Maximal respiratory pressures of healthy children: comparison between obtained and predicted values.

PURPOSE: To compare maximal inspiratory and expiratory pressures (PImax and PEmax, respectively) obtained in Brazilian children who are healthy with reference and predicted values from previous studies. METHODS: Respiratory muscle strength of 144 children (63 boys), aged 7 to 11 years, was assessed. A digital manovacuometer was used to measure PImax and PEmax from residual volume and total lung capacity, respectively. Children were assessed in the sitting position while wearing a nose clip. RESULTS: Mean values of PImax for boys and girls were 81.6 ± 20.2 and 66.1 ± 19.5 cmH2O, respectively. Mean values of PEmax in boys and girls were 95.6 ± 21.1 and 78.9 ± 19.7 cmH2O, respectively. CONCLUSIONS: Published reference values demonstrated a wide diversity across age groups studied, and published equations were not successful in predicting maximal respiratory pressures; thus, the assessment of respiratory muscle strength of children should consider the minimization of ethnic and methodological differences.

Pediatric Asthma Therapy Assessment Questionnaire for the Brazilian population: Cross-cultural adaptation and measurement properties.

OBJECTIVE: To cross-culturally adapt the Pediatric Asthma Therapy Assessment Questionnaire (ATAQ) into Brazilian Portuguese and analyze its measurement properties. METHODS: This exploratory methodological study included eight experts and 30 caregivers in the translation and cross-cultural adaptation steps. Thereafter, 118 caregivers of pediatric patients with asthma aged between 5 and 17 years were involved in the analysis of measurement properties. We analyzed the content, structural (exploratory and confirmatory factorial), construct (convergent and discriminant), and known-groups validities; floor and ceiling effects; and determined the cut-off point (receiver operator characteristic curve) to identify pediatric patients with uncontrolled asthma. Intraclass correlation coefficient (ICC) analyzed test-retest reliability with 54 caregivers, whereas Cronbach's α and composite reliability verified the internal consistency of the items. RESULTS: The committee of experts and caregivers found the instructions and response options relevant, understandable, and clear (K > 0.75). During the cross-cultural adaptation, three items (2, 4, and 12) were slightly modified by including terms to facilitate understanding. A two-factor structure (asthma control and patient-provider communication) was identified. Internal consistency (α > .67; composite reliability > 0.73) and test-retest reliability (ICC > 0.80) were acceptable. For construct and know-groups validities, 85.71% of the hypothesis were confirmed. A cut-off point of >3 for the control domain was considered adequate to identify pediatric patients with uncontrolled asthma (sensitivity: 86.21%; specificity: 80.90%). CONCLUSION: The Pediatric ATAQ was adequately adapted for Brazilian pediatric patients with asthma and produced valid and reliable measures for assessing asthma control. Therefore, it may be considered an adequate instrument for monitoring asthma control in the Brazilian pediatric population.

Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis.

AIMS: To summarise the evidence on barriers to and facilitators of population adherence to prevention and control measures for coronavirus disease 2019 (COVID-19) and other respiratory infectious diseases. METHODS: A qualitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. We performed an electronic search on MEDLINE, Embase and PsycINFO from their inception to March 2023. RESULTS: We included 71 studies regarding COVID-19, pneumonia, tuberculosis, influenza, pertussis and H1N1, representing 5966 participants. The measures reported were vaccinations, physical distancing, stay-at-home policy, quarantine, self-isolation, facemasks, hand hygiene, contact investigation, lockdown, infection prevention and control guidelines, and treatment. Tuberculosis-related measures were access to care, diagnosis and treatment completion. Analysis of the included studies yielded 37 barriers and 23 facilitators. CONCLUSIONS: This review suggests that financial and social support, assertive communication, trust in political authorities and greater regulation of social media enhance adherence to prevention and control measures for COVID-19 and infectious respiratory diseases. Designing and implementing effective educational public health interventions targeting the findings of barriers and facilitators highlighted in this review are key to reducing the impact of infectious respiratory diseases at the population level.

Relationship between anxiety symptoms, clinical control and quality of life of children with asthma: A cross-sectional study.

OBJECTIVE: To investigate the relationship between anxiety symptoms and factors related to clinical control and quality of life of children with asthma aged 7-12 years. METHODS: A cross-sectional comparative study involving children recruited from a reference center for asthma treatment in the city of Natal-RN. Diagnosis, control and severity were performed following GINA recommendations (2019). Sociodemographic information and spirometry results from a bronchodilator test were collected. Modified Fisher's scale, clinical control questionnaires (c-ACT and ACT), quality of life assessment (PAQLQ) (total score and domains) and anxiety symptoms assessment (SCAS) (total score and domains) were applied. RESULTS: The sample consisted of 42 children with asthma. Symptoms of social phobia (as identified by SCAS), and household head education were related to clinical asthma control (p = .006; R 2 = .19). Total SCAS score, guardian's education and physical activity were related to total PAQLQ (p < .0001; R 2 = .33). SCAS was related to the activity limitation domain of PAQLQ (p = .004; R 2 = .17). SCAS, gender, and physical activity were related to the PAQLQ symptoms domain (p = .003; R 2 = .32). The guardian's education, physical activity practice, and the symptoms of separation anxiety, panic attack and agoraphobia (as identified by SCAS) were related to the emotional domain of PAQLQ (p = .004; R 2 = .45). CONCLUSION: The present study shows evidence of an association between anxiety symptoms, poorer clinical control, and health-related quality of life in children with asthma.

Effects of aerobic interval training on glucose tolerance in children and adolescents with cystic fibrosis: a randomized trial protocol.

BACKGROUND: Individuals with cystic fibrosis (CF) may develop CF-related diabetes (CFDR). This comorbidity is related to a poorer quality of life, microvascular complications, a decline in lung function, and an increase in exacerbations, as well as delayed growth and puberty. Evidence exists that physical exercise contributes to glycemic control in individuals with non-CF-related diabetes. This exercise is usually continuous with moderate intensity and long duration, which can cause muscle dyspnea and fatigue in CF individuals. Aerobic interval training (AIT) emerges as a safe and effective alternative for treating these individuals. The objective of this study is to evaluate the effects of AIT on glucose tolerance in children and adolescents with CF. METHODS: This study will be a two-arm, prospectively registered, randomized controlled trial with blind assessors and twenty 6- to 18-year-old individuals with cystic fibrosis (CF) from two different Brazilian states. People with CF will be randomly allocated to either the experimental or control group using block randomization, stratified by puberty stage,. Participants from both groups will receive an educational intervention and will be asked to continue their usual daily treatment for the full duration of the study. Those in the experimental group will perform AIT on a cycle ergometer at home three times a week, for 8 consecutive weeks. The sample characterization will include an assessment of puberty stage, socioeconomic status, dyspnea, and anthropometry. The primary outcome will be the change in glucose tolerance, while the secondary outcomes will include lung function, exercise tolerance, respiratory muscle strength, quality of life, and CF exacerbations. All outcomes will be assessed at baseline, week 9, and week 17. DISCUSSION: This is the first study to evaluate the effects of AIT on glucose tolerance in children and adolescents with CF. This study will serve as a basis for guiding clinical practice and decision-making in treating glucose intolerance and CF-related diabetes (CFRD) in children and adolescents with CF. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration System: NCT03653949. Registered on August 31, 2018.

Prediction equations for spirometry in four- to six-year-old children.

OBJECTIVE: To generate prediction equations for spirometry in 4- to 6-year-old children. METHODS: Forced vital capacity, forced expiratory volume in 0.5s, forced expiratory volume in one second, peak expiratory flow, and forced expiratory flow at 25-75% of the forced vital capacity were assessed in 195 healthy children residing in the town of Sete Lagoas, state of Minas Gerais, Southeastern Brazil. The least mean squares method was used to derive the prediction equations. The level of significance was established as p<0.05. RESULTS: Overall, 85% of the children succeeded in performing the spirometric maneuvers. In the prediction equation, height was the single predictor of the spirometric variables as follows: forced vital capacity=exponential [(-2.255)+(0.022×height)], forced expiratory volume in 0.5s=exponential [(-2.288)+(0.019×height)], forced expiratory volume in one second=exponential [(-2.767)+(0.026×height)], peak expiratory flow=exponential [(-2.908)+(0.019×height)], and forced expiratory flow at 25-75% of the forced vital capacity=exponential [(-1.404)+(0.016×height)]. Neither age nor weight influenced the regression equations. No significant differences in the predicted values for boys and girls were observed. CONCLUSION: The predicted values obtained in the present study are comparable to those reported for preschoolers from both Brazil and other countries.

[Pulmonary function of children with acute leukemia in maintenance phase of chemotherapy]. / Função pulmonar de crianças com leucemia aguda na fase de manutenção da quimioterapia.

OBJECTIVE: The aim of this study was to assess the pulmonary function of children with acute leukemia. METHODS: Cross-sectional observational analytical study that enrolled 34 children divided into groups A (17 with acute leukemia in the maintenance phase of chemotherapy) and B (17 healthy children). The groups were matched for sex, age and height. Spirometry was measured using a spirometer Microloop Viasys(®) in accordance with American Thoracic Society and European Respiratory Society guidelines. Maximal respiratory pressures were measured with an MVD300 digital manometer (Globalmed(®)). Maximal inspiratory pressures and maximal expiratory pressures were measured from residual volume and total lung capacity, respectively. RESULTS: Group A showed a significant decrease in maximal inspiratory pressures when compared to group B. No significant difference was found between the spirometric values of the two groups, nor was there any difference between maximal inspiratory pressure and maximal expiratory pressure values in group A compared to the lower limit values proposed as reference. CONCLUSION: Children with acute leukemia, myeloid or lymphoid, during the maintenance phase of chemotherapy exhibited unchanged spirometric variables and maximal expiratory pressure; However, there was a decrease in inspiratory muscle strength.