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Aim: To describe the relationship between loss of control events in preschoolers with asthma and persistence of disease. Methods: We reviewed medical records of children <6 years diagnosed with asthma in 2018 to assess loss of control events during three years of follow‐up. Asthma persistency was defined by redeem of short‐acting β2‐agonist or asthma controllers within one year after the end of follow‐up. Logistic regression models were applied to analyse the association between loss of control events and persistence of asthma. Results: We included 172 patients (median age 1.8 years), whereof 126 (73.3%) experienced a loss of control event and 87 (50.6%) had asthma one year after the end of follow‐up. Any loss of control event was associated with persistence of asthma adjusted for controller treatment at inclusion, prior exacerbations, atopic comorbidity and caesarean section: aOR, 10.9 (95% CI, 3.9–34.6), p < 0.001. This was also significant restricted to events in the first year of follow‐up: 3.52 (1.50–8.67), p < 0.01 and among children only experiencing one event: 6.4 (1.7–27.3), p = 0.01. Conclusion: Loss of control events during a 3‐year period among preschoolers with asthma are closely related to disease persistency, which may aid clinicians to assess risk of persistent asthma in young children. [ABSTRACT FROM AUTHOR]

Non-adherence to asthma controllers increases morbidity among school-aged children. This study aimed to determine non-adherence risk factors in preschool children with asthma. We investigated 172 children <6 years diagnosed with asthma in 2018 and analyzed baseline characteristics and loss of control events extracted from the medical records for four years following diagnosis. At end of follow-up, 79 children had a prescription of inhaled corticosteroids (ICS) and were included in the analyses. Adherence was assessed in a two-year period through pharmacy claims using percentage of days covered (PDC) analyzed dichotomously with non-adherence defined as PDC < 80% and using adherence ratio (AR) defined as days with medical supply divided by days without. Of the 79 children, 59 (74.7%) were classified as non-adherent. In analyses adjusted for sex, age and exacerbations prior to inclusion, adherence was positively associated with having had a loss of control event requiring a step-up in asthma controller (aAR:2.34 [1.10;4.98], p = 0.03), oral corticosteroids (aAR:2.45 [1.13;5.34], p = 0.026) or redeeming a short-acting b2-agonist prescription (aAR:2.91 [1.26;6.74], p = 0.015). Further, atopic comorbidity was associated with increased adherence (aAR:1.18 [1.01;1.37], p = 0.039), whereas having a first degree relative with asthma was associated with worse adherence (aAR:0.44 [0.23;0.84], p = 0.015). This study found poor adherence to ICS among three quarters of preschool children with asthma. Increasing adherence was associated with atopic comorbidity and loss of control events, whereas lower adherence was associated with atopic predisposition. These findings should be considered to improve adherence in preschool children with asthma. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the diagnostic workup in children with asthma hypothesising that objective confirmation of the diagnosis is associated with improved treatment adherence and patient outcomes. Methods: We reviewed medical records of children aged 5–18 years diagnosed with asthma at the Department of Paediatric and Adolescent Medicine, Herlev‐Gentofte Hospital, Denmark, in 2018. Objective confirmation of the diagnosis was based on either (1) lung function, (2) bronchodilator response, (3) bronchial hyperresponsiveness and/or (4) elevated FeNO and was associated with treatment adherence (proportion of days covered, PDC), lung function development and exacerbations during a two‐year follow‐up period. Results: A total of 88 children were included. Asthma was objectively confirmed in 67 (76%). Children with objective confirmation of the diagnosis were more likely to redeem short‐acting beta‐2‐agonist prescriptions: at least once, aOR = 1.3 (95% CI, 1.1–13.1), p = 0.036, and were more adherent to inhaled corticosteroid treatment: PDC>80%, aOR = 10.4 (1.8–201.1), p = 0.033. Further, objective confirmation was associated with improved lung function and reduced bronchodilator response, but not with exacerbations. Conclusion: Objective confirmation of the asthma diagnosis in children is associated with an increased treatment adherence and improved lung function, which underlines the importance of conducting objective tests in the diagnostic workup in paediatric asthma management. [ABSTRACT FROM AUTHOR]

A study aims to find a possible association between bacterial colonization of the hypopharynx in asymptomatic neonates and later development of recurrent wheeze, asthma and allergy within 5 years of age. The results reveal that neonates colonized in the hypopharyngeal region with Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis have higher risk for recurrent wheeze and asthma in early life.

The Prevention of Asthma in Childhood (PAC) study was conducted to assess the efficacy of inhaled budesonide relative to that of placebo after a first episode of wheezing in reducing subsequent respiratory symptoms during the first three years of life. The result obtained caution against the widespread use of short courses of inhaled corticosteroids in the treatment of episodic wheezing while regular inhaled corticosteroid therapy should be reserved for young children with persistent wheezing.

Asthma is one of the most common chronic diseases in children globally. Previous studies have shown that not attending asthma primary care consultations is associated with poorer treatment adherence and increased risk of loss of asthma control on a short-term basis. Here, we investigated long-term patterns and predictors of not attending scheduled asthma outpatient visits during 5-years of follow-up in 146 children with asthma. Of the 146 children, 67 (46%) did not attend at least one scheduled appointment, amounting to a total of 122 (10.8%) missed of 1133 scheduled appointments. In a multivariate analysis adjusting for total scheduled visits in the 5-year period any allergic sensitization was a significant risk factor for not attending ≥1 scheduled appointment (aOR = 6.6 (95% CI, 1.3–39.7), p = 0.03), which was not the case for asthma treatment step or lung function. Furthermore, atopic predisposition decreased the risk of non-attendance (aOR = 0.36 (0.13–0.92), p = 0.04). We found no association between non-attendance, treatment adherence or loss of asthma control. This study highlights that allergic comorbidity, but not degree of asthma severity, identifies a group of children with asthma who are prone to not attend scheduled outpatient appointments. [ABSTRACT FROM AUTHOR]

Background: Low adherence to asthma controllers is known to increase the risk of uncontrolled disease and poor health outcomes. We aimed to study risk factors of long‐term adherence to preventive medications in children and adolescents with asthma. Methods: Adherence was assessed during a two‐year period in 155 children with asthma followed in a tertiary pediatric asthma outpatient clinic using percentage of days covered (PDC) based on physician prescriptions and pharmacy claims data. The risk factor analysis included age, sex, ethnicity, BMI, atopic comorbidity, spirometry incentives, and fractional exhaled nitric oxide (FeNO). Results: Ninety‐five children, 50 (53%) males, mean age of 16.3 years (SD, 2.36), received at least one prescription for asthma controllers in the study period. Fifty‐two (54%) children were classified as non‐adherent with a PDC cutoff at 80%. Adherence was negatively associated with age: adherence ratio (AR) 0.84 (95% CI, 0.73‐0.95), P =.008; forced expiratory volume in 1 second (FEV1): AR per L 0.6 (0.91‐1.0), P =.03; unfilled inhaled beta‐2‐agonist prescription: AR 0.45 (0.23‐0.89), P =.02; and FeNO level: AR per ppb 0.98 (0.97‐0.99), P =.03, where age and FeNO retained significance in multivariate analysis. Type and number of asthma controllers were not associated with adherence. Conclusions: This study shows low adherence to preventive medication among half of the children with asthma, which is associated with increasing age and FeNO level. Therefore, an extra effort should be directed toward teenagers transitioning from pediatric to adult medicine and toward inhaled corticosteroid‐treated patients with elevated FeNO to increase their adherence to asthma controllers. [ABSTRACT FROM AUTHOR]

To the Editor, Exercise is a common trigger of bronchoconstriction in children with asthma. GLO:FS1/01jul20:pai13224-fig-0001.jpg PHOTO (COLOR): 1 Receiver operating characteristic (ROC) curve analyses for BMI z-score and the combined value of BMI z-score and sports activity status for predicting exercise test completion. The blue curve shows the ROC curve analysis for the predictive value of body mass index (BMI) z-score and the best cutoff value for BMI z-score with area under the curve (AUC [95% CI]) for predicting exercise test completion. The red curve shows the ROC curve analysis for the predictive value of the combined effect of BMI z-score and sports activity gl Of the 85 children completing the test, 30 (35%) had a post-exercise FEV1 drop >= 10%. [Extracted from the article]

Background: Histological examination of small bowel biopsies is normally the gold standard for the diagnosis of celiac disease (CD). The objective of this study was to investigate whether the rate of decreases in elevated plasma IgA tissue transglutaminase antibody (IgA-tTG) and/or IgG deamidated gliadin peptides antibody (IgG - DGP) concentrations could be used as a confirming test for CD in children on a gluten-free diet (GFD) when biopsy was omitted in the diagnostic process.Methods: In this retrospective study we compared children (≤18 years old) with a CD-confirming biopsy (n = 16) to children without a biopsy (n = 18). After initiation of GFD the antibody half-life (the time (T½) when the antibody concentration is 50% decreased) was determined in all children.Results: Children with a biopsy (IgA-tTG, T½ = 1.9 months; IgG - DGP, T½ = 2.2 months) and children without a biopsy (IgA-tTG, T½ = 1.6 months; IgG - DGP, T½ = 2.7 months) had comparable T½ (mean) results (p < 0.05) supporting that all children had the CD diagnosis.Conclusions: When biopsy was omitted a rapid rate of decrease in CD antibody concentrations confirmed the CD diagnosis in children on GFD. The half-lives (T½) of IgA-tTG were less than 2 months in CD children. [ABSTRACT FROM AUTHOR]

Background: A cost-effective identification of HLA- DQ risk haplotypes using the single nucleotide polymorphism (SNP) technique has recently been applied in the diagnosis of celiac disease (CD) in four European populations. The objective of the study was to map risk HLA- DQ haplotypes in a group of Danish CD patients using the SNP technique. Methods: Cohort A: Among 65 patients with gastrointestinal symptoms we compared the HLA- DQ2 and HLA- DQ8 risk haplotypes obtained by the SNP technique (method 1) with results based on a sequence specific primer amplification technique (method 2) and a technique used in an assay from BioDiagene (method 3). Cohort B: 128 patients with histologically verified CD were tested for CD risk haplotypes (method 1). Patients with negative results were further tested for sub-haplotypes of HLA- DQ2 (methods 2 and 3). Results: Cohort A: The three applied methods provided the same HLA- DQ2 and HLA- DQ8 results among 61 patients. Four patients were negative for the HLA- DQ2 and HLA- DQ8 haplotypes (method 1) but were positive for the HLA- DQ2.5-trans and HLA- DQ2.2 haplotypes (methods 2 and 3). Cohort B: A total of 120 patients were positive for the HLA- DQ2.5-cis and HLA- DQ8 haplotypes (method 1). The remaining seven patients were positive for HLA- DQ2.5-trans or HLA- DQ2.2 haplotypes (methods 2 and 3). One patient was negative with all three HLA methods. Conclusions: The HLA- DQ risk haplotypes were detected in 93.8% of the CD patients using the SNP technique (method 1). The sensitivity increased to 99.2% by combining methods 1 - 3. [ABSTRACT FROM AUTHOR]

Non-adherence to asthma controllers increases morbidity among school-aged children. This study aimed to determine non-adherence risk factors in preschool children with asthma. We investigated 172 children <6 years diagnosed with asthma in 2018 and analyzed baseline characteristics and loss of control events extracted from the medical records for four years following diagnosis. At end of follow-up, 79 children had a prescription of inhaled corticosteroids (ICS) and were included in the analyses. Adherence was assessed in a two-year period through pharmacy claims using percentage of days covered (PDC) analyzed dichotomously with non-adherence defined as PDC < 80% and using adherence ratio (AR) defined as days with medical supply divided by days without. Of the 79 children, 59 (74.7%) were classified as non-adherent. In analyses adjusted for sex, age and exacerbations prior to inclusion, adherence was positively associated with having had a loss of control event requiring a step-up in asthma controller (aAR:2.34 [1.10;4.98], p = 0.03), oral corticosteroids (aAR:2.45 [1.13;5.34], p = 0.026) or redeeming a short-acting b2-agonist prescription (aAR:2.91 [1.26;6.74], p = 0.015). Further, atopic comorbidity was associated with increased adherence (aAR:1.18 [1.01;1.37], p = 0.039), whereas having a first degree relative with asthma was associated with worse adherence (aAR:0.44 [0.23;0.84], p = 0.015). This study found poor adherence to ICS among three quarters of preschool children with asthma. Increasing adherence was associated with atopic comorbidity and loss of control events, whereas lower adherence was associated with atopic predisposition. These findings should be considered to improve adherence in preschool children with asthma.

Delayed introduction of allergenic foods has failed to prevent the development of food allergy in children. This observation has led to randomised controlled trials of early introduction of allergenic foods. These trials are presented in this review. Early introduction of peanut in the LEAP and EAT trials and the introduction of cooked egg in PETIT and EAT was safe and significantly reduced challenge-proven peanut and egg allergy. Further studies are needed to explore the optimal age for introduction to different allergenic foods to reduce the prevalence of food allergy.

Introduction: The aim of this retrospective case series is to describe the epidemiology, symptoms and findings of acute epiglottitis in hospitalized patients after the introduction of the Haemophilus influenzae type B (HIB) vaccine and to identify any symptoms or findings predictive of a prolonged hospital stay., Material and Methods: Medical records on all patients discharged with the International Classification of Diseases 10 diagnostic code DJ051, acute epiglottitis, from January 1997 to December 2012 were reviewed. A total of 41 patients were identified., Results: In all, 37 patients were included, only one of whom was a child. The dominating symptom was a sore throat (97.2%). A hoarse voice was found in 20 patients (58.8%), and 14 patients (40.0%) were drooling. Thirteen patients (36.1%) had trouble breathing. Nine patients (24.3%) were diagnosed with abscess. Two adults tested positive for HIB. The average length of hospitalization was 6.1 days. The average stay in the intensive care unit was 1.2 days for patients who were not intubated and 4.0 days for patients who were intubated or tracheotomised. Six patients (16.2%) were intubated. One patient (2.7%) was directly tracheotomised., Conclusion: Our study shows that the incidence of adult acute epiglottis seems to remain unchanged compared with a previous investigation from the same geographical region. The disease is potentially life-threatening, and intubation or tracheostomy was required in 18.9% patients in this study. Respiratory distress had the largest impact on the length of hospitalization., Funding: not relevant., Trial Registration: not relevant.

A newborn colonized with Chlamydia trachomatis will often show symptoms of conjunctivitis and/or pneumonia. We report a case of interstitial pneumonia caused by C. trachomatis in a 2-month-old boy admitted with RSV. We point to the importance of C. trachomatis in the differential diagnostics of an infant with respiratory symptoms even in the presence of additional infectious agents.

Virilisation in girls includes androgen dependent growth of terminal hair, acne, deepening of the voice and increased muscle mass. Sudden onset of symptoms, rapid progression, short duration and hyperandrogenaemia are ominous signs and the patient must be referred to a specialist as soon as possible to rule out cancer and avoid worsening of the irreversible virilisation. We describe a girl with severe virilisation as the sole symptom of an androgen producing Sertoli-Leydig cell tumour. Ovarian tumours are rare in children and malignant ovarian tumours account for less than 1% of childhood cancer.

Objective: To study the association between wheezy symptoms in young children and the presence of bacteria in the airways., Design: Birth cohort study., Setting: Clinical research unit in Copenhagen., Participants: Children of asthmatic mothers, from age 4 weeks to 3 years, with planned visits and acute admissions to the research clinic., Main Outcome Measure: Frequency of bacteria and virus carriage in airway aspirates during wheezy episodes and at planned visits without respiratory symptoms., Results: 984 samples (361 children) were analysed for bacteria, 844 (299 children) for viruses, and 696 (277 children) for both viruses and bacteria. Wheezy episodes were associated with both bacterial infection (odds ratio 2.9, 95% confidence interval 1.9 to 4.3; P<0.001) and virus infection (2.8, 1.7 to 4.4; P<0.001). The associations of bacteria and viruses were independent of each other., Conclusion: Acute wheezy episodes in young children were significantly associated with bacterial infections similar to but independent of the association with virus infections.