Impacto de una intervención educativa sobre asma en los profesores / Impact of an asthma educational intervention programme on teachers

Objetivo: Determinar el impacto de una intervención educativa en el nivel de conocimientos de los profesores sobre el asma y su manejo. Material y método: Estudio cuasiexperimental, de tipo antes y después, con grupo control, de una intervención educativa (IE) dirigida a mejorar el grado de conocimientos sobre el asma infantil y su manejo en profesores de centros escolares de San Sebastián (Gipuzkoa). Se utilizó como elemento de medida el cuestionario de conocimientos Newcastle Asthma Knowledge Questionnaire (NAKQ) y como intervención educativa, una adaptación del programa Asma, Deporte y Salud. Se utilizó el test de los rangos con signo de Wilcoxon para comparar la puntuación total en el cuestionario antes y después de la intervención, el test de McNemar para comparar el porcentaje de respuestas correctas a cada ítem y el test U de Mann-Whitney para la comparación en la puntuación basal y a los 3 meses entre el grupo de intervención y el grupo control. Se estudiaron el tamaño del efecto y la respuesta media estandarizada. Resultados: Participaron 138 docentes de 6 centros elegidos aleatoriamente (grupo estudio) y 43 en el grupo control. En el grupo estudiado la puntuación media del cuestionario de conocimientos de asma NAKQ antes de la realización de la intervención educativa fue de 16,1±3,4 puntos, con una mediana de 16 (rango 7-23). Tras la intervención educativa, la puntuación ascendió a 22,3±4,1 con una mediana de 23 (rango 6-29), siendo la diferencia media en la puntuación global de conocimientos de 7,0±4,2 puntos, con una mediana de 8 (rango -2; 17), tamaño del efecto de 2,0(>0,8) siendo la respuesta media estandarizada de 1,7. A los 3 meses de la intervención, la puntuación media del cuestionario fue de 21,4±3,0 puntos, con una mediana de 22 (rango 12-29), significativamente superior al momento previo a la intervención (p<0,001) y algo menor que el inmediatamente posterior a la misma, suponiendo un tamaño del efecto de 1,6 y una respuesta media estandarizada de 1,2. En el grupo control no se modificó el nivel de conocimientos, permaneciendo más bajo que el grupo intervenido (p<0,001). Conclusiones: Una intervención educativa dirigida a los profesores aumenta significativamente el nivel de conocimientos sobre el asma. Además, el incremento disminuye algo pero se mantiene elevado durante al menos 3 meses. Algunos aspectos del conocimiento, aunque mejoran con la intervención educativa, no son óptimos (AU)

Objective: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. Material and method: Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. Results: A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<0.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<0.001). Conclusions: An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal (AU)

[Impact of an asthma educational intervention programme on teachers]. / Impacto de una intervención educativa sobre asma en los profesores.

OBJECTIVE: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. MATERIAL AND METHOD: Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. RESULTS: A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001). CONCLUSIONS: An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.

[Fractional exhaled nitric oxide: validation of a 6 second exhalation time with two different analysers]. / Fracción exhalada de óxido nítrico: validación de la medida con tiempo de espiración de 6 s con dos analizadores diferentes.

OBJECTIVE: To validate the measurement of fractional exhaled nitric oxide concentration (FE(NO)) using a 6-sec exhalation time in patients aged between 5 and 17 years with a stationary chemiluminescence analyser (NIOX, Aerocrine) and a portable electrochemical analyser (NIOX-MINO, Aerocrine). MATERIAL AND METHODS: FE(NO) was assessed in 60 patients randomised into two groups. In Group 1 (n = 30, NIOX analyser), three valid FE(NO) measurements were obtained for two exhalation times (10 sec and 6 sec); the mean of the three measurements was recorded. In Group 2 (n = 30, NIOX-MINO), a single valid measurement of FE(NO) was obtained for each exhalation time. We analysed age, gender, weight, height, diagnosis, treatment, FE(NO) and the number of attempts with both exhalation times in each analyser. Agreement between FE(NO) assessed using 10-sec and 6-sec exhalations was assessed by Bland-Altman analysis and Cohen's kappa. RESULTS: The mean (SD) age in Group 1 was 10.1 (3.07) years. The mean age in Group 2 was 10.43 (2.94) years. Bland-Altman analysis demonstrated good agreement between FE(NO) values obtained with both exhalation times and with both devices. Cohen's kappa, also demonstrated good agreement (NIOX, kappa = 1; NIOX-MINO, kappa = 0.93). CONCLUSIONS: A 6-sec exhalation time is valid for measuring FE(NO) with both analysers in children aged over 5 years.

Fracción exhalada de óxido nítrico: validación de la medida con tiempo de espiración de 6 s con dos analizadores diferentes / Fractional exhaled nitric oxide: Validation of a 6 second exhalation time with two different analysers

Objetivo. Validar la determinación de la fracción exhalada de óxido nítrico (FENO) con tiempo de espiración de 6 s con un analizador de quimioluminiscencia estacionario (NIOX(R), Aerocrine) y con un analizador electroquímico portátil (NIOX-MINO(R), Aerocrine). Material y métodos. Determinaciones de la FENO en 60 pacientes entre 5 y 17 años. Grupo 1 (n=30, NIOX(R)): tres medidas válidas para cada tiempo de espiración (10 y 6 s) y cálculo de la media de las tres determinaciones. Grupo 2 (n=30, NIOX-MINO(R)): una determinación válida con cada tiempo de espiración. Variables: edad, sexo, peso, talla, diagnóstico, tratamiento, FENO y número de intentos con cada tiempo de espiración en cada analizador. Análisis de concordancia y grado de acuerdo entre los valores de FENO obtenidos con cada dispositivo, con tiempos espiratorios de 10 y 6 s mediante el método Bland y Altman y la kappa de Cohen (κ). Resultados. Grupo 1 (NIOX(R)), edad media 10,1 ± 3,07 años. Grupo 2 (NIOX-MINO(R)), edad media 10,43 ± 2,94 años. Existe una buena concordancia entre los valores obtenidos con NIOX(R) y con NIOX-MINO(R) a 10 y 6 s. Hubo un acuerdo sustancial entre los valores obtenidos con NIOX(R) a 10 y 6 s ( κ=1) y con NIOX-MINO(R) a 10 y 6 s ( κ=0,93). Conclusiones. El tiempo de espiración de 6 s es válido para la determinación de la FENO con cada uno de los dispositivos de medida en niños mayores de 5 años

Objective. To validate the measurement of fractional exhaled nitric oxide concentration (FENO) using a 6-sec exhalation time in patients aged between 5 and 17 years with a stationary chemiluminescence analyser (NIOX(R), Aerocrine) and a portable electrochemical analyser (NIOX-MINO(R), Aerocrine). Material and methods. FENO was assessed in 60 patients randomised into two groups. In Group 1 (n = 30, NIOX(R) analyser), three valid FENO measurements were obtained for two exhalation times (10 sec and 6 sec); the mean of the three measurements was recorded. In Group 2 (n = 30, NIOX-MINO(R)), a single valid measurement of FENO was obtained for each exhalation time. We analysed age, gender, weight, height, diagnosis, treatment, FENO and the number of attempts with both exhalation times in each analyser. Agreement between FENO assessed using 10-sec and 6-sec exhalations was assessed by Bland-Altman analysis and Cohen's kappa. Results. The mean (SD) age in Group 1 was 10.1 (3.07) years. The mean age in Group 2 was 10.43 (2.94) years. Bland-Altman analysis demonstrated good agreement between FENO values obtained with both exhalation times and with both devices. Cohen's kappa, also demonstrated good agreement (NIOX(R), κ = 1; NIOX-MINO(R), κ = 0.93). Conclusions. A 6-sec exhalation time is valid for measuring FENO with both analysers in children aged over 5 years

[Agreement between two devices for measuring exhaled nitric oxide]. / Concordancia entre dos dispositivos de medida de óxido nítrico exhalado.

BACKGROUND: Measurement of fractional exhaled nitric oxide (FENO) is a non-invasive marker of eosinophilic airway inflammation that can be useful in asthma diagnosis and control, as well as in treatment monitoring. OBJECTIVE: We studied the correlation between two techniques for measuring FENO: the chemiluminescence-based analyzer (NIOX, Aerocrine, Sweden) and a new portable electrochemical sensor-based analyzer (NIOX-MINO, Aerocrine). MATERIAL AND METHODS: FENO was measured by the single breath on-line method. In all children, three consecutives measurements were obtained with NIOX, with a maximum of six attempts, and the arithmetic mean was calculated. Next, using NIOX-MINO, a single measurement was made successively in each of the children. The variables analyzed were sex, age, height, weight, diagnosis, treatment, NIOX-MINO value, mean of three values obtained with NIOX and the NO elimination rate (nL/min). For the statistical analysis, the Bland-Altman plot was used to compare the means and the differences between measurements of FENO from NIOX and NIOX-MINO. The agreement between the two analyzers was estimated by Cohen's Kappa statistic. RESULTS: Thirty children were included, 14 (46.67%) boys and 16 (53.33%) girls. The mean age was 11.3+/-3.09 years. All of the children successfully performed the measurements with two analyzers. The relationship between the means and the differences in the values obtained with NIOX-MINO and NIOX were statistically significant (p<0.005). In addition, Cohen's Kappa statistic (0.78) suggested a high degree of agreement between the results obtained with the two devices. CONCLUSIONS: The two analyzers, NIOX-MINO and NIOX, were not equivalent. There was good agreement between the FENO values measured with the two devices. Measurement of FENO with the portable electrochemical sensor-based analyzer (NIOX-MINO) is valid and feasible in children older than 5 years.

Concordancia entre dos dispositivos de medida de óxido nítrico exhalado / Agreement between two devices for measuring exhaled nitric oxide

Antecedentes La fracción exhalada de óxido nítrico (FENO) se comporta como un marcador no invasivo de inflamación eosinófila de la vía aérea, que resulta de utilidad en el diagnóstico de asma, en el control de la enfermedad y en la monitorización del tratamiento. Objetivo Analizar la concordancia entre dos dispositivos de medida de la FENO, un analizador de quimioluminiscencia estacionario (NIOX(R), Aerocrine, Suecia) y un analizador electroquímico portátil (NIOX-MINO(R), Aerocrine, Suecia). Material y métodos Las medidas se han realizado mediante registro on-line de respiración única (single breath on-line measurement). Se han obtenido tres medidas consecutivas con el analizador NIOX(R), máximo de seis intentos, y se ha calculado la media. Asimismo, y de forma sucesiva en cada uno de los niños, se realizó otra medición con el analizador NIOX-MINO(R). Se han analizado las variables cuantitativas edad, talla, peso, valor NIOX-MINO(R), valor medio NIOX(R) y flujo de óxido nítrico (NO) (nl/min), y las variables cualitativas sexo, diagnóstico y tratamiento. En el análisis estadístico se han estudiado la regresión de las medias de FENO (Bland-Altman) y el grado de acuerdo entre ambos dispositivos (estadístico kappa de Cohen). Resultados Se han estudiado 30 niños, edad media 11,3 ± 3,09 años, distribuidos en 14 varones (46,67 %) y 16 mujeres (53,33 %). El 100 % de los casos realizaron con éxito las mediciones con ambos dispositivos. La regresión de las medias obtenidas fue significativa, tanto en valores absolutos como relativos. Asimismo, hubo acuerdo entre los resultados con ambos dispositivos (kappa de Cohen, 0,78). Conclusiones Los dos sistemas estudiados de determinación de la FENO no son equivalentes. Existe entre ambas técnicas un acuerdo sustancial en las determinaciones obtenidas. La FENO determinada mediante técnica electroquímica con sistemas portátiles es válida en niños mayores de 5 años

Background Measurement of fractional exhaled nitric oxide (FENO) is a non-invasive marker of eosinophilic airway inflammation that can be useful in asthma diagnosis and control, as well as in treatment monitoring. Objective We studied the correlation between two techniques for measuring FENO: the chemiluminescence-based analyzer (NIOX(R), Aerocrine, Sweden) and a new portable electrochemical sensor-based analyzer (NIOX-MINO(R), Aerocrine). Material and methods FENO was measured by the single breath on-line method. In all children, three consecutives measurements were obtained with NIOX(R), with a maximum of six attempts, and the arithmetic mean was calculated. Next, using NIOX-MINO(R), a single measurement was made successively in each of the children. The variables analyzed were sex, age, height, weight, diagnosis, treatment, NIOX-MINO(R) value, mean of three values obtained with NIOX(R) and the NO elimination rate (nL/min). For the statistical analysis, the Bland-Altman plot was used to compare the means and the differences between measurements of FENO from NIOX(R) and NIOX-MINO(R). The agreement between the two analyzers was estimated by Cohen's Kappa statistic. Results Thirty children were included, 14 (46.67 %) boys and 16 (53.33 %) girls. The mean age was 11.3 ± 3.09 years. All of the children successfully performed the measurements with two analyzers. The relationship between the means and the differences in the values obtained with NIOX-MINO(R) and NIOX(R) were statistically significant (p < 0.005). In addition, Cohen's Kappa statistic (0.78) suggested a high degree of agreement between the results obtained with the two devices. Conclusions The two analyzers, NIOX-MINO(R) and NIOX(R), were not equivalent. There was good agreement between the FENO values measured with the two devices. Measurement of FENO with the portable electrochemical sensor-based analyzer (NIOX-MINO(R)) is valid and feasible in children older than 5 years

[Diagnostic utility of nocturnal in-home respiratory polygraphy]. / Rentabilidad de la poligrafía respiratoria del sueño realizada en el domicilio.

INTRODUCTION: Sleep apnea-hypopnea syndrome (SAHS) is relatively frequent in children. The gold standard for diagnosis is polysomnography. However, because of technical difficulties and the cost of this method, new alternatives have become available, such as respiratory polygraphy (RP) performed at home or in hospital, which have provided satisfactory results in children with clinical suspicion of SAHS. OBJECTIVE: The aim of this study was to analyze the diagnostic utility of in-home RP in the diagnosis of SAHS in a sample of boys and girls referred to the pediatric respiratory care department for suspected sleep apnea, snoring, or both. MATERIAL AND METHODS: In all patients, a history and physical examination were performed; X-ray of the chest and cavum and RP were carried out. The following qualitative variables were analyzed: place where RP was performed, the result, sex, the reason for consulting, place of residence, results of otorhinolaryngological examination, and treatment. The quantitative variables analyzed were age, total number of apneas, total number of hypopneas, apnea index/hour, hypopnea index/hour, mean and minimum SpxO2, number of snores per hour and the snore index/hour. Statistical analysis was performed using Pearson's chi-square test and Student's t-test. RESULTS: A total of 132 patients were studied, 44 (33.3 %) through in-home RP (group 1) and 88 (66.6 %) through in-hospital RP (group 2). In group 1, two recordings (4.5 %) were considered nonvalid. The mean age of the patients was 8.3 years (SD 3.02). The results [means (standard deviation)] of in-home RP were as follows: apnea-hypopnea index (AHI)/h: 3.4 (4.3); mean SpxO2: 97.3 (1.8); minimum SpxO2: 87.7 (10.3). In group 2, four recordings (4.5 %) were nonvalid. The mean age of the patients was 7.4 years (SD 3). The results of in-hospital RP were as follows: AHI/h: 4.45 (5.4); mean SpxO2: 96.8 (1.8); minimum SpxO2: 87 (11). No significant differences were found between the validity of in-home and in-hospital RP. Likewise, no significant differences were found between AHI/h, SpxO2 and in-home and in-hospital RP. CONCLUSION: In conclusion, in our sample, the diagnostic utility of in-home RP was equal to that of in-hospital RP. In-home RP allows the possibility of performing a more physiological sleep study and, by eliminating the cost of hospitalization, is more cost-efficient. Therefore, in-home RP is a valid and reliable technique for the diagnosis of childhood SAHS.

Rentabilidad de la poligrafía respiratoria del sueño realizada en el domicilio / Diagnostic utility of nocturnal in-home respiratory polygraphy

Introducción El síndrome de apneas-hipopneas del sueño (SAHS) es una entidad relativamente frecuente en niños. La polisomnografía es el patrón oro para el diagnóstico; sin embargo, dada la dificultad técnica y económica para realizarla, han surgido nuevas alternativas como la poligrafía respiratoria hospitalaria (PRH) y domiciliaria (PRD), que en niños con sospecha clínica de SAHS están obteniendo resultados satisfactorios. Objetivo El objetivo de nuestro estudio ha sido analizar en una muestra de niños y niñas, remitidos a consultas de Neumología Infantil por sospecha de apneas del sueño, ronquido o ambos, la rentabilidad de la PRD en el diagnóstico de SAHS. Material y métodos Se ha realizado anamnesis, exploración física, radiografía de tórax y cavum y poligrafía respiratoria (PR) del sueño en todos los casos. Se han analizado las variables cualitativas: lugar de realización, resultado, sexo, motivo de consulta, procedencia, consultas externas de otorrinolaringología (ORL) y tratamiento. Las variables cuantitativas han sido la edad, el número total apneas y de hipopneas, el índice de apneas hora, el índice de hipopneas hora, índice de apneas-hipopneas hora, saturación de oxígeno por pulsioximetría (SpxO2) medio y mínimo, número ronquidos e índice ronquidos hora. Se ha realizado análisis estadístico mediante chi cuadrado de Pearson y la t de Student. Se han estudiado 132 pacientes, 44 de ellos (33,3 %) mediante PRD (grupo 1) y 88 (66,6 %) mediante PRH (grupo 2). En el grupo 1, fueron estudios no válidos 2 (4,5 %) y la edad media fue de 8,3 años (desviación estándar [DE] 3,02). Resultados Los resultados de la PRD en medias y DE fueron: índice de apnea-hipopnea (IAH)/h 3,4 (4,3), SpxO2 media 97,3 (1,8) y SpxO2 mínima 87,7 (10,3). En el grupo 2 fueron estudios no válidos 4 (4,5 %) y la edad media fue de 7,4 años (DE 3). Los resultados de la PRH fueron: IAH/h 4,45 (5,4), SpxO2 media 96,8 (1,8) y SpxO2 mínima 87 (11). No se han encontrado diferencias significativas entre validez de la PR y lugar de realización de la prueba. Así mismo, tampoco se han encontrado diferencias entre edad, IAH/h, SpxO2 y lugar de realización de la PR. Conclusión Podemos decir que en nuestra muestra, la rentabilidad diagnóstica de la poligrafía respiratoria domiciliaria ha sido igual que la hospitalaria. Así mismo, ofrece la posibilidad de realizar un estudio más fisiológico del sueño y ofrece además una mayor rentabilidad económica, al eliminar el coste de hospitalización. Se trataría, por tanto, de una técnica diagnóstica válida y fiable para el diagnóstico de SAHS en la infancia

Introduction Sleep apnea-hypopnea syndrome (SAHS) is relatively frequent in children. The gold standard for diagnosis is polysomnography. However, because of technical difficulties and the cost of this method, new alternatives have become available, such as respiratory polygraphy (RP) performed at home or in hospital, which have provided satisfactory results in children with clinical suspicion of SAHS. Objective The aim of this study was to analyze the diagnostic utility of in-home RP in the diagnosis of SAHS in a sample of boys and girls referred to the pediatric respiratory care department for suspected sleep apnea, snoring, or both. Material and methods In all patients, a history and physical examination were performed; X-ray of the chest and cavum and RP were carried out. The following qualitative variables were analyzed: place where RP was performed, the result, sex, the reason for consulting, place of residence, results of otorhinolaryngological examination, and treatment. The quantitative variables analyzed were age, total number of apneas, total number of hypopneas, apnea index/hour, hypopnea index/hour, mean and minimum SpxO2, number of snores per hour and the snore index/hour. Statistical analysis was performed using Pearson's chi-square test and Student's t-test. Results A total of 132 patients were studied, 44 (33.3 %) through in-home RP (group 1) and 88 (66.6 %) through in-hospital RP (group 2). In group 1, two recordings (4.5 %) were considered nonvalid. The mean age of the patients was 8.3 years (SD 3.02). The results [means (standard deviation)] of in-home RP were as follows: apnea-hypopnea index (AHI)/h: 3.4 (4.3); mean SpxO2: 97.3 (1.8); minimum SpxO2: 87.7 (10.3). In group 2, four recordings (4.5 %) were nonvalid. The mean age of the patients was 7.4 years (SD 3). The results of in-hospital RP were as follows: AHI/h: 4.45 (5.4); mean SpxO2: 96.8 (1.8); minimum SpxO2: 87 (11). No significant differences were found between the validity of in-home and in-hospital RP. Likewise, no significant differences were found between AHI/h, SpxO2 and in-home and in-hospital RP. Conclusion In conclusion, in our sample, the diagnostic utility of in-home RP was equal to that of in-hospital RP. In-home RP allows the possibility of performing a more physiological sleep study and, by eliminating the cost of hospitalization, is more cost-efficient. Therefore, in-home RP is a valid and reliable technique for the diagnosis of childhood SAHS

[Obstructive sleep apnea-hypopnea syndrome]. / Síndrome de apneas-hipopneas obstructivas del sueño.

We analyzed a cohort of 400 patients referred from the otorhinolaryngology department (40.05 %), primary care (PC) (36.52 %), and the pediatric pulmonary unit (17.63 %). The children were referred for clinical suspicion of apneas in 191 (47.87 %), snoring and apneas in 101 (25 %), and snoring in 87 (21.80 %). Adenotonsillar hypertrophy was found in 211 patients (52.75 %), tonsillar hypertrophy in 87 (21.75 %), and adenoid hypertrophy in 73 (18.25 %). All patients underwent respiratory polygraphy (RP) during sleep. Obstructive sleep apnea-hypopnea syndrome (OSAHS) was diagnosed in 298 patients (74.5 %). OSAHS was mild in 96 patients (24 %), moderate in 148 (37 %), and severe in 54 (13.5 %). The results of RP expressed in means plus standard deviation were as follows: number of apneas 21.38 (24.47), number of hypopneas 19.81 (20.74), apnea-hypopnea index per hour (AHI/h) 5.29 (7.10), mean oxygen saturation 94.60 (11.80), minimal saturation 83.14 (13.45), number of snores 98.27 (254.55), and snoring index per hour 5.68 (6.5). Significant differences were found between oxygen saturation and AHI/h per hour. No differences were found among age, mean oxygen saturation, area of residence, reason for consulting, and AHI/h. Adenotonsillectomy was performed in 289 patients (72.25 %) of the initial cohort. In conclusion, OSAHS in childhood is frequent. RP during sleep aids diagnosis. The main cause of OSAHS in children is adenotonsillar hypertrophy.

[Current prevalence of asthma in schoolchildren in San Sebastián (Spain)]. / Prevalencia actual de asma en escolares en San Sebastián.

OBJECTIVE: To determine the current prevalence of asthma in children aged 6-12 years old in San Sebastian (Guipuzcoa, Spain). PATIENTS AND METHODS: An observational, cross sectional study was performed in 6-12-year-old children in schools. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was employed. Bronchial hyperresponsiveness was investigated using the free running test, with peak expiratory flow (PEF) measured with a peak flow meter as the main measurement. The ISAAC questionnaire (n = 919) was distributed to 460 boys (50.1%) and 459 girls (49.9%) with a mean age of 8 years (SD 1.87). The response rate to the questionnaire was 93 % (n = 855). Participation in the free running test was 90.8% (n = 835). A total of 89.88% of the children (n = 826) completed both tests. RESULTS: The questionnaire of symptoms and signs compatible with asthma revealed a current prevalence of asthma of 25.56% (n = 216) and a cumulative prevalence of 25.44% (n = 85). Nocturnal asthma was found in 29.37% (n = 47) and severe asthma in 9.27% (n = 14). Bronchial hyperresponsiveness was found in 23% of the participants. An epidemiological diagnosis of asthma (asthma-related symptoms plus bronchial hyperresponsiveness) was made in 6.54%. CONCLUSIONS: The current prevalence of asthma in 6-12-year-old schoolchildren in San Sebastian, determined through symptoms and signs compatible with asthma in the previous year and a positive free running test, is similar to that reported in other national studies.

Prevalencia actual de asma en escolares en San Sebastián / Current prevalence of asthma in schoolchildren in San Sebastián (Spain)

Objetivo: Determinar la prevalencia actual de asma en escolares de 6 a 12 años en San Sebastián (España). Pacientes y métodos: Estudio observacional y transversal en centros escolares en niños de 6 a 12 años, mediante cuestionario de síntomas relacionados con asma (International Study of Asthma and Allergies in Childhood, ISAAC) y estudio de la hiperreactividad bronquial (HRB) (carrera al aire libre con esfuerzo máximo), utilizando como medida principal el flujo espiratorio máximo (FEM) medido con mini-wright. Se distribuyó el cuestionario ISAAC (n = 919) a 460 niños (50,1 %) y 459 niñas (49,9 %), con una media de edad de 8 años (desviación estándar [DE]: 1,87). La tasa de respuesta al cuestionario ISAAC fue del 93 % (n = 855). La participación en el test de carrera al aire libre fue del 90,8 % (n = 835). Completaron ambas pruebas el 89,88 % (n = 826). Resultados: Cuestionario de signos y síntomas compatibles con asma: prevalencia actual del asma, 25,56 % (n = 216); prevalencia acumulada, 25,44 % (n = 85); asma nocturna, 29,37 % (n = 47), y asma grave, 9,27 % (n = 14). Se ha objetivado HRB en el 23 % de los participantes. El diagnóstico epidemiológico del asma (síntomas relacionados con asma más HRB) ha sido del 6,54 %. Conclusiones: La prevalencia actual del asma en San Sebastián en escolares de 6-12 años, determinada mediante signos y síntomas compatibles con asma durante el último año y test de carrera libre positivo, es similar a otros estudios nacionales

Objective: To determine the current prevalence of asthma in children aged 6-12 years old in San Sebastian (Guipuzcoa, Spain). Patients and methods: An observational, cross sectional study was performed in 6-12-year-old children in schools. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was employed. Bronchial hyperresponsiveness was investigated using the free running test, with peak expiratory flow (PEF) measured with a peak flow meter as the main measurement. The ISAAC questionnaire (n = 919) was distributed to 460 boys (50.1 %) and 459 girls (49.9 %) with a mean age of 8 years (SD 1.87). The response rate to the questionnaire was 93 % (n = 855). Participation in the free running test was 90.8 % (n = 835). A total of 89.88 % of the children (n = 826) completed both tests. Results: The questionnaire of symptoms and signs compatible with asthma revealed a current prevalence of asthma of 25.56 % (n = 216) and a cumulative prevalence of 25.44 % (n = 85). Nocturnal asthma was found in 29.37 % (n = 47) and severe asthma in 9.27 % (n = 14). Bronchial hyperresponsiveness was found in 23 % of the participants. An epidemiological diagnosis of asthma (asthma-related symptoms plus bronchial hyperresponsiveness) was made in 6.54 %. Conclusions: The current prevalence of asthma in 6-12-year-old schoolchildren in San Sebastian, determined through symptoms and signs compatible with asthma in the previous year and a positive free running test, is similar to that reported in other national studies

Síndrome de apneas-hipopneas obstructivas del sueño / Obstructive sleep apnea-hypopnea syndrome

Se ha analizado una cohorte de 400 pacientes remitidos desde consultas de otorrinolaringología (ORL) (40,05 %), de atención primaria (AP) (36,52 %) y de la unidad de neumología infantil (UNI) (17,63 %). El motivo de consulta fue la sospecha clínica de apneas en 191 pacientes (47,87 %), ronquido y apneas en 101 (25 %) y ronquido en 87 (21,80 %). En 211 casos (52,75 %) se constató hipertrofia adenoamigdalar, en 87 (21,75 %) hipertrofia amigdalar y en 73 (18,25 %) hipertrofia adenoidea. En todos los casos se realizó poligrafía respiratoria del sueño (PR) y se diagnosticó síndrome de apneas-hipopneas obstructivas del sueño (SAHOS) en 298 casos (74,5 %), distribuido en leve en 96 casos (24 %), moderado en 148 casos (37 %) y grave en otros 54 casos (13,5 %). Los resultados de la PR del sueño expresados en medias y desviación estándar fueron los siguientes: número de apneas 21,38 (24,47); número de hipopneas 19,81 (20,74); índice de apneas-hipopneas por hora 5,29 (7,10); saturación media de oxígeno 94,60 (11,80); saturación mínima 83,14 (13,45); número de ronquidos 98,27 (254,55) e índice de ronquidos por hora 5,68 (6,5). Se han encontrado diferencias significativas entre saturación de oxígeno y el índice de apneas e hipopneas por hora. No se han encontrado diferencias entre edad, saturación media, procedencia, motivo de consulta e índice de apneas e hipopneas por hora. Se realizó adenoamigdalectomía en 289 casos (72,25 %) de la cohorte inicial. En conclusión, el SAHOS en la infancia es una patología frecuente, el estudio mediante poligrafía respiratoria del sueño facilita el diagnóstico y la hipertrofia adenoamigdalar es la principal causa de SAHOS en niños

We analyzed a cohort of 400 patients referred from the otorhinolaryngology department (40.05 %), primary care (PC) (36.52 %), and the pediatric pulmonary unit (17.63 %). The children were referred for clinical suspicion of apneas in 191 (47.87 %), snoring and apneas in 101 (25 %), and snoring in 87 (21.80 %). Adenotonsillar hypertrophy was found in 211 patients (52.75 %), tonsillar hypertrophy in 87 (21.75 %), and adenoid hypertrophy in 73 (18.25 %). All patients underwent respiratory polygraphy (RP) during sleep. Obstructive sleep apnea-hypopnea syndrome (OSAHS) was diagnosed in 298 patients (74.5 %). OSAHS was mild in 96 patients (24 %), moderate in 148 (37 %), and severe in 54 (13.5 %). The results of RP expressed in means plus standard deviation were as follows: number of apneas 21.38 (24.47), number of hypopneas 19.81 (20.74), apnea-hypopnea index per hour (AHI/h) 5.29 (7.10), mean oxygen saturation 94.60 (11.80), minimal saturation 83.14 (13.45), number of snores 98.27 (254.55), and snoring index per hour 5.68 (6.5). Significant differences were found between oxygen saturation and AHI/h per hour. No differences were found among age, mean oxygen saturation, area of residence, reason for consulting, and AHI/h. Adenotonsillectomy was performed in 289 patients (72.25 %) of the initial cohort. In conclusion, OSAHS in childhood is frequent. RP during sleep aids diagnosis. The main cause of OSAHS in children is adenotonsillar hypertrophy

[Agreement between tracheal auscultation and pulmonary function in methacholine bronchial inhalation challenge in asthmatic children]. / Medida de la respuesta bronquial a la metacolina en niños asmáticos mediante la auscultación traqueal.

BACKGROUND: PC wheezing (PCw) is defined as the concentration of methacholine at which wheeze is detected on auscultation of the trachea. PCw has been suggested as a measure of bronchial hyperresponsiveness in methacholine challenge testing (MCT). OBJECTIVE: The aim of this study was to determine the agreement between the concentration of methacholine that produces a 20 % decrease in forced expiratory volume in 1 second (FEV1) (PC20) and PCw in MCT in asthmatic children. PATIENTS AND METHODS: Eighteen asthmatic children with a mean age of 11.5 years (range: 6-16 years) were studied. Fifteen of the children were under treatment with inhaled glucocorticoids. MCT was performed according to the guidelines of the American Thoracic Society (1999) using a Hudson nebulizer calibrated to obtain a mean output of 0.14 ml/min. After each nebulization, two independent observers registered FEV1 and tracheal auscultation. FEV1 was determined by forced spirometry 30 and 90 seconds after the end of nebulization and PC20 was registered (exponential model). Respiratory rate and transcutaneous oxygen saturation were continuously monitored. Tracheal auscultation was performed at 0, 60 and 120 seconds after the end of nebulization. The end point was defined as the appearance of wheezing over the trachea. The values of PC20 and PCw, as well as the concentration of methacholine corresponding to a decrease in FEV1 equal to or higher than 20 %, were compared using Student's matched pairs-test and Wilcoxon's test. The degree of agreement between variables was compared by using Bland-Altman's test. RESULTS: MCT was positive in 17 of 18 patients. No differences were found between PC20 and PCw (p 0.15). Both variables showed agreement in 12 of 17. A clear association was found between both measures (log PCw, log PC20): R: 0.92; p < 0.001. The mean decrease in FEV1 on reaching PCw was 24.8 % (range: 10-41). No adverse effects were observed. CONCLUSION: The agreement between PC20 and PCw in MCT in asthmatic children is excellent. PCw could be helpful in determining bronchial hyperresponsiveness in young asthmatic children in whom spirometry is not feasible.

Medida de la respuesta bronquial a la metacolina en niños asmáticos mediante la auscultación traqueal / Agreement between tracheal auscultation and pulmonary function in methacholine bronchial inhalation challenge in asthmatic children

Antecedentes: La PC wheezing (PCw) o concentración de metacolina que provoca sibilancias auscultables en tráquea parece ser un parámetro válido de la respuesta bronquial mediante el test de metacolina (TMCh). Objetivo: Evaluar la concordancia entre la concentración de metacolina que produce un descenso del 20% del volumen espiratorio máximo al primer segundo (FEV1, PC20) y PCw en el TMCh en niños asmáticos colaboradores. Pacientes y métodos: Se estudian 18 niños asmáticos de edad media 11,5 (límites, 6-16) años, 15/18 en tratamiento con glucocorticoides inhalados. Se realizó el TMCh según las normas de la American Thoracic Society (ATS) (1999) utilizando un nebulizador Hudson calibrado para obtener un débito de 0,14 ml/min. Tras cada nebulización, dos observadores independientes registraron el FEV1 y la auscultación traqueal. El FEV1 se determinó mediante espirometría forzada a los 30 y 90 s posnebulización y la PC20 por interpolación exponencial. Se monitorizaron de forma continua la frecuencia respiratoria y la saturación transcutánea de oxígeno. La tráquea se auscultó los 0, 60 y 120 s posnebulización. La prueba se consideró positiva al auscultar sibilancias sobre la tráquea. Se compararon los valores de PC20 y PCw, así como la concentración de metacolina correspondiente al descenso del FEV1 igual o superior al 20% con la PCw, mediante el test de la t de Student pareada y la prueba de Wilcoxon, y el grado de acuerdo de dichas variables con el test de Bland-Altman. Resultados: El TMCh fue positivo en 17/18 pacientes, sin diferencias entre PC20 y PCw (p 0,15). Ambos parámetros coincidieron en 12/17 casos. Hay una asociación evidente entre ambas medidas (log PCw, log PC20): R, 0,92; p < 0,001. El descenso medio del FEV1 al alcanzar la PCw fue del 24,8% (rango, 10-41). No se objetivaron efectos adversos en ningún caso. Conclusión: La concordancia entre PCw y PC20 en el TMCh en niños asmáticos colaboradores es excelente, y la PCw podría evaluar la hiperreactividad bronquial en el niño no colaborador (AU)