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Montero-Arias F, Garcia JCH, Gallego MP, Antila MA, Schonffeldt P, Mattarucco WJ, Gallegos LFT, Beekman MJHI. Over-prescription of short-acting β 2-agonists is associated with poor asthma outcomes: results from the Latin American cohort of the SABINA III study. J Asthma 2023; 60:574-587. [PMID: 35670783 DOI: 10.1080/02770903.2022.2082305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Short-acting β2-agonist (SABA) over-reliance is associated with poor asthma outcomes. As part of the SABA Use IN Asthma (SABINA) III study, we assessed SABA prescriptions and clinical outcomes in patients from six Latin American countries. METHODS In this cross-sectional study, data on disease characteristics/asthma treatments were collected using electronic case report forms. Patients (aged ≥12 years) were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma) and practice type (primary/specialist care). Multivariable regression models analyzed the associations between SABA prescriptions and clinical outcomes. RESULTS Data from 1096 patients (mean age, 52.0 years) were analyzed. Most patients were female (70%), had moderate-to-severe asthma (79.4%), and were treated by specialists (87.6%). Asthma was partly controlled/uncontrolled in 61.5% of patients; 47.4% experienced ≥1 severe exacerbation in the previous 12 months. Overall, 39.8% of patients were prescribed ≥3 SABA canisters in the preceding 12 months (considered over-prescription). SABA canisters were purchased over the counter (OTC) by 17.2% of patients, of whom 38.8% purchased ≥3 canisters in the 12 months prior. Of patients who purchased SABA OTC, 73.5% were prescribed ≥3 SABA canisters. Higher SABA prescriptions (vs. 1 - 2 canisters) were associated with an increased incidence rate of severe exacerbations (ranging from 1.31 to 3.08) and lower odds ratios of having at least partly controlled asthma (ranging from 0.63 to 0.15). CONCLUSIONS SABA over-prescription was common in Latin America, highlighting the need for urgent collaboration between healthcare providers and policymakers to align clinical practices with the latest evidence-based recommendations to address this public health concern.
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Affiliation(s)
- Felicia Montero-Arias
- Servicio de Neumología, Hospital México, CCSS y Hospital Clínica Bíblica Santa Ana, San José, Costa Rica
| | - Jose Carlos Herrera Garcia
- Pulmonary Function Unit, Unidad de Funcion Pulmonar, Unidad de investigación Clínica de Puebla, UISP Unidad de Investigación y Salud de Puebla, Puebla, Mexico
| | - Manuel Pacheco Gallego
- Neumología, Unversidad Tecnológica de Pereira Y Fundación Universitaria Visión de las Américas. Respiremos S.A.S-Clinical Comfamiliar, Pereira, Colombia
| | - Martti Anton Antila
- Clinical Research/Allergy, Clínica de Alergia Martti Antila, São Paulo, Brazil
| | - Patricia Schonffeldt
- Especialista Médicina Interna y Enfermedades Respiratorias, Instituto Nacional del Tórax ITMS Telemedicina de Chile, Santiago, Chile
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Agnihotri NT, Nyenhuis SM. Global Considerations in Asthma Treatment: Management in Low Resource Settings. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:377-394. [PMID: 37464129 DOI: 10.1007/978-3-031-32259-4_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Low-resource settings have a disproportionately higher burden of asthma due to factors that include environmental triggers, access to healthcare, availability of medications, and uncoordinated health systems. The application of guideline-based management can vary, which further impacts the treatment delivered. This chapter aims to outline the global landscape of asthma management, including cultural and social factors, with suggestions for interventions.
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Affiliation(s)
- Neha T Agnihotri
- University of Illinois at Chicago, Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, Chicago, IL, USA
| | - Sharmilee M Nyenhuis
- University of Chicago, Pediatrics, Section of Allergy and Immunology, Chicago, IL, USA.
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Leal LF, Tavares NUL, Borges RB, Mengue SS, Fagondes SC, Masarwa R, Pizzol TDSD. Prevalence of chronic respiratory diseases and medication use among children and adolescents in Brazil - a population based cross-sectional study. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-93042022000100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil),a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting β2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population.
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Faleiro RC, Mancuzo EV, Lanza FC, Queiroz MVNP, de Oliveira LFL, Ganem VO, Lasmar LB. Exercise Limitation in Children and Adolescents With Severe Refractory Asthma: A Lack of Asthma Control? Front Physiol 2021; 11:620736. [PMID: 33574767 PMCID: PMC7870485 DOI: 10.3389/fphys.2020.620736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background Patients with severe refractory asthma (SRA), even when using high doses of multiple controller medications in a regular and appropriate way, can have persistent complaints of exercise limitation. Methods This was a cross-sectional study involving patients with SRA (treated with ≥ 800 μg of budesonide or equivalent, with ≥ 80% adherence, appropriate inhaler technique, and comorbidities treated), who presented no signs of a lack of asthma control other than exercise limitation. We also evaluated healthy controls, matched to the patients for sex, age, and body mass index. All participants underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer, maximum exertion being defined as ≥ 85% of the predicted heart rate, with a respiratory exchange ratio ≥ 1.0 for children and ≥ 1.1 for adolescents. Physical deconditioning was defined as oxygen uptake (VO2) < 80% of predicted at peak exercise, without cardiac impairment or ventilatory limitation. Exercise-induced bronchoconstriction (EIB) was defined as a forced expiratory volume in one second ≥ 10% lower than the baseline value at 5, 10, 20, and 30 minutes after CPET. Results We evaluated 20 patients with SRA and 19 controls. In the sample as a whole, the mean age was 12.9 ± 0.4 years. The CPET was considered maximal in all participants. In terms of the peak VO2 (VO2 peak), there was no significant difference between the patients and controls, (P = 0.10). Among the patients, we observed isolated EIB in 30%, isolated physical deconditioning in 25%, physical deconditioning accompanied by EIB in 25%, and exercise-induced symptoms not supported by the CPET data in 15%. Conclusion and Clinical Relevance Physical deconditioning, alone or accompanied by EIB, was the determining factor in reducing exercise tolerance in patients with SRA and was not therefore found to be associated with a lack of asthma control.
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Affiliation(s)
- Rita C Faleiro
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eliane V Mancuzo
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda C Lanza
- School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mônica V N P Queiroz
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciano F L de Oliveira
- School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vinicius O Ganem
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Laura B Lasmar
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Fischer GB, Sarria EE, Camargos P, Mocelin HT, Soto-Quiroz M, Cruz AA, Bousquet J, Zar HJ. Childhood asthma in low and middle-income countries: Where are we now? Paediatr Respir Rev 2019; 31:52-57. [PMID: 30987798 DOI: 10.1016/j.prrv.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/04/2018] [Indexed: 01/08/2023]
Abstract
Pediatric asthma has been increasing in LMICs (Low Middle-Income Countries), leading to an important burden for both children and national health systems. Implementing measures to achieve control are influenced by the degree of organization health systems have, the availability and affordability of essential asthma medications, and the effective implementation of asthma programs and asthma guidelines. In this review authors give an updated view of the current situation of these components of asthma management in LMICs.
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Affiliation(s)
- Gilberto Bueno Fischer
- Department of Paediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Paediatric Pulmonology Section, Hospital da Crianças Santo Antônio (HCSA), Porto Alegre, Brazil.
| | - Edgar E Sarria
- Department of Biology and Pharmacy, School of Medicine, Universidade de Santa Cruz do Sul (UNISC), Brazil; Paediatric Pulmonology Section - HCSA, Brazil
| | - Paulo Camargos
- Department of Paediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Postgraduate Program on Health Sciences, Universidade Federal de São João del-Rei, Divinópolis, Brazil.
| | - Helena Teresinha Mocelin
- Department of Paediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Paediatric Pulmonology Section - HCSA, Porto Alegre, Brazil
| | - Manuel Soto-Quiroz
- Pediatric Pulmology, University of Costa Rica, Hospital CIMA, San Jose, Costa Rica
| | - Alvaro A Cruz
- ProAR - Federal University of Bahia, School of Medicine, Bahia, Brazil
| | - Jean Bousquet
- MACVIA, France; Contre les Maladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.
| | - Heather J Zar
- Dept Pediatrics & Child Health, Red Cross Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, South Africa.
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Herrera AM, Brand P, Cavada G, Koppmann A, Rivas M, Mackenney J, Sepúlveda H, Wevar ME, Cruzat L, Soto S, Pérez MA, León A, Contreras I, Alvarez C, Walker B, Flores C, Lezana V, Garrido C, Herrera ME, Rojas A, Andrades C, Chala E, Martínez RA, Vega M, Perillán JA, Seguel H, Przybyzsweski I. Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study. Allergol Immunopathol (Madr) 2019; 47:282-288. [PMID: 30595390 PMCID: PMC7125869 DOI: 10.1016/j.aller.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.
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Affiliation(s)
- A M Herrera
- Santa María Clinic, Santa María 500, Santiago, Zip Code 7520378 Región Metropolitana, Chile; School of Medicine, Los Andes University, Monseñor Alvaro del Portillo 12455, Santiago, Zip Code 7620001 Región Metropolitana, Chile.
| | - P Brand
- Isala Women's and Children's Hospital, Zwolle, The Netherlands
| | - G Cavada
- School of Medicine, Finis Terrae University, Av Providencia 1509, Santiago, Zip Code 7501015 Región Metropolitana, Chile
| | - A Koppmann
- San Borja Arriarán Hospital, Av Santa Rosa 1234, Santiago, Zip Code 8360160 Región Metropolitana, Chile; School of Medicine, University of Chile, Chile
| | - M Rivas
- San Borja Arriarán Hospital, Av Santa Rosa 1234, Santiago, Zip Code 8360160 Región Metropolitana, Chile
| | - J Mackenney
- Roberto del Río Hospital, Av Profesor Zañartu 1085, Santiago, Zip Code 8380418 Región Metropolitana, Chile; School of Medicine, University of Chile, Chile
| | - H Sepúlveda
- Luis Calvo Mackenna Hospital, Av Antonio Varas 360, Santiago, Zip Code 7500539 Región Metropolitana, Chile
| | - M E Wevar
- Luis Calvo Mackenna Hospital, Av Antonio Varas 360, Santiago, Zip Code 7500539 Región Metropolitana, Chile
| | - L Cruzat
- Luis Calvo Mackenna Hospital, Av Antonio Varas 360, Santiago, Zip Code 7500539 Región Metropolitana, Chile
| | - S Soto
- Concepción Regional Hospital, San Martín 1436, Concepción, Zip Code 4070038 Región del Bío Bío, Chile
| | - M A Pérez
- Santa María Clinic, Santa María 500, Santiago, Zip Code 7520378 Región Metropolitana, Chile
| | - A León
- Santa María Clinic, Santa María 500, Santiago, Zip Code 7520378 Región Metropolitana, Chile
| | - I Contreras
- Padre Hurtado Hospital, Esperanza 2150, Santiago, Zip Code 8880465 Región Metropolitana, Chile
| | - C Alvarez
- Alemana Clinic, Av Vitacura 5951, Santiago, Zip Code 7650568 Región Metropolitana, Chile; School of Medicine, Desarrollo University, Av Las Condes 12496, Santiago, Zip Code 7590943 Región Metropolitana, Chile
| | - B Walker
- Alemana Clinic, Av Vitacura 5951, Santiago, Zip Code 7650568 Región Metropolitana, Chile; School of Medicine, Desarrollo University, Av Las Condes 12496, Santiago, Zip Code 7590943 Región Metropolitana, Chile
| | - C Flores
- Ovalle Hospital, Ariztía Pte. 7, Ovalle, Zip Code 1842054 Región de Coquimbo, Chile
| | - V Lezana
- Gustavo Fricke Hospital, Av Alvarez 1532, Viña del Mar, Zip Code 2570017 Región de Valparaíso, Chile
| | - C Garrido
- Gustavo Fricke Hospital, Av Alvarez 1532, Viña del Mar, Zip Code 2570017 Región de Valparaíso, Chile
| | - M E Herrera
- José Joaquín Aguirre Hospital, Santos Dumont 999, Santiago, Zip Code 8380456 Región Metropolitana, Chile
| | - A Rojas
- José Joaquín Aguirre Hospital, Santos Dumont 999, Santiago, Zip Code 8380456 Región Metropolitana, Chile
| | - C Andrades
- Valdivia Hospital, Coronel Santiago Bueras y Avaria 1003, Valdivia, Zip Code 5090146 Región de los Ríos, Chile
| | - E Chala
- Fusat Hospital, Carretera el Cobre Presidente Frei Montalva 1002, Zip Code 2820945 Rancagua, VI Región, Chile; School of Medicine, Los Andes University, Monseñor Alvaro del Portillo 12455, Santiago, Zip Code 7620001 Región Metropolitana, Chile
| | - R A Martínez
- Fusat Hospital, Carretera el Cobre Presidente Frei Montalva 1002, Zip Code 2820945 Rancagua, VI Región, Chile
| | - M Vega
- Leonardo Guzmán Hospital, Veintiuno de Mayo 1310, Zip Code 1271847 Antofagasta, Región de Antofagasta, Chile
| | - J A Perillán
- San Juan De Dios Hospital, Huérfanos 3255, Zip Code 8350488 Santiago, Región Metropolitana, Chile; School of Medicine, University of Chile, Chile
| | - H Seguel
- San Juan De Dios Hospital, Huérfanos 3255, Zip Code 8350488 Santiago, Región Metropolitana, Chile
| | - I Przybyzsweski
- San Juan De Dios Hospital, Huérfanos 3255, Zip Code 8350488 Santiago, Región Metropolitana, Chile
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Herrera A, Brand P, Cavada G, Koppmann A, Rivas M, Mackenney J, Sepúlveda H, Wevar M, Cruzat L, Soto S, Pérez M, León A, Contreras I, Alvarez C, Walker B, Flores C, Lezana V, Garrido C, Herrera M, Rojas A, Andrades C, Chala E, Martínez R, Vega M, Perillán J, Seguel H, Przybyzsweski I. Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study. Allergol Immunopathol (Madr) 2018; 46:533-538. [PMID: 29720350 DOI: 10.1016/j.aller.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS 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.
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Lenney W, Bush A, Fitzgerald DA, Fletcher M, Ostrem A, Pedersen S, Szefler SJ, Zar HJ. Improving the global diagnosis and management of asthma in children. Thorax 2018. [PMCID: PMC6035489 DOI: 10.1136/thoraxjnl-2018-211626] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. Guidelines are increasingly evidence based, but their impact on improving outcomes has been negligible in many parts of the world, often due to lack of implementation. New thinking is needed to enable substantial improvements in outcomes. The disease varies globally and plans will need to differ for individual countries or places where region-specific barriers prevent optimal care. A wide selection of educational activities is needed, including community-targeted initiatives, to engage with families. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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Affiliation(s)
- Warren Lenney
- Department of Child Health, Keele University, Stoke-on-Trent, UK
- Department of Child Health, Royal Stoke University Hospital (RSUH), Stoke-on-Trent, UK
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, London, UK
| | - Andrew Bush
- Paediatrics, Imperial College London, London, UK
- Paediatrics, National Heart and Lung Institute, London, UK
- Paediatrics, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Dominic A Fitzgerald
- Sydney Medical School, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Monica Fletcher
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, London, UK
- Asthma UK Centre for Applied Research (AUKCAR), University of Edinburgh, Edinburgh, UK
| | | | - Soren Pedersen
- Pediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | - Stanley J Szefler
- Pediatric Asthma Research Program, Section of Pediatric Pulmonary Medicine, Breathing Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
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Versiani Nunes Pinheiro de Queiroz M, Gonçalves Alvim C, Cruz ÁA, de Lima Belizário Facury Lasmar LM. Lung function in severe pediatric asthma: a longitudinal study in children and adolescents in Brazil. Clin Transl Allergy 2017; 7:48. [PMID: 29259760 PMCID: PMC5731068 DOI: 10.1186/s13601-017-0183-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022] Open
Abstract
Background In severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day. Methods This was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6–18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day. Results At baseline, the forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity (FVC) ratio were both < 80% of the predicted values in 50.8% of the patients. The median age of the patients was 10.4 years (interquartile range 7.8–13.6 years). In the sample as a whole, there were significant increases in FEV1% and in the FEV1/FVC% ratio (p = 0.01 and p < 0.001, respectively) over the course of the study. In the > 800 µg/day group, there were no statistical increases or decreases in FEV1, the FEV1/FVC ratio, or forced expiratory flow between 25 and 75% of the FVC (FEF25–75%), when calculated as percentages of the predicted values. However, the z-score for FEF25–75% showed a statistically significant reduction, in the sample as a whole and in the > 800 µg/day group. Also in the > 800 µg/day group, there was a significant reduction in the post-bronchodilator FEV1% (p = 0.004). Conclusions The fact that the spirometric parameters (as percentages of the predicted values) remained constant in the > 800 µg/day group, whereas there was a gain in lung function in the sample as a whole, suggests an early plateau phase in the > 800 µg/day group. However, there was some loss of lung function in the > 800 µg/day group, as evidenced by a decrease in the z-score for FEF25–75%, suggesting irreversible small airway impairment, and by a reduction in the post-bronchodilator FEV1%, suggesting reduced reversibility of airway obstruction. Among children and adolescents with severe asthma, the use of ICS doses higher than those recommended for age does not appear to improve lung function.
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Affiliation(s)
- Mônica Versiani Nunes Pinheiro de Queiroz
- Department of Pediatrics, School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil.,Departamento de Clínicas Pediátrica e do Adulto, Escola de Medicina, Universidade Federal de Ouro Preto, Rua Dois 697, Ouro Preto, MG 35400-000 Brazil
| | - Cristina Gonçalves Alvim
- Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Álvaro A Cruz
- ProAR - Federal University of Bahia, Salvador, Brazil
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Lasmar L, Brand PLP, Lima ACL, Maciel MF, Camargos P. Growth velocity in prepubertal children using both inhaled and intranasal corticosteroids. Ann Allergy Asthma Immunol 2016; 116:368-70. [PMID: 26896882 DOI: 10.1016/j.anai.2016.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/30/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Laura Lasmar
- Pediatric Pulmonology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paul L P Brand
- Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands; Postgraduate School of Medicine, University Medical Centre, University of Groningen, Groningen, The Netherlands
| | - Anna Carolina Lustosa Lima
- Department of Professional Masters on Information Technology Applied to Computational Biology, Inforium College of Technology, Belo Horizonte, Brazil
| | - Maria Fernanda Maciel
- Pediatric Pulmonology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Camargos
- Pediatric Pulmonology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Stelmach R, Cerci Neto A, Fonseca ACDCF, Ponte EV, Alves G, Araujo-Costa IN, Lasmar LMDLBF, Castro LKKD, Lenz MLM, Silva P, Cukier A, Alves AM, Lima-Matos AS, Cardoso ADRO, Fernandes ALG, São-José BPD, Riedi CA, Schor D, Peixoto DM, Brandenburg DD, Camillo EGDS, Serpa FS, Brandão HV, Lima JAB, Pio JE, Fiterman J, Anderson MDF, Cardoso MDSDL, Rodrigues MT, Pereira MNEU, Antila M, Martins SM, Guimarães VGT, Mello YAM, Andrade WCCD, Salibe-Filho W, Caldeira ZMDR, Cruz-Filho ÁASD, Camargos P. A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts. J Bras Pneumol 2015; 41:3-15. [PMID: 25750669 PMCID: PMC4350820 DOI: 10.1590/s1806-37132015000100002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/17/2014] [Indexed: 11/22/2022] Open
Abstract
Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.
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Affiliation(s)
- Rafael Stelmach
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology, Heart Institute, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - HC-FMUSP, University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Alcindo Cerci Neto
- State University at Londrina, Londrina, Brazil. (Paraná) State University at Londrina; and Coordinator. Programa Respira Londrina (Breathe, Londrina Program), Londrina, Brazil
| | | | - Eduardo Vieira Ponte
- Jundiaí School of Medicine, Jundiaí, Brazil. Jundiaí School of Medicine, Jundiaí, Brazil
| | - Gerardo Alves
- Fortaleza Municipal Department of Health, Fortaleza, Brazil. Programa de Atenção Integral à Criança e Adulto com Asma de Fortaleza - PROAICA, Integrated Asthma Management Program for Chidren and Adults in Fortaleza - Fortaleza Municipal Department of Health, Fortaleza, Brazil
| | - Ildely Niedia Araujo-Costa
- University Hospital, Federal University of Maranhão, São Luís, Brazil. Asthma Patient Care Program, Federal University of Maranhão University Hospital, São Luís, Brazil
| | - Laura Maria de Lima Belizário Facury Lasmar
- Federal University of Minas Gerais, Belo Horizonte, Brazil. Federal University of Minas Gerais; and Pediatric Pulmonologist. Centro Multidisciplinar para Asma de Difícil Controle - CEMAD, Multidisciplinary Center for the Treatment of Difficult-to-Control Asthma - and Programa Criança que Chia (Wheezing Child Program), Belo Horizonte City Hall, Belo Horizonte, Brazil
| | - Luci Keiko Kuromoto de Castro
- Programa Respira Londrina, Londrina, Brazil. Programa Respira Londrina (Breathe, Londrina Program), Londrina, Brazil
| | - Maria Lucia Medeiros Lenz
- Conceição Hospital Group, Porto Alegre, Brazil. Asthma Program, Conceição Hospital Group, Porto Alegre, Brazil
| | - Paulo Silva
- Asthma Patient Management Program, Montenegro, Brazil. Asthma Patient Management Program - RESPIRAÇÃO - Montenegro, Brazil
| | - Alberto Cukier
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology. Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Alexssandra Maia Alves
- Fortaleza Municipal Department of Health, Fortaleza, Brazil. Fortaleza Municipal Department of Health, Fortaleza, Brazil
| | - Aline Silva Lima-Matos
- Bahia State Asthma Control Program, Salvador, Brazil. Programa para Controle da Asma na Bahia - ProAR, Bahia State Asthma Control Program - Salvador, Brazil
| | - Amanda da Rocha Oliveira Cardoso
- Goiânia Municipal Department of Health, Goiânia, Brazil. Programa Catavento (Pinwheel Program), Goiânia Municipal Department of Health, Goiânia, Brazil
| | - Ana Luisa Godoy Fernandes
- Federal University of São Paulo, Paulista School of Medicine, Department of Pulmonology, São Paulo, Brazil. Department of Pulmonology, Federal University of São Paulo Paulista School of Medicine, São Paulo, Brazil
| | - Bruno Piassi de São-José
- Federal University of Minas Gerais, Hospital das Clínicas, Belo Horizonte, Brazil. Pulmonology Outpatient Clinic, Federal University of Minas Gerais Hospital das Clínicas, Belo Horizonte, Brazil
| | - Carlos Antônio Riedi
- Federal University of Paraná, Curitiba, Brazil. Federal University of Paraná, Curitiba, Brazil
| | - Deborah Schor
- Federal University of Pernambuco, Hospital das Clínicas, Recife, Brazil. Allergy Outpatient Clinic, Recife Allergology Center; and Volunteer Preceptor. Asthma Outpatient Clinic, Federal University of Pernambuco Hospital das Clínicas, Recife, Brazil
| | - Décio Medeiros Peixoto
- Federal University of Pernambuco, Mother and Child Department, Recife, Brazil. Mother and Child Department, Federal University of Pernambuco, Recife, Brazil
| | - Diego Djones Brandenburg
- Porto Alegre Hospital de Clínicas, Montenegro, Brazil. Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil and Asthma Patient Management Program - RESPIRAÇÃO - Montenegro, Brazil
| | | | - Faradiba Sarquis Serpa
- School of Medical Sciences, Santa Casa de Misericórdia de Vitória, Vitória, Brazil. Asthma Program, Santa Casa de Misericórdia de Vitória School of Medical Sciences, Vitória, Brazil
| | - Heli Vieira Brandão
- Bahia State University at Feira de Santana, Department of Pediatrics, Feira de Santana, Brazil. Department of Pediatrics, Bahia State University at Feira de Santana; and Coordinator. Feira de Santana Asthma and Allergic Rhinitis Control Program, Feira de Santana, Brazil
| | - João Antonio Bonfadini Lima
- Porto Alegre Municipal Department of Health, Porto Alegre, Brazil. Asthma Program, Porto Alegre Municipal Department of Health, Porto Alegre, Brazil
| | - Jorge Eduardo Pio
- Rio de Janeiro Municipal Department of Health, Rio de Janeiro, Brazil. Rio de Janeiro Municipal Department of Health, Rio de Janeiro, Brazil
| | - Jussara Fiterman
- Pontifical Catholic University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Pontifical Catholic University of Rio Grande do Sul - School of Medicine, Porto Alegre, Brazil
| | - Maria de Fátima Anderson
- Brazilian Association of Asthma Patients, Rio de Janeiro, Brazil. Associação Brasileira de Asmáticos - ABRA, Brazilian Association of Asthma Patients - Rio de Janeiro, Brazil
| | - Maria do Socorro de Lucena Cardoso
- Federal University of Amazonas, Manaus, Brazil. Programa de Assistência e Controle da Asma - PACA, Asthma Care and Control Program - and Associate Professor. Universidade Federal do Amazonas - UFAM, Federal University of Amazonas - Manaus, Brazil
| | - Marcelo Tadday Rodrigues
- Santa Casa Sisters of Mercy, Hospital of Porto Alegre, Porto Alegre, Brazil. Universidade de Santa Cruz do Sul - UNISC, University of Santa Cruz do Sul - Santa Cruz do Sul, Brazil; and Pulmonologist. Pereira Filho Ward, Irmandade da Santa Casa de Misericórdia de Porto Alegre - ISCMPA, Santa Casa Sisters of Mercy Hospital of Porto Alegre - Porto Alegre, Brazil
| | - Marilyn Nilda Esther Urrutia Pereira
- Uruguaiana Municipal Department of Health, Uruguaiana, Brazil. Programa Infantil de Prevenção de Asma - PIPA, Children's Asthma Prevention Program - Uruguaiana Municipal Department of Health, Uruguaiana, Brazil
| | - Marti Antila
- Sorocaba Municipal Asthma Program, Sorocaba, Brazil. Sorocaba Municipal Asthma Program, Sorocaba, Brazil. Physician. Programa Respira Rio, Rio de Janeiro, Brazil. Programa Respira Rio (Breathe, Rio Program), Rio de Janeiro, Brazil
| | - Sonia Maria Martins
- Brazilian Society of Family and Community Medicine, Rio de Janeiro, Brazil. Grupo de Trabalho de Problemas Respiratórios - GRESP, Working Group on Respiratory Problems - Sociedade Brasileira de Medicina de Família e Comunidade - SBMFC, Brazilian Society of Family and Community Medicine - Rio de Janeiro, Brazil
| | - Vanessa Gonzaga Tavares Guimarães
- Brasília Mother and Child Hospital, Brasília, Brazil. Programa de Atendimento ao Paciente Asmático do Distrito Federal - PAPA-DF, Asthma Patient Management Program in the Federal District of Brasília - and Supervisor. Residency Program in Pediatric Allergy and Immunology, Brasília Mother and Child Hospital, Brasília, Brazil
| | - Yara Arruda Marques Mello
- Associação Brasileira de Asmáticos, São Paulo, Brazil. Department of Allergy and Immunology, Edmundo Vasconcelos Hospital Complex; and Director. Associação Brasileira de Asmáticos-São Paulo - ABRA, Brazilian Association of Asthma Patients-SP - São Paulo, Brazil
| | - Wenderson Clay Correia de Andrade
- Itabira Municipal Department of Health, Itabira, Brazil. Projeto Respirai (Breathe Project), Itabira Municipal Department of Health, Itabira, Brazil
| | - William Salibe-Filho
- São Camilo University Center, School of Medicine, São Paulo, Brazil. Department of Pulmonology, ABC School of Medicine, Santo André, Brazil; and Professor. São Camilo University Center School of Medicine, São Paulo, Brazil
| | - Zelina Maria da Rocha Caldeira
- Associação Brasileira de Asmáticos, São Paulo, Brazil. Niterói Municipal Health Foundation, Niterói, Brazil. Pediatrician and Director of Government Policy and International Relations. Associação Brasileira de Asmáticos-São Paulo - ABRA, Brazilian Association of Asthma Patients-SP - São Paulo, Brazil
| | - Álvaro Augusto Souza da Cruz-Filho
- Federal University of Bahia, School of Medicine, Salvador, Brazil. Federal University of Bahia School of Medicine; and Coordinator. Center of Excellence in Asthma, Salvador, Brazil
| | - Paulo Camargos
- Federal University of Minas Gerais, Department of Pediatrics, Belo Horizonte, Brazil. Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Silva Segundo GR, Ribeiro JL. A successful asthma treatment program in Brazil. Am J Public Health 2013; 103:e1-2. [PMID: 23947321 DOI: 10.2105/ajph.2013.301466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gesmar Rodrigues Silva Segundo
- Gesmar Rodrigues Silva Segundo and Juliana Lima Ribeiro are with the Pediatrics Department, Federal University of Uberlândia, Minas Gerais, Brazil
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Abstract
Asthma prevalence in low- to middle-income countries is at least the same or higher than in rich countries, but with increased severity. Lack of control in these settings is due to various factors such as low accessibility to effective medications, multiple and uncoordinated weak infrastructures of medical services for the management of chronic diseases such as asthma, poor compliance with prescribed therapy, lack of asthma education, and social and cultural factors. There is an urgent requirement for the implementation of better ways to treat asthma in underserved populations, enhancing the access to preventive medications and educational approaches with modern technological methods.
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