Browsing by Author "Castro-Rodriguez, Jose A."

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    A cost-effectiveness threshold analysis of a multidisciplinary structured educational intervention in pediatric asthma
    (2018) Rodriguez-Martinez, Carlos E.; Sossa-Briceno, Monica P.; Castro-Rodriguez, Jose A.
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    A cost-utility analysis of single maintenance and reliever (SMART) therapy as compared to step 3 fixed-dose therapy in patients aged 12 years or more with uncontrolled asthma
    (2024) Rodriguez-Martinez, Carlos E.; Sossa-Briceno, Monica P.; Castro-Rodriguez, Jose A.
    ObjectivesA significant percentage of patients with asthma appear to benefit from the addition of long-acting beta 2-agonists (LABAs) to ICS to achieve better control of their disease. The aim of the present study was to determine the cost-utility of single inhaler combination inhaled ICS/LABAs as both maintenance and reliever (SMART) versus remaining at the same treatment step with fixed-dose ICS-LABA maintenance with a short-acting beta 2-agonist (SABA) as reliever in patients aged 12 years or more with uncontrolled asthma.MethodsA Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The effectiveness data and transition probabilities were obtained from a recent meta-analysis. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs).ResultsThe base-case analysis showed that compared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART was associated with lower costs, US$2,906.92 versus $4,462.02 average cost per patient, and the greatest gain in QALYs, 0.8540 versus 0.8258 QALYs on average per patient, thus leading to dominance.ConclusionsCompared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART is more cost-effective in patients aged 12 years or more with uncontrolled asthma. This is because ICS/LABAs as SMART showed a greater gain in QALYs at lower total treatment costs.
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    Association of adenotonsillectomy with wheezing episodes in childhood: A secondary analysis of the Childhood Adenotonsillectomy Trial
    (2023) Castro-Rodriguez, Jose A.; Biancardi, Fiorella; Padilla, Oslando; Beckhaus, Andrea A.; Tapia, Ignacio E.
    BackgroundObservational studies suggest that asthma/wheezing improves after adenotonsillectomy (AT). However, there is a paucity of randomized clinical trial (RCT) specifically studying the effects of AT in asthma/wheezing. Therefore, we conducted a post-hoc analysis of the Childhood Adenotonsillectomy Trial (CHAT), the largest RCT of AT in children with obstructive sleep apnea (OSA) to test the hypothesis that AT would result in fewer wheezing episodes. MethodsIn the CHAT study, 464 children with OSA, aged 5-9 years, were randomized to early AT (n = 226) or watchful waiting with supportive care (WWSC) (n = 227). For this post-hoc analysis, children were categorized as having "any wheezing" versus "no wheezing" at baseline and at 7 months of follow-up. A multivariate analysis was conducted to evaluate the association between "any wheezing" at follow-up and treatment group after controlling for several potential confounders. ResultsChildren in the "any wheezing" group were predominantly black, had more allergic rhinitis, eczema, second-hand smoke exposure, body mass index, apnea-hypopnea index (AHI), and had lower maternal education and family income than those in the "no wheezing group." In the AT arm, the prevalence of wheezing significantly decreased from baseline to follow-up (at 7 months of the intervention) (47% vs. 21.6%, p < 0.001); while in the WWSC arms did not change (45.2% vs. 43.1%, p = 0.67). In the multivariate analysis, second-hand smoke exposure, wheezing at baseline, and belong to WWSC arm (odds ratio: 3.65 [2.16-6.19]) increase the risk of wheezing at follow-up. ConclusionThis study demonstrated that AT decreased the risk of wheezing at 7 months of follow-up.
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    Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multinational cohort
    (2021) Papadopoulos, Nikolaos G.; Mathioudakis, Alexander G.; Custovic, Adnan; Deschildre, Antoine; Phipatanakul, Wanda; Wong, Gary; Xepapadaki, Paraskevi; Abou-Taam, Rola; Agache, Ioana; Castro-Rodriguez, Jose A.; Chen, Zhimin; Cros, Pierrick; Dubus, Jean-Christophe; El-Sayed, Zeinab Awad; El-Owaidy, Rasha; Feleszko, Wojciech; Fierro, Vincenzo; Fiocchi, Alessandro; Garcia-Marcos, Luis; Goh, Anne; Hossny, Elham M.; Huerta Villalobos, Yunuen R.; Jartti, Tuomas; Le Roux, Pascal; Levina, Julia; Lopez Garcia, Aida Ines; Ramos, Angel Mazon; Morais-Almeida, Mario; Murray, Clare; Nagaraju, Karthik; Nagaraju, Major K.; Navarrete Rodriguez, Elsy Maureen; Namazova-Baranova, Leyla; Nieto Garcia, Antonio; Pozo Beltran, Cesar Fireth; Ratchataswan, Thanaporn; Rivero Yeverino, Daniela; Rodriguez Zagal, Erendira; Schweitzer, Cyril E.; Tulkki, Marleena; Wasilczuk, Katarzyna; Xu, Dan
    Background The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.
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    Cost Effectiveness of Pharmacological Treatments for Asthma: A Systematic Review
    (2018) Rodriguez-Martinez, Carlos E.; Sossa-Briceno, Monica P.; Castro-Rodriguez, Jose A.
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    Differences between preschoolers with asthma and allergies in urban and rural environments
    (2018) Marfortt, Daniel A.; Josviack, Dario; Lozano, Alejandro; Cuestas, Eduardo; Agueero, Luis; Castro-Rodriguez, Jose A.
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    Exercise Challenge Test: Is a 15% Fall in FEV1 Sufficient for Diagnosis?
    (2011) Fuentes, Claudia; Contreras, Stefani; Padilla, Oslando; Castro-Rodriguez, Jose A.; Moya, Ana; Caussade, Solange
    Introduction. In the exercise challenge test (ECT), a drop in forced expiratory volume in the first second (FEV1) of between 10 and 15% is the determinant variable for a diagnosis of exercise-induced bronchospasm. Hypothesis. The use of FEV1 plus mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF25-75%) may increase the sensitivity of the ECT in asthmatic children. Specific objective. To compare FEV1 and FEF25-75% changes in a group of asthmatic and healthy children. Methodology. This was a cross-sectional study. Asthmatics were categorized by their severity (GINA) and after 1 month without controller therapy, an ECT was done under standard protocol. As well, a questionnaire about rhinitis and asthma was conducted with the entire population. ROC curves were used for analysis. Results. A total of 147 children (34 healthy and 113 asthmatics, 18 and 58 males, respectively) were evaluated. Divided into healthy children and intermittent, mild and moderate persistent asthmatics, they had similar average ages (9.4, 9.48, 8.97, and 11.2 years, respectively). Using a 15% fall in FEV1, we obtained 29% sensitivity and 100% specificity. However, when we used a 10% fall in FEV1, sensitivity was 47% and specificity was 97%. Adding a 28% fall in FEF25-75%, sensitivity was 52% and specificity was 94%. Conclusion. This study suggests that test sensitivity can increase by using a lower FEV1 cut-off (10%) and adding a 28% fall in FEF25-75%.
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    Impact of COVID-19 on Pediatric Asthma: Practice Adjustments and Disease Burden
    (2020) Papadopoulos, Nikolaos G.; Custovic, Adnan; Deschildre, Antoine; Mathioudakis, AleXander G.; Phipatanakul, Wanda; Wong, Gary; Xepapadaki, Paraskevi; Agache, Ioana; Bacharier, Leonard; Bonini, Matteo; Castro-Rodriguez, Jose A.; Chen, Zhimin; Craig, Timothy; Ducharme, Francine M.; El-Sayed, Zeinab AWad; Feleszko, Wojciech; Fiocchi, Alessandro; Garcia-Marcos, Luis; Gern, James E.; Goh, Anne; Gomez, Rene MaXimiliano; Hamelmann, Eckard H.; Hedlin, Gunilla; Hossny, Elham M.; Jartti, Tuomas; Kalayci, Omer; Kaplan, Alan; Konradsen, Jon; Kuna, Piotr; Lau, Susanne; Souef, Peter Le; Lemanske, Robert F.; Makela, Mika J.; Morais-Almeida, Manio; Murray, Clare; Nagaraju, Karthik; Namazova-Baranova, Leyla; Garcia, Antonio Nieto; Yusuf, Osman M.; Pitrez, Paulo M. C.; Pohunek, Petr; Beltran, Cesar Fireth Pozo; Roberts, Graham C.; Valiulis, Arunas; Zar, Heather J.
    BACKGROUND: It is unclear whether asthma may affect susceptibility or severity of coronavirus disease 2019 (COVID-19) in children and how pediatric asthma services worldwide have responded to the pandemic.
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    Impulse oscillometry in preschool children with persistent asthma can predict spirometry at school age
    (2023) Vidal Grell, Alberto; Gonzalez Vera, Ramiro; Mendez Yarur, Alejandra; Castro-Rodriguez, Jose A.; Palomino Montenegro, Maria Angelica; Fielbaum Colodro, Oscar; Abara Elias, Selim; Saavedra Bentjerodt, Monica; Mackenney Poblete, Jorge
    BackgroundLung function in children with persistent asthma may be impaired during preschool and school ages. The aim of this study was to describe if some preschool impulse oscillometry (IOS) parameters are related to spirometry alterations on reaching school age. MethodsIn 66 diagnosed with persistent asthma, an IOS was performed at entrance and followed-up to school age where a spirometry was done. ResultsThe mean age was 4.9 years at the first evaluation and 7.9 years at the second evaluation, and 59.1% were male. During preschool, R5, R20, Fres, AX, and D5-20 were found to have diagnostic accuracy (area under the curve > 0.7) for predicting abnormal spirometry during school age (defined as FEV1 and/or FEV/FVC and/or FVC values below the lower limit of normality according to Quanjer predictive values). AX, D5-20, and R5 had the best LR+ to increase the probability of abnormal spirometry (50, 10, and 7.1, respectively). R20, R5, and AX was the best IOS parameters for discriminating bronchodilator response (BDR) in schoolchildren (LR+ = 3.4, 2.9, and 2.8, respectively). ConclusionThe findings of this study indicate that some IOS parameters between 3 and 5 years of age are useful for predicting abnormal spirometry and BDR at school age.
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    Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank
    (2021) Mathioudakis, Alexander G.; Miligkos, Michael; Boccabella, Cristina; Alimani, Gioulinta S.; Custovic, Adnan; Deschildre, A.; Ducharme, Francine Monique; Kalayci, Omer; Murray, Clare; Garcia, Antonio Nieto; Phipatanakul, Wanda; Price, David; Sheikh, Aziz; Agache, Ioana Octavia; Bacharier, Leonard; Beloukas, Apostolos; Bentley, Andrew; Bonini, Matteo; Castro-Rodriguez, Jose A.; De Carlo, Giuseppe; Craig, Timothy; Diamant, Zuzana; Feleszko, Wojciech; Felton, Tim; Gern, James E.; Grigg, Jonathan; Hedlin, Gunilla; Hossny, Elham M.; Ierodiakonou, Despo; Jartti, Tuomas; Kaplan, Alan; Lemanske, Robert F.; Le Souef, Peter N.; Makela, Mika J.; Mathioudakis, Georgios A.; Matricardi, Paolo; Mitrogiorgou, Marina; Morais-Almeida, Mario; Nagaraju, Karthik; Papageorgiou, Effie; Pite, Helena; Pitrez, Paulo M. C.; Pohunek, Petr; Roberts, Graham; Tsiligianni, Ioanna; Turner, Stephen; Vijverberg, Susanne; Winders, Tonya A.; Wong, Gary W. K.; Xepapadaki, Paraskevi; Zar, Heather J.; Papadopoulos, Nikolaos G.
    Introduction Clinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted. Methods and analysis Standard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively. Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence. Ethics and dissemination Ethics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank. PROSPERO registration numbers CRD42020132990, CRD42020171624.
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    Maternal obesity and high leptin levels prime pro-inflammatory pathways in human cord blood leukocytes
    (2023) Krause, Bernardo J.; Vega-Tapia, Fabian A.; Soto-Carrasco, Gustavo; Lefever, Isidora; Letelier, Catalina; Saez, Claudia G.; Castro-Rodriguez, Jose A.
    Introduction: Maternal obesity alters the immune function in the offspring. We hypothesize that maternal obesity and pro-inflammatory pathways induce leptin-related genes in neonatal monocytes, whereby high leptin levels enhance their inflammatory response. Methods: Transcriptional profiles of cord blood leukocytes (CBL) in basal and pro-inflammatory conditions were studied to determine differentially expressed genes (DEG). The DNA methylation profile of CB monocytes (CBM) of neonates born to control BMI mothers and women with obesity was assayed to identify differentially methylated probes (DMP). CBM-derived macrophages were cultured with or without leptin (10-100 ng/ml) and then stimulated with lipopolysaccharide (LPS, 100 ng/ml) and interferon-gamma (20 ng/ml) to assess the induction of TNF-& alpha; and IL-10 transcripts. Results: CBL from pregnancies with obesity (CBL-Ob) showed 12,183 DEG, affecting 49 out of 78 from the leptin pathway. Control CBM exposed to LPS showed 45 leptin-related DEG, an effect prevented by the co-exposure to LPS and IL-10. Conversely, CBM-Ob showed 5279 DMP enriched in insulin- and leptin-related genes, and Lasso regression of leptin-related DMP showed high predictive value for plasma leptin levels (r2 = 0.9897) and maternal BMI categories (AUC = 1). Chronic exposure to leptin increased TNF-& alpha; and decreased IL-10 levels in control BMI samples but not in Ob-CBM. Enhanced TNF-& alpha; induction after proinflammatory stimulation was observed in leptin-treated control BMI samples. Discussion: Obesity in pregnancy is associated with a distinctive expression and DNA methylation profile of leptin-related genes in cord blood monocytes, meanwhile, leptin enhances the expression of pro-inflammatory cytokines upon stimulation with M1-skewing agents.
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    Maternal obesity is associated with a sex-specific epigenetic programming in human neonatal monocytes
    (2020) Vega-Tapia, Fabian; Artigas, Rocio; Hernandez, Cherie; Uauy, Ricardo; Casanello, Paola; Krause, Bernardo J.; Castro-Rodriguez, Jose A.
    Aim: To determine changes in global DNA methylation in monocytes from neonates of women with obesity, as markers of an immune programming resulting from maternal obesity. Materials & methods: Cord blood monocytes were obtained from neonates born to women with obesity and normal weight, genome-wide differentially methylated CpGs were determined using an Infinium MethylationEPIC-BeadChip (850K). Results: No clustering of samples according to maternal BMI was observed, but sex-specific analysis revealed 71,728 differentially methylated CpGs in female neonates from women with obesity (p < 0.01). DAVID analysis showed increased methylation levels within genes involved in the innate immune response and inflammation. Conclusion: Maternal obesity induces, in a sex-specific manner, an epigenetic programming of monocytes that could contribute to disease later in life.
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    Percent body fat, skinfold thickness or body mass index for defining obesity or overweight, as a risk factor for asthma in schoolchildren
    (2008) Garcia-Marcos, Luis; Valverde-Molina, Jose; Ortega, Maria L. Castanos; Sanchez-Solis, Manuel; Martinez-Torres, Antonia E.; Castro-Rodriguez, Jose A.
    None of the epidemiological studies indicating that obesity is a risk factor for asthma in schoolchildren have used the percent body fat (PBF) to define obesity. The present study compares the definition of obesity using body mass index (BMI), PBF and the raw sum of the thickness of four skinfolds (SFT) to evaluate this condition as a risk factor for asthma. All classes of children of the target ages of 6-8 years of all schools in four municipalities of Murcia (Spain) were surveyed. Participation rate was 70.2% and the number of children included in the study was 931. Height, weight and SFT (biceps, triceps, subscapular and suprailiac) were measured according to standard procedures. Current active asthma was defined from several questions of the International Study of Asthma and Allergies in Childhood questionnaire. Obesity was defined using two standard cut-off points for BMI and PBF, and the 85th percentile for BMI, PBF and SFT. The highest quartile of each type of measurement was also compared with the lowest. A multiple logistic regression analysis was made for the various obesity definitions, adjusting for age, asthma in the mother and father and gender. The adjusted odds ratios of having asthma among obese children were different for boys and girls and varied across the different obesity definitions. For the standard cut-off points of BMI they were 1.19 [95% confidence interval (CI) 0.41-3.43] for girls and 2.00 (95% CI 0.97-4.10) for boys; however, for PBF (boys 25%, girls 30%) the corresponding figures were 1.54 (95% CI 0.63-3.73) and 1.20 (95% CI 0.66-2.21). BMI, PBF and SFT showed more consistency between each other when using the other cut-off points. BMI, PBF (except standard cut-off points) and SFT produce relatively comparable results when analysing the interaction between obesity and asthma.
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    Reactance inversion in moderate to severe persistent asthma: low birth weight, prematurity effect, and bronchodilator response
    (2024) Vera, Ramiro Gonzalez; Grell, Alberto Vidal; Castro-Rodriguez, Jose A.; Montenegro, Maria A. Palomino; Yarur, Alejandra Mendez
    IntroductionReactance inversion (RI) has been associated with impaired peripheral airway function in persistent asthma. However, there is little to no data about the difference between asthmatic children with and without RI. This study aimed to detect clinical and lung function differences in moderate-severe asthmatic children with and without RI.MethodsThis study was conducted between 2021 and 2022 in asthmatic school-age children. Impulse oscillometry (IOS) and spirometry were performed according to ATS/ERS standards.ResultsA total of 62 patients, with a mean age of 8.4 years, 54.8% were males and were divided into three groups: group 1 (32.3%) with no RI, group 2 (27.4%) with RI but disappearing after bronchodilator test and group 3 (40.3%) with persistent RI after bronchodilator test. Children in groups 2 and 3 had significantly lower birth weights than in group 1. Group 2 had lower gestational age compared to group 1. FEV1 and FEF25-75 of forced vital capacity were significantly lower in groups 2 and 3. In group 3, R5, AX, R5-20, and R5-R20/R5 ratios were significantly higher. Bronchodilator responses (BDR) in X5c, AX, and R5-R20 were significantly different between groups and lower in group 3.ConclusionRI is frequently found in children with moderate-severe persistent asthma, particularly in those with a history of prematurity or low birth weight. In some patients, RI disappears after the bronchodilator test; however, it, persists in those with the worst pulmonary function. RI could be a small airway dysfunction marker.
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    Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO
    (2024) Papadopoulos, Nikolaos G.; Custovic, Adnan; Deschildre, Antoine; Gern, James E.; Nieto Garcia, Antonio; Miligkos, Michael; Phipatanakul, Wanda; Wong, Gary; Xepapadaki, Paraskevi; Agache, Ioana; Arasi, Stefania; El-Sayed, Zeinab Awad; Bacharier, Leonard B.; Bonini, Matteo; Braido, Fulvio; Caimmi, Davide; Castro-Rodriguez, Jose A.; Chen, Zhimin; Clausen, Michael; Craig, Timothy; Diamant, Zuzana; Ducharme, Francine M.; Ebisawa, Motohiro; Eigenmann, Philippe; Feleszko, Wojciech; Fierro, Vincezo; Fiocchi, Alessandro; Garcia-Marcos, Luis; Goh, Anne; Gomez, Rene Maximiliano; Gotua, Maia; Hamelmann, Eckard; Hedlin, Gunilla; Hossny, Elham M.; Ispayeva, Zhanat; Jackson, Daniel J.; Jartti, Tuomas; Jesenak, Milos; Kalayci, Omer; Kaplan, Alan; Konradsen, Jon R.; Kuna, Piotr; Lau, Susanne; Le Souef, Peter; Lemanske, Robert F.; Levin, Michael; Makela, Mika J.; Mathioudakis, Alexander G.; Mazulov, Oleksandr; Morais-Almeida, Mario; Murray, Clare; Nagaraju, Karthik; Novak, Zoltan; Pawankar, Ruby; Pijnenburg, Marielle W.; Pite, Helena; Pitrez, Paulo M.; Pohunek, Petr; Price, David; Priftanji, Alfred; Ramiconi, Valeria; Rivero Yeverino, Daniela; Roberts, Graham; Sheikh, Aziz; Shen, Kun-Ling; Szepfalusi, Zsolt; Tsiligianni, Ioanna; Turkalj, Mirjana; Turner, Steve; Umanets, Tetiana; Valiulis, Arunas; Vijveberg, Susanne; Wang, Jiu-Yao; Winders, Tonya; Yon, Dong Keon; Yusuf, Osman M.; Zar, Heather J.
    Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization, and natural history review. Numerous factors that may affect disease activity and patient well-being need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even "real-time," monitoring between visits. Following an approach that included needs assessment, evidence appraisal, and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design. image
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    Single inhaler combination inhaled corticosteroid-formoterol as both maintenance and reliever (SMART) compared with a step up of treatment with fixed-dose inhaled corticosteroid-long-acting β2-agonist maintenance with a short-acting β2-agonist as reliever in adolescents and adults with poorly controlled asthma in Colombia: a cost-utility analysis
    (2024) Rodriguez-Martinez, Carlos E.; Sossa-Briceno, Monica P.; Castro-Rodriguez, Jose A.
    ObjectiveThe aim of the present study was to determine the cost-utility of single inhaler combination inhaled corticosteroid and a long-acting beta 2-agonist (ICS/LABAs) as both maintenance and reliever (SMART) compared with a step-up maintenance treatment with a fixed medium to high dose of ICS combined with LABA and a short-acting beta 2-agonist (SABA) as reliever (ICS-LABA maintenance plus SABA) among patients aged 12 years or more with poorly controlled asthma in Colombia.MethodsA Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The main effectiveness data were obtained from a recent meta-analysis. The main outcome was the variable ''quality-adjusted life-years'' (QALYs).ResultsThe base-case analysis showed that the budesonide/formoterol (BUD/FORM) SMART strategy was associated with lower overall treatment costs (US $3,062.37 vs. $4,462.02 average cost per patient over 12 months) and the greatest gain in QALYs (0.8511 vs. 0.8258 QALYs on average per patient over 12 months) compared with ICS-LABA maintenance plus SABA at step 4, thus leading to dominance.ConclusionsIn patients aged 12 years or more with uncontrolled asthma at GINA step 3 or 4, the BUD/FORM SMART strategy at either step 3 or 4 is cost-effective compared with the ICS-LABA maintenance plus SABA at step 4 strategy, because it shows a greater gain in QALYs at lower total treatment costs.
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    The relationship between inflammation and remodeling in childhood asthma: A systematic review
    (2018) Castro-Rodriguez, Jose A.; Saglani, Sejal; Rodriguez-Martinez, Carlos E.; Oyarzun, Maria A.; Fleming, Louis; Bush, Andrew