serum periostin levels for predict positive API was 0.5, 95% CI [0.29-0.70], p=0.9. No significant correlation between serum periostin levels and peripheral blood eosinophils was found. CONCLUSION Serum periostin levels were no significantly different between wheezer pre-schoolers with positive and negative API. More studies are needed to confirm this finding.
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Affiliation(s)
- J A Castro-Rodriguez
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - I Atton
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - G Villarroel
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - C A Serrano
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Castro-Rodriguez JA, Ramirez-Hernandez M, Padilla O, Pacheco-Gonzalez RM, Pérez-Fernández V, Garcia-Marcos L. Effect of foods and Mediterranean diet during pregnancy and first years of life on wheezing, rhinitis and dermatitis in preschoolers. Allergol Immunopathol (Madr) 2016; 44:400-9. [PMID: 27087566 DOI: 10.1016/j.aller.2015.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 12/30/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is a conflictive position if some foods and Mediterranean diet (MedDiet) consumed by the mother during pregnancy and by the child during the first years of life can be protective for current wheezing, rhinitis and dermatitis at preschool age. METHODS Questionnaires of epidemiological factors and food intake by the mother during pregnancy and later by the child were filled in by parents in two surveys at two different time points (1.5 yrs and 4 yrs of life) in 1000 preschoolers. RESULTS The prevalences of current wheezing, rhinitis and dermatitis were 18.8%, 10.4%, and 17.2%, respectively. After multiple logistic analysis children who were low fruit consumers (never/occasionally) and high fast-food consumers (≥3 times/week) had a higher risk for current wheezing; while intermediate consumption of meat (1 or 2 times/week) and low of pasta by mothers in pregnancy were protected. For current rhinitis, low fruit consumer children were at higher risk; while those consuming meat <3 times/week were protected. For current dermatitis, high fast food consumption by mothers in pregnancy; and low or high consumption of fruit, and high of potatoes in children were associated to higher prevalence. Children consuming fast food >1 times/week were protected for dermatitis. MedDiet adherence by mother and child did not remain a protective factor for any outcome. CONCLUSION Low consumption of fruits and high of meat by the child, and high consumption of potatoes and pasta by the mother had a negative effect on wheezing, rhinitis or dermatitis; while fast food consumption was inconsistent.
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Affiliation(s)
- J A Castro-Rodriguez
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile; Division of Public Health, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | | | - O Padilla
- Division of Public Health, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - R M Pacheco-Gonzalez
- Pediatric Allergy and Pulmonology Units, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia and IMIB-Arrixaca Research Institute, Murcia, Spain
| | - V Pérez-Fernández
- Pediatric Allergy and Pulmonology Units, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia and IMIB-Arrixaca Research Institute, Murcia, Spain
| | - L Garcia-Marcos
- Pediatric Allergy and Pulmonology Units, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia and IMIB-Arrixaca Research Institute, Murcia, Spain
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Beckhaus AA, Garcia-Marcos L, Forno E, Pacheco-Gonzalez RM, Celedón JC, Castro-Rodriguez JA. Maternal nutrition during pregnancy and risk of asthma, wheeze, and atopic diseases during childhood: a systematic review and meta-analysis. Allergy 2015; 70:1588-604. [PMID: 26296633 DOI: 10.1111/all.12729] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Epidemiologic studies suggest a relationship between maternal nutrition during pregnancy and the occurrence of asthma and atopic conditions during childhood. However, individual study results are conflicting. The objective of this meta-analysis was to critically examine the current evidence for an association between nutrition (dietary patterns, food groups, vitamins, or oligo-elements) ingestion during pregnancy and asthma, wheeze, or atopic conditions in childhood. METHODS The inclusion criteria were as follows: (i) systematic recording of diet during the gestational period and (ii) documentation of asthma, wheezing, eczema, or other atopic disease in the offspring. The primary outcomes were prevalence of asthma or wheeze among the offspring during childhood; and secondary outcomes were prevalence of eczema, allergic rhinitis, or other atopic conditions. RESULTS We found 120 titles, abstracts, and citations, and 32 studies (29 cohorts) were included in this analysis. Data on vitamins, oligo-elements, food groups, and dietary patterns during pregnancy were collected. A meta-analysis revealed that higher maternal intake of vitamin D [odds ratio (OR) = 0.58, 95% confidence interval (CI) = 0.38-0.88], vitamin E (OR = 0.6, 95% CI = 0.46-0.78), and zinc (OR = 0.62, 95% CI = 0.40-0.97) was associated with lower odds of wheeze during childhood. However, none of these or other nutrients was consistently associated with asthma per se or other atopic conditions. CONCLUSIONS Current evidence suggests a protective effect of maternal intake of each of three vitamins or nutrients (vitamin D, vitamin E, and zinc) against childhood wheeze but is inconclusive for an effect on asthma or other atopic conditions.
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Affiliation(s)
- A. A. Beckhaus
- Division of Pediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - L. Garcia-Marcos
- Respiratory and Allergy Units; Arrixaca University Children's Hospital; University of Murcia; Murcia Spain
- IMIB Bio-research Institute; Murcia Spain
| | - E. Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology; Children's Hospital of Pittsburgh of UPMC; University of Pittsburgh; Pittsburgh PA USA
| | - R. M. Pacheco-Gonzalez
- Respiratory and Allergy Units; Arrixaca University Children's Hospital; University of Murcia; Murcia Spain
- IMIB Bio-research Institute; Murcia Spain
| | - J. C. Celedón
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology; Children's Hospital of Pittsburgh of UPMC; University of Pittsburgh; Pittsburgh PA USA
| | - J. A. Castro-Rodriguez
- Division of Pediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
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Castro-Rodriguez JA, Jakubson L, Padilla O, Gallegos D, Fasce R, Bertrand P, Sanchez I, Perret C. Many respiratory viruses have temporal association with meningococcal disease. Allergol Immunopathol (Madr) 2015; 43:487-92. [PMID: 25456529 DOI: 10.1016/j.aller.2014.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous ecological studies have shown a temporal and spatial association between influenza epidemics and meningococcal disease (MNG); however, none have examined more than two respiratory viruses. METHODS Data were obtained in Chile between 2000 and 2005 on confirmed cases of MNG and all confirmed cases of respiratory viruses (influenza A and B; parainfluenza; adenovirus; and respiratory syncytial virus [RSV]). Both variables were divided by epidemiological weeks, age range, and regions. Models of transference functions were run for rates of MNG. RESULTS In this period, 1022 reported cases of MNG and 34,737 cases of respiratory virus were identified (25,137 RSV; 4300 parainfluenza; 2527 influenza-A; 356 influenza-B; and 2417 adenovirus). RSV was the major independent virus temporally associated to MNG (it appears one week before MNG), followed by parainfluenza, influenza-B, adenovirus, and influenza-A. CONCLUSIONS The rate of MNG in Chile is temporally associated to all of the respiratory viruses studied, but with variability according age range, and regions.
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Affiliation(s)
- J A Castro-Rodriguez
- Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - L Jakubson
- Department of Pediatrics, School of Medicine, Universidad de Chile, Santiago, Chile
| | - O Padilla
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - R Fasce
- Chilean Public Health Institute, Santiago, Chile
| | - P Bertrand
- Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - I Sanchez
- Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Perret
- Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Pérez-Yarza EG, Castro-Rodriguez JA, Villa Asensi JR, Garde Garde J, Hidalgo Bermejo FJ. [Validation of a Spanish version of the Childhood Asthma Control Test (Sc-ACT) for use in Spain]. An Pediatr (Barc) 2014; 83:94-103. [PMID: 25555366 DOI: 10.1016/j.anpedi.2014.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The Childhood Asthma Control Test (c-ACT) is a validated tool for determining pediatric asthma control. However, it is not validated in the Spanish language in Spain. We evaluated the psychometric properties of the Spanish version of the Childhood Asthma Control Test (Sc-ACT) for assessing asthma control in children ages 4 to11. METHODS This national, multicentre, prospective study was conducted in Spain with asthmatic children and their caregivers. Patients were assessed at 3 visits (Baseline, 2 Weeks, and 4 Months). Clinical variables included: symptoms, exacerbations, FEV1, asthma classification, PAQLQ and PACQLQ questionnaire scores, and asthma control as perceived by physicians, patients and caregivers. The Sc-ACT feasibility, validity, reliability, and sensitivity to change were assessed. RESULTS A total of 394 children were included; mean (SD) time to complete the Sc-ACT was 5.3 (4.4) minutes. Sc-ACT score was correlated with asthma control as perceived by physician (-0.52), patient (-0.53), and caregiver (-0.51) and with the PAQLQ (0.56) and PACQLQ (0.55) scores. Sc-ACT was found to be significantly related to intensity and frequency of asthma symptoms. Cronbach alpha coefficient α was 0.81 and intraclass correlation coefficient was ≥0.85 for all of the items. The global effect size of Sc-ACT was 0.55. The cutoff point scores of 21 or higher indicated a good asthma control and their MCID was 4 points. CONCLUSION The Spanish version of the c-ACT was found to be a reliable and valid questionnaire for evaluating asthma control in Spanish-speaking children ages 4 to 11 in Spain.
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Affiliation(s)
- E G Pérez-Yarza
- Sección de Neumología Infantil, Hospital Universitario Donostia-Instituto Biodonostia, San Sebastián, Guipúzcoa, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), San Sebastián, Guipúzcoa, España; Departamento de Pediatría, Universidad del País Vasco (UPV/EHU), San Sebastián, Guipúzcoa, España.
| | - J A Castro-Rodriguez
- Sección de Enfermedades Respiratorias, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J R Villa Asensi
- Sección de Neumología Pediátrica, Hospital Niño Jesús, Madrid, España
| | - J Garde Garde
- Sección de Alergia Infantil, Hospital General, Elche, Alicante, España
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Garcia-Marcos L, Castro-Rodriguez JA, Weinmayr G, Panagiotakos DB, Priftis KN, Nagel G. Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis. Pediatr Allergy Immunol 2013; 24:330-8. [PMID: 23578354 DOI: 10.1111/pai.12071] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is epidemiological evidence that Mediterranean diet exposure is associated with lower asthma prevalence in children. We aimed to summarize the available data and to know whether the Mediterranean setting modifies this association. METHODS The literature search, up to May 2012, was on epidemiological studies in the general population of children assessing whether adherence to Mediterranean diet (measured as a score) was associated with the prevalence of 'current wheeze'; 'current severe wheeze'; or 'asthma ever'. Odds ratios (OR) of the eight included studies compared the highest tertile of the score with the lowest. Random-effects meta-analyses for the whole group of studies and stratified by Mediterranean setting (centers <100 Km from the Mediterranean coast) were performed. Differences between strata were assessed using the Q test. RESULTS For 'current wheeze', there was a negative significant association with the highest tertile of Mediterranean diet score (OR 0.85, 95% CI 0.75-0.98; p = 0.02), driven by Mediterranean centers (0.79, 0.66-0.94, p = 0.009), although the difference with the non-Mediterranean centers (0.91, 0.78-1.05, p = 0.18) was not significant. The results for 'current severe wheeze' were as follows: 0.82, 0.55-1.22, p = 0.330 (all); 0.66, 0.48-0.90, p = 0.008 (Mediterranean); and 0.99, 0.79-1.25, p = 0.95 (non-Mediterranean); with the difference between regions being significant. For 'asthma ever', the associations were as follows: 0.86, 0.78-0.95, p = 0.004 (all); 0.86, 0.74-1.01, p = 0.06 (Mediterranean); 0.86, 0.75-0.98; p = 0.027 (non-Mediterranean); with the difference between regions being negligible. CONCLUSIONS Adherence to the Mediterranean diet tended to be associated with lower occurrence of the three respiratory outcomes. For current and current severe wheeze, the association was mainly driven by the results in Mediterranean populations.
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Affiliation(s)
- L Garcia-Marcos
- Pediatric Respiratory and Allergy Units, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain
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Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, Gern J, Lemanske R, Le Souef P, Mäkelä M, Roberts G, Wong G, Zar H, Akdis CA, Bacharier LB, Baraldi E, van Bever HP, de Blic J, Boner A, Burks W, Casale TB, Castro-Rodriguez JA, Chen YZ, El-Gamal YM, Everard ML, Frischer T, Geller M, Gereda J, Goh DY, Guilbert TW, Hedlin G, Heymann PW, Hong SJ, Hossny EM, Huang JL, Jackson DJ, de Jongste JC, Kalayci O, Aït-Khaled N, Kling S, Kuna P, Lau S, Ledford DK, Lee SI, Liu AH, Lockey RF, Lødrup-Carlsen K, Lötvall J, Morikawa A, Nieto A, Paramesh H, Pawankar R, Pohunek P, Pongracic J, Price D, Robertson C, Rosario N, Rossenwasser LJ, Sly PD, Stein R, Stick S, Szefler S, Taussig LM, Valovirta E, Vichyanond P, Wallace D, Weinberg E, Wennergren G, Wildhaber J, Zeiger RS. International consensus on (ICON) pediatric asthma. Allergy 2012; 67:976-97. [PMID: 22702533 DOI: 10.1111/j.1398-9995.2012.02865.x] [Citation(s) in RCA: 259] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 01/08/2023]
Abstract
Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype-specific treatment choices; however, this goal has not yet been achieved.
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Brockmann PE, Castro-Rodriguez JA, Holmgren NL, Cerda J, María Contreras A, Moya A, Bertrand PJ. Urinary leukotriene excretion profile in children with exercise-induced asthma compared with controls: a preliminary study. Allergol Immunopathol (Madr) 2012; 40:181-6. [PMID: 21703750 DOI: 10.1016/j.aller.2011.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 03/29/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Leukotrienes are among the most important mediators associated with inflammatory responses in patients with exercise induced asthma (EIA). The aim of this study was to investigate the impact of exercise on the urinary leukotriene profile. Hence, we compared post exercise changes of urinary leukotriene E4 (LTE4) concentration between children with EIA and healthy controls. METHODS Ten children with EIA and 15 controls were enrolled. Both groups underwent a standardised exercise challenge test (ECT). LTE4 concentration was measured in urine samples obtained pre and post ECT, using enzyme immunoassay and adjusted by urinary creatinine concentrations. RESULTS Median (minimum-maximum) pre ECT concentration of LTE4 was 17.82 (7.58-90.23 pg/ml) in EIA and 17.24 (4.64-64.02 pg/ml) in controls, p=0.86. LTE4 concentration post ECT were 23.37 (4.02-93.00 pg/ml) in EIA and 11.74 (0.13-25.09 pg/ml) in controls, p=0.02. Changes of LTE4 concentration post ECT were 2.54 (-31.98 to 43.31 pg/ml) in cases and -13.53 (-46.00 to 11.02 pg/ml) in controls, p=0.03. There was no significant correlation between basal predicted FEV(1) [%] and changes in LTE4 concentration in cases (i.e., r(s)=0.14) nor controls (i.e., r(s)=0.12). There was a tendency towards more pronounced changes in LTE4 concentration post ECT in children with moderate/mild persistent asthma compared to those with mild but intermittent asthma. CONCLUSIONS Children with EIA had significantly higher changes of urinary LTE4 concentrations post ECT compared to healthy controls. Urinary measurement of LTE4 may be an interesting and non-invasive option to assess control of EIA in children.
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Affiliation(s)
- P E Brockmann
- Department of Pediatrics, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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10
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Brand PLP, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, de Blic J, de Jongste JC, Eber E, Everard ML, Frey U, Gappa M, Garcia-Marcos L, Grigg J, Lenney W, Le Souëf P, McKenzie S, Merkus PJFM, Midulla F, Paton JY, Piacentini G, Pohunek P, Rossi GA, Seddon P, Silverman M, Sly PD, Stick S, Valiulis A, van Aalderen WMC, Wildhaber JH, Wennergren G, Wilson N, Zivkovic Z, Bush A. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2009; 32:1096-110. [PMID: 18827155 DOI: 10.1183/09031936.00002108] [Citation(s) in RCA: 493] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.
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Affiliation(s)
- P L P Brand
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands.
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Rodriguez-Martinez CE, Sossa MP, Castro-Rodriguez JA. Factors associated to recurrent visits to the emergency department for asthma exacerbations in children: implications for a health education programme. Allergol Immunopathol (Madr) 2008; 36:72-8. [PMID: 18479658 DOI: 10.1157/13120391] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Recurrent emergency department (ED) visits for asthma exacerbations produce anxiety as well as high costs to the health system and the family. OBJECTIVE To identify factors associated with recurrent ED visits for asthma exacerbations in children in Bogotá, Colombia. METHODS Data obtained from a survey of parents of 223 patients with asthma (mean +/- SD: 4.8+/-3.5 years of age) attending an asthma clinic were analysed. Demographic data and a broad asthma knowledge and attitudes questionnaire were completed by the parents. RESULTS Of the 223 asthmatic patients enrolled, 60 (26.9 %) had 3 or more visits to the ED for asthma in the last 6 months ("recurrent ED visits"). After controlling by age, educational level of the father, and severity of the disease; parents of children with "recurrent ED visits" were more prone to report that they attended ED because the asthma exacerbations were severe enough to go to the primary care physician (OR, 2.45; CI 95 %, 1.13-5.30; p=0.02); that asthma medications should be administered only when the children are symptomatic (OR, 3.26; CI 95 %, 1.45-7.36; p=0.004), and conversely they were less prone to have knowledge that asthma exacerbations can be avoided if medications are administered in the asymptomatic periods (OR, 0.31; CI 95 %, 0.14-0.68; p=0.003). CONCLUSIONS An educational programme intended to reduce the recurrent ED visits for asthma exacerbations should consider the inclusion of an explanation about the chronic nature of the disease and the importance of long-term therapy.
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Affiliation(s)
- C E Rodriguez-Martinez
- Department of Pediatric Respiratory Medicine, Clínica Colsánitas, Clínica Infantil Colsubsidio, Bogotá, Colombia.
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Castro-Rodriguez JA, Mallol J, Rodriguez J, Auger F, Andrade R. Risk factors for X-ray pneumonia in the first year of life and its relation to wheezing: a longitudinal study in a socioeconomic disadvantaged population. Allergol Immunopathol (Madr) 2008; 36:3-8. [PMID: 18261426 DOI: 10.1157/13115664] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although thousands of infants under the age of 12 months die each year from pneumonia in Latin America, little is known regarding the true occurrence of pneumonia, wheezing and other related respiratory illnesses in this age group. METHODS AND RESULTS In order to describe the prevalence and risk factors for radiologically confirmed pneumonia during the first year of life, a birth-cohort (n = 188) of infants born in a low-income area in Santiago, Chile was followed up monthly. RESULTS The prevalence of pneumonia during the first year of life was 13.3 % and there were no fatal events. Exclusive breastfeeding during the first 4 months of life was more prevalent in the non pneumonia group; conversely, wheezing episodes during 0-3 and 3-6 months of age, and hospitalization due to lower respiratory infection during 3-6 and 9-12 months of age were more prevalent in the pneumonia group. After a logistic multivariate analysis, the only risk factor that remained related with pneumonia was wheezing during the first 3 months of life (adjusted OR: 7.7, 95 CI: 1.32-44.92, p = 0.024); while breastfeeding during the first 4 months was an independent protective factor for pneumonia (adjusted OR: 0.11, 95 CI: 0.03-0.44, p = 0.002). CONCLUSION The significant protective effect of exclusive breast feeding against pneumonia in this cohort and the evident role of recurrent wheezing as risk factor for pneumonia during the first year of life support the implementation or reinforcement of public policies encouraging exclusive breastfeeding and an adequate management of wheezing since the first months of life.
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Mallol J, Castro-Rodriguez JA, Cortez E, Aguirre V, Aguilar P, Barrueto L. Heightened bronchial hyperresponsiveness in the absence of heightened atopy in children with current wheezing and low income status. Thorax 2007; 63:167-71. [PMID: 17901160 DOI: 10.1136/thx.2006.063180] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although global studies such as the International Study of Asthma and Allergies in Childhood (ISAAC) have provided valuable data on the prevalence of asthma in children in Latin America, there is little information on the relationship between asthma symptoms, pulmonary function, bronchial hyperresponsiveness (BHR) and atopy in the region. METHODS This study examined the relationship between self-reported wheezing in the past 12 months, pulmonary function, airway responsiveness and atopy in children from a low income population in a neighbourhood of Santiago, Chile. Two random samples (100 each) of children aged 13-14 years who participated in ISAAC phase I were selected according to whether or not they reported wheezing in the past 12 months. Spirometry, the methacholine bronchial challenge test and the prick test were performed in all individuals. RESULTS Children who reported current wheezing had significantly higher BHR to methacholine compared with those without wheezing (71.6% vs 52.6%; p = 0.007) and no significant difference was found in forced expiratory volume in 1 s (116.7 (12.3)% vs 120.3 (14.5%); p = 0.11). The prevalence of atopy was not significantly different between those children who reported wheezing compared with those who did not (44.2% vs 42.3%; p = 0.89). Multiple regression analysis showed that only BHR to methacholine (OR 2.72, 95% CI 1.25 to 4.13; p = 0.01) and maternal asthma (OR 3.1, 95% CI 1.2 to 8.3, p = 0.03) were significant risk factors for current wheezing. CONCLUSIONS Our results support previous findings suggesting that in adolescents from underprivileged populations, self-reported current wheezing is related to BHR but not to atopy.
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Affiliation(s)
- J Mallol
- Department of Paediatric Respiratory Medicine, Hospital El Pino, Ave Los Morros 13560, Santiago, Chile.
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Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis. Thorax 2005; 60:740-6. [PMID: 16055613 PMCID: PMC1747524 DOI: 10.1136/thx.2005.040444] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Current guidelines recommend the use of a combination of inhaled beta(2) agonists and anticholinergics, particularly for patients with acute severe or life threatening asthma in the emergency setting. However, this statement is based on a relatively small number of randomised controlled trials and related systematic reviews. A review was undertaken to incorporate the more recent evidence available about the effectiveness of treatment with a combination of beta(2) agonists and anticholinergics compared with beta(2) agonists alone in the treatment of acute asthma. METHODS A search was conducted of all randomised controlled trials published before April 2005. RESULTS Data from 32 randomised controlled trials (n = 3611 subjects) showed significant reductions in hospital admissions in both children (RR = 0.73; 95% CI 0.63 to 0.85, p = 0.0001) and adults (RR = 0.68; 95% CI 0.53 to 0.86, p = 0.002) treated with inhaled anticholinergic agents. Combined treatment also produced a significant increase in spirometric parameters 60-120 minutes after the last treatment in both children (SMD = -0.54; 95% CI -0.28 to -0.81, p = 0.0001) and adults (SMD = -0.36; 95% CI -0.23 to -0.49, p = 0.00001). CONCLUSIONS This review strongly suggests that the addition of multiple doses of inhaled ipratropium bromide to beta(2) agonists is indicated as the standard treatment in children, adolescents, and adults with moderate to severe exacerbations of asthma in the emergency setting.
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Affiliation(s)
- G J Rodrigo
- Departamento de Emergencia, Hospital Central de las FF.AA, Av 8 de octubre 3020, Montevideo 11600, Uruguay.
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Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis. Thorax 2005. [DOI: 10.1136/thx.2005.047803] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Quezada A, Norambuena X, Bravo A, Castro-Rodriguez JA. Recurrent pneumonia as warning manifestation for suspecting primary immunodeficiencies in children. J Investig Allergol Clin Immunol 2002; 11:295-9. [PMID: 11908819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Two hundred and eight children with recurrent pneumonia were studied over a 5-year period. Among these patients we found 10 cases with primary immunodeficiency disease: 6 cases of IgA deficiency, 1 case of X-linked agammaglobulinemia, 1 case of common variable immunodeficiency, 1 case of hyper IgM syndrome, and 1 case of Wiskott-Aldrich syndrome. This study describes the clinical features of these cases and assesses the usefulness of our immunodeficiency screening protocol. In this group 6 were males; the mean age at first episode of pneumonia was 3 years (range 3 months to 18 years), and the age of diagnosis ranged between 10 months and 19 years. The average number of episodes of pneumonia in each patient was 5 (range 2 to 12), and the number of hospitalizations ranged up to 13. The etiologic agents isolated from this recurrent pneumonia were S. pneumoniae, Moraxella, adenovirus, respiratory syncytial virus, and influenza B virus. Intravenous immunoglobulin was used in four cases. Two patients had chronic pulmonary damage with bronchiectasis and interstitial pneumonia. Only one patient died (Wiskott-Aldrich syndrome) during the follow-up from an intracranial hemorrhage. We found that the screening protocol applied to patients with recurrent pneumonia is a useful tool for ruling out the primary immunodeficiency disorders.
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Affiliation(s)
- A Quezada
- Department of Pediatric, School of Medicine, University of Chile, Santiago.
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Remes ST, Castro-Rodriguez JA, Holberg CJ, Martinez FD, Wright AL. Dog exposure in infancy decreases the subsequent risk of frequent wheeze but not of atopy. J Allergy Clin Immunol 2001; 108:509-15. [PMID: 11590373 DOI: 10.1067/mai.2001.117797] [Citation(s) in RCA: 207] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Influence of household pets in the development of childhood asthma or atopy has been controversial. OBJECTIVE The purpose of this study was to investigate whether pet exposure in early life decreases the subsequent risk of frequent wheezing and/or allergic sensitization. METHODS This was a prospective observational birth cohort study. The setting was a large health maintenance organization in Tucson, Ariz; the subjects were a population sample of 1246 newborns enrolled at birth and followed prospectively to age 13 years. The main outcome measures were as follows: time to first report of frequent wheezing (>3 episodes in the past year), skin prick test reactivity at 6 years and 11 years of age, and total serum IgE at 9 months, 6 years, and 11 years of age. RESULTS Children living in households with > or =1 indoor dogs at birth were less likely to develop frequent wheeze than those not having indoor dogs (P =.004). This inverse association was confined to children without parental asthma (hazard ratio = 0.47; P <.001 [Cox regression]) and was not evident for children with parental asthma (hazard ratio = 0.96; P =.87). Adjustment by potential confounders did not change the results. Indoor cat exposure was not significantly associated with the risk of frequent wheezing. Neither cat exposure in early life nor dog exposure in early life was associated with skin prick test reactivity or total serum IgE at any age. CONCLUSION Dog exposure in early life might prevent the development of asthma-like symptoms, at least in low-risk children with no family history of asthma. Nevertheless, early pet exposure does not seem to significantly influence the development of allergic sensitization.
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Affiliation(s)
- S T Remes
- Respiratory Sciences Center, Arizona Health Sciences Center, University of Arizona, Tucson 85724, USA
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Abstract
BACKGROUND Young children with older siblings and those who attend day care are at increased risk for infections, which in turn may protect against the development of allergic diseases, including asthma. However, the results of studies examining the relation between exposure to other children and the subsequent development of asthma have been conflicting. METHODS In a study involving 1035 children followed since birth as part of the Tucson Children's Respiratory Study, we determined the incidence of asthma (defined as at least one episode of asthma diagnosed by a physician when the child was 6 to 13 years old) and the prevalence of frequent wheezing (more than three wheezing episodes during the preceding year) in relation to the number of siblings at home and in relation to attendance at day care during infancy. RESULTS The presence of one or more older siblings at home protected against the development of asthma (adjusted relative risk for each additional older sibling, 0.8; 95 percent confidence interval, 0.7 to 1.0; P=0.04), as did attendance at day care during the first six months of life (adjusted relative risk, 0.4; 95 percent confidence interval, 0.2 to 1.0; P=0.04). Children with more exposure to other children at home or at day care were more likely to have frequent wheezing at the age of 2 years than children with little or no exposure (adjusted relative risk, 1.4; 95 percent confidence interval, 1.1 to 1.8; P=0.01) but were less likely to have frequent wheezing from the age of 6 (adjusted relative risk, 0.8; 95 percent confidence interval, 0.6 to 1.0; P=0.03) through the age of 13 (adjusted relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.5; P<0.001). CONCLUSIONS Exposure of young children to older children at home or to other children at day care protects against the development of asthma and frequent wheezing later in childhood.
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Affiliation(s)
- T M Ball
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, USA
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Abstract
The aim of this study was to compare the efficacy of salbutamol delivered via a metered-dose inhaler with a spacer and facial mask (MDI-S) vs. a nebulizer (NEB) for the treatment of acute exacerbations of wheezing in children. In a single-blind, prospective, randomized clinical trial, 123 outpatients (1-24 months of age), presenting with "moderate to severe" wheezing, were seen in the emergency department. Children were randomly assigned to one of two salbutamol treatment groups. In the first hour, the MDI-S group received 2 puffs (100 microg/puff) every 10 min for 5 doses, and the NEB group received 0.25 mg/kg every 13 min for 3 doses. If the clinical score was >5 at the end of the first hour, the patients received another hour of the same treatment and also betamethasone (0.5 mg/kg intramuscular). On enrollment and after the first and the second hour of treatment each child had a validated clinical score assigned by a blinded investigator. There were no differences at the time of admission to the emergency department between groups in clinical score or demographic data. Success (clinical score </=5) after the first hour of treatment was 90% (56/62) in the MDI-S group and 71% (43/61) in the NEB group (odds ratio 3.9, 95% confidence interval 1.5-10.4, P = 0.01). After the second hour, the success was 100% in the MDI-S and 94% in the NEB (P > 0.05). We conclude that in this study population, children less than 2 years of age with moderate-severe exacerbations of wheezing responded faster to salbutamol delivered by MDI with a spacer and facial mask than to salbutamol delivered by nebulizer.
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Affiliation(s)
- L Rubilar
- Pediatric Pulmonology Unit, Department of Pediatrics, Exequiel González Cortes Children's Hospital, University of Chile, Santiago, Chile
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