Practical recommendations for home-nebulized corticosteroid use in children aged ≤ 5 years with asthma: A review and advisory group consensus.

BACKGROUND: Despite nebulized budesonide being identified by the Global Initiative for Asthma report as a viable alternative to inhaled corticosteroids (ICS) delivered by pressurized metered-dose inhalers (pMDIs) with spacers, practical guidance on nebulized corticosteroid use in the pediatric population remains scarce. OBJECTIVE: To review the current literature and provide practical recommendations for nebulized budesonide use in children aged ≤ 5 years with a diagnosis of asthma. METHODS: A group of 15 expert pediatricians in the respiratory and allergy fields in Thailand developed Delphi consensus recommendations on nebulized budesonide use based on their clinical expertise and a review of the published literature. Studies that evaluated the efficacy (effectiveness) and/or safety of nebulized budesonide in children aged ≤ 5 years with asthma were assessed. AR patients. RESULTS: Overall, 24 clinical studies published between 1993 and 2020 met the inclusion criteria for review. Overall, results demonstrated that nebulized budesonide significantly improved symptom control and reduced exacerbations, asthma-related hospitalizations, and the requirement for oral corticosteroids compared with placebo or active controls. Nebulized budesonide was well tolerated, with no severe or drug-related adverse events reported. Following a review of the published evidence and group consensus, a treatment algorithm as per the Thai Pediatric Asthma 2020 Guidelines was proposed, based on the availability of medications in Thailand, to include nebulized budesonide as the initial treatment option alongside ICS delivered by pMDIs with spacers in children aged ≤ 5 years. CONCLUSIONS: ThNebulized budesonide is an effective and well-tolerated treatment option in children aged ≤ 5 years with asthma.

Predictors of plasma leakage among dengue patients in Thailand: A plasma-leak score analysis.

Delayed plasma leakage recognition could lead to improper fluid administration resulting in dengue shock syndrome, subsequently, multi-organ failure, and death. This prospective observational study was conducted in Bangkok, Thailand, between March 2018 and February 2020 to determine predictors of plasma leakage and develop a plasma leakage predictive score among dengue patients aged ≥15 years. Of 667 confirmed dengue patients, 318 (47.7%) developed plasma leakage, and 349 (52.3%) had no plasma leakage. Multivariate analysis showed three independent factors associated with plasma leakage, including body mass index ≥25.0 kg/m2 (odds ratio [OR] = 1.784; 95% confidence interval [CI] = 1.040-3.057; P = 0.035), platelet count <100,000/mm3 on fever days 3 to 4 (OR = 2.151; 95% CI = 1.269-3.647; P = 0.004), and aspartate aminotransferase or alanine aminotransferase ≥100 U/l on fever days 3 to 4 (OR = 2.189; 95% CI = 1.231-3.891; P = 0.008). Because these three parameters had evidence of equality, each independent factor was weighted to give a score of 1 with a total plasma-leak score of 3. Higher scores were associated with increased plasma leakage occurrence, with ORs of 2.017 (95% CI = 1.052-3.869; P = 0.035) for score 1, 6.158 (95% CI = 2.914-13.015; P <0.001) for score 2, and 6.300 (95% CI = 2.419-16.407; P <0.001) for score 3. The area under the receiver operating characteristics curves for predicting plasma leakage was good (0.677 [95% CI = 0.616-0.739]). Patients with a plasma-leak score ≥1 had high sensitivity (88.8%), and those with a plasma-leak score of 3 had high specificity (93.4%) for plasma leakage occurrence. This simple and easily accessible clinical score might help physicians provide early and timely appropriate clinical dengue management in endemic areas.

Practical considerations of nebulized corticosteroid in children with acute asthmatic exacerbation: A consensus.

BACKGROUND: Acute asthmatic exacerbation in children causes economic burdens both directly and indirectly. The GINA guideline does mention the use of inhaled or oral corticosteroids in the treatment of asthmatic exacerbation, it provides little practical guidance on the use of nebulized corticosteroid. OBJECTIVE: To review and recommend the practical considerations in the use of nebulized corticosteroid in children with acute asthmatic exacerbation. METHODS: This consensus was developed by a group of expert pediatricians in respiratory and allergy fields in Thailand. The recommendations were made based on a review of published studies and clinical opinions. The eligible studies were confined to those published in English, and randomized controlled trials and meta-analyses involving nebulized corticosteroids in asthmatic exacerbation in children aged between 1-18 years. RESULTS: There were 13 randomized controlled-trial studies published from 1998 to 2017. Nine of the 13 studies compared nebulized with systemic corticosteroid conducted in moderate to severe exacerbation, while the remaining four compared nebulized corticosteroid with placebo conducted in mild to severe exacerbation. The admission rate was significantly lower in severe exacerbation (one study) and pooled four mild to severe exacerbation studies comparing with placebo (p 0.022). Other clinical parameters were significantly improved with nebulized corticosteroid such as clinical scores, systemic corticosteroid/bronchodilator use, or shorter ER stays. Only one study used fluticasone, while the other 12 studies conducted by budesonide (92.31%). CONCLUSIONS: Nebulized corticosteroid may offer an effective therapeutic option for the management of acute exacerbation of asthma in all severities. Nebulized budesonide is the preferred corticosteroid.

Latex allergy in dental students: a cross-sectional study.

BACKGROUND: Latex allergy is a major occupational health problem in health care workers who regularly use latex gloves. Dentists are one of the high risk groups for latex allergy and sensitization as it is generally found that healthcare workers (HCW) have 3 times greater prevalence of latex allergy. There are very few studies of latex allergy in HCW in Thailand. OBJECTIVE: To study the prevalence of latex-related symptoms, latex-sensitization and possible risk factors in dental students. MATERIAL AND METHOD: A cross-sectional study was performed on all dental students of the Faculty of Dentistry, Chulalongkorn University, during Dec 2007 to May 2008, using questionnaires and skin prick tests (SPT), using 3 latex extracts prepared from Proglove, Doctor Plus gloves and a commercial latex allergen (Stallergenes, France). SPT was done only in those who were willing and signed informed consents. RESULTS: There were 617 completed questionnaires (87.3%). The mean age of the volunteers was 20.9 +/- 1.7 years with 29.3% male and 70.7% female. The prevalence of latex glove-related symptoms was 5.0%. These symptoms were all local, cutaneous symptoms, ranging from hand pruritus (64.5%), hand eczema (19.4%) and contact urticaria (16.1%). Eight subjects (1.3%) reported pruritus or urticaria on exposure to other rubber products while 12 subjects (1.9%) reported reactions to some fruits. The risk factors for latex-glove allergy were personal history of allergic diseases (atopic dermatitis, urticaria, pruritus and rubber allergy), duration of using gloves more than 18 hours per week, more than 3 pairs of gloves used per day and timing of glove exposure. The 4th to 6th year students were observed significantly more prevalence of symptoms than the 1st to 3rd year students (OR, 3.69; 95% CI, 1.73-7.87; p = 0.0003). SPT for 3 extracts of latex was done in 247 cases (40.0%); overall latex sensitization rate was 14.2%. The commercial extract had higher incidence of latex sensitization compared to the 2 gloves extract. The 1st year students had the lowest percentage of latex sensitization (3.2%) and positive skin test was significantly found in the 2nd year students (20.8%; OR, 6.46; 95% CI, 1.87-47.98; p = 0.04). CONCLUSION: The prevalence of latex allergy in dental students is 5% and the signs and symptoms were local cutaneous reaction; pruritus, eczema and contact urticaria. The latex sensitization rate in dental students was14.2%, which is higher than the general population. The possible risk factors included personal history of allergic diseases, duration and frequency of exposure. Therefore, primary prevention of the occupational latex allergy should be carefully considered especially concerning high risk factors.

Comparison of salbutamol efficacy in children--via the metered-dose inhaler (MDI) with Volumatic spacer and via the dry powder inhaler, Easyhaler, with the nebulizer--in mild to moderate asthma exacerbation: a multicenter, randomized study.

BACKGROUND: Beta(2) agonist administered via a nebulizer is the standard treatment for acute asthma exacerbation. There are some limitations for the use of nebulization. We conducted a study to determine the efficacy of salbutamol administered via the pMDI with Volumatic spacer and the Easyhaler (DPI) compared to nebulization in mild to moderate asthma exacerbations in children. METHODS: A multicenter, randomized, controlled study was conducted in children between 5 and 18 years of age who presented at an emergency or outpatient department. They were randomized to receive either 6 puffs of salbutamol via the pMDI with Volumatic spacer, or via the Easyhaler, or 0.15 mg/kg of salbutamol nebulized via oxygen (or compressed air). The primary outcome was the clinical response which was assessed using the modified Wood's asthma score. The secondary outcomes were: hospitalization, asthma revisit within 3 days, systemic corticosteroid use and adverse events. The clinical score, oxygen saturation, PR, RR, BP and adverse events were recorded at time 0 (before treatment) and 20, 40 and 60 minutes after drug administration. RESULTS: There were no statistically significant differences in the clinical response between the three groups at the 1st, 2nd or 3rd dose or for the SpO(2) or the respiratory rate while the children in the Easyhaler group had significantly less tachycardia after the 2nd dose. No significant adverse events were noted among the three groups. CONCLUSIONS: Salbutamol administered via pMDI with Volumatic spacer or DPI (Easyhaler) are as effective as salbutamol given via a nebulizer in providing effective relief of mild to moderate severity acute asthma exacerbation in children between 5 and 18 years of age.

A comparative study of efficacy of salbutamol via metered dose inhaler with volumatic spacer and via dry powder inhaler, easyhaler, to nebulization in mild to moderate severity acute asthma exacerbation in childhood.

BACKGROUND: Rapid-acting inhaled beta-2 agonist is standard treatment in acute asthmatic patient; it causes smooth muscle dilatation, gives rapid action and has less side effect compared with parenteral and oral form. There are many forms of inhaler including nebulization, MDI and DPI. In Thailand the most common form of salbutamol administration for the treatment of acute exacerbation of asthma is via nebulization. OBJECTIVE: To compare the clinical effectiveness and side effects of salbutamol via MDI with Volumatic spacer and via DPI (Easyhaler), with nebulization in mild to moderate severity of acute asthma exacerbation in childhood. MATERIAL AND METHOD: A prospective, randomized controlled study in children, aged 5- 18-years-old with mild to moderate severe asthmatic attack, is done at the Emergency Room, QSNICH during October 2004 to February 2006. These children with acute asthma attack are randomly-assigned to 3 groups of different salbutamol administrations: group 1 via nebulization, group 2 via MDI with volumatic spacer and group 3 via DPI (Easyhaler). Salbutamol is administered and clinical responses: asthma score, oxygen saturation, PR, RR, BP and side effects (tremor and palpitation) are recorded at 0, 20, 40 and 60 minutes after the drug administrations. The drug will be repeated every 20 minutes for the total maximum of 3 times. If there is no clinical improvement, they will be admitted to the hospital for further management. RESULTS: There are 54 asthmatic children, 35 male (64.8%) and 19 female (35.2%). Their mean age is 8.4 +/- 2.3 years. There are 18patients in each group. There is no significant difference in efficacy of salbutamol among the 3 groups as measured by asthma score, O2 saturation, PR, RR and BP Tremor are equally observed in all 3 groups (5.5%) while palpitation are observed in 11.1% of group 1 and 2 only. One patient in group 2 and 3 are admitted while no patient in group 1 is. CONCLUSION: Rapid-acting inhaled beta-2 agonist via MDI with volumatic spacer and DPI (Easyhaler) can be used effectively compared with nebulization form in treating mild to moderate degrees of acute exacerbation of asthma in children with comparable side effects.

Childhood asthma: proper managements do reduce severity.

RATIONALE: Asthma is an increasing problem, both in children and adults which is due to an increase in environmental pollution. The current management of asthmatic patients is different from the previous decade as more understanding of the mechanism of asthma pathology is known. OBJECTIVES: To study the prevalence of hospitalized asthmatic patients of different age groups in the past decade and to compare the results of different treatments during each 5-year period, 1986-1990, 1991-1995 and 1997-2001. MATERIAL AND METHOD: A retrospective review of the Out-patient Department (OPD) and In-patient Department (IPD) cases of asthma patients, sorted by International Classification of Diseases (ICD 9 & 10) at the Queen Sirikit National Institute of Child Health (QSNICH), previously known as Children's Hospital was carried out. The patients were divided into 3 groups according to the 5-year period of admissions: 1986-1990, 1991-1995 and 1997-2001. Comparison of the prevalence, age distribution, management, severity and outcomes of the patients in different groups using the standard statistical package SPSS for windows. RESULTS: The prevalence of asthma increased from 7,476 OPD visits in 1986 to the peak of 15,576 visits in 1997 and about 13,000-14,000 stable visits from 1998 through 2001. About 2-3 per cent of these OPD cases were admitted to the hospital. After the hospital charts had been reviewed, 2,927 cases of true asthma cases (81.9%) were studied and they were divided into 3 groups, group 1, 2 and 3 consisting of 1,140, 716 and 1,071 patients, respectively. About 60-80 per cent of the admitted cases were children under 5 years old. With the different management of hospitalized cases between the 3 periods, a significant reduction in the readmission rate was outstanding from 14 per cent to 5 per cent and the maximum number of readmissions was reduced from 8 times to 5 times (the majority was 2 times). The length of stay and the percentage of complicated respiratory failure cases were not different. CONCLUSION: The asthma prevalence is increasing. Young children 0-2 years of age tend to have more severe diseases that need hospitalization. Current management, inhaled beta 2 agonists, together with anti-inflammatory drugs do reduce asthma severity to a certain degree. Early intervention of controller medications and regular follow-up care do reduce the readmissions. Further newer treatment of asthma is required for better outcomes of these asthmatic patients.