Uncontrolled Asthma In Children Research Articles

GAMBARAN STATUS KONTROL ASMA DAN KUALITAS HIDUP ANAK DENGAN ASMA DI RSUP PROF. DR. I.G.N.G NGOERAH DENPASAR DAN RSUD WANGAYA DENPASAR TAHUN 2020-2021

Asthma is a chronic and emergency disease in children. Uncontrolled asthma in children can affect the quality of life of children and even lead to death. Bali is the province with the third highest prevalence of asthma after the Special Region of Yogyakarta and East Kalimantan. However, data regarding the description of asthma control status and quality of life of children with asthma in Bali, especially in Denpasar, are still limited. Therefore, the authors want to know the overview of asthma control status and quality of life of children with asthma at Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar and Wangaya Hospital Denpasar in 2020-2021. The design of this research is descriptive observational with a cross-sectional approach. After the approval of the constitutional ethics committee, all children aged 6-11 years with asthma at the Outpatient and Inpatient Respirology Pediatric Clinic Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar and Wangaya Hospital Denpasar in 2020-2021 which is recorded in a complete medical record and has approval for participation in the study by parents/guardians (n=32) will be given a questionnaire containing the child and parent’s biodata, Childhood Asthma Control Test (C-ACT) to assess asthma control status, and Pediatric Quality of Life (PedsQL) to assess children's quality of life through an electronic form. Based on asthma control status, the results showed that 27 children (84.4%) had fully controlled asthma control status and 5 children (15.6%) had partially controlled asthma control status. In controlled asthma control status, all children were male. The majority of children (3 children) have poor nutritional status and some (2 children) have obese nutritional status. All children have a family history of asthma. Most of the children's parents have the latest education in college (3 children), senior high school (1 child), and elementary school (1 child). All parents of children have jobs and most of them (3 parents of children) have salaries above the minimum wage. Based on the quality of life, there were 4 children (12.5%) with a disturbed quality of life and 28 (87.5%) children with an undisturbed quality of life. In terms of quality of life, there were 2 children, male and female, respectively. The majority of these children had good nutritional status (2 children) and did not have a family history of asthma (3 children). The parents of the 2 children have the last education in elementary school, while the other 2 parents have the last education in college. All of the children's parents have jobs and the majority (3 parents of children) have salaries above the minimum wage. Further research is needed with a larger sample size and should be carried out prospectively so that the data obtained is more complete.

Childhood asthma complications, management, and environmental triggers

Childhood asthma, which is a chronic respiratory condition, presents challenges in terms of its complications, management, and identification of environmental triggers. This review of existing literature explores the complexities surrounding asthma. It delves into complications, strategies for managing the condition, and the crucial role that environmental factors play in worsening it. Uncontrolled asthma in children has far-reaching consequences as it affects lung function, physical activity levels, and overall quality of life. Early recognition and addressing of these complications are essential to minimize long-term effects. The management of childhood asthma has evolved to focus on treatment plans, with corticosteroids being a key component. For cases, advanced therapeutic options like biologics are available. Indoor and outdoor environmental triggers have an impact on asthma exacerbations, making targeted preventive measures necessary. Education plays a role by providing caregivers and children with asthma action plans as well as proper inhaler technique guidance. Regular follow-up visits ensure assessment and adjustment of treatment plans while fostering a relationship between healthcare providers and families. Comprehensive care for childhood asthma involves an approach that includes pediatricians, pulmonologists, allergists, and respiratory therapists. The triad of interventions, environmental modifications, and educational strategies forms an encompassing framework for the management of asthma. This review highlights how crucial it is to tackle childhood asthma issues. By doing so, we can improve outcomes. Promote the overall well-being of children who are affected by this condition.

Measuring PROMIS Asthma Impact cut point scores for identifying uncontrolled asthma in children

Measuring PROMIS Asthma Impact cut point scores for identifying uncontrolled asthma in children

A Comparative Analysis of Factors Affecting Uncontrolled Asthma among Paediatric Population in Urumqi vs Islamabad

The prevalence of paediatric asthma, a serious worldwide health issue, varies greatly across different geographical areas. Particularly striking contrasts have been found between Islamabad, Pakistan, and Urumqi, China, prompting a comparison of the underlying causes of uncontrolled asthma. Objective: To determine and evaluate the variables influencing uncontrolled asthma in children in the populations of Urumqi and Islamabad. Methods: A comparative cross-sectional study on children with uncontrolled asthma aged 3 to 18 years old was carried out in Urumqi, China, and Islamabad, Pakistan. Analysis of hospital data were used to evaluate the uncontrolled factors related to patient’s demographics, medical history, factors related to asthma control and living conditions and the environment. Results: In both cities, the study found important causes of uncontrolled asthma. Poor inhaler technique, raised BMI, environmental triggers such pollen allergies, poorly ventilated homes, and treatment non-compliance were also noted in both populations. In addition, the study indicated that uncontrolled asthma was present in 32% of paediatric patients in Urumqi and 56% of those in Islamabad for a variety of reasons. Conclusions: The results underscore the importance of context-specific interventions in managing paediatric asthma. Measures such as improving inhaler techniques, ensuring treatment compliance, healthy BMI and proper ventilation can significantly improve asthma control in paediatric populations of both Urumqi and Islamabad.

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.

Caregivers’ Self-Rated General Health, Physical and Mental Health Status, Disease Morbidity and Association with Uncontrolled Asthma in Children

This study examined the association between caregivers' self-rated general health, poor physical/mental health days, disease morbidity and asthma control in children from the United States with current asthma. The data analyzed for this study were obtained from 7522 children aged 0-17 years who participated in the 2012-2014, 2015-2017, 2018, and 2019 cycles of the Behavioral Risk Factor Surveillance System Asthma Call-back Survey (ACBS). We employed univariate analysis to describe the study population and weighted binary logistic regression to examine the association of predictors with asthma control. Approximately 50% of the children had uncontrolled asthma. The results show that caregivers who reported fair general health had a 61% higher likelihood of reporting uncontrolled asthma in their children compared to those who reported good/very good/excellent health (adjusted odds ratio [aOR] = 1.61; 95% confidence interval [CI], 1.14-2.26). Poor caregiver general health did not reach statistical significance in predicting uncontrolled asthma (aOR = 1.05, 95% CI, 0.62-1.75). Furthermore, having 1 to 14 poor physical/mental health days ([aOR] = 1.70; 95% CI, 1.28-2.227) and ≥15 poor physical/mental health days (aOR = 1.82, 95% CI, 1.31-2.53) was predictive of uncontrolled asthma in children. Additionally, endorsing one reported disease (aOR = 1.49, 95% CI, 1.15-1.93) and ≥2 diseases (aOR = 1.38, 95% CI, 1.08-1.78) was associated with uncontrolled child asthma. These findings underscore the association between caregivers' self-reported general health, poor mental/physical health days, disease morbidity and uncontrolled asthma among children from the U.S. with asthma. Pediatricians and child health practitioners should recall the importance of this relationship. To facilitate the identification of caregivers at risk and provide more comprehensive and effective care for children with asthma, healthcare practitioners should utilize every child asthma care encounter to inquire about the overall health of caregivers.

Uncontrolled Asthma Among Children and Its Association With Parents' Asthma Knowledge and Other Socioeconomic and Environmental Factors.

Objective To estimate the frequency of uncontrolled asthma among asthmatic children from Jeddah and to analyze its association with parental asthma knowledge and other socioeconomic and environmental factors. Method A cross-sectional study was conducted at the Pediatrics Departments of King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, from July to December 2018. It involved the caregivers of 150 children with asthma, who were following at KAUH.A structured questionnaire was administered by a phone interview to collect the following: socioeconomic and environmental factors of asthma, answers to the Arabic version of the Asthma Control TestTM(ACT), and answers to the Arabic version of the caregiver Asthma Knowledge questionnaire (AKq). Result The frequencyof uncontrolledasthma was 32.7% (95%CI:25.2 - 40.8). Parents had myths about asthma such as "children with asthma should use asthma control medications (inhaled corticosteroids) only when they have symptoms" and "it's not good for children to use the inhaler for too long". Besides, we observed mixed results regarding parents' knowledge about the disease, with correct answers ranging from 56.0% to 88.7% depending on the item. Exposure to bakhoor (aromatic woodchips) at home (OR = 0.41, p=0.044), two or more ICU admissions during the past 12 months (OR = 3.30, p=0.030), and using a rescue inhaler even if there's no cough or wheeze when the child gets the flu (OR = 0.22, p=0.001) were the three independent factors of uncontrolled asthma among children. Conclusion Uncontrolled asthma concerns one-third of the asthmatic children following at our centre, representing a less concerning figure compared to the national data. The contribution of parents' knowledge to asthma control did not show significant results, although uncontrolled asthma may represent an opportunity to increase parents' knowledge and awareness. We emphasize the significance of exposure to bakhoor, the use of oral steroids, and the number of ICU admission as strong indicators for uncontrolled asthma in children. An adaptive national strategy should be designed to enable effective and personalized interventions, resources, and objectives for maximized benefits.

External validation can provide the clinician with IOS equations that best predict the risk of uncontrolled asthma in their population.

Peripheral airway impairment (PAI) has been shown to have a close association to risk of uncontrolled asthma in children. However, clear methods have not been established for the clinician to select impulse oscillometry(IOS) reference equations best suited for their population. Our study aimed to develop a practical external validation analytic approach for the clinician to determine which of the available reference equations best predicts uncontrolled asthma for their patients. This is a post hoc analyses of data collected at baseline in a randomized controlled studythat occurred from March 2016 to 2018. The study population consisted of 227 children, ages 4-18 years, with moderate to severe asthma. Discrimination and calibration predictive performance of available and suitable IOS equations were assessed by using uncontrolled asthma as the criterion outcome. Discrimination statistics of accuracy, sensitivity, and specificity served as the primary performance indicators. Rank scores were determined by the number of acceptable limit thresholds met for these measures (≥60%, ≥50%, and ≥60%, respectively) across IOS metrics (R5, R5-R20, AX, and X5) resulting in a total possible score of 12. External validity assessment determined the rank order of best to worst equations as being Gochicoa-Rangel (rank score = 10) > Nowowiejska (rank score = 9) > Assumapcao (rank score = 6) > Amra (rank score = 2). Gochicoa-Rangel reference equations provided the best option for universal application with accuracy of 73.1%, 72.2%, 76.7%, and 66.2% for R5, R5-R20, AX, and X5, respectively. External validation, particularly discrimination in asthmatic children, offers the clinician a practical approach to selecting the most suitable predictive equations for their patients.

Evaluation of Asthma Control Assessment in School-Age Asthmatic Children

Asthma is the most common chronic disease among children. Some 235 million people worldwide suffer from this non-communicable disease but effective medicines are available that can control it. Asthma is said to be under-estimated and under diagnosed in tropical countries including Sudan. Several tools are useful for detecting uncontrolled asthma in children; however, childhood asthma control test is a validated tool for assessing asthma control in pediatric asthma. A cross sectional study conducted over a period of six months (March 2016- September 2016) covering all school age asthmatic children attending the Asthma Clinic in Ahmed Gassim Children Specialized Hospital and Mohammed Elamin Hamid Pediatric Hospital during the period of study. The aim of this study is to assess asthma control in school age asthmatic children at Khartoum using childhood asthma control test (C- ACT) and peak flow meter (PEFR) and to detect associated factors with impaired asthma control. Result: A total of (84) asthmatics children most of them on prophylactic medications, according to ACT were found to be controlled 35 (41.7%), partially controlled 26 (22.2%) and uncontrolled 27 (32.1%). The main triggers as in other countries are infections, environmental factors and exercise. Conclusion: In this study, we realized that none of the children of study group underwent any PEFR measurement in their asthma follow up and none of them has been assessed with ACT before. There was a high percentage of partially controlled and uncontrolled asthma in the selected group.

The Interrelationship Between Persistent Asthma and Atopy in Children

Background: Childhood asthma is mainly developed by an interplay between genetic and environmental factors. Atopic asthma has been regarded as the most common form of asthma in the pediatric age group. Therefore, we aimed to evaluate the role of atopy in inducing uncontrolled asthma in children. Materials and Methods: Seventy-five children between 1 to 14 years of age, referred to The Asthma and allergy clinics of Azad University hospitals for a period of one year because of wheezing and or chronic cough with a diagnosis of asthma were enrolled in this cross-sectional study. After scrutinizing the children’s medical history relevant to their asthmatic manifestations, they were evaluated with a skin prick test (SPT) for common aero and food allergens. Results: Thirty-five asthmatic children had positive SPTs with their mean age higher than those with negative skin test results (P≤0.0001). In those with positive SPTs, the symptoms recurred if the medications were discontinued within a month of symptom improvement (P=0.001). The same results were true considering the history of previous atopic disorders in response to the discontinuation of therapy (P<0.0001). Conclusion: To conclude, in most patients with negative skin tests, symptoms of asthma improved in less than a month from the initiation of appropriate therapies. However, in those with positive SPTs and a history of atopy, the symptoms recurred if the medications were discontinued within less than a month of symptom improvement (P=0.001 and P<0.0001, respectively).

Safety of ciclesonide in children with asthma: A review of randomized controlled trials.

Background: Parental concerns about the adverse effects of asthma medications can lead to nonadherence and uncontrolled asthma in children. Ciclesonide (CIC) is a prodrug, with low oropharyngeal deposition and bioavailability that may minimize the risk of local and systemic adverse effects. CIC is U.S. Food and Drug Administration approved for asthma in children ages ≥ 12 years. Objective: To summarize safety results from the 13 phase II or III randomized controlled trials conducted in children with asthma during CIC clinical development. Methods: Four 12- to 24-week trials compared the safety of once-daily CIC 40, 80, or 160 µg/day with placebo; four 12-week trials compared the safety of CIC 80 or 160 µg/day with either fluticasone or budesonide; one 12-month trial compared the long-term safety of CIC 40, 80, or 160 µg/day with fluticasone; one 12-month trial compared growth velocity of CIC 40 or 160 µg/day with placebo; and three cross-over trials compared short-term growth velocity and hypothalamic-pituitary-adrenal (HPA) axis effects of CIC 40, 80, or 160 µg/day with placebo or fluticasone. Results: In all, 4399 children were treated with CIC. The incidence of treatment-emergent adverse events (AE) was similar among the CIC doses and between CIC and placebo in short-term studies and between CIC and fluticasone in the long-term safety study. No CIC-related serious AEs were reported in any study. The incidence of treatment-related oral candidiasis was low and similar between CIC (≤0.5%) and placebo (≤0.7%) or active controls (≤0.5%) in the short-term studies. There was no clinically relevant HPA axis suppression or reduction in growth velocity associated with CIC. Conclusion: Data from 13 studies demonstrate that CIC is associated with low rates of oropharyngeal AEs, with no indication of clinically relevant systemic effects in children with asthma. The favorable safety profile and demonstrated improvements in asthma control make CIC an ideal inhaled corticosteroid for the treatment of asthma in children.

Biologics in the Treatment of Severe Uncontrolled Asthma in Children

Asthma is the most common chronic disease in children, currently affecting about 7 million children. Severe uncontrolled asthma is rare in children with a prevalence of about 2.1% to 5%, but inflicts a disproportionate health burden. Children with severe asthma have increased risk of life threatening exacerbations, frequent hospitalization, worsening health-related quality of life, and impaired physical activity. Severe asthma in childhood is associated with long-term morbidities, such as bronchiolitis obliterans, impaired airway development, and development of chronic obstructive pulmonary disease in adulthood. Childhood asthma like adult-onset asthma, is classified into four cellular inflammatory phenotypes using induced sputum cytometry. The four phenotypes of asthma include eosinophilic asthma, neutrophilic asthma, paucigranulocytic asthma, and mixed cellularity asthma. The pathophysiological mechanisms of asthma involve airway inflammation and remodeling. Inflammatory mediators such as cytokines, chemokines, adhesion molecules, and growth factors play a key role in orchestration airway remodeling. During airway inflammation, cytokines secreted by type 2 helper (Th2) lymphocytes, such as interleukin-5 (IL-5), IL-4, IL-13, IL-25, IL-33, and thymic stromal lymphopoietin (TSLP) play a key role in the pathogenesis of eosinophilic asthma. Whereas, the Th17 axis cytokines, including IL-17, IL-23, and IL-8 are responsible for the pathophysiology of neutrophilic asthma. The airway structural changes due to airway remodeling lead to thickening of the airway wall, narrowing of the bronchiolar lumen, airway obstruction, and decline in pulmonary function. Most of the children with asthma respond to low and medium inhaled corticosteroids, however a significant proportion still have severe asthma uncontrolled on the standard of care. The most common asthma phenotype in children is eosinophilic asthma, which responds superbly to biologic therapy. Children with severe asthma require add-on targeted interleukin antagonists (ILA), such as mepolizumab (anti-IL-5), benralizumab (anti-IL-5Rα), and dupilumab (anti-4Rα). ILAs have been shown to ameliorate asthma symptoms, reduce moderate and severe exacerbations, and improve pulmonary function. Additionally, ILAs have been demonstrated to improve the health-related quality of life, and have steroid sparing effect.

Characteristics of Asthma Patients and Risk Factors of Uncontrolled Asthma in Children

Objective: To identify factors associated with baseline severity and control of asthma in pediatric patients. Materials and Methods: The medical records of 279 newly diagnosed patients with asthma aged younger than 15 years and that visited Taksin Hospital in Bangkok were reviewed. Demographic and clinical characteristics at first diagnosis and three months after treatment were collected. Medication and treatment compliance were recorded. Asthma control status was classified according to the Global Initiative for Asthma (GINA) guideline. Factors associated with baseline severity and levels of control were determined. Results: Among the 279 pediatric patients with asthma, 48 (17.6%) were severe asthma at time of diagnoses. Patient’s comorbidities, including acute rhinosinusitis, a family history of atopy, and a history of preterm birth, were significantly associated with severe asthma at baseline. Asthma severity can be assessed retrospectively from the level of treatment required to control symptom and exacerbation according to the GINA. At the 3-month visit, 105 (37.6%) patients had uncontrolled asthma. Factors associated with uncontrolled asthma included severe asthma at baseline (RR 4.86, 95% CI 2.96 to 7.99), a family history of atopy (RR 1.54, 95% CI 1.12 to 2.12), acute rhinosinusitis and snoring (RR 1.54, 95% CI 1.09 to 2.17), severe allergic rhinitis (RR 2.32, 95% CI 1.78 to 3.04), poor compliance (RR 4.66, 95% CI 3.36 to 6.45), and aggravated factors (RR 3.88, 95% CI 3.05 to 4.92). Environmental factors, such as owning pets and environmental tobacco smoke, were not associated with asthma control. Conclusion: Good treatment compliance for asthma and other comorbidities are important for well-controlled asthma. Keywords: Uncontrolled asthma, Pediatric asthma, Asthma severity, Treatment compliance, Asthma control

Parental attitude and knowledge towards asthma care measures for their children in Saudi Arabia.

Appropriate asthma management in children reduces emergency department visits, hospitalization, and improves the quality of life. We aim to assess the level of children asthma control and its association with parental knowledge. A prospective study conducted to measure childhood asthma control with a validated childhood asthma control test (C-ACT), and to assess asthma knowledge among the parents of children aged 4-11 years and their parents upon asthma clinic visits. C-ACT score ≤ 19 is considered as uncontrolled child asthma. We have invited 238 parents to participate in the study; 177 (74.4%) completed the survey. The mean age of the parents and their children were 38.8 ± 7.6and 7.8 ± 2.7 years, respectively; 28.2% of parents were smokers, and 46.3% of them were college graduated. Nearly 61.6% of the parents and children scored ≤ 19 on C-ACT; 54.2% and 37.9% of parents knew how inhaled salbutamol and corticosteroids work, respectively. A quarter of the parents received an asthma action plan. Multinomial logistic regression analysis showed that parents who did not know their children's medications name (OR, 6.1; 95% CI, 2.15-17.29), and when to use inhaled corticosteroid (OR, 2.1; 95% CI, 1.32-3.45) were independent factors predicting uncontrolled asthma in children with score ≤ 19. The study indicated that there is an association between poor asthma control (scored ≤ 19 on C-ACT) and parental knowledge of asthma medications. The parents should be educated thoroughly on asthma care, including medications used to minimize asthma exacerbations in their children.

Formative Evaluation for Implementation of a Low Literacy Pictorial Asthma Action Plan Delivered via Telehealth Improves Asthma Control.

Consistently uncontrolled asthma in children is an increasing concern in the United States. The use of asthma action plans with asthma education is inconsistent and may be improved with adaptations for low literacy. The objective of this study was formative evaluation for implementation of the New Mexico Pictorial Asthma Action Plan (NM PicAAP). Quality improvement processes guided NM PicAAP face validation and telehealth direct patient care implementation. The asthma control test was selected to measure asthma control. NM PicAAP was revised for face validity, and training curriculum on its use and telehealth implementation processes were developed. Seven youth received NM PicAAP via telehealth direct care, which increased overall asthma control scores over 1 month. NM PicAAP may be useful and effective for improving asthma care in children via telehealth. Additional testing is needed to assess applicability.

Severe uncontrolled asthma in children: practical approach on diagnosis and management.

Severe uncontrolled asthma in children is a complex and heterogeneous disease and is considered a challenge for the pediatricians. Although nearly 5% of children with asthma present with a severe uncontrolled disease, these patients and their caregivers face a significant burden, including troublesome persistent symptoms, life-threatening acute attacks, medication side effects, impaired school performance, neuropsychological problems, and lower quality of life (QoL). Moreover, these patients also account for substantially higher healthcare resource use and costs than average patients with asthma. Thus, it is essential to accurately define and diagnose severe asthma in children as they potentially need close monitoring and additional treatment with advanced therapies. This review aims to update knowledge on diagnosis and management of severe uncontrolled asthma in childhood. We describe a practical approach to differentiate children with difficult-to-treat asthma from those with true severe therapy-resistant asthma. Moreover, the recent advances in the understanding of the pathogenetic mechanisms and inflammatory mediators involved in asthma have paved the way for the development of a precision medicine approach. In this context, we analyze approved personalized therapies for severe uncontrolled asthma, focusing on the pediatric indications.

Prevalence and Predictors of Uncontrolled Asthma in Children Referred for Asthma and Other Atopic Diseases.

BackgroundUncontrolled asthma in children is still highly prevalent despite the availability of effective asthma treatment. We investigated 1) the prevalence of uncontrolled asthma among children referred for asthma and referred for atopic diseases other than asthma (ie food allergy, allergic rhinitis or atopic dermatitis) to secondary care; and 2) the predictors associated with uncontrolled asthma.MethodsAll children (4 to 18 years) referred for asthma or atopic diseases other than asthma to 8 secondary care centers in The Netherlands were invited to an electronic portal (EP). The EP is a web-based application with several validated questionnaires including the ISAAC questionnaires and the Asthma Control Test (ACT). Children were eligible for inclusion in this study when their parents reported in the EP that their child had asthma diagnosed by a physician. The ACT was used to assess asthma control. Multiple predictors of asthma control (patient, asthma and atopic characteristics) were evaluated by univariable and multivariable logistic regression analyses.ResultsWe included 408 children: 259 children (63%) with asthma referred for asthma and 149 children (37%) with asthma referred for atopic diseases other than asthma. Thirty-nine percent of all children had uncontrolled asthma: 47% of the children referred for asthma and 26% of the children referred for atopic diseases other than asthma. Predictors associated with uncontrolled asthma were a family history of asthma (odds ratio [OR] 2.08; 95% confidence interval [95% CI] 1.34 to 3.24), and recurrent upper and lower respiratory tract infections in the past year (OR 2.40; 95% CI 1.52 to 3.81 and OR 2.00; 95% CI 1.25 to 3.23, respectively).ConclusionUncontrolled asthma is highly prevalent in children with asthma referred to secondary care, even if children are primarily referred for atopic diseases other than asthma. Thus, attention should be paid to asthma control in this population.

Clinical efficacy and safety of anticholinergic therapies in pediatric patients.

The burden of uncontrolled asthma in children and adolescents is high. Treatment options for pediatric patients (aged under 18 years) with asthma are largely influenced by the Global Initiative for Asthma recommendations. Algorithms for adolescents (12–18 years) and adults are identical, but recommendations for children aged under 6 years and 6–11 years differ. Although the goals of treatment for pediatric patients with asthma are similar to those for adults, relatively few new therapies have been approved for this patient population within the last decade. Designing clinical trials involving children presents several challenges, notably that children are often less able to perform lung function tests, and traditional endpoints used in clinical trials with adults, such as forced expiratory volume in 1 second, asthma exacerbations and questionnaires, have limitations associated with their use in children. There are also ethical considerations related to the performance of longer placebo-controlled exacerbation trials. This review considers additional clinical endpoints to those traditionally reported, including forced expiratory flow at 25%–75% of forced vital capacity, which may help shed light on which treatments are most effective for use in pediatric patients with asthma. The pros and cons of specific and potentially clinically relevant endpoints are considered, along with device considerations and patient preferences that may enhance adherence and quality of life. Recent advances in the management of children and adolescents, including the US Food and Drug Administration and European Medicines Agency approval of tiotropium in patients with asthma aged 6 years and over, are also discussed.

Comparative Effectiveness of Step-up Therapies in Children With Asthma Prescribed Inhaled Corticosteroids: A Historical Cohort Study

CS Murray. M Thomas. K Richardson. DB Price. SW Turner. J Allergy Clin Immunol Pract. 2017;5(4):1082–1090.e7 Current guidelines offer a number of different choices for step-up treatment of uncontrolled asthma in children on low-dose inhaled corticosteroids (ICSs). In this study, the authors compared the relative effectiveness of step-up treatment to fixed-dose combination (FDC) ICSs and long-acting β2-agonists as opposed to an increased dose of inhaled corticosteroids (i-ICSs) or adding a leukotriene receptor antagonist (LTRA). This matched cohort study included children with uncontrolled persistent asthma aged 5 to 12 years from 2 UK primary-care databases who were receiving …

Difficult vs. Severe Asthma: Definition and Limits of Asthma Control in the Pediatric Population.

Evaluating the degree of disease control is pivotal when assessing a patient with asthma. Asthma control is defined as the degree to which manifestations of the disease are reduced or removed by therapy. Two domains of asthma control are identified in the guidelines: symptom control and future risk of poor asthma outcomes, including asthma attacks, accelerated decline in lung function, or treatment-related side effects. Over the past decade, the definition and the tools of asthma control have been substantially implemented so that the majority of children with asthma have their disease well controlled with standard therapies. However, a small subset of asthmatic children still requires maximal therapy to achieve or maintain symptom control and experience considerable morbidity. Childhood uncontrolled asthma is a heterogeneous group and represents a clinical and therapeutic challenge requiring a multidisciplinary systematic assessment. The identification of the factors that may contribute to the gain or loss of control in asthma is essential in differentiating children with difficult-to-treat asthma from those with severe asthma that is resistant to traditional therapies. The aim of this review is to focus on current concept of asthma control, describing monitoring tools currently used to assess asthma control in clinical practice and research, and evaluating comorbidities and modifiable and non-modifiable factors associated with uncontrolled asthma in children, with particular reference to severe asthma.