Asthma is a heterogeneous group of diseases manifested by recurrent episodes of wheezing, cough, shortness of breath and chest tightness. The unique features of childhood asthma make its classification, diagnosis and treatment differ substantially from adult asthma, particularly in the preschool age. This creates doubts and difficulties in managing these patients, which can be done in most cases in the Primary Care setting, without referral to the specialist. This paper provides a current review of the scientific literature, structured in questions of clinical interest for the Primary Care Pediatrician, ranging from the treatment of asthmatic patients according to age to more concrete aspects such as exercise induced asthma, inhalation devices or safety of the anti-asthmatic drugs.

Background: Recurrent pneumonia (RP) is defined as the presence of radiographic infiltrates recurring after complete resolution of initial pneumonic process. Although it is a common cause of demand for assistance in pediatric respiratory units, there are few studies to evaluate the actual impact.
Patients and methods: A descriptive study of patients diagnosed with RP in the Pediatric Respiratory Unit of Carlos Haya's University Hospital (Málaga), both ambulatory and in hospital wards during a period of one year. We proceeded to the devel­opment of a database through an evaluation questionnaire.
Results: We collected 157 patients with RP, 61.8% attended in outpatient clinics and 37.6% in hospital wards. Etiological diagnosis was established in 97.5% of cases, the most frequent asthma (37.2%), cystic fibrosis (23.7%) and aspiration syndrome (11.5%). In 75.3% of recurrences location was variable, 14.3% were unique location and 9.7% had interstitial distribution.
Conclusions: The clinical history and detailed physical examination, with radiographic features, guide the diagnosis of RP in most cases. Choose of additional tests depends on the location of recurrences, the patient's age and the prevalence of the diseases. In our study, overall, the most common underlying causes of RP were asthma, cystic fibrosis and chronic aspiration syndromes.

Introduction: There are many factors implicated in the development and progression of childhood bronchial asthma.

Objective: To determine whether these factors are clearly involved in the etiology and pathogenesis of this disease.

Material and methods: Structured review of the articles dealing with risk factors for asthma published in the biomedical literature updated over the last 5 years.

Results: The authors selected fourteen articles that contribute information in favor of and against the factors considered to indicate risk for the development and progression of bronchial asthma. These include genetics or family history, atopy, abnormal lung function, sex, breastfeeding and eating habits, smoking, viral respiratory infections and environmental factors (the hygiene hypothesis).

Conclusions: There is no consensus as to the involvement of the different etiological and pathogenic factors associated with asthma in the disease itself.

The authors present an update of the most widely accepted preventive and therapeutic measures in the management of children with bronchial asthma. After pointing out the alarming and increasing morbidity and the need for a broad but individualized approach, they review the available resources for the acute phase, regression period and base therapy. The measures for modifying the predisposing factors, the management of the symptoms (antileukotrienes, corticosteroids) and the possible defenses against environmental factors and treatment of the underlying causes (reduction or elimination of allergens, immunotherapy) are discussed.

Bronchiolitis due to respiratory syncytial virus (RSV) is one of the leading causes of hospitalization of infants under 12 months of age in our patient population; the mortality associated with this infection ranges around 0.5%, although in risk groups, the rate can reach up to approximately 3%. For this reason, it is important to clearly define the groups at risk for this infection, as well as to design adequate prevention strategies for these patient subgroups. The importance of understanding this infection lies not only in its early diagnosis and proper therapeutic management, but in the in-depth knowledge of the virus and the immune response of the organism, as well. There is a large body of evidence supporting a causal relationship between RSV infection and post-bronchiolitis asthma, although we still need to clarify key aspects that will enable us to determine which patients will present recurrent wheezing and which patients will not, and whether the virus actually triggers asthma or is simply a marker that selects individuals who are genetically predisposed to develop this disease.

Following the ISAAC methodology, we studied 4,644 schoolchildren between the ages of 11 and 16 (2,435 boys and 2,209 girls).

The objective of our study is to determine the influence of the habit of tobacco smoking in the group of adolescents that at some point has suffered from asthma or from asthma symptoms.

Of the adolescents who at some point had suffered from asth¬ma 66.5% cohabited with a smoker in the home (59.5% in phase I). Of the adolescents who suffered from wheezing in the last 12 months 69% cohabited with a smoker in the home (58.2% in phase I).

Having suffered from asthma at some point (p= 0.074; OR 0.83), or having suffered from wheezing in the last 12 months (p= 0.54; OR 0.91) is not associated with the presence of a smoker in the home.

Of the adolescents studied 5.6% were smokers, and in 60.7% of the cases the parents were smokers (73.9% in phase I). Among the non-smoking adolescents, in 53.1% of the cases the parents smoked (56.8% in phase I). A significant association was found between the parents smoking and the adolescents smoking (p= 0.034).

In phase I, 8.1% smoked between 1-8 cigarettes per day, compared to 4.2% in phase III, showing significant statistical differences (p <0.05).

A significant statistical association was found between having suffered from asthma at some point and the habit of tobacco smoking (p <0.001; OR 1.75), although not between having suffered from wheezing in the last 12 months and the habit of tobacco smoking. These results are very similar to those of phase I.

Allergens are substances, usually protein in nature, that are capable of inducing specific IgE antibodies in genetically predisposed individuals (atopic), but are innocuous in the remainder of the population. Depending on the route of entry and the organ of involved, the immune response or allergic hypersensitivity will give rise to clinical manifestations at the ocular level (conjunctivitis), in the gastrointestinal tract (food allergies) or in the respiratory tract (asthma and/or rhinitis). The allergens most frequently related to asthma are those present in air (Aeroallergens), which, when inhaled, exert their effects on the respiratory mucosa. They are the leading causes of asthma and contribute to the persistence of symptoms in children with established asthma. The main sensitizing aeroallergens among our general population, which is quite significant in number, are the pollens (grasses and olive), ornamental trees (cypress and shade plantain), animal dander, house dust mites and fungi.

Allergic rhinitis is not a trivial process considering its prevalence and the impact it exerts on life quality.

Although allergic rhinitis is a very common disease in childhood, sometimes it is under-diagnosed and under-treated, mainly in low-aged children, due to inability to verbalize their symptoms and the frequent overlapping with viral rhinitis and other associated comorbidities.

Although the entity is relatively easy to diagnose in adults, it shows a higher symptomatic heterogeneity in children being the postnasal drip cough one of the most typical symptoms.

Allergic rhinitis is rarely showed as an isolated entity in children, having to be considered in the allergy context as a system­ic disease and therefore frequently associated with other allergic disorders including asthma. Likewise, the presence of other associated entities or as consequence of the allergic rhinitis is very frequent.

The conceptual aspects of allergic rhinitis, its clinical manifestations in childhood and its links with asthma are revised.