Sensitivity of FEV1 and Clinical Parameters in Children With a Suspected Asthma Diagnosis

Fillard, Anouchka; Licari, Amelia; Molinari, Nicolas; Marseglia, Gian Luigi; Démoly, P.; Caimmi, Davide

doi:10.1016/j.jaip.2022.10.011

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…A recent study investigated the sensitivity of different clinical parameters in identifying children with asthma and found that using a combination of clinical symptoms had high sensitivity to diagnose asthma in children. 44 This supports that the definition of AA applied in the base case of the BEAT model is clinically relevant for identification of AA cases. To investigate the results of the BEAT model when a more conservative definition of AA was applied, a sensitivity analysis was conducted.…”

Section: Potential Limitationssupporting

confidence: 73%

“…Whether having asthma symptoms and taking asthma medication are adequate measures for AA is debatable, and the persistency of the AA diagnosis might be questionable when based on AA symptoms and the use of AA medication. A recent study investigated the sensitivity of different clinical parameters in identifying children with asthma and found that using a combination of clinical symptoms had high sensitivity to diagnose asthma in children 44 . This supports that the definition of AA applied in the base case of the BEAT model is clinically relevant for identification of AA cases.…”

Section: Discussionmentioning

confidence: 69%

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Quantifying the benefits of early sublingual allergen immunotherapy tablet initiation in children

Hamelmann,

Hammerby,

Scharling

et al. 2023

Allergy

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BackgroundAllergic rhinitis (AR) is a chronic inflammatory disease of the upper airway, which progresses into allergic asthma (AA) in up to 45% of children. This analysis aimed to investigate clinical and economic benefits of sublingual allergen immunotherapy (SLIT tablets) initiated early in childhood for the treatment of AR by quantifying the long‐term reduction in new cases of AA.MethodsA Markov model was developed to estimate the long‐term effects of SLIT tablets on the risk of developing asthma. Key parameters were primarily based on data from the GRAZAX® Asthma Prevention trial and included the age‐ and treatment‐dependent risk of developing AA as well as annual probabilities of progression/remission in AR severity. Healthcare costs were estimated using data from the REACT study.ResultsIn a modelled cohort of children with moderate‐to‐severe seasonal AR initiated on SLIT tablets at ages 7 and 12, 24% and 29%, respectively, develop AA during a 20‐year period. In comparison, when initiated at age 5, 19% develop AA. Additionally, initiation of SLIT tablets at age 5 is associated with a total healthcare cost of EUR 20,429 per patient, whereas initiation at ages 7 and 12 is associated with, respectively, EUR 21,050 and EUR 22,379 per patient 20 years after AR diagnosis.ConclusionInitiation of SLIT tablets in early childhood is associated with a clinically meaningful and permanent reduction in new cases of AA and lower healthcare costs among children with AR. This finding supports the clinical relevance of initiating SLIT tablets early for children with AR to obtain long‐term clinical benefits.

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Section: Potential Limitationssupporting

confidence: 73%

Section: Discussionmentioning

confidence: 69%

Quantifying the benefits of early sublingual allergen immunotherapy tablet initiation in children

Hamelmann,

Hammerby,

Scharling

et al. 2023

Allergy

View full text Add to dashboard Cite

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“…Studies addressing the diagnostic accuracy of spirometry in children reported low sensitivity and moderate to high specificity of the fixed cut-offs for FEV 1 of less than 80% predicted or FEV 1 /FVC less than 80% [8][9][10]. Also, the reversibility cut-off of FEV 1 of 12% after bronchodilation has been recently questioned in children, as it showed a low sensitivity (30.4%) in reaching a diagnosis of asthma, compared with a combination of clinical symptoms, in a recent multicentre international retrospective cohort study [11]. Finally, the increase of the forced expiratory flow between 25 and 75% of the FVC (FEF 25-75 ) after bronchodilation is not yet considered a reliable parameter to reinforce asthma diagnosis in children, although it may provide crucial information on early airflow impairment [12].…”

Section: Andandmentioning

confidence: 99%

Applying the new guidelines to asthma management in children

Castagnoli

Brambilla

Giudice

et al. 2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewThis review aims to provide paediatricians with novel concepts from scientific evidence applicable to treating children with asthma. The latest guideline updates on paediatric asthma are discussed here, with a focus on the 2022 update of the GINA document. Recent findingsMild asthma remains to be an important challenge for the paediatrician, and the introduction of new evidence-based treatment strategies, particularly those symptom-driven, could have a significant impact on the paediatric population. The identification of predictive biomarkers, the definition of biological treatment response, the possible duration of these therapies in this age group, as well as their potential action on airway remodelling are desirable in the short term. As the number of available biological treatment options expands, paediatricians should be supported by further evidence in decision-making. SummaryThere is an urgent need to implement at multiple levels the latest therapeutic strategies proposed for asthma at all severities.

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