Tratamiento farmacológico del asma / Pharmacological treatment of asthma

El asma se considera un síndrome que agrupa diferentes formas de enfermedad, en la que factores genéticos y ambientales interaccionan y generan manifestaciones de la enfermedad. Su expresión clínica es muy variable: desde síntomas agudos y esporádicos a crónicos, desde estacionales o que aparecen en relación con el ejercicio, hasta una enfermedad grave y persistente. En España afecta a uno de cada diez niños, con amplias variaciones regionales. En tratamiento del asma nos encontramos con dos situaciones clínicas: 1) las sibilancias recurrentes en lactantes y preescolares son un motivo frecuente de consulta y el retraso en el inicio del tratamiento en muchos casos puede tener gran impacto sobre la salud del paciente a largo plazo. Algunos niños serán asmáticos que inician los síntomas precozmente, pero otros tendrán sibilancias que desaparecerán en la edad escolar. Por tanto, no siempre es fácil diagnosticarla y decidir el tratamiento en estos casos. 2) La elección del tratamiento farmacológico en el niño mayor de cinco años debe de hacerse en base a la evidencia clínica disponible y en ese sentido las propuestas de la GINA y de la guía de British Thoracic Society, Scottish Intercollegiate Guidelines Network (SIGN), modificadas siguiendo recomendaciones de la guía de práctica clínica sobre asma infantil. El conocimiento y la utilización de estas guías y consensos con las recomendaciones actuales para el tratamiento de mantenimiento y de la crisis de asma en la infancia, son junto con la educación basada en el autocontrol, puntos básicos de un programa de atención al niño y adolescente con asma

Asthma is considered a syndrome that groups different forms of disease, in which genetic and environmental factors interact and generate manifestations of the disease. Its clinical expression is very variable: from acute and sporadic symptoms to chronic, from seasonal or appearing in relation to exercise, to a serious and persistent disease. In Spain it affects one in 10 children with wide regional variations. In asthma treatment we find two clinical situations: 1) recurrent wheezing in infants and pre-schoolers is a frequent reason for consultation and delay in the onset of treatment in many cases can have a great impact on the health of the patient in the long run. Some children will be asthmatics who start symptoms early, but others will have wheezing that disappears in school age. Therefore, it is not always easy to diagnose and decide the treatment in these cases. 2) The choice of pharmacological treatment in the child over five years old should be based on the clinical evidence available and in this sense the proposals of the GINA and the guide British Thoracic Society, Scottish Intercollegiate Guidelines Network (SIGN) modified following recommendations of the child asthma CPG. The knowledge and use of these guidelines and consensus with current recommendations for the treatment of maintenance and the asthma crisis in childhood, are along with education based in self-control, basic points of a program of care for children and adolescents with asthma

Crisis de asma / Asthma crisis

No disponible

Educación en el niño y adolescente con asma (2ª parte) / Education in children and adolescents with asthma (part 2)

No disponible

Quality of life in caregivers of children with asthma: Validity and reliability of the IFABI-R questionnaire.

BACKGROUND: Parents'/caregivers' quality of life is an important aspect to consider when handling paediatric asthma, but there is a paucity of valid and reliable instruments to measure it. The Family Impact of Childhood Bronchial Asthma (IFABI-R) is a recently developed questionnaire to facilitate the assessment of asthma-related parents'/caregivers' quality of life. This study researches the psychometric properties of IFABI-R. METHODS: Parents/main caregivers of 462 children between 4 and 14 years of age with active asthma were included in the sample. IFABI-R was administered on two different occasions and a number of other variables related to the parents'/caregivers' quality of life were measured: child's asthma control, family functioning, and parents'/caregivers' perception of asthma symptoms in the child. IFABI-R evaluative and discriminative properties were analysed, and the minimal important change in the IFABI-R score was identified. RESULTS: IFABI-R showed high internal consistency (Cronbach's alpha=0.941), cross-sectional construct validity (correlation with the degree of child's asthma control, family functioning and parent/caregiver perception of the child's asthma symptoms), longitudinal construct validity (correlation of changes in the IFABI-R with changes in asthma control and changes in the perception of symptoms), sensitivity to change and test-retest reliability. An absolute change of 0.3 units in IFABI-R related to a minimal significant change in the parents'/caregivers' quality of life. CONCLUSIONS: IFABI-R is a reliable and valid instrument to study the quality of life of parents/caregivers of children with asthma.

Atención en las primeras 48 horas tras el alta de maternidad en la consulta de enfermería o Pediatría / Assistance on the first 48 hours after discharge from maternity in Primary Care Practice

Introducción: desde el momento en que el recién nacido es dado de alta de la maternidad hasta que es atendido en su centro de salud (CS) pasa un periodo de tiempo crucial y, a veces, excesivamente prolongado. Objetivo: conocer la edad en que son atendidos por primera vez los recién nacidos en Atención Primaria (AP) en la Comunidad Valenciana. Material y métodos: encuesta dirigida a los pediatras de AP. Resultados: participaron 46 CS de las provincias de Castellón y Valencia (de un total de 162 centros). Se declararon datos de 248 recién nacidos durante el periodo del 9 de abril al 30 de junio del año 2013. El 58% de los recién nacidos fueron vistos por primera vez en su CS a partir del quinto día de vida. Los niños nacidos en un hospital público tienen casi dos veces más probabilidades de acudir al CS antes de los seis días de vida que los niños nacidos en un hospital privado (odds ratio [OR]: 1,97; intervalo de confianza del 95% [IC 95%]: 0,92 a 4,1; p=0,07). El 56,93% de las lactancias maternas y mixtas fueron vistas después del quinto día de vida. El 24,2% de los casos estudiados no tenía la tarjeta de asistencia sanitaria (TAS) al salir de la maternidad. La mayoría de los niños nacidos en maternidades privadas no tenía la TAS al alta, requisito imprescindible para solicitar cita en su CS. Conclusiones: desde el momento en que el recién nacido es dado de alta de la maternidad hasta que es atendido por primera vez por el equipo de pediatra-enfermera, pasa un periodo de tiempo importante (AU)

Introduction: a critical period of time, sometimes too long, passes since healthy term infants are discharged from hospital until they are visited at primary care practices. Objective: to assess the age after birth when healthy term infants are first checked at primary care practices in Comunitat Valenciana. Material and methods: survey of primary care pediatricians from Comunitat Valenciana. Results: Forty-six Primary Care Practices participated in the provinces of Castellón and Valencia (from a total of 162 practices). Data from 248 term infants from April 9th to June 30th 2013 were collected. Fifty-eight percent of the infants were first seen after the fifth day of life. Children born in a public hospital are almost twice as much likely to be visited before 6 days of life than children born in a private hospital (odds ratio [OR]: 1.97, 95% CI: 0.92 to 4.1, p = 0.07). Exclusive breastfeeding and mixed feeding were seen after the fifth day of life in 56.93%. No health insurance card at discharge (most of children born in a private maternity), essential to make an appointment, was observed in 24.2% of the cases studied. Conclusions: since the time healthy term infants are discharged from hospital until they are first visited by the pediatric-nurse team, a too long critical period passes

Claves de educación en asma: casos clínicos interactivos / Keys of education in asthma: interactive cases report

El asma es una enfermedad crónica compleja, con una gran variabilidad y que tiene un enorme impacto, no solo en los pacientes afectados y sus familias, sino también en la sociedad en general. La prevalencia de asma en la infancia es elevada, afecta alrededor del 10% de la población infantil y adolescente, siendo en nuestro medio la patología crónica que consume un mayor número de recursos y tiempo en la Atención Primaria pediátrica. El manejo adecuado del asma implica que se realice un diagnóstico correcto, se evalúe la gravedad y se prescriba el tratamiento indicado. Un componente esencial en el tratamiento del asma infantil es la educación terapéutica, en la que el paciente y su familia han de ser formados y educados, con la finalidad de conseguir un buen control de la enfermedad y mejorar la calidad de vida. Para que los programas educativos sean efectivos, es necesaria una adecuada formación de los profesionales de la salud, siendo importante una buena comunicación y relación entre sanitarios y pacientes para conseguir que estos entiendan la enfermedad y su tratamiento, y mejoren la adherencia. En este seminario se van a presentar una serie de casos clínicos para desarrollar diversos contenidos diagnósticos, terapéuticos y educativos del asma infantil (AU)

Asthma is a chronic complex disease, with a great variability and a big impact, not only in the affected patients and their families, but also in general society. The prevalence of childhood asthma is high, it affects about 10% of the children and adolescents, and it is the chronic condition that consumes more resources and time in pediatric primary care in our population. The correct asthma management implies that a proper diagnosis is made, that the seriousness of the condition has been evaluated and that the appropriate treatment has been prescribed. Therapeutic education is an essential component in the treatment of childhood asthma in which the patient and his family have to be trained and educated, in order to achieve a good control of the disease and improve the quality of life. In order that educational programs are effective it is necessary the adequate training of health professionals, being important an adequate communication and relationship between them and the patients so that they understand the disease, its treatment and they improve the adherence to treatment. This seminar will present a series of clinical cases to approach various diagnostic, therapeutic and educational contents of childhood asthma (AU)

[Cholestatic-type hepatitis in childhood]. / Hepatitis de tipo colestásico en la infancia.

OBJECTIVE: The aim of this study was to evaluate the incidence, etiology, clinical evolution and prognosis of cholestatic hepatitis during childhood. PATIENTS AND METHODS: A retrospective study of 145 children hospitalized for acute hepatitis between December 1983 and September 1996 were studied. Cholestatic hepatitis was defined by a direct bilirubin higher than 50% of the total bilirubin. RESULTS: Five cases were identified, which represents 3.45% of all hospitalized hepatitis cases. The average age was 8 years. Cholestatic symptomatology was predominant in all cases with bilirubin values ranging from 10.5 to 32 mg/dl. Cytolysis ranged from moderate to intense. Regarding enzymes indicating cholestasis, the most elevated was 5'nucleotidase, followed by GGT. Quick's index was abnormal in 2 cases, one of which was not corrected by vitamin K. Cholesterol, triglycerides and gamma globulins were slightly increased. In only one case was there a thickening of the wall of the vesicula, which was dilated. Three cases corresponded to hepatitis A virus, one to hepatitis B virus and SMA (smooth muscle autoantibodies) were identified in the fifth. Evolution was favorable in all patients within 8 weeks, except for a girl with subacute hepatocellular insufficiency (SMA positive) where a normal state was achieved 3 months after immunosuppression treatment was started. CONCLUSIONS: 1) Cholestatic hepatitis is an infrequent form of acute hepatitis evolution in childhood and can be promoted by hepatitis virus A or B. 2) It shows a favorable prognosis, except when it comes from a non-viral etiology.