Small-particle Inhaled Corticosteroid as First-line or Step-up Controller Therapy in Childhood Asthma

Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.Peer reviewedPublisher PD

Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist

The analyses were funded by an unrestricted grant from Teva Pharmaceuticals Limited of Petach Tikva, Israel. Access to data from the Optimum Patient Care Research Database was co-funded by Research in Real-Life Ltd (RiRL), Cambridge, UK. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. The authors thank Julie von Ziegenweidt for assistance with data extraction.Peer reviewedPublisher PD

Assessment of current serum levels of PCDD/Fs, dl-PCBs and PBDEs in a Dutch cohort with known perinatal PCDD/F exposure

As part of a longitudinal cohort study, now in its second decade, we determined PCDDs/Fs dl-PCBs and PBDEs in serum of adolescents with known perinatal PCDD/F exposure. Of the original cohort, 33 adolescents aged 14-19 years, who had been studied previously during their neonatal (n=60), toddler and pre-pubertal period (n=41) agreed to participate in the current follow-up. PCDD/F-, dl-PCB- and PBDE congeners were measured using GC/MS. Current serum levels of PCDD/Fs determined in our cohort were relatively low (mean of 2.2pg/g) compared to the perinatal exposure. No correlation between perinatal exposure and current serum PCDD/F was found. Planar PCB TEQ levels were 2.2pg/g. Current summation operatorPBDE levels were 8.7ng/g lipid. There was one outlier with a summation operatorPBDE of 74ng/g lipid. The presence of this high value indicates that the exposure pathway is different from PCDD/F and PCB, most likely by dust and food contaminated with dust. Concluding we can say that current PCDD/F levels are quite low compared to the perinatal PCDD/F exposure of the cohort. PBDE levels however are relatively high compared to other European countries, more research on possible health effects of these levels, especially for subjects with outlier concentrations, should be performe

Harmonizing the Nomenclature for Therapeutic Aerosol Particle Size: A Proposal

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A Disease Model for Wheezing Disorders in Preschool Children Based on Clinicians' Perceptions

Background: Wheezing disorders in childhood vary widely in clinical presentation and disease course. During the last years, several ways to classify wheezing children into different disease phenotypes have been proposed and are increasingly used for clinical guidance, but validation of these hypothetical entities is difficult. Methodology/Principal Findings: The aim of this study was to develop a testable disease model which reflects the full spectrum of wheezing illness in preschool children. We performed a qualitative study among a panel of 7 experienced clinicians from 4 European countries working in primary, secondary and tertiary paediatric care. In a series of questionnaire surveys and structured discussions, we found a general consensus that preschool wheezing disorders consist of several phenotypes, with a great heterogeneity of specific disease concepts between clinicians. Initially, 24 disease entities were described among the 7 physicians. In structured discussions, these could be narrowed down to three entities which were linked to proposed mechanisms: a) allergic wheeze, b) non-allergic wheeze due to structural airway narrowing and c) non-allergic wheeze due to increased immune response to viral infections. This disease model will serve to create an artificial dataset that allows the validation of data-driven multidimensional methods, such as cluster analysis, which have been proposed for identification of wheezing phenotypes in children. Conclusions/Significance: While there appears to be wide agreement among clinicians that wheezing disorders consist of several diseases, there is less agreement regarding their number and nature. A great diversity of disease concepts exist but a unified phenotype classification reflecting underlying disease mechanisms is lacking. We propose a disease model which may help guide future research so that proposed mechanisms are measured at the right time and their role in disease heterogeneity can be studied

Classification of wheezing disorders in children aged 0-5 years as initially suggested by panel members.

<p>Classification of wheezing disorders in children aged 0-5 years as initially suggested by panel members.</p