To help assess the causes and frequency of acute respiratory illnesses (ARI) during the first 18 months of life in Chile, a cohort of 437 children born in good health between May 1991 and April 1992 was followed at an urban health clinic in northern Santiago. Information was obtained from medical checkups performed at the clinic, from emergency health care services, from private physicians, and from interviews with each child's mother when the child was enrolled in the study and when it was 6, 12, and 18 months old. Followup was completed for 379 (87%) of the children. ARI accounted for 67% of all 3762 episodes of illness recorded for these children in the 18-month study period, 1384 (55%) of the ARI episodes affecting the upper respiratory tract and the remaining 1144 (45%) affecting the lower. The overall rate of ARI observed was 33 episodes per 100 child-months of observation. The incidences of upper, lower, and total ARI episodes decreased significantly in the third six months of life. A statistically significant association was found between upper ARI (≥2 episodes) and maternal smoking (≥5 cigarettes per day), but no significant associations were found with any of the other risk factors studied. However, lower ARI (≥2 episodes) was significantly associated with maternal schooling (<8 years), a family history of atopic allergy, and substandard housing conditions; and lower ARI (≥4 episodes) was significantly associated with these factors and also with the existence of one or more siblings, birth in a cold season, limited breast-feeding (<4 months), and low socioeconomic status. Significant associations were found between obstructive bronchitis episodes and most of the risk factors studied (gender, siblings, season of birth, duration of breast-feeding, maternal schooling, smoking, use of polluting fuels in the home, and a family history of atopic allergy); similarly, significant associations were found between the occurrence of pneumonia and many risk factors (including siblings, season of birth, duration of breast-feeding, maternal schooling, smoking, and socioeconomic level). Overall, 42 of the study children were hospitalized during the study period for lower tract ARI, and two children died of pneumonia at home during their first 6 months of life. The rate of hospitalization fell significantly with increasing age.

Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.

Objective: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures.

No abstract

V. Laringitis obstructive.La obstruction laringea es un sindrome relativamente frecuente en la infancia, especialmente en el niho menor y que plantea tmportantes problemas diagnosticos y de tratamiento. Sus causas son variadas (infecciones, tumores, aspiracion de cuerpos extranos o causticos, paralisis laringea), pero destacan en la practica pediatrica, las relacionadas con el cuadro de las Laringitis Obstructivas. El comentario de esta exposicion se basa en la experiencia recogida en nuestro Servicio, desde 1947 a 1954, sobre 279 enfermos con laringitis obstructiva que han sido estudiados a traves de una planificacion previa. Setenta y nueve fueron catalogados como diftericas, 94 como sarampionosas y 149 como infecciones agudas (microbiana, a virus). Concepto, etiologia y frecuenciaEs una afeccion laringea infecciosa, que se acompana de manifestaciones clinicas de obstruccion respiratoria alta, condicionadas por lesiones generalmente inflamatorias.En nuestra experiencia el mayor numero de casos correspondio a laringitis "microbianas" (infecciosas agudas de Chevalier Jackson) 46,2%; el resto de los casos se determina fundamentalmente por la difteria (24,5%) y el sarampion (79,3 por ciento).La laringitis obstructiva constituye el motivo de ingreso de aproximadamente el 10% de los enferrnos en nuestro Servicio de Enfermedades Infecciosas. Existe una mayor incidencia en las estaciones frias del ario, susceptibles de influenciarse por la aparicion de brotes epidemicos de las enfermedades causales. Es una afeccion que predomina manifiestamente en el lactante mayor y preescolar. * Extracto de clases dktadas en Curso dc Perfeccionamiento de Pediatria, 1954.Necesidad de un diagnostics oportuno a) Antecedentes: Enfermedad infecciosa especifica, catarro previc-de las vias respiratorias, alergia familiar o personal, crisis anteriores, antecedentes de cuerpo extrano en las vias aereas. Forma de comienzo, que en nuestra experiencia demostro ser algo mas lento en las formas diftericas (b3,3%) que en los otros tipos etiologicos (alrededor del 40 % ). b) Manifestaciones clinicas de otastruccion crupal, disfonia, disnea, tiraje, cornaje. Estas alteraciones pueden conducir por anoxia a la cianosis, inconsciencia y muerte. c) Estudio endoscopico: debe realizarse por rino, laringo y broncoscopia. Puede comprobarse en la laringe, congestion (80,4% y 62% de las laringitis sarampionosas y laringitis microbianas), edema alrededor del 50% en las formas no diftericas) y exudado, que es la lesion fundamental en la laringitis difterica, de caracter membranoso (localizado en la glotis en el 41,6%). En las laringitis sarampionosas y laringitis microbianas el exudado estuvo presente en el 56,5% y 31,3%, respectivamente; en estos casos el exudado de tipo puriforme puede plantear dificiles problemas diagnosticos. d) Estudio bacteriologico de las secreciones nasal, faringea y laringea. En nuestra experiencia este estudio demostro que el 61,7% de las laringitis diftericas fue primitiva. En las otras formas hubo predominio de Stafilococo Albus, dor...