[Consensus on the treatment of asthma in pediatrics]

[Effectiveness of therapeutic education and respiratory rehabilitation programs for the patient with asthma]

Asthma is a chronic complex and heterogeneous disease, with great variability and has a huge impact, not only on patients who suffer the disease but also their families and society in general. The education of the asthmatic patient and their families is essential for therapeutic intervention. Through continuous, dynamic and adaptive education, changes in attitudes and behaviours of the patient and family can be achieved, and will undoubtedly lead to an improvement in their quality of life. Among other non-pharmacological interventions, respiratory rehabilitation is an alternative treatment, and is primarily aimed at patients with moderate to severe asthma. Although the latest clinical practice guidelines published in the scientific literature recommend two strategies for treatment, the results of relevant publications are diverse. The objective of this study was to describe the effectiveness of therapeutic and educational programs in respiratory rehabilitation of the asthmatic patient.

Environmental factors affecting children's respiratory health in the first years of life: a review of the scientific literature

The aim of this paper is to quantitatively summarize the original articles on the relationship between environmental hazards and respiratory health in young children. A search was carried out in the main biomedical bibliographical sources in December 2006 and then the results were updated in June 2007. The study period covered 11 years (1996-2006). The information was assessed by reviewing the abstracts. Six hundred and forty documents were recovered. Documents from the United States accounted for 23.5% of articles. The production tended to increase over the study period. The factor most widely studied was air pollution, with outdoor air pollution being studied more (just over 50% of articles) than indoor air pollution (40%). Asthma was the most often studied condition (75% of articles). In a third of the cases, the information was obtained from hospital or health center records, and in 20% from questionnaires. The main diagnostic criterion was clinical. Infection of the inferior respiratory tracts predominated in children less than 3 years of age. An awareness of the role played by pollution and environmental hazards is fundamental in the management and prevention of respiratory problems in childhood, and this is reflected in the literature reviewed. However, very few synthesis studies have been carried out on this matter.

[Variability in peak expiratory flow does not classify asthma according to severity]

OBJECTIVE

The aim of this study was to determine whether variability in peak expiratory flow (PEF) could be used to classify the level of severity of asthma in children.

PATIENTS AND METHODS

We studied 387 boys and girls diagnosed with asthma and classified severity according to clinical criteria (Spanish Society of Pediatric Pneumology). PEF variability was determined using a portable mini-Wright peak flow meter (Clement Clarke International, London, UK; range, 50 L/min-800 L/min) over a 14-day period, with no changes in normal treatment. The following indices were used to calculate PEF variability: 1) difference between morning PEF and nighttime PEF, expressed as a percentage of the mean value of the PEF measurements taken on that day; 2) minimum PEF rate during a week, expressed as a percentage of the highest value recorded during that week; 3) difference between the highest and the lowest PEF values, expressed as a percentage of the highest value; and 4) the 10th percentile of PEF values recorded during a week, expressed as a percentage of the highest value recorded during that week. We assessed agreement between clinical classification and PEF variability using the weighted kappa coefficient. We also analyzed the sensitivity and specificity of PEF variability indices for episodic and persistent asthma.

RESULTS

The analysis of levels of agreement between clinical classification of asthma and formulas 1, 2, 3, and 4 gave quadratic weighted kappa coefficients of 0.494, 0, 0.488, and 0.346, respectively. The results were similar when patients were grouped and analyzed by type of asthma (episodic or persistent asthma).

CONCLUSIONS

The monitoring of PEF variability, a recommendation common in national and international guidelines on the management of asthma in children, is not valid for classifying severity of asthma in children.

[Management of acute asthma exacerbations in pediatrics]

Despite the significant advances that have been produced in the management of asthma in the last few decades, crises, attacks, or asthma exacerbations (acute asthma) continue to be the most common cause of consultation in pediatric emergency units. Visits to these units and hospital admissions due to acute asthma represent three quarters of the direct costs due to this disease. Acute asthma is a medical emergency that should be rapidly diagnosed and treated. Evaluation of children with acute asthma exacerbations should consist of two phases: a static phase (determination of the severity of the crisis on admission) and a dynamic phase (treatment response). The present article provides an in-depth review and analysis of current pharmacological and nonpharmacological treatments (oxygen, bronchodilators, corticosteroids - inhaled and systemic - aminophylline, magnesium sulfate, etc.) of acute asthma exacerbations and proposes management protocols for use in both primary care and emergency units.

[Therapeutic education in asthma management]

All guidelines, protocols and recommendations underline the importance of therapeutic education as a key element in asthma management and control. Considerable evidence supports the efficacy and effectiveness of this measure. Health personnel, as well as patients and their parents, can and should be educated with two main objectives: to achieve the best possible quality of life and to allow self control of the disease. These goals can be attained through an educational process that should be individually tailored, continuous, progressive, dynamic, and sequential. The process poses more than a few difficulties involving patients, health professionals, and the health systems. Knowledge of the various psychological factors that can be present in asthmatic patients, as well as the factors related to the highly prevalent phenomenon of non-adherence, is essential. Awareness of the factors influencing physician-patient-family communication is also highly important to achieve the objectives set in therapeutic education. The educational process helps knowledge and abilities to be acquired and allows attitudes and beliefs to be modified. Patients and caregivers should be provided with an individual written action plan based on symptoms and/or forced expiratory volume in 1 second. Periodic follow-up visits are also required.

[Incidence of asthma and risk factors in a cohort of schoolchildren aged from 6-7 years old to 14-15 years old in Castellón (Spain) following the International Study of Asthma and Allergies in Childhood (ISAAC)]

BACKGROUND AND OBJECTIVE

To estimate the incidence of asthma in schoolchildren from 6-7 years old to 14-15 years old and associated risk factors.

POPULATION AND METHOD

A cohort study, with the ISAAC phases I and III in 1994 and 2002, respectively, was carried out in Castellón, and the nearby towns Vila-real, Almassora, Benicàssim, El Grau de Castelló, Borriol, and L'Alcora. In 1992, 3,607 schoolchildren aged 6-7 years old took part, of whom 1,805 were again studied in 2002, at the age of 14-15. New cases of asthma were defined following the ISAAC questionnaire. Poisson regression was used in the analysis of asthma risk factors.

RESULTS

Participation was 50.0%. The cumulative incidence of asthma was 6.4% during the 8 years of study, 108 new cases of 1,698 schoolchildren free of asthma at beginning. Incidence was greater in boys than girls, and in 14-year old teenagers compared to 15-year olds, although differences were not significant. Risk factors associated with the incidence of asthma were: family history of asthma, history of allergic rhinitis, history of bronchitis and upper-middle compared to lower social class.

CONCLUSIONS

A low incidence of asthma was found in schoolchildren from Castellón, Spain, in comparison with other cohort studies. Estimated risk factors were generally in accordance with incidence studies.