Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper

Ducharme, Francine M; Dell, Sharon; Radhakrishnan, Dhenuka; Grad, Roland; Watson, Wade; Yang, Connie L.; Zelman, Mitchell

doi:10.1093/pch/20.7.353

Cited by 60 publications

(38 citation statements)

References 44 publications

(49 reference statements)

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“…This position statement applies to children (six years of age and over), adolescents (12 to 17 years), and adults (18 years of age and over) with asthma confirmed in accordance with published criteria, 5,6 and who meet the definition of 'severe asthma' outlined below.…”

Section: Target Populationmentioning

confidence: 69%

“…3 In addition there are accumulating data to suggest that uncontrolled asthma is highly prevalent in Canada. 4 While most uncontrolled asthma cases can be addressed with self-management education and pharmacologic strategies outlined in recent evidence-based guidelines, 5,6 a subset of individuals have severe asthma which remains poorly controlled despite these best practices. It should be noted that having severe asthma does not imply the presence of uncontrolled asthma.…”

Section: Introductionmentioning

confidence: 99%

“…Severe asthma accounts for only approximately 5 to 10% 5 of the population with asthma, yet it is responsible for up to 50% of direct asthma costs and likely a much higher burden if one considers indirect costs. 7 Recognition of the significant impact of severe asthma on individuals' quality of life 6 and its associated costs occurs at a time when we have much greater understanding of the pathophysiology of asthma, particularly that of severe asthma. Consequently, many new novel therapies 8 for severe asthma have emerged, some of which are currently available, with others in the late stage development.…”

Section: Introductionmentioning

confidence: 99%

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Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: While severe asthma affects approximately 5% of all individuals with asthma, this small minority of individuals accounts for a large proportion of the asthma-related costs. Greater understanding of the pathophysiology of asthma combined with the emergence of novel biologic therapies for severe asthma supported the need for a thorough review of the diagnosis, investigation, phenotyping, and management of severe asthma. OBJECTIVES: We aimed to propose a practical approach to distinguish uncontrolled asthma due to inadequate asthma management from severe asthma despite optimal asthma management. Moreover, based on emerging scientific evidence, we sought to provide guidance for characterizing individuals with severe asthma and considering a phenotype-specific management. We also aimed to review other novel new potential therapeutic approaches. METHODS: We systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert opinion, were agreed upon by unanimous consensus. MAIN RESULTS: We defined severe asthma and outlined its significant impact from the societal and patient perspectives. We outlined a practical approach to distinguish severe from uncontrolled but not severe asthma, based on stepwise investigation and management of potential reasons for uncontrolled asthma. After reviewing the current evidence we concluded that: 1) Several biomarkers (e.g. sputum or blood eosinophil count, total IgE, or FeNO) can help identify potential responders to new therapeutic options; 2) Tiotropium may be considered as an add-on therapy for individuals 12 years of age and over with severe asthma uncontrolled despite combination ICS/LABA therapy; 3) The chronic use of macrolides may decrease asthma exacerbations in individuals 18 years of age and over with severe asthma independent of their inflammatory profile; 4) Children aged 6 years and older and adults who are sensitized to at least one relevant perennial allergen and who remain poorly controlled asthmatics despite high dose ICS and a second controller can benefit from the addition of anti-IgE therapy to reduce asthma exacerbations; due to the known risk of side effects associated with high-dose ICS in children, omalizumab should also be considered in children and adolescents who repeatedly exacerbate or have poor control when therapy is stepped down from high-dose to moderate-dose ICS and at least one other controller; 5) Anti-IL5 therapies may be considered for adults 18 years of age and over with severe eosinophilic asthma who experience recurrent asthma exacerbations in spite of high doses of ICS in addition to at least one other controller; and 6) Although bronchial thermoplasty has shown a decrease in asthma exacerbations in one study, its role in the treatment of severe asthma remains uncertain. CONCLUSIONS: After reviewing existing and emerging therapies for severe asthma, we developed ke...

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Section: Target Populationmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

View full text Add to dashboard Cite

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“…Asthma remains uncontrolled in most patients in Canada and abroad leading to preventable impaired quality of life, acute care visits and a large economic burden. [1,2] National [3] and international guidelines [4][5][6] regular monitoring of asthma control, patient asthma education, use of written self-management, plans and daily asthma controller medication in individuals with persistent asthma. [3] Yet, only a minority of patients have received asthma education, own a self-management plan, or have benefited from spirometric testing.…”

Section: Introductionmentioning

confidence: 99%

“…[1,2] National [3] and international guidelines [4][5][6] regular monitoring of asthma control, patient asthma education, use of written self-management, plans and daily asthma controller medication in individuals with persistent asthma. [3] Yet, only a minority of patients have received asthma education, own a self-management plan, or have benefited from spirometric testing. [7,8] Patient management is clearly improved by a multidisciplinary team approach in the context of a chronic care model.…”

Section: Introductionmentioning

confidence: 99%

Physician agreement regarding the expansion of pharmacist professional activities in the management of patients with asthma

Tilly-Gratton

Lamontagne

Blais

et al. 2016

International Journal of Pharmacy Practice

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Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department

Schuh,

Coates,

Sweeney

et al. 2023

JAMA Netw Open

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ImportanceAlthough nasal suctioning is the most frequently used supportive management for bronchiolitis, its benefit remains unknown.ObjectiveTo evaluate the effectiveness of enhanced vs minimal nasal suctioning in treating infants with bronchiolitis after discharge from the emergency department (ED).Design, Setting, and ParticipantsThis single-blind, parallel-group, randomized clinical trial was conducted from March 6, 2020, to December 15, 2022, at 4 tertiary-care Canadian pediatric EDs. Participants included otherwise healthy infants aged 1 to 11 months with a diagnosis of bronchiolitis who were discharged home from the ED.InterventionsParticipants were randomized to minimal suctioning via bulb or enhanced suctioning via a battery-operated device before feeding for 72 hours.Main Outcomes and MeasuresThe primary outcome was additional resource use, a composite of unscheduled revisits for bronchiolitis or use of additional suctioning devices for feeding and/or breathing concerns. Secondary outcomes included health care utilization, feeding and sleeping adequacy, and satisfaction.ResultsOf 884 screened patients, 352 were excluded for criteria, 79 declined participation, 81 were otherwise excluded, 372 were randomized (185 to the minimal suction group and 187 to the enhanced suction group), and 367 (median [IQR] age, 4 [2-6] months; 221 boys [60.2%]) completed the trial (184 in the minimal suction and 183 in the enhanced suction group). Additional resource use occurred for 68 of 184 minimal suction participants (37.0%) vs 48 of 183 enhanced suction participants (26.2%) (absolute risk difference, 0.11; 95% CI, 0.01 to 0.20; P = .03). Unscheduled revisits occurred for 47 of 184 minimal suction participants (25.5%) vs 40 of 183 enhanced suction participants (21.9%) (absolute risk difference, 0.04; 95% CI, −0.05 to 0.12; P = .46). A total of 33 of 184 parents in the minimal suction group (17.9%) used additional suctioning devices vs 11 of 183 parents in the enhanced suction group (6.0%) (absolute risk difference, 0.12; 95% CI, 0.05 to 0.19; P &lt; .001). No significant between-group differences were observed for all bronchiolitis revisits (absolute risk difference, 0.07; 95% CI, −0.02 to 0.16; P = .15), ED revisits (absolute risk difference, 0.04; 95% CI, −0.03 to 0.12; P = .30), parental care satisfaction (absolute risk difference, −0.02; 95% CI, −0.10 to 0.06; P = .70), and changes from baseline to 72 hours in normal feeding (difference in differences, 0.03; 95% CI, −0.10 to 0.17; P = .62), normal sleeping (difference in differences, 0.05; 95% CI, −0.08 to 0.18; P = .47), or normal parental sleeping (difference in differences, 0.10; 95% CI, −0.02 to 0.23; P = .09). Parents in the minimal suction group were less satisfied with the assigned device (62 of 184 [33.7%]) than parents in the enhanced suction group (145 of 183 [79.2%]) (risk difference, 0.45; 95% CI, 0.36 to 0.54; P &lt; .001).Conclusions and RelevanceCompared with minimal suctioning, enhanced suctioning after ED discharge with bronchiolitis did not alter the disease course because there were no group differences in revisits or feeding and sleeping adequacy. Minimal suctioning resulted in higher use of nonassigned suctioning devices and lower parental satisfaction with the assigned device.Trial RegistrationClinicalTrials.gov Identifier: NCT03361371

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Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper

Cited by 60 publications

References 44 publications

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

Physician agreement regarding the expansion of pharmacist professional activities in the management of patients with asthma

Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department

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