Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study.

Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma. Methods: Participants (6-14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort-a prospective, multicenter, observational study (NCT04480242)-were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey-Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System-Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables. Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting ß-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (p = 0.002) and HRQoL over time (p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (p = 0.012), but they showed better HRQoL in future assessments (p = 0.012). The frequency of reliever use was associated with symptom control (p < 0.001), exacerbation occurrence (p < 0.001), and HRQoL (p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls. Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population.

Omalizumab outcomes for up to 6 years in pediatric patients with severe persistent allergic asthma.

BACKGROUND: Various studies have assessed omalizumab outcomes in the clinical practice setting but follow-up and/or number of patients included were limited. We aim to describe the long-term outcomes of pediatric patients with severe persistent allergic asthma receiving omalizumab in the largest real-life cohort reported to date. METHODS: ANCHORS was a multicenter, observational, retrospective cohort study conducted in 25 Pediatric Allergy and Pulmonology units in Spain. We collected data of patients < 18 years and initiating omalizumab between 2006 and 2018, from the year prior to omalizumab initiation to discontinuation or last available follow-up. The primary outcome was the evolution of the annual number of moderate-to-severe exacerbations compared with the baseline period. RESULTS: Of the 484 patients included, 101 (20.9%) reached 6 years of treatment. The mean ± standard deviation number of exacerbations decreased during the first year of treatment (7.9 ± 6.6 to 1.1 ± 2.0, P < .001) and remained likewise for up to 6 years. The other clinical parameters assessed also improved significantly during the first year and stabilized or continued to improve thereafter. The percentage of patients experiencing adverse events was consistently low, and the main reason for discontinuation was good disease evolution. CONCLUSION: In this large, long-term, observational study, moderate-to-severe exacerbations decreased significantly from the first year of treatment with omalizumab. The beneficial effect was maintained in the long term, along with a good safety profile. Our results position omalizumab as an effective long-term treatment in pediatric patients with severe persistent allergic asthma.

Características clínicas y epidemiológicas de niños con infección por gripe A (H1N1) 2009 / Clinical and epidemiological characteristics of children with 2009 influenza A (H1N1) infection

Fundamento. El virus pandémico H1N1 ha causado patología grave en personas previamente sanas de mediana edad. La incidencia de infección por H1N1 fue muy superior entre los niños de 5 a 14 años si se compara con otros grupos y si se compara con la gripe estacional. Objetivo. Describir las características de los pacientes con diagnóstico de infección por el virus influenza A (H1N1) 2009. Característiques clíniques i epidemiològiques de nens amb infecció per grip A (H1N1) 2009 María Araceli Caballero Rabasco 1, Mireia Tirado Capistros 2, Adela Retana Castán 2, Pere Sala Castellví 3, Valentí Pineda Solas 4, Antoni Martínez-Roig 1 1 Servei de Pediatria. Hospital del Mar. Parc de Salut Mar. Barcelona. 2 Servei de Pediatria. Hospital de Sant Pau. Barcelona. 3 Servei de Pediatria. Hospital de Barcelona. Barcelona. 4 Servei de Pediatria. Hospital de Sabadell, Corporació Sanitària Parc Taulí. Sabadell Método. Se realiza estudio retrospectivo, descriptivo, mediante revisión de historias clínicas de una cohorte de niños con infección respiratoria aguda y/o síndrome gripal con confirmación de infección por H1N1. Resultados. Un total de 202 pacientes fueron identificados, la media de edad fue de 7,29 años. 55,4% fueron niños y 44,6% fueron niñas. En el 41% de los casos había antecedentes de riesgo. El síntoma clínico más prevalente fue la fiebre (95,5%) seguido de tos (76,7%) y rinorrea (48,5%). La coinfección bacteriana se confirmó en el 8,9%. El patrón intersticial fue el hallazgo radiológico más frecuente (38%). El 39,1% recibieron tratamiento antiviral. El 9,4% ingresaron en la unidad de cuidados intensivos (UCI), la mayoría de ellos con patología previa, y un 1,5% murieron. Conclusiones. En la gran mayoría de los casos, procedentes de un grupo de población con escasos antecedentes de riesgo, cursaron con un cuadro clínico leve con respuesta adecuada a tratamiento sintomático como en la gripe estacional. La coinfección neumocócica estuvo íntimamente relacionada con evolución tórpida y la mayoría de los pacientes que requirieron atención en UCI presentaban patología de base previa(AU)

Background. The 2009 H1N1 pandemic caused severe disease in previously healthy middle-aged individuals. The incidence of H1N1 infection was much higher among children 5 to 14 years old when compared with other age groups and with seasonal influenza A infection. Objective. To describe the characteristics of patients with 2009 influenza A (H1N1) infection. Method. Retrospective study with review of medical records of a cohort of children with acute respiratory infection and/or flu symptoms with confirmation of H1N1 infection. Results. A total of 202 patients (55.4% males) were identified. Mean age was 7.29 years. Risk factors were present in 41% of the cases. The most prevalent clinical symptom was fever (95.5%), followed by cough (76.7%), and rhinorrhea (48.5%). Bacterial coinfection was confirmed in 8.9% of the patients. Interstitial lung disease was the most common radiological finding (38%). Antiviral treatment was administered to 39.1% of the children; 9.4% of children were admitted to the intensive care unit, most of them with pre-existing conditions, and 1.5% of children died. Conclusions. H1N1 infection affected mostly children with low-risk factors, and patients presented with mild clinical symptoms that responded well to symptomatic treatment as it is given for seasonal flu. Pneumococcal co-infection was closely related to protracted evolution; most patients that required intensive care had underlying morbidities(AU)