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PRACTICE GUIDELINES
National Guideline Clearinghouse | Guidelines by Topic: Manometry
www.guidelines.gov -
NGC is the National Guideline Clearinghouse.

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JOURNAL SCAN
Age and risks of FDA-approved long-acting -adrenergic receptor agonists.
pubmed.gov - 11/2/11
To determine the risk, by age group, of serious asthma-related events with long-acting (2)-adrenergic receptor agonists marketed in the United States for asthma.|The US Food and Drug Administration performed a meta-analysis of controlled clinical trials comparing the risk of LABA use with no LABA use for patients 4 to 11, 12 to 17, 18 to 64, and older than 64 years old. The effects of age on a composite of asthma-related deaths, intubations, and hospitalizations (asthma composite index) and the effects of concomitant inhaled corticosteroid (ICS) use were analyzed.|One hundred ten trials with 60 954 patients were included in the meta-analysis. The composite event incidence difference for all ages was 6.3 events per 1000 patient-years (95% confidence interval [CI]: 2.2-10.3) for using LABAs compared with not using LABAs. The largest incidence difference was observed for the 4- to 11-year age group (30.4 events per 1000 patient-years [95% CI: 5.7-55.1]). Differences according to age
Subcutaneous immunotherapy and pharmacotherapy in seasonal allergic rhinitis: a comparison based on meta-analyses.
pubmed.gov - 10/1/11
Allergen-specific subcutaneous immunotherapy (SCIT) of seasonal allergic rhinitis (SAR) is usually considered a "second-line," slow-acting, disease-modifying treatment.|We sought to test whether SCIT is as effective as antisymptomatic treatment in the control of symptoms in patients with SAR in the first year of treatment.|We reviewed meta-analyses with 5 or more randomized, double-blind, placebo-controlled trials of SCIT or antisymptomatic treatment in patients with SAR. We then selected trials measuring the total nasal symptom score (TNSS), the total symptom score (TSS), or both during the first pollen season after treatment initiation. Efficacy was determined as the percentage reduction in TSSs and TNSSs obtained with active treatment compared with placebo (relative clinical impact [RCI]) and the standardized mean difference (SMD) of treatment verses placebo (effect size [ES]).|The weighted mean RCI of SCIT on TNSSs (-34.7% 6.8%) was higher than those of mometasone (-31.7%
Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?: a meta-analysis of published RCTs.
pubmed.gov - 3/1/11
To determine whether specific oral tolerance induction (SOTI) is more effective than avoidance in inducing tolerance in children aged 0-18 years who have immunoglobulin E (IgE)-mediated food allergy.|MEDLINE (1950 to July 2009), EMBASE (1980 to July 2009) and all EBM Reviews: Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database (from start date to November 2008). The online table of contents (November 2003 to July 2009) of the Journal of Allergy and Clinical Immunology, Pediatric Allergy and Immunology and Allergy were also searched, and reference lists of retrieved articles were scrutinised for relevant studies.|Randomised controlled trials (RCT) were included providing they enrolled children with IgE-mediated food allergy diagnosed using the criterion standard tool (double-blind placebo-controlled food challenge) before randomisation and
Practice parameters for the respiratory indications for polysomnography in children.
pubmed.gov - 3/1/11
There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidence-based practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine.|A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence. RECOMMENDATIONS FOR PSG USE: 1. Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard) 2. Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS)
Pooled genome-wide analysis to identify novel risk loci for pediatric allergic asthma.
pubmed.gov - 1/1/11
Genome-wide association studies of pooled DNA samples were shown to be a valuable tool to identify candidate SNPs associated to a phenotype. No such study was up to now applied to childhood allergic asthma, even if the very high complexity of asthma genetics is an appropriate field to explore the potential of pooled GWAS approach.|We performed a pooled GWAS and individual genotyping in 269 children with allergic respiratory diseases comparing allergic children with and without asthma. We used a modular approach to identify the most significant loci associated with asthma by combining silhouette statistics and physical distance method with cluster-adapted thresholding. We found 97% concordance between pooled GWAS and individual genotyping, with 36 out of 37 top-scoring SNPs significant at individual genotyping level. The most significant SNP is located inside the coding sequence of C5, an already identified asthma susceptibility gene, while the other loci regulate functions that are

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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
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 »
February 16, 2012
Wood Smoke, Indoor Air, and Asthma
In many parts of the country—and for people of all ages—a turn of the calendar to the winter months means more time spent indoors. For patients with asthma, however, an evening spent in front of a crackling fire may simply serve as a trigger for an attack. More »
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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
Five Steps to Improving Patient Access
Judy Capko,  May 21, 2013
Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.
Growing HIPAA Threat – Ignore Windows XP at Your Own Peril
Marion K. Jenkins,  May 21, 2013
Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.
Finding Physician Work-Life Balance in the Small Moments
Jennifer Frank, MD,  May 21, 2013
At my practice and at home, things are always busy. There's laundry or homework, or a patient with needs.
Three Areas to Reduce Costs at Your Medical Practice
Greg Mertz,  May 19, 2013
By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.
Dos and Don’ts for Starting a Physician Blog
Michael Woo-Ming, MD,  May 18, 2013
Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.
 

 
 
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