The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Dean Edell - One of the best experts on this subject based on the ideXlab platform.
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Early Ribavarin Treatment of Bronchiolitis: Effect on Long-term Respiratory Morbidity
Chest, 2002Co-Authors: Dean Edell, Vikram Khoshoo, Gerald Ross, Karen SalterAbstract:Background The mortality rate from respiratory syncytial virus (RSV) bronchiolitis has significantly reduced over the last decade. A major concern now is the long-term respiratory morbidity following RSV bronchiolitis. Methods In this prospective study, we randomly assigned 49 previously healthy infants with severe RSV bronchiolitis, early in the course of illness ( Results During a prospective, closely monitored, 1-year follow-up period, the group treated with ribavirin had significantly fewer episodes (2.7 ± 2.3 episodes vs 6.4 ± 4.2 episodes per patient per year) and reduced severity of Reactive Airway Disease (0.08 episodes vs 1.09 episodes of moderate-to-severe illness per patient per year) and respiratory illness-related hospitalization (25 hospital days vs 90 hospital days per 100 patients per year). Conclusions Early ribavirin treatment of RSV bronchiolitis in previously healthy infants resulted in reduction of incidence and severity of Reactive Airway Disease as well as respiratory illness-related hospitalization.
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Reduced long-term respiratory morbidity after treatment of respiratory syncytial virus bronchiolitis with ribavirin in previously healthy infants: a preliminary report.
Pediatric pulmonology, 1998Co-Authors: Dean Edell, Erik Bruce, Kathe Hale, Vikram KhoshooAbstract:Previously healthy infants less than 6 months of age with severe respiratory syncytial virus bronchiolitis who required hospitalization were identified from hospital records. Infants had been treated either conservatively (control group, n = 19) or with ribavirin added to conservative management (study group, n = 22). All infants underwent a 1-year follow-up after the initial illness. There was a significant reduction in the prevalence of Reactive Airway Disease in the group treated with ribavirin (P < 0.05) compared with the control group, both in terms of the proportion of patients developing Airway reactivity (59% vs. 89%) and the number of episodes of Reactive Airway Disease (31 vs. 70). Our data suggest that ribavirin reduces the prevalence of Airway reactivity.
Jan L. L. Kimpen - One of the best experts on this subject based on the ideXlab platform.
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Prevention and treatment of respiratory syncytial virus bronchiolitis and postbronchiolitic wheezing
Respiratory Research, 2002Co-Authors: Jan L. L. KimpenAbstract:Respiratory syncytial virus (RSV) is the primary cause of hospitalization for acute respiratory tract illness in general and specifically for bronchiolitis in young children. The link between RSV bronchiolitis and Reactive Airway Disease is not completely understood, even though RSV bronchiolitis is frequently followed by recurrent episodes of wheezing. Therapy with ribavirin does not appear to significantly reduce long-term respiratory outcome of RSV lower respiratory tract infection, and corticosteroid or bronchodilator therapy may possibly improve outcomes only on a short-term basis. No vaccine against RSV is yet available. It is not known whether prophylaxis with RSV intravenous immune globulin or palivizumab can reduce postbronchiolitic wheezing.
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Introduction. RSV and RAD: possibilities for prevention? The link between respiratory syncytial virus and Reactive Airway Disease
Respiratory Research, 2002Co-Authors: Xavier Carbonell-estrany, Jan L. L. KimpenAbstract:Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infections in infants and small children worldwide. There is no cure for RSV Disease, but immunoprophylaxis using humanized monoclonal antibody has proven to be safe and efficacious in preventing Disease. Extensive research supports the hypothesis that RSV bronchiolitis in infancy results in increased risk for development of wheezing, asthma, and possibly atopy throughout childhood. In spite of this, the pathophysiologic mechanisms that are responsible for this association have not been fully elucidated. We recently co-chaired an international panel of physicians that met to discuss the link between RSV and Reactive Airway Disease (RAD). Research results in the clinical arena and current opinion on RSV prophylaxis and the RSV-RAD association are presented in this special supplement to Respiratory Research. Professor Rosalind Smyth from the University of Liverpool, UK, presented evidence supporting the argument that asthma is a major pediatric health issue. The incidence of asthma has increased considerably over the past three decades in the UK, although since the early 1990s the incidence of new episodes has declined. This overall increase has been observed worldwide, but there is broad variation between countries. Environmental factors, genetic factors, the hygiene hypothesis, and lifestyle differences may play roles in causing asthma, but currently there is no unifying explanation for these trends. One hypothesis for the etiology of asthma suggests that asthmatic children have normal lung function at birth, but inflammatory and immunologic events in the Airways, such as those seen in RSV bronchiolitis during infancy, contribute to persistence of wheeze. Dr Nele Sigurs of Boras Central Hospital, Sweden, presented clinical perspectives on the association between RSV and RAD. She reviewed the eight studies to date that have compared children with and without RSV bronchiolitis, and all have found an increased incidence of bronchial obstructive symptoms in the ex-bronchiolitics. There were no significant differences in family history of atopy or asthma in any of those studies. An increased risk for allergic sensitization was observed in three of the studies. It remains unclear whether RSV bronchiolitis alone is responsible for these symptoms or whether other risk factors contribute. Further studies are needed to investigate the effect of RSV interventional agents in order to resolve this issue. Professor Peter Openshaw of the Imperial College of Science, Technology and Medicine in London addressed the question of whether RSV is a cause or consequence of Airway pathology. He reviewed the various inflammatory and cytokine responses associated with RSV infection and showed that data from animal studies support the possibility that wheezing in childhood results from viral bronchiolitis in infancy. The timing of severe Disease appears to be critical for the development of pulmonary sequelae, and preventing or delaying RSV infection could reduce the number of children who suffer from recurrent wheeze during childhood. He concurred that prospective interventional studies are needed. Professor Giovanni Piedimonte of the University of Miami, Florida, USA, proposed pathophysiologic mechanisms for the RSV-RAD link, based on his studies in rats. He has observed upregulation of receptors for substance P, a proinflammatory neuropeptide, in T-lymphocyte subpopulations within the bronchial-associated lymphoid tissue of RSV-infected rats. He postulates that this mechanism establishes important neuroimmune interactions that result in long-term dysregulation, predisposing to Airway inflammation and hyperreactivity. More importantly, these changes were avoided if rats were administered palivizumab, a monoclonal antibody to the fusion protein of RSV, before or during the early phase of infection. Therefore, results in animal studies suggest that prevention of RSV lower respiratory tract infection with anti-RSV antibody protects against respiratory sequelae associated with this virus. Professor Eric Simoes of The Children's Hospital in Denver, Colorado, USA, reviewed the global experience of immunoprophylaxis for RSV. He presented a combined analysis of several studies that have reported hospitalization rates for RSV in children who had received palivizumab and in children who did not receive prophylaxis. The children were divided into three subgroups: those with chronic lung Disease (CLD) and/or bronchopulmonary dysplasia (BPD); premature infants born at gestational age 29–32 weeks without CLD/BPD; and premature infants born at gestational age 32–35 weeks without CLD/BPD. The hospitalization rates were significantly lower in the children who had received palivizumab for all three groups. He also reviewed several studies conducted in Europe and North America that continue to support the safety and efficacy of palivizumab. Dr Lone Graff Stensballe of the Statens Serum Institut in Copenhagen, Denmark, presented the design of a study she has initiated in Denmark to investigate prospectively the incidence of RSV infection in Denmark and factors that predispose to or protect against serious RSV Disease, and to examine the association between severe RSV infection and RAD. Several population-based registers will be used to examine the influence of various biologic, social, and environmental factors on hospitalization for RSV Disease. Professor Jan Kimpen of the University Medical Center Utrecht, The Netherlands, concluded the session with his examination of the impact of prevention and treatment of RSV on development of RAD. His review of published studies revealed that ribavirin does not appear to reduce significantly the long-term respiratory morbidity associated with RSV bronchiolitis. Corticosteriod or bronchodilator therapy may improve outcomes, but only on a short-term basis. Investigations are underway to determine whether immunoprophylaxis reduces the incidence of RAD in children.
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RSV and RAD: possibilities for prevention? The link between respiratory syncytial virus and Reactive Airway Disease
2002Co-Authors: Xavier Carbonell-estrany, Jan L. L. KimpenAbstract:Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infections in infants and small children worldwide. There is no cure for RSV Disease, but immunoprophylaxis using humanized monoclonal antibody has proven to be safe and efficacious in preventing Disease. Extensive research supports the hypothesis that RSV bronchiolitis in infancy results in increased risk for development of wheezing, asthma, and possibly atopy throughout childhood. In spite of this, the pathophysiologic mechanisms that are responsible for this association have not been fully elucidated. We recently co-chaired an international panel of physicians that met to discuss the link between RSV and Reactive Airway Disease (RAD). Research results in the clinical arena and current opinion on RSV prophylaxis and the RSV–RAD association are presented in this special supplement to Respiratory Research.
Hans Bisgaard - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial of montelukast in respiratory syncytial virus postbronchiolitis
American Journal of Respiratory and Critical Care Medicine, 2003Co-Authors: Hans BisgaardAbstract:Infants often develop Reactive Airway Disease after respiratory syncytial virus (RSV) bronchiolitis. Cysteinyl-leukotrienes (cys-LT) are released during RSV infection and may contribute to the inflammation. We hypothesized that a cys-LT receptor antagonist would ameliorate Reactive Airway Disease subsequent to RSV bronchiolitis. One hundred and thirty infants who were 3 to 36 months old, hospitalized with acute RSV bronchiolitis, were randomized into a double-blind, parallel comparison of 5-mg montelukast chewable tablets or matching placebo given for 28 days starting within 7 days of symptom debut. Infants with a suspected history of asthma were excluded. One hundred sixteen infants provided diary card data for the treatment period. Median age was 9 months. Infants on montelukast were free of any symptoms on 22% of the days and nights compared with 4% of the days and nights in infants on placebo (p = 0.015). Daytime cough was significantly reduced on active treatment (p = 0.04). Exacerbations were signif...
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A Randomized Trial of Montelukast in Respiratory Syncytial Virus Postbronchiolitis
American journal of respiratory and critical care medicine, 2002Co-Authors: Hans BisgaardAbstract:Infants often develop Reactive Airway Disease after respiratory syncytial virus (RSV) bronchiolitis. Cysteinyl-leukotrienes (cys-LT) are released during RSV infection and may contribute to the inflammation. We hypothesized that a cys-LT receptor antagonist would ameliorate Reactive Airway Disease subsequent to RSV bronchiolitis. One hundred and thirty infants who were 3 to 36 months old, hospitalized with acute RSV bronchiolitis, were randomized into a double-blind, parallel comparison of 5-mg montelukast chewable tablets or matching placebo given for 28 days starting within 7 days of symptom debut. Infants with a suspected history of asthma were excluded. One hundred sixteen infants provided diary card data for the treatment period. Median age was 9 months. Infants on montelukast were free of any symptoms on 22% of the days and nights compared with 4% of the days and nights in infants on placebo (p = 0.015). Daytime cough was significantly reduced on active treatment (p = 0.04). Exacerbations were significantly delayed from montelukast compared with placebo (p < 0.05). In conclusion, cys-LT antagonist treatment reduces lung symptoms subsequent to RSV bronchiolitis.
Vikram Khoshoo - One of the best experts on this subject based on the ideXlab platform.
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Early Ribavarin Treatment of Bronchiolitis: Effect on Long-term Respiratory Morbidity
Chest, 2002Co-Authors: Dean Edell, Vikram Khoshoo, Gerald Ross, Karen SalterAbstract:Background The mortality rate from respiratory syncytial virus (RSV) bronchiolitis has significantly reduced over the last decade. A major concern now is the long-term respiratory morbidity following RSV bronchiolitis. Methods In this prospective study, we randomly assigned 49 previously healthy infants with severe RSV bronchiolitis, early in the course of illness ( Results During a prospective, closely monitored, 1-year follow-up period, the group treated with ribavirin had significantly fewer episodes (2.7 ± 2.3 episodes vs 6.4 ± 4.2 episodes per patient per year) and reduced severity of Reactive Airway Disease (0.08 episodes vs 1.09 episodes of moderate-to-severe illness per patient per year) and respiratory illness-related hospitalization (25 hospital days vs 90 hospital days per 100 patients per year). Conclusions Early ribavirin treatment of RSV bronchiolitis in previously healthy infants resulted in reduction of incidence and severity of Reactive Airway Disease as well as respiratory illness-related hospitalization.
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Reduced long-term respiratory morbidity after treatment of respiratory syncytial virus bronchiolitis with ribavirin in previously healthy infants: a preliminary report.
Pediatric pulmonology, 1998Co-Authors: Dean Edell, Erik Bruce, Kathe Hale, Vikram KhoshooAbstract:Previously healthy infants less than 6 months of age with severe respiratory syncytial virus bronchiolitis who required hospitalization were identified from hospital records. Infants had been treated either conservatively (control group, n = 19) or with ribavirin added to conservative management (study group, n = 22). All infants underwent a 1-year follow-up after the initial illness. There was a significant reduction in the prevalence of Reactive Airway Disease in the group treated with ribavirin (P < 0.05) compared with the control group, both in terms of the proportion of patients developing Airway reactivity (59% vs. 89%) and the number of episodes of Reactive Airway Disease (31 vs. 70). Our data suggest that ribavirin reduces the prevalence of Airway reactivity.
Giovanni Piedimonte - One of the best experts on this subject based on the ideXlab platform.
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Pathophysiological mechanisms for the respiratory syncytial virus-Reactive Airway Disease link
Respiratory Research, 2002Co-Authors: Giovanni PiedimonteAbstract:There is substantial epidemiological evidence supporting the concept that respiratory syncytial virus (RSV) lower respiratory tract infection in infancy may be linked to the development of Reactive Airway Disease (RAD) in childhood. However, much less is known concerning the mechanisms by which this self-limiting infection leads to Airway dysfunction that persists long after the virus is cleared from the lungs. A better understanding of the RSV–RAD link may have important clinical implications, particularly because prevention of RSV lower respiratory tract infection may reduce the occurrence of RAD later in life. Among the mechanisms proposed to explain the chronic sequelae of RSV infection is the interaction between the subepithelial neural network of the Airway mucosa and the cellular effectors of inflammatory and immune responses to the virus. The body of clinical literature linking RSV and RAD is reviewed herein, as are the cellular and molecular mechanisms of neuroimmune interactions and neural remodeling that may underlie this link, and the possibility that preventing the infection may result in a decreased incidence of its chronic sequelae
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The association between respiratory syncytial virus infection and Reactive Airway Disease.
Respiratory Medicine, 2002Co-Authors: Giovanni PiedimonteAbstract:Evidence has been accumulating that respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) in infants may be linked to subsequent development of Reactive Airway Disease (RAD) in childhood, and therefore research into the prevention of RSV LRTI may have important implications for the prevention of RAD. This article reviews the epidemiological evidence linking RSVand RAD and some ofthe theories concerning cellular and molecular mechanisms of post-viral Airway inflammation in order to understand how RSV prophylaxis may assist in reducing the occurrence of RSV LRTI and RAD.
