The effect of high dose inhaled corticosteroids on wheeze in infants after respiratory syncytial virus infection: randomised double blind placebo controlled trial

Objective To determine whether early initiated anti-inflammatory therapy with prolonged high dose inhaled glucocorticoids influences the occurrence and severity of recurrent wheeze after respiratory syncytial virus related lower respiratory tract infections

Increased Risk of Wheeze and Decreased Lung Function after Respiratory Syncytial Virus Infection

<div><p>Background</p><p>A relationship between hospitalization for respiratory syncytial virus (RSV) bronchiolitis and asthma development has been suggested in case-control studies.</p><p>Objective</p><p>The aim of this study was to assess the risk of current wheeze, asthma, and lung function at school age in infants previously hospitalized for RSV bronchiolitis compared to non-hospitalized children.</p><p>Methods</p><p>For this study, data from a prospective birth cohort of unselected, term-born infants (n = 553), of whom 4 (0.7%) were hospitalized for RSV bronchiolitis, and a prospective patient cohort of 155 term infants hospitalized for RSV bronchiolitis were used. Respiratory outcomes at age 6 in children hospitalized for RSV bronchiolitis were compared to non-hospitalized children.</p><p>Results</p><p>The risk of current wheeze was higher in hospitalized patients (n = 159) compared to non-hospitalized children (n = 549) (adjusted odds ratio (OR) 3.2 (95% CI 1.2–8.1). Similarly, the risk of current asthma, defined as a doctor’s diagnosis of asthma plus current symptoms or medication use, was higher in hospitalized patients (adjusted OR 3.1 (95% CI 1.3–7.5). Compared to non-hospitalized children, RSV bronchiolitis hospitalization was associated with lower lung function (mean difference FEV1% predicted −6.8 l (95% CI (−10.2 to −3.4).</p><p>Conclusions and Clinical Relevance</p><p>This is the first study showing that hospitalization for RSV bronchiolitis during infancy is associated with increased risk of wheezing, current asthma, and impaired lung function as compared to an unselected birth cohort at age 6.</p></div

Group characteristics at age 6 for 159 hospitalized RSV bronchiolitis patients [13], and non-hospitalized children [12].

<p>Data are numbers (percentages) unless stated otherwise.</p>*<p>Caucasian = Not born in Africa, Latin America and Asia (Japan and Indonesia excluded) or Turkey.</p

Respiratory morbidity of hospitalized RSV bronchiolitis patients and non-hospitalized children at the age of 6 years.

<p>Data are numbers (percentages) unless stated otherwise;</p>*<p>Adjusted for sex and age;</p>**<p>Adjusted for sex, age, birth weight, birth season, smoke exposure during pregnancy and during life, breastfeeding, daycare, siblings, maternal atopy, ethnicity, year of birth, and maternal educational level;</p>***<p>Defined as combination of a history of doctor’s diagnosed asthma plus asthma symptoms or medication use in the last 12 months (beta-mimetics or inhaled corticosteroids).</p

FEV₁ values presented as % predicted values for hospitalized RSV bronchiolitis patients and non-hospitalized children measured at the age of 6 years.

<p>Hospitalized patients had a lower mean FEV_1% predicted compared to non hospitalized children (93.3 (SD12.2) versus 100.3% (SD 13.9), mean difference −7.0 (95% CI (−9.7 to −4.2)).</p

Experiences of bereaved family caregivers with shared decision making in palliative cancer treatment: a qualitative interview study

BACKGROUND: Patients with incurable cancer face complex medical decisions. Their family caregivers play a prominent role in shared decision making processes, but we lack insights into their experiences. In this study, we explored how bereaved family caregivers experienced the shared decision making process. METHODS: We performed a qualitative interview study with in-depth interviews analysed with inductive content analysis. We used a purposive sample of bereaved family caregivers (n = 16) of patients with cancer treated in a tertiary university hospital in the Netherlands. RESULTS: Four themes were identified: 1. scenarios of decision making, 2. future death of the patient 3. factors influencing choices when making a treatment decision, and 4. preconditions for the decision making process. Most family caregivers deferred decisions to the patient or physician. Talking about the patient’s future death was not preferred by all family caregivers. All family caregivers reported life prolongation as a significant motivator for treatment, while the quality of life was rarely mentioned. A respectful relationship, close involvement, and open communication with healthcare professionals in the palliative setting were valued by many interviewees. Family caregivers’ experiences and needs seemed to be overlooked during medical encounters. CONCLUSIONS: Family caregivers of deceased patients with cancer mentioned life prolongation, and not quality of life, as the most important treatment aim. They highly valued interactions with the medical oncologist and being involved in the conversations. We advise medical oncologists to take more effort to involve the family caregiver, and more explicitly address quality of life in the consultations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12904-021-00833-z

Genetic susceptibility to respiratory syncytial virus bronchiolitis is predominantly associated with innate immune genes

Background. Respiratory syncytial virus (RSV) is a common cause of severe lower respiratory tract infection in infants. Only a proportion of children infected with RSV require hospitalization. Because known risk factors for severe disease, such as premature birth, cannot fully explain differences in disease severity, genetic factors have been implicated. Methods. To study the complexity of RSV susceptibility and to identify the genes and biological pathways involved in its development, we performed a genetic association study involving 470 children hospitalized for RSV bronchiolitis, their parents, and 1008 random, population controls. We analyzed 384 single - nucleotide polymorphisms (SNPs) in 220 candidate genes involved in airway mucosal responses, innate immunity chemotaxis, adaptive immunity, and allergic asthma. Results. SNPs in the innate immune genes VDR (rs10735810; P = .0017), JUN (rs11688; P = .0093), IFNA5 (rs10757212; P = .0093), and NOS2 (rs1060826; P = .0031) demonstrated the strongest association with bronchiolitis. Apart from association at the allele level, these 4 SNPs also demonstrated association at the genotype level (P = .0056, P = .0285, P = .0372, and P = .0117 for the SNPs in VDR, JUN, IFNA5, and NOS2, respectively). The role of innate immunity as a process was reinforced by association of the whole group of innate immune SNPs when the global test for groups of genes was applied (P = .046) Conclusion. SNPs in innate immune genes are important in determining susceptibility to RSV bronchiolitis

GENETIC SUSCEPTIBILITY TO RESPIRATORY SYNCYTIAL VIRUS BRONCHIOLITIS IN PRETERM CHILDREN IS ASSOCIATED WITH AIRWAY REMODELING GENES AND INNATE IMMUNE GENES

Prematurity is a risk factor for severe respiratory syncytial virus bronchiolitis. We show that genetic factors in innate immune genes (IFNA13, IFNAR2, STAT2. IL27, NFKBIA, C3, IL1RN, TLR5), in innate and adaptive immunity (IFNG), and in airway remodeling genes (ADAM33 and TGFBR1), affect disease susceptibility to a different extent in preterm children, born with underdeveloped lungs, than in term children