Assessment of Clinical Asthma Score and Asthma Severity Score in Preschool Children with Recurrent Wheezing

Objective: There is no definitive consensus on asthma exacerbation scoring for preschool children with recurrent wheezing. The Clinical Asthma Score (CAS) and Asthma Severity Score (ASS) are two scoring systems that can be used in this population. The aim of this study was to evaluate the relationship between CAS and ASS, acute treatment, and exacerbation outcomes in preschool children with wheezing. Materials and Methods: The study included 70 patients aged 2-5 years who presented to the pediatric emergency department due to an acute wheezing episode. CAS and ASS were evaluated at exacerbation presentation and after initial salbutamol therapy. Results: Presenting scores were significantly higher among patients who had three or more episodes within the last year (p=0.01 for CAS, p=0.019 for ASS). Presenting scores were significantly higher in patients treated with systemic steroid therapy during the episode compared to those who were not (p=0.006 for CAS; p=0.003 for ASS). CAS and ASS predicted the use of acute steroid therapy with a sensitivity of 73.7% and 52.6%, and predicted hospitalization with a sensitivity of 95% and 82.5%, respectively. Conclusion: Our data suggest that these scoring systems can be used to judge the need for systemic steroid therapy and that high scores are associated with greater likelihood of hospital admission. Keywords: Asthma score, children, hospitalization, wheezing, exacerbation

Association of Treated and Untreated Gastroesophageal Reflux Disease in the First Year of Life with the Subsequent Development of Asthma

Introduction: Gastroesophageal reflux disease (GERD) as well as its treatment with acid-suppressive medications have been considered possible risk factors for the development of asthma, but few studies have disentangled the role of GERD with that of its treatment. The present study aimed at estimating the association of treated and untreated GERD in the first year of life with the risk of asthma. Methods: Retrospective cohort study including all children born between 2004 and 2015 registered in Pedianet, an Italian primary care database. We analyzed the association of children exposed to GERD (both treated and untreated) in the first year of life with the risk of developing clinically assessed asthma (clinical asthma) after 3 years. Secondary outcomes included asthma identified by anti-asthmatic medications (treated asthma) and wheezing after 3 years. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated comparing children with and without GERD, stratifying by treatment with acid-suppressive medications. Results: Out of 86,381 children, 1652 (1.9%) were affected by GERD in the first year of life, of which 871 (53%) were treated with acid-suppressive medications. Compared with controls, children with GERD were at increased risk of clinical asthma (HR: 1.40, 95% CI 1.15–1.70). Risks were similar between treated and untreated GERD (p = 0.41). Comparable results were found for treated asthma, but no risk increase was seen for wheezing. Discussion: Early-life GERD was associated with subsequent childhood asthma. Similar risks among children with treated and untreated GERD suggest that acid-suppressive medications are unlikely to play a major role in the development asthma.

Review on Medicinal benefits of London Rocket or SisymbriumIrio in different contextual aspects

Several studies done throughout the world on ‘SisymbriumIrio L’, also known as ‘London Rocket’ or ‘Khakshi’ have established that this annual herb is of tremendous medicinal benefits. This review paper will focus on researches done using samples collected at widespread geographical range such as Jordan, Saudi Arabia, Kashmir, Rawalpindi, Lahore, Rajasthan, UK, Europe, Mediterranean Islands, North America, and Caucasia among others. Further, we will study various phytochemicals produced by aerial parts, seeds, and other partsofSisymbriumIrio L and their clinical uses which were discovered experimentally. Such as alkaloids of aerial parts for ‘Liver Disease’; flavonoids, steroids, and alkaloids in seeds as expectorant and stimulant for ‘Clinical Asthma’; histamine aerosol for protection against ‘Bronchospasm’; ethyl acetate, aqueous extracts, and butanol from other parts as potential ‘Nutraceutical Antioxidant’. Apart from these, there is the presence of various secondary metabolites such as flavonoids, triterpenoids or steroids, saponins, alkaloids, carbohydrates, and tannins, and the absence of Anthraquinones and cardiac glycosides which were found to be of ‘Chemotherapeutic Interest’. Hence we will analyze the overall effects of various phytochemicals produced from different parts of Sisymbriumirio L and further study the possibility to use this plant as a potential replacement for various commercially used Antibiotics.

Circulating miRNA expression in asthmatics is age-related and associated with clinical asthma parameters, respiratory function and systemic inflammation

Background The course of asthma may differ between elderly asthmatics (EA) and non-elderly asthmatics (nEA), which may be partially associated with an age-dependent aberrant immune response. The aim of the study was to determine the influence of serum miRNA expression on asthma characteristics and systemic inflammation markers in EA and nEA. Methods Control and severity of asthma, pulmonary function and FeNO were assessed in 28 EA and 31 nEA patients. The control group included 59 elderly and non-elderly healthy individuals. The expression of selected miRNAs in serum was measured with rt-PCR, and proinflammatory cytokine activity was assayed by ELISA or flow cytometry. Results No difference in serum miRNA expression was observed between the asthmatics and healthy controls. EA demonstrated lower expression of miRNA-106a and miRNA-126a than nEA (p = 0.003 and p = 0.02) and EC had lower expression of miRNA-146a, -126a, -106a and 19b than nEC (p = 0.001, p = 0.003, p = 0.005 and p < 0.001 respectively). Only nEA demonstrated a relationship between the expression of selected miRNAs and the level of asthma control (assessed with ACT) and with airway inflammation, measured by FeNO level. All patients with asthma demonstrated elevated TNFα, IL-6 and sTNF RI levels compared to controls (p = 0.026, p = 0.03 and p < 0.001 respectively). EA demonstrated a higher TNFα level than EC (p < 0.001), and EA had a higher level of sTNF RI than nEA (p < 0.001). A significant correlation was observed between serum levels of proinflammatory cytokines and selected miRNAs. Conclusion Serum miRNA expression was found to correlate with clinical characteristics of asthma and systemic inflammation in an age-dependent fashion, suggesting that miRNA may differentially contribute to asthma pathogenesis in elderly and non-elderly patients.

Study on the relationship between respiratory scores and hyponatremia in children with bronchiolitis

Background: Tal et al. severity score (TSS) and Modified Wood’s Clinical Asthma Score (M-WCAS) are used to evaluate the severity of the disease in children with bronchiolitis. It has recently been suggested that there is a relationship between bronchiolitis severity and hyponatremia. Aims and Objective: This study aimed to evaluate the relationship between both of scores and hyponatremia in children with bronchiolitis. Materials and Methods: This prospective observational study included 172 patients (age range: 1-24 months) admitted to the hospital with bronchiolitis diagnosis. Demographic and clinical features of patients were recorded, and the TSS and the M-WCAS were calculated. These values and their components were compared with serum sodium (Na) results obtained at hospital admission. Results: Of the 172 patients, 114 (66.3%) were male, and the mean age was 5.5 ± 4.6 months. The mean TSS and M-WCAS of the patients were 6.73±1.9, and 3.34±1.4, respectively. Hyponatremia (Na<135mEq/L) was detected in 30 (17.4%) patients. When the TSS and M-WCAS of patients with and without hyponatremia were compared, there was no statistically significant difference (p = 0.517; p = 0.662, respectively); however, there was a significant relationship between hyponatremia and low oxygen saturation levels (p= 0.026). Conclusion: No relationship was found between hyponatremia and TSS & M-WCAS. However, the relationship between hyponatremia and hipoxia suggests that hyponatremia is likely to increase with the severity of the disease.

EFFICACY OF SALBUTAMOL DELIVERED THROUGH A METERED DOSE INHALER & SPACER IN CHILDREN WITH ACUTE EXACERBATION OF ASTHMA

Objective: To assess efficacy of salbutamol delivered through metered dose inhaler (MDI) - spacer in paediatric patients with acute exacerbation of asthma. Study Design: Prospective observational study. Place and Duration of Study: Department of Paediatrics, Pakistan Naval Ship, Shifa Hospital, Karachi-Pakistan, from Jan to Dec 2018. Methodology: Ninety Five patients aged ≥6 to ≤12 years, with acute asthma exacerbation were enrolled. Any patient with fever, clinical asthma score (CAS) >7, on home treatment with drugs delivered through nebulization or on oral steroids was excluded. Clinical asthma score recorded on presentation, followed with salbutamol via Metered Dose Inhaler & spacer at dose of 400 µgm (4 x puffs of 100 µgm). Clinical asthma score rechecked after 20 min. Response to salbutamol was then compared in relation to the presenting Clinical asthma score. Results: Out of 95 children, 45 (47.9%) were male & 50 (52.1%) female with 67.4% having positive family history for asthma. Average premedication clinical asthma score was 2.44. Sixty nine (72.9%) patients had an adequate response as they exhibited clinical asthma score of 0 or fall in score of ≥2. Patients with adequate response had average clinical asthma score of 2.07 on presentation in contrast to 3.42 with inadequate response. Conclusion: Salbutamol delivered via Metered Dose Inhaler & spacer at dose of 400 µgm is an effective medication for quick relief in children with acute exacerbation of asthma. Moreover, its administration at a point where exacerbation is not much severe steers us towards more favourable outcome.

Characteristics and impact of exercise-induced laryngeal obstruction: an international perspective

BackgroundExercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathlessness and wheeze yet frequently misdiagnosed as asthma. Insight regarding the demographic characteristics, laryngeal abnormalities and impact of EILO are currently limited, with data only available from individual centre reports. The aim of this work was to provide a broader perspective from a collaboration between multiple international expert centres.MethodsFive geographically distinct clinical paediatric and adult centres (3 Denmark, 1 UK, 1 US) with an expertise in assessing unexplained exertional breathlessness completed database entry of key characteristic features for all cases referred with suspected EILO, over a 5-year period. All included cases completed clinical asthma work-up and continuous laryngoscopy during exercise (CLE) testing for EILO.ResultsData were available for 1007 individuals (n=713 female (71%)), median (range) age of 24 (8–76) years and of these 586 (58%) were diagnosed with EILO. In all centres, EILO was frequently misdiagnosed as asthma; on average there was a 2-year delay to diagnosis of EILO and current asthma medication was discontinued in 20%. Collapse at the supraglottic level was seen in 60% whereas vocal cord dysfunction (VCD) was only detected/visualised in 18%. Nearly half (45%) of individuals with EILO were active participants in recreational level sports, suggesting that EILO is not simply confined to competitive/elite athletes.ConclusionOur findings outline key clinical characteristics and the impact of EILO/VCD similar in globally distinct regions, facilitating improved awareness of this condition to enhance recognition and avoid erroneous asthma treatment.