Search

Globally, asthma remains the most widespread chronic respiratory condition in children, with a larger proportion of children being affected by the condition. Regardless of the higher prevalence rates, the outcomes of pediatric asthma have remained inadequate, even as there are numerous preventable deaths (approximately 300 children in the United States and 250 children in Canada, annually). The characteristic symptoms of pediatric asthma include wheezing, cough, and shortness of breath that are characteristically triggered by several potential stimuli. However, several diagnostic challenges exist and have resulted in either overdiagnosis or underdiagnosis, making pediatric asthma diagnosis and management problematic. Effective management of asthma in children entails a holistic approach that encompasses non-pharmacological and pharmacological management, alongside self-management and educational aspects. Working with pediatric asthma patients and their families/caregivers is vital to promoting and realizing better asthma diagnosis and management outcomes. Educational guidelines regarding the best ways for effective treatment, avoidance of triggers, modifiable risk factors, and the actions that should be taken during chronic asthma attacks through individualized action plans are vital. Thus, the objective of this systematic review is to provide an overview of the latest guidelines on pediatric asthma diagnosis and management. In this regard, this review presents several similarities in existing pediatric asthma diagnosis and management guidelines in the United States and Canada. For instance, most guidelines and studies reviewed have proposed the use of objective tests for confirmation of asthma diagnosis, particularly in symptomatic individuals. The peak flow variability measurement, bronchodilator reversibility testing, and spirometry have also been proposed by the guidelines and studies, even as the recommendations regarding the timing and hierarchy of the objective test substantially vary between the guidelines and studies. We hope that the present review will be helpful to physicians and healthcare service providers working within pediatric health contexts., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Okobi et al.)

Objective: To assess the prevalence and severity of wheezing in the first year of life of infants, using the standardized protocol of the Estudio Internacional de Sibilancias en Lactantes - phase 3, and compare the values obtained with those found in phase 1, conducted at the same center. Methods: Between 2009 and 2010, parents and guardians of infants answered the written questionnaire of the Estudio Internacional de Sibilancias en Lactantes - phase 3, and its results were compared to those of phase 1, performed between 2005 and 2006. We divided the infants into wheezing and non-wheezing. The wheezing group was stratified according to the frequency of episodes: occasional wheezing - less than three -, and recurrent wheezing - three or more. Results: Wheezing prevalence was similar in both phases (44.6 versus 46%). Regarding frequency, the prevalence of occasional wheezing increased (19.4 versus 23%; p=0.03) and recurrent wheezing decreased (26.7 versus 21.6%; p=0.005). Also, diagnosis of asthma (7.5 versus 21.8%), use of inhaled corticosteroids (11.7 versus 35%), and hospitalization for wheezing (19.7 versus 32.6%) grew significantly in phase 3. This period coincides with the Influenza A (H1N1) pandemic, which could have contributed to this outcome. Conclusions: Wheezing prevalence in the first year of life remains high. Despite the temporal assessment showing a decrease in the prevalence of recurrent wheezing, a significant increase in its morbidity was identified due to the higher number of hospitalizations. In addition, there were signs of improvement in the wheezing management of infants, reflected by an increase in the diagnosis of asthma and a greater indication of preventive treatments. [ABSTRACT FROM AUTHOR]

Background. Inuit children in Nunavut, Canada, have high rates of lower respiratory tract infection (LRTI) early in life. Whether this commonly results in chronic respiratory symptoms later in life is unknown. Methods. A cross-sectional survey of 3- to 5-years-old Inuit children was conducted in all three regions of Nunavut, as part of the '' Qanuippitali, what about us, how are we??'' survey. Results. Reported chronic cough and wheezing were common in preschool Inuit children, although reported asthma diagnosed by a healthcare professional was uncommon. The presence of smokers in the home tended to be associated with severe LRTI in the first 2 years of life. Reported wheezing as well as reported bronchitis or pneumonia in the previous 12 months was significantly associated with severe LRTI in the first 2 years of life. Reported wheezing was also strongly associated with reported bronchitis or pneumonia in the past 12 months. The prevalence of chronic moist cough could not be clearly assessed, due to limitations in the questionnaire. Interpretation. Severe LRTI in the first 2 years of life was associated with ongoing respiratory morbidity in preschool Inuit children, although symptoms appeared to lessen in severity over time. [ABSTRACT FROM AUTHOR]

RESUMO Objetivo: Avaliar a prevalência e a gravidade da sibilância em lactentes no primeiro ano de vida, utilizando o protocolo padronizado do Estudio Internacional de Sibilancias en Lactantes- fase 3, e comparar os valores obtidos com os observados no Estudio Internacional de Sibilancias en Lactantes- fase 1, realizado no mesmo centro. Métodos: Entre 2009 e 2010, pais e responsáveis de lactentes responderam ao questionário escrito do Estudio Internacional de Sibilancias en Lactantes- fase 3, e os resultados obtidos foram comparados aos do Estudio Internacional de Sibilancias en Lactantes- fase 1, realizado entre 2005 e 2006. Oslactentes foram separados em sibilantes e “não sibilantes”. Osprimeiros foram divididos de acordo com a frequência dos episódios: sibilância ocasional, quando apresentaram menos de três, e sibilância recorrente, quando manifestaram três ou mais. Resultados: A prevalência de sibilantes foi similar nas duas fases (44,6 versus46%). Segundo a frequência, houve aumento na prevalência de sibilância ocasional (19,4 versus 23%; p=0,03) e redução na de sibilância recorrente (26,7 versus 21,6%; p=0,005). Observou-se, ainda, aumento expressivo no diagnóstico de asma (7,5 versus 21,8%) e no uso de corticosteroides inalatórios (11,7 versus 35%), como também na hospitalização por sibilância na fase 3 (19,7 versus 32,6%), período da pandemia Influenza A (H1N1), o que pode ter contribuído para este desfecho. Conclusões: A prevalência da sibilância no primeiro ano de vida permanece elevada. Apesar de a avaliação temporal mostrar queda na prevalência da sibilância recorrente, aumento significante de sua morbidade foi identificado pelo maior número de hospitalizações. Além disso, houve indícios de melhora no manejo da sibilância dos lactentes, refletido pelo aumento do diagnóstico de asma e maior indicação de tratamentos preventivos.