Treatment Of Asthma In Children Research Articles

Meta-analysis of the efficacy of montelukast sodium combined with nebulized inhalation in the treatment of childhood asthma.

Meta-analysis of the efficacy of montelukast sodium combined with nebulized inhalation in the treatment of childhood asthma.

Chronic treatment of childhood asthma and MART concept

Chronic treatment of childhood asthma and MART concept

START CARE: a protocol for a randomised controlled trial of step-wise budesonide-formoterol reliever-based treatment in children.

Asthma is the most common chronic childhood respiratory condition globally. Inhaled corticosteroid (ICS)-formoterol reliever-based regimens reduce the risk of asthma exacerbations compared with conventional short-acting β2-agonist (SABA) reliever-based regimens in adults and adolescents. The current limited evidence for anti-inflammatory reliever therapy in children means it is unknown whether these findings are also applicable to children. High-quality randomised controlled trials (RCTs) are needed. The study aim is to determine the efficacy and safety of budesonide-formoterol reliever alone or maintenance and reliever therapy (MART) compared with standard therapy: budesonide or budesonide-formoterol maintenance, both with terbutaline reliever, in children aged 5 to 11 years with mild, moderate and severe asthma. A 52-week, multicentre, open-label, parallel group, phase III, two-sided superiority RCT will recruit 400 children aged 5 to 11 years with asthma. Participants will be randomised 1:1 to either budesonide-formoterol 100/6 µg Turbuhaler reliever alone or MART; or budesonide or budesonide-formoterol Turbuhaler maintenance, with terbutaline Turbuhaler reliever. The primary outcome is moderate and severe asthma exacerbations as rate per participant per year. Secondary outcomes are asthma control, lung function, exhaled nitric oxide and treatment step change. Assessment of Turbuhaler technique and cost-effectiveness analysis are also planned. This will be the first RCT to compare the efficacy and safety of a step-wise budesonide-formoterol reliever alone or MART regimen with conventional inhaled ICS or ICS-long-acting β-agonist maintenance plus SABA reliever in children. The results will provide a much-needed evidence base for the treatment of asthma in children.

Diagnosis and treatment of asthma in childhood: an overview of guidelines.

Diagnosis and treatment of asthma in childhood: an overview of guidelines.

Analysis of risk factors for acute attacks complicated by respiratory failure in children with asthma.

To describe the proportion and clinical characteristics of hospitalized children with acute asthma attacks complicated by respiratory failure and to analyze the risk factors. This retrospective study analyzed hospital admissions of children and adolescents with acute asthma attacks between January 2016 and December 2021. Inclusion criteria were used to identify eligible cases, and demographic information and disease characteristics were collected. Patients were categorized into respiratory failure group and the other group based on the result of artery blood gas analysis. Multivariate logistic regression was utilized to investigate the risk factors associated with respiratory failure resulting from acute asthma attacks. The data were analyzed using SPSS 22.0, and significance was considered at P < 0.05. Our research involved 225 participants, with 18.7% diagnosed with respiratory failure. The respiratory failure group was found to be younger and have higher percentage of male, while birth weight, nationality, and type of residence did not differ between the two groups. In the respiratory failure group, a significant difference was observed in emergency hospitalization, ICU treatment, severe to critical attack, dyspnea and allergy history. The two groups did not differ in admission season, first asthma diagnosis, respiratory infection and comorbidity. The respiratory failure group exhibited a higher proportion of atopy-only asthma and a lower proportion of T2-high asthma. The eosinophil count, and eosinophil percentage were lower in the respiratory failure group, while neutrophil count was higher. Having a history of allergies (OR = 2.46, 95% CI: 1.08-5.59) and neutrophil count (OR = 1.10, 95% CI: 1.00-1.21) were the risk factors for respiratory failure in children with asthma. There also existed that the risk of respiratory failure increases with decreasing age of the children (OR = 0.85, 95% CI: 0.73-0.99). Notably, risk factors for respiratory failure in hospitalized asthma children include age, having a history of allergies, and neutrophil count. The identification of the above factors and the implementation of timely intervention can optimize the treatment of asthma in children.

There’s something in the air – the role of volatile organic compounds in exhaled air in the diagnosis and treatment of asthma in children

There’s something in the air – the role of volatile organic compounds in exhaled air in the diagnosis and treatment of asthma in children

Progress on the advanced prevalence and treatment of childhood asthma based on genetic and epigenetics mechanisms

Over the previous ten years, there has been a notable escalation in the global prevalence of asthma in children. This increased incidence has predominantly manifested in regions and countries with greater economic development. Therefore, it demands significant attention. The occurrence of childhood asthma is known to be influenced by both genetics and epigenetics. Epigenetics, e.g., DNA methylation, can be influenced by the environmental factors, thus affect gene expression. These environmental factors include exposure to smoking, viral infections, allergens, and endotoxins. This article analyzes relevant research in recent years and finds that: Regarding genetics, several susceptible genes associated with childhood asthma have been identified, such as ORMDL3, GSDMB, RAD50, HLA-G, CXCR5, IL-4, IL-13 and TSLP; In recent times, it has been observed by an expanding body of researchers that the interplay between environmental elements and genetic factors collectively influence the onset and progression of asthma. Nowadays, the primary treatment for asthma involves medication, while immunotherapy is still under investigation. Therefore, strengthening the prevention of childhood asthma is of utmost importance.

Recent research on the relationship between pulmonary microbiome and asthma endotypes in children

Bronchial asthma is not considered a singular disease, but rather a collection of syndromes with multiple phenotypes and mechanisms that involve various signaling pathways. It typically emerges during the preschool years, and its etiology is intricate and diverse. In recent years, the advancement of high-throughput sequencing technology has revealed that early alterations in lung microbiota may be associated with asthma incidence and progression. Moreover, significant variations in lung microbiota have been observed among different airway inflammation profiles, known as asthma endotypes. Hence, a comprehensive understanding of the characteristics of lung microbiota in children with asthma can aid in managing disease progression and improving long-term prognosis. Additionally, such insights may spark novel approaches to diagnosing and treating childhood asthma.

Effectiveness of Community-Based Nursing Intervention for Asthmatic Children: A Systematic Review and Meta-Analysis.

Preventive care can support and direct the nurse's efforts to deliver an asthma intervention for children as part of nursing interventions. Despite the significance, there have been few meta studies demonstrating the effectiveness of nursing interventions for the treatment of childhood asthma that includes only randomised controlled trials (RCTs). Therefore, this meta study was conducted to comprehensively evaluate the efficacy of nursing care interventions for the management of childhood asthma. STATA 14.2 (StataCorp, College Station, TX, USA) was used to conduct the meta-analysis. From 1964 to July 2022, we searched Medline, the Cochrane library, EMBASE, Scopus Science Direct, and Google Scholar. Depending on the type of outcome, a meta-analysis was performed using a random-effects model, pooled weight mean difference (WMD), standardised mean difference (SMD), and/or risk ratio (RR) with stated 95 percent confidence intervals (CIs). PRISMA guidelines were followed for conducing this study. Nine studies were analysed in total. The pooled RR for emergency visits was 0.49 (95%CI: 0.32 to 0.77), for hospitalizations was 0.64 (95%CI: 0.21 to 1.89). The pooled SMD for frequency of asthma attacks was -2.88 (95%CI: -3.22 to -2.54), quality of life was 0.49 (95%CI: 0.22 to 0.75) and asthma control was 1.25 (95%CI: -0.77 to 3.28). Paediatric asthma patients who received nursing interventions reported an improved quality of life and a decrease in emergencies and acute attacks due to asthma. Future RCTs should focus on uncovering the short- and long-term effects of these nursing interventions to provide optimal management and care.

Retracted: Traditional Chinese Medicine Based Acupoint Application for Asthma Treatment in Children: A Meta-Analysis and Systematic Review.

[This retracts the article DOI: 10.1155/2022/7500056.].

Efficacy, Safety, and Systemic Exposure of Once-Daily Indacaterol Acetate in Pediatric Asthma: A Randomized, Double-Blind, Controlled Dose-Finding Study.

Indacaterol acetate (IND), a long-acting β2-agonist in combination with mometasone furoate (MF), an inhaled corticosteroid (ICS), is being explored as a once-daily (od) treatment for asthma in children. This study examined the efficacy, safety, and systemic exposure of IND 75 µg and IND 150 µg in children with persistent asthma. In this Phase IIb, multicenter, randomized, double-blind, parallel-group study, pediatric patients (aged ≥6 to <12 years) with persistent asthma were randomized (1:1) to receive either IND 75 µg od or IND 150 µg od via Breezhaler® in combination with ICS background therapy. The primary endpoint was change from baseline in pre-dose trough forced expiratory volume in one second (FEV1) after two weeks of treatment. In total, 80 patients received IND 75 µg (n = 39) or IND 150 µg (n = 41). The study met its primary endpoint; both doses demonstrated improvements in pre-dose trough FEV1 from baseline to Day 14 (mean change [Δ]: 212 mL, IND 75 µg; 171 mL, IND 150 µg). The secondary spirometry parameters (post-dose FEV1 after 1-h, post-dose forced vital capacity; morning and evening peak expiratory flow) also improved. Overall, 36.1% in IND 75 μg group and 25% patients in IND 150 μg group achieved a decrease from baseline in Pediatric Interviewer-administered Asthma Control Questionnaire score of ≥0.5 units. A dose-dependent increase in plasma IND concentration was noted between the two groups. Both IND doses demonstrated an acceptable safety profile. Once-daily IND 75 μg and IND 150 μg via Breezhaler® in combination with background ICS therapy provided substantial bronchodilation in children with asthma and were well tolerated. Taken together, these clinical and systemic exposure findings support IND 75 μg as the most appropriate dose for evaluation in Phase III trials in combination with MF in pediatric asthma. ClinicalTrials.gov (NCT02892019; 08-Sep-2016).

The Efficacy of Nebulized Epinephrine in Children with Acute Asthma: A Randomized Double-blind Trial

Introduction: Countries like Bangladesh have seen an increase in the prevalence of bronchial asthma. The goal of the study was to compare the efficacy of nebulized salbutamol and nebulized epinephrine in treating children with acute asthma. Objectives: To assess the clinical improvement of acute bronchial asthma in children following nebulization with salbutamol and epinephrine. Methodology: This random, double-blind clinical trial was conducted in the paediatric department of the Mymensingh Medical College Hospital. Children of either sex with clinical features of acute exacerbation of asthma, an asthma score &gt;5 to 11, an age range from 6 to 12 years, and the ability to measure peak expiratory flow rate (PEFR) were enrolled in this study. Outcomes were observed by measuring PEFR, respiratory rate, pulse rate, and SaO2 and also by determining asthma scores at 15, 35, 55, and 90 min after nebulization at a regular interval at 0, 20, 40, and 60 min. Differences from the base line and differences between both groups were observed. Results: A total of 56 patients with acute asthma were enrolled in this study. Among them, 27 children were in the salbutamol group, and 29 patients were in the epinephrine group. Among baseline characteristics, there was no statistically significant difference (p &gt; 0.05) between the two groups. Asthma score and respiratory rate decreased more in the salbutamol group with time after nebulization, but no statistically significant differences existed for the follow-up at 15, 35, and 55 minutes. A statistically significant increase in asthma score and respiratory rate was seen at 90 minutes of treatment in the salbutamol group. On the other hand, percent of predicted PEFR and SpO2 increased with time in both groups, and no statistically significant differences existed except for SpO2 at 35 min of follow-up in the salbutamol group. The epinephrine-treated group had a higher incidence of side effects as compared with the salbutamol group, but there was no statistically significant difference. Conclusion: Based on this study, in the treatment of asthmatic children with a mild to moderate exacerbation, both nebulized epinephrine and nebulized salbutamol were effective when given in addition to oral steroids.

The effect of pulmonary rehabilitation on childhood asthma: a systematic review and meta-analysis.

Pulmonary rehabilitation (PR) is a comprehensive nursing intervention for lung function improvement in patients with respiratory diseases. This systematic review focused on further exploration of the unclear impacts of PR on childhood asthma. Web of Science, Cochrane Library, Embase, PubMed, and other databases were searched until May 2021. Randomized controlled trials (RCTs) comparing the effects of PR (including exercise training and education) and routine care on childhood asthma were included. Study selection, data extraction, and bias risk assessment were performed independently by two investigators. Fourteen RCTs involving 1401 patients were included. Relative to the control group, the total scores of the asthma quality of life questionnaire were evidently improved in the experimental group, including motor domain scores (MD=0.88, 95% CI: 0.67-1.09), symptom domain scores (MD=1.23, 95% CI: 0.61-1.85), and affective domain scores (MD=1.38, 95% CI: 0.63-2.14). Besides, 6-min walk distance (MD=2.01, 95% CI: 0.86-3.15) and asthma control test (MD=0.31, 95% CI: 0.02-0.60) were prominently improved. However, the maximum oxygen uptake (MD=0.81, 95% CI: -0.2 to 1.82) was not markedly improved. The forced expiratory volume in 1 s (MD=0.42, 95% CI: -0.29 to 1.13), and forced vital capacity (MD=0.07, 95% CI: -0.14 to 0.28) were not remarkably improved. There was an evident improvement in the peak expiratory flow (MD=1.22, 95% CI: 0.15-2.30). PR improves some lung functions, exercise tolerance and the quality of life of children with asthma, and it might work as a supplementary therapy for the treatment of childhood asthma. Moreover, more RCTs of high quality and in large sample size are needed for further confirmation.

New approaches in childhood asthma treatment.

This review aims to summarize the most recent advances in asthma management, focusing on novel approaches to pediatric asthma. In recent years, the therapeutic tools for pediatric asthma have expanded significantly for both the nonsevere and severe forms. The use of anti-inflammatory treatment, even for the mildest cases, and the withdrawal of symptomatic bronchodilation as monotherapy have been included in the most recent guidelines. Also, different biological therapies have revolutionized the therapeutical approach for severe uncontrolled asthma in children and adolescents. With the expanding landscape of novel therapeutic approaches for pediatric asthma, further evidence is needed to help clinicians choose the best option for patients, particularly those with severe asthma. The identification of novel predictive biomarkers may also help pediatricians in selecting children and adolescents for innovative therapies.

ADP Ribosylation Factor 6 Relieves Airway Inflammation and Remodeling by Inhibiting Ovalbumin Induced-Epithelial Mesenchymal Transition in Experimental Asthma, Possibly by Regulating of E2F Transcription Factor 8

ABSTRACT Background Childhood asthma is a major global health concern. ADP-ribosylation factor 6 (ARF6) is a low-molecular-weight GTPase; however, its role in childhood asthma remains unclear. Methods Ovalbumin (OVA)-challenged neonatal mice and transforming growth factor-β1 (TGF-β1)-induced BEAS-2B cells were used as in vivo and in vitro models of childhood asthma, respectively. Results Upon OVA stimulation, ARF6 expression was upregulated in the lung tissue. Neonatal mice administered SehinH3 (an ARF6 inhibitor) exhibited improved pulmonary pathological injury, along with reduced inflammatory cell infiltration in the lungs and cytokine release in bronchial alveolar lavage fluid and serum (interleukin [IL]−3, IL−5, IL−13, IgE, and OVA-specific IgE). SehinH3 treatment restrained epithelial – mesenchymal transition (EMT) in the lungs of asthmatic mice, as evidenced by increased E-cadherin and decreased N-cadherin and α-smooth muscle actin expression. Different TGF-β1 exposures to BEAS-2B cells induced a time- and dose-dependent increase in ARF6 expression in vitro. Upon TGF-β1 stimulation, ARF6 knockdown repressed EMT and SehinH3 treatment caused similar results in BEAS-2B cells. The transcription factor E2F8 is involved in diverse biological functions and its increased expression was confirmed in vivo and in vitro. Dual-luciferase assays confirmed that E2F8 binds to the ARF6 promoter and promotes its transcriptional activity. In vitro results revealed that E2F8 silencing suppressed EMT, whereas rescue experiments showed that ARF6 overexpression partly reversed these phenomena. Conclusion Our study showed that ARF6 is associated with childhood asthma progression and may be positively regulated by E2F8. These results provide insight into the pathogenesis and treatment of childhood asthma.

Based on what parameters is safe to discontinuate inhaled corticosteroids in children with asthma?

Objective Remission of childhood asthma has not been widely studied. Patients in clinical remission continue to have some degree of bronchial hyperresponsiveness (BHR). The aim of this study was to investigate whether clinical parameters and lung function test are good parameters for discontinuation of inhaled corticosteroids (ICS) in asthmatic children, including patients with persistent BHR, as measured by the methacholine challenge test (MCT). Methods One year after discontinuation of inhaled corticosteroids (ICS), MCT was performed in a group of 40 asthmatic children to confirm or exclude BHR. In all patients, ICS treatment was discontinued based on the same parameters: symptoms, spirometry, daily PEF, and negative bronchodilator test. After achieving complete asthma control for at least 6 to 12 months, ICS treatment was stepped down and discontinued. Clinical course and spirometry were followed up after ICS discontinuation. Results Positive MCT was found in 50% of the patients. There was no statistically significant difference between the positive and negative MCT groups in age at initiation and discontinuation of ICS therapy, duration of ICS therapy, duration of stepping down period, FEV1, and PEF at the time of withdrawal of ICS and one year later. ICS treatment had to be restarted in two patients from the positive MCT group, due to recurrence of asthma symptoms. Conclusion Clinical parameters, normal spirometry, daily PEF values, and a negative bronchodilator test are good parameters for discontinuing ICS treatment in asthmatic children, even in patients with persistent BHR. Children should continue to be monitored, as symptoms may recur.

Effects of Short-Acting Beta-Agonist (SABA) Alone and SABA with Inhaled Corticosteroids in the Management of Asthma among Children

Introduction: However, the comparative efficacy of SABA alone vs SABA in conjunction with ICS in the treatment of childhood asthma remains an important topic of research. Understanding the comparative efficacy of SABA alone versus SABA in conjunction with ICS in the treatment of childhood asthma is critical for evidence-based decision-making. Methodology: This randomized controlled study (RCT) included 80 children aged 6 to 12 years who were diagnosed with mild chronic asthma. The participants were separated into two groups: SABA alone and SABA plus ICS. For symptom alleviation, the SABA alone group got as-needed treatment with a short-acting beta-agonist (SABA). The SABA with ICS group got SABA therapy on a regular basis for symptom alleviation, as well as daily inhaled corticosteroid (ICS) therapy for maintenance. To compare the outcomes of the two groups, statistical analysis was done using an independent t-test. A statistically significant p-value of less than 0.05 was evaluated. Results: Spirometry measures were taken to quantify vital capacity (VC), forced expiratory volume at one second (FEV1), and the FEV1/VC ratio. Both groups had lower baseline values for these measures, indicating decreased lung function. However, both groups' lung function improved significantly following the intervention (p&lt;0.05). Practical Implication: The findings of this study can not only educate clinical practice, but also assist healthcare practitioners in making informed treatment decisions in order to enhance asthma management and outcomes for patients. Conclusion: According to the data, combining these drugs can enhance symptom management and lung function in children with moderate chronic asthma. Keywords: Asthma, Lung Function test, Forced expiratory volume, Short Acting Beta Agonist, Inhaled Corticosteroids, Children.

Retracted: Effect Evaluation of Electronic Health PDCA Nursing in Treatment of Childhood Asthma with Artificial Intelligence.

[This retracts the article DOI: 10.1155/2022/2005196.].

Wisdom Data Analysis Framework of Dose-Effect Correlation Between Acupoint Application in the Treatment of Asthma in Children Based on AdaBoost

Wisdom Data Analysis Framework of Dose-Effect Correlation Between Acupoint Application in the Treatment of Asthma in Children Based on AdaBoost

The Use of Lactobacillus reuteri as an Adjunct in the Treatment of Children with Newly Diagnosed Asthma in a Tertiary Hospital in the Philippines

Rationale: Probiotics are live microorganisms that exert beneficial effects on the host, including a reduction of allergic disease symptoms. Lactobacillus reuteri in particular was shown to attenuate the allergic airway, and when used as an adjunct in the treatment of asthma in children, resulted in decreased fractional exhaled nitric oxide and interleukin levels when compared to placebo. However, insufficient information is available regarding the significance of L. reuteri as an adjunct in the treatment of allergic disorders, particularly in allergic airway disease. Objectives: The objective of the study was to determine the efficacy of L. reuteri as an adjunct for the control of newly diagnosed asthma in children. Methodology and Population: In this analytical, experimental, prospective, randomized controlled trial, 44 asthmatic patients aged 6–18 years were recruited from the University of Santo Tomas Hospital outpatient department, for a study period of three months. Baseline clinical assessment included skin prick test to aeroallergens, spirometry, and Childhood Asthma Control Test. Asthma severity and level of control was based on the National Asthma Education and Prevention Program’s Expert Panel 3 (EPR-3) and the Global Initiative for Asthma Guidelines 2018, respectively. Patients were randomized and half of them received L. reuteri 26.5 mg/chewable tab (at least 100 million colony forming units) once daily for 30 days, while the other half did not. Spirometry and C-ACT test were conducted at the start of intervention as baseline, after one month, two months, and three months post intervention. The results of patients from the experimental group were compared to results of patients in the control group. Results: The FEV1 of patients in the L. reuteri group was significantly higher than those in the control group (p = 0.045). The median FVC of the two groups significantly differed from each other through time (p = 0.007), with the L. reuteri group having significantly higher FVC than the control group. There were statistically significant improvements in ACT scores between patients in the L. reuteri and control groups, particularly at two months and three months of treatment. Among polysensitized patients, there were significant improvements in the FEV1, FEF25–75, and FVC between the L. reuteri and control group. Conclusion: The use of L. reuteri as an adjunct was associated with significant lung function improvement and asthma symptom control amongst newly diagnosed asthmatic children. Key Words: Lactobacillus reuteri, Probiotics, Asthma, Children