Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank

Alexander G Mathioudakis; Michael Miligkos; Cristina Boccabella; Gioulinta S Alimani; Adnan Custovic; A Deschildre; Francine Monique Ducharme; Omer Kalayci; Clare Murray; Antonio Nieto Garcia; Wanda Phipatanakul; David Price; Aziz Sheikh; Ioana Octavia Agache; Leonard Bacharier; Apostolos Beloukas; Andrew Bentley; Matteo Bonini; Jose A Castro-Rodriguez; Giuseppe De Carlo; Timothy Craig; Zuzana Diamant; Wojciech Feleszko; Tim Felton; James E Gern; Jonathan Grigg; Gunilla Hedlin; Elham M Hossny; Despo Ierodiakonou; Tuomas Jartti; Alan Kaplan; Robert F Lemanske; Peter N Le Souëf; Mika J Mäkelä; Georgios A Mathioudakis; Paolo Matricardi; Marina Mitrogiorgou; Mario Morais-Almeida; Karthik Nagaraju; Effie Papageorgiou; Helena Pité; Paulo M C Pitrez; Petr Pohunek; Graham Roberts; Ioanna Tsiligianni; Stephen Turner; Susanne Vijverberg; Tonya A Winders; Gary Wk Wong; Paraskevi Xepapadaki; Heather J Zar; Nikolaos G Papadopoulos

doi:10.1136/bmjopen-2020-048338

Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank

BMJ Open. 2021 Jul 2;11(7):e048338. doi: 10.1136/bmjopen-2020-048338.

Authors

Alexander G Mathioudakis^#^{1

2

3}, Michael Miligkos^#⁴, Cristina Boccabella⁵, Gioulinta S Alimani^{3

6}, Adnan Custovic⁷, A Deschildre⁸, Francine Monique Ducharme⁹, Omer Kalayci¹⁰, Clare Murray^{1

2}, Antonio Nieto Garcia¹¹, Wanda Phipatanakul¹², David Price^{13

14}, Aziz Sheikh¹⁵, Ioana Octavia Agache¹⁶, Leonard Bacharier¹⁷, Apostolos Beloukas^{6

18}, Andrew Bentley^{2

19}, Matteo Bonini^{5

20}, Jose A Castro-Rodriguez²¹, Giuseppe De Carlo²², Timothy Craig²³, Zuzana Diamant^{24

25

26}, Wojciech Feleszko²⁷, Tim Felton^{1

2}, James E Gern²⁸, Jonathan Grigg²⁹, Gunilla Hedlin³⁰, Elham M Hossny³¹, Despo Ierodiakonou³², Tuomas Jartti³³, Alan Kaplan³⁴, Robert F Lemanske²⁸, Peter N Le Souëf³⁵, Mika J Mäkelä³⁶, Georgios A Mathioudakis³, Paolo Matricardi³⁷, Marina Mitrogiorgou³⁸, Mario Morais-Almeida³⁹, Karthik Nagaraju⁴⁰, Effie Papageorgiou⁶, Helena Pité^{39

41

42}, Paulo M C Pitrez⁴³, Petr Pohunek⁴⁴, Graham Roberts^{45

46

47}, Ioanna Tsiligianni³², Stephen Turner⁴⁸, Susanne Vijverberg⁴⁹, Tonya A Winders⁵⁰, Gary Wk Wong⁵¹, Paraskevi Xepapadaki⁵², Heather J Zar^{53

54}, Nikolaos G Papadopoulos^{55

52}

Affiliations

¹ Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK.
² North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK.
³ Athens Breath Centre, Athens, Greece.
⁴ First Department of Pediatrics, "Aghia Sofia" Children's Hospital, University of Athens, Athens, Attica, Greece.
⁵ Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Milano, Lombardia, Italy.
⁶ Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece.
⁷ Department of Paediatrics, Imperial College London, London, UK.
⁸ Unité de Pneumologie et Allergologie Pédiatriques, Hôpital Jeanne de Flandre, CHU Lille, Lille, Hauts-de-France, France.
⁹ Pediatrics, University of Montreal, Montreal, Quebec, Canada.
¹⁰ Pediatric Allergy and Asthma Unit, Hacettepe Universitesi, Ankara, Turkey.
¹¹ Pulmonology and Allergy Unity, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain.
¹² Pediatric Allergy and Immunology, Children's Hospital Boston, Boston, Massachusetts, USA.
¹³ Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
¹⁴ Observational and Pragmatic Research Institute, Singapore.
¹⁵ Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
¹⁶ Allergy and Clinical Immunology, Transylvania University, Brasov, Romania.
¹⁷ Department of Allergy, Immunology, and Pulmonary Medicine, University of Washington, Seattle, Washington, USA.
¹⁸ Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
¹⁹ Acute Intensive Care Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, Greater Manchester, UK.
²⁰ National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
²¹ Department of Pediatrics, Pontifical Universidad Catolica de Chile, Santiago, Chile.
²² Allergy and Airway Diseases Patient's Associations, European Federation of Pharmaceutical Industries and Associations, Brussels, Belgium.
²³ Allergy, Asthma and Immunology, Penn State University, Hershey, Pennsylvania, USA.
²⁴ Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital Lund Hematological Clinic, Lund, Skåne, Sweden.
²⁵ Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
²⁶ Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center of Groningen and QPS-NL, Groningen, Netherlands.
²⁷ Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Warszawa, Poland.
²⁸ Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
²⁹ Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK.
³⁰ Department of Women's and Children's Health, Karolinska Institute, Stockholm, Stockholm, Sweden.
³¹ Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt.
³² Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece.
³³ Department of Paediatrics, University of Turku, Turku, Finland.
³⁴ Family Physician, Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada.
³⁵ School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
³⁶ Department of Allergy, University of Helsinki, Helsinki, Uusimaa, Finland.
³⁷ Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine, Berlin, Germany.
³⁸ Third Department of Paediatrics, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece.
³⁹ Allergy Center, Hospital CUF Descobertas, Lisboa, Portugal.
⁴⁰ Allergy & Asthma, VN, Chennai, India.
⁴¹ Allergy Center, CUF Infante Santo Hospital, Lisbon, Portugal.
⁴² Chronic Diseases Research Center (CEDOC), NOVA Medical School / Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal.
⁴³ Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
⁴⁴ Paediatric Department, Motol University Hospital, Praha, Czech Republic.
⁴⁵ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK.
⁴⁶ Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK.
⁴⁷ NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁴⁸ Department of Child Health, University of Aberdeen, Aberdeen, Aberdeen, UK.
⁴⁹ Department of Respiratory Medicine and Department of Pediatric Pulmonology, University of Amsterdam, Amsterdam, Netherlands.
⁵⁰ Allergy & Asthma, Global Patient Platform, Virginia, Virginia, USA.
⁵¹ Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
⁵² Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Attica, Greece.
⁵³ Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa.
⁵⁴ Unit on Child and Adolescent Health, Medical Reaserch Council, Cape Town, South Africa.
⁵⁵ Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK ngpallergy@gmail.com.

^# Contributed equally.

Abstract

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.

Keywords: asthma; paediatric thoracic medicine; paediatrics; thoracic medicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Asthma* / drug therapy
Bias
Child
Hospitalization
Humans
Research Design
Systematic Reviews as Topic