[Risk assessment in children with lithogenic kidney stones]. / Evaluatión del perfil de riesgo litógeno en niños con litiasis renal.

OBJECTIVE: The aim of this study was to describe the lithogenic risk profile of pediatric patients with lithiasis. METHODS: We retrospectively analyzed the metabolic studies in 24-hour urine samples in 47 pediatric patients with lithiasis. Biochemical determinations were made in blood and 24-hour urine. Oxalate calcium, brushite, struvite and uric acid salt saturations were calculated. 49 healthy children were used as a control group. RESULTS: No significant differences were found in biochemical blood parameters between children with stones and the group without stones. Calciuria, uricosuria and phosphaturia, oxalate calcium, brushite and uric acid saturations were higher in lithiasic children. In the multivariate analysis, using a logistic regression model, we only found hypercalciuria as lithogenic risk factor. (OR = 1.96 p <0.002). CONCLUSIONS: Urinary metabolic abnormalities and elevated salt saturations in urine are a frequent finding in children with urolithiasis, but in our study we only found hypercalciuria as an independent risk factor for the formation of lithiasis.

[Validation of a Spanish version of the Childhood Asthma Control Test (Sc-ACT) for use in Spain]. / Validación de la versión en español de la prueba de control del asma infantil (ACT) para su uso en España.

OBJECTIVE: The Childhood Asthma Control Test (c-ACT) is a validated tool for determining pediatric asthma control. However, it is not validated in the Spanish language in Spain. We evaluated the psychometric properties of the Spanish version of the Childhood Asthma Control Test (Sc-ACT) for assessing asthma control in children ages 4 to11. METHODS: This national, multicentre, prospective study was conducted in Spain with asthmatic children and their caregivers. Patients were assessed at 3 visits (Baseline, 2 Weeks, and 4 Months). Clinical variables included: symptoms, exacerbations, FEV1, asthma classification, PAQLQ and PACQLQ questionnaire scores, and asthma control as perceived by physicians, patients and caregivers. The Sc-ACT feasibility, validity, reliability, and sensitivity to change were assessed. RESULTS: A total of 394 children were included; mean (SD) time to complete the Sc-ACT was 5.3 (4.4) minutes. Sc-ACT score was correlated with asthma control as perceived by physician (-0.52), patient (-0.53), and caregiver (-0.51) and with the PAQLQ (0.56) and PACQLQ (0.55) scores. Sc-ACT was found to be significantly related to intensity and frequency of asthma symptoms. Cronbach alpha coefficient α was 0.81 and intraclass correlation coefficient was ≥0.85 for all of the items. The global effect size of Sc-ACT was 0.55. The cutoff point scores of 21 or higher indicated a good asthma control and their MCID was 4 points. CONCLUSION: The Spanish version of the c-ACT was found to be a reliable and valid questionnaire for evaluating asthma control in Spanish-speaking children ages 4 to 11 in Spain.

Factors associated with cortisol levels and health in 5-6-year-old children.

OBJECTIVES: This study assesses the relationships between social context (family and inter-peer context), stress, and illness in 5-6-year-old children. METHODS: To this end, data were collected on spontaneous social interpeer behavior; families provided data on stress, anxiety, and parental acceptance-rejection; and the children's pediatricians provided data relative to their health. Data on stress-related hormones (cortisol) were collected using saliva samples. RESULTS: The results revealed that none of the variables examined were significantly related to illness development in the subjects in the sample group. Cortisol levels, however, were positively associated with a record of chronic or congenital illnesses, the manifestation of behaviors related to the search for leadership status in the group and the presence of stressful events in the family environment. CONCLUSIONS: Despite finding no relationship between children's level of adrenocortical activity and the contracting or contingent development of diseases, we did find that chronic/congenital diseases may constitute a source of early stress in childhood. Certain conditions of uncertainty in the social context (family and interpeer) also seem to constitute different sources of stress.

Outbreak of Streptococcus pyogenes infection in healthcare workers in a paediatric intensive care unit: transmission from a single patient.

A 15-h stay in a paediatric intensive care unit by a girl with generalized dermal lesions superinfected with Streptococcus pyogenes led to four streptococcal infections in healthcare workers. Phenotypic and molecular analyses of the strains revealed that four isolates, characterized as emm87/ST62/T28, were identical to the isolate obtained from the index case. The occurrence of this outbreak, despite of the girl's brief hospital stay and appropriate patient management, highlights the high transmissibility of this pathogen.

Rotavirus genotypes in children in the Basque Country (North of Spain): rapid and intense emergence of the G12[P8] genotype.

Between July 2009 and June 2011, rotavirus was detected in 507 of 4597 episodes of acute gastroenteritis in children aged <3 years in Gipuzkoa (Basque Country, Spain), of which the G-type was determined in 458 (90·3%). During the annual seasonal epidemic of 2010-2011, the unusual G-type 12 was predominant, causing 65% (145/223) of cases of rotavirus gastroenteritis. All the G12 strains were clustered in lineage III and were preferentially associated with P-type 8. This epidemic was characterized by broad geographical distribution (rural and urban) and, over 7 months, affected both infants and children, the most frequently affected being children between 4 and 24 months. Of children with rotavirus G12, 16% required hospital admission, the admission rate in children aged <2 years being 20·7 cases/10 000 children. The sudden emergence and predominance of G12 rotaviruses documented in this winter outbreak suggest that they may soon become a major human rotavirus genotype.

[Impact of an asthma educational intervention programme on teachers]. / Impacto de una intervención educativa sobre asma en los profesores.

OBJECTIVE: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. MATERIAL AND METHOD: Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. RESULTS: A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001). CONCLUSIONS: An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.

[Bronchiolitis obliterans: outcome in the medium term]. / Bronquiolitis obliterante. Evolución a medio plazo.

BACKGROUND: Bronchiolitis obliterans is a chronic obstructive lung disease that follows a severe insult to the lower respiratory tract. Severity and outcome are different depending on the geographic area. The aim of this study was to communicate the results of our sample. METHODS: A retrospective study was performed in a sample of boys and girls with a medical diagnosis of bronchiolitis obliterans (BO) between December 1994 and February 2011. The diagnosis was made by high-resolution computed tomography (HRCT) scan and lung function. Lung biopsy was performed in one case. Pulmonary function testing included; forced spirometry (≥ 3 years old), plethysmography (≥ 5 years), bronchodilator tests (BDT), single-breath determination of carbon monoxide uptake in the lung (D(LCO)) (≥ 6 years) and measurement of exhaled lower respiratory nitric oxide (FE(NO)). Quantitative variables were; age at diagnosis, respiratory morbidity before the diagnosis, time from the start of the symptomatology until the diagnosis, follow-up time, respiratory morbidity after the diagnosis, airway specific resistance (sR(eff)), airway specific conductance (sG(eff)), residual volume, total lung capacity, thoracic gas volume, FEV(1), FVC, FEV(1)/FVC, FEF(25-75), D(LCO) and FE(NO). Qualitative variables were; sex, reason for consulting, viral infections, atopy, smoke exposure, HRCT scan and current treatment. Descriptive analysis was performed and pulmonary function before and after BDT was studied using paired-sample Wilcoxon and Student́s t-test. RESULTS: We studied a cohort of 22 cases, 10 (45.4%) boys and 12 (54.5%) girls. The mean age at the diagnosis was 4.87 ± 3, 27 years old. The follow-up period was 5 years (range 1 to 8 years). Related virus were; influenza 2 (9.09%), parainfluenza 2 (9.09%), adenovirus 3 (13.69%), syncytial respiratory virus 1 (4.5%) and rhinovirus 1 (4.54%). HRCT scan: mosaic pattern of lung attenuation 22 (100%) and bronchiectasis 8 (36.36%). Lung function at diagnosis showed fixed airflow obstruction and increased lung volumes. The global analysis showed a progressive decrease in FEV(1), FVC, FVC/FEV(1,) FEF(25-75) and increase in sR(eff) and residual volume with decrease in sG(eff). Individually, there was a tendency to stabilise the lung function comparing with initial values at diagnosis. Respiratory morbidity was low after the diagnosis. CONCLUSIONS: In most cases, fixed air-flow obstruction and lung function stability with low respiratory morbidity were observed. HRCT scan and lung function testing supported the diagnosis.

Improving anaphylaxis management in a pediatric emergency department.

BACKGROUND: The management of anaphylaxis in pediatric emergency units (PEU) is sometimes deficient in terms of diagnosis, treatment, and subsequent follow-up. The aims of this study were to assess the efficiency of an updated protocol to improve medical performance, and to describe the incidence of anaphylaxis and the safety of epinephrine use in a PEU in a tertiary hospital. METHODS: We performed a before-after comparative study with independent samples through review of the clinical histories of children aged <14 years old diagnosed with anaphylaxis in the PEU according to the criteria of the European Academy of Allergy and Clinical Immunology (EAACI). Two allergists and a pediatrician reviewed the discharge summaries codified according to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) as urticaria, acute urticaria, angioedema, angioneurotic edema, unspecified allergy, and anaphylactic shock. Patients were divided into two groups according to the date of implantation of the protocol (2008): group A (2006-2007; the period before the introduction of the protocol) and group B (2008-2009; after the introduction of the protocol). We evaluated the incidence of anaphylaxis, epinephrine administration, prescription of self-injecting epinephrine (SIE), other drugs administered, the percentage of admissions and length of stay in the pediatric emergency observation area (PEOA), referrals to the allergy department, and the safety of epinephrine use. RESULTS: During the 4 years of the study, 133,591 children were attended in the PEU, 1673 discharge summaries were reviewed, and 64 cases of anaphylaxis were identified. The incidence of anaphylaxis was 4.8 per 10,000 cases/year. After the introduction of the protocol, significant increases were observed in epinephrine administration (27% in group A and 57.6% in group B) (p = 0.012), in prescription of SIE (6.7% in group A and 54.5% in group B) (p = 0.005) and in the number of admissions to the PEOA (p = 0.003) and their duration (p = 0.005). Reductions were observed in the use of corticosteroid monotherapy (29% in group A, 3% in group B) (p = 0.005), and in patients discharged without follow-up instructions (69% in group A, 22% in group B) (p = 0.001). Thirty-three epinephrine doses were administered. Precordial palpitations were observed in one patient. CONCLUSION: The application of the anaphylaxis protocol substantially improved the physicians' skills to manage this emergency in the PEU. Epinephrine administration showed no significant adverse effects.

[Whooping cough in the first year of life in a region with high vaccination coverage]. / Tos ferina en el primer año de vida en una región con elevada cobertura vacunal.

INTRODUCTION: Despite vaccination, reports of cases and outbreaks of pertussis (whooping cough) continue to appear sporadically, sometimes in young children who are at higher risk of severe disease. The aim of the present study was to evaluate the impact of this infection in infants in a region with high vaccination coverage in the pediatric population. PATIENTS AND METHODS: We performed a retrospective observational chart-review study of pertussis cases occurring over a decade (1999-2008), microbiologically confirmed through a polymerase chain reaction technique that amplifies the IS481 Bordetella pertussis sequence. RESULTS: There were 54 confirmed cases, of which 33 (61.1%) occurred in infants aged less than 3 months. Cases were detected in all the study years, with periodic outbreaks (1999, 2004 and 2008). Half of the cases occurred in summer. Due to their young age, 55% of the infants had not received a vaccine dose and only 11% had received the first three doses. Hospitalization was required in 39 cases (72%) and admission to the pediatric intensive care unit in 17 cases (31.5%). One premature infant, with symptoms compatible with malignant pertussis, died at 49 days of life. CONCLUSIONS: Despite the high pertussis vaccination coverage, infants aged less than 6 months continue to be at risk of severe disease. New preventive strategies are required to further reduce the impact of this infection.

[Cost of childhood asthma in Spain: a cost evaluation model based on the prevalence]. / Coste del asma en pediatría en España: un modelo de evaluación de costes basado en la prevalencia.

INTRODUCTION: Asthma is the most common chronic disease in childhood, reduces the quality of life of children and their families, and produces high social and health care costs. In Spain, the cost of managing paediatric asthma is unknown. OBJECTIVE: To estimate the cost of managing paediatric asthma in Spain and to examine its variability depending on asthma severity. PATIENTS AND METHODS: The cost of asthma in children under 16 years in 2008 was estimated by building a costs assessment model including the factors that influence the cost of asthma in children: prevalence, distribution of disease severity, age, frequency of resources use depending on severity, and the cost of each resource. A sensitivity analysis was conducted to evaluate the underlying uncertainty depending on the variability of the estimators of resource use, the unit cost of each resource, and the prevalence. RESULTS: According to the model, the total cost of paediatric asthma in Spain is around 532 million euros, with a range of 392 to 693 million euros. Direct costs (health care costs) represent 60% of the total costs, and indirect costs (carer time), 40%. The mean annual cost per child with asthma is 1,149 euros, ranging from 403 euros for the mildest category of the disease to 5,380 euros for the most severe. CONCLUSIONS: The cost of paediatric asthma in Spain is very high and depends on disease severity. Although the most important costs are for the health care system, indirect costs are not negligible.

[Rotavirus and seizures. A well-defined uncommon association]. / Rotavirus y crisis convulsivas. Una asociación poco frecuente aunque bien definida.

INTRODUCTION: Rotavirus infection, besides gastrointestinal symptoms, may cause several neurological complications. Among these, are benign convulsions with mild gastroenteritis (CwG). Despite having well defined clinical features, its incidence is not well known. METHODS: We selected discharge diagnoses of acute diarrhea in children aged 1 month to 5 years who were admitted to Donostia Hospital between July 1996 and June 2008. Among them, we selected those cases with concomitant diagnosis of seizure. RESULTS: Rotavirus was detected in 419 of 1114 children hospitalized for gastroenteritis. (39.2%), Five (1.2%) had symptoms compatible with CwG. The episodes occurred between December and January in all cases. The mean age at diagnosis was 19.6 months. The number of seizures per patient was 2.6 (range 1-4). All the crises were short, the longest being 15min. The total duration of the episode was 1.6 days on average, with up to 3 days. Additional tests performed in all cases, were normal. In subsequent follow-up, one child at 26 months had another episode compatible with this entity at 26 months. During the follow-up period, all patients displayed normal psychomotor development with noe recurrence of seizures. CONCLUSION: CwG is a rare entity within all acute gastroenteritis associated with rotavirus, but has very specific clinical features that enable it to be identified which could avoid excessive medical tests, and aggressive treatment.

Association among lung function, exhaled nitric oxide, and the CAN questionnaire to assess asthma control in children.

BACKGROUND: The aim of this study was to investigate the association among a validated symptom-based questionnaire for asthma control in children (CAN), forced expiratory volume in 1 sec (FEV(1)), and fractional exhaled nitric oxide (FE(NO)). METHODS: Observational cross-sectional study was performed in a consecutive sample of asthmatic children aged between 7 and 14 years old from December 2007 to February 2008. FE(NO) was measured with a portable electrochemical analyzer and forced spirometry was performed according to American Thoracic Society/European Respiratory Society. The CAN questionnaire was completed by the parents (aged <9 years old) or by the children (> or = 9 years old). The strength of the association among FEV(1), FE(NO), and CAN questionnaire was studied using Spearman's rho, and the degree of agreement for asthma control among FEV(1), FE(NO), and CAN questionnaire, with classification of these variables according to values of normality, was studied using Pearson's chi(2) test and Cohen's kappa (KC). RESULTS: We studied 268 children, mean age 9.7 +/- 2.1 years. Significant correlations were found between FE(NO) and CAN (r = 0.2), between FEV(1) and CAN (r = -0.3), and between FE(NO) and FEV(1) (r = -0.12). On classifying the variables according to values of normality, no agreement was found to establish the degree of asthma control between FE(NO) and CAN (KC = 0.18, chi(2) Pearson = 9.63); between FEV(1) and CAN (KC = 0.29, chi(2) = 38.5); or between FE(NO) and FEV(1) (KC = 0.07, chi(2) = 4.9). CONCLUSIONS: The association among the three measurement instruments used to assess asthma control (FEV(1), FE(NO), and CAN) was weak. These are instruments that quantify variables that influence asthma in different ways, in this sense, none can be used instead of another in asthma management although they are complementary.

[Endobronchial chondromesenchymal hamartoma]. / Hamartoma condromesenquimal endobronquial.

Primary lung tumours are uncommon in childhood. Among these tumours, endobronchial masses are even less common and, among benign tumours, inflammatory pseudotumours and hamartomas have the highest incidence in children. We present the case of a 2.5-year-old girl with a left endobronchial chondromesenchymal hamartoma with obstruction of 90% of the bronchial lumen. Complete resection of the endobronchial mass was performed by rigid bronchoscopy and application of topical mitomycin C. After tumour resection and a 12-month follow-up, the patient has shown a favourable outcome with immediate disappearance of respiratory symptoms. Successive fibreoptic bronchoscopies have shown no residual tumour.

Incidence of hospitalization due to community-acquired rotavirus infection: a 12-year study (1996-2008).

The incidence of hospitalization for acute gastroenteritis (AGE) is a useful parameter to assess the utility of the new rotavirus vaccines in high-income countries. Children hospitalized for AGE were identified by searching hospital discharge data and the records of the microbiology laboratory of Hospital Donostia. Rotavirus antigen was investigated in 96.1% of the 1114 children aged 1 month to <5 years hospitalized for AGE in the study period. Nearly 40% were rotavirus positive (44.9% of the 798 children aged 1 month to <2 years), with G1[P8] being the predominant genotype. The mean annual incidence rate of hospitalization due to rotavirus AGE was 29.8 and 63.7 cases/10 000 inhabitants in the <5 and <2 years age groups, respectively, in 1996-1999, decreasing to 13.6 and 27.4 cases/10 000 inhabitants in <5 and <2 years age groups, respectively, in 2002-2005 (P<0.001). This decrease coincided with a significant increase in the consumption of oral rehydration solutions.

Invasive Streptococcus pneumoniae infections in children and older adults in the north of Spain before and after the introduction of the heptavalent pneumococcal conjugate vaccine.

In the last two decades, an increasing trend in the incidence of pneumococcal disease in Europe has been reported. We investigated the effect of the use of the heptavalent pneumococcal conjugate vaccine (PCV7) in an area of northern Spain, where all recorded cases of invasive pneumococcal diseases (IPD) were included (n = 450; 91 between 1996-2007 in children aged <5 years and 359 between 1998-2007 in adults aged >64 years). All isolates were serotyped. In children, the overall IPD incidence did not significantly decrease after the introduction, in late 2001, of PCV7. However, the incidence of PCV7 serotypes significantly decreased by 137.2% from 31.59 cases/100,000 population in 1996-2001 to 13.42 in 2002-2007 (95% confidence interval [CI] -27.2 to -342.4%), as did the overall rates of penicillin resistance (from 45.6 to 18.6%) and multiresistance (from 30.3 to 11%). In older adults, the overall IPD incidence showed a non-significant increase due to non-PCV7 serotypes, which seemed to continue a previous trend in our region.

[Forced spirometry in healthy preschool children]. / Espirometría forzada en preescolares sanos bajo las recomendaciones de la ATS/ERS: estudio CANDELA.

INTRODUCTION: Reference values for spirometry in healthy preschool children have not yet been obtained in accordance with American Thoracic Society (ATS) and the European Respiratory Society (ERS) guidelines. The objective was to establish reference values for spirometry in healthy preschoolers under the ATS/ERS 2007 statement. MATERIAL AND METHOD: Children of at least 2 and under 7 years of age were tested in 9 pediatric pulmonary function laboratories. The technicians were trained to apply a standardized protocol to perform spirometry. RESULTS: Valid spirometry results were obtained in 455 (81.54%) out of 558 children: 242 boys (53.2%) and 213 girls (46.8%). Ages were as follows: 31 at least 2 and under 3 years old; 96, at least 3 and under 4; 108, at least 4 and under 5; 122, at least 5 and under 6 years, and 98, at least 6 and under 7 years. Formulas were used to calculate the reference values for all the spirometry variables in preschoolers. CONCLUSIONS: Spirometry is feasible in the majority of preschool children under the new guidelines. The availability of the reference values presented is an important step, both for the care of preschoolers and for further research on pulmonary function.

Hospitalization rates for human metapneumovirus infection among 0- to 3-year-olds in Gipuzkoa (Basque Country), Spain.

Numerous studies have been published on human metapneumovirus (HMPV) infection, but few have been population based. The main aim of this study was to estimate the incidence rate of hospitalization for community-acquired HMPV infection in infants and children aged <3 years. Between July 2004 and June 2007, 796 episodes (742 patients) of community-acquired acute respiratory infection were hospitalized. HMPV was detected in 90 episodes (11.3%). Fifty-nine episodes occurred in infants aged <1 year. The mean length of hospital stay was 6.2 days (range 2-31 days). Thirteen children required admission to the intensive care unit. Viral co-infections were detected in 46 episodes (51.1%). The incidence rate of hospitalization per 1000 inhabitants was 2.6 (95% CI 2.1-3.2), lower than that for respiratory syncytial virus, but higher than that observed for the influenza and parainfluenza viruses. HMPV is a major respiratory pathogen that leads to a high hospitalization rate.

Development and validation of a questionnaire to assess asthma control in pediatrics.

OBJECTIVE: To develop and validate a questionnaire to assess asthma control in children (CAN). DESIGN: Two versions of the CAN (for carers and children) were developed. Both versions were validated in an observational, prospective, multicenter study performed in 38 hospital outpatient clinics throughout Spain. Four hundred fifteen patients and their carers agreed to participate. Of these, 414 patients under 14 years old with frequent episodic or persistent (moderate to severe) asthma completed the questionnaire on 3 occasions (baseline, week 2, and week 12). For patients aged 2-8 the questionnaire was only completed by the carers, but for patients aged 9-14 the questionnaire was completed by the carers and the children. Clinician ratings of asthma control were used as a gold standard to assess the sensitivity, specificity, PPV and NPV of the new measure. RESULTS: Evaluable responses were obtained from 215 carers for children aged 2-8 years and 199 children aged 9-14 years, and their parents. Using a questionnaire total score cut-off of 8 the patient version had a sensitivity of 76.3% and a specificity of 62.9%. For carer version these values were 73% and 69.7%, respectively. A cut point of 8 was selected to maximize the screening accuracy of the CAN questionnaire. Effect sizes in patients with clinician-rated improvements in asthma control were 0.33 and 0.57 for the carer and child versions, respectively. CONCLUSIONS: The screening accuracy and validity of the CAN questionnaire make it suitable for use in research and clinical practice. The sensitivity and specificity were close to 70%, which is acceptable for the study objective: obtain a tool to measure the level of asthma control.

[Recurrent wheezing in three year-olds: facts and opportunities]. / Sibilancias recurrentes en menores de tres años: evidencias y oportunidades.

The 3 year-old group of children has an increased incidence and prevalence of recurrent wheezing episodes. There are different subgroups, who give different inflammatory responses to different triggering agents, and subgroups that differ in aetiopathology and immunopathology. Current diagnostic methods (exhaled nitric oxide in multiple breaths, nitric oxide in exhaled air condensate, induced sputum, broncho-alveolar lavage and endo-bronchial biopsy), enable the inflammatory pattern to be identified and to give the most effective and safe treatment. The various therapeutic options for treatment are reviewed, such as inhaled glucocorticoids when the inflammatory phenotype is eosinophilic, and leukotriene receptor antagonists, when the inflammatory phenotype is predominantly neutrophilic. In accordance with the current recommendations, for the diagnosis as well as for the therapy initiated in children of this age, they must be regularly reviewed, so that if the benefit is not clear, the treatment must be stopped and an alternative diagnosis and treatment considered. The start of treatment should be determined depending on the intensity and frequency of the symptoms, with the aim of decreasing morbidity and increasing the quality of life of the patient.