MedicalResearch.com Interview with:
Francine M. Ducharme, MD, FRCPC
Professor, Departments of Paediatrics and Social and Preventive Medicine
University of Montreal
Associate Director of Clinical Research and Knowledge Transfer, Research Centre, CHU Ste-Justine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The management of asthma attacks in preschoolers has been the subject of much recent debate. The results of a study published in 2009 had shaken the pediatric world. The study reported that preschool children with viral-triggered flare-ups did not respond to standard treatment and, suggesting that this was due to their young age. Such finding was particularly worrisome as the majority of asthma-related emergency room visits and hospitalizations involve preschool children.
We conducted this large cohort study in which children aged 1 to 17 years with a moderate or severe asthma attack were treated using the established evidence-based therapy adjusted to the severity of exacerbation assessed by the Pediatric Respiratory Assessment Measure (PRAM), administered rapidly. We explored the determinants of the failure of emergency therapy. Age was not a factor. Instead, in addition to attack severity and symptoms between attacks, it was rather the presence of respiratory viral infection or fever triggering the attack that was more often associated with treatment failure, i.e., higher hospitalization rates, more returns to the emergency room, and reduced speed of recovery over the 10 days after discharge. Viral detection occurred more frequently in preschoolers (67%) than in older children (46%) with asthma.
Nevertheless, the results confirm the overall effectiveness of standard treatment, adjusted to the severity of the attack and administered early, in the vast majority of children, regardless of age and viral detection. Indeed, although a failure rate of nearly 40% was expected in this group of children with moderate to severe attack, only 17% of the participants did not respond to standard treatment. This rate was significantly higher (19%) in children with viral infection compared to uninfected children (13%).
MedicalResearch.com: What should readers take away from your report?
• Young children respond as well to evidence-based therapy adjusted according to the severity.
• Children with a viral trigger or fever are at a higher risk of failure but still more than 80% respond well to therapy.
• Don’t hesitate to offer the standard of care therapy to young children.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: This is the latest in series of studies have improve the care of children with acute asthma and that have contributed to the establishment of the gold therapy . We are exploring novel strategies to prevent or decrease the severity of asthma attacks triggered by the common cold in pre-schoolers children with asthma.
Use of rapid test to identify infection may help to identify children at higher risk of failure and to personalize therapy
MedicalResearch.com: Is there anything else you would like to add?
Response: The second message is that the rapid administration of therapy based on the evidence and adjusted for the severity works in the overwhelming majority (83%) of children .
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Factors associated with failure of emergency department management in children with acute moderate or severe asthma: a prospective, multicentre, cohort study
Ducharme, Francine M et al.
The Lancet Respiratory Medicine , Volume 0 , Issue 0 ,
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