European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years

Gaillard, Erol; Kuehni, Claudia E.; Turner, Steven; Goutaki, Myrofora; Holden, Karl A; Jong, Carmen C.M. de; Lex, Christiane; Lo, David; Lucas, Jane S.; Midulla, Fabio; Mozún, Rebeca; Piacentini, Giorgio; Rigau, David; Rottier, Bart L.; Thomas, Mike; Tonia, Thomy; Usemann, Jakob; Yılmaz, Özge; Zacharasiewicz, Angela; Moeller, Alexander

doi:10.1183/13993003.04173-2020

Cited by 137 publications

(210 citation statements)

References 74 publications

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“…It also affects longitudinal analyses when using GLI references may make lung function in older children at follow-up appear poorer than at baseline. Clinicians commonly use spirometry to diagnose respiratory disease in children with respiratory symptoms.Over detection of pulmonary restriction and obstruction may induce unnecessary treatments and surveillance burdens on patients, as well as unnecessary costs on healthcare systems[42]. For example, underestimated FEV 1 in adolescents may lead to misdiagnosis of asthma[43].…”

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confidence: 99%

Age and body mass index affect fit of spirometry Global Lung Function Initiative references in schoolchildren

et al. 2022

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BackgroundReferences from the Global Lung Function Initiative (GLI) are widely used to interpret children's spirometry results. We assessed fit for healthy schoolchildren.MethodsLuftiBus in the school (LUIS) is a population-based cross-sectional study done from 2013–2016 in the canton of Zurich, Switzerland. Parents and children aged 6–17 years answered questionnaires about respiratory symptoms and lifestyle. Children underwent spirometry in a mobile lung function lab. We calculated GLI-based z-scores for FEV1, FVC, FEV1/FVC, and FEF25–75 for healthy White participants. We defined appropriate fit to GLI references by mean values between+0.5 and −0.5 z-scores. We assessed if fit varied by age, body mass index, height, and sex using linear regression models.ResultsWe analysed data from 2036 children with valid FEV1 measurements of which 1762 also had valid FVC measurements. The median age was 12.2 years. Fit was appropriate for children aged 6–11 years for all indices. In adolescents aged 12–17 years, fit was appropriate for FEV1/FVC (mean: −0.09; sd: 1.02) z-scores, but not for FEV1 (mean: −0.62; sd: 0.98), FVC (mean: −0.60; sd: 0.98), and FEF25–75 (mean: −0.54; sd: 1.02). FEV1, FVC, and FEF25–75 z-scores fitted better in children considered overweight (means: −0.25, −0.13, −0.38) than normal weight (means: −0.55, −0.50, −0.55; p-trend: <0.001, 0.014, <0.001). FEV1, FVC, and FEF25–75 z-scores depended on both age and height (p-interaction: 0.034, 0.019, <0.01).ConclusionGLI-based FEV1, FVC, and FEF25–75 z-scores do not fit White Swiss adolescents well. This should be considered when using reference equations for clinical decision making, research and international comparison.

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confidence: 99%

Age and body mass index affect fit of spirometry Global Lung Function Initiative references in schoolchildren

et al. 2022

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“…Results of objective measurements are valuable data in epidemiological studies, though also time‐consuming and costly. In clinical settings, a complete clinical assessment must include a detailed clinical history and physiological measurements 36 . Our study raises awareness of the fact that parents and children do not report wheeze consistently.…”

Section: Implications and Conclusionmentioning

confidence: 89%

Agreement of parent‐ and child‐reported wheeze and its association with measurable asthma traits

Mozún

Ardura‐Garcia

Pedersen

et al. 2021

Pediatric Pulmonology

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Objectives: In epidemiological studies, childhood asthma is usually assessed with questionnaires directed at parents or children, and these may give different answers. We studied how well parents and children agreed when asked to report symptoms of wheeze and investigated whose answers were closer to measurable traits of asthma.Methods: LuftiBus in the school is a cross-sectional survey of respiratory health among Swiss schoolchildren aged 6-17 years. We applied questionnaires to parents and children asking about wheeze and exertional wheeze in the past year. We assessed agreement between parent-child answers with Cohen's kappa (k), and associations of answers from children and parents with fractional exhaled nitric oxide (FeNO) and forced expiratory volume in 1 s over forced vital capacity (FEV 1 /FVC), using quantile regression.Results: We received questionnaires from 3079 children and their parents. Agreement was poor for reported wheeze (k = 0.37) and exertional wheeze (k = 0.36). Median FeNO varied when wheeze was reported by children (19 ppb, interquartile range [IQR]: 9-44),

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“…The age cut-off of 15 years was in keeping with the New Zealand child asthma guidelines at the time of study development [ 37 ] and aligns with the 2021 European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children [ 38 ]. The SYGMA trials [ 12 , 13 ] included participants aged 12 years and older, providing some data for adolescents [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

The Children's Anti-inflammatory Reliever (CARE) study: a protocol for a randomised controlled trial of budesonide-formoterol as sole reliever therapy in children with mild asthma

et al. 2021

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BackgroundAsthma is the most common chronic disease in children, many of whom are managed solely with a short-acting β2-agonist (SABA). In adults, the evidence that budesonide-formoterol as sole reliever therapy markedly reduces the risk of severe exacerbations compared with SABA alone has contributed to the Global Initiative for Asthma recommending against SABA monotherapy in this population. The lack of current evidence in children means it is unknown whether these findings are also relevant to this demographic. High-quality randomised controlled trials (RCTs) are needed.ObjectiveTo determine the efficacy and safety of as-needed budesonide-formoterol therapy compared with as-needed salbutamol in children aged five to 15 years with mild asthma, who only use a SABA.MethodsA 52-week, open-label, parallel group, phase III, RCT will recruit 380 children aged five to 15 years with mild asthma (ACTRN12620001091998). Participants will be randomised 1:1 to either budesonide-formoterol (Symbicort Rapihaler®) 50/3mcg, two actuations as needed or salbutamol (Ventolin®) 100mcg, two actuations as needed. The primary outcome is asthma attacks as rate per participant per year. Secondary outcomes assess asthma control, lung function, exhaled nitric oxide, and treatment step change. A cost-effectiveness analysis is also planned.ConclusionThis is the first RCT to assess the safety and efficacy of as-needed budesonide-formoterol in children with mild asthma. The results will provide a much-needed evidence base for the treatment of mild asthma in children.

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European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years

Cited by 137 publications

References 74 publications

Age and body mass index affect fit of spirometry Global Lung Function Initiative references in schoolchildren

Age and body mass index affect fit of spirometry Global Lung Function Initiative references in schoolchildren

Agreement of parent‐ and child‐reported wheeze and its association with measurable asthma traits

The Children's Anti-inflammatory Reliever (CARE) study: a protocol for a randomised controlled trial of budesonide-formoterol as sole reliever therapy in children with mild asthma

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