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

doi:10.1186/s13052-021-01013-8

. 2021 Apr 21;47(1):97.

doi: 10.1186/s13052-021-01013-8.

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

Marzia Duse^#¹, Francesca Santamaria^#², Maria Carmen Verga³, Marcello Bergamini⁴, Giovanni Simeone⁵, Lucia Leonardi⁶, Giovanna Tezza⁷, Annamaria Bianchi⁸, Annalisa Capuano⁹, Fabio Cardinale¹⁰, Giovanni Cerimoniale¹¹, Massimo Landi¹², Monica Malventano⁴, Mariangela Tosca¹³, Attilio Varricchio¹⁴, Anna Maria Zicari¹⁵, Carlo Alfaro¹⁶, Salvatore Barberi¹⁷, Paolo Becherucci¹⁸, Roberto Bernardini¹⁹, Paolo Biasci²⁰, Carlo Caffarelli²¹, Valeria Caldarelli²², Carlo Capristo²³, Serenella Castronuovo²⁴, Elena Chiappini^{25

26}, Renato Cutrera²⁷, Giovanna De Castro¹⁵, Luca De Franciscis²⁸, Fabio Decimo²³, Iride Dello Iacono²⁹, Lucia Diaferio³⁰, Maria Elisa Di Cicco³¹, Caterina Di Mauro³², Cristina Di Mauro⁹, Dora Di Mauro³³, Francesco Di Mauro³⁴, Gabriella Di Mauro⁹, Mattia Doria³⁵, Raffaele Falsaperla³⁶, Valentina Ferraro³⁷, Vassilios Fanos³⁸, Elena Galli³⁹, Daniele Giovanni Ghiglioni⁴⁰, Luciana Indinnimeo¹, Ahmad Kantar⁴¹, Adima Lamborghini⁴², Amelia Licari⁴³, Riccardo Lubrano⁴⁴, Stefano Luciani⁴⁵, Francesco Macrì⁴⁶, Gianluigi Marseglia⁴³, Alberto Giuseppe Martelli⁴⁷, Luigi Masini⁴⁸, Fabio Midulla⁶, Domenico Minasi⁴⁹, Vito Leonardo Miniello⁵⁰, Michele Miraglia Del Giudice²³, Sergio Renzo Morandini¹¹, Germana Nardini⁵¹, Agostino Nocerino⁵², Elio Novembre⁵³, Giovanni Battista Pajno⁵⁴, Francesco Paravati⁵⁵, Giorgio Piacentini⁵⁶, Cristina Piersantelli⁵⁷, Gabriella Pozzobon⁵⁸, Giampaolo Ricci⁵⁹, Valter Spanevello⁶⁰, Renato Turra⁶¹, Stefania Zanconato⁶², Melissa Borrelli⁶³, Alberto Villani⁶⁴, Giovanni Corsello⁶⁵, Giuseppe Di Mauro³⁴, Diego Peroni⁶⁶

Affiliations

¹ Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
² Department of Translational Medical Sciences, Federico II University, Naples, Italy. santamar@unina.it.
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 Maternal, Infantile and Urological Sciences Department, Sapienza University, Rome, Italy.
⁷ Pediatric Department, Franz Tappeiner Hospital, Meran, Italy.
⁸ 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 Pediatric and Emergency Unit Giovanni XXIII Pediatric Hospital University of Bari, Bari, Italy.
¹¹ Family Pediatrician Local Health Unit Latina, Latina, Italy.
¹² Family Pediatrician Local Health Unit, Turin and IRIB-CNR, Palermo, Italy.
¹³ Family Pediatrician Local Health Unit, Ferrara, Italy.
¹⁴ 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 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 Department of Obstetrics Gynaecology and Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, 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 Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department Of Health Sciences, University of Florence, Florence, Italy.
²⁷ 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 Department of Paediatrics, Aldo Moro University of Bari, Bari, Italy.
³¹ Paediatrics Unit, University Hospital of Pisa, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
³² 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 Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, University Hospital San Marco, University of Catania, Catania, Italy.
³⁷ Unit of Paediatric Allergy and Respiratory Medicine Women's and Children's Health Department, University Hospital Padua, Padua, Italy.
³⁸ 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 Paediatric and Neonatology Unit Santa Maria Goretti Hospital, Department of Pediatrics, University of Pavia, Pavia, Italy.
⁴⁴ 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 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 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 Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, Naples, Italy.
⁵³ Division of Pediatrics, University Hospital of Udine, Udine, Italy.
⁵⁴ Department Health Science, University of Florence, Florence, Italy.
⁵⁵ 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 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 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 Department of Translational Medical Sciences, Federico II University, Naples, Italy.
⁶⁴ Unit of Pediatric Allergy and Respiratory Medicine Women's and Children's Health Department University Hospital, Padua, Italy.
⁶⁵ Family Pediatrician, Local Health Unit Salerno, Aversa, Italy.
⁶⁶ Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.

^# Contributed equally.

PMID: 33882987
PMCID: PMC8058583
DOI: 10.1186/s13052-021-01013-8

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

Marzia Duse et al. Ital J Pediatr. 2021.

. 2021 Apr 21;47(1):97.

doi: 10.1186/s13052-021-01013-8.

Authors

Affiliations

¹ Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
² Department of Translational Medical Sciences, Federico II University, Naples, Italy. santamar@unina.it.
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 Maternal, Infantile and Urological Sciences Department, Sapienza University, Rome, Italy.
⁷ Pediatric Department, Franz Tappeiner Hospital, Meran, Italy.
⁸ 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 Pediatric and Emergency Unit Giovanni XXIII Pediatric Hospital University of Bari, Bari, Italy.
¹¹ Family Pediatrician Local Health Unit Latina, Latina, Italy.
¹² Family Pediatrician Local Health Unit, Turin and IRIB-CNR, Palermo, Italy.
¹³ Family Pediatrician Local Health Unit, Ferrara, Italy.
¹⁴ 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 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 Department of Obstetrics Gynaecology and Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, 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 Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department Of Health Sciences, University of Florence, Florence, Italy.
²⁷ 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 Department of Paediatrics, Aldo Moro University of Bari, Bari, Italy.
³¹ Paediatrics Unit, University Hospital of Pisa, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
³² 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 Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, University Hospital San Marco, University of Catania, Catania, Italy.
³⁷ Unit of Paediatric Allergy and Respiratory Medicine Women's and Children's Health Department, University Hospital Padua, Padua, Italy.
³⁸ 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 Paediatric and Neonatology Unit Santa Maria Goretti Hospital, Department of Pediatrics, University of Pavia, Pavia, Italy.
⁴⁴ 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 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 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 Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, Naples, Italy.
⁵³ Division of Pediatrics, University Hospital of Udine, Udine, Italy.
⁵⁴ Department Health Science, University of Florence, Florence, Italy.
⁵⁵ 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 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 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 Department of Translational Medical Sciences, Federico II University, Naples, Italy.
⁶⁴ Unit of Pediatric Allergy and Respiratory Medicine Women's and Children's Health Department University Hospital, Padua, Italy.
⁶⁵ Family Pediatrician, Local Health Unit Salerno, Aversa, Italy.
⁶⁶ Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.

^# Contributed equally.

PMID: 33882987
PMCID: PMC8058583
DOI: 10.1186/s13052-021-01013-8

Erratum in

Correction: Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases.
Duse M, Santamaria F, Verga MC, Bergamini M, Simeone G, Leonardi L, Tezza G, Bianchi A, Capuano A, Cardinale F, Cerimoniale G, Landi M, Malventano M, Tosca M, Varricchio A, Zicari AM, Alfaro C, Barberi S, Becherucci P, Bernardini R, Biasci P, Caffarelli C, Caldarelli V, Capristo C, Castronuovo S, Chiappini E, Cutrera R, De Castro G, De Franciscis L, Decimo F, Iacono ID, Diaferio L, Di Cicco ME, Di Mauro C, Di Mauro C, Di Mauro D, Di Mauro F, Di Mauro G, Doria M, Falsaperla R, Ferraro V, Fanos V, Galli E, Ghiglioni DG, Indinnimeo L, Kantar A, Lamborghini A, Licari A, Lubrano R, Luciani S, Macrì F, Marseglia G, Martelli AG, Masini L, Midulla F, Minasi D, Miniello VL, Del Giudice MM, Morandini SR, Nardini G, Nocerino A, Novembre E, Pajno GB, Paravati F, Piacentini G, Piersantelli C, Pozzobon G, Ricci G, Spanevello V, Turra R, Zanconato S, Borrelli M, Villani A, Corsello G, Di Mauro G, Peroni D. Duse M, et al. Ital J Pediatr. 2022 Feb 25;48(1):35. doi: 10.1186/s13052-022-01231-8. Ital J Pediatr. 2022. PMID: 35216620 Free PMC article. No abstract available.

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.

Keywords: Adenoid hypertrophy; Asthma; Inhaled corticosteroids; Laryngospasm; Laryngotracheitis; Rhinitis; Rhinosinusitis; Wheezing.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

**Fig. 1**
Inhaled corticosteroids currently available

**Fig. 2**
“Pulmonary” bioavailability and “oral” bioavailability of inhaled corticosteroids

See this image and copyright information in PMC

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References

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[1] Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011;6:e20476. - PMC - PubMed

[2] Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011;6:e20476. - PMC - PubMed

[3] Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet. 2000;355(9198):103–106. - PubMed

[4] Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet. 2000;355(9198):103–106. - PubMed

[5] Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839–E842. - PMC - PubMed

[6] Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839–E842. - PMC - PubMed

[7] Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. - PMC - PubMed

[8] Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. - PMC - PubMed

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[10] Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions [updated march 2011] Chichester: Wiley-Blackwell; 2011.

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

Affiliations

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

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