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Clippings
Theme: Pediatric
Pulmonology and Sleep Medicine
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Ankit Parakh
Email:
[email protected]
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Tiotropium is efficacious in 6- to 17-year-olds with
asthma, independent of T2 phenotype. (J Allergy Clin Immunol
Pract. 2019;7:2286-95)
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Tiotropium is an anticholinergic drug that has shown to be efficacious
as an add-on controller for poorly controlled asthma at GINA step 4 and
5 in children 6 years of age and older. It is a non-biological step-up
used through inhalational route with a big cost advantage. The current
study explored whether the response to tiotropium was influenced by
patients’ type 2 status (assessed by serum IgE levels and blood
eosinophil counts). The results of this exploratory analysis show that
the improvement in lung function parameters (FEV1, FEF 25-75 and
FEV1/VC), risk of exacerbations and improvement in Asthma Control
Questionnaire were largely independent of systemic markers of T2
inflammation. This data can further expand the use of tiotropium in
children with poorly controlled asthma with a non-eosinophilic
phenotype.
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Subcutaneous mepolizumab in children aged 6 to
11 years with severe eosinophilic asthma (Pediatr
Pulmonol. 2019 Sep 9. [Epub ahead of print])
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Mepolizumab is a humanized monoclonal antibody that selectively blocks
the interleukin-5 (a signalling protein of the immune system). It is
approved for treatment of severe eosinophilic asthma in adults. This
multinational, non-randomized, open-label trial evaluated the
pharmacokinetics and pharmacodynamics of subcutaneous mepolizumab for
children 6 to 11 years of age with severe eosinophilic asthma (blood
eosinophil count
³150
cells/µL at screening or ³300
cells/µL <12 months of screening) and
³2 exacerbations in
the prior year. Mepolizumab was well tolerated; no new safety signals
were observed compared with previous adult/adolescent studies.
Mepolizumab (subcutaneous) 40 or 100 mg provided body weight-adjusted
drug exposure within two-fold of target adult exposure as well as marked
reductions to blood eosinophil counts similar to adults. Although this
trial was not designed to evaluate efficacy outcomes, it demonstrated a
positive clinical profile. Further efficacy trials would be required
before this drug can be used in clinical practice for children.
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EAACI Guidelines on Allergen Immunotherapy:
House dust mite-driven allergic asthma. (Allergy.
2019;74:855-73).
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Children with allergic asthma not adequately controlled on
pharmacotherapy (including biologics) represent an unmet health need.
Allergen immunotherapy (AIT) is underused in asthma, both in children
and in adults. The European Academy of Allergy and Clinical Immunology
clinical practice guideline provides an evidence-based recommendation
for the use of house dust mites AIT as add-on treatment for house dust
mite-driven allergic asthma. AIT with house dust mite sublingual
immunotherapy (SLIT) tablet has demonstrated a robust effect in adults
for critical end points (exacerbations, asthma control and safety).
Thus, it is recommended as an add-on to regular asthma therapy for
adults with controlled or partially controlled house dust mite-driven
allergic asthma. A randomized control trial is underway for children
with such asthma using house dust mite SLIT tablet. SLIT tablet is
recommended for adults and children, and SLIT drops are recommended for
children with controlled house dust mite-driven allergic asthma as the
add-on to regular asthma therapy to decrease symptoms and medication
needs. The evidence for this is although of low quality.
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Chronic cough and gastroesophageal reflux in
children: CHEST guideline and expert panel report (Chest.
2019;156:131-40)
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The current meta-analysis and Expert Panel evaluated whether
gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough
(>4 weeks) in children without underlying lung disease. The study also
evaluated what investigations and diagnostic criteria best determine
GERD as the cause of the cough, whether empirical treatment for GERD be
used for children with chronic cough with or without GER symptoms, and
what GER-based therapies should be used and for how long? The authors
could not find any trials on the investigative modality for GERD
diagnosis in children with chronic cough. The single meta-analysis (two
randomized controlled trials) showed no significant difference between
the groups (any intervention for GERD vs placebo for cough
resolution; OR 1.14; 95% CI 0.45-2.93; P=0.78). Proton pump
inhibitors (vs placebo) caused increased serious adverse events.
The panelists endorsed that: (i) treatment(s) for GERD should not
be used when there are no clinical features of GERD; and (ii)
pediatric GERD guidelines should be used to guide treatment and
investigations.
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Accuracy of high-speed video analysis to
diagnose primary ciliary dyskinesia (Chest.
2019;155:1008-17)
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Primary ciliary dyskinesia (PCD) remains underdiagnosed because of poor
awareness of the condition and poor availability of confirmatory tests.
European Respiratory Society (ERS) PCD diagnostic guidelines recommends
a combination of diagnostic tests. High-speeda video microscopy analysis
(HSVA) has been commonly used in the UK and has the advantage of giving
the results on the same day but the qualitative analyses are subjective.
The study aimed to establish the accuracy of HSVA to diagnose PCD
compared with a combination of tests, and to assess the interobserver
reliability of HSVA analysis across three UK PCD centers. HSVA had
excellent sensitivity and specificity to diagnose PCD: (i) 100%
and 96%, respectively, compared with ERS guidelines; and (ii) 96%
and 91% compared with diagnostic outcomes. There was high interobserver
agreement for "PCD-positive" outcomes (
k=0.7).
HSVA can be reliably used to counsel patients and commence treatment on
the day of testing while awaiting confirmatory investigations.
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