Test-retest repeatability of child’s respiratory symptoms and perceived indoor air quality – comparing self- and parent-administered questionnaires

Juan Carlos Ivancevich Sunday, 11 February 2018 14:04
 
Jussi Lampi, Sari Ung-LankiPäivi Santalahti and Juha Pekkanen
 

Abstract

Background

Questionnaires can be used to assess perceived indoor air quality and symptoms in schools. Questionnaires for primary school aged children have traditionally been parent-administered, but self-administered questionnaires would be easier to administer and may yield as good, if not better, information. Our aim was to compare the repeatability of self- and parent-administered indoor air questionnaires designed for primary school aged pupils.

Methods

Indoor air questionnaire with questions on child’s symptoms and perceived indoor air quality in schools was sent to parents of pupils aged 7–12 years in two schools and again after two weeks. Slightly modified version of the questionnaire was administered to pupils aged 9–12 years in another two schools and repeated after a week. 351 (52%) parents and 319 pupils (86%) answered both the first and the second questionnaire. Test-retest repeatability was assessed with intra-class correlation (ICC) and Cohen’s kappa coefficients (k).

Results

Test-retest repeatability was generally between 0.4–0.7 (ICC; k) in both self- and parent-administered questionnaire. In majority of the questions on symptoms and perceived indoor air quality test-retest repeatability was at the same level or slightly better in self-administered compared to parent-administered questionnaire. Agreement of self- and parent administered questionnaires was generally < 0.4 (ICC; k) in reported symptoms and 0.4–0.6 (ICC; k) in perceived indoor air quality.

Conclusions

Children aged 9–12 years can give as, or even more, repeatable information about their respiratory symptoms and perceived indoor air quality than their parents. Therefore, it may be possible to use self-administered questionnaires in future studies also with children.

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Nerve ablation after bronchial thermoplasty and sustained improvement in severe asthma

Juan Carlos Ivancevich Saturday, 10 February 2018 03:19
N. FacciolongoA. DiStefanoV. PietriniC. GaleoneF. BellanovaF. MenzellaN. ScichiloneR. PiroG. L. BajocchiB. BalbiL. AgostiniP. P. SalsiD. Formisano and M. Lusuardi
 
BMC Pulmonary Medicine BMC series – open, inclusive and trusted 201818:29

https://doi.org/10.1186/s12890-017-0554-8

Abstract

Background

Bronchial thermoplasty (BT) is a non-pharmacological intervention for severe asthma whose mechanism of action is not completely explained by a reduction of airway smooth muscle (ASM). In this study we analyzed the effect of BT on nerve fibers and inflammatory components in the bronchial mucosa at 1 year.

Methods

Endobronchial biopsies were obtained from 12 subjects (mean age 47 ± 11.3 years, 50% male) with severe asthma. Biopsies were performed at baseline (T0) and after 1 (T1), 2 (T2) and 12 (T12) months post-BT, and studied with immunocytochemistry and microscopy methods. Clinical data including Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ) scores, exacerbations, hospitalizations, oral corticosteroids use were also collected at the same time points.

Results

A statistically significant reduction at T1, T2 and T12 of nerve fibers was observed in the submucosa and in ASM compared to T0. Among inflammatory cells, only CD68 showed significant changes at all time points. Improvement of all clinical outcomes was documented and persisted at the end of follow up.

Conclusions

A reduction of nerve fibers in epithelium and in ASM occurs earlier and persists at one year after BT. We propose that nerve ablation may contribute to mediate the beneficial effects of BT in severe asthma.

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Virus-triggered exacerbation in allergic asthmatic children: neutrophilic airway inflammation and alteration of virus sensors characterize a subgroup of patients

Juan Carlos Ivancevich Friday, 26 January 2018 12:57
Open Access
 
Antoine Deschildre, Muriel Pichavant, Ilka Engelmann, Carole Langlois, Elodie Drumez, Guillaume Pouessel, Sophie Boileau, David Romero-Cubero, Irina Decleyre-Badiu, Anny Dewilde, Didier Hober, Véronique Néve, Caroline Thumerelle, Stéphanie Lejeune, Clémence Mordacq and Philippe Gosset

Abstract

Background

Viruses are important triggers of asthma exacerbations. They are also detected outside of exacerbation. Alteration of anti-viral response in asthmatic patients has been shown although the mechanisms responsible for this defect remain unclear. The objective of this study was to compare in virus-infected and not-infected allergic asthmatic children, aged 6 to 16 years, admitted to hospital for a severe exacerbation, the innate immune response and especially the expression of pattern recognition receptor (PRR) and their function.

Methods

Virus identification was performed both during the exacerbation and at steady state (eight weeks later). Data assessed at both periods included clinical features, anti-viral response and inflammation (in sputum and plasma), and PRR expression/function in blood mononuclear cells.

Results

Viruses were identified in 46 out of 72 children (median age 8.9 years) during exacerbation, and among them, in 17 at steady state. IFN-β, IFN-γ and IL-29 levels in sputum and plasma were similar between infected and not infected patients at both times, as well as the expression of TLR3, RIG-I and MDA5 in blood monocytes and dendritic cells. Airway inflammation in infected patients was characterized by significantly higher IL-5 concentration and eosinophil count. Compared to patients only infected at exacerbation, the re-infected children significantly exhibited lower levels of IFN-γ in plasma and sputum at exacerbation associated with modifications in PRR expression and function in blood mononuclear cells. These re-infected patients also presented an airway neutrophilic inflammation at steady state.

Conclusion

Our results reports in asthmatic children that impaired anti-viral response during virus-induced exacerbation is more pronounced in a subgroup of patients prone to re-infection by virus. This subgroup is characterized by altered PRR function and a different pattern of airway inflammation.

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Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE

Super User Thursday, 08 February 2018 11:51
 
Research and Guideline updates
 
Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE
 FREE
 
John White1, James Y Paton2, Robert Niven3, Hilary Pinnock4 on behalf of the British Thoracic Society

The British Thoracic Society (BTS) first produced a guideline on asthma and its management in 1990. The first collaborative guideline with the Scottish Intercollegiate Guideline Network (SIGN) using evidence-based medicine methodology was published in 2003.1 It has since become a mainstay of asthma management across the UK and beyond with updates published regularly every 18–24 months. The latest BTS/SIGN guideline for the management of asthma was published in 2016.2 Both BTS and SIGN are committed to continuing updates with the next update planned for publication in 2019.

Following publication of National Institute for Health and Care Excellence (NICE) guidelines for diagnosis and monitoring, and for management of chronic asthma,3–5 there are now two if not three national guidelines, for England at least, with some (apparently) striking differences. This statement considers the similarities and differences to assist clinical colleagues in the care of people with asthma.

The evidence base considered by the BTS/SIGN and NICE guideline development groups is broadly the same for each guideline, but the methodology used to produce recommendations is significantly different:

  • SIGN methodology is a multidisciplinary clinically led process which employs robust critical appraisal of the literature, coupled with consideration of pragmatic studies to ensure that guidelines provide clinically relevant recommendations.

  • NICE methodology overlays critical appraisal of the literature with health economic modelling, with interpretation supported by advice from a multidisciplinary guideline development group.

These different processes have resulted in some discrepancies in recommendations made by BTS/SIGN and NICE. This article seeks to provide some context to these differences in key areas:

  • Diagnosis

  • Pharmacological management:

    • Treatment at diagnosis.

    • The introduction of leukotriene receptor antagonists (LTRA) after low-dose inhaled corticosteroids (ICS).

    • Maintenance and reliever therapy (MART).

    • Treatment beyond combined inhaler therapy.

    • Some other issues in managing asthma in children.

The BTS/SIGN guideline also provides recommendations for important aspects of asthma management that are not addressed within NICE guidelines. These include guidance on inhaler devices, the management of acute asthma attacks in both adults and children, the management of difficult asthma, guidance on asthma in adolescents, in pregnant women and on occupational factors.

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Role of airway epithelial barrier dysfunction in pathogenesis of asthma

Juan Carlos Ivancevich Friday, 26 January 2018 12:15
Abstract
Bronchial asthma is characterized by persistent cough, increased sputum, and repeated wheezing. The pathophysiology underlying these symptoms is the hyper-responsiveness of the airway along with chronic airway inflammation. Repeated injury, repair, and regeneration of the airway epithelium following exposure to environmental factors and inflammation results in histological changes and functional abnormalities in the airway mucosal epithelium; such changes are believed to have a significant association with the pathophysiology of asthma. Damage to the barrier functions of the airway epithelium enhances mucosal permeability of foreign substances in the airway epithelium of patients with asthma. Thus, epithelial barrier fragility is closely involved in releasing epithelial cytokines (e.g., TSLP, IL-25, and IL-33) because of the activation of airway epithelial cells, dendritic cells, and innate group 2 innate lymphoid cells (ILC2). Functional abnormalities of the airway epithelial cells along with the activation of dendritic cells, Th2 cells, and ILC2 form a single immunopathological unit that is considered to cause allergic airway inflammation. Here we use the latest published literature to discuss the potential pathological mechanisms regarding the onset and progressive severity of asthma with regard to the disruption of the airway epithelial function.
 

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Editor: Juan C. Ivancevich, MD

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