Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Duse, Marzia; Santamaria, Francesca; Verga, Maria Carmen; Bergamini, Marcello; Simeone, Giovanni; Leonardi, Lucia; Tezza, Giovanna; Bianchi, Annamaria; Capuano, Annalisa; Cardinale, Fabio; Cerimoniale, Giovanni; Landi, Massimo; Malventano, Monica; Tosca, Mariangela; Varricchio, Attilio; Zicari, Anna Maria; Alfaro, Carlo; Barberi, Salvatore; Becherucci, Paolo; Bernardini, Roberto; Biasci, Paolo; Caffarelli, Carlo; Caldarelli, Valeria; Capristo, Carlo; Castronuovo, Serenella; Chiappini, Elena; Cutrera, Renato; Castro, Giovanna De; Franciscis, Luca De; Decimo, Fabio; Iacono, Iride Dello; Diaferio, Lucia; Cicco, Maria Di; Mauro, Caterina Di; Mauro, Cristina Di; Mauro, Dora Di; Mauro, F.; Mauro, Gabriella di; Doria, Mattia; Falsaperla, Raffaele; Ferraro, Valentina; Fanos, Vassilios; Galli, Elena; Ghiglioni, Daniele Giovanni; Indinnimeo, Luciana; Kantar, Ahmad; Lamborghini, Adima; Licari, Amelia; Lubrano, Riccardo; Luciani, Stefano; Macrı̀, Francesco; Martelli, Alberto; Masini, Luigi; Midulla, Fabio; Minasi, Domenico; Miniello, Vito Leonardo; Giudice, Michele Miraglia Del; Morandini, Sergio Renzo; Nardini, Germana; Nocerino, Agostino; Novembre, Elio; Pajno, Giovanni Battista; Paravati, Francesco; Piacentini, Giorgio; Piersantelli, Cristina; Pozzobon, Gabriella; Ricci, Giampaolo; Spanevello, Valter; Turra, Renato; Zanconato, Stefania; Borrelli, Melissa; Villani, Alberto; Corsello, Giovanni; Mauro, Giuseppe Di; Peroni, Diego

doi:10.1186/s13052-021-01013-8

Cited by 12 publications

(12 citation statements)

References 134 publications

(185 reference statements)

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“…BTS guidelines encouraged the use of ICS in preschool children with one or more awakenings at night/week, or with symptoms, or use of SABA ≥ three times/week [ 29 ], whereas NICE guidelines recommend starting ICS if symptoms (nocturnal awakenings, cough) occurred three times per week or more [ 82 ]. The recent Italian intersociety consensus published in 2021, summarizing all these guidelines and recommendations, concluded that a trial with daily ICS is recommended in all preschool children with recurrent wheezing or with less frequent but severe exacerbations, regardless of the definitive diagnosis [ 83 ].…”

Section: Resultsmentioning

confidence: 99%

“…A study by Brand and colleagues found that controller therapy with daily ICS reduced the risk of acute exacerbation over a 24-week period [ 86 ]. A recent Italian consensus on airway disease in children suggested that, when started, controller therapy should be continued for at least 3 months [ 83 ]. The same article reported that NICE 2017 guidelines suggested at least an eight-week trial with a moderate dose of ICS.…”

Section: Resultsmentioning

confidence: 99%

“…The same article reported that NICE 2017 guidelines suggested at least an eight-week trial with a moderate dose of ICS. According to this consensus, the efficacy of treatment should be assessed 4–8 weeks after initiation [ 83 ].…”

Section: Resultsmentioning

confidence: 99%

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Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Fainardi

Caffarelli

Deolmi

et al. 2022

JCM

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Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Fainardi

Caffarelli

Deolmi

et al. 2022

JCM

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“…The correct diagnostic and therapeutic approaches to this condition require further investigations [2,3,5]. In such a scenario, due to the lack of firm evidence, a major role is acquired by experts' opinion, which can be addressed through consensus approaches, such as the Delphi Panel, a methodology increasingly used also in the field of pediatrics [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Impact and management of drooling in children with neurological disorders: an Italian Delphi consensus

Riva

Amadori²,

Vari³

et al. 2022

Ital J Pediatr

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Background The rate of chronic drooling in children older than 4 years is 0.5%, but it rises to 60% in those with neurological disorders. Physical and psychosocial consequences lead to a reduction in the quality of Life (QoL) of affected patients; however, the problem remains under-recognized and under-treated. We conducted an Italian consensus through a modified Delphi survey to discuss the current treatment paradigm of drooling in pediatric patients with neurological disorders. Methods After reviewing the literature, a board of 10 experts defined some statements to be administered to a multidisciplinary panel through an online encrypted platform. The answers to the questions were based on a 1–5 Likert scale (1 = strongly disagree; 5 = strongly agree). The scores were grouped into 1–2 (disagreement) and 4–5 (agreement), while 3 was discarded. The consensus was reached when the sum of the disagreement or agreement was ≥75%. Results Fifteen statements covered three main topics, namely clinical manifestations and QoL, quantification of drooling, and treatment strategies. All statements reached consensus (≥75% agreement). The 55 Italian experts agreed that drooling should be assessed in all children with complex needs, having a major impact on the QoL. Attention should be paid to investigating posterior hypersalivation, which is often neglected but may lead to important clinical consequences. Given that the severity of drooling fluctuates over time, its management should be guided by the patients’ current needs. Furthermore, the relative lack of validated and universal scales for drooling quantification limits the evaluation of the response to treatment. Finally, the shared therapeutic paradigm is progressive, with conservative treatments preceding the pharmacological ones and reserving surgery only for selected cases. Conclusion This study demonstrates the pivotal importance of a multidisciplinary approach to the management of drooling. National experts agree that progressive treatment can reduce the incidence of complications, improve the QoL of patients and caregivers, and save healthcare resources. Finally, this study highlights how the therapeutic strategy should be reconsidered over time according to the available drugs on the market, the progression of symptoms, and the patients’ needs.

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“…The treatment of RARS and CRS is controversial; several types of antibiotics have been used with limited results, since after initial improvement, patients eventually relapse [9,17]. Corticosteroid irrigations through the nasal passages and oral corticosteroids have also been used based on the few studies conducted in children with different results [1,[18][19][20]. Mucolytics, expectorants, and antihistamines have not been shown to be helpful [21,22].…”

Section: Introductionmentioning

confidence: 99%

Effects of the Traditional Mediterranean Diet in Childhood Recurrent Acute Rhinosinusitis

Calatayud-Sáez¹,

Calatayud²,

Calatayud³

2021

Sinusitis

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Introduction: There are more and more studies that demonstrate the anti-inflammatory effects of the traditional Mediterranean diet (TMD). The aim of the study was to assess the effects of an intervention with the TMD in patients with recurrent acute and chronic rhinosinusitis. Material and Methods: We performed a pretest–posttest comparison study in 114 patients (56 girls and 58 boys) aged one to five years who had three or more acute rhinosinusitis episodes in the period of 1 year. They were included for a year in the nutritional program “Learning to eat from the Mediterranean”. The anthropometric, clinical, and therapeutic characteristics were studied. Results: All the studied indicators showed a positive and statistically significant evolution. Of the patients, 53.5% did not have any episode of acute rhinosinusitis, and 26.3% had only one, compared to the 3.37 they had on average in the previous year. The use of antibiotics decreased by 87.6%. The degree of satisfaction of the families was very high. The Mediterranean Diet Quality Index (KIDMED) that assesses the quality of the TMD rose from 7.7 to 11 points. Conclusions: The adoption of the TMD could have promising effects in the prevention and treatment of recurrent acute and chronic rhinosinusitis, limiting the pharmacological and surgical intervention in many of these patients.

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Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Cited by 12 publications

References 134 publications

Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Impact and management of drooling in children with neurological disorders: an Italian Delphi consensus

Effects of the Traditional Mediterranean Diet in Childhood Recurrent Acute Rhinosinusitis

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