Prevalence of symptoms, severity and diagnosis of asthma in adolescents in the Province of Salamanca, Spain: Global Asthma Network (GAN) Phase I.

INTRODUCTION AND OBJECTIVES: Asthma is the most prevalent chronic disease in childhood. However, the latest data on its prevalence in Spain are from Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC), 2004. The objective of our study was to assess the prevalence of asthma symptoms, severity and diagnosis in the paediatric population aged between 13 and 14 years in the province of Salamanca. MATERIAL AND METHODS: Cross-sectional multicentre study carried out in 2017-2018 in 13-and 14-year-old school children in the province of Salamanca as a centre participating in of the Global Asthma Network (GAN) Phase I. The standardised validated written questionnaire and that directed by a video was administered; it was self-completed by the pupils. RESULTS: A total of 3485 questionnaires were completed, and the pupils' participation rate was 95.01%. Among the total, 25.7% indicated having had wheeze ever (20.7% in the video questionnaire); 14.7% indicated having had wheeze in the past 12 months (11.3% in the video questionnaire). The prevalence of current wheeze that limited speech was 3.9% (7.5% in the video questionnaire) and the current prevalence of severe wheeze was 6.5%. Regarding asthma diagnosis, 19.7% of the sample answered that they had had asthma ever, whilst 14.0% referred to having physician-diagnosed asthma. The agreement between the written questionnaire and that directed by video was acceptable for the questions of wheeze ever (Cohen Kappa index [k] = 0.53) and current wheeze (k = 0.42). CONCLUSIONS: The prevalence of current asthma (wheeze in the past 12 months) in the population aged 13 and 14 years in the province of Salamanca is higher compared with that presented in 2004 in Spain, but similar to that described at the world level (low-moderate level), according to the ISAAC Phase III studies.

Prevalence of symptoms, severity and diagnosis of asthma in adolescents in the Province of Salamanca, Spain: Global Asthma Network (GAN) Phase I

Introduction and objectives: Asthma is the most prevalent chronic disease in childhood. However, the latest data on its prevalence in Spain are from Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC), 2004. The objective of our study was to assess the prevalence of asthma symptoms, severity and diagnosis in the paediatric population aged between 13 and 14 years in the province of Salamanca. Material and methods: Cross-sectional multicentre study carried out in 2017–2018 in 13-and 14-year-old school children in the province of Salamanca as a centre participating in of the Global Asthma Network (GAN) Phase I. The standardised validated written questionnaire and that directed by a video was administered; it was self-completed by the pupils. Results: A total of 3485 questionnaires were completed, and the pupils’ participation rate was 95.01%. Among the total, 25.7% indicated having had wheeze ever (20.7% in the video questionnaire); 14.7% indicated having had wheeze in the past 12 months (11.3% in the video questionnaire). The prevalence of current wheeze that limited speech was 3.9% (7.5% in the video questionnaire) and the current prevalence of severe wheeze was 6.5%. Regarding asthma diagnosis, 19.7% of the sample answered that they had had asthma ever, whilst 14.0% referred to having physician-diagnosed asthma. The agreement between the written questionnaire and that directed by video was acceptable for the questions of wheeze ever (Cohen Kappa index [k] = 0.53) and current wheeze (k = 0.42). Conclusions: The prevalence of current asthma (wheeze in the past 12 months) in the population aged 13 and 14 years in the province of Salamanca is higher compared with that presented in 2004 in Spain, but similar to that described at the world level (low-moderate level), according to the ISAAC Phase III studies (AU)

Alimentación complementaria. ¿Hay novedades? / Complementary nourishment. Are there any new developments?

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Factors associated to recurrent wheezing in infants under one year of age in the province of Salamanca, Spain: Is intervention possible? A predictive model

OBJECTIVES: Wheezing is a very common problem in infants in the first months of life. The objective of this study is to identify risk factors that may be acted upon in order to modify the evolution of recurrent wheezing in the first months of life, and to develop a model based on certain factors associated to recurrent wheezing in nursing infants capable of predicting the probability of developing recurrent wheezing in the first year of life. METHODS: The sample was drawn from a cross-sectional, multicentre, descriptive epidemiological study based on the general population. A total of 1164 children were studied, corresponding to a questionnaire response rate of 71%. The questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL) was used. Multiple logistic regression analysis was used to estimate the probability of developing recurrent wheezing and to quantify the contribution of each individual variable in the presence of the rest. RESULTS: Infants presenting eczema and attending nursery school, with a mother who has asthma, smoked during the third trimester of pregnancy, and did not consume a Mediterranean diet during pregnancy were found to have a probability of 79.7% of developing recurrent wheezing in the first year of life. In contrast, infants with none of these factors were seen to have a probability of only 4.1% of developing recurrent wheezing in the first year of life. These results in turn varied according to modifications in the risk or protective factors. CONCLUSIONS: The mathematical model estimated the probability of developing recurrent wheezing in infants under one year of age in the province of Salamanca (Spain), according to the risk or protective factors associated to recurrent wheezing to which the infants are or have been exposed

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Factors associated to recurrent wheezing in infants under one year of age in the province of Salamanca, Spain: Is intervention possible? A predictive model.

OBJECTIVES: Wheezing is a very common problem in infants in the first months of life. The objective of this study is to identify risk factors that may be acted upon in order to modify the evolution of recurrent wheezing in the first months of life, and to develop a model based on certain factors associated to recurrent wheezing in nursing infants capable of predicting the probability of developing recurrent wheezing in the first year of life. METHODS: The sample was drawn from a cross-sectional, multicentre, descriptive epidemiological study based on the general population. A total of 1164 children were studied, corresponding to a questionnaire response rate of 71%. The questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL) was used. Multiple logistic regression analysis was used to estimate the probability of developing recurrent wheezing and to quantify the contribution of each individual variable in the presence of the rest. RESULTS: Infants presenting eczema and attending nursery school, with a mother who has asthma, smoked during the third trimester of pregnancy, and did not consume a Mediterranean diet during pregnancy were found to have a probability of 79.7% of developing recurrent wheezing in the first year of life. In contrast, infants with none of these factors were seen to have a probability of only 4.1% of developing recurrent wheezing in the first year of life. These results in turn varied according to modifications in the risk or protective factors. CONCLUSIONS: The mathematical model estimated the probability of developing recurrent wheezing in infants under one year of age in the province of Salamanca (Spain), according to the risk or protective factors associated to recurrent wheezing to which the infants are or have been exposed.

Wheezing and risk factors in the first year of life in Cantabria, Spain. The EISL study

OBJECTIVES: To determine the prevalence of wheezing during the first year of life in Cantabria, Spain and its associated risk factors. METHODOLOGY: A cross-sectional, multicentre, descriptive epidemiological study was carried out in a representative sample of 958 infants in the first year of life, born in Cantabria. A previously validated and standardised written questionnaire was completed by the parents of infants seen between 12 and 15 months of age in the Primary Care Centres. RESULTS: The prevalence of wheezing was 32.7%. A relationship was found with male gender (OR 1.38, 95%CI [1.05-1.81]), the presence of a sibling (OR 2.43 [1.38-3.98]), attending nursery school (OR 2.40 [1.71-3.35]), exclusive breastfeeding for <3 months (OR 1.47 [1.12-1.93]), a first cold at ≤3 months (OR 2.07 [1.56-2.74]), asthma in siblings (OR 2.17 [1.25-3.77]), parental allergic rhinitis (OR 1.62 [1.10-2.37]) and paracetamol use >1 a week (OR 2.49 [1.31-4.73]), and maternal smoking during pregnancy (OR 2.18 [1.51-3.15]). The prevalence of recurrent wheezing (≥3 episodes) was 14.3%. Significant associations were observed with the male gender (OR 1.79 [1.23-2.60]), attending nursery school (OR 2.92 [1.96-4.35]), first cold at ≤3 months (OR 2.11 [1.46-3.04]), eczema (OR 1.92 [1.21-3.04]), maternal asthma (OR 1.77 [1.00-3.14]), exclusive breastfeeding for <3 months (OR 1.53 [1.06-2.22]), and maternal smoking during pregnancy (OR 1.53 [1.05-2.22]). CONCLUSIONS: One third of the infants experienced wheezing during the first year of life; those who were less exclusively breastfed, attended nursery school, presented eczema, family asthma or allergic rhinitis, and maternal smoking during pregnancy

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Wheezing and risk factors in the first year of life in Cantabria, Spain. The EISL study.

OBJECTIVES: To determine the prevalence of wheezing during the first year of life in Cantabria, Spain and its associated risk factors. METHODOLOGY: A cross-sectional, multicentre, descriptive epidemiological study was carried out in a representative sample of 958 infants in the first year of life, born in Cantabria. A previously validated and standardised written questionnaire was completed by the parents of infants seen between 12 and 15 months of age in the Primary Care Centres. RESULTS: The prevalence of wheezing was 32.7%. A relationship was found with male gender (OR 1.38, 95%CI [1.05-1.81]), the presence of a sibling (OR 2.43 [1.38-3.98]), attending nursery school (OR 2.40 [1.71-3.35]), exclusive breastfeeding for <3 months (OR 1.47 [1.12-1.93]), a first cold at ≤3 months (OR 2.07 [1.56-2.74]), asthma in siblings (OR 2.17 [1.25-3.77]), parental allergic rhinitis (OR 1.62 [1.10-2.37]) and paracetamol use >1 a week (OR 2.49 [1.31-4.73]), and maternal smoking during pregnancy (OR 2.18 [1.51-3.15]). The prevalence of recurrent wheezing (≥3 episodes) was 14.3%. Significant associations were observed with the male gender (OR 1.79 [1.23-2.60]), attending nursery school (OR 2.92 [1.96-4.35]), first cold at ≤3 months (OR 2.11 [1.46-3.04]), eczema (OR 1.92 [1.21-3.04]), maternal asthma (OR 1.77 [1.00-3.14]), exclusive breastfeeding for <3 months (OR 1.53 [1.06-2.22]), and maternal smoking during pregnancy (OR 1.53 [1.05-2.22]). CONCLUSIONS: One third of the infants experienced wheezing during the first year of life; those who were less exclusively breastfed, attended nursery school, presented eczema, family asthma or allergic rhinitis, and maternal smoking during pregnancy.

Urticaria crónica en Pediatría / No disponible

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Sibilancias en el lactante / No disponible

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Asociación entre la exposición a paracetamol y el asma: estado de la cuestión y recomendaciones prácticas / Association between paracetamol exposure and asthma: update and practice guidelines

La prevalencia del asma ha aumentado en las últimas décadas, especialmente en los países desarrollados, por motivos no bien esclarecidos. En los últimos años se ha observado una asociación entre el uso de paracetamol en distintas etapas de la vida, incluyendo la gestación y la infancia, y la prevalencia de asma. El carácter observacional de los estudios publicados no permite establecer una relación causal. Sería necesario realizar ensayos clínicos para comprobar la naturaleza de la asociación, que podría deberse a la presencia de diversos factores de confusión. Las sociedades pediátricas españolas firmantes de este artículo consideran que los datos disponibles hasta la fecha no son suficientes para desaconsejar el uso de paracetamol durante la gestación ni en niños asmáticos o con riesgo de asma (AU)

Asthma prevalence has increased over the last few decades, especially in developed countries, and possibly due to different reasons. An association between paracetamol use or exposure at different periods of life, including gestation and childhood, and asthma prevalence has been observed in the last few years. Causality can not be established from observational reports, due to the arguable presence of many confounding factors and biases. Randomised trials are needed to elucidate the nature of this association. The Spanish Paediatric societies subscribing to this paper consider that current evidence is insufficient to discourage the use of paracetamol during gestation or in children with or at risk of asthma (AU)

[Association between paracetamol exposure and asthma: update and practice guidelines]. / Asociación entre la exposición a paracetamol y el asma: estado de la cuestión y recomendaciones prácticas.

Asthma prevalence has increased over the last few decades, especially in developed countries, and possibly due to different reasons. An association between paracetamol use or exposure at different periods of life, including gestation and childhood, and asthma prevalence has been observed in the last few years. Causality can not be established from observational reports, due to the arguable presence of many confounding factors and biases. Randomised trials are needed to elucidate the nature of this association. The Spanish Paediatric societies subscribing to this paper consider that current evidence is insufficient to discourage the use of paracetamol during gestation or in children with or at risk of asthma.

Study of wheezing and its risk factors in the first year of life in the Province of Salamanca, Spain. The EISL Study

Objectives: To determine the prevalence of wheezing and its associated risk factors in infants in the first year of life in the province of Salamanca, Spain. Methods: A multicentre, cross-sectional, descriptive epidemiological study was designed to evaluate a representative sample of 750 infants in the first year of life, born in the province of Salamanca between 1 June 2008 and 30 September 2009.The study was based on a previously validated and standardised written questionnaire administered among the parents of those children seen for control at 12 months of age in any of the Primary Care centres in the province of Salamanca. Results: The recorded wheezing rate was 32.3%. Feeding and sleep were seen to be affected in 46.3% and 80.9% of the wheezing children, respectively, and parent activity was also altered in 39.3% of the cases. A relationship was found between wheezing and nursery attendance (OR: 1.66, 95% confidence interval [1.19-2.31]); weight at birth >3500g (OR: 1.45 [1.02-2.06]); the presence of eczema at this age (OR: 2.72 [1.75-4.24]); exclusive breastfeeding for <3 months (OR: 1.33 [0.98-1.81]); and maternal smoking during the last three months of pregnancy (OR: 1.60 [0.96-2.68]).The prevalence of recurrent wheezing (defined as three or more episodes) was 11.9%. Significant differences were observed with respect to nursery attendance (OR: 1.71 [1.08-2.72]), the presence of eczema at this age (OR: 2.55 [1.48-4.42]), a history of maternal asthma (OR: 2.19 [1.08-4.44]) and exclusive breastfeeding for <3 months (OR: 1.53 [0.98-2.38]). Conclusions: In the province of Salamanca, one third of the infants studied suffered wheezing in the first year of life. Infants exclusively breastfed for less than three months; attending a nursery; having suffered eczema; or with an asthmatic mother showed significantly more wheezing than the rest. Wheezing proved recurrent in 11.9% of the cases(AU)

Study of wheezing and its risk factors in the first year of life in the Province of Salamanca, Spain. The EISL Study.

OBJECTIVES: To determine the prevalence of wheezing and its associated risk factors in infants in the first year of life in the province of Salamanca, Spain. METHODS: A multicentre, cross-sectional, descriptive epidemiological study was designed to evaluate a representative sample of 750 infants in the first year of life, born in the province of Salamanca between 1 June 2008 and 30 September 2009. The study was based on a previously validated and standardised written questionnaire administered among the parents of those children seen for control at 12 months of age in any of the Primary Care centres in the province of Salamanca. RESULTS: The recorded wheezing rate was 32.3%. Feeding and sleep were seen to be affected in 46.3% and 80.9% of the wheezing children, respectively, and parent activity was also altered in 39.3% of the cases. A relationship was found between wheezing and nursery attendance (OR: 1.66, 95% confidence interval [1.19-2.31]); weight at birth >3500 g (OR: 1.45 [1.02-2.06]); the presence of eczema at this age (OR: 2.72 [1.75-4.24]); exclusive breastfeeding for <3 months (OR: 1.33 [0.98-1.81]); and maternal smoking during the last three months of pregnancy (OR: 1.60 [0.96-2.68]). The prevalence of recurrent wheezing (defined as three or more episodes) was 11.9%. Significant differences were observed with respect to nursery attendance (OR: 1.71 [1.08-2.72]), the presence of eczema at this age (OR: 2.55 [1.48-4.42]), a history of maternal asthma (OR: 2.19 [1.08-4.44]) and exclusive breastfeeding for <3 months (OR: 1.53 [0.98-2.38]). CONCLUSIONS: In the province of Salamanca, one third of the infants studied suffered wheezing in the first year of life. Infants exclusively breastfed for less than three months; attending a nursery; having suffered eczema; or with an asthmatic mother showed significantly more wheezing than the rest. Wheezing proved recurrent in 11.9% of the cases.

Exploración funcional pulmonar en pediatría / Pulmonary function tests in pediatrics

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Genética del asma / Genetics of asthma

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Protocolo de actuación ante el maltrato infantil y situaciones de riesgo en el ámbito sanitario en la provincia de Salamanca / Action protocol when there is child battering and situations of risk in the health care setting in the province of Salamanca (Spain)

El maltrato infantil en sus diversas formas de manifestaciónes un problema que afecta a la infancia en el mundo entero y los pediatras, como responsables de la salud integral del niño, debemos estar concienciados de la importancia de intervenir en nuestro entorno para identificar situaciones de riesgo y aprovechar todos los recursos sociosanitarios para la implementación de medidas preventivas adecuadas. Se ha elaborado un protocolo con el fin de facilitarla atención adecuada de estos niños en la provincia de Salamanca (AU)

Child battering in its different manifestation forms is a problem that affects young children worldwide. The pediatricians, who are responsible for the integral health of the child, should be aware of the importance of intervening within their setting in order to identify risk situations and to take advantage of the social-health care resources for the establishment of adequate preventive measures. A protocol has been elaborated in order to facilitate adequate care for these children in the providence of Salamanca (AU)

Consensus Statement on the Management of Paediatric Asthma. Update 2007

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How pediatricians in Spain manage the first acute wheezing episode in an atopic infant. Results from the TRAP study.

BACKGROUND: Although the treatment of asthma has been addressed in several guidelines, the management of the first acute wheezing episode in infants has not often been evaluated. We surveyed practicing pediatricians in Spain about the treatment they would provide in a simulated case. MATERIAL AND METHODS: A random sample of 3000 pediatricians and physicians who normally treated children was surveyed. The questionnaire inquired about how they would treat a first mild-to-moderate wheezing attack in a 5-month-old boy with a personal and family history of allergy. Pediatricians were asked about their professional background. RESULTS: A total of 2347 questionnaires were returned with useful data (78.2%). Most (90.4%) of the pediatricians would use a short-acting beta2 agonist (SABA) via a metered-dose inhaler with a spacer and a face mask or nebulizer. However, only 34.5% chose a SABA alone: 31.3% added an oral steroid and 27.6% added an inhaled corticosteroid (ICS). The factors associated with the use of ICS in the acute attack were: (1) lack of specific training in pediatrics (OR 1.45; 1.12-1.85) and (2) primary care health center setting (OR 1.31; 1.01-1.69) or rural setting (OR 1.28; 1.01-1.66). Forty-four percent did not recommend any follow-up treatment while 20.7% prescribed ICS as maintenance therapy. The factors related to this decision were the same as those described above. CONCLUSIONS: The management of a first wheezing episode seems to meet published guidelines among Spanish pediatricians with formal training in pediatrics and in those who work in a hospital setting or in urban areas.