Smartphone App for monitoring Asthma in children and adolescents.

PURPOSE: The asthma stepwise treatment approach recommended is based on monitoring patients' symptoms. The Asthma Research in Children and Adolescents (ARCA) cohort was created to provide evidence about the evolution of persistent asthma. This manuscript describes the development of an electronic health tool, comprising a mobile health application for patients with asthma and its associated online platform for pediatricians to monitor them. METHODS: The development process followed 7 phases: the first 5 (Conceptualization, Preparation, Assessment scheduling, Image and user interface, and Technical development) defined and designed the tool, followed by a testing phase (functionality assessment and pilot test with ARCA patients), and a last phase which evaluated usability. Since the target population was aged 6-16 years, three versions were designed within the same smartphone application: parents/proxy, children, and adolescents. The online platform for pediatricians provides real-time information from the application: patients' responses over time with color-coded charts (red/amber/green, as in traffic lights). RESULTS: The pilot test through semi-structured phone interviews of the first 50 participants included in the ARCA study (n = 53) detected their misunderstandings. Pediatricians were trained to emphasize that the application is free of charge and requires monthly answers. Median of the System Usability Scale scores (n = 85), ranging 0 (negative)-100 (positive), was > 93 in the three age versions of the application. CONCLUSIONS: Technology has the capability of transforming the use of patient-reported outcomes. Describing all the development phases of a mobile health application for monitoring children and adolescents with asthma may increase the knowledge on how to design applications for young patients.

Asthma diagnosis in infants and preschool children: a systematic review of clinical guidelines.

BACKGROUND AND AIM: The definition and diagnosis of asthma are the subject of controversy that is particularly intense in the case of individuals in the first years of life, due to reasons such as the difficulty of performing objective pulmonary function tests or the high frequency with which the symptoms subside in the course of childhood. Since there is no consensus regarding the diagnosis of asthma in preschool children, a systematic review has been carried out. MATERIALS AND METHODS: A systematic search was made of the clinical guidelines published in the last 10 years and containing information referred to the concept or diagnosis of asthma in childhood - including the first years of life (infants and preschool children). A series of key questions were established, and each selected guide was analyzed in search of answers to those questions. The review protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42017074872. RESULTS: Twenty-one clinical guidelines were selected: 10 general guides (children and adults), eight pediatric guides and three guides focusing on preschool children. The immense majority accepted that asthma can be diagnosed from the first years of life, without requiring pulmonary function tests or other complementary techniques. The response to treatment and the exclusion of other alternative diagnoses are key elements for establishing the diagnosis. Only one of the guides denied the possibility of diagnosing asthma in preschool children. CONCLUSIONS: There is generalized although not unanimous agreement that asthma can be diagnosed in preschool children.

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.

Asthma education taught by physical education teachers at grade schools: A randomised cluster trial.

OBJECTIVE: Assess whether the Asthma, Sport and Health (ASAH) programme taught by teachers improves asthmatics' quality of life, asthma knowledge, and reduces school absenteeism. DESIGN: Randomised cluster trial parallel group. PARTICIPANTS: 2293 students (203 asthmatic) in the Intervention School group (IS) and 2214 in the Comparison School (CS) (224 asthmatic) belonging to primary school. INTERVENTION: Implementation of the educational programme "Asthma, Sport and Health" at grade schools, taught by physical education teachers. MAIN OUTCOME: Quality of life according to the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). SECONDARY OUTCOMES: Asthma knowledge, asthma control, school absenteeism. RESULTS: After implementing the programme in the IS group, global quality of life improved significantly (p<0.001) as did their domains, symptoms (p<0.001), emotional function (p<0.001) and activity limitations (p<0.01), while in the CS group improvement was seen in global life quality (p<0.01) without any significant changes in the domains for emotional function and activity limitations. Asthma knowledge only increased in IS, among asthmatic students from 16.51 (CI 95% 16.04-16.98) to 18.16 (CI 95% 17.69-18.62) (p<0.001) and students without asthma from 15.49 (CI95% 15.36-15.63) to 17.50 (CI95% 17.36-17.64) (p<0.001). The multiple regression analysis showed that quality of life and its domains depend on asthma knowledge and above all, having well-controlled asthma. We found no decrease in school absenteeism. CONCLUSIONS: The ASAH programme improved certain quality of life aspects regarding asthma (emotional function and limitation of activities) and asthma knowledge, but it failed to reduce school absenteeism NCT01607749.

Quality of life in caregivers of children with asthma: Validity and reliability of the IFABI-R questionnaire.

BACKGROUND: Parents'/caregivers' quality of life is an important aspect to consider when handling paediatric asthma, but there is a paucity of valid and reliable instruments to measure it. The Family Impact of Childhood Bronchial Asthma (IFABI-R) is a recently developed questionnaire to facilitate the assessment of asthma-related parents'/caregivers' quality of life. This study researches the psychometric properties of IFABI-R. METHODS: Parents/main caregivers of 462 children between 4 and 14 years of age with active asthma were included in the sample. IFABI-R was administered on two different occasions and a number of other variables related to the parents'/caregivers' quality of life were measured: child's asthma control, family functioning, and parents'/caregivers' perception of asthma symptoms in the child. IFABI-R evaluative and discriminative properties were analysed, and the minimal important change in the IFABI-R score was identified. RESULTS: IFABI-R showed high internal consistency (Cronbach's alpha=0.941), cross-sectional construct validity (correlation with the degree of child's asthma control, family functioning and parent/caregiver perception of the child's asthma symptoms), longitudinal construct validity (correlation of changes in the IFABI-R with changes in asthma control and changes in the perception of symptoms), sensitivity to change and test-retest reliability. An absolute change of 0.3 units in IFABI-R related to a minimal significant change in the parents'/caregivers' quality of life. CONCLUSIONS: IFABI-R is a reliable and valid instrument to study the quality of life of parents/caregivers of children with asthma.

Indicators for childhood asthma in Spain, using the Rand method.

OBJECTIVE: To develop quality indicators to measure asthma care in primary health care. METHOD: A modified RAND was used, which included the systematic review of the literature in Embase, Cochrane and Pubmed Quality Agencies and Database. The work group identified the indicators, translated them into Spanish and resolved any duplicates. Each indicator is composed of several dimensions (access to care, clinical effectiveness, patient-centred quality and patient safety). A multidisciplinary panel of 98 professionals from all over Spain were invited to score each indicator using a Likert scale. After calculating the average and median of each indicator, this information was sent to those who responded (n=38) for a second round and further scoring. The agreement percentage for the group was obtained for each indicator. RESULTS: Of the 105 asthma indicators reviewed, we selected 46 that were presented to the panel of experts. In both Delphi phases, 37.1% of the members of the initial panel of experts responded. Of these, 26 were primary care paediatricians, six were pulmonologists, three were nurses, two were pharmacists and one was an allergist. For 32 indicators, agreement exceeded 70% and seven of those scored highest for the various care aspects for asthmatic children. CONCLUSION: Quality indicators are presented for the follow-up of asthma and their implementation in primary care, which have undergone a strict selection and agreement process by a multidisciplinary work group.

[Association between paracetamol exposure and asthma: update and practice guidelines]. / Asociación entre la exposición a paracetamol y el asma: estado de la cuestión y recomendaciones prácticas.

Asthma prevalence has increased over the last few decades, especially in developed countries, and possibly due to different reasons. An association between paracetamol use or exposure at different periods of life, including gestation and childhood, and asthma prevalence has been observed in the last few years. Causality can not be established from observational reports, due to the arguable presence of many confounding factors and biases. Randomised trials are needed to elucidate the nature of this association. The Spanish Paediatric societies subscribing to this paper consider that current evidence is insufficient to discourage the use of paracetamol during gestation or in children with or at risk of asthma.

[Knowledge, attitudes and asthma quality of life of adolescents in schools. The need to educate our teaching centres]. / Situación de los conocimientos, las actitudes y la calidad de vida en asma de adolescentes y profesorado. Necesidad de educar en los centros de enseñanza.

INTRODUCTION: Knowledge and attitudes toward asthma can condition the integration of adolescents with asthma in school and affect their quality of life. Our objective was to determine the state of knowledge, attitudes on asthma in secondary schools, and its relationship to quality of life of pupils with asthma, as an early step to an educational intervention. METHODS: Descriptive and cross-sectional study of pupils aged 13 and 14 years old and their teachers in 26 schools of Seville and province. We used, as study tools, the Newcastle Asthma Knowledge Questionnaire, the Gibson attitudes towards asthma, and the Paediatric Asthma Quality of Life Questionnaire. To assess the normality of variables, the Kolmogorov-Smirnov test was used, and for non-parametric variables the U Mann-Whitney and W Wilcoxon tests were used. For the association between variables, we use the regression coefficients and rho Spearman. RESULTS: We studied 3827 pupils (279 with asthma) and 548 teachers. All had little knowledge about asthma. The quality of life in asthma was mild to moderately affected, and lower in girls, 5.38±1.08 (95% CI=5.20 to 5.55) than in boys 5.77 (± 1.18) (95% CI=5.56 to 5.97), P=.0000. We found no relationship between knowledge, attitudes and quality of life in asthma. CONCLUSIONS: We found a low level of knowledge about asthma in pupils and teacher. Asthma sufferers have a mild to moderate asthma quality of life, which is worse for girls. Knowledge has no relationship with attitudes to asthma in all groups, or with the quality of life of asthma sufferers.

[The Spanish version of the Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ). Transcultural adaptation and reliability analysis]. / Versión española del NAKQ. Adaptación transcultural y análisis de fiabilidad y validez.

INTRODUCTION: The Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ) has proven to be a valid instrument for asthma knowledge assessment of patients and their parents. The widespread use of the SRS-22 in non-English-speaking countries requires its transcultural adaptation. Our objective was to obtain a version of the NAKQ questionnaire adapted to Spanish and to analyze its validity and reliability. MATERIAL AND METHODS: The Spanish version was obtained by using the forward/back-translation method with expert, bilingual translators. The questionnaire was administered to 157 parents with high knowledge (n = 78) and low knowledge (n = 79) of asthma. The differences in the number of answers between both groups were analyzed with the chi(2) test. Internal consistency was determined with Cronbach's alpha coefficient and test-retest reliability with the tau-b of Kendall correlation coefficient, and kappa statistics. RESULTS: At the end of the process, 23 of the 31 items were classified as of total equivalence and eight ase of moderate equivalence. The mean score of parents high knowledge was 23 +/- 2.94 and the mean score of parents low knowledge was 16.84 +/- 2.56. The difference between the two groups was statistically significant (p < 0.001). The overall Cronbach's alpha coefficient of the questionnaire was 0.72, the Kendall's tau-b 0,8573 was significant (p = 0.01) and the kappa index showed good or very good consistency in more than half of the items. CONCLUSIONS: The Spanish version of the NAKQ has proven to be acceptable and culturally equivalent to the original version and it has a good degree of consistency, validity and reliability.

Group education on asthma for children and caregivers: a randomized, controlled trial addressing effects on morbidity and quality of life.

OBJECTIVE: To establish the efficacy in terms of morbidity and quality of life of a group education program on asthma aimed at children and caregivers. METHODS: An open, randomized, controlled trial was undertaken in 13 primary health care centers in Spain, Cuba, and Uruguay and involved 245 children with active asthma aged 9 to 13 years and their caregivers. The intervention consisted of 3 educational sessions lasting 45 to 60 minutes each and was performed with 3 intervention groups: children alone, caregivers alone, and both children and caregivers. The outcome measures were difference between intervention and control groups in the rate of asthma attacks and hospital admission, as well as the quality of life of children and caregivers in the 6 months following the intervention. RESULTS: The rate of asthma attacks per patient-year decreased when the intervention was given only to children (mean difference, -1.61; 95% confidence interval [CI], -2.87 to -0.34) or to both children and caregivers (-1.60; 95% CI, -2.88 to -0.31). Hospital admissions per patient-year decreased in the intervention groups children alone (-0.28; 95% CI, -0.51 to -0.05) and both children and caregivers (-0.25; 95% CI, -0.49 to -0.02). Education provided to caregivers alone was not associated with any changes in morbidity. No differences were observed in terms of quality of life between controls and any of the intervention groups. CONCLUSIONS: Group education on asthma reduces morbidity but does not improve quality of life. The benefits are apparent when education is aimed at children but no additional benefit is obtained if the intervention is also aimed at their caregivers. Finally, group education for adult caregivers alone is not effective.

[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.

[Organochlorine compounds: blood levels in mothers, newborns, and infants, in maternal milk and formula. Study in the province of Huelva]. / Compuestos organoclorados: niveles sanguíneos en madres, recién nacidos y lactantes, en leche materna y de fórmula. Estudio en la provincia de Huelva.

We have studied the presence of organochlorine compounds (OCC), DDT, HCB, HCH and isomers alpha, beta and gamma or lindane, hepta-chloro-epoxide (HE) and polychlorobiphenyl compounds (PCB), in 50 mothers and their newborn babies. The samples studied included the umbilical cord blood, blood from the mothers during the delivery, blood from the baby at one and three months of age, and the milk fed to the babies at these periods (breast n = 30; bottle n = 20). The objectives of the study were: 1) To detect the levels of OCC in the different samples. 2) To discover the difference in levels between breast and bottle fed babies. 3) To quantify the variations of the levels in the different samples. 4) To check whether the acceptable daily intake (ADI) established for these OCC is exceeded among these babies. The analyses were done in the National Institute of Toxicology in Seville, by using the following methods, gas chromatography, electron capture detector and mass spectrometry. The statistical analysis was based on the Kruskal-Wallis, Shapiro-Wilks, Levene, Pooled and Separate tests. We have found significant levels of OCC in the samples analyzed. The PCBs are the compounds in our study which have the highest levels, indeed being one of the highest levels documented to date. We verify the decline in OCC of agricultural origin in relation to previous reports in our country, as has also been reflected in the international literature in recent years. The levels of OCC in breast fed babies are significantly higher than those in bottle fed babies.

[Organochlorine compounds: correlation between maternal and infantile blood levels, maternal milk and maternal-infantile parameters. Study in the province of Huelva]. / Compuestos organoclorados: relación de niveles sanguíneos en madres y recién nacidos y en leche materna con parámetros maternos y de lactantes. Estudio en la provincia de Huelva.

In our study of the levels of organochlorine compounds (OCC), several factors were taken into account. In the mother, age, diet, place of residency, profession, the number of previous breast-fed children and alcohol and tobacco intake. We then studied the effect of the OCC passed through the placenta. Here, we checked the length of gestation, the birth weight, the cephalic perimeter measurement, the possible neurological alterations such as hypotonie and hyporreflexie and the possible clinical repercussions of the OCC. The OCC studied were, DDT, hexachlorobenzene (HCB), hexachlorocyclohexanes (HCH) and isomers alpha, beta and gamma or lindane, dieldrin, heptachloro epoxide (HE) and polychlorobiphenyl compounds (PCB). The samples studies included, blood for the mother and umbilical cord during the delivery, blood from the babies at the ages of one and three months, and the mother's milk (n = 30) and formula milk (n = 20) one and three months after birth. The analytical study was made at the National Institute o Toxicology in Seville with the following methods, gas chromatography, electron capture detector and mass spectrometry. The statistical analysis was based on the Kruskal-Wallis, Shapiro Wilks, Levene, Pooled and Separate tests. We have found that older mothers and those who consumed more fatty meat and blue fish had statistically significant higher levels of OCC. There were also differences depending on the place of residency. The newborn babies with a greater birth-weight and cephalic perimeter measurements also had higher levels of OCC. In these babies, we also found clinical symptoms such as hypotonie and hyporreflexie.