Spacers versus nebulizers in treatment of acute asthma - a prospective randomized study in preschool children.

OBJECTIVE: To compare administration of bronchodilators by nebulizers with delivery by metered dose inhalers (MDIs) with spacers and to evaluate the clinical effect of the treatment of acute asthma in preschool children. METHODS: A prospective randomized clinical trial in a pediatric emergency department (PED). Preschool children who were admitted for virus induced wheezing or acute asthma exacerbation were randomly allocated to receive bronchodilator treatment by nebulizer or by metered dose inhaler. The accompanying parents completed a questionnaire. RESULTS: The length of stay in the PED and the hospitalization rate were similar and no difference was seen in the parents' view of ease of use and device acceptance. Baseline data were similar for both groups apart from the family history of asthma and atopic disease that was greater in the nebulizer group. No significant differences were seen in heart rate, respiratory rate and oxygen saturation at baseline and after the treatment. According to the parents 40% of the participants had asthma diagnosis though up to 66% had some kind of asthma medication. CONCLUSIONS: Our data suggests that MDIs with spacers are at least as effective as nebulizers in the delivery of beta agonists to treat preschool children with virus induced wheezing or acute exacerbations of asthma in the PED. Parents may underestimate the gravity of their children's asthma. It is mandatory to provide adequate information to the staff and parents in order to treat pediatric acute asthma successfully.

Six-year follow-up of an intervention to improve the management of preschool children with asthma.

AIMS: In a randomized controlled study involving 60 preschool children with asthma, an intervention with extra information and support to parents in the form of group discussions was performed. An earlier follow-up after 18 months revealed an improved adherence and a reduction of exacerbation days. This is a 6-year follow-up. METHODS: Fifty-four children performed clinical examinations, blood tests, measurements of exhaled nitric oxide, spirometry, bronchial provocation with dry air and skin prick tests. Data from the patients' records and questionnaires were obtained. RESULTS: Twenty-nine per cent had no current signs of asthma, whereas 43% exhibited persistent and 28% intermittent asthma. The burden on the healthcare system was minimal. Intermittent inhaled corticosteroid (ICS) therapy was used by 81%. The intervention group (IG) had fewer contacts with nurses. Their parents had a better quality of life. Interviewing children separately contributed in identification of children needing treatment. More children in the IG had to restart ICS as they had signs of worse asthma control. CONCLUSION: Straightforward and timely support to parents of children with asthma can have long-term positive effects by strengthening the ability of parents to treat their children at home, although parents may also develop an underestimation of mild symptoms. It is important to directly ask children about their disease and to maintain regular follow-up visits.

A gender perspective on parents' answers to a questionnaire on children's asthma.

BACKGROUND: Is there a difference in the answers of mothers and fathers to the Paediatric Caregiver's Quality of Life Questionnaire (PACQLQ)? If so, does this reflect a perception that has any consequence for the medication and health of the child? METHODS: We performed a randomised prospective intervention study with extra support and education in the form of group discussions with half of the parents of 60 pre-school children with newly diagnosed asthma. Parents answered separately the PACQLQ at inclusion, and after 6 and 18 months. RESULTS: There were no major gender differences in indices at any occasion, but mothers were more disturbed at night, felt more helpless and frightened and the child's asthma interfered more with their work at inclusion. After 6 months the mothers in the intervention group showed improvements in all indices. After 18 months the children in the intervention group had better adherence and their exacerbation rate was half that of the control group. In the region where this method now is standard the in-hospital days with asthma are the lowest in the country. CONCLUSION: There are differences in the answers of fathers and mothers to the PACQLQ. In the intervention group the mothers reported that they were less worried and less restricted in their activities. This equalisation of the parent's roles in handling their child's asthma might be part of the explanation as to why the children in the intervention group had better adherence and were healthier.

Iron Deficiency Is Common During Remission in Children With Inflammatory Bowel Disease.

The aim was to study prevalence of iron deficiency in children with inflammatory bowel disease (IBD) during remission. In addition, there was an observational evaluation of hematological response to oral iron. A population-based retrospective study including 90 Swedish children (median 13 years) with IBD was performed. Patient records covered in median 25 months. Iron deficiency was present in 70/77 children (91%) in which iron status could be assessed. In clinical and biochemical remission, iron deficiency was found in 57/67 (85%) of children, and 23 (34%) of them had iron deficiency anemia. Thirty-six iron-deficient children were prescribed oral iron supplementation and 32 (89%) improved hemoglobin levels over 6 months. In conclusion, iron deficiency is common during clinical remission in children with IBD, even in cohorts with low prevalence of anemia. Therefore, regular biochemical screening for iron deficiency is warranted during all stages of disease, irrespective of symptoms and inflammatory blood markers.

Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire.

Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ with the corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1-6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient clinics in the same region, were analysed in parallel. Finally, a complementary WQ was sent to the parents of children identified as asthmatic by either or both of this approaches. In response to the WQ 5.9% were claimed to suffer from asthma diagnosed by a doctor. According to the medical records, the prevalence of clinically diagnosed asthma was 4.9%. The estimated prevalence among children requiring treatment for their asthma was 4.4%. The sensitivity of the WQ was 77%, the specificity 97.5%. In the 1-2 yr age group the sensitivity was only 22%. This WQ was able to identify 54% of the children with a medical record of asthma. Forty percent of the children claimed by their parents to be asthmatic had no medical record of asthma. An ISAAC-based parentally completed WQ provided an acceptable estimation of the prevalence of asthma in children 2-6 yr of age, although only half of the individual patients identified in this manner are the same as those identified clinically.

Chest X-ray investigation in newly discovered asthma.

Chest X-ray in 60 children (0-6 yr old) with newly diagnosed asthma at the primary care level showed normal findings in 85% at paediatric follow-up. The pathological findings were transient. The only X-ray tht led to change in treatment was performed on clinical grounds due to concurrent disease. In conclusion, routine X-ray need not be part of the initial routine work up of asthma in preschool children.