Transition of Adolescents With Severe Asthma From Pediatric to Adult Care in Spain: The STAR Consensus.

OBJECTIVES: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. METHODS: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. RESULTS: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. CONCLUSION: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.

[Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP)]. / Neumonía adquirida en la comunidad: tratamiento de los casos complicados y en situaciones especiales. Documento de consenso de la Sociedad Española de Infectología Pediátrica (SEIP) y Sociedad Española de Neumología Pediátrica (SENP).

The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression.

[Community acquired pneumonia in children: Outpatient treatment and prevention]. / Neumonía adquirida en la comunidad: tratamiento ambulatorio y prevención.

There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed.

[Recommendations for management of patients with lung disease planning a flight or high altitude travel]. / Recomendaciones previas al vuelo y a viajes con exposición a altitud en pacientes con patología respiratoria.

Every year a large number of children travel by plane and/or to places with high altitudes. Most of these journeys occur without incident. Immigration and recent socioeconomic changes have also increased the number of patients with cardiopulmonary disease who travel. Environmental changes in these places, especially lower oxygen, can lead to a risk of significant adverse events. The paediatrician must be aware of the diseases that are susceptible to complications, as well as the necessary preliminary studies and recommendations for treatment in these circumstances. The Techniques Group of the Spanish Society of Paediatric Chest Diseases undertook to design a document reviewing the literature on the subject, providing some useful recommendations in the management of 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.

[Prevalence of current asthma in Majorca. Value of a bronchial hyperresponsiveness test in combination with a questionnaire]. / Prevalencia actual de asma en Mallorca. Utilidad de la prueba de hiperreactividad bronquial y un cuestionario asociado.

BACKGROUND: The prevalence of asthma shows marked variability and consequently it should be determined in different geographical areas. Standardized questionnaires are reliable for identifying and comparing the prevalences of asthma among areas. However, asthma prevalence based on the use of questionnaires alone could overestimate the true prevalence of this illness. Therefore, the use of other methods such as determination of bronchial hyperresponsiveness is useful as an adjunct to questionnaires in asthma screening and epidemiological studies. OBJECTIVE: To assess the prevalence of current asthma among schoolchildren in Majorca. PATIENTS AND METHODS: A total of 608 schoolchildren aged 8-15 years in the island of Majorca were studied. Participants answered a questionnaire on symptoms and performed a free running test for measuring bronchial responsiveness. RESULTS: The prevalence of wheezing during the previous 12 months was 18.1% (11.5% for the group aged 12-15 years). A fall in forced expiratory volume in one second (FEV1) greater than 15% after exercise testing was found in 61 children (10.5%). An association between bronchial responsiveness and the results of the written questionnaire referring to wheezing was found, but not between bronchial responsiveness and nocturnal coughing. The prevalence of "current asthma" (recent wheezing and bronchial responsiveness) was 3.4%. CONCLUSION: The prevalence of current asthma in our area is lower than that reported for other Spanish areas. The use of questionnaires and a free running test can be useful in identifying children at greatest risk.

[Contribution of flexible bronchoscopy to the diagnosis of upper airway alterations]. / Contribución de la fibrobroncoscopia al diagnóstico de las enfermedades de la vía aérea superior.

INTRODUCTION: Flexible bronchoscopy (FB) is becoming an increasingly common diagnostic and therapeutic technique and is currently an essential procedure in pediatric pulmonology departments. Because the procedure is easy to perform under sedation and topical anesthesia, avoiding surgery with general anesthesia, which is required for rigid bronchoscopy, it has allowed the use of airway endoscopy in infants and children to be increased and has reduced patient risks. OBJECTIVE: To analyze the contribution of FB to the diagnosis of upper airway alterations and to characterize the frequency and type of upper airway anomalies. PATIENTS AND METHODS: We retrospectively reviewed the FB performed in our center between January 1993 and March 2003 in children aged less than 14 years old. RESULTS: A total of 456 FB were performed in 378 children. One hundred eleven FB (24.5 % of all endoscopies) were required for suspected upper airway anomalies and 55.8 % corresponded to stridor. Upper airway inspection revealed abnormality in 30.7 % (140 FB). There were no severe complications. CONCLUSION: FB is useful in the diagnosis of upper airway abnormalities. The main indication for FB is stridor and the most common abnormal finding of the upper airway is laryngomalacia.

[Gastroenteritis caused by enteric adenovirus serotypes 40 and 41. Preliminary study]. / Gastroenteritis por adenovirus entéricos serotipos 40 y 41. Estudio preliminar.

We present the preliminary results of a prospective study of childhood gastroenteritis associated with enteric adenovirus (AE-40 and AE-41). In a period of five months we have studied 499 children with enteritis; 9 (1.8%) were positive for enteric adenoviruses (latex agglutination). The mean age of the children was 16.2 months (extreme ages 10 days and 5 years). The mean duration of diarrhoea was 2.8 days with 4-5 times daily. Respiratory symptoms were present in 44.4% of the patients and one patient was infected simultaneously with Campylobacter jejuni. All clinical syndromes were self-limiting and were treated with diet and rehydration.