Historia natural precoz de la enfermedad. ¿Qué podemos decir de los estudios longitudinales de cohortes? / No disponible

No disponible

[Study of the obsesity and overweight as a risk factor for asthma and severity of the asthma in children of Valencia (Spain)]. / Estudio de la obesidad y del sobrepeso como factores de riesgo de la prevalencia y severidad del asma en niños de Valencia.

BACKGROUND: Obesity and overweight have been described as factors associated with asthma. Our aim was to evaluate the role obesity plays on asthma in children. SCOPE AND SUBJECTs: A study carried out on children and teenagers between 8 and 15 years of age, chosen for a cluster-type random sampling from children who studied in 80 schools, which represents 30% of the schools in the city of Valencia. MATERIAL AND METHODS: The analysed data was organized into two groups, obese (from the Body Mass Index (Kg/m2)), showing children with a percentile over 85% of the measuring reference for the Spanish population) and non obese, when they did not fulfil this condition. The prevalence of the different parameters studied was calculated by an Interval of Confidence of 95%. The risk was calculated (Relative Risk) from those symptoms compatible with asthma among obese children compared to non obese children. RESULTS: No significant relative risk (RR) was seen for obesity with regards to asthma in those percentiles of obesity over 85. Otherwise, an increase in the relative risk (RR) regarding the severity of asthma was seen in relation to obesity, mainly in the 85th percentile (RR = 1.51 of suffering between 4-12 wheezing attacks and RR = 1.86 of suffering more than 12 attacks in obese children as opposed to non obese children). CONCLUSIONS: In this study, we did not identify a higher risk of asthma among obese children than among non obese children, although we did find there was a higher risk of severity of asthmatic symptoms. As far as the severity of the asthma is concerned, we saw a higher risk of wheezing and whistling attacks among obese children with the 85th and the 95th percentiles according to the Body Mass Index.

Estudio de la obesidad y del sobrepeso como factores de riesgo de la prevalencia y severidad del asma en niños de Valencia / Study of the obsesity and overweight as a risk factor for asthma and severity of the asthma in children of Valencia (Spain)

Antecedentes: La obesidad y el sobrepeso se han descrito como factores de riesgo asociados a la prevalencia y severidad del asma en niños y adolescentes. El objetivo del estudio ha sido el valorar el papel de la obesidad en el asma infantil. Ámbito de estudio y sujetos: Estudio realizado en niños y adolescentes entre 8 y 15 años, elegidos por un muestreo aleatorio tipo cluster entre los niños que estudiaban en 80 colegios, el cual representa el 30% de los colegios de la ciudad de Valencia. Material y métodos: El análisis de los datos se organizó en dos grupos, obesos (aquellos niños en un percentil superior al 85 del Índice de Masa Corporal (kg/m2), tomando como referencia la población española) y no obesos, cuando no cumplían esta condición. Se calcularon la prevalencia de los diferentes parámetros con un intervalo de confianza al 95%, y el riesgo relativo (RR) de los síntomas compatibles con asma entre niños obesos comparándolos con los no obesos. Resultados: No se obtuvo un riesgo relativo significativo para la obesidad con respecto al asma en aquellos niños por encima del percentil 85. Por otra parte, un incremento en el riesgo en relación con la severidad del asma se observó con la obesidad, principalmente en el percentil 85 (RR = 1,51 de sufrir entre 4-12 ataques de pitos y RR = 1,86 de sufrir más de 12 ataques en niños obesos frente a los no obesos). Conclusiones: En este estudio, no identificamos un riesgo más alto de asma entre niños obesos frente a los no obesos, aunque encontramos que hubiera un riesgo más alto de severidad de síntomas asmáticos. En relación con la severidad del asma, observamos un riesgo más alto de ataques de pitos y sibilancias entre los niños obesos en los percentiles 85 y 95 del Indice de Masa Corporal (AU)

Background: Obesity and overweight have been described as factors associated with asthma. Our aim was to evaluate the role obesity plays on asthma in children. Scope and subjects: A study carried out on children and teenagers between 8 and 15 years of age, chosen for a cluster-type random sampling from children who studied in 80 schools, which represents 30% of the schools in the city of Valencia. Material and Methods: The analysed data was organized into two groups, obese (from the Body Mass Index (Kg/m2)), showing children with a percentile over 85% of the measuring reference for the Spanish population) and non obese, when they did not fulfil this condition. The prevalence of the different parameters studied was calculated by an Interval of Confidence of 95%. The risk was calculated (Relative Risk) from those symptoms compatible with asthma among obese children compared to non obese children. Results: No significant relative risk (RR) was seen for obesity with regards to asthma in those percentiles of obesity over 85. Otherwise, an increase in the relative risk (RR) regarding the severity of asthma was seen in relation to obesity, mainly in the 85th percentile (RR = 1.51 of suffering between 4-12 wheezing attacks and RR = 1.86 of suffering more than 12 attacks in obese children as opposed to non obese children).  Conclusions: In this study, we did not identify a higher risk of asthma among obese children than among non obese children, although we did find there was a higher risk of severity of asthmatic symptoms. As far as the severity of the asthma is concerned, we saw a higher risk of wheezing and whistling attacks among obese children with the 85th and the 95th percentiles according to the Body Mass Index (AU)

Conocimientos sobre el asma infantil entre el profesorado escolar / Knowledge about asthma in children between school teachers

Antecedentes y objetivo: El asma continúa siendo la causa más común de enfermedad crónica entre los escolares, y es una de las principales causas de absentismo. Estudios sobre la salud escolar mostraron la relevancia de los profesores desde el punto de vista sanitario. Estudiar los conocimientos sobre el asma y enfermedades alérgicas del profesorado de los centros escolares para conocer las posibles orientaciones en la atención al niño asmático. Material y métodos: Estudio realizado en centros escolares de educación primaria y secundaria de Valencia. Se trata de un estudio descriptivo, entre 772 profesores que cumplimentaron un cuestionario sobre experiencia personal, conocimientos generales e información sobre el asma y la alergia. Resultados: El 92,2% de los profesores identificaba el ahogo como un síntoma del asma, el 71,9% y el 66,0% relacionan los sibilancias espontáneas y las sibilancias al realizar el ejercicio físico, respectivamente. El 88,5% manifestó que no había recibido suficiente información sobre el asma y el 92,1% sobre la alergia. Conclusiones: Se necesitaría una mayor información en los centros escolares de las pautas a seguir en caso de que haya niños asmáticos para su mejor atención así como para identificar a aquellos niños con esta enfermedad

Antecedents and objectives: Asthma is the most common cause of chronic disease in childhood, and one the most causes of scholar absenteeism. Studies showed the importance of the role that teachers play in children´s health. This work is performed to study the knowledge about asthma and allergy between school teachers, to know possible ways in the asthmatic child care. Material and Methods: Study about the knowledge of asthma and allergy in childhood. It was carried out in school canters of compulsory education in Valencia (Spain). The descriptive study was made among 772 teachers, who filled a questionnaire about personal experience, general knowledge and information about asthma, allergy and atopic dermatitis in childhood. Results: The 92.2% of the teachers identified the breathlessness as an asthma symptom, 71,9% and 66.0% knew whistles and whistle during physical exercise, respectively. The 88.5% answered they had not received enough information about asthma and 92.1% about allergy. Conclusions: In the case of asthmatic children in school centers, more information about the guidelines to follow will be necessary to improve their care, as well as to identify these children with asthma symptoms

[Prevalence of atopic dermatitis in schoolchildren from Cartagena (Spain) and relationship with sex and pollution]. / Prevalencia de la dermatitis atópica en escolares de Cartagena y su relación con el sexo y la contaminación.

BACKGROUND: Atopic dermatitis is favored by exogenous factors, such as air pollution interacting with a genetic predisposition. OBJECTIVE: The aim of the present study was to evaluate the influence of sex and air pollution in the city of Cartagena on the prevalence of atopic dermatitis. DESIGN AND METHODS: We performed a cross-sectional study using the ISAAC questionnaire in schoolchildren aged 13 and 14 years old from Cartagena (Murcia). The influence of sex and the schools' location in two distinct areas (polluted and unpolluted) on the prevalence of atopic dermatitis and its severity (described as being awakened by nocturnal itching) was analyzed. RESULTS: The prevalence of atopic eczema was 6.3 %. Atopic eczema was severe in 19 % of the cases. Risk factors for atopic eczema were female sex (OR 2.19 95 % CI: 1.59-3. 02) and attending school in a polluted area (OR: 1.83, 95 % CI 1.01-1.87) but these factors were not associated with greater severity. CONCLUSIONS: Air pollution is associated with a higher prevalence of atopic eczema and there is a trend that this eczema is more severe. The condition was more prevalent among girls.

Prevalencia de la dermatitis atópica en escolares de Cartagena y su relación con el sexo y la contaminación / PRevalence of atopic dermatitis in schoolchildren from Cartagena (Spain) and relationship with sex and pollution

Objetivo El objetivo del presente trabajo es estudiar la prevalencia de la dermatitis atópica y la influencia del sexo y la contaminación atmosférica de la ciudad de Cartagena. Métodos y diseño Estudio transversal, mediante encuesta de investigación del Estudio ISAAC (International Study of Asthma and Allergies in Childhood), en los escolares de 13 y 14 años de Cartagena (Murcia), analizando el sexo y la ubicación de los colegios a los que acuden estos escolares según dos zonas (contaminada y no), establecidas previamente; y la prevalencia y gravedad del eccema (manifestado por despertar por la noche a causa del prurito), según el sexo y según cada zona analizada. Resultados Los resultados muestran una prevalencia del eccema atópico del 6,3 por ciento, y es grave en una quinta parte de los casos, con mayor prevalencia significativa (odds ratio [OR], 2,19; intervalo de confianza del 95 por ciento [IC 95 por ciento], 1,59-3,02), pero no mayor gravedad, en el sexo femenino, y con mayor prevalencia (OR, 1,83; IC 95 por ciento, 1,01-1,87), pero tampoco mayor gravedad significativas en los escolares que asisten a los colegios en la zona contaminada. Conclusiones La contaminación atmosférica se asocia con una mayor prevalencia de eccema atópico y existe una tendencia de que éste sea más grave. El eccema fue más prevalente entre las niñas (AU)

Asociación entre dermatitis atópica, rinitis alérgica y asma en escolares de 13 y 14 años / Association between atopic dermatitis, allergic rhinitis and asthma in schoolchildren aged 13-14 years old

Antecedentes La dermatitis atópica está en íntima relación con otras enfermedades atópicas, particularmente con asma y rinitis alérgica. A pesar de haber cierto acuerdo en que el padecimiento de eccema atópico predispone al padecimiento de asma y rinitis, es preciso cuantificar el riesgo en las poblaciones, siguiendo un método de estudio estandarizado, que es el objetivo del presente trabajo.Método Siguiendo una metodología de encuesta de investigación del estudio ISAAC, en un estudio transversal, hemos analizado, y cuantificado, en la población de escolares de 13 y 14 años de la ciudad de Cartagena (Murcia), la asociación del padecimiento y gravedad de eccema atópico con el de la rinitis alérgica, el asma y el asma alérgica.Resultados Los resultados han mostrado, cuantificando el riesgo, que los escolares con eccema atópico, respecto a los que no lo padecen, tienen un riesgo triple de tener rinitis alérgica (odds ratio [OR], 3,33; intervalo de confianza del 95 por ciento [IC 95 por ciento], 2,45-4,54), cuádruple de tener asma (OR, 3,85; IC 95 por ciento, 2,74-5,42) y quíntuple de tener asma alérgica (OR, 4,91; IC 95 por ciento, 3,17-7,59), estando en relación directa las gravedades respectivas (AU)

[Association between atopic dermatitis, allergic rhinitis and asthma in schoolchildren aged 13-14 years old]. / Asociación entre dermatitis atópica, rinitis alérgica y asma en escolares de 13 y 14 años.

BACKGROUND: Atopic dermatitis is closely related to other atopic diseases, especially asthma and allergic rhinitis. Although there is a certain agreement that suffering from atopic eczema predisposes to asthma and allergic rhinitis, the risk of developing these diseases should be quantified in populations following a standardized method, which is the objective of this study. METHOD: Using the questionnaire from the International Study of Asthma and Allergy in Childhood (ISAAC), we performed a cross-sectional study of all schoolchildren aged 13 and 14 years old in the city of Cartagena (Murcia, Spain). The relationship between atopic dermatitis and its severity with asthma, allergic asthma, and allergic rhinitis was analyzed. RESULTS: Quantification of risk showed that schoolchildren with atopic eczema had a 3-fold risk of allergic rhinitis (OR: 3.33; 95 % CI: 2.45-4.54), a 4-fold risk of asthma (OR: 3.85; 95 % CI: 2.74-5.42) and a 5-fold risk of allergic asthma (OR: 4.91; 95 % CI: 3.17-7.59) compared with schoolchildren without atopic eczema. The severity of eczema was also directly related to that of asthma and rhinitis.

[International Study of Asthma and Allergies in Childhood (ISAAC) Phase II: Methodology and results of the participation rate in Spain]. / International Study of Asthma and Allergies in Childhood (ISAAC) fase II: metodología y resultados de participación en España.

BACKGROUND: The ISAAC phase I results have supplied valuable information on the prevalence of asthma and allergy in childhood throughout the world. OBJECTIVES: To describe the implementation and participation rate of normal children in each test performed in phase II of the ISAAC in the four Spanish cities participating the study, and to establish the influence of type of school and geographical situation (in a polluted or unpolluted area) in Cartagena. METHODS: The ISAAC phase II included a questionnaire on symptoms, risk factors and treatment, skin examination, skin-prick test, bronchial challenge test, total and specific IgE measurement, as well as mite and bacterial endotoxin determination in house dust. The questionnaire was distributed with a letter requesting authorization from the parents in primary schools (fourth and fifth grades) in sufficient number to achieve approximately 1,000 skin prick-test authorizations in each city. RESULTS: The participation rate for the questionnaire, skin examination, skin-prick test, blood extraction, bronchial challenge test, and dust collection was, respectively, for each city: Cartagena: 58.9, 49.2, 43.2, 33.1, 39.9 and 29.8 %; Almería: 42.5, 40.6, 39.1, 39.1 and 37.6 %; Valencia: 43.7, 30.4, 23.5, 21.5, 20.1 and 17.1 %; Madrid: 53.2, 40.8, 38.6, 27.6, 30.6 and 21.1 %. In Cartagena, participation was significantly higher in private schools receiving a state subsidy and in those in unpolluted areas. CONCLUSIONS: The participation rate was highly variable and lower than that among the European centres that have already completed the study. The rate was significantly influenced by geographical area and type of school.

International Study of Asthma and Allergies in Childhood (ISAAC) fase II: metodología y resultados de participación en España / International study of asthma and allergies in childhood (isaac) phase ii: methodology and results of the participation rate in spain

Antecedentes: La fase I del ISAAC ha proporcionado información muy valiosa sobre la prevalencia mundial de asma y alergia en la infancia. Objetivos: Describir la puesta en marcha de la fase II del estudio y la participación de niños normales en cada una de las pruebas que se realizan, en las cuatro ciudades participantes en España, y establecer en Cartagena, qué influencia puede tener el tipo de colegio o la localización (área contaminada o no). Métodos: En su fase II, el ISAAC incluye cuestionario de síntomas y de factores de riesgo y tratamiento, examen de piel, prick-test cutáneo, prueba de provocación bronquial, determinación de inmunoglobulina E (IgE) total y específica, y medición de ácaros y endotoxinas bacterianas en polvo doméstico. Se repartió un cuestionario junto con la petición de autorización de los padres, al número de colegios necesario (clase de cuarto y quinto de primaria) para obtener alrededor de 1.000 autorizaciones para la realización de la prueba de prick-test en cada ciudad. Resultados: La participación en el cuestionario, examen de piel, prick-test, extracción de sangre, provocación bronquial y recogida de polvo fueron, respectivamente, para cada ciudad: Cartagena, 58,9; 49,2; 43,2; 33,1; 39,9 y 29,8%; Almería, 42,5; 40,6; 39,1; 39,1 y 37,6 %; Valencia, 43,7; 30,4; 23,5; 21,5; 20,1 y 17,1%; Madrid, 53,2; 40,8; 38,6; 27,6; 30,6 y 21,1%. En Cartagena, la participación fue significativamente mayor en los colegios concertados, así como en los del área no contaminada. Conclusiones: La participación es muy variable, aunque más baja que en los centros europeos en los que el estudio ha finalizado. La zona y el tipo de colegio influyen significativamente en la participación (AU)

[Asthma and chronic diseases of the upper respiratory airway]. / Asma y enfermedades crónicas de la vía respiratoria superior.

There is enough evidence of an epidemiological, etiological and physiopathological link between chronic rhinitis (usually allergic) and asthma, and also between chronic sinusitis (generally bacterial) and this disease. Allergic inflammation of nasal mucosa could favor the development of chronic sinusitis. Indeed, some authors believe that the term "rhinosinusitis" should be used as nasal and sinus mucosa are one and the same thing. Some studies have demonstrated that treatment of chronic rhinitis or chronic sinusitis produces a benefit in the evolution of asthma when both diseases co-occur in the same patient, which suggests a therapeutic link. However, there is insufficient evidence that adenoidectomy and/or tonsillectomy worsen the evolution of asthma. When managing the asthmatic child, physicians should not forget to pay attention to the upper respiratory tract, evaluating and treating diseases in this area if necessary, as such therapeutic measures will also benefit asthma control.

Asma y enfermedades crónicas de la vía respiratoria superior / Asthma and chronic diseases of the upper respiratory airway

Existen suficientes pruebas de una conexión epidemiológica, etiológica y fisiopatológica entre la rinitis crónica, en la mayoría de los casos de etiología alérgica, y el asma, así como entre la sinusitis crónica, por lo general bacteriana, y esta misma enfermedad. La inflamación alérgica de la mucosa nasal podría favorecer el desarrollo de una sinusitis crónica propiamente dicha. De hecho, algunos autores piensan que debería hablarse de "rinosinusitis" puesto que se trata de la misma mucosa. Algunos estudios demuestran que el control terapéutico tanto de la rinitis como de la sinusitis crónicas produce una mejoría en la evolución del asma cuando ambas entidades clínicas se observan en el mismo enfermo, por lo que también existe una conexión terapéutica. Por otra parte, no existen pruebas suficientes de que la adenoidectomía y/o la amigdalectomía empeore la evolución del asma. En el tratamiento del niño asmático debe prestarse también atención a la vía superior y evaluar y tratar la enfermedad de esta zona, sabiendo que este control redundará en un beneficio del control de la propia asma (AU)

[Peak inspiratory flow using 2 different inhalers and a new portable device]. / Pico de flujo inspiratorio de dos inhaladores diferentes con un nuevo aparato portátil.

BACKGROUND: Inhaled medication through dry powder inhalers is widely used in children, but pediatric studies focussing on the ages at which these devices can be used are sparse. OBJECTIVE: To establish the difference in peak inspiratory flow (PIF) through Accuhaler and Turbuhaler in healthy children using a new device, In-check, and to determine the differences between the two different models of this device. METHODS: PIF was measured in 64 healthy male children (mean age 11.2 years, range 8.8-14.7) by means of In-check and In-check Dial using Accuhaler and Turbuhaler resistances. The best attempt of three was chosen. Height,weight, and forced expiratory volume in 1 second were also measured. RESULTS: Significant differences in PIF were found between the two inhalers: PIF In-check Accuhaler-PIF In-check Turbuhaler (134.4 +/- 15.5 L/min vs 99.9 6 +/- 11.1 L/min; p<0,000) and PIF In-check Dial Accuhaler-PIF In-check Dial Turbuhaler (109.6+/-10.5 L/min vs 86.8+/-8.9 L/min; p<0.000). The best correlation obtained among the different In-check measurements was between In-check Ac-cuhaler and In-check Turbuhaler (r=0.88; p<0.001), and the worst was between In-check Dial Accuhaler and In-check Turbuhaler (r =0.71; p<0.001). CONCLUSIONS: PIF through Accuhaler is significantly higher than that through Turbuhaler, although in both cases PIF was sufficient to provide adequate distribution of the inhaled medication in children aged 9-14 years. Consequently, in children younger than 9 years old, and especially during an asthma attack, In-check should be tried in order to discover whether the child is capable of using Turbuhaler correctly.

Pico de flujo inspiratorio de dos inhaladores diferentes con un nuevo aparato portátil / Peak inspiratory flow in healthy children aged 9-14years through two inhalers, using two different models of a new portable apparatusbackground

Antecedentes: La medicación inhalada a través de dispositivos de polvo seco se utiliza cada vez más en niños, pero hay pocos estudios pediátricos que determinen a qué edades es posible su uso. Objetivos: Establecer la diferencia en el pico de flujo inspiratorio (PIF) a través de Accuhaler y Turbuhaler en niños normales por medio del dispositivo In-check y determinar las diferencias entre dos modelos distintos de este aparato. Métodos: A 64 varones normales (media, 11,2 años; límites, 8,8-14,7), se les midió el pico de flujo inspiratorio (PIF) con In-check e In-check Dial utilizando las resistencias de Accuhaler y Turbuhaler . Se eligió la mejor maniobra de entre tres. Además se midió peso, talla y volumen espiratorio máximo al primer segundo (FEV1 ). Resultados: Existieron diferencias significativas cuando se compararon los PIF a través de ambos inhaladores: PIF In-check Accuhaler- PIF In-check Turbuhaler (134,4 +/- 15,5 frente a 99,9 6 11,1 l/min; p ,0,000) y PIF In-check Dial Accuhaler-PIF In-check Dial Turbuhaler (109,6 6 10,5 l frente a 86,8 6 8,9 l/min; p ,0,000). La mejor correlación conseguida entre las distintas mediciones del In-check lo fue entre In-check Accuhaler e In-check Turbuhaler (r 5 0,88; p ,0,001), y la peor lo fue entre In-check Dial Accuhaler e In-check Turbuhaler (r 5 0,71; p ,0,001). Conclusiones: El PIF a través de Accuhaler es significativamente mayor que a través de Turbuhaler , aunque en ambos casos suficiente para una buena distribución de la medicación inhalada en niños de 9 a 14 años. Por consiguiente, por debajo de esta edad, y en especial durante una crisis asmática, puede ser adecuado practicar una prueba con In-check para determinar si un niño concreto es capaz de utilizar Turbuhaler (AU)

[The short-term results of air pollution on mortality: the results of the EMECAM project in Cartagena, 1992-96. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en Cartagena, 1992-96.

BACKGROUND: The problems of air pollution became noticeable in Cartagena in the seventies, high SO2 and particle levels having been reached from time to time. Our aim is to assess, using the EMECAM methodology, the acute impact of SO2 and particle air pollution on the daily death rate of the city of Cartagena in the 1992-1996 period. METHODS: A daily listing is provided of the total number of non-accidental deaths within the population as a whole and for those over age 70, the cardiovascular and the respiratory deaths due to dioxide and particle air pollution for the 1992-1996 period using autoregressive Poisson models which control seasonality, weather, time of year, flu, special events, and time lags. RESULTS: In the period under study, there has been a drop in the SO2 air pollution as compared to previous years, which was not as marked for the particles. The analyses reveal significant relationships in the total non-accidental deaths in those over age 69, with the average particle count and those particles with cardiovascular deaths for the months of May to October. In the six-month period of the year, when the weather is cold, we found a positive statistically significant relationship to exist in the maximum daily hourly value of the particles and the deaths due to cardiocirculatory and respiratory diseases. However, there is no consistency in the between on assessing the reliability of the models.

[Unusual attendance at Hospital Emergency Services for asthma and chronic obstructive pulmonary disease and SO2 air pollution in Cartagena (Spain)]. / Afluencia inusual por asma y enfermedad pulmonar obstructiva crónica en urgencias hospitalarias y contaminación por SO2 en Cartagena.

BACKGROUND: The objective of this investigation is to determine the influence of air pollution (SO2 and particulate matter) on the existence of days of unusual attendance at emergency services for asthma and chronic obstructive pulmonary lung disease (COPD). A registry of attendances for these diseases and the daily mean concentrations of SO2 and particles were used (1989-1991). RESULTS: Unusual attendance days are establish by the fortnightly movable mean of the period that has that day as central one, under the hypothesis of a Poisson distribution with equal mean as the calculated one. In the logistic regression model, Odds Ratio (OR) between an excess of attendance of cases for asthma and SO2 levels greater than 80.60 m/m3 was 3.6 (CI95%: 1.1-11.7). For COPD, SO levels ten days before were introduced, and OR for SO2 levels more than 56.5m/m was 4.7 (CI95%: 1.5-15.1). CONCLUSIONS: High SO2 levels are related with the appearances of days with an excessive use of emergencies for Asma and EPOC.

[Childhood scabies: a different entity]. / Sarna infantil: una entidad diferente.

Epidemiological, clinical, diagnostic and therapeutic aspects that make scabies a clinical entity with a special personality in the pediatric field, are reviewed. On the epidemiological aspects, a special mention of its unsuspected frequency in this age is made. Scabies is an endemic disease in our country among the more deprived people. On the clinical aspects, the great importance of clinical history and distribution of skin lesions for the early diagnosis is pointed out. Some "alert pointers" are described for this early diagnosis. On the therapeutic field, the importance of the primary care prevention is discussed, and the drug approach for its relieve is commented.