Association between fractional exhaled nitric oxide and therapeutic adherence to controller management in pediatric asthma patients.

OBJECTIVES: Guidelines for asthma management recommend, before establishing additional therapeutic behaviors, to confirm correct use and adequate therapeutic adherence to treatment. Evidence exists on the use of fractional exhaled nitric oxide (FeNO) values for monitoring therapeutic adherence in adults. It is important to establish whether there is a correlation between FeNO and therapeutic adherence in children. This study aims to provide new knowledge about the relationship between FeNO and therapeutic adherence in asthmatic children. MATERIALS AND METHODS: Analytical cross-sectional study including asthma patients 5-18 years of age, attending follow-up at Hospital Militar Central (HMC) between May and November 2022 in Colombia. A sociodemographic survey was carried out, followed by the Pediatric Inhaler Adherence Questionnaire (PIAQ), and asthma control test (ACT) or childhood asthma control test (cACT). We defined adequate therapeutic adherence as not missing a single application of inhaled steroids in the last 15 days according to PIAQ. A poisson regression model was carried out including relevant predictors for therapeutic adherence such as FeNO values, age, tobacco exposure at home, atopy, and time since initiation of use of inhaled controller. RESULTS: Eighty-two children with a median age of 10 years (interquartile range: 7-12 years) were included. Adequate therapeutic adherence was reported by 68.3%. After adjusting for age, sex, exposure to cigarette smoke, duration of controller therapy, and atopy, FeNO < 20 ppb was independently associated with adequate therapeutic adherence (RR = 1.5, p = .04, 95% confidence interval: 1.03-2.19). CONCLUSIONS: FeNO values seem to be useful to identify pediatric patients with asthma who have adequate adherence to inhaled steroids in a MIC.

A comparative analysis of the bronchodilatador response measured by impulse oscillometry and spirometry in asthmatic children living at high altitude.

OBJECTIVE: Although the assessment of a bronchodilator response (BDR) is a routine and important procedure when performing lung function tests, comparisons between spirometric and oscillometric BDRs in asthmatic children living at high altitude have not been previously reported. The aim of the present study was to compare spirometric and oscillometric BDRs in children living at high altitude, and to identify independent predictors of spirometric and oscillometric BDRs. METHODS: Between January and December, 2015, asthmatic children aged between 5 and 17 years old performed impulse oscillometry (IOS) and spirometry during the same visit before and after albuterol administration. The data were analyzed, and children were classified into those positive for oscillometric BDR only, those positive for spirometric BDR only, those positive for both BDRs, and those negative for both BDRs. RESULTS: Ninety-three asthmatic children (56 boys, 37 girls), with a median (IQR) age of 11 (8-13) years, made up the study population. Among the total of 93 participants, 13 (14.0%), 4 (4.3%), 0 (0%), and 76 (81.7%) were positive for spirometric BDR only, positive for oscillometric BDR only, positive for both BDRs, and negative for both BDRs, respectively. Age and baseline lung function were identified as significant predictors of positive spirometric BDR. CONCLUSIONS: The present study shows poor concordance between positive spirometric and oscillometric BDRs, with a greater proportion of patients with a spirometric BDR when compared to those with positive oscillometric BDR. Additionally, age and baseline lung function are useful for predicting spirometric BDR results.

Development of spirometric reference equations for children living at high altitude.

OBJECTIVES: This study was aimed to provide locally derived spirometric equations from a population of healthy children residing in Bogota, Colombia, a high-altitude city. METHODS: Healthy children aged more than 6 years up to less than 18 years underwent spirometry from January 2017 to January 2018, following the recommendations made by the American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force. We performed stepwise multiple regression analyses to predict each spirometric parameter. We also performed extensive residual analyses comparing the measured values with those calculated with our new spirometric equations and with other commonly used equations. RESULTS: Predictive equations for each spirometric variable were derived from 326 spirometric tests (149 boys, 177 girls). Our newly derived spirometric equations provided the minimum of median of prediction error for almost all spirometric indices measured. CONCLUSION: We recommend the newly developed spirometric equations for assessing the ventilatory function of children living in Bogota, Colombia.

Reference values for spirometric parameters in healthy children living in a Colombian city located at 2640 m altitude.

OBJECTIVES: To identify the spirometric equations that are most appropriate for use in children and adolescents living in Bogota, Colombia after evaluating a set of relevant previously-developed equations, including the Global Lung Function Initiative (GLI) 2012 spirometry reference equations. METHODS: Healthy children aged between 6 and 17 years that were attending two randomly-selected schools in Bogota were invited to participate in the study, from January 2017 to January 2018. All participants underwent spirometry, following the procedures recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force. To identify the model or group of models that best predict each spirometric parameter in our population, we performed extensive residuals analyses and constructed Bland-Altman plots. RESULTS: Three hundred twenty-six spirometric tests (149 boys, 177 girls) formed the reference data set. Knudson and GLI-2012 spirometry reference equations proved to be the most accurate in predicting the majority of spirometry parameters in both sexes and both age groups, each providing the lowest median prediction error in the residual analyses or the narrowest limits of agreement in the Bland-Altman plots in approximately one-third of the spirometry parameters analyzed. CONCLUSION: For the majority of spirometry parameters, we recommend the use of Knudson and GLI-2012 spirometry reference equations for evaluating the respiratory function of children living in Bogota, Colombia, a city located at an altitude of 2640 m. Future investigations should target additional spirometric equations from Latin American populations living at moderate to high altitude to improve the GLI-2012 equations.

Seguimiento clínico y gasimétrico en la infección respiratoria aguda baja viral en pacientes menores de 2 años en el Hospital Santa Clara / Follow up of clinical and blood gas analysis of acute lower respiratory tract viral infection in patients younger than 2 Years of age

Se evaluó la secuencia gasimétrica por gases capilares arterializados (BCA) saturación por oximetría transcutánea (St02) y la evolución clínica de pacientes que requirieron hospitalización por Infección Respiratoria Aguda de Vías aéreas bajas (IRAB) de probable etiología viral. Se incluyó los pacientes hospitalizados por IRAB de posible etiología viral en el período de Marzo de 1992 a Mayo de 1993. Debido a que no se contó con cultivos ni métodos serológicos para detección de Virus, el diagnóstico se hizo mediante la clínica (episodio de menos de 15 días con tos, ruidos bronquiales audibles a distancia, dificultad respiratoria, fiebre, signología bronco-obstructiva (SBO) o sin ella, sin signos de consolidación y que no necesitaran antibióticos) asociado a ninguno o máximo uno de los reactantes de fase aguda (leucocitos mayor a 20.000 x mm3, PMN mayor a 30 mm y PCR mayor a 64 mg/L). Al ingreso se tomó CH, VSG, PCR, Rx de Tórax, GCA y St02 con Fi02 al 0.21. Se dió de alta cuando la clínica mostraba mejoría y la St02 era mayor o igual a 85 por ciento. Se excluyó a todo paciente con antecedente de enfermedad respiratoria en el período neonatal, patología respiratoria crónica, malformaciones congénitas o episodios sibilantes previos. Se hizo seguimiento clínico, GCA y St02 mensualmente después de su egreso hasta obtener dos St02 consecutivos normales (mayor o igual a 88 por ciento) a Fi02 0.21. De 60 pacientes seleccionados sólo 30 asistieron a los controles post-hospitalización