How to match the optimal currently available inhaler device to an individual child with asthma or recurrent wheeze

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Trace elements in medicinal plants traditionally used in the treatment of diabetes—do they have a role in the claimed therapeutic effect?

Medicinal plants are often used in the treatment of diabetes mellitus, although knowledge about their mode of action and the substances responsible for their antidiabetic potential is limited. It is well known that some trace elements play a role in glucose metabolism and insulin action. Thus, a particular trace elements profile could be associated with the antidiabetic properties observed for some medicinal plants. Methods: Infusions (n = 102) prepared from commercial herbal products (n = 34) containing medicinal plants indicated for the treatment of diabetes (n = 16 different plant species) and infusions (n = 60) prepared from commercial herbal products (n = 20) containing medicinal plants without such an indication (n = 7 different plant species) were analyzed by ICP-MS for their trace elements content. In both groups, results varied significantly between different medicinal plants and also between different origins (brands) of the same medicinal plant. Significant differences (p < 0.05) between the two groups were found for nine elements, including four trace elements related to glucose metabolism (Mn, B, V, and Se), but with lower median contents in the group of medicinal plants for diabetes. Except for some particular species (e.g., Myrtilli folium) in which the trace element Mn may play a role in its antidiabetic effect, globally, a direct association between the claimed antidiabetic properties and a specific trace element profile of the studied medicinal plants was not evident.info:eu-repo/semantics/publishedVersio

Paediatric HERMES: European accreditation of training centres in paediatric respiratory medicine

HERMES: European accreditation of training centres in paediatric respiratory medicine http://ow.ly/ZBmUg

Differences in lung clearance index and functional residual capacity between two commercial multiple-breath nitrogen washout devices in healthy children and adults

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Severe Paediatric Asthma Collaborative in Europe (SPACE):protocol for a European registry

The development of new asthma biologics and receptor blockers for the treatment of paediatric severe asthma raises challenges. It is unclear whether there are sufficient children in Europe to recruit into randomised placebo-controlled trials to establish efficacy and safety in this age group. In February 2016, the European Respiratory Society funded a clinical research collaboration entitled “Severe Paediatric Asthma Collaborative in Europe” (SPACE). We now report the SPACE protocol for a prospective pan-European observational study of paediatric severe asthma. Inclusion criteria are: 1) age 6–17 years, 2) severe asthma managed at a specialised centre for ≥6 months, 3)clinical and spirometry evidence of asthma, and 4) reaching a pre-defined treatment threshold. The exclusion criterion is the presence of conditions which mimic asthma symptoms. Eligible children will be prospectively recruited into a registry, recording demographics, comorbidities, quality of life, family history, neonatal history, smoking history, asthma background, investigations, and treatment. Follow-up will provide longitudinal data on asthma control and treatment changes. The SPACE registry, by identifying well-phenotyped children eligible for clinical trials, and the amount of overlap in eligibility criteria, will inform the design of European trials in paediatric severe asthma, and facilitate observational research where data from single centres are limited

First analysis of the Severe Paediatric Asthma Collaborative in Europe registry.

New biologics are being continually developed for paediatric asthma, but it is unclear whether there are sufficient numbers of children in Europe with severe asthma and poor control to recruit to trials needed for registration. To address these questions, the European Respiratory Society funded the Severe Paediatric Asthma Collaborative in Europe (SPACE), a severe asthma registry. We report the first analysis of the SPACE registry, which includes data from 10 paediatric respiratory centres across Europe. Data from 80 children with a clinical diagnosis of severe asthma who were receiving both high-dose inhaled corticosteroid and long-acting β2-agonist were entered into the registry between January 2019 and January 2020. Suboptimal control was defined by either asthma control test, or Global Initiative for Asthma criteria, or ≥2 severe exacerbations in the previous 12 months, or a combination. Overall, 62 out of 80 (77%) children had suboptimal asthma control, of whom 29 were not prescribed a biologic. However, in 24 there was an option for starting a licensed biologic. 33 children with suboptimal control were prescribed a biologic (omalizumab (n=24), or mepolizumab (n=7), or dupilumab (n=2)), and for 29 there was an option to switch to a different biologic. We conclude that the SPACE registry provides data that will support the planning of studies of asthma biologics. Not all children on biologics achieve good asthma control, and there is need for new trial designs addressing biologic switching

Implications of the Transition From Zapletal to GLI Reference Values for Spirometry

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Clinical application of inert gas Multiple Breath Washout in children and adolescents with asthma

SummaryIntroductionChildren with asthma often have normal spirometry despite significant disease. The pathology of the small airways in asthma may be assessed using Multiple Breath Washout (MBW) and calculating the Lung Clearance Index (LCI). There are only few studies using MBW in children with asthma and existing data regarding bronchodilator effect are contradictory. The aim of the present pilot study was to compare LCI in asthma and controls and assess the effect of salbutamol in children with asthma on the LCI.MethodsUnselected patients with a diagnosis of asthma visiting the outpatient department of our hospital between 04-2010 and 03-2011 were recruited and compared to a healthy control group. MBW was performed as inert gas MBW using sulfurhexafluorid (SF6) as the tracer gas. Clinical data were documented and spirometry and MBW (EasyOne Pro, MBW module, NDD Switzerland) were performed before and after the use of salbutamol (200–400 μg). Healthy controls performed baseline MBW only.Results32 children diagnosed with asthma (4.7–17.4 years) and 42 controls (5.3–20.8) were included in the analysis. LCI differed between patients and controls, with a mean LCI (SD) of 6.48 (0.48) and 6.21 (0.38) (P = 0.008). Use of salbutamol had no significant effect on LCI for the group.ConclusionThese pilot data show that clinically stable asthma patients and controls both have a LCI in the normal range. However, in patients the LCI is significantly higher indicating that MBW may have a role in assessing small airways disease in asthma

Full Breastfeeding and Allergic Diseases—Long-Term Protection or Rebound Effects?

A previous follow-up of the GINIplus study showed that breastfeeding could protect against early eczema. However, effects diminished in adolescence, possibly indicating a “rebound effect” in breastfed children after initial protection. We evaluated the role of early eczema until three years of age on allergies until young adulthood and assessed whether early eczema modifies the association between breastfeeding and allergies. Data from GINIplus until 20-years of age (N = 4058) were considered. Information on atopic eczema, asthma, and rhinitis was based on reported physician’s diagnoses. Adjusted Odds Ratios (aOR) were modelled by using generalized estimating equations. Early eczema was associated with eczema (aORs = 3.2–14.4), asthma (aORs = 2.2–2.7), and rhinitis (aORs = 1.2–2.7) until young adulthood. For eczema, this association decreased with age (p-for-interaction = 0.002–0.006). Longitudinal models did not show associations between breastfeeding and the respective allergies from 5 to 20 years of age. Moreover, early eczema generally did not modify the association between milk feeding and allergies except for rhinitis in participants without family history of atopy. Early eczema strongly predicts allergies until young adulthood. While preventive effects of full breastfeeding on eczema in infants with family history of atopy does not persist until young adulthood, the hypothesis of a rebound effect after initial protection cannot be confirmed