Does inhaled steroid therapy help emerging asthma in early childhood?

Abrams, Elissa M.; Szefler, Stanley J.; Becker, Allan B.

doi:10.1016/s2213-2600(17)30295-3

Cited by 13 publications

(20 citation statements)

References 47 publications

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“…Therefore, the Asthma Predictive Index (API) has been used to predict the risk of asthma development in children aged 5 years or younger, 9 – 11 and API-positive children are recommended to receive long-term daily inhaled corticosteroid (ICS). 12 , 13 In this regard, it is predicted that 77% of children will have asthma between age of 6 and 13 years if they were API positive at the age of 3, while only 3% of the children will have asthma if they were API negative at the age of 3. 10 In addition, the lung function of the children with positive API was worse than that of the children with negative API.…”

Section: Introductionmentioning

confidence: 99%

“…15 ICS could effectively control airway inflammation and hyperreactivity and improve symptoms such as wheezing, lung function, and quality of life in asthmatic children. 13 , 16 , 17 However, daily adherence to ICS was low in children at young age because the majority of children did not take their inhalers as prescribed even if they or their parents reported they did. 18 In this context, it has been reported that adherence to long-term ICS in asthmatic children varied from 22% to 63%, and adherence to ICS remained mostly less than 50%.…”

Section: Introductionmentioning

confidence: 99%

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Short-term effect of a smart nebulizing device on adherence to inhaled corticosteroid therapy in Asthma Predictive Index-positive wheezing children

Zhou¹,

Lu²,

Zhu³

et al. 2018

PPA

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ObjectiveTo explore the effect of a smart nebulizing device on the rate of adherence to inhaled corticosteroid (ICS) in children with positive Asthma Predictive Index.MethodsIn total, 65 children with positive Asthma Predictive Index and under the age of 5 years who visited our hospital from October 2015 through October 2016, were randomly assigned to receive conventional nebulization or smart nebulization. The smart nebulizer was connected to smart phones via an App. The following information was collected: rate of adherence to ICS, frequency of emergency visits or hospitalizations, application of antibiotics or oral steroids, and wheezing progression or improvement.ResultsThe rate of adherence to ICS was 86.67% (26/30), 76.67% (23/30), and 67.33% (20/30) in the smart nebulization group, and 62.86% (22/35), 51.42% (18/35), and 40.00% (14/35) in the conventional nebulization group after 4-, 8-, and 12-week therapy, respectively. There were significant differences between the 2 groups at all of the time points (P<0.05). Both day- and night-time wheezing scores were significantly lower in the smart nebulization group than those of the conventional nebulization group after 4-, 8-, and 12-week therapy (P<0.05). The frequency of emergency visits, comorbidity of respiratory infection, antibiotics or systemic steroid usage, and therapeutic cost for additional treatment during the 12-week study period, was significantly lower in the smart nebulization group than that in the conventional nebulization group (P<0.05).ConclusionA smart electronic nebulization device could significantly improve the rate of adherence to ICS in children under the age of 5 years, and thus could significantly reduce the frequency of emergency visits and respiratory infections as well as the usage of antibiotics or systemic steroids.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short-term effect of a smart nebulizing device on adherence to inhaled corticosteroid therapy in Asthma Predictive Index-positive wheezing children

Zhou¹,

Lu²,

Zhu³

et al. 2018

PPA

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“…The INFANT trial conducted by National Heart, Lung, and Blood Institute (NHLBI) AsthmaNet showed that biomarkers of type 2 inflammation, such as blood eosinophil counts, can be used to identify children who may benefit from daily ICS treatment . Evaluation of a child's atopic status could also help to distinguish between patients at risk for persistent asthma, those who are likely to respond to daily ICS therapy, and those likely to develop severe, uncontrolled asthma . Figure illustrates how asthma treatment could be personalized based on phenotype observed for children with uncontrolled asthma.…”

Section: Biomarkers Of Asthma Phenotypesmentioning

confidence: 99%

“…Figure illustrates how asthma treatment could be personalized based on phenotype observed for children with uncontrolled asthma. Precision treatment of asthma will be especially important in young children, as early identification and individualized therapy for asthma may prevent disease progression . However, prospective studies with or without various interventions other than long‐term ICS have not been done to assess the specific relationship of uncontrolled asthma to long‐term fixed airway obstruction.…”

Section: Biomarkers Of Asthma Phenotypesmentioning

confidence: 99%

“…Precision treatment of asthma will be especially important in young children, as early identification and individualized therapy for asthma may prevent disease progression. 48 However, prospective studies with or without various interventions other than long-term ICS have not FIGURE 3 Personalized asthma treatment algorithm for uncontrolled asthma. 87 Personalized courses of therapy for uncontrolled asthma from phenotype to targeted treatment.…”

Section: The Effects Of Asthma On Lung Developmentmentioning

confidence: 99%

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Can early intervention in pediatric asthma improve long‐term outcomes? A question that needs an answer

Lanz

Gilbert

Szefler

et al. 2019

Pediatric Pulmonology

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Objective Although many children with asthma do not experience persistence into adulthood, recent studies have suggested that poorly controlled asthma in childhood may be associated with significant airflow obstruction in adulthood. However, data regarding disease progression are lacking, and clinicians are not yet able to predict the course of a child's asthma. The goal of this article was to assess the current understanding of childhood asthma treatment and progression and to highlight gaps in information that remain. Data Sources Nonsystematic PubMed literature search and authors’ expertise. Study Selection Articles were selected at the authors’ discretion based on areas of interest in childhood asthma treatment and progression into adulthood. Results Uncontrolled asthma in early childhood can potentially have lasting effects on lung development, but it is unclear whether traditional interventions in very young children preserve lung function. Although not all children respond to standard interventions, certain asthma phenotypes have been identified that can help to understand which children may respond to a particular treatment. Conclusion Clinicians should monitor children's asthma control and pulmonary function over time to assess the long‐term impact of an intervention and to minimize the effect of uncontrolled asthma, especially exacerbations, on lung development. New biologic therapies have shown promise in treating adults with severe, uncontrolled asthma, and some of these therapies are approved in the United States for children as young as age 6. However, knowledge gaps regarding the efficacy and safety of these treatments in younger children hamper our understanding of their effect on long‐term outcomes.

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The pediatric asthma yardstick

Chipps

Bacharier

Farrar

et al. 2018

Annals of Allergy, Asthma & Immunology

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Current asthma guidelines recommend a control-based approach to management involving assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient's needs and preferences. However, for children with asthma, achieving control can be elusive. Although tools are available to help children (and families) track and manage day-to-day symptoms, when and how to implement a longer-term step-up in care is less clear. Furthermore, treatment is challenged by the 3 age groups of childhood-adolescence (12-18 years old), school age (6-11 years old), and young children (≤5 years old)-and what works for 1 age group might not be the best approach for another. The Pediatric Asthma Yardstick provides an in-depth assessment of when and how to step-up therapy for the child with not well or poorly controlled asthma. Development of this tool follows others in the Yardstick series, presenting patient profiles and step-up strategies based on current guidance documents, but modified according to newer data and the authors' combined clinical experience. The objective is to provide clinicians who treat children with asthma practical and clinically relevant recommendations for each step-up and each intervention, with the intent of helping practitioners better treat their pediatric patients with asthma, particularly those who do not always respond to recommended therapies.

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Does inhaled steroid therapy help emerging asthma in early childhood?

Cited by 13 publications

References 47 publications

Short-term effect of a smart nebulizing device on adherence to inhaled corticosteroid therapy in Asthma Predictive Index-positive wheezing children

Short-term effect of a smart nebulizing device on adherence to inhaled corticosteroid therapy in Asthma Predictive Index-positive wheezing children

Can early intervention in pediatric asthma improve long‐term outcomes? A question that needs an answer

The pediatric asthma yardstick

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