Multicenter Adherence Study of Asthma Medication for Children in Korea

PURPOSE: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide. METHODS: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma. RESULTS: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered “taking as prescribed” was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups (P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was “Easy” or “Very easy” to use (P < 0.001). “Method of administration” was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration (i.e., “Frequency of administration”). CONCLUSIONS: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine.

Viral Infections and Associated Factors That Promote Acute Exacerbations of Asthma

Despite asthma being the most common chronic childhood ailment, there is still much to learn about the disease. Early childhood infections with well-known or emerging viruses can lay the pathophysiologic framework for asthma development and exacerbation later in life, which may be due partly to alteration of the airway microbiome. Once asthma is established, acute exacerbations are usually associated with infections with respiratory viruses, such as rhinoviruses (RVs). Once again, there are bidirectional interactions between viruses and airway bacteria that appear to influence the severity of illness and the likelihood of exacerbation. Studies employing recent advances in viral and bacterial identification analytic techniques will clarify these new concepts and may provide the basis for new treatments or prevention or respiratory infection-associated exacerbation. This paper is a review of the associations among respiratory viruses, bacteria, inflammatory mechanisms, and asthma exacerbation.

Montelukast Reduces Serum Levels of Eosinophil-Derived Neurotoxin in Preschool Asthma

PURPOSE: Several markers for eosinophilic inflammation have been proposed to predict response to asthma treatment. However, definitive criteria for treatment decisions have not yet been established. We investigate a potentially useful relatively non-invasive biomarker, eosinophil-derived neurotoxin (EDN), to predict favorable responses to budesonide or montelukast, common treatment for children with asthma. METHODS: Young children (1 to 6 years old) were enrolled in this randomized, parallel, 2-group, open-label trial. Criteria for eligibility included: 1) being symptomatic during the run-in period; and 2) having a serum EDN (sEDN) level ≥ 53 ng/mL, with positive specific immunoglobulin E to house dust mite. Eligible patients were randomly placed into 2 groups: the BIS group received budesonide inhalation suspension (BIS) 0.5 mg once daily; the MONT group received montelukast 4 mg once daily. Ineligible patients were invited to receive montelukast 4 mg once daily (OBS group). Treatment period was 12 weeks. RESULTS: Asthma control days increased significantly in the BIS and MONT groups (P < 0.000) over the 12-week study period. There was no significant change in sEDN in the BIS group but there was a significant decrease in the MONT group (P < 0.000). Patients in the OBS group with high EDN levels (< 53 ng/mL) showed a significant decrease due to MONT treatment (P = 0.023). Rescue medication usage significantly decreased in the BIS and MONT groups (P < 0.000). CONCLUSIONS: EDN is a useful relatively non-invasive biomarker for predicting responses to montelukast and budesonide treatment of preschool children with beta2-agonist responsive recurrent wheeze and multiple-trigger wheeze (Trial registry at UMIN Clinical Trials Registry, UMIN000008335).

Comparison of nasal cytokine profiles of human metapneumovirus and respiratory syncytial virus

BACKGROUND: Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) share some epidemiological and clinical characteristics; however, few studies have examined the mechanisms by which these viruses induce airway inflammation. OBJECTIVE: This study was undertaken to compare cytokine profiles in hMPV and RSV patients to investigate possible differences in inflammatory pathways. METHODS: Nasopharyngeal aspirate specimens were collected from 1,008 pediatric patients hospitalized for acute lower respiratory tract infection with wheezing and 20 normal healthy controls. Patients were tested for 7 common respiratory viruses then divided into hMPV (n = 35) and RSV groups (n = 67). T helper (Th) 1 (interferon [IFN]-γ), Th2 (interleukin [IL]-4, eotaxin) and Th17 (IL-1β, IL-6) cytokine profiles were analyzed in the 3 groups. RESULTS: IFN-γ and IL-2 levels were significantly increased in the hMPV and RSV groups compared to the control group (p < 0.0001 and p < 0.0001, respectively). IL-4 levels were significantly higher in the RSV group compared to the hMPV and control groups (p = 0.0003 and p < 0.0001, respectively). Eotaxin levels showed a tendency to be higher in the RSV group compared to the hMPV group (p = 0.0580), and significantly higher compared to the control group (p < 0.0001). IL-1β levels were significantly higher in the hMPV compared to the RSV group (p < 0.0001), and IL-6 levels were significantly higher in the hMPV group compared to the control group (p < 0.0001). CONCLUSION: Our results suggest that hMPV and RSV have different inflammatory mechanisms. hMPV induces airway inflammation by the Th17 pathway through release of IL-1β and IL-6, whereas RSV acts through the Th2 pathway.

Infection, eosinophilia and childhood asthma

There is a growing list of viruses and bacteria associated with wheezing illness and asthma. It is well known that a few of these pathogens are strongly associated with wheezing illness and asthma exacerbations. What is not known is if early childhood infections with these pathogens cause asthma, and, if so, exactly what are the pathophysiologic mechanisms behind its development. The current consensus is respiratory infection works together with allergy to produce the immune and physiologic conditions necessary for asthma diasthesis. One link between respiratory infection and asthma may be the eosinophil, a cell that plays prominently in asthma and allergy, but can also be found in the body in response to infection. In turn, the eosinophil and its associated products may be novel therapeutic targets, or at the very least used to elucidate the complex pathophysiologic pathways of asthma and other respiratory illnesses. Together or separately, they can also be used for diagnosis, treatment and monitoring. The optimal care of a patient must take into consideration not only symptoms, but also the underlying disease mechanisms.

Clinical and Epidemiological Comparison of Human Metapneumovirus and Respiratory Syncytial Virus in Seoul, Korea, 2003-2008

Human metapneumovirus (HMPV) shares clinical and epidemiological characteristics with well-known respiratory syncytial virus (RSV). The aim of this study was to investigate the clinical and epidemiological differences between HMPV- and RSV-induced wheezing illnesses. A total of 1,008 nasopharyngeal aspirate specimens was collected from 1,008 pediatric patients hospitalized with acute respiratory tract infection at Inje University Sanggye Paik Hospital from December 2003 to April 2008, and tested for seven common respiratory viruses. Conditions classified as wheezing illness were bronchiolitis, reactive airways disease, and bronchial asthma. HMPV caused a significantly lower proportion of wheezing illness when compared to RSV (48.1% vs. 82.2%, P<0.05). HMPV-induced wheezing illness occurred predominantly in older patients when compared to RSV patients (P<0.001). RSV infections peaked in the fall and winter followed by peaks of HMPV infection in winter and spring. Eosinophil counts were significantly higher (P<0.01) in RSV patients when compared to HMPV patients. These results show that human metapneumovirus patients exhibit several different clinical and epidemiological characteristics, such as higher proportion of wheezing illness, age and seasonal incidence, and eosinophil counts, when compared to RSV patients.

Fatal and Near-fatal Cases of Lower Respiratory Tract Infection with Human Rhinovirus Group A / 소아알레르기및호흡기학회지

Human rhinoviruses (HRV) mostly cause mild and self-limiting upper respiratory tract infections. We report 2 infants with acute respiratory failure requiring mechanical ventilation, 1 of whom deteriorated to death. The causal pathogen was HRV group A confirmed by multiplex-PCR. In Korea, this is the first report of severe respiratory failure caused by HRV group A during the same season.