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.
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.