Maintenance therapies for asthma are vulnerable to low adherence. Clinicians would benefit from having a validated questionnaire to assess adherence to metered-dose inhaler use in children with asthma. The objective of this study was to design and validate a questionnaire assessing adherence to metered-dose inhaler use, to be filled out by the parents and/or caregivers of children with asthma. The six questions on the Pediatric Inhaler Adherence Questionnaire were obtained from reviewing the literature, from carrying out focus group discussions, and from the researchers' professional experience. We assessed concurrent criterion validity using canister weight change as the gold standard and also assessed test-retest reliability. The questionnaire was administered to the parents/caregivers of 64 children aged 3.6 ؎ 2.2 years. Questionnaire scores correlated positively with the absolute value of the difference between 100 and percent taken of prescribed (Spearman correlation coefficient rho ‫؍‬ 0.42, p ‫؍‬ 0.001). The sensitivity of the questionnaire in detecting nonadherent patients ranged from 50% to 75%; positive predictive value ranged from 23.1% to 66.7%; and likelihood ratio ranged from 1.5 to 5.5 for the detection of nonadherent patients. The Pediatric Inhaler Adherence Questionnaire is a valid, reliable, quick, inexpensive, and easy-to-use instrument that allows quantitative assessment of metered-dose inhaler adherence in children with asthma, and may be useful across a range of clinical and research settings. (Pediatr Asthma Allergy Immunol 2007; 20[4]:243-253.)

Background: The heterogeneity of bronchiolitis may imply or reflect a different predisposition to respiratory sequelae.Objective: Our aim was to investigate whether, among infants hospitalized with bronchiolitis, different clinical profiles extracted by latent class analysis (LCA) are associated with different risks of wheezing.Methods: Over 15 consecutive epidemic seasons (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019), we prospectively enrolled infants <1 year hospitalized for the first episode of bronchiolitis in a single tertiary hospital. A detailed clinical questionnaire was filled for each infant. LCA was applied to differentiate bronchiolitis phenotypes, and after hospital discharge, a phone interview was performed annually to record the presence of wheezing episodes. Adjusted multivariate regression analyses were run to investigate the risk of wheezing during 7 years follow-up according to clinical phenotypes.Results: LCA performed on 1312 infants resulted in a three-class model. Profile 1 (65.5%): moderate bronchiolitis; Profile 2 (6.1%): severe bronchiolitis; and Profile 3(28.4%): bronchiolitis infants with high eosinophils blood count. At 1 year of follow up, about 50% of children presented wheezing in each profile. Compared to Profile 1, the adjusted odds ratio (OR) of having wheezing episodes was significantly higher in Profile 2 at 2, 3, and 4 years of follow-up. At 7 years, Profile 3 had an adjusted OR = 2.58, higher than Profile 2 (adjusted OR = 2.29).Conclusions: LCA clearly identified a "moderate", "severe," and "high eosinophils blood count" bronchiolitis. During the first 4 years after bronchiolitis, the "severe" profile showed the higher risk of wheezing, but after 7 years this risk seems higher in the "high eosinophils blood count" group.

Our study suggests the need for further research with larger number of children to identify an optimal Pao2/Fio2 threshold for identifying ARDS in this population.

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