Predictors for failed dose reduction of inhaled corticosteroids in childhood asthma

Li, Albert M.; Tsang, Terence; Lam, Hugh Simon; Sung, Rita Yn Tz; Chang, Anne B.

doi:10.1111/j.1440-1843.2007.01222.x

Cited by 20 publications

(29 citation statements)

References 34 publications

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“…Some studies have demonstrated the possibility of steroid reduction in asthma 48,49 ; in some investigations, however, the clinical benefits were not sustained for long periods. [50][51][52][53] Although ICS reduction was quite high in the SCIT group, no worsening of the clinical features of the disease from baseline to the second year could be seen. Among the inclusion criteria to define asthma control, morning PEF had to be >80% of predicted normal on each day.…”

Section: Discussionmentioning

confidence: 89%

Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: A randomized controlled trial

Zielen

Kardos²,

Madonini

2010

Journal of Allergy and Clinical Immunology

145

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Section: Discussionmentioning

confidence: 89%

Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: A randomized controlled trial

Zielen

Kardos²,

Madonini

2010

Journal of Allergy and Clinical Immunology

145

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“…and induced sputum eosinophils ⩾2% had a sensitivity of 63.6% and a specificity of 75.7% for predicting failed reduction [109]. Eosinophils in induced sputum were significantly higher in children with stable asthma who experienced exacerbations on reducing ICSs [132]. In severe asthmatic children a tailored intervention based on sputum eosinophils did not significantly reduce overall asthma exacerbations or improve asthma control when compared with conventional management based on clinical symptoms and lung function [130].…”

Section: Sputum Analysismentioning

confidence: 90%

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

et al. 2015

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This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children.Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases. @ERSpublications Review on the role of lung function, measurement of BHR and airway inflammation in monitoring of children with asthma

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“…Percentage of eosinophils is the marker used most frequently in clinical studies. Elevated sputum eosinophils were reported to be predictive of failed ICS reduction and asthma exacerbations in mild-to-moderate asthma, but incorporating the control of sputum eosinophils into the management algorithm did not significantly reduce overall exacerbations or improve asthma control in severe asthma [25,159,160]. This may be due to the observation that sputum inflammatory phenotypes are not stable over time [161].…”

Section: Sputum Analysismentioning

confidence: 99%

Monitoring asthma in children

et al. 2015

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The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma.22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus.This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised.Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence. @ERSpublications ERS statement summarising and discussing the available literature on monitoring children with asthma

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Predictors for failed dose reduction of inhaled corticosteroids in childhood asthma

Abstract: Older boys with raised FeNO and sp-Eos are at higher risk of failure of reduction in their ICS dose. Monitoring airway inflammation in children with asthma using FeNO or sp-Eos is clinically useful in guiding ICS dose reduction in a non-Western outpatient setting.

Cited by 20 publications

References 34 publications

Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: A randomized controlled trial

Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: A randomized controlled trial

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

Monitoring asthma in children

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