Definition, assessment and treatment of wheezing disorders in preschool children: An evidence-based approach
Paul L. P. Brand,Eugenio Baraldi,Hans Bisgaard,A. L. Boner,Jose A. Castro-Rodriguez,Adnan Custovic,J. de Blic,J. C. de Jongste,Ernst Eber,M. L. Everard,Urs Frey,Monika Gappa,Luis Garcia-Marcos,Jonathan Grigg,Warren Lenney,P. N. Le Souëf,Sheila A. McKenzie,Peter J. F. M. Merkus,Fabio Midulla,James Y. Paton,Giorgio Piacentini,Petr Pohunek,G. A. Rossi,Paul Seddon,Michael Silverman,Peter D. Sly,Stephen M. Stick,Arunas Valiulis,W.M.C. van Aalderen,Johannes H. Wildhaber,Göran Wennergren,Nicola Wilson,Zorica Zivkovic,Andrew Bush +33 more
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TLDR
Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.Abstract:
There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.read more
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Uniform definition of asthma severity, control, and exacerbations: Document presented for the World Health Organization Consultation on Severe Asthma
Jean Bousquet,Jean Bousquet,Eva Mantzouranis,Alvaro A. Cruz,Nadia Aït-Khaled,Carlos E. Baena-Cagnani,Eugene R. Bleecker,Christopher E. Brightling,Peter Burney,Andrew Bush,William W. Busse,Thomas B. Casale,Moira Chan-Yeung,Rongchang Chen,Badrul A. Chowdhury,Kian Fan Chung,Ronald Dahl,Jeffrey M. Drazen,Leonardo M. Fabbri,Stephen T. Holgate,Francine Kauffmann,Tari Haahtela,Nikolai Khaltaev,James P. Kiley,Mohammad R. Masjedi,Yousser Mohammad,Paul M. O'Byrne,Martyn R Partridge,Klaus F. Rabe,Alkis Togias,Christiaan van Weel,Sally E. Wenzel,Nanshan Zhong,Torsten Zuberbier +33 more
TL;DR: Asthma is a global health problem affecting around 300 million individuals of all ages, ethnic groups and countries, and a common international approach is favored to define severe asthma, uncontrolled asthma, and when the 2 coincide, although adaptation may be required in accordance with local conditions.
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A summary of the new GINA strategy: a roadmap to asthma control.
Helen K. Reddel,Eric D. Bateman,Allan B. Becker,Louis-Philippe Boulet,Alvaro A. Cruz,Jeffrey M. Drazen,Tari Haahtela,Suzanne S. Hurd,Hiromasa Inoue,Johan C. de Jongste,Robert F. Lemanske,Mark L Levy,Paul M. O'Byrne,Pierluigi Paggiaro,Søren Pedersen,Emilio Pizzichini,Manuel Soto-Quiroz,Stanley J. Szefler,Gary W.K. Wong,J. Mark FitzGerald +19 more
TL;DR: The changes include a revised asthma definition, tools for assessing symptom control and risk factors for adverse outcomes, and updated strategies for adaptation and implementation of GINA recommendations.
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Respiratory Viral Infections in Infants: Causes, Clinical Symptoms, Virology, and Immunology
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Journal ArticleDOI
Respiratory syncytial virus and recurrent wheeze in healthy preterm infants.
Maarten O Blanken,Maroeska M. Rovers,Jorine M Molenaar,Pauline L Winkler-Seinstra,Adam Meijer,Jan L. L. Kimpen,Louis Bont +6 more
TL;DR: Findings implicate RSV infection as an important mechanism of recurrent wheeze during the first year of life in otherwise healthy preterm infants, even after the end of treatment.
Journal ArticleDOI
Glucocorticoids for acute viral bronchiolitis in infants and young children.
Ricardo M. Fernandes,Liza Bialy,Ben Vandermeer,Lisa Tjosvold,Amy C Plint,Hema Patel,David W. Johnson,Terry P. Klassen,Lisa Hartling +8 more
TL;DR: Current evidence does not support a clinically relevant effect of systemic or inhaled glucocorticoids on admissions or length of hospitalisation, but combined dexamethasone and epinephrine may reduce outpatient admissions, but results are exploratory and safety data limited.
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