Spirometry and respiratory oscillometry: Feasibility and concordance in schoolchildren with asthma.

OBJECTIVE: The purpose of this study was to describe the feasibility of respiratory oscillometry (RO) in schoolchildren with asthma, and the concordance of its results with those of spirometry, to determine its clinical usefulness. METHODS: RO and spirometry were performed in 154 children (6 to 14-year-old) with asthma, following strict quality criteria for the tests. Their feasibility (probability of valid test, time of execution, number of maneuvers needed to achieve a valid test, and perceived difficulty) was compared. The factors that influence feasibility were analyzed with multivariate methods. FEV1, FEV1/FVC, FVC and FEF25-75 for spirometry, and R5, AX and R5-19 for RO, were converted into z-scores and their concordance was investigated through intraclass correlation coefficients (ICC) and kappa indices for normal/abnormal values. RESULTS: There were no differences in the probability of obtaining a valid RO or spirometry (83.1% vs. 81.8%, p = 0.868). RO required a lower number of maneuvers [mean (SD) 4.2 (1.8) versus 6.0 (1.6), p < 0.001] and less execution time [5.1 (2.7) versus 7.6 (2.4) minutes, p < 0.001], and patients considered it less difficult. Age increased the probability of obtaining valid RO and spirometry. The concordance of results between RO and spirometry was low, and only between zFEV1 and zAX could it be considered moderate (ICC = 0.412, kappa = 0.427). CONCLUSION: RO and spirometry are feasible in children with asthma. RO has some practical advantages, but the concordance of its results with spirometry is low.

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.

[Childhood obesity: pediatricians' attitudes and opinions]. / Obesidad infantil: opiniones y actitudes de los pediatras.

OBJECTIVES: To identify the Spanish pediatricians' opinions and attitudes towards obesity, in relation with its treatment, prevention, and care organization, barriers they find in its treatment, and to know the tools they consider more useful to have for the management of obese children. METHODS: Mail survey posted to the primary care pediatricians of Castilla-León (Spain) exploring: willingness to act against obesity, utility of therapies and preventive strategies, barriers found in treating obese patients, most needed tools for treating obesity, autoefficacy, and support to an obese children management programme in primary care. RESULTS: There was a broad consensus in seeing obesity as an important health problem that demands action from pediatricians. This willingness to action decreased when bigger personal barriers were found. The most frequently encountered barriers came from the social milieu: easy access and advertisement of certain foods and beverages, lack of implication of parents, lack of perception of a weight problem in children and parents. Training was the most trusted tool. Pediatricians considered themselves as some or low efficacious in treating obesity. The effectiveness of an obese children management program in primary care was surpassed by the work it would need. CONCLUSIONS: In spite of their high willingness to act against obesity, pediatricians feel themselves limited because they find barriers mainly from the social and cultural milieus. They ask for training to fight pediatric obesity.

Obesidad infantil: opiniones y actitudes de los pediatras / Childhood obesity: pediatricians' attitudes and opinions

Objetivos: Identificar las actitudes y opiniones de los pediatras respecto al tratamiento, la prevención y la organización asistencial de la obesidad, identificar las barreras que encuentran en el tratamiento de la obesidad y las herramientas que creen más útiles para prestar una atención más efectiva. Métodos: Encuesta postal a los pediatras de atención primaria de Castilla y León, explorando la necesidad de acción frente a la obesidad, la utilidad de medidas terapéuticas y estrategias preventivas, las barreras que obstaculizan el tratamiento, las herramientas útiles para el pediatra, la eficacia propia en el tratamiento de la obesidad y la utilidad de incorporar la obesidad a la cartera de servicios. Resultados: Se consideró la obesidad como un problema de salud importante que necesita una actuación por parte de los pediatras. Esta disposición a la acción era menor entre quienes manifestaron más barreras personales. Las barreras más frecuentes procedían del medio social: disponibilidad y publicidad de determinados alimentos y bebidas, dificultades en involucrar a los padres en el tratamiento, ausencia de percepción del problema por el niño y los padres. La herramienta mejor considerada fue la formación del personal sanitario. Los pediatras se consideraban algo o poco eficaces en el tratamiento de la obesidad. La efectividad de un servicio de atención a la obesidad en atención primaria pareció ligeramente superada por la carga de trabajo que requeriría. Conclusiones: Pese a su alta disposición a la acción frente a la obesidad, los pediatras se sienten limitados debido a las barreras que encuentran, sobre todo de tipo social o cultural, y demandan más formación como una herramienta frente a la epidemia de obesidad infantil (AU)

Objectives: To identify the Spanish pediatricians' opinions and attitudes towards obesity, in relation with its treatment, prevention, and care organization, barriers they find in its treatment, and to know the tools they consider more useful to have for the management of obese children. Methods: Mail survey posted to the primary care pediatricians of Castilla-León (Spain) exploring: willingness to act against obesity, utility of therapies and preventive strategies, barriers found in treating obese patients, most needed tools for treating obesity, autoefficacy, and support to an obese children management programme in primary care. Results: There was a broad consensus in seeing obesity as an important health problem that demands action from pediatricians. This willingness to action decreased when bigger personal barriers were found. The most frequently encountered barriers came from the social milieu: easy access and advertisement of certain foods and beverages, lack of implication of parents, lack of perception of a weight problem in children and parents. Training was the most trusted tool. Pediatricians considered themselves as some or low efficacious in treating obesity. The effectiveness of an obese children management program in primary care was surpassed by the work it would need. Conclusions: In spite of their high willingness to act against obesity, pediatricians feel themselves limited because they find barriers mainly from the social and cultural milieus. They ask for training to fight pediatric obesity (AU)