Trends in the age of diagnosis of childhood asthma

Radhakrishnan, Dhenuka; Dell, Sharon D.; Guttmann, Astrid; Shariff, Salimah Z.; Liu, Kuan; To, Teresa

doi:10.1016/j.jaci.2014.05.012

Cited by 76 publications

(45 citation statements)

References 19 publications

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“…Inhaled glucocorticoids are currently the first-line treatment for persistent asthma in both children and adults, with clear, demonstrated benefits to controlling asthma symptoms, improving quality of life, and reducing airway inflammation, hospitalizations, and asthma-related deaths [35]. The average age of an asthma diagnosis is 2.6 years [36]. Initiation of inhaled glucocorticoids at a young age has potential effects on bone accrual, peak bone mass and growth in addition to the cumulative lifetime effects of these medications.…”

Section: Skeletal Effects Of Inhaled Glucocorticoids In Pediatric Astmentioning

confidence: 99%

The Skeletal Effects of Inhaled Glucocorticoids

Sutter

Stein

2016

Curr Osteoporos Rep

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The skeletal effects of inhaled glucocorticoids are poorly understood. Children with asthma treated with inhaled glucocorticoids have lower growth velocity, bone density, and adult height. Studies of adults with asthma have reported variable effects on BMD, although prospective studies have demonstrated bone loss after initiation of inhaled glucocorticoids in premenopausal women. There is a dose response relationship between inhaled glucocorticoids and fracture risk in asthmatics; the risk of vertebral and non-vertebral fractures is greater in subjects treated with the highest doses in the majority of studies. Patients with COPD have lower BMD and higher fracture rates compared to controls, however, the majority of studies have not found an additional detrimental effect of inhaled glucocorticoids on bone. While the evidence is not conclusive, it supports using the lowest possible dose of inhaled glucocorticoids to treat patients with asthma and COPD and highlights the need for further research on this topic.

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Section: Skeletal Effects Of Inhaled Glucocorticoids In Pediatric Astmentioning

confidence: 99%

The Skeletal Effects of Inhaled Glucocorticoids

Sutter

Stein

2016

Curr Osteoporos Rep

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“…First, the burden of disease is greatest in preschoolers with a significantly higher proportion of emergency department (ED) visits, more hospitalizations, more sleep disturbances and more limitation of family activities/play, than older children [5, 6]. Secondly, the irreversible impairment in lung function may occur during the preschool period, suggesting a window of opportunity to perhaps prevent irreversible damage; [7] It is possible that the repeated and cumulative lung injury caused by various respiratory infections (e.g., rhinovirus, respiratory syncytial virus, etc.)…”

Section: Introductionmentioning

confidence: 99%

Treatment of asthma in young children: evidence-based recommendations

Castro-Rodriguez

Čustović

Ducharme

2016

asthma res and pract

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In the present review, we focus on evidence-based data for the use of inhaled corticosteroids (ICS), leukotriene receptor antagonist (LTRA), long-acting beta2-agonits (LABA) and oral corticosteroids (OCS), with a special emphasis on well-performed randomized clinical trials (RCTs) and meta-analyses of such trials for the chronic management of asthma/wheeze in infants and preschoolers. Results: Seven meta-analyses and 14 RCTs were reviewed. Daily ICS should be the preferred drug for infants/preschoolers with recurrent wheezing, especially in asthmatics. For those with moderate or severe episodes of EVW, the use of high intermittent ICS doses significantly reduce the use of OCS. There is no evidence of effect of intermittent ICS at low-moderate dose in preschoolers with mild EVW episodes. In preschoolers with asthma, there were no significant differences between daily vs. intermittent ICS in terms of asthma exacerbations with insufficient power to conclude to equivalence; however, for other asthma control outcomes, daily ICS works significantly better than intermittent ICS for older children. Daily ICS is superior to daily or intermittent LRTA for reducing symptoms, preventing exacerbations, and improving lung function. No RCTs testing combination therapy with ICS and LABA (or LTRA) were published in infant/preschoolers. Parent-initiation of OCS at the first sign of symptoms is not effective in children with recurrent wheezing episode. In terms of ICS safety, growth suppression is dose and molecule-dependent but it’s effect is not cumulative beyond the first year of therapy and may be associated with some catch-up growth while on or off therapy. Linear growth must be monitored as individual susceptibility to ICS drugs may vary considerably.

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“…Although the prevalence of respiratory allergies, such as allergic rhinitis and asthma, has reached a plateau or even declined [1] in many high-income regions, the rate a School of Paediatrics and Child Health, University of Western Australia, b Telethon Kids Institute, University of Western Australia and c International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), Perth, Australia of early-onset diseases such as food allergy and eczema are continuing to rise, in what we have described as 'a second wave' of the allergy epidemic [2]. The reasons for this are unclear, but suggest evolving environmental influences.…”

Section: Introductionmentioning

confidence: 99%