Treating asthma patients with probiotics: a systematic review and meta-analysis / Tratamiento de pacientes asmáticos con probióticos: revisión sistemática y metaanálisis

Objective: to evaluate the role of probiotics in the treatment of asthma patients by meta-analysis.Methods: PubMed, Embase, The Cochrane Library, Web of Science, and other databases were searched by computer, and the relevant literature on the treatment of asthma by probiotics that met the inclusion criteria was screened by manual retrieval. Meta-analysis was performed using Revman 5.4 software and the combined effect was evaluated by odds ratio (OR) or mean difference (MD) and 95 % confidence interval (CI). Results: a total of ten references were included, all of which were randomized controlled studies, and a total of 1,101 people were investigated. Fractional exhaled nitric oxide (FeNO) (MD = -7.17, 95 % CI: -12.81, -1.54), asthma symptom severity (MD = -0.07, 95 % CI: -0.10, -0.04), Childhood Asthma Control Test (CACT) (MD = 2.26, 95 % CI: 1.14, 3.39), and the number of acute episodes of asthma (OR = 0.30, 95 % CI: 0.19, 0.47) in the probiotics group were better than those in the control group. There was no significant difference in forced expiratory volume in the first second (FEV1) (MD = 0.11, 95 % CI: -0.05, 0.26) and FEV1/FVC (%) (MD = 0.32, 95 % CI: -1.48, 2.12). Conclusion: the use of probiotics in patients with asthma can improve lung inflammation and asthma symptoms, reduce the number of asthma attacks, and have no effect on lung function.(AU)

Objetivo: evaluar el papel de los probióticos en el tratamiento de pacientes con asma mediante metaanálisis.Métodos: se realizaron búsquedas informáticas en PubMed, Embase, The Cochrane Library, Web of Science y otras bases de datos, y se examinó la literatura relevante sobre el tratamiento del asma con probióticos que cumplía con los criterios de inclusión mediante recuperación manual. El metaanálisis se realizó con el software Revman 5.4 y el efecto combinado se evaluó mediante la razón de probabilidades (OR) o diferencia media (MD) y el intervalo de confianza (IC) del 95 %. Resultados: se incluyó un total de diez referencias, todas ellas estudios controlados aleatorios, y se investigó un total de 1.101 personas. El óxido nítrico exhalado (FeNO) (MD = -7,17, IC 95 %: -12,81, -1,54), la gravedad de los síntomas del asma (MD = -0,07, IC 95 %: -0,10, -0,04), la Prueba de Control del Asma (CACT-ACT) (MD = 2,26, IC 95 %: 1,14, 3,39) y el número de episodios agudos de asma (OR = 0,30, IC 95 %: 0,19, 0,47) en el grupo de probióticos fueron mejores que en el grupo de control. No hubo diferencia significativa en volumen espiratorio forzado en el primer segundo (FEV1) (DM = 0,11, IC 95 %: -0,05, 0,26) y FEV1/FVC (%) (DM = 0,32, IC 95 %: -1,48, 2,12). Conclusión: el uso de probióticos en pacientes con asma puede mejorar la inflamación pulmonar y los síntomas del asma, reducir el número de ataques de asma y no tener efecto sobre la función pulmonar.(AU)

Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities?

African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.

Eficacia de la tintura de ajo al 20 por ciento en pacientes asmáticos. Policlínico 13 de Marzo. 2018 –2019 / Efficacy of 20% garlic tincture in asthmatic patients. Polyclinic March 13. 2018–2019

Se realizó un estudio prospectivo, con modelo cuasi experimental en los pacientes asmáticos pertenecientes del Policlínico 13 de Marzo, con el objetivo de evaluar la eficacia de la tintura de ajo al 20 por ciento en el tratamiento intercrisis del Asma Bronquial, en el período comprendido de enero de 2018 a mayo de 2019. El Universo estuvo representado por 88 pacientes asmáticos entre 20-59 años de edad dispensarizados en el consultorio 25. La muestra quedó constituida por 84 pacientes que cumplieron con los criterios de inclusión y de exclusión. Los pacientes fueron distribuidos de forma aleatoria, en dos grupos control y experimental, utilizando la tabla de números aleatorios computarizados, en una proporción pareada de 1:1. Se empleó la prueba de diferencia de proporciones para muestras independientes y se trabajó con un nivel de significación p=0,05. Con este proyecto se contribuyó al desarrollo de la medicina natural y tradicional en nuestro país. Se demostró la eficacia de la tintura de ajo en el 97.6 por ciento de los pacientes. Los hombres fueron los más afectados por las crisis y se reportaron 3 efectos adversos de forma leve(AU)

A prospective study was carried out, with a quasi-experimental model in asthmatic patients belonging to the 13 de Marzo Polyclinic, with the aim of evaluating the efficacy of the 20 percent garlic tincture in the inter-crisis treatment of Bronchial Asthma, in the period from January from 2018 to May 2019. El universo was represented by 88 asthmatic patients between 20-59 years of age dispensed in the office 25. The sample consisted of 84 patients who met the inclusion and exclusion criteria. The patients were randomized into two control and experimental groups, using the table of computerized random numbers, in a paired ratio of 1: 1. The difference of proportions test was used for independent samples and the level of significance was p = 0.05. This project contributed to the development of natural and traditional medicine in our country. The efficacy of garlic tincture was demonstrated in 97.6 percent of patients. Men were the most affected by the seizures and 3 mild adverse effects were reported(EU)

Control de asma bronquial en niños y adolescentes atendidos en establecimientos de salud de Chiclayo / Control of bronchial asthma in children and adolescents treated in health facilities in Chiclayo

Introducción: El asma es un problema frecuente en la niñez y adolescencia y es importante su adecuado control. Objetivos: Estimar el nivel de control de asma en niños y adolescentes atendidos en establecimientos de salud. Métodos: Estudio censal de tipo transversal descriptivo realizado en la ciudad de. Chiclayo, entre julio-diciembre 2013. Se incluyeron menores de edad de 5 a 18 años con diagnóstico de asma. Se identificaron a los pacientes en la base de datos de la red de salud Lambayeque y se les realizó una visita domiciliaria donde se les invitó al estudio y se aplicó el instrumento de evaluación. Resultados: Se identificaron 203 pacientes, se contactaron y reclutaron 107 individuos. Se incluyeron 89 (83,2 por ciento) niños y 18 (16,8 por ciento) adolescentes con una mediana de edad de 7 (p25= 5/p75= 9) años y 15 (p25= 15/p75= 17) años, respectivamente. Según el puntaje del instrumento de evaluación: 52 (48,6 por ciento) estaban mal controlados; 46 (43,0 por ciento) parcialmente controlados; y 9 (8,4 por ciento), bien controlados. En el caso de los niños, la frecuencia de no control fue de 48,3 por ciento, parcialmente controlado 43,8 por ciento y controlado 7,9 por ciento; y en los adolescentes fue de 50,0; 38,9 y 11,1 por ciento, respectivamente. Se observó una relación significativa entre el nivel de control y el nivel educativo del cuidador en niños (p= 0,006) y adolescentes (p= 0,005). Conclusiones: Se demuestra una frecuencia elevada de control inadecuado de asma, lo cual contrasta con otras realidades similares donde hay una mayor frecuencia de control(AU)

Introduction: Asthma is a common problem in childhood and adolescence and is important its adequate control. Objectives: To estimate the level of asthma control in children and adolescents treated in health facilities. Methods: Census data of descriptive cross-sectional type study conducted in the city of Chiclayo, from July to December, 2013. There were included children from 5 to 18 years diagnosed with asthma. Patients were identified in the database of Lambayeque health network and underwent a home visit where they were invited to the study and it was applied the assessment instrument. Results: 203 patients were identified, and there were contacted and recruited 107 individuals. 89 (83.2 percent) children and 18 (16.8 percent) adolescents were included with a mean age of 7 (p25= 5/p75= 9) and 15 (p25= 15/p75= 17) years, respectively. According to the score of the assessment instrument: 52 (48.6 percent) were poorly controlled; 46 (43.0 percent) partially controlled; and 9 (8.4 percent), well-controlled. In the case of children, the frequency of no control was of 48.3 percent, partially controlled was 43.8 percent and controlled was 7.9 percent; and in the adolescents, it was 50.0, 38.9 and 11.1 percent , respectively. It was observed a significant relationship between the level of control and the educational level of the caregiver in children (p= 0.006) and adolescents (p= 0.005). Conclusions: It is demonstrated the high frequency of inadequate control of asthma, which contrasts with other similar realities where there is a greater frequency of control(AU)

Treating asthma in the age of biologics.

Many patients with severe asthma continue to have high symptom burden despite maximization of conventional therapy. As the understanding of asthma pathophysiology has evolved, however, more personalized therapy options have become available. Asthma biologics are a new class of medications that target the specific pathways that underlie a patient's disease and can reduce the frequency of asthma exacerbations and improve patient quality of life. Clinicians should refer potential candidates to a specialist for further evaluation.

Management of Severe Asthma: a European Respiratory Society/American Thoracic Society Guideline

This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on 6 specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) Suggest using anti-IL5 and anti IL-5Rα for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using blood eosinophil cut-point of ≥150/µL to guide anti-IL5 initiation in adult patients with severe asthma; and 3) Suggest considering specific eosinophil (≥260/µL) and FeNO (≥19.5 ppb) cutoffs to identify adolescents or adults with the greatest likelihood or response to anti-IgE therapy; 4) Suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite GINA step 4-5 or NAEPP step 5 therapies; 5) Suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; 6) Suggest using anti-IL4/13 for adult patients with severe eosinophilic asthma, and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.

BACKGROUND: Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist-driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS). This pathway was associated with decreased hospital length of stay (LOS) for all pediatric asthma patients; however, the effect on PICU patients was unclear. We hypothesized that the implementation of a pediatric asthma pathway would reduce hospital LOS for asthmatic patients admitted to the PICU. METHODS: We retrospectively reviewed the medical records of all pediatric asthma subjects 2-17 y old admitted to our PICU before and after pathway initiation. Primary outcome was hospital LOS. Secondary outcomes were PICU LOS and time on continuous albuterol. Data were analyzed using the chi-square test for categorical data, the t test for normally distributed data, and the Mann-Whitney test for nonparametric data. RESULTS: A total of 203 eligible subjects (49 in the pre-pathway group, 154 in the post group) were enrolled. There were no differences between groups for age, weight, gender, home medications, cause of exacerbation, medical history, or route of admission. There were significant decreases in median (interquartile range) hospital LOS (4.4 [2.9-6.6] d vs 2.7 [1.6-4.0] d, P < .001), median PICU LOS (2.1 [1.3-4.0] d vs 1.6 [0.8-2.4] d, P = .003), and median time on continuous albuterol (39 [25-85] h vs 27 [13-42] h, P = .001). Significantly more subjects in the post-pathway group were placed on high-flow nasal cannula (32% vs 6%, P = .001) or noninvasive ventilation (10% vs 4%, P = .02). CONCLUSION: The implementation of an asthma pathway was associated with decreased hospital LOS, PICU LOS, and time on continuous albuterol. There was also an increase in the use of high-flow nasal cannula and noninvasive ventilation after the implementation of this clinical pathway.

At-risk registers integrated into primary care to stop asthma crises in the UK (ARRISA-UK): study protocol for a pragmatic, cluster randomised trial with nested health economic and process evaluations.

BACKGROUND: Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. ARRISA involved identifying individuals at risk of adverse asthma events, flagging their electronic health records, training practice staff to develop and implement practice-wide processes of care when alerted by the flag, plus motivational reminders. We now seek to determine the effectiveness and cost-effectiveness of ARRISA in reducing asthma-related crisis events. METHODS: We are undertaking a pragmatic, two-arm, multicentre, cluster randomised controlled trial, plus health economic and process evaluation. We will randomise 270 primary care practices from throughout the UK covering over 10,000 registered patients with 'at-risk asthma' identified according to a validated algorithm. Staff in practices randomised to the intervention will complete two 45-min eLearning modules (an individually completed module giving background to ARRISA and a group-completed module to develop practice-wide pathways of care) plus a 30-min webinar with other practices. On completion of training at-risk patients' records will be coded so that a flag appears whenever their record is accessed. Practices will receive a phone call at 4 weeks and a reminder video at 6 weeks and 6 months. Control practices will continue to provide usual care. We will extract anonymised routine patient data from primary care records (with linkage to secondary care data) to determine the percentage of at-risk patients with an asthma-related crisis event (accident and emergency attendances, hospitalisations and deaths) after 12 months (primary outcome). We will also capture the time to crisis event, all-cause hospitalisations, asthma control and any changes in practice asthma management for at-risk and all patients with asthma. Cost-effectiveness analysis and mixed-methods process evaluations will also be conducted. DISCUSSION: This study is novel in terms of using a practice-wide intervention to target and engage with patients at risk from their asthma and is innovative in the use of routinely captured data with record linkage to obtain trial outcomes. TRIAL REGISTRATION: ISRCTN95472706 . Registered on 5 December 2014.

Crisis de asma / Asthma crisis

No disponible

[Anesthetic management in bronchial asthma]. / Asthma bronchiale - Anästhesiologisches Management.

In daily practice, acute and chronic pulmonary diseases are common issues presenting to the anesthetist. Respiratory physiology in general is affected by both general and regional anesthesia, which results in an increased number of perioperative complications in pulmonary risk patients. Therefore, anesthetic management of patients with bronchial asthma needs to address different clinical topics: the physical appearance of pulmonary disease, type and extent of surgical intervention as well as effects of therapeutic drugs, anesthetics and mechanical ventilation on respiratory function. The present work describes important precautions in preoperative scheduling of the asthmatic patient. In the operative course, airway manipulation and a number of anesthetics are able to trigger intraoperative bronchial spasm with possibly fatal outcome. It is essential to avoid these substances to prevent asthma attack. If asthmatic status occurs, appropriate procedures according to therapeutic standards have to be applied to the patient. Postoperatively, sufficient pain therapy avoids pulmonary complications and improves outcome.

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

No disponible

GEMA 4.0. Spanish Guigeline on the Management of Asthma

No disponible

[Severe asthmatic crisis during general anesthesia in a patient with IgG4 related disease].

We experienced severe asthmatic crisis during general anesthesia in a 45-year-old man with IgG4-related disease, COPD and athma undergoing removal of submandibular gland. The ventilatiory failure was caused by the stimulation of the operation, sputum, and neostigmine. His serum IgG4 level was extremely high. IgG4 related disease is a recently emerging entity characterized by a diffuse or mass forming inflammatory reaction rich in IgG4-positive plasma cells associated with fibrosclerosis and obliterative phlebitis. It is associated with an elevated serum level of IgG4 and an allergic disease. We must be careful in perioperative management of the patients with IgG4-related disease because general anesthesia can induce asthmatic crisis.

[Development and effectiveness of a tailored education program for caregivers of asthmatic children].

BACKGROUND: We developed a tailored education program using a touch-screen computer for changing management behavior with asthmatic children and their caregivers. The purpose of this study was to examine the effect of the tailored education program. METHODS: Caregivers including children with asthma were recruited during visits to a national children's hospital and those whose month-long asthma condition on the JPAC (Japanese Pediatric Asthma Program) score was 14 and below were included. Caregivers were randomized to the tailored education (intervention group) or non-tailored education (control group). The intervention group underwent a patient education program using a touch-screen computer, and they received tailored messages generated by a computer program. A research nurse and clinical psychologist used a computer-based resource to tailor the education messages and provided counseling using motivational interviewing for the caregivers including children with asthma. The control group received only a booklet on asthma. RESULTS: Forty-seven subjects aged 1 to 6 years were enrolled. Forty-seven caregivers were randomized to the tailored education (n=22) or non-tailored education (n=25) group. The results of two-way ANOVA showed that interactions between groups were observed in the score of JPAC and asthma knowledge for preschool children whose asthma onset was within one year and a half. The main effects of time were observed in the total and subscale score of QOL (Quality of Life) and the total score of P-CASES (Parental Childhood Asthma's Self-efficacy Scale). CONCLUSION: These findings indicate the benefit of a tailored education program to control symptoms in such caregivers.

Factores de riesgo de gravedad de la crisis de Asma Bronquial en niños, Bayamo 2010 / Risk factors of the severity of Bronchial Asthma in children. Bayamo, 2010

Introducción: el asma es la enfermedad crónica que produce mayor morbilidad y alteración de la calidad de vida del niño durante toda la infancia, no siempre diagnosticada adecuadamente en la edad infantil. Objetivo: determinar los factores de riesgo que inciden en la gravedad de la Crisis Aguda del Asma Bronquial. Método: se realizó un estudio de caso control, en niños pertenecientes al área urbana del municipio Bayamo que ingresaron en la Unidad de Terapia Intensiva Pediátrica del Hospital General Luís Ángel Milanés Tamayo, durante 2010. El universo estuvo constituido por 118 pacientes que ingresaron por Asma Bronquial, la muestra quedó conformada por pacientes que ingresaron con este diagnóstico, y se dividió en 13 casos: pacientes con asma grave y 32 controles con una relación 1:4. Resultados: resultaron factores de riesgo de gravedad de la Crisis Aguda del Asma Bronquial: exposición pasiva al humo del cigarro, desnutrición por defecto, edad menor de 5 años, más de 5 crisis en un año, antecedentes de ingresos en Terapia intensiva. Conclusiones: la asociación entre los factores: ingresos previos en Terapia, fumadores pasivos, desnutrición por defecto y más de 5 crisis en el último año; en este orden de importancia, determinó el riesgo de ingreso por asma grave(AU)

Introduction: bronchial asthma is the chronic disease that produces a greater morbidity and alteration of the life quality of children during their childhood; it is not always diagnosed properly in the childish age. Objective: to determine the risk factors that influence in the severity of the Acute Crisis of Bronchial Asthma. Method: it was performed a case control study, in children that belonged to the urban area of Bayamo municipality, who were admitted in the Paediatric Intensive Therapy Unit at General Luís Ángel Milanés Tamayo Hospital, during the year 2010. The universe was constituted by 118 patients that were hospitalized for Bronchial Asthma; the sample was made by hospitalized patients with this diagnostic, and they were divided into 13 cases: patients with severe asthma and 32 controls with a 1: 4 relation. Results: the severe risk factors of the Acute Crisis of Bronchial Asthma were: passive exposure to the cigar smoke, malnutrition by defect, and the age was under 5 years, having more than 5 crises per year, finally the antecedents of admissions in the Intensive Therapy. Conclusions: the association between the factors: previous admission in Therapy, passive smokers, malnutrition by defect and more than 5 crises last year; in this order of importance, it was determined the risk of admission by severe asthma(EU)

[Retrospective analysis of omalizumab in patients with severe allergic asthma]. / Estudio observacional retrospectivo de la utilización de omalizumab en el tratamiento del asma grave persistente.

OBJECTIVE: To assess the efficacy and safety profile of omalizumab treatment. The conditions under which omalizumab was prescribed agreed with those in Xolair® drug information: age > 12 years old, severe uncontrolled asthma, FEV1 < 80%, IgE 30-700 UI/ml and positive test results for perennial allergens. METHODS: Asthmatic patients treated with omalizumab between January 2010 and July 2011 were evaluated retrospectively. Age, sex, weight, IgE level, concomitant asthma medications, change in FEV1, emergency department visits, hospitalizations, asthma exacerbations and corticosteroids bursts were recorded before and after omalizumab initiation. A 1.5- year period was chosen. RESULTS: A total of 22 patients were included. The mean weight of subjects was 73 Kg (range, 51-102). Mean IgE was 203 UI/ml (range, 30-992) and mean FEV1 60% (range, 30-93%) at baseline. Adverse events were observed in 4 patients. There were no significant changes in FEV1 values after omalizumab treatment but omalizumab was associated with a reduction in concomitant asthma medications use in 14 patients and improvements in global asthma control in 12. CONCLUSION: In these patients add-on therapy with omalizumab reduced asthma exacerbations and emergency visits or hospitalizations. Only 55% of patients significantly improved global asthma control and no significant changes in FEV1 were observed.

Objetivo: Evaluar la eficacia y seguridad del omalizumab. Las condiciones para la administración de dicho fármaco fueron las indicadas en ficha técnica: edad superior a 12 años, asma alérgica grave persistente, mal control de síntomas, FEV1<80%, IgE total entre 30 y 700 UI/mL y pruebas cutáneas y/o IgE específica positiva al alérgeno persistente. Método: Estudio retrospectivo observacional de pacientes que hubieran sido tratados con omalizumab en la indicación de asma grave durante el período enero 2010 a julio de 2011. Se registraron la edad, sexo, peso, IgE y reactividad in vitro a los alergenos perennes, FEV1, tratamiento de base, exacerbaciones asmáticas y necesidad de corticosteroides sistémicos o ingresos en urgencias, presencia de síntomas durante el día o que originen despertares durante la noche al inicio del tratamiento, a las 16 semanas, 32 semanas y a los 1,5 años tras al inicio del tratamiento. Se recogieron los efectos secundarios y los cambios en el tratamiento de base. Resultados: 22 pacientes con un peso medio de 73 kg (51-102). La concentración basal de IgE antes del inicio de omalizumab fue de 203 UI/ml (30-992). 21 pacientes presentaban una función pulmonar reducida, con un FEV1 al inicio del 60% (30-93%). El FEV1 a las 16 semanas fue del 60% (39-71%) y a las 32 semanas del 68% (29-102%). La dosis media de omalizumab administrada cada 30 días fue de 368 mg (150- 900 mg). Se observaron reacciones adversas en 4 pacientes, uno de los cuales requirió la retirada del tratamiento. Al final del periodo de seguimiento 14 pacientes habían disminuido el tratamiento control y doce presentaron mejoría global. Conclusión: Omalizumab se ha utilizado en pacientes con asma grave alérgica no respondedores a terapia convencional observándose una disminución en el número de exacerbaciones y visitas a urgencias e ingresos. Sólo un 55% experimentan una mejoría global según criterios clínicos y no se observaron cambios estadísticamente significativos en la FEV1.

Association between Genetic Polymorphisms of ß2 Adrenergic Receptors and Nocturnal Asthma in Egyptian children

Introducción: La identificación de las bases genéticas del asma puede contribuir al descubrimiento de una terapia antiasmática efectiva. Objetivo: Estimar la asociación entre polimorfismos del receptor beta2-adrenérgico (RB2A) y el asma nocturna en niños egipcios. Métodos: Se genotiparon los polimorfismos de RB2A Gly16 y Glu27 en 200 niños egipcios (90 con asma nocturna y 110 controles sanos), mediante la técnica de la reacción en cadena de la polimerasa. Resultados: El genotipo homozigoto (Gly16) incrementa el riesgo de padecer asma nocturna (OR: 3.2, 95% CI, 1.3-7.7) (p=0.003) y el alelo Gly se asocia significativamente con el riesgo de padecer asma nocturna (OR: 1.8, 95% CI, 1.2-2.8). Conclusión: Este estudio demuestra una asociación de polimorfismos Arg/Gly del RB2A con el asma nocturna y una falta de asociación del polimorfismo Gln/Glu con dicho tipo de asma (AU)

Background: Identification of the genetic basis of asthma may contribute to the discovery of effective asthma drugs. Objective: Our aim was to estimate the association between B2 adrenergic receptor (ADRB2) polymorphisms and nocturnal asthma in Egyptian children. Methods: ADRB2 polymorphisms Gly16 and Glu27 were genotyped in 200 Egyptian children (90 with nocturnal asthma and 110 healthy controls) using allele-specific polymerase chain reaction. Results: The homozygous (Gly16) genotype significantly increased the risk of nocturnal asthma (odds ratio [OR], 3.2; 95% CI, 1.3-7.7; P=.003), as did the Gly allele (OR, 1.8: 95% CI, 1.2-2.8). Conclusions: Our study demonstrated that nocturnal asthma was associated with ADRB2 Arg/Gly polymorphisms but not with ADRB2 Gln/Glu polymorphisms (AU)

Conocimientos acerca del asma de los padres de niños asmáticos que acuden a un servicio de urgencias / Knowledge about asthma of parents of asthmatic children who come to Emergency Department

Objetivo: Evaluar los conocimientos sobre el asma de los padres de niños asmáticos que acuden por una crisis a urgencias. Material y métodos: Se entregó la versión validada en español del Newcastle Asthma Knowledge Questionnaire a los progenitores seleccionados arbitrariamente. Resultados: Se encuestó a 95 progenitores (con una media de edad de 32,1 años; un 77,7% eran madres). La puntuación media del cuestionario fue de 16/31. No se encontró ninguna relación significativa entre la puntuación obtenida y la gravedad de la crisis, la necesidad de ingreso, las hospitalizaciones previas o el uso de tratamiento preventivo. Un 39,4% de los padres identificó correctamente los síntomas de las exacerbaciones. La implicación de la bronco constricción y la inflamación bronquial en las exacerbaciones fuere conocida por un 76,6 y un 63,8%, respectivamente. Sin embargo, el 47,9% opinó que el asma es un «problema nervioso», y un 91,5% no supo nombrar correctamente tres factores precipitantes de una crisis. En relación con el tratamiento, un 68,1% no reconoció dos fármacos útiles ante las exacerbaciones de la enfermedad, y un 41,5% respondió que los beta2-agonistas de acción corta son tratamientos de mantenimiento. Desconocían la existencia de tratamiento preventivo un 31,9%, un 73,4% no supo nombrar dos de ellos y para un 51,1% los antibióticos son parte fundamental del manejo del asma. Además, un 63,8% de los padres pensaba que la leche de vaca aumenta la mucosidad, y un 25,6% que estos pacientes no deberían consumir lácteos. Conclusiones: El conocimiento de los progenitores respecto al asma es escaso en nuestra población, y existen falsas creencias acerca de la patogenia de esta enfermedad. Sin embargo, no se encontró relación entre esta deficiencia y la gravedad de la crisis ,las hospitalizaciones previas o el uso de tratamiento preventivo (AU)

Objective: To evaluate parents' knowledge about asthma. Material and methods: We delivered the Spanish version of the Newcastle Asthma Knowledge Questionnaire to parents of children with an asthma attack. Results: The questionnaire was administered to 95 parents (average age of 32.1; 77.7% mothers). The mean score was 16/31. We did not find statistically significant between the score and severity of the asthma attack, need to stay in hospital, previous hospitalization or use of preventive treatment.39.4% of parents identified correctly the symptoms of an asthma exacerbation. The implication of the bronchospasm and bronchial inflammation in this exacerbation was recognized by 76.6% and 63.8%, respectively. Nevertheless, 47.9 % thought that asthma is a "nervous problem", and 91.5% could not name three triggered factors.68.1% did not know the names of two medicines useful foran asthma exacerbation, and 41.5% answered that short action beta2-agonist are "control medications". 31.9% of these parents did not know about "control medications", 73.4% could not name two of these medicines, and 51.1% answered that antibiotics are an important part in the treatment of asthma. In addition, 63.8% of these parents believed that cow's milk increases the mucosity, and 25.6% that these patients should not consume dairy produce. Conclusions: The knowledge of these progenitors was poor; they have false beliefs about the pathogenesis of this disease. Nevertheless, we did not find statistically significant between this low knowledge and the severity of the asthma exacerbation, previous hospitalization or use of "control medications" (AU)