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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
[Consensus-based approach for severe paediatric asthma in routine clinical practice]
A M Plaza1, M D P Ibáñez2, M Sánchez-Solís3
1Alergología Infantil, Hospital Sant Joan de Deu, Barcelona, España.
Insights
This study defines severe paediatric asthma using expert consensus, recommending omalizumab before oral steroids. These guidelines aid in better management for children with difficult-to-control asthma.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Practice Guidelines
Background:
- Accurate identification of severe paediatric asthma is crucial for effective disease management.
- Existing guidelines for severe asthma definition and control recommendations lack uniformity.
- Variability in criteria complicates optimal care for children with severe asthma.
Purpose of the Study:
- To establish expert consensus on the definition and management of severe paediatric asthma.
- To develop practice guidelines for severe paediatric asthma based on expert opinion.
- To address the need for standardized criteria in managing this condition.
Main Methods:
- An online survey utilizing a modified Delphi technique was employed.
- Expert opinions from eleven paediatric chest disease physicians and allergy specialists were gathered.
- Analysis of survey results informed the development of consensus-based practice guidelines.
Main Results:
- Consensus was achieved on 76.92% of the surveyed questions (50 out of 65).
- Key criteria for severe paediatric asthma include frequent oral steroid use, high-dose inhaled corticosteroids, lack of response to treatment, or life-threatening/quality-of-life impairing disease.
- Recommendations include using paediatric-specific monitoring questionnaires (e.g., CAN, ACT) and considering omalizumab before oral corticosteroids.
Conclusions:
- The study provides consensus recommendations for the management of severe paediatric asthma.
- These guidelines offer a standardized approach to identifying and treating children with severe asthma.
- The recommendations aim to improve clinical decision-making and patient outcomes.
Introduction:
Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines.
Material And Methods:
An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results.
Results:
Eleven paediatric chest disease physicians and allergy specialists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they have required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impairs their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids.
Conclusions:
This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma.
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