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Davas A, Çiçeklioğlu M. Understanding the determinants of self-reported asthma in Turkey: insights from national data on individual, lifestyle, socioeconomic, and healthcare access factors. BMC Pulm Med 2024; 24:349. [PMID: 39026200 PMCID: PMC11256495 DOI: 10.1186/s12890-024-03159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024] Open
Abstract
Asthma, influenced by genetic, environmental, and social factors is leading to poor outcomes and preventable mortality due to inadequate care and limited access to effective treatments. This study aimed to analyze self-reported asthma prevalence in Turkey, focusing on its determinants, such as individual factors, lifestyle, socioeconomic status, and healthcare access.This study conducts a secondary analysis of the 2019 Turkiye Health Survey (THS), employing a nationally representative cross-sectional design by the Turkish Statistical Institute. The sampling utilized a stratified, two-stage cluster sampling method, with data from 16,976 adults (aged 15 years and older) analyzed for asthma determinants. The independent variables are categorized into four domains: individual factors, lifestyle assessment, socioeconomic factors, and access to the healthcare services.The prevalence of asthma is 9.8%, varying significantly across demographics. Higher asthma rates are observed among older, divorced/widowed individuals, those with communication difficulties, and obese individuals. Cost-related unmet healthcare needs and appointment scheduling delays increase asthma risk. Logistic regression models identified age, marital status, obesity, education level, and healthcare access as significant predictors of asthma.This study underscores the multifaceted determinants of asthma in Turkey, highlighting the necessity for targeted interventions addressing individual, lifestyle, socioeconomic, and healthcare access factors.
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Affiliation(s)
- Aslı Davas
- Department of Public Health, Ege University Faculty of Medicine, Bornova, Izmir, Türkiye, 35100
| | - Meltem Çiçeklioğlu
- Department of Public Health, Ege University Faculty of Medicine, Bornova, Izmir, Türkiye, 35100.
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Li X, Guo M, Niu Y, Xie M, Liu X. Secular trends of asthma mortality in China and the United States from 1990 to 2019. Chin Med J (Engl) 2024; 137:273-282. [PMID: 37882090 PMCID: PMC10836907 DOI: 10.1097/cm9.0000000000002855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Asthma imposes a large healthcare burden in China and the United States (US). However, the trends of asthma mortality and the relative risk factors have not been comparatively analyzed between the countries. The aim of this study was to compare the mortality and risk factors between China and the US. METHODS The deaths, and mortality rates of asthma in China and the US during 1990-2019 were obtained from the Global Burden of Disease Study 2019. The age-period-cohort model was used to estimate these mortality rates based on a log-linear scale with additive age, period, and cohort effects. The population attributable fractions of risk factors for asthma were estimated. RESULTS In 1990-2019, the asthma mortality rate was higher in China than in the US. The crude and age-standardized asthma mortality rates trended downward in both China and the US from 1990 to 2019. The decline in mortality was more obvious in China. Mortality gap between the two countries was narrowing. A sex difference in asthma mortality was observed with higher mortality in males in China and females in the US. The age effects showed that mortality increased with age in adults older than 20 years, particularly in the elderly. Downward trends were generally observed in the period and cohort rate ratios in both countries, with China experiencing a more obvious decrease. Smoking and high body mass index (BMI) were the leading risk factors for asthma mortality in China and the US, respectively. Mortality attributable to occupational asthmagens and smoking decreased the most in China and the US, respectively. CONCLUSIONS In 1990-2019, the asthma mortality rate was higher in China than in the US; however, the mortality gap has narrowed. Mortality increased with age in adults. The improvements in asthma death risk with period and birth cohort were more obvious in China than in the US. Smoking, high BMI, and aging are major health problems associated with asthma control. The role of occupational asthmagens in asthma mortality underscores the importance of management and prevention of occupational asthma.
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Affiliation(s)
- Xiaochen Li
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
- NHC Key Laboratory of Respiratory Diseases, Wuhan, Hubei 430030, China
| | - Mingzhou Guo
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
- NHC Key Laboratory of Respiratory Diseases, Wuhan, Hubei 430030, China
| | - Yang Niu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
- NHC Key Laboratory of Respiratory Diseases, Wuhan, Hubei 430030, China
| | - Min Xie
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
- NHC Key Laboratory of Respiratory Diseases, Wuhan, Hubei 430030, China
| | - Xiansheng Liu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
- NHC Key Laboratory of Respiratory Diseases, Wuhan, Hubei 430030, China
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Ponte EV, Rocha DGD, Guinossi RM, Bertoche L, Bertolino JR, Belleze L, Galastri ALB, Mamoni RL. Evaluating the relationship between the type of rescue medication and the adequacy of asthma maintenance therapy. Respir Med 2023; 217:107364. [PMID: 37474077 DOI: 10.1016/j.rmed.2023.107364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/28/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Current guidelines incorporate the option of a rapid onset bronchodilator (ROB) plus an inhaled corticosteroid (ICS) for the relief of asthma symptoms, but there is doubt whether the combined therapy for relief could lead to suboptimal maintenance therapy since individuals might prefer it to the maintenance therapy. The objective of this study was to assess whether the type of rescue medication that the individual with asthma has available is associated with suboptimal maintenance therapy. METHODS This cross-sectional study included non-smokers with asthma, ≥12 years old. The individuals attended an appointment with a physician, responded questionnaires and performed a spirometry. Adjusted regression analysis evaluated whether the type of rescue medication was associated with suboptimal maintenance therapy. RESULTS We enrolled 953 individuals, of which 221 reported having no rescue medication, 171 carried any ROB + ICS for symptoms relief and 561 carried SABA alone to rescue. The frequency of suboptimal maintenance therapy was not different between individuals carrying the combination and those carrying SABA alone for symptoms relief, but individuals who reported having no rescue medication had less suboptimal maintenance therapy (P < 0.01). CONCLUSIONS The frequency of suboptimal maintenance therapy for asthma was similar between individuals carrying any ROB + ICS for symptoms relief and those carrying SABA alone to rescue, whilst it was less frequent in the group that reported not having any reliever medication. Data from this study indicate that recent changes in asthma guidelines regarding the use of rescue medication have little risk of impairing maintenance therapy.
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Affiliation(s)
| | | | | | - Lais Bertoche
- Jundiaí School of Medicine, Department of Internal Medicine, Brazil.
| | | | - Leticia Belleze
- Jundiaí School of Medicine, Department of Internal Medicine, Brazil.
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Figueiredo RG, Holguin F, Pizzichini M, Pinheiro GP, Arata V, Leal MFM, Santana CVN, Cruz ÁA, Bessa J. Handgrip strength as a diagnostic tool for frailty risk in elderly patients with moderate to severe asthma. J Bras Pneumol 2023; 49:e20220465. [PMID: 37493789 PMCID: PMC10578904 DOI: 10.36416/1806-3756/e20220465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/17/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To evaluate handgrip strength (HGS) as a diagnostic tool for frailty risk in elderly patients with asthma, as well as to investigate the prevalence of frailty in this population. METHODS This was a cross-sectional study including 96 patients ≥ 60 years of age diagnosed with moderate to severe asthma and treated at a tertiary referral center in Brazil. We measured HGS using a calibrated hydraulic hand dynamometer. We used a frailty scale and the AUC to assess the diagnostic accuracy of the HGS test. RESULTS The median age of participants was 67 years. Most (78%) were women and non-White (91%) of low socioeconomic status. HGS identified those at risk for frailty, with an AUC of 71.6% (61.5-80.4%; p < 0.002), as well as a sensitivity of 73.58% and a specificity of 67.53%, on the basis of a cutoff of ≤ 19 kgf. CONCLUSIONS HGS appears to be a simple, reliable tool for clinicians to determine frailty risk in older asthma patients in a point-of-care setting.
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Affiliation(s)
- Ricardo G Figueiredo
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Feira de Santana - PPGSC-UEFS - Feira de Santana (BA) Brasil
- . Fundação Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
| | - Fernando Holguin
- . Division of Pulmonary Sciences and Critical Care, University of Colorado, Aurora (CO) USA
| | - Marcia Pizzichini
- . Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Gabriela P Pinheiro
- . Fundação Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
- . Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Vanessa Arata
- . Departamento de Saúde, Universidade Estadual de Feira de Santana - UEFS - Feira de Santana (BA) Brasil
| | - Maisa F M Leal
- . Fundação Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
| | - Cinthia V N Santana
- . Fundação Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
| | - Álvaro A Cruz
- . Fundação Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
- . Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - José Bessa
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Feira de Santana - PPGSC-UEFS - Feira de Santana (BA) Brasil
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Theodoro EE, Rocha DGD, Bertolino JR, Guinossi RM, Burch MO, Mingotti CFB, Assunção RP, Ponte EV. Evaluating the effect of antidepressants on the relationship between depression and asthma. Respir Med 2023; 207:107099. [PMID: 36584793 DOI: 10.1016/j.rmed.2022.107099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND It is unclear if depression is associated with impaired lung function in subjects with asthma, while few studies evaluated the effect of antidepressants on the relationship between depression and asthma. We designed this study to investigate if subjects with concomitant asthma and depression not taking antidepressants have worse asthma outcomes compared to asthmatic subjects without depression, and to evaluate whether antidepressants modify this association. METHODS This is a cross-sectional study. We included non-smokers with asthma, 18 years old or above. Study subjects attended an appointment with a chest physician, answered study questionnaires and underwent a spirometry test. We performed crude and adjusted binary logistic regression analyses. RESULTS We enrolled 309 subjects with asthma, of whom 48 with depression taking antidepressants, 52 with depression not taking antidepressants, and 209 without depression (control group). Asthmatic subjects with depression who had not used antidepressants before enrollment were more likely to have uncontrolled symptoms of asthma [adjusted OR 3.10, 95CI (1.56-6.15)] and airway obstruction [adjusted OR 2.41, 95CI (1.24-4.69)] compared to the control group. Subjects who had used antidepressants had higher odds of uncontrolled symptoms of asthma [adjusted OR 3.02, 95CI (1,50-6.07)], but similar odds of airway obstruction [adjusted OR 1.24, 95CI (0.87-1.77)] compared to the control group. CONCLUSIONS Non-treated depression is associated with airway obstruction in subjects with asthma, but antidepressants modify this association. Thus, we recommend regular screening of depression in subjects with asthma, and prescription of antidepressants whenever depression symptoms justify pharmacological therapy.
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Suzukawa M, Ohta K, Hashimoto H, Oyamada Y, Miki M, Ogawara M, Inoue Y, Saito AM, Fukutomi Y, Kobayashi N, Taniguchi M. Characterization and cluster analyses of elderly asthma in comparison with nonelderly patients with asthma in Japan. Ann Allergy Asthma Immunol 2023; 130:607-616.e3. [PMID: 36657562 DOI: 10.1016/j.anai.2023.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Asthma is a heterogeneous disease with multiple phenotypes that are useful in precision medicine. As the population ages, the elderly asthma (EA, aged ≥ 65 years) population is growing, and EA is now a major health problem worldwide. OBJECTIVE To characterize EA and identify its phenotypes. METHODS In adult patients with asthma (aged ≥ 18 years) who had been diagnosed with having asthma at least 1 year before study enrollment, 1925 were included in the NHOM-Asthma (registered in UMIN-CTR; UMIN000027776), and the data were used for this study, JFGE-Asthma (registered in UMIN-CTR; UMIN000036912). Data from EA and non-EA (NEA) groups were compared, and Ward's minimum-variance hierarchical clustering method and principal component analysis were performed. RESULTS EA was characterized by older asthma onset, longer asthma duration and smoking history, more comorbidities, lower pulmonary function, less atopic, lower adherence, and more hospital admissions because of asthma. In contrast, the number of eosinophils, total immunoglobulin E level, oral corticosteroid use, and asthma control questionnaire scores were equivalent between EA and NEA. There were 3 distinct phenotypes in EA, which are as follows: EA1: youngest, late onset, short duration, mild; EA2: early onset, long duration, atopic, low lung function, moderate; and EA3: oldest, eosinophilic, overweight, low lung function, most severe. The classification factors of the EA phenotypes included the age of onset and asthma control questionnaire-6. Similarities were observed between EA and NEA phenotypes after principal component analysis. CONCLUSION The EA in Japan may be unique because of the population's high longevity. Characterization of EA phenotypes from the present cohort indicated the need for distinct precision medicine for EA. TRIAL REGISTRATION JFGE-Asthma registered in UMIN-CTR (https://www.umin.ac.jp/ctr/); UMIN000036912.
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Affiliation(s)
- Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
| | - Ken Ohta
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Japan Anti-Tuberculosis Association, JATA Fukujuji Hospital, Tokyo, Japan
| | - Hiroya Hashimoto
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Mari Miki
- Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Mitsumasa Ogawara
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuma Fukutomi
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | | | - Masami Taniguchi
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Shonan Kamakura General Hospital, Kanagawa, Japan
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Soares LON, Theodoro EE, Angelelli MM, Lin LL, Carchedi GR, Silva CC, Rocha DGD, Ponte EV. Evaluating the effect of childhood and adolescence asthma on the household economy. J Pediatr (Rio J) 2022; 98:490-495. [PMID: 35227657 PMCID: PMC9510812 DOI: 10.1016/j.jped.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between asthma control, family income and family costs of asthma in a population of children-adolescents; to detail the family costs of asthma in this age range; and to compare asthma costs for the families of children-adolescents and adults. METHODS The authors invited asthmatic subjects who attended a scheduled spirometry test at the Jundiaí School of Medicine (FMJ). The FMJ performs all spirometry tests requested by staff physicians who serve at the public healthcare system in the municipality. Volunteers responded to the ACQ, the Asthma Family Costs Questionnaire and underwent a spirometry test. RESULTS The authors included 342 children-adolescents. Families of children-adolescents taking maintenance therapy and families of those reporting uncontrolled asthma symptoms were more likely to report any expenditure with asthma during the preceding month. In this age range, the smallest expenditures were on diagnostic tests and medical consultations, while home expenditures to avoid asthma triggers were the highest ones. As compared to adults' families, the children and adolescents families reported a greater proportion of income committed with asthma. Expenditures with transportation to healthcare facilities for asthma care were greater in the families of children-adolescents as compared to the values reported by the adults' families; in contrast, loss of income due to asthma was smaller in the families of children-adolescents. CONCLUSIONS Children-adolescents' asthma affects the household economy. The authors believe researchers should assess this outcome when designing studies about asthma. Finally, the study's data support the necessity of public policies in low-resource communities to minimize the economic impact of children and adolescents' asthma.
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Affiliation(s)
| | | | | | - Larissa Luhi Lin
- Faculdade de Medicina de Jundiaí, Departamento de Pneumologia, Jundiaí, SP, Brazil
| | | | | | | | - Eduardo Vieira Ponte
- Faculdade de Medicina de Jundiaí, Departamento de Pneumologia, Jundiaí, SP, Brazil.
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Nakamuta JS, Puglia ALP, Meireles P, Blanco DC, Lima MA, Birck MG, Braga MC, Oliveira RWD, Julian GS, Forestiero FJ. Asthma control in Brazil: a systematic review. J Asthma 2022; 60:868-880. [PMID: 35896311 DOI: 10.1080/02770903.2022.2107537] [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: 10/16/2022]
Abstract
Objectives: To explore asthma control in patients undergoing pharmacotherapy on studies in the last 20 years in Brazil. Asthma is a chronic airway inflammation disease with a high prevalence worldwide. Even with a variety of drug treatment improvements, attaining asthma control is challenging, since it should have a personalized approach. In Brazil, studies on the prevalence of asthma control are scarce and usually from a small sample size.Data Sources: A systematic review was performed to assess asthma control in Brazilian population. Terms related to "asthma", "asthma control" and "Brazil" were used in the search strategies in PubMed, BVSalud, Embase and Cochrane Library, including Brazilian Journal of Allergy and Immunology as data sources. A narrative synthesis was performed to report key outcome.Study Selections: In total, 23 studies were included. Most of them were conducted in the Southeastern and Northeast regions, in a short duration.Results: Pediatric and non-pediatric population were assessed, with a higher proportion of female. In pediatric population, those with poorly controlled asthma usually had severe or persistent disease. In elderly, an increased asthma severity was found, although proper treatment might be effective. Most studies (70%) also described exacerbations, hospitalizations (48%), quality of life (39%), and emergency visits (30%). Despite heterogeneity of outcomes and population, studies show an important prevalence of uncontrolled asthma even in patients being treated, with better disease control with treatment improvements.Conclusions: Studies in Brazil have shown that asthma control remains a challenge and there is still a need for improvement on disease management.
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Affiliation(s)
| | | | | | | | - Marina Andrade Lima
- Departamento de Pesquisas Clínicas, Hospital Dia do Pulmão, Blumenau, Brazil
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Silva JN, Rocha A, de Souza IA, Athanazio R, Ponte EV. Does peripheral blood eosinophil count predict lung function improvement in adult subjects with asthma? Ann Allergy Asthma Immunol 2021; 127:388-389. [PMID: 34052424 DOI: 10.1016/j.anai.2021.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/01/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Juçara Noeli Silva
- Department of Internal Medicine, Faculdade de Medicina de Jundiaí, Jundiaí, São Paulo, Brazil
| | - Alcides Rocha
- Department of Internal Medicine, Faculdade de Medicina de Jundiaí, Jundiaí, São Paulo, Brazil
| | | | - Rodrigo Athanazio
- Pulmonary Division-Heart Institute (InCor), Universidade de São Paulo, Butantã, São Paulo, Brazil
| | - Eduardo Vieira Ponte
- Department of Internal Medicine, Faculdade de Medicina de Jundiaí, Jundiaí, São Paulo, Brazil.
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Bezerra de Menezes M, Ponte EV, Bertagni Mingotti CF, Carvalho Pinto RM, Bagatin E, Bião Lima V, Vianna EO, Cruz ÁA. Provision of inhaled corticosteroids is associated with decrease in hospital admissions in Brazil: A longitudinal nationwide study. Respir Med 2020; 166:105950. [PMID: 32250873 DOI: 10.1016/j.rmed.2020.105950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe trends of hospital admissions due to asthma from 2008 to 2015 and to evaluate their relationship with trends of inhaled corticosteroids (ICS) provision by the government in Brazil. METHODS We used Brazilian Government data to calculate hospital admission rates due to asthma, number of physicians, number of hospital beds, number of subjects that received ICS per 100,000 inhabitants in Brazil and in each of its municipalities for each year of the study. We performed Poisson Multilevel Regression Analyses to evaluate the relationship between the trends of hospital admission rates due to asthma with the trends of the number of subjects that had been receiving ICS during the study period. The analyses were adjusted for the number of physicians and hospital beds. FINDINGS The number of patients who received ICS/100,000 inhabitants increased from 2008 to 2015 (943.9-1988.5). Hospital admissions/100,000 inhabitants decreased in patients aged 5-14 years (148.3-110.9) and in patients aged 15-39 years (59.9-32.3); the reduction was greater in municipalities in which ICS provision increased. The number of physicians/100,000 inhabitants increased and the number of hospital beds/100,000 inhabitants decreased in the study period. The increase in the number of physicians and in the number of subjects that received ICS were associated with reduction in hospital admissions. CONCLUSION We found that provision of ICS by the Brazilian Government was associated with a decrease of hospital admissions for asthma in the municipalities and country levels from 2008 to 2015.
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Affiliation(s)
| | | | | | | | - Ericson Bagatin
- Medical School of Jundiaí. State University of Campinas, Brazil.
| | | | - Elcio Oliveira Vianna
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
| | - Álvaro A Cruz
- ProAR - Faculdade de Medicina da Bahia, Federal University of Bahia, Brazil.
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Evaluating the FEV 1/FVC ratio in the lower range of normality as a marker of worse clinical outcomes in asthmatic subjects without airway obstruction. Respir Med 2020; 162:105880. [PMID: 32056671 DOI: 10.1016/j.rmed.2020.105880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/11/2020] [Accepted: 01/17/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND We should continually improve tools for evaluating asthma. The aim of this study was to evaluate whether the FEV1/FVC ratio in the lower range of normality is associated with worse outcomes in asthmatics without airway obstruction. METHODS We screened asthmatics at eight clinics. Subjects answered the Asthma Control Questionnaire and underwent spirometry. We assigned individuals without airway obstruction in three groups according to the post bronchodilator FEV1/FVC ratio: lower range of normality, intermediary range of normality and upper range of normality. Asthma outcomes were hospital admission due to asthma during the preceding year, non-controlled asthma symptoms and moderate-high inhaled maintenance therapy need. RESULTS In subjects from six to 18 years old, the rate of hospital admission was higher in the group with FEV1/FVC ratio in the lower range of normality as compared with the other two groups but the frequency of non-controlled symptoms of asthma and moderate-high dose of inhaled maintenance therapy need was similar. From 19 to 59 years old, the rate of moderate-high inhaled maintenance therapy need was higher in the group with FEV1/FVC ratio in the lower range of normality as compared with the other two groups, but the frequency of hospital admissions and non-controlled symptoms of asthma was similar. Above 59 years old, there was no difference in clinical asthma outcomes between lung function groups. CONCLUSIONS FEV1/FVC ratio in the lower range of normality is a marker of worse clinical outcomes in asthmatics without airway obstruction.
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Ponte EV, Lima A, Almeida PCA, de Jesus JPV, Souza-Machado A, Barreto ML, Cruz ÁA. Rural to urban migration contributes to the high burden of asthma in the urban area. CLINICAL RESPIRATORY JOURNAL 2019; 13:560-566. [PMID: 31301264 DOI: 10.1111/crj.13058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 03/02/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is unknown whether rural-urban migration contributes to worse the burden of asthma in the cities. OBJECTIVES The aim of this study was to evaluate whether subjects with asthma that migrated from rural areas to a large urban center in Brazil have more severe disease than asthmatic subjects that was born and always lived in the urban area. METHODS This is a case-control study. We enrolled two groups of subjects with asthma currently living in a large urban center in Brazil: 486 subjects with moderate-severe asthma and 432 subjects with mild asthma. RESULTS Rural-urban migrants had higher odds of moderate-severe asthma [adjusted OR 1.57, 95% CI (1.18-2.01)] and uncontrolled symptoms of asthma [adjusted OR 1.80, 95% CI (1.16-2.76)] than urban-born subjects. CONCLUSIONS Rural-urban migrants in Brazil have more severe asthma than urban-born subjects. Our results suggest that rural-urban migration is associated with the high burden of asthma in the urban area.
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Affiliation(s)
- Eduardo Vieira Ponte
- Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | - Aline Lima
- Núcleo de Excelência em Asma, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Álvaro A Cruz
- Núcleo de Excelência em Asma, Universidade Federal da Bahia, Salvador, Brazil
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Emilio CC, Mingotti CFB, Fiorin PR, Lima LA, Muniz RL, Bigotto LH, Marchi E, Ponte EV. Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment? ACTA ACUST UNITED AC 2019; 45:e20180052. [PMID: 30758430 PMCID: PMC6534401 DOI: 10.1590/1806-3713/e20180052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. METHODS This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. RESULTS 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). CONCLUSIONS Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.
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Affiliation(s)
| | | | - Paula Regina Fiorin
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Leydiane Araujo Lima
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Raisa Lemos Muniz
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Luis Henrique Bigotto
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Evaldo Marchi
- . Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Eduardo Vieira Ponte
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
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Bedolla-Barajas M, Raúl Ortiz-Peregrina J, Daniel Hernández-Colín D, Morales-Romero J, Ramses Bedolla-Pulido T, Larenas-Linnemann D. The characterization of asthma with blood eosinophilia in adults in Latin America. J Asthma 2018; 56:1138-1146. [PMID: 30395744 DOI: 10.1080/02770903.2018.1520863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To identify and characterize asthma with blood eosinophilia in adults. Methods: This cross-sectional study consisted of 164 asthma patients, aged 18 years or older. Multivariate analyses by logistic regression were performed to identify clinical characteristics and biomarkers associated with asthma with blood eosinophilia (defined as asthma and a peripheral blood eosinophil count ≥400 cells/mm3). To evaluate the diagnostic accuracy of these biomarkers, the sensitivity, specificity and predictive values were calculated. Additionally, the area under the receiver operating characteristic (ROC) curve (AUC) was estimated for each biomarker. Results: Overall, 37.8% (95%CI: 30.7-45.4%) of asthma patients had blood eosinophilia. The following factors were associated with this characteristic: patient age <50 years (OR 3.25; 95% CI: 1.33-7.94), a serum level of IgE ≥300 UI/mL (OR 2.32; 95%CI: 1.14-4.75), and an Asthma Control Test (ACT) score <20 points (OR 3.10; 95%CI: 1.35-4.75); asthma with blood eosinophilia was also associated with a baseline FEV1/FVC <70% (OR 2.68; 95%CI: 1.28-5.59). On the other hand, age <50 years and ACT score <20 showed the highest sensitivity (above 80% each). Serum IgE level ≥300 UI/mL had the highest specificity (almost 68%). Finally, those with an ACT score <20 had the highest AUC (68%). Conclusions: In our study population, one-third of asthmatic adults had asthma with blood eosinophilia. Furthermore, the prevalence was greater in those ≤50 years of age; these patients experienced more severe, more poorly controlled asthma and had higher total serum IgE levels.
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Affiliation(s)
- Martín Bedolla-Barajas
- Servicio de Alergia e Inmunología Clínica, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca ," Salvador de Quevedo y Zubieta No. 750, Colonia La Perla , Guadalajara , Jalisco , CP. 44340 , México
| | - José Raúl Ortiz-Peregrina
- Servicio de Neumología, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" , Salvador de Quevedo y Zubieta No. 750, Colonia La Perla , CP. 44340 , Guadalajara , Jalisco , México
| | - Dante Daniel Hernández-Colín
- Servicio de Alergia e Inmunología Clínica, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca ," Salvador de Quevedo y Zubieta No. 750, Colonia La Perla , Guadalajara , Jalisco , CP. 44340 , México
| | - Jaime Morales-Romero
- Instituto de Salud Pública, Universidad Veracruzana. , Av. Luis Castelazo Ayala s/n. Col. Industrial Ánimas , Xalapa , Veracruz , CP. 91190 , México
| | - Tonatiuh Ramses Bedolla-Pulido
- Servicio de Alergia e Inmunología Clínica, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca ," Salvador de Quevedo y Zubieta No. 750, Colonia La Perla , Guadalajara , Jalisco , CP. 44340 , México
| | - Désirée Larenas-Linnemann
- Unidad de Investigación, Hospital Médica Sur , Puente de Piedra 150, Colonia Toriello Guerra , Ciudad de México , CP. 14050 , México
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15
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Lima-Matos A, Ponte EV, de Jesus JPV, Almeida PCA, Lima VB, Kwon N, Riley J, de Mello LM, Cruz ÁA. Eosinophilic asthma, according to a blood eosinophil criterion, is associated with disease severity and lack of control among underprivileged urban Brazilians. Respir Med 2018; 145:95-100. [PMID: 30509723 DOI: 10.1016/j.rmed.2018.10.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/10/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Asthma is a syndrome with multiple phenotypes. Peripheral blood eosinophil counts might be the ideal biomarker to identify subjects with eosinophilic asthma. It is available, inexpensive, and it is associated with eosinophilia in sputum. OBJECTIVE The aim of this study was to evaluate whether blood eosinophilia is associated with asthma severity and to evaluate whether blood eosinophilia is associated with lack of control of asthma symptoms and airway obstruction. METHODS Case control study. The cases were subjects recruited from a cohort of patients with severe asthma, in Salvador-BR, demanding continuous inhaled corticosteroids and LABA. There were two control groups: 1) subjects with mild/moderate asthma, 2) subjects with no asthma. Subjects enrolled in the study answered questionnaires, had their blood and stool samples collected, performed spirometry and SPT. We established a cutoff ≥ 260 cells/mm3 for blood eosinophilia. RESULTS We evaluated 544 subjects in the case group, 452 subjects with mild to moderate asthma and 450 subjects with no asthma. The subjects of the case group had higher odds of presenting the eosinophilic phenotype in comparison to subjects with mild to moderate asthma [OR 1.60 95CI(1.19-2.16)] and no asthma [OR 3.93; 95CI(2.90-5.33)]. The eosinophilic phenotype, according to blood count, is associated with uncontrolled asthma [OR 1.56; 95CI(1.06-2.28)], but it is not associated with airway obstruction [OR 0.87; 95CI(0.61-1.24)]. CONCLUSION We conclude that the blood eosinophilia is a biomarker associated with asthma severity and poor symptom control, but we found no association with reduced lung function.
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Affiliation(s)
- Aline Lima-Matos
- ProAR, Núcleo de Excelência Em Asma, Universidade Federal da Bahia, Brazil.
| | | | | | | | - Valmar Bião Lima
- ProAR, Núcleo de Excelência Em Asma, Universidade Federal da Bahia, Brazil.
| | | | - John Riley
- Global Medical Affairs, GSK, Brentford, UK.
| | | | - Álvaro A Cruz
- ProAR, Núcleo de Excelência Em Asma, Universidade Federal da Bahia, Brazil.
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16
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Benton MJ, Lim TK, Ko FWS, Kan-O K, Mak JCW. Year in review 2017: Chronic obstructive pulmonary disease and asthma. Respirology 2018; 23:538-545. [PMID: 29502339 DOI: 10.1111/resp.13285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Melissa J Benton
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado, Colorado Springs, CO, USA
| | - Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Keiko Kan-O
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Judith C W Mak
- Department of Medicine, The University of Hong Kong, Hong Kong.,Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
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Bialek-Gosk K, Maskey-Warzechowska M, Krenke R, Dabrowska M, Paplinska-Goryca M, Nejman-Gryz P, Domagala-Kulawik J, Przybylowski T, Chazan R. Menopausal asthma-much ado about nothing? An observational study. J Asthma 2017; 55:1197-1204. [PMID: 29240514 DOI: 10.1080/02770903.2017.1407336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Menopausal asthma is considered a distinct asthma phenotype. Our aim was to identify potential specific features of asthma in postmenopausal women in a cohort of Polish females. METHODS Asthma severity and control, pulmonary function, exhaled nitric oxide (FENO), peripheral blood and induced sputum (IS) differential cell count were compared in three groups: women with premenopausal asthma (group 1), menopausal women with pre-existing asthma (group 2A) and menopausal women with asthma onset in the perimenopausal or menopausal period (group 2B). RESULTS We enrolled 27 women to group 1, 13 to group 2A and 16 to group 2B. Asthma severity and control, blood eosinophil count and FENO did not differ among the groups. Menopausal women had a higher incidence of irreversible airway obstruction (84.6% in group 2A and 56.2% in group 2B vs. 22.2% in group 1, p < 0.001 and p = 0.03, respectively). The proportion of patients with sputum eosinophilia was highest in menopausal women with pre-existing asthma, although the difference did not reach statistical significance (88.9% in group 2A vs. 66.7% in group 2B and 65.0% in group 1, respectively, p = 0.86). CONCLUSIONS Menopausal women with asthma are characterized by an increased incidence of irreversible airway obstruction regardless of disease duration. This may indicate that age may contribute to pulmonary function impairment in asthmatic women independently of their hormonal status at the time of asthma diagnosis. Our results failed to confirm the presence of specific asthma features which would allow to distinguish the phenotype of menopausal asthma.
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Affiliation(s)
- Katarzyna Bialek-Gosk
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
| | - Marta Maskey-Warzechowska
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
| | - Rafal Krenke
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
| | - Marta Dabrowska
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
| | - Magdalena Paplinska-Goryca
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
| | - Patrycja Nejman-Gryz
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
| | - Joanna Domagala-Kulawik
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
| | - Tadeusz Przybylowski
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
| | - Ryszarda Chazan
- a Department of Internal Medicine , Pulmonary Diseases and Allergy, Medical University of Warsaw , Warsaw , Poland
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18
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Athanazio R, Cukier A. Phenotyping asthma: More complex than just age. Respirology 2017; 22:1485-1486. [PMID: 28691285 DOI: 10.1111/resp.13120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/15/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Rodrigo Athanazio
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alberto Cukier
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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