Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation.

El tratamiento de la fibrosis quística es hoy en día principalmente sintomático. Sin embargo, están apareciendo resultados positivos en la farmacoterapia, la cual busca corregir la expresión del defecto genético. Dado la baja prevalencia de la enfermedad y su tratamiento tan específico es muy importante contar con un centro especializado para su manejo a fin de otorgar una alta calidad de atención. Para este centro se requiere un equipo multidisciplinario que involucre a la familia y el paciente. Siguen siendo de vital importancia el soporte nutricional, el tratamiento antibiótico precoz y agresivo y la eliminación de las secreciones de la vía aérea.

Introduction:Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized pediatric patients, and there are no reports in Latin America. Method: Evaluate whether a full education with self management plan (SMP) was more effective than standar education plan (SP) to reduce asthma exacerbations, a prospective, randomized study was designed. Children (5−15 yrs) hospitalized for an asthma exacerbation at public hospital were divided in the two groups. The SP group received general instruction and the SMP received a pocket guideline with a domino game to reinforce knowledge with his family. Patients were followed for one year every 3 months by phone calls. Hospitalizations for asthma, number of exacerbations, emergency visits and oral steroids use were recorded. Results: 77 out of 88 (86%) hospitalized patients completed the follow−up. After this time, there was not difference in hospitalization, emergency visits, exacerbation and oral steroids use between the two groups. However, if we compare the baseline historic exacerbations and the future exacerbations in each group, children from the SMP group had a significant decrease after the intervention (SP group: from 4.4 to 3.1, p = 0.078 and SMP group: from 5.8 to 2.8, p = 0.01). Conclusions: Asthma education plan with or without self management in children admitted with asthma were effective in reducing futures exacerbations; however it seems that the effect is greater using a self management plan. These findings support the importance of asthma education plan in any patient who is admitted for asthma exacerbation. This abstract is funded by: None.

La sialorrea se define como la pérdida no intencional de saliva desde la boca. Su presencia puede conducir a alteraciones funcionales, psicológicas y sociales, que afectan tanto al paciente como a sus cuidadores. La sialorrea anterior, donde la saliva es derramada desde la boca al exterior afecta la socialización, constituyéndose como una barrera para el contacto físico e impacta en forma negativa sobre la calidad de vida, además interfiere en el len­guaje, el habla y la comunicación. La sialorrea posterior que es derramada hacia del itsmo de las fauces, se asocia a trastornos severos de la deglución, constituyendo un riesgo importante de aspiración. Aún cuando la etiología de la sialorrea es multifactorial, frecuentemente la vemos asociada a una disfunción neuromuscular. Su abordaje debe ser realizado por un equipo multidisciplinario. El enfoque terapéutico puede ser, no farmacológico o farma­cológico, sistémico o local. Una de las alternativas es la infiltración con toxina botulínica guiada en forma ecográfica que ha demostrado ser eficiente y segura. Se presenta el caso de un preescolar de 4 años con antecedente de astrocitoma de fosa posterior, compromiso de VI al XI pares craneanos, ventilación mecánica prolongada a través de traqueostomía, trastorno de deglución e hipersalivación secundaria. Se realiza el manejo de la sialorrea con toxina botulínica A en parótidas y glándulas submandibulares con marcación ecográfica, resultando una disminución importante del flujo de saliva que le permite abrir la boca sin escurrimiento. Lo anterior impacta positivamente en la comunicación y socialización, además de mejorar su calidad de vida.