Wim C J Hop

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (674)2786.68 Total impact

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    ABSTRACT: To investigate changes in trapped air volume and distribution over time and compare computed tomography (CT) with pulmonary function tests for determining trapped air.
    European Journal of Radiology 02/2015; DOI:10.1016/j.ejrad.2015.02.011 · 2.16 Impact Factor
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    ABSTRACT: We prospectively studied the incidence and clinical course of hypertriglyceridemia and hypercholesterolemia during very prolonged use of asparaginase or in relation to asparaginase activity levels in children with acute lymphoblastic leukemia. Also, incidence of pancreatitis, thrombosis, hyperammonemia and central neurotoxicity and their association with asparaginase activity levels were evaluated. 89 patients were treated according to Dutch Childhood Oncology Group Acute Lymphoblastic Leukemia 10 medium-risk intensification protocol, which includes 15 doses PEGasparaginase(2,500 IU/m2) for 30 weeks. Erwinia-asparaginase(20,000 IU/m2) was administered when allergy to or silent inactivation of PEGasparaginase occurred. Triglyceride/cholesterol/ammonia levels increased rapidly in children with PEGasparaginase and remained temporary elevated, but normalized after finishing the last asparaginase dose. Hypertriglyceridemia and hypercholesterolemia(grade 3/4) were found in 47% and in 25%, respectively, of PEGasparaginase-treated patients. Studying the correlations between PEGasparaginase activity levels and triglyceride levels showed the strongest correlation at week 5 (Spearman correlation coefficient=0.36, p=0.005). Children >10 years had higher triglyceride levels as compared to younger patients(<10 years) adjusted for asparaginase preparations: median 4.9 mmol/L versus 1.6 mmol/L(p<0.001). In patients receiving Erwinia-asparaginase, triglyceride levels increased in the first weeks as well, but no grade 3/4 dyslipidemia was found. Hyperammonemia(grade 3/4) was only found in Erwinia-asparaginase treated patients(9%). Thrombosis occurred in 4.5%, pancreatitis in 7 %, and central neurotoxicity in 9 % of patients using each of both agents; these toxicities were not related to asparaginase activity levels nor to triglyceride levels. Severe dyslipidemia occurred frequently, but was temporary and was not associated with relevant clinical events and therefore should not be considered a reason for asparaginase treatment modifications. Only dyslipidemia was related to asparaginase activity levels.
    Haematologica 08/2014; DOI:10.3324/haematol.2014.109413 · 5.94 Impact Factor
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    ABSTRACT: The aim of this cross-sectional study was to analyze the incidence of incisional hernia after liver transplantation (LT), to determine potential risk factors for their development and to assess their impact of incisional hernia on health-related quality of life (HRQoL).Patients who underwent LT through a J-shaped incision with a minimum follow-up of 3 months were included. Follow-up was conducted at the outpatient clinic. Short form 36 (SF-36) and body image questionnaire (BIQ) were used for the assessment of HRQoL.A total of 140 patients was evaluated. The mean follow-up period was 33 (SD 20) months. Sixty patients (43%) were diagnosed with an incisional hernia. Multivariate analysis revealed surgical site infection (OR 5.27, p = 0.001), advanced age (OR 1.05, p = 0.003), and prolonged ICU stay (OR 1.54, p = 0.022) to be independent risk factors for development of incisional hernia after LT. Patients with an incisional hernia experienced significantly diminished HRQoL with respect to physical, social, and mental aspects.In conclusion, patients who undergo LT exhibit a high incidence of incisional hernia, which has a considerable impact on HRQoL. Development of incisional hernia was shown to be related to surgical site infection, advanced age and prolonged ICU stay.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 05/2014; DOI:10.1111/ctr.12386 · 1.49 Impact Factor
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    ABSTRACT: Background: To validate commonly used bedside right ventricular impedance parameters, which are used in determining heart-lung interactions during mechanical ventilation. Methods: Fifteen pigs were equally assigned to either an open or a closed pericardium group. In all animals, an inflatable vascular occluder and a flow probe were placed around the main pulmonary artery, which allowed for a gradual increase in pulmonary vascular impedance with banding of the pulmonary artery. A median sternotomy was performed for the open pericardium group, and a lateral thoracotomy was performed for the closed pericardium group. Results: In the open pericardium group, mean acceleration time (ACmean) and the slope of the pulmonary artery flow correlated significantly with Poiseuille resistance over the banding (r =0.67 and r = 0.65, respectively). In the closed pericardium group, the ratio of the right to left ventricular area, eccentricity index, and tricuspid annular plane systolic excursion did not correlate with resistance over the banding, only the ACmean showed a significant correlation with resistance over the banding (r = 0.88). Conclusions: ACmean is a reliable parameter of right ventricular impedance that can be used to study the heartlung interactions during mechanical ventilation.
    Minerva anestesiologica 03/2014; · 2.27 Impact Factor
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    ABSTRACT: Small airway obstruction is important in the pathophysiology of cystic fibrosis (CF) lung disease. Additionally, many CF patients lose lung function in the long term as a result of respiratory tract exacerbations (RTEs). No trials have been performed to optimize mucolytic therapy during a RTE. We investigated whether specifically targeting dornase alfa to the small airways improves small airway obstruction during RTEs. In a multi-center, double-blind, randomized controlled trial CF patients hospitalized for a RTE and on maintenance treatment with dornase alfa were switched to a smart nebulizer. Patients were randomized to small airway deposition (n = 19) or large airway deposition (n = 19) of dornase alfa for at least 7 days. Primary endpoint was forced expiratory flow at 75% of forced vital capacity (FEF75 ). Spirometry parameters improved significantly during admission, but the difference in mean change in FEF75 between treatment groups was not significant: 0.7 SD, P = 0.30. FEF25-75 , FEV1 , nocturnal oxygen saturation and diary symptom scores also did not differ between groups. This study did not detect a difference if inhaled dornase alfa was targeted to small versus large airways during a RTE. However, the 95% confidence interval for the change in FEF75 was wide. Further studies are needed to improve the effectiveness of RTE treatment in CF. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.
    Pediatric Pulmonology 02/2014; 49(2). DOI:10.1002/ppul.22800 · 2.38 Impact Factor
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    ABSTRACT: This study prospectively analyzed the efficacy of very prolonged PEGasparaginase and Erwinia asparaginase (Erwinia-asp) courses in pediatric acute lymphoblastic leukemia (ALL) patients. Patients received 15 PEGasparaginase infusions (2,500 IU/m2 q2 weeks) in intensification after receiving native E.coli asparaginase in induction. In case of allergy to or silent inactivation of PEGasparaginase, Erwinia-asp (20,000 IU/m2 2-3 times weekly) was given. Eighty-nine patients were enrolled in the "PEGasparaginase study". Twenty(22%) of the PEGasparaginase-treated patients developed an allergy; seven (8%) showed silent inactivation. PEGasparaginase level was zero in all allergic patients (grade 1-4). Patients without hypersensitivity to PEGasparaginase had serum mean trough levels of 899 U/L. Fifty-nine patients were included in the "Erwinia-asp study", two (3%) developed an allergy and none silent inactivation. Ninety-six percent had at least one trough level ≥100 U/L. Serum asparagine level was not always completely depleted with Erwinia-asp in contrast to PEGasparaginase. Presence of asparaginase-antibodies was related to allergies and silent inactivation, but with low specificity (64%). Use of native E.coli asparaginase in induction leads to high hypersensitivity rates to PEGasparaginase in intensification. Therefore, PEGasparaginase should be used already in induction and we suggest that the dose could be lowered. Switching to Erwinia-asp leads to effective asparaginase levels in most patients. Therapeutic drug monitoring has been added to our ALL-11-protocol to individualize asparaginase therapy.
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    ABSTRACT: This study prospectively analyzed the efficacy of very prolonged PEGasparaginase and Erwinia-asparaginase (Erwinia-asp) courses in pediatric acute lymphoblastic leukemia (ALL) patients. Patients received 15 PEGasparaginase infusions (2,500IU/m(2) q2 weeks) in intensification after receiving native E.coli-asparaginase in induction. In case of allergy to or silent-inactivation of PEGasparaginase, Erwinia-asp(20,000IU/m(2) 2-3 times weekly) was given. Eighty-nine patients were enrolled in the "PEGasparaginase study". Twenty(22%) of the PEGasparaginase-treated patients developed an allergy; seven(8%) showed silent inactivation. PEGasparaginase level was zero in all allergic patients(grade 1-4). Patients without hypersensitivity to PEGasparaginase had serum mean trough levels of 899 U/L. Fifty-nine patients were included in the "Erwinia-asp study", two(3%) developed an allergy and none silent-inactivation. Ninety-six percent had at least one trough level ≥100 U/L. Serum asparagine level was not always completely depleted with Erwinia-asp in contrast to PEGasparaginase. Presence of asparaginase-antibodies was related to allergies and silent-inactivation, but with low specificity(64%). Use of native E.coli-asparaginase in induction leads to high hypersensitivity rates to PEGasparaginase in intensification. Therefore, PEGasparaginase should be used already in induction and we suggest that the dose could be lowered. Switching to Erwinia-asp leads to effective asparaginase levels in most patients. Therapeutic-drug-monitoring has been added to our ALL-11-protocol to individualize asparaginase therapy.
    Blood 01/2014; DOI:10.1182/blood-2013-10-534347 · 9.78 Impact Factor
  • Annals of Surgery 01/2014; 259(1):e7. DOI:10.1097/SLA.0b013e31827b9d21 · 7.19 Impact Factor
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    ABSTRACT: Background Vitamin A is a multifunctional vitamin that can inhibit the formation of Th17 cells, which are probably involved in the development of relapses in MS. Furthermore, it promotes Treg formation. Therefore, vitamin A can be hypothesized to be lower in patients than in healthy controls, and to decrease relapse risk in relapsing–remitting MS (RRMS) patients. Objective To compare vitamin A levels in MS patients and controls, and to investigate whether vitamin A levels are associated with relapse risk. Methods In a case-control study all-trans-retinol levels were compared between 31 RRMS patients and 29 matched controls. In a prospective longitudinal study in 73 RRMS patients, serum samples for all-trans-retinol measurements were taken every eight weeks. Associations between all-trans-retinol concentrations and relapse rates were calculated using Poisson regression with the individual serum levels as time-dependent variable. Associations between vitamin A and vitamin D were calculated. Results Mean vitamin A levels were lower in patients (2.16 μmol/l) than in controls (2.44 μmol/l) but with borderline significance (p=0.05). In the longitudinal study, during follow-up (mean 1.7 years), 58 patients experienced a total of 139 relapses. Monthly moving averages of all-trans retinol levels were categorized into tertiles: a low (<2.9 μmol/l), medium (2.9–3.7 μmol/l) and high level (>3.7 μmol/l). Relapse rates were not associated with serum all-trans retinol levels (p>0.2), in univariate nor in multivariate analysis. Serum concentrations of all-trans-retinol and 25-OH-vitamin D were positively correlated, although this correlation was weak (r=0.15). Conclusion We did not find evidence for a role for vitamin A in the disease course of RRMS. We did find an association between vitamin A and D levels in the RRMS patients, possibly explained by dietary products that contain both fat-soluble vitamins.
    01/2014; 3(1):34–39. DOI:10.1016/j.msard.2013.06.011
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    ABSTRACT: To elucidate incidence and risk factors of bone mineral density and fracture risk in children with Acute Lymphoblastic Leukemia (ALL). Prospectively, cumulative fracture incidence, calculated from diagnosis until one year after cessation of treatment, was assessed in 672 patients. This fracture incidence was compared between subgroups of treatment stratification and age subgroups (Log-Rank test). Serial measurements of bone mineral density of the lumbar spine (BMDLS) were performed in 399 ALL patients using dual energy X-ray absorptiometry. We evaluated risk factors for a low BMD (multivariate regression analysis). Osteoporosis was defined as a BMDLS≤-2 SDS combined with clinical significant fractures. The 3-years cumulative fracture incidence was 17.8%. At diagnosis, mean BMDLS of ALL patients was lower than of healthy peers (mean BMDLS=-1.10 SDS, P<0.001), and remained lower during/after treatment (8months: BMDLS=-1.10 SDS, P<0.001; 24months: BMDLS=-1.27 SDS, P<0.001; 36months: BMDLS=-0.95 SDS, P<0.001). Younger age, lower weight and B-cell-immunophenotype were associated with a lower BMDLS at diagnosis. After correction for weight, height, gender and immunophenotype, stratification to the high risk (HR)-protocol arm and older age lead to a larger decline of BMDLS (HR group: β=-0.52, P<0.01; age: β=-0.16, P<0.001). Cumulative fracture incidences were not different between ALL risk groups and age groups. Patients with fractures had a lower BMDLS during treatment than those without fractures. Treatment-related bone loss was similar in patients with and without fractures (respectively: ΔBMDLS=-0.36 SDS and ΔBMDLS=-0.12 SDS; interaction group time, P=0.30). Twenty of the 399 patients (5%) met the criteria of osteoporosis. Low values of BMDLS at diagnosis and during treatment, rather than the treatment-related decline of BMDLS, determines the increased fracture risk of 17.8% in children with ALL.
    Bone 11/2013; DOI:10.1016/j.bone.2013.11.017 · 4.46 Impact Factor
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    ABSTRACT: No abstract available.
    Pediatric Blood & Cancer 11/2013; DOI:10.1002/pbc.24661 · 2.35 Impact Factor
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    Dataset: JPO HADS
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    ABSTRACT: After a more successful treatment of pediatric cancer, the number of childhood cancer survivors is progressively increasing. Consequently, awareness of psychological late sequelae is important. The Hospital Anxiety and Depression Scale (HADS) was used as a screening tool for emotional distress in a single center cohort of 652 childhood cancer survivors (median age 23 y [range, 15 to 46 y], median follow-up time 15 y [range, 5 to 42 y]). Results were compared with a control group of 440 Dutch subjects. A higher HADS score linearly reflect a higher level of emotional distress, and a score ≥15 is indicative of clinically significant emotional distress. Mean HADS score of the childhood cancer survivors was not different from the control group (P=0.38). Survivors exposed to global central nervous system (CNS) irradiation had a significantly higher HADS score than the control group (8.3±6.6; P=0.05) as well as other survivors (P=0.01). Forty-three survivors (7%) had a HADS score ≥15. Survivors with a HADS score ≥15 were variously spread over the diagnostic-related and treatment-related subgroups. Linear regression analysis showed that high educational achievement (β=-1.28; P<0.01) and age at the time of the study (β=0.08; P=0.03) were both significantly associated with the HADS score. Emotional distress does not occur more often in childhood cancer survivors than in the normal population. No disease-related or treatment-related variable was independently associated with emotional distress.
    Journal of Pediatric Hematology/Oncology 10/2013; 35(7):525-9. DOI:10.1097/MPH.0b013e31829f2799 · 0.96 Impact Factor
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    ABSTRACT: Randomized studies support the closure of midline incisions with a suture length to wound length ratio (SL:WL) of more than 4, accomplished with small tissue bites and short stitch intervals to decrease the risk of incisional hernia and wound infection. We investigated practical aspects of this technique possibly hampering the introduction of this technique. Patient data, operative variables and SL:WL ratio were collected at two hospitals: Sundsvall Hospital (SH) and Erasmus University Medical Center (EMC). A structured implementation of the technique had been performed at SH but not at EMC. Personnel were interviewed by questionnaire. At each hospital, 18 closures were analyzed. Closure time was significantly longer (p = 0.023) at SH (median 18 minutes, range: 9-59) than at EMC (median 13 minutes, range: 5-23). An SL:WL ratio of more than 4 was achieved in 8 of 18 cases at EMC and in all 18 cases at SH. We conclude that calculation of an SL:WL ratio is easily performed. Suturing with the small bite-short stitch interval technique of SH required 5 minutes extra, outweighing the morbidity of incisional hernia. Without a structured implementation to suture with an SL:WL ratio of more than 4, a lower ratio is often achieved.
    Surgical technology international 09/2013; XXIII.
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    ABSTRACT: In chronic obstructive pulmonary disease (COPD), there is a poor correlation between forced expiratory volume in 1 second (FEV1) and dyspnea following bronchodilator use. Better correlations have been observed between inspiratory lung function parameters (ILPs) and dyspnea, which drives our interest in ILPs. However, the acute and prolonged effects of long-acting bronchodilators and oral corticosteroids on ILPs have not been well investigated. Therefore, the aim of this study was to investigate the effects of these treatments on the ILPs, FEV1, dyspnea (visual analogue scale (VAS)) and clinical COPD questionnaire (CCQ). Twenty-eight stable COPD patients had their ILPs and FEV1 measured both before and 2 hours after the use of a single dose of 18 mcg bronchodilator tiotropium and 50 mcg salmeterol. Thereafter, the patients were randomized to 2 weeks of treatment with 30 mg oral prednisolone once daily or oral placebo in combination with daily treatment with these two bronchodilators. Four weeks after the cessation of the randomized treatment, the ILPs and FEV1 were again measured. After each intervention, any change in the VAS score was assessed. With both bronchodilators, significant improvements in ILPs was demonstrated (p < 0.005), with the exception of changes in ILPs inspiratory capacity (IC) and forced inspiratory flow at 50% of the vital capacity (FIF50) after tiotropium inhalation. After 2 weeks of treatment with prednisolone, significant differences were found for ILP forced inspiratory volume in one second (FIV1) and FEV1 compared with placebo. These differences were no longer present 4 weeks after the cessation of prednisolone. Significant relationships between ILPs and VAS scores were only found after 2 weeks of treatment with prednisolone or placebo. After a single dose of long-acting bronchodilator salmeterol, significant improvements are observed in all ILPs and in FIV1 and PIF after tiotropium. Two weeks of oral corticosteroid treatment improved the FIV1 and FEV1. The dyspnea VAS score was only significantly correlated with the ILPs after 2 weeks of oral corticosteroid treatment.
    Pulmonary Pharmacology &amp Therapeutics 09/2013; DOI:10.1016/j.pupt.2013.09.002 · 2.54 Impact Factor
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    ABSTRACT: To investigate the implementation of the International Confederation of Midwives/ International Federation of Gynecology and Obstetrics (ICM/ FIGO) guideline on active third stage management in vaginal deliveries in daily clinical practice. Observational, cross-sectional study. One tertiary and one teaching hospital in the Netherlands. Population Women undergoing vaginal deliveries. A case record form was completed after every vaginal delivery. Primary outcome was adequate guideline adherence, defined as initial administration of 10 IU oxytocin, performance of controlled cord traction and uterine massage. Adequate guideline adherence was a priori estimated to be 10%. With a sample size of 600, i.e. 300 women per hospital, the standard error of the resulting percentage would be less than 2% for each hospital. Six-hundred-twenty-six women were included. Guideline adherence was adequately performed in 48% of vaginal deliveries. Oxytocin was administered after birth in 98% of deliveries and in 80% the correct dose was used. Controlled cord traction was performed in 63% and uterine massage in 93%; however, the latter was performed as advised (at least eight times) in only 8%. The amount of blood loss was not associated with the use of either 5 or 10 IU oxytocin (p = 0.818). Controlled cord traction and uterine massage were more frequently performed when blood loss exceeded 500 mL (p < 0.001). Active third stage management according to the ICM/FIGO guideline is adequately performed in only 48% of all vaginal deliveries. Results of this study call for training programs to enhance adherence to the ICM/ FIGO guideline. This article is protected by copyright. All rights reserved.
    Acta Obstetricia Et Gynecologica Scandinavica 08/2013; 92(11). DOI:10.1111/aogs.12238 · 1.85 Impact Factor
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    ABSTRACT: Newborns in need of extracorporeal membrane oxygenation (ECMO) support are at high risk of developing acute kidney injury (AKI). AKI may occur as part of multiple organ failure and can be aggravated by exposure to components of the extracorporeal circuit. AKI necessitates adjustment of dosage of renally eliminated drugs and avoidance of nephrotoxic drugs. We aimed to systematically define the incidence and clinical course of AKI in critically ill neonates receiving ECMO support. This study reviewed prospectively collected clinical data (including age, diagnosis, ECMO course, and serum creatinine [SCr]) of all ECMO-treated neonates within our institution spanning a fourteen-year period. AKI was defined using the Risk, Injury, Failure, Loss of renal function, and End-stage renal disease (RIFLE) classification. SCr data were reviewed per ECMO day and compared to age-specific SCr reference values. Accordingly, patients were assigned to RIFLE categories (Risk, Injury, or Failure as 150%, 200% or 300% of median SCr reference values). Data are presented as median and interquartile range (IQR) or number and percentage (%). 242 patients were included of whom 179 survived (74%). Median age at start ECMO was 39 hours [IQR 26 - 63]; median ECMO duration was 5.8 days [IQR 3.9 - 9.4]. 153 patients (64%) had evidence of AKI, with 72 (30%) qualifying as Risk, 55 (23%) as Injury and 26 (11%) as Failure. At the end of the study period only 71 patients (46%) out of all 153 AKI patients improved at least one RIFLE category. Using regression analysis it was found that nitric oxide ventilation (p=0.04) and younger age at start ECMO (p=0.004) were significant predictors of AKI. Survival until intensive care unit discharge was significantly lower for patients in the Failure category (35%) as compared to the Non-AKI (78%), Risk (82%) and Injury category (76%), with all p<0.001, while there were no significant differences between the three latter RIFLE categories. Two thirds of neonates on ECMO suffered from AKI, with a significantly increased mortality risk for patients in the Failure category. As AKI during childhood may predispose for chronic kidney disease in adulthood, long-term monitoring of kidney function after ECMO is warranted.
    Critical care (London, England) 07/2013; 17(4):R151. DOI:10.1186/cc12830 · 5.04 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: Routine histopathological examination of gallbladder specimens is mainly performed to identify unexpected gallbladder carcinoma (GBC). This systematic review assesses the prevalence and characteristics of GBC in cholecystectomy specimens. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for all articles reporting on the finding of GBC in cholecystectomy specimens. Of the 30 articles included, 20 were from Europe and the United States, and 10 were of Asian origin. In the Western studies, 276 cases of GBC were found in 61,542 specimens (median prevalence 0.4 %, 95 % confidence interval [CI] 0.3-0.6). Of these, 65 % were expected pre- or intraoperatively. In the Asian studies, 344 cases of GBC were found in 37,365 specimens (median prevalence 1.2 %, 95 % CI 0.8-1.7). Of these, 45 % were expected pre- or intraoperatively. In a subgroup analysis, identification of previously unexpected GBC affected treatment in only a minority of patients. In total, 72 % of the patients received no further treatment and 32 patients (22 %) received secondary surgery, of whom 15 patients survived at least 1 year. The histopathological finding of GBC after cholecystectomy appears to be a rare event. The prevalence of unexpected GBC was higher in Asian studies than in Western studies. The pre- and intraoperative sensitivity for this carcinoma is low. Moreover, the diagnosis of GBC at the time of histopathology is usually inconsequential. The results of this systematic review do not support routine histopathology of cholecystectomy specimens in clinical practice.
    Surgical Endoscopy 07/2013; 27(12). DOI:10.1007/s00464-013-3084-3 · 3.31 Impact Factor
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    ABSTRACT: Introduction Children with persistent asthma may have diminished lung function in early adulthood. In our previous study (‘CATO’) we showed preservation of lung function in asthmatic children, during 2 years of treatment that was guided by airway hyperresponsiveness (AHR). The aim of the present prospective follow up study was to investigate whether the positive effect of the AHR strategy on lung function had persisted beyond the duration of the intervention study, after several years of usual care by paediatrician and general practitioner. Methods With a mean interval of 4.4 y after the last visit, 137 subjects (67% of the original CATO population) participated in this follow-up study. Evaluation consisted of spirometry (n = 137), a methacholine challenge test (n = 83), data on inhaled steroid treatment and asthma exacerbations (n = 137), and an asthma symptom diary during 6 weeks (n = 90). Results At follow-up, lung function, % symptom-free days and exacerbation rates of both treatment strategy groups was similar. The mean dose of inhaled corticosteroids had diminished from 550 μg/day at the end of CATO to 235 μg/day at follow-up. The decrease in AHR measured at the end of CATO was maintained at follow-up for both treatment strategy groups. Conclusion The beneficial effect on lung function of 2 years treatment guided by AHR was lost after 3–7 years of usual care. This suggests that an AHR-guided treatment strategy may need to be sustained in order to preserve lung function.
    Respiratory Medicine 07/2013; 107(7):981–986. DOI:10.1016/j.rmed.2013.03.008 · 2.92 Impact Factor

Publication Stats

20k Citations
2,786.68 Total Impact Points

Institutions

  • 1998–2015
    • Erasmus MC
      • • Department of Biostatistics
      • • Department of Pediatrics
      • • Department of Surgery
      • • Department of Radiology
      • • Department of Oncological Surgery
      Rotterdam, South Holland, Netherlands
  • 2009–2013
    • HagaZiekenhuis van Den Haag
      's-Gravenhage, South Holland, Netherlands
  • 2002–2013
    • IJsselland Ziekenhuis
      Kapelle, South Holland, Netherlands
    • The University of Manchester
      Manchester, England, United Kingdom
    • University of Milan
      Milano, Lombardy, Italy
  • 1982–2012
    • Erasmus Universiteit Rotterdam
      • • Department of Pathology
      • • Department of Epidemiology
      • • Department of Obstetrics and Gynaecology
      • • Department of Surgery
      • • Department of Virology
      • • Department of Internal Medicine
      • • Department of Urology
      Rotterdam, South Holland, Netherlands
  • 2005–2009
    • Radboud University Nijmegen
      • Department of Pediatrics
      Nymegen, Gelderland, Netherlands
    • Medisch Centrum Zuid
      Groningen, Groningen, Netherlands
  • 2008
    • Institute of Immunology and Physiology
      Sverolovsk, Sverdlovsk, Russia
    • Delft University Of Technology
      • Department of Industrial Design
      Delft, South Holland, Netherlands
  • 2005–2008
    • Canadian Society for Epidemiology and Biostatistics 
      Canada
  • 2007
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • University Medical Center Utrecht
      • Urology
      Utrecht, Utrecht, Netherlands
  • 2006–2007
    • University of Groningen
      Groningen, Groningen, Netherlands
    • Hospital of Nij Smellinghe
      Drachten, Friesland, Netherlands
  • 2001–2005
    • Maastricht Universitair Medisch Centrum
      Maestricht, Limburg, Netherlands
    • Leiden University
      • Molecular Cell Biology Group
      Leyden, South Holland, Netherlands
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 2004
    • St Anna's Kinderspital
      Wien, Vienna, Austria
  • 2002–2004
    • Groene Hart Ziekenhuis
      Guda, South Holland, Netherlands
  • 1991–2004
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Department of Radiology
      • • Department of Obstetrics & Gynecology
      Amsterdam, North Holland, Netherlands
  • 2003
    • George Washington University
      • Department of Pediatrics
      Washington, Washington, D.C., United States
    • Karolinska Institutet
      • Department of Oncology-Pathology
      Solna, Stockholm, Sweden
  • 1994–2002
    • Het Oogziekenhuis Rotterdam
      Rotterdam, South Holland, Netherlands
  • 2000
    • University of California, San Francisco
      San Francisco, California, United States
    • VU University Amsterdam
      Amsterdamo, North Holland, Netherlands
    • Maastricht University
      • Pulmonologie
      Maastricht, Provincie Limburg, Netherlands