Pediatric asthma and eosinophilia: insights from nasal and blood smear analyses

Background: Allergic respiratory maladies, particularly pediatric asthma, pose substantial challenges in public health. This cross-sectional investigation endeavours to unravel the eosinophilic landscape within nasal cytological specimens and peripheral blood samples of pediatric asthma cohorts, with a keen focus on discerning the correlation between nasal and systemic eosinophilia.Methods: Sixty-six pediatric asthma subjects, aged 6 to 18, under the care of Cheluvamba hospital in Mysuru, were meticulously recruited over an extensive 18-month period.Results: Analysis unveiled a conspicuous preponderance of male participants, with a mean age range spanning 9 to 13 years. Intriguingly, the presence of allergic rhinitis (AR) exhibited no discernible statistically significant nexus with either asthma severity or eosinophilic markers. Noteworthy findings include peripheral eosinophilia detected in 56% of subjects, juxtaposed against nasal eosinophilia observed in 20%; however, no statistically meaningful correlation emerged between nasal and peripheral eosinophilia.Conclusions: The inquiry culminated in a robust affirmation that mean nasal eosinophil count and blood absolute eosinophil count (AEC) exhibit a salient association with asthma severity and control in pediatric cohorts, irrespective of AR presence. Particularly, a discernible augmentation in mean AEC and nasal eosinophil count was discerned concomitant with exacerbating asthma severity and in cases of partial/ uncontrolled asthma.

Exploration on Mechanism of Xiaoer Zhixiao Pingchuan Granules in the Treatment of Pediatric Asthma Based on Network Pharmacology and Experimental Validation / 中国中医药信息杂志

Objective To explore the potential mechanism underlying the treatment of pediatric asthma using Xiaoer Zhixiao Pingchuan Granules through network pharmacology analysis and animal experimental validation.Methods Active components and their associated targets in Xiaoer Zhixiao Pingchuan Granules were identified through screening and retrieval of TCMSP,BATMAN-TCM,and UniProt databases.Disease-related targets for pediatric asthma were selected from GeneCards,DisGeNET,and OMIM databases.The target protein-protein interaction(PPI)relationship between the intersecting targets of the two was obtained through the STRING database,and import it into Cytoscape 3.8.0 software to construct a PPI network.GO and KEGG enrichment analyses were conducted using the Metascape platform to identify potential pathways.An asthmatic mouse model was induced by ovalbumin,and different concentrations of Xiaoer Zhixiao Pingchuan Granules were administered as interventions.Histopathological changes were evaluated using HE staining and PAS staining,and the network pharmacology findings were validated through Western blot analysis.Results A total of 154 active ingredients targeting 283 pediatric asthma-related genes were identified in Xiaoer Zhixiao Pingchuan Granules.KEGG enrichment analyses revealed significant enrichment of signaling pathways such as the PI3K-Akt signaling pathway,TNF signaling pathway,and MAPK signaling pathway among intersection targets.Thirteen key targets were identified through topological analysis of ingredients-targets-pathways network.Animal experiments demonstrated that Xiaoer Zhixiao Pingchuan Granules significantly alleviated ovalbumin-induced airway inflammation and goblet cell hyperplasia,while downregulating the expression of key proteins in the PI3K-Akt signaling pathway(P<0.05).Conclusion The therapeutic efficacy of Xiaoer Zhixiao Pingchuan Granules in pediatric asthma involves a multi-pathway and multi-target mechanism,with the PI3K-Akt signaling pathway emerging as a potential key molecular target.

Knowledge Domain and Emerging Trends of Chinese Medicine in Management of Pediatric Asthma: A Scientometric Study / 中国结合医学杂志

OBJECTIVE@#To analyze the intellectual landscape and emerging research trends of Chinese medicine (CM) in the management of pediatric asthma through a scientometric study.@*METHODS@#Publications related to CM in the management of pediatric asthma were retrieved from the Web of Science Core Collection using relevant keywords. A scientometric study was performed using CiteSpace and VOSviewer.@*RESULTS@#A total of 1,673 original articles and reviews from 1991 to 2019 were included in the analysis. The amount of annual publications had a gradual increase with time. USA was the major contributor both in country and institution analyses. Based on the co-citation, the published journals were grouped into 4 clusters. Keyword analysis indicated that the main hotspots were: (1) comprehensive management; (2) risk factors, mechanism, and prevalence; (3) prevention and treatment; (4) inflammation; and (5) environmental research. Lastly, we predicted that three emerging trends were quality of life promotion, immune response, and combination therapy.@*CONCLUSIONS@#CM research in the management of pediatric asthma will maintain the current trend of steady growth. This scientometric analysis may help scientists to identify the areas of interests and future directions in the field.

Mechanism of gubenfangxiaoyin drinking in the treatment of infantile asthma prevention by network pharmacology and molecular docking / 中国药理学通报

Aim To explore the mechanism of pediatric asthma based on network pharmacology and molecular docking technology. Methods Through TCMSP database, the chemical information and the targets of TCM chemical components and pediatric asthma targets in PubChem, SwissTargetPrediction and GeneCards were collected, and the intersection gene, namely the target gene of pediatric asthma was used. The “Drug-active ingredient-target” map was plotted with the Cytosacape 3.7.2 software. Protein interaction network maps were constructed based on the String database and analyzed by Cytoscape 3.7.2. GO and KEGG pathway analysis of acting targets using the Metascape database and bubbles were plotted on the Omicshare platform. Results A total of 238 active components and 11 corresponding 697 main targets were selected, 1 052 pediatric asthma disease target targets and 242 common targets were selected. Enrichment analysis found that common targets were primarily involved in biological processes such as MAPK cascade regulation and inflammatory response, as well as calcium signaling pathway, cAMP signaling pathway, AGE-RAGE signaling pathway, cGMP-PKG signaling pathway, etc. Molecular docking results showed that the active components of Astragalus(5'hydroxyiso-muronulatol-2',5'-di-O-Glucoside)docked well with the SRC, TP53, and IL-6 targets. We proved that anti-resistant drinking could down-regulate the expression of IL-6, SRC and TP53. Conclusions Gubenfangxiaoyin drinking may be involved in the regulation of the STAT3, SRC, AKT1, TP53, TNF, MAPK3, TP53,TNF,MAPK3 and IL6 and other targets, involved in the regulation of calcium-CAMP signaling pathway in childhood asthma, AGE-RAGE signaling pathway, cGMP-PKG signaling pathway, reduce the MAPK cascade, inflammatory response, etc, and play a role in the prevention and treatment of asthma.

Omalizumab and unmet needs in severe asthma and allergic comorbidities in Japanese children

Childhood asthma is one condition within a family of allergic diseases, which includes allergic rhinitis, atopic dermatitis, and food allergy, among others. Omalizumab is an anti-IgE antibody therapy that was approved in Japan for children with asthma and added to the Japanese pediatric asthma guidelines in 2017. This review highlights the Japanese clinical perspectives in pediatric allergic asthma, and consideration for allergic comorbidities, and reflects on omalizumab clinical trials in progress to present comprehensive future opportunities.

Investigation on Drugs for Asthma Control Administered by Pediatric Clinicians-Selection of Inhaled Corticosteroids and Compliance Evaluation of Patients / 中国药房

OBJECTIVE： To provide reference for the selection of inhaled corticosteroids （ICS） in clinic. METHODS： A questionnaire survey was conducted among pediatricians from medical institutions of 11 provinces （districts， cities） to analyze the drug selection and reasons， dosage form selection [by comprehensive score （CS）] of 3 kinds of ICS as budesonide （BUD）， beclomethasone （BDP） and fluticasone （FP）， medication compliance and influential factors （by CS）. RESULTS： A total of 200 questionnaires were sent out， and 196 valid questionnaires were collected with effective rate of 98.00％. Pediatric clinicians preferred BUD as a control drug for asthma in children （158 cases， 80.61％）， followed by FP （22 cases， 11.22％） and BDP （2 cases， 1.02％） and the rest had no tendency （14 cases， 7.14％）. Clinicians who chose BUD mainly believed that the drug had better clinical efficacy， and was more recommended by guidelines and experts， more recognized by patients and so on. In addition， of all inhalation equipment for children asthma， pediatric clinicians believed that parents or children were more easier to master atomizer （CS： 4.04）， followed by pressurized metered dose inhalers （pMDI） （with spacer） （CS： 2.75）， pMDI （without spacer） （CS： 1.71）， dry powder inhalers （DPI） （turbuhaler） （CS： 1.46） and DPI （accuhaler） （CS： 1.08）. For the evaluation of patients’ medication compliance， 48 （24.49％）， 88 （44.90％）， 58 （29.59％） pediatricians thought that the actual administration accounted for ＜50％， 50％-74％， 75％-99％ of the medical order dosages， respectively. Only 2 （1.02％） subjects thought that the patients would fully obey. The main factors affecting children’s medication compliance were worrying about side effects of long-term medication （CS： 9.19）， drug withdrawal after improvement （CS： 8.16）， and children’s treatment incompatibility （CS： 7.82）. CONCLUSIONS： Pediatricians tend to choose BUD as drug for asthma control， and atomizer is treated as the easiest inhalation equipment for children. At the same time， pediatricians have low evaluation on the medication compliance of parents and children.

Relationship between Pediatric Wheezing Attack Frequency and Sugarcane Harvest Work: Prospective Cohort Study / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>Our aim was to determine the relationship between pediatric wheezing attacks and sugarcane harvest work.</p><p><b>Methods: </b>We recorded daily symptoms, including wheezing attacks, from 167 children attending kindergarten, elementary and junior high school on Minamidaito Island, Okinawa. We calculated wheezing attack frequency every two months and checked the seasonal changes. Logistic regressions were performed to examine the relationship between wheezing attacks and background factors.</p><p><b>Result: </b>The collection rate of the check sheets was 62.5%. The median age was 7.5 years old, male-to-female ratio was 8:7 and the percentage of children with asthma was 36%. Wheezing attack frequency during sugarcane harvest work (January-March) had increased significantly compared with other periods. There was a number of wheezing attacks even in children without asthma.</p><p><b>Conclusion: </b>There is a possibility that sugarcane harvest work is related with pediatric wheezing attacks.</p>

Clinical Observation of Budesonide Aerosol Inhalation for Pediatric Acute Asthma Attack / 中国药房

OBJECTIVE:To observe therapeutic efficacy and safety of budesonide aerosol inhalation for pediatric acute asthma attack. METHODS:Ninety patients diagnosed as acute asthma attack selected from our hospital during Jan. 2014-May 2016 were di-vided into observation group and control group in accordance with random number table,with 45 cases in each group. Control group was given Potassium sodium dehydroandroandrographolide and sodium chloride injection 10 mg/(kg·d),ivgtt,qd+Azithromy-cin injection 10 mg/(kg·d),ivgtt,qd for anti-infective therapy. Observation group was additionally given Budesonide aerosol 0.5 mg,aerosol inhalation,bid. Both groups received treatment for consecutive 7 d. Clinical efficacy,lung function index,T cell sub-group,symptom relief time were observed,and the occurrence of ADR was recorded. RESULTS:Total response rate of observa-tion group (91.11%) was significantly higher than that of control group (71.11%),with statistical significance (P0.05). CONCLUSIONS:Budesonide aerosol inhalation shows significant therapeutic effi-cacy for pediatric acute asthma attack with good safety.

Research on the IgE, EOS, LTE-4 content and its clinical significance with the inacute phase of pediatric asthma / 中国生化药物杂志

Objective To explore the clinical significance of total serum immunoglobulin ( IgE) , peripheral blood eosinophils ( EOS) and urinary leukotriene E4 ( LTE-4 ) detection on pediatric asthma clinical symptoms of the inacute phase .Methods 90 cases with pediatric asthma clinical symptoms of the inacute phase from March 2014 to March 2015 were selected as experimental group, and divided into the general asthma group(n=32), the moderate asthma group(n=31), the sereval asthma group(n=27) and another 30 health children as control group.Give each patients children doses of β2 agonists (LABA) as monotherapy, and inhaled corticosteroids (ICS) used as combination therapy.The use of LABA is 3-4 times/d.After three months' treatment, clinical efficacy were evaluated, and IgE, EOS, LTE-4 content were detected.Results After 3 months' treatment, IgE, EOS, LTE-4 contents in three experiment groups were significantly decreased (P<0.05), improved to the basic condition compared to control groups.The clinical efficacy among three groups had no significant differences.Conclusion IgE, EOS, LTE-4 levels detection of patients with pediatric asthma clinical symptoms of the inacute phase had evaluation significance, can be a good indicator of pediatric asthma health recovery in patients of the inacute phase.

Clinical efficacy and safety of montelukast combined with budesonide in the treatment of children / 中国生化药物杂志

Objective To investigate the clinical efficacy and safety of montelukast combined with budesonide in the treatment of children with asthma. Methods 70 cases of children with asthma were randomly divided into group A and group B, included 35 cases in each group. Group A was treated with single budesonide and Group B was given montelukast combined with budesonide. The clinical efficacy of two groups of asthma was compared, the body temperature returned to normal time, the time of wheezing disappeared, the normal time of the laboratory index, the normal time of the chest radiograph, the inflammatory factors and the lung function indexes and the side effects. Results The clinical curative effect of group B was higher than that of group A(P<0.05); Body temperature in group B returned to normal time, the time of wheezing disappeared, the normal time of laboratory index was shorter than that of group A(P<0.05); Inflammatory factors and lung function were similar. After intervention, the inflammatory factors and lung function of group B were better than those of group A(P<0.05). There were no obvious side effects in the two groups. Conclusion The clinical efficacy and safety of montelukast combined with budesonide in the treatment of children with asthma can improve the symptoms of children, cause the symptoms to recite in a short time, reduce the inflammatory factors, improve lung function, no obvious adverse reactions, safety effective.

Effect of salbutamol aerosol combined with magnesium sulfate on IL-2, IL-4, IL-5, IFN-γand T lymphocyte subsets in pediatric asthma patients / 中国生化药物杂志

Objective To investigate the effect of salbutamol aerosol combined with magnesium sulfate on IL-2, IL-4, IL-5, IFN-γand T lymphocyte subsets in pediatric asthma patients.Methods 38 pediatric asthma patients were selected and randomly divided into control group and experimental group.Control group was treated by clinical routine method.Experimental group was treated by salbutamol aerosol combined with magnesium sulfate.The IL-2, IL-4, IL-5, IFN-γ, T lymphocyte subsets, blood pressure, heart rate, respiratory and clinical effects were observed and compared.ResuIts Compared with control group, the serum levels of IL-2 and IFN-γwere higher(P<0.05).The IL-5, IL-4 level were lower(P<0.05).The CD3 +, CD4 +, CD4 +/CD8 +level were higher(P<0.05).The serum CD8 +were lower(P<0.05).The total efficiency were higher(P<0.05).ConcIusion Salbutamol aerosol combined with magnesium sulfate can effectively regulate T lymphocyte subsets proportion and cytokine levels in asthmatic children, enhance immunity, and improve the clinical symptoms.

<i>Ascaris lumbricoids</i> infection as a risk factor for asthma and atopy in rural Bangladeshi children

Controversy persists as to whether helminth infections cause or protect against asthma and atopy. The aim of this study was to investigate the effects of helminth infection on asthma and atopy among Bangladeshi children. A total of 912 children aged 4.5 years (mean = 54.4, range = 53.5–60.8 months) participated in a cross-sectional study nested into a randomized controlled trial in Bangladesh. Ever-asthma, ever-wheezing and current wheezing were identified using the International Study of Asthma and Allergies in Childhood questionnaire. Current helminth infection was defined by the presence of helminth eggs in stools, measured by routine microscopic examination. Repeated <i>Ascaris</i> infection was defined by the presence of anti-<i>Ascaris</i> IgE≥0.70 UA/ml in serum measured by the CAP-FEIA method. Atopy was defined by specific IgE to house dust mite (anti-DP IgE) ≥0.70 UA/ml measured by the CAP-FEIA method and/or positive skin prick test (≥5 mm). Anti-<i>Ascaris</i> IgE was significantly associated with ever asthma (odds ratio (OR) = 1.86, 95% CI: 1.14–3.04, highest vs. lowest quartile; <i>P</i> for trend 0.016). Anti-<i>Ascaris</i> IgE was also significantly associated with positive anti-DP IgE (OR = 9.89, 95% CI: 6.52–15.00, highest vs. lowest; <i>P</i> for trend <0.001) and positive skin prick test (OR = 1.69, 95% CI: 1.01–2.81, highest vs. lowest, <i>P</i> for trend 0.076).These findings suggest that repeated <i>Ascaris</i> infection is a risk factor for asthma and atopy in rural Bangladeshi children. Further analysis is required to examine the mechanism of developing asthma and atopy in relation to helminth infection.

<i>Ascaris lumbricoids</i> Infection as a Risk Factor for Asthma and Atopy in Rural Bangladeshi Children

Controversy persists as to whether helminth infections cause or protect against asthma and atopy. The aim of this study was to investigate the effects of helminth infection on asthma and atopy among Bangladeshi children. A total of 912 children aged 4.5 years (mean = 54.4, range = 53.5–60.8 months) participated in a cross-sectional study nested into a randomized controlled trial in Bangladesh. Ever-asthma, ever-wheezing and current wheezing were identified using the International Study of Asthma and Allergies in Childhood questionnaire. Current helminth infection was defined by the presence of helminth eggs in stools, measured by routine microscopic examination. Repeated <i>Ascaris</i> infection was defined by the presence of anti-<i>Ascaris</i> IgE ≥ 0.70 UA/ml in serum measured by the CAP-FEIA method. Atopy was defined by specific IgE to house dust mite (anti-DP IgE) ≥ 0.70 UA/ml measured by the CAP-FEIA method and/or positive skin prick test (≥ 5 mm). Anti-<i>Ascaris</i> IgE was significantly associated with ever asthma (odds ratio (OR) = 1.86, 95% CI: 1.14–3.04, highest vs. lowest quartile; <i>P</i> for trend 0.016). Anti-<i>Ascaris</i> IgE was also significantly associated with positive anti-DP IgE (OR = 9.89, 95% CI: 6.52–15.00, highest vs. lowest; <i>P</i> for trend < 0.001) and positive skin prick test (OR = 1.69, 95% CI: 1.01–2.81, highest vs. lowest, <i>P</i> for trend 0.076). These findings suggest that repeated <i>Ascaris</i> infection is a risk factor for asthma and atopy in rural Bangladeshi children. Further analysis is required to examine the mechanism of developing asthma and atopy in relation to helminth infection.

Educación en niños asmáticos controlados en hospital Roberto del Río: impacto en conocimientos, adherencia y control de la enfermedad / Education in asthmatic children controlled at Roberto del Rio Hospital. Impact on knowledge, adhesion and disease control

Introduction: today is clear the role of educational programs in the control of chronic diseases. The goal was optimize the knowledge, adhesion, inhalation technique and asthma control through an educational workshop. Methods: we enrolled asthmatic patients (age 5 to 14 years), with questionnaire "control of asthma in children " (CAN). Patients with an score greater than or equal to 8 were invited to the educational workshop with a class of asthma, after a evaluation of knowledge and inhalation technique. These patients were reevaluated 6 months later. Results: 91 patients were recruited with a CAN score greater than or equal to 8, only 49 attended the workshop and 40 attended the reevaluation. Of these, 52,5 percent of the patients achieved a CAN score less than 8. Two patients were excluded because of modification of treatment, resulting in 47,5 percent of patients with CAN score less than 8. Conclusion: the education improved the knowledge, inhalation technique and adherence. Educational workshop should be implemented in our clinical practice.

Introducción: el objetivo fue optimizar los conocimientos, técnica inhalatoria, adherencia y el control del asma, mediante un taller de educación. Métodos: se enrolaron pacientes asmáticos (edad: entre 5 y 14 años), con cuestionario CAN (Control del Asma en Niños). Los pacientes con puntaje mayor o igual a 8, se invitaron a un taller de educación, se evaluó conocimientos, técnica inhalatoria y se realizó una clase sobre asma. A los 6 meses, se reevaluaron con cuestionario CAN, prueba de conocimientos y técnica inhalatoria. Resultados: se reclutaron 91 pacientes con CAN mayor o igual a 8, de los cuales asistieron 49 al taller. En la segunda etapa asistieron 40 pacientes. En el 52,5 por ciento de los pacientes, se logró puntaje CAN menor a 8 puntos. Se excluyeron 2 pacientes, por modificación del tratamiento, como resultado final 47,5 por ciento de los pacientes, disminuyó su puntaje CAN a menos de 8. Conclusiones: la educación mejoró conocimientos, técnica inhalatoria y adherencia. Se deberían implementar talleres educativos en nuestra práctica clínica.

Multicenter Study on Factors Influencing the Quality of Life of Asthmatic Children and Their Caregivers / 소아알레르기및호흡기학회지

PURPOSE: Pediatric asthma is the most common chronic disease in children. It negatively affects the health-related quality of life (QoL) in children with this disease and of their caregivers. This study evaluated the relationship between clinical disease severity and the QoL of patients with asthma and their caregivers. METHODS: The study included 247 patients with asthma and their caregivers. The patients and caregivers completed the Korean Pediatric Asthma Quality of Life Questionnaire and the Korean Pediatric Asthma Caregivers Quality of Life Questionnaire, respectively, during clinic visits. The results were expressed as the mean score for each domain. All items were rated from 1 to 5: 1, low QoL; and 5, satisfactory QoL. RESULTS: The emotion and activity QoL scores of boys were significantly higher than those of girls (P=0.001). The QoL of both patients and their caregivers was correlated more with the patients' subjective symptom scores than with the clinical severity of asthma or with lung function. CONCLUSION: The QoL of patients with asthma and their caregivers decreased as asthmatic symptoms became worse. Controlling asthma symptoms is important for improving the QoL of both patients and their caregivers. Patients and their caregivers need to be evaluated and counseled during asthma treatment to improve their QoL.

Environmental Tobacco Smoking, Parental Allergy History and Pediatric Asthma and Wheezing / 農村醫學 地域保健

OBJECTIVES: This study was conducted to investigate whether joint effects between family allergy history and environmental tobacco smoke(ETS) by parents were associated with pediatric asthma and wheezing. METHODS: The study objects of this study were 2301 element school students and their parents in an urban-rural areas of Gyeonggi-do. Pediatric asthma and wheezing were identified by measures of International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. We investigated history of parental allergy, ETS, and other socioeconomic status of both parent. Data were analyzed using logistic regression methods. RESULTS: After adjusting other variables, children with maternal asthma history were more likely to be reported life time wheezing (OR: 3.79 95%CI:2.43-5.90), recent wheezing (OR:4.09 95%CI:2.28-7.38), and diagnostic asthma (OR:2.61 95%CI: 1.44-4.75). Paternal asthma history increasing risk of life time wheezing (OR 2.01 95%CI:1.19-3.38) and recent wheezing (OR:2.38 95%CI:1.24-4.56). Joint effect between parental allergy history and ETS significantly effected on child's life time wheezing and recent wheezing. The risks of life time wheezing (OR:2.47 95%CI:1.64-3.717) and recent wheezing (OR: 2.51 95%CI:1.34-4.69) were significantly higher than others without both factors. The risk of recent wheezing of children with maternal recent smoking and parental allergy history (OR:4.83 95%CI:1.89-12.33) was higher than their counterpart. CONCLUSIONS: The result of this study implies that children with family allergy history and passive smoking are more likely to be get asthma and wheezing than children with family allergy history and non-passive smoking. This study provide the object information to increase the efficiency of non-smoking campaign and education for decreasing pediatric asthma risk.

Avaliação familiar sistêmica: sua validade com crianças asmáticas e suas famílias / The systemic family assessment system: its validity with asthmatic children and their families / Evaluación familiar sistémica: su validez con niños asmáticos y sus familias

The construct and concurrent validity of the Systemic Family Assessment (SFA) system was tested. Participants were 11 asthmatic and 14 healthy Brazilian children (aged 5 to 9) along with their intact families. Measures included the SFA, the Family Colored Drawing Test with children (FCDT), and a semi-structured interview with parents (PI). Comparisons between families of asthmatic and healthy children yielded significant differences for all family dimensions of the SFA. The most affected dimensions for families of asthmatic children were the individuation process within the family, family conflicts, family integration and cohesion, roles, and quality of leadership within the family. Significative correlation between the SFA and the two independent measures were found. Results support the construct and concurrent validity of the SFA.

Foi testada a validade de construto e a validade concorrente do protocolo de Avaliação Familiar Sistêmica (AFS). Os participantes foram crianças brasileiras, 11 com asma e 14 saudáveis (5 a 9 anos) e suas famílias intactas. Medidas incluíram o protocolo AFS, o Teste de Desenho Colorido da Família com as crianças (TDCF), e uma entrevista semi-estruturada com os pais (EP). Comparações entre as famílias de crianças asmáticas e as saudáveis evidenciaram diferenças significativas em todas as dimensões familiares da AFS. As dimensões mais afetadas nas famílias de crianças asmáticas foram o processo de individuação familiar, conflitos, integração familiar e coesão, papéis, e qualidade da liderança dentro da família. Foi encontrada uma correlação significativa entre a AFS e as duas medidas independentes. Os resultados apóiam a validade de construto e a validade concorrente da AFS.

La validez de constructo y la validad coexistente do protocolo de Evaluación Familiar Sistémica (EFS) fue establecida. El estudio fue realizado en Brasil con familias intactas, y observó 11 niños con asma y 14 saludables, con edades de 5 a 9 años. Las medidas analizadas incluyeron el EFS, el Test del Dibujo Coloreado de la Familia aplicado a los niños (TDCF), y una entrevista semi-estructurada aplicada a los padres (EP). Las comparaciones entre las familias de niños asmáticos y saludables apuntaron diferencias significativas en todas las dimensiones familiares de la EFS. En las familias de niños asmáticos las dimensiones más afectadas fueron el proceso de la individuación dentro de la familia, los conflictos familiares, la integración familiar y la cohesión, los papeles y la calidad de liderazgo dentro de la familia. Se encontró una correlación significativa entre el EFS y las dos medidas independientes. Los resultados prueban la validez del constructo y la validad coexistente del EFS.

Development and multicenter study on Korean pediatric asthma quality of life questionnaire (KPAQLQ) / 천식및알레르기

BACKGROUND AND OBJECT: Traditional asthma outcome measures such as symptoms, spirometry, and medication requirements usually provide valuable information about the asthmatic status but they rarely capture the functional impairments. Thus, many clinicians are increasingly recognizing the importance of an assessment of health-related quality of life (HRQL) as an outcome measure in asthma. We developed a questionnaire to measure asthma-specific quality of life in Korean children and evaluated the measurement properties. MATERIALS AND METHODS: The questionnaire for children with asthma included 14 items in three domains (symptoms-6 items, activity limitation-4 items, and emotional function-4 items) and the response options for each item were on a 5-point scale where 1 indicated maximum impairment and 5 indicated no impairment. Results were expressed as the mean score for overall quality of life as well as for each of the domains. At follow-up clinic visit, patients completed global assessment of change related to their symptoms, activities and emotions. We recruited children (7~17 years of age) with asthma from thirty-three general hospitals. RESULTS: Data from 214 patients (144 boys and 70 girls) who completed the questionnaire were analyzed. The mean age was 10.0 years and the disease severity consisted of mild intermittent (26.6%), mild persistent (36.0%), moderate persistent (32.2%), and severe persistent (3.3%). The questionnaire for children with asthma showed a high index of responsiveness, reproducibility, and both longitudinal and cross-sectional correlations with the conventional asthma indices and with the questionnaire score. But there was no relationship between changes in questionnaire score of the domain of emotional function and changes in FEV1 or PEFR. CONCLUSION: The questionnaire of children is straight forword, and easy to apply.

Development and multicenter study on Korean pediatric asthma caregiver's quality of life questionnaire (KPACQLQ) / 천식및알레르기

BACKGROUND AND OBJECTIVE: Asthma is the most common chronic disease among children. Thus, when children have asthma, it can have a significant impact on health-related quality of life, not only for children, but also for parents and family. We developed to measure asthma- specific quality of life in caregivers of children with asthma age 7~17 years and evaluated the measurement properties of the questionnaire. MATERIALS AND METHOD: The questionnaire of caregivers of children with asthma include 13 items in two areas (activity limitation-4 items, emotional function-9 items) and the response options for each item are on a 5-point scale where 1 indicates maximum impairement and 5 indicates no impairement. Results are expressed as the mean score for overall quality of life as well as for each of the domains. At follow-up visit, we asked caregivers whether they had experienced any change in their overall quality of life related to their children's asthma since the previous visit. They responded on a 11-point scale from -5 (a very great deal worse) to 0 (no change) to +5 (a very great deal better). We recruited 195 caregivers of children with asthma from thirty-three general hospitals and evaluated the measurement properties of the questionnaire. RESULT: The questionnaire of caregivers of children with asthma showed excellent responsiveness in changed group, but the change in score of stable and changed group has no difference. It was reproducible in subjects who are stable. There was no longitudinal and crosssectional correlations between caregiver's questionnaire score and the child's asthma status, while cross-sectional correlations were found between caregiver's questionnaire score and PEFR. CONCLUSION: The questionnaire of caregivers of children with asthma is simple and easy to use, and is applicable.

The Role of Patient and Parents Education in the Management of Pediatric Asthma / 소아알레르기및호흡기학회지

PURPOSE: Patient education is an important part of asthma management. This study was designed to evaluate the role of education program for asthmatic children and their parents. In the western countries, the effectiveness of patient education on improving self-management of asthma has been well documented. However, data from Korean population is lacking. METHODS: We performed the study to evaluate the efficacy of a hospital based education program aimed at improving self-management skills and reducing morbidity. Twenty patient and their parents attending Korea University Ansan Hospital allergy clinic were enrolled in the study. They were instructed 4 times of 10-15 minutes session with every 3 month interval on the pathophysiology of asthma, treatment and the appropriate use of medication including proper inhaler technique and the self-management of their diseases. The instructions were reinforced by three more education session at subsequent outpatient clinic attendance. RESULT: After twelve months, morbidity was assessed by the numbers of hospitalization, emergency department attendance and outpatient clinic attendance, use of oral steroids and steroid inhalation and impairment of quality of life. The efficacy of the education was demonstrated by significant reduction in the number of hospitalization(P<0.005), emergency department visit(P<0.005), outpatient clinic visit(P<0.05) and reduction of oral steroid use(P<0.001). There were also reduction of outpatient department attendance and improvement in steroid inhalation and quality of life. CONCLUSION: The result of this study suggest that a proper patient education is essential in reduction of asthma morbidity and improving in quality of life.