Paradigm Shift in Asthma Therapy for Adolescents Should It Apply to Younger Children as Well?

-
Source: JAMA Pediatrics Published online January 6, 2020

Background Knowledge


  1. GINA presented a significant change in asthma therapy.
  2. Step 1 recommendations for mild asthma in adolescents 12 years and older and adults changed from as-needed short-acting β-agonist (SABA) to as-needed low-dose inhaled corticosteroid (ICS) formoterol (a long-acting β-agonist [LABA]).
  3. In children aged 6 to 11 years, GINA recommends that ICS therapy be used with SABA as needed or regular ICS with as needed SABA as an alternative approach.

Why was it changed ?

It was because the SABA only had shown to increase mortality also various trials have shown superiority.

What were the trials?

SYGMA 1 and 2
NovelSTART studies

What is SYGMA1 and SYGMA2?

Both these trials had randomised adoslescents and adults into 3 groups
  1. Budesonide maintenance and as needed terbutaline
  2. Budesonide and formeterol as needed
  3. only as needed terbutaline
  4. Twice daily placebo in all groups
Conclusion:
Budesonide maintenance and Budesonide formeterol had same annualised exacerberation rate however dose of ICS was drastically low in AS needed ICS-formeterol group.

What is NovelSTART?

Similar randomisation as SYGMA

Similar results

BUT ONLY OLDER PATIENTS WERE ENROLLED.

➽2 randomised control trials are available for comparision of the use of combination ICS plus LABA or ICS plus SABA as maintenance and reliever therapy.
                                                                          ⤋
Exacerbations were significantly reduced in the single inhaler group (P < .001), with approximately one-half dose extra per day of combined budesonide-formoterol, with no effect on linear growth.

What is TREXA ( TREATING CHILDREN TO PREVENT EXACERBERATION OF ASTHMA) STUDY?

Study groups were:

Children aged 5 to 18 years with mild persistent asthma controlled receiving low-dose ICS were randomized to 1 of 4 treatment groups:
  1. twice daily beclomethasone with beclomethasone/albuterol (SABA) as reliever (combined group),
  2. twice-daily beclomethasone with placebo/albuterol as reliever (daily beclomethasone group),
  3. twice-daily placebo with beclomethasone/albuterol as reliever (rescue beclomethasone group), or
  4. twice-daily placebo with placebo/albuterol as rescue (placebo group)
Conclusion :
Significant increase in FEV1 in the placebo and rescue beclomethasone groups (P = .001 and P = .02, respectively).
There were increases in fractional exhaled nitric oxide in the rescue beclomethasone and placebo groups compared with the combined and daily beclomethasone groups.

What is INDIVIDUALISED THERAPY FOR ASTHMA IN TODDLERS(INFANT) 

THIS TRIAL Randomized 300 children aged 12 to 59 months requiring daily asthma controller therapy to
Daily ICS,
Daily leukotriene receptor antagonist, or
As-needed ICS with albuterol.
The group that did best with daily ICS therapy had increased eosinophils and/or allergic sensitization

Comments

Post a Comment

Popular posts from this blog

TURNER SYNDROME

-
Image
What is the other name of Turner Syndrome? Ullrich-Turner syndrome  What is the m/c sex chromosome disorder in female? Turner syndrome and occurs in approximately 1 in 2000 to 1 in 2500 live female births. What are the genotypes of Turner syndrome? 45X monosomy in 45% of cases  45X mosaicism with normal cell line in 15% cases  X chromosome anomalies like - Isochromosome, Ring chromosome, Xp or Xq deletion Y chromosome mosaicism in 10-12% cases. What gene is responsible for short stature in Turner syndrome? SHOX (short stature homeobox-containing gene on the X-chromosome) is associated with short stature in Turner syndrome and in Leri-Weill dyschondrosteosis. What gene is responsible for gonadal insufficiency in Turner syndrome? BMP15 (bone morphogenetic protein 15 (BMP15) on the short arm of the X chromosome (Xp)). What is the frequency of the 45X karyotype at conception? 3% approx, but  99% of these are spontaneously aborted, accounting for 5–10% of all abortuses. Mosaics are found to
Read more

HYPOTHYROIDISM CLINICAL FEATURES

-
Image
     1.       What are the clinical features of congenital hypothyroidism in a newborn? The clinical manifestations are commonly subtle in newborns with congenital hypothyroidism (CH).   Newborns with CH may be asymptomatic because of presence of maternal T 4 (which contributes to approximately one-third of circulating T 4 in a newborn) and residual functioning thyroid tissue.   FEATURES AT BIRTH   The classical symptoms of congenital hypothyroidism include ·          lethargy, ·          hoarse cry, ·          feeding difficulty, ·          constipation not responding to treatment, and increased somnolence.   The characteristic signs of CH include ·          Prolonged neonatal jaundice, ·          Macroglossia, ·          Umbilical hernia, ·          Wide posterior fontanelle, ·          Hypotonia, ·          Dry skin, ·          Head circumference may be slightly increased d/t myxedema of brain ·          Hypothermia. ·          Hirsute for
Read more

Congenital Hypertrophic Pyloric Stenosis

-
Image
What are the parts of pylorus? The incisura angularis divides the stomach into a body to the left and a pyloric portion to the right. The sulcus intermedius further divides the pyloric portion of the stomach: the pyloric vestibule to the left, denoted by an outward convexity of the greater curvature. The pyloric antrum or pyloric canal to the right The pyloric antrum is 2.5 cm and terminates in pyloric orifice into duodenum.   What happens to the normal anatomical structural in CHPS? In infants with IHPS, the pyloric ring is no longer identifiable as a clearly definable separation between the normally distensible pyloric antrum and the duodenal cap. Instead, a channel of variable length (1.5–2.0 cm) corresponding to the pyloric canal separates the normally distensible portion of the antrum from the duodenal cap. ·          Infantile hypertrophic pyloric stenosis  was first fully described by  Harald Hirschsprung  in 1888. ·          IHPS VS CHPS - ????? IHPS is would b
Read more