Asthma

Patel, Shilpa J.; Teach, Stephen J.

doi:10.1542/pir.2018-0282

Cited by 86 publications

(86 citation statements)

References 107 publications

(114 reference statements)

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“…Total number of unscheduled clinical utilization visits and steroid prescriptions over the study year were analyzed in linear regression models with robust standard errors. All models included a priori determined covariates that are known to be strongly associated with pediatric asthma outcomes including sex, age, controller medication use, season, and baseline value of the outcome metric [29].…”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of a Portable HEPA Air Cleaner Intervention to Reduce Asthma Morbidity among Latino Children in an Agricultural Community

Drieling

Sampson

Krenz

et al. 2021

Preprint

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BackgroundData on pediatric asthma morbidity and effective environmental interventions in agricultural settings are few.ObjectivesTo evaluate the effectiveness of HEPA air cleaners on asthma morbidity among a cohort of rural Latino children.MethodsSeventy-five children with poorly controlled asthma and residing in non-smoking homes were randomly assigned to asthma education alone or along with HEPA air cleaners placed in their sleeping area and home living room. Asthma Control Test (ACT) score, asthma symptoms in prior two weeks, unplanned clinical utilization for asthma, creatinine-adjusted urinary leukotriene E4 (uLTE4 [ng/mg]), and other secondary asthma outcomes were assessed at baseline, six and 12 months later. Multivariable-adjusted generalized estimating equations examined differences between groups based on repeated measures. Incident rate ratios of ever experiencing the metrics of poorer asthma health during follow-up (suboptimal asthma management) were estimated using Poisson regression models.ResultsMean intervention group child age was 9.2 years, control mean age was 8.6, and two-thirds of participants were male. In repeated measures analysis, intervention participants were less likely to have an ACT score representing poorly controlled asthma (IRR: 0.45 [95% CI: 0.21–0.97]). In Poisson models, intervention participants had reduced risk of ever experiencing an ACT score representing poorly controlled asthma (IRR: 0.43 [95% CI: 0.21–0.89]), ever having any asthma symptoms in the past two weeks (IRR: 0.71 [95% CI: 0.52–0.98]), and lower risk of any unplanned clinical utilization over the year of follow-up (IRR: 0.35 [95% CI: 0.13–0.94]) compared to control participants. There was a suggestion of greater decrease in uLTE4 (ng/mg creatinine) levels among intervention participants (-10% [95% CI: -20% -1%]).DiscussionHEPA air cleaners may provide additional benefit for child asthma health even in settings with strong asthma education programs and in areas where traditional asthmagens (traffic, tobacco smoke) are not prominent factors.Trial RegistrationClinicalTrials.gov Identifier: NCT04919915. Date of retrospective registration: May 19, 2021.

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Section: Discussionmentioning

confidence: 99%

Randomized Trial of a Portable HEPA Air Cleaner Intervention to Reduce Asthma Morbidity among Latino Children in an Agricultural Community

Drieling

Sampson

Krenz

et al. 2021

Preprint

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“…nicotine smoking), exercise and environmental irritants. 20 Of note, long-term asthma control significantly reduces the likelihood that exposure to the previously mentioned triggers results in an AAE and that medications fail to treat an AAE. 7 Pathophysiologically, AAEs evolve from a complex interplay of three processes, namely airway inflammation, bronchiolar hyper-responsiveness and bronchial constriction 20 – 23 ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“… 20 Of note, long-term asthma control significantly reduces the likelihood that exposure to the previously mentioned triggers results in an AAE and that medications fail to treat an AAE. 7 Pathophysiologically, AAEs evolve from a complex interplay of three processes, namely airway inflammation, bronchiolar hyper-responsiveness and bronchial constriction 20 – 23 ( Figure 1 ). Children with poorly controlled baseline asthma have structural remodelling, such as hypertrophic smooth muscle, thickened basement membranes and collagen deposition, resulting in decreased compliance.…”

Section: Resultsmentioning

confidence: 99%

“…Critical differential diagnoses include bronchiolitis, anaphylaxis, pertussis, vocal cord dysfunction, heart failure, foreign body aspiration, cystic fibrosis and lower airway mass effects. 20 Of note, in children <1 year of age, bronchiolitis is the most common reason for wheeze. Bronchiolitis is classically refractory to asthma pharmacotherapy and current treatment guidelines recommend against routine asthma medication ‘trials’ in children with this suspected diagnosis.…”

Section: Resultsmentioning

confidence: 99%

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Paediatrics: how to manage acute asthma exacerbations

Leung¹

2021

DIC

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Background Asthma is the most common chronic disease of childhood and a major source of childhood health burden worldwide. These burdens are particularly marked when children experience characteristic ‘symptom flare-ups’ or acute asthma exacerbations (AAEs). AAE are associated with significant health and economic impacts, including acute Emergency Department visits, occasional hospitalizations, and rarely, death. To treat children with AAE, several medications have been studied and used. Methods We conducted a narrative review of the literature with the primary objective of understanding the evidence of their efficacy. We present this efficacy evidence in the context of a general stepwise management pathway for paediatric AAEs. This framework is developed from the combined recommendations of eight established (inter)national paediatric guidelines. Discussion Management of paediatric AAE centres around four major care goals: (1) immediate and objective assessment of AAE severity; (2) prompt and effective medical interventions to decrease respiratory distress and improve oxygenation; (3) appropriate disposition of patient; and (4) safe discharge plans. Several medications are currently recommended with varying efficacies, including heliox, systemic corticosteroids, first-line bronchodilators (salbutamol/albuterol), adjunctive bronchodilators (ipratropium bromide, magnesium sulfate) and second-line bronchodilators (aminophylline, i.v. salbutamol, i.v. terbutaline, epinephrine, ketamine). Care of children with AAE is further enhanced using clinical severity scoring, pathway-driven care and after-event discharge planning. Conclusions AAEs in children are primarily managed by medications supported by a growing body of literature. Continued efforts to study the efficacy of second-line bronchodilators, integrate AAE management with long-term asthma control and provide fair/equitable care are required.

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“…Childhood asthma is a chronic inflammatory disorder of the airways characterized by episodic and reversible airway constriction and inflammation in response to infection, environmental allergens, and irritants 1 . The prevalence of childhood asthma in the U.S is estimated at 10%, affecting 7.1 million children, 2 and it is estimated that 0.80%–1.02% of children hospitalized for asthma exacerbation require invasive mechanical ventilation (IMV) 2 .…”

Section: Introductionmentioning

confidence: 99%

Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation

Tsou

Cielo

Xanthopoulos

et al. 2021

Pediatric Pulmonology

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Objective To determine the impact of obstructive sleep apnea (OSA) on asthma exacerbation severity in children hospitalized for asthma exacerbation. Hypothesis OSA is associated with greater use of invasive mechanical ventilation (IMV) and noninvasive mechanical ventilation (NIMV) in children hospitalized for asthma exacerbation. Study Design A retrospective cohort study. Patient–Subject Selection Hospitalization records of children aged 2–18 years admitted for acute asthma exacerbation were obtained for 2000, 2003, 2006, 2009, and 2012 from the Kids’ Inpatient Database. Methodology The primary exposure was OSA, the primary outcome was IMV, and secondary outcomes were NIMV, length of hospital stay (LOS), and inflation‐adjusted cost of hospitalization. Multivariable logistic regression, negative binomial, and linear regression were conducted to ascertain the impact of OSA on primary and secondary outcomes. Exploratory analyses investigated the impact of obesity on primary and secondary outcomes. Results Among 564,467 hospitalizations for acute asthma exacerbation, 4209 (0.75%) had OSA. Multivariable regression indicated that OSA was associated with IMV (adjusted odds ratio [OR], 5.33 [95% confidence interval, CI: 4.35–6.54], p < .0001), NIMV (adjusted OR, 8.30 [95% CI: 6.56–10.51], p < .0001), longer LOS (adjusted incidence rate ratio, 1.34 [95% CI 1.28–1.43], p < .0001), and greater inflation‐adjusted cost of hospitalization (adjusted β, 0.38 [95% CI: 0.33–0.43], p < .0001). Obesity was also significantly associated IMV, NIMV, longer LOS, and greater inflation‐adjusted cost of hospitalization. There was no interaction between OSA and obesity. Conclusion OSA is an independent risk factor for IMV, NIMV, longer LOS, and elevated inflation‐adjusted costs of hospitalization in children hospitalized for asthma exacerbation.

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Asthma

Cited by 86 publications

References 107 publications

Randomized Trial of a Portable HEPA Air Cleaner Intervention to Reduce Asthma Morbidity among Latino Children in an Agricultural Community

Randomized Trial of a Portable HEPA Air Cleaner Intervention to Reduce Asthma Morbidity among Latino Children in an Agricultural Community

Paediatrics: how to manage acute asthma exacerbations

Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation

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