Test for respiratory and asthma control in preschool kids in the emergency department as a predictor of wheezing exacerbations
Maya Harel‐SterlingRuixue DaiTheo J. MoraesKathy BoutisThomas EiweggerIndra NarangC LépineMay BrydgesAimée DubeauPadmaja SubbaraoSuzanne Schuh
3
Citation
43
Reference
10
Related Paper
Citation Trend
Abstract:
Abstract Objective The test for respiratory and asthma control in kids (TRACK score) is a standardized questionnaire tool validated to identify poor symptom control in children with stable preschool wheeze. This study determined if TRACK score measured within 5 days of an Emergency Department (ED) visit for acute wheezing predicts a subsequent wheezing exacerbation requiring an ED visit and/or treatment with systemic corticosteroids within 3 months. Methods This was a single‐center prospective cohort study of children aged 36 to 71 months who presented to the ED with an acute episode of wheezing and had TRACK score measured at a clinic visit within 5 days of the index ED encounter, focused on information about symptoms occurring before the onset of the current acute episode. The outcomes were the independent association of a repeat wheezing exacerbation with the overall TRACK score (primary) and with mutually uncorrelated TRACK items (secondary), adjusted for sex and atopy. Results We enrolled 102 children; median age 52.3 (44.1, 59.9) months, 59% males. Of these, 33 (32.4%) had further wheezing exacerbations. For each 10 unit decrease in TRACK, the odds of a future exacerbation was 1.38 (95% CI, 1.10‐1.75); male sex demonstrated OR, 5.13 (1.84‐14.33). A model that included TRACK items reflecting more than equal to 1 awakenings for wheezing in the past 4 weeks, receipt of more than equal to 2 courses of corticosteroids in the last year and male sex was predictive of wheezing exacerbations: OR, 6.43 (2.18‐19.00). Conclusion In preschoolers with acute wheezing episodes in the ED, we have identified the TRACK score components which, together with male sex, can be used to identify children at risk of future exacerbations requiring referral for specialized care. These results need to be confirmed and validated in other populations enrolled at multiple sites before they can be implemented in practice.Keywords:
Wheeze
Asthma Exacerbations
Respiratory sounds
Asthma accounts for 1 out of every 250 deaths worldwide. Many of these deaths are preventable as they occur as a result of suboptimal long-term medical care and delay in seeking help during severe exacerbation. It is believed that increased concentrations of dust, high winds, low temperatures, and low humidity may cause exacerbation of asthma.The aim of this study is to assess seasonal variation in asthma exacerbation among patients attending Usmanu Danfodiyo University Teaching Hospital, Sokoto.Eighty-seven patients aged 16 years and above with physician-diagnosed asthma were selected by systematic random sampling. Clinical information was obtained from each participant about history of asthma exacerbation and health-care utilization. Meteorological data were obtained from the Nigerian Meteorological Agency corresponding to period of patient's recruitment.Eighty-seven patients comprising 60 females and 27 males aged 32.1 ± 10.8 years participated in the study. Among the study participants, 50.6%, 28.7%, and 20.7% had exacerbation during harmattan, rainy, and dry (hot) seasons, respectively. Correlation analysis shows a significant negative relationship between temperature and asthma exacerbation (r = -0.372, P < 0.01).This study shows that asthma exacerbation is most frequent during the harmattan season and low temperature is associated with its exacerbation.RésuméContexte: L'asthme est responsable de 1 décès sur 250 dans le monde. Beaucoup de ces décès sont évitables car ils surviennent à la suite de soins médicaux à long terme sous-optimaux et retard dans la recherche d'aide en cas d'exacerbation grave. On pense que l'augmentation des concentrations de poussière, les vents, les basses températures et une faible humidité peuvent provoquer une exacerbation de l'asthme. Objectif: Le but de cette étude est d'évaluer la variation saisonnière exacerbation de l'asthme chez les patients fréquentant l'hôpital universitaire Usmanu Danfodiyo, Sokoto. Matériel et méthodes: quatre-vingt-sept les patients âgés de 16 ans et plus souffrant d'asthme diagnostiqué par un médecin ont été sélectionnés par échantillonnage aléatoire systématique. L'information clinique était obtenu de chaque participant sur les antécédents d'exacerbation de l'asthme et l'utilisation des soins de santé. Les données météorologiques ont été obtenues à partir du Agence météorologique nigériane correspondant à la période de recrutement des patients. Résultats: quatre-vingt-sept patients dont 60 femmes et 27 hommes âgés de 32,1 ± 10,8 ans ont participé à l'étude. Parmi les participants à l'étude, 50,6%, 28,7% et 20,7% ont eu une exacerbation pendant les saisons harmattan, pluvieuse et sèche (chaude), respectivement. L'analyse de corrélation montre une relation négative significative entre la température et exacerbation de l'asthme (r = −0,372, p <0,01). Conclusion: Cette étude montre que l'exacerbation de l'asthme est la plus fréquente pendant l'harmattan la saison et les basses températures sont associées à son exacerbation. Mots-clés: asthme, exacerbation, saison.
Asthma Exacerbations
Cite
Citations (3)
Summary Background A predisposition to exacerbations is being recognized as a distinct phenotype with “previous exacerbations” representing the strongest clinical factor associated with future exacerbation. Thus, to identify additional novel biomarkers associated with asthma exacerbations, “past exacerbation status” must be included as a confounding factor. Objective This study aimed to characterize the clinical and biomarker features associated with asthma exacerbations in severe asthma. Methods We evaluated clinical parameters from 105 severe asthmatics yearly for 3 years, as well as their exacerbation status. We classified the subjects into 3 groups: (i) consistent non‐exacerbators ( CNE , subjects who did not experience any exacerbation over the 3‐year period); (ii) consistent frequent exacerbators ( CFE , subjects with frequent exacerbation, defined as those who had 2 or more exacerbations within 1 year, throughout the 3‐year period); and (iii) intermittent exacerbators ( IE ). We conducted multivariate analysis for comparisons among the groups for multiple factors, including several Th2‐related biomarkers, in addition to the “past exacerbation status.” Results Thirty‐nine subjects were classified as CNE , 15 as CFE , and 51 as IE . Frequent exacerbations in the previous year predicted exacerbations for the following year ( P < .001). Among the several Th2‐related biomarkers, only Fe NO was associated with exacerbation status. When we analysed the data after the second visit, the impact of Fe NO on predicting future exacerbation remained significant, even after considering the exacerbation status during the first year ( P < .05). Conclusions and Clinical Relevance Measurement of Fe NO has a significant potential to predict future asthma exacerbation, which is independent of the “past exacerbation history.”
Asthma Exacerbations
Cite
Citations (54)
Objective To explore the relationship of rhinovirus(RV)with asthma exacerbation in children.Method To detect the RV frequently irritate acute respiratory tract infection in children in72cases with asthma exacerbation by reverse tran-scription-PCR(RT-PCR).Results Evidence of RV were obtained in29cases(27.8%)of the group of asthma exacerbation,in the group of 3years,27cases were found positive(51.9%),a significant difference was found in the two groups of different ages.Conclusion27.8%of the asthma attacks in children were precipitated by acute RV infections,the ratio in3years was51.9%,RV was the most common agent in asthma exacerbation of 3years.
Rhinovirus
Asthma Exacerbations
Respiratory tract
Cite
Citations (0)
Asthma is one of the most common chronic diseases in children and adults. Cocaine is associated with asthma exacerbations. In Denmark, the prevalence of cocaine use has been increasing in recent years. This is a case report of a 47-year-old male with acute asthma exacerbation after cocaine use. Cocaine use is probably an underestimated reason for acute asthma exacerbations.
Asthma Exacerbations
Cite
Citations (0)
Over 20 years ago, the concept of asthma control was created and appropriate measurement tools were developed and validated. Loss of asthma control can lead to an exacerbation. Years ago, the term "clinically significant asthma exacerbation" was introduced to define when a loss of control is severe enough to declare it an asthma exacerbation. This term is also used by health insurances to determine when an exacerbation is eligible for reimbursement of biologics in clinical practice, however, it sometimes becomes apparent that a clear separation between loss of "asthma control" and an exacerbation is not always possible. In this review, we attempt to justify why exacerbations in early allergic asthma and adult eosinophilic asthma can differ significantly and why this is important in clinical practice as well as when dealing with health insurers.
Asthma Exacerbations
Reimbursement
Cite
Citations (0)
The definition of asthma exacerbation is not univocal. The criteria which currently characterize asthma exacerbation are clinical and functional, and imply a destabilization of the asthmatic disease for more than 24 hours, with no return to the initial condition, which requires a treatment change. Bronchial inflammation precedes and is associated with asthma exacerbation. Exacerbation is induced by infectious, irritating or allergenic triggering factors associated with a specific immunogenetic susceptibility. Disease stabilization, which requires an adequate long-term treatment, associating inhaled corticosteroids and long-acting beta-2 mimetics, as well as the management of triggering factors and comorbidities, allows to limit the number of exacerbations. In the event of an exacerbation, the quick systemic administration of corticosteroids reduces the number of hospitalizations.
Asthma Exacerbations
Cite
Citations (0)
Background: Bronchiectasis and asthma are different disease, However, some patients have both diseases. There are insufficient data for the effect of bronchiectasis on asthma exacerbations. Methods: We investigated 2270 patients having asthma in our hospital. Fifty patients had bronchiectasis and asthma. These patients were compared with fifty age and gender matched patients having asthma only. We evaluated frequency of asthma exacerbations (steroid use, emergency room (ER) visit and hospitalization) in each group. Results: The prevalence of bronchiectasis among the asthma patients was 2.2%. Follow up duration of each group was 51.9 ± 35.2 months for asthma with bronchiectasis and 53.8 ± 29.8 months for pure asthmatics. The number of asthma exacerbation/year (1.08±1.68 vs 0.35±0.42, p=0.004), steroid use/year (0.9±1.54 vs 0.26±0.36, p=0.006), ER visit/year (0.46±0.84 vs 0.26±0.36, p=0.001) and hospitalization/year (0.7±1.44 vs 0.1±0.17, p=0.4) due to asthma exacerbation was higher in asthma with bronchiectasis. Conclusion: The number of asthma exacerbation, steroid use, and ER visit due to asthma exacerbation was higher in asthma with bronchiectasis than pure asthma.
Asthma Exacerbations
Cite
Citations (0)
Computerized wheeze detection is an established method for objective assessment of respiratory sounds. In infants, this method has been used to detect subclinical airway obstruction and to monitor treatment effects. The optimal location for the acoustic sensors, however, is unknown. The aim of this study was to evaluate the quality of respiratory sound recordings in young infants, and to determine whether the position of the sensor affected computerized wheeze detection. Respiratory sounds were recorded over the left lateral chest wall and the trachea in 112 sleeping infants (median postmenstrual age: 49 weeks) on 129 test occasions using an automatic wheeze detection device (PulmoTrack®). Each recording lasted 10 min and the recordings were stored. A trained clinician retrospectively evaluated the recordings to determine sound quality and disturbances. The wheeze rates of all undisturbed tracheal and chest wall signals were compared using Bland–Altman plots. Comparison of wheeze rates measured over the trachea and the chest wall indicated strong correlation (r ⩾ 0.93, p < 0.001), with a bias of 1% or less and limits of agreement of within 3% for the inspiratory wheeze rate and within 6% for the expiratory wheeze rate. However, sounds from the chest wall were more often affected by disturbances than sounds from the trachea (23% versus 6%, p < 0.001). The study suggests that in young infants, a better quality of lung sound recordings can be obtained with the tracheal sensor.
Wheeze
Respiratory sounds
Auscultation
Subclinical infection
Cite
Citations (13)
To investigate the relationship between exacerbation of asthma and PEF variability, 32 institutionally hospitalized asthmatic children were enrolled in the study. Methods: PEF variability, asthma attack score, medication score were evaluated every one week for four weeks before 40 episodes of acute exacerbation, being required frequent inhalations of β-agonist, intravenous aminophylline, and/or systemic steroid during long-term hospitalization. Those parameters during most stable period were also evaluated to compare with 2 weeks before acute exacerbation. Subjects were divided into unstable group and stable group with or without asthma attack during 1 week before episode of acute exacerbation respectively. Results: 1. Averaged % PEF decreased and daily variability of PEF increased significantly in 1st week than in 2nd-4th week before acute exacerbation. 2. Averaged % PEF decreased and daily variability of PEF increased significantly in 2 weeks before acute exacerbation than in most stable periods. 3. Averaged daily variability of PEF was proportional to asthma attack score during 1 week before acute exacerbation. 4. Although no significant changes in % PEF and daily variability for 4 weeks before acute exacerbation were observed in stable group, averaged % PEF decreased and daily variability of PEF increased significantly in 2 weeks before acute exacerbation than in stable periods. Conclusions: These results suggest that information obtained by long term PEF monitoring is useful for predicting asthma exacerbation, and that measuring PEF and its daily variability even in stable period are also important to know individual PEF change.
Aminophylline
Asthma Exacerbations
B2 receptor
Cite
Citations (2)