A comparative study of bronchodilator reversibility with albuterol, between asthma symptomatic and asymptomatic children according to ISAAC questionnaire in Mexico City.

BACKGROUND: Asthma is an important childhood disease. Recent surveys of the International Study of Asthma and Allergies in Childhood (ISAAC) suggest that the prevalence of asthma is increasing but these surveys do not include any pulmonary tests to confirm the possible diagnosis of asthma. OBJECTIVE: To compare bronchodilator reversibility with the albuterol test in symptomatic and asymptomatic 6-7-year-old children with asthma participating in the ISAAC survey and living in Mexico City. PATIENTS AND METHODS: We performed an observational, descriptive, comparative, cross sectional study in children participating in phase 3b of the ISAAC study. According to the ISAAC questionnaire children were classified as asthma symptomatic or asymptomatic. Both groups had bronchodilator reversibility with the albuterol test, using the guidelines of the American Thoracic Society to confirm or rule out the diagnosis of asthma. RESULTS: The asymptomatic group had a baseline FEV1 of 1.70 +/- 0.34 l/sec (mean +/- SD) and an endpoint FEV1 of 1.76 +/- 0.42 l/sec; in the symptomatic group the respective values were 1.51 +/- 0.41 l/sec and 1.57 +/- 0.44 l/sec (p < 0.05). A positive reversibility test was found in 13/136 (9.6 %) children in the asymptomatic group and in 22/112 (19.6 %) children in the symptomatic group (p < 0.05). CONCLUSION: Because of its low sensitivity, bronchodilator reversibility cannot be considered a diagnostic tool to confirm diagnosis of asthma.

A comparative study of bronchodilator reversibility with albuterol, between asthma symptomatic and asymptomatic children according to ISAAC Questionnaire in Mexico City

Background: Asthma is an important childhood disease. Recent surveys of the International Study of Asthma and Allergies in Childhood (ISAAC) suggest that the prevalence of asthma is increasing but these surveys do not include any pulmonary tests to confirm the possible diagnosis of asthma. Objective: To compare bronchodilator reversibility with the albuterol test in symptomatic and asymptomatic 6-7-year-old children with asthma participating in the ISAAC survey and living in Mexico City. Patients and methods: We performed an observational, descriptive, comparative, cross sectional study in children participating in phase 3b of the ISAAC study. According to the ISAAC questionnaire children were classified as asthma symptomatic or asymptomatic. Both groups had bronchodilator reversibility with the albuterol test, using the guidelines of the American Thoracic Society to confirm or rule out the diagnosis of asthma. Results: The asymptomatic group had a baseline FEV1 of 1.70 ± 0.34 l/sec (mean ± SD) and an endpoint FEV1 of 1.76 ± 0.42 l/sec; in the symptomatic group the respective values were 1.51 ± 0.41 l/sec and 1.57 ± 0.44 l/sec (p < 0.05). A positive reversibility test was found in 13/136 (9.6 %) children in the asymptomatic group and in 22/112 (19.6 %) children in the symptomatic group (p < 0.05). Conclusion: Because of its low sensitivity, bronchodilator reversibility cannot be considered a diagnostic tool to confirm diagnosis of asthma (AU)

Introducción: El asma es una enfermedad infantil importante. Las encuestas recientes del Estudio Internacional sobre Asma y Alergias en la Infancia (ISAAC, por sus siglas en inglés) sugieren un aumento de la prevalencia del asma, si bien este instrumento de estudio no incluye ninguna prueba pulmonar para confirmar el posible diagnóstico de la enfermedad. Objetivo: Comparar la reversibilidad con tratamiento broncodilatador a base de albuterol entre niños asmáticos sintomáticos y asintomáticos según el estudio ISAAC, de edades comprendidas entre los 6 y 7 años y residentes en Ciudad de México. Pacientes y métodos: Se trató de un ensayo comparativo transversal, de carácter descriptivo y basa- do en la observación, realizado sobre niños que participaron en una encuesta de la fase 3b del ISAAC. Según el cuestionario del ISAAC, los niños se clasificaron como asmáticos sintomáticos o asintomáticos para asma. Ambos grupos fueron sometidos a la prueba de reversibilidad con tratamiento broncodilatador a base de albuterol, siguiendo las directrices de la Sociedad Torácica Americana, para confirmar o descartar el diagnóstico de asma. Resultados: El grupo asintomático presentó un FEV1 inicial de 1,70 ñ 0,34 l/seg (media ñ DE) y un FEV1 final de 1,76 ñ 0,42 l/seg; en el grupo sintomático, los valores respectivos fueron 1,51 ñ 0,41 l/seg y 1,57 ñ 0,44 l/seg (p < 0,05). En el grupo asintomático, 13 de 196 niños (el 9,6 por ciento) dieron positivo en la prueba de reversibilidad; en el grupo sintomático dieron positivo 22 de 112 niños (el 19,6 por ciento) (p < 0.05). Conclusión: La reversibilidad con tratamiento broncodilatador no puede considerarse una herramienta para confirmar el diagnóstico del asma debido a su bajo nivel de precisión (AU)

[Clinical and spirometric correlation with home allergens and with pollutants]. / Correlación clínica y espirométrica con alergenos intradomiciliarios y con contaminantes.

INTRODUCTION: Environmental contamination causes an increase in respiratory symptoms, especially in patients with asthma. The severity of allergic asthma in children is associated with the presence of intradomicilliary aeroallergens and intramural contaminants. OBJECTIVE: Correlation to clinical abnormalities, spyrometryand skin test with the intradomiciliary pollution. MATERIALS AND METHODS: Children who participated ranged in age from 6 to 15 years, attended public schools, and were classified as healthy and asthmatic. A questionnaire was applied to them, as well as a clinical history, spirometry, skin tests, and an environmental study at home. RESULTS: Fifty-seven children were studied, of 10 years of age (+/- 3). Group 1 (23 healthy children): Positive skin tests, dust 66.6%, cockroaches 66.6%, mites 33.3%, cat 33.3%, dog 4.3%. Principal clinical symptoms were cough 91.3%, wheezing 78.3%, respiratory difficulty 39.1% with a morning predominance of 78.3%. Spirometry showed an obstructive pattern in 30.5%. Group 2 (34 asthmatic children): Positive skin tests, mites 52.1%, dust 47.8%, cockroach 21.7%, cat 21.7%, dog 4.3%, passive exposure to tobacco smoke 79.5%. Principal clinical symptoms were cough 91.3%, respiratory 82.3%, wheezing 79.4%, predominantly at night 70.5%. Spirometry showed obstructive pattern in 67.7%. CONCLUSIONS: Children with asthma present great contact and sensitivity for intradomicilliary allergens such as mites in household dust, proteins from cat, dog, and cockroach feces, in addition to greater frequency of passive smoking. It is important to point out that these factors can be modifiable at low cost, thus presenting the conditions for a better quality of life for the patient and diminishing costs of medical attention.

[Results of an educational program for adults with asthma]. / Resultados de un programa educativo para adultos con asma.

BACKGROUND: Asthma is a world health problem. Education of asthmatic patient has been proposed as a choice for diminishing mortality due to asthma. OBJECTIVE: To demonstrate that educational programs for asthmatic patients help to reduce disease's severity, crises and hospitalizations number and encourage a bigger therapeutic compliance. MATERIAL AND METHODS: 80 asthmatic patients were divided into two groups; first one received educational curse and second one does not. All patients received treatment according to international guides, including monthly consultation, flow-meter, and symptoms day book; an initial and final evaluation was made about disease's knowledge. Course consisted of a workshop including crisis management, use of inhaled medication, flow-metry and relaxation techniques. RESULTS: We studied 76 patients, with a mean age of 34 years; 36 were assigned to group 1 and 40 to group 2. Initial assessment of both groups was of 7.8, while final evaluation of groups 1 and 2 was of 9.3 and 8.4, respectively. Group 1 had lesser number of hospitalizations than group 2 (p-0.005), lesser number of emergency consultations (p-0.005) and a higher overall improvement than group 2, in which only 8 patients got well. A third part of the group 1 abandoned treatment, while patients that abandoned treatment in group 2 accounted for 79% (p < 0.0005). CONCLUSIONS: Educational programs for asthmatic adult patients diminish severity of disease, number of crises and hospitalizations, and also increase therapeutic compliance.

[The use of the International Guidelines for the Diagnosis and Treatment of Asthma (GINA) in clinical practice among family physicians]. / El uso de las Guías internacionales de Diagnóstico y Tratamiento del Asma (GINA) en la práctica clínica de los médicos familiares.

OBJECTIVE: To evaluate the degree of knowledge of family physicians related to the International Guidelines for the Diagnosis and Treatment (GINA) of Asthmatic Patients. MATERIAL AND METHOD: We invited the family physicians from some clinics of Mexico City. A questionnaire was applied to 50 doctors who accepted to participate in the study; they had a 46 year-old age average and a proportion 1:1 between genders. The analysis was carried out with the test r of Pearson. RESULTS: The correlation between general knowledge of asthma and knowledge of GINA was r = 0.022; between the general knowledge of asthma and the specialty of family medicine was r = -0.117; and that among the knowledge on International Guides of Asthma and the specialty of family medicine was r = 0.33. CONCLUSIONS: A scarce knowledge exists on the guides proposed by GINA.

[Spirometric pulmonary age and its correlation with the chronological age of asthma patients]. / Edad pulmonar por espirometría y su correlación con la edad cronológica de pacientes con asma.

AIMS: Pulmonary age as a linear regression spirometric index, expresses pulmonary ventilatory function. OBJECTIVE: A pilot study was done to assess the differences of the values of the pulmonary age index and chronological age in patients with bronchial asthma and healthy volunteers. MATERIAL AND METHOD: We studies 111 subjects, 31 healthy and 80 with asthma. RESULTS: All of them underwent spirometry. Healthy individuals showed a mean chronological age of 35 years, and a pulmonary age of 26 years. Asthmatic patients showed a mean chronological age of 38 years, and a pulmonary age of 59 years. CONCLUSION: Both the time course and the severity of the disease increased pulmonary age.

[Effect of heating on FEV-1 in children with asthma challenged with exercise]. / Efecto del calentamiento sobre el VEF-1 en niños con asma sometidos a reto por ejercicio.

AIMS: The exercise-induced bronchoespasm, also called asthma for exercise, it corresponds to a frequent clinical entity that commonly accompanies the asthmatic patient. Their frequency is of around the 80 to 90% for the patients with asthma; it is presented among 40 to 50% of the children with allergic rhinitis, in the athletes 14% and in the population's 12% in general. OBJECTIVE: To determine the effectiveness of a heating routine like preventive agent of the exercise-induced bronchoespasm. METHOD: 30 patients were included of between 10 and 16 years of age, asthmatic and with exercise-induced bronchoespasm by diagnosed by means of challenge test to the exercise. All the patients carried out an exercise routine with duration of 20 minutes during which movements of elasticity, calisthenics and light activity were made directed to the exercise to develop, taking as objective parameter 60% of the frequency heart submax. Did all the patients carry out challenge at once, again to the exercise, in which a band numberless was used, with speeds that were increased progressively from 1 to 8 km/h and with inclination of 0? 10 0. The spirometrics registrations was made before the challenge and at the 2, 5, 10, 15, 20, 25, 30 and 60 minutes after the same one. RESULTS: The average of the patient's age was of 12.8 +/- 2 years with size of 157 +/- 10 cm. CONCLUSION: The heating in children with broncoespasmo induced by exercise acts as a protective agent against the decrement of the VEF-1. Although the heating can be a good control method in the asthmatic patient, it is necessary to keep in mind that not all the patients have a benefit of this protection. This can only be used in patient with programmed physical activity, since in the preschoolers it is not possible to implant a heating routine for the characteristics characteristic of their activity.

Exercise induced bronchospasm in asthmatic and non-asthmatic obese children.

AIM: to investigate the spirometric response to the exercise challenge in asthmatic and non-asthmatic obese children. PATIENTS, MATERIALS AND METHODS: it was a prospective, longitudinal, open label clinical trial with four groups of children from 8 to 16 years. The group 1 had 15 asthmatic non-obese children. The group 2 had 15 asthmatic obese children. The group 3 had 15 non-asthmatic obese children. The group 4 had 13 control healthy children. Spirometry measures were realized at baseline, and after exercise at 2, 5, 10, 15, 20, 25, 30 and 60 minutes. Exercise challenge was performed on a walking band at 6 km/h speed and a slope of 10 degrees with a duration of 6 to 8 minutes. Data were are analyzed by repeated measures ANOVA. RESULTS: the mean age was 11.8 +/- 2.1, and the mean height was 150.2 +/- 11.3 cm, the mean weight was 46.3 +/- 17.15 in the group 1, 59.4 +/- 11.9 in the group 2, 67.8 +/- 20.6 in the group 3, and 44.2 +/- 9.7 in the group 4. The mean values of forced expiratory volume in one second (FEV1) for each group are shown on table II. CONCLUSIONS: the non-asthmatic obese children had a significant decrease in FEV1, meanwhile the asthmatic obese children had a deeper decrease in FEV1 than the asthmatic non-obese children. Obesity ay be a conditioning factor for bronchial hyperreactivity to the exercise.

Exercise induced bronchospasm in asthmatic and non-asthmatic obese children

Aim: to investigate the spirometric response to the exercise challenge in asthmatic and non-asthmatic obese children. Patients, materials and methods: it was a prospective, longitudinal, open label clinical trial with four groups of children from 8 to 16 years. The group 1 had 15 asthmatic non-obese children. The group 2 had 15 asthmatic obese children. The group 3 had 15 non-asthmatic obese children. The group 4 had 13 control healthy children. Spirometry measures were realized at baseline, and after exercise at 2, 5, 10, 15, 20, 25, 30 and 60 minutes. Exercise challenge was performed on a walking band at 6 km/h speed and a slope of 10° with a duration of 6 to 8 minutes. Data were are analized by repeated measures ANOVA. Results: the mean age was 11.8 ± 2.1, and the mean height was 150.2 ± 11.3 cm, the mean weight was 46.3 ± 17.15 in the group 1, 59.4 ± 11.9 in the group 2, 67.8 ± 20.6 in the group 3, and 44.2 ± 9.7 in the group 4. The mean values of forced expiratory volume in one second (FEV1) for each group are shown on table II. Conclusions: the non-asthmatic obese children had a significant decrease in FEV1, meanwhile the asthmatic obese children had a deeper decrease in FEV1 than the asthmatic non-obese children. Obesity ay be a conditioning factor for bronchial hyperreactivity to the exercise (AU)

La obesidad en el niño se ha incrementado en la última década. Desafortunadamente las alteraciones de la función pulmonar han sido poco estudiadas en niños obesos con y sin patología respiratoria como el asma. Nuestro objetivo fue evaluar la función pulmonar al reto con ejercicio en niños obesos con asma y sin asma. Se realizó un estudio prospectivo, longitudinal, abierto, en 58 niños de 8 a 16 años, divididos en cuatro grupos: grupo 1 (15 asmáticos no obesos), grupo 2 (15 asmáticos obesos), grupo 3 (15 obesos no asmáticos) y grupo 4 (13 niños sanos). Antes de iniciar el reto con ejercicio se realizó una espirometría basal y posteriormente a los 2', 5', 10', 15', 20', 25', 30' y 60'. La prueba de ejercicio fue en una banda sin fin con una velocidad inicial de 1 km/h y una inclinación de 0° hasta llegar a 6 km/h y 10° por 6 a 8'. Cuando el FEV1 disminuía más del 15 por ciento de los valores basales y/o tenían sibilancias y tos se consideraba que el paciente presentaba una obstrucción de la vía aérea de gran calibre, diagnosticándose así broncoespasmo inducido por ejercicio. El estudio estadístico fue mediante el análisis de varianza de medidas repetidas.Resultados: la edad media de los cuatro grupos fue de 11,8 ñ 2,1 años y la talla de 150 ñ 11,3 cm.De acuerdo a cada grupo el peso medio del grupo 1 fue de 46,3 ñ 17,1 kg, grupo 2: 59,4 ñ 11,9, grupo 3: 67,8 ñ 20,64 y grupo 4: 44,2 ñ 9,7 kg. El descenso del FEV1 mayor del 15 por ciento después del ejercicio se presentó en el 80 por ciento (12/15) del grupo 1, en el 100 por ciento del 2, en el 73,3 por ciento (11/15) del grupo 3 y en 1 de los 13 del grupo 4. De acuerdo con esto, los obesos no asmáticos tuvieron una respuesta al ejercicio semejante a los asmáticos no obesos (p = 0,05) y los obesos asmáticos respondieron más al ejercicio comparado con los asmáticos no obesos (p < 0,01) (tabla II). Conclusiones: la obesidad es un factor que condiciona una mayor respuesta bronquial al ejercicio tanto en niños asmáticos como no asmáticos y es de llamar la atención que los obesos sin asma tengan hiperreactividad bronquial al ejercicio semejante a la de los asmáticos no obesos. (AU)

[Hyper-IgE syndrome treated with interferon alpha 2 beta. Report of a case]. / Síndrome de hiper IgE con tratamiento de interferón alfa 2 beta. Reporte de un caso.

The hyper IgE syndrome is characterized by recurrent abscess on the skin, and airways and itching dermatitis. The data acquired in the lab is hypergammaglobulinemy, eosinophil in blood, tissue, sputum, with fagocitos, and quimiotaxis defect. Since 1972 it has been reported 150 cases in the world without no geographic difference and 2:1 relation with the masculine gender. The therapeutic ways are even controversial. The therapy with interferon alpha 2 beta is the alternative treatment so diminish the dermis inflammation as the seric IgE reduction. This case shows a patient with the classic clinic data and seric IgE levels who didn't present response to the habitual therapy, because of this. He was the switch to the interferon alpha 2 beta. Later on the therapy it wasesented clinical changes over the symptomatology with reduction in the over seric IgE.