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Asthma-community acquired pneumonia co-diagnosis in children: a scoping review
Md Mahbubur Rashid1, Shamim Ahmed2, Louisa Owens1,3
1Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia.
Insights
This review found chest X-rays are common for diagnosing asthma and community-acquired pneumonia (CAP) in children. Antibiotics are frequently used without confirming bacterial infection, highlighting a need for standardized clinical guidelines.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Asthma and community-acquired pneumonia (CAP) co-diagnosis in children presents diagnostic and management challenges.
- Existing literature shows variability in diagnostic and treatment approaches for this specific pediatric population.
Purpose of the Study:
- To conduct a scoping review of the literature on the diagnosis and management of children (2-18 years) with co-occurring asthma and CAP.
- To identify evidence gaps and variations in clinical practice for this patient group.
Main Methods:
- A comprehensive scoping review was performed using the Arksey and O'Malley framework and PRISMA extension.
- Literature searches were conducted across five major databases (PubMed, CINAHL, Scopus, Web of Science, Embase) from 2003 to June 2023.
- Twelve selected abstracts were analyzed, referencing established guidelines (GINA, IMCI, PIDS/IDSA).
Main Results:
- Chest X-rays were utilized in 83.3% of studies to confirm the asthma-CAP co-diagnosis.
- Significant variation existed in laboratory investigations and infectious etiology detection (41.7% of studies).
- Antimicrobials were administered in 75% of cases, often without reported bacterial etiology (44.4% of treated cases).
Conclusions:
- Chest X-rays are a common diagnostic tool for asthma-CAP co-diagnosis in children.
- Antibiotic use frequently lacks laboratory confirmation of bacterial infection, indicating potential overuse.
- Standardized clinical practice guidelines are needed to improve care consistency and reduce variability in managing pediatric asthma-CAP co-diagnosis.
Objective:
This scoping review investigated the existing literature and identified the evidence gaps related to diagnosis and management in children aged 2-18 years presenting to hospitals with a co-diagnosis of asthma and community-acquired pneumonia.
Data Sources:
We designed a scoping review following Arksey and O'Malley's scoping review framework and PRISMA extension for a scoping review. We searched literature using five electronic databases: PubMed, CINAHL, Scopus, Web of Science, and Embase from 2003 to June 2023.
Results:
A total of 1599 abstracts with titles were screened and 12 abstracts were selected for full review. Separate guidelines including Modified Global Initiative for Asthma (GINA) guidelines; modified Integrated Management of Childhood Illness (IMCI) guidelines; and a consensus guideline developed by the Pediatric Infectious Diseases Society (PIDS) and Infectious Diseases Society of America (IDSA) were used for diagnosing asthma and CAP individually. Chest X-rays were used in 83.3% (10/12) of studies to establish the co-diagnosis of asthma-CAP in children. Variations were observed in using different laboratory investigations across the studies. Infectious etiologies were detected in five (41.7%) studies. In 75% (9/12) of studies, children with asthma-CAP co-diagnosis were treated with antimicrobials, however, bacterial etiology was not reported in 44.4% (4/9) of the studies.
Conclusions:
Our scoping review suggests that chest X-rays are commonly used to establish the co-diagnosis of asthma-CAP and antibiotics are often used without laboratory confirmation of a bacterial etiology. Clinical practice guidelines for the management of asthma and pneumonia in children who present with co-diagnosis may standardize clinical care and reduce variation.
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