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Article ; Online: Evidence-based European guidelines for the diagnosis of asthma in children aged 5-16 years.

Gaillard, Erol A / Moeller, Alexander

2021 Volume 9, Issue 6, Page(s) 558–560

MeSH term(s)	Adolescent ; Asthma/diagnosis ; Child ; Child, Preschool ; Europe ; Evidence-Based Medicine/methods ; Female ; Humans ; Male ; Practice Guidelines as Topic
Language	English
Publishing date	2021-04-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2686754-0
ISSN	2213-2619 ; 2213-2600
ISSN (online)	2213-2619
ISSN	2213-2600
DOI	10.1016/S2213-2600(21)00183-1
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Zs.A 7041: Show issues

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Article ; Online: Practical approaches to the diagnosis of asthma in school-age children.

Devani, Pooja / Lo, David K H / Gaillard, Erol A

Expert review of respiratory medicine

2022 Volume 16, Issue 9, Page(s) 973–981

Abstract: Introduction: Asthma is a chronic airways disease characterized by episodes of wheeze, chest tightness, and evidence of reversible airflow obstruction. Symptoms are frequently triggered by exercise, exposure to aeroallergens, and respiratory viruses. It ...

Abstract	Introduction: Asthma is a chronic airways disease characterized by episodes of wheeze, chest tightness, and evidence of reversible airflow obstruction. Symptoms are frequently triggered by exercise, exposure to aeroallergens, and respiratory viruses. It is the commonest non-communicable respiratory condition in children, affecting over 5.5 million children in the European Union alone. Both over- and under- diagnosis of asthma are common for several reasons. Areas covered: The diagnosis is frequently based on parental or patient reported non-specific symptoms alone. All major asthma guidelines now recommend the use of objective tests, including spirometry, bronchodilator reversibility testing, fraction of exhaled nitric oxide measurements and challenge testing to confirm the diagnosis. Recently, the European Respiratory Society published the first evidence-based international guidelines for diagnosing asthma in school-age children using objective measures. Major barriers to implementation in primary care and less well-resourced healthcare settings are access to relevant objective tests for children and quality assurance to obtain reliable results. Expert opinion: We highlight the importance of diagnosing asthma in school-age children using objective tests and outline a practical approach for the use of widely available tests. We also review challenges and barriers to implementation of objective testing in children managed outside specialist settings.
MeSH term(s)	Child ; Humans ; Breath Tests/methods ; Nitric Oxide ; Asthma/diagnosis ; Exhalation ; Spirometry/methods
Chemical Substances	Nitric Oxide (31C4KY9ESH)
Language	English
Publishing date	2022-09-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2479146-5
ISSN	1747-6356 ; 1747-6348
ISSN (online)	1747-6356
ISSN	1747-6348
DOI	10.1080/17476348.2022.2126355
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Article: Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction.

Ramphul, Manisha / Lo, David K H / Gaillard, Erol A

Journal of asthma and allergy

2021 Volume 14, Page(s) 525–538

Abstract: Asthma is a heterogeneous disease, characterised by different phenotypes and endotypes. Precision medicine in asthma refers to the implementation of a targeted therapy for each individual child, based on the identification of treatable traits, including ... ...

Abstract	Asthma is a heterogeneous disease, characterised by different phenotypes and endotypes. Precision medicine in asthma refers to the implementation of a targeted therapy for each individual child, based on the identification of treatable traits, including environmental, immunological and genetic factors. Severe asthma in children is associated with increased hospitalisation rates, a lower quality of life, increased healthcare costs and an increased mortality. In the era of new molecular biologics treatments, it is essential to improve deep phenotyping of children with severe asthma in order to deliver the most effective treatment to each individual child. In this review, we discuss the personalised approach to the assessment and management of severe asthma. We explore the indications and use of the currently licensed biologics, as well as the potential of other emerging treatments.
Language	English
Publishing date	2021-05-20
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2494877-9
ISSN	1178-6965
ISSN	1178-6965
DOI	10.2147/JAA.S265657
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Article ; Online: Ventilation heterogeneity in children with severe asthma.

Nuttall, Amy G / Beardsmore, Caroline S / Gaillard, Erol A

European journal of pediatrics

2021 Volume 180, Issue 11, Page(s) 3399–3404

Abstract: Small airway disease, characterised by ventilation heterogeneity (VH), is present in a subgroup of patients with asthma. Ventilation heterogeneity can be measured using multiple breath washout testing. Few studies have been reported in children. We ... ...

Abstract	Small airway disease, characterised by ventilation heterogeneity (VH), is present in a subgroup of patients with asthma. Ventilation heterogeneity can be measured using multiple breath washout testing. Few studies have been reported in children. We studied the relationship between VH, asthma severity, and spirometry in a cross-sectional observational cohort study involving children with stable mild-moderate and severe asthma by GINA classification and a group of healthy controls. Thirty-seven participants aged 5-16 years completed multiple breath nitrogen washout (MBNW) testing (seven controls, seven mild-moderate asthma, 23 severe asthma). The lung clearance index (LCI) was normal in control and mild-moderate asthmatics. LCI was abnormal in 5/23 (21%) of severe asthmatics. The LCI negatively correlated with FEV
MeSH term(s)	Asthma/diagnosis ; Child ; Cross-Sectional Studies ; Humans ; Lung ; Respiratory Function Tests ; Spirometry
Language	English
Publishing date	2021-05-13
Publishing country	Germany
Document type	Journal Article ; Observational Study
ZDB-ID	194196-3
ISSN	1432-1076 ; 0340-6199 ; 0943-9676
ISSN (online)	1432-1076
ISSN	0340-6199 ; 0943-9676
DOI	10.1007/s00431-021-04101-3
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Article ; Online: Asthma medication adherence and exacerbations and lung function in children managed in Leicester primary care.

Paracha, Razi / Lo, David K H / Montgomery, Ursula / Ryan, Louise / Varakantam, Vivek / Gaillard, Erol A

NPJ primary care respiratory medicine

2023 Volume 33, Issue 1, Page(s) 12

Abstract: Poor adherence to asthma preventer medication is associated with life-threatening asthma attacks. The quality and outcomes framework mandated primary care annual asthma review does not include adherence monitoring and the effect of poor adherence on lung ...

Abstract	Poor adherence to asthma preventer medication is associated with life-threatening asthma attacks. The quality and outcomes framework mandated primary care annual asthma review does not include adherence monitoring and the effect of poor adherence on lung function in paediatric primary care patients is unknown. The aim was to investigate the link between inhaled corticosteroid (ICS) adherence and spirometry, fraction of exhaled nitric oxide (FeNO) and asthma control in asthmatic school-age children in this cross-sectional observational study involving three Leicestershire general practices. Children 5-16 years on the practice's asthma registers, were invited for a routine annual asthma review between August 2018 and August 2019. Prescription and clinical data were extracted from practice databases. Spirometry, bronchodilator reversibility (BDR) and FeNO testing were performed as part of the review. 130 of 205 eligible children (63.4%) attended their review. Mean adherence to ICS was 36.2% (SEM 2.1%) and only 14.6% of children had good adherence (≥75% prescriptions issued). We found no differences in asthma exacerbations in the preceding 12 months between the adherence quartiles. 28.6% of children in the lowest and 5.6% in the highest adherence quartile had BDR ≥ 12% but this was not statistically significant (p = 0.55). A single high FeNO value did not predict adherence to ICS. Adherence to ICS in children with asthma in primary care is poor. The link between adherence to ICS and asthma exacerbations, spirometry and FeNO is complex but knowledge of adherence to ICS is critical in the management of children with asthma.
MeSH term(s)	Humans ; Child ; Cross-Sectional Studies ; Asthma/drug therapy ; Bronchodilator Agents/therapeutic use ; Adrenal Cortex Hormones/therapeutic use ; Medication Adherence ; Lung ; Primary Health Care ; Anti-Asthmatic Agents/therapeutic use ; Observational Studies as Topic
Chemical Substances	Bronchodilator Agents ; Adrenal Cortex Hormones ; Anti-Asthmatic Agents
Language	English
Publishing date	2023-03-25
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2780812-9
ISSN	2055-1010 ; 2055-1010
ISSN (online)	2055-1010
ISSN	2055-1010
DOI	10.1038/s41533-022-00323-6
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Article ; Online: Rhinovirus persistence during the COVID-19 pandemic-Impact on pediatric acute wheezing presentations.

Teo, Kah Wee / Patel, Deepa / Sisodia, Shilpa / Roland, Damian / Gaillard, Erol A / Tang, Julian W

Journal of medical virology

2022 Volume 94, Issue 11, Page(s) 5547–5552

Abstract: Rhinoviruses have persisted throughout the COVID-19 pandemic, despite other seasonal respiratory viruses (influenza, parainfluenza, respiratory syncytial virus, adenoviruses, human metapneumovirus) being mostly suppressed by pandemic restrictions, such ... ...

Abstract	Rhinoviruses have persisted throughout the COVID-19 pandemic, despite other seasonal respiratory viruses (influenza, parainfluenza, respiratory syncytial virus, adenoviruses, human metapneumovirus) being mostly suppressed by pandemic restrictions, such as masking and other forms of social distancing, especially during the national lockdown periods. Rhinoviruses, as nonenveloped viruses, are known to transmit effectively via the airborne and fomite route, which has allowed infection among children and adults to continue despite pandemic restrictions. Rhinoviruses are also known to cause and exacerbate acute wheezing episodes in children predisposed to this condition. Noninfectious causes such as air pollutants (PM
MeSH term(s)	Adult ; COVID-19/epidemiology ; Child ; Communicable Disease Control ; Enterovirus Infections/epidemiology ; Humans ; Pandemics ; Respiratory Sounds/etiology ; Respiratory Syncytial Virus, Human ; Respiratory Tract Infections ; Retrospective Studies ; Rhinovirus
Language	English
Publishing date	2022-07-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	752392-0
ISSN	1096-9071 ; 0146-6615
ISSN (online)	1096-9071
ISSN	0146-6615
DOI	10.1002/jmv.27986
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Article ; Online: Prevalence of childhood cough in epidemiological studies depends on the question used: findings from two population-based studies.

Mallet, Maria Christina / Mozun, Rebeca / Pedersen, Eva S L / Ardura-Garcia, Cristina / Gaillard, Erol A / Latzin, Philipp / Moelller, Alexander / Kuehni, Claudia E

Swiss medical weekly

2023 Volume 153, Page(s) 40044

Abstract: Background: Epidemiological studies use different questions to assess recurrent cough in children. In two independent population-based studies, we assessed how prevalence estimates of cough vary depending on the questions parents are asked about their ... ...

Abstract	Background: Epidemiological studies use different questions to assess recurrent cough in children. In two independent population-based studies, we assessed how prevalence estimates of cough vary depending on the questions parents are asked about their child's cough and how answers to the different questions overlap. Methods: We analysed cross-sectional data from two population-based studies on respiratory health: LuftiBus in the School (LUIS), conducted in 2013-2016 among 6- to 17-year-school children in the Canton of Zurich, Switzerland, and the 1998 Leicester Respiratory Cohort (LRC) study, UK where we used data from 6- to 8-year-old children from the 2003 follow-up survey. Both studies used parental questionnaires that included the same three questions on the child's cough, namely cough without a cold, dry cough at night and coughing more than others. We assessed how the prevalence of cough varied depending on the question and how answers to the different questions on cough overlapped. We also assessed how results were influenced by age, sex, presence of wheeze and parental education. Results: We included 3457 children aged 6-17 years from LUIS and 2100 children aged 6-8 years from LRC. All respiratory outcomes - cough, wheeze and physician-diagnosed asthma - were reported twice as often in the LRC as in LUIS. We found large differences in the prevalence of parent-reported cough between the three cough questions. In LUIS, 880 (25%) parents reported cough without a cold, 394 (11%) dry night cough, and 159 (5%) reported that their child coughed more than other children. In the LRC, these numbers were 1003 (48%), 527 (25%) and 227 (11%). There was only partial overlap of answers, with 89 (3%) answering yes to all questions in LUIS and 168 (8%) in LRC. Prevalence of all types of cough and overlap between the cough questions was higher in children with current wheeze. Conclusion: In both population-based studies prevalence estimates of cough depended strongly on the question used to assess cough with only partial overlap of responses to different questions. Epidemiological studies on cough can only be compared if they used exactly the same questions for cough.
MeSH term(s)	Child ; Humans ; Cross-Sectional Studies ; Cough ; Prevalence ; Cohort Studies ; Asthma ; Respiratory Sounds ; Surveys and Questionnaires
Language	English
Publishing date	2023-03-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2036179-8
ISSN	1424-3997 ; 1424-7860
ISSN (online)	1424-3997
ISSN	1424-7860
DOI	10.57187/smw.2023.40044
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Article ; Online: Comparative Analysis of Clinical Parameters and Sputum Biomarkers in Establishing the Relevance of Filamentous Fungi in Cystic Fibrosis.

Patel, Deepa / Dacanay, Keith Chester / Pashley, Catherine H / Gaillard, Erol A

Frontiers in cellular and infection microbiology

2021 Volume 10, Page(s) 605241

Abstract: Background: The relationship between fungal culture (FC) positivity and airway inflammation in CF is largely unknown. Identifying the clinical significance of filamentous fungi in CF using both clinical parameters and biomarkers may change our ... ...

Abstract	Background: The relationship between fungal culture (FC) positivity and airway inflammation in CF is largely unknown. Identifying the clinical significance of filamentous fungi in CF using both clinical parameters and biomarkers may change our antimicrobial therapeutic strategies. Objectives: To investigate the clinical characteristics and airway biomarker profile in relation to the detection of filamentous fungi in respiratory samples obtained from CF patients. Methods: A prospective cohort study over 24 months, including children and adults with CF. Participants provided sputum and/or bronchoalveolar lavage samples, which underwent processing for bacterial and fungal culture, leukocyte differential cell count and biomarker analysis for neutrophil elastase (NE), interleukin-8 (IL-8), galactomannan and tumor necrosis factor receptor type 2 (TNF-R2). We performed FC using neat sputum plugs, an approach shown to be more sensitive compared to routine laboratory testing. Results: Sixty-one patients provided 76 respiratory samples (72 sputum and 4 BAL). Median age was 17 years (range 6 months-59 years). FC positivity was noted in 49% of the cohort. FC positivity was greater during pulmonary exacerbation compared to the stable state (67 versus 50%). Participants aged 5-30 years had a lower FEV1 within the FC positive group. A significant association between FC positivity and non-tuberculosis mycobacterial (NTM) culture was observed on non-parametric testing (p = 0.022) and regression analysis (p = 0.007). Exposure to indoor mold was a predictor for FC positivity (p = 0.047). There was a trend towards increased lung clearance index (LCI), bronchiectasis and intravenous antibiotic use in the FC positive group. There was no significant difference in biomarkers between FC positive and negative patients. Conclusion: Aspergillus. fumigatus
MeSH term(s)	Adult ; Biomarkers ; Child ; Cystic Fibrosis ; Fungi ; Humans ; Infant ; Leukocyte Count ; Prospective Studies ; Sputum
Chemical Substances	Biomarkers
Language	English
Publishing date	2021-01-22
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2619676-1
ISSN	2235-2988 ; 2235-2988
ISSN (online)	2235-2988
ISSN	2235-2988
DOI	10.3389/fcimb.2020.605241
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Article ; Online: Differences in respiratory oscillometry measurements using mouthpiece, mouth, and nasal mask in healthy adults.

Alshlowi, Malak / Hakizimana, Ali / Alraimi, Afnan / Devani, Pooja / Lundblad, Lennart K A / Beardsmore, Caroline S / Gaillard, Erol A

Journal of applied physiology (Bethesda, Md. : 1985)

2022 Volume 134, Issue 1, Page(s) 142–146

Abstract: Airway resistance measurements using oscillometry provide a potential alternative to spirometry in assessing airway obstruction and dynamics due to measurements taken during tidal breathing. Oscillometry typically requires participants to form a tight ... ...

Abstract	Airway resistance measurements using oscillometry provide a potential alternative to spirometry in assessing airway obstruction and dynamics due to measurements taken during tidal breathing. Oscillometry typically requires participants to form a tight seal around a mouthpiece that can prove challenging for some people. To address this challenge, we conducted a prospective study to evaluate the effect of different interfaces like mouthpiece, mouth mask, and nasal mask on respiratory impedance results from oscillometry in a cohort of healthy adults. Ten healthy adults [7 females; mean age: 38.9 yr (SD ±15.5)] underwent oscillometry using each of the three interfaces. We measured resistance at 5 Hz (Rrs
MeSH term(s)	Female ; Humans ; Adult ; Oscillometry/methods ; Prospective Studies ; Airway Resistance ; Lung ; Spirometry ; Mouth
Language	English
Publishing date	2022-12-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	219139-8
ISSN	1522-1601 ; 0021-8987 ; 0161-7567 ; 8750-7587
ISSN (online)	1522-1601
ISSN	0021-8987 ; 0161-7567 ; 8750-7587
DOI	10.1152/japplphysiol.00491.2022
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Article ; Online: The role of objective tests to support a diagnosis of asthma in children.

Danvers, Lesley / Lo, David K H / Gaillard, Erol A

Paediatric respiratory reviews

2019 Volume 33, Page(s) 52–57

Abstract: In many healthcare settings asthma in children is a clinical diagnosis based on parental reported symptoms. These include intermittent episodes of wheezing, breathlessness and periodic nocturnal dry cough. Increased symptoms often coincide with colds. ... ...

Abstract	In many healthcare settings asthma in children is a clinical diagnosis based on parental reported symptoms. These include intermittent episodes of wheezing, breathlessness and periodic nocturnal dry cough. Increased symptoms often coincide with colds. Confirming a diagnosis of asthma in children can be difficult and recent reports highlight that misdiagnosis, including over- and under-diagnosis of asthma are common. Recent UK National Institute of Health and Care Excellence guidelines recommend diagnostic algorithms for children from five years and adults to support a clinical suspicion of asthma. Spirometry, bronchodilator reversibility and fractional exhaled nitric oxide testing are the first line tests to diagnose asthma in children. The introduction of these tests across all healthcare settings has the potential to reduce misdiagnosis, improve asthma management and reduce healthcare spending for asthma.
MeSH term(s)	Administration, Inhalation ; Adrenal Cortex Hormones/therapeutic use ; Asthma/diagnosis ; Asthma/drug therapy ; Asthma/physiopathology ; Breath Tests/methods ; Bronchodilator Agents ; Child ; Diagnostic Errors ; Forced Expiratory Volume ; Humans ; Nitric Oxide/metabolism ; Peak Expiratory Flow Rate ; Practice Guidelines as Topic ; Sensitivity and Specificity ; Spirometry/methods ; Spirometry/standards ; United Kingdom ; Vital Capacity
Chemical Substances	Adrenal Cortex Hormones ; Bronchodilator Agents ; Nitric Oxide (31C4KY9ESH)
Language	English
Publishing date	2019-02-28
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2147664-0
ISSN	1526-0550 ; 1526-0542
ISSN (online)	1526-0550
ISSN	1526-0542
DOI	10.1016/j.prrv.2019.02.001
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