Treatment Of Asthma In Children Research Articles

Analysis of the list of dugs for the treatment of bronchial asthma in children acording to state form

Today, in the conditions of economic instability of the country, provision of rational pharmacotherapy is an important element of the development of the health system of Ukraine. An effective tool for this is the state form of drugs that allows to remove ineffective drugs, and the treatment of proven efficacy by evidence-based medicine.
 The purpose of the work was to study the lists and dynamics of the number of drugs for the treatment of bronchial asthma in children in the State form of the Ministry of Health of the first-tenth issues.
 Material and method of research was the content analysis of the State form for the first-tenth issues of the Ministry of Health and the Unified Clinical Protocol for Primary, Secondary (Specialized) Medical Aid «Bronchial Asthma in Children».
 In the results of the conducted research, the number of drugs for the treatment of asthma in children contains 13 international non-proprietary names (INNs), all of which were presented in 10 issues of the State form of drugs, except for Omalizumab, which was available in 9 out of 10 issues. In general, there is an increase number of trade names (TN) with each issue of the State form of drugs, analysis of the data carried out on chain indicators allowed to establish that the number of TN in the tenth issue compared with the first increased by 22%. A study of quantitative changes in TN shows us that for most INNs, the range of drugs increases or does not change, but the difference between the first and the tenth release of the State form of INN drugs use for Beclometasone and Methylprednisolone is – 40%. The analysis allows producing countries to establish that 87% of the analyzed group of drugs manufactured by foreign pharmaceutical companies, and only 13% – domestic. This production represented 20 foreign countries and domestic – 10 companies. The largest segment of the studied sample drugs generates India – 24.3%, Great Britain and Ukraine – by 12.6%.
 The conducted studies allow us to conclude that the domestic production of this group of drugs with proven efficacy and safety according to evidence-based medicine is advisable, which will reduce the total cost of treatment for asthma in children, by increasing the proportion of Ukrainian drug production.

Synbiotics and Treatment of Asthma: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial.

Background: We examined the efficiency and safety of a specific synbiotic compound, brand name Kidilact®, in the treatment of asthma in children 12 years of age or younger. Materials and Methods: This double-blinded, randomized, placebo-controlled clinical trial was conducted in Tehran, Iran, from May 22, 2016, to May 21, 2017. One hundred children, 12 years of age or younger, who suffered from mild to moderate asthma were recruited in this study. The subjects were randomly divided into two groups; the experimental group received a sachet of Kidilact®, and the control group received a sachet of placebo once a day for six months. Both groups were compared in terms of the frequency of asthma attacks that were severe enough to require administration of fast-acting medications, the number of outpatient visits for asthma-related problems, and the frequency of hospitalization due to exacerbated symptoms of asthma. Results: There were fewer complaints of drug-induced side effects, e.g., vomiting, headache, stomachache, and diarrhea, exacerbated cough, and constipation in the experimental group than in the control group. Overall, a significantly greater number of participants in the experimental group were satisfied with the therapeutic intervention than those in the control group, as verified by the participants and their parents/guardians self-report. There was no significant difference between both groups in the frequency of asthma attacks and hospitalization due to exacerbated symptoms of asthma. The only significant difference between both groups was the count of outpatient visits. While the control group made 55 outpatient visits to the hospital, participants in the experimental group visited the hospital only 19 times (P=0.001). Conclusion: Results of our study indicates that synbiotic compound Kidilact® generally alleviates the symptoms of asthma in children of 12 years of age or younger, resulting in less frequent outpatient visits to the hospital due to asthma-related problems while rarely causing any side effects. Due to ease of use, the rarity of side effects, and their indirect positive effects on quality of life of asthmatic patients, we recommend that synbiotics be incorporated in regular treatment and management of children with asthma.

Synbiotics and Treatment of Asthma: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial

Background: We examined the efficiency and safety of a specific synbiotic compound, brand name Kidilact®, in the treatment of asthma in children 12 years of age or younger. Materials and Methods: This double-blinded, randomized, placebo-controlled clinical trial was conducted in Tehran, Iran, from May 22, 2016, to May 21, 2017. One hundred children, 12 years of age or younger, who suffered from mild to moderate asthma were recruited in this study. The subjects were randomly divided into two groups; the experimental group received a sachet of Kidilact®, and the control group received a sachet of placebo once a day for six months. Both groups were compared in terms of the frequency of asthma attacks that were severe enough to require administration of fast-acting medications, the number of outpatient visits for asthma-related problems, and the frequency of hospitalization due to exacerbated symptoms of asthma. Results: There were fewer complaints of drug-induced side effects, e.g., vomiting, headache, stomachache, and diarrhea, exacerbated cough, and constipation in the experimental group than in the control group. Overall, a significantly greater number of participants in the experimental group were satisfied with the therapeutic intervention than those in the control group, as verified by the participants and their parents/guardians self-report. There was no significant difference between both groups in the frequency of asthma attacks and hospitalization due to exacerbated symptoms of asthma. The only significant difference between both groups was the count of outpatient visits. While the control group made 55 outpatient visits to the hospital, participants in the experimental group visited the hospital only 19 times (P=0.001). Conclusion: Results of our study indicates that synbiotic compound Kidilact® generally alleviates the symptoms of asthma in children of 12 years of age or younger, resulting in less frequent outpatient visits to the hospital due to asthma-related problems while rarely causing any side effects. Due to ease of use, the rarity of side effects, and their indirect positive effects on quality of life of asthmatic patients, we recommend that synbiotics be incorporated in regular treatment and management of children with asthma. [GMJ.2019;8:e1350]

Tiotropium in asthma: From bench to bedside.

Tiotropium is a long-acting muscarinic antagonist approved for maintenance treatment of asthma in children, adolescents, and adults in the United States, and recommended as add-on treatment for uncontrolled asthma despite treatment with inhaled corticosteroids and/or long-acting beta-2 agonists. This review traces the journey of tiotropium from its historical origins through early preclinical testing to human clinical trials and real-life studies. A search was performed in PubMed using search terms 'tiotropium' and 'asthma.' Relevant references cited in those articles were reviewed. English language articles published from December 2008-December 2018 were screened. Articles evaluating the efficacy, cost-effectiveness, real-life evidence, and steroid-sparing effect of tiotropium with inadequately controlled asthma were included. Anticholinergics have a long history of use in the treatment of obstructive airway diseases. Evidence indicates that tiotropium's mechanism of action consists of bronchodilation and diminished mucus secretion, with preclinical evidence suggesting an anti-inflammatory effect as well. Phase 2 and 3 clinical trials have demonstrated that tiotropium is efficacious and safe, resulting in significant improvements in lung function in adults, adolescents, and children across asthma severities. Emerging evidence suggests that add-on tiotropium might potentially enable reductions in inhaled corticosteroid dose in patients with uncontrolled asthma. Further, tiotropium is a cost-effective treatment option that is also effective in the clinical practice setting. An increasing body of evidence indicates that tiotropium can play a significant role in the treatment of patients with uncontrolled asthma.

INFLUENCE OF INTERFERON INDUCER (CYCLOPHERON) ON NONSPECIFIC AND HUMORAL IMMUNITY FACTORS IN BRONCHIAL ASTHMA IN CHILDREN

Bronchial asthma (BA) remains one of the most pressing problems in modern pediatrics. The incidence of this pathology is increasing annually and, according to WHO, about 300 million people in the world suffer from asthma. Despite the recent advances in the diagnosis and treatment of asthma, complete control over the course of asthma has failed. The objective of the workwas to evaluate the effect of immunomodulatory therapy on nonspecific and humoral immunity in children with BA by including interferon inducer (cycloferon) in a standard base therapy. There were 120 children with bronchial asthma aged 5 to 14 years, with an average age of (11.6 ± 1.5) years. To determine the diagnosis and effectiveness of therapy used the international classification of diseases of the 10th examination, protocol for the diagnosis and treatment of bronchial asthma in children (order of the Ministry of Health of Ukraine № 767 from 27.12.2005), GINA 2011. The main group (n = 60) included children, who, in addition to basic therapy, received in addition interferon inducer (cycloferon) according to the scheme: 150 mg on 1-, 2-, 4-, 6- and 8-th day of therapy (No. 5) and then 150 mg after 72 hours. (No. 5) (1500 mg total). The comparison group included children (n = 60) who received only basic therapy, depending on the severity of the disease. The control group consisted of 25 healthy children. The level of serum interferon, virus-induced production of interferon-a (IFN-a), mitogen-stimulated production of interferon-g (IFN-g), the level of total serum IgE were determined by the enzyme-linked immunosorbent assay. The phagocytic activity of neutrophils (NG) was evaluated. The circulating immune complexes (CECs), immunoglobulins (Ig) A, M and G in serum were determined by the immunodiffusion reaction method. It was found that the additional use of cycloferon had a corrective effect on phagocytes, which led to an increase in the synthesis of IFN-a and IFN-g, a decrease in the severity of the allergic component due to the decrease in IgE and circulating immune complexes and a normalization of the synthesis of IgA, IgM, IgG with further development of long-term clinical remission of the disease.

Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression.

A recently published approach to paediatric asthma management neither recommended screening for nor suggested any management of hypothalamic-pituitary-adrenal axis suppression in asthmatic children treated with corticosteroids. The existing literature on this topic was therefore reviewed and the quality of the evidence assessed. Recommendations for diagnosis, screening and management are made utilising the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Can early intervention in pediatric asthma improve long-term outcomes? A question that needs an answer.

ObjectiveAlthough many children with asthma do not experience persistence into adulthood, recent studies have suggested that poorly controlled asthma in childhood may be associated with significant airflow obstruction in adulthood. However, data regarding disease progression are lacking, and clinicians are not yet able to predict the course of a child's asthma. The goal of this article was to assess the current understanding of childhood asthma treatment and progression and to highlight gaps in information that remain.Data SourcesNonsystematic PubMed literature search and authors’ expertise.Study SelectionArticles were selected at the authors’ discretion based on areas of interest in childhood asthma treatment and progression into adulthood.ResultsUncontrolled asthma in early childhood can potentially have lasting effects on lung development, but it is unclear whether traditional interventions in very young children preserve lung function. Although not all children respond to standard interventions, certain asthma phenotypes have been identified that can help to understand which children may respond to a particular treatment.ConclusionClinicians should monitor children's asthma control and pulmonary function over time to assess the long‐term impact of an intervention and to minimize the effect of uncontrolled asthma, especially exacerbations, on lung development. New biologic therapies have shown promise in treating adults with severe, uncontrolled asthma, and some of these therapies are approved in the United States for children as young as age 6. However, knowledge gaps regarding the efficacy and safety of these treatments in younger children hamper our understanding of their effect on long‐term outcomes.

Serum Levels of Trace Elements, Vitamin D and Oxidant Status in Children with Asthma

Purpose: The aim of this study was to detect serum levels of trace elements, vitamin D and oxidant status in asthmatic children and to understand whether these elements reduce the number of attacks or use them as supplementation.Methods: Fifty children with asthma and 50 healthy children were included in the study. We studied serum levels of vitamin D, selenium Se , manganese Mn , chromium Cr , chlorine Cl , iron Fe , calcium Ca , zinc Zn , sodium Na , magnesium Mg , potassium K , copper Cu , total antioxidant capacity TAS , total oxidative status TOS and oxidative stress index OSI in both group.Results: In asthmatic group, the serum level of Cr, Se, Zn and TAS levels were lower p=0.040, p=0.000, p=0.000, p=0.000 respectively and serum Cu, TOS and OSI levels were higher than controls p=0.000, p=0.000, p=0.000 respectively . Serum TAS level showed negative correlation with TOS, OSI, Fe, Cu, Mn, Se, Zn and positive correlation with Se and Vitamin D.Conclusion: The supplementation of Se, Zn and Cr may provide better control of attacks and can be use treatment of asthma in children and modulating plasma antioxidants may have a beneficial effect on asthma progression

Moderate-persistent asthma in children – omalizumab benefits. Case presentation

Asthma is the most common chronic illness of the child, a frequent cause of hospitalization and morbidity in pe­diatrics. Symptomatology control is the therapeutic target, and the practitioner has to adapt the treatment recommendations to each case, with its own clinical and evolutionary particularities. Omalizumab is a humanized anti-human immunoglobulin E (human IgG) recombinant monoclonal antibody used in the treatment of asthma in children over 12 years of age. The authors exemplify the benefit of omalizumab in the management of asthma by presenting a clinical case.

New perspectives of childhood asthma treatment with biologics.

Asthma is no longer considered as a single disease but rather as a syndrome corresponding to different entities and pathophysiologic pathways. A targeted strategy is part of personalized medicine which aims to better define each patient's phenotype and endotype so as to prescribe the most suitable treatment at an individual level. Omalizumab and, more recently, mepolizumab are the first biologics approved for children (6-18years). Omalizumab is now widely used to treat severe allergic asthma in children and is highly effective for asthma exacerbations and asthma control with a good safety profile. Moreover, several other drugs-lebrikizumab, dupilumab, tezepelumab, mepolizumab, reslizumab, benralizumab-are used or are being studied in both teenagers and adults and could benefit younger children in the near future. We hypothesize that defining the asthma phenotype/endotype regarding the type and intensity of inflammation, association with allergic or non-allergic comorbidities, and airway remodeling should contribute to the choice of a specific biologic. Pediatric specificities have to be addressed and validated by studies in children. Long-term effectiveness and particularly the impact on the natural history of asthma should also be investigated. Severe asthma in children is a complex disease, and patients have to be referred to a specialized pediatric asthma center to confirm diagnosis and initiate the best treatment strategy which could include biologics while taking into account their high cost.

Recent Evidence on the Use of Tiotropium Bromide in Pediatric Asthma: Summary Results of Eight Clinical Trials

Purpose of Review To collect the existing information on tiotropium as an add-on treatment for asthma in children and adolescents.

Asthma in Childhood: Current Perspectives on Diagnosis and Treatment

This narrative review aims to appraise the current perspectives on the diagnosis and treatment of asthma in childhood, with a focus on diagnostic steps, disease phenotypes and endotypes, and novel biologic therapies. Asthma in children and adults is now regarded as a complex cluster of disease phenotypes linked to specific endotypes. Unravelling asthma heterogeneity is key to understanding the pathogenic mechanisms of the disease and developing novel treatment strategies that are tailored according to these phenotypes and endotypes. This will make for a more precise diagnosis and more personalised treatments. There is currently no gold-standard method for making the diagnosis of asthma due to the non-specific nature of asthma symptoms; respiratory symptoms and airflow limitation need to be carefully evaluated to establish a causal relationship with the disease. Although corticosteroids and bronchodilators still constitute the recommended step-wise pharmacological based therapy in both childhood and adult asthma, novel biologic therapies targeting type 2 immunity have been proven effective in severe childhood and adult asthma and will likely lead to improved disease outcomes.

Long-acting muscarinic antagonists for the treatment of asthma in children — a new kid in town

Background Asthma is the most prevalent chronic airway disease observed in children and adolescents, yet the variety of treatment options available for this age group is limited. With many factors influencing therapeutic efficacy including patient knowledge, adherence, and therapy choice as well as delivery device, it is important to have more options to tailor to individual patient needs.

New possibilities for asthma therapy in children

This article discusses issues of clinical diagnosis and course of bronchial asthma in children. We discuss assessment of asthma severity and, accordingly, the extent of the step-by-step therapy according to updated recommendations (GINA 2018). Particular attention is paid to the possibility of improving the control of asthma with the help of the M-cholinolytic drug of long-acting tiotropium bromide, presented as a special inhalation form of tiotropium Respimat and registered in the Russian Federation for treatment of asthma in children of moderate and severe course from 6 years of age. Application tiotropium Respimat in children with insufficient control of asthma allows to improve lung function and asthma control.

Exploring Socio-Environmental Determinants of Pediatric Asthma Disparities in South Carolina

Treating childhood asthma symptoms through an emergency department (ED) visit is a major burden for both patients and healthcare systems. One opportunity that could improve understanding of risk and ultimately lead to improved public health strategies to reduce ED visits is a better understanding of socio-environmental determinants of disease. The objective of this research is to explore the spatial distribution of pediatric asthma ED visits across South Carolina in order to better understand geographic patterns of socio-environmental risks and disparities, and to support hypothesis generation for future epidemiologic study. To achieve, we map overall ED visit rates, the white/non-white ED visit rate ratio, and socio-environmental factors including median family income and point pollution sources by ZIP code tabulation area (ZCTA) in South Carolina for the period 2005-2015. Results show that elevated ED visit rates exist in rural areas, that low income areas generally coincide with high rate areas, and that there are relatively large statewide disparities between non-white and white residents. In summary, our results reveal striking disparities in the burden of asthma across South Carolina warranting further study.

Current State and Future of Biologic Therapies in the Treatment of Asthma in Children

There is increasing recognition of phenotypic variability in pediatric asthma, providing the opportunity for a more personalized approach to therapy. Increasingly biologic therapies, in particular those targeting the "allergic" (or T helper 2) pathway, are being considered for children with severe asthma. However, there is a great deal of variability in the extent these biologic therapies have been studied in children, as well as efficacy of results thus far. The goal of this article is to review the mechanism of action, efficacy, and potential predictive and monitoring biomarkers of the biologic medications focusing on the pediatric population, in an effort to establish a more personalized approach to asthma in the pediatric population for the 21st century.

Asthma treatment in children: A pragmatic approach

Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. Objectives. To provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children. Methods. The South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ . Conclusions. To ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.

Effect of whole course nursing intervention on atomizing treatment of asthma in children

目的 探讨全程护理干预用于小儿哮喘雾化治疗中的效果。 方法 选取接受雾化吸入治疗的哮喘患儿120例为研究对象，采用随机数字表法分为对照组60例、观察组60例，对照组采用常规护理方法进行干预，观察组采用全程护理进行干预，比较两组总有效率、治疗依从性、肺通气功能指标。 结果 观察组总有效率(95.00%)、治疗依从性(91.67%)均明显高于对照组的83.33%、76.67%(χ2＝4.227、5.065，均P<0.05)；治疗后，观察组1秒用力呼吸容积(FEV1)、FEV1与用力肺活量的比值(FEV1/FVC)分别为(2.89±0.79)L、(65.98±15.67)%，对照组分别为(1.45±0.47)L、(42.12±10.23)%，两组差异均有统计学意义(t＝6.056、6.565，均P<0.05)。 结论 在哮喘患儿的雾化吸入治疗中实施全程护理干预的护理效果显著，可有效提高患儿的治疗依从性，提高患儿的治疗效果，改善其肺通气功能。

Update on Interventions in Prevention and Treatment of Pediatric Asthma

Asthma represents a worldwide health problem with a strong morbidity and a major impact on the health care system. Multiple efforts have been made towards the development of new strategies for the prevention and treatment of this disorder. In the light of this the present review of the literature aimed at summarizing the latest advances in prevention and treatment of pediatric asthma with a focus on the most effective options of interventions during the first stages of life. References were identified by searches of PubMed. Search terms used in the search were "pediatric asthma", "treatment" and "prevention". We included only meta-analysis, randomized controlled trials, reviews and systematic review articles pertaining to humans and subjects aged 0-18 years. All the interventions have been classified as "non-pharmacological" and "pharmacological". Non-pharmacological interventions have been focused in identifying the genetic and environmental factors underlying the pathogenesis of this disease, including the individual genetic susceptibility, the early allergic sensitization, the role of the environmental microbiome and the exposure to infections and to pollutants. Moreover, the optimization of the existing pharmacological strategies and the development of new treatment options have improved markedly the management of this disease, thereby reducing the health care costs and ameliorating the quality of life of patients. Childhood asthma prevention and treatment still represents a worldwide challenge. Future efforts should be aimed at identifying high risk target populations, minimizing the costs of each policy of intervention and increasing adherence to treatment strategies.

Taming Asthma in School-Aged Children: A Comprehensive Review

Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity as measured by school absences, emergency department visits, and hospitalizations. Multiple factors play a role in the development, treatment and prevention of childhood asthma including racial/ethnic and socioeconomic disparities, both the home and school environments, and medication use. The goals of this review are to summarize these aspects of asthma in school-aged children and to present an updated review of medications as it relates to treatment strategies that will help in the care of these children. We conclude that phenotypic heterogeneity and appropriate environmental assessments and interventions are important considerations in the management of childhood asthma.