[Assessment of patient satisfaction and preferences with inhalers in asthma with the FSI-10 Questionnaire]. / Satisfacción y preferencia del paciente asmático por los dispositivos de inhalación. Aplicación del FSI-10.

BACKGROUND AND OBJECTIVE: Lack of adherence to inhaled corticosteroid therapy is common in patients with asthma, and it has been suggested that allowing patients to choose their own inhalers would resolve this problem. The FSI-10 (Feeling of Satisfaction with Inhaler) is a self-completed questionnaire to assess patient opinions regarding ease or difficulty of use, portability, and usability of devices for delivery of inhaled corticosteroids. The aim of this study was to define the measurement properties of the FSI-10 questionnaire and to use this inventory to compare satisfaction and preferences of patients with asthma regarding 3 different devices for delivery of inhaled corticosteroids: Turbuhaler, Accuhaler, and Novolizer. PATIENTS AND METHODS: We performed a multicenter, prospective, observational study in 112 stable asthmatic patients (64 women; mean [SD] age, 37 [22] years) treated on a regular basis with inhaled corticosteroids. The use of the devices was explained to the patients and the order in which they should be used in each case was randomly assigned. The devices were used for 7-day periods and at the end of each the FSI-10 questionnaire was completed for the device used. Once the protocol was completed, patients stated their preference for the different devices used. RESULTS: The FSI-10 was easily understood and rapidly completed, and it exhibited acceptable measurement properties. Factor analysis showed that the measure was unidimensional. Although acceptance of all 3 devices assessed was reasonable, the FSI-10 questionnaire detected significant differences between them: Turbuhaler and Novolizer scored higher than Accuhaler on a number of questions. This preference is partly explained by Turbuhaler having been the device that was commonly used by the patients prior to the study. However, the highest scoring and most often preferred inhaler in patients under 16 years of age was the Novolizer, even though the Turbuhaler had also usually been used by those patients prior to the study. CONCLUSIONS: The FSI-10 is a useful instrument for assessing the degree of satisfaction of asthmatic patients regarding available inhalation devices. It is easy to understand and complete, and able to identify differences in patient satisfaction with the different inhalers.

[Variability in peak expiratory flow does not classify asthma according to severity]. / La variabilidad del flujo espiratorio máximo no clasifica el asma por niveles de gravedad.

OBJECTIVE: The aim of this study was to determine whether variability in peak expiratory flow (PEF) could be used to classify the level of severity of asthma in children. PATIENTS AND METHODS: We studied 387 boys and girls diagnosed with asthma and classified severity according to clinical criteria (Spanish Society of Pediatric Pneumology). PEF variability was determined using a portable mini-Wright peak flow meter (Clement Clarke International, London, UK; range, 50 L/min-800 L/min) over a 14-day period, with no changes in normal treatment. The following indices were used to calculate PEF variability: 1) difference between morning PEF and nighttime PEF, expressed as a percentage of the mean value of the PEF measurements taken on that day; 2) minimum PEF rate during a week, expressed as a percentage of the highest value recorded during that week; 3) difference between the highest and the lowest PEF values, expressed as a percentage of the highest value; and 4) the 10th percentile of PEF values recorded during a week, expressed as a percentage of the highest value recorded during that week. We assessed agreement between clinical classification and PEF variability using the weighted kappa coefficient. We also analyzed the sensitivity and specificity of PEF variability indices for episodic and persistent asthma. RESULTS: The analysis of levels of agreement between clinical classification of asthma and formulas 1, 2, 3, and 4 gave quadratic weighted kappa coefficients of 0.494, 0, 0.488, and 0.346, respectively. The results were similar when patients were grouped and analyzed by type of asthma (episodic or persistent asthma). CONCLUSIONS: The monitoring of PEF variability, a recommendation common in national and international guidelines on the management of asthma in children, is not valid for classifying severity of asthma in children.

Parents' adherence with nebulizer treatment of their children when using an adaptive aerosol delivery (AAD) system.

The objective of this study was to analyze data on parents' adherence to their child's prescribed nebulizer treatment regimen and compliance with the demands of the nebulizer and the face mask. Data on adherence and compliance were recorded in a 24-week double-blind, randomized, parallel-group study with budesonide inhalation suspension in 125 young children with mild to moderate asthma. Budesonide was administered with an Adaptive Aerosol Delivery (AAD) system, which recorded adherence to treatment and compliance with the AAD system. A total of 35,481 treatments were recorded and analyzed. A study questionnaire regarding the parents' and children's acceptance of the AAD system has also been analyzed. The adherence to the treatment regimen was 91.3%, and the compliance with the AAD system was 90.4%. True adherence, the product of adherence and compliance, was 82.5%. Approximately 90% of the parents found the face mask easy to seal and the AAD equipment easy to use, and over 90% of the children accepted it within 1 week. In conclusion, the results indicate that the AAD system could be of real clinical advantage for treatment of asthma in young children.

[Cystic fibrosis in adults: study of 111 patients]. / Fibrosis quística del adulto: estudio de 111 pacientes.

BACKGROUND: Our goal was to establish the clinical and genetic characteristics of patients diagnosed with adult-onset cystic fibrosis (CF). PATIENTS AND METHOD: This was a retrospective observational descriptive comparative study of CF patients according to their age at the time of diagnosis. All adult patients (> 16 years old) attended in our CF Unit until November 2001 were included in the study. Those patients diagnosed of CF at their childhood (< 16 years old) were categorized as Group A patients, and those diagnosed in adulthood (>= 16 years old) were categorized as group B patients. Anthropometric parameters, respiratory and digestive clinical abnormalities, chest and abdominal radiological exams, sputum bacteriology, respiratory function and genetic tests were evaluated. Statistical analysis between groups was performed by comparing chi square test for qualitative values and the Student t test for quantitative values. RESULTS: One hundred and eleven patients (60 women, mean age 28, range 16-69 years) out of a total sample of 245 (45.3%) patients attended at the CF unit were enrolled in the study. Group A included 61 patients (32 women; mean age 23) and group B included 50 patients (28 women; mean age 32). The comparative study between both groups showed that patients in group B were older, had a higher weight and less incidence of initial digestive abnormalities, pancreatic insufficiency, malnutrition, hepatic disease, chronic bronchial colonization by Pseudomonas aeruginosa, admissions, lung transplantation and deaths due to CF. On the contrary, these patients had a higher incidence of pancreatitis, allergic bronchopulmonary aspergillosis at diagnosis and better respiratory function test parameters. The sweat test was negative in 4 patients of group B and 1 of group A. The genetic study showed 31 different CF mutations, from which only 10 were observed in group B. CONCLUSIONS: CF can also be diagnosed in adult age. Patients diagnosed in adulthood have less digestive abnormalities, better lung function and different genetic mutations. The sweat test can be negative or undetermined. These patients also display a better prognosis.