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Background: Wheezing phenotypes in young children have usually been described on the basis of questionnaire surveys instead of prospectively doctor-diagnosed episodes, and have never been described in terms of incidence rates. Aims: To identify wheezing phenotypes in the first three years and describe their incidence trends, and to investigate their relationship with asthma at six years of age. Methods: Doctor-diagnosed wheezing episodes in the first 36 months and active asthma at six years were identified in a historical cohort of 3,739 children followed from birth in 29 primary care health centres in Spain. Wheezing phenotypes were identified by means of latent class analysis. Changes in incidence rates of wheezing were identified through joinpoint regression models and their predictive ability for asthma was analysed. Results: One never/infrequent wheeze phenotype and three wheezing phenotypes were identified. There were two early phenotypes which started wheezing at a median age of six months, one of which was transient while the other had a heavy recurrence of episodes. A third phenotype exhibited a delayed onset of wheezing, a constant rise in incidence through the first 36 months, and a relationship with allergic asthma. These three phenotypes had a higher prevalence of active asthma at six years than the never/infrequent wheeze phenotype, but the classification had a weak predictive ability for asthma due to low sensitivity. Conclusions: The use of incidence rates contributes to the clarification of the natural history of infant wheezing.

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.Determine whether the parents' quality of life predicts medium-term asthma control in children.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.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.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. © 2015 Wiley Periodicals, Inc.

Background Parents’/caregivers’ quality of life is an important aspect to consider when handling paediatric asthma, but there is a paucity of valid and reliable instruments to measure it. The Family Impact of Childhood Bronchial Asthma (IFABI-R) is a recently developed questionnaire to facilitate the assessment of asthma-related parents’/caregivers’ quality of life. This study researches the psychometric properties of IFABI-R. Methods Parents/main caregivers of 462 children between 4 and 14 years of age with active asthma were included in the sample. IFABI-R was administered on two different occasions and a number of other variables related to the parents’/caregivers’ quality of life were measured: child's asthma control, family functioning, and parents’/caregivers’ perception of asthma symptoms in the child. IFABI-R evaluative and discriminative properties were analysed, and the minimal important change in the IFABI-R score was identified. Results IFABI-R showed high internal consistency (Cronbach's alpha = 0.941), cross-sectional construct validity (correlation with the degree of child's asthma control, family functioning and parent/caregiver perception of the child's asthma symptoms), longitudinal construct validity (correlation of changes in the IFABI-R with changes in asthma control and changes in the perception of symptoms), sensitivity to change and test–retest reliability. An absolute change of 0.3 units in IFABI-R related to a minimal significant change in the parents’/caregivers’ quality of life. Conclusions IFABI-R is a reliable and valid instrument to study the quality of life of parents/caregivers of children with asthma.

Describe the association between parents' quality of life and the two components of asthma control in children: impairment and risk.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.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.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.

The aim of this study was to describe the time patterns of wheezing in both asthmatic and nonasthmatic children during the first 36 months of life, and to determine whether there are asthma-related breakpoints in the incidence of wheezing. Data from a historical cohort of children followed from birth to 6 years (SLAM cohort) were used. Wheezing episodes until 36 months and asthma at 6 years were both recorded by a doctor. Monthly mean incidence rate of wheezing and rate ratio were calculated. Joinpoint regression models were built to identify breakpoints in the risk of wheeze. Complete information was available for 3739 children. Wheezing in the first 36 months was more frequent in asthmatic than in nonasthmatic children (rate ratio 2.62, 95% CI 1.81–3.78). Differences were appreciable within the first months and increased steadily thereafter because of a persistently high rate in asthmatic children. No breakpoint in the rate ratio could be identified. Asthmatic children exhibited a one-phase curve of incidence and nonasthmatic children exhibited a two-phase curve. However, children with allergic asthma also displayed a two-phase curve. There is no identifiable breakpoint during the first 36 months of life at which the incidence of wheezing in asthmatic children begins to stand out.

Redactores (por orden alfabetico): Vicente Baos Vicente (medico de familia, coordinador del grupo de utilizacion de farmacos de la semFYC) Antonio Barbero Gonzalez (farmaceutico comunitario, Vicepresidente de la REAP) Eduard Diogene Fadini (farmacologo clinico, SEFC) Alejandro Eguilleor Villena (farmaceutico comunitario, Vocal de la SEFaC) Teresa Eyaralar Riera (farmaceutica comunitaria, Vocal de Farmacia de la REAP) Jose Ibanez Fernandez (farmaceutico comunitario, Presidente de la SEFaC) Africa Mediavilla Martinez (farmacologa clinica, Presidente de la SEFC) Isabel Mora Gandarillas (pediatra, Vicepresidente de la AEPap) Vicente Palop Larrea (medico de familia, grupo de utilizacion de farmacos de la semFYC) Raimundo Pastor Sanchez (medico de familia, Secretario de la REAP) Ana Maria Quintas Rodriguez (farmaceutica comunitaria, Vocal de la SEFaC) Carlos Rodriguez Moreno (farmacologo clinico, SEFC) Juan Ruiz-Canela Caceres (pediatra, Presidente de la AEPap) Fernando Sanchez Perales (pediatra, AEPap) Ermengol Sempere i Verdu (medico de familia, grupo de utilizacion de farmacos de la semFYC)