The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Michael C Mckean - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Nedocromil sodium for chronic Asthma in Children
The Cochrane database of systematic reviews, 2006Co-Authors: Arani Sridhar, Michael C MckeanAbstract:BACKGROUND Currently inhaled corticosteroids are the main stay in the maintenance treatment of chronic Asthma in Children. Although inhaled corticosteroids play a crucial role in the management of childhood Asthma, the long-term side effects of inhaled corticosteroids used in the management of chronic Asthma in Children are not clearly known. OBJECTIVES The objective of this review is to compare the safety and efficacy of inhaled nedocromil sodium with placebo in the treatment of chronic Asthma in Children. SEARCH STRATEGY We searched the Cochrane airway group trials register, Cochrane controlled trials register, Current contents, review articles, reference lists of articles. We also contacted the drug manufacturer and primary authors for additional citations. We also searched abstracts of major respiratory society meetings. The last search was carried out in October 2004 SELECTION CRITERIA Randomised placebo controlled trials comparing nedocromil sodium to placebo in the treatment of chronic Asthma in Children (0 to 18 years). DATA COLLECTION AND ANALYSIS Both authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAin RESULTS Fifteen trials (twelve parallel group studies; three crossover trials recruiting 1422 Children (837 males and 585 females)) were included. The studies were generally of good methodological quality. Two large long term studies used nedocromil for six months and four to six years and showed conflicting results in symptom free days. Short term studies (duration between 4 weeks to 12 weeks) showed that nedocromil sodium produced some improvement in a number of efficacy measures compared to placebo including FEV(1), FVC, FEV(1) % predicted, PC20 FEV(1), evening PEF and symptom scores. The parent's assessment of efficacy was in favour of nedocromil (odds ratio (OR) 0.5 (95% CI 0.3 to 0.8). Nedocromil sodium has a good safety profile. The only significant side effect observed was unpleasant taste. There was little evidence for a clinically dose response effect and only a few studies recruited participants with severe Asthma. AUTHORS' CONCLUSIONS A limited number of small studies have shown that nedocromil is of benefit in improving lung function and some measures of symptoms, but the evidence with regard to the primary outcome of the review was conflicting. Two long-term trials did not show consistent effects on lung function outcomes, whereas several small short-term trials have shown benefit in these outcomes. Differing severities at baseline may explain this difference with milder participants experiencing less benefit, although the discrepancy between study findings may also reflect publication bias. Nedocromil sodium is associated with a very good safety profile with no significant short term or long- term adverse side effects. Although nedocromil may have advantages over inhaled corticosteroids in terms of side effects, there is a need for head to head trials of nedocromil and inhaled corticosteroids to establish whether Asthma control is similar, especially in mild Asthma. It is not yet clear where nedocromil should sit in relation to other therapies in the treatment of Asthma in Children.
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nedocromil sodium for chronic Asthma in Children
Cochrane Database of Systematic Reviews, 2006Co-Authors: Arani Sridhar, Michael C MckeanAbstract:BACKGROUND Currently inhaled corticosteroids are the main stay in the maintenance treatment of chronic Asthma in Children. Although inhaled corticosteroids play a crucial role in the management of childhood Asthma, the long-term side effects of inhaled corticosteroids used in the management of chronic Asthma in Children are not clearly known. OBJECTIVES The objective of this review is to compare the safety and efficacy of inhaled nedocromil sodium with placebo in the treatment of chronic Asthma in Children. SEARCH STRATEGY We searched the Cochrane airway group trials register, Cochrane controlled trials register, Current contents, review articles, reference lists of articles. We also contacted the drug manufacturer and primary authors for additional citations. We also searched abstracts of major respiratory society meetings. The last search was carried out in October 2004 SELECTION CRITERIA Randomised placebo controlled trials comparing nedocromil sodium to placebo in the treatment of chronic Asthma in Children (0 to 18 years). DATA COLLECTION AND ANALYSIS Both authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAin RESULTS Fifteen trials (twelve parallel group studies; three crossover trials recruiting 1422 Children (837 males and 585 females)) were included. The studies were generally of good methodological quality. Two large long term studies used nedocromil for six months and four to six years and showed conflicting results in symptom free days. Short term studies (duration between 4 weeks to 12 weeks) showed that nedocromil sodium produced some improvement in a number of efficacy measures compared to placebo including FEV(1), FVC, FEV(1) % predicted, PC20 FEV(1), evening PEF and symptom scores. The parent's assessment of efficacy was in favour of nedocromil (odds ratio (OR) 0.5 (95% CI 0.3 to 0.8). Nedocromil sodium has a good safety profile. The only significant side effect observed was unpleasant taste. There was little evidence for a clinically dose response effect and only a few studies recruited participants with severe Asthma. AUTHORS' CONCLUSIONS A limited number of small studies have shown that nedocromil is of benefit in improving lung function and some measures of symptoms, but the evidence with regard to the primary outcome of the review was conflicting. Two long-term trials did not show consistent effects on lung function outcomes, whereas several small short-term trials have shown benefit in these outcomes. Differing severities at baseline may explain this difference with milder participants experiencing less benefit, although the discrepancy between study findings may also reflect publication bias. Nedocromil sodium is associated with a very good safety profile with no significant short term or long- term adverse side effects. Although nedocromil may have advantages over inhaled corticosteroids in terms of side effects, there is a need for head to head trials of nedocromil and inhaled corticosteroids to establish whether Asthma control is similar, especially in mild Asthma. It is not yet clear where nedocromil should sit in relation to other therapies in the treatment of Asthma in Children.
Stanley J. Szefler - One of the best experts on this subject based on the ideXlab platform.
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Understanding mild persistent Asthma in Children: The next frontier
The Journal of allergy and clinical immunology, 2005Co-Authors: Hans Bisgaard, Stanley J. SzeflerAbstract:Limitations in Asthma prevalence studies and difficulties in diagnosing pediatric Asthma lead to uncertainty over the full extent of mild persistent Asthma in Children and adolescents. Although recent surveys have reported that the majority of pediatric patients with Asthma in the United States and Europe have symptoms consistent with mild disease, these surveys have limitations in design. Thus, the true prevalence of mild Asthma remains unknown. It is unclear whether Children with mild persistent Asthma progress to more severe Asthma, but the risk of severe Asthma exacerbations seems to be unrelated to the symptom severity. Clinical studies restricted to pediatric patients with mild Asthma are limited, but available data do suggest substantial morbidity of mild persistent Asthma in this population and support inhaled corticosteroid intervention. There is a need for further investigation into the true prevalence of mild persistent Asthma in Children and adolescents, and optimal treatment.
Arani Sridhar - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Nedocromil sodium for chronic Asthma in Children
The Cochrane database of systematic reviews, 2006Co-Authors: Arani Sridhar, Michael C MckeanAbstract:BACKGROUND Currently inhaled corticosteroids are the main stay in the maintenance treatment of chronic Asthma in Children. Although inhaled corticosteroids play a crucial role in the management of childhood Asthma, the long-term side effects of inhaled corticosteroids used in the management of chronic Asthma in Children are not clearly known. OBJECTIVES The objective of this review is to compare the safety and efficacy of inhaled nedocromil sodium with placebo in the treatment of chronic Asthma in Children. SEARCH STRATEGY We searched the Cochrane airway group trials register, Cochrane controlled trials register, Current contents, review articles, reference lists of articles. We also contacted the drug manufacturer and primary authors for additional citations. We also searched abstracts of major respiratory society meetings. The last search was carried out in October 2004 SELECTION CRITERIA Randomised placebo controlled trials comparing nedocromil sodium to placebo in the treatment of chronic Asthma in Children (0 to 18 years). DATA COLLECTION AND ANALYSIS Both authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAin RESULTS Fifteen trials (twelve parallel group studies; three crossover trials recruiting 1422 Children (837 males and 585 females)) were included. The studies were generally of good methodological quality. Two large long term studies used nedocromil for six months and four to six years and showed conflicting results in symptom free days. Short term studies (duration between 4 weeks to 12 weeks) showed that nedocromil sodium produced some improvement in a number of efficacy measures compared to placebo including FEV(1), FVC, FEV(1) % predicted, PC20 FEV(1), evening PEF and symptom scores. The parent's assessment of efficacy was in favour of nedocromil (odds ratio (OR) 0.5 (95% CI 0.3 to 0.8). Nedocromil sodium has a good safety profile. The only significant side effect observed was unpleasant taste. There was little evidence for a clinically dose response effect and only a few studies recruited participants with severe Asthma. AUTHORS' CONCLUSIONS A limited number of small studies have shown that nedocromil is of benefit in improving lung function and some measures of symptoms, but the evidence with regard to the primary outcome of the review was conflicting. Two long-term trials did not show consistent effects on lung function outcomes, whereas several small short-term trials have shown benefit in these outcomes. Differing severities at baseline may explain this difference with milder participants experiencing less benefit, although the discrepancy between study findings may also reflect publication bias. Nedocromil sodium is associated with a very good safety profile with no significant short term or long- term adverse side effects. Although nedocromil may have advantages over inhaled corticosteroids in terms of side effects, there is a need for head to head trials of nedocromil and inhaled corticosteroids to establish whether Asthma control is similar, especially in mild Asthma. It is not yet clear where nedocromil should sit in relation to other therapies in the treatment of Asthma in Children.
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nedocromil sodium for chronic Asthma in Children
Cochrane Database of Systematic Reviews, 2006Co-Authors: Arani Sridhar, Michael C MckeanAbstract:BACKGROUND Currently inhaled corticosteroids are the main stay in the maintenance treatment of chronic Asthma in Children. Although inhaled corticosteroids play a crucial role in the management of childhood Asthma, the long-term side effects of inhaled corticosteroids used in the management of chronic Asthma in Children are not clearly known. OBJECTIVES The objective of this review is to compare the safety and efficacy of inhaled nedocromil sodium with placebo in the treatment of chronic Asthma in Children. SEARCH STRATEGY We searched the Cochrane airway group trials register, Cochrane controlled trials register, Current contents, review articles, reference lists of articles. We also contacted the drug manufacturer and primary authors for additional citations. We also searched abstracts of major respiratory society meetings. The last search was carried out in October 2004 SELECTION CRITERIA Randomised placebo controlled trials comparing nedocromil sodium to placebo in the treatment of chronic Asthma in Children (0 to 18 years). DATA COLLECTION AND ANALYSIS Both authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAin RESULTS Fifteen trials (twelve parallel group studies; three crossover trials recruiting 1422 Children (837 males and 585 females)) were included. The studies were generally of good methodological quality. Two large long term studies used nedocromil for six months and four to six years and showed conflicting results in symptom free days. Short term studies (duration between 4 weeks to 12 weeks) showed that nedocromil sodium produced some improvement in a number of efficacy measures compared to placebo including FEV(1), FVC, FEV(1) % predicted, PC20 FEV(1), evening PEF and symptom scores. The parent's assessment of efficacy was in favour of nedocromil (odds ratio (OR) 0.5 (95% CI 0.3 to 0.8). Nedocromil sodium has a good safety profile. The only significant side effect observed was unpleasant taste. There was little evidence for a clinically dose response effect and only a few studies recruited participants with severe Asthma. AUTHORS' CONCLUSIONS A limited number of small studies have shown that nedocromil is of benefit in improving lung function and some measures of symptoms, but the evidence with regard to the primary outcome of the review was conflicting. Two long-term trials did not show consistent effects on lung function outcomes, whereas several small short-term trials have shown benefit in these outcomes. Differing severities at baseline may explain this difference with milder participants experiencing less benefit, although the discrepancy between study findings may also reflect publication bias. Nedocromil sodium is associated with a very good safety profile with no significant short term or long- term adverse side effects. Although nedocromil may have advantages over inhaled corticosteroids in terms of side effects, there is a need for head to head trials of nedocromil and inhaled corticosteroids to establish whether Asthma control is similar, especially in mild Asthma. It is not yet clear where nedocromil should sit in relation to other therapies in the treatment of Asthma in Children.
Hans Bisgaard - One of the best experts on this subject based on the ideXlab platform.
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Understanding mild persistent Asthma in Children: The next frontier
The Journal of allergy and clinical immunology, 2005Co-Authors: Hans Bisgaard, Stanley J. SzeflerAbstract:Limitations in Asthma prevalence studies and difficulties in diagnosing pediatric Asthma lead to uncertainty over the full extent of mild persistent Asthma in Children and adolescents. Although recent surveys have reported that the majority of pediatric patients with Asthma in the United States and Europe have symptoms consistent with mild disease, these surveys have limitations in design. Thus, the true prevalence of mild Asthma remains unknown. It is unclear whether Children with mild persistent Asthma progress to more severe Asthma, but the risk of severe Asthma exacerbations seems to be unrelated to the symptom severity. Clinical studies restricted to pediatric patients with mild Asthma are limited, but available data do suggest substantial morbidity of mild persistent Asthma in this population and support inhaled corticosteroid intervention. There is a need for further investigation into the true prevalence of mild persistent Asthma in Children and adolescents, and optimal treatment.
Anne M. Fitzpatrick - One of the best experts on this subject based on the ideXlab platform.
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Chapter 4 – Management and Prevention of Severe Asthma in Children
Personalizing Asthma Management for the Clinician, 2018Co-Authors: Anne M. FitzpatrickAbstract:Severe Asthma in Children is difficult to treat, in part, because it is a highly heterogeneous condition associated with a variety of “phenotypes” (i.e., clinical characteristics), necessitating a more “personalized” as opposed to a “one-size-fits-all” treatment approach. Although the existing evidence base is somewhat limited, this chapter outlines strategies for the definition and diagnosis of severe Asthma in Children and reviews potential phenotype-directed treatment strategies. Unique aspects of Children with severe Asthma as well as future directions and challenges with the application of precision medicine for these Children are also discussed.
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Severe Asthma in Children: Lessons Learned and Future Directions
The journal of allergy and clinical immunology. In practice, 2016Co-Authors: Anne M. FitzpatrickAbstract:Severe Asthma in Children is a complicated and heterogeneous disorder that is extremely challenging to treat. Although most Children with Asthma derive clinical benefit from daily administration of low-to-medium-dose inhaled corticosteroid (ICS) therapy, a small subset of Children with "severe" or "refractory" Asthma require high doses of ICS and even systemic corticosteroids to maintain symptom control. These Children with severe Asthma are at increased risk for adverse outcomes including medication-related side effects and recurrent and life-threatening exacerbations that significantly impair quality of life. This review highlights findings on severe Asthma in school-age Children (age 6-17 years) from the National Heart, Lung and Blood institute's Severe Asthma Research Program (SARP) over a 10-year period, between 2001 and 2011. Although SARP has advanced knowledge of the unique clinical, biological, and molecular attributes of severe Asthma in Children, considerable gaps remain for which additional studies are needed.
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The molecular phenotype of severe Asthma in Children
The Journal of allergy and clinical immunology, 2010Co-Authors: Anne M. Fitzpatrick, Melinda Higgins, Fernando Holguin, Lou Ann S. Brown, W. Gerald TeagueAbstract:Background Although the clinical attributes of severe Asthma in Children have been well described, the differentiating features of the lower airway inflammatory response are less understood. Objectives We sought to discriminate severe from moderate Asthma in Children by applying linear discriminant analysis, a supervised method of high-dimensional data reduction, to cytokines and chemokines measured in the bronchoalveolar lavage (BAL) fluid and alveolar macrophage (AM) lysate. Methods Bronchoalveolar lavage fluid was available from 53 Children with Asthma (severe Asthma, n=31) undergoing bronchoscopy for clinical indications and 30 nonsmoking adults. Twenty-three cytokines and chemokines were measured by using bead-based multiplex assays. Linear discriminant analyses of the BAL fluid and AM analytes were performed to develop predictive models of severe Asthma in Children. Results Although univariate analysis of single analytes did not differentiate severe from moderate Asthma in Children, linear discriminant analyses allowed for near complete separation of the moderate and severe Asthmatic groups. Significant correlations were also noted between several of the AM and BAL analytes measured. in the BAL fluid, IL-13 and IL-6 differentiated subjects with Asthma from controls, whereas growth-related oncogene (CXCL1), RANTES (CCL5), IL-12, IFN-γ, and IL-10 best characterized severe versus moderate Asthma in Children. in the AM lysate, IL-6 was the strongest discriminator of all the groups. Conclusion Severe Asthma in Children is characterized by a distinct airway molecular phenotype that does not have a clear T H 1 or T H 2 pattern. Improved classification of Children with severe Asthma may assist with the development of targeted therapeutics for this group of Children who are difficult to treat.
