Medicaciones inhaladas y cámaras de inhalación para el asma infantil. Red española de grupos de trabajo sobre asma en pediatría (REGAP) / Inhaled medications and inhalation chambers for childhood asthma. Spanish network of working groups on asthma in pediatrics (REGAP)

El asma, la enfermedad crónica más prevalente en la edad pediátrica, continúa planteando desafíos en su manejo y tratamiento1. Guías nacionales e internacionales destacan la importancia de la educación terapéutica (ET) para lograr el control de esta enfermedad2,3. Esta educación implica la transmisión de conocimientos y habilidades al paciente y su familia, mejorando la adherencia a la medicación, corrigiendo errores en la técnica de inhalación y ajustando el tratamiento según las características individuales de cada paciente4,5. Es esencial que la ET sea progresiva, gradual e individualizada, y que esté presente en todos los niveles asistenciales. La formación en ET de profesionales sanitarios es crucial, especialmente para los pediatras, quienes además deben conocer la extensa variabilidad de medicamentos e inhaladores disponibles y sus indicaciones para cada edad6. Para abordar esta necesidad, el Grupo red española de grupos de trabajo sobre asma en pediatría (REGAP) ha revisado exhaustivamente los inhaladores actualmente disponibles en España para el tratamiento del asma en la edad pediátrica. La revisión incluye una revisión de los distintos sistemas de inhalación y los distintos fármacos inhalados, utilizados para el tratamiento del asma en la edad pediátrica. Esta revisión se actualizará anualmente, incluyendo información sobre fármacos, dispositivos, cámaras de inhalación, indicaciones y financiación. El Grupo REGAP espera que estas tablas sean una valiosa ayuda para los pediatras en su práctica clínica diaria y constituyen una eficaz herramienta de ET.(AU)

Asthma, the most prevalent chronic disease in pediatric age, continues to pose challenges in its management and treatment. National and international guidelines emphasize the importance of therapeutic education (TE) to achieve disease control. TE involves imparting knowledge and skills to the patient and their family, enhancing medication adherence, rectifying errors in inhalation technique, and tailoring treatment based on individual patient characteristics. It is essential for TE to be progressive, gradual, and personalized, spanning all levels of care. Training healthcare professionals in TE is crucial, particularly for pediatricians, who must also be aware of the extensive variability of available meds and inhalers and their respective age-specific indications. Addressing this need, the REGAP Group extensively reviewed inhalers currently available in Spain for pediatric asthma treatment. The review encompassed different inhalation systems and inhaled drugs used for pediatric asthma treatment. This review will be updated annually, providing information on medications, devices, inhalation chambers, indications, and financiation. The REGAP Group hopes that these tables will be a valuable help for pediatricians in their daily clinical practice and serve as an effective TE tool.(AU)

Inhaled medications and inhalation chambers for childhood asthma. Spanish network of working groups on asthma in pediatrics (REGAP).

Asthma, the most prevalent chronic disease in pediatric age, continues to pose challenges in its management and treatment. National and international guidelines emphasize the importance of therapeutic education (TE) to achieve disease control. TE involves imparting knowledge and skills to the patient and their family, enhancing medication adherence, rectifying errors in inhalation technique, and tailoring treatment based on individual patient characteristics. It is essential for TE to be progressive, gradual, and personalized, spanning all levels of care. Training healthcare professionals in TE is crucial, particularly for pediatricians, who must also be aware of the extensive variability of available meds and inhalers and their respective age-specific indications. Addressing this need, the REGAP Group extensively reviewed inhalers currently available in Spain for pediatric asthma treatment. The review encompassed different inhalation systems and inhaled drugs used for pediatric asthma treatment. This review will be updated annually, providing information on medications, devices, inhalation chambers, indications, and financiation. The REGAP Group hopes that these tables will be a valuable help for pediatricians in their daily clinical practice and serve as an effective TE tool.

Pediatric asthma: The REGAP consensus.

Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting ß2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units.

Asma en pediatría: consenso REGAP / Pediatric asthma: The REGAP consensus

El asma es una de las principales enfermedades crónicas de la infancia, por su elevada prevalencia y por su coste sociosanitario. Este artículo es un resumen de la guía de consenso alcanzada por 6 sociedades pediátricas relacionadas con el asma y avalada por la Asociación Española de Pediatría. El asma es fácilmente identificable por criterios clínicos en la mayoría de los pacientes. La espirometría y otras pruebas son de gran ayuda, especialmente en los casos atípicos. La crisis de asma es una manifestación frecuente de la enfermedad y debe ser identificada y tratada con prontitud. Cuando los síntomas de asma son frecuentes y afectan a la calidad de vida es preciso instaurar un tratamiento de mantenimiento para conseguir el control de la enfermedad. Los glucocorticoides inhalados a dosis bajas son eficaces y seguros para su uso prolongado. La educación del paciente con asma es esencial para obtener un buen control. El principal motivo de mal control del asma es el incumplimiento del tratamiento, ya sea por su administración errática e insuficiente, o por la mala técnica de administración de los fármacos inhalados. Si no se obtiene el control pese a un tratamiento adecuado es preciso reconsiderar el diagnóstico, así como los factores o comorbilidades que dificultan el control. Se pueden añadir otros fármacos para evitar las dosis altas de los glucocorticoides inhalados, principalmente el montelukast o los agonistas β2 adrenérgicos de acción prolongada. El asma grave o de difícil control, que no responde a las medidas habituales, debe ser atendida en unidades especializadas. (AU)

Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units. (AU)

¿Qué medidas fortalecen y cuáles debilitan la Pediatría de Atención Primaria? Posicionamiento de la Asociación Española de Pediatría de Atención Primaria / Which are the measurements that strengthen and which are the ones that weaken the Primary Care Pediatrics? Stance of the Spanish Association of Primary Care Pediatrics

Introducción: la Asociación Española de Pediatría de Atención Primaria (AEPap) ha querido conocer las repercusiones que podrían tener en la continuidad de la actividad pediátrica en el primer nivel asistencial algunas propuestas que se están haciendo desde diversas instituciones. Análisis realizado: la Junta directiva de la AEPap y el grupo de trabajo profesional han analizado seis propuestas para ver si fortalecen o debilitan a la Pediatría de Atención Primaria. Las propuestas analizadas han sido: 1) prolongación de la edad pediátrica en Atención Primaria; 2) prolongación de la duración de la especialidad de Pediatría y sus Áreas Específicas; 3) adecuación de las salidas profesionales; 4) adecuación del número de tarjetas individuales sanitarias; 5) aumento de las plazas de médicos internos residentes de Pediatría, y 6) mantenimiento de oposiciones diferenciadas de Pediatría de Atención Primaria y facultativo especialista de área de Pediatría. Conclusiones: la prolongación de la edad pediátrica en Atención Primaria de los 14 a los 18 años y la prolongación de la duración de la especialidad de Pediatría y sus Áreas Específicas serían perjudiciales para la continuidad de la Pediatría de Atención Primaria

Introduction: the Spanish Association of Primary Care Pediatrics (SAPCP) had wanted to know the repercussions that some proposals that are being made from different institutions could have on the continuity of primary care pediatrics. Analysis performed: the SAPCP and the professional working group have analyzed six proposals to see if they strengthen or weaken Primary Care Pediatrics. The proposals that have been analyzed are: 1) prolongation of the pediatric age in primary care; 2) prolongation of the duration of the specialty of Pediatrics and its Specific Areas; 3) adjustment of professional opportunities; 4) adaptation of the number of individual health cards; 5) increase in Internal medical residents of pediatrics, and 6) maintenance of differentiated oppositions of Pediatrics of Primary Care and facultative specialist of Area of Pediatrics. Conclusions: the prolongation of the pediatric age in primary care from 14 to 18 years and the prolongation of the duration of the specialty of Pediatrics and its Specific Areas would be detrimental for the continuity of Primary Care Pediatrics

Situación de la Pediatría de Atención Primaria en España en 2018 / Situation of the Primary Care Pediatrics in Spain in 2018

Introducción: la Asociación Española de Pediatría de Atención Primaria (AEPap) ha querido conocer el porcentaje de plazas de Pediatría de Atención Primaria (PAP) del sector público ocupadas por médicos no especialistas en Pediatría y sus Áreas Específicas (PAE), las condiciones laborales de las mismas y el número de profesionales que se encuentran próximos a la jubilación. Para ello, se ha realizado una encuesta entre los vocales de las asociaciones autonómicas que componen la asociación. Resultados: se han obtenido datos del 90% de las plazas de PAP. El porcentaje de plazas a nivel nacional no ocupadas por especialistas en PAE es del 25,1% (IC 95: 24,1-26,4%), habiendo mucha variabilidad entre comunidades autónomas y provincias, que va del 48,97% en las Islas Baleares al 0% en La Rioja. En relación con la edad de los profesionales, con datos obtenidos del 47,0% de las plazas, la cuarta parte tiene más de 60 años y un 40% supera los 55. En cuanto a los horarios de atención, con datos recogidos del 72,1% de las plazas, un 42,2% de los pediatras de AP trabajan exclusivamente de mañanas, un 29,9% cuatro mañanas y una tarde semanal y un 27,8% un mayor porcentaje de tardes o tardes exclusivas. Conclusiones: existe un déficit de pediatras de AP y una previsión de que este déficit aumente. Las autoridades sanitarias tienen que hacer un esfuerzo en la formación MIR y tienen que conseguir que las plazas de PAP sean más atractivas para los nuevos especialistas, favoreciendo la formación, investigación y disminuyendo el 30% de horarios de tarde exclusivas o predominantes

Introduction: the Spanish Association of Primary Care Pediatrics (AEPap) wants to know the percentage of primary care paediatrics (PAP) places in public health services occupied by non-specialists in Pediatrics and their Specific Areas (PSA), the working conditions of the same and the number of professionals who are next to retirement. For this, a survey has been carried out among the members of the autonomous associations that make up the association. Results: data of 90% of the PAP places have been obtained. The percentage of places at the national level not occupied by specialists in PSA is 25.1% (IC 95: 24,1 a 26,4%), there is a lot of variability among regions and provinces, ranging from 48.97% in the Balearic Islands to 0% in La Rioja. With data on the age obtained from 47% of the places, a quarter of the pediatricians are over 60 years old and 40% are more than 55. Regarding the hours of care, with data collected from 72,1% of the places, a 42,2% of the PAP works in the mornings, 29,9% in the morning and one evening per week and 27,8% in a higher percentage of evenings. Conclusions: there is a deficit of PAP and a forecast that this deficit will increase. The health authorities have to make an effort in the MIR training and they have to make PAP seats more attractive for new specialists, favoring training, research and decreasing 30% of exclusive or predominant evening schedules

Cómo actuar en asma de difícil control en Atención Primaria / How to act in uncontrolled asthma in Primary Care

El diagnóstico de asma en la infancia, basado, fundamentalmente, en los signos y síntomas característicos, no suele tener dificultades. El manejo de la enfermedad, sustentado en la evaluación del grado de control y del riesgo futuro, está bien establecido por las guías y consensos tanto nacionales como internacionales. Sin embargo, la identificación del asma grave puede llevar consigo una mayor dificultad, bien porque se infravaloran los síntomas por parte de los padres o adolescentes y por los sanitarios, o bien por falta de recursos para una evaluación más adecuada. La identificación de la falta de control, de la gravedad de la enfermedad y el conocimiento de los criterios de derivación son fundamentales para el pediatra de Atención Primaria

The diagnosis of asthma in childhood does not usually have difficulties, based, fundamentally, on the characteristic signs and symptoms. The management of the disease is based on the evaluation of the degree of control and future risk, by national and international guidelines and consensus. However, the identification of severe asthma can lead to greater difficulty, either because the symptoms are underestimated by parents and/or adolescents and by health personnel, or due to a lack of resources for a more adequate evaluation. The identification of the lack of control, of the severity of the disease and knowledge of referral criteria is fundamental for the Primary Care pediatrician

La Reunión Anual de la Asociación Española de Pediatría de Atención Primaria en el congreso de la Asociación Española de Pediatría. Análisis de las comunicaciones científicas / Spanish Primary Care Pediatric Association meeting in the Spanish Pediatric Association annual congress. Analysis of scientific communications

Objetivos: analizar las comunicaciones presentadas por los pediatras de Atención Primaria en el congreso de la Asociación Española de Pediatría, en las secciones de Pediatría Extrahospitalaria y Atención Primaria, antes y después de la realización de la Reunión de la Asociación Española de Pediatría de Atención Primaria en el congreso de la Asociación Española de Pediatría. Métodos: revisión de los libros de comunicaciones de los congresos de la Asociación Española de Pediatría. Se analizan los trabajos presentados en las secciones de Pediatría Extrahospitalaria y Atención Primaria. Para realizar el análisis estadístico se compararán, mediante el cálculo de las odds ratio de las frecuencias y sus respectivos intervalos de confianza del 95%, mediante la prueba de χ2 (nivel de significación p < 0,05). Resultados: en el periodo en que la AEPap realizaba su reunión fuera del congreso de la AEP, el porcentaje de presentaciones con participación de Pediatría de Atención Primaria en el apartado Pediatría Extrahospitalaria y Atención Primaria rondaba el 50%; posteriormente han aumentado al 70%. Analizando el cambio entre la participación de la Pediatría de Atención Primaria en los congresos de la Asociación Española de Pediatría de 2012 y 2016, del total de comunicaciones del congreso, el apartado Pediatría Extrahospitalaria y Atención Primaria en 2012 representaba un 4% (38/896; IC 95: 3 a 6), mientras que en 2016 fue de un 7% (84/1138; IC 95: 6 a 9). La odds ratio fue de 1,80 al comparar 2016 con 2012 (IC 95: 1,21 a 2,67; p = 0,006). Conclusiones: la participación de los pediatras de Atención Primaria en el congreso de la AEP ha aumentado desde que la AEPap participa en dicho congreso (AU)

Objectives: to analyze the lectures and the posters on Outpatient Pediatrics and Primary Care areas submitted by Primary Care pediatricians to the Spanish Pediatric Association annual congress, and to compare the Primary Care pediatricians' participation before and after the Spanish Primary Care Pediatric Association meeting that took place during the AEP annual congress. Methods: review of the abstract books published in the AEP congresses. Oral lectures and posters in Outpatient Pediatrics and Primary Care areas are evaluated. Statistical analysis is performed calculating the frequency's odds ratio and their respective confidence intervals at 95% by X2 test (p < 0.05). Results: when the Spanish Primary Care Pediatric Association meetings took place outside of the Spanish Pediatric Association congress, the percentage of abstracts submitted from Outpatient Pediatrics and Primary Care areas with he reports of the Primary Care pediatricians was about 50%. After this period the percentage increased to 70%. The percentage of Primary Care pediatrician's collaborations to Outpatient Pediatrics and Primary Care areas ofthe total ofabstracts submitted to the congresses was 4% (38/896, 95 CI: 3 to 6) in 2012 while in 2016 it was 7% (84/1138, 95 CI: 6 to 9). The odds ratio was 1.80 when comparing 2016 with 2012 (95 Cl: 1.21 to 2.67; p 2 0.006). Conclusions:the involvement and collaborations of Primary Care pediatricians in the Spanish Pediatric Association Annual Congress has increased since the Spanish Primary Care Pediatric Association meeting takes place during this congress (AU)

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.