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Donadio MVF, Barbosa MA, Vendrusculo FM, Ramirez TI, Santana-Sosa E, Sanz-Santiago V, Perez-Ruiz M. Mechanisms of ventilatory limitation to maximum exercise in children and adolescents with chronic airway diseases. Pediatr Pulmonol 2023; 58:3293-3302. [PMID: 37671821 DOI: 10.1002/ppul.26659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Exercise intolerance is common in chronic airway diseases (CAD), but its mechanisms are still poorly understood. The aim of this study was to evaluate exercise capacity and its association with lung function, ventilatory limitation, and ventilatory efficiency in children and adolescents with cystic fibrosis (CF) and asthma when compared to healthy controls. METHODS Cross-sectional study including patients with mild-to-moderate asthma, CF and healthy children and adolescents. Anthropometric data, lung function (spirometry) and exercise capacity (cardiopulmonary exercise testing) were evaluated. Primary outcomes were peak oxygen consumption (VO2 peak), forced expiratory volume in 1 s (FEV1 ), breathing reserve (BR), ventilatory equivalent for oxygen consumption (VE /VO2 ) and for carbon dioxide production (VE /VCO2 ), both at the ventilatory threshold (VT1 ) and peak exercise. RESULTS Mean age of 147 patients included was 11.8 ± 3.0 years. There were differences between asthmatics and CF children when compared to their healthy peers for anthropometric and lung function measurements. Asthmatics showed lower VO2 peak when compared to both healthy and CF subjects, although no differences were found between healthy and CF patients. A lower BR was found when CF patients were compared to both healthy and asthmatic. Both CF and asthmatic patients presented higher values for VE /VO2 and VE /VCO2 at VT1 when compared to healthy individuals. For both VE /VO2 and VE /VCO2 at peak exercise CF patients presented higher values when compared to their healthy peers. CONCLUSION Patients with CF achieved good exercise capacity despite low ventilatory efficiency, low BR, and reduced lung function. However, asthmatics reported reduced cardiorespiratory capacity and normal ventilatory efficiency at peak exercise. These results demonstrate differences in the mechanisms of ventilatory limitation to maximum exercise testing in children and adolescents with CAD.
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Affiliation(s)
- Márcio Vinícius Fagundes Donadio
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Marta Amor Barbosa
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Fernanda Maria Vendrusculo
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Tamara Iturriaga Ramirez
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Elena Santana-Sosa
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Veronica Sanz-Santiago
- Department of Pulmonology, Hospital Universitario Infantil Niño Jesús de Madrid, Madrid, Spain
| | - Margarita Perez-Ruiz
- Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid (UPM), Madrid, Spain
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Chu F, Kappel N, Akel M, Press VG, Alexander JT, Volerman A. Validity of the Childhood Asthma Control Test in diverse populations: A systematic review. Pediatr Pulmonol 2023; 58:1322-1336. [PMID: 36718492 PMCID: PMC10121871 DOI: 10.1002/ppul.26342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE We examined the validity of the Childhood Asthma Control Test (C-ACT) and identified recommended thresholds for uncontrolled asthma in children from varying backgrounds. METHODS A systematic literature review was performed utilizing PubMed, Ovid Medline, SCOPUS, CINAHL, and conference proceedings. Studies were included if they enrolled children, had a primary outcome of asthma control, examined test validity or psychometrics, and utilized the C-ACT. Along with study design and demographic data, we extracted all outcomes and comparisons used to validate the C-ACT. We evaluated risk of bias using the COSMIN Risk of Bias tool. Our protocol was registered with PROSPERO (CRD42020211119). RESULTS Of 4924 records screened, 28 studies were included. Studies were conducted internationally and published between 2007 and 2018. Average number of enrolled participants was 193 (SD = 155, range = 22-671). Ten studies calculated Cronbach's α (mean [SD] = 0.78(0.05), range = 0.677-0.83). Thirteen studies recommended cut-offs for uncontrolled asthma (≤18-≤24). Nine studies found significant agreement or correlation between C-ACT and Global Initiative for Asthma guidelines/physician assessment of asthma control (correlation coefficients range = 0.219-0.65). Correlation coefficients between C-ACT and spirometry were <0.6 in five of six studies that included spirometry. Kappa values for C-ACT and various spirometry measurements ranged 0.00-0.34. CONCLUSIONS The C-ACT showed good internal consistency and mixed levels of agreement and correlation with various clinical asthma measures. Recommended cut-offs for asthma control varied and had no consistent relationship with nationality, race, ethnicity, or language. Few studies examined cross-cultural validity and multiple populations remain under-studied.
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Affiliation(s)
- Francesca Chu
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Nicole Kappel
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Mary Akel
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Valerie G Press
- University of Chicago, Department of Medicine, Section of General Internal Medicine
- University of Chicago, Department of Pediatrics, Section of Academic Pediatrics
| | - Jason T Alexander
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Anna Volerman
- University of Chicago, Department of Medicine, Section of General Internal Medicine
- University of Chicago, Department of Pediatrics, Section of Academic Pediatrics
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Fungi Sensitization in Spain: Importance of the Alternaria alternata Species and Its Major Allergen Alt a 1 in the Allergenicity. J Fungi (Basel) 2021; 7:jof7080631. [PMID: 34436170 PMCID: PMC8398619 DOI: 10.3390/jof7080631] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/12/2023] Open
Abstract
Prevalence of allergy to fungi is around 3–10%. The most prevalent species involved in sensitizations are Alternaria alternata, Aspergillus fumigatus, Cladosporium herbarum, and Penicillium notatum. Our main objective was to estimate the prevalence of fungal sensitization and its variation across Spain. Following the ICH-GCP, we recruited 1156 patients from 15 allergy departments in Spain. Hospitals were selected by bioclimatic areas. Patients underwent a skin prick test (SPT) with fungi, pollens, house dust mites, and animal dander. Specific IgE to Alternaria alternata and Alt a 1 was assessed in patients with positive SPT to fungi. Of the 233 patients (20.2%) sensitized to at least one of the five fungi tested, 162 (69.5%) were sensitized to Alternaria alternata and Alt a 1, of whom 113 (69.8%) were children; 181 (77.7%) were also polysensitized to other allergens. Alternaria alternata and Alt a 1 sensitization was present in 25.4% of patients in the Continental area, 12.0% in the Mediterranean area, 7.0% in the Semidesertic area, and 2.3% in the Oceanic area. Prevalence of sensitization to the other tested sources was 63.8% to pollens, 60.5% to house dust mite, and 38.1% to animal dander. We concluded that the prevalence of fungal allergy is increasing. Fungi are still the fourth source of allergen sensitization. Alternaria alternata sensitization is the most prevalent in allergic patients to fungi. Alt a 1 is present in almost 90% of the patients sensitized to Alternaria alternata.
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Sanz-Santiago V, Diez-Vega I, Donadio MVF, Schiwe D, Lopez-Nuevo C, Vendrusculo FM, Santana-Sosa E, Burgos S, Escribano-Ceruelo E, Villa-Asensi JR, Perez-Ruiz M. Comparison of physical fitness between healthy and mild-to-moderate asthmatic children with exercise symptoms: A cross-sectional study. Pediatr Pulmonol 2021; 56:2512-2521. [PMID: 34061472 DOI: 10.1002/ppul.25506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Asthma is a chronic disease that may affect physical fitness, although its primary effects on exercise capacity, muscle strength, functionality and lifestyle, in children and adolescents, are still poorly understood. This study aimed to evaluate the differences in cardiorespiratory fitness, muscle strength, lifestyle, lung function, and functionality between asthmatics with exercise symptoms and healthy children. In addition, we have analyzed the association between clinical history and the presence of asthma. STUDY DESIGN Cross-sectional study including 71 patients with a diagnosis of asthma and 71 healthy children and adolescents (7-17 years of age). Anthropometric data, clinical history, disease control, lifestyle (KIDMED and physical activity questionnaires), lung function (spirometry), exercise-induced bronchoconstriction test, aerobic fitness (cardiopulmonary exercise test), muscle strength and functionality (timed up and go; timed up and down stairs) were evaluated. RESULTS Seventy-one patients with asthma (mean age 11.5 ± 2.7) and 71 healthy subjects (mean age 10.7 ± 2.5) were included. All asthmatic children had mild to moderate and stable asthma. EIB occurred in 56.3% of asthmatic children. Lung function was significantly (p < .05) lower in the asthmatic group when compared to healthy peers, as well as the cardiorespiratory fitness, muscle strength, lifestyle and functionality. Moreover, asthmatic children were more likely to have atopic dermatitis, allergic reactions, food allergies, and a family history of asthma when compared to healthy children. CONCLUSIONS Children with mild-to-moderate asthma presenting exercise symptoms show a reduction in cardiorespiratory fitness, muscle strength, lung function, functionality, and lifestyle when compared to healthy peers. The study provides data for pediatricians to support exercise practice aiming to improve prognosis and quality of life in asthmatic children.
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Affiliation(s)
| | - Ignacio Diez-Vega
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Ponferrada, León, Spain
| | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Daniele Schiwe
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Fernanda M Vendrusculo
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Silvia Burgos
- Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
| | | | - Jose R Villa-Asensi
- Section of Pulmonology, Niño Jesús Children's University Hospital, Madrid, Spain
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Sanz-Santiago V, Diez-Vega I, Santana-Sosa E, Lopez Nuevo C, Iturriaga Ramirez T, Vendrusculo FM, Donadio MVF, Villa Asensi JR, Pérez-Ruiz M. Effect of a combined exercise program on physical fitness, lung function, and quality of life in patients with controlled asthma and exercise symptoms: A randomized controlled trial. Pediatr Pulmonol 2020; 55:1608-1616. [PMID: 32353218 DOI: 10.1002/ppul.24798] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Asthmatic patients may benefit from exercise training, although the effects of a combined aerobic and resistance training program are still poorly investigated in children and adolescents. OBJECTIVE To analyze the effects of a combined exercise training (resistance and aerobic) program on aerobic fitness, lung function, asthma control and quality of life in a group of mild-moderate asthmatic children with exercise symptoms. METHODS This was a 12-week randomized controlled trial including children and adolescents diagnosed with mild-moderate asthma and presenting exercise-induced symptoms. The intervention group (IG) performed the exercise training (resistance and aerobic) 3 days/week, for 60 minutes. The control group (CG) followed routine clinical orientations. The main outcomes were cardiorespiratory fitness, muscle strength, lung function, quality of life, asthma control, and functional tests after 3 months of the intervention. RESULTS Fifty-three patients (IG = 25 and CG = 28) with a mean age of 11.5 ± 2.6 years were included. No significant differences were found between groups regarding lung function, asthma control, quality of life, and functional tests. Ventilatory equivalent for oxygen consumption at ventilatory threshold (P = .025; ηp2 = 0.083), peak oxygen consumption (P = .008; ηp2 = 0.116) and test duration (P = .014; ηp2 = 0.1) presented greater improvements in the IG. In addition, improvements were observed in leg press (P < .001; ηp2 = 0.36), hamstring curl (P = .001; ηp2 = 0.217), high row (P = .003; ηp2 = .167), low row (P = .009; ηp2 = 0.128) and quadriceps leg extension (P = .015; ηp2 = 0.108) in the IG. CONCLUSION Combined exercise training (resistance and aerobic) improved cardiorespiratory fitness and muscle strength in children and adolescents with controlled asthma and exercise symptoms.
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Affiliation(s)
| | - Ignacio Diez-Vega
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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Martínez-González CL, Camargo-Fajardo MCC, Segura-Medina P, Quezada-Bolaños P. Therapeutic Patient Education with Learning Objects Improves Asthma Control in Mexican Children. J Med Syst 2020; 44:79. [PMID: 32128625 DOI: 10.1007/s10916-020-1539-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
One of the most common chronic diseases that causes missed school days and workdays is pediatric asthma, producing education, health and economic delays in low and middle-income countries. A patient-centered remarkable therapeutic strategy in the prevention and treatment of chronic diseases is the Therapeutic Patient Education (TPE) which denotes an outstanding difference in the outcomes, from the awareness, to the personal treatment adaption to prevent crises. In this paper, an intervention of TPE with learning objects (LOs) of a pediatric asthma course, designed to train the uncontrolled patient and the caregiver as a team on the specific knowledge to self-control the disease, was carried out at a health facility in Mexico. The Asthma Control Test (ACT) was used and the learning performance was evaluated with formative quizzes. A randomized controlled trial was designed, with pairs of children patients and caregivers during 60 days; the control group was trained with the usual approach, receiving general information about the disease. ACT measures showed statistical significance for the TPE group after the use of the LOs, achieving a controlled state, while the control group did not show difference. Also, the intervention group obtained a higher score in learning performance assessment. The users learned how to avoid risks, the personal triggers of the patient, how to correctly use the different treatments and accessories, consequently, they learned how to self-manage the disease. Our study also confirmed that control of asthma is not only a matter of knowledge, but financial issues to afford the treatment.
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Affiliation(s)
- C L Martínez-González
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, 07738, México, Mexico.
| | - M C C Camargo-Fajardo
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, 07738, México, Mexico
| | - P Segura-Medina
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias, 14080, México, Mexico.,Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, 14380, México, Mexico
| | - P Quezada-Bolaños
- CECyT2 "Miguel Bernard", Instituto Politécnico Nacional, Lomas de Sotelo, 11200, México, Mexico
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Asthma control in the quality of life levels of asthmatic patients’ caregivers: a systematic review with meta‐analysis and meta‐regression. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Asthma control in the quality of life levels of asthmatic patients' caregivers: a systematic review with meta-analysis and meta-regression. J Pediatr (Rio J) 2019; 95:401-409. [PMID: 30540924 DOI: 10.1016/j.jped.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To perform a systematic review with meta-analysis and meta-regression to correlate the total scores of asthma control with the increase in the total scores of health-related quality of life levels of parents of asthmatic children. SOURCES The search was carried out in the following databases: PubMed (MEDLINE); Embase and ScienceDirect (Elsevier); SciELO and LILACs (Bireme) in June 2017. The included studies assessed asthma control through the Asthma Control Questionnaire (ACQ), Asthma Control Test (C-ACT/ACT), and Global Initiative for Asthma (GINA) questionnaires, whereas the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) was applied to assess the HRQoL of parents and family members. SUMMARY OF THE FINDINGS 294 articles were evaluated in the selected databases, of which (n=38) were excluded for duplicity; (n=239) after the reading of the titles and abstracts and (n=5) after reading the studies in full, totaling 12 studies eligible for the meta-analysis. Of the 12 eligible articles, 11 (92%) were published in the last five years, and evaluated children and adolescents aged 1-20 years, totaling 2804 samples. In the evaluation of the correlation between the disease control scores by ACQ and C-ACT/ACT, the results were satisfactory for both ACQ analyses [R2: -0.88; p<0.001], and for C-ACT/ACT [R2: 0.82; p<0.001]. CONCLUSIONS The results show that asthma control levels can influence the total HRQoL scores of parents or relatives of children and adolescents with asthma.
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Azaldegi G, Korta J, Sardón O, Corcuera P, Pérez-Yarza EG. Small Airway Dysfunction in Children With Controlled Asthma. Arch Bronconeumol 2019; 55:208-213. [PMID: 30770124 DOI: 10.1016/j.arbres.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/02/2018] [Accepted: 08/29/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Asthma is characterized by chronic inflammation of the central and distal airways. The aim of this study was to assess the small airway (SA) of children with moderate-severe asthma with normal FEV1. METHODS This was an open-label, prospective, observational, cross-sectional study with consecutive inclusion of patients with moderate-severe asthma, receiving standard clinical treatment, with normal baseline FEV1. We determined multiflow FEno (CAno), oscillatory resistance and reactance (R5-R20, X5), forced spirometry (FEV1, FEF25-75), total body plethysmography (RV/TLC) and bronchodilation test. SA involvement was defined as: CAno>4.5 ppb, R5-R20>0.147kPa/L/s, X5<-0.18kPa/L, FEF25-75<-1.65 z-score, RV/TLC>33%. Poor asthma control was defined as ≤ 19 points on the ACT questionnaire or ≤ 20 on the c-ACT. RESULTS In a cohort of 100 cases, 76 had moderate asthma and 24 had severe asthma; 71 children were classified as poorly controlled and 29 were well-controlled. In total, 77.78% of the group with all the correct determinations (n=72) showed ≥ 1 altered SA parameter and 48.61% ≥ 2 parameters. There were no differences between well-controlled or poorly controlled cases. CONCLUSIONS Children with moderate-severe asthma, with normal FEV1, show a phenotype of dysfunctional SA. In our series, the evaluation of SA using the techniques described above did not provide information on disease control.
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Affiliation(s)
- Garazi Azaldegi
- Sección de Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España
| | - Javier Korta
- Sección de Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España; Departamento de Pediatría, Universidad del País Vasco (UPV/EHU), San Sebastián, España
| | - Olaia Sardón
- Sección de Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España; Departamento de Pediatría, Universidad del País Vasco (UPV/EHU), San Sebastián, España
| | - Paula Corcuera
- Sección de Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España
| | - Eduardo G Pérez-Yarza
- Sección de Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España; Departamento de Pediatría, Universidad del País Vasco (UPV/EHU), San Sebastián, España; Centro de Investigación Biomédica en Red, Enfermedades Respiratorias (CIBERES), San Sebastián, España.
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Herrera A, Brand P, Cavada G, Koppmann A, Rivas M, Mackenney J, Sepúlveda H, Wevar M, Cruzat L, Soto S, Pérez M, León A, Contreras I, Alvarez C, Walker B, Flores C, Lezana V, Garrido C, Herrera M, Rojas A, Andrades C, Chala E, Martínez R, Vega M, Perillán J, Seguel H, Przybyzsweski I. Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study. Allergol Immunopathol (Madr) 2018; 46:533-538. [PMID: 29720350 DOI: 10.1016/j.aller.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.
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AlTeneiji M, AlKalbani A, Nasser H, Iram D, Alblooshi A, Narchi H. Cross-sectional study assessing the performance of the Arabic translated childhood asthma control test. NPJ Prim Care Respir Med 2018; 28:41. [PMID: 30385757 PMCID: PMC6212419 DOI: 10.1038/s41533-018-0109-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/01/2018] [Indexed: 11/25/2022] Open
Abstract
The standard Arabic version of the Childhood Asthma Control Test (C-ACT) has never been previously evaluated in Arab countries. We studied its correlation in Arabic speaking children in the United Arab Emirates (UAE), with both the GINA assessment of asthma control and the resulting changes in asthma management. The Arabic C-ACT was completed by the children or by their parents when needed. A GINA based level of asthma control score was assigned by their managing physician. The correlation between the different cut- scores of the C-ACT and GINA were studied. A total of 105 eligible children with asthma (aged between 4 and 11.8 years, 61% boys) were enrolled. The Arabic translated C-ACT had a high reliability (Cronbach alpha 81%) and validity (as it correlated well with the GINA level of control). We found that using it with the traditional cut-score of 19 overestimated the degree of asthma control. Instead, a calculated optimal cut-score of 20 estimated more accurately the level of asthma control as assessed both by the GINA assessment and also by changes in asthma management. The current Arabic version of the C-ACT has a good reliability and validity. By using a single optimal cut-point of 20, it can be used to assess both the level of asthma control and of treatment control. It does not, however, accurately define asthma control when using the originally proposed cut-score of 19. Physicians need to recognise that the C-ACT cut-points may vary in different populations. We suggest that cut-scores of translated versions need to be modified in different geographical settings. The cut-off score suggestive of poor disease management in the Childhood Asthma Control Test (C-ACT) may need to be changed for different geographical populations. Majid AlTeneiji at Tawam Hospital in Al-Ain, and co-workers across the United Arab Emirates compared the performance of the Arabic version of the C-ACT with the global asthma control test, GINA, in verifying levels of asthma and treatment control. The researchers enrolled 105 children aged 4 to 11 who completed both tests. The Arabic C-ACT performed with high reliability and validity, but the team found that the original English cut-point score of 19, indicating poor disease management, should be raised to 20 in their Arabic population to improve test accuracy. AlTeneiji’s team suggest that the C-ACT test points system may need to be revised for different geographical settings around the world.
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Affiliation(s)
- Majid AlTeneiji
- Department of Pediatrics, Tawam Hospital in affiliations with Johns Hopkins Medicine, P.O.Box 15258, Abu Dhabi, United Arab Emirates.
| | - Alia AlKalbani
- Department of Pediatrics, Tawam Hospital in affiliations with Johns Hopkins Medicine, P.O.Box 15258, Abu Dhabi, United Arab Emirates
| | - Huda Nasser
- Department of Pediatrics, Tawam Hospital in affiliations with Johns Hopkins Medicine, P.O.Box 15258, Abu Dhabi, United Arab Emirates
| | - Durdana Iram
- Department of Pediatrics, Tawam Hospital in affiliations with Johns Hopkins Medicine, P.O.Box 15258, Abu Dhabi, United Arab Emirates
| | - Afaf Alblooshi
- Department of Pediatrics, College of Medicine and Health Science, United Arab Emirates University, P.O.Box 17666, Al-Ain, United Arab Emirates
| | - Hassib Narchi
- Department of Pediatrics, College of Medicine and Health Science, United Arab Emirates University, P.O.Box 17666, Al-Ain, United Arab Emirates
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MONITOREO DEL ASMA: APORTE DE LA OSCILOMETRÍA DE IMPULSO (IOS). REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Montalbano L, Cilluffo G, Gentile M, Ferrante G, Malizia V, Cibella F, Viegi G, Passalacqua G, La Grutta S. Development of a nomogram to estimate the quality of life in asthmatic children using the Childhood Asthma Control Test. Pediatr Allergy Immunol 2016; 27:514-20. [PMID: 27018497 DOI: 10.1111/pai.12571] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric Asthma Quality of Life Questionnaire (PAQLQ) provides detailed information on QoL in asthmatic children, whereas Childhood Asthma Control Test (C-ACT) Questionnaire is the most validated instrument for asthma control. No study assessed the relationship between C-ACT and QoL in children by means of those instruments. The aim of this study was to determine whether a QoL estimation is possible using the C-ACT questionnaire in asthmatic children. METHODS Medical history, spirometry, C-ACT, and PAQLQ were assessed in 144 (60% male) outpatient asthmatic children from September 2011 to November 2014. A generalized linear model (GLM) for the prediction of PAQLQ was obtained through a stepwise procedure starting from a full model with all C-ACT items, and predictive nomograms were created. RESULTS Fifty-five (38%) well-controlled (WC) asthma, 37 (26%) partially controlled (PC) asthma, and 52 (36%) uncontrolled asthma (UA) patients were enrolled. Persistent asthmatics (PA) were significantly more uncontrolled (p < 0.0001). A significant reduction in FEV1 , FEV1 /FVC, and FEF25-75 (p = 0.005, p < 0.0001, and p < 0.001, respectively) was found in WC vs. UA. Through a stepwise process, a reduced model showed a positive relationship between the PAQLQ and the four items of C-ACT. The regression equations for predicted PAQLQ were ln(PAQLQ) = 1.17 + 0.05*C-ACT2 + 0.03*C-ACT3 + 0.04*C-ACT6 + 0.03*C-ACT7. Thus, a nomogram was constructed. CONCLUSION The designed nomogram provides a highly predictive assessment of QoL in individual patients, facilitating a more comprehensive assessment of asthmatic children in usual clinical care.
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Affiliation(s)
- Laura Montalbano
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Department of Psychological Educational and Training Sciences, University of Palermo, Palermo, Italy
| | - Giovanna Cilluffo
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Department of Economics, Statistics and Business Sciences, University of Palermo, Palermo, Italy
| | - Manuel Gentile
- Institute for Educational Technologies, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Department of Science for Health promotion and Mother and Child care, University of Palermo, Palermo, Italy
| | - Velia Malizia
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Fabio Cibella
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Giovanni Viegi
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, National Research Council of Italy, Pisa, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Genoa, Italy
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
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