El pediatra de Atención Primaria y la laringitis aguda / Primary care pediatrician and acute laryngitis

La laringitis aguda (crup) es una enfermedad común de origen viral, que constituye la causa más frecuente de obstrucción de la vía aérea superior en la infancia. Se caracteriza por la presencia de un grado variable de tos perruna o metálica, afonía, estridor y dificultad respiratoria. La incidencia estimada es del 3-6% de niños entre 3-6 meses y 6 años, con un pico máximo en el segundo año de vida y durante el otoño y el invierno. La principal causa es el virus parainfluenza tipo 1. El diagnóstico se realiza por la clínica, tos perruna, afonía y estridor inspiratorio. No son necesarias otras exploraciones. En función de la gravedad, que estableceremos con un score clínico, pautaremos el tratamiento. El tratamiento farmacológico será a base de corticoides y adrenalina en las laringitis moderadas y graves. La dexametasona oral es el corticoide de elección en todos los casos. (AU)

Acute laryngitis/croup is a common disease of viral origin, which is the most frequent cause of upper airway obstruction in childhood. It is characterized by the presence of a variable degree of dog or metal cough, aphonia, stridor and respiratory distress. The estimated incidence is 3-6% of children between 3-6 months and 6 years, with a peak in the second year of life and during the autumn and winter. The main cause is the parainfluenza virus type 1. The diagnosis is made based on the symptoms, barking cough, hoarseness and inspiratory stridor. No other examinations are necessary. Depending on the severity, which will be objectively established with a clinical score, will the treatment be prescribed. Oral corticosteroids are the treatment of choice in all diagnosed children. Pharmacological treatment is corticosteroids and adrenaline in moderate and severe laryngitis. Oral dexamethasone is the corticosteroid of choice in all cases. (AU)

Heterogeneidad de criterios en el diagnóstico de bronquiolitis aguda en España / Criteria heterogeneity in the diagnosis of acute bronchiolitis in Spain

Introducción: La bronquiolitis vírica aguda (BA) es una de las enfermedades respiratorias más frecuentes en los lactantes. Sin embargo, los criterios utilizados para su diagnóstico son heterogéneos e insuficientemente conocidos. Objetivo: Identificar los criterios de diagnóstico de BA empleados en España, tanto por expertos como por pediatras clínicos. Métodos: Estudio de metodología Delphi con expertos españoles en BA, buscando los puntos de consenso sobre el diagnóstico de BA. Posteriormente se realizó un estudio transversal mediante encuesta on-line dirigida a todos los pediatras españoles, contactados a través de mensajes de correo electrónico enviados por nueve sociedades científicas pediátricas. Se hizo análisis descriptivo y análisis factorial de los resultados de la encuesta, buscando si los criterios diagnósticos empleados se relacionaban con variables demográficas, geográficas o con la subespecialidad pediátrica. Resultados: Los 40 expertos participantes alcanzaron un consenso en muchos aspectos (primer episodio de dificultad respiratoria y aumento de la frecuencia respiratoria, diagnóstico en cualquier estación del año, y utilidad de la identificación de virus para el diagnóstico), pero manteniendo opiniones enfrentadas en cuestiones importantes como la edad máxima aceptable para el diagnóstico. A la encuesta on-line respondieron 1297 pediatras. Los criterios diagnósticos que aplican son heterogéneos y están fuertemente asociados con la subespecialidad pediátrica. Su acuerdo con el consenso de expertos y con estándares internacionales es muy bajo. Conclusiones: Los criterios usados en España para el diagnóstico de BA son heterogéneos. Esas diferencias pueden causar variabilidad en la práctica clínica en pacientes con BA

Introduction: Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. Objective: To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. Methods: Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an on-line questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. Results: Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics such as the maximum age for diagnosis. The on-line questionnaire was completed by 1297 paediatricians. Their diagnostic criteria were heterogeneous and strongly associated with their paediatric sub-specialty. Their agreement with the Spanish expert consensus and with international standards was very poor. Conclusions: Diagnostic criteria for AB in Spain are heterogeneous. These differences could cause variability in clinical practice with AB patients

Criteria heterogeneity in the diagnosis of acute bronchiolitis in Spain.

INTRODUCTION: Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. OBJECTIVE: To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. METHODS: Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an online questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. RESULTS: Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics such as the maximum age for diagnosis. The online questionnaire was completed by 1297 paediatricians. Their diagnostic criteria were heterogeneous and strongly associated with their paediatric sub-specialty. Their agreement with the Spanish expert consensus and with international standards was very poor. CONCLUSIONS: Diagnostic criteria for AB in Spain are heterogeneous. These differences could cause variability in clinical practice with AB patients.

INTRODUCCIÓN: La bronquiolitis vírica aguda (BA) es una de las enfermedades respiratorias más frecuentes en los lactantes. Sin embargo, los criterios utilizados para su diagnóstico son heterogéneos e insuficientemente conocidos. OBJETIVO: Identificar los criterios de diagnóstico de BA empleados en España, tanto por expertos como por pediatras clínicos. MÉTODOS: Estudio de metodología Delphi con expertos españoles en BA, buscando los puntos de consenso sobre el diagnóstico de BA. Posteriormente se realizó un estudio transversal mediante encuesta online dirigida a todos los pediatras españoles, contactados a través de mensajes de correo electrónico enviados por nueve sociedades científicas pediátricas. Se hizo análisis descriptivo y análisis factorial de los resultados de la encuesta, buscando si los criterios diagnósticos empleados se relacionaban con variables demográficas, geográficas o con la subespecialidad pediátrica. RESULTADOS: Los 40 expertos participantes alcanzaron un consenso en muchos aspectos (primer episodio de dificultad respiratoria y aumento de la frecuencia respiratoria, diagnóstico en cualquier estación del año, y utilidad de la identificación de virus para el diagnóstico), pero manteniendo opiniones enfrentadas en cuestiones importantes como la edad máxima aceptable para el diagnóstico. A la encuesta online respondieron 1297 pediatras. Los criterios diagnósticos que aplican son heterogéneos y están fuertemente asociados con la subespecialidad pediátrica. Su acuerdo con el consenso de expertos y con estándares internacionales es muy bajo. CONCLUSIONES: Los criterios usados en España para el diagnóstico de BA son heterogéneos. Esas diferencias pueden causar variabilidad en la práctica clínica en pacientes con BA.

[Criteria heterogeneity in the diagnosis of acute bronchiolitis in Spain]. / Heterogeneidad de criterios en el diagnóstico de bronquiolitis aguda en España.

INTRODUCTION: Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. OBJECTIVE: To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. METHODS: Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an on-line questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. RESULTS: Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics such as the maximum age for diagnosis. The on-line questionnaire was completed by 1297 paediatricians. Their diagnostic criteria were heterogeneous and strongly associated with their paediatric sub-specialty. Their agreement with the Spanish expert consensus and with international standards was very poor. CONCLUSIONS: Diagnostic criteria for AB in Spain are heterogeneous. These differences could cause variability in clinical practice with AB patients.

Looking beyond patients: Can parents' quality of life predict asthma control in children?

BACKGROUND: Social and family factors may influence the probability of achieving asthma control in children. Parents' quality of life has been insufficiently explored as a predictive factor linked to the probability of achieving disease control in asthmatic children. OBJECTIVE: Determine whether the parents' quality of life predicts medium-term asthma control in children. METHODS: Longitudinal study of children between 4 and 14 years of age, with active asthma. The parents' quality of life was evaluated using the specific IFABI-R instrument, in which scores were higher for poorer quality of life. Its association with asthma control measures in the child 16 weeks later was analyzed using multivariate methods, adjusting the effect for disease, child and family factors. RESULTS: The data from 452 children were analyzed (median age 9.6 years, 63.3% males). The parents' quality of life was predictive for asthma control; each point increase on the initial IFABI-R score was associated with an adjusted odds ratio (95% confidence interval) of 0.56 (0.37-0.86) for good control of asthma on the second visit, 2.58 (1.62-4.12) for asthma exacerbation, 2.12 (1.33-3.38) for an unscheduled visit to the doctor, and 2.46 (1.18-5.13) for going to the emergency room. The highest quartile for the IFABI-R score had a sensitivity of 34.5% and a specificity of 82.2% to predict poorly controlled asthma. CONCLUSIONS: Parents' poorer quality of life is related to poor, medium-term asthma control in children. Assessing the parents' quality of life could aid disease management decisions. Pediatr Pulmonol. 2016;51:670-677. © 2015 Wiley Periodicals, Inc.

Association between quality of life in parents and components of asthma control in children.

OBJECTIVE: Describe the association between parents' quality of life and the two components of asthma control in children: impairment and risk. METHODS: Cross-sectional study with children between 4 and 14 years of age with active asthma recruited at primary care centers in Spain. Asthma control was assessed according to the Third National Asthma Expert Panel Report, classifying "impairment" in three levels (well-controlled asthma, partially controlled, and poorly controlled), and "risk" as high or low. The parents' quality of life was evaluated using the specific Family Impact of Childhood Bronchial Asthma Questionnaire instrument (IFABI-R). The association between asthma control and the parents' quality of life was analyzed using multivariate regression models adjusted for other social and family variables. RESULTS: Data from 408 children were analyzed. The parents' quality of life was affected in the partially controlled asthma group when compared with well-controlled asthma, as showed by an increase in IFABI-R scores in all dimensions: functional 17.2% (p < 0.001), emotional 10.4% (p = 0.021), and socio-occupational 6.8% (p = 0.056). The differences were higher in poorly controlled asthma compared with well-controlled asthma: functional 24.3% (p = 0.001), emotional 18.9% (p = 0.008), and socio-occupational 11.5% (p = 0.036). The "risk" component was independently associated with the parents' quality of life. Of all the elements used to assess the control, the only one independently associated with the parents' quality of life was recurrent asthma crisis. CONCLUSIONS: In asthma control, both "impairment" and "risk" in children are gradually associated with the parents' quality of life. The global assessment of the control surpasses the importance of each individual element used in this assessment.