Апр 18, 2019
Asthma exacerbation in children :
For many people, longer days and the rise of temperatures mean the return of severe asthma symptoms. These symptoms can be extremely uncomfortable, especially for young asthmatic individuals, such as children but also teenagers.
Asthma is an extremely common chronic and potentially life-threatening condition that affects 300 millions of people worldwide and nearly 10% of children. Furthermore, the International Study of Asthma and Allergies in Childhood, ISAAC study1 evaluated the prevalence of Asthma among 13-14 years old teenagers. The average prevalence of severe asthma was more than 7,5% in many countries with highest Asthma prevalence in English speaking countries, European Union and Latin America countries (more than 20%).
Despite progress in asthma management, prevention of asthma exacerbation remains challenging in school-aged children with allergic asthma. Respiratory tract viruses in particular have emerged as the most frequent triggers for exacerbations in both children and adults.
Studies have shown that viral respiratory infections are the major cause of acute asthma exacerbations and may even contribute to asthma inception in high risk young children with susceptible genetic background.2
A recent clinical study EOLIA study (Efficiency Of Lysate In Asthmatic children) highlighted that immunostimulation with bacterial lysate, may help control the course of asthma and represent an interesting tool for asthma management. The authors concluded « The administration of PMBL® Tablet represents a safe and effective means for significantly reducing the rate of exacerbations in school-aged allergic asthmatic children. »3
A large part of keeping asthma under control and preventing ‘asthma attacks’ involves preventative measures like avoiding known triggers.
- Mallol J, Crane J, von Mutius E, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis. Allergol Immunopathol (Madr) 2013;41:73. https://doi.org/10.1016/j.aller.2012.03.001
- Hamid Ahanchian, Carmen M Jones, Yueh-sheng Chen,Peter D Sly, BMC Pediatrics, Respiratory viral infections in children with asthma: do they matter and can we prevent them? (2012) https://doi.org/10.1186/1471-2431-12-147
- Emeryk A, Bartkowiak-Emeryk M, Raus Z, Braido F, Ferlazzo G, Melioli G. Mechanical bacterial lysate administration prevents exacerbation in allergic asthmatic children—The EOLIA study. Pediatr Allergy Immunol. 2018;29:394–401 https://doi.org/10.1111/pai.12894
Interview of Pr Andrzej EMERYK, co-author of the EOLIA study :
Question 1: Why did you study the benefits of bacterial lysates in asthmatic population?
Pr Emeryk: “Asthma is still a poorly controlled disease in children and adults. Asthma exacerbations associated with respiratory tract infections are a significant medical problem. New therapeutic options are being sought to improve the clinical course of asthma in children.”
Question 2: How do you explain that respiratory infections can lead to exacerbations in asthmatic children? In your practice, what is the proportion of your patients having wheezing attacks in correlation with an infection?
Pr Emeryk: “Several factors can contribute to asthma exacerbation, including infections (viral, bacterial, mixed), misuse of asthma control medications (often poor inhaled technique of corticosteroids), genetic factor or exposure to allergens or pollutants. In most cases there is more than one contributing factor, and this is especially true for severe asthma exacerbations. Viral infections are of special importance because they contribute to up to 90% of exacerbations (particularly in small children), especially during the fall and spring in temperate climates, when viral respiratory tract infections are most common. Rhinoviruses (RVs) are most closely associated with exacerbations of childhood asthma. RV infections increase the frequency and quantity of S. pneumoniae, M. catarrhalis, and H. influenzae detected in airway secretions and bacterial pathogens are more likely to be associated with asthma exacerbations.
In my practice ca. 80-95% of asthmatic children have asthma exacerbation related to respiratory infection (viral, typical bacterial or atypical bacterial or mixed).”
Question 3: What is the most important result and adding value of PMBL sublingual tablets in EOLIA study?
Pr Emeryk: “PMBL® Tablet reduces the number of asthma exacerbations in school age children with IgE-dependent asthma. Treatment with PMBL® Tablet prolonged the time to second asthma exacerbation by 55% and to third asthma exacerbation by 74%. These therapy also reduces SABA (Short-Acting Beta Agonists) consumption.”
Question 4: As regard to Pharmaco-economic data, what were the most relevant results?
Pr Emeryk : “Treatment with PMBL® Tablet allows cost-saving and provides better control of the disease in comparison to the placebo group. The largest reduction in costs was observed from the perspective of a patient and of the society.”