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BACKGROUND: Compared with a lower neutrophil to lymphocyte ratio(NLR), a higher one denotes severe asthma exacerbation in hospitalized asthmatic children. In addition, NLR is significantly higher in pediatric patients with community-acquired pneumonia (CAP) than those without. Nevertheless, its role in pediatric patients with concomitant asthmatic exacerbation and CAP remains unknown. METHODS: In this retrospective study including 1032 pediatric patients aged 5 to 14 years old, the diagnostic and prognostic value of NLR in children with concomitant asthmatic exacerbation and non-severe CAP were investigated. RESULTS: The sensitivity and specificity of NLR for a diagnosis of CAP in patients with asthmatic exacerbation were 56.9% and 90.1%, respectively. The cutoff value of NLR for a diagnosis of CAP in patients with asthmatic exacerbation was 4.15 (P < 0.001). The cumulative asthmatic exacerbation during 3-month followup of patients with high NLR were 23 (21.3%) and 58 (42.0%) in the asthma and asthmatic CAP groups, respectively (P < 0.001). The patients with high NLR who had unimproved CAP were 15 (8.3%) and 23 (12.2%) in the CAP and asthmatic CAP groups, respectively (P = 0.006). Multivariate analyses showed that along with the increase of NLR by 1.0 point, the HR for the occurrence of asthmatic exacerbation and unimproved CAP were 2.91 [1.83-3.96] (P = 0.001) and 3.38 [1.66-5.10] (P < 0.001), respectively. CONCLUSIONS: NLR had high and moderate diagnostic value for the exclusion and indication of CAP, respectively, in pediatric patients with asthmatic exacerbation. It also had prognostic value for the outcomes of pediatric patients with concomitant asthmatic exacerbation and CAP.

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Background: Several studies have suggested that HIF-1α regulates eosinophil activity and induces epithelial inflammation via NF-κB activation in the pathophysiology of asthma. The purpose of this study was to examine the expression of the transcription factors HIF-1α and nuclear HIF in mononuclear cells obtained from peripheral blood samples of healthy pediatric patients, asthmatic patients, and asthmatic exacerbations, regardless of disease severity. Methods: HIF-1 levels were measured using immunocytochemistry in 133 patients aged 6 to 17 years in this crosssectional and comparative study. A microscope was used to examine glass slides, and positive cells were counted in four fields per slide using an image analyzer. Results: HIF-1α and nuclear HIF levels were significantly higher in asthma patients and even higher in patients experiencing asthma attacks (p<0.0001, 95% CI). There was no significant difference in the percentage of HIF-1α expression between groups with intermittent asthma and those with mild persistent asthma, nor between patients with asthma and those experiencing asthma exacerbations. Conclusions: When compared to healthy individuals, the expression of nuclear HIF and HIF-1α is increased in peripheral mononuclear cells in asthma patients and even more so in asthma exacerbations. This suggests that HIF-1α is important in the pathogenesis of this disease.

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OBJECTIVE: To identify the predictors of requiring intubation and invasive mechanical ventilation (IMV) in asthmatic exacerbation (AE)-related hospitalizations. METHODS: This study was conducted in southern Thailand between October 2016 and September 2018. The characteristics and clinical findings of patients admitted for AE requiring intubation and IMV were analyzed. The variables were evaluated by univariate and multivariate analysis to identify the independent predictors. RESULTS: A total of 509 patients with a median age of 53 years were included in the study. Being female (60.2%), having no previous use of a controller (64.5%), having a history of smoking, and having a high level of white blood cell count (14,820 cells/mm3) were the significantly more common characteristics of the patients requiring mechanical ventilation. Univariate analysis showed that being male (OR = 1.96 95% CI, 1.22-3.13), having a history of 1-2 AEs in the past 12 months (OR = 3.27 95% CI, 1.75-6.12), and having an absolute eosinophil count ≥300 cells/mm3 (OR = 1.68 95% CI, 1.05-2.69) were associated with patients requiring IMV, whereas the patients who were taking a reliever (OR = 0.36 95% CI, 0.23-0.57) and controller (OR = 0.42 95% CI, 0.27-0.68) were associated with a decreased risk of requiring intubation and IMV. In multivariate analysis, only 1-2 AEs within the past 12 months (OR = 3.12, 95% CI, 1.19-8.21) was an independent predictor of requiring intubation and IMV in patients with AE-related hospitalization (p = 0.021). CONCLUSIONS: This study found that a history of 1-2 AEs in the past 12 months was a strong independent predictor for the requirement of intubation and IMV in patients hospitalized for AE-related conditions.

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BACKGROUND: To investigate the impact of disease severity on exacerbation patterns and identify its potential as a risk factor for future exacerbations in patients admitted for asthma exacerbations. METHODS: We analyzed frequency and time to next exacerbation over a period of three years in 532 patients admitted for exacerbation. Disease severity was selected as a potential risk factor for the events. Kaplan-Meier analysis was used to identify the probability of future exacerbations. A Cox-proportional hazards model was used to assess independent relative risks. RESULTS: Out of 532 patients analyzed, the frequency of exacerbations rose as the severity of the asthma increased. The exacerbation rates in the following year were 1.66 per person for patients with mild asthma and 3.98 for patients with severe asthma. The median time to the next exacerbation in patients with mild asthma was 61.4 weeks (95% CI, 40.1-82.6) compared to 15.0 weeks (95% CI, 11.3-18.6) in patients with severe asthma (p<0.001). Multivariate analysis showed that asthma severity (severe vs mild asthma, HR=1.42, 95% CI, 1.07-1.89), a history of 1-2 exacerbations (HR=1.95, 95% CI, 1.45-2.63) or > 2 exacerbations (HR=2.32, 95% CI, 1.56-3.44) in the previous 12 months, and a high number of comorbidities (≥5 vs none, HR=2.5, 95% CI, 1.41-4.45) were independent predictors of the probability of future exacerbations. CONCLUSION: Asthma severity is a strong independent risk factor for future exacerbations, and exacerbation rates also become more frequent as the severity of the asthma increases. These findings help in better understanding of the natural course of exacerbations across the spectrum of asthma disease severity.

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Introduction. The early use of systemic steroids has been associated with a decrease in the rate of hospitalizations in pediatric patients with asthma exacerbation. The objective was to compare the equivalence of two forms of administration, as well as to determine the optimal time for its indication. Material and methods: Observational, randomized, open study of equivalence, comparing oral versus parenteral steroids. The primary outcomes were changes in the severity scale and the rate of hospitalizations. The secondary result was the time until improvement was reached. ANOVA and Chi square tests were used to determine the statistical significance; it was considered significant when p <0,05. Results: In both groups both the severity scale and the hospitalization rate were considerably modified with early administration. At 30 minutes after using hydrocortisone (p<0,05). The greatest variation in the severity scale was observed. Conclusion: both routes of administration proved to be effective and should be used early.

Introducción: El uso precoz de los esteroides sistémicos ha sido asociado con disminución de la tasa de hospitalizaciones en los pacientes pediátricos con exacerbación asmática. El objetivo de este estudio es comparar la equivalencia de dos formas de administración, así como determinar el tiempo óptimo para su indicación. Material y métodos: Estudio observacional, aleatorizado, abierto de equivalencia, comparando esteroides por via oral contra parenteral. Los outcomes primarios fueron los cambios en la escala de gravedad y la tasa de hospitalizaciones y el secundario fue el tiempo en alcanzar la mejoría. Se utilizó ANOVA, prueba Chi cuadrado para determinar las significaciones estadísticas, se consideró significancia p<0,05. Resultados: En ambos grupos tanto la escala de gravedad como la tasa de mortalidad se modificaron de forma importante con la administración precoz. A los 30 minutos de administrar hidrocortisona (p<0,05) se observó la mayor variación en la escala de gravedad. Conclusión: ambas vías de administración demostraron ser efectivas y deben ser usadas de forma precoz.

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BACKGROUND: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. METHODS: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. RESULTS: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. CONCLUSIONS: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.

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Introducción: El objetivo de este estudio consistió en un análisis de la base de datos del proyecto EAGLE (características de los pacientes hospitalizados por asma) limitado a la Argentina y el Uruguay. Pacientes y métodos: Para evaluar los cambios producidos en los asmáticos hospitalizados en Argentina y Uruguay, fueron revisadas las historias clínicas de 215 pacientes (15-69 años de edad) hospitalizados en 4 centros médicos durante los años 1994, 1999 y 2004. Resultados: Si bien se verificó una reducción significativa en el uso de teofilinas, la utilización de corticoides inhalados fue baja (16% de todos los pacientes) y se mantuvo incambiada. Se verificó una tendencia a una disminución en el tiempo de hospitalización (10.5 días en 1994 a 8.2 días en 2004, p = 0.2). La tasa global de mortalidad para todos los pacientes estudiados durante los tres años fue 1.4% correspondiendo a un total de 3 fallecimientos. Por el contrario el uso de espirometría o flujo espiratorio máximo en urgencias se mantuvo por debajo del 60% de los pacientes hospitalizados. Globalmente, un 29% de todos los pacientes hospitalizados fueron ingresados a una unidad de cuidados intensivos. Conclusiones: Aunque este estudio sugiere algunas mejoras en el manejo del asma tanto durante el período intercrisis como durante las exacerbaciones, todavía subsisten importantes carencias tanto en Argentina como en Uruguay.(AU)

Introduction: The objective of this study was to assess the data base of project EAGLE (characteristics of the patients hospitalized because of asthma) in Argentina and Uruguay. Patients and Methods: In order to evaluate the changes produced in asthma hospitalizations in Argentina and Uruguay, the records of 215 patients (15-69 years old) admitted for acute asthma at third level hospitals during the years of 1994, 1999, and 2004 were reviewed. Results: Although a the use of theophylline was significantly decreased, the utilization of inhaled corticosteroids was low (16% of all patients) and remained unchanged during the study period. There was a trend towards a reduction in the length of hospital stay (from 10.5 days in 1994, to 8.2 days in 2004, p = 0.2). The overall case fatality rate for all patients admitted during the study period was 1.4% (3 deaths). The use of spirometry or peak expiratory flow measurements in the emergency room was registered in less of 60% of hospitalized patients. Overall, 29% of hospitalized patients required admission into an intensive care unit. Conclusions: Although this study suggests some improvements in the management of asthma in the period between severe exacerbations and during hospitalization, suboptimal case management is still common in Argentina and Uruguay.(AU)

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Introducción: El objetivo de este estudio consistió en un análisis de la base de datos del proyecto EAGLE (características de los pacientes hospitalizados por asma) limitado a la Argentina y el Uruguay. Pacientes y métodos: Para evaluar los cambios producidos en los asmáticos hospitalizados en Argentina y Uruguay, fueron revisadas las historias clínicas de 215 pacientes (15-69 años de edad) hospitalizados en 4 centros médicos durante los años 1994, 1999 y 2004. Resultados: Si bien se verificó una reducción significativa en el uso de teofilinas, la utilización de corticoides inhalados fue baja (16% de todos los pacientes) y se mantuvo incambiada. Se verificó una tendencia a una disminución en el tiempo de hospitalización (10.5 días en 1994 a 8.2 días en 2004, p = 0.2). La tasa global de mortalidad para todos los pacientes estudiados durante los tres años fue 1.4% correspondiendo a un total de 3 fallecimientos. Por el contrario el uso de espirometría o flujo espiratorio máximo en urgencias se mantuvo por debajo del 60% de los pacientes hospitalizados. Globalmente, un 29% de todos los pacientes hospitalizados fueron ingresados a una unidad de cuidados intensivos. Conclusiones: Aunque este estudio sugiere algunas mejoras en el manejo del asma tanto durante el período intercrisis como durante las exacerbaciones, todavía subsisten importantes carencias tanto en Argentina como en Uruguay.

Introduction: The objective of this study was to assess the data base of project EAGLE (characteristics of the patients hospitalized because of asthma) in Argentina and Uruguay. Patients and Methods: In order to evaluate the changes produced in asthma hospitalizations in Argentina and Uruguay, the records of 215 patients (15-69 years old) admitted for acute asthma at third level hospitals during the years of 1994, 1999, and 2004 were reviewed. Results: Although a the use of theophylline was significantly decreased, the utilization of inhaled corticosteroids was low (16% of all patients) and remained unchanged during the study period. There was a trend towards a reduction in the length of hospital stay (from 10.5 days in 1994, to 8.2 days in 2004, p = 0.2). The overall case fatality rate for all patients admitted during the study period was 1.4% (3 deaths). The use of spirometry or peak expiratory flow measurements in the emergency room was registered in less of 60% of hospitalized patients. Overall, 29% of hospitalized patients required admission into an intensive care unit. Conclusions: Although this study suggests some improvements in the management of asthma in the period between severe exacerbations and during hospitalization, suboptimal case management is still common in Argentina and Uruguay.

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