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.

[Therapeutic education in asthma management]. / La educación terapéutica en el asma.

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.

[Guidelines for the follow up of patients with bronchopulmonary dysplasia]. / Protocolo de seguimiento de los pacientes con displasia broncopulmonar.

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD.

[Analysis of puberal development and influence of weight loss in obese adolescent girls]. / Análisis e influencia de la pérdida de peso en el desarrollo puberal de adolescentes obesas.

OBJECTIVES: To study several aspects of puberal development in obese adolescent girls, and the influence of weight loss on these aspects. METHODS: A longitudinal retrospective study was performed of a sample of 26 adolescent girls with normal weight and 46 obese adolescent girls at the onset of puberty. The obese teenagers were further divided into two groups (normal and obese) according to their body mass index (BMI) at the end of puberty. Height, chronological and bone age, and growth velocity were evaluated in both groups. RESULTS: Of the teenagers who were obese at the onset of puberty, 63 % remained obese at the end of puberty. The obese teenagers were significantly taller than non-obese teenagers at the onset of puberty (143.2 +/- 6.96 vs 138.9 +/- 5.95 cm, respectively; p < 0.01). However, there were no differences between the two groups in final height. No differences were found between obese teenagers who lost weight and those who did not. There were no differences in chronological or bone age throughout puberal development in any of the groups. The mean growth velocity during puberty was significantly lower in obese teenagers than in non-obese teenagers (6.18 +/- 1.94 and 6.90 +/- 127 cm/year, respectively; p < 0.02). However, there were no differences between obese teenagers who lost weight and those who did not. CONCLUSIONS: Height gain in obese girls is greater in childhood but lower in adolescence. Final height is similar in both groups. Chronological age at the onset and end of puberty and bone maturation are similar in both groups. Weight loss during puberty does not modify growth pattern during this period of development.

Protocolo de seguimiento de los pacientes con displasia broncopulmonar / Guidelines for the follow up of patients with bronchopulmonary dysplasia

La displasia broncopulmonar (DBP) es la secuela más prevalente del recién nacido pretérmino, y sigue suponiendo un motivo frecuente de consulta en las unidades de Neumología Pediátrica. La decisión del alta de la unidad neonatal debe apoyarse en una valoración exhaustiva de la situación clínica del paciente y en el cumplimiento de unos requisitos, que incluyen la estabilidad respiratoria y nutricional, y la instrucción a los cuidadores en el manejo domiciliario. Para un control adecuado de la enfermedad, es necesario que quede establecido, previamente al alta, un calendario de visitas y de exploraciones complementarias, y deben aplicarse las pautas de prevención de exacerbaciones y el tratamiento apropiados. El concepto de DBP como enfermedad multisistémica es fundamental en el seguimiento de los pacientes y debe ser tenido en cuenta para un buen control de la enfermedad. En este documento, el Grupo de Trabajo de Patología Respiratoria Perinatal de la Sociedad Española de Neumología Pediátrica propone un protocolo que sirva como referencia para unificar el seguimiento de los pacientes con DBP entre los diferentes centros y ámbitos asistenciales. Se revisan los aspectos a tener en cuenta en la evaluación previa al alta de la Unidad Neonatal y las principales complicaciones durante el seguimiento. Seguidamente, se detallan las recomendaciones en materia de tratamiento de la enfermedad y prevención de complicaciones, los controles tras el alta y su cronología

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD

Asma en el niño y adolescente (controversias): Atención Primaria versus Atención Hospitalaria. A favor del manejo en el hospital / Asthma in children and adolescents (controversy): Primary Care versus Hospital Care. In favour of the management by the Hospital

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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

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[Exhaled nitric oxide in healthy and asthmatic children]. / Oxido nítrico exhalado en niños sanos y asmáticos.

OBJECTIVES: One of the main findings in asthma is chronic inflammation of the airway. Exhaled nitric oxide may be a useful marker of airway inflammation in asthmatic children. To evaluate the concentration of nitric oxide (NO) in exhaled air in healthy and asthmatic children and to relate this variable with different treatments. MATERIAL AND METHODS: A cross-sectional study was performed in a tertiary hospital. The concentration of exhaled NO (in parts per billion) was analyzed by chemoluminescence using the T technique of exhaling against expiratory resistance with positive mouthpiece pressure in two different study groups: group A (control group) consisted of 105 healthy children aged 6-14 years old without a history of respiratory disease; group B (asthmatic group) consisted of 79 children aged 6-14 years old diagnosed with asthma and undergoing anti-asthmatic treatment for at least the previous two months, depending on the severity of their disease. Quantitative variables were analyzed using Student's t-test and the relationship between qualitative variables was analyzed using the chi-squared test. RESULTS: Expired NO concentrations were significantly higher in the asthma group (15.02 ppb) than in the control group (5.40 ppb) (p < 0.01). No significant differences were found among the asthmatic children in asthma severity. Expired NO was higher in asthmatic children treated with nedocromil (16.62 ppb) than in those treated with inhaled corticosteroids (11.8 ppb) but this difference was not significant (p 0.08). Children who presented signs of acute asthma (22.87 ppb) and those with a positive bronchial dilatation test (20.65) showed higher expired NO values (p < 0.05) than those without asthmatic crises and/or a negative bronchial dilatation test. Likewise, children with atopic dermatitis showed higher expired NO concentrations (23.07 ppb) than those without atopic dermatitis (11.68 ppb) (p < 0.001). CONCLUSIONS: Children with asthma of various degrees of severity have higher levels of expired NO than do healthy children. Measurement of expired NO concentrations can be used to monitor bronchial inflammation and to evaluate the efficacy of anti-inflammatory treatments.

[Eosinophil cationic protein in the asthmatic infant: correlation with the clinic and pulmonary function]. / Proteína catiónica del eosinófilo en el asma infantil. Correlación con la clínica y función pulmonar.

PATIENTS AND METHODS: Serum eosinophil cationic protein (ECP) was measured in 99 chronic asthmatic patients (51 males and 48 females) with a mean age of 10.59 years and correlated with the number of eosinophils, lung function, symptoms in the last 6 months and clinical scoring (that reflecting the clinical situation during the last 15 days). RESULTS: Serum ECP showed a significant correlation with the total number of eosinophils (p < 0.001, R = 0.44), clinical scoring (p < 0.05, R = 0.26), number of inhaled beta 2-agonist doses needed in the last 15 days (p < 0.05, R = 0.26), forced expiratory volume during 1 second (FEV1; p < 0.01, R = -0.27), forced vital capacity (FVC; p < 0.05, R = -0.23), maximal mid-expiratory flow (FEF25-27; p < 0.001, R = -0.37). However, there was no significant correlation between the total number of eosinophils and the clinical situation of the children or the FEV1, but we found a significant correlation with the FEF25-27. Patients with ECP < 20 had better results on lung function tests than patients with ECP > 20 (FEV1: 108.89 +/- 17.7 vs 100.5 +/- 22 (p < 0.05), FEF25-27: 93.81 +/- 24.4 vs 75.21 +/- 24.5 (p < 0.001). CONCLUSIONS: The findings of this study suggest that the ECP level is a good marker of the situation of asthma in childhood. The levels of ECP will probably be able to help us to evaluate the degree of bronchial inflammation that neither the clinical state nor the lung function define completely.

Neumonías neonatales / Neonatal pneumonia

El pulmón constituye el lugar más común de asentamiento de los microorganismos causales de sepsis del recién nacido. Este origen corresponde tanto a la vida prenatal y al parto como a la vida posnatal. Es por ello por lo que deben observarse estrechamente los signos sugerentes de dificultad respiratoria en el neonato, con el fin de llevar a cabo un diagnóstico y un tratamiento precoces. Estos cuadros se asocian a una gran morbilidad, pues se estima en unas 800.000 las muertes neonatales al año debidas a infecciones respiratorias en países en vías de desarrollo. En nuestro medio se estima que la incidencia es menor del 1%, pero sería cercana al 10% en niños con comorbilidad si se englobasen tanto los recién nacidos con peso adecuado para la edad gestacional como los de bajo peso. Además, en la práctica clínica se observa que casi en la totalidad de los cuadros sépticos existe afectación neumónica más o menos significativa tanto clínica como radiológica. En este artículo revisamos los diversos aspectos y retos que plantean las neumonías neonatales (en especial los gérmenes más habituales), y su enfoque terapéutico(AU)

The lung is the most common site of entry of the microorganisms causing sepsis in the newborn infant. This invasion can occur during the prenatal period and labor, as well as during the postnatal period. Thus, we must closely monitor signs suggestive of respiratory distress in the newborn infant in order to establish an early diagnosis and initiate treatment. These conditions are associated with a high rate of morbidity, and it is estimated that, in developing countries, approximately 800,000 neonatal deaths a year are due to respiratory infections. In our population, the incidence is calculated to be less than 1%, but it would be nearly10% in children with co-morbidity if the population includes those with a birth weight adequate for their gestational age and full term and premature infants. In addition, in clinical practice, it is observed that in nearly every case of sepsis, there is more or less significant evidence of pulmonary involvement in both the clinical and radiological examinations. In this article, we review the different aspects and challenges associated with neonatal pneumonia, focusing especially on the most common microorganisms and the therapeutic approach (AU)

Enfoque terapéutico de las neumonías en la infancia / General management of pneumonia in childhood

Los niños con neumonía y afectación media o moderada pueden ser cuidados en su domicilio con seguridad y reexaminados a las 48 horas del inicio del tratamiento. En los niños pequeños, una afectación más intensa –como tener una SaO2 <92%, cianosis, polipnea >70 rpm, esfuerzo respiratorio, apneas intermitentes, quejido, incapacidad para ingerir alimentos y limitación para observación o supervisión familiar– es indicación para su ingreso hospitalario. En los niños más mayores, estas indicaciones serían una SaO2 <92%, cianosis, polipnea >50 rpm, dificultad para ingerir líquidos o alimentos, quejido, signos de deshidratación o dificultad familiar para su observación o supervisión. Como los virus son la causa única de muchos casos de neumonía en la infancia no parece apropiado tratar a cada niño con antibióticos. Las decisiones terapéuticas en un niño concreto pueden ser difíciles, pues la mayoría de las pruebas no son útiles para diferenciar de modo adecuado las infecciones virales de las bacterianas. La resistencia antibacteriana se ha incrementado constantemente en los últimos años y está relacionada con su uso abusivo en situaciones en que la afectación viral es muy probable o la enfermedad es leve y limitada a vías superiores. Por esta razón, es preferible restringir los antibióticos tanto como sea posible y, si se usan, utilizar agentes de espectro estrecho siempre que sea posible, pues la menor presión antibiótica limita la emergencia de resistencia antibiótica. Finalmente, se comenta el enfoque terapéutico de las neumonías, de acuerdo con la edad, la repercusión sobre el estado general, el patrón radiológico, los datos de laboratorio y la epidemiología de estas infecciones en nuestro medio (AU)

Infants and children with moderate pneumonia can be safely cared for at home and should be re-examined within 48 hours of the beginning of treatment. An SaO2 of 92% or less, cyanosis, respiratory rate greater than70 breaths per minute, difficulty in breathing, intermittent apnea, grunting, inability to eat, and a family incapable of providing appropriate observation or supervision are indicators for hospital admission among infants. In the case of older children, theses indicators are an SaO2 of 92% or less, cyanosis, respiratory rate greater than 50 breaths per minute, difficulty in the intake of fluids or solids, grunting, signs of dehydration, or a family incapable of providing either appropriate observation or supervision. Since viruses are the sole cause of many cases of pneumonia in childhood, it is not appropriate to treat every child with antibiotics. However, therapeutic decisions can be difficult, because most tests do not adequately differentiate viral from bacterial infection in a given child. The problem of bacterial resistance to antibiotics has increased steadily in recent years, and it is certainly related to their overuse in situations in which viral involvement is quite probable or the illness is trivial and self-limiting, such as an upper respiratory infection. Hence, it is preferable to restrict antibiotics as much as possible and to use narrow-spectrum agents whenever appropriate, because less antibiotic pressure limits the emergence of bacterial resistance. Finally, we comment on the general management of pneumonias depending on the age, the impact on the general condition of the patient and the radiological pattern, laboratory data and the epidemiology of these infections in our general population (AU)

Neumonías virales / Viral pneumonia

La neumonía viral es una de las enfermedades más comunes que afecta a lactantes y niños. La OMS comunica que la infección respiratoria aguda continúa siendo una causa importante de morbimortalidad infantil; se estima que aproximadamente 2 millones de niños menores de 5 años de edad mueren por esta causa en los países del Tercer Mundo y el 40% de estas muertes son debidas a infecciones virales. El problema que plantean las neumonías virales es triple: por un lado, el descubrimiento de nuevos virus patógenos, algunos de los cuales causan graves cuadros neumónicos; por otro, las dificultades para conocer la etiología, problema de difícil solución, y un problema no menor, su coexistencia con otros patógenos, con el probable aumento de la morbimortalidad asociada. Una cuestión todavía no resuelta y que preocupa en todo el mundo es la infección por el virus de la gripe aviar, tipo H1N5, cuyo hipotético paso a humanos por infección humana (no animal-humano) no descarta la posibilidad de una pandemia. Parece razonable pensar que el enfoque futuro para un aumento del control de estas infecciones virales vendrá por bioingienería genética, lo que mejorará su identificación y el desarrollo de vacunas para los virus más agresivos causantes de neumonías virales graves(AU)

Viral pneumonia is one of the most common diseases affecting infants and children throughout the world. The WHO reports that acute respiratory infections continue to be a leading cause of morbidity and mortality in young children; they kill approximately two million children under the age of 5 years in developing countries, and about 40% of these deaths are due to viral infections. The challenge posed by the viral pneumonias is triple: on the one hand, the discovery of new pathogenic viruses, some of which cause serious pulmonary problems; on the other hand, the difficulties involved in determining the etiology, a question that is difficult to resolve; and another that is by no means minor, their coexistence with other pathogens, probably accompanied by an increase in the associated morbidity and mortality. Another problem that remains to be solved, and has become a worldwide concern, is infection by the H5N1 avian flu virus, the hypothetical transfer of which from an infected human to other humans (not animal-to-human) does not rule out the possibility of a pandemic. It seems to be reasonable to think that the future approach to controlling an increase in these viral infections will come from genetic engineering to improve their identification and the development of vaccines for the most aggressive causative viruses of serious viral pneumonias(AU)

Prevalencia de la sensibilización a neumoalérgenos en nuestro medio / Prevalence of sensitization to aeroallergens in our general population

Los alérgenos son sustancias, habitualmente de naturaleza proteica, capaces de inducir en individuos predispuestos genéticamente (atópicos) anticuerpos IgE específicos, y que resultan inocuas para el resto de la población1-3. Según la vía de entrada y el órgano de contacto, la respuesta inmunitaria o de hipersensibilidad alérgica dará lugar a manifestaciones clínicas oculares (conjuntivitis), digestivas (alergias alimentarias) o respiratorias (asma y/o rinitis). Los alérgenos más frecuentemente relacionados con el asma son los que están presentes en el aire (aeroalérgenos o neumoalérgenos) y, al ser inhalados, ejercen sus efectos sobre la mucosa respiratoria, siendo los principales factores desencadenantes del asma y contribuyendo a la persistencia de síntomas en niños con asma establecida4. Los principales neumoalérgenos sensibilizantes en nuestro medio, con una población bastante significativa, son los pólenes (gramíneas y olivo), los árboles ornamentales (arizónicas y plátano de sombra), el epitelio de animales, los ácaros del polvo y los hongos

Allergens are substances, usually protein in nature, that are capable of inducing specific IgE antibodies in genetically predisposed individuals (atopic), but are innocuous in the remainder of the population. Depending on the route of entry and the organ of involved, the immune response or allergic hypersensitivity will give rise to clinical manifestations at the ocular level (conjunctivitis), in the gastrointestinal tract (food allergies) or in the respiratory tract (asthma and/or rhinitis). The allergens most frequently related to asthma are those present in air (Aeroallergens), which, when inhaled, exert their effects on the respiratory mucosa. They are the leading causes of asthma and contribute to the persistence of symptoms in children with established asthma. The main sensitizing aeroallergens among our general population, which is quite significant in number, are the pollens (grasses and olive), ornamental trees (cypress and shade plantain), animal dander, house dust mites and fungi

Neumonías adquiridas en la comunidad / Community-acquired pneumonia

Las neumonías adquiridas en la comunidad (NAC) y otras infecciones neumónicas son uno de los problemas de salud más importantes que afectan a los niños de todo el mundo. Hay 4-5 millones de muertes anuales registradas en niños menores de 5 años, de forma especial en los países en vías de desarrollo, donde figuran entre las más frecuentes causas de morbimortalidad. No es ése el caso de nuestro país, donde sin embargo constituyen una de las causas de mayor morbilidad, por lo que el problema que representan no es menor. Quisiera agradecer a la Dirección de Acta Pediátrica Española su amabilidad por permitirnos exponer nuestra experiencia y una puesta al día de esta problemática infantil, cambiante en estos últimos años por la inmigración y el cambio epidemiológico, y quizás ecológico, que se está originado en nuestro medio por esta nueva situación

Community-acquired pneumonia is one of the most important health problems affecting children all over the world. Four to five million deaths are reported annually in children younger than 5 years of age, especially in developing countries, where it ranks among the most common causes of both mortality and morbidity. This is not the case in Spain, but it does represent one of the major causes of morbidity and, thus, can not be considered a minor problem. I wish to express my appreciation to the Editorial Board of Acta Pediátrica Española for enabling us to relate our experience and provide an update on this disease in childhood, which, in recent years, is being affected by immigration and the epidemiological and possibly ecological changes that this new situation may be originating

La educación terapéutica en el asma / Therapeutic education in asthma management

Todas las recomendaciones, guías y protocolos establecen el papel de la educación terapéutica como elemento clave en el manejo y control del asma, disponiéndose de evidencias que demuestran su eficacia y efectividad. Tanto los profesionales sanitarios como los pacientes y sus familias pueden y han de ser formados y educados, con dos objetivos fundamentales: conseguir una óptima calidad de vida y una capacidad suficiente para manejar el asma de una forma autogestionada. Ello se puede conseguir a través de un proceso educativo que ha de ser individualizado, continuo, progresivo, dinámico y secuencial. En este proceso han de superarse no pocas dificultades, relacionadas con el paciente, con los profesionales y con el propio sistema sanitario. Es preciso conocer los diferentes aspectos psicológicos que pueden relacionarse con el paciente asmático, así como aquellos que están relacionados con el fenómeno tan prevalente de la falta de adherencia. El conocimiento de los factores que inciden en la comunicación médico-paciente-familia es de enorme importancia para conseguir los objetivos que se plantean en la educación terapéutica. El proceso educativo conduce, no sólo a la adquisición de conocimientos y habilidades, sino también a un cambio de actitudes y creencias. Es necesario proveer al paciente y a sus cuidadores de un plan de acción por escrito individualizado, basado en síntomas y/o flujo espiratorio máximo (FEM), ligado siempre a revisiones periódicas

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

Estado actual de la tuberculosis (I) / Current status of tuberculosis

La tuberculosis es un problema de salud pública mundial. Más del 95% de los casos ocurren en países en vías de desarrollo; el continente africano es donde aparecen más casos, superior en número a cualquier otra región del mundo. En España, como en los países desarrollados, la mayoría de los casos se produce en grupos de riesgo (inmigrantes, niños con sida). En nuestro medio, parece que la incidencia de tuberculosis ha aumentado en los últimos años, motivo que nos ha inducido a efectuar una revisión clínica de la tuberculosis en la edad pediátrica

Tuberculosis is a worldwide public health problem. Over 95% of the cases occur in countries of the developing world, particularly Africa, which has the highest incidence of all the regions of the globe. In Spain, as in other developed nations, the majority of the cases are produced in risk groups (immigrants, children with acquired immunodeficiency syndrome). The incidence of tuberculosis among our general population appears to be increasing in recent years. This trend has led us to carry out a clinical review of tuberculosis in the pediatric age group

Tuberculosis (II): diagnóstico y tratamiento / Tuberculosis: diagnoses and treatment

La tuberculosis es un problema de salud pública mundial. Más del 95% de los casos ocurren en países en vías de desarrollo; el continente africano es donde aparecen más casos, superior en número a cualquier otra región del mundo. En España, como en los países desarrollados, la mayoría de los casos se produce en grupos de riesgo (inmigrantes, niños con sida). En nuestro medio, parece que la incidencia de tuberculosis ha aumentado en los últimos años, motivo que nos ha inducido a efectuar una revisión clínica de la tuberculosis en la edad pediátrica

Tuberculosis is a worldwide public health problem. Over 95% of the cases occur in countries of the developing world, particularly Africa, which has the highest incidence of all the regions of the globe. In Spain, as in other developed nations: the majority of the cases are produced in risk groups (immigrants, children with acquired immunodeficiency syndrome). The incidence of tuberculosis among our general population appears to be increasing in recent years. This trend has led us to carry out a clinical review of tuberculosis in the pediatric age group

Óxido nítrico exhalado en niños asmáticos tratados con corticoides inhalados / Exhaled nitric oxide in asthmatic children treated with inhaled corticosteroids

Objetivos: Estudiar los valores de óxido nítrico exhalado (ONE), la evolución clínica y la función pulmonar en una población de niños con asma episódica frecuente de nuevo diagnóstico, antes y después de recibir tratamiento con corticoides inhalados durante 8 semanas. Material y métodos: Estudio prospectivo de ámbito hospitalario en el que se analizaron distintos parámetros en un grupo de 21 niños asmáticos: 1. valores de ONE, mediante la técnica en T de exhalación lenta contra resistencia; 2. clínicos, evaluados mediante encuesta: episodios de sibilancias y síntomas nocturnos a la semana, y número de semanas que transcurrían entre las exacerbaciones asmáticas; 3. función pulmonar mediante espirometría. Resultados: Tras el tratamiento se constató: 1. las cifras de ONE disminuyeron de 22,47 antes del tratamiento a 7,95 ppb tras éste (p <0,0001); 2. mejoría clínica de los pacientes: disminución de los episodios de sibilancias de 2,68 días a la semana antes del tratamiento a 0,25 tras él (p <0,012); síntomas nocturnos de 2,45 días a la semana a 0,13 días (p <0,039); de una exacerbación asmática cada 3,64 semanas a una cada 7,94 (p <0,001); y 3. la función pulmonar mejoró en todos los parámetros evaluados FVC, FEV1, y FEF25-75%. Conclusiones: Los corticoides inhalados disminuyen los valores elevados de ONE en pacientes asmáticos. La medición de la concentración de ONE puede ser un medio complementario para monitorizar la inflamación en el tracto respiratorio inferior, y así poder valorar la eficacia de tratamientos antinflamatorios como los corticoides inhalados

Objectives. To study the exhaled nitric oxide (NO) levels, the clinical course and pulmonary function in a population of children with newly diagnosed asthma, before and after 8 weeks of treatment with inhaled corticosteroids. Material and methods. A prospective, hospital-based study was carried out to analyze different parameters in a group of 21 asthmatic children: the exhaled NO level, analyzed by the T-piece technique, which involves exhaling against expiratory resistance; clinical symptoms were evaluated by means of a survey to establish the number of episodes of wheezing and nocturnal symptoms a week and number of weeks between asthma exacerbations, and pulmonary function by spirometry. Results: Exhaled NO concentrations decreased from 22.47 ppb before treatment to 7.95 ppb afterwards (p <0.0001). Clinical symptoms improved after treatment. The frequency of episodes of wheezing decreased from 2.68 days a week before treatment to 0.25 after treatment (p <0.012), and nocturnal symptoms decreased from 2.45 days a week before treatment to 0.13 days (p <0.039). The children went from presenting an asthma exacerbation every 3.64 weeks before treatment to one every 7.94 weeks (p <0.001). Pulmonary function parameters (FVC, FEV1, MMEF25-75) improved after treatment. Conclusions: Inhaled corticosteroids decrease exhaled nitric oxide in asthmatic children. The measurement of expired NO concentrations can be used to monitor bronchial inflammation and, therefore, to evaluate the efficacy of antiinflammatory treatments such us inhaled corticosteroids

Fisiopatología, etiología y tratamiento complementario del asma / Pathophysiology, etiology and additional treatment of asthma

El asma es un desorden inflamatorio crónico de las vías aéreas respiratorias, que se caracteriza por una inflamación bronquial que da como resultado hiperreactividad de la vía aérea y producción excesiva de moco. La sintomatología resultante incluye episodios de sibilancias, tos y acortamiento de la respiración. El asma es una enfermedad multifactorial con componentes genéticos, alérgicos, ambientales, infecciosos y alimenticios, y su fisiopatología subyacente es la inflamación de la vía aérea. Así, el fenómeno que conduce y mantiene el proceso inflamatorio asmatico parece ser una respuesta inadecuada de los linfocitos T CD4+. El subgrupo Th2 produce citoquinas (como las interleucinas IL-4, IL-5, IL-6, IL-9, IL-10 e IL-13), que estimulan el crecimiento, diferenciación y reclutamiento de células cebadas, basófilos, eosinófilos y células B, todos ellos implicados en la inmunidad humoral, la inflamación y la respuesta alérgica. En el asma, esta rama de la respuesta inmune está sobreactivada, mientras que la actividad Th1, que generalmente corresponde más a la inmunidad transmitida por células, está amortiguada. Todavía no se sabe por qué los asmáticos presentan esta actividad inmune desequilibrada, pero tanto la genética como los virus, los hongos, los metales pesados, la nutrición y la contaminación pueden contribuir a ello. Los alimentos antioxidantes, especialmente las vitaminas C y E, el selenio y el cinc, parecen ser necesarios en el tratamiento del asma; asimismo, pueden ser provechosas las vitaminas B6 y Bl. Finalmente, los ácidos grasos omega-3 del pescado también intervienen en el proceso inflamatorio asmático (AU)