Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults

Lougheed, M. Diane; Lemière, Catherine; Ducharme, Francine M; Licskai, Chris; Dell, Sharon; Rowe, Brian H.; FitzGerald, Mark; Leigh, Richard; Watson, Wade; Boulet, Louis‐Philippe

doi:10.1155/2012/635624

Cited by 263 publications

(268 citation statements)

References 116 publications

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“…Most paediatric trials tested montelukast as monotherapy [30]; few tested it as adjunct therapy [27]. In contrast, 72% of children in our trial used montelukast as adjunct therapy to ICS or ICS/LABA [1,3]. Furthermore, after the 2008 FDA-requested updated labels for montelukast, there was an increase in reporting of various neuropsychiatric ADRs in comparison with other ADRs for montelukast [31].…”

Section: Discussionmentioning

confidence: 86%

“…Children were eligible if they were aged 1-17 years; had a physician-confirmed diagnosis of asthma [1,19]; and made a clinic visit during which they were initiated on maintenance montelukast as monotherapy or as adjunct therapy to ICS or to ICS combined with LABA, providing that montelukast was the only new added medication. Patients were excluded if they denied having taken the medication of interest.…”

Section: Methodsmentioning

confidence: 99%

“…Intervention patients were initiated on daily montelukast as monotherapy or as adjunct to ICS, whereas control patients were initiated on ICS monotherapy, both at an ICS dose of ⩽250 μg·day −1 in hydrofluoroalkane-propelled beclomethasone or equivalent (where 1 µg of fluticasone=1 µg ciclesonide=2 µg dry powder budesonide) [1]. Neither group had been prescribed maintenance montelukast at any prior medical visit.…”

Section: Methodsmentioning

confidence: 99%

“…International guidelines recommend inhaled corticosteroids (ICS) as the preferred daily controller medication for children with asthma, with leukotriene receptor antagonists (LTRA) as second-line alternative [1][2][3]. Systemic adverse effects such as growth suppression and local effects including oropharyngeal candidiasis are well recognised in association with ICS [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice

et al. 2017

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@ERSpublicationsThe incidence of children on montelukast with drug cessation due to neuropsychiatric adverse events was >10% http://ow.ly/nCGG30bgjpd ABSTRACT Although montelukast is generally well tolerated, postmarketing studies have reported serious neuropsychiatric adverse drug reactions (ADRs) leading to a United States Food and Drug Administration black box warning. The objective of this study was to determine the incidence of neuropsychiatric ADRs leading to discontinuation of montelukast in asthmatic children.We conducted a retrospective cohort study in children aged 1-17 years initiated on montelukast. In a nested cohort study, children initiated on montelukast as monotherapy or adjunct therapy to inhaled corticosteroids (ICS) were matched to those initiated on ICS monotherapy. A non-leading parental interview served to ascertain the occurrence of any ADRs with any asthma medication, and circumstances related to, and evolution of, the event.Out of the 106 participants who initiated montelukast, most were male (58%), Caucasian (62%) with a median (interquartile range) age of 5 (3-8) years. The incidence (95% CI) of drug cessation due to neuropsychiatric ADRs was 16 (10-26)%, mostly occurring within 2 weeks. Most frequent ADRs were irritability, aggressiveness and sleep disturbances. The relative risk of neuropsychiatric ADRs associated with montelukast versus ICS was 12 (2-90).In the real-life setting, asthmatic children initiated on montelukast experienced a notable risk of neuropsychiatric ADRs leading to drug cessation, that is significantly higher than that associated with ICS.

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Section: Discussionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice

et al. 2017

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“…3 Use of spirometry is valued in most guidelines on approaches to and treatment of asthma. 3,4 Another functional test that is used for diagnosing asthma is measurement of airway responsiveness, i.e. the bronchial challenge test.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of spirometry for detection of asthma: a cross-sectional study

Meneghini

Paulino

Pereira³

et al. 2017

Sao Paulo Med. J.

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BACKGROUND: Asthma is a chronic inflammatory disease with airway hyperresponsiveness. Spirometry is the most commonly used test among asthmatic patients. Another functional test used for diagnosing asthma is the bronchial challenge test. The aim of this study was to analyze the accuracy of spirometry for detecting asthma in the general population. DESIGN AND SETTING: Cross-sectional study with data analysis to evaluate the accuracy of spirometry through calculating sensitivity, specificity and predictive values and through the kappa agreement test. METHODS: Subjects who constituted a birth cohort were enrolled at the age of 23 to 25 years. Spirometric abnormality was defined as reduced forced expiratory volume in one second, i.e. lower than 80% of the predicted value. Measurement of bronchial responsiveness was performed by means of the bronchial challenge test with methacholine. The gold-standard diagnosis of asthma was defined as the presence of bronchial hyperresponsiveness in association with respiratory symptoms. RESULTS: Asthma was detected in 200 subjects (10.4%) out of the sample of 1922 individuals. Spirometric abnormality was detected in 208 subjects (10.9%) of the sample. The specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%. The kappa test revealed weak agreement of 0.13 (95% confidence interval, CI: 0.07-0.19) between spirometry and the diagnosis of asthma. CONCLUSION: Spirometry, as a single test, has limitations for detecting asthma in the general population.

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Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma

Aaron

Vandemheen

FitzGerald

et al. 2017

JAMA

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379

306

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IMPORTANCE Although asthma is a chronic disease, the expected rate of spontaneous remissions of adult asthma and the stability of diagnosis are unknown. OBJECTIVE To determine whether a diagnosis of current asthma could be ruled out and asthma medications safely stopped in randomly selected adults with physician-diagnosed asthma. DESIGN, SETTING, AND PARTICIPANTS A prospective, multicenter cohort study was conducted in 10 Canadian cities from January 2012 to February 2016. Random digit dialing was used to recruit adult participants who reported a history of physician-diagnosed asthma established within the past 5 years. Participants using long-term oral steroids and participants unable to be tested using spirometry were excluded. Information from the diagnosing physician was obtained to determine how the diagnosis of asthma was originally made in the community. Of 1026 potential participants who fulfilled eligibility criteria during telephone screening, 701 (68.3%) agreed to enter into the study. All participants were assessed with home peak flow and symptom monitoring, spirometry, and serial bronchial challenge tests, and those participants using daily asthma medications had their medications gradually tapered off over 4 study visits. Participants in whom a diagnosis of current asthma was ultimately ruled out were followed up clinically with repeated bronchial challenge tests over 1 year. EXPOSURE Physician-diagnosed asthma established within the past 5 years. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of participants in whom a diagnosis of current asthma was ruled out, defined as participants who exhibited no evidence of acute worsening of asthma symptoms, reversible airflow obstruction, or bronchial hyperresponsiveness after having all asthma medications tapered off and after a study pulmonologist established an alternative diagnosis. Secondary outcomes included the proportion with asthma ruled out after 12 months and the proportion who underwent an appropriate initial diagnostic workup for asthma in the community. RESULTS Of 701 participants (mean [SD] age, 51 [16] years; 467 women [67%]), 613 completed the study and could be conclusively evaluated for a diagnosis of current asthma. Current asthma was ruled out in 203 of 613 study participants (33.1%; 95% CI, 29.4%-36.8%). Twelve participants (2.0%) were found to have serious cardiorespiratory conditions that had been previously misdiagnosed as asthma in the community. After an additional 12 months of follow-up, 181 participants (29.5%; 95% CI, 25.9%-33.1%) continued to exhibit no clinical or laboratory evidence of asthma. Participants in whom current asthma was ruled out, compared with those in whom it was confirmed, were less likely to have undergone testing for airflow limitation in the community at the time of initial diagnosis (43.8% vs 55.6%, respectively; absolute difference, 11.8%; 95% CI, 2.1%-21.5%). CONCLUSIONS AND RELEVANCE Among adults with physician-diagnosed asthma, a current diagnosis of asthma could not be established i...

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Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults

Cited by 263 publications

References 116 publications

Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice

Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice

Accuracy of spirometry for detection of asthma: a cross-sectional study

Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma

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