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      Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

      research-article
      1 , 2 , , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 4 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 15 , 28 , 23 , 29 , 30 , 31 , 32 , 9 , 33 , 34 , 9 , 35 , 36 , 37 , 38 , 39 , 40 , 1 , 41 , 42 , 43 , 44 , 45 , 46 , 43 , 47 , 48 , 6 , 49 , 50 , 23 , 11 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 2 , 63 , 64 , 34 , 65
      Italian Journal of Pediatrics
      BioMed Central
      Inhaled corticosteroids, Asthma, Wheezing, Rhinitis, Rhinosinusitis, Laryngospasm, Laryngotracheitis, Adenoid hypertrophy

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          Abstract

          Background

          In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine.

          Methods

          Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published.

          Results

          The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm.

          Conclusions

          We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research.

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          Most cited references124

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          AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

          The number of published systematic reviews of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions. Systematic reviews are subject to a range of biases and increasingly include non-randomised studies of interventions. It is important that users can distinguish high quality reviews. Many instruments have been designed to evaluate different aspects of reviews, but there are few comprehensive critical appraisal instruments. AMSTAR was developed to evaluate systematic reviews of randomised trials. In this paper, we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic reviews, including those based on non-randomised studies of healthcare interventions.
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            AGREE II: advancing guideline development, reporting and evaluation in health care.

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              Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision.

              Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update.
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                Author and article information

                Contributors
                santamar@unina.it
                Journal
                Ital J Pediatr
                Ital J Pediatr
                Italian Journal of Pediatrics
                BioMed Central (London )
                1824-7288
                21 April 2021
                21 April 2021
                2021
                : 47
                : 97
                Affiliations
                [1 ]GRID grid.417007.5, Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, ; Rome, Italy
                [2 ]GRID grid.4691.a, ISNI 0000 0001 0790 385X, Department of Translational Medical Sciences, , Federico II University, ; Naples, Italy
                [3 ]Family Pediatrician Local Health Unit Salerno, Vietri sul Mare, Italy
                [4 ]Family Pediatrician, Local Health Unit, Ferrara, Italy
                [5 ]Family Pediatrician, Local Health Unit, Mesagne, Italy
                [6 ]GRID grid.7841.a, Maternal, Infantile and Urological Sciences Department, , Sapienza University, ; Rome, Italy
                [7 ]Pediatric Department, Franz Tappeiner Hospital, Meran, Italy
                [8 ]GRID grid.416308.8, ISNI 0000 0004 1805 3485, Pediatric Unit, Department of Women’s and Children’s Health, , San Camillo Forlanini Hospital, ; Rome, Italy
                [9 ]Department of Experimental Medicine, University “Luigi Vanvitelli”, Regional Centre of Pharmacovigilance Campania, Naples, Italy
                [10 ]GRID grid.7644.1, ISNI 0000 0001 0120 3326, Pediatric and Emergency Unit Giovanni XXIII Pediatric Hospital University of Bari, ; Bari, Italy
                [11 ]Family Pediatrician Local Health Unit Latina, Latina, Italy
                [12 ]GRID grid.510483.b, Family Pediatrician Local Health Unit, , Turin and IRIB-CNR, ; Palermo, Italy
                [13 ]Family Pediatrician Local Health Unit, Ferrara, Italy
                [14 ]GRID grid.419504.d, ISNI 0000 0004 1760 0109, Allergy Centre, Department of Pediatric Sciences IRCCS Gaslini Institute, ; Genova, Italy
                [15 ]Departmental Operative Unit of Diagnostic and Surgical Videoendoscopy of the Upper Airways, Asl Napoli 1 Center, Naples, Italy
                [16 ]GRID grid.7841.a, Maternal, infantile and urological sciences Department, Pediatric Allergic Unit, , Sapienza University, ; Rome, Italy
                [17 ]Paediatrics Unit, Reunited Hospitals Castellammare of Stabia, Naples, Italy
                [18 ]Paediatric Unit, ASST-Rhodense, RHO, Italy
                [19 ]Family Pediatrician, Local Health Unit Tuscany center, Florence, Italy
                [20 ]Pediatric Unit San Giuseppe Hospital, Empoli, Florence, Italy
                [21 ]Family Paediatrician, Local Health Unit, FIMP National President, Livorno, Italy
                [22 ]GRID grid.10383.39, ISNI 0000 0004 1758 0937, Medicine and Surgery Department, , University of Parma, ; Parma, Italy
                [23 ]Pediatric Unit, Department of Mother and Child, AUSL-IRCCS, Reggio Emilia, Italy
                [24 ]Department of Woman, Child and of General and Specialized Surgery, University “Luigi Vanvitelli”, Naples, Italy
                [25 ]Family Paediatrician Local Health Unit Nettuno-Anzio, Rome, Italy
                [26 ]GRID grid.8404.8, ISNI 0000 0004 1757 2304, Paediatric Infectious Disease Unit, , Meyer Children’s University Hospital, Department Of Health Sciences, University of Florence, ; Florence, Italy
                [27 ]GRID grid.414125.7, ISNI 0000 0001 0727 6809, Pediatric Pulmonology Unit, Academic Department of Paediatrics, , Bambino Gesù Children’s Hospital, IRCCS, ; Rome, Italy
                [28 ]Endocrinologist Specialist, Salerno, Italy
                [29 ]Independent Paediatrician Researcher, Benevento, Italy
                [30 ]GRID grid.7644.1, ISNI 0000 0001 0120 3326, Department of Paediatrics, , Aldo Moro University of Bari, ; Bari, Italy
                [31 ]GRID grid.5395.a, ISNI 0000 0004 1757 3729, Paediatrics Unit, University Hospital of Pisa, Department of Clinical and Experimental Medicine, , University of Pisa, ; Pisa, Italy
                [32 ]GRID grid.8158.4, ISNI 0000 0004 1757 1969, General Paediatrics and Paediatric Acute and Emergency Unit, , University Hospital San Marco, University of Catania, ; Catania, Italy
                [33 ]Family Paediatrician Local Health Unit, Ausl, Modena, Italy
                [34 ]Family Paediatrician, Local Health Unit, Caserta, Italy
                [35 ]Primary Care Paediatrician, Local Health Unit, National Secretary for the Scientific and Ethical Activities of FIMP, Chioggia, Italy
                [36 ]GRID grid.8158.4, ISNI 0000 0004 1757 1969, Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, , University Hospital San Marco, University of Catania, ; Catania, Italy
                [37 ]GRID grid.411474.3, ISNI 0000 0004 1760 2630, Unit of Paediatric Allergy and Respiratory Medicine Women’s and Children’s Health Department, , University Hospital Padua, ; Padua, Italy
                [38 ]GRID grid.7763.5, ISNI 0000 0004 1755 3242, Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, , AOU and University of Cagliari, ; Monserrato (CA), Italy
                [39 ]Pediatric Allergy Unit, Department of Paediatric Medicine, S. Pietro Hospital Fatebenefratelli, Rome, Italy
                [40 ]Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, UOSD Paediatric Highly Intensive Care Unit, Milan, Italy
                [41 ]Pediatric Asthma and Cough Center Istituti Ospedalieri Bergamaschi, Gruppo Ospedaliero San Donato, Ponte San Pietro, Bergamo, Italy
                [42 ]Family Pediatrician Local Health Unit Teramo, Teramo, Italy
                [43 ]GRID grid.8982.b, ISNI 0000 0004 1762 5736, Paediatric and Neonatology Unit Santa Maria Goretti Hospital, Department of Pediatrics, , University of Pavia, ; Pavia, Italy
                [44 ]GRID grid.7841.a, Paediatric and Neonatology Unit Santa Maria Goretti Hospital, Department of Pediatrics, , Sapienza University, ; Rome, Italy
                [45 ]Pediatric and Neonatal Intensive Care Unit Fatebenefratelli Isola Tiberina, Rome, Italy
                [46 ]Allergist Pediatrician National Secretary of Italian Federation for Medical Scientific Societies (FISM), Rome, Italy
                [47 ]Department of Pediatrics G. Salvini Hospital Garbagnate Milanese, Milan, Italy
                [48 ]GRID grid.415247.1, ISNI 0000 0004 1756 8081, Pediatric Pulmonology and Subintensive Respiratory Therapy Unit Department of Pediatrics Santobono-Pausilipon Children’s Hospital, ; Naples, Italy
                [49 ]Pediatric Unit Great Metropolitan Hospital Reggio Calabria, Reggio Calabria, Italy
                [50 ]GRID grid.7644.1, ISNI 0000 0001 0120 3326, Department of Biomedical Science and Human Oncology, , University of Bari, Children’s Hospital “Giovanni XXIII”, ; Bari, Italy
                [51 ]Family Pediatrician, Local Health Unit, Latina, Italy
                [52 ]GRID grid.4691.a, ISNI 0000 0001 0790 385X, Department of Translational Medical Sciences, Pediatric Pulmonology, , Federico II University, ; Naples, Italy
                [53 ]GRID grid.411492.b, Division of Pediatrics, , University Hospital of Udine, ; Udine, Italy
                [54 ]GRID grid.8404.8, ISNI 0000 0004 1757 2304, Department Health Science, , University of Florence, ; Florence, Italy
                [55 ]GRID grid.10438.3e, ISNI 0000 0001 2178 8421, Department of Human Pathology in Adult and Development Age, Pediatric Unit, , University of Messina, ; Messina, Italy
                [56 ]Pediatric Unit, S. Giovanni di Dio Hospital, Crotone, Italy
                [57 ]GRID grid.5611.3, ISNI 0000 0004 1763 1124, Paediatric Section Department of Surgery, Dentistry, , Paediatrics and Gynaecology University of Verona, ; Verona, Italy
                [58 ]Family Pediatrician, Paediatric Allergy, Local Health Unit TO1, Turin, Italy
                [59 ]Department of Pediatrics, IRCC San Raffaele, Milan, Italy
                [60 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Alma Mater Studiorum, , Univesity of Bologna, ; Bologna, Italy
                [61 ]Family Pediatrician Local Health Unit, Caselle Torinese, Vicenza, Italy
                [62 ]Family Pediatrician Local Health Unit Caselle Torinese, Turin, Italy
                [63 ]GRID grid.411474.3, ISNI 0000 0004 1760 2630, Unit of Pediatric Allergy and Respiratory Medicine Women’s and Children’s Health Department University Hospital, ; Padua, Italy
                [64 ]Family Pediatrician, Local Health Unit Salerno, Aversa, Italy
                [65 ]GRID grid.5395.a, ISNI 0000 0004 1757 3729, Department of Clinical and Experimental Medicine, Section of Pediatrics, , University of Pisa, ; Pisa, Italy
                Author information
                http://orcid.org/0000-0002-9375-7429
                Article
                1013
                10.1186/s13052-021-01013-8
                8058583
                33882987
                2d6caae1-9baf-44d5-ade5-46d030dd6ba2
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 10 February 2021
                : 26 February 2021
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Pediatrics
                inhaled corticosteroids,asthma,wheezing,rhinitis,rhinosinusitis,laryngospasm,laryngotracheitis,adenoid hypertrophy

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