Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Canada.
Pediatr Pulmonol. 2022 Jun;57(6):1401-1415. doi: 10.1002/ppul.25910. Epub 2022 Apr 22.
Inducible laryngeal obstruction (ILO) in children is underrecognized. This systematic review characterizes the scientific evidence on the impact of pediatric ILO diagnosis and treatment on asthma medication use. This review, registered with PROSPERO (CRD42020209168), utilized database searches in MEDLINE, EMBASE, CINAHL, and Web of Science from inception to October 2020. Both experimental and observational studies on ILO and asthma outcomes in patients ≤18 years were included. Population characteristics (sample size, sex, age, and comorbidities) and study outcomes (medication usage and respiratory symptoms) were extracted. The risk of bias was assessed with the National Toxicology Program's Office of Health Assessment and Risk of Bias Rating Tool. Data are presented narratively due to study heterogeneity. Of 1091 studies, 1076 titles and abstracts were screened after duplicate removal. Screening 31 full texts yielded eight pre-post studies. Patients were an average of 14.1 years old, 15% male, and >90% used asthma medication; 40% reported allergies, 30% gastroesophageal reflux, and 20% anxiety or depression. Most patients received at least one intervention, with 75% showing symptomatic improvement and >75% decreasing or stopping asthma medications. Studies were small with a high risk of selection, confounding, and detection bias. Asthma management was not a primary outcome in any of the studies. Overall, ILO patients were often diagnosed with or treated for asthma before ILO diagnosis. Evidence from individual studies suggests that comorbidities including ILO, gastroesophageal reflux, allergies, and anxiety should be considered in pediatric patients with asthma not responsive to medical therapy. Further research is required to determine the proportion of impacted asthma patients.
儿童可诱导性喉阻塞(ILO)认识不足。本系统评价描述了儿科 ILO 诊断和治疗对哮喘药物使用影响的科学证据。本研究于 2020 年 10 月在 MEDLINE、EMBASE、CINAHL 和 Web of Science 数据库中进行了检索,使用 PROSPERO(CRD42020209168)进行了注册。纳入了年龄≤18 岁的患者 ILO 和哮喘结局的实验和观察性研究。提取了人口统计学特征(样本量、性别、年龄和合并症)和研究结局(药物使用和呼吸道症状)。使用国家毒理学计划健康评估和偏倚风险评估工具评估了偏倚风险。由于研究异质性,数据以叙述方式呈现。在排除重复项后,对 1091 项研究的 1076 项标题和摘要进行了筛选。对 31 篇全文进行筛选后,得到 8 项前后对照研究。患者平均年龄为 14.1 岁,15%为男性,超过 90%使用哮喘药物;40%报告过敏,30%胃食管反流,20%焦虑或抑郁。大多数患者接受了至少一种干预措施,75%的患者症状改善,超过 75%的患者减少或停止使用哮喘药物。这些研究规模较小,存在选择、混杂和检测偏倚的高风险。在任何研究中,哮喘管理都不是主要结局。总体而言,在 ILO 诊断之前,ILO 患者通常被诊断为或接受哮喘治疗。来自个别研究的证据表明,在对药物治疗无反应的哮喘患儿中,应考虑 ILO、胃食管反流、过敏和焦虑等合并症。需要进一步研究来确定受影响的哮喘患者的比例。