Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study.

Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma. Methods: Participants (6-14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort-a prospective, multicenter, observational study (NCT04480242)-were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey-Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System-Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables. Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting ß-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (p = 0.002) and HRQoL over time (p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (p = 0.012), but they showed better HRQoL in future assessments (p = 0.012). The frequency of reliever use was associated with symptom control (p < 0.001), exacerbation occurrence (p < 0.001), and HRQoL (p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls. Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population.

Montelukast in paediatric asthma and allergic rhinitis: a systematic review and meta-analysis.

BACKGROUND: We aim to assess the impact of montelukast on paediatric patients with asthma/allergic rhinitis, measured using patient-reported outcome measures, compared with other treatments or placebo. METHODS: Protocol registration CRD42020216098 (www.crd.york.ac.uk/PROSPERO). MEDLINE and Embase databases were used to conduct the search. Two authors independently selected studies and extracted data, and a third reviewer resolved discrepancies. Meta-analyses were constructed to estimate the standardised mean difference (SMD) using a random-effects model. RESULTS: Out of 3937 articles identified, 49 studies met the inclusion criteria, mostly randomised clinical trials (sample sizes: 21-689 patients). The SMD of change pooled estimators for the global, mental and physical domains of health-related quality of life were not statistically significant. For daytime and night-time symptoms scores, the SMD (95% CI) was in favour of inhaled corticosteroids (-0.12, -0.20- -0.05 and -0.23, -0.41- -0.06, respectively). The pooled estimator for global asthma symptoms was better for montelukast when compared with placebo (0.90, 0.44-1.36). CONCLUSIONS: The synthesis of the available evidence suggests that, in children and adolescents, montelukast was effective in controlling asthma symptoms when compared with placebo, but inhaled corticosteroids were superior in controlling symptoms, especially at night-time. These findings of our systematic review concur with current guidelines for asthma treatment.

GEMA 5.3. Spanish Guideline on the Management of Asthma.

The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).

La Guía Española para el Manejo del Asma, mejor conocida por su acrónimo en español, GEMA, está a nuestra disposición desde hace más de veinte años. Veintiuna sociedades científicas o grupos relacionados, tanto de España como de otros países, han participado en la preparación y desarrollo de la edición actualizada de GEMA que, de hecho, se ha posicionado en la actualidad a nivel mundial como la guía de referencia sobre asma en lengua española.Su objetivo es prevenir y mejorar la situación clínica de las personas con asma, aumentando el conocimiento de los profesionales sanitarios involucrados en su cuidado. Su propósito es convertir la evidencia científica en recomendaciones prácticas sencillas y fáciles de seguir. Por lo tanto, no se trata de una monografía que reúna todo el conocimiento científico sobre la enfermedad, sino más bien de un documento conciso con lo esencial, diseñado para ser aplicado rápidamente en la práctica clínica de rutina. Las recomendaciones son necesariamente multidisciplinares, están desarrolladas para ser útiles y una herramienta indispensable para médicos de diferentes especialidades, así como para profesionales de enfermería y farmacia.Seguramente, los aspectos más destacados de la guía son las recomendaciones para: establecer el diagnóstico del asma utilizando un algoritmo secuencial basado en pruebas diagnósticas objetivas; el seguimiento de los pacientes, preferentemente basado en la estrategia de lograr y mantener el control de la enfermedad; el tratamiento según el nivel de gravedad del asma utilizando seis escalones, desde la menor hasta la mayor necesidad de medicamentos, y el algoritmo de tratamiento basado en fenotipos para la indicación de biológicos en pacientes con asma grave no controlada. A esto se suma ahora una novedad para su fácil uso y seguimiento a través de una aplicación informática basada en la inteligencia artificial conversacional de tipo chatbot (ia-GEMA).

¿Cómo realizamos el cribado visual en Atención Primaria? / How is vision screening performed in primary care?

Introducción: la ambliopía es la causa más común de pérdida de visión prevenible en los países desarrollados. Dicha prevención depende de una detección y tratamiento precoces mediante un adecuado cribado visual en la infancia. Nuestro objetivo es describir la situación del cribado visual en Atención Primaria en España y su relación con la formación de los profesionales. Material y métodos: estudio observacional descriptivo mediante encuesta telemática a los pediatras de Atención Primaria acerca de sus conocimientos sobre el desarrollo visual y las técnicas de cribado, material y formación al respecto. Análisis estadístico descriptivo y univariado en busca de relación entre la formación recibida y sus conocimientos. Resultados: el 79,3% de los participantes acierta más de la mitad de las preguntas teóricas. El 82,8% tiene optotipos estandarizados y el 30,7%, el test de Lang. El 72,7% conoce la distancia óptima y el 76,6% la altura óptima para explorar la agudeza visual con optotipos. El 50%, 68,3% y 44,5% realiza el reflejo rojo, el test de Hirschberg y el Cover test en las revisiones indicadas, respectivamente. Más del 90% conoce los criterios de derivación al oftalmólogo. El 3,1% ha recibido formación institucional y el 54,8% autónoma. Existen diferencias en la puntuación obtenida entre los profesionales según la formación recibida. Conclusiones: se detectan aspectos a mejorar. Se debe explorar el reflejo rojo en todas las revisiones del lactante y la alineación ocular desde los 6 meses, así como disponer y mejorar la utilización del test de Lang y de optotipos estandarizados. Existe relación entre un mayor nivel de conocimientos teóricos y prácticos y la formación recibida (AU)

Introduction: amblyopia is the most frequent cause of preventable vision loss in developed countries. Its prevention depends on early detection and treatment through adequate vision screening in childhood. Our objective was to describe the current situation in vision screening at the primary care level in Spain and its association with the training of professionals.Material and methods: observational descriptive study via a remote survey of primary care paediatricians of their knowledge on visual development and vision screening techniques, equipment and training. We conducted a statistical descriptive and univariate analysis to assess the association between the training received and the level of knowledge. Results: of all respondents, 79.3% answered the theoretical questions correction, 82.8% had standardised optotypes and 30.7% used the Lang test. Also, 72.7% knew the adequate distance and 76.6% the optimal height to assess visual acuity with optotypes. Fifty percent used the red reflex test, 68.3% the Hirschberg test and 44.5% the cover test in the appropriate check-ups. As regards training, 3.1% received it from their institutions, and 54.8% independently. Over 90% knew the criteria for referral to the ophthalmologist. We found differences in the scores of the respondents based on the training received.Conclusion: we identified opportunities for improvement: the red reflex test should be performed during all infant check-ups and ocular alignment checked from 6 months, and the Lang test and standardised optotypes should be available and their use improved. Higher levels of theoretical and practical knowledge are positively correlated with the amount of training received by health professionals. (AU)

Measurement properties of the EQ-5D-Y administered through a smartphone app in children with asthma: a longitudinal questionnaire study.

BACKGROUND: Asthma impacts children's physical, emotional, and psychosocial Health-Related Quality of Life (HRQL). The EQ-5D-Y is a generic econometric instrument developed to measure HRQL in children. OBJECTIVE: Evaluation of feasibility, validity, reliability, and responsiveness of EQ-5D-Y descriptive system and utility index to allow the assessment of HRQL in children with asthma, aged 8-11 years (self-response version) or under 8 years old (proxy-response version). METHODS: We used data from baseline to 10 months of follow-up of an observational, prospective study of children with persistent asthma recruited by pediatricians in Spain (2018-2020). HRQL instruments were administered through a smartphone application: ARCA app. The EQ-5D-Y is composed of a 5-dimension descriptive system, a utility index ranging from 1 to - 0.5392, and a general health visual analogue scale (EQ-VAS). The Pediatric Asthma Impact Scale (PROMIS-PAIS) includes 8 items, providing a raw score. Construct validity hypotheses were stated a priori, and evaluated following two approaches, multitrait-multimethod matrix and known groups' comparisons. Reliability and responsiveness subsamples were defined by stability or change in EQ-VAS and the Asthma Control Questionnaire (ACQ), to estimate the intraclass correlation coefficient (ICC) and the magnitude of change over time. RESULTS: The EQ-5D-Y was completed at baseline for 119 children (81 self-responded and 38 through proxy response), with a mean age of 9.1 (1.7) years. Mean (SD) of the EQ-5D-Y utility index was 0.93 (0.11), with ceiling and floor effects of 60.3% and 0%, respectively. Multitrait-multimethod matrix confirmed the associations previously hypothesized for the EQ-5D-Y utility index [moderate with PROMIS-PAIS (0.38) and weak with ACQ (0.28)], and for the EQ-5D-Y dimension "problems doing usual activities" [moderate with the ACQ item (0.35) and weak with the PROMIS-PAIS item (0.17)]. Statistically significant differences were found in the EQ-5D-Y between groups defined by asthma control, reliever inhalers use, and second-hand smoke exposure, with mostly moderate effect sizes (0.45-0.75). The ICC of the EQ-5D-Y utility index in the stable subsamples was high (0.81 and 0.79); and responsiveness subsamples presented a moderate to large magnitude of change (0.68 and 0.78), though without statistical significance. CONCLUSIONS: These results support the use of the EQ-5D-Y as a feasible, valid, and reliable instrument for evaluating HRQL in children with persistent asthma. Further studies are needed on the responsiveness of the EQ-5D-Y in this population.

COVID-19, contaminación y asma / COVID-19, contamination and asthma

En diciembre de 2019, comenzó en Wuhan, China, una pandemia cuya repercusión a nivel mundial aún está por determinar. Al tratarse de un proceso infeccioso que afecta fundamentalmente a las vías respiratorias se propusieron en primera instancia dos vías de transmisión, fómites y gotas. La evolución de la enfermedad ha revelado el papel de los aerosoles en su propagación descubriendo así nuevas medidas para evitar la expansión del virus. A diferencia de otras infecciones respiratorias, los pacientes con asma no han visto agravada su enfermedad, evaluándose en algunos estudios el posible efecto protector de los corticoides inhalados. Tras analizar los factores de riesgo asociados a esta enfermedad, la contaminación ambiental vuelve a estar en el punto de mira como en brotes previos originados por el SARS-CoV-1. Algunos autores relacionan los niveles de contaminación y el aumento de la morbimortalidad por COVID-19, aunque reconocen que hacen falta otro tipo de estudios para demostrar causalidad ya que son múltiples los factores de confusión implicados. Las medidas de: distanciamiento social, uso de mascarillas, equipos de protección individual, desinfección de superficies… han resultado eficaces en la protección frente al virus. La significativa reducción de los desplazamientos y la actividad industrial durante la pandemia ha demostrado la influencia del ser humano sobre la calidad del aire y nos conduce a reflexionar sobre la necesidad de seguir implementando medidas para mejorar el entorno ambiental (AU)

In December 2019, a pandemic began in Wuhan, China, whose global impact has yet to be determined. It is an infectious process that mainly affects the respiratory tract. Two transmission routes, fomites and drops, were proposed in the first instance. The evolution of the disease has revealed the role of aerosols in its spread, thus discovering new measures to prevent the spread of the virus. Unlike other respiratory infections, patients with asthma have not seen their disease worsened, and the possible protective effect of inhaled corticosteroids has been evaluated in some studies. After analyzing the risk factors associated with this disease, environmental contamination is once again in the spotlight as in previous outbreaks caused by SARS-CoV-1. Some authors relate the levels of contamination and the increase in morbidity and mortality due to COVID-19, although they acknowledge that other types of studies are needed to demonstrate causality since there are multiple confounding factors involved. The measures of social distancing, use of masks, individual protection equipment, disinfection of surfaces … have been effective in protecting against the virus. The significant reduction in travel and industrial activity during the pandemic has demonstrated the influence of human beings on air quality and leads us to reflect on the need to continue implementing measures to improve the environment. (AU)

Asociación entre variables indicadoras del nivel socioeconómico del lugar de residencia en Sevilla y la incidencia y frecuentación hospitalaria pediátrica por tosferina / Association between indicators of neighbourhood socioeconomic status in Seville and the incidence of pertussis and related hospital admissions in children

Introducción: el objetivo de este estudio es analizar la asociación entre nivel socioeconómico del lugar de residencia y la incidencia y frecuentación hospitalaria infantil por tosferina.Material y método: estudio observacional, transversal, con dos unidades de observación de menores de 15 años residentes en Sevilla: 1) hospitalizaciones en los dos hospitales públicos de la ciudad por cualquier motivo (2013-2015): n = 7315; y 2) casos declarados confirmados de tosferina (2013-2017): n = 102. Las variables independientes fueron edad, sexo y residencia en zonas con necesidad de transformación social (ZNTS), en riesgo de pobreza (ZRP) y con educación insuficiente (EIZR). Las variables dependientes fueron hospitalizaciones y casos declarados confirmados de tosferina. Se realizaron análisis univariantes, bivariantes y multivariantes en la unidad Hospitalizaciones, mediante test χ2 y modelos de regresión logística, con el programa R. Se calcularon tasa y razón de incidencia por subdistritos en la unidad casos declarados. Resultados: el 1,12% de las hospitalizaciones fue por tosferina (n = 82). Entre el 2,0 y el 2,4% de las hospitalizaciones por tosferina procedieron de los subdistritos más desfavorecidos, en comparación con el 0,8 y 0,9% del resto de la ciudad (p <0,001). Las odds ratios, ajustadas por edad y sexo, y sus intervalos de confianza del 95%, fueron: ZNTS = 2,76 (1,74-4,32), ZRP = 2,48 (1,47-4,04) y EIZR = 2,17 (1,38-3,39). La razón de incidencia también fue superior en las zonas más desfavorecidas (2,50, 1,99 y 2,01, respectivamente). Conclusiones: el menor nivel socioeconómico de las áreas residenciales de Sevilla se asocia a la mayor frecuentación hospitalaria e incidencia de tosferina infantil (AU)

Introduction: the aim of our study was to analyse the association between the SES of the neighbourhood of residence and the incidence of pertussis and frequency of hospital visits associated with pertussis in the paediatric population.Material and methods: we conducted a cross-sectional observational study, with 2 sets of observations in children under 15 years living in Seville: 1) admissions for any reason to the 2 public hospitals of Seville (2013-2015; n = 7315) and 2) reported cases of pertussis (2013-2017; n = 102). The independent variables were age, sex and residence in areas in need of social transformation (ANSTs), areas at risk of poverty (ARPs) and areas with low educational attainment (ALEAs). In the analysis of the reported cases data set, we calculated the incidence and incidence ratio for each subdistrict.Results: of the total hospital admissions, 1.12% (n = 82) were due to pertussis. Between 2.0 and 2.4% of admissions in children that resided in disadvantaged subdistricts were due to pertussis, compared to 0.8 to 0.9% in children living in the rest of the city (p <0.001). The sex- and age-adjusted odds ratios (with their corresponding 95% confidence intervals) were: ANST 2.76 (1.74-4.32) for ANSTs, 2.48 (1.47-4.04) for ARPs and 2.17 (1.38-3.39) for ALEAs. The incidence ratios were also higher in these disadvantaged areas (2.50, 1.99 and 2.01, respectively).Conclusions: low neighbourhood socioeconomic status in Seville was associated with a higher incidence of pertussis and a higher frequency of related hospital admissions in the paediatric population. (AU)

Pediatría de atención primaria centrada en el paciente. ¿Se necesita un cambio de paradigma? / Patient-centered primary care pediatrics. Is a paradigm change needed?

No disponible

Discrepancias en la clasificación de los glucocorticoides inhalados entre GEMA y GINA / Discrepancies Between GEMA and GINA in the Classification of Inhaled Corticosteroids

No disponible

Características nutricionales y composición de las galletas disponibles en el mercado español y de las galletas dirigidas a la población infantil / Nutritional characteristics and composition of the biscuits available in the Spanish market and biscuits marketed to children

INTRODUCCIÓN: en España existe un elevado consumo de galletas en la población infantil. Son productos ultraprocesados de alto contenido energético y densidad calórica, en general con azúcar añadido y grasas poco saludables. MATERIAL Y MÉTODOS: estudio descriptivo transversal sobre características y composición nutricional de galletas disponibles en supermercados españoles y comparativo entre las dirigidas al público infantil y el resto. RESULTADOS: se analizaron 350 galletas: valor energético medio 471,86 ± 35,83 kcal/100 g. El 53,1% contenían grasas saturadas, aceite de palma el 47,1% y azúcar añadido el 90%. Mediana de azúcares 25 g/100 g (rango intercuartílico [RI]: 20-33). Mediana de fibra alimentaria 3,2 g/100 g (RI: 2,4-5,2); 86 galletas mostraban publicidad sobre fibra y 95,34% indicaban la cantidad, mediana de 5,45 g/100 g (RI: 4-7,9). Se analizaron 53 galletas (15,1%) dirigidas al público infantil. Valor energético medio 466,47 ± 19,31 kcal/100 g. El aceite de oliva/girasol alto oleico (GAO) fue la grasa principal en el 67,9%. Aceite de palma presente en el 37,7% y azúcar añadido en 98,1% (media 25,88 ± 6,82 g/100 g). Mediana de fibra alimentaria 2,9 g/100 g (RI: 2,27-3,42). El 75,5% mostraron publicidad de reclamo. Las galletas dirigidas al público infantil contenían azúcar añadido en mayor porcentaje (98,1 frente a 88,6%; p = 0,033), menos fibra (mediana 2,9 g/100 g frente a 3,5 g/100 g; p = 0,005), aceite de oliva/GAO en mayor porcentaje (67,9 frente a 36,7%; p <0,001) y más publicidad de reclamo (75,5 frente a 45,5%; p <0,001). CONCLUSIONES: las galletas dirigidas al público infantil contienen azúcar añadido, elevado contenido calórico, grasas saturadas en más del 37% y publicidad de reclamo en elevado porcentaje. Por otro lado, se observa el uso de grasas monoinsaturadas en más del 50%. La información de este estudio podría facilitar intervenciones de salud pública e incentivar a los fabricantes para reformular sus productos

INTRODUCTION: the consumption of biscuits is high in the Spanish paediatric population. Biscuits are ultra-processed products with a high energy content and energy density and generally contain added sugars and unhealthy fats. METHODS: we conducted a cross-sectional descriptive study on the characteristics and nutritional composition of biscuits available in Spanish supermarkets, and compared biscuits marketed to children to all other biscuits. RESULTS: we analysed a sample of 350 biscuits. The mean energy content was 471.86 ± 35.83 kcal/100 g. Saturated fats were used in 53.1%, palm oil in 47.1% and added sugars in 90% (median content, 25 g/100 g; IQR: 20-33). The median dietary fibre content was 3.2 g/100 g (IQR: 2.4-5.2). The packaging of 86 advertised that the product contained fibre, specifying the total fibre content in 95.34% of cases, with a median value of 5.45 g/100 g (IQR: 4-7.9). Of the total products, 53 (15.1%) were marketed to children, and their mean energy content was 466.47 ± 19.31 kcal/100 g. The main fat was olive oil or high oleic sunflower oil (HOSO) in 67.9%, and palm oil was present in 20 (37.7%). There were added sugars in 98.1% (mean sugar content, 25.88 ± 6.82 g/100 g). The median dietary fibre content was 2.9 g/100 g (IQR 2.27-3.42). The packaging of 75.5% featured some form of advertising. The comparative analysis showed that a greater percentage of biscuits specifically marketed to children had added sugars (98.1% vs 88.6%, p = 0.033) and that these biscuits had a lower fibre content (median, 2.9 g/100 g vs. 3.5 g/100 g, p = 0.005), that a greater percentage contained olive oil or HOSO (67.9% vs 36.7%, p <0.001), and a greater percentage featured promotional advertising in their packaging (75.5% vs 45.5%, p <0.001). CONCLUSIONS: biscuits marketed to the paediatric population had added sugars and a high energy content; more than 37% had saturated fats and a high proportion featured advertising in the packaging. On the other hand, we found that monounsaturated fats were used in more than 50% of these products. The findings of this study could serve as reference to guide the development of public health interventions or product reformulation by manufacturers

[Clinical Practice Guide for Anaphylaxis in Latin America (Galaxia-Latam)]. / Guía de Actuación en Anafilaxia en Latinoamérica. Galaxia-Latam.

Anaphylaxis is a severe allergic reaction with a rapid onset and it is potentially life-threatening. Its clinical manifestations are varied; they may affect the skin, the cardiovascular system, the respiratory system, and the digestive system, among others. The treatment of choice, which is an intra-muscular injection of epinephrine (adrenaline), must be applied promptly. Therefore, being prepared to recognize it properly is of crucial importance. The objective of this clinical practice guide is to improve the knowledge of health professionals about anaphylaxis and, consequently, to optimize the treatment and long-term management of this reaction. This guide is adapted to the peculiarities of Latin America; especially in matters regarding the treatment. The need to introduce epinephrine auto-injectors in countries that don't have them yet is highlighted.

La anafilaxia es una reacción alérgica grave de instauración rápida y potencialmente mortal. Sus manifestaciones clínicas son muy variadas, pudiendo afectar la piel, el sistema cardiovascular, el aparato respiratorio y el digestivo, entre otros. El tratamiento de elección, mediante la inyección intramuscular de adrenalina, debe ser precoz. Por lo anterior, es vital estar preparados para reconocerla adecuadamente. El objetivo de la presente guía de actuación clínica es mejorar el conocimiento de los profesionales sanitarios sobre anafilaxia y, consecuentemente, optimizar el tratamiento y manejo a largo plazo de esta entidad. La guía está adaptada a las peculiaridades de América Latina, especialmente en los aspectos relativos al tratamiento. Se destaca la necesidad de introducir los autoinyectores de adrenalina en los países que no dispongan de ellos.

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.

Guía de práctica clínica (GPC): guía de actuación en AnafiLAXIA 2016 / Clinical practice guide (CPG): guide to action in AnafiLAXIA 2016

Esta nueva versión de GALAXIA está dirigida a todos los profesionales sanitarios, en todos los niveles de asistencia, para proporcionar recomendaciones en el manejo de la anafilaxia. La anafilaxia es la reacción alérgica más grave que puede ocurrir, e incluso puede llegar a poner en peligro la vida del paciente. Todos los profesionales sanitarios deberían ser capaces de reconocerla y actuar de forma rápida y adecuada. Se incluyen recomendaciones para pacientes adultos y pediátricos, se comentan situaciones especiales, y se consideran situaciones en el ambiente sanitario y fuera de el.