Seasons and other factors affecting the quality of life of asthmatic children.

OBJECTIVE: To study the effect of seasons on the health-related quality of life (HRQL) of asthmatic children. METHODS: Four groups of asthmatic children 7 to 14 years old were recruited by pediatricians during each season of the year. Their HRQL was assessed by means of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ). Other factors surveyed were asthma severity, atopy, medical treatment, immunotherapy, obesity, parental smoking, and anti-allergic measures. RESULTS: The mean (SD) overall PAQLQ score was highest in summer at 6.2 (1.0) and lowest in autumn at 5.5 (1.2). The same trend was found for domains in summer and autumn, respectively: symptoms, 6.2 (1.0) vs 5.4 (1.4); emotions, 6.5 (0.8) vs 6.0 (1.0); and activities, 5.9 (1.4) vs. 5.0 (1.5). Factors such as male gender (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.41-0.87), being on immunotherapy (OR, 0.59; 95% CI, 0.38-0.92), living in an urban environment (OR, 0.56; 0.33-0.93), and residing on the northern coast of Spain along the Bay of Biscay (OR, 0.56; 0.36-0.89) were independent protective factors against having a total PAQLQ score in the lower tertile. Conversely, being recruited in a primary care setting (OR, 1.55; 1.01-2.38) and having more severe asthma were risks for being in the lower tertile. CONCLUSIONS: Irrespective of the severity of the disease, season has a significant influence on the HRQL of asthmatic children.

[Impact of the long active beta-2 agonists inhaled therapy on the quality of life in asthmatic patients]. / Impacto de la terapia inhalada con beta-2 agonistas de larga duración sobre la calidad de vida en pacientes asmáticos.

OBJECTIVE: To assess the impact of the addition of inhaled therapy with long acting beta2-agonists (formoterol) on the health related quality of life (HRQL) in asthmatic patients treated with inhaled corticosteroids and poorly controlled. METHODS: Observational prospective naturalistic study with a cohort of 343 ambulatory patients during 6 months. We collected socio-demographic, clinical and lung function variables. The HRQL was assessed by means of a generic scale (SF-36) and a specific one (Marks's AQLQ). RESULTS: They were evaluated 268 patients (78%). mean age 48.6 years (SD 16.28), 64.15% women. Women and the subjects with worse socioeconomic situation had poor basal HRQL scores. During the follow-up an average improvement in FEV1 of 0.26 l (SD 0.44; p <0.001) was observed. The average change in the AQLQ was -1.92 (-2.09-1.75) being the larger improvement in the breathlessness domain. The average change in SF-36 was 5.13 (4.75-5.51) for physical standardized component and 5.23 (4.83-5.63) for mental component. The effect size was "large" with the measurement of the AQLQ and "moderate" with SF-36. The AQLQ and SF-12 scores are strongly correlated. basally and after the treatment (r > 0.5). CONCLUSION: To add long acting beta2-agonists to the asthmatic patients treated with inhaled corticosteroids and poorly controlled, under usual clinical practice conditions, is associated with an improvement of the HRQL perception measured by means of generic and specific instruments.

Impacto de la terapia inhalada con ß-2 agonistas de larga duración sobre la calidad de vida en pacientes asmáticos / Impact of the long acting beta-2 agonists inhaled therapy on the quality of life in asthmatic patients

Objetivo: Evaluar el impacto sobre la calidad de vida relacionada con la salud (CVRS), de la adición de un ß2-agonista de larga duración inhalado (formoterol) en pacientes asmáticos en tratamiento con corticoesteroides inhalados, sin buen control. Métodos: Estudio observacional, prospectivo, naturalístico de 6 meses de duración de una cohorte de 343 pacientes. Se recogieron variables sociodemográficas, clínicas y de función pulmonar. Se valoró la CVRS mediante una escala genérica (SF-36) y una específica (AQLQ de Marks). Resultados: Se evaluaron 268 pacientes (78 por ciento), con una edad media de 48,6 años (DE 16,28), el 64,15 por ciento mujeres. Las mujeres y las personas con peor situación socioeconómica tenían basalmente una peor percepción de la CVRS. Durante el seguimiento se observó un incremento medio en el FEV1 de 0,26 l (DE 0,44; p0,5).Conclusión: Añadir un ß2-agonista de larga duración inhalado (formoterol) al tratamiento de fondo de un paciente asmático mal controlado, en condiciones de práctica clínica habitual se asocia con una mejora significativa de su percepción de la CVRS medida con instrumentos genéricos y específicos (AU)

[Lisinopril in the treatment of heart insufficiency]. / Lisinopril en el tratamiento de la insuficiencia cardíaca.

The prognosis in patients with heart failure (HF) is poor. The angiotensin converting enzyme (ACE) inhibitors are among the most promising of current options, with benefits not only in terms of haemodynamic and clinical improvement but also in mortality. Data are reviewed comparing the once-daily ACE inhibitor lisinopril with captopril or enalapril in patients already receiving digoxin and/or diuretics for heart failure. Data are also reviewed which compare lisinopril with digoxin in patients already receiving diuretics alone for heart failure. Lisinopril is more effective than placebo and at least as effective as captopril or enalapril in these comparative studies on the basis of haemodynamics, exercise test results and clinical signs and symptoms of heart failure. Lisinopril may also be a suitable alternative, as well as being an adjunct, to digoxin in patients already receiving diuretics alone. Lisinopril is usually well tolerated in patients with heart failure. The mechanism of benefit of ACE inhibitors in heart failure is not clear, but apart from blockade of the renin-angiotensin-aldosterone system (RAAS), may also involve modulation of sympathetic stimulation, cardioreparation and regulation of potassium balance. The new ATLAS study (Assessment of Treatment with Lisinopril And Survival) is being conducted to address the question of whether ACE inhibitors in general practice should be given at the current low doses, or at the higher doses used in large survival studies.