Browsing by Author "Nino, Gustavo"

Now showing 1 - 5 of 5
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    Cost-effectiveness analysis of phenotypic-guided versus guidelines-guided bronchodilator therapy in viral bronchiolitis
    (2021) Rodriguez Martinez, Carlos E.; Nino, Gustavo; Castro Rodríguez, José Antonio; Pérez, Geovanny F.; Sossa Briceño, Mónica P.; Buendia, Jefferson A.
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    Cost-utility analysis of daily versus intermittent inhaled corticosteroids in mild-persistent asthma
    (2015) Rodriguez-Martinez, Carlos E.; Nino, Gustavo; Castro Rodríguez, José Antonio
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    For which infants with viral bronchiolitis could it be deemed appropriate to use albuterol, at least on a therapeutic trial basis?
    (2021) Rodríguez Martínez, Carlos E.; Nino, Gustavo; Castro-Rodriguez, José A.; Acuña-Cordero, Ranniery; Sossa-Briceño, Mónica P.; Midulla, Fabio
    Although there is increasing evidence showing that infants with viral bronchiolitis exhibit a high degree of heterogeneity, a core uncertainty shared by many clinicians is with regard to understanding which patients are most likely to benefit from bronchodilators such as albuterol. Based on our review, we concluded that older infants with rhinovirus (RV) bronchiolitis, especially those with a nasopharyngeal microbiome dominated by Haemophilus influenzae; those affected during nonpeak months or during non-respiratory syncytial virus (RSV) predominant months; those with wheezing at presentation; those with clinical characteristics such as atopic dermatitis or a family history of asthma in a first-degree relative; and those infants infected with RSV genotypes ON1 and BA, have the greatest likelihood of benefiting from albuterol. Presently, this patient profile could serve as the basis for rational albuterol administration in patients with viral bronchiolitis, at least on a therapeutic trial basis, and it could also be the starting point for future targeted randomized clinical trials (RCTs) on the use of albuterol among a subset of infants with bronchiolitis.
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    Genes, environment, and developmental timing: New insights from translational approaches to understand early origins of respiratory diseases
    (2021) Gutierrez, Maria J. ; Perez, Geovanny F. ; Gomez, Jose L. ; Rodriguez‐Martinez, Carlos E. ; Castro‐Rodriguez, Jose A. ; Nino, Gustavo
    Over the past decade, "omics" approaches have advanced our understanding of the molecular programming of the airways in humans. Several studies have identified potential molecular mechanisms that contribute to early life epigenetic reprogramming, including DNA methylation, histone modifications, microRNAs, and the homeostasis of the respiratory mucosa (epithelial function and microbiota). Current evidence supports the notion that early infancy is characterized by heightened susceptibility to airway genetic reprogramming in response to the first exposures in life, some of which can have life-long consequences. Here, we summarize and analyze the latest insights from studies that support a novel epigenetic paradigm centered on human maturational and developmental programs including three cardinal elements: genes, environment, and developmental timing. The combination of these factors is likely responsible for the functional trajectory of the respiratory system at the molecular, functional, and clinical levels.
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    The use of β2-adrenoreceptor agonists in viral bronchiolitis: scientific rationale beyond evidence-based guidelines
    (2020) Nino, Gustavo; Rodríguez-Martínez, Carlos E.; Castro Rodríguez, José Antonio
    Despite scientific evidence proving that inhaled β2-adrenergic receptor (β2-AR) agonists can reverse bronchoconstriction in all ages, current guidelines advocate against the use of β2-AR bronchodilators in infants with viral bronchiolitis because clinical trials have not demonstrated an overall clinical benefit. However, there are many different types of viral bronchiolitis, with variations occurring at an individual and viral level. To discard a potentially helpful treatment from all children regardless of their clinical features may be unwarranted. Unfortunately, the clinical criteria to identify the infants that may benefit from bronchodilators from those who do not are not clear. Thus, we summarised the current understanding of the individual factors that may help clinicians determine the highest probability of response to β2-AR bronchodilators during viral bronchiolitis, based on the individual immunobiology, viral pathogen, host factors and clinical presentation.