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Challenges and choices in the pharmacological treatment of non-severe pediatric asthma: A commentary for the practicing physician.

ABSTRACT: In recent years, asthma research has focused intensely on the severe part of the disease spectrum, leading to new treatments, mostly therapeutic monoclonal antibodies. However, severe asthma accounts for not more than 2% of asthma in the pediatric population. Therefore, non-severe asthma remains a major health problem in children, not only for patients and parents but also for healthcare professionals such as general practitioners, pediatricians and allergists who take care of these patients. It is thus essential to identify and put in context novel concepts, applicable to the treatment of these patients. Recent evidence suggests benefits from using anti-inflammatory treatment even for the mildest cases, for whom until now only symptomatic bronchodilation was recommended. Likewise, "reliever" medication may be better combined with an inhaled corticosteroid (ICS). Among "new" treatments (for children), ICS formulation in ultrafine particles has showed promise and tiotropium is gaining access to the pediatric population. Maintenance and reliever therapy (MART) is an option for moderate disease. Most importantly, personalized response to medications appears to be considerable, therefore, it may need to be taken into account. Overall, these new options provide opportunities for multiple new management strategies. The deployment of such strategies in different populations remains to be evaluated.

SUBMITTER: Kalayci O

PROVIDER: S-EPMC6796770 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Challenges and choices in the pharmacological treatment of non-severe pediatric asthma: A commentary for the practicing physician.

Kalayci Omer O Abdelateef Hanan H Pozo Beltrán César Fireth CF El-Sayed Zeinab A ZA Gómez René Maximiliano RM Hossny Elham E Morais-Almeida Mário M Nieto Antonio A Phipatanakul Wanda W Pitrez Paulo P Wong Gary Wk GW Xepapadaki Paraskevi P Papadopoulos Nikolaos G NG

The World Allergy Organization journal 20190901 9

In recent years, asthma research has focused intensely on the severe part of the disease spectrum, leading to new treatments, mostly therapeutic monoclonal antibodies. However, severe asthma accounts for not more than 2% of asthma in the pediatric population. Therefore, non-severe asthma remains a major health problem in children, not only for patients and parents but also for healthcare professionals such as general practitioners, pediatricians and allergists who take care of these patients. It ...[more]

PMID: 31641403

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Project description:RationaleMore targeted management of severe acute pediatric asthma could improve clinical outcomes.ObjectivesTo identify distinct clinical phenotypes of severe acute pediatric asthma using variables obtained in the first 12 h of hospitalization.MethodsWe conducted a retrospective cohort study in a quaternary care children's hospital from 2014 to 2022. Encounters for children ages 2-18 years admitted to the hospital for asthma were included. We used consensus k means clustering with patient demographics, vital signs, diagnostics, and laboratory data obtained in the first 12 h of hospitalization.Measurements and main resultsThe study population included 683 encounters divided into derivation (80%) and validation (20%) sets, and two distinct clusters were identified. Compared to Cluster 1 in the derivation set, Cluster 2 encounters (177 [32%]) were older (11 years [8; 14] vs. 5 years [3; 8]; p < .01) and more commonly males (63% vs. 53%; p = .03) of Black race (51% vs. 40%; p = .03) with non-Hispanic ethnicity (96% vs. 84%; p < .01). Cluster 2 encounters had smaller improvements in vital signs at 12-h including percent change in heart rate (-1.7 [-11.7; 12.7] vs. -7.8 [-18.5; 1.7]; p < .01), and respiratory rate (0.0 [-20.0; 22.2] vs. -11.4 [-27.3; 9.0]; p < .01). Encounters in Cluster 2 had lower percentages of neutrophils (70.0 [55.0; 83.0] vs. 85.0 [77.0; 90.0]; p < .01) and higher percentages of lymphocytes (17.0 [8.0; 32.0] vs. 9.0 [5.3; 14.0]; p < .01). Cluster 2 encounters had higher rates of invasive mechanical ventilation (23% vs. 5%; p < .01), longer hospital length of stay (4.5 [2.6; 8.8] vs. 2.9 [2.0; 4.3]; p < .01), and a higher mortality rate (7.3% vs. 0.0%; p < .01). The predicted cluster assignments in the validation set shared the same ratio (~2:1), and many of the same characteristics.ConclusionsWe identified two clinical phenotypes of severe acute pediatric asthma which exhibited distinct clinical features and outcomes.

Dataset Information

Challenges and choices in the pharmacological treatment of non-severe pediatric asthma: A commentary for the practicing physician.

Publications

Challenges and choices in the pharmacological treatment of non-severe pediatric asthma: A commentary for the practicing physician.

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