Supplemental material, Reviewer_1_v.1 for Eradication of Pseudomonas aeruginosa in cystic fibrosi... more Supplemental material, Reviewer_1_v.1 for Eradication of Pseudomonas aeruginosa in cystic fibrosis patients with inhalation of dry powder tobramycin by Anne M. Akkerman-Nijland, Mina Yousofi, Bart L. Rottier, Hester Van der Vaart, Johannes G. M. Burgerhof, Henderik W. Frijlink, Daan J. Touw, Gerard H. Koppelman and Onno W. Akkerman in Therapeutic Advances in Respiratory Disease
Introduction: International evidence-based pediatric asthma guidelines are often not used in clin... more Introduction: International evidence-based pediatric asthma guidelines are often not used in clinical practice. In step 3 of pediatric asthma management some guidelines make clear choices for LABA were others give alternative options, but without being transparent in why choices are made. To enhance the usefulness of guidelines, the ATS has chosen GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) as the preferred methodology for rating the quality of evidence and strength of recommendations in clinical practice guidelines. Objective: Our aim was to develop transparent recommendations on step 3 of asthma management in children. Methods: We used GRADE to assess the quality of evidence and separately reported other considerations. Final recommendations were formulated on both evidence as well as the other considerations in cooperation with the Dutch Society of Pediatric Pulmonologists. Results: We found 7 RCTs comparing doubling the dose of ICS versus a combinat...
In context of the development of evidence-based guidelines by the Dutch Paediatric Society, the t... more In context of the development of evidence-based guidelines by the Dutch Paediatric Society, the three most important controversies in asthma treatment in children were investigated by systematic literature review and assessed based on the quality of evidence according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Although the quality of evidence was low, this method did result in clear, although weak, recommendations, in which the considerations playing a role are made clear. In young children with severe and/or recurrent wheezing, maintenance treatment using an inhalation corticosteroid (ICS) is initially recommended. When inhalation technique is poor, a leukotriene receptor antagonist (LTRA) can be given instead. Inhalation corticosteroids with ultrafine particles are not specifically recommended as first line treatment in young children. If asthma is not controlled despite use of ICS, it is advised to double the dose of ICS after unfavourable envir...
BackgroundDiagnosing asthma in children represents an important clinical challenge. There is no s... more BackgroundDiagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children.MethodsA task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsThe task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preference...
In this article, the Group Chairs and early career members of the European Respiratory Society (E... more In this article, the Group Chairs and early career members of the European Respiratory Society (ERS) Paediatric Assembly highlight some of the most interesting findings in the field of paediatrics which were presented at the 2018 international ERS Congress.
Background congenital pulmonary airway malformation (CPAM) is the most frequent congenital lung d... more Background congenital pulmonary airway malformation (CPAM) is the most frequent congenital lung disorder. CPAM type 1 is the most common subtype, typically having a cystic radiological and histological appearance. Mucinous clusters in CPAM type 1 have been identified as premalignant precursors for mucinous adenocarcinoma. These mucinous adenocarcinomas and the mucinous clusters in CPAM commonly harbor a specific KRAS mutation. Case presentation we present a case of a 6-weeks-old girl with CPAM type 1 where evaluation after lobectomy revealed a highly unusual complex non-mucinous papillary architecture in all cystic parts, in which both mucinous clusters and non-mucinous papillary areas harbored the known KRAS mutation. Conclusions we found that a KRAS mutation thought to be premalignant in mucinous clusters only, was also present in the other cyst lining epithelial cells of this unusual non-mucinous papillary variant of CPAM type 1, warranting clinical follow-up because of uncertain...
In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society ... more In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
Introduction Although several eHealth interventions have been shown to be effective, little is kn... more Introduction Although several eHealth interventions have been shown to be effective, little is known about the actual use of these interventions among patients in real life. Aim of the study The aim were to describe and analyse website-use among children with asthma receiving online care through the virtual asthma clinic (VAC) and to develop recommendations for further use of the VAC in paediatric asthma care. Methods Observational study conducted alongside a randomized controlled trial on the efficacy of the VAC. Website log-data of the participants were analysed in retrospect: activity (page views of information pages and treatment plan), communication with the medical team (frequency and content of messages) and login (frequency and duration) were compared between different age groups (6-11 years and 12-16 years). Results 105 children (mean age 11.2 years (± SD 2.9 years; 61% male) were included. Younger participants or parents accessed the (general) information pages significantly more often than teenagers (median page views 10 versus 4, P =.003). The median number of messages was also significantly higher (median 4 versus 2, P =.04) in the younger group. No significant difference in login frequency was found between the two age groups, but the login-frequency decreased significantly within both groups during the 16-month study period. Conclusions The VAC was used significantly different by teenagers and younger children and/or their parents regarding the need of information and communication with the medical team. Younger children used the information and communication modules more often in comparison to teenagers. These differences should be taken into account while designing an eHealth intervention for children.
Management-related issues are an important aspect of monitoring asthma in children in clinical pr... more Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood.The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis...
This update will describe the paediatric highlights from the 2013 European Respiratory Society (E... more This update will describe the paediatric highlights from the 2013 European Respiratory Society (ERS) annual congress in Barcelona, Spain. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology) have been chosen by group officers and are presented in the context of current literature.
Nederlands tijdschrift voor geneeskunde, Jan 27, 2003
The case history and physical examination form the corner-stones for asthma diagnosis. Establishi... more The case history and physical examination form the corner-stones for asthma diagnosis. Establishing the correct diagnosis may be difficult in infants and preschool children; in such cases the progression of the symptoms over time is important. Routine laboratory and radiological investigations are advised against. Allergy testing may be useful in children under the age of 4 years. Lung function investigations can be used from the age of 5 to 6 years onwards. Non-invasive investigations into the degree of bronchial inflammation can be performed by measuring the fraction nitric oxide in exhaled air. House dust mite reduction is a useful measure for preventing asthma if sensitisation has been demonstrated. Breast-feeding during the first 4 to 6 months of life can be considered as a preventive measure in infants with an increased risk of developing asthma and allergy.
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient... more The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described ...
OBJECTIVES: To develop explicit and transparent recommendations on controversial asthma managemen... more OBJECTIVES: To develop explicit and transparent recommendations on controversial asthma management issues in children and to illustrate the usefulness of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in rating the quality of evidence and strength of recommendations. METHODS: Health care questions were formulated for 3 controversies in clinical practice: what is the most effective treatment in asthma not under control with standard-dose inhaled corticosteroids (ICS; step 3), the use of leukotriene receptor antagonist for viral wheeze, and the role of extra fine particle aerosols. GRADE was used to rate the quality of evidence and strength of recommendations after performing systematic literature searches. We provide evidence profiles and considerations about benefit and harm, preferences and values, and resource use, all of which played a role in formulating final recommendations. RESULTS: By applying GRADE and focusing on outcomes that are im...
Inhalatietherapie is een veelgebruikte behandeling tegen longziekten zoals astma en COPD. Een eff... more Inhalatietherapie is een veelgebruikte behandeling tegen longziekten zoals astma en COPD. Een effectieve toediening van inhalatiemedicatie is echter afhankelijk van veel factoren. Zo kan gebruik van een bepaald type inhalator in een vochtige badkamer leiden tot een verdubbeling van de afgegeven hoeveelheid inhalatiemedicatie. Ook biedt nieuwe inhalatietechnologie mogelijkheden voor de terugkeer van inhaleerbare insuline en om middelen tegen bijvoorbeeld TBC en vaccins via de luchtwegen toe te dienen. Bart Rottier, kinderarts-pulmonoloog in het UMCG, deed onderzoek naar de toediening van medicatie aan en via de luchtwegen en concludeert dat er nog veel verbeteringen mogelijk zijn. Rottier promoveert op 28 november 2012 op de resultaten van zijn onderzoek aan de Rijksuniversiteit Groningen. Inhalatietherapie biedt voordelen ten opzichte van medicijnen die oraal of via injecties worden toegediend, maar een effectieve toediening is afhankelijk van veel factoren. Die factoren zijn onder ...
Supplemental material, Reviewer_1_v.1 for Eradication of Pseudomonas aeruginosa in cystic fibrosi... more Supplemental material, Reviewer_1_v.1 for Eradication of Pseudomonas aeruginosa in cystic fibrosis patients with inhalation of dry powder tobramycin by Anne M. Akkerman-Nijland, Mina Yousofi, Bart L. Rottier, Hester Van der Vaart, Johannes G. M. Burgerhof, Henderik W. Frijlink, Daan J. Touw, Gerard H. Koppelman and Onno W. Akkerman in Therapeutic Advances in Respiratory Disease
Introduction: International evidence-based pediatric asthma guidelines are often not used in clin... more Introduction: International evidence-based pediatric asthma guidelines are often not used in clinical practice. In step 3 of pediatric asthma management some guidelines make clear choices for LABA were others give alternative options, but without being transparent in why choices are made. To enhance the usefulness of guidelines, the ATS has chosen GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) as the preferred methodology for rating the quality of evidence and strength of recommendations in clinical practice guidelines. Objective: Our aim was to develop transparent recommendations on step 3 of asthma management in children. Methods: We used GRADE to assess the quality of evidence and separately reported other considerations. Final recommendations were formulated on both evidence as well as the other considerations in cooperation with the Dutch Society of Pediatric Pulmonologists. Results: We found 7 RCTs comparing doubling the dose of ICS versus a combinat...
In context of the development of evidence-based guidelines by the Dutch Paediatric Society, the t... more In context of the development of evidence-based guidelines by the Dutch Paediatric Society, the three most important controversies in asthma treatment in children were investigated by systematic literature review and assessed based on the quality of evidence according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Although the quality of evidence was low, this method did result in clear, although weak, recommendations, in which the considerations playing a role are made clear. In young children with severe and/or recurrent wheezing, maintenance treatment using an inhalation corticosteroid (ICS) is initially recommended. When inhalation technique is poor, a leukotriene receptor antagonist (LTRA) can be given instead. Inhalation corticosteroids with ultrafine particles are not specifically recommended as first line treatment in young children. If asthma is not controlled despite use of ICS, it is advised to double the dose of ICS after unfavourable envir...
BackgroundDiagnosing asthma in children represents an important clinical challenge. There is no s... more BackgroundDiagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children.MethodsA task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsThe task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preference...
In this article, the Group Chairs and early career members of the European Respiratory Society (E... more In this article, the Group Chairs and early career members of the European Respiratory Society (ERS) Paediatric Assembly highlight some of the most interesting findings in the field of paediatrics which were presented at the 2018 international ERS Congress.
Background congenital pulmonary airway malformation (CPAM) is the most frequent congenital lung d... more Background congenital pulmonary airway malformation (CPAM) is the most frequent congenital lung disorder. CPAM type 1 is the most common subtype, typically having a cystic radiological and histological appearance. Mucinous clusters in CPAM type 1 have been identified as premalignant precursors for mucinous adenocarcinoma. These mucinous adenocarcinomas and the mucinous clusters in CPAM commonly harbor a specific KRAS mutation. Case presentation we present a case of a 6-weeks-old girl with CPAM type 1 where evaluation after lobectomy revealed a highly unusual complex non-mucinous papillary architecture in all cystic parts, in which both mucinous clusters and non-mucinous papillary areas harbored the known KRAS mutation. Conclusions we found that a KRAS mutation thought to be premalignant in mucinous clusters only, was also present in the other cyst lining epithelial cells of this unusual non-mucinous papillary variant of CPAM type 1, warranting clinical follow-up because of uncertain...
In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society ... more In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
Introduction Although several eHealth interventions have been shown to be effective, little is kn... more Introduction Although several eHealth interventions have been shown to be effective, little is known about the actual use of these interventions among patients in real life. Aim of the study The aim were to describe and analyse website-use among children with asthma receiving online care through the virtual asthma clinic (VAC) and to develop recommendations for further use of the VAC in paediatric asthma care. Methods Observational study conducted alongside a randomized controlled trial on the efficacy of the VAC. Website log-data of the participants were analysed in retrospect: activity (page views of information pages and treatment plan), communication with the medical team (frequency and content of messages) and login (frequency and duration) were compared between different age groups (6-11 years and 12-16 years). Results 105 children (mean age 11.2 years (± SD 2.9 years; 61% male) were included. Younger participants or parents accessed the (general) information pages significantly more often than teenagers (median page views 10 versus 4, P =.003). The median number of messages was also significantly higher (median 4 versus 2, P =.04) in the younger group. No significant difference in login frequency was found between the two age groups, but the login-frequency decreased significantly within both groups during the 16-month study period. Conclusions The VAC was used significantly different by teenagers and younger children and/or their parents regarding the need of information and communication with the medical team. Younger children used the information and communication modules more often in comparison to teenagers. These differences should be taken into account while designing an eHealth intervention for children.
Management-related issues are an important aspect of monitoring asthma in children in clinical pr... more Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood.The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis...
This update will describe the paediatric highlights from the 2013 European Respiratory Society (E... more This update will describe the paediatric highlights from the 2013 European Respiratory Society (ERS) annual congress in Barcelona, Spain. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology) have been chosen by group officers and are presented in the context of current literature.
Nederlands tijdschrift voor geneeskunde, Jan 27, 2003
The case history and physical examination form the corner-stones for asthma diagnosis. Establishi... more The case history and physical examination form the corner-stones for asthma diagnosis. Establishing the correct diagnosis may be difficult in infants and preschool children; in such cases the progression of the symptoms over time is important. Routine laboratory and radiological investigations are advised against. Allergy testing may be useful in children under the age of 4 years. Lung function investigations can be used from the age of 5 to 6 years onwards. Non-invasive investigations into the degree of bronchial inflammation can be performed by measuring the fraction nitric oxide in exhaled air. House dust mite reduction is a useful measure for preventing asthma if sensitisation has been demonstrated. Breast-feeding during the first 4 to 6 months of life can be considered as a preventive measure in infants with an increased risk of developing asthma and allergy.
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient... more The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described ...
OBJECTIVES: To develop explicit and transparent recommendations on controversial asthma managemen... more OBJECTIVES: To develop explicit and transparent recommendations on controversial asthma management issues in children and to illustrate the usefulness of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in rating the quality of evidence and strength of recommendations. METHODS: Health care questions were formulated for 3 controversies in clinical practice: what is the most effective treatment in asthma not under control with standard-dose inhaled corticosteroids (ICS; step 3), the use of leukotriene receptor antagonist for viral wheeze, and the role of extra fine particle aerosols. GRADE was used to rate the quality of evidence and strength of recommendations after performing systematic literature searches. We provide evidence profiles and considerations about benefit and harm, preferences and values, and resource use, all of which played a role in formulating final recommendations. RESULTS: By applying GRADE and focusing on outcomes that are im...
Inhalatietherapie is een veelgebruikte behandeling tegen longziekten zoals astma en COPD. Een eff... more Inhalatietherapie is een veelgebruikte behandeling tegen longziekten zoals astma en COPD. Een effectieve toediening van inhalatiemedicatie is echter afhankelijk van veel factoren. Zo kan gebruik van een bepaald type inhalator in een vochtige badkamer leiden tot een verdubbeling van de afgegeven hoeveelheid inhalatiemedicatie. Ook biedt nieuwe inhalatietechnologie mogelijkheden voor de terugkeer van inhaleerbare insuline en om middelen tegen bijvoorbeeld TBC en vaccins via de luchtwegen toe te dienen. Bart Rottier, kinderarts-pulmonoloog in het UMCG, deed onderzoek naar de toediening van medicatie aan en via de luchtwegen en concludeert dat er nog veel verbeteringen mogelijk zijn. Rottier promoveert op 28 november 2012 op de resultaten van zijn onderzoek aan de Rijksuniversiteit Groningen. Inhalatietherapie biedt voordelen ten opzichte van medicijnen die oraal of via injecties worden toegediend, maar een effectieve toediening is afhankelijk van veel factoren. Die factoren zijn onder ...
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