Asthma is a common disease in both high and lower income countries that starts early and persists often for life. A correct and accurate diagnosis, treatment and follow-up during childhood are essential for a better understanding of adult asthma and avoiding over- or under-treatment.Th2 inflammation in children with asthma symptoms is usually assessed by measuring with serum total IgE, blood eosinophilia and FeNO levels that may help to predict asthma, particularly in those infants and young children in whom lung function tests are difficult to perform. FeNO measurement, compared to intra-individual levels, may be useful also for ascertaining treatment adherence. Nevertheless, an isolated measurement may be insufficient and only the combination of these markers improves the diagnosis, phenotyping and follow-up of an asthmatic child.

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Background: Asthma is the most common chronic disease in children. Cases of severe asthma (SA) are underdiagnosed. Periostin is a biomarker for SA in adults, but its role in children is poorly understood. Objectives: The aims of the study were to estimate the percentage of cases of uncontrolled severe asthma (UcSA) in children with poorly controlled asthma and to evaluate the role of periostin as a biomarker. Materials and Methods: We performed an observational study in children aged 5 to 14 years with poorly controlled asthma. Demographic and clinical data were collected in addition to the results of the lung function test, the fraction of exhaled nitric oxide, the skin prick test, total IgE, specific IgE, blood eosinophil count, serum periostin, treatment, asthma control, and quality of life. Variables were compared between the group with UcSA and the other children. Results: Fifty children with poorly controlled asthma (72% male) were included. Nineteen children (38%) had UcSA. Most children had limitations in their activities of daily living and had visited the emergency department. In addition, 38% were hospitalized. Quality of life was poor. Only 42% of the children received appropriate treatment. The UcSA group was more likely to have a total IgE >500 kU A /mL (52.6% vs 19%, P=.02) and less likely to have serum periostin >1000 ng/mL (31.2% vs 63%, P=.04). Conclusions: In our setting, 38% of children with poorly controlled asthma have UcSA, which is associated with higher levels of total serum IgE and lower levels of serum periostin.

These represent 221,054 lost working days per year. Low back pain and sprained ankles are the most frequent processes. We find an increase in the incidence of temporary disability due to low back pain and lumbar/sciatica in the basic rural areas of the middle region. There are no statistically significant differences with a p<0.05 in the duration of temporary disability according to Health Area, rural or urban milieu or geographical accessibility to the Rehabilitation Services. A statistically significant fall can be observed in the first year of operation of a temporary disability management program.

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