[Assessment of the humoral immunity induced by Sputnik V COVID-19 vaccine (Gam-COVID-Vac) in healthcare workers]. / Evaluación de la respuesta de los anticuerpos IGG específicos contra SARS-CoV-2 en el personal de salud con el esquema completo de la vacuna Sputnik V (Gam-COVID-Vac).

Background: Vaccination for COVID-19 in healthcare workers (HCW) is essential to protect one of the populations most exposed to this disease. However, data on the humoral response rate to the vaccine and the factors associated with it in this population are limited. Therefore, we aimed to evaluate the antibody response against SARS-CoV-2 in HCWs with complete Sputnik V vaccine scheme and factors associated with an increased antibody response. Material and methods: Prospective study to evaluate the anti-SARS-CoV-2 humoral response in HCWs vaccinated with two doses of the Sputnik V vaccine (April-July 2021). The assessment of anti-Spike IgG antibodies in plasma was performed using the COVIDAR IgG enzyme-linked immunosorbent assay. A logistic regression was performed to identify independent factors associated with a positive IgG serology test and an elevated antibody response. Results: A total of 630 HCWs were enrolled. Median age (IQR): 47 years (35-56). Female sex: 462 (73.33%). Previous COVID-19: 158 (25%). The median interval time between vaccine doses was 3 (3-4) weeks. Positive serology was observed in 607 (96.35%) HCWs. In the multivariate analysis, a history of systemic reactogenicity was identified as an independent variable associated with a positive serology; and history of systemic reactogenicity, COVID-19, interval between doses ≥ 4 weeks and time to serology < 14 weeks were associated with an elevated antibody response. Conclusions: This study provides data on the humoral response to the Sputnik V vaccine in a real-life setting. These initial data can contribute to the development of future immunization strategies in HCWs.

Fisiología pulmonar: laboratorios de función pulmonar en pandemia y post pandemia COVID-19 / Pulmonary function laboratories in pandemic and post-pandemic COVID-19

La pandemia por COVID19 ha provocado, en los laboratorios de función pulmonar del planeta, una reestructuración en el funcionamiento, redundando en un descenso en el número y tipo de exámenes realizados. Durante el desarrollo de la pandemia y desde distintos grupos de expertos en el tema, se han publicado recomendaciones para el funcionamiento de los laboratorios, destinadas a crear condiciones seguras para evitar contagios. Este artículo pretende resumir el estado actual de las recomendaciones de funcionamiento de acuerdo a los distintos grupos de expertos y las distintas etapas de la pandemia.

The COVID19 pandemic has caused, in the lung function laboratories of the planet, a restructuring in the operation, resulting in a decrease in the number and type of tests performed. During the development of the pandemic and from different groups of experts on the subject, recommendations have been published for the operation of laboratories, aimed at creating safe conditions to avoid contagion. This article aims to summarize the current status of the operating recommendations according to the different groups of experts and the different stages of the pandemic.

Hospital admission for symptoms exacerbation in 2,075 infants suffering from recurrent asthma-like symptoms: (EISL-3 South America).

BACKGROUND: Contrary to what happens in children and adults, the prevalence and the factors related to hospitalisation for asthma/wheezing in infants with recurrent asthma-like symptoms are poorly known. METHODS: This study is part of the International Study of Wheezing in infants Phase 3; 2,079 infants (aged 12-18 months) with recurrent asthma-like symptoms, from 11 South American centres, were studied to determine the prevalence and the associated factors for wheezing exacerbation admission. Descriptive statistics and multivariate logistic regression were employed for analysis. RESULTS: The prevalence of admission for wheezing was 29.7% (95% CI 27.7-31.6) and was significantly associated to severe wheezing episodes (OR: 3.89; 95% CI: 2.93-5.18, p < 0.001), physician-diagnosed asthma (OR: 1.79; 95% CI: 1.33-2.41, p < 0.0001), use of inhaled corticosteroids (OR: 1.78; 95%CI: 1.38-2.29, p < 0.0001), maternal tobacco smoking during pregnancy (OR: 1.69; 95% CI: 1.19-2.39, p = 0.003) and onset of wheezing in the first trimester of life (OR: 1.30; 95% CI: 1.02-1.66, p = 0.038). Breast feeding ≥4 months (OR: 0.72; 95% CI: 0.54-0.96, p = 0.004), maternal high educational level (>12 years) (OR: 0.66; 95% CI: 0.51-0.85, p = 0.001) and total monthly household income ≥US$ 3,000 (OR: 0.34; 95% CI: 0.18-0.67, p = 0.002), were protective factors. CONCLUSIONS: Infants with recurrent asthma-like symptoms have a high rate of admissions. Tobacco smoking in pregnancy, viral respiratory illness in the first trimester of life and severe progression were risks for admissions. Improving medical management to prevent severe exacerbations, prolonging the postnatal period at home longer than 3 months, favouring breastfeeding and avoiding smoking during pregnancy may have a preventive role for admissions in infants with recurrent asthma-like symptoms.

Hospital admission for symptoms exacerbation in 2.075 infants suffering from recurrent asthma-like symptoms: (EISL-3 South America)

Background: Contrary to what happens in children and adults, the prevalence and the factors related to hospitalisation for asthma/wheezing in infants with recurrent asthma-like symptoms are poorly known. Methods: This study is part of the International Study of Wheezing in infants Phase 3; 2,079 infants (aged 12–18 months) with recurrent asthma-like symptoms, from 11 South American centres, were studied to determine the prevalence and the associated factors for wheezing exacerbation admission. Descriptive statistics and multivariate logistic regression were employed for analysis. Results: The prevalence of admission for wheezing was 29.7% (95% CI 27.7–31.6) and was significantly associated to severe wheezing episodes (OR: 3.89; 95% CI: 2.93–5.18, p < 0.001), physician-diagnosed asthma (OR: 1.79; 95% CI: 1.33–2.41, p < 0.0001), use of inhaled corticosteroids (OR: 1.78; 95%CI: 1.38–2.29, p < 0.0001), maternal tobacco smoking during pregnancy (OR: 1.69; 95% CI: 1.19–2.39, p = 0.003) and onset of wheezing in the first trimester of life (OR: 1.30; 95% CI: 1.02–1.66, p = 0.038). Breast feeding ≥4 months (OR: 0.72; 95% CI: 0.54–0.96, p = 0.004), maternal high educational level (>12 years) (OR: 0.66; 95% CI: 0.51–0.85, p = 0.001) and total monthly household income ≥US$ 3,000 (OR: 0.34; 95% CI: 0.18–0.67, p = 0.002), were protective factors. Conclusions: Infants with recurrent asthma-like symptoms have a high rate of admissions. Tobacco smoking in pregnancy, viral respiratory illness in the first trimester of life and severe progression were risks for admissions. Improving medical management to prevent severe exacerbations, prolonging the postnatal period at home longer than 3 months, favouring breastfeeding and avoiding smoking during pregnancy may have a preventive role for admissions in infants with recurrent asthma-like symptoms (AU)

Value of bronchial reversibility to salbutamol, exhaled nitric oxide and responsiveness to methacholine to corroborate the diagnosis of asthma in children

INTRODUCTION AND OBJECTIVES: Functional and inflammatory measures have been recommended to corroborate asthma diagnosis in schoolchildren, but the evidence in this regard is conflicting. We aimed to determine, in real-life clinical situation, the value of spirometry, spirometric bronchial reversibility to salbutamol (BDR), bronchial responsiveness to methacholine (MCT) and fractional exhaled nitric oxide (FENO), to corroborate the diagnosis of asthma in children on regular inhaled corticosteroids (ICS) referred from primary care. METHODS: One hundred and seventy-seven schoolchildren with mild-moderate persistent asthma, on treatment with regular ICS, participated in the study. Abnormal tests were defined as FENO ≥ 27 ppb, BDR (FEV1 ≥ 12%) and methacholine PC20 ≤ 4 mg/mL. RESULTS: The proportions of positive BDR, FENO and MCT, were 16.4%, 33.3%, and 87.0%, respectively. MCT was associated with FENO (p < 0.03) and BDR (p = 0.001); FENO was associated with BDR (p = 0.045), family history of asthma (p = 0.003) and use of asthma medication in the first two years of life (p = 0.004). BDR was significantly related with passive tobacco exposure (p = 0.003). CONCLUSIONS: Spirometry, BDR and BDR had a poor performance for corroborating diagnosis in our asthmatic children on ICS treatment; on the contrary, MCT was positive in most of them, which agrees with previous reports. Although asthma tests are useful to corroborate asthma when positive, clinical diagnosis remains the best current approach for asthma diagnosis, at least while better objective and feasible measurements at the daily practice are available. At present, these tests may have a better role for assessing the management and progression of the condition

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Value of bronchial reversibility to salbutamol, exhaled nitric oxide and responsiveness to methacholine to corroborate the diagnosis of asthma in children.

INTRODUCTION AND OBJECTIVES: Functional and inflammatory measures have been recommended to corroborate asthma diagnosis in schoolchildren, but the evidence in this regard is conflicting. We aimed to determine, in real-life clinical situation, the value of spirometry, spirometric bronchial reversibility to salbutamol (BDR), bronchial responsiveness to methacholine (MCT) and fractional exhaled nitric oxide (FENO), to corroborate the diagnosis of asthma in children on regular inhaled corticosteroids (ICS) referred from primary care. METHODS: One hundred and seventy-seven schoolchildren with mild-moderate persistent asthma, on treatment with regular ICS, participated in the study. Abnormal tests were defined as FENO ≥ 27 ppb, BDR (FEV1 ≥ 12%) and methacholine PC20 ≤ 4 mg/mL. RESULTS: The proportions of positive BDR, FENO and MCT, were 16.4%, 33.3%, and 87.0%, respectively. MCT was associated with FENO (p < 0.03) and BDR (p = 0.001); FENO was associated with BDR (p = 0.045), family history of asthma (p = 0.003) and use of asthma medication in the first two years of life (p = 0.004). BDR was significantly related with passive tobacco exposure (p = 0.003). CONCLUSIONS: Spirometry, BDR and BDR had a poor performance for corroborating diagnosis in our asthmatic children on ICS treatment; on the contrary, MCT was positive in most of them, which agrees with previous reports. Although asthma tests are useful to corroborate asthma when positive, clinical diagnosis remains the best current approach for asthma diagnosis, at least while better objective and feasible measurements at the daily practice are available. At present, these tests may have a better role for assessing the management and progression of the condition.

Actualización de la prueba de provocación bronquial con ejercicio (PPBE) / Update of the bronchial provocation test with exercise

The bronchial challenge test with exercise aims to demonstrate the presence of exercise-induced bronchial hyperreactivity, characteristic of bronchial asthma. Its realization is well standardized, requiring special environmental conditions, preparation and submaximum effort of the patient. The response is measured by spirometry, and it is considered a positive exercise test a drop in the expired volume at the first second (FEV1) of 10%. This article describes the elements necessary to facilitate this exam, according to national and international standards and guidelines.

La prueba de provocación bronquial con ejercicio tiene como objetivo demostrar la presencia de hiperreactividad bronquial inducida por ejercicio, característica del asma bronquial. Su realización está bien estandarizada, requiriendo de condiciones ambientales especiales, preparación y esfuerzo submáximo del paciente. La respuesta se mide mediante espirometría, y se considera una prueba de provocación con ejercicio positivo, a una caída del volumen espirado al primer segundo (VEF1) del 10%. En este artículo se describen los elementos necesarios para facilitar la realización de este examen, acorde a normas y guías nacionales e internacionales.

Actualización en la prueba de provocación bronquial con metacolina en el niño / Update in the bronchial challenge test with methacholine in children

This document updates the recommendations of the bronchial challenge test with methacholine in children. It is based primarily on the recommendations contained in the guide on the technical standard of the bronchial challenge test for methacholine from the European Society of Respiratory Diseases. The main change is the recommendation to use PD20 (methacholine dose that causes a 20% drop in FEV1) instead of PC20 (methacholine concentration that causes a 20% drop in FEV1), which allows for comparable results when different devices and different protocols are used.

Este documento actualiza las recomendaciones de la prueba de provocación bronquial con metacolina en niños. Se basa fundamentalmente en las recomendaciones contenidas en la guía sobre el estándar técnico de la prueba de provocación bronquial de metacolina de la Sociedad Europea de Enfermedades Respiratorias. El principal cambio es la recomendación de utilizar la PD20 (dosis de metacolina que provoca una caída de 20% del VEF1) en vez de PC20 (concentración de metacolina que provoca una caída del 20% en el VEF1), lo cual permite tener resultados comparables cuando se usan diferentes dispositivos y diferentes protocolos.

Actualización en espirometría en el preescolar / Preeschools spirometry update

Spirometry is better pulmonary function test for evaluating preschoolers with chronic lung disease and recurrent wheeze. It is useful, accessible and very good performance. For a correct interpretation it must be under the conditions specially controlled for this age group. In this review, product of the work done during the year 2018, by the Committee on pulmonary function in pediatric pulmonology Chilean society, will be showcased aspects for the realization and interpretation of spirometry in preschool children, with emphasis on the differences in the criteria typically described for older children and adults.

La espirometría es la prueba de función pulmonar más adecuada para evaluar a preescolares con enfermedades pulmonares crónicas y sibilancias recurrentes. Es útil, accesible y de buen rendimiento. Para una correcta interpretación debe realizarse bajo las condiciones especialmente normadas para este grupo etario. En esta revisión, producto del trabajo realizado durante el año 2018, por la comisión de función pulmonar de la sociedad Chilena de Neumología Pediátrica, se expondrán los aspectos actualizados para la realización e interpretación de la espirometría en preescolares, con énfasis en las diferencias de los criterios clásicamente descritos para niños mayores y adultos.

Situación epidemiológica de las infecciones de transmisión vertical (Sífilis, Chagas, Hepatitis B y VIH) en el Hospital General de Agudos Dr C. Argerich: Años 2016-2018 / Epidemiological situation of vertical transmitted infections (Syphilis, Chagas, Hepatitis B and HIV) at the Acute General Hospital Dr C. Argerich Years 2016-2018

Se describe la modalidad de presentación y notificación de los casos de infecciones de transmisión vertical que fueron reportados a la División de Promoción y Protección (P y P) desde los Servicios del Hospital Argerich de la Ciudad de Buenos Aires, y los efectores de su Área Programática, entre la Semana Epidemiológica (SE) 1 y 52 del trienio 2016-2018, con el propósito de mejorar el proceso de diagnóstico-notificación-atención-cuidado (PDNAC) y seguimiento de los casos de ITS y transmisión vertical atendidos en el hospital. Para esto, se realizó un estudio descriptivo con los datos de los casos de sífilis en población general y en embarazadas, sífilis congénita, hepatitis B en embarazadas y recién nacidos, VIH en embarazadas y VIH expuesto perinatal, enfermedad de Chagas en embarazada y congénita notificados a la División de PyP.

Actualización en espirometría y curva flujo / volumen en escolares y adolescentes / School and adolescent spirometry and flow / volume curve update

Spirometry is the most commonly used test to evaluate lung function in children and adults. To obtain good quality results, several requirements must be fulfilled: professional capacity of the technician, the quality of the equipment, the patient's collaboration, the use of appropriate reference standards. The purpose of spirometry is to define types of ventilatory alterations of the central and peripheral airways, to evaluate the response to bronchodilators and to guide the presence of restrictive diseases. The new consensus of national and international experts are described, which have been perfecting several aspects of this test.

La espirometría es el examen más comúnmente utilizado para evaluar la función pulmonar en niños y adultos. Para obtener resultados de buena calidad deben cumplirse varios requisitos, desde la capacidad profesional del técnico, calidad de los equipos, colaboración del paciente y utilización de patrones de referencia adecuados. La espirometría tiene como utilidad definir alteraciones ventilatorias obstructivas de vía aérea central y periférica, evaluar respuesta a broncodilatador y orientar al diagnóstico de enfermedades restrictivas. Se describen los nuevos consensos de expertos nacionales e internacionales, los cuales han ido perfeccionando varios aspectos de este examen.

Situación epidemiológica de los casos de sífilis en el Hospital General de Agudos Dr. Cosme Argerich: Años 2016 y 2017 / Epidemiological situation of syphilis at the Acute General Hospital Dr Cosme Argerich: 2016 and 2017

La sífilis es una enfermedad infectocontagiosa producida por la bacteria Treponema pallidum. Se transmite fundamentalmente por contacto sexual y por transmisión perinatal durante el embarazo y a través del canal de parto. Afecta tanto a varones como a mujeres y los síntomas surgen dos o tres semanas después del contacto sexual sin protección. Las infecciones perinatales por sífilis representan en la actualidad una problemática por su gran impacto en la morbilidad y mortalidad materno-infantil. A pesar de existir medidas profilácticas eficaces y de que podría eliminarse mediante un control prenatal eficaz y el tratamiento de las embarazadas infectadas, la sífilis sigue constituyendo un problema de Salud Pública a escala mundial, con 12 millones de personas infectadas cada año. Su eliminación reduciría el número de abortos, muertes fetales, partos prematuros, neonatos de bajo peso al nacer y muertes perinatales. En América Latina y el Caribe, la prevalencia en embarazadas varía de un país a otro (del 0,1% al 7,0%). En 2015, la tasa de sífilis congénita estimada fue de 1,7 casos por 1000 nacidos vivos en la Región. En Argentina, de las embarazadas estudiadas para sífilis durante el 2016 2,68% resultaron positivas para pruebas no treponémicas (PNT), mientras que en 2017 el 3,16% fueron positivas para dichas pruebas.En residentes de la Ciudad Autónoma de Buenos Aires (CABA), se notificaron 1336 casos de sífilis en el año 2016 al módulo SNVS- C2 con modalidad agrupada y 1899 casos durante 2017. Las PNT en embarazadas residentes de CABA fueron positivas en 1,7% en 2016 y 5,1% en 20176. Este informe especial se centra en los casos notificados en el Hospital General de Agudos Cosme Argerich, de la Ciudad de Buenos Aires, donde se realizó un estudio descriptivo con los datos de los casos de sífilis notificados a la División de Promoción y Protección del hospital, desde la Semana Epidemiológica (SE) 1 a 52 de 2016 y 2017 .

Changes in the prevalence and severity of recurrent wheezing in infants: The results of two surveys administered 7 years apart.

OBJECTIVE: To identify changes in the prevalence and severity of recurrent wheezing (RW) in infants using data obtained from two surveys administered seven years apart. METHODS: A cross-sectional, international, population-based study in infants aged 12-15 months was conducted. Data were obtained from two surveys (S1 and S2, in 2005 and 2012, respectively) using the same methodology in three large Latin American cities: Curitiba (Brazil), São Paulo (Brazil), and Santiago (Chile). RESULTS: A decrease in the overall prevalence of RW was identified between S1 (23.3%) and S2 (20.4%), p = 0.004, but it was mainly driven by the reduction observed in São Paulo; in Curitiba and Santiago, this change was not significant. The mean prevalence of the following RW severity indicators remained high and stable: severe wheezing episodes (56.9% in S1 and 54.2% in S2, p = 0.32) and emergency department (ED) visits for wheezing (S1 = 68.1%, S2 70.9%, p = 0.21). A significant increase in admissions for wheezing (21.1% to 26.7%, p = 0.004) was observed. In Curitiba and São Paulo, there were significant increases in the prevalence of physician-diagnosed asthma and in the use of inhaled corticosteroids and oral antileukotrienes. CONCLUSIONS: The prevalence and severity of RW during the first year of life remained high over time, with remarkably high rates of ED visits, admissions for wheezing and use of asthma medications. This study suggests the need for considering early asthma diagnosis and to establish an appropriate treatment in infants with recurrent and severe asthma-like symptoms.

Fructose sensitizes Jurkat cells oxidative stress-induced apoptosis via caspase-dependent and caspase-independent mechanisms.

Whether fructose (FRU), as the sole energy source, confers a metabolic advantage on cancer cells against noxious stimuli is unknown. The aim of this study was to evaluate the effects of low (11 mM), moderate (25 mM), and high (55 mM) FRU concentrations alone or in combination with rotenone (ROT) or doxorubicin (DOX) in Jurkat cells, an acute lymphoblastic leukemia cell model. Glucose (GLU) was used as a control. Using different cell analysis techniques, we demonstrated that FRU was predominantly metabolized via oxidative phosphorylation (∼95%) (i.e., lactate production was reduced >120-fold), resulting in endogenous oxidative stress-induced conditions. The cells were characterized by generation of O2•- (43%)/ H2 O2 (40%) and activation of NF-κB (∼95-fold increase, fi), c-Jun-N terminal kinase (JNK), p53 (40-fi), and c-Jun (9-fi). In addition, we observed a loss of ΔΨm (10%), activation of caspase-3 (50-fi) and apoptosis-inducing factor (AIF, 2-fi), and condensation and fragmentation of the nuclei [20% by acridine orange/ethidium bromide/Hoechst (AO/EB/H) staining, 15% by flow cytometry] compared to those of GLU 11 at 24 h. Although DOX killed Jurkat cells independent of sugar content in the culture medium, leukemic cells in low, but not high, FRU were extremely sensitive to ROT. Taken together, our findings suggest that Jurkat cells are more susceptible to cell death if forced to shift from GLU metabolism (i.e., aerobic glycolysis) to FRU metabolism (i.e., oxidative phosphorylation) after treatment with mitochondria-targeting molecules. These observations may help elucidate the cell death mechanism of leukemic cells cultured in FRU.

Prevalence, Severity, and Treatment of Recurrent Wheezing During the First Year of Life: A Cross-Sectional Study of 12,405 Latin American Infants.

PURPOSE: This study aimed to determine the prevalence and severity of recurrent wheezing (RW) defined as ≥3 episodes of wheezing, risk factors, and treatments prescribed during the first year of life in Latin American infants. METHODS: In this international, cross-sectional, and community-based study, parents of 12,405 infants from 11 centers in 6 South American countries (Argentina, Brazil, Chile, Colombia, Peru, and Uruguay) completed a questionnaire about wheezing and associated risk/protective factors, asthma medications, and the frequency of and indications for the prescription of antibiotics and paracetamol during the first year of life. RESULTS: The prevalence of RW was 16.6% (95% CI 16.0-17.3); of the 12,405 infants, 72.7% (95% CI 70.7-74.6) visited the Emergency Department for wheezing, and 29.7% (27.7-31.7) was admitted. Regarding treatment, 49.1% of RW infants received inhaled corticosteroids, 55.7% oral corticosteroids, 26.3% antileukotrienes, 22.9% antibiotics ≥4 times mainly for common colds, wheezing, and pharyngitis, and 57.5% paracetamol ≥4 times. Tobacco smoking during pregnancy, household income per month <1,000 USD, history of parental asthma, male gender, and nursery school attendance were significant risk factors for higher prevalence and severity of RW, whereas breast-feeding for at least 3 months was a significant protective factor. Pneumonia and admissions for pneumonia were significantly higher in infants with RW as compared to the whole sample (3.5-fold and 3.7-fold, respectively). CONCLUSIONS: RW affects 1.6 out of 10 infants during the first year of life, with a high prevalence of severe episodes, frequent visits to the Emergency Department, and frequent admissions for wheezing. Besides the elevated prescription of asthma medications, there is an excessive use of antibiotics and paracetamol in infants with RW and also in the whole sample, which is mainly related to common colds.

Cómo ayudar a un niño que fuma? / How to help a child who smokes?

El consumo de tabaco es un problema frecuente en la edad pediátrica, con cifras nacionales de prevalencia de 14,6 por ciento, ocupando el primer lugar de Latinoamérica en los menores de 16 años. Los jóvenes empiezan a fumar por numerosas razones psicológicas y socio-ambientales, y el factor más claramente identificado, relacionado con el desarrollo de dependencia, es la sensación de relajación asociado a la primera vez que se fuma. A diferencia del adulto, en el niño y adolescente se disponen de pocas herramientas terapéuticas efectivas para la cesación del hábito tabáquico. Dentro de éstas, la que cuenta con mayor evidencia es la consejería, con enfoques específicos para este grupo. Respecto a la terapia farmacológica, si bien no tiene una indicación formal en este grupo etario, la terapia de reemplazo de la nicotina es segura y podrían usarse en algunos casos seleccionados. Considerando los pobres resultados obtenidos con las herramientas actualmente disponibles para tratar este problema en el niño y adolescente, debemos concentrar los esfuerzos en acciones preventivas del hábito y en desarrollar estrategias de consejería y farmacológicas más exitosas que las ya existentes.

Effect of inhaled fluticasone on lung function in infants with recurrent wheezing: a randomised controlled trial.

BACKGROUND: Inhaled corticosteroids are used to treat infants with troublesome asthma-like symptoms but their effect on the lung function of these young patients is controversial. MATERIAL AND METHODS: Forty-four infants with recurrent wheezing (more than 3 episodes) and family history of asthma completed this randomised, parallel, double-blind, controlled trial to compare the effect on lung function (main endpoint) of once-daily inhaled fluticasone (375 microg) versus placebo for 3 months. Pulmonary function was measured while infants were asymptomatic, using the raised volume rapid thoracic compression technique (spirometry-like), and values were converted to z-scores. RESULTS: The fluticasone group showed a significant increase in forced flows, (p < 0.001), a lower number of physician diagnosed wheezing episodes (p < 0.002), and a significant decrease in the parent-reported number of wheezing episodes per month (p < 0.03), as compared to placebo. One third of parents in the placebo group reported a clinical improvement in their infants. There was no significant difference in morning plasma cortisol between groups at entry or discharge. CONCLUSIONS: We conclude that once-daily treatment with 375 microg fluticasone increased forced flows and controlled symptoms in infants with recurrent wheezing without altering plasma cortisol levels. The spirometry-like technique is a useful tool to objectively assess the efficacy of anti-asthma medications in infants with repeated troublesome asthma-like symptoms.

Effect of inhaled fluticasone on lung function in infants with recurrent wheezing: a randomised controlled trial

Background: Inhaled corticosteroids are used to treat infants with trouble some asthma-like symptoms but their effect on the lung function of these young patients is controversial. Material and Methods: Forty-four infants with recurrent wheezing (more than 3 episodes) and family history of asthma completed this randomised, parallel, double-blind, controlled trial to compare the effect on lung function (main end point) of once-daily inhaled fluticasone (375g) versus placebo for 3 months. Pulmonary function was measured while infants were asymptomatic, using the raised volume rapid thoracic compression technique (spirometry-like), and values were converted to z-scores. Results: The fluticasone group showed a significant increase in forced flows, (p < 0.001), a lower number of physician diagnosed wheezing episodes (p < 0.002), and a significant decrease in the parent-reported number of wheezing episodes per month (p < 0.03), as compared to placebo. One third of parents in the placebo group reported a clinical improvement in their infants.There was no significant difference in morning plasma cortisol between groups at entry or discharge. Conclusions: We conclude that once-daily treatment with 375g fluticasone increased forced flows and controlled symptoms in infants with recurrent wheezing without altering plasma cortisol levels. The spirometry-like technique is a useful tool to objectively assess the efficacy of anti-asthma medications in infants with repeated trouble some asthma-like symptoms (AU)

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[Changes in the prevalence of asthma in Chilean school age children between 1994 and 2002. International Study of Asthma and Allergies in Childhood (ISAAC)--Chile phases I and III]. / Cambios en la prevalencia de asma en escolares chilenos entre 1994 y 2002.

BACKGROUND: In developed countries, the prevalence of asthma in children has significantly increased in the last decades. However, there is no information about the trends of asthma in Latin America. AIM: To determine changes in asthma prevalence between 1994 and 2002 in Chilean schoolchildren. MATERIAL AND METHODS: The prevalence of asthma symptoms in schoolchildren aged 7 (n =18.697) and 13 years (n =18.939), from South Santiago, Valdivia and Punta Arenas, obtained during phases I and III of the ISAAC, carried out in 1994 and 2002, was compared. RESULTS: From 1994 to 2002, the mean national prevalence of "wheezing in the last 12 months" in the group aged 6-7 years, changed from 18.2% to 17.9% (p =NS); "asthma ever" from 12.5% to 10.7% (p =NS), and "severe episode" from 3.2% to 2.8% (p =NS). There was a significant increase of the prevalence of "wheezing in the last 12 months", in children aged 13-14 years, from 9.8% to 15.5% (p =0.01); in "asthma ever" from 10.2% to 14.9% (p =0.01), and for "severe episode" from 2.8% to 3.8% (p =0.01). CONCLUSIONS: There was a significant increase in the prevalence of respiratory symptoms related to asthma in children aged 13-14 years that was consistent in all the 3 participating centres of the ISAAC. However, the prevalence of asthma symptoms in children aged 6-7 years remained without significant changes between 1994 and 2002.

The International Study of Wheezing in Infants: questionnaire validation.

BACKGROUND: There are no internationally validated questionnaires to investigate the prevalence of infant wheezing. This study was undertaken to validate a questionnaire for the International Study on the Prevalence of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). MATERIAL AND METHODS: Construct and criterion validity were tested for the question 'Has your baby had wheezing or whistling in the chest during his/her first 12 months of life?'. Construct validity (i.e. the ability of parents and doctors to refer to the same symptoms with the same words) was tested in a sample of 50 wheezing and 50 non-wheezy infants 12-15 months of age in each of 10 centres from 6 different Spanish- or Portuguese-speaking countries. Criterion validity (i.e. the ability of parents to correctly detect the symptom in the general population) was evaluated in 2 samples (Santiago, Chile and Cartagena, Spain) of 50 wheezing and 50 non-wheezing infants (according to parents) of the same age, randomly selected from the general population, who were later blindly diagnosed by a paediatric pulmonologist. RESULTS: Construct validity was very high (kappa test: 0.98-1) in all centres. According to Youden's index, criterion validity was good both in Cartagena (75.5%) and in Santiago (67.0%). Adding questions about asthma medication did not improve diagnosis accuracy. CONCLUSIONS: The EISL questionnaire significantly distinguished wheezy infants from healthy ones. This questionnaire has a strong validity and can be employed in large international multicentre studies on wheezing during infancy.