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Plaza A, Ibáñez M, Sánchez-Solís M, Bosque-García M, Cabero M, Corzo J, García-Hernández G, de la Hoz B, Korta-Murua J, Sánchez-Salguero C, Torres-Borrego J, Tortajada-Girbés M, Valverde-Molina J, Zapatero L, Nieto A. Consensus-based approach for severe paediatric asthma in routine clinical practice. Anales de Pediatría (English Edition) 2016. [DOI: 10.1016/j.anpede.2015.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Plaza AM, Ibáñez MDP, Sánchez-Solís M, Bosque-García M, Cabero MJ, Corzo JL, García-Hernández G, de la Hoz B, Korta-Murua J, Sánchez-Salguero C, Torres-Borrego J, Tortajada-Girbés M, Valverde-Molina J, Zapatero L, Nieto A. [Consensus-based approach for severe paediatric asthma in routine clinical practice]. An Pediatr (Barc) 2015; 84:122.e1-122.e11. [PMID: 26515042 DOI: 10.1016/j.anpedi.2015.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023] Open
Abstract
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.
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Affiliation(s)
- A M Plaza
- Alergología Infantil, Hospital Sant Joan de Deu, Barcelona, España
| | - M D P Ibáñez
- Alergología Infantil, Hospital Niño Jesús, Madrid, España
| | - M Sánchez-Solís
- Neumología Infantil, Hospital Virgen de la Arrixaca, Murcia, España
| | - M Bosque-García
- Unidad de Alergia, Neumología e Inmunología Pediátrica, Hospital de Sabadell, Corporación Universitaria Parc Taulí, Barcelona, España
| | - M J Cabero
- Neumología Infantil, Hospital Marqués de Valdecilla, , Santander, España
| | - J L Corzo
- Sección de Alergia Infantil, HMI, Málaga, España
| | - G García-Hernández
- Neumología y Alergia Pediátricas, Hospital Universitario 12 de Octubre, Madrid, España
| | - B de la Hoz
- Alergología Infantil, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Korta-Murua
- Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España
| | | | - J Torres-Borrego
- Unidad de Alergia y Neumología Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España
| | - M Tortajada-Girbés
- Neumología y Alergología Infantil, Hospital Universitario Dr. Peset, Valencia, España
| | - J Valverde-Molina
- Neumología Infantil, Hospital Universitario Los Arcos del Mar Menor, San Javier (Murcia), España
| | - L Zapatero
- Alergología Infantil, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - A Nieto
- Neumología y Alergología Infantil, Hospital La Fe, Valencia, España.
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Genuneit J, Cantelmo JL, Weinmayr G, Wong GWK, Cooper PJ, Riikjärv MA, Gotua M, Kabesch M, von Mutius E, Forastiere F, Crane J, Nystad W, El-Sharif N, Batlles-Garrido J, García-Marcos L, García-Hernández G, Morales-Suarez-Varela M, Nilsson L, Bråbäck L, Saraçlar Y, Weiland SK, Cookson WOC, Strachan D, Moffatt MF. A multi-centre study of candidate genes for wheeze and allergy: the International Study of Asthma and Allergies in Childhood Phase 2. Clin Exp Allergy 2010; 39:1875-88. [PMID: 20085599 DOI: 10.1111/j.1365-2222.2009.03364.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Common polymorphisms have been identified in genes suspected to play a role in asthma. We investigated their associations with wheeze and allergy in a case-control sample from Phase 2 of the International Study of Asthma and Allergies in Childhood. METHODS We compared 1105 wheezing and 3137 non-wheezing children aged 8-12 years from 17 study centres in 13 countries. Genotyping of 55 candidate single nucleotide polymorphisms (SNPs) in 14 genes was performed using the Sequenom System. Logistic regression models were fitted separately for each centre and each SNP. A combined per allele odds ratio and measures of heterogeneity between centres were derived by random effects meta-analysis. RESULTS Significant associations with wheeze in the past year were detected in only four genes (IL4R, TLR4, MS4A2, TLR9, P<0.05), with per allele odds ratios generally <1.3. Variants in IL4R and TLR4 were also related to allergen-specific IgE, while polymorphisms in FCER1B (MS4A2) and TLR9 were not. There were also highly significant associations (P<0.001) between SPINK5 variants and visible eczema (but not IgE levels) and between IL13 variants and total IgE. Heterogeneity of effects across centres was rare, despite differences in allele frequencies. CONCLUSIONS Despite the biological plausibility of IgE-related mechanisms in asthma, very few of the tested candidates showed evidence of association with both wheeze and increased IgE levels. We were unable to confirm associations of the positional candidates DPP10 and PHF11 with wheeze, although our study had ample power to detect the expected associations of IL13 variants with IgE and SPINK5 variants with eczema.
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Affiliation(s)
- J Genuneit
- Institute of Epidemiology, Ulm University, Ulm, Germany.
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Antón-Pacheco JL, García-Hernández G, Villafruela MA. The management of tracheobronchial obstruction in children. Minerva Pediatr 2009; 61:39-52. [PMID: 19180001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Tracheobronchial obstruction is very uncommon in children and small infants. Stenosis and malacia, either congenital or acquired, are probably the most frequent diagnosis in this setting. Clinical symptoms are common to both airway anomalies and bronchoscopy plays a crucial role in the diagnostic work-up. Management is complex and surgeons involved in it should be familiar with multiple surgical and endoscopical techniques. Symptomatic short tracheal stenosis are best treated by means of resection and reconstruction, although endoscopic dilation or laser resection can be tried first in selected cases. In long tracheal stenosis, slide tracheoplasty is the surgical procedure of choice. Tracheobronchial malacia is usually self-limiting by the age of 3 years and most cases show mild symptoms that can be treated conservatively. In a small group of patients airway compromise is severe enough to require surgical or endoscopical treatment. Aortopexy or tracheostomy are the classic treatments for congenital tracheomalacia, but increasing experience with endoscopic airway stent placement in children is making this technique more attractive and popular. Acquired tracheomalacia is usually caused by a long-standing tracheostomy and if decannulation is impaired surgical treatment is mandatory.
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Affiliation(s)
- J L Antón-Pacheco
- Pediatric Airway Unit, Department of Pediatrics, University Hospital ''12 de Octubre'', Madrid, Spain.
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Garcia-Marcos L, Arnedo Pena A, Busquets-Monge R, Morales Suárez-Varela M, García de Andoin N, Batlles-Garrido J, Blanco-Quirós A, López-Silvarrey Varela A, García-Hernández G, Aguinaga-Ontoso I, González-Díaz C, Garcia-Merino A. How the presence of rhinoconjunctivitis and the severity of asthma modify the relationship between obesity and asthma in children 6-7 years old. Clin Exp Allergy 2008; 38:1174-8. [PMID: 18462453 DOI: 10.1111/j.1365-2222.2008.02993.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association between asthma and obesity in children, and the effect modification of allergy on this association have not been fully established. Aims The objective of the study was to know the effect modification of the severity of asthma and of the coexistence of rhinoconjunctivitis (RC) in the relationship between obesity and asthma. METHODS A cross-sectional study of 17 145 schoolchildren 6-7 years old from eight Spanish cities who had completed information on height and weight of the ISAAC phase III questionnaire, which also included questions about asthma and RC symptoms and on various risk factors. Body mass index (BMI) was used to define obesity according to international standards. Two different logistic regressions, using current occasional asthma (COA) and current severe asthma (CSA) as dependent variables, were made stratifying for gender and for the coexistence of RC and controlling for age, older and younger siblings, exercise, mother's education, truck traffic, cat/dog during the first year of life and smoking father or mother. RESULTS Obesity was a risk factor of CSA without RC, both for boys (1.92, CI 95% 1.13-3.25) and for girls (2.99, CI 95% 1.68-5.32). Every BMI unit increment increased by 6.7% the risk of CSA without RC in boys and by 12.4% in girls. Obesity was not a risk factor for CSA with RC. The association between COA and obesity was weaker and the coexistence of RC did not modify it greatly. CONCLUSIONS Obese schoolchildren are more at risk of suffering from non-allergic asthma than the non-obese subjects.
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Affiliation(s)
- L Garcia-Marcos
- Institute of Respiratory Health, University of Murcia, Murcia, Spain.
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Carvajal-Urueña I, García-Marcos L, Busquets-Monge R, Morales Suárez-Varela M, García de Andoin N, Batlles-Garrido J, Blanco-Quirós A, López-Silvarrey A, García-Hernández G, Guillén-Grimaj F, González-Díaz C, Bellido-Blasco J. [Geographic variation in the prevalence of asthma symptoms in Spanish children and adolescents. International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3, Spain]. Arch Bronconeumol 2006; 41:659-66. [PMID: 16373042 DOI: 10.1016/s1579-2129(06)60333-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze geographic variations in the prevalence of symptoms related to asthma in Spanish children and adolescents. POPULATION AND METHODS In 2001 and 2002, the Spanish arm of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3 collected information on 28 445 children in the age bracket of 6-7 years in 10 metropolitan areas (A Coruña, Asturias, Barcelona, Bilbao, Cartagena, Castellón, Madrid, Pamplona, San Sebastián, and Valencia) and on 31 257 adolescents in the bracket 13-14 years in 11 areas (the previously named areas plus Valladolid). An asthma symptom questionnaire was filled in by parents or the adolescents themselves. Differences in symptoms between geographic areas were analyzed by fitting a logistic regression model. The relationship between symptoms and age was analyzed by linear correlation. RESULTS The prevalence of recent wheezing (last 12 months) ranged from 7.1% to 12.9% among 6-7-year-olds and from 7.1% to 15.3% among the 13-14-year-olds. The greatest risk of recent wheezing was observed for children in A Coruña (odds ratio [OR] =1.96 in comparison with the area of lowest prevalence; 95% confidence interval [CI], 1.65-2.33) and Bilbao (OR=1.83; 95% CI, 1.54-2.18) and for adolescents in A Coruña (OR=2.38; 95% CI, 2.04-2.79) and Asturias (OR=2.37; 95% CI, 2.03-2.77). A strong correlation (r=0.72) was observed between the prevalence of recent wheezing and age in each of the geographic areas. CONCLUSIONS Considerable geographic variation in the prevalence of asthma symptoms can be seen in Spain even among young children. Symptoms are more frequent in children and adolescents who live on the Spain s northern Atlantic coast.
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Affiliation(s)
- I Carvajal-Urueña
- Centro de Salud de Las Vegas, Area Sanitaria III. Avilés, Servicio de Salud del Principado de Asturias, Asturias, Spain. ignacio,
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Moreno Villares JM, Oliveros Leal L, Torres Peral R, Luna Paredes C, Martínez-Gimeno A, García-Hernández G. ¿Cómo crecen los lactantes diagnosticados de alergia a proteínas de leche de vaca? An Pediatr (Barc) 2006; 64:244-7. [PMID: 16527091 DOI: 10.1157/13085511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Approximately 2-3 % of infants develop cow's milk allergy (CMA). Treatment consists of eliminating milk from the diet. Some studies have shown growth failure in children with CMA and a milk-free diet. OBJECTIVES To evaluate growth status at 1 and 2 years of age in infants diagnosed with CMA. MATERIAL AND METHODS An observational, longitudinal, retrospective study of all infants diagnosed with CMA from 2000-2001 was performed. The following data were analyzed: chronology and type of feeding, the presence of allergy to other foods, atopic dermatitis or other symptoms of allergy, duration of CMA, and anthropometric data (weight and height) at diagnosis, and at 1 and 2 years of age. Anthropometric data were expressed as Z-scores. RESULTS A total of 141 infants (71 boys and 70 girls) were studied. Atopic dermatitis was found in 67 infants (47.5%) and wheezing in 36 (25.5%). Allergy to foods other than milk was found in 27%. Only 21.3% of the infants grew out of CMA at the age of 2 years, of which 37% did so in the first year of life. Z-scores for weight were -0.5 at birth, -0.25 at the first follow-up visit, -0.25 at 1 year, and -0.19 at 2 years. Z-scores for height were 10.26 at the first follow-up visit, 10.64 at 1 year, and 10.35 at 2 years. A significant difference in Z scores for weight was found in infants with allergies to other foods, atopic dermatitis or wheezing compared with those with CMA only. CONCLUSIONS Infants with CMA receiving a substitute formula (hydrolyzed or soy formulae) showed normal weight and height at 2 years, although the percentile for height tended to be better than that for weight. The presence of other food allergies, atopic dermatitis or wheezing seems to affect the nutritional status of infants with CMA.
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Affiliation(s)
- J M Moreno Villares
- Unidad de Nutrición Clínica, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Estrada-Reyes E, García-Hernández G, Martínez-Gimeno A, Nava-Ocampo AA. Effect of extensively hydrolyzed milk formula on growth and resistance to bronchitis and atopic dermatitis in infants and toddlers. J Investig Allergol Clin Immunol 2006; 16:183-7. [PMID: 16784012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the adverse effects of extensively hydrolyzed milk formula on growth in infants and toddlers. METHODS Prospectively, 45 infants and toddlers with a positive history of cow's milk allergy confirmed by positive skin prick test and high IgE levels for either alpha-lactalbumin, beta-lactoglobulin, or casein and positive single-blind food challenge received extensively hydrolyzed milk formulas for 1 year. Sex-normalized percentiles of heights and weights of infants and toddlers before their enrollment in the study were compared to those at the end of the study. The contribution of breastfeeding, early use of bottle feeding and intake of adapted or special milk formulas, and history of bronchitis and atopic dermatitis on toddlers' growth were also evaluated by multivariate analysis. RESULTS Similar percentiles of the children's weight and height were observed at the beginning of the study and 1 year later. According to the multivariate analysis, sex, breastfeeding, early bottle feeding, ingestion of adapted or special milk formulas, atopic dermatitis, and bronchitis were not correlated with either the children's weight or height at diagnosis of the allergy or at 1 year of follow-up (P > .10). Weights and heights were not different between toddlers who had atopic dermatitis or bronchitis during the study period and those who did not. CONCLUSIONS Growth of infants and toddlers with cow's milk allergy was not affected by the intake of extensively hydrolyzed milk for 1 year. Atopic dermatitis and bronchitis did not appear to have any deleterious effect on these children's growth.
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Affiliation(s)
- E Estrada-Reyes
- Consulta de Alergología Pediatrica, Hospital Angeles Metropolitano, Mexico City, Mexico
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Macías-Chapula CA, Mijangos-Nolasco A, Eguía Lis-Márquez JJ, Ramírez Godoy ME, García-Hernández G. Bibliometric analysis on AIDS publications in South Africa. Rev esp doc cient 2002. [DOI: 10.3989/redc.2002.v25.i4.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Badia X, García-Hernández G, Cobos N, López-David C, Nocea G, Roset M. [Validity of the Spanish version of the Pediatric Quality of Life Questionnaire for evaluating quality of life in asthmatic children]. Med Clin (Barc) 2001; 116:565-72. [PMID: 11412631 DOI: 10.1016/s0025-7753(01)71907-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To analyze the clinical utility of the quality of life questionnaire for asthmatic children (PAQLQ) and to validate it for use in clinical practice. PATIENTS AND METHOD 1,012 children between 6 and 14 years of age, with a diagnosis of mild to moderate asthma attending 48 Spanish hospitals were included in the study. The patients' socio-demographic and clinical characteristics were recorded and all patients were administered the PAQLQ and EQ-5D questionnaires on two occasions: at the baseline visit and at 2-3 months from baseline in patients with uncontrolled asthma(group A) and at baseline and 15 days from baseline in patients with controlled asthma (group B). The feasibility, validity, reliability and sensitivity to change of the PAQLQ were assessed. RESULTS The PAQLQ proved to be feasible for use in children over 7 years of age with mild or moderate asthma. The PAQLQ did not show a statistically significant relationship with socio-demographic variables, nor with the majority of clinical variables, with the exception of asthma severity, number of exacerbations, symptoms and use ofon- demand short-term beta2 agonist drugs. Correlations between PAQLQ and EQ-5D dimensions were strongest between dimensions measuring similar attributes. Cronbach's *coefficients for the PAQLQ ranged from 0.88 for the limitations in activities dimension to 0.96 for the overall score. The intraclass correlation coefficient for PAQLQscores in group B ranged from 0.71 (limitation of activities)to 0.83 (overall score). The effect size between both visits ranged from 0.49 to 0.69. CONCLUSIONS The Spanish version of the PAQLQ proved to be valid for use in children with mild to moderate asthma.
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Affiliation(s)
- X Badia
- Institut de Salut Pública de Catalunya. Universitat de Barcelona. L'Hospitalet de Llobregat. Barcelona.
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