Manuel Praena-Crespo

Effects of fine particles on children's hospital admissions for respiratory health in Seville, Spain.

This study analyzes the influence of fine particles PM2.5 on nonprogrammed children’s hospital admissions that occurred in the city of Seville between 2007 and 2011, and makes an economic assessment of the cost of the children’s hospital admissions for respiratory causes due to particle pollution. The PM2.5 dose-response functions for each type of hospital admission were used to quantify the cost of the hospital admissions. It can be concluded that the PM2.5 concentrations have negative effects on bronchiolitis, pneumonia, asthma, and bronchitis and other causes. A reduction of the daily average annual PM2.5 concentration from the existing levels to 10 µg/m3 would show an annual average reduction of children’s hospital admissions due to respiratory diseases of 0.09 cases. This paper shows that the daily average cost for children hospital admissions due to respiratory reasons in the city of Seville, associated with daily average annual levels of PM2.5 above 10 µg/m3, was almost 200€. Implications: Elevated PM2.5 concentrations in Seville have negative effects on children’s bronchiolitis, pneumonia, asthma, and bronchitis and other causes. A reduction of the daily average annual PM2.5 concentration from the existing levels to 10 μg/m3 would suppose an annual mean reduction of children’s hospital admissions due to respiratory diseases of 0.09 cases.

Association between quality of life in parents and components of asthma control in children

Abstract Objective: Describe the association between parents’ quality of life and the two components of asthma control in children: impairment and risk. Methods: Cross-sectional study with children between 4 and 14 years of age with active asthma recruited at primary care centers in Spain. Asthma control was assessed according to the Third National Asthma Expert Panel Report, classifying “impairment” in three levels (well-controlled asthma, partially controlled, and poorly controlled), and “risk” as high or low. The parents’ quality of life was evaluated using the specific Family Impact of Childhood Bronchial Asthma Questionnaire instrument (IFABI-R). The association between asthma control and the parents’ quality of life was analyzed using multivariate regression models adjusted for other social and family variables. Results: Data from 408 children were analyzed. The parents’ quality of life was affected in the partially controlled asthma group when compared with well-controlled asthma, as showed by an increase in IFABI-R scores in all dimensions: functional 17.2% (p < 0.001), emotional 10.4% (p = 0.021), and socio-occupational 6.8% (p = 0.056). The differences were higher in poorly controlled asthma compared with well-controlled asthma: functional 24.3% (p = 0.001), emotional 18.9% (p = 0.008), and socio-occupational 11.5% (p = 0.036). The “risk” component was independently associated with the parents’ quality of life. Of all the elements used to assess the control, the only one independently associated with the parents’ quality of life was recurrent asthma crisis. Conclusions: In asthma control, both “impairment” and “risk” in children are gradually associated with the parents’ quality of life. The global assessment of the control surpasses the importance of each individual element used in this assessment.

Indicators for childhood asthma in Spain, using the Rand method

OBJECTIVE To develop quality indicators to measure asthma care in primary health care. METHOD A modified RAND was used, which included the systematic review of the literature in Embase, Cochrane and Pubmed Quality Agencies and Database. The work group identified the indicators, translated them into Spanish and resolved any duplicates. Each indicator is composed of several dimensions (access to care, clinical effectiveness, patient-centred quality and patient safety). A multidisciplinary panel of 98 professionals from all over Spain were invited to score each indicator using a Likert scale. After calculating the average and median of each indicator, this information was sent to those who responded (n=38) for a second round and further scoring. The agreement percentage for the group was obtained for each indicator. RESULTS Of the 105 asthma indicators reviewed, we selected 46 that were presented to the panel of experts. In both Delphi phases, 37.1% of the members of the initial panel of experts responded. Of these, 26 were primary care paediatricians, six were pulmonologists, three were nurses, two were pharmacists and one was an allergist. For 32 indicators, agreement exceeded 70% and seven of those scored highest for the various care aspects for asthmatic children. CONCLUSION Quality indicators are presented for the follow-up of asthma and their implementation in primary care, which have undergone a strict selection and agreement process by a multidisciplinary work group.

Looking beyond patients: Can parents’ quality of life predict asthma control in children?

Background: Social and family factors may influence the probability of achieving asthma control in children. Parents’ quality of life has been insufficiently explored as a predictive factor linked to the probability of achieving disease control in asthmatic children. Objective: Determine whether the parents’ quality of life predicts medium‐term asthma control in children. Methods: Longitudinal study of children between 4 and 14 years of age, with active asthma. The parents’ quality of life was evaluated using the specific IFABI‐R instrument, in which scores were higher for poorer quality of life. Its association with asthma control measures in the child 16 weeks later was analyzed using multivariate methods, adjusting the effect for disease, child and family factors. Results: The data from 452 children were analyzed (median age 9.6 years, 63.3% males). The parents’ quality of life was predictive for asthma control; each point increase on the initial IFABI‐R score was associated with an adjusted odds ratio (95% confidence interval) of 0.56 (0.37–0.86) for good control of asthma on the second visit, 2.58 (1.62–4.12) for asthma exacerbation, 2.12 (1.33–3.38) for an unscheduled visit to the doctor, and 2.46 (1.18–5.13) for going to the emergency room. The highest quartile for the IFABI‐R score had a sensitivity of 34.5% and a specificity of 82.2% to predict poorly controlled asthma. Conclusions: Parents’ poorer quality of life is related to poor, medium‐term asthma control in children. Assessing the parents’ quality of life could aid disease management decisions. Pediatr Pulmonol. 2016;51:670–677.

Heterogeneidad de criterios en el diagnóstico de bronquiolitis aguda en España

INTRODUCTION Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. OBJECTIVE To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. METHODS Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an on-line questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. RESULTS Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics such as the maximum age for diagnosis. The on-line questionnaire was completed by 1297 paediatricians. Their diagnostic criteria were heterogeneous and strongly associated with their paediatric sub-specialty. Their agreement with the Spanish expert consensus and with international standards was very poor. CONCLUSIONS Diagnostic criteria for AB in Spain are heterogeneous. These differences could cause variability in clinical practice with AB patients. Resumen Introducción La bronquiolitis vírica aguda (BA) es una de las enfermedades respiratorias más frecuentes en los lactantes. Sin embargo, los criterios utilizados para su diagnóstico son heterogéneos e insuficientemente conocidos. Objetivo Identificar los criterios de diagnóstico de BA empleados en España, tanto por expertos como por pediatras clínicos. Métodos Estudio de metodología Delphi con expertos españoles en BA, buscando los puntos de consenso sobre el diagnóstico de BA. Posteriormente se realizó un estudio transversal mediante encuesta on-line dirigida a todos los pediatras españoles, contactados a través de mensajes de correo electrónico enviados por nueve sociedades científicas pediátricas. Se hizo análisis descriptivo y análisis factorial de los resultados de la encuesta, buscando si los criterios diagnósticos empleados se relacionaban con variables demográficas, geográficas o con la subespecialidad pediátrica. Resultados Los 40 expertos participantes alcanzaron un consenso en muchos aspectos (primer episodio de dificultad respiratoria y aumento de la frecuencia respiratoria, diagnóstico en cualquier estación del año, y utilidad de la identificación de virus para el diagnóstico), pero manteniendo opiniones enfrentadas en cuestiones importantes como la edad máxima aceptable para el diagnóstico. A la encuesta on-line respondieron 1297 pediatras. Los criterios diagnósticos que aplican son heterogéneos y están fuertemente asociados con la subespecialidad pediátrica. Su acuerdo con el consenso de expertos y con estándares internacionales es muy bajo. Conclusiones Los criterios usados en España para el diagnóstico de BA son heterogéneos. Esas diferencias pueden causar variabilidad en la práctica clínica en pacientes con BA. Abstract Introduction Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. Objective To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. Methods Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an on-line questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. Results Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics such as the maximum age for diagnosis. The on-line questionnaire was completed by 1297 paediatricians. Their diagnostic criteria were heterogeneous and strongly associated with their paediatric sub-specialty. Their agreement with the Spanish expert consensus and with international standards was very poor. Conclusions Diagnostic criteria for AB in Spain are heterogeneous. These differences could cause variability in clinical practice with AB patients.

Asthma diagnosis in infants and preschool children: a systematic review of clinical guidelines

BACKGROUND AND AIM The definition and diagnosis of asthma are the subject of controversy that is particularly intense in the case of individuals in the first years of life, due to reasons such as the difficulty of performing objective pulmonary function tests or the high frequency with which the symptoms subside in the course of childhood. Since there is no consensus regarding the diagnosis of asthma in preschool children, a systematic review has been carried out. MATERIALS AND METHODS A systematic search was made of the clinical guidelines published in the last 10 years and containing information referred to the concept or diagnosis of asthma in childhood - including the first years of life (infants and preschool children). A series of key questions were established, and each selected guide was analyzed in search of answers to those questions. The review protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42017074872. RESULTS Twenty-one clinical guidelines were selected: 10 general guides (children and adults), eight pediatric guides and three guides focusing on preschool children. The immense majority accepted that asthma can be diagnosed from the first years of life, without requiring pulmonary function tests or other complementary techniques. The response to treatment and the exclusion of other alternative diagnoses are key elements for establishing the diagnosis. Only one of the guides denied the possibility of diagnosing asthma in preschool children. CONCLUSIONS There is generalized although not unanimous agreement that asthma can be diagnosed in preschool children.

Resources to handle childhood asthma in Spain: The role of plans and guides and the participation of nurses.

BACKGROUND Describe the assistance provided to asthmatic patients by Primary Care Paediatricians (PCP) in Spain and the material and human resources available for diagnosis and follow-up. METHODS A cross-sectional descriptive study using an on-line survey, sent to PCP regarding the availability of diagnostic resources, carrying out programmed and educational activities, collaboration of nursing staff and their relationship with existing institutional plans to care for children with asthma. A latent class model (LCM) was used to describe the differences among paediatricians based on the variables studied. RESULTS Of the 708 answers, 675 were considered valid; 76% of the paediatricians had a spirometer, 75% specific IgE, 17% prick-test, 95% had placebo inhalers and 97% inhalation chambers. 57% performed programmed activities with their patients, while 56% shared their care of asthmatic patients with their nursing staff, but only 25% of the nurses were involved in the follow-up and 12% in education. LCM identified four patterns. The two groups with greater access to diagnostic resources counted on institutional plans/guidelines. However, the only variable differentiating the groups with more programmed and educational activities was the participation of nurses. CONCLUSIONS The availability of asthma plans/guidelines and resources for diagnosis and follow-up is not sufficient to improve important aspects of primary care for children with asthma. Organisational changes are necessary to include programmed asthma-related visits and paediatric teams with greater involvement of the nurses when caring for these patients.