Introduction. Respiratory syncytial virus infection is the leading cause of lower respiratory infection globally. Recently, nirsevimab has been approved to prevent RSV infection. This study explores the economically justifiable price of nirsevimab for preventing RSV infection in Colombia’s children under one year of age. Materials and methods. A static model was developed using the decision tree microsimulation to estimate the quality-adjusted costs and life years of two interventions: a single intramuscular dose of nirsevimab versus not applying nirsevimab. This analysis was made during a time horizon of 1 year and from a societal perspective. Results The annual savings in Colombia associated with this cost per dose ranged from U$ 2.5 to 4.1 million. Based on thresholds of U$4828, U$ 5128, and U$19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices of U$ 21.88, U$ 25.04, and U$ 44.02 per dose of nirsevimab. Conclusion the economically justifiable cost for nirsevimab in Colombia is between U$21 to U$44 per dose, depending on the WTP used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Objectives: The aim of the present study was to summarize the principal findings of all available studies that have evaluated the use of ICS on an intermittent or as-needed basis as an add-on therapy to short-acting β2-agonists (SABAs) or fast-acting β2-agonists (FABAs), given alone or in addition to daily controller therapy, in pediatric asthmatic patients. Methods: Studies published by February 2021 that evaluate the use of ICS on an intermittent or as-needed basis as an add-on therapy to SABAs or FABAs given alone or in addition to daily controller therapy in pediatric asthma were identified. The quality of the studies was assessed using the Cochrane Risk of Bias and the AMSTAR 2 tools. Results: Of 294 references identified, 14 studies were included. The use of ICS on an intermittent or as-needed basis (as an add-on therapy to SABAs) has been shown to be more effective than treatment with SABA alone and to be similarly or less effective compared to regular daily ICS administration. Furthermore, strategies involving increasing the dose of ICS only when needed (as an add-on therapy to FABAs such as formoterol) and keeping it low during stable stages of the disease have been shown to be similarly or more effective than comparators. Conclusion: The use of ICS on an intermittent or as-needed basis as an add-on therapy to SABAs or FABAs, given alone or in addition to daily controller therapy in pediatric asthmatic patients, is an effective and well-tolerated treatment strategy.

Objectives. The aim of this study was to investigate the epidemiology of RSV bronchiolitis and the influence of meteorological and air pollutant factors on the isolation of RSV in infants admitted for viral bronchiolitis during three consecutive years, before and during the COVID-19 pandemic, in Bogota, Colombia, a middle-income country (MIC) with a tropical climate. Methods. An analytical cross-sectional study was conducted before and during the COVID-19 pandemic, including patients with a diagnosis of viral bronchiolitis admitted to all the hospitals of the city between January 2019 and November 2021. Predictor variables included meteorological and air pollutant parameters. We adjusted multivariable analysis to identify factors independently associated with isolation of RSV as the causative agent of viral bronchiolitis. Results. A total of 12,765 patients were included in the study. After controlling for potential confounders, it was found that age (OR 0.87; CI 95% 0.77–0.98; p=0.029), COVID-19 pandemic (OR 0.74; CI 95% 0.64–0.86; p<0.001), temperature (OR 1.85; CI 95% 1.47–2.33; p<0.001), and interaction terms between SES and NO2 (OR 1.04; CI 95% 1.01–1.07; p=0.002), and between rainfall and NO2 (OR 0.99; CI 95% 0.998–0.999; p=0.010) independently predicted the isolation of RSV as the causative agent of viral bronchiolitis in our sample of patients. Conclusions. The identified predictors for isolation of RSV as the causative agent of viral bronchiolitis provide additional scientific evidence that may be useful in the development of specific interventions aimed at ameliorating or preventing the impact of RSV in Bogota and probably other similar LMICs in high-risk infants.

Introduction The risk stratification of infants presenting to the emergency department with bronchiolitis who are at risk for receiving airway support during their hospital stay has been insufficiently studied. The aim of this study was to determine the clinical predictors of hospitalization with airway support (“escalated care”) among infants with recurrent wheezing evaluated in the emergency department Methods: We conducted a retrospective cohort study in infants with one or more wheezing episode, younger than two years of age in tertiary centers in Rionegro, Colombia. The primary outcome measure was escalated care defined as hospitalization plus any airway support. A multivariate logistic regression model was performed to estimate predictors of escalated care. To assess discrimination and calibration, area-under-the-curve (AUC) and calibration plots were calculated. Results A total of 665 cases were included and 85 infants received escalated care. The variables included risk score for escalated care within 5 days of admission to the emergency room including prematurity, poor feeding, nasal flaring and/or grunting, and previous wheezing episodes requiring hospitalization, The model has a high specificity (99.6%) with acceptable AUC of 0.70 (CI 95% 0.60- 0.74). Conclusion: A clinical risk score was created based on the odds ratio of each of the identified variables, which appears to be useful for estimating the absolute risk of escalated care within 5 days of admission to the ED. However, external validation is required before this clinical score is applied in general practice in any ED setting

Introduction Fractional exhaled nitric oxide (FeNO) is a simple, noninvasive measurement of airway inflammation with minimal discomfort to the patient and with results available with a few minutes. This study aimed to evaluate the cost-effectiveness of the Fractional exhaled nitric oxide in asthma. Methods A markov model was used to estimate the cost-utility of FeNO versus standard treatment (control group) an infant with mild to moderate allergic asthma. Cost data were obtained from a retrospective study on asthma from tertiary center, in Medellin, Colombia, while utilities were collected from the literature. The analysis was carried out from a societal perspective. Results The model showed that FeNO, was associated with lower total cost than SC (US $1333 vs US $1452 average cost per patient), and higher QALYs (0.93 vs. 0.92 average per patient); showing dominance. The probability that MS provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness to pay thresholds Conclusion FeNO was cost-effective for the hospital treatment of an infant with infant with mild to moderate allergic asthma. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

Objectives. We aimed to validate a Spanish version of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (SRBD-PSQ) in children living in a high-altitude Colombian city. Methods. In a prospective cohort validation study, patients aged between 2 and 18 years who attended the Ear, Nose, and Throat pediatric department of our institution for symptoms related to sleep-related breathing disorders had a baseline visit at enrollment, a second visit the day scheduled for the surgical intervention, and a follow-up visit at least three months after the surgical intervention. In these three visits, we gathered the necessary data for assessing the criterion validity, construct validity, test–retest reliability, internal consistency, and sensitivity to change of the Spanish version of the SRBD-PSQ. Results. In total, 121 patients were included in the analyses. The exploratory factor analysis (generalized least squares method, varimax rotation) yielded a four-factor structure, explaining 65.93% of the cumulative variance. The intraclass correlation coefficient (ICC) of the measurements was 0.887 (95% CI: 0.809–0.934), and the Lin concordance correlation coefficient was 0.882 (95% CI, 0.821-0.943). SRBD-PSQ scores at baseline were significantly higher than those obtained after adeno-tonsillectomy surgery (median [IQR] 11.0 [9.0- 14.0] vs. 4.00 [1.50- 7.0]; p<0.0001). Cronbach’s α was 0.7055 for the questionnaire as a whole. Conclusions. The Spanish version of the SRBD-PSQ has acceptable construct validity, excellent test-retest reliability and sensitivity to change, and adequate internal consistency-reliability when used in pediatric patients living at high altitude with symptoms related to sleep-related breathing disorders.

Objectives. Although recent evidence suggests that management of viral bronchiolitis requires something other than guidelines-guided therapy, there is a lack of evidence supporting the economic benefits of phenotypic-guided bronchodilator therapy for treating this disease. The aim of the present study was to compare the cost-effectiveness of phenotypic-guided versus guidelines-guided bronchodilator therapy in infants with viral bronchiolitis. Methods: A decision‐analysis model was developed in order to compare the cost-effectiveness of phenotypic-guided versus guidelines-guided bronchodilator therapy in infants with viral bronchiolitis. The effectiveness parameters and costs of the model were obtained from electronic medical records. The main outcome was avoidance of hospital admission after initial care in the ED. Results: Compared to guidelines-guided strategy, treating patients with viral bronchiolitis with the phenotypic-guided bronchodilator therapy strategy was associated with lower total costs (US$250.99 vs US$263.46 average cost per patient) and a higher probability of avoidance of hospital admission (0.7902 vs 0.7638), thus leading to dominance. Results were robust to deterministic and probabilistic sensitivity analyses. Conclusions: Compared to guidelines-guided strategy, treating infants with viral bronchiolitis using the phenotypic-guided bronchodilator therapy strategy is a more cost-effective strategy, because it involves a lower probability of hospital admission at lower total treatment costs.

Objectives: Although albuterol, the most frequently used bronchodilator, has been traditionally and generally delivered via nebulization (NEB) with compressed air/oxygen, the benefits of metered‐dose inhalers with a spacer (MDI+S) have been widely recognized as an alternative method for albuterol administration. The aim of this systematic review was to compare the response to albuterol delivered through NEB with albuterol delivered through MDI+S in pediatric patients with asthma exacerbations. Methods: We conducted an electronic search in MEDLINE/PubMed, EMBASE, Ovid and ClinicalTrials. To be included in the review, a study had to a randomized clinical trial comparing albuterol delivered via NEB versus MDI+S; and had to report the rate of hospital admission (primary outcome), or any of the following secondary outcomes: oxygen arterial saturation, heart rate (HR), respiratory rate, the pulmonary index score (PIS), adverse effects, and need for additional treatment. Results: Fifteen studies (n=2057) met inclusion criteria. No significant differences were found between the two albuterol delivery methods in terms of hospital admission (RR 0.89; 95% CI 0.55 to 1.46; I2=32%; p=0.65). There was a significant reduction in the PIS score (MD -0.63; 95% CI -0.91 to -0.35; I2=0%; p < 0.00001), and a significantly smaller increase in HR (better) (MD -6.47; 95% CI -11.69 to -1.25; I2=0%; p=0.02) when albuterol was delivered through MDI+S than when it was delivered through NEB. Conclusions: This review showed a significant reduction in the PIS and a significantly smaller increase in HR when albuterol was delivered through MDI+S than when it was delivered through NEB.

Introduction Despite the evidence supporting the use of intravenous Magnesium Sulfate (MS) in acute asthma; this drug continues being considered as the second line in pediatric acute asthma exacerbations. This study aimed to evaluate the cost-effectiveness of the MS in acute asthma. Methods A decision tree model was used to estimate the Cost-utility study that compared MS versus standard treatment (control group) in an infant with acute asthma in the emergency setting. Cost data were obtained from a retrospective study on asthma from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. The analysis was carried out from a societal perspective. Results The model showed that MS for treating pediatric patient with acute asthma, was associated with lower total cost than standard therapy (US $1149 vs US $1598 average cost per patient), and higher QALYs ( 0.60 vs 0.52 average per patient); showing dominance. the probabilty that MS provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness to pay thresholds Conclusion MS in emergency settings was cost-effective for the hospital treatment of an infant with asthma moderate or severe. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

International guidelines have recommended the use of inhaled beta-2 agonists and systemic corticosteroids (SC) as the first-line treatment for acute asthma. Objective: To evaluate the evidence for the efficacy of inhaled corticosteroids (ICS) in addition to SC compared to SC alone in children with acute asthma in the ED or during hospitalization. Data sources: Five electronic databases were searched. Study Selection: All RCTs that compared ICS (via nebulizer or metered dose inhaler) plus SC (oral or parenteral) with placebo (or standard care) plus SC were included without language restriction. Data extraction: Two reviewers independently reviewed all studies. The primary outcomes were hospital admission or hospital length of stay [LOS], and secondary outcomes were readmissions during follow-up, ED-LOS, lung function, asthma clinical score, oxygen saturation, and heart and respiratory rates. Results: Nine studies (n=1473) met the inclusion criteria. In all the studies, the ICS was budesonide. Compared to SC alone, adding budesonide to SC did not affect hospitalization rate, but decreased hospital LOS by more than one day (MD= -29.08 hours [-39.9 to -18.3]; I2=0%, p=<0.00001). Moreover, adding budesonide (especially with ≥2mg doses) significantly improved the acute asthma severity score among patients at ED. Conclusions: Compared to SC alone, adding budesonide to SC did not affect hospitalization rate, but decreases the LOS and improves the acute asthma score in children at ED setting.