Variaciones geográficas en la prevalencia de síntomas de asma en los niños y adolescentes españoles. International Study of Asthma and Allergies in Childhood (ISAAC) fase III España

Respiratory, cardio-metabolic and neurodevelopmental long-term outcomes of moderate to late preterm birth: not just a near term-population. A follow-up study

Introduction

Moderate-to-late preterm infants constitute the majority within the preterm infant population. Most research on preterm infants has focused on very preterm children, often treating moderate-to-late preterm infants as similar to full-term infants. Our objective was to compare clinical, respiratory, cardio-metabolic and neurodevelopmental outcomes in adolescents aged 12-15 years born moderate and late preterm with a control group of the same age born full-term.

Methods

Observational cross-sectional study, comparing moderate-to-late preterm (32-36+6 weeks' gestational age) with full-term adolescents (37-41+6 weeks' gestational age; 75 each group). Perinatal and neonatal history were collected as well as data on respiratory evolution (ISAAC questionnaire for asthma symptoms for adolescents 13-14 years), anthropometric values, learning difficulties, behavioral test (screening questionnaire for high-performance autism spectrum disorder and evaluation test for attention deficit hyperactivity disorder), skin prick test, pulmonary function test, echocardiogram and blood pressure. A blood test with metabolic profile was conducted.

Results

Moderate-to-late preterm adolescents had more current asthma [p = 0.008, OR3 (95% CI 1.26-7.14)] and longer duration of combined treatments to control asthma (inhaled corticosteroids and anti-leukotrienes; p = 0.048). Forced vital capacity <80% was detected more often in moderate-to-late preterm patients (p = 0.013). When assessing right ventricle, moderate-to-late preterm adolescents showed better tricuspid annular plane systolic excursion z-score (p = 0.003), shortening fraction (p < 0.001) and E/A ratio z-score (p = 0.002). Regarding left ventricular assessment, moderate-to-late preterm group had smaller ventricle diastolic diameter (p = 0.04) and lower posterior wall z-score values (p = 0.037). They also showed a better S'wave z-score (p = 0.027), E wave (p = 0.005), E/A ratio (p = 0.003) and a higher septal myocardial performance index z-score (p = 0.025). Moderate-to-late preterm adolescents presented lower weight z-score (p = 0.039), body mass index z-score (p = 0.013), Waterlow weight index (p = 0.006) and higher undernutrition index [p = 0.04; OR 1.4 (95% CI 1-1.9)]. Although there were no differences in neurodevelopmental survey or behavioral tests.

Conclusion

Our findings underscore the importance of extended follow-up for this predominant group of premature infants to identify potential respiratory, cardiac and anthropometric issues that may emerge in the future.

GEMA 5.3. Spanish Guideline on the Management of Asthma

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).

Prevalence and time trends of symptoms of allergic rhinitis and rhinoconjunctivitis in Spanish children: Global Asthma Network (GAN) study

INTRODUCTION

The time trends of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy previously described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 are unknown; or if the geographical or age differences in Spain persist.

OBJECTIVE

To describe the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy in different Spanish geographical areas and compare them with those of the ISAAC.

METHODS

Cross-sectional study of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy, carried out in 2016-2019 on 19943 adolescents aged 13-14 years and 17215 schoolchildren aged 6-7 years from six Spanish areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona, and Salamanca), through a questionnaire based on the Global Asthma Network (GAN) protocol.

RESULTS

The prevalences of recent rhinitis and rhinoconjunctivitis (last 12 months), and nasal allergy/hay fever were 35.1%, 17.6%, and 14.6% in the adolescents and 20%, 8.5%, and 8.9% in the schoolchildren, respectively, with rhinoconjunctivitis in adolescents varying from 20.9% in Bilbao to 13.4% in Cartagena; and in schoolchildren, from 9.8% in La Coruña to 6.4% in Pamplona. These prevalences of rhinoconjunctivitis and nasal allergy in adolescents were higher than those described in the ISAAC (16.3% and 13%) and similar in schoolchildren to the ISAAC (9% and 9.4%).

CONCLUSIONS

There has been a stabilisation of rhinitis, rhinoconjunctivitis and nasal allergy in schoolchildren that slows the previous upward trend of ISAAC; and a slight non-significant increase in rhinoconjunctivitis and nasal allergy in adolescents. The variability found in adolescents would require local research to be better understood.

Prevalence and Impact of Asthma and Allergy on Daily Life, Health Outcomes and Use of Healthcare Services in Children: A Population-Based Study

INTRODUCTION

Studies on the prevalence of asthma and allergies often lack representation of the pediatric population, and their impact has not been examined using children without these diseases as a reference group. This study aimed to determine the prevalence of asthma and allergies in children under 14 years old in Spain and their impact on health-related quality of life, activities, healthcare utilization, and environmental and household exposure risk factors.

METHODS

Data came from a Spanish population-based representative survey of children aged <14 years (N=6297). A sample of controls (1:4) from the same survey was matched using propensity score matching. Logistic regression models and population-attributable fractions were calculated to determine the impact of asthma and allergy.

RESULTS

The population prevalence of asthma was 5.7% (95% CI: 5.0%, 6.4%), and of allergy was 11.4% (95% CI: 10.5%, 12.4. In children with lower percentiles of health-related quality of life (≤20th), 32.3% (95% CI, 13.6%, 47.0%) was attributed to asthma and 27.7% (95% CI: 13.0%, 40.0%) to allergy. Forty-four percent of restrictions in usual activity were attributed to asthma (OR: 2.0, p-value: <0.001), and 47.9% to allergy (OR: 2.1, p-value: <0.001). 62.3% of all hospital admissions were attributed to asthma (OR: 2.8, p-value: <0.001), and 36.8% (OR: 2.5, p-value: <0.001) of all specialist consults to allergy.

CONCLUSIONS

The high prevalence of atopic disease and its impact on daily life and healthcare utilization call for an integrated healthcare system focused on children and caregivers' needs with continuity of care across education and healthcare settings.

Family styles and quality of life in adolescents with bronchial asthma: The important role of self-esteem and perceived threat of the disease

OBJECTIVES

Analyze the relationship between family styles and quality of life (QoL) in adolescents with bronchial asthma and study the influence of self-esteem as a protective factor and threat perception as a risk factor.

METHODS

Family styles, QoL, perceived threat of the disease, and self-esteem were assessed in a total of 150 adolescents diagnosed with bronchial asthma with ages ranging from 12 to 16 years (M = 13.28; SD = 1.29), 60.7% being male. Descriptive statistics and mean comparisons were conducted according to the level of self-esteem. Relationships between variables were also studied using Pearson's correlations, and finally, the mediating role of self-esteem and the perceived threat of the disease was assessed using PROCESS.

RESULTS

Adolescents shown healthy family characteristics (high scores on affect and parental mood and low scores on psychological control) and high scores on QoL. Thirty-five percent of adolescents showed low self-esteem and a tendency to underestimate the disease. There are existing relationships between family styles and QoL; thus, healthy family characteristics (affection, parental mood, autonomy promotion) were positively associated with QoL, while psychological control was negatively associated with QoL. Disease threat and self-esteem mediated the relationship between family styles and adolescent QoL. Disease threat was negatively, and self-esteem was positively associated with QoL.

CONCLUSIONS

Self-esteem and family support are protective factors for the well-being of adolescents with bronchial asthma; however, the high perceived threat of the disease can have negative consequences for the adolescent's health and negatively impact their QoL.

Arsenic exposure and respiratory outcomes during childhood in the INMA study

Ingested inorganic arsenic (iAs) is a human carcinogen that is also linked to other adverse health effects, such as respiratory outcomes. Yet, among populations consuming low-arsenic drinking water, the impact of iAs exposure on childhood respiratory health is still uncertain. For a Spanish child study cohort (INfancia y Medio Ambiente—INMA), low-arsenic drinking water is usually available and ingestion of iAs from food is considered the major source of exposure. Here, we explored the association between iAs exposure and children’s respiratory outcomes assessed at 4 and 7 years of age (n = 400). The summation of 4-year-old children’s urinary iAs, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) was used as a biomarker of iAs exposure (∑As) (median of 4.92 μg/L). Children’s occurrence of asthma, eczema, sneeze, wheeze, and medication for asthma and wheeze at each assessment time point (i.e., 4- and 7-year) was assessed with maternal interviewer-led questionnaires. Crude and adjusted Poisson regression models using Generalized Estimating Equation (GEE) were performed to account for the association between natural logarithm transformed (ln) urinary ∑As in μg/L at 4 years and repeated assessments of respiratory symptoms at 4 and 7 years of age. The covariates included in the models were child sex, maternal smoking status, maternal level of education, sub-cohort, and children’s consumption of vegetables, fruits, and fish/seafood. The GEE—splines function using Poisson regression showed an increased trend of the overall expected counts of respiratory symptoms with high urinary ∑As. The adjusted expected counts (95% confidence intervals) at ln-transformed urinary ∑As 1.57 (average concentration) and 4.00 (99^th percentile concentration) were 0.63 (0.36, 1.10) and 1.33 (0.61, 2.89), respectively. These exploratory findings suggest that even relatively low-iAs exposure levels, relevant to the Spanish and other populations, may relate to an increased number of respiratory symptoms during childhood.

Prevalence and temporal evolution of asthma symptoms in Spain. Global Asthma Network (GAN) study

INTRODUCTION

The temporal evolution of the prevalence of asthma described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 is unknown, or if the geographical or age differences are maintained in Spain.

OBJECTIVE

To describe the prevalence of asthma symptoms in different Spanish geographic areas and compare it with that of those centers that participated in the ISAAC.

METHODS

Cross-sectional study of asthma prevalence, carried out in 2016-2019 with 19,943 adolescents aged 13-14 years and 17,215 schoolchildren aged 6-7 years from 6 Spanish geographical areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona and Salamanca). Asthma symptoms were collected using a written questionnaire and video questionnaire according to the Global Asthma Network (GAN) protocol.

RESULTS

The prevalence of recent wheezing (last 12 months) was 15.3% at 13-14 years and 10.4% at 6-7 years, with variations in adolescents, from 19% in Bilbao to 10.2% in Cartagena; and in schoolchildren, from 11.7% in Cartagena to 7% in Pamplona. These prevalences were higher than those of the ISAAC (10.6% in adolescents and 9.9% in schoolchildren). 21.3% of adolescents and 12.4% of schoolchildren reported asthma at some time.

CONCLUSIONS

There is a high prevalence of asthmatic symptoms with an increase in adolescents and a stabilization in Spanish schoolchildren with respect to the ISAAC. Geographic variations in asthma prevalence are not so clearly appreciated, but areas with high prevalences maintain high numbers.

Pediatric asthma: The REGAP consensus

Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units.

Consumption of ultra-processed products and wheezing respiratory diseases in children: The SENDO project

INTRODUCTION

The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma.

OBJECTIVE

To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing).

MATERIAL AND METHODS

A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development (SENDO) project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according to the NOVA classification, and the daily consumption was estimated along with the percentage of Kilocalories from the UP. The exposure was grouped into "high" and "low" from the median consumption. Odds Ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings.

RESULTS

In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76 g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR: 1.87, 95% CI: 1.01-3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI: 1.10-4.05) the prevalence of bronchitis/recurrent wheezing.

CONCLUSIONS

The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children.

[Pediatric asthma: The REGAP consensus]

Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units.

Long and winding road: from infant wheeze to adult asthma

PURPOSE OF REVIEW

This review aims to recognize the multifactorial cause of asthma, from the influence of mother until adulthood, highlight the main characteristics of the disease at different ages and summarize the evidence of potential prevention strategies.

RECENT FINDINGS

To date, regarding the prenatal period, the presence of specific genes, maternal asthma, drugs, and tobacco exposure are the most relevant predisposing features for an asthmatic offspring. For newborns, preterm, bronchopulmonary dysplasia, and low birth weight has been associated with low lung function. Among young children, atopic dermatitis, lower respiratory tract infections, and increased levels of total Immunoglobulin E (IgE) and allergen-specific IgE are important determinants.Breastfeeding has been demonstrated being protective for the onset of asthma. Allergen immunotherapy has also been shown to have significant preventive effect decreasing asthma development. Inhaled corticosteroids use in early childhood prevents exacerbations but does not alter the natural history of asthma. Other interventions, such as the use of palivizumab, probiotics, vitamin D supplementation, and fish consumption presented controversial results.

SUMMARY

A good knowledge of risk factors for asthma development, from prenatal period to adulthood, may lead to efficacious preventive strategies. Further data of long-term follow-up in population-based studies according to different phenotypes are needed.

[Consumption of ultra-processed products and wheezing respiratory diseases in children: The SENDO project]

INTRODUCTION

The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma.

OBJECTIVE

To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing).

MATERIAL AND METHODS

A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development ?SENDO? project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according the NOVA classification, and the daily consumption was estimated along with the percentage of kilocalories from the UP. The exposure was grouped into "high" and "low" from the median consumption. Odds ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings.

RESULTS

In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR 1.87; 95% CI 1.01-3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI 1.10-4.05) the prevalence of bronchitis/recurrent wheezing.

CONCLUSIONS

The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children.

Recurrent wheezing during the first 3 years of life in a birth cohort of moderate-to-late preterm infants

BACKGROUND

Data addressing short- and long-term respiratory morbidity in moderate-late preterm infants are limited. We aim to determine the incidence of recurrent wheezing and associated risk and protective factors in these infants during the first 3 years of life.

METHODS

Prospective, multicenter birth cohort study of infants born at 32⁺⁰ to 35⁺⁰  weeks' gestation and followed for 3 years to assess the incidence of physician-diagnosed recurrent wheezing. Allergen sensitization and pulmonary function were also studied. We used multivariate mixed-effects models to identify risk factors associated with recurrent wheezing.

RESULTS

A total of 977 preterm infants were enrolled. Rates of recurrent wheezing during year (Y)1 and Y2 were similar (19%) but decreased to 13.3% in Y3. Related hospitalizations significantly declined from 6.3% in Y1 to 0.75% in Y3. Independent risk factors for recurrent wheezing during Y2 and Y3 included the following: day care attendance, acetaminophen use during pregnancy, and need for mechanical ventilation. Atopic dermatitis on Y2 and male sex on Y3 were also independently associated with recurrent wheezing. Palivizumab prophylaxis for RSV during the first year of life decreased the risk or recurrent wheezing on Y3. While there were no differences in rates of allergen sensitization, pulmonary function tests (FEV_0.5 ) were significantly lower in children who developed recurrent wheezing.

CONCLUSIONS

In moderate-to-late premature infants, respiratory symptoms were associated with lung morbidity persisted during the first 3 years of life and were associated with abnormal pulmonary function tests. Only anti-RSV prophylaxis exerted a protective effect in the development of recurrent wheezing.

Resources to handle childhood asthma in Spain: The role of plans and guides and the participation of nurses

BACKGROUND

Describe the assistance provided to asthmatic patients by Primary Care Paediatricians (PCP) in Spain and the material and human resources available for diagnosis and follow-up.

METHODS

A cross-sectional descriptive study using an on-line survey, sent to PCP regarding the availability of diagnostic resources, carrying out programmed and educational activities, collaboration of nursing staff and their relationship with existing institutional plans to care for children with asthma. A latent class model (LCM) was used to describe the differences among paediatricians based on the variables studied.

RESULTS

Of the 708 answers, 675 were considered valid; 76% of the paediatricians had a spirometer, 75% specific IgE, 17% prick-test, 95% had placebo inhalers and 97% inhalation chambers. 57% performed programmed activities with their patients, while 56% shared their care of asthmatic patients with their nursing staff, but only 25% of the nurses were involved in the follow-up and 12% in education. LCM identified four patterns. The two groups with greater access to diagnostic resources counted on institutional plans/guidelines. However, the only variable differentiating the groups with more programmed and educational activities was the participation of nurses.

CONCLUSIONS

The availability of asthma plans/guidelines and resources for diagnosis and follow-up is not sufficient to improve important aspects of primary care for children with asthma. Organisational changes are necessary to include programmed asthma-related visits and paediatric teams with greater involvement of the nurses when caring for these patients.

Factors associated with asthma control: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco)

BACKGROUND

The purpose of the study is to describe the profile of patients with asthma and to identify the signifiant risks and the protective factors associated with asthma control.

METHODS

A prospective epidemiological study was conducted in three hospitals of Rabat-Morocco and included 396 patients with asthma. Differences in characteristics across the levels of asthma control were compared by the one-way analysis of variance for continuous variables, and chi-square test was used for categorical variables. The risk and protective factors associated with the asthma control levels were determined by Proportional Odds Model (POM) for bivariate and multivariate ordinal logistic regression, also expressed as Odds Ratios (OR) and 95% Confidence Intervals (95% CI).

RESULTS

From 7440 patients screened by 28 physicians, 396 were included in study. 53% of the particiants sufferd controlled, 18% had partly controlled and 29% had uncontrolled asthma symptoms. A multivariate ordinal logistic regression analysis showed that having respiratory infections (AOR = 5.71), suffering from concomitant diseases (AOR = 3.36) and being allergic to animals (AOR = 2.76) were positively associated with poor control of asthma. However, adherence to treatement (AOR = 0.07), possession of health insurance (AOR = 0.41) and having more than 2 children (AOR = 0.47) were associated with good asthma control.

CONCLUSION

The study established a clinical-epidemiological profile of asthmatic patients in Rabat region in Morocco. By ordinal logistic regression we found that 6 factors - respiratory infections, concomitant diseases, animals allergy, adherence to treatment, health insurance and having more than two children - were associated with asthma control.

Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study

BACKGROUND

The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors.

METHODS

In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012.

RESULTS

The mean age of participants was 24.9±0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR)=2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR=4.05; 95% CI 1.7-9.6), bronchitis (RR=2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR=0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed.

CONCLUSIONS

A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found.

Asthma education taught by physical education teachers at grade schools: A randomised cluster trial

OBJECTIVE

Assess whether the Asthma, Sport and Health (ASAH) programme taught by teachers improves asthmatics' quality of life, asthma knowledge, and reduces school absenteeism.

DESIGN

Randomised cluster trial parallel group.

PARTICIPANTS

2293 students (203 asthmatic) in the Intervention School group (IS) and 2214 in the Comparison School (CS) (224 asthmatic) belonging to primary school.

INTERVENTION

Implementation of the educational programme "Asthma, Sport and Health" at grade schools, taught by physical education teachers.

MAIN OUTCOME

Quality of life according to the Pediatric Asthma Quality of Life Questionnaire (PAQLQ).

SECONDARY OUTCOMES

Asthma knowledge, asthma control, school absenteeism.

RESULTS

After implementing the programme in the IS group, global quality of life improved significantly (p<0.001) as did their domains, symptoms (p<0.001), emotional function (p<0.001) and activity limitations (p<0.01), while in the CS group improvement was seen in global life quality (p<0.01) without any significant changes in the domains for emotional function and activity limitations. Asthma knowledge only increased in IS, among asthmatic students from 16.51 (CI 95% 16.04-16.98) to 18.16 (CI 95% 17.69-18.62) (p<0.001) and students without asthma from 15.49 (CI95% 15.36-15.63) to 17.50 (CI95% 17.36-17.64) (p<0.001). The multiple regression analysis showed that quality of life and its domains depend on asthma knowledge and above all, having well-controlled asthma. We found no decrease in school absenteeism.

CONCLUSIONS

The ASAH programme improved certain quality of life aspects regarding asthma (emotional function and limitation of activities) and asthma knowledge, but it failed to reduce school absenteeism NCT01607749.

The influence of gender and atopy in the relationship between obesity and asthma in childhood

BACKGROUND

The objective of the study was to examine the relationship between asthma and overweight-obesity in Spanish children and adolescents and to determine whether this relationship was affected by gender and atopy.

METHODS

The study involves 8607 Spanish children and adolescents from the International Study of Asthma and Allergies in Childhood phase III. Unconditional logistic regression was used to obtain adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association between asthma symptoms and overweight-obesity in the two groups. Afterwards, it was stratified by sex and rhinoconjunctivitis.

RESULTS

The prevalence of overweight and obesity in 6-7-year-old children was 18.6% and 5.2% respectively and in 13-14 year-old teenagers was 11.4% and 1.1% respectively. Only the obese children, not the overweight children, of the 6-7 year old group had a higher risk of any asthma symptoms (wheezing ever: OR 1.68 [1.15-2.47], asthma ever: OR 2.29 [1.43-3.68], current asthma 2.56 [1.54-4.28], severe asthma 3.18 [1.50-6.73], exercise-induced asthma 2.71 [1.45-5.05]). The obese girls had an increased risk of suffering any asthma symptoms (wheezing ever: OR 1.73 [1.05-2.91], asthma ever: OR 3.12 [1.67-5.82], current asthma 3.20 [1.65-6.19], severe asthma 4.83[1.94-12.04], exercise-induced asthma 3.68 [1.67-8.08]). The obese children without rhinoconjunctivitis had a higher risk of asthma symptoms.

CONCLUSIONS

Obesity and asthma symptoms were associated in 6-7 year-old children but not in 13-14 year-old teenagers. The association was stronger in non-atopic children and obese girls.

Mould and grass pollen allergy as risk factors for childhood asthma in Zaragoza, Spain

OBJECTIVE

Examine the prevalence of asthma and associated predictive factors in a group of 468 students.

PATIENTS AND METHODS

A descriptive, cross-sectional observational study in a randomly selected population of 468 children aged 10-12, in the city of Zaragoza. We used the ISAAC questionnaire on asthma completed by children under supervision of the investigators. We assessed the genetic risk (family history of asthma) and environmental risks. The risk for atopy was assessed by the presence of positive skin prick tests.

RESULTS

25.3% of the children had symptoms consistent with asthma in the city of Zaragoza. Among them 33.1% reported a history of asthma in close relatives (OR=1.78, p<0.001). The history of hospitalisations for lower respiratory tract illness was strongly associated with the presence of asthma (OR=6.72, p<0.0001). Positive skin tests to Alternaria (OR=2.00, p<0.0001) and grass pollen (OR=1.76, p<0.001) were predictors of asthma. 63.6% of asthmatic children had presented clinical rhinitis in the previous 12 months, compared with 32% of non-asthmatics, and this difference was statistically significant (OR=3.89, p<0.0001). 47% of asthmatics presented with or previously had eczema, whereas only 26.9% of non-asthmatics presented with or previously had these types of lesions (p<0.0001).

CONCLUSION

The following are predictors of asthma: History of hospital admissions for lower respiratory tract illness, presence of rhinitis and/or eczema, positive prick test for certain aeroallergens, especially Alternaria and grass pollen, and family history of asthma.

Epidemiology of asthma exacerbations and their relation with environmental factors in the Basque Country

BACKGROUND

Asthma is a highly prevalent chronic inflammatory disease characterised by reversible airflow obstruction and hyperreactivity and inflammation of the airways. Factors that cause and/or trigger asthma attacks include host-related factors (genetic predisposition, obesity and sex) and environmental factors (allergens, infections, occupational sensitisation, smoking status, pollution and diet).

OBJECTIVE

To describe the epidemiology of asthma exacerbations (AEs) in the Basque Country and to explore its relationship with potentially associated environmental variables. We studied a total of 31,579 emergency department (ED) visits and 28,189 hospitalisations due to asthma. We describe the trends, incidence, seasonality and the influence of age and sex, as well as of exposure to NO2 , CO, PM, O3 , and pollen, temperature, relative humidity and flu status. We calculated the Pearson's R correlation coefficient for the study variables.

RESULTS

The incidence was 486 and 88.9 cases per 100,000 people for ED visits and hospitalisations, respectively. Slightly over half (53.5%) of the ED cases were male, while females represented 62.6% of the hospital admissions. Hospitalisations are tending to decrease in children and increase in over 64-year-olds. Peaks in cases occur at the beginning of autumn in children and in winter in adults. AEs were correlated positively with exposure to NO2 , CO and to the influenza virus and negatively with temperature and exposure to O3 . These relationships vary, however, with age and season.

CONCLUSIONS AND CLINICAL RELEVANCE

Rates of hospitalisation for AEs and trends in these rates over time are different in adults and children with the patterns varying by sex, season and environmental conditions.

Wheezing and risk factors in the first year of life in Cantabria, Spain. The EISL study

OBJECTIVES

To determine the prevalence of wheezing during the first year of life in Cantabria, Spain and its associated risk factors.

METHODOLOGY

A cross-sectional, multicentre, descriptive epidemiological study was carried out in a representative sample of 958 infants in the first year of life, born in Cantabria. A previously validated and standardised written questionnaire was completed by the parents of infants seen between 12 and 15 months of age in the Primary Care Centres.

RESULTS

The prevalence of wheezing was 32.7%. A relationship was found with male gender (OR 1.38, 95%CI [1.05-1.81]), the presence of a sibling (OR 2.43 [1.38-3.98]), attending nursery school (OR 2.40 [1.71-3.35]), exclusive breastfeeding for <3 months (OR 1.47 [1.12-1.93]), a first cold at ≤3 months (OR 2.07 [1.56-2.74]), asthma in siblings (OR 2.17 [1.25-3.77]), parental allergic rhinitis (OR 1.62 [1.10-2.37]) and paracetamol use >1 a week (OR 2.49 [1.31-4.73]), and maternal smoking during pregnancy (OR 2.18 [1.51-3.15]). The prevalence of recurrent wheezing (≥3 episodes) was 14.3%. Significant associations were observed with the male gender (OR 1.79 [1.23-2.60]), attending nursery school (OR 2.92 [1.96-4.35]), first cold at ≤3 months (OR 2.11 [1.46-3.04]), eczema (OR 1.92 [1.21-3.04]), maternal asthma (OR 1.77 [1.00-3.14]), exclusive breastfeeding for <3 months (OR 1.53 [1.06-2.22]), and maternal smoking during pregnancy (OR 1.53 [1.05-2.22]).

CONCLUSIONS

One third of the infants experienced wheezing during the first year of life; those who were less exclusively breastfed, attended nursery school, presented eczema, family asthma or allergic rhinitis, and maternal smoking during pregnancy.

[Consensus-based approach for severe paediatric asthma in routine clinical practice]

INTRODUCTION

Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines.

MATERIAL AND METHODS

An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results.

RESULTS

Eleven paediatric chest disease physicians and allergy specialists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they have required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impairs their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids.

CONCLUSIONS

This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma.

Anti-asthmatic prescription variability in children according to age

INTRODUCTION

There is little research in the Spanish paediatric population about the consumption of anti-asthmatic agents. The aim of this study was to describe the current pattern of anti-asthmatic drug prescription in the paediatric population from a region of Spain, using the prescribed daily dose as a unit of measurement.

METHODS

We analysed the requirements of R03 therapeutic subgroup (anti-asthmatic agents) in children less than 14 years of age in the Public Health System of Castilla y León from 2005 to 2010. Consumption data are presented in prescribed daily doses per thousand inhabitants per day (PDHD) and compared with defined daily doses per thousand inhabitants per day (DHD).

RESULTS

394 876 prescriptions of anti-asthmatics were given to a population of 1 580 229 persons/year. Bronchodilators, leukotriene receptor antagonists, single inhaled corticosteroids (ICS) and long-acting β2-adrenergics associated with inhaled corticosteroids were the most commonly prescribed drugs: 7.5, 5.2, 4.9 and 2.2 PDHD, respectively. The maximum prescription of bronchodilators (15.9 PDHD/9.8 DHD) occurred in children under 12 months, with montelukast (8.9 PDHD/3.6 DHD) and single inhaled corticosteroids (7.9 PDHD/2.9 DHD) at one year of age.

CONCLUSIONS

Between 2005 and 2010, children under four years received a high prescription of anti-asthmatic drugs. The use of maintenance therapy was poorly aligned with the recommendations of asthma guidelines. The PDHD was more accurate for measuring consumption than DHD, especially in younger children.

[Paediatric prescribing of anti-asthmatics in primary care in Castilla-León. Geographical variability]

INTRODUCTION AND OBJECTIVES

Asthma is one of the most prevalent chronic diseases with effective treatment in paediatrics. The aim of this study is to describe the paediatric prescribing of anti-asthmatics in Castilla-León, analyzing its geographic variability and temporal evolution.

MATERIAL AND METHODS

An analysis was made of prescriptions dispensed in pharmacies of R03 therapeutic subgroup (anti-asthmatic agents), and the active ingredients mepyramine and ketotifen, prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 in Primary Care. Data is presented in prescribed daily doses per thousand inhabitants per day (PDHD) for each active ingredient being calculated raw rates and age-adjusted to the variables health area, type of health zone and year of study.

RESULTS

A total of 462,354 prescriptions of anti-asthmatic agents were dispensed to a population of 1,580,229 persons/year. There was wide variation between areas in the type and intensity of anti-asthmatic agents used, partly explained by differences in the prevalence of asthma. Montelukast predominated as controller drug in most of them (PDHD 3.1 to 7.7), being similar the consumption intensity in the three types of health zones (PDHD 4.7 to 4.8). The annual variability was low.

CONCLUSIONS

The study describes the paediatric prescribing pattern of anti-asthmatic agents in Castilla-León between 2005-2010. It shows wide geographical variation, as well as inadequacies regarding current recommendations of asthma treatment.

Prevalence and clinical profile of difficult-to-control severe asthma in children: results from pneumology and allergy hospital units in Spain

BACKGROUND

Severe asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents.

METHODS

Observational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians' criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6-14 years with severe asthma (difficult-to-control or controlled) were included in the second phase.

RESULTS

12,376 asthmatic children were screened in the first phase. According to physicians' criteria, 8.8% (95% CI 8.3-9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7-26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 ± 2.3 years; 61.4% male; mean of 5.5 ± 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p<0.0001, all) and poor HRQoL (p<0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians' criteria were poorly controlled according to GEMA.

CONCLUSIONS

Around one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents.

Prenatal exposure to bisphenol A and phthalates and childhood respiratory tract infections and allergy

BACKGROUND

There is growing concern that prenatal exposure to bisphenol A (BPA) and phthalates, which are widely used in consumer products, might affect susceptibility to infections and the development of allergy and asthma in children, but there are currently very few prospective studies.

OBJECTIVE

We sought to evaluate whether prenatal exposure to BPA and phthalates increases the risk of respiratory and allergic outcomes in children at various ages from birth to 7 years.

METHODS

We measured BPA and metabolites of high-molecular-weight phthalates, 4 di-(2-ethylhexyl) phthalate (DEHP) metabolites (Σ4DEHP) and mono-benzyl phthalate (MBzP), and 3 low-molecular-weight phthalate (LMWP) metabolites (Σ3LMWP) in urine samples collected during the first and third trimesters in pregnant women participating in the Infancia y Medio Ambiente-Sabadell birth cohort study. The occurrence of chest infections, bronchitis, wheeze, and eczema in children was assessed at ages 6 and 14 months and 4 and 7 years through questionnaires given to the mothers. Atopy (specific IgE measurement) and asthma (questionnaire) were assessed at ages 4 and 7 years, respectively.

RESULTS

The relative risks (RRs) of wheeze (RR, 1.20; 95% CI, 1.03-1.40; P = .02), chest infections (RR, 1.15; 95% CI, 1.00-1.32; P = .05), and bronchitis (RR, 1.18; 95% CI, 1.01-1.37; P = .04) at any age increased for each doubling in concentration of maternal urinary BPA. Σ4DEHP metabolites were associated with the same outcomes (wheeze: RR, 1.25; 95% CI, 1.04-1.50, P = .02; chest infections: RR, 1.15; 95% CI, 0.97-1.35; P = .11; bronchitis: RR, 1.20; 95% CI, 1.01-1.43; P = .04). MBzP was associated with higher risk of wheeze (RR, 1.15; 95% CI, 1.00-1.33; P = .05). The risk of asthma at age 7 years was also increased with increasing prenatal BPA, Σ4DEHP, and MBzP exposure. There were no other exposure-outcome associations.

CONCLUSIONS

Prenatal exposure to BPA and high-molecular-weight phthalates might increase the risk of asthma symptoms and respiratory tract infections throughout childhood.

Asthma, respiratory symptoms and lung function in children living near a petrochemical site

Residential proximity to environmental hazards has been related to adverse health outcomes. Respiratory health and allergies in children living near petrochemical sites have not been extensively studied. We evaluated the association between residential proximity to the petrochemical site of Tarragona (Catalonia, Spain) and the prevalence of asthma, respiratory symptoms and lung function in children. Children aged 6-7 (n=2672) and adolescents aged 13-14 (n=2524) residing near two large petrochemical sites and those living in a city with medium vehicular traffic were cross-sectionally compared with children from an area with low vehicular traffic and without industry. The prevalence of symptoms was measured using the International Study of Asthma and Allergies in Childhood written and video questionnaires. Lung function measurements were done in a subsample of 959 adolescents in the four areas. Multivariable analyses were done to estimate the effects of the residential area on symptoms and lung function adjusted for potential confounders. Crude prevalence of symptoms was similar across the studied areas. After adjustment, children and adolescents living near a petrochemical site had a statistically significant higher prevalence of respiratory hospitalizations in the previous year (Prevalence Ratio (PR)=1.49; 95%CI, 1.06-2.09) and of nocturnal cough (PR=1.29; 95%CI 1.05-1.57), respectively. Reduced lung function values among adolescents residing near the petrochemical areas were not observed. Although a higher prevalence of asthma in children and adolescents living near the petrochemical sites could not be demonstrated, as described in other studies, respiratory hospitalizations and nocturnal cough could be related to short-term exposures to pollutants. Other clinical and sub-clinical respiratory health effects in the petrochemical industry areas should be investigated.

Trends in the use of antiasthmatic medications in Morocco (1999-2010)

Background

Asthma is a big public health problem in Morocco. The drug therapy existing in Morocco is currently insufficient because of the low purchasing power and the low health insurance coverage available to the average citizen in Morocco. In this study we evaluated the consumption of antiasthmatics in Morocco during the period 1999–2010, the classes of used drugs and the generics’ market share.

Methods

We used sales data from the Moroccan subsidiaries of the IMS Health “Intercontinental Marketing Service”. The consumption volume was converted to Defined Daily Doses (DDDs).

Results

During 1999–2010, antiasthmatics’s consumption increased from 3.91 to 14.47 DDD per 1000 inhabitants per day. In 2010, the association Beta-2-mimetic-Glucocorticosteroids were the most consumed (8.53 DDD/1000 Inhabitants/day) followed by the short-acting inhaled Beta-2-mimetic (4 DDD/1000 Inhabitants/day) and inhaled Glucocorticosteroids alone accounted for 1.13 DDD/1000 Inhabitants/day. The largest consumption share in volume was held by the short-acting inhaled Beta-2-mimetic (42%) followed by the combination Beta-2-mimetic-Glucocorticosteroids (38%). Between 1999 and 2010, the market for generic antiasthmatics increased from 1.84 to 2.18 DDD/1000 Inhabitants/day. The ratio of the monthly average cost of treatment to the minimum wage in Morocco decreased from 10.8% in 1999 to 7.11% in 2010.

Conclusion

Antiasthmatics’ consumption in Morocco has undergone significant changes between 1999 and 2010. However, the availability of these drugs expressed as the Average Monthly Expenditure/Guaranteed Minimum Wage ratio improved. Despite this, the use of antiasmathics in Morocco remains low.

[Asthma crisis in emergency departments in Spain: what is our usual practice?]

BACKGROUND

Despite there being various guidelines and consensus statements on asthma, great variability still exists in its treatment approach; although this has been little discussed in Emergency Departments (ED).

OBJECTIVE

To describe the usual management of asthma exacerbations in Spanish ED, and to determine the degree of variability among different professionals, as well as analyse factors that may influence their management.

MATERIAL AND METHODS

A questionnaire was developed based on clinical cases, which was distributed among members of the Spanish Society of Paediatric Emergencies and attendees at the meeting in 2011.

RESULTS

A total of 300 surveys were analysed. In 190 cases the place of work was in a tertiary care hospital. There was high agreement in the assessment of the severity of the cases mentioned. Over 90% use inhaled β2 agonists in mild asthma exacerbations, 75.3% used oral corticosteroids in moderate exacerbations, and 79% use ipratropium bromide in severe exacerbations. Almost all (98%) considered Therapeutic Education important in the Emergency Department. Only 8 (2.7%) used peak expiratory flow measurements. Respondents working in a tertiary hospital used severity scales more frequently (90.5% vs 80%, P=.009) and administered parenteral corticosteroids less frequently (53.2% vs 66.4%, P=.017).

CONCLUSIONS

Although a high percentage of paediatricians working in the ED follow Clinical Practice Guidelines, some different points of the approach among professionals have been identified.

[Control of bronchial asthma in children seen in a primary care centre]

OBJECTIVES

This study aimed to assess the level of asthma control in children aged 6 to 14 years old in a Primary Care Centre.

METHODOLOGY

A cross-sectional descriptive study was conducted on asthmatic children aged 6 to 14 years old followed up in a Primary Health Care Centre in a metropolitan area of Barcelona. The Asthma Control Test (ACT) was the tool used to measure asthma control. Asthma was considered to be well controlled with an ACT score >20. Demographic and disease specific data were also collected.

RESULTS

A total of 46 patients (45% girls, 55% boys) completed the ACT. Their mean age was 8,9 years (SD 2.8). The prevalence of poorly controlled asthma was 41.3%. A family history of asthma was found in 36% of the children, and 43% of them declared to have activity limitations.

CONCLUSIONS

The high percentage of poorly controlled asthma in children raises the need for reviewing the effectiveness in the processes to improve asthma control in these patients.

[Knowledge, attitudes and asthma quality of life of adolescents in schools. The need to educate our teaching centres]

INTRODUCTION

Knowledge and attitudes toward asthma can condition the integration of adolescents with asthma in school and affect their quality of life. Our objective was to determine the state of knowledge, attitudes on asthma in secondary schools, and its relationship to quality of life of pupils with asthma, as an early step to an educational intervention.

METHODS

Descriptive and cross-sectional study of pupils aged 13 and 14 years old and their teachers in 26 schools of Seville and province. We used, as study tools, the Newcastle Asthma Knowledge Questionnaire, the Gibson attitudes towards asthma, and the Paediatric Asthma Quality of Life Questionnaire. To assess the normality of variables, the Kolmogorov-Smirnov test was used, and for non-parametric variables the U Mann-Whitney and W Wilcoxon tests were used. For the association between variables, we use the regression coefficients and rho Spearman.

RESULTS

We studied 3827 pupils (279 with asthma) and 548 teachers. All had little knowledge about asthma. The quality of life in asthma was mild to moderately affected, and lower in girls, 5.38±1.08 (95% CI=5.20 to 5.55) than in boys 5.77 (± 1.18) (95% CI=5.56 to 5.97), P=.0000. We found no relationship between knowledge, attitudes and quality of life in asthma.

CONCLUSIONS

We found a low level of knowledge about asthma in pupils and teacher. Asthma sufferers have a mild to moderate asthma quality of life, which is worse for girls. Knowledge has no relationship with attitudes to asthma in all groups, or with the quality of life of asthma sufferers.

Comparison in asthma and allergy prevalence in the two major cities in Greece: the ISAAC phase II survey

BACKGROUND

Variability in the prevalence of allergic diseases has been detected not only between different countries, but also between cities with similar national and different socio-economic or climatic characteristics. The aim of this study was to determine the prevalence of childhood asthma and allergies and which factors are associated with them, in the two largest Greek cities, Athens and Thessaloniki.

METHODS

Two thousand and twenty-three Greek 9-10-year-old schoolchildren from Athens (Central Greece) and Thessaloniki (North Greece, more humid), were included in ISAAC-II study. All participants followed the ISAAC-II protocol by questionnaire, skin prick testing and flexural dermatitis examination.

RESULTS

Compared with Athens, the prevalence of current wheezing (8.4% vs. 5.7%, p=0.002), lifetime asthma (11.5% vs. 7.7%, p=0.004), atopic current asthma (3.2% vs. 1.6%, p=0.02), allergic rhinitis (8.2% vs. 5.2%, p=0.007), and hay fever (21.7% vs. 12.5%, p<0.001) were higher in Thessaloniki. The overall sensitisation rate was also higher in Thessaloniki than in Athens (25.2% vs. 16%, p<0.001) with more prevalent sensitising due to the perennial allergens (D. pteronyssinus, D. farinae, Alternaria tenuis) and cat dander. Perennial allergens sensitisation was a risk factor for current asthma in both cities.

CONCLUSION

A higher prevalence of asthma symptoms, allergic rhinitis, and sensitisation rate was detected in Greek schoolchildren living in Thessaloniki compared to those in Athens. Allergy to mites and mould was more prevalent in Thessaloniki. The more humid weather of Thessaloniki may be implicated.

[Chronic obstructive pulmonary disease and asthma]

Chronic obstructive pulmonary disease and asthma are both highly prevalent inflammatory diseases characterized by airway obstruction with distinct pathogenic mechanisms and different degrees of response to antiinflammatory therapy. However, forms of presentation that show overlap between both diseases and which are not clearly represented in clinical trials are frequently encountered in clinical practice. These patients may show accelerated loss of pulmonary function and have a worse prognosis. Therefore their early identification is essential. Biomarkers such as bronchial hyperreactivity or nitric oxide in exhaled air have yielded discrepant results. Phenotypic characterization will allow treatment with inhaled corticosteroids to be individually tailored and optimized.

Sunny hours and variations in the prevalence of asthma in schoolchildren according to the International Study of Asthma and Allergies (ISAAC) Phase III in Spain

The objective of this study was to estimate the relationship between the prevalence of asthma in schoolchildren aged 6-7 years and 13-14 years and the mean annual sunny hours (MASH) in Spain, and to explore predictive models for asthma prevalence. The prevalence of asthma was obtained from the International Study of Asthma and Allergies (ISAAC) Phase III 2002-2003, and climate and socio-economic variables from official sources. Nine centres were studied and a further four centres, two of which are in ISAAC, to test the predictive models. Logistic regression was used to estimate adjusted prevalence rates of asthma for each centre, and multiple regression models to study the effects of MASH and other meteorological and socio-economic variables. The adjusted prevalence rate of asthma decreased 0.6% [95% confidence interval (CI) 0.4-0.8%] for the 6-7 years group and 1.1% (95% CI 0.8-1.3%) for the 13-14 years group with an increase in the MASH of 100 h. Relative humidity was negatively associated with asthma in the older age group, and gross province product per capita (GPP) was positively associated with asthma in the younger age group. The predictive models, which included MASH, gender, relative humidity, and GPP, anticipated prevalence rates of asthma without significant differences between the levels observed and those expected in 9 of the 11 measurements carried out. The results indicate that sunny hours have a protective effect on the prevalence of asthma in schoolchildren.

[Asthma in the Archivos de Bronconeumología: a review of publications in the year 2009]

A total of 16 articles (Table 1), were published in the Archivos de Bronconeumología in the past year (December 2008 to November 2009), 9 of which were Originals, which was 17.6% of the originals published in that period. Fortunately, the tendency of a decreasing interest in asthma by pneumologists does not seem to have materialised as was feared a few years ago, on the contrary it seems that research is increasing. All articles that appeared in the journal during the period mentioned are reviewed.

Prevalence and geographic variations in asthma symptoms in children and adolescents in Galicia (Spain)

OBJECTIVES

To determine the prevalence and geographic variations of the symptoms associated with asthma in Galician children and adolescents.

POPULATION AND METHODS

A cross-sectional epidemiological study following ISAAC (International Study of Asthma and Allergies in Childhood) methodology, and using a written questionnaire distributed in schools. The study sample included 10,371 6-7 year-old children and 10,372 13-14 year-old adolescents, all of them from Galician Health Areas. A logistic regression model was used to analyse geographic variations.

RESULTS

In the 6-7 year-old group, wheezing in the last 12 months varied from 11.4% (Santiago) to 15.7% (Vigo) and in the adolescents varied from 8.8% (Ourense) to 18.8% (Vigo). The distribution by gender showed a predominant significance in 6-7 year-old males (P<.001), and near to be statistically significant in 13-14 year-old females (P=.08). The risk (odds ratio [OR]) of wheezing in the last 12 months in the area with highest prevalence in comparison with the area of lowest prevalence was 1.45 (95% Confidence Interval [CI], 1.12-1.88) for children and 2.39 (95% CI, 1.82-3.13) for adolescents. The estimated prevalence of asthma in the Autonomous Community of Galicia was 13.6% in younger children and 12.2% in adolescents.

CONCLUSIONS

The prevalence of wheezing in the last 12 months in the different areas of Galicia is considerably higher than the rest of Spanish ISAAC cities in the 6-7 years group and very similar in the 13-14 years group, except in Vigo where it is considerably higher. We found a clearly defined geographic pattern in the adolescent group, with higher prevalences in coastal areas than in the interior.

[Cost of childhood asthma in Spain: a cost evaluation model based on the prevalence]

INTRODUCTION

Asthma is the most common chronic disease in childhood, reduces the quality of life of children and their families, and produces high social and health care costs. In Spain, the cost of managing paediatric asthma is unknown.

OBJECTIVE

To estimate the cost of managing paediatric asthma in Spain and to examine its variability depending on asthma severity.

PATIENTS AND METHODS

The cost of asthma in children under 16 years in 2008 was estimated by building a costs assessment model including the factors that influence the cost of asthma in children: prevalence, distribution of disease severity, age, frequency of resources use depending on severity, and the cost of each resource. A sensitivity analysis was conducted to evaluate the underlying uncertainty depending on the variability of the estimators of resource use, the unit cost of each resource, and the prevalence.

RESULTS

According to the model, the total cost of paediatric asthma in Spain is around 532 million euros, with a range of 392 to 693 million euros. Direct costs (health care costs) represent 60% of the total costs, and indirect costs (carer time), 40%. The mean annual cost per child with asthma is 1,149 euros, ranging from 403 euros for the mildest category of the disease to 5,380 euros for the most severe.

CONCLUSIONS

The cost of paediatric asthma in Spain is very high and depends on disease severity. Although the most important costs are for the health care system, indirect costs are not negligible.

Evaluation of quality of life among the caregivers of asthmatic children: the new IFABI-R questionnaire

BACKGROUND

The health-related quality of life (HRQoL) of asthmatic children and their caregivers is correlated to management of the disease and the presence of certain morbidity indicators. The integral assessment of paediatric asthma must include the evaluation of HRQoL among the caregivers, although existing questionnaires only partially assess the dimensions of this aspect. The present study describes a new questionnaire for evaluating HRQoL among the caregivers, comprising three dimensions (functional, emotional, and socio-occupational).

MATERIAL AND METHODS

The study involves two phases. A total of 81 patients between 3 and 9 years of age and their caregivers participated in the first phase, involving a qualitative and psychometric study of the preliminary version of the questionnaire (IFABI). A total of 137 patients between 2 and 17 years of age and their caregivers participated in the second phase, in which the revised version of the questionnaire (IFABI-R) was developed and subjected to psychometric evaluation.

RESULTS

First phase: The IFABI showed important reliability and internal consistency (Cronbach alpha=0.93), concurrent validity requiring improvement, and a scantly clear internal structure. Second phase: The IFABI-R showed important reliability and internal consistency (Cronbach alpha=0.90), adequate concurrent validity, and a three-dimensional structure whose three factors correspond to the three dimensions of the questionnaire.

CONCLUSIONS

The good psychometric results obtained with the IFABI-R justify its use in paediatric asthmatic patients. The questionnaire is currently being scaled, and its sensitivity to change is being assessed.

[Relationship between lower respiratory tract infections in the first year of life and the development of asthma and wheezing in children]

INTRODUCTION

There is limited knowledge on the relationship between lower respiratory tract infections (LRTI) and asthma and wheezing during infancy, as there are few studies with prospective design, birth cohort and in non selected population. The objectives of the present study were to determine the prevalence of asthma and recurrent wheezing in childhood and to analyse the relationship between LTRI during the first year of life and the development of asthma and/or wheezing in childhood.

PATIENTS AND METHODS

Prospective birth cohort study conducted in the Hospital del Mar (Barcelona). We recruited 487 children, followed up from the pregnancy to the 6th year of life. As outcomes we studied: the presence of asthma and wheezing. As independent variables we studied: LTRI occurring during the first year of life, and some covariables including, among others: prematurity, birth weight, maternal history of asthma and atopy, breastfeeding, prenatal exposure to tobacco.

RESULTS

The asthma prevalence at 6 year of age was 9.3%. The variables associated with the development of asthma were LTRI, prematurity, atopic mother and formula breastfeeding. LTRI during the first year of life were also related with early recurrent wheezing and persistent wheezing.

CONCLUSIONS

Our results confirm that LTRI during the first year of life are related to the diagnosis of asthma and with the clinical phenotypes of early wheezing and persistent wheezing. These results are in accordance with the concept that LTRI occurring during a critical period of development, as are the first years of life, have an important role on in the later development of asthma and recurrent wheezing.

Prevalence and factors linked to atopy in 10-and 11-year-old children in Almería, Spain

BACKGROUND

During the last decades there has been an increase in both allergic diseases and allergic sensitisation, probably due to changes in the environment and living habits. ISAAC Phase II was designed to establish the prevalence and associated factors to asthma and allergic disorders in childhood.

AIM

To assess the prevalence and factors linked to atopy in 10-11 year-old children from Almería (Spain).

METHODS

As a part of ISAAC II, a survey was conducted among a sample of 1143 schoolchildren using standardised questionnaires and skin-prick testing.

RESULTS

The overall prevalence of atopy was 42.5%. Most common sensitisations were to Dermatophagoides pteronyssinus (36.2%), D. farinae (32.3%), cat (10.8%), Alternaria (7%), grass (6%), and tree pollen (1.7%). 34.9% of these sensitisations could be regarded as subclinical sensitisations. The fractions of asthma, rhinitis and eczema attributable to atopy were 49.2%, 40.4% y 18.6%, respectively. After multivariate analysis, the risk of atopy was significantly lower among females (OR 0.62, CI 95% 0.45-0.86); children with older siblings (OR 0.67; CI 95% 0.49-0.92); intestinal parasites (OR 0.68; CI 95% 0.48-0.97); contact with farm animals in the past (OR 0.48 CI 95% 0.23-0.99); or other animals at present (OR 0.53 CI 95% 0.30-0.95). To have an allergic father (OR 2.96 CI 95% 1.77-4.94) was the only significant risk factor.

CONCLUSIONS

We found several independent factors which significantly protect against atopic sensitisation. These protective factors were not the same for asthma, rhinitis or eczema, suggesting that other factors could interact to influence atopy and act against such protective factors.

Calculating the prevalence of atopy in children

BACKGROUND

Atopy is an important risk factor for asthma, rhinitis, atopic eczema and urticaria. For this reason, several studies have been done to determine the prevalence of atopy in the paediatric population. The important differences among these studies do not allow the extrapolating of results. In this study, we calculate the prevalence of atopy and atopy-related diseases in a paediatric population using a different methodology.

METHODS

Retrospective study among children referred for drug allergy in which the latter was discarded. We evaluated the prevalence of atopy (measured by allergen sensitisation), asthma, rhinitis, urticaria, atopic eczema and their characteristics.

RESULTS

Three hundred and forty-two patients were studied for adverse drug reaction. This was discarded in 325/342 patients. 20 % of the children in the sample were atopic. Atopy prevalence increased with age. Some atopy related disease was observed in 83/325 (25.5 %) children. Among these children allergen sensitisation increased from 42.3 % in the 0-3 years age group to 93.3 % in the 7-14 age group (p < 0.0001). Prevalence of asthma was 11.5 %, 10.2 % and 7 % in the 0-3, 4-6 and 7-14 age groups, respectively. Prevalence of rhinoconjunctivitis increased through age groups with a prevalence of 20 % among the 7 to 14-year old children.

CONCLUSION

The use of this type of methodology seems to be correct to estimate the prevalence of atopy. Prevalence of allergen sensitisation is very high among 7 to 14-year old children with asthma and/or rhinoconjunctivitis.