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Any transmission of this document by any media or format is strictly prohibited.
Guzmn-Pantoja JE et al.
ORIGINAL ARTICLE Family Dysfunction and Paediatric Patients With Asthma
References
1. The Global Initiative for Asthma (GINA) [homepage on the In-
ternet]. Ontario, Canada: c1996-2008 [updated 2007 Oct 12; ci-
ted 2006 Dic 20]. Available from: www.ginasthma.org
2. Alvarado M. Evaluacin del impacto familiar del asma bronquial
infantil. Universidad Autnoma de Barcelona [thesis]. Barcelona:
Universidad Nacional de la Plata; 2002.
3. Vzquez F. El paciente asmtico y su dinmica familiar. Rev Aler-
gia Mxico. 2003;50:214-9.
4. delVecchio M, Smilkstein G, Joseph B, Shaffer T, Arons T. The
Family APGAR Index: a study of construct validity. J Fam Prac.
1979;8:577-82.
5. Smilkstein G. The Family APGAR: a proposal for a family func-
tion test and its use by physicians. J Fam Prac. 1979;6:1231-9.
COMMENTARY
Assessment of Family Functioning May Improve
the Therapeutic Approach to Childhood Asthma
Manuel Praena Crespo
La Candelaria Health Centre, Seville, Spain
Many guides and consensuses have been produced all over
the world on the diagnosis and treatment of asthma
recommending different evaluation tools to optimise its
management; the spirometer, which measures the effect on
pulmonary function, the symptoms diary, which gives
information on the impact of asthma, the use of relief
medication by the patient and questionnaires on quality of
life which can assess how asthma influences the quality of
life of the patient and even of their carers. Research works
currently include these tools to evaluate the response of the
disease to different pharmacological and immunotherapy
treatment and even therapeutic education. All using an
approach very much directed at the disease, thus avoiding
the biopsychosocial approach which must prevail in patient
care, and forgetting to a certain extent the effects that
asthma has on the family of which the patient forms a part.
546 | Aten Primaria. 2008;40(11):543-8 |
6. Smilkstein G, Ashworth C, Montano D. Validity and reliability
of the Family APGAR as a test of family Function. J Fam Prac.
1982;15:303-11.
7. Lozano J, Blanco A. Un anlisis de los factores de personalidad de
nios asmticos y sus progenitores. Psicologemas. 1996;10:193-
207.
8. Lozano J, Blanco A. Problemas emocionales y de salud experi-
mentados por los progenitores de nios asmticos. Clnica y Sa-
lud. 1996;7:317-28.
9. Schulz R, Dye J, Jolicoeur L, Caffeterty T, Watson J. Quality of
life factors for parents of children with asthma. Journal of Asth-
ma. 1994;31:209-19.
10. Fernndez A, Bujalance M, Leiva F, Martos F. Salud auto perci-
bida, apoyo social y familiar de los pacientes con enfermedad pul-
monar obstructiva crnica. Medifam. 2001;11:9.
11. Pacheco C, Daz-Meja G. Programa de actualizacin continua
para medicina general. Neumologa Mxico. 2000;PAC MG-
1:A4.
12. McClellan C, Cohen L. Family functioning in children with ch-
ronic illness compared with healthy controls: a critical review.
J Pediatr. 2007;150:221-3.
13. Caroselli M. Asthma and adaptation: exploring the family sys-
tem. J Psychosoc Nurs Ment Health Serv. 1990;28:34-9.
Following the systematic theory of the family, if one of
its members is ill, it can have consequences on the
health of the family dynamics as the disease represents a
Key Points
Control of the asthma patient must include an assessment
of how the family functions.
Prospective studies on family function should provide
better knowledge of the patient with asthma and their
progression.
Assessing family function will provide a starting point for
deciding and/or evaluating family therapy.
Document downloaded from http://www.elsevier.es, day 26/04/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.
Family Dysfunction and Paediatric Patients With Asthma
stress situation to which not only the patient has to
adapt but also all of their family. Research has shown
that families who have a child with a chronic disease
may lack cohesion, adaptability, and parent-child
interaction. Also, there may be family conflicts and
limited abilities to resolve conflicts. On the other hand,
there are certain internal circumstances within families
that make it difficult to adapt to stressful life events,
such as a new family member, loss of employment,
death of a near family member, etc. Depending on the
family dynamics, this can have a direct positive or
negative effect on the care that the family provides to
the patient.
In the article that we are commenting on,2 the authors
investigated changes in the family functioning of
paediatric patients with asthma. For this, they used the
family APGAR, a tool constructed to measure family
functioning.
This tool was created in 1978 by Smilkstein3 as an
attempt to respond to the need to assess family function,
using a simple tool, which could be self-completed in very
little time by people with a low educational level.
Smilkstein used the acronym APGAR to highlight the 5
components of family function: adaptability, partnership,
growth, affection, and resolve, and followed the
comparison with the APGAR score of the newborn,
giving scores of 0, 1, or 2 to each of the variables of this
family APGAR. Once all the scores are added up, it is
estimated that that there is a severe or mild dysfunction in
a family when the total is between 0 and 3 or between 4
and 6, respectively.
If the score obtained is between 7 and 10, the person who
answers perceives their family as functional. This tool has
been criticised by other authors due to it having low
sensitivity and specificity, with errors in assigning whether
a family is dysfunctional or not. However, the family
APGAR has been validated by Belln et al,4 in our country,
and was considered a useful tool to find out the family
situation and its possible role in the origin of conflicts and
their solution, and given its simplicity, it is possibly the
questionnaire of choice with this purpose in clinical
practice. There are other questionnaires that probably
could improve the validity of the family APGAR, but they
have against them the high number of items which make
them impractical in our overcrowded clinics. On the other
hand, the performing of the family APGAR must not be a
substitute for a good family anamnesis which should be
practiced when opening and updating all the clinical
histories.
Guzmn-Pantoja et al2 present a paper in which the
families of patients with asthma (other chronic diseases
excluded) had more family dysfunction than those with
healthy children. To assess family function they used the
family APGAR, which is a very rapid, specific and simple
to use tool.
Guzmn-Pantoja JE et al.
ORIGINAL ARTICLE
Although the design of their investigation did not allow the
causality of these variables to be established, as they
themselves recognise, their study opens new working
practices in the management and follow up of the patient
with asthma, highlighting new applications.
Gustaffson et al5 in 1994, using a fairly complex
standardised family interview, carried out a prospective
study on family dysfunction in a group of families from
before the birth of their child. At 3 and 18 months from the
birth, family function, and the appearance of respiratory
problems in their child was investigated again, and it was
observed that family dysfunction was significant in those
families where their child suffered a respiratory disorder.
Therefore, it concluded that respiratory disease was the
cause of the family dysfunction and not the other way
round.
After the work by Guzmn-Pantoja et al2 a new line of
research should be open, by carrying out a prospective
study with the family APGAR, a specific tool and suitable
for use in primary care, to assess family functioning from
birth. Its usefulness in detecting changes in family function
will have to be demonstrated when there are stressful
events in the family or there is a chronic disease such as
asthma. At the same time it could help to identify families
with a present or recently appeared family dysfunction due
to asthma. A review by the Cochrane group6 concludes that
family therapy can be a useful complement to drugs for
children with asthma, but it adds that this conclusion is
limited, due to the small sample size of the studies and the
lack of standardisation in the choice in the measurement of
results. The studies on which this review was based were
very limited, since this type of treatment is hardly used in
the control of asthma.
One of the consequences mentioned on the applicability of
studying family function with a tool such as the family
APGAR is that, up until now, the majority of research
work has been aimed at evaluating the response of the
asthma to some type of pharmacological treatment, and
other procedures such as family therapy have not been well
researched and evaluated, due to having ignored the
importance of having the family present in the treatment of
asthma. Paraphrasing other authors2; the evaluation of
family dynamics must be considered a fundamental part in
the integral approach of the paediatric patient with
asthma and we could addwith potential therapeutic
implications.
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1. Schor EL; American Academy of Pediatrics Task Force on the
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2. Guzmn-Pantoja JE, Reyes Barajas-Mendoza E, Luce-Gonz-
lez EG, Valadez-Toscano FJ, Gutirrez-Romane EA, Robles-
| Aten Primaria. 2008;40(11):543-8 | 547
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Guzmn-Pantoja JE et al.
ORIGINAL ARTICLE Family Dysfunction and Paediatric Patients With Asthma
Romerof MA. Disfuncion familiar en pacientes pediatricos con
asma. Aten Primaria. 2008;40:553-46.
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tion test and its use by physicians. J Fam Prac. 1979;6:1231-9.
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JD, Lardelli Claret P. Validez y fiabilidad del cuestionario de
funcin familiar Apgar-familiar Aten Primaria. 1996;18:289-
96.
548 | Aten Primaria. 2008;40(11):543-8 |
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6. Yorke J, Shuldham C. Terapia familiar para el asma crnica en ni-
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