Introduction Asthma imposes a substantial economic burden on health systems. By understanding the economic burden and its projections, public health officials and governments can design more effective asthma management and prevention strategies. This study aimed to estimate the global economic burden of asthma. Methods We projected future year DALYs lost to asthma based on age- and country-specific YLL and YLD rates and their annual rates of change derived from the Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Diseases (GBD) study for 1990–2021. We applied the concept of value of a statistical life year (VSLY) to estimate the value of a year of life lost to asthma. Results Our study reveals a disparity between high-income countries (HICs) and low- and middle-income countries (LMICs). The economic burden in low-income countries is expected to increase from 1,090 million dollars in 2023 to 1,265 million dollars in 2050, reflecting both population growth and increased prevalence of asthma. Meanwhile, high-income countries face a much higher burden, with costs rising from 130,290 million dollars in 2023 to 133,370 million dollars in 2050 Conclusion Our study reveals that the economic impact of asthma is projected to increase significantly globally, with a greater growth in low- and middle-income countries compared to high-income countries. Our results show a consistent rise in the economic burden of asthma from 2023 to 2050, both in absolute terms and per capita.

INTRODUCTION:Respiratory syncytial virus (RSV) causes significant morbidity and mortality in young children. For 25 years, palivizumab has been the only effective pharmaceutical RSV preventive. AREAS COVERED:We summarize the development and a quarter-century of real-world evidence with palivizumab. We highlight its positive impact on the burden of RSV in high-risk children. Based on lessons learnt from its implementation, we suggest strategies for effective and equitable deployment of newer RSV preventives. EXPERT OPINION:Following failure of the formalin-inactivated RSV vaccine in 1967, RSV intravenous immunoglobulin was approved in 1996 after three decades' research. Subsequently, palivizumab emerged as the most effective and safe RSV preventive, demonstrated by the IMpact trial, and was licensed in 1998 in the United States. Over the last 25 years, the benefits of palivizumab have been firmly established through a wealth of evidence, predominantly from high-income countries (HICs). To achieve a global impact with the newer RSV preventives, evidenced-based universal guidelines must be developed and endorsed by regulatory authorities and relevant scientific societies. Independent economic evaluations should incorporate all RSV-associated healthcare costs, reduction of long-term respiratory sequelae, and standardized outcomes. Most importantly, equity in product availability and implementation, particularly in low- and middle-income countries (LMICs) is essential.

BACKGROUND:Bronchopulmonary dysplasia (BPD), a chronic lung disease in preterm infants, often leads to acute respiratory exacerbations triggered by infections. Our previous mouse study suggested that azithromycin's anti-inflammatory properties may benefit virus-induced respiratory illnesses prophylactically. METHODS:In this single-center, double-blind RCT, 60 children (6 months to 6 years) with BPD received azithromycin (5 mg/kg three times weekly; n = 30) or placebo (n = 30) for one winter season (October to March). Primary outcome was the total number of days of unscheduled healthcare clinic visits, ER visits, and hospital days. Secondary outcomes comprised clinic visits, ER visits, hospital admissions, hospital days, and adverse events. Standard frequentist and Bayesian analyses were used. RESULTS:No significant difference in primary outcomes, unscheduled healthcare visits (macrolides 14.9 vs. 4.2 per child-year; p = 0.1, IRR = 2.1; 95% CI: 0.8-5.4), Bayesian analysis showing 11% probability of benefit; however, high-risk children (< 2 years, no tracheostomy), rates were lower with the macrolide group (2.7 vs. 4.6 per child-year; IRR = 0.6; 95% CI: 0.2-1.5), with an 82% probability of benefit. Two outliers in the macrolide group stayed > 40 days in the hospital for non-medical reasons. For secondary outcomes, we observe a decrease in the intervention group on ER visits (0.5 vs. 1.3 per child-year; p = 0.047, IRR = 0.4; 95% CI: 0.1-0.9). Hospital days increased (12.1 vs. 1.2 per child-year; IRR = 9.3; 95% CI: 5.5-16.8). CONCLUSIONS:Macrolide prophylaxis did not lead to a significant reduction in the primary outcome of unscheduled healthcare encounter days, but subgroup analysis suggests a potential benefit in high-risk children, with 82% probability of benefit. TRIAL REGISTRATION:NCT02544984.

Aim Approximately 20% of people in Latin America live more than 2500 m above sea level. In this ethnically and socioeconomically diverse population, it is challenging to differentiate the effects of altitude from population differences in lung function. The aim of the present study was to quantify the contribution of altitude on the variability in lung function measured by spirometry in Latin America. Methods Data from healthy individuals living in nine cities across Latin America (from sea level to >2500 m above sea level) were collated. Z -scores for forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC) and FEV 1 /FVC were calculated using available reference equations. Mixed-effects linear regression models were used to quantify the variance in spirometry explained by altitude. The percentage of individuals that were below the lower limit of normal (fifth percentile) were summarised. Results A total 4480 subjects (3–94 years) were included. Average FEV 1 and FVC z -scores differed between the altitude groups, whereas FEV 1 /FVC did not. After adjusting for sex, height and age, altitude explained up to ∼18% of the variability in lung function measured by spirometry. Conclusion For people living at altitude, existing approaches to interpreting spirometry measures may misclassify individuals.

Rationale: Obstructive Sleep Apnea (OSA) affects 2-3% of children, and hypertrophy of the adenoids and tonsils has been described as the most common cause. Adenoidectomy and/or tonsillectomy is the first line of treatment in paediatric patients, but residual OSA has been described in 10-77% of these patients.Our aim was to evaluate the polysomnogram (PSG) results of patients who underwent adenoidectomy and/or tonsillectomy for OSA and to determine the frequency of residual OSA in a high-altitude city. Methods:Analytical, cross-sectional study, including patients under 18 years of age who underwent adenoidectomy and/or tonsillectomy in 2018, with pre- and post-operative PSG. Hospital located in Bogotá at 2640 metres above sea level. Residual OSA was defined as obstructive apnoea-hypopnoea index (AHI) >1.5/h on postoperative PSG. Analysis of variables between preoperative and postoperative PSG was performed using the Wilcoxon test. ResultsIn 2018, 432 patients underwent adenoidectomy and/or tonsillectomy. The 28 (6.4%) children who had pre- and post-PSG were included. 57% of patients were male, median age 5 years, IQR 6 years, median weight 18 kg (IQR 9.8 kg). 18.5% had mild, 29.6% moderate and 51.9% severe OSA. Adenotonsillectomy was performed in 78% of patients. Patients showed significant improvement in total AHI, apnea index, total obstructive index and sleep efficiency. See bivariate analysis in Table 1. 7 (25%) patients had resolution of OSA (AHI <1.5/h) and 21 patients (75%) had residual OSA. 3 patients had OSA and obesity, 2 with improvement but still with mild OSA and one with obesity plus hypotension with severe residual OSA. Improvement was seen in most PSG variables, but with a high rate of residual OSA. This may be related to the fact that post-operative PSG is prioritized in patients with persistent symptoms and/or risk factors versus clinical follow-up in patients with symptomatic improvement, as per the American Sleep Academy guideline. We consider the number of patients included as a limitation, but it reflects the national reality and is the first high-altitude study. Mean desaturation did not improve, suggesting a role of altitude in lower inspired oxygen pressure. ConclusionPSG parameters improve with surgical treatment, but residual OSA remains a challenge in pediatric patients living at high altitude.

INTRODUCTION:Childhood asthma is a significant public health challenge in low- and middle-income countries (LMICs), with a high clinical and economic burden due to increased mortality, disability, and healthcare costs. Although numerous studies have been published assessing the economic burden of childhood asthma, most of these studies have focused on the financial burden of asthma in high-income countries. AREAS COVERED:This narrative review aims to identify studies that report the economic burden of childhood asthma in LMICs. We extracted the reported asthma-related costs, the type of institution where the study was conducted, the method of cost calculation, the proportion of direct costs to total costs, the leading direct cost items, and the main cost drivers, if reported, from the identified studies. EXPERT OPINION:This review highlights the high economic cost of childhood asthma in LMICs and provides an opportunity to rethink asthma management. Future strategies should prioritize prevention, ensure universal access to medicines, and incorporate cost assessment. A more proactive and integrated approach, combining a substantial primary care infrastructure, digital health interventions, and financial protection mechanisms, is crucial to reducing the economic burden of asthma and improving health outcomes for children in LMICs.

Preschool recurrent wheezing is a prevalent and heterogeneous condition that can develop into childhood asthma, significantly damaging public health. Preschool recurrent wheeze and asthma are influenced by a multifactorial interplay of biological, environmental, early life, behavioral, and psychosocial factors. Genes such as Gasdermin B, Orosomucoid 1-like 3, Cadherin-related family member 3, Annexin A1, and IL33/IL1RL1, and the methylation of cell-type-specific CpG sites are associated with airway-remodeling, increased inflammatory responses, and enhanced susceptibility to environmental factors. Biomarkers such as allergen sensitization, blood eosinophil levels, FeNO, and volatile organic compounds may guide treatment decisions based on the type of immune response in wheezing episodes. Several asthma-predicted clinical indices have been developed, and some have been validated. Although lower airway samples obtained through bronchoalveolar lavage and biopsy in young children are limited, they are essential in understanding the pathophysiology and developing personalized treatment of recurrent preschool wheezing. Early evaluations of lung function, airway hyperresponsiveness, and bronchodilator response can be valuable objective tools. However, because of physiologic variability and inconsistent methods and definitions, these tests cannot confirm or rule out a diagnosis of asthma at preschool age. Future research should investigate the interplay of factors across biological, environmental, and social domains to enhance predictive models and inform targeted interventions that promote health equity and reduce the global burden of preschool recurrent wheeze and asthma.

Rationale:Research on social determinants of health has facilitated the evaluation of variables such as socioeconomic context, gender-based disparities in care, social class, and access to health services, all of which influence health outcomes and coping strategies for disease. The Multidimensional Poverty Index (MPI) is an indicator that captures the deprivations experienced by individuals and households across multiple dimensions. Previous studies have demonstrated a correlation between MPI and asthma prevalence. This study aimed to assess the association between MPI and the prevalence of childhood asthma in Colombia. Methods:This was a cross-sectional, analytical observational study. Data from the individual registry of health services provision within the SISPRO database was utilized, focusing on ICD-10 codes for asthma as the primary or related diagnosis in patients under 18 years of age between 2018 and 2022. Official MPI data for Colombia from 2022 was also used. Prevalence rates were calculated using data from the 2018 Colombian national census as the denominator. Statistical analysis was conducted using SPSS. A bivariate analysis was performed between asthma prevalence and MPI components for each department, followed by a linear regression model adjusted for significant MPI variables. This study received ethical approval from the Ethics Committee of Fundación Santa Fe de Bogotá (CCEI16205 of 2024). Results:The highest prevalence of childhood asthma was observed in Bogotá, with 99 cases per 100,000 population, while the lowest prevalence was found in Nariño, with 8 cases per 100,000 population. In multivariate analysis, after adjusting for factors such as illiteracy, low educational attainment, barriers to early childhood care, restricted access to healthcare services, unemployment, overcrowding, inadequate sanitation, school absenteeism, substandard materials for exterior walls and floors, educational delays, limited access to improved water sources, child labor, and informal employment, the lack of health insurance emerged as an independent predictor of asthma prevalence. This variable had a coefficient of -4.29 (95% CI: -8.25 to -0.32) with a p-value of 0.036. A linear regression model was established: Prevalence = 238.13 + (no health insurance [asterisk] -4.29), with an R² of 0.73. Conclusions:Lack of health insurance, as a component of multidimensional poverty, is an independent predictor of asthma prevalence in childhood in Colombia.

Introduction: Impulse Oscillometry (IOS) is a non-invasive technique used to assess lung function, particularly useful in pediatric populations as it provides detailed information on R5(Resistance at 5 Hz), R20(Resistance at 20Hz), X5(Reactance at 5Hz), R5-R20(Frequency dependence of resistance), AX(Reactance area) of the respiratory system without requiring forced maneuvers. However, the accurate interpretation of IOS results requires specific reference equations that can vary significantly based on ethnic, geographic, and environmental factors. This project developed a tool based on Agentic Workflow that generates AI-assisted clinical reports to help the medical community interpret and compare existing global prediction equations for approximating IOS parameters (X5, R20, AX, R5) in children. It is important to emphasize that this system is designed to complement, rather than replace, the clinical judgment of healthcare professionals. Methods: Ten IOS equations from global studies in children aged 3 to 18 years were collected. The data were grouped by sample size, geographic region, mean and standard deviation of weight and height. Using the distribution of the collected demographic data, 1000 synthetic data points were generated to train a recommendation system with the KNeighborsClassifier model. A language chain system was implemented based on the few-shot learning technique, utilizing the LangChain framework. This system was developed using three inputs for the Agentic Workflow analysis. The first input consists of the IOS data predicted by 10 equations, the second input is a knowledge base extracted from reviewed literature on these 10 equations with a deterministic, rule-based approach, and the third input is the recommendation system's result. Finally, an evaluation node corrects potential hallucinations iteratively. Results: The average R² obtained from the equations was 39%. We identified that the most used parameters for calculating z-scores were Xrs5, Rrs20, AX, and Rrs5, which were incorporated in the tool for automated reading analysis. The interface provides comparative visualizations of the normality limits among the 10 equations, including the bronchodilator response. The system integrates these elements into a PDF report, which includes the recommended equation, parametric analysis, and diagnostic hypotheses.

OBJECTIVES:This study aimed to evaluate the applicability of existing 6MWT reference equations to healthy children and adolescents living in a high-altitude city. METHODS:Healthy children aged 5 to 15 years attending two non-randomly selected schools in Bogotá were invited to participate in the study. All participants performed the 6MWT according to the European Respiratory Society/American Thoracic Society technical standards. To identify the model or set of 6MWT equations that best predicted individually measured 6MWT values in our population, we identified the narrowest limits of agreement (LOA) (mean difference between measured and predicted values ± 1.96 SD) after constructing Bland-Altman plots. We performed separate analyzes based on sex and onset of puberty, which was assumed to occur at 12 years of age for girls and 13 years of age for boys. RESULTS:105 children and adolescents (61 girls, 58.1%) with a mean age of 10.04 years (±2.21), ranging from 6 to 15 years, were evaluated. We determined that equations derived from two different studies conducted in Brazil, de Assis, and Oliveira 6MWT equations provided the narrowest LOA in the Bland-Altman plots for the individually-measured 6MWT values for all study participants, except for the older female participants who obtained narrower LOA with the Ulrich equations. CONCLUSION:For the mean walked distance of the 6MWT, we have provided information on the 6MWT predictive equations that may be most appropriate for use in healthy children living in Bogota, Colombia, a city at 2640 m altitude.

BACKGROUND:Viral bronchiolitis is the most common cause of lower respiratory tract infection in infants and the leading cause of hospitalization in infants under 1 year of age. Most clinical practice guidelines (CPGs) recommend a minimalist management approach based on supportive therapy, focusing solely on maintaining oxygenation and hydration. OBJECTIVES:To examine the reasons behind the poor adherence to evidence-based guidelines for bronchiolitis in real-world clinical practice and to explore potential strategies to improve future management. METHODS:This narrative review discusses factors that may explain the observed gap between guideline recommendations and clinical practice, including recent findings from the field that help clarify this poor adherence. RESULTS:We highlight the discrepancy between guideline-based recommendations and clinical implementation. We also discuss the evolving landscape of bronchiolitis management, including evidence supporting novel interventions such as maternal RSV vaccination during pregnancy and the use of monoclonal antibodies like nirsevimab and ziresovir, an oral RSV F protein inhibitor. CONCLUSIONS:Understanding and addressing the causes of poor adherence to bronchiolitis guidelines is critical. Future research should aim to integrate evidence-based treatments with options for personalized adjustments. Updated guidelines should reflect emerging interventions and provide rational management pathways until robust evidence from new studies becomes available.

OBJECTIVES:Since 2019 as-needed low-dose ICS-formoterol in a single inhaler has been recommended for treatment of mild asthma in children aged more than 12 years. Alternatively, the use of ICS-albuterol has been proposed in countries where ICS-formoterol is not available or affordable. The aim of the present study was to evaluate the cost-utility of as-needed ICS-albuterol in separate inhalers compared to ICS-formoterol in a single inhaler as reliever therapy in pediatric patients with mild asthma living in Colombia. METHODS:A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of pediatric patients with mild asthma treated for 12 months. The effectiveness data and transition probabilities were obtained from relevant randomized clinical trials (RCTs). 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). RESULTS:The base-case analysis showed that compared with the use of as-needed ICS-albuterol in separate inhalers, the use of ICS-formoterol in a single in pediatric patients with mild asthma was associated with lower costs (US$475.51 vs. 735.33 average cost per patient) and the greatest gain in QALYs (0.9367 vs. 0.9352 QALYs on average per patient), thus leading to dominance. CONCLUSIONS:Compared with the use of as-needed ICS-albuterol in separate inhalers, the use of ICS-formoterol in a single inhaler as reliever therapy is cost-effective in patients aged 12 years or more with mild asthma, because it showed a greater gain in QALYs at lower total treatment costs.

Although severe asthma in low- and middle-income countries (LMICs) is relatively uncommon in children and adolescents (2.1 % and 4.3 %, respectively), it results in significant morbidity, occasional fatality, and great challenges of management, compared to high-income countries. Additionally, nearly 6 % of infants in LMICs experience nighttime symptoms on a weekly basis. Socioeconomic inequities and exposure to environmental risk factors contributed to variability in prevalence, with children from disadvantaged backgrounds being at a higher risk of developing the condition. Numerous preventable risk factors have been identified in these regions, including tobacco smoke, indoor and outdoor pollution (e.g., the use of biomass fuels), allergens, diet, and urbanization, among other lifestyle factors. Almost half of the patients with severe asthma received inadequate treatment. For example, only 55 % use inhaled corticosteroids (ICS), and while most physicians prefer pressurized metered-dose inhalers, only a third recommend using spacers. In some countries, oral short-acting beta agonists and theophylline are still used as treatment options. Compared to fixed-dose ICS/long-acting beta-agonists (LABA), maintenance and reliever therapy (MART), adding tiotropium, and triple therapy (ICS + LABA + LAMA) are cost-effective options in LMICs. Biologic drugs are expensive and have limited access, and studies have shown that omalizumab and dupilumab are not cost-effective treatments in LMICs. Barriers to adequate follow-up include poorly organized health services, limited spirometry, and patients' non-compliance. Public health efforts should prioritize improving access to affordable asthma medications, enhancing diagnostic capacity in underserved areas, and addressing environmental risk factors that contribute to asthma.

Background: The Pediatric Asthma Severity Score (PASS) is one of the most-used clinical scoring systems for assessing the severity of asthma exacerbations in children. The aim of the present study was to validate a Spanish version of the PASS in a population of Hispanic children with asthma exacerbations living in urban Bogota, Colombia. Methods: In a prospective cohort and a validation study, parents/caregivers of children between 2 and 18 years old attended in the emergency department (ED) with asthma exacerbations who were admitted to the inpatient unit were invited to participate in the study. During the hospitalization period, we gathered the necessary data for assessing the criterion validity (comparing its score with the Pediatric Respiratory Assessment Measure [PRAM]), construct validity, interrater reliability, responsiveness, and internal consistency of the Col-PASS, the Colombian version of the PASS. Results: At baseline, the scores of the Col-PASS correlated positively with the scores of the PRAM score (rho = 0.588, p < .001). The baseline Col-PASS scores in patients who required admission to a more complex service were significantly higher than those in patients who presented clinical improvement (1.0 (0.0-2.0) vs. 0.0 (0.0-0.0), p < .001). The interrater reliability was found to be kappa = 0.897, 95% CI 0.699-1.000, p < .001. Cronbach's alpha was .701 for the questionnaire as a whole. Conclusion: The Col-PASS has excellent construct validity, adequate criterion validity, interrater reliability, responsiveness; and acceptable internal consistency when used in children between 2 and 18 years old with asthma exacerbations.

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.

OBJECTIVES:To provide a comprehensive overview of disparities in prevalence and outcomes of respiratory diseases and notable challenges for providing optimal treatment to pediatric patients with respiratory diseases living in low- and middle-income countries (LMICs), as an input to help better understand the roots of respiratory health disparities. METHODS:We conducted a narrative review of relevant literature published in electronic databases from inception to February 2023 that present data on disparities in prevalence and outcomes of respiratory disease in LMICs. Additionally, we included studies that describe and discuss challenges for providing optimal treatment to pediatric patients with respiratory diseases living in LMICs. RESULTS:A number of early life exposures have been associated with adverse respiratory outcomes in later life. Several studies have shown marked geographical variations in the prevalence and burden of pediatric asthma, with consistently lower prevalence rates but significantly higher burdens and worse outcomes in LMICs. There is a wide range of challenges that adversely affect the efficient care of children with respiratory diseases that can be classified into three categories: patient-related factors, social/environmental factors, and factors related to healthcare providers or the healthcare system. CONCLUSIONS:Respiratory health disparities in children living in LMICs represent a global public health issue mainly explained by an unequal distribution of preventable and modifiable risk factors for respiratory diseases across different demographic groups.

Obstructive sleep apnea (OSA) is a respiratory disorder that has a high prevalence in patients with craniofacial, neurocognitive, and neuromuscular disorders. Currently, the treatments for this population are diverse and depend on the individual conditions of the patient and the severity of the case. However, there are no multidisciplinary dental treatment guidelines. The aim of the present study was to determine the multidisciplinary dental treatment alternatives in patients with craniofacial, neurocognitive, and neuromuscular disorders with a diagnosis of OSA through evidence-based medicine. A systematic review of the literature has been performed by searching scientific articles in the PubMed, Cochrane, Ovid, ScienceDirect and Scopus databases, through controlled and uncontrolled language. Articles were classified according to the level of evidence and grades of recommendation through the Scottish Intercollegiate Guidelines Network. A total of 19,439 references were identified, of which 15 articles met the predetermined requirements to be included in the investigation. The articles included for this systematic review showed that mandibular distraction osteogenesis and adenotonsilectomy are the first-choice therapies for craniofacial and neurocognitive disorders. However, for neuromuscular disorders, the findings reported were not enough to provide information about surgical or nonsurgical alternatives. Despite the reported high frequency of OSA in those children with craniofacial, neurocognitive, and neuromuscular disorders, the evidence on the surgical and nonsurgical therapeutic success for OSA in these patients is scarce. It is necessary to perform future studies to investigate successful therapies for OSA in children. [Pediatr Ann. 2024;53(2):e62-e69.].

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.

Introduction: Respiratory syncytial virus infection is the leading cause of lower respiratory infection globally. Recently, nirsevimab has been approved to prevent respiratory syncytial virus (RSV) infection. This study explores the economically justifiable price of nirsevimab for preventing RSV infection in Colombia's children under 1 year of age. Materials and Methods: A static model was developed using the decision tree microsimulation to estimate the quality-adjusted costs and life years of two interventions: a single intramuscular dose of nirsevimab versus not applying nirsevimab. This analysis was made during a time horizon of 1 year and from a societal perspective. Results: The annual savings in Colombia associated with this cost per dose ranged from U$ 2.5 to 4.1 million. Based on thresholds of U$ 4828, U$ 5128, and U$ 19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices of U$ 21.88, U$ 25.04, and U$ 44.02 per dose of nirsevimab. Conclusion: the economically justifiable cost for nirsevimab in Colombia is between U$ 21 to U$ 44 per dose, depending on the willingness to pay used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are essential in asthma management, but the guidelines for treatment in preschool children remain heterogeneous worldwide. This systematic review evaluates the efficacy and safety of LABA + ICS therapy in asthmatic children under six years. We searched four databases, identifying six eligible studies (n = 1415 preschoolers), and in all the LABA used was salmeterol. Due to high heterogeneity, quantitative analysis was not feasible. Three before-and-after studies demonstrated significant reductions in unscheduled visits and hospitalizations due to asthma exacerbations with LABA + ICS. One RCT showed fewer exacerbations in the LABA + ICS group compared to ICS alone. Night-time awakenings decreased significantly in two studies but not in one RCT. Improvements in lung function using impulse oscillometry and FeNO levels were noted with LABA+ICS in one RCT. No significant adverse effects were reported. Despite positive findings, high-quality trials are needed to confirm these results, particularly using formoterol as LABA, aligning with the recommendations. Further research is imperative to optimize asthma management in preschool children.