Physical Activity and Obesity in Asthmatic Children Background: Exercise-induced asthma is frequent among children. Objective: To compare physical activity (PA) and nutritional status in asthmatic (A) versus healthy (H) children. Methods: 81 school children were enrolled (40 A and 41 H). A validated interview with opinions and attitude towards PA was performed to parents in both groups. Nutritional status was classified according to body mass index. Answers were associated with χ 2 test. Results: 44% girls, average age 9 years-old. Average hours per week of PA = 2.4 in H and 1.9 in A (p=NS); 88% of A versus 56% of H performed < 2 hours per week of PA (p < 0.05). 85% of A reported frequent symptoms associated to PA. Overweight and obesity were diagnosed in 15/40 A and 11/41 H (p < 0.05). Parents of A thought that PA was "dangerous" more frequently than parents of H (p < 0.05). Conclusions: Asthmatic children practice less PA than recommendations. There is an association between asthma, obesity and less PA level. Parents of asthmatic children have a negative opinion about PA, explaining the diminished PA performed by this group.

Tabla 3. Signos y síntomas asociados a Trastornos Respiratorios del Sueño Síntomas Signos Vigilia Sueño Mal rendimiento escolar Ronquido Fascie adenoidea Somnolencia Apnea constatada por padres Respirador bucal Agresividad Respiración paradojal Aumento tejido amigdaliano Hiperactividad Enuresis Alteraciones craneofaciales Cefalea matinal Sueño no reparador Micrognatia

Re sum enSe analizcn "• 37 fibrobro-xoscopias reahzadas en 121 pacientes duranre 25 meses (abril 1995 a mayo 19971 con rongo de edad entre 20 dias a 15 anos y p'omedic de A3 anos. Noventa y cinco proced'mientos Fueron diagn6s r icos (70%],. e resto terapeutico. Las principals rdicac'ones clinicos que en su conjun'c representan el 77% de los procedimienros fueron: atelec'asias (3'%)., lavado oroncoalveola r |22%), estridor [14%) y evaluacion de! paciente traqueostomizado cronicc 110%]. Veintidos de los procedimienlos diogncsticos [23%) se h c'eron en patclogia congenita, 14 [64%) per es*ridor siendo Ic aringomalacia el principal diagnosMco [50%]. it lavado broncoalveolar permitio hacer diagnos'ico bacteriolcgico en 25% de Ics casos y tambien r ue uti! en hemosiderosis ou'moncr y aspi'acion cronico. En 90% de los pccien'es co" oatologia adquir'da de la v'a aerea superior se es'ablecio diagnostico y se dieron las recomendaciores de estudio, constituyendose en e: metodo de evaluacion de Tiejor rendlmiento. Los procedimientos teraoeuticos se realizaron principalmenle en ateleclasia aguda (78%), con mejoria en a mayoria de e'las [63%j. Ex'raccio 1 -de cuerpo ex'rano, selle de fistulcs broncopleurcles, intubaciones dificiles y reseccion ce granuloma subgloiico. .a fibrcendoscopia es un me^odo segu'o, versatil y altamen^e resolurivo con pocas cornplicaciones de orden mencr. En esta cominicacion ias comprcccio r "es mayores fueron inferiores al 1 %.[Palabras clave: broncoscopia flexible., pedict-'a, via aerea, estridor, atelectasia pulnonar.) Flexible bronchoscopie in pediatrics. A useful therapeutic and diagnostic toolOne hundred and thirty seven flexible bronchoscopies done in 121 patients from april 1995 to mcy 1997, are analysed. The ranee of ace was 20 days ~c 15 veers, mean 4,3 years. Seventy per cent of them were made with diagnostic purposes and 23% cs therapeutic procedure. Principal clinicai mdicctio-s were athelectasias, bronchoalveolar lovcge [BAL], stridor anc evaLaNon of chronic trac-eostony. Twenty two of the diagnostic procedures were indicatec in congenital disease of the upper a'rwcy, most of then associated to strccr, berg larinccma'acia the mos* frecjent (50%). BAL was useful! fo' oac ; enclogic diagnosis, hemosiderosis and chronic aspira'ion. Among patients with adquired diseases of the upper a'rway, bronchoscopie lead to a right diagnosis ir 90% or t^ern, and allowed to make recomendations for furt n er work up. When used as c therapeutic procedure, bronchoscopie showed good results in 'esolving athelecasias (63%|, foreing body cspira'ion, sealing bronchopleural fistulas, hard intubation and resection of subg^cNc granucma. Flexible brorcnosccpie is a safe and versatile procecure with hig^ clinical value and few complications.{Keywords Flexible bronchosccpie, pediatrics, airway, stridor, athelactasia.)

At-home non-invasive ventilatory assistance for children: initial impact of a national program in Chile Introduction: Prolonged mechanical ventilation may be provided to children with chronic ventilatory failure as non-invasive ventilatory assistance at home (NIVA). Objective: To describe clinical characteristics, evolution outcomes and Health Related Quality of Life (HRQOL) of pediatric patients admitted into the Chilean NIVA program. Patients and Methods: Medical fi les of patients included in the program, were reviewed during a period of 24 months (2006-2008), using follow-up protocols. Results: There were a total of 177 children, with an average age of 9.7 ± 4.7 years. Fourteen patients died of non-related causes. Diagnoses were: neuromuscular disease (NMD) 64%, myelomeningocele 6%, obstructive sleep apnea syndrome 6%, lung disease 20% and miscellaneous 4%. Compared to the previous year, hospitalization decreased from 60 to 21% (p < 0.00001) and from 1.3 hospitalizations/patient/year to 0.3 (p < 0.00001). HRQOL improved signifi cantly, AUQUEI 17.2 ± 5.6 (p < 0.05), IRS 26.4 ± 8.2 points (p < 0.05) in 82 patients. In 21 patients with NMD an average increase of 27 cmH 2 O on muscular inspiratory pressure (p < 0.05) after respiratory training was observed. Conclusions: The NIVA program reduced hospitalizations and improved HRQOL. In a group of patients the muscle strength increased with stable respiratory function.

Usefulness of a clinical questionnaire for diagnosis of respiratory disorders of sleep in children with neuromuscular diseases Objectives: To analyze the usefulness of a clinical questionnaire for the diagnosis of sleep disordered breathing in children with neuromuscular diseases. Patients and Methods: A sleep questionnaire and a polysomnography were performed in a cohort of 21 children (14 boys) with neuromuscular diseases. ROC analysis was used to assess the diagnostic accuracy of the questionnaire for diagnosing sleep disordered breathing compared with polysomnography. Results: Median age was 10.7 years (2-17). According to polysomnography, 8 patients were classifi ed as normal, 3 had primary snoring, 5 had central sleep apnea syndrome and 5 an obstructive sleep apnea syndrome. Eleven questionnaire's scores suggested sleep disordered breathing. The questionnaire's score showed a sensitivity of 75%, specifi city of 60%, positive predictive value of 33% and negative predictive value of 90% for the diagnosis of an obstructive sleep apnea syndrome. The same fi gure for the diagnosis of a central sleep apnea syndrome was 80%, 64%, 44% and 90%. Conclusions: The questionnaire showed a moderate sensitivity and specifi city. Nevertheless, the high negative predictive value of the questionnaire may support its use for screening of sleep disordered breathing. A follow-up of questionnaire's scores may identify patients, who would benefi t from performance of polysomnography.