Professional Documents
Culture Documents
Craiu Mihai
INSMC „Alessandrescu-Rusescu”
UMF „Carol Davila” Bucuresti
Accurate assessment of asthma severity is essential
to predict future risk and impairment and to guide
asthma management (GINA 2018)
The NAEPP and GINA guidelines divide asthma
severity based on
• lung function (FEV1),
• daytime and nocturnal symptoms,
• frequency of rescue bronchodilator use.
https://ginasthma.org/2018-gina-report-
global-strategy-for-asthma-management-
and-prevention/
A Task Force, supported by the ERS and
Severe asthma ATS, reviewed the definition and provided
recommendations and guidelines on the
evaluation and treatment of severe
asthma in children and adults *
Alexandru B.
Wei Wu et al - Unsupervised phenotyping of Severe Asthma
Research Program participants using expanded lung data. J
Allergy Clin Immunol 2014;133(5):1280-8
Nieuwnhuis MA et al – Combining Genome Wide Association Study and lung eQTL analysis provides evidence for
novel genes associated with asthma. Allergy 2016;71(12):1712-20
Siroux V et al – Genetic heterogeneity of asthma phenotypes
identified by a clustering approach. Eur Respir J 2014;43:439-52
Severe asthma approach in clinic
A child is not a small adult!
Uncontrolled asthma / severe asthma versus
other disease
In children with recurrent lung signs and symptoms that exhibit
bronchospasm one should exclude :
CF
PCD
Alfa1-AntiTripsin Deficiency
Bronchopulmonary Dysplasia
Foreign body aspiration
Tracheo-bronchomalacia
etc.
REAL-LIFE MEDICINE
4
27
101
Dr House and asthma inhaler
Anna :
Do I look line an
idiot?
SPACER USAGE
FOLOSIREA SPACER
15
86
19
82
Only 12 parents
DESCARCAREA (11.88%)
"STATICA" were
A SPACER providing static
discharge by regular detergent washing
12
89
23
78
34 children (33.66%) were compliant with delivery technique
4 of the “inpatient” patients (5.97%) had ADHD diagnosis!
34
67
RW SUBGROUP & EDUCATION
• Education is essential
• Hands-on training.
• Repeated PFTs
RESULTS
FEV1 valuesVEMS
EVOLUTIA after retraining/videotraining
DUPA INSTRUIRE
You Tube videos
1
17 150 2
16 3
100
15 4
50
14 5
0
13 6
12 7
11 8
10 9
CURRENT ON-LINE EDUCATION in INSMC
SOCIAL MEDIA EDUCATION IMPACT IN PEDIATRIC ASTHMA
PATIENTS *
OR = 0.1143 in study group
[p 0.0151, 95% CI 0.0199 – 0.6571]
Unscheduled ED visit
20
18
16
14
12
10
0
1 2
* Mihai Craiu, Iustina Violeta Stan – Social media education decreases unscheduled outpatient visits in paediatric
asthma patients. Archives of Disease in Childhood 2017;102 Suppl2:A4-A4
Uncontrolled asthma & severe asthma
Bousquet J et al – Care pathways for the selection of a biologic in severe asthma. Eur Respir J 2017 50: 1701782
Buhl R et al – Severe eosinophilic asthma: a roadmap
to consensus. Eur Respir J 2017 49: 1700634
Case scenario
• His mother RN
Sept 2015
20
18
16
14
12
10
0
1 2 3 4 5
Training for PEF metry
Functional impact of Omalizumab
ACT 15
PEF 101%
PFTs after restart of Omalizumab
10th Oct 2018
Let’s hear Daniel’s opinion about his disease
Madalina Camelia Dianu - Project of Group 1 / XVth Series 5th year medical students
Severe asthma is not undertreated asthma
nor difficult-to-treat asthma
Perspective for severe asthma