Field-test validation of the brazilian version of the Paediatric Asthma Quality of Life Questionnaire

Avaliação dos níveis de alfabetismo em saúde, conhecimento em asma e qualidade de vida de pais associados ao controle da doença em crianças e adolescentes com diagnóstico de asma de centros especializados

Objetivo: avaliar o nível de conhecimento em asma, alfabetismo em saúde e qualidade de vida de cuidadores de crianças e adolescentes com diagnóstico da doença, bem como, a associação com o controle da asma, adesão ao tratamento e qualidade de vida.Métodos: estudo transversal, realizado com cuidadores e pacientes de dois centros especializados de referência no Sul do Brasil, entre março de 2018 e novembro de 2018. Participaram pais e cuidadores de crianças e adolescentes com diagnóstico de asma, com idade a partir de 18 anos. Foram aplicados os questionários: sociodemográfico, Short Assessment of Health Literacy for Portuguese-Speaking Adults, Questionário de Conhecimento em Asma Pediátrica e Paediatric Asthma Caregiver’s Quality of Life Questionnaire. Para fins estatísticos, foram utilizados o teste t, qui-quadrado e Regressão Logística Binária.Resultados: foram incluídos 125 cuidadores, sendo 89 (71,2%) mães, com idade média de 35,7±9,2 anos, 65 (52%) com ensino médio completo e 100 (80%) pertencentes à classe econômica C. Do total, 74 (59,2%) apresentaram níveis inadequados de alfabetismo em saúde e 117 (94,4%) inadequados níveis de conhecimento em asma. A asma não estava controlada em 91 (72,8%) dos pacientes, estando associado a menor qualidade de vida deles e de seus cuidadores (p<0,001). A Regressão Logística verificou se o alfabetismo em saúde, o conhecimento em asma e a qualidade de vida dos cuidadores estavam associados ao controle da asma dos pacientes, sendo esse modelo significativo [X2(4) = 22,083; p<0,001, R2Nagelkerke = 0,484]. As variáveis categóricas utilizadas como referência foram as que apresentaram maior frequência (asma não controlada e conhecimentos inadequados). O alfabetismo em saúde (OR = 3,650; IC95% = 1,335 - 9,984) e qualidade de vida (OR = 3,095; IC95% = 1,850 – 5,178) também foram significativos.Conclusão: a população analisada apresentou níveis de alfabetismo em saúde e conhecimento em asma insatisfatórios. Ainda, os níveis de controle da doença foram baixos podendo estar associados aos níveis de qualidade de vida.

Differences between patients who achieved asthma control and those who remain uncontrolled after standardized severe asthma care strategy

OBJECTIVE

To assess clinical, functional, and inflammatory patterns of children and adolescents with severe uncontrolled asthma, and investigate the differences between patients who achieved asthma control and those who remain uncontrolled after standardized asthma care strategy.

METHODS

Screening all children and adolescents with asthma from the Pediatric Pulmonology Outpatient Clinic of Unicamp, Brazil, and included those with severe uncontrolled asthma according to GINA guidelines criteria. Patients were assessed at baseline and after by demographic and medication data, questionnaires (Asthma Control Test and Pediatric Asthma Quality of Life Questionnaire), Six-Minute Walk Test, skin prick test, spirometry, induced sputum, and blood collection (total immunoglobulin E and eosinophil count). Cytokine dosage was analyzed in sputum supernatant and serum by Cytometric Bead Array.

RESULTS

Thirty-three patients with severe uncontrolled asthma were included (median age 10.9 [7.00-17.60] years). All patients presented satisfactory adherence to treatment and 50% of them achieved good asthma control after six-month follow-up (p < 0.001). Patients who achieved asthma control reported higher intervals since their last exacerbation episode (p = 0.008) and higher quality of life scores (p < 0.001) as compared to patients who remained uncontrolled. We found no changes in lung function markers, inflammatory biomarkers, or cytokine levels between patients with uncontrolled and controlled asthma.

CONCLUSION

Participation of six months in a structured outpatient clinic for children with severe asthma had a notable improvement in control and quality of life of patients. This demonstrates the importance of a global assessment, focused on peculiarities presented by patients with severe uncontrolled asthma.

Linking quality of life questionnaires for asthma to the International Classification of Functioning

OBJECTIVE

To link the content of the most common quality of life instruments for children with asthma to the International Classification of Functioning, Disability and Health (ICF).

METHODS

The study was conducted in two stages. The first involved a review of the literature to select quality of life questionnaires and in the second, two independent reviewers identified questionnaire items, and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient.

RESULTS

Two questionnaires were selected: the Pediatric Asthma Quality of Life (PAQLQ) and Pediatric Quality of Life Asthma Module (PedsQL-Asthma), self and proxy versions. The degree of agreement was strong for all the instruments: PAQLQ (k = 0.624), PedsQL- Asthma self (k = 0.610), and PedsQL-Asthma proxy (k = 0.673). A total of 114 concepts were identified in the 77 items. Thirty-five different ICF categories were linked, 16 (45.7%) related "body function," 13 (37.1%) "activity and participation," and 6 (17.1%) "environmental factors." Two items (1.7%) could not be linked because they represent personal factors or are not covered by the ICF.

CONCLUSION

The categories linked to the PAQLQ contained primarily "body function" and "activity and participation," but not "environmental factors." Those linked to the PedsQL-Asthma versions encompass three of the four ICF components, where the highest content frequency was associated with "body function," followed by "environmental factors" and "activities and participation."

QUALITY OF LIFE EVALUATION AND ASSOCIATED FACTORSIN ASTHMATIC CHILDREN AND ADOLESCENTS ATTENDED IN A SPECIALIZED OUTPATIENT CLINIC

OBJECTIVE

To evaluate the quality of life and its association with disease control, severity, allergic comorbidities and adherence to treatment in children and adolescents with asthma.

METHODS

A cross-sectional study that included children and adolescents aged seven to 17. The Paediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to assess their quality of life. Sociodemographic and clinical data were obtained from the chart and from a questionnaire. Descriptive statistics were performed and chi-square or Fisher's exact tests were used to verify the existence of associations between quality of life and disease control, severity, comorbidities and adherence to treatment. The level of statistical significance was set at p<0.05.

RESULTS

101 children/adolescents were evaluated (62.4% boys), with a mean age of 10.1 years. On average, the PAQLQ score was ≤5.9 points, indicating moderate / severe quality of life impairment. Higher levels of control, as well as higher disease severity, were associated with higher quality of life impairment, both in total PAQLQ score and domains (p<0.05). The presence of comorbidities was also associated with higher quality of life impairment (p=0.01), except in the emotional function domain. Adherence to treatment showed no association with quality of life.

CONCLUSIONS

Children and adolescents with asthma present impairment in their quality of life, and this is related to poorer control and severity of the disease, as well as to the presence of allergic comorbidities.

Health-related quality of life in post-infectious bronchiolitis obliterans: agreement between children and their proxy

OBJECTIVE

To assess the level of agreement in health-related quality of life between children with Post-infectious Bronchiolitis Obliterans and their parent (so-called proxy).

METHODS

Participants aged between 8and 17 years who had been previously diagnosed with Post-infectious Bronchiolitis Obliterans were regularly followed up at a pediatric pulmonology outpatient clinic. Parents or legal guardians (caregivers) of these patients were also recruited for the study. A validated and age-appropriate version of the Pediatric Quality of Life Inventory 4.0 was used for the assessment of health-related quality of life. Caregivers completed the corresponding proxy versions of the questionnaire. The correlation between self and proxy reports of health-related quality of life was determined by intra-class correlation coefficient and dependent t-tests.

RESULTS

The majority of participants were males (79.4%), and the average age was 11.8 years. Intra-class correlations between each of the Pediatric Quality of Life Inventory 4.0 domains and the total score were all lower than 0.6, with a range between 0.267 (poor) and 0.530 (fair). When the means of each domain and the total score of the questionnaires were compared, caregivers were observed to have a significantly lower health-related quality of life score than children, with the exception of the social domain in which the difference was not significant. However, the differences in score exceeded the critical threshold difference of four points in all other domains.

CONCLUSION

Proxies of children and adolescents with Post-infectious Bronchiolitis Obliterans appear to consistently perceive their children as having lower health-related quality of life than how the patients perceive themselves.

Association between quality of life, severity of asthma, sleep disorders and exercise capacity in children with asthma: a cross-sectional study

OBJECTIVE

To assess the association between quality of life, asthma severity, sleep disorders and exercise capacity in children with asthma.

METHODS

We evaluated 45 children with asthma of both sexes aged between 7 and 12 years, diagnosed by a pediatrician/pulmonologist and classified according to the IV Brazilian Guidelines for Asthma Management: severity (intermittent/mild and moderate/severe) and control (controlled, partially controlled and uncontrolled). Quality of life (QoL), presence of sleep disorders and exercise capacity were respectively assessed using the following instruments: Pediatric Asthma Quality of Life Questionnaire (PAQLQ); Sleep Disturbance Scale for Children (SDSC); and six-minute step test (6MST).

RESULTS

Intermittent/mild and moderate/severe asthma were observed in 51.1% and 48.9% of the children evaluated, respectively. Only 8.89% of the sample had uncontrolled asthma. In the regression model, a better QoL was observed in children with lower asthma severity, lower SDSC total score and lower levels of dyspnea induced by the 6MST (β=-0.395, p=0.003; β=-0.338, p=0.011; β=-0.352, p=0.008; respectively). These factors explained 31% of the PAQLQ total score variation. Other variables (such as cardiorespiratory variables, spirometry, asthma control and number of steps in 6MST) did not predict quality of life.

CONCLUSIONS

Lower asthma severity (intermittent/mild), fewer symptoms of sleep disorder, and lower exercise-induced dyspnea predicts better quality of life in children with asthma.

APPLICABILITY OF A GENERIC QUESTIONNAIRE FOR QUALITY OF LIFE ASSESSMENT FOR ASTHMATIC CHILDREN

Objective:

To determine the applicability of the generic instrument Pediatric Quality of Life Inventory (PedsQL 4.0) to assess health-related quality of life of asthmatic children compared to the specific instrument Pediatric Asthma Quality of Life Questionnaire (PAQLQ).

Methods:

This research involved the evaluation of 30 children aged seven to eleven years, who had been diagnosed with asthma for at least six months prior to research. Both quality of life questionnaires were applied to children by an interviewer over the period of one day. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 20.0, with significance level set at 5%.

Results:

No differences in quality of life was found when genders were compared. Asthmatic children classified as practitioners and non-practitioners of physical activity had different scores in the physical health-related domain (PedsQL 4.0). The scores of children with different levels of asthma severity and control were significantly different in two out of three domains evaluated by PAQLQ. When assessed by PedsQL 4.0, no significant difference was observed as to quality of life of children with different levels of asthma control and severity. Quality of life measurements of asthmatic children by PedsQL 4.0 and PAQLQ instruments had a moderate and significant correlation (r=0.415, p=0.02).

Conclusions:

PedsQL 4.0 could distinguish children practicing different levels of physical activity, but it was not sensitive enough to distinguish health-related quality of life among children with different levels of asthma severity and control.

Quality of life in mucopolysaccharidoses: construction of a specific measure using the focus group technique

OBJECTIVE

To describe the perceptions of patients, their caregivers, and their healthcare providers to the development of a new specific instrument for assessment of the quality of life (QoL) in patients with mucopolysaccharidoses (MPS) using a qualitative focus group (FG) design. FGs were held in two Brazilian states (Rio Grande do Sul and Rio de Janeiro).

RESULTS

Three versions of the new instrument were developed, each for a different age group: children (age 8-12 years), adolescents (age 13-17), and adults (age ≥ 18). The FGs mostly confirmed the relevance of items. All FGs unanimously agreed on the facets: School, Happiness, Life Prospects, Religiosity, Pain, Continuity of Treatment, Trust in Treatment, Relationship with Family, Relationship with Healthcare Providers, Acceptance, and Meaning of Life. The overall concept of QoL (as proposed by the WHO-World Health Organization) and its facets apply to this patient population. However, other specific facets-particularly concerning clinical manifestations and the reality of the disease-were suggested, confirming the need for the development of a specific QoL instrument for MPS.

Physical activity and asthma control level in children and adolescents

BACKGROUND AND OBJECTIVE

Physical activity is defined as any bodily movement produced by a muscle contraction with increased energy expenditure. The aim of this study was to assess the physical activity, asthma control level, spirometric measurements and quality of life in children and adolescents with asthma.

METHODS

We included all children and adolescents aged 7-17 years who had a diagnosis of atopic asthma and who attended the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas, Brazil. Asthma control levels were evaluated by the Asthma Control Test (ACT). Physical activity was measured using the long version of the International Physical Activity Questionnaire (IPAQ) and by other questions about daily activities at school and at home over the last week. Lung function was assessed by spirometry, both pre- and post-bronchodilator (BD). Quality of life was evaluated using the Paediatric Asthma Quality of Life Questionnaire (PAQLQ).

RESULTS

Out of 100 patients, 60 were classified as presenting with controlled asthma (CA) and 40 as presenting with uncontrolled asthma (UA). In the IPAQ, 29% were classified as sedentary, 17% as active and 54% as very active. There was no significant association between physical activity and the level of asthma control. We found no differences between active and sedentary children and adolescents with asthma in spirometric variables or quality of life.

CONCLUSION

No associations were observed between physical activity and asthma control level, spirometric measurements and quality of life in children and adolescents with asthma.

Cultural validation of the post-Liver transplant quality of life (pLTQ) questionnaire for the Brazilian population

BACKGROUND AND RATIONALE

The post-Liver Transplant Quality of Life (pLTQ) questionnaire, developed in the United States, is a disease-targeted instrument designed to evaluate health-related quality of life (HRQoL) in liver transplant recipients. Our study sought to validate a version of the pLTQ for use in the Brazilian population. Translation and cross-cultural adaptation were carried out in accordance with international standard practices for questionnaire validation. Validity was measured by means of convergent validity (correlations between pLTQ domains and WHOQOL-Bref domains). Reliability was assessed by measurement of internal consistency (Cronbach's alpha coefficient), reproducibility (intraclass correlation coefficient), sensitivity to change (effect size), and floor and ceiling effects.

RESULTS

The study sample comprised 160 liver transplant recipients, with a mean age of 56.9 ± 10.4 years, treated at a tertiary hospital in Southern Brazil. The sample was largely male (62.5%), and the predominant indication for liver transplant was hepatocellular carcinoma (49.4%). Only two questionnaire items were modified during the translation and cross-cultural validation stage. The mean total pLTQ score was 5.58 ± 0.9, with < 20% floor/ceiling effect. Correlations between pLTQ and WHOQOL-Bref domains were acceptable (r = 0.37-0.40). For similar dimensions, the correlations between WHOQOL-Bref and pLTQ were statistically significant (p ≤ 0.001). Cronbach's alpha for the total score was 0.91 (95% CI 0.89-0.93), with a range of 0.51 to 0.77 across domains. Reproducibility was 0.90, and sensitivity to change was 0.84.

CONCLUSION

In conclusion, the Brazilian Portuguese versión of the pLTQ exhibited good psychometric performance, suggesting that it can be a useful tool in the Brazilian cultural context.

Quality of life of asthmatic children and adolescents: Portuguese translation, adaptation, and validation of the questionnaire "Pediatric Quality of Life (PedsQL) Asthma Module"

OBJECTIVE

The objectives of the study were to translate, validate, and verify the psychometric properties of the Portuguese version of the instrument "Pediatric Quality of Life Asthma Module" (PedsQL Asthma) culturally adapted for the Brazilian culture.

METHODS

After being translated to Portuguese and being culturally adapted, the questionnaire was answered by 200 asthmatic children and adolescents (aged 2-18) as well as the adults responsible for them. Validation required the use of the following instruments: PedsQL Asthma Children (applied to children and adolescents), PedsQL Asthma Parents (applied to adults responsible for children and adolescents), Pediatric Asthma Quality of Life (PAQLQ), Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT), as well as socioeconomic and personal information questionnaires. A group of 45 clinically stable children repeated the questionnaires 15-60 days after answering the first questionnaire.

RESULTS

Correlations between the scores of PedsQL Children and PedsQL Parents (r  =  0.67), PedsQL Children and PAQLQ (r  =  0.66), and PedsQL Parents and PAQLQ (r  =  0.64) were moderate and significant. Correlations were higher for men (r  =  0.72) when analyzing the children's and parents' answers to PedsQL according to gender. The 5- to 7-year-old age group had the strongest correlations with PAQLQ (r  =  0.79). Cronbach's alpha coefficient for PedsQL Children and Parents had values of 0.85 and 0.87, respectively. A high concordance was observed in both tests at different times, with kappa values of 0.89 and 0.87 for PedsQL Children and Parents, respectively.

CONCLUSION

The instrument used in this study was considered valid, consistent, and reproducible and has acceptable psychometric properties for the Brazilian population.

Evaluation of quality of life according to asthma control and asthma severity in children and adolescents

OBJECTIVE:

To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents.

METHODS:

We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life.

RESULTS:

The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups.

CONCLUSIONS:

Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.

Validation of the Brazilian version of the childhood asthma control test (c-ACT)

BACKGROUND

Children's perception of their symptoms has proved reliable and relevant to disease management and should be considered when assessing their asthma control. The aim of the study is to validate the Brazilian Portuguese version of the Childhood Asthma Control Test (c-ACT) in children aged 4-11 years.

METHODS

This is a cross-sectional study in children diagnosed with asthma undergoing treatment in a pediatric pulmonology outpatient clinic in Porto Alegre, Brazil. The translation and linguistic adaptation of the instrument were performed in accordance with international recommendations for questionnaire validation.

RESULTS

A total of 105 participants were included, aged 4-11 years.

VALIDITY

all correlations between the total score and items on the questionnaire were significant and obtained values of r ≥ 0.3, and c-ACT means showed statistically significant differences between the GINA categories (P < 0.01). The controlled asthma group showed significantly higher c-ACT scores than those of uncontrolled asthma group (controlled 22.0 ± 2.9 vs. uncontrolled 16.3 ± 5.3 P < 0.01); and partially controlled asthma group showed significantly higher c-ACT scores than those of uncontrolled asthma group (partially controlled 20.0 ± 4.0 vs. uncontrolled 16.3 ± 5.3 P = 0.03). Correlations between the c-ACT total score and spirometry and nitric oxide were poor (r = 0.020; P = 0.866 and r = 0.035; P = 0.753, respectively). Reliability: the α-C coefficient for the c-ACT total score was 0.677 (95%CI 0.573-0763). Sensitivity to change had an effect size of 0.8 and an intraclass correlation coefficient of 0.598. No floor or ceiling effects were observed.

CONCLUSION

The Brazilian version of the Childhood Asthma Control Test proved to be valid and reliable in children aged 4-11 years.

The quality of life of Brazilian adolescents with asthma: associated clinical and sociodemographic factors

OBJECTIVE

Asthma is the most common chronic disease among adolescents. This study assessed the quality of life (QOL) related to health in adolescents with asthma and its determining factors (demographic, socioeconomic, and clinical). We also separately evaluated each of the parameters that comprised the asthma control classification.

METHODS

This was an observational, cross-sectional study of 114 adolescents who had doctor-diagnosed asthma. QOL was assessed using a version of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) that was adapted and validated for Brazil, and higher scores indicated a better QOL. The level of asthma control was assessed using the rating system proposed by the Global Initiative for Asthma, and sociodemographic factors were evaluated.

RESULTS

When the averages of the PAQLQ domains and overall scores were compared to the potentially explanatory variables, significantly lower average PAQLQ scores were obtained for individuals with an inadequate level of asthma control (p < 0.001). Of the control components, daytime symptoms, nighttime symptoms, and limited physical activity were related to QOL. However, the use of the β2 agonist and the peak flow functional parameter were not related to QOL.

CONCLUSIONS

The level of asthma control was related to QOL, but this association manifested mainly in the subjective control domains, such as nighttime and daytime symptoms and physical activity limitations. The objective domain for control classification, represented by pulmonary function, was not an independent predictor or determinant of the QOL of adolescent asthma patients.

Quality of life in children with asthma in Rio de Janeiro, Brazil

OBJECTIVES

To evaluate the impact of asthma on activity limitation, symptoms and emotional function in the health-related quality of life (HRQL) of asthmatic children.

METHODS

A cross-sectional study involving 59 children of 7 to 12 y of age. A standardized version of the Pediatric Asthma Quality of Life Questionnaire was used to evaluate HRQL and the current criteria for socioeconomic stratification in Brazil were used to assess socioeconomic status. Independent variables evaluated included clinical and sociodemographic characteristics. The association between mean HRQL scores and the independent variables was evaluated using the Mann-Whitney, Kruskal-Wallis and Dunn tests. Statistical significance was defined as a p-value < 0.05.

RESULTS

Thirty-two families (56.1 %) had a total household income of more than two minimum wages, while 37 families (62.7 %) were considered lower middle class. Mean overall HRQL score was 4.8 ± 1.3 (out of a maximum score of 7), suggesting reasonable HRQL. There was a weak association between independent variables and mean overall HRQL scores and the mean scores in the emotional function domain. Higher socioeconomic status was related to higher scores for the symptoms domain (p = 0.041). Furthermore, children exposed to indoor mould reported greater impairment in the symptoms domain(p = 0.022). The severity of asthma was associated with the activity limitation domain (p = 0.025).

CONCLUSIONS

These results showed a reasonable mean HRQL score and an association between the severity of asthma and the activity limitation domain.

Qualidade de vida de crianças e adolescentes asmáticos: sua relação com estratégias de enfrentamento materno

OBJETIVO: Avaliar a qualidade de vida de crianças e adolescentes asmáticos, sua relação com variáveis sociodemográficas e clínicas e estratégias de enfrentamento materno. MÉTODOS: Estudo transversal no qual crianças e adolescentes com asma responderam a um questionário de qualidade de vida, e suas mães a uma escala de enfrentamento. RESULTADOS: Foram estudadas 42 crianças e adolescentes com idades entre 7 e 15 anos, sendo 74% classificados como tendo um quadro de asma persistente moderada/grave, 19% como persistente leve e 7% asma intermitente; 69% dos entrevistados apresentaram prejuízo na qualidade de vida, com escores médios variando de 4,7 a 3,5 e maior prejuízo no domínio sintomas (escore=3,6). Houve associação significativa entre escolaridade materna e índice geral de qualidade de vida, mas não entre gravidade da asma e tipo de enfrentamento materno. Grande parte das estratégias utilizadas pelas mães para enfrentar as crises do filho estava direcionada ao manejo de estressores ou práticas religiosas, estas com correlação negativa com o índice geral de qualidade de vida da criança, sinalizando que mães cujos filhos tinham pior qualidade de vida usavam mais enfrentamentos religiosos. CONCLUSÕES: Crianças asmáticas, especialmente com asma persistente moderada/grave, apresentaram alterações significativas em sua qualidade de vida. A alta porcentagem de uso de estratégias religiosas por parte das mães, especialmente frente a quadros mais graves, parece indicar que elas se sentem impotentes para atuar, necessitando de orientações concretas e factíveis para uma população de baixa renda.

Specific instruments to assess quality of life in children and adolescents with asthma

OBJECTIVE

To identify and describe specific instruments to assess health-related quality of life (HRQoL) in children and adolescents with asthma.

DATA SOURCE

Searches were performed in the PubMed, Ovid, and LILACS databases using different combinations of key words (MeSH terms), selecting original articles on the development of specific HRQoL questionnaires, published in English, Portuguese, or Spanish, between 1990 and 2012.

DATA SYNTHESIS

A total of 15 instruments that met the inclusion criteria were identified. Most studies assessed reliability through internal consistency, reproducibility, and/or sensitivity to changes. Validity was assessed by comparison with healthy controls (discordant validity) or factorial analysis.

CONCLUSIONS

Of the 15 instruments, three are the most frequently used: Pediatric Asthma Quality of Life Questionnaire (PAQLQ), Pediatric Quality of Life Inventory 4.0 (PedsQL-Asthma), and Disability Kids (DISABKIDS). In general, these three tools have adequate psychometric characteristics and are practical to implement, but only PAQLQ has been culturally adapted to Brazil.

Monitoring asthma status

PURPOSE

Asthma is a chronic disorder of the airways involving inflammation and airway hyper-reactivity. Clinical diagnosis and monitoring of asthma must incorporate the immunological, biochemical, and histological changes of a chronic disorder, while recognizing acute phenotypic changes in order to optimally tailor therapeutics to each individual.

RECENT FINDINGS

Articles published within the previous 18 months are summarized in this article in order to present an up to date review of the latest findings regarding the monitoring of asthma. The articles encompass a wide array of specialties from basic research and histology to clinical medicine as well as community medicine and nursing.

SUMMARY

Exciting new advancements in the monitoring of asthma continue to unfold. Potentially new diagnostic and monitoring tools are highlighted in this study. Continued investigations may enable a select few methodologies to reach clinical utility in the ongoing monitoring and treatment of patients with asthma.

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

Recent original scientific contributions published in selected Brazilian periodicals and classifiable under cardiovascular and pulmonary subject categories cover a wide range of sub specialties, both clinical and experimental. Because they appear in journals with only recently enhanced visibility, we have decided to highlight a number of specific items appeared in four Brazilian journals, because we understand that this is an important subsidy to keep our readership adequately informed. These papers cover extensive sub-areas in both fields.