Recommendations for Treatment of Intermittent Mild Persistent Asthma in Children and Adolescents

Many parents and caretakers of children and adolescents with Mild persistent asthma (MPA) do not follow proposed guidelines, namely the daily and continuous administration of inhaled corticosteroids (ICS). Instead, parents and caretakers tend to use ICS and bronchodilators intermittently for short periods and restart such therapy only when symptoms reappear It is our opinion that intermittent treatment of MPA in children and adolescents might achieve the same level of asthma control as has been achieved in adults. We propose, therefore, that after an initial period of stabilization with age-appropriate doses of oral glucocorticoids or high-dose ICS and short-acting beta-2 agonists (SABA), caretakers can stop treatment once there are no longer signs or symptoms of asthma. When asthmatic symptoms recur, treatment should be restarted with ICS and SABA, or oral corticosteroids if the exacerbation is severe. the perception of developing asthma symptoms remains an unsolved problem. Based on our clinical experience in children and adolescents with asthma, we list a number of signs and symptoms that precede an exacerbation of asthma, allowing for an early re-introduction of treatment to prevent an exacerbation. Pediatr Pulmonal. 2009; 44:205-208. (C) 2009 Wiley-Liss, Inc.Universidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilUniv Calif San Francisco, Dept Pediat, San Francisco, CA 94143 USAUniversidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilWeb of Scienc

Adaptação e validação do Pediatric Asthma Quality of Life Questionnaire (PAQLQ-A) em crianças e adolescentes brasileiros com asma Adaptation and validation of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) in Brazilian asthmatic children and adolescents

OBJETIVOS: Traduzir e adaptar ao português (cultura brasileira) o Pediatric Asthma Quality of Life Questionnaire (PAQLQ) para uso em crianças e adolescentes com asma e validar a versão adaptada (PAQLQ-A). MÉTODOS: Crianças e adolescentes (7 a 17 anos) com asma foram entrevistados e responderam o PAQLQ-A à admissão, sendo avaliados por escore clínico de gravidade. Segundo o escore clínico de gravidade, os pacientes foram classificados em leves (< 2) ou moderados/graves (> 2). Eles foram reavaliados em pelo menos mais duas ocasiões, com intervalo de 2 a 4 semanas. RESULTADOS: Durante o seguimento, alguns se mantiveram sem mudança no escore clínico de gravidade e foram identificados como estáveis; já os que variaram foram identificados como instáveis. A reprodutibilidade do PAQLQ-A foi avaliada entre os estáveis comparando-se as médias dos domínios sintomas, emoções, atividades e total e do escore clínico de gravidade em dois tempos predeterminados (15 a 30 dias de intervalo), sem diferenças entre elas. A avaliação da suscetibilidade à alteração foi feita entre os pacientes instáveis. As médias dos domínios e o total em dois tempos foram significantemente diferentes, assim como o escore clínico de gravidade. A validação do instrumento foi realizada pela aplicação do teste de confiabilidade de Cronbach (a = 0,909). CONCLUSÕES: A tradução do PAQLQ para a língua portuguesa não modificou estruturalmente o questionário original; o PAQLQ-A é de fácil aplicação, reprodutível, capaz de detectar mudanças e constitui-se em instrumento valioso para a avaliação da qualidade de vida em crianças e adolescentes com asma.<br>OBJECTIVES: To translate the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) into Portuguese and adapt it to the Brazilian context, for use in children and adolescents with asthma and to validate the adapted version of the questionnaire (PAQLQ-A). METHODS: Children and adolescents (7 to 17 years old) with asthma answered the PAQLQ-A on admission and were assessed using a clinical severity score. According to this score, patients were classified as mild (< 2) or moderate/severe (> 2). They were reassessed on at least two occasions at an interval of 2 to 4 weeks. Furthermore, patients in whom asthma was properly controlled were classified as stable, and those in whom it could not be controlled, as unstable. RESULTS: The reproducibility of the PAQLQ-A was evaluated in stable patients by comparing the mean domain scores: symptoms, emotions, activities, and the overall clinical severity score on two predefined occasions with an interval of 15 to 30 days in between. Responsiveness was evaluated among unstable patients. The mean domain scores and the overall score were different on both occasions, and so was the clinical severity score. The validity of the questionnaire was determined by the application of Cronbach's alpha reliability coefficient (a = 0.909). CONCLUSIONS: The translation of the PAQLQ into Portuguese did not modify the framework of the original questionnaire; the PAQLQ-A is easy to use, with easy reproducibility, constituting a valuable instrument for the evaluation of the quality of life in children and adolescents with asthma

Daycare centers and schools as sources of exposure to mites, cockroach, and endotoxin in the city of São Paulo, Brazil

Background: Public places, including schools, have been identified as sources of exposure to allergens derived from mites, cockroach, cat, and dog and to endotoxin.Objectives: the purposes of this study were to assess and compare exposure to allergens and endotoxin in 4 types of public child-care facilities in Brazil and to investigate whether the presence of children and the performance of cleaning procedures could have an influence on allergen and endotoxin levels. Methods: We have analyzed dust from bedding, floors, chairs, and tables of daycare centers (DCs), preschools, kindergartens, and elementary schools (ESs). Major allergens from mites, cockroach, cat, and dog were quantitated by means of ELISA, and endotoxin content was determined by using the Limulus Amebocyte Lysate assay.Results: Group 1 mite allergens were greater than 2 mug/g in 67% of DC and preschool samples and in 8.9% and 2.2% of kindergarten and ES samples, respectively. the presence of bedding in DCs and preschools accounted for increased levels of mite allergens in these settings. Levels of Bla g I were higher in ES floors compared with those found in DC and preschool floors. Low levels (<1 mug/g) of Fel d 1 e Can f 1 were found in most samples. Levels of endotoxin in DCs and preschools were 3 times higher than in ESs.Conclusions: DCs and schools in Brazil should be considered as important sources of exposure to dust mites and cockroach allergens and to endotoxin. Recommendations for mite allergen avoidance should include appropriate care of bedding in DCs and preschools.Univ São Paulo, Sch Med Ribeirao Preto, Dept Pediat, Div Rheumatol Allergy & Immunol, BR-14049900 Ribeirao Preto, SP, BrazilUniversidade Federal de São Paulo, Paulista Sch Med, Dept Pediat, Div Rheumatol Allergy & Clin Immunol, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Sch Med, Dept Pediat, Div Rheumatol Allergy & Clin Immunol, São Paulo, BrazilWeb of Scienc