Resumen
En esta sección mostramos una selección de citas bibliográficas de interés para quien desee profundizar en el tema.
4.- Pedersen S. What are the goals of treating padiatric asthma? Pe diatric Pulmonol 1997;supl 15:22-6.
5.- Wilson I, Cleary P. Linking Clinical variables with Health-Related Quality of Life. A
6. - conceptual model of patient outcomes. JAMA 1995. p. 59-65.
7- . Hunt SM, Alonso J, Bucquet N, Niero M, Wiklund I, McKenna S. Cross- cultural adaptation of health mesures. Health Policy 1991;19:34-44.
8.- Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 1993;12:1417-32.
1.-Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Griffith LE, Townsend M. Measuring quality of life in children with asthma. Quality of Life Research 1996; 5: 35-46.
2.-Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Griffith LE, Townsend M. Measuring quality of life in the parents of children with asthma. Quality of Life Research 1996; 5: 27-34.
3.-Guyatt GH, Juniper EF, Feeny DH, Griffith LE. Children and adult perceptions of childhood asthma. Pediatrics 1997; 99: 165-8.
4.-Juniper EF, Guyatt GH, Feeny DH, Griffith LE, Ferrie PJ. Minimum skills required by children to complete health-related quality of life instruments: comparison of instruments for measuring asthma-specific quality of life. Eur Respir J 1997; 10: 2285-2294.
5.-Juniper E. How important is Quality of Life in Pediatrica Asthma? Ped Pulmonol 1997: 15(S): 17-21
6.-Guyatt GH, Juniper E. Interpreting treatment effects in randomised trials. BMJ. 1998 Feb 28;316(7132):690-3.
7.-E Juniper. Quality of life questionnaires: does statistically significant = clinically important? Allergy Clin Immunol. 1998 Jul;102(1):16-7
Validacion de la Versión en Español
1.-.Tauler E, Grau G, González A, Sánchez E, Figueras G, Vall O, et al. Metric properties of the Spanish version of the paediatric asthma quality of life questionnaire (PAQLQ). Qual Life Res 1999;8:645.
2.-.Tauler E. Quality of life among pediatric asthma patients. Immunol Immunopathol 2000;28:168-75.
5.- Tauler E, Vilagut G, Grau G, González A, Sánchez E, Figueras G, et al. The Spanish version of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ): metric characteristics and equivalence with the original version. Qual Life Res 2001;10:81-91.
4.-.Tauler E, Grau G, González G, Sánchez E, Figueras G, Vall O, et al. Resultados finales de la validación de la versión española del Paediatric Asthma Quality of Life Questionnaire (PAQLQ): Cuestionario de Calidad de vida en niños con asma. Immunol Immunopathol 2000;28:187.
5.-. Badia X, García-Hernández G, Cobos N, López-Lavid C, Nocea G, Roset M (grupo VALAIR). Validación de la versión española del Paediatric Quality of Life Questionnaire en la valoración de la calidad de vida del niño asmático. Med Clin (Barc) 2001;116:565-72.
6.-Alonso E. Utilization and clinical validation of the Spanish version of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Diary for Caregivers of Asthmatic Children (DCA). VALAIR study. Allergol Immunopathol (Madr) 2000 ; 28:175-83
1.-The EuroQoL Group Title EuroQoL-a new facility for the measurement of health-related quality of life. Health Policy (1990;16(3):199-208).
2.- Dolan P. Modelling valuations for EuroQoL health states. Med Care (1997;35(11:1095-108.)
3.-Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United Kingdom national questionnaire survey. BMG (1998;316: 736-741).
4.-Roset M, Badia X, Mayo NE. Sample size calculations in studies using the EuroQoL 5D. Qual Life Res (1999;8(6):539-49).
5.-Brooks R. EuroQoL: the current state of play. Health Policy (1996;37(1):53-72)
6.-Badia Llach X, Herdman M, Schiaffino A. Determining correspondence between scores on the EQ-5D "thermometer" and a 5-point categorical rating scale. Med Care. 1999 Jul;37(7):671-7.
Validacion de la Versión en Español
1.- Badia X, Roset M, Montserrat S, Herdman M, Segura A. The Spanish version of EuroQol: a description and its applications. European Quality of Life scale. Med Clin (Barc) 1999;112 (Suppl 1): 79-85
Resumen
Se desconocen las razones para la diferencia en las cifras de prevalencia y severidad de sibilancias recurrentes en lactantes entre regiones desarrolladas y en desarrollo.
Al menos para Latinoamérica, esta condición no debe considerarse benigna.
Informaciones recientes sugieren que la inmunidad congénita podría ser alterada por exposiciones ambientales (incluyendo biológicas) durante los 3 primeros meses. Otros factores relacionados con el nivel socioeconómico probablemente tenga un papel relevante.
(los números entre paréntesis son citas bibliográficas que podrá consultar al final del texto)
Las sibilancias recurrentes y las infecciones respiratorias agudas (IRA) en lactantes juegan un papel compartido muy importante en la morbilidad y mortalidad respiratoria en regiones en desarrollo del mundo.
Se desconocen las razones para la diferencia en las cifras de prevalencia y severidad de sibilancias recurrentes en lactantes entre regiones desarrolladas (1-3) y en desarrollo (4-5).
Sin embargo, es probable que semejante diferencia en frecuencia y severidad de los episodios de sibilancias esté determinada principalmente por exposiciones a riesgo ambiental, en especial a aquellos relacionados con una condición socioeconómica baja (5). La exposición temprana (desde el nacimiento) y sostenida a fuertes agentes inhalados ambientales (ambiente agresivo) parece determinar un fenotipo de sibilancias relacionado comúnmente con infecciones respiratorias virales, que comienza en los primeros 3 meses de vida, progresa con episodios más severos y frecuentes de sibilancias y se asocia generalmente con complicaciones como la neumonía (5).
Esta condición, que se presentaría como el tipo predominante de sibilancias en lactantes en América Latina, es sin lugar a dudas no benigna como se la considera tradicionalmente, y genera un número enorme de consultas y ocupación de recursos de cuidado sanitario, y contribuye fuertemente a la alta morbimortalidad en lactantes debida a complicaciones respiratorias de esta región procedentes en su mayor parte de poblaciones pobres.
Informaciones recientes sugieren que la inmunidad congénita podría ser alterada por exposiciones ambientales (incluyendo biológicas) durante los 3 primeros meses, lo que daría por resultado un número mayor de episodios de sibilancias durante el primer año, y relaciona exposiciones ambientales más altas con episodios más frecuentes y posiblemente más severos de sibilancias (2,3,6). Es probable que los factores de riesgo ambiental como aquellos relacionados con condiciones socioeconómicas bajas jueguen un papel en la frecuencia y severidad de las sibilancias (5,7,8).
Los diferentes niveles de desarrollo que se pueden encontrar entre los países de América Latina y de la Península Ibérica ofrecen una magnífica oportunidad para verificar esta (y otras) hipótesis.
Bibliografía
1. Gold DR, Burge HA, Carey V, Milton DK, Platts-Mills T, Weiss ST. Predictors of repeated wheeze in the first year of life. The relative roles of cockroach, birth weight, acute lower respiratory illness, and maternal smoking. Am J Respir Crit Care Med 1999;160:227-236.
2. Guerra S, Lohman C, Halonen M, Martinez FD, Wright AL. Reduced Interferon gamma production and soluble CD14 levels in early life predict recurrent wheezing by 1 year of age. Am J Respir Crit Care Med 2004;169:70-76
3. Copenhaver CC, Gern JE, Li Z, Shult PA, Rosenthal LA, Mikus LD, Kirk CJ, Roberg KA, Anderson EL, Tisler CJ, DaSilva DF, Hiemke HJ, Gentile K, Gangnon RE, and Lemanske RF, Jr.Cytokine Response Patterns, Exposure to Viruses, and Respiratory Infections in the First Year of Life. Am J Respir Crit Care Med 2004;170:175-180.
4. López IM, Sepúlveda H, Valdés I. Risk factors in infants with lower respiratory tract diseases. Rev Chil Pediatr 1994;65:154-157.
5. Mallol J, Andrade R, Auger F, Rodriguez J, Alvarado R, Figueroa L. Wheezing during the first year of life in infants from low-income population: a descriptive study. Allergol Immunopathol 2005;33:257-263.
6. Bont L, Heijnen CJ, Kavelaars A, van Aalderen WMMC, Brus F, Draaisma JTM, Geelen SM, and Kimpen JLL. Monocyte IL-10 Production during Respiratory Syncytial Virus Bronchiolitis Is Associated with Recurrent Wheezing in a One-Year Follow-up Study. Am J Respir Crit Care Med 2000;161:1518–1523.
7. Margolis PA, Greenberg RA, Keyes LL, La Vange LM, Chapman RS, Denny FW, Bauman KE, Boat BW. Lower respiratory illness in infants and low socioeconomic status. Am J Public Health 1992;82:119-1126.
8. Klinnert MD, Price MR, Liu AH, Robinson JAL. Morbidity Patterns Among Low-Income Wheezing Infants. Pediatrics 2003;112;49-57
Resumen
Existe muy poca información sobre las sibilancias en lactantes, a pesar del impacto de este problema en la salud publica.
Tampoco existen datos comparativos entre países en vías de desarrollo y paises desarrollados.
El EISL ofrece una oportunidad única para la integración científica y la creación de una red de trabajo entre sus centros participantes.
(los números entre paréntesis son citas bibliográficas que podrá consultar al final del texto)
A pesar de que las sibilancias recurrentes representan un importante problema de salud publica en todo el mundo, particularmente en los países en desarrollo, la información respecto a la prevalencia de sibilancias, de sus características y complicaciones es muy escasa.
Lo anterior es sorprendente porque es posible que los eventos qué determinarán el tipo de respuesta asmática (inmunológica, clínica y funcional) sean configurados durante los primeros meses de la vida (1-5). No existe información publicada proveniente de estudios internacionales multicéntricos, que utilicen una metodología estandarizada, sobre la verdadera tasa de prevalencia de las sibilancias recurrentes en el primer año de vida en lactantes que viven en regiones en vías de desarrollo como América Latina y otras.
Tampoco hay estudios internacionales comparativos sobre este tema que involucren tanto países desarrollados como en vías de desarrollo. Un estudio longitudinal reciente (cohorte de nacimiento) proveniente de América Latina sugiere que las sibilancias serían mucho más frecuentes y severas en localidades en desarrollo que en países desarrollados (4).
Es probable que, como sucedió con estudios sobre el asma (6-7), puedan existir verdaderas diferencias en la prevalencia y fenotipos de sibilancias en lactantes entre centros y países. Este estudio permitirá examinar diferentes aspectos de las sibilancias recurrentes durante el primer año de vida en países que comparten la misma lengua y costumbres similares pero que difieren significativamente en el nivel de desarrollo socioeconómico.
Este estudio obtendrá por primera vez información crucial para poner a prueba las diversas hipótesis actuales sobre sibilancias en lactantes provenientes de estudios en países desarrollados, predominantemente de habla inglesa.
EISL ofrece una oportunidad única como es la integración científica y la creación de una red de trabajo entre sus centros participantes. No cabe duda que las comparaciones de resultados de los centros de América Latina con aquellos de países originales como España u Holanda, proporcionarán una muy valiosa información epidemiológica y ecológica internacional, actualmente inexistente en la literatura mundial, sobre sibilancias recurrentes y sus verdaderos factores de riesgo y complicaciones.
Bibliografía
1. Guerra S, Lohman C, Halonen M, Martinez FD, Wright AL. Reduced Interferon gamma production and soluble CD14 levels in early life predict recurrent wheezing by 1 year of age. Am J Respir Crit Care Med 2004;169:70-76
2. Copenhaver CC, Gern JE, Li Z, Shult PA, Rosenthal LA, Mikus LD, Kirk CJ, Roberg KA, Anderson EL, Tisler CJ, DaSilva DF, Hiemke HJ, Gentile K, Gangnon RE, and Lemanske RF, Jr.Cytokine Response Patterns, Exposure to Viruses, and Respiratory Infections in the First Year of Life. Am J Respir Crit Care Med 2004;170:175-180.
3. López IM, Sepúlveda H, Valdés I. Risk factors in infants with lower respiratory tract diseases. Rev Chil Pediatr 1994;65:154-157.
4. Mallol J, Andrade R, Auger F, Rodriguez J, Alvarado R, Figueroa L. Wheezing during the first year of life in infants from low-income population: a descriptive study. Allergol Immunopathol 2005;33:257-263.
5. Bont L, Heijnen CJ, Kavelaars A, van Aalderen WMMC, Brus F, Draaisma JTM, Geelen SM, and Kimpen JLL. Monocyte IL-10 Production during Respiratory Syncytial Virus Bronchiolitis Is Associated with Recurrent Wheezing in a One-Year Follow-up Study. Am J Respir Crit Care Med 2000;161:1518–1523.
6. ISAAC Steering Committee. World-wide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998; 12: 315-335.
7. Mallol J, Solé D, Asher MI, Clayton T, Stein R, Soto-Quiróz M. The prevalence of asthma symptoms in children from Latin America. The ISAAC study. Pediatr Pulmonol 2000; 30:439-444.
Coordinador General del Proyecto
Coordinador para Europa:
Coordinador para América Latina
Centro de Control de Calidad de Datos EISL
Universidad de Murcia, España; Universidad de Santiago de Chile (USACH), Chile
Dra.Viviana Aguirre
Antonela Martinez, M.Sc.
Virginia Perez, M.Sc
Prof . L. García Marcos
Prof. J. Mallol
Ver ademas: Directorio de Investigadores principales por países
Resumen
El Estudio Internacional de Sibilancias en Lactantes (EISL) es un estudio multicéntrico internacional, en el que participan actualmente centros de América Latina y Europa.
En esta sección puede consultar la relación de investigadores principales de cada país en las fases 1 y 3 del estudio
Centros Fase 1 |
Investigadores responsables |
|---|---|
| Brasil | Coordinador nacional: Prof. Dirceu Solé |
| Belem | Elaine Xavier Prestes |
| Belo Horizonte I | Dr. Wilson Rocha Filho |
| Belo Horizonte II | Prof. Paulo Camargos, Dra. María Jussara Fernández-Fontes |
| Curitibia | Prof. Nelson Rosário Filho, Dr. Herberto Chong |
| Fortaleza | Dr. Alvaro Madeiro, Dra. Olivia Costa Besa |
| Porto Alegre | Prof. Gilberto Fischer |
| Recife | Dr. Emanuel Sarinho, Dra Almerinda Silva |
| São Paulo | Prof Dirceu Solé, Dra. Caroline Della Bianca |
| Chile | Coordinador Nacional Dra. Viviana Aguirre |
| Santiago | Dr. Alejandro Gallardo, Prof. J Mallol |
| Valdivia | Prof. Mario Calvo |
| Venezuela | |
| Caracas | Dr. Oscar Aldrey, Dr, Arnaldo Capriles |
| Colombia | |
| Barranquilla | Dr. Alfonso Cepeda |
| México | |
| Mérida | Dr. Manuel Baeza-Bacab |
| España | Coordinador Nacional Prof. Luis García-Marcos |
| Bilbao | Dr. Carlos González-Díaz, Dr. Andrés González Hermosa |
| Cantabria | Dr. Alberto Bercedo Sanz, Dr. Luis Lastra Martínez. |
| La Coruña | Dr. Ángel López-Silvarrey Varela |
| Murcia | Prof. Luis García-Marcos, Dra. Antonela Martínez-Torres, Dra. Virginia Pérez-Fernández |
| Pamplona | Dr. Ismael Alvarez Alvarez, Dra. Ines Aguinaga Ontoso, Dr. Francisco Guillén Grima |
| Salamanca | Dr. Francisco Javier Pellegrini Belinchón, Dra. Elena Vicente Galindo, Dr. Félix Lorente Toledano. |
| Holanda | |
| Zwolle | Prof. Paul L.P. Brand, Dra. Chantal AN Visser |
Centros Fase 3 |
Investigadores responsables |
|---|---|
| Brasil | Coordinador nacional: Prof. Dirceu Solé |
| São José do Rio Preto | Dra. Eliana C. Toledo, Dra. Cibele Matsuura de Oliveira |
| Cuiabá | Dra. Líllian Sanchez-Lacerda Moraes, Dra. Olga Akiko Takano |
| Uruguaiana | Dra. Marilyn Urrutia-Pereira, Dr. Juan Carlos Ivancevich |
| Curitibia | Prof. Nelson Rosário Filho, Dr. Herberto Chong |
| São Carlos | Dra. Patrícia Polles de Oliveira Jorge |
| São Paulo | Prof. Dirceu Solé, Dra. Carolina Aranda, Dra. Caroline Della Bianca |
| Chile | Coordinador Nacional Dra. Viviana Aguirre |
| Santiago | Prof. J Mallol, Dra. Viviana Aguirre |
| Argentina | |
| Buenos Aires | Dra. Gabriela A. Szulman, Dra. Ilse Behrends, Dra. Ángela Spagnuolo de Gentile |
| Colombia | |
| Bucaramanga | Dr. Jurg Niederbacher-Velásquez, Dr. Carlos A. Cuadros-Mendoza, Dra. Diana C. Archila-Santamaria, Dra. Leonela Ballesteros-Chaparro, Dr. Juan M. Joya-Moreno, |
| Perú | |
| Lima | Dra. Erika Arruda-Chaves, Dra. Silvia Cachay-Chávez, Dra. Claudia Mory-Arciniega |
| España | Coordinador Nacional Prof. Luis García-Marcos |
| Murcia | Prof. Luis García-Marcos, Dra. Antonela Martínez-Torres, Dra. Virginia Pérez-Fernández |
| Uruguay | |
| Montevideo | Dra. Catalina Pinchak, Dra. Anabel Akiki, Dra. Silvia Brea, Dra. María Nelly Márquez, Dra. Isabel Moreira, Dra. Adriana Muiño, Dra. Marilyn Valentín |
Los aspectos epidemiológicos y ecológicos que examina este estudio, principalmente enfocados a las sibilancias durante el primer año de vida, han sido largamente ignorados y no existen estudios comparativos internacionales al respecto que empleen la misma metodología y que por lo tanto aseguren la validez de las comparaciones. Un dato crucial y que apoya fuertemente la realización de este estudio es el antecedente de que en América Latina mueran cada año miles de lactantes menores de un año por neumonía y la que la mayoría de esos lactantes tenga el antecedente de haber tenido sibilancias recurrentes (1,2). Este estudio define como sibilancias recurrentes al hecho de haber tenido 3 o más episodios de sibilancias en el primer año de vida y su población blanco son lactantes de 12 a 15 meses de vida.
La metodología empleada por EISL esta basada en aquella empleada por ISAAC (3-6) y los centros participantes en la Fase I del EISL son aquellos que han participado exitosamente en las Fases I o III del ISAAC. Luego para la Fase II ha habido algunos cambios en la composición de los equipos de investigación.
El principal instrumento empleado es un cuestionario central de sibilancias durante el primer año en el cual se incorporan aspectos epidemiológicos, terapéuticos y ecológicos. Además el estudio incluye información demográfica y ambiental de cada centro. Como el principal objetivo de EISL es comparar los datos entre los centros y países, se ha estimado que cada centro de investigación deberá reclutar una muestra aleatoria de 1000 a 3000 lactantes entre 12 y 15 meses de edad. En aquellos centros en que la población de lactantes en ese rango de edad no permita satisfacer el tamaño de la muestra, esta deberá ser semejante a la de la población general de lactantes en ese rango de edad.
Para completar el cuestionario sobre sibilancias y temas ambientales se abordan a los padres durante el control de salud de 12-15 meses en cualquiera de las instancias de control de salud dispuestos por los programas nacionales que existen para ese fin en los centros participantes. Las definiciones de caso y gravedad se establecen preguntando acerca de síntomas cardinales, y también refiriéndose a etiquetas diagnósticas (Ej. asma). La validez del cuestionario ha sido investigada y ratificada en algunos de los centros participantes. La versión en portugués del cuestionario ha sido traducida del español al portugués y el autor principal y los colaboradores brasileños la han re-traducido al español (back-translation).
1. López-Antuñano FJ. Epidemiología de las infecciones respiratorias agudas en niños: panorama regional. In: Benguigui Y, ed. Infecciones respiratorias en niños. Washington D.C., OPS (Serie HCT/AIEPI-1), c 1997, p:13.
2. Infecciones respiratorias agudas: fundamentos técnicos de las estrategias de control. Eds. Benguigui Y. 1997. PAHO/WHO, Washingtton DC. Chapter 5º, 1997, p:65-92.
3. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, Mitchell EA, Pearce N, Sibbald B, Stewart AW, Strachan D, Weiland SK, Williams HC. International study of asthma and allergies in childhood (ISAAC): rationale and methods. Eur Respir J 1995; 8: 483-91.
4. Ellwood P, Asher MI, Beasley R, Clayton TO, Stewart AW and the ISAAC Steering Committee. The International Study of Asthma and Allergies in Childhood (ISAAC): Phase Three rationale and methods. Int J Tuberc Lung Dis 2005; 9(1): 10-6.
5. ISAAC Steering Committee. World-wide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998; 12: 315-335.
6. Gold DR, Burge HA, Carey V, Milton DK, Platts-Mills T, Weiss ST. Predictors of repeated wheeze in the first year of life. The relative roles of cockroach, birth weight, acute lower respiratory illness, and maternal smoking. Am J Respir Crit Care Med 1999;160:227-236.
Resumen
Cualquier programa sanitario de intervención sobre asma en niños y adolescentes debe marcarse como objetivo fundamental la mejora de la calidad de vida de estos y de sus familias. El principal instrumento de medición de la calidad de vida es el Cuestionario de calidad de Vida. El cuestionario de calidad de vida relacionada con el asma de mayor difusión es el desarrollado por la Prof. Elizabeth Juniper (PAQLQ y PACQLQ). El (EQ-5D) es un instrumento genérico y complementario de utilidad en adolescentes.
La calidad de vida no es fácil de definir. ¿Quién de nosotros puede establecer con rotundidad lo que es calidad de vida y lo que no? Resulta obvio que se trata de un concepto subjetivo, propio de cada persona, con una notable influencia del entorno en el que vive (la sociedad, la cultura, las escalas de valores...). "me encuentro bien, no me falta de nada, soy feliz, la gente me aprecia..." son frases que reflejan aspectos positivos, anhelos, a los que aspiramos cada uno en la construcción de nuestro proyecto vital como persona. Estos aspectos (físico, afectivo y social) que reflejan las frases anteriores, expresan las tres dimensiones fundamentales de la calidad de vida. Pero no siempre somos iguales de felices, ni siempre nos encontramos igual de bien... Por tanto también podemos afirmar que la calidad de vida es, en cada uno de nosotros, un concepto dinámico; unas veces tenemos más y otras menos. Otra característica importante es la interdependencia de un aspecto con otro, de tal modo que cuando alguien se ve afectado físicamente, esto repercute en los aspectos afectivo y social. No en vano el ser humano es un todo.
No hay duda que estar sano es un elemento esencial para tener una vida con calidad. La sociedad occidental ha logrado dar años a la vida y ahora lo que queremos es dar vida a todos y cada uno de nuestros años (calidad). Cuando perdemos la salud (lo físico), se resienten los aspectos afectivos y sociales. Por lo tanto cuando nos hallamos ante una persona enferma e intentamos evaluar su calidad de vida, no es suficiente con evaluar la dimensión "salud", sino que deben valorarse las tres dimensiones.
Los principales consensos (GINA, Panel del Expertos, etc) plantean que la evaluación de la calidad de vida en niños/adolescentes con asma y sus padres debe cubrir al menos cinco áreas clave:
Ello implica, en el caso de los niños, que también debe evaluarse la calidad de vida de los cuidadores.
Resulta ineludible valorar la calidad de vida en los niños y adolescentes con asma. No es suficiente evaluar si un niño/adolescente tiene menos crisis de asma, o ingresa menos, o mejora de su función pulmonar; y a la luz de dichas mejoras concluir que su calidad de vida ha mejorado. Aunque todo eso es muy importante, pudiera ser que no tuviera nada que ver con su calidad de vida (que es algo subjetivo, que valora sus sentimientos, impresiones e integración social, y que solo el afectado puede expresar).
Las escalas de calidad de vida.
La calidad de vida de una persona solo se puede valorar preguntándole a ella. Son un importante instrumento de medición que consiste en unas encuestas-cuestionarios (escritas o mediante entrevistas), con preguntas acerca de las dimensiones de la calidad de vida. Estas escalas suelen incluir preguntas que deben valorarse 0-1-2-3-4-5, otros 0-1 ... de tal manera que al final se obtiene una puntuación (por ejemplo 4,1). Ello permite repetir la escala pasados unos meses y ver si la calidad ha mejorado o empeorado.
Escalas específicas (para asma).
Existen varias escalas, pero en la actualidad la de mayor relevancia para el asma es el PAQLQ de la Prof E. Juniper (http://www.qoltech.co.uk), tanto en versión para niños/adolescentes, como para padres (cuidadores); y que ya ha sido validada al español (versiones para España y para algunos países latinoamericanos).
Escalas genéricas
Otra escala que se va abriendo paso poco a poco, por su simplicidad y reproducibilidad es el EuroQol (EQ-5D) una escala genérica de solo 5 cuestiones y una escala analógico-visual. Está disponible en español (versiones para España, Argentina, Chile, Colombia, Costa Rica, Guatemala, Mexico, Peru, Uruguay, USA y Venezuela). Es de dominio publico y se puede obtener gratuitamente para fines no comerciales. Información adicional en www.euroqol.org
Aplicabilidad de los Cuestionarios de Calidad de Vida
En general los Cuestionarios son empleados como una herramienta más en los Ensayos Clínicos, pero excepcionalmente en la práctica clínica diaria (necesidad de sistematizacion, carga de trabajo, etc...). Aunque es posible encontrar trabajos científicos que utilizan Cuestionarios de Calidad de Vida, resulta sorprendente que una Revision Sistemática de la colaboración Cochrane (Revision Cochrane. Intervenciones Educativas en el Asma Infantil, Wolf FM, 2002) que analizó 32 Ensayos Clínicos válidos afirme que la dimensión Calidad de Vida no se pudo analizar, porque ninguno de los trabajos la evaluó. Queda, por tanto, mucho camino por recorrer.
Cualquier programa sanitario de intervención sobre asma en niños y adolescentes debe marcarse como objetivo fundamental la mejora de la calidad de vida de estos y de sus familias. La meta del programa sería ofrecer al niño/adolescente con asma una vida normal (igual que la de los demás niños/adolescentes de su entorno). Desde el punto de vista técnico podría formularse de la siguiente forma: "Lograr que el niño/adolescente asmático y su familia alcancen la calidad de vida diana que tendrían si el niño/adolescente no tuviera asma".
La calidad de vida diana se obtendría de medir esta en los niños/adolescentes no asmáticos y sus familias, en el mismo entorno geográfico y de unas condiciones socioculturales similares. Para mas información sobre programas de intervención en asma del niño/adolescente, acude a la sección organización sanitaria.
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Pediatric Allergy and immunoloy
|
Dr Luis García Marcos
coordinador del ISAAC -España
El International Study of Asthma and Allergies in Childhood (ISAAC) comenzó en el año 1992, cuando un grupo de pediatras y epidemiólogos alemanes (Bochum y Munich), neozelandeses (Wellington y Auckland) decidieron poner en marcha un estudio epidemiológico sobre el asma y enfermedades alérgicas con una metodología común, que permitiera hacer comparables los resultados en distintas áreas geográficas, incluso con un idioma diferente.
Para ello, además de un cuestionario escrito, basado en el cuestionario para asma de la "International Union against Tuberculosis and Lung Diaseases (IUTLD), se diseñó un cuestionario dirigido por video para que fuera auto-cumplimentado por los propios niños.
La metodología del estudio estuvo preparada a mediados de 1994.
Por esa época, la Unidad de Investigación de Cartagena había tenido noticia del video-cuestionario, y tenía su propio interés para utilizarlo en estudios epidemiológicos sobre el asma y su relación con la contaminación atmosférica de la ciudad. Al contactar con el grupo de Wellington, se abrió la posibilidad de participar en el ISAAC. El entonces centro coordinador para Europa Occidental –situado en el Departamento de Epidemiología de la Universidad de Bochum, que posteriormente se trasladó a Munster- decidió confiar en Cartagena la coordinación en España, desde donde se invitó a participar a una buena cantidad de grupos en toda España, procurando incluir todas las regiones del país.
En 1996 había datos de centros en 10 ciudades (Almería, Barcelona, Bilbao, Cádiz, Cartagena Castellón, Madrid, Pamplona, Valencia y Valladolid). Estos datos provenían de la realización de más de 3000 encuestas en cada uno de dos grupos de edad: 13-14 años (auto-cumplimentación de cuestionario escrito y video-cuestionario) y 6-7 años (cuestionario escrito rellenado por los padres. Todos los centros recogieron datos de los dos grupos de edad: todos incluyeron el grupo de mayores, pero sólo 6 centros incluyeron también a los pequeños. Los resultados, que sugieren dos prevalencias distintas –una para la costa y otra para la meseta, si se tiene en cuenta que Castellón y Almería incluyeron áreas del interior de la provincia- pueden verse en las figuras (una para cada grupo de edad).
Una descripción más detallada referente a asma se puede encontrar en la revista Medicina Clínica (Med Clin Bar 1999;112:171-175).
Los resultados nacionales sobre prevalencia de rinitis y dermatitis fueron publicados en Anales Españoles de Pediatría (An Esp Pediatr 1999; 51: 369-76).
La comparación de los resultados internacionales fue publicada en la revista The Lancet (Lancet 1998; 352: 1225-32). España fue el país que más niños reclutó en ambos grupos de edad.
La Fase I fase del ISAAC se dio por terminada en 1998. A partir de ese momento se puso en marcha una segunda fase y en preparación una tercera. La segunda fase, en las que hay involucrados unos 30 centros en todo el mundo, es mucho más ambiciosa y complicada y proporcionará datos muy interesantes. Básicamente consiste en obtener un cuestionario muy pormenorizado en una muestra de 1000 niños normales, a los que también se le realiza un prick con una batería de alergenos estándar.
A una submuestra de estos niños se les extraerá sangre –para IgE total, específica y estudios genéticos-, se les realizará una prueba de provocación bronquial y se analizará el polvo de su casa.
En España hay cuatro centros con el trabajo de campo realizado: Cartagena, Castellón, Madrid y Valencia. Nuestro país es el único del mundo que participa con más de un centro.
La tercera fase del ISAAC es una repetición de la primera, pero separada de ella al menos 6 años, de manera que con los datos obtenidos se podrá saber –por primera vez- si la prevalencia del asma y de las enfermedades alérgicas aumenta en nuestro país, como lo así sucede en otros. La mayoría de los centros que participaron en la primera fase lo harán también en la tercera, aunque la incorporación de grupos nuevos será bien recibida. Esta fase se desarrolló a partir del 2002
Almeria. José Batllés. Hospital Torrecárdenas
Asturias. Ignacio Carvajal Urueña. Centro de Salud de Las Vegas (Avilés)
Barcelona. Rosa Busquets. Hospital del Mar
Bilbao. Carlos Gonzalez. Hospital Basurto
Cadiz. Andrés Rabadan. Gerencia Atención Primaria Bahía-Vejer.
Cartagena. Luis Garcia Marcos. Unidad de Investigación
Castellón. Alberto Arnedo. Dirección Territorial de Sanidad
Madrid. Gloria Garcia Hernandez. Hospital 12 de Octubre
Pamplona. Francisco Guillén. UP Navarra
Valencia. Maria Morales. Hospital Peset
Valladolid. Alfredo Blanco. Universidad de Valladolid
6-7 años: diagnóstico de asma
Se evaluaron 16.240 niños. La figura muestra los resultados cuando se les pregunta ¿ha tenido su hijo, alguna vez, asma? El porcentaje de respuestas afirmativas oscila entre el 4 y el 10%
6- 7 años sibilancias en el ultimo año
Se evaluaron 16.240 niños. Para el conjunto de España, el 6,2% de los niños de 6-7 años habían presentado sibilancias en el ultimo año.
6-7 años: sibilancias graves en el ultimo año
Se evaluaron 16.240 niños. Para el conjunto de España, el 1% de los niños de 6-7 años habían presentado sibilancias graves en el ultimo año.
13-14 años: diagnóstico de asma
Se evaluaron 30.626 niños. La figura muestra los resultados cuando se les pregunta ¿alguna vez has tenido asma? El porcentaje de respuestas afirmativas oscila entre el 6 y el 16%
13-14 años: sibilancias en el ultimo año
Se evaluaron 30.626 niños. Para el conjunto de España, se obtuvo una prevalencia del 9,6% (método cuestionario escrito. Figura anterior) y 6,6% (método videocuestionario. Figura siguiente) de sibilancias en el ultimo año.
La Figura siguiente compara los resultados segun el método empleado
13-14 años: sibilancias graves en el ultimo año
Se evaluaron 30.626 niños. Para el conjunto de España, se obtuvo una prevalencia del 2,2% (método cuestionario escrito)
y 3,6% (método videocuestionario. Figura 2) de sibilancias graves en el ultimo año.
La Figura siguiente compara los resultados según el método empleado:
La tabla muestra los países participantes en el Estudio ISAAC, con un enlace en aquellos que han publicado resultados propios. Pulsando en los diferentes enlaces puedes acceder a los trabajos publicados y que muestran: resultados globales (y metodología del ISAAC); y resultados por países.
Para regresar al Observatorio, no tienes más que cerrar la nueva ventana que se abre.
Ellwood P, Asher MI, Beasley R, Clayton TO, Stewart AW; ISAAC Steering Committee.
The international study of asthma and allergies in childhood (ISAAC): phase three rationale and methods.
Int J Tuberc Lung Dis. 2005 Jan;9(1):10-6.
Weiland SK, Bjorksten B, Brunekreef B, Cookson WO, von Mutius E, Strachan DP.
Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods.
Eur Respir J. 2004 Sep;24(3):406-12.
Crane J, Mallol J, Beasley R, Stewart A, Asher MI; International Study of Asthma and Allergies in Childhood Phase I study group. Agreement between written and video questions for comparing asthma symptoms in ISAAC. Eur Respir J. 2003 Mar;21(3):455-61.
Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, Mitchell EA, Pearce N, Sibbald B, Stewart AW, et al.International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods.
Eur Respir J. 1995 Mar;8(3):483-91
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Jenkins MA, Clarke JR, Carlin JB, Robertson CF, Hopper JL, Dalton MF, Holst DP, Choi K, Giles GG. Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma.
Int J Epidemiol. 1996 Jun;25(3):609-16
Lewis S.ISAAC--a hypothesis generator for asthma? International Study of Asthma and Allergies in Childhood.
Lancet. 1998 Apr 25;351(9111):1220-1. No abstract available.
Asher MI, Weiland SK. The International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Steeriing Committee. Clin Exp Allergy. 1998 Nov;28 Suppl 5:52-66; discussion 90-1.
Gibson PG, Henry R, Shah S, Toneguzzi R, Francis JL, Norzila MZ, Davies H. Validation of the ISAAC video questionnaire (AVQ3.0) in adolescents from a mixed ethnic background. Clin Exp Allergy. 2000 Aug;30(8):1181-7.
Comparaciones entre paises y ecológicos
Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR; International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide?J Allergy Clin Immunol. 2008 Apr;121(4):947-54.e15.
Foliaki S, Annesi-Maesano I, Daniel R, Fakakovikaetau T, Magatongia M, Tuuau-Potoi N, Waqatakirewa L, Cheng SK, Pearce N.
Prevalence of symptoms of childhood asthma, allergic rhinoconjunctivitis and eczema in the Pacific: the International Study of Asthma and Allergies in Childhood (ISAAC).
Allergy. 2007 Mar;62(3):259-64.
Pearce N, Douwes J.
The global epidemiology of asthma in children.
Int J Tuberc Lung Dis. 2006 Feb;10(2):125-32. Review.
Mallol J, Castro-Rodriguez JA.
Differences in prevalence of asthma, rhinitis, and eczema between parental and self-completed questionnaires in adolescents.
Pediatr Pulmonol. 2006 May;41(5):482-7.
Marc N, Bernard AM.
Ecological association between childhood asthma and availability of indoor chlorinated swimming pools in Europe.
Occup Environ Med. 2006 Jul 17
Weiland SK, Husing A, Strachan DP, Rzehak P, Pearce N; ISAAC Phase One Study Group.
Climate and the prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children.
Occup Environ Med. 2004 Jul;61(7):609-15
Mallol J. Satellite symposium: Asthma in the World. Asthma among children in Latin America] Allergol Immunopathol (Madr). 2004 May-Jun;32(3):100-3. Spanish.
Weiland SK, Husing A, Strachan DP, Rzehak P, Pearce N; ISAAC Phase One Study Group. Climate and the prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children. Occup Environ Med. 2004 Jul;61(7):609-15.
Foliaki S, Nielsen SK, Bjorksten B, Von Mutius E, Cheng S, Pearce N; ISAAC Phase I Study Group. Antibiotic sales and the prevalence of symptoms of asthma, rhinitis, and eczema: The International Study of Asthma and Allergies in Childhood (ISAAC). Int J Epidemiol. 2004 Jun;33(3):558-63. Epub 2004 Mar 11. Worlwide
Burr ML, Emberlin JC, Treu R, Cheng S, Pearce NE; ISAAC Phase One Study Group. Pollen counts in relation to the prevalence of allergic rhinoconjunctivitis, asthma and atopic eczema in the International Study of Asthma and Allergies in Childhood (ISAAC). Clin Exp Allergy. 2003 Dec;33(12):1675-80. Worlwide
Meerwaldt R, Odink RJ, Landaeta R, Aarts F, Brunekreef B, Gerritsen J, Van Aalderen WM, Hoekstra MO. A lower prevalence of atopy symptoms in children with type 1 diabetes mellitus. Clin Exp Allergy. 2002 Feb;32(2):254-5.
Shirtcliffe P, Weatherall M, Beasley R. An inverse correlation between estimated tuberculosis notification rates and asthma symptoms. Respirology. 2002 Jun;7(2):153-5.
Braback L, Plaschke P, Nilsson L, Boman G, Janson C. [Great geographic variations in the prevalence of asthma and allergy. International population studies to explain the associative factors] Lakartidningen. 2001 Nov 21;98(47):5322-6. Swedish.
Pearce N, Weiland S, Keil U, Langridge P, Anderson HR, Strachan D, Bauman A, Young L, Gluyas P, Ruffin D, et al. Self-reported prevalence of asthma symptoms in children in Australia, England, Germany and New Zealand: an international comparison using the ISAAC protocol.
Eur Respir J. 1993 Nov;6(10):1455-61.
Bjorksten B, Dumitrascu D, Foucard T, Khetsuriani N, Khaitov R, Leja M, Lis G, Pekkanen J, Priftanji A, Riikjarv MA. Prevalence of childhood asthma, rhinitis and eczema in Scandinavia and Eastern Europe.
Eur Respir J. 1998 Aug;12(2):432-7.
von Mutius E, Pearce N, Beasley R, Cheng S, von Ehrenstein O, Bjorksten B, Weiland S.International patterns of tuberculosis and the prevalence of symptoms of asthma, rhinitis, and eczema.
Thorax. 2000 Jun;55(6):449-53.
von Kries R, Hermann M, Grunert VP, von Mutius E. Is obesity a risk factor for childhood asthma? Allergy. 2001 Apr;56(4):318-22.
Stewart AW, Mitchell EA, Pearce N, Strachan DP, Weilandon SK. The relationship of per capita gross national product to the prevalence of symptoms of asthma and other atopic diseases in children (ISAAC). Int J Epidemiol. 2001 Feb;30(1):173-9.
Newson RB, Shaheen SO, Chinn S, Burney PG. Paracetamol sales and atopic disease in children and adults: an ecological analysis. Eur Respir J. 2000 Nov;16(5):817-23.
Mallol J, Sole D, Asher I, Clayton T, Stein R, Soto-Quiroz M. Prevalence of asthma symptoms in Latin America: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Pulmonol. 2000 Dec;30(6):439-44.
Pearce N, Sunyer J, Cheng S, Chinn S, Bjorksten B, Burr M, Keil U, Anderson HR, Burney P. Comparison of asthma prevalence in the ISAAC and the ECRHS. ISAAC Steering Committee and the European Community Respiratory Health Survey. International Study of Asthma and Allergies in Childhood. Eur Respir J. 2000 Sep;16(3):420-6.
Anderson HR, Gupta R, Kapetanakis V, Asher MI, Clayton T, Robertson CF, Strachan DP; ISAAC Steering Committee. International correlations between indicators of prevalence, hospital admissions and mortality for asthma in children.Int J Epidemiol. 2008 Jun;37(3):573-82.
Flohr C, Weiland SK, Weinmayr G, Björkstén B, Bråbäck L, Brunekreef B, Büchele G, Clausen M, Cookson WO, von Mutius E, Strachan DP, Williams HC; ISAAC Phase Two Study Group. The role of atopic sensitization in flexural eczema: findings from the International Study of Asthma and Allergies in Childhood Phase Two.J Allergy Clin Immunol. 2008 Jan;121(1):141-147.e4.
Weinmayr G, Weiland SK, Björkstén B, Brunekreef B, Büchele G, Cookson WO, Garcia-Marcos L, Gotua M, Gratziou C, van Hage M, von Mutius E, Riikjärv MA, Rzehak P, Stein RT, Strachan DP, Tsanakas J, Wickens K, Wong GW; ISAAC Phase Two Study Group. Atopic sensitization and the international variation of asthma symptom prevalence in children.Am J Respir Crit Care Med. 2007 Sep 15;176(6):565-74.
Strachan D, Sibbald B, Weiland S, Ait-Khaled N, Anabwani G, Anderson HR, Asher MI, Beasley R, Bjorksten B, Burr M, Clayton T, Crane J, Ellwood P, Keil U, Lai C, Mallol J, Martinez F, Mitchell E, Montefort S, Pearce N, Robertson C, Shah J, Stewart A, von Mutius E, Williams H. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol. 1997 Nov;8(4):161-76.
[No authors listed] Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood. Eur Respir J. 1998 Aug;12(2):315-35.
Williams H, Robertson C, Stewart A, Ait-Khaled N, Anabwani G, Anderson R, Asher I, Beasley R, Bjorksten B, Burr M, Clayton T, Crane J, Ellwood P, Keil U, Lai C, Mallol J, Martinez F, Mitchell E, Montefort S, Pearce N, Shah J, Sibbald B, Strachan D, von Mutius E, Weiland SK.Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. .J Allergy Clin Immunol 1999 Jan;103(1 Pt 1):125-38
Björkstén B, Clayton T, Ellwood P, Stewart A, Strachan D; ISAAC Phase III Study Group. Worldwide time trends for symptoms of rhinitis and conjunctivitis: Phase III of the International Study of Asthma and Allergies in Childhood.Pediatr Allergy Immunol. 2008 Mar;19(2):110-24.
Pearce N, Aït-Khaled N, Beasley R, Mallol J, Keil U, Mitchell E, Robertson C; and the ISAAC Phase Three Study Group. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007 Sep;62(9):758-66.
Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, Williams H; ISAAC Phase Three Study Group.
Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys.
Lancet. 2006 Aug 26;368(9537):733-43.
[No authors listed] Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee.
Lancet. 1998 Apr 25;351(9111):1225-32
Georgy V, Fahim HI, El Gaafary M, Walters S.
Prevalence and socioeconomic associations of asthma and allergic rhinitis in Cairo, Egypt.
Eur Respir J. 2006 May 31;
Georgy V, Fahim HI, El Gaafary M, Walters S.
Prevalence and socioeconomic associations of asthma and allergic rhinitis in Cairo, Egypt.
Eur Respir J. 2006 May 31;
Haileamlak A, Lewis SA, Britton J, Venn AJ, Woldemariam D, Hubbard R, Williams HC.
Validation of the International Study of Asthma and Allergies in Children (ISAAC) and U.K. criteria for atopic eczema in Ethiopian children.
Br J Dermatol. 2005 Apr;152(4):735-41.
Esamai F, Ayaya S, Nyandiko W. Prevalence of asthma, allergic rhinitis and dermatitis in primary school children in Uasin Gishu district, Kenya. East Afr Med J. 2002 Oct;79(10):514-8.
Esamai F, Anabwani GM.Prevalence of asthma, allergic rhinitis and dermatitis in primary school children in Uasin Gishu district, Kenya.
East Afr Med J. 1996 Jul;73(7):474-8.
Bouayad Z, Aichane A, Afif A, Benouhoud N, Trombati N, Chan-Yeung M, Ait-Khaled N.
Prevalence and trend of self-reported asthma and other allergic disease symptoms in Morocco: ISAAC phase I and III.
Int J Tuberc Lung Dis. 2006 Apr;10(4):371-7.
Mavale-Manuel S, Joaquim O, Nunes E, Pedro A, Bandeira S, Eduardo E, Macome C, Almeida L, Cossa A, Malichocho J, Maciel L, Constance E, Marques S, Tembe A, de Blic J, Annesi-Maesano I. Prevalence of asthma-like symptoms by ISAAC video questionnaire in Mozambican schoolchildren.
Monaldi Arch Chest Dis. 2006 Dec;65(4):189
Falade AG, Olawuyi JF, Osinusi K, Onadeko BO. Prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 6- to 7-year-old Nigerian primary school children: the international study of asthma and allergies in childhood. Med Princ Pract. 2004 Jan-Feb;13(1):20-5.
Falade AG, Olawuyi F, Osinusi K, Onadeko BO. Prevalence and severity of symptoms of asthma, allergic rhino-conjunctivitis and atopic eczema in secondary school children in Ibadan, Nigeria.
East Afr Med J. 1998 Dec;75(12):695-8.
South Africa
Wichmann J, Wolvaardt JE, Maritz C, Voyi KV. Household Conditions, Eczema Symptoms and Rhinitis Symptoms: Relationship with Wheeze and Severe Wheeze in Children Living in the Polokwane Area, South Africa.Matern Child Health J. 2008 Jan 10.
Mercer MJ, Joubert G, Ehrlich RI, Nelson H, Poyser MA, Puterman A, Weinberg EG.Socioeconomic status and prevalence of allergic rhinitis and atopic eczema symptoms in young adolescents. Pediatr Allergy Immunol. 2004 Jun;15(3):234-41. South Africa
Khaldi F, Fakhfakh R, Mattoussi N, Ben Ali B, Zouari S, Khemiri M.
Prevalence and severity of asthma, allergic rhinoconjunctivitis and atopic eczema in "Grand Tunis" schoolchildren: ISAAC.
Tunis Med. 2005 May;83(5):269-73.
Petry C, Pereira MU, Pitrez PM, Jones MH, Stein RT. [The prevalence of symptoms of sleep-disordered breathing in Brazilian schoolchildren]J Pediatr (Rio J). 2008 Mar-Apr;84(2):123-9.
Palvo F, Toledo EC, Menin AM, Jorge PP, Godoy MF, Solé D. Risk factors of childhood asthma in Sao Jose do Rio Preto, Sao Paulo, Brazil.J Trop Pediatr. 2008 Aug;54(4):253-7.
Pastorino AC, Kuschnir FC, Arruda LK, Casagrande RR, de Souza RG, Dias GA, Silveira HH, da Cunha AJ, Jacob CM, Solé D. Sensitisation to aeroallergens in Brazilian adolescents living at the periphery of large subtropical urban centres.Allergol Immunopathol (Madr). 2008 Jan-Feb;36(1):9-16.
Solé D, Camelo-Nunes IC, Wandalsen GF, Mallozi MC, Naspitz CK; Brazilian ISAAC's Group. Is the prevalence of asthma and related symptoms among Brazilian children related to socioeconomic status?J Asthma. 2008 Jan-Feb;45(1):19-25.
Solé D, Melo KC, Camelo-Nunes IC, Freitas LS, Britto M, Rosário NA, Jones M, Fischer GB, Naspitz CK.
Changes in the prevalence of asthma and allergic diseases among Brazilian schoolchildren (13-14 years old): comparison between ISAAC Phases One and Three.
J Trop Pediatr. 2007 Feb;53(1):13-21.
Solé D, Cassol VE, Silva AR, Teche SP, Rizzato TM, Bandim LC, Sarinho ES, Camelo-Nunes IC. Prevalence of symptoms of asthma, rhinitis, and atopic eczema among adolescents living in urban and rural areas in different regions of Brazil.Allergol Immunopathol (Madr). 2007 Nov-Dec;35(6):248-53.
Soares FA, Segundo GR, Alves R, Ynoue LH, Resende RO, Sopelete MC, Silva DA, Sung SS, Taketomi EA. [Indoor allergen sensitization profile in allergic patients of the allergy clinic in the University Hospital in Uberlândia, BrazilRev Assoc Med Bras. 2007 Jan-Feb;53(1):25-8.
Cassol V, Rizzato TM, Teche SP, Basso DF, Centenaro DF, Maldonado M, Moraes EZ, Hirakata VN, Sole D, Menna-Barreto SS.
Obesity and its relationship with asthma prevalence and severity in adolescents from southern Brazil.
J Asthma. 2006 Feb;43(1):57-60.
Pastorino AC, Rimazza RD, Leone C, Castro AP, Solé D, Jacob CM.
Risk factors for asthma in adolescents in a large urban region of Brazil.
J Asthma. 2006 Nov;43(9):695-700.
Sole D, Wandalsen GF, Camelo-Nunes IC, Naspitz CK; ISAAC - Brazilian Group.
Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood (ISAAC) - Phase 3.
Sole D, Camelo-Nunes IC, Wandalsen GF, Sarinho E, Sarinho S, Britto M, Rosario NA, de Freitas Souza LS, Stein R, Fischer GB, Naspitz CK.
Ecological correlation among prevalence of asthma symptoms, rhinoconjunctivitis and atopic eczema with notifications of tuberculosis and measles in the Brazilian population.
Pediatr Allergy Immunol. 2005 Nov;16(7):582-6.
Riedi CA, Rosario NA, Ribas LF, Backes AS, Kleiniibing GF, Popija M, Reisdorfer S.
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