Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma

In acute asthma inhaled beta 2-agonists are often administered to relieve bronchospasm by wet nebulisation, but some have argued that metered-dose inhalers with a holding chamber (spacer) can be equally effective. Nebulisers require a power source and need regular maintenance, and are more expensive in the community setting.ObjectivesTo assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta 2-agonists for acute asthma.Search strategyWe last searched the Cochrane Airways Group trials register in January 2006 and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2005).Selection criteriaRandomised trials in adults and children (from two years of age) with asthma, where spacer beta 2-agonist delivery was compared with wet nebulisation.Data collection and analysisTwo reviewers independently applied study inclusion criteria (one reviewer for the first version of the review), extracted the data and assessed trial quality. Missing data were obtained from the authors or estimated. Results are reported with 95% confidence intervals (CI).Main resultsThis review has been updated in January 2006 and four new trials have been added. 2066 children and 614 adults are now included in 25 trials from emergency room and community settings. In addition, six trials on in-patients with acute asthma (213 children and 28 adults) have been reviewed. Method of delivery of beta 2-agonist did not appear to affect hospital admission rates. In adults, the relative risk of admission for spacer versus nebuliser was 0.97 (95% CI 0.63 to 1.49). The relative risk for children was 0.65 (95% CI: 0.4 to 1.06). In children, length of stay in the emergency department was significantly shorter when the spacer was used, with a mean difference of -0.47 hours (95% CI: -0.58 to -0.37). Length of stay in the emergency department for adults was similar for the two delivery methods. Peak flow and forced expiratory volume were also similar for the two delivery methods. Pulse rate was lower for spacer in children, mean difference -7.6% baseline (95% CI: -9.9 to -5.3% baseline).Authors' conclusionsMetered-dose inhalers with spacer produced outcomes that were at least equivalent to nebuliser delivery. Spacers may have some advantages compared to nebulisers for children with acute asthma

Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma

Background In acute asthma inhaled beta₂-agonists are often administered by nebuliser to relieve bronchospasm, but some have argued that metered-dose inhalers with a holding chamber (spacer) can be equally effective. Nebulisers require a power source and need regular maintenance, and are more expensive in the community setting. Objectives To assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta₂-agonists for acute asthma. Search methods We searched the Cochrane Airways Group Trial Register and reference lists of articles. We contacted the authors of studies to identify additional trials. Date of last search: February 2013. Selection criteria Randomised trials in adults and children (from two years of age) with asthma, where spacer beta₂-agonist delivery was compared with wet nebulisation. Data collection and analysis Two review authors independently applied study inclusion criteria (one review author for the first version of the review), extracted the data and assessed risks of bias. Missing data were obtained from the authors or estimated. Results are reported with 95% confidence intervals (CIs). Main results This review includes a total of 1897 children and 729 adults in 39 trials. Thirty-three trials were conducted in the emergency room and equivalent community settings, and six trials were on inpatients with acute asthma (207 children and 28 adults). The method of delivery of beta₂-agonist did not show a significant difference in hospital admission rates. In adults, the risk ratio (RR) of admission for spacer versus nebuliser was 0.94 (95% CI 0.61 to 1.43). The risk ratio for children was 0.71 (95% CI 0.47 to 1.08, moderate quality evidence). In children, length of stay in the emergency department was significantly shorter when the spacer was used. The mean duration in the emergency department for children given nebulised treatment was 103 minutes, and for children given treatment via spacers 33 minutes less (95% CI -43 to -24 minutes, moderate quality evidence). Length of stay in the emergency department for adults was similar for the two delivery methods. Peak flow and forced expiratory volume were also similar for the two delivery methods. Pulse rate was lower for spacer in children, mean difference -5% baseline (95% CI -8% to -2%, moderate quality evidence), as was the risk of developing tremor (RR 0.64; 95% CI 0.44 to 0.95, moderate quality evidence). Authors' conclusions Nebuliser delivery produced outcomes that were not significantly better than metered-dose inhalers delivered by spacer in adults or children, in trials where treatments were repeated and titrated to the response of the participant. Spacers may have some advantages compared to nebulisers for children with acute asthma

Changes in the global hospitalisation burden of respiratory syncytial virus in young children during the COVID-19 pandemic: a systematic analysis

Background The coronavirus disease 2019 (COVID-19) pandemic was reported to have impacted RSV epidemiology and could have important implications for RSV prevention and control strategies. We aimed to understand the RSV-associated acute lower respiratory infection (ALRI) hospitalisation burden in children younger than five years during the COVID-19 pandemic period and the possible changes in RSV epidemiology from a global perspective.Methods We conducted a systematic literature search for studies published between January 1, 2020 and June 30, 2022, from MEDLINE (Ovid), Embase (Ovid), Global Health (Ovid), Web of Science, WHO COVID-19 database, CINAHL, LILACS, OpenGrey, CNKI, WanFang and ChongqingVIP. We included unpublished RSV epidemiology data shared by international collaborators. Eligible studies reported data for RSV-associated ALRI hospital admission rates or at least one of the following severity measures: the proportion of RSV cases that needed supplemental oxygen, mechanical ventilation or intensive care unit admission, and in-hospital case fatality ratio. A generalised linear mixed-effects model was used for data synthesis to understand the changes in the incidence, age distribution and severity of RSV-associated ALRI hospitalisations in children under five years during the COVID-19 pandemic, compared to the year 2019. Findings We included 61 studies, 14 studies from published literature and 47 unpublished datasets. Most studies (51/61) were from the high-income region, followed by the upper-middle-income region (9/61); only one study was from the lower-middle-income region, and no studies were from the low-income region. Compared to 2019, all income regions saw substantial decreases in RSV-associated ALRI hospitalisation rate across all age groups in 2020; the number of RSV-associated ALRI hospitalisations in children aged 0–&lt;60 months decreased by approximately 80% (325,000 to 66,000), 14% (581,000 to 501,000) and 42% (1,378,000 to 795,000) for high-income, upper-middle-income and lower-middle-income countries, respectively. RSV hospitalisation rate started to rise in 2021, and by March 2022, the annualised rate returned to a level comparable to 2019 (6·0/1000, 95% uncertainty interval [UI] 5·4–6·8 by March 2022 vs 5·0/1000, 3·6–6·8 in 2019) in high-income countries while remaining lower in middle-income countries. Across all time periods and income regions, RSV-associated ALRI hospitalisation rates peaked in infants aged 0–&lt;3 months and declined with increasing age. Compared to the pre-pandemic period, there was a significantly increased proportion of RSV-associated ALRI hospitalisations in those aged 12–&lt;24 months in high-income and upper-middle-income regions (ORs ranged from 1·30 [1·07–1·59] to 2·05 [1·66–2·54]). No consistent changes in disease severity were observed. Interpretation Our study documented a significant reduction in RSV-associated ALRI hospitalisation burden in children under five years during the first year of the COVID-19 pandemic. A rebound to pre-pandemic levels in RSV-associated ALRI hospitalisation rate was observed in the high-income region by March 2022 but not in the middle-income region, suggesting a more persistent negative impact of the COVID-19 pandemic on health-care systems and health-care access in middle-income regions. RSV surveillance needs to be established (or re-established) to monitor the changes in RSV epidemiology, particularly in low- and lower-middle-income countries.Funding EU Innovative Medicines Initiative Preparing for RSV Immunisation and Surveillance in Europe (PROMISE); Bill &amp; Melinda Gates Foundation; World Health Organization. <br/

Autoantibodies against type I IFNs in patients with life-threatening COVID-19

Interindividual clinical variability in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is vast. We report that at least 101 of 987 patients with life-threatening coronavirus disease 2019 (COVID-19) pneumonia had neutralizing immunoglobulin G (IgG) autoantibodies (auto-Abs) against interferon-w (IFN-w) (13 patients), against the 13 types of IFN-a (36), or against both (52) at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs. The auto-Abs neutralize the ability of the corresponding type I IFNs to block SARS-CoV-2 infection in vitro. These auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only 4 of 1227 healthy individuals. Patients with auto-Abs were aged 25 to 87 years and 95 of the 101 were men. A B cell autoimmune phenocopy of inborn errors of type I IFN immunity accounts for life-threatening COVID-19 pneumonia in at least 2.6% of women and 12.5% of men

L'Efficacité de l'éducation thérapeutique de l'enfant asthmatique (synthèse de la littérature à partir d'une recherche bibliographique Medline 1995-2002)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Indication et modalités du prélèvement urinaire à visée diagnostique d'une infection urinaire en pédiatrie (audit des pratiques cliniques)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Hospitalisation des nourrissons et jeunes enfants grippés lors du pic épidémique hivernal (adaptation des critères de l'AEPf [version française de l'Appriopriateness Evaluation Protocol] pour 287 enfants âgés de 0 à 35 mois)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF