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

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Tratamiento de las sibilancias recurrentes/asma en el niño menor de 3 años de edad / No disponible

Las guías y consensos actuales enfatizan la importancia del control del asma para disminuirla morbilidad y mejorar la calidad de vida de estos pacientes. En niños menores de 3años, conseguir un adecuado control resulta más difícil que a otras edades debido a la heterogeneidadde fenotipos de sibilantes recurrentes, patrón inflamatorio predominante y factoresdesencadenantes, probablemente distintos y evolución y respuesta al tratamiento variables.Identificar el fenotipo sibilante podría ayudar a tomar decisiones terapéuticas,aunque en ocasiones se solapan en un mismo paciente características de distintos fenotiposy el tratamiento debería individualizarse en función de la respuesta.Se revisan los tres pilares básicos del tratamiento: educación, medidas preventivas y tratamientofarmacológico tanto del episodio agudo como de mantenimiento. Los fármacos recomendadospara el tratamiento de mantenimiento en menores de 3 años son los corticoides inhalados(CI) y los inhibidores de leucotrienos. Los CI son de elección en el asma y la respuestaes más satisfactoria ante niños con sibilancias y atopia. No existen evidencias para recomendardosis bajas de CI en la prevención de episodios de sibilancias desencadenadas exclusivamentepor virus a esta edad; los inhibidores de los leucotrienos estarían más indicados en estos casos.También constituyen una alternativa a los CI en el asma leve y podrían asociarse a ellos paradisminuir las exacerbaciones inducidas por virus. No obstante, algunos niños no responden aninguno de estos fármacos. Se recomienda revisar periódicamente el tratamiento y suspenderloo considerar un diagnóstico o tratamiento alternativo si no se observan beneficios(AU)

Today’s guides and consensus emphasize the importance of asthma control in diminishingmorbidity and improving these patients’ quality of life. This control is not easy in childrenunder 3 years of age due to: recurrent wheezing phenotype heterogeneity, triggeringfactors and predominant inflammatory pattern (probably different), and variable evolutionand treatment response. Identifying the wheezing phenotype could help making therapeutic decisions. However,characteristics from different phenotypes can sometimes overlap in a patient, so thetreatment should be adjusted according to the patient’s response.We review the 3 basic pillars of treatment: education, preventive measures and drugtreatment. We do this for the acute episode and for the treatment maintenance.The recommended drugs on children under 3 are inhaled corticoids (IC) and leukotrieneinhibitors. IC are the treatment of choice for asthma and there is a better response on childrenwith wheezing plus atopy. There is no evidence in the recommendation of low IC doses in theprevention of wheezing episodes exclusively triggered by virus on children of this age. Leukotrieneinhibitors are more appropriate in these cases. They are an alternative to IC on childrenwith mild asthma and they could be used to decrease exacerbations induced by virus.Some children, however, do not respond to any of these drugs. It is recommended toreview the treatment periodically and suspend it or consider an alternative treatment ordiagnosis if benefits are not observed(AU)

Consensus Statement on the Management of Paediatric Asthma. Update 2007

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Evaluación diagnóstica básica del niño y adolescente asmático en Atención Primaria / No disponible

El diagnóstico de asma se basa en la presencia de síntomas debidos a la obstrucción del flujo aéreo, en la demostración de una obstrucción del flujo aéreo reversible, y en la exclusión de posibles diagnósticos alternativos. Se debe realizar una historia clínica exhaustiva, una exploración física centrada en el tracto respiratorio superior, pulmón y piel, unas pruebas defunción pulmonar (espirometría), si el niño es capaz de colaborar, para evidenciar la obstrucción reversible del flujo aéreo, una clasificación de la gravedad del asma, y otras pruebas adicionales para evaluar diagnósticos alternativos e identificar factores precipitantes.El asma suele debutar en la infancia y se suele asociar con la atopia. La historia familiar de atopia es el factor de riesgo más importante para el desarrollo de atopia en el niño. La existencia de asma o rinitis en la madre es el factor de riesgo más significativo de iniciode asma en la infancia y su persistencia hasta la edad adulta. La atopia en el propio niño (diagnosticada mediante prick test o IgE específica en suero) está relacionada con la gravedad del “asma actual” y su persistencia a lo largo de la infancia

To establish the diagnosis of asthma, the clinician must determine that episodic symptoms of airflow obstruction are present, airflow obstruction is at least partially reversible and alternative diagnoses are excluded. Recommended mechanisms to establish the diagnosis are detailed medical history, physical exam focusing on the upper respiratory tract, chest and skin, and spirometry to demonstrate reversibility. Additional studies may be considered to evaluate alternative diagnoses, identify precipitating factors and assess the severity of asthma. Asthma often begins in childhood, and when it does, it is frequently found in association with atopy. A family history of atopy is the most important clearly defined risk factor for atopy in children. A maternal history of asthma and/or rhinitis is a significant risk factor for late childhood onset asthma. Markers of allergic disease at presentation (skin prick tests and peripheral blood markers) are related to severity of current asthma and persistence through childhood (AU)