Predicting asthma exacerbations in children

Forno, Erick; Celedón, Juan C.

doi:10.1097/mcp.0b013e32834db288

Cited by 84 publications

(78 citation statements)

References 42 publications

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“…Serum 25(OH)D level is a novel and modifiable potential risk marker for severe asthma exacerbations [55]. Taken together existing mechanistic and observational data support a role for vitamin D as an important factor in asthma and infection.…”

Section: Future Recommendationsmentioning

confidence: 83%

Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies

Kerley

Elnazir

Faul

et al. 2015

Pulmonary Pharmacology & Therapeutics

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This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. Emerging evidence suggests that VDD is associated with increased airway hyperresponsiveness, decreased pulmonary function, worse asthma control, and possibly decreased response to standard antiasthma therapy. However the effect is inconsistent with preliminary evidence from different studies suggesting vitamin D is both beneficial and detrimental to asthma genesis and severity.Current evidence suggests that supplementation with moderate doses of vitamin D may be appropriate for maintenance of bone health in asthmatics, particularly steroid users. However emerging data from an increasing number of randomized, controlled, intervention studies of vitamin D supplementation in pediatric and adult asthma are becoming available and should help determine the importance, if any of vitamin D for asthma pathogenesis.The purpose of this second of a two-part review is to review the current human literature on vitamin D and asthma, discussing the possible consequences of VDD for asthma and the potential for vitamin D repletion as adjunct therapy.

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Section: Future Recommendationsmentioning

confidence: 83%

Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies

Kerley

Elnazir

Faul

et al. 2015

Pulmonary Pharmacology & Therapeutics

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“…It is clear that better studies about adherence to treatments are needed, and that more homogeneous outcomes and study design would be useful in order to reach conclusions. For clinicians, it seems evident that efforts directed at improving, evaluating and measuring adherence should be a routine component of asthma care [63]. The recognition of nonadherence is an important first step towards optimal asthma control.…”

Section: Discussionmentioning

confidence: 99%

Medication adherence and the risk of severe asthma exacerbations: a systematic review

et al. 2014

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The benefits of drug therapy for asthma have been well established, but adherence to treatment is poor, and this might be associated with an increased risk of asthma exacerbations. The aim of this study was to review the literature on the association between adherence to asthma controller treatment and risk of severe asthma exacerbations in children and adults.A systematic literature search was performed in PubMed, Embase and Web of Science, from inception until January 2014. Studies were included if data on the association between medication adherence and severe asthma exacerbations were presented. Quality was assessed using a modified version of the Newcastle-Ottawa Scale.The search yielded 2319 unique publications, of which 23 met the inclusion criteria and underwent data extraction and quality scoring. High levels of heterogeneity across studies with regard to adherence and exacerbation measurements, designs and analysis precluded a formal meta-analysis. Although effect measures varied widely, good adherence was associated with fewer severe asthma exacerbations in highquality studies.Good adherence tended to be associated with lower risk of severe asthma exacerbations. Future studies should use standardised methodology to assess adherence and exacerbations, and should consider inhaler competence.@ERSpublications High-quality studies indicated that better adherence is associated with fewer severe asthma exacerbations

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“…In childhood asthma, acute exacerbations are one of the main causes for emergency department visits [1,2,3,4,5]. Whereas the use of anti-inflammatory therapy in moderate to severe asthmatics is well established, strategies to prevent asthma exacerbations (AEs) in young children with intermittent asthma are unclear.…”

Section: Introductionmentioning

confidence: 99%

“…Predictive models use clinical variables, healthcare data, pulmonary function testing (PFT), and biomarkers [4]. Data from young children are rare, because most studies only enroll children of the age of 6 years and older, and the outcome parameters are usually severe and not moderate AEs.…”

Section: Introductionmentioning

confidence: 99%

Impulse Oscillometry as a Predictor of Asthma Exacerbations in Young Children

et al. 2016

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Background: In a post-hoc analysis of a pediatric asthma study, we identified the predictors of asthma exacerbations (AEs) and related them to forced expiratory volume (FEV₁), the FEV₁/FVC ratio, and bronchial hyperresponsiveness (BHR). Objectives: We sought to detect predictors of AEs in a prospective study that utilizes impulse oscillometry (IOS) and to compare the results to previously determined predictors. Methods: A moderate AE was defined as an increased use of salbutamol during coughing episodes. Pulmonary function and BHR were measured during symptom- and medication-free periods. Additionally, allergen testing and IOS were included. To calculate the sensitivity and specificity of AE detection, a receiver-operating characteristic (ROC) curve was plotted, and accuracy was measured with the area under the ROC curve (AUC). A logistic regression analysis was used to predict the probability of an exacerbation. Results: Seventy-five pediatric patients (4-7 years of age) with intermittent asthma were included. In 69 patients, the following cut-off values demonstrated the best sensitivity and specificity combination for predicting an AE: FEV₁ 103.2% (AUC 0.62), BHR (PD₂₀methacholine) 0.13 mg (AUC 0.61), and, in 54 children, Rrs5 0.78 kPa × l^-1 × s (AUC 0.80). Logistic regression analysis demonstrated that the combination of all parameters predicted the individual risk of AEs with an accuracy of 86%. Conclusions: IOS, a simple method, predicted the probability of AEs in young children. Airway resistance, measured by IOS, was superior to FEV₁ and methacholine testing. The current data suggest that peripheral airway obstruction is present during symptom-free periods and that these children more likely experience AEs.

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Predicting asthma exacerbations in children

Cited by 84 publications

References 42 publications

Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies

Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies

Medication adherence and the risk of severe asthma exacerbations: a systematic review

Impulse Oscillometry as a Predictor of Asthma Exacerbations in Young Children

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