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PRACTICE GUIDELINES
National Guideline Clearinghouse | Search Results
www.guidelines.gov -
NGC is the National Guideline Clearinghouse.
www.naspghan.org/user-assets/Documents/pdf/CDHNF%20Old%20Site/Reflux%20and%20GERD%20Medical%20Professional%20Resources/PediatricGastroRefluxClinicalPracticeGuidelineSummary.pdf
www.naspghan.org -
primary and specialist healthcare provider in the evaluation and management of gastroesophageal reflux ( GER) and gastroesophageal reflux disease ( GERD) in the pediatric age group infants, children and adolescents. ... They were written by a joint
Evidence Table 20. Managing Exacerbations: Heliox
www.nhlbi.nih.gov -
37 White, 3 not given Moderate to-severe asthma Patients presented to urban, pediatric ED Pulmonary index ( PI) score of > 8 out of 15; mean 10.2 at entry Beta2-agonist, ... Albuterol nebulized in heliox in the initial ED treatment of pediatric asthma:
Evidence Table 19. Managing Exacerbations: Magnesium Sulfate
www.nhlbi.nih.gov -
July 2007 2 Evidence Table 19. Managing Exacerbations: Magnesium Sulfate Study Population Citation ( Sponsor) Study Design Study N ( Number Evaluable) Population Characteristics Asthma Severity at Baseline ( if reported) Magnesium by Nebulizer

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JOURNAL SCAN
Polymorphism of the ADRB2 gene and response to inhaled beta- agonists in children with asthma: a meta-analysis.
pubmed.gov - 11/1/09
About 9% of children have asthma, corresponding to almost 6.8 million children in the USA and 1.1 million in the UK. Asthma exacerbations are the leading cause of pediatric emergency room visits and impose a large burden on the individual, family, and society. There is mounting evidence that therapeutic failure of inhaled beta-agonists is associated with polymorphisms of the beta(2)-adrenergic receptor gene (ADRB2); specifically, mutations leading to amino acid changes at positions 16 and 27, which alter down-regulation of the beta(2)-adrenergic receptor (beta(2)AR), induce resistance to the smooth-muscle relaxing effect of beta(2)-adrenergic agonists.|We conducted a meta-analysis to examine the association between ADRB2 polymorphisms and the response to inhaled beta(2)-adrenergic agonists in children with asthma. We included all published studies until November 2008, in which asthmatic children underwent testing for acute bronchodilator response, defined as > or = 15% improvement in
Sublingual immunotherapy in children: complete and updated review supporting evidence of effect.
pubmed.gov - 4/2/09
The interest in sublingual immunotherapy (SLIT) is still growing worldwide and especially for the pediatric age group, this modality is appealing. Lately, some negative systematic review articles have been published on SLIT in children. However, high quality articles published from 2007 onward had not been included.|Explanations are sought for the negative outcomes in these reviews and shortcomings are discussed. New pediatric studies - not included in the previous reviews -designed taking into account the golden rules for SLIT (high daily dose, starting at least 4 months before pollen season) do show statistically significant improvement in symptom and medication scores for rhinitis and asthma in pollen allergy. New house dust mite studies still show inconsistent data.|Evidence of effect is confirmed for SLIT in children with allergic rhinitis or asthma caused by pollen exposure. For house dust mite asthma, evidence is still nonconcordant. New techniques to improve SLIT efficacy are
Efficacy of probiotics in the treatment of pediatric atopic dermatitis: a meta-analysis of randomized controlled trials.
pubmed.gov - 11/2/08
Several articles describing the efficacy of probiotics in atopic dermatitis (AD) have been published. However, not all studies support a similar outcome.|To determine whether probiotics are efficacious in treating AD and to explore whether type of probiotic used, duration of therapy, patient age, severity of disease, and IgE sensitization are factors in determining efficacy.|For this meta-analysis of randomized controlled trials describing the efficacy of probiotics in AD, a comprehensive search was performed of databases through January 2008. Three reviewers independently evaluated the studies for methodological qualities. All the data were analyzed, and forest plots were evaluated for the overall efficacy of probiotics in AD and the therapeutic benefit to subgroups of selected patient populations.|Eleven studies were identified, and data from 10 studies (n = 678) were available to analyze. There was an overall statistically significant difference favoring probiotics compared with
Inhaled corticosteroids or montelukast as the preferred primary long-term treatment for pediatric asthma?
pubmed.gov - 7/1/08
According to current guidelines, inhaled corticosteroids (ICS) are the preferred primary long-term treatment for asthmatic children of all age groups, but leukotriene receptor antagonists can be considered to be an alternative treatment for mild persistent asthma. In this article, all randomized double-blind efficacy studies comparing the long-term (>4-week) treatment using a leukotriene receptor antagonist with an inhaled corticosteroid in asthmatic children were critically reviewed. In school-aged children, five reports with an adequate study design were available. All of these studies compared montelukast with inhaled fluticasone. The meta-analysis of the two main outcome measures, forced expiratory volume in 1 s (weighted mean difference, 4.6% predicted, 95% confidence interval: 3.5-5.5) and asthma control days (respectively, 5.6%, 4.3-6.9) demonstrated the superiority of fluticasone over montelukast. Many other clinical and pulmonary outcomes also consistently showed that
Metaanalysis of the efficacy of sublingual immunotherapy in the treatment of allergic asthma in pediatric patients, 3 to 18 years of age.
pubmed.gov - 3/1/08
Recent studies have documented the efficacy and safety of sublingual immunotherapy (SLIT) in patients with rhinitis, but the value of this treatment in those with asthma is still debated. We evaluated the efficacy of SLIT in the treatment of allergic asthma in children by a metaanalysis of randomized, double-blind, and placebo-controlled (DBPC) clinical trials.|Electronic databases were searched up to May 31, 2006, for randomized DBPC trials assessing SLIT in pediatric cases of asthma. Effects on primary outcomes (ie, symptom scores and concomitant use of rescue medication) were calculated with standardized mean differences (SMDs) using the random-effects model. We performed the metaanalysis using a statistical software package (RevMan, 4.2.8; The Cochrane Collaboration; Oxford, UK), and we followed the recommendations of the Cochrane Collaboration and the Quality of Reporting of Metaanalyses guidelines.|Seventy-three articles were identified and reviewed. Nine studies, all published

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Asthma

  • Infant and Toddler With History of Cough

    A 6-month-old boy has a 1-week history of dry cough that worsens at night. He has been wheezing intermittently for the past month. A 2-year-old girl has had severe nighttime cough, congestion, and fever for 2 days. She recently recovered from a respiratory illness of 1 month's duration. Chest radiographs of both patients are shown… Read More

  • Is Your Room an Asthma "Nightmare"?

    If your bedroom or other rooms in your home look a lot like the one here, you may be living in an asthma "nightmare"—an environment full of potential causes of asthma attacks. Many people with asthma have allergies that make their asthma worse… Read More

  • Exercise and Asthma: Guidelines From the NIH

    Patients with asthma may be reluctant to exercise for fear of triggering an attack. You can reassure them that adequate control can allow them to participate in almost any physical activity they wish. Recommendations from the NIH offer guidance on prevention of exercise-induced bronchospasm… Read More

  • Asthma Control in Children Younger Than 5 Years

    In the United States, asthma affects approximately 1.4 million children younger than 5 years and causes frequent activity limitations and hospitalizations. Unfortunately, a substantial number of children in this age-group have suboptimal asthma control, demonstrated by the higher rates of ER visits and hospitalizations in preschool-aged children than in older children … Read More

 
 
LATEST FEATURES
June 11, 2013
Asthma a Risk Factor for Sleep Apnea?
Asthma may be a risk factor for the development of obstructive sleep apnea, according to the results of a new longitudinal study. More »
April 3, 2013
Go For The Glory Quiz: Carcinoma?; Spirometry to Assess Chronic Cough?; Neurofibroma?; Laryngeal Neoplasm?
Carcinoma?; spirometry to assess chronic cough?; neurofibroma?; laryngeal neoplasm?; More »
March 7, 2013
An Overview of Chronic Cough in Children
Here: an overview of the pathophysiology of chronic cough, its epidemiology and etiology; the clinical evaluation, diagnostic workup, and a summary of treatment options. More »
February 26, 2013
Allergy, Asthma, and Immunology Meeting Research Update
Increased exposure to polycyclic aromatic hydrocarbons in air pollution is associated with certain immune system effects and asthma diagnosis, according to research reported the 2013 Annual Meeting of the American Academy of Allergy, Asthma & Immunology. More »
January 28, 2013
Depression Alters Asthma Interventions and Quality of Life in Urban Teens
Primary care physicians can take the lead in helping address these additional comorbidities in their patients with asthma. More »
December 10, 2012
Asthma Therapy Complicated by Peters Plus Syndrome
The authors describe the case of a 2-year-old girl with severe persistent asthma whose disease management was complicated by this rare clinical diagnosis. More »
October 18, 2012
Asthma Medication: Lowest Effective Dose Works Best
Children who use glucocorticoid inhalers to prevent asthma attacks may be on average a half-inch shorter as adults, according to a recent study. More »
June 6, 2012
Atopic Dermatitis
This distribution of an inflammatory disorder in a very young child almost always indicates atopic dermatitis. The family history of asthma suggests the atopic diathesis. More »
March 14, 2012
Home Remedies for Bronchitis: Maybe Your Mother Was Right?
Persistent cough and bronchitis are common, and normal, among children. Here are some home treatments I have recommended. More »
February 17, 2012
Update on Pediatric Pneumonia: Causes—Treatment Options
Here we summarize the evaluation of pediatric pneumonia and offer our management recommendations—based on a literature review and on clinical experience—in the outpatient setting. More »
Showing 1 - 10 of 101 results.
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MULTIMEDIA

Podcast: 5 Myths About Office-Based Spirometry—and Why You Really Do Need This Essential Tool
December 2, 2011

In this podcast, Dr John Kelso dispels myths and makes a case for office-based spirometry for pediatricians.

Video: Conducting Spirometry in Children
October 19, 2011

Prof. Dominic Fitzgerald, a pediatric respiratory and sleep physician, reviews the basics about spirometry, and explains its use in children.

 
MEDLINE
Evaluation of laryngopharyngeal reflux in pediatric patients with asthma using a new technique of pharyngeal pH-monitoring.
pubmed.gov - 12/31/12
There is a debate about the association between asthma and gastroesophageal and/or laryngopharyngeal reflux (LPR). Pharyngeal pH-monitoring is a new technique that allows a physician to assess whether reflux passes the upper esophageal sphincter barrier. The aim of the study was to assess the prevalence of LPR in children with difficult-to-treat asthma. The present study was an open, prospective one. A total of 21 subjects of the mean age 12.7 years were enrolled in the study. All children were asked to fill out a Reflux Symptoms Index questionnaire and a 24-h pharyngeal pH monitoring was performed, using the Dx-pH Measurement System. The LPR was diagnosed in 13 (61.9%) children. There was a positive correlation between LPR diagnosis and the degree of asthma control. The LPR was more frequent in children treated with a higher than lower doses of fluticasone (p = 0.019, OR = 17.3) and in those using montelukast compared with non-users (p = 0.008, OR = 19.0). The mean Reflux Symptoms
Correlation of care process measures with childhood asthma exacerbations.
pubmed.gov - 12/31/12
We sought to define processes of pediatric asthma care identifiable through administrative data that correlate with asthma exacerbations for use in quality improvement.|Commercially insured children aged 5 to 17 years from the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, with persistent asthma in 2008, 2009, or 2010 were identified. The correlations of various process measures with asthma exacerbations, defined as hospitalizations or emergency department visits for asthma or outpatient visits for asthma with an oral steroid prescription, were analyzed by using logistic regression.|Significant correlations were found between filling 0 vs 1 controller medications in all years (relative risk [RR] 3.35, 2.11, and 2.71 in 2008, 2009, and 2010, respectively) although only 4% of subjects overall filled no controller medications. The asthma medication ratio (controller prescriptions divided by total
Secondhand tobacco smoke exposure and severity of influenza in hospitalized children.
pubmed.gov - 12/31/12
To assess whether children with influenza who are exposed to secondhand tobacco smoke (SHS) would have more severe illness than those not exposed.|We abstracted charts from pediatric inpatients with confirmed influenza from 2002-2009 for demographics, medical history, and smoke exposure. Severity indicators included intensive care, intubation, and length of stay (LOS) in the hospital; potential confounding factors included demographics and the presence of asthma or chronic conditions. All (2), t tests, and regression analyses were run using SPSS v. 18.0.|Of 117 children, 40% were exposed to SHS, who had increased need for intensive care (30% vs 10%, P < .01) and intubation (13% vs 1%, P < .05), and had longer LOS (4.0 vs 2.4 days, P < .01). Children with chronic conditions and SHS exposure required more intensive care (53% vs 18%, P < .05) and had longer LOS (10.0 vs 3.5 days, P < .01) than children not exposed to SHS with chronic conditions. In multivariate analyses controlling for
Medical home quality and readmission risk for children hospitalized with asthma exacerbations.
pubmed.gov - 12/31/12
The medical home likely has a positive effect on outpatient outcomes for children with asthma. However, no information is available regarding the impact of medical home quality on health care utilization after hospitalizations. We sought to explore the relationship between medical home quality and readmission risk in children hospitalized for asthma exacerbations.|We enrolled 601 children, aged 1 to 16 years, hospitalized for an acute asthma exacerbation at a single pediatric facility that captures >85% of all asthma admissions in an 8-county area. Caregivers completed the Parent's Perception of Primary Care (P3C), a Likert-based, validated survey. The P3C yields a total score of medical home quality and 6 subscale scores assessing continuity, access, contextual knowledge, comprehensiveness, communication, and coordination. Asthma readmission events were prospectively collected via billing data. Hazards of readmission were calculated by using Cox proportional hazards adjusting for
Readability, suitability, and characteristics of asthma action plans: examination of factors that may impair understanding.
pubmed.gov - 12/31/12
Recognition of the complexity of asthma management has led to the development of asthma treatment guidelines that include the recommendation that all pediatric asthma patients receive a written asthma action plan. We assessed the readability, suitability, and characteristics of asthma action plans, elements that contribute to the effectiveness of action plan use, particularly for those with limited literacy.|This was a descriptive study of 30 asthma action plans (27 state Department of Health (DOH)-endorsed, 3 national action plans endorsed by 6 states). Outcome measures: (1) readability (as assessed by Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast), (2) suitability (Suitability Assessment of Materials [SAM], adequate: 0.4; unsuitable: <0.4), (3) action plan characteristics (peak flow vs symptom-based, symptoms, recommended actions).|Mean (SD) overall readability grade level was 7.2 (1.1) (range = 5.7-9.8); 70.0% were above a sixth-grade

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ASTHMA NEWS
U.K. Kids Breath Easier With Smoke-Free Laws (CME/CE)
www.medpagetoday.com - 1/20/13
(MedPage Today) -- English anti-smoking legislation was significantly associated with reductions in asthma-related hospitalizations in pediatric patients, researchers found.
www.medpagetoday.com/upload/2008/10/30/NEJMoa0804633v1.pdf
www.medpagetoday.com -
10.1056/nejmoa0905506 nejm.org 1 The new england journal of medicine Combined Immunodeficiency Associated with DOCK8 Mutations Qian Zhang, M.D., Jeremiah C. Davis, M.P.H., Ian T. Lamborn, B.S., Alexandra F. Freeman, M
www.medpagetoday.com -
Asthma News, Pulmonology News plus CME
www.medpagetoday.com -
said. 02/27/2010. NEW ORLEANS -- Vitamin D may boost the anti-inflammatory efficacy of asthma medications but tends to be low in kids who need the drugs, researchers said. ... trials. 11/12/2009. MIAMI BEACH -- Researchers reported here that pediatric
ACAAI News, Meeting Coverage plus CME
www.medpagetoday.com -
Friday, May 11, 2012. Other Tools. 11/12/2009. MIAMI BEACH -- Researchers reported here that pediatric patients with asthma treated with fluticasone propionate plus salmeterol in a fixed-dose combination experienced ... fewer serious asthma exacerbations

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FROM PHYSICIANS PRACTICE
Key Differences between FQHCs and RHCs
Chastity Werner, RHIT, June 13, 2013
FQHCs and RHCs take up a unique niche among physician practices. And that affects compensation and billing.
Improving Care Coordination in Your Practice
Susanne Madden,  June 12, 2013
Practices are feverishly working to control the rising costs of healthcare - effective care coordination can help.
Refunding Overpayments: Two Options for Medical Practices
Ericka L. Adler,  June 12, 2013
Medicare and Medicaid providers must return overpayments once identified. Here are two different refund approaches for practices to consider when necessary.
Four Easy Ways to Boost Patient Time of Service Collections
Aubrey Westgate,  June 12, 2013
Simple ways your medical practice staff can increase the likelihood patients will pay when presenting for appointments.
iPad Alternatives for Mobile Physicians
Marisa Torrieri, June 11, 2013
As more physicians are seeing the merits of media tablets, the market is expanding, too.
 

 
 
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