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Parent‐initiated oral corticosteroid therapy for intermittent wheezing illnesses in children

Oral corticosteroids have been shown to be effective in the treatment of acute asthma in children if they are commenced after the child has been assessed by a doctor. This review identified two randomised trials of parent‐initiated oral corticosteroids in the management of an intermittent wheezing illness in children. There was no evidence of more benefit than harm. Widespread use of this strategy cannot be recommended at present. Further randomised clinical trials are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Ketotifen alone or as additional medication for long‐term control of asthma and wheeze in children

Children with asthma can find using inhaled treatments medication difficult and so oral medication such as ketotifen, which is an antihistamine, can be used to help control symptoms. The review found that mild asthma symptoms were well‐controlled in the studies of 4 to 32 week duration with reduction in use of rescue bronchodilator, rescue oral steroids and in exacerbations as well as clear perception of effectiveness from physicians, parents and children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Short acting beta2‐agonists for recurrent wheeze in children under two years of age

Beta‐agonists such as salbutamol are the most frequently prescribed reliever medication for asthma. They work well in adults and children but their effectiveness in infants is less clear. Eight trials were reviewed involving 229 patients in four different settings. Although infants have the capability to respond to salbutamol, there is only limited relief of acute symptoms when given to acutely ill patients. This did not impact on requirement for hospital admission or length of hospital stay. Regular salbutamol has not been shown to offer protection against developing symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Anticholinergic drugs for wheeze in children under the age of two years

Anti‐cholinergic drugs are widely used to treat infants and young toddlers with acute and recurrent wheeze though the role of these agents remain controversial. Six trials involving 321 infants in three different settings were reviewed. The review was unable to identify clear benefits in outcomes such as duration of hospitalisation or improvement in oxygenation though there were suggestions that some patients may benefit particularly in recurrently wheezy infants treated at home. Well designed studies are required to clarify the role of these agents in young children with wheeze.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Glucocorticoids for acute viral bronchiolitis in infants and young children under two years of age

Bronchiolitis is the most common acute infection of the airways and lungs during the first years of life. It is caused by viruses, the most common being respiratory syncytial virus. The illness starts similar to a cold, with symptoms such as a runny nose, mild fever and cough. It later leads to fast, troubled and often noisy breathing (for example, wheezing). While the disease is often mild for most healthy babies and young children, it is a major cause of clinical illness and financial health burden worldwide. Hospitalisations have risen in high‐income countries, there is substantial healthcare use and bronchiolitis may be linked with preschool wheezing disorders and the child later developing asthma.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Antibiotics for persistent cough or wheeze following acute bronchiolitis in children

Bronchiolitis is a common lung infection, affecting children across the world. It is usually caused by a virus called RSV (respiratory syncytial virus) but other viruses can cause this too. Young children with bronchiolitis normally have a cough, fast and difficult breathing, and poor feeding. Antibiotics are not normally prescribed to children with bronchiolitis unless there is concern of a secondary bacterial infection. However, some children continue to have ongoing problems (i.e. wheeze, cough) after the acute viral infection (> 14 days); increasing the risk of burden of disease and cost to the health system. These children often re‐present for further medical care in the community (general practitioners and health providers) or in hospital (emergency departments). Antibiotics may help treat these ongoing symptoms and get rid of the bacteria in the lungs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions for preventing or reducing respiratory tract infections and asthma symptoms in mould‐damaged buildings

Our aim was to find out if repairing buildings damaged by dampness and mould reduces or prevents respiratory symptoms and asthma.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions to treat noisy breathing, or 'death rattle': the unpleasant, gurgling breathing occuring in many patients who are about to die

Approximately half of those relatives and friends who witness it, as well as hospital staff, find the noise of 'death rattle' distressing. For this reason, doctors and nurses try to eliminate the sound using a variety of methods, from changing the position of the patient to giving drugs to stop the noise. The aim of this review is to find out which treatment, if any, is best. Only four of 32 reports identified met the inclusion criteria for this review; none showed a convincing benefit of any single drug over any others. Some treatments may be worth trying but staff should watch carefully for any side effects of the treatment (e.g. agitation or excessively dry mouth). Anxious relatives need explanation, reassurance and discussion about any fears and concerns associated with the terminal phase and 'death rattle'. Research in this difficult area is necessary to understand the cause of the noise, its effect on the patient and those around them and the best ways of managing this condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Does taking inhaled steorids either before or after being intubated (having a tube down the throat to help you breathe) prevent the painful swelling that can result?

When people in intensive care need assistance breathing, they may need to have a breathing tube inserted down through their windpipe (trachea or airway ‐ the passage to the lungs). After it is taken out (extubation), the airways can be swollen (inflamed). This swelling can make it hard to breathe, cause stridor (noisy breathing), and the tube may need to be replaced. Corticosteroids are anti‐inflammatory drugs that might reduce this swelling. The review of 11 trials involving 2301 people found that using corticosteroids to prevent (or treat) stridor after extubation has not been proven overall effective for babies or children, but this intervention does merit further study particularly for those at high risk to fail extubation. For high risk adults, multiple doses of corticosteroids begun 12‐24 hours before extubation appear to be helpful.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Clinical symptoms and signs for the diagnosis of Mycoplasma pneumoniae in children and adolescents with community‐acquired pneumonia

Background: Mycoplasma pneumoniae (M. pneumoniae) is a significant cause of community‐acquired pneumonia in children and adolescents. Treatment with macrolide antibiotics is recommended. However, M. pneumoniae is difficult to diagnose based on clinical symptoms and signs. Diagnostic uncertainty can lead to inappropriate antibiotic prescribing, which may worsen clinical prognosis and increase antibiotic resistance.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Bronchodilators for bronchiolitis for infants with first‐time wheezing

Bronchiolitis is an acute, highly contagious, viral infection of the lungs that is common in infants 0 to 12 months of age. It occurs every year in the winter months. It causes the small airways in the lungs to become inflamed and fill with debris. The airways are narrowed and this leads to blocking of the free passage of air. The infant has a harsh cough, runny nose and usually a fever. S/he can become breathless, wheezy and short of oxygen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Inhaled steroids for episodic viral wheeze of childhood

A wheeze that is recurrent and caused by a viral upper respiratory tract infection (URTI) is different to asthma. Episodic recurrent wheezing happens in children who have no symptoms in between episodes and is different to wheezing that is persistent. Corticosteroids are used to relieve a wheeze caused by a viral infection. This review of trials found high dose inhaled corticosteroids help treat mild episodic viral wheeze of childhood. There is no evidence to support the use of maintenance low dose inhaled corticosteroids to prevent or manage episodic mild wheeze caused by a virus. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Asthma: Symptoms and diagnosis

In people with asthma, the airways are overly sensitive. This chronic disease typically comes in episodes or attacks of wheezing, coughing and shortness of breath. But other diseases can have similar symptoms. So before starting with treatment, it is important to find out what exactly is causing the breathing problems.The mucous membranes lining the airways of people with chronic asthma are constantly on stand-by, ready to trigger an inflammatory response. This means that certain substances can set off a very rapid and very intense reaction. Compared to people who have healthy lungs, their mucous membranes are red and swollen, and more blood flows through them. The cells in the membranes start producing thicker mucus. If an asthma trigger is also present, the muscles surrounding the walls of the airways tighten as well. Together, all of these factors cause the bronchi (lung airway passages) to narrow and prevent air from flowing freely in and out of the lungs. This leads to shortness of breath.A severe asthma attack feels somewhat like trying to breathe only through a straw for a few minutes. Even if you blow air into it and suck air out of it as hard as you can, you are unable to get enough air into and out of your lungs.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 26, 2014

Asthma: Overview

Asthma is a disease in which the airways become so narrow that it is difficult to breathe, either temporarily or permanently. Nowadays asthma can be treated quite effectively, meaning that most people with asthma can manage their illness and live a life largely free of symptoms.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 25, 2014

Allergy Shots and Allergy Drops for Adults and Children: A Review of the Research

This summary will cover: What allergies are How allergies are treated What researchers found about how well allergy shots and allergy drops work Possible side effects of allergy shots and allergy drops This summary can help you talk with your doctor about whether allergy shots or allergy drops might be right for you or your child.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 22, 2013

Chronic obstructive pulmonary disease (COPD): Overview

Chronic obstructive pulmonary disease (COPD) is quite common, even more so than asthma. A typical symptom is a persistant cough. When the condition is advanced, it gets harder and harder to breathe. At that point even everyday activities such as climbing stairs, gardening, or taking a walk can leave you out of breath. COPD develops gradually over the course of many years.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 12, 2015

Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 7, 2016

Chest physiotherapy for pneumonia in children

Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Accumulation of secretions in the airways due to respiratory infections contributes to the worsening of clinical symptoms making it very difficult for the child to breathe. Chest physiotherapy may contribute to patient recovery as a complementary treatment because it can help to eliminate inflammatory secretions, remove airway obstructions, reduce airway resistance and the work of breathing. Chest physiotherapy techniques combine manual percussion of the chest wall and strategic positioning of the patient for mucus drainage, with cough and breathing techniques.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Interventions for preventing voice disorders in adults

People in occupations where voice use is central, such as teachers, are more at risk of developing voice disorders. The definition of voice disorders and their possible causes as well as the best methods for preventing them are still being debated. There is also no consensus on the best method of evaluating the voice, although many consider auditory voice quality assessment (where an expert judge listens to a recording of a participant's voice and makes his or her own judgment of its level of abnormality) as a gold standard measure. Voice training is used to prevent voice disorders. Voice training usually consists of a combination of 'direct' and 'indirect' treatment techniques. Direct techniques focus on the underlying physiological changes needed to improve an individual's technique in using the vocal system and may aim to alter vocal fold closure (adduction), respiratory patterns or resonance, pitch or articulatory tension. In practice this means training about how to achieve correct posture, breathing techniques and making various sounds like humming, singing musical scales or yawning. Indirect techniques, on the other hand, concentrate on contributory and maintenance aspects of the voice disorder and may involve relaxation strategies, counselling, explanation of the normal anatomy and physiology of the vocal tract, explanation of the causal factors of voice disorders and voice care and conservation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

What is the evidence for benefit from leukotriene receptor antagonists in pre‐school children who wheeze when they have a cold?

Acute episodes of wheezing in pre‐school aged children are common. Many children in this age group seem to wheeze only when they have a common cold‐type virus with no ongoing symptoms between episodes, unlike older children with allergic‐type asthma. Acute episodes of wheezing cause the child to breathe more quickly than normal and they may require supportive treatment such as the use of rescue inhalers; in moderate or severe episodes they may also need a short course of oral steroids and not uncommonly may require treatment in hospital and supplemental oxygen. Their carers may need to take time off work to look after children who are unwell. Although episodic wheezing with viruses is a common problem, there is controversy about the best way to prevent or shorten episodes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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