Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

[Flexible rhinopharyngolaryngoscopy in the evaluation of patients with allergic and upper respiratory airway disorders]. / Rinofaringolaringoscopia flexible en la evaluación de pacientes con problemas alérgicos y de vías respiratorias altas.

Flexible rhinofaringolaryngoscopy is a valuable diagnostic tool in our daily practice, adding up to 60% of additional information in the diagnosis and clinical approach in neonates, children and adults with pathology of the upper respiratory tract and allergic diseases. We present a practical method for office use, and review our experience with 423 patients in whom the exam was performed. 49% had an abnormal nasal mucosa and middle meatus, site related to ethmoidal and maxillary sinus drainage. In 23 patients we found abnormal turbinates, either clefting, polypoidal changes, degeneration or concha bullosa; most of these findings were not appreciated after routine speculum examination. 7% of our patients had mucosal changes in the area related to the olfactory epithelium, edema and inflammation related to taste and smell disorders. 56 patients had inflammation and hypertrophy in adenoids, 50% of these with some degree of auditory canal obstruction (Eustaquian orifice). In the inferior pharynx and larynx, 58 patients had abnormalities, inflammation in glotic area (8%) due to speech dysfunction. They required speech therapy 4% (14 patients) with abnormal vocal cords, polyps (5), paralysis (4). 2 patients with carcinoma, were referred for biopsy and specific treatment. After gaining sufficient expertise rhinofaringolaryngoscopy is a useful and safe procedure which enhances the diagnostic ability of the practicing allergist/immunologist to evaluate complains referable to the upper airways.

[Recurrent upper respiratory tract obstruction in children]. / Estudio del niño con obstrucción recurrente de las vías respiratorias superiores.

BACKGROUND: The systematic approach of the pediatric patient with recurrent upper airway obstruction (RUAO) must be based on a through clinical history, physical examination, and the adequate use of the laboratory and diagnostic procedures, which must complement the correct identification of the causes of UAO and its interrelation with comorbid conditions as allergic rhinitis, rhinosinusitis and adenoiditis, with or without significant hypertrophy. OBJECTIVE: this work, is to propose the study protocol of the patient with recurrent upper airway obstruction used in our own Instituto Privado de Alergia, Inmunología y Vías Respiratorias. MATERIAL AND METHODS: We studied in a prospective fashion, a cohort of 117 pediatric patients, 12 years old and under, with clinical complaints of RUAO. 2/3 of these patients had a suggestive cytology pattern of nasal allergy and infection at the same time, following the method proposed by Dr. Alfredo Jalowayski from UC San Diego. RESULTS: The use of conventional radiology (lateral neck x ray) in the diagnosis of hypertrophy/hyperplasia of adenoidal tissue is useful and give us an orientation regarding the adenoidal size in 75% of the patients; nevertheless, it should not be considered as the most sensible diagnostic procedure to decide the best therapeutic option. If this study shows a decrease in diameter of the airway between the hard palate and the adenoidal shadow of 20% or more, we should proceeded with a flexible rhinopharyngoscopy to evaluate not only the real size of the adenoidal tissue, its mucosal appearance and its relation within the posterior pharynx with the Eustaquian tube (oto-pharyngeal tube-OPT). The endoscopic procedure is easy to perform, even in small children and showed us that almost half of the patients with abnormal lateral X-ray, have at least some degree of OFT obstruction. Aside from these results, the nasopharyngoscope give us useful information about comorbid and or existing conditions such as allergic rhintis, nasal polyposis, status of the osteomeatal complex, presence of bullae, anatomic variations, septal deviations and status of the olfactory epithelium. CONCLUSIONS: The use and feasibility to perform the nasal cytology test using the rhinoprobe technique, allow us to know the predominant cellular pattern of the nasal mucous, differentiate the allergic or non allergic rhintis, eosinophilic, basophilic, infectious or non infectious process.

[Olfaction dysfunction]. / Disfunción del olfato.

OBJECTIVE: To report of results obtained with the systematized boarding (physiopathology, diagnosis and treatment) to dysfunction of the smell that can affect the patient's life in significant form. MATERIAL AND METHOD: 58 patients were evaluated that went to the clinic with alterations in the olfaction or the pleasure, or both. The protocol includes a guided questionnaire, tests of identification of scent and threshold olfactory, rhinomanometry, nasal histogram, I simple study radiological of the roads breathing superiors and paranasals sinus, besides computer axial tomography and endoscopy. RESULTS: The most frequent cause in the olfactory dysfunction was the due mechanical obstruction to inflammatory processes, as chronic sinusitis and nasal polyposis, which obstruct the olfactory niche like complication; of the 58 patients, 48% belonged to this group. This inflammatory illness was divided, in turn, in allergy pure 25%, infectious 21% and pattern mixed 54%. The olfactory tests showed hyponia severe. In the general analysis the rest of the olfactory dysfunction was classified as postviral in 20%, posttraumatic in 12.1%, a group miscellaneous 8.6%, caused by toxins 6-9%, being a group of idiopathic cause in 3.4%.