A worldwide charter for all children with asthma

Szefler, Stanley J.; Fitzgerald, Dominic A.; Adachi, Yuichi; Doull, Iolo; Fischer, Gilberto Bueno; Fletcher, Monica; Hong, Jian‐Guo; García‐Marcos, Luis; Pedersen, Søren; Østrem, Anders; Sly, Peter D.; Williams, Siân; Winders, Tonya; Zar, Heather J.; Bush, Andy; Lenney, Warren

doi:10.1002/ppul.24713

Cited by 28 publications

(28 citation statements)

References 101 publications

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“…In primary care and emergency departments, acute asthma exacerbations are one of the main causes for pediatric emergency visits (1,2). Although the prevalence of asthma among school children is higher than among pre-school children, severe asthma exacerbations with emergency consultations and hospitalizations are much more common in pre-school children (1,3,4).…”

Section: Introductionmentioning

confidence: 99%

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Hospitalization, Asthma Phenotypes, and Readmission Rates in Pre-school Asthma

et al. 2020

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Objective: Children with pre-school asthma suffer disproportionally more often from severe asthma exacerbations with emergency visits and hospital admissions compared to school children. Despite this high disease burden, there are only a few reports looking at this particular severe asthma cohort. Similarly, there is little real-life research on the distribution of asthma phenotypes and personalized treatment at discharge in this age group.Patients and Methods: Retrospective analysis of the electronic charts of all children aged 1–5 years with asthma hospitalizations (ICD J45) at the Frankfurt University between 2008 and 2017. An acute severe asthma exacerbation was defined as dyspnea, oxygen demand, and/or systemic steroid therapy. Age, gender, duration of hospitalization, asthma phenotype, treatment, and readmission rate were analyzed.Results: Of 572 patients, 205 met the definition of acute severe asthma. The phenotypic characterization showed 56.1% had allergic asthma, 15.2% eosinophilic asthma and 28.7% non-allergic asthma. Of these patients, 71.7% were discharged with inhaled corticosteroids (ICS) or ICS + long-acting-beta-agonists (LABA), 15.1% with leukotriene antagonists (LTRA) and 7.3% salbutamol on demand. The rate of emergency presentations (emergency department and readmission) within 12 months after discharge was high (n = 42; 20.5%). No phenotype tailored treatment was detectable. Neither the number of eosinophils (>300/μl) nor the treatment at discharge had an effect on emergency visits and readmission rate.Conclusion: Despite protective therapy with ICS, ICS + LABA, or LTRA, the readmission rate was high. Thus, current care and treatment strategies should be reevaluated continuously, in order to better control asthma in pre-school children and prevent hospitalization.

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Section: Introductionmentioning

confidence: 99%

“…Severe asthma exacerbations with hospitalization are a pivotal event that requires careful reevaluation of the previous asthma treatment and a new personalized approach of future asthma management (1,2,13). Ideally, the current treatment options should be based on the underlying asthma phenotype (13).…”

Section: Introductionmentioning

confidence: 99%

Hospitalization, Asthma Phenotypes, and Readmission Rates in Pre-school Asthma

et al. 2020

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“…The first item listed under the heading "Rights of Children with Asthma" is 'I deserve a timely and accurate diagnosis of asthma within the primary care/community setting'. (11). As outlined by a recent Concise Clinical Review (21) "Under diagnosis can occur either because the patient has not communicated his/her symptoms to a physician, because the physician has not assigned a diagnosis to explain the patient's symptoms, or because the physician has attributed the patient's respiratory symptoms to a condition other than asthma."…”

Section: Discussionmentioning

confidence: 99%

“…Under diagnosis is frequently associated with inappropriate management and increased morbidity including school absence and disturbance of family work practices with consequent economic consequences for the family and society (6,7). The need for timely and accurate diagnosis in young children is recognized (7), is considered as a research priority (10), and forms part of a recently published Children's Asthma Charter that sets out the rights and expectations of children with asthma (11). Appropriate diagnosis and management leads to improved outcomes for children and their families (7).…”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of a school program of early detection of asthma

Busi¹,

Fernandez²,

Sly³

2020

Preprint

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Background: Wheeze-associated disorders are common in childhood, associated with considerable morbidity, if not detected and treated. Under diagnosis of asthma remains a problem, especially in resource-limited settings. Methods: We used a validated school-based screening questionnaire to detect children likely to have asthma. Children with positive screening were referred to the Pulmonology Department for clinical review and lung function testing. We compared asthma-like symptoms, activity limitation, school absence and health service utilization before and after in those diagnosed with, and treated for asthma. Results: 6400 children, from a potential population of 70,000 were screened between 2010 and 2016, with 900 (14.1%) screening positive. Lung function data were available from 578 (64.2%) children (5.7 to 6.5 years old). Asthma was confirmed in 549 children; 438 were treated with short acting bronchodilator alone and 111 with inhaled corticosteroids. Asthma control improved in 58% of children, with fewer daytime [mean 4.7 (SD1.9), vs 11.1 (0.6) days per week, p<0.001] and nocturnal [4.3 (1.1) vs 0.89 (0.5) days per month, p<0.001] symptoms. Activity improved and fewer school days were lost due to asthma [12.8 (3.0) vs 1.9 (0.9) days in past 3 months, p<0.001] in over 50% of children. Emergency department visits were reduced [1.8 (0.7) vs 0.3 (0.2) visits in past 3 months, p<0.001] in over 80% of children. Conclusions: Asthma under diagnosis remains a problem in Argentina. Our school-based assessment is an effective tool for detecting children with undiagnosed asthma. Instituting effective asthma treatment in these children reduces symptoms and improves control.

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“…Asthma is a common chronic disease of children in the developed world, and recent evidence suggests that this disease is a significant cause of morbidity and mortality in some low and middle income countries 1,2 . In Nicaragua, the estimated national prevalence of asthma is 15.2%, 3 but this may represent an underestimate, as asthma is often under‐diagnosed due to a variety of factors, including overlap of clinical features with acute lower respiratory infections such as pneumonia and bronchiolitis 4 .…”

Section: Introductionmentioning

confidence: 99%

Community health worker case‐detection of asthma or reactive airways disease in a resource‐poor community in Nicaragua

Crocker

Loughlin

Esther

et al. 2020

Pediatric Pulmonology

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Introduction Asthma is a major cause of morbidity and mortality in children worldwide, but many cases may remain undiagnosed. Community health worker (CHW) programs have improved detection of other diseases such as childhood pneumonia, but none have been validated for detection of asthma in resource‐poor settings. We hypothesized that a CHW administered questionnaire would be effective in case‐detection of asthma in a poor Nicaraguan community. Methods We enrolled children aged 2–17 from a small semiurban Nicaraguan community. A trained CHW administered a questionnaire based on a previously validated school‐based screening questionnaire, which was compared to pediatric pulmonologist evaluation as a reference standard. We determined the questionnaire's sensitivity, specificity, and positive and negative likelihood ratios at different score cut‐points. Results A total of 199 out of 218 eligible children were enrolled. Total asthma prevalence based on physician diagnosis was 33%. Mean scores on the CHW questionnaire were 3.6 points out of 22 (SD = 4.3) for nonasthmatics and 11.0 points (SD = 5.3) for children with asthma (p < .001). Area under the curve was 0.87. Multivariable analysis showed increased association of asthma/reactive airways disease with respiratory infection in the first 3 months of life and with family history of asthma. Conclusions Prevalence of asthma in this community was high compared to previously reported national prevalence (15.2%), possibly due to increased exposure to risk factors. The questionnaire had a high area under the receiver operating characteristic curve, making it an excellent screening tool. This questionnaire could greatly increase the detection of asthma, allowing for education and referral for ongoing care.

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A worldwide charter for all children with asthma

Cited by 28 publications

References 101 publications

Hospitalization, Asthma Phenotypes, and Readmission Rates in Pre-school Asthma

Hospitalization, Asthma Phenotypes, and Readmission Rates in Pre-school Asthma

Assessing the impact of a school program of early detection of asthma

Community health worker case‐detection of asthma or reactive airways disease in a resource‐poor community in Nicaragua

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