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Current Research - Asthma

young patient holding puffer to mouthMagnesium Nebulization Utilization in Management of Pediatric Asthma -  "MagNUM PA" 

Acute asthma is the most common cause of pediatric hospitalizations. While we know that repeat inhalations of bronchodilator's with early oral steroids substantially reduce hospitalizations, many children are resistant to this standard initial therapy. About a third of children remaining in moderate to severe distress after standard therapy are admitted to hospital and comprise 84% of pediatric acute asthma hospitalizations. Finding safe, non-invasive, and effective strategies to treat children resistant to standard therapy would substantially decrease hospitalizations resulting in considerable health care savings and reduction of the psycho-social burden of the disease. While studies of magnesium sulfate (Mg) given intravenously (IV) suggest that this agent can reduce hospitalizations in both adults and children resistant to standard initial therapy, a North America-wide survey completed by us shows that only 7% of Emergency Department (ED) physicians give IV Mg to prevent hospitalizations. Nebulization (inhalation) is an alternate route for administering Mg. This route has the advantage of being non-invasive and is likely much safer due to lower systemic delivery. Direct delivery via nebulization allows higher Mg concentrations at the target site, the lower airways, with a smaller total drug dose. This definitive trial of children in significant respiratory distress after optimized initial therapy will assess the impact of inhaled Mg on hospitalizations, use of medical resources and additional rescue co-interventions. 
UPDATE: Patient enrollment is underway currently in the CHEO Emergency Department. More than 283 families are currently enrolled in the trial. 

child with oxygen mask Indoor Air Quality and the Effect on Children’s Respiratory Health in First Nations Reserves in the Sioux Lookout Zone, Northern Ontario

According to the Canadian Paediatric Society, housing directly affects the health of children and youth, and some populations, including First Nations and Inuit are disproportionately affected by crowded and inadequate housing, which has been associated with increased hospital admissions of children for respiratory tract illnesses. Previous research shows that Aboriginal children in communities in the Sioux Lookout Zone (Sioux Lookout First Nations Health Authority; SLZ) in northern Ontario have elevated rates of asthma, bronchiolitis and pneumonia, but there is little objective information on their indoor environmental quality (IEQ). This study will evaluate IEQ in houses of approximately 100 children living in isolated communities in the SLZ in relation to respiratory health. The information garnered will help us to more effectively work with this community to identify simple home improvements and other building interventions that could improve the respiratory health of this vulnerable population. The findings of this study will also be used to plan future, similar studies / interventions in remote First Nations reserves across Canada.

Consenting households will receive a respiratory health questionnaire for their youngest child. A standardized housing inspection will be carried out in partnership with Band officials. Monitors will be placed to record basic IEQ and the relationship between it and the child’s respiratory health will be examined. 
This study will commence in November 2017 until approx. April 2018 under the leadership of Dr. Tom Kovesi from CHEO.
Derivation of a clinical score to predict risk of future emergency department visits and hospitalizations among children with asthma

Currently, most children who leave the ED after an asthma visit do not receive proven preventative treatments such as asthma education. However, these treatments are only needed for children at high-risk for repeat visits. There are no guidelines to direct clinicians how to practically identify these high-risk children before discharge from the ED. With this study, researchers will derive a clinical risk score to identify children at high-risk for repeat asthma visits within a year after a first asthma ED visit. Data collected from a previous study of children visiting the ED for asthma will be analyzed. The information on participants of this previous study will be linked with Ontario and Quebec health administrative data to identify repeat ED or hospital visits over the following year. This will enable development of a clinical score to identify high-risk asthma patients. Importance: This study will provide a method to identify children at high risk for future asthma ED visits or hospitalizations and in future, to target treatments to children who would benefit most.

UPDATE: Data analysis underway
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