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Coelho C, Pinho J, Pinto M, Pedrosa C, Costa H, Romariz J, Carvalho MI. Pediatric asthma knowledge: Insights from a Portuguese central hospital study. Pediatr Pulmonol 2024. [PMID: 39073035 DOI: 10.1002/ppul.27196] [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: 11/11/2023] [Revised: 06/12/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Asthma is a common chronic condition in children, with parental and child health literacy affecting health outcomes and asthma control. This study examined pediatric asthma knowledge at a Portuguese central hospital and its determinants. METHODS We conducted a comparative cross-sectional study, applying the Asthma Knowledge Questionnaire (QCSA), answered by adolescents and/or caregivers. The sample was categorized into two groups based on the presence or absence of respiratory conditions, such as asthma or recurrent wheezing, in children. Those with such conditions (Group A) were further divided into two subgroups: those receiving general pediatric care (Group A2) and those receiving specialized care, followed in pulmonology or allergology consultations (Group A1). RESULTS The study involved 154 participants, predominantly female (74%) with an average age of 31.2 years ( ± 13.4). The average QCSA score was 14.8 ( ± 3.2), and Group A exhibited a statistically higher score, 15.5 points ±3.2 versus Group B, 14.2 points ± 3.2, p = .034. Group A1 achieved significantly better scores (16 points: range 4-21) than Group A2 (14 points: range 9-21) (p = .029). Scores were correlated positively with the duration of specialized follow-up (ρ = .326; p = .027). Asthma knowledge was correlated with the level of education (r = .468; p < .001). The number of wheezing episodes (r = -.466; p < .001) within the past year were associated to QCSA scores. CONCLUSION In summary, the presence of respiratory condition, the follow-up in specialized appointments and higher levels of education were associated with greater asthma knowledge.
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Affiliation(s)
- Cristina Coelho
- Department of Immunology and Allergology, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Joana Pinho
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Mariana Pinto
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Cláudia Pedrosa
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Herculano Costa
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Jorge Romariz
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Maria I Carvalho
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
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Rufo JC, Annesi-Maesano I, Carreiro-Martins P, Moreira A, Sousa AC, Pastorinho MR, Neuparth N, Taborda-Barata L. Issue 2 - "Update on adverse respiratory effects of indoor air pollution" Part 1): Indoor air pollution and respiratory diseases: A general update and a Portuguese perspective. Pulmonology 2024; 30:378-389. [PMID: 37230882 DOI: 10.1016/j.pulmoe.2023.03.006] [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: 03/05/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population. RESULTS Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances. CONCLUSIONS Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.
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Affiliation(s)
- J C Rufo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - I Annesi-Maesano
- Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France
| | - P Carreiro-Martins
- Comprehensive Health Research Center (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Immunoallergology Service, Dona Estefânia Hospital, Centro Hospitalar e Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
| | - A Moreira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A C Sousa
- Comprehensive Health Research Centre (CHRC) and Department of Biology, University of Évora, Évora, Portugal; NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - M R Pastorinho
- NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; Comprehensive Health Research Centre (CHRC) and Department of Medical and Health Sciences, University of Évora, Évora, Portugal
| | - N Neuparth
- Comprehensive Health Research Center (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Immunoallergology Service, Dona Estefânia Hospital, Centro Hospitalar e Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - L Taborda-Barata
- NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; UBIAir-Clinical & Experimental Lung Centre, University of Beira Interior, CACB - Clinical Academic Centre of Beiras, Covilhã, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, CACB - Clinical Academic Centre of Beiras, Covilhã, Portugal; Immunoallergology Service, Centro Hospitalar Universitário Cova da Beira, CACB - Clinical Academic Centre of Beiras, Covilhã, Portugal
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Vieira RJ, Leemann L, Briggs A, Pereira AM, Savouré M, Kuna P, Morais-Almeida M, Bewick M, Azevedo LF, Louis R, Klimek L, Bahbah F, Samolinski B, Anto JM, Zuberbier T, Fonseca JA, Bousquet J, Sousa-Pinto B. Poor Rhinitis and Asthma Control Is Associated With Decreased Health-Related Quality of Life and Utilities: A MASK-air Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1530-1538.e6. [PMID: 38561141 DOI: 10.1016/j.jaip.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Allergic rhinitis (AR) and asthma may affect health-related quality of life. However, national estimates on the quality of life of patients with AR or asthma are lacking. OBJECTIVE To provide estimates for utility scores and EuroQoL five-dimension (EQ-5D) visual analog scale (VAS) for patients with AR or asthma. METHODS We conducted a cross-sectional study using direct patient data from the MASK-air app on European MASK-air users with self-reported AR or asthma. We used a multi-attribute instrument (EQ-5D) to measure quality of life (as utility scores and EQ-5D VAS values). Mean scores were calculated per country and disease control level using multilevel regression models with poststratification, accounting for age and sex biases. RESULTS We assessed data from 7905 MASK-air users reporting a total of up to 82,737 days. For AR, utilities ranged from 0.86 to 0.99 for good control versus 0.72 to 0.85 for poor control; EQ-5D VAS levels ranged from 78.9 to 87.9 for good control versus 55.3 to 64.2 for poor control. For asthma, utilities ranged from 0.84 to 0.97 for good control versus 0.73 to 0.87 for poor control; EQ-5D VAS levels ranged from 68.4 to 81.5 for good control versus 51.4 to 64.2 for poor control. Poor disease control was associated with a mean loss of 0.14 utilities for both AR and asthma. For the same control levels, AR and asthma were associated with similar utilities and EQ-5D VAS levels. However, lower values were observed for asthma plus AR compared with AR alone. CONCLUSIONS Poor AR or asthma control are associated with reduced quality of life. The estimates obtained from mobile health data may provide valuable insights for health technology assessment studies.
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Affiliation(s)
- Rafael José Vieira
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lucas Leemann
- Department of Political Science, University of Zurich, Zurich, Switzerland
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana Margarida Pereira
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marine Savouré
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France; Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Villejuif, France
| | - Piotr Kuna
- Division of Internal Medicine, Asthma, and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | - Michael Bewick
- University of Central Lancashire Medical School, Preston, United Kingdom
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - João A Fonseca
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany; MASK-air SAS, Montpellier, France.
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
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Madeira Gerardo A, da Silva Alves C, Gomes M, Pardal C, Sokolova A, Liberato H, Mendes A, Tonin FS, Duarte-Ramos F, Lopes C. The Effects of Benralizumab on Lung Volumes and Airway Resistance in Severe Eosinophilic Asthma: A Real-World Study. Cureus 2024; 16:e52452. [PMID: 38371150 PMCID: PMC10871543 DOI: 10.7759/cureus.52452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Add-on biological monoclonal antibodies such as benralizumab (anti-IL-5Ra) are recommended by international guidelines to reduce exacerbations in severe eosinophilic asthma (SEA). However, few studies have assessed the impact of these therapies on lung function-related outcomes. Our goal was to evaluate the effectiveness of benralizumab on lung function, including lung volumes and airway resistance, in SEA patients in Portugal. METHODS This was a real-world, observational, prospective, multicentric study including adult patients diagnosed with SEA (January-June 2023). Spirometry and plethysmography were performed at baseline (T0) and after six months of treatment (T6) with benralizumab to assess: total lung capacity (TLC), residual volume (RV), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), mean forced expiratory flow between 25% and 75% of FVC (mFEF-25/75), intrathoracic gas volume (ITGV), and respiratory airway resistance (Raw). Descriptive statistics (with categorical variables described as frequencies and continuous values as mean and standard deviation (SD)) and paired t-test and Cohen's d effect size were calculated (analyses performed in StataCorp v.15.1; StataCorp LLC, TX, USA). RESULTS Overall, 30 SEA patients were evaluated, mostly women (n=18, 60.0%), with atopy (n=22, 73.3%), a mean age of 58.4 years (SD 11.7), and assisted by pulmonology (n=19, 63.3%) or immunology-allergology (n=11, 36.7%) services. Mean eosinophilia at baseline was 1103.57 cells/mcL (SD 604.88; minimum-maximum 460-2400); after the use of benralizumab, the count dropped to zero. After six months of treatment, a significant increase (p<0.0001) in FVC (15.3%), FEV1 (22.6%), and mFEF-25/75 (17.7%) were observed from baseline (Cohen's d between 0.78 and 1.11). ITGV, RV, RV/TLC, and Raw significantly decreased (p<0.0001) during the study period (-17.3%, -29.7%, -8.9%, and -100.6%, respectively) (Cohen's d between -0.79 and -1.06). No differences in TLC were obtained (p=0.173). No differences between sexes were observed for any measure. Patients with more significant eosinophilia (>900 cells/mcL count; n=15) presented better responses in FEV1 (p=0.001) and mFEF-25/75 (p=0.007). CONCLUSIONS A notable eosinophil depletion with add-on benralizumab led to significant improvements in SEA patients' respiratory function (static lung volumes and airway resistance) in real-world settings after six months. The significant deflating effect of benralizumab on patients' hyperinflated lungs led to enhanced expiratory flow (increased FEV1 and mFEF-25/75) and air trapping (decreased RV/TLC), suggesting this antibody improves bronchial obstruction, lung hyperinflation, and airway resistance. Further studies in a larger population are required to confirm these findings.
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Affiliation(s)
| | | | - Margarida Gomes
- Allergy and Immunology, Hospital de Santa Maria, Unidade Multidisciplinar de Asma Grave, Lisboa, PRT
| | - Cecília Pardal
- Pulmonology, Hospital Professor Doutor Fernando Fonseca, Lisboa, PRT
| | - Anna Sokolova
- Pulmonology, Hospital Professor Doutor Fernando Fonseca, Lisboa, PRT
| | - Hedi Liberato
- Pulmonology, Hospital Professor Doutor Fernando Fonseca, Lisboa, PRT
| | - Ana Mendes
- Allergy and Immunology, Hospital de Santa Maria, Unidade Multidisciplinar de Asma Grave, Lisboa, PRT
| | - Fernanda S Tonin
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL) Instituto Politécnico de Lisboa (IPL), Lisbon, PRT
| | | | - Carlos Lopes
- Pulmonology, Hospital de Santa Maria, Unidade Multidisciplinar de Asma Grave, Lisboa, PRT
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Silva JM, Ferreira L. Underestimated asthma prevalence in Guarda's district leads to overestimated hospitalizations. Pulmonology 2023; 29:573. [PMID: 37394338 DOI: 10.1016/j.pulmoe.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- J M Silva
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal; Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal.
| | - L Ferreira
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal; Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
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6
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Simões Cunha M, Amaral R, Pereira AM, Almeida R, Alves-Correia M, Loureiro CC, Lopes C, Carvalho J, Ribeiro C, Vidal C, Antolín-Amérigo D, Pinto D, Ferreira-Magalhães M, Vasconcelos MJ, Lozoya C, Santos N, Cardia F, Taborda-Barata L, Ferreira R, Morais Silva P, Ferreira TM, Câmara R, Silva E, Bordalo D, Guimarães C, Calix MJ, da Silva S, Marques ML, Morete A, Nunes C, Vieira C, Páscoa R, Alves A, Marques JV, Reis B, Monteiro L, Monteiro R, Cepa M, Valentim B, Coelho DS, Fernandes S, Meireles P, Aguiar MA, Mourão AR, Fonseca JA, Jácome C. Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies. BMJ Open 2023; 13:e068725. [PMID: 37147092 PMCID: PMC10163458 DOI: 10.1136/bmjopen-2022-068725] [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] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms. METHODS This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built. RESULTS According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression. CONCLUSION At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.
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Affiliation(s)
- Mafalda Simões Cunha
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rita Amaral
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
- Department of Women's and Children's Health, Paediatric Research, Uppsala University, Uppsala, Sweden
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Magna Alves-Correia
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Cláudia Chaves Loureiro
- Pulmonology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Lopes
- Basic and Clinic Immunology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Immuno-allergology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Carmelita Ribeiro
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carmen Vidal
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostella, Spain
| | - Dario Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Diana Pinto
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Ferreira-Magalhães
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carlos Lozoya
- Allergy, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Francisca Cardia
- Unidade de Saúde Familiar Terras de Azurara, Agrupamento de Centros de Saúde Dão Lafões, Mangualde, Portugal
| | - Luís Taborda-Barata
- CICS-UBI Centro de Investigação em Ciências da Saúde - Health Sciences Research Centre & UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, Covilha, Portugal
- Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Rosário Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | | | - Tania Monteiro Ferreira
- Unidade de Saúde Familiar Progresso e Saúde, Agrupamento de Centros de Saúde Baixo Mondego, Tocha, Portugal
| | - Raquel Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Eurico Silva
- Unidade de Saúde Familiar João Semana, Agrupamento de Centros de Saúde de Baixo Vouga, Ovar, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Cristina Guimarães
- Unidade de Cuidados de Saúde Personalizados Norte (Arnaldo Sampaio), Agrupamento de Centros de Saúde Pinhal Litoral, Monte Redondo, Portugal
| | - Maria José Calix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Sofia da Silva
- Unidade de Saúde Familiar Cuidarte, Unidade Local de Saúde do Alto Minho, Portuzelo, Portugal
| | - Maria Luís Marques
- Serviço de Imunoalergologia, Hospital da Senhora da Oliveira, Guimarães, Guimaraes, Portugal
| | - Ana Morete
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Serviço de Imunoalergologia, Hospital Infante D Pedro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Carlos Nunes
- Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - Cláudia Vieira
- Unidade de Saúde Familiar Corgo, Agrupamento de Centros de Saúde Douro I - Marão e Douro Norte, Vila Real, Portugal
| | - Rosália Páscoa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Homem do Leme, ACeS Porto Ocidental, Porto, Portugal
| | - Adelaide Alves
- Serviço de Pneumologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Varanda Marques
- Unidade de Saúde Familiar Viseu-Cidade, Agrupamento de Centros de Saúde do Dão Lafões, Viseu, Portugal
| | - Bruno Reis
- Unidade de Cuidados Saúde Personalizados Sicó, Agrupamento de Centros de Saúde Pinhal Litoral, Leiria, Portugal
| | - Luís Monteiro
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- USF Esgueira +, ACES Baixo Vouga, Esgueira, Portugal
| | - Rosário Monteiro
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Homem do Leme, ACeS Porto Ocidental, Porto, Portugal
| | - Margarida Cepa
- Unidade de Saúde Familiar Marquês, ACES Pinhal Litoral, Pombal, Portugal
| | - Bruno Valentim
- Unidade de Saúde Familiar Condeixa, ACES Baixo Mondego, Condeixa-a-Nova, Portugal
| | - Daniela Sousa Coelho
- Unidade de Cuidados de Saúde Personalizados de Amarante, ACES Tâmega I - Baixo Tâmega, Amarante, Portugal
| | - Sara Fernandes
- Unidade de Saúde Familiar Bracara Augusta, ACES Cávado I, Braga, Portugal
| | - Patrícia Meireles
- Unidade de Saúde Familiar Almedina, ACES Douro II - Douro Sul, Lamego, Portugal
| | - Margarida Abreu Aguiar
- Unidade de Saúde Familiar Valongo, ACES Grande Porto III - Maia / Valongo, Valongo, Portugal
| | - Ana Rita Mourão
- Unidade de Saúde Familiar Canelas, ACES Grande Porto VIII - Espinho / Gaia, Vila Nova de Gaia, Portugal
| | - Joao A Fonseca
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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7
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Vieira RJ, Sousa-Pinto B, Pereira AM, Cordeiro CR, Loureiro CC, Regateiro F, Taborda-Barata L, Bousquet J, Fonseca J. Asthma hospitalizations: A call for a national strategy to fight health inequities. Pulmonology 2023; 29:179-183. [PMID: 36907817 DOI: 10.1016/j.pulmoe.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 03/12/2023] Open
Affiliation(s)
- R J Vieira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Portugal
| | - B Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Portugal.
| | - A M Pereira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal; Allergy Unit, CUF Porto Hospital & Institute, Portugal
| | - C R Cordeiro
- Department of Pulmonology, University Hospital of Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal
| | - C C Loureiro
- Department of Pulmonology, University Hospital of Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal
| | - F Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - L Taborda-Barata
- UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, Covilhã, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - J Bousquet
- Institute for Allergology, Charité - Universitätsmedizin Berlin, Corporate, Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; University Hospital, Montpellier, France; ARIA, Montpellier, France
| | - J Fonseca
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Portugal; Allergy Unit, CUF Porto Hospital & Institute, Portugal
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8
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Pérez-Losada M, Castro-Nallar E, Laerte Boechat J, Delgado L, Azenha Rama T, Berrios-Farías V, Oliveira M. Nasal Bacteriomes of Patients with Asthma and Allergic Rhinitis Show Unique Composition, Structure, Function and Interactions. Microorganisms 2023; 11:microorganisms11030683. [PMID: 36985258 PMCID: PMC10056468 DOI: 10.3390/microorganisms11030683] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023] Open
Abstract
Allergic rhinitis and asthma are major public health concerns and economic burdens worldwide. However, little is known about nasal bacteriome dysbiosis during allergic rhinitis, alone or associated with asthma comorbidity. To address this knowledge gap we applied 16S rRNA high-throughput sequencing to 347 nasal samples from participants with asthma (AS = 12), allergic rhinitis (AR = 53), allergic rhinitis with asthma (ARAS = 183) and healthy controls (CT = 99). One to three of the most abundant phyla, and five to seven of the dominant genera differed significantly (p < 0.021) between AS, AR or ARAS and CT groups. All alpha-diversity indices of microbial richness and evenness changed significantly (p < 0.01) between AR or ARAS and CT, while all beta-diversity indices of microbial structure differed significantly (p < 0.011) between each of the respiratory disease groups and controls. Bacteriomes of rhinitic and healthy participants showed 72 differentially expressed (p < 0.05) metabolic pathways each related mainly to degradation and biosynthesis processes. A network analysis of the AR and ARAS bacteriomes depicted more complex webs of interactions among their members than among those of healthy controls. This study demonstrates that the nose harbors distinct bacteriotas during health and respiratory disease and identifies potential taxonomic and functional biomarkers for diagnostics and therapeutics in asthma and rhinitis.
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Affiliation(s)
- Marcos Pérez-Losada
- Computational Biology Institute, Department of Biostatistics & Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
- CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Campus Agrário de Vairão, 4485-661 Vairão, Portugal
| | - Eduardo Castro-Nallar
- Departamento de Microbiología, Facultad de Ciencias de la Salud, Campus Talca, Universidad de Talca, Avda. Lircay s/n, Talca 3460000, Chile
- Centro de Ecología Integrativa, Campus Talca, Universidad de Talca, Avda. Lircay s/n, Talca 3460000, Chile
| | - José Laerte Boechat
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS@RISE), Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Luis Delgado
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS@RISE), Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João (CHUSJ), 4200-319 Porto, Portugal
| | - Tiago Azenha Rama
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS@RISE), Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Valentín Berrios-Farías
- Departamento de Microbiología, Facultad de Ciencias de la Salud, Campus Talca, Universidad de Talca, Avda. Lircay s/n, Talca 3460000, Chile
- Centro de Ecología Integrativa, Campus Talca, Universidad de Talca, Avda. Lircay s/n, Talca 3460000, Chile
| | - Manuela Oliveira
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Ipatimup-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal
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Romão M, Bulhosa C, Mendes Z, Sousa C, Silva G, Pereira M, Bernardo F, Teixeira Rodrigues A, Fonseca JA, Correia de Sousa J. Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies. J Asthma Allergy 2022; 15:1579-1592. [PMID: 36387837 PMCID: PMC9656491 DOI: 10.2147/jaa.s377896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/28/2022] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Oral corticosteroids (OCS) are frequently used in asthma management but have an important risk-profile. The aim of the study is to characterize and compare the sociodemographic and clinical characteristics, treatment regimen and asthma control between OCS users and non-users among the population of asthma patients (≥18 years) at GINA step 3 and above treated with a fixed combination of an inhaled corticosteroid and a long-acting beta-agonist (ICS/LABA). METHODS Cross-sectional study in Portuguese community pharmacies. Data was collected via paper-based interview delivered at the pharmacy (sociodemographic characteristics and asthma treatment regimen, namely ICS/LABA and OCS utilization), followed by a telephonic interview collecting smoking history, comorbidities, body mass index (BMI), history of exacerbations and asthma-related healthcare resource utilization (HCRU) in the previous 12 months, as well as asthma control using the Control of Allergic Rhinitis and Asthma Test (CARAT®). RESULTS A total of 347 patients recruited in 98 pharmacies were included in the analysis. Of those, 328 had completed both questionnaires. A quarter of the individuals reported OCS use in the previous 12 months (OCS users), either as add-on therapy (6%) or exacerbation treatment (19%). Patients were mostly females (72%), with an average age of 59.5 years (SD=15.4). OCS users were significantly older and reported more frequently having conjunctivitis (25.9% vs 15.0%), osteoporosis (25.9% vs 13.4%), arthritis (14.6% vs 6.9%), and gastrointestinal disease (16.1% vs 8.1%). OCS users also reported greater urgent HCRU: unscheduled consultations (33.3% vs 9.3%) and emergency department (ED) visits (32.1% vs 12.1%). Both groups presented poor disease control (85.2% of OCS users vs 72.9% of non-OCS users). CONCLUSION These results highlight the burden of OCS therapy to asthma patients and the need to improve asthma management, by adopting OCS sparing strategies in this subgroup of patients.
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Affiliation(s)
- Mariana Romão
- Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal
| | - Carolina Bulhosa
- Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal
| | - Zilda Mendes
- Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal
| | | | - Graça Silva
- Medical Department, AstraZeneca, Barcarena, Portugal
| | - Mariana Pereira
- MEDIDA – Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | | | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal
- Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal
| | - João A Fonseca
- MEDIDA – Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- CUF Allergy Unit, Porto Hospital and Institute, Porto, Portugal
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal
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10
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João C, Jácome C, Brito D, Teixeira P, Quelhas-Santos J, Amorim L, Barbosa MJ, Bulhões C, Lopes F, Pardal M, Bernardo F, Fonseca JA, Correia de Sousa J. Prevalence and Characterisation of Patients with Asthma According to Disease Severity in Portugal: Findings from the EPI-ASTHMA Pilot Study. J Asthma Allergy 2022; 15:1441-1453. [PMID: 36303890 PMCID: PMC9594360 DOI: 10.2147/jaa.s381716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the feasibility of the procedures of EPI-ASTHMA. EPI-ASTHMA is a population-based multicentre stepwise study about the prevalence and characterisation of patients with asthma based on disease severity in Portugal. Methods A pilot study of EPI-ASTHMA was conducted with adults from three primary care centres. We followed a stepwise approach comprising 4 stages: stage 0-invitation phone call (n ~1316); stage 1-telephone interview (n ~658); stage 2-clinical assessment with physical examination, diagnostic tests, and patient-reported outcome measures, to confirm the diagnosis of those with possible asthma at stage 1 (n ~160); stage 3-characterization of a subgroup of asthma patients by collecting data through a telephone interview, patient file review and CARATm app (n ~40), after 3-months. The frequency of asthma was calculated in relation to the entire study population (stage 1) and the frequency of difficult-to-treat/severe asthma in relation to the number of asthma patients (stage 3). Results From 1305 adults invited, 892 (68%) accepted to participate (stage 0) and 574 (64%; 53[42-67] y; 43% male) were interviewed (stage 1). From those, 148 (26%; 60[46-68] y; 43% male) were assessed at stage 2, and 46 (31%; 51[39-67] y; 44% male) were diagnosed with asthma. Half of these patients (n = 23) accepted to install the app. Stage 3 was completed by 41 (93%) patients, of whom 31 (83%) had asthma confirmed by their file review. A total of 8% of participants had asthma, of those 17% had difficult-to-treat and 5% severe asthma. Conclusion Attained recruitment rates and the quality of the results confirmed the feasibility of the EPI-ASTHMA stepwise approach. This pilot study provided insight into the improvement of the procedures to be generalized across the country.
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Affiliation(s)
- Catarina João
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal,Correspondence: Cristina Jácome, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal, Email
| | - Dinis Brito
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, ICVS/3Bs, PT Government Associate Laboratory, Braga, PortugaI
| | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, ICVS/3Bs, PT Government Associate Laboratory, Braga, PortugaI,Association P5 Digital Medical Center (ACMP5), Braga, Portugal
| | - Janete Quelhas-Santos
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Liliana Amorim
- Association P5 Digital Medical Center (ACMP5), Braga, Portugal
| | - Maria João Barbosa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, ICVS/3Bs, PT Government Associate Laboratory, Braga, PortugaI,Gualtar Family Health Unit, Braga, Portugal
| | - Cláudia Bulhões
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, ICVS/3Bs, PT Government Associate Laboratory, Braga, PortugaI,Vila Verde (VIDA+) Family Health Unit, Braga, Portugal
| | | | | | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal,MEDIDA Lda, Porto, Portugal,Allergy Unit, Hospital and Institute CUF, Porto, Portugal
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, ICVS/3Bs, PT Government Associate Laboratory, Braga, PortugaI
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11
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Jácome C, Brito D, João C, Lopes F, Santos J, Amorim L, Barbosa MJ, Pardal M, Teixeira P, Bernardo F, Fonseca JA, Correia-de-Sousa J. EPI-ASTHMA study protocol: a population-based multicentre stepwise study on the prevalence and characterisation of patients with asthma according to disease severity in Portugal. BMJ Open 2022; 12:e064538. [PMID: 36123070 PMCID: PMC9486331 DOI: 10.1136/bmjopen-2022-064538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION In Portugal as in other countries, data on the epidemiology of asthma are mainly grounded in questionnaire studies. Additionally, the detailed characterisation of asthma in terms of disease severity, control and phenotypes remain scarce. Studies assessing the prevalence of asthma and its subgroups using accurate methods are needed. This study aims to determine the prevalence of asthma, difficult-to-treat asthma and severe asthma, and to evaluate sociodemographic and clinical characteristics of those patients, in mainland Portugal. METHODS AND ANALYSIS A population-based nationwide study with a multicentre stepwise approach will be conducted between 2021 and 2023 in 38 primary care centres of the Portuguese National Health Service. The stepwise approach will comprise four stages: Stage 0-telephone call invitation to adult subjects (≥18 years) randomly selected (n~15 000); stage 1-telephone screening interview assessing the participants' respiratory symptoms (n~7500); stage 2-diagnostic visit, including physical examination, diagnostic tests (eg, spirometry, fraction of exhaled nitric oxide, blood eosinophil count) and patient-reported outcome measures for diagnostic confirmation of those identified with possible asthma at stage 1 (n~1800); stage 3-further evaluation of patients with asthma and of patients with difficult-to-treat asthma and severe asthma, after 3 months (n~460). At stage 3, data will be collected from a review of the patient's electronic health records, a follow-up telephone call and the CARATm (Caracteristicas Auto-reportadas de Asma em Tecnologias Móveis) app database. The prevalence of asthma, difficult-to-treat asthma and severe asthma will be determined as the percentage of patients with asthma confirmed from the overall population (stage 1). For the analysis of factors associated with asthma, difficult-to-treat asthma and severe asthma, logistic regression models will be explored. ETHICS AND DISSEMINATION Ethical approvals for the study were obtained from the ethics committee of the local health unit of Matosinhos, Porto (38/CES/JAS), Alto Minho (38/2021/CES) and the regional health administration of Lisbon-Vale do Tejo (035/CES/INV/2021). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05169619.
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Affiliation(s)
- Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dinis Brito
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Sete Fontes, Family Health Unit, Braga, Portugal
| | - Catarina João
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Janete Santos
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Maria João Barbosa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Gualtar Family Health Unit, Braga, Portugal
| | | | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Digital Medicine Center P5, Braga, Portugal
| | | | - Joao A Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- MEDIDA, Porto, Portugal
- Allergy Unit, Hospital and Institute CUF, Porto, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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12
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Rodrigues J, Pinto JV, Alexandre PL, Sousa-Pinto B, Pereira AM, Raemdonck K, Vaz RP. Allergic Rhinitis Seasonality, Severity, and Disease Control Influence Anxiety and Depression. Laryngoscope 2022; 133:1321-1327. [PMID: 35912902 DOI: 10.1002/lary.30318] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/17/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Allergic rhinitis (AR) has been associated with anxiety and depression. A possible influence of frequency and intensity of the AR symptoms has remained unclear. Therefore, we evaluated the association between AR, as well as its control, seasonality and severity, and the presence of anxiety and depression. METHODS Participants were selected from a preexistent national database and consecutively contacted by phone. AR was classified according to Allergic Rhinitis and its Impact on Asthma. Presence of anxiety and depression was identified by Hospital Anxiety and Depression Scale (HADS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II). We built linear regression models assessing the association between any of the assessed anxiety or depression scores and the occurrence, degree of control, seasonality or severity of AR. RESULTS We analyzed 115 participants with AR and 38 participants with no respiratory symptoms. Patients with AR presented higher scores of anxiety (HADS: 3.1; 95% confidence interval [CI] = 1.9; 4.3; p < 0.001) and depression (HADS: 3.8; 95% CI = 2.5; 5.0; p < 0.001). Poorer AR control was positively associated with higher prevalence and scores of anxiety (HADS: 3.0; 95% CI = 1.5; 4.5; p < 0.001) and depression (HADS: 1.8; 95% CI = 0.2; 3.4; p = 0.031). Similar results were obtained with BAI and BDI-II scales. A moderate/severe presentation of AR were also related with higher scores of anxiety (HADS: 1.7; 95% CI = 0.1; 3.2; p = 0.040) and depression (HADS: 1.7; 95% CI = 0.1; 3.3; p = 0.037). CONCLUSION The presence of AR, a poorer control, and a moderate/severe presentation of the disease were significantly associated with higher scores of anxiety and depression. Thus, it is important to alert to this association to allow a quick diagnosis of AR-associated pathologies. Laryngoscope, 2022.
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Affiliation(s)
- Jorge Rodrigues
- Otorhinolaryngology Department, Centro Hospitalar Universitário de S. João, EPE, Porto, Portugal.,Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - João V Pinto
- Otorhinolaryngology Department, Centro Hospitalar Universitário de S. João, EPE, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, University of Porto, Porto, Portugal
| | - Pedro L Alexandre
- Otorhinolaryngology Department, Centro Hospitalar Universitário de S. João, EPE, Porto, Portugal.,Department of Surgery and Physiology, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana M Pereira
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF-Porto, Porto, Portugal
| | - Kristof Raemdonck
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,TOXRUN - Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal
| | - Ricardo P Vaz
- Otorhinolaryngology Department, Centro Hospitalar Universitário de S. João, EPE, Porto, Portugal.,Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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13
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Costa-Santos C, Neves AL, Correia R, Santos P, Monteiro-Soares M, Freitas A, Ribeiro-Vaz I, Henriques TS, Pereira Rodrigues P, Costa-Pereira A, Pereira AM, Fonseca JA. COVID-19 surveillance data quality issues: a national consecutive case series. BMJ Open 2021; 11:e047623. [PMID: 34872992 PMCID: PMC8649880 DOI: 10.1136/bmjopen-2020-047623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES High-quality data are crucial for guiding decision-making and practising evidence-based healthcare, especially if previous knowledge is lacking. Nevertheless, data quality frailties have been exposed worldwide during the current COVID-19 pandemic. Focusing on a major Portuguese epidemiological surveillance dataset, our study aims to assess COVID-19 data quality issues and suggest possible solutions. SETTINGS On 27 April 2020, the Portuguese Directorate-General of Health (DGS) made available a dataset (DGSApril) for researchers, upon request. On 4 August, an updated dataset (DGSAugust) was also obtained. PARTICIPANTS All COVID-19-confirmed cases notified through the medical component of National System for Epidemiological Surveillance until end of June. PRIMARY AND SECONDARY OUTCOME MEASURES Data completeness and consistency. RESULTS DGSAugust has not followed the data format and variables as DGSApril and a significant number of missing data and inconsistencies were found (eg, 4075 cases from the DGSApril were apparently not included in DGSAugust). Several variables also showed a low degree of completeness and/or changed their values from one dataset to another (eg, the variable 'underlying conditions' had more than half of cases showing different information between datasets). There were also significant inconsistencies between the number of cases and deaths due to COVID-19 shown in DGSAugust and by the DGS reports publicly provided daily. CONCLUSIONS Important quality issues of the Portuguese COVID-19 surveillance datasets were described. These issues can limit surveillance data usability to inform good decisions and perform useful research. Major improvements in surveillance datasets are therefore urgently needed-for example, simplification of data entry processes, constant monitoring of data, and increased training and awareness of healthcare providers-as low data quality may lead to a deficient pandemic control.
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Affiliation(s)
- Cristina Costa-Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Luisa Neves
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ricardo Correia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Matilde Monteiro-Soares
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Escola Superior de saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ines Ribeiro-Vaz
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Teresa S Henriques
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pereira Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Altamiro Costa-Pereira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joao A Fonseca
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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Inhaled Drug Therapy-Associated Adverse Reactions in Obstructive Respiratory Diseases: A Review of a Decade of Reporting to the Portuguese Pharmacovigilance System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312411. [PMID: 34886135 PMCID: PMC8656767 DOI: 10.3390/ijerph182312411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022]
Abstract
Inhaled medication used for treatment of chronic obstructive lung diseases (asthma, chronic obstructive pulmonary disease-COPD, and Asthma-COPD overlap) may be associated with adverse drug reactions (ADRs). The aim of this study was to characterise spontaneous reports (SRs) of suspected ADRs received by the Portuguese Pharmacovigilance System (PPS), from 2007 to 2017. Methods: Retrospective observational study of SRs associated with single substance and combination inhalers, analysed in terms of pharmacological class of the involved drugs, sex and age range of the involved patients, and seriousness and type of ADRs. Results: 230 SRs were analysed, accounting for a total of 599 suspected ADRs. Inhaled corticosteroid/long-acting beta-2 agonist combination had the highest frequency in SRs (32.2%) and in ADRs (32.7%). There was a slight predominance in men (51.3%) and non-elderly adults were the most affected age group (39.1%). Most SRs were serious (70.4%). In total, “respiratory, thoracic and mediastinal diseases” ADRs were the most reported (19.5%), with “dyspnea” being the most frequent (4.8%). Conclusions: Most SRs were associated with controller medications and were expected. Most ADRs involved non-elderly adults, were serious and of respiratory nature and many were due to overuse of reliever medication.
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Romão M, Godinho AR, Teixeira PM, Mendes Z, Bernardo F, Teixeira Rodrigues A, Correia de Sousa J. Characteristics of Reliever Inhaler Users and Asthma Control: A Cross-Sectional Multicenter Study in Portuguese Community Pharmacies. J Asthma Allergy 2021; 14:943-954. [PMID: 34354362 PMCID: PMC8331120 DOI: 10.2147/jaa.s315678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE SABA overuse might indicate poorly managed or uncontrolled asthma and be responsible for poor health outcomes. The aim of this study integrated in new fourth multi-design SABINA+ pillar was to characterize the population using short-acting β2-agonists for asthma and examine the patterns of its use among community pharmacy customers in Portugal, as well as identify characteristics associated with disease control and explore potential differences between GINA treatment steps. PATIENTS AND METHODS This cross-sectional multicenter study was conducted in Portuguese community pharmacies between 29 May 2018 and 15 August 2018. Participants were adults (age ≥18 years) self-reporting asthma diagnosis recruited in the context of a short-acting β2-agonist dispense. A two-part questionnaire (pharmacist interview and self-administered) was used to collect information about sociodemographic characteristics, comorbidities, reliever inhaler use, healthcare resource consumption and self-reported disease control (assessed by the Control of Allergic Rhinitis and Asthma Test - CARAT®). Descriptive statistics was done to characterize the study sample. After categorizing patients according to GINA steps, based on their therapeutic regimen, we performed an exploratory subgroup analysis to evaluate if there were any differences between such groups in terms of the variables collected. A logistic regression was used to identify the potential determinants of overall disease control. RESULTS Around 50.8% of patients were male, and the average age was 52 years old. Half of the patients never smoked, and 51.9% were employed. More than half of the patients report inhaler overreliance - purchasing more than 1 pack in 3 months (65.0%) or using the inhaler on more than 8 days over the previous 4 weeks (50.2%). Of the total number of patients in the study, 79.1% had poorly controlled asthma symptoms, and 78.7% had overall poorly controlled respiratory symptoms. We found statistically significant differences between GINA treatment steps in all sociodemographic characteristics (sex, mean age, education level, employment status); maximum number of SABA uses in 24h, CARAT score (total an asthma sub-score); history of exacerbations requiring ED visits or treatment with OCS for at least 3 days in the previous 12 months. Logistic regression revealed that patients reporting SABA use in more than 8 days in the previous 4 weeks and patients with at least 1 exacerbation requiring treatment with OCS for at least 3 days in the previous 12 months have greater odds of poor disease control [adjusted OR (95% CI): 2.6 (1.3-5.2) and 3.0 (1.3-6.6)]. CONCLUSION Based on the results of this study, it can be inferred that the asthma population using SABA is largely uncontrolled and uses reliever inhalers excessively.
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Affiliation(s)
- Mariana Romão
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Ana Rita Godinho
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Pedro M Teixeira
- Life and Health Sciences Research Institute (ICVS)/3B’s-PT Government Associate Laboratory, University of Minho, Braga, Portugal
| | - Zilda Mendes
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | | | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS)/3B’s-PT Government Associate Laboratory, University of Minho, Braga, Portugal
- Horizonte Family Health Unit, ULS Matosinhos, Matosinhos, Portugal
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Carreiro-Martins P, Regateiro FS, Ferreira J, Plácido JL, Gerardo R, Loureiro C. FeNO testing in severe asthma: A clinical argument or an access constraint? Pulmonology 2021; 27:383-385. [PMID: 34134929 DOI: 10.1016/j.pulmoe.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Pedro Carreiro-Martins
- Comprehensive Health Research Center (CHRC), NOVA Medical School, Lisbon, Portugal; Immunoallergy Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jorge Ferreira
- Pneumology Service, Hospital de São Sebastião - Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - José Luís Plácido
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Rita Gerardo
- Pneumology Unit, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Cláudia Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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Maricoto T, Santos D, Carvalho C, Teles I, Correia-de-Sousa J, Taborda-Barata L. Assessment of Poor Inhaler Technique in Older Patients with Asthma or COPD: A Predictive Tool for Clinical Risk and Inhaler Performance. Drugs Aging 2020; 37:605-616. [PMID: 32602039 DOI: 10.1007/s40266-020-00779-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Older patients with asthma or chronic obstructive pulmonary disease (COPD) are particularly susceptible to inhaler technique errors and poor clinical outcomes. Several factors may influence their risk, but most studies are inconsistent and contradictory. We developed a tool for the major predictors of individual risk in these patients. DESIGN, SETTING AND PARTICIPANTS In this multicentre, cross-sectional study, several demographic, socioeconomic and clinical characteristics were collected as potential predictors. Clinical features and inhaler technique performance were the main outcomes. Linear and logistic regression models were set up to identify significant variables. Subgroup analysis was performed according to age, cognitive performance and different types of inhalers. RESULTS We included 130 participants, mean age of 74.4 (± 6.4) years. Mean years of device use were 5.8 (± 7.3). Inhaler errors affected 71.6% (95% CI 64-78.5) and critical mistakes 31.1% (95% CI 24-38.8). There were respiratory comorbidities in 82.3% of participants, and 56.2% had moderate to severe disease. A predictive score of misuse probability was developed for clinical practice, including points attributable to cognitive score, adherence and having received previous education on a placebo device. Other significant variables of individual risk were having respiratory allergies or comorbidities, smoking status, depression and educational level. Worse performance was detected in cognitively impaired patients older than 75 years who were using dry powder inhalers (DPI). Lung function was associated with smoking load, incorrect dose activation and absent end pause after inhalation. CONCLUSIONS Individual risk assessment in older individuals should focus on inhaler technique performance (mainly on dose activation and end pause) and adherence, smoking, respiratory comorbidities and cognitive impairment. Placebo device training provided by doctors seems to best suit these patients.
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Affiliation(s)
- Tiago Maricoto
- Aveiro-Aradas Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal.
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
- USF Aveiro-Aradas, Praceta Rainha D. Leonor, 3800, Aveiro, Portugal.
| | - Duarte Santos
- Aveiro-Aradas Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Catarina Carvalho
- Flor de Sal Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Inês Teles
- Flor de Sal Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS)/3B's-PT Government Associate Laboratory, University of Minho, Braga, Portugal
- Horizonte Family Health Unit, ULS Matosinhos, Matosinhos, Portugal
| | - Luís Taborda-Barata
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
- CACB-Clinical Academic Center of Beiras, Covilhã, Portugal
- Department of Allergy and Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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Chaves Loureiro C, Branco Ferreira M, Ferreira J, Lima R, Marques J, Sokolova A, Tonin FS, Duarte Ramos F. Reducing oral corticosteroids in severe asthma (ROSA Project): a nationwide Portuguese consensus. Pulmonology 2020; 27:313-327. [PMID: 33177008 DOI: 10.1016/j.pulmoe.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES We aimed to build a national consensus to optimize the use of oral corticosteroids (OCS) in severe asthma in Portugal. MATERIAL AND METHODS A modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy, therapeutic schemes, asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-'strongly disagree'; 5-'strongly agree'). Consensus threshold was established as a percentage of agreement among participants ≥90% in the 1st round and ≥85% in the 2nd and 3rd rounds. The level of consensus achieved by the panel was discussed with the participants (face-to-face meeting). RESULTS Forty-eight expert physicians in severe asthma (specialists in allergology and pulmonology) participated in the study. Almost half of the statements (28/65; 43.1%) obtained positive consensus by the end of round one. By the end of the exercise, 12 (18.5%) statements did not achieve consensus. Overall, 87% of physicians agree that further actions for OCS cumulative risk assessment in acute asthma exacerbations are needed. The vast majority (91.7%) demonstrated a favorable perception for using biological agents whenever patients are eligible. Most participants (95.8%) are more willing to accept some degree of lung function deterioration compared to other outcomes (worsening of symptoms, quality of life) when reducing OCS dose. Monitoring patients' comorbidities was rated as imperative by all experts. CONCLUSIONS These results can guide an update on asthma management in Portugal and should be supplemented by studies on therapy access, patients' adherence, and costs.
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Affiliation(s)
- Claudia Chaves Loureiro
- Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Portugal; Centre of Pulmonology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Manuel Branco Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Imunoalergologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Jorge Ferreira
- Pulmonology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE, Vila Nova de Gaia, Portugal
| | - Ricardo Lima
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - João Marques
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal; CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Anna Sokolova
- Immunology and Allergy Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Program, Federal University of Parana, Brazil
| | - Filipa Duarte Ramos
- Department of Social Pharmacy, Faculty of Pharmacy, University of Lisboa, Lisboa, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal
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19
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Exploring Volatile Organic Compound Exposure and Its Association with Wheezing in Children under 36 Months: A Cross-Sectional Study in South Lisbon, Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186929. [PMID: 32971966 PMCID: PMC7559785 DOI: 10.3390/ijerph17186929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022]
Abstract
Air quality and other environmental factors are gaining importance in public health policies. Some volatile organic compounds (VOCs) have been associated with asthma and symptoms of respiratory disease such as wheezing. The aim of this study was to measure the concentration of Total VOCs and assess their possible association with the occurrence of wheezing episodes in children under 36 months of age, in a region south of Lisbon, Portugal. A cross-sectional study was performed from October 2015 to March 2016. The sample of children under 36 months of age was selected by convenience, by inviting parents to take part in the study. A survey was applied to collect information on bedroom features, as well as to verify the occurrence of wheezing episodes. The indoor air quality parameters of bedrooms were measured using three 3M Quest® EVM-7 environmental monitors. In total, 34.4% of infants had had wheezing episodes since birth, with 86.7% of these presenting at least one episode in the previous 12 months. Total VOC levels were above the reference values in 48% of the analyzed bedrooms. No significant association of VOC exposure in a domestic setting with episodes of wheezing was found. However, children living in households with smokers were 4 times more likely to develop wheezing episodes. Thus, this study provides relevant information that warrants further studies to assess infant exposure to indoor air pollution and parental smoking in a residential context.
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Morais-Almeida M, Pité H, Cardoso J, Costa R, Robalo Cordeiro C, Silva E, Todo-Bom A, Vicente C, Agostinho Marques J. Strengths of breath-triggered inhalers in asthma management. Pulmonology 2020; 26:327-329. [PMID: 32474058 DOI: 10.1016/j.pulmoe.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - H Pité
- Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisboa, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisboa, Portugal
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Lisboa, Portugal
| | - R Costa
- Family Medicine, Porto, Portugal; Coordinator of GRESP (Grupo de Estudos de Doenças Respiratórias da APMGF), Portugal
| | - C Robalo Cordeiro
- Pulmonology Department, Centro Hospitalar Universitário de Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal
| | - E Silva
- Family Medicine USF João Semana, Ovar, Aveiro, Portugal; Coordinator of GRESP Inhalers and Technical Devices Working Group, Portugal
| | - A Todo-Bom
- Immunoallergology Department, Centro Hospitalar Universitário de Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal
| | - C Vicente
- Family Medicine UCSP Soure, Coimbra, Portugal; Secretary of GRESP (Grupo de Estudos de Doenças Respiratórias da APMGF), Portugal
| | - J Agostinho Marques
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Arrobas A, Barbosa MP, Rabiais S, Vandewalle B, Félix J. Cost-effectiveness of omalizumab in real world uncontrolled allergic asthma patients. Pulmonology 2020; 27:124-133. [PMID: 32247710 DOI: 10.1016/j.pulmoe.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of omalizumab compared with standard of care in the treatment and control of severe persistent asthma, using the outcomes from the Portuguese subpopulation of the eXpeRience registry. METHODS This was a pragmatic cost-effectiveness analysis based on real world data from the eXpeRience registry which recruited 62 patients with uncontrolled persistent allergic asthma from 20 participating centers in Portugal. Response to omalizumab treatment was measured prospectively up to 24 months by the physician's Global Evaluation of Treatment Effectiveness (GETE). Retrospective data on patients' clinical symptoms, asthma control, lung function, exacerbations, and healthcare utilization were available for up to 12 months before omalizumab initiation and served as the standard of care comparator. The number of exacerbations (severe and non-severe), the number of clinical episodes, the number of days absent from work and/or school, and GETE response to therapy were considered as effectiveness outcomes. Following a societal perspective, as cost indicators, both direct and indirect costs were considered. Direct costs relate to the cost of omalizumab, standard of care and clinical episodes (emergency room visits, hospitalizations, and unscheduled doctor visits). Indirect costs relate to the societal cost of work absenteeism. Unit costs for clinical episodes and drugs were taken from official sources within the Portuguese Health Authority. A univariate sensitivity analysis was performed. RESULTS A rate of 1.5 exacerbations per patient-year was estimated following omalizumab treatment compared with 8.2 exacerbations per patient-year prior to omalizumab initiation, implying an 82.1% reduction in the incidence of exacerbations following omalizumab treatment relative to standard of care alone. A 54.1% reduction in GETE score was also observed in favor of omalizumab treatment. The mean cost per person-year was 3023є in the 12 months of standard of care prior to omalizumab and 16,111є in the period of treatment with omalizumab. The incremental cost-effectiveness ratios were 2244є/exacerbation avoided, and 1750є/unit decrease in GETE classification. CONCLUSION Our results demonstrate that adding omalizumab to the treatment of patients with uncontrolled severe persistent asthma reduces the number of exacerbations, improving overall treatment effectiveness at an acceptable cost from a societal perspective.
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Affiliation(s)
- A Arrobas
- Pulmonology Unit, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - M P Barbosa
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
| | | | | | - J Félix
- Exigo Consultores, Lisboa, Portugal.
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22
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Sousa J, Taborda-Barata L, Monteiro C. Biological therapy-associated adverse reactions in asthma: analysis of reporting to the Portuguese pharmacovigilance system. Expert Opin Drug Saf 2019; 19:99-106. [PMID: 31661986 DOI: 10.1080/14740338.2020.1686481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objectives: Biological drugs have been successfully tested in asthma, especially in the most severe forms of the disease. The goal of this study was to characterize the safety profile of biologicals used in asthma.Methods: Retrospective and descriptive analysis of spontaneous reports (SRs) involving omalizumab and mepolizumab, sent to the Portuguese Pharmacovigilance System, since market launch until October 2018.Results: A total of 127 SRs for omalizumab and 10 SRs mepolizumab were found. Most patients were female (75.6% omalizumab and 90.0% mepolizumab), and aged 18-64 years (61.4% and 50.0%, respectively). 71.7% of the reports for omalizumab were serious, with 2 cases of anaphylaxis, 12 malignant neoplasms and 2 abortions. Only 20.0% of the reports for mepolizumab were considered serious. A total of 391 adverse drug reactions (ADRs) for omalizumab and 20 ADRs for mepolizumab were found. Most reported ADRs belonged to System organ class (SOC) groups: 'respiratory, thoracic and mediastinal disorders' and 'investigations', for omalizumab; 'musculoskeletal and connective tissue disorders' and 'general disorders and administration site conditions' for mepolizumab.Conclusion: Over the years, there was an increasing trend of SRs with these biological drugs. However, it is necessary to continue to develop educational programs in order to get a better reporting system.
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Affiliation(s)
- José Sousa
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Luís Taborda-Barata
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,UFBI - Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal.,Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Cristina Monteiro
- UFBI - Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal
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Sá-Sousa A, Almeida R, Vicente R, Nascimento N, Martins H, Freitas A, Fonseca JA. High oral corticosteroid exposure and overuse of short-acting beta-2-agonists were associated with insufficient prescribing of controller medication: a nationwide electronic prescribing and dispensing database analysis. Clin Transl Allergy 2019; 9:47. [PMID: 31559008 PMCID: PMC6755705 DOI: 10.1186/s13601-019-0286-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recurrent use of oral corticosteroids (OCS) and over-use of short-acting beta-2-agonists (SABA) are factors associated with adverse side effects and asthma-related death. We aim to quantify high OCS exposure, SABA over-use and its association with prescription and adherence to maintenance treatment for respiratory disease, among patients with prescriptions for respiratory disease, from the Portuguese electronic prescription and dispensing database (BDNP). METHODS This was a 1-year (2016) retrospective population-based analysis of a random sample of adult patients from the BDNP, the nationwide compulsory medication prescription system. We assessed high OCS exposure (dispensing ≥ 4 packages containing 20 doses of 20 mg each of prednisolone-equivalent, ≥ 1600 mg/year) on patients on persistent respiratory treatment (PRT-prescription for > 2 packages of any respiratory maintenance medications). Excessive use of SABA was defined as having a ratio of SABA-to-maintenance treatment > 1 or having SABA over-use (dispensing of > 1 × 200 dose canister/month, of 100 μg of salbutamol-equivalent). Factors associated with high OCS exposure were assessed by multinomial logistic regression. RESULTS The estimated number of patients on PRT was 4786/100,000 patients. OCS was prescribed to more than 1/5 of the patients on PRT and 101/100,000 were exposed to a high-dose (≥ 1600 mg/year). SABA excessive use was found in 144/100,000 patients and SABA over-use in 24/100,000. About 1/6 of SABA over-users were not prescribed any controller medication and 7% of them had a ratio maintenance-to-total ≥ 70% (high prescription of maintenance treatment). Primary adherence (median%) to controller medication was 66.7% for PRT patients, 59.6% for patients exposed to high OCS dose and 75.0% for SABA over-users. High OCS exposure or SABA over-use were not associated with primary adherence. High OCS exposure was associated with a maintenance-to-total medication ratio < 70% (insufficient prescription of maintenance treatment), age > 45 years old and male sex. CONCLUSIONS Exposure to high-dose of OCS (101 per 100,000 patients) and SABA over-use (24 per 100,000) were frequent, and were associated with a low maintenance-to-total prescription ratio but not with primary non-adherence. These results suggest there is a need for initiatives to reduce OCS and SABA inappropriate prescribing.
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Affiliation(s)
- Ana Sá-Sousa
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ricardo Vicente
- SPMS Shared Services of the Ministry of Health, Lisbon, Portugal
| | | | - Henrique Martins
- SPMS Shared Services of the Ministry of Health, Lisbon, Portugal
| | - Alberto Freitas
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information, and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Almeida Fonseca
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information, and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
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Ostovar A, Fokkens WJ, Pordel S, Movahed A, Ghasemi K, Marzban M, Farrokhi S. The prevalence of asthma in adult population of southwestern Iran and its association with chronic rhinosinusitis: a GA 2LEN study. Clin Transl Allergy 2019; 9:43. [PMID: 31497279 PMCID: PMC6717339 DOI: 10.1186/s13601-019-0283-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background Asthma is recognized as a major public health concern in the world. The aim of this investigation was to evaluate the prevalence of asthma by using the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire and examine its association with chronic rhinosinusitis, in the province of Bushehr, Southwestern of Iran. Methods In a cross-sectional, population-based study, a total of 5420 invited individuals, aged 15–65, were selected through a multi-stage, stratified, cluster random sampling and from which 5201 completed the GA2LEN questionnaire (response rate = 95.9%). The prevalence of asthma, current, and physician-diagnosed asthma were analyzed by using sex and age groups and the association of asthma and chronic rhinosinusitis (CRS) was investigated using a multiple logistic regression model. Results Based on the information from the GA2LEN questionnaire, the overall prevalence of asthma in the population under study was 10.0% (95% CI 9.2–10.8). Moreover, the prevalence of current asthma was 8.9% (95% CI 8.1–9.7). Further, the prevalence of current early, late-onset and physician-diagnosed asthma within the asthma group was 51.1% (95% CI 46.5–55.7), 48.9% (95% CI 44.3–53.5) and 3.9% (95% CI 2.1–2.5), respectively. Additionally, CRS was more frequent among the participants with asthma [(57.3%, OR = 2.3; 95% CI 2.1–2.5)], and there was a significant association between CRS and current, early and late-onset of asthma (P < 0.001; OR = 4.4, 3.2 and 6, respectively). Conclusion This large population study conducted in the southwestern part of Iran suggests that the prevalence of asthma is high. Moreover, the result of this study showed a strong association of asthma with CRS; also after adjusting for sex, age, educational level, and smoking.
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Affiliation(s)
- Afshin Ostovar
- 1Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Wytske J Fokkens
- 2Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Safoora Pordel
- 3Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Sangi St, PO Box: 75 16 68 88 76, Bushehr, Iran
| | - Ali Movahed
- 4The Persian Gulf Tropical Research Center, Biochemistry Group, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Khadijeh Ghasemi
- 5Department of Pediatrics, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Maryam Marzban
- 6Department of Epidemiology, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Shokrollah Farrokhi
- 3Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Sangi St, PO Box: 75 16 68 88 76, Bushehr, Iran
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Fernández-González M, Ribeiro H, Pereira JRS, Rodríguez-Rajo FJ, Abreu I. Assessment of the potential real pollen related allergenic load on the atmosphere of Porto city. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 668:333-341. [PMID: 30852210 DOI: 10.1016/j.scitotenv.2019.02.345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 05/25/2023]
Abstract
The knowledge of the allergen content in the atmosphere is a useful tool to stablish the risk allergy warnings for the sensitive people. In Portugal the main airborne allergenic pollen come from trees (such as Betula or Olea), grasses or weeds (mainly Urticaceae). The present study sought the quantification of the Bet v 1, Ole e 1, Lol p1 and Par j1-2 aeroallergen concentration as well as how weather variables influence in the pollen and allergen concentration in Porto city. Aerobiological study was carried out by a Hirst-type volumetric sampler for pollen collection and a Burkard Cyclone sampler for the aeroallergens. A regression analysis between pollen and allergens was conducted for the identification the allergenic risk days. High Pollen Allergen Potency in the atmosphere was observed considering the low levels of airborne pollen detected. A significant and positive correlation has been obtained between pollen and aeroallergen values with the temperatures whereas the correlation was negative with relative humidity, rainfall and wind speed. Back trajectory methodology was applied in order to analyse the discordances between pollen and allergen maximum concentrations. The analysis showed that when the pollen and allergen peaks were registered on the same day, air masses always comes from the continent. However, when the peaks do not coincide, the air mass comes from the continent in the case of the pollen peak and from the sea for the allergen peak. This behaviour can be a consequence of the high humidity in the air masses from the sea, which can benefit the allergen release from pollen grains. In our study it was observed that the available traditional information for allergenic Type I patients, corresponding to the amount of pollen grains in the bioaerosol, do not accurately identify the real allergenic load in the air.
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Affiliation(s)
- M Fernández-González
- Earth Sciences Institute (ICT), Pole of the Faculty of Sciences University of Porto, Porto, Portugal; Department of Plant Biology and Soil Sciences, University of Vigo, Vigo, Spain.
| | - H Ribeiro
- Earth Sciences Institute (ICT), Pole of the Faculty of Sciences University of Porto, Porto, Portugal; Department of Geosciences, Environment and Spatial Plannings, Faculty of Sciences, University of Porto, Rua do Campo Alegre, 687, 4169-007 Porto, Portugal
| | - J R S Pereira
- Earth Sciences Institute (ICT), Pole of the Faculty of Sciences University of Porto, Porto, Portugal; Department of Biology of the Faculty of Sciences, University of Porto, Porto, Portugal
| | - F J Rodríguez-Rajo
- Department of Plant Biology and Soil Sciences, University of Vigo, Vigo, Spain
| | - I Abreu
- Earth Sciences Institute (ICT), Pole of the Faculty of Sciences University of Porto, Porto, Portugal; Department of Biology of the Faculty of Sciences, University of Porto, Porto, Portugal
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D’Elia C, Mallol J, Solé D. Prevalence of recurrent wheezing during the first year of life in Setúbal district, Portugal. Allergol Immunopathol (Madr) 2019; 47:122-127. [PMID: 30078621 DOI: 10.1016/j.aller.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recurrent wheezing during the first year of life is a major cause of respiratory morbidity worldwide, yet there are no studies on its prevalence in Portugal. OBJECTIVE Determine the prevalence and severity of recurrent wheezing, treatments employed and other related aspects, in infants during their first year of life in Setúbal, Portugal. METHODS This is a cross-sectional study of a random sample of infants aged 12-15 months living in Setúbal district. It uses a validated questionnaire answered by parents/caregivers at local healthcare facilities where infants attend for growth/development monitoring and/or vaccine administration. RESULTS Among the 202 infants surveyed, 44.6% (95% CI 37.7-51.4) had at least one episode of wheezing; and 18.3% (95% CI 12.9-23.6) had recurrent wheezing. There was significant morbidity associated to recurrent wheezing in terms of severe episodes (17.3%-95% CI 12-22.5), visits to the emergency department (26.2%-95% CI 20.1-32.2) and hospital admissions (5.4%-95% CI 2.2-8.5); 10.4% (95% CI 6.1-14.6) used inhaled corticosteroids and 7.9% (95% CI 4.1-11.6) used a leukotriene receptor antagonist. CONCLUSIONS The prevalence of recurrent wheezing in infants during the first year of life is high and is associated with significant morbidity, presenting as a relevant public health problem. An important proportion of infants' progress with a more severe condition, resulting in high use of health resources (visits to emergency department and hospitalisations). The prevalence of recurrent wheezing in this district of Portugal stays between those related in other European and Latin American Centres, suggesting that maybe some of the well-known risk factors are shared with affluent countries.
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Maricoto T, Correia-de-Sousa J, Taborda-Barata L. Inhaler technique education in elderly patients with asthma or COPD: impact on disease exacerbations-a protocol for a single-blinded randomised controlled trial. BMJ Open 2019; 9:e022685. [PMID: 30696670 PMCID: PMC6352786 DOI: 10.1136/bmjopen-2018-022685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD)and asthma affect more than 10% of the population. Most patients use their inhaler incorrectly, mainly the elderly, thereby becoming more susceptible to poor clinical control and exacerbations. Placebo device training is regarded as one of the best teaching methods, but there is scarce evidence to support it as the most effective one to improve major clinical outcomes. Our objective is to perform a single-blinded RCT to assess the impact of this education tool in these patients. METHODS AND ANALYSIS A multicentre single-blinded Randomised Controlled Trial (RCT) will be set up, comparing an inhaler education programme with a teach-to-goal placebo-device training versus usual care, with a 1-year follow-up, in patients above 65 years of age with asthma or COPD. Intervention will be provided at baseline, and after 3 and 6 months, with interim analysis at an intermediate time point. Exacerbation rates were set as primary outcomes, and quality of life, adherence rates, clinical control and respiratory function were chosen as secondary outcomes. A sample size of 146 participants (73 in each arm) was estimated as adequate to detect a 50% reduction in event rates. Two-sample proportions χ² test will be used to study primary outcome and subgroup analysis will be carried out according to major baseline characteristics. ETHICS AND DISSEMINATION Every participant will sign a written consent form. A Data Safety Monitoring Board will be set up to evaluate data throughout the study and to monitor early stopping criteria. Identity of all participants will be protected. This protocol was approved on 22 November 2017 by the local Ethics Committee of University of Beira Interior, with the reference number CE-UBI-Pj-2017-025. Results will be presented in scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03449316; Pre-Results.
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Affiliation(s)
- Tiago Maricoto
- Aveiro-Aradas Family Health Unit, Aveiro Health Centre, Aveiro, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS)/3B’s—PT Government Associate Laboratory, University of Minho, Braga, Portugal
- Horizonte Family Health Unit, Matosinhos Health Centre, Matosinhos, Portugal
| | - Luís Taborda-Barata
- CICS—Health Sciences Research Centre; NuESA—Environment & Health Study Group, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
- Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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Berenguer PH, Camacho IC, Câmara R, Oliveira S, Câmara JS. Determination of potential childhood asthma biomarkers using a powerful methodology based on microextraction by packed sorbent combined with ultra-high pressure liquid chromatography. Eicosanoids as case study. J Chromatogr A 2018; 1584:42-56. [PMID: 30482430 DOI: 10.1016/j.chroma.2018.11.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 11/18/2022]
Abstract
Leukotrienes and prostaglandins are arachidonic acid bioactive derived eicosanoids and key mediators of bronchial inflammation and response modulation in the airways contributing to the pathophysiology of asthma. An easy-to-use ultra-high pressure liquid chromatography (UHPLC)-based strategy was developed to characterize biomarkers of lipid peroxidation: leukotrienes E (LTE4) and B4 (LTB4) and 11β-prostaglandin F2α (11βPGF2α), present in urine of asthmatic patients (N = 27) and healthy individuals (N = 17). A semi-automatic eVol®-microextraction by packed sorbent (MEPS) was used to isolate the target analytes. Several experimental parameters with influence on the extraction efficiency and on the chromatographic resolution, were evaluated and optimized. The method was fully validated under optimal extraction (R-AX sorbent, 3 conditioning-equilibration cycles with 250 μL of ACN-water at 0.1% FA, 10 extract-discard cycles of 250 μL of sample at a pH of 5.1, elution with 2 times 50 μL of MeOH and concentration of the eluate until half of its volume) and chromatographic conditions (14-min analysis at a flow rate of 300 μL min-1 in an UHPLC-PDA equipped with a BEH C18 column), according to IUPAC guidelines. The findings indicated good recoveries (>95%) in addition to excellent extraction efficiency (>95%) at three concentration levels (low mid and high) with precision (RSDs) less than 11%. The lack-of-fit test, goodness-of-fit test and Mandel's fitting test, revealed good linearity within the concentration range. Good selectivity and sensitivity were achieved with a limits of detection ranging from 0.04 μg L-1 for LTB4 to 1.12 μg L-1 for 11βPGF2α, and limits of quantification from 0.10 μg L-1 for the LTB4 to 2.11 μg L-1 for 11βPGF2α. The successful application of the fully validated method shows that, on average, the asthmatic patients had significantly higher concentrations of 11βPGF2α (112.96 μg L-1vs 62.56 μg L-1 in normal controls), LTE4 (1.27 μg L-1vs 0.89 μg L-1 in normal controls), and LTB4 (1.39 μg L-1vs 0.76 μg L-1 in normal controls). The results suggest the potential of the target eicosanoids on asthma diagnosis, however, a larger and more extensive study will be necessary to confirm the data obtained and to guarantee a greater robustness to the approach.
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Affiliation(s)
- Pedro H Berenguer
- CQM - Centro de Química da Madeira, Universidade da Madeira, Campus Universitário da Penteada, 9020-105 Funchal, Portugal
| | - Irene C Camacho
- Faculdade de Ciências da Vida, Universidade da Madeira, Campus Universitário da Penteada, 9020-105, Funchal, Portugal
| | - Rita Câmara
- Unidade de Imunoalergologia, Hospital Dr. Nélio Mendonça, SESARAM, E.P.E., 9004-514 Funchal, Portugal
| | - Susana Oliveira
- Unidade de Imunoalergologia, Hospital Dr. Nélio Mendonça, SESARAM, E.P.E., 9004-514 Funchal, Portugal
| | - José S Câmara
- CQM - Centro de Química da Madeira, Universidade da Madeira, Campus Universitário da Penteada, 9020-105 Funchal, Portugal; Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Campus Universitário da Penteada, 9020-105, Funchal, Portugal.
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Sá-Sousa A, Fonseca JA, Pereira AM, Ferreira A, Arrobas A, Mendes A, Drummond M, Videira W, Costa T, Farinha P, Soares J, Rocha P, Todo-Bom A, Sokolova A, Costa A, Fernandes B, Chaves Loureiro C, Longo C, Pardal C, Costa C, Cruz C, Loureiro CC, Lopes C, Mesquita D, Faria E, Magalhães E, Menezes F, Todo-Bom F, Carvalho F, Regateiro FS, Falcão H, Fernandes I, Gaspar-Marques J, Viana J, Ferreira J, Silva JM, Simão L, Almeida L, Fernandes L, Ferreira L, van Zeller M, Quaresma M, Castanho M, André N, Cortesão N, Leiria-Pinto P, Pinto P, Rosa P, Carreiro-Martins P, Gerardo R, Silva R, Lucas S, Almeida T, Calvo T. The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1495039. [PMID: 30584531 PMCID: PMC6280304 DOI: 10.1155/2018/1495039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/08/2018] [Indexed: 12/26/2022]
Abstract
The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.
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Affiliation(s)
- Ana Sá-Sousa
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of Community Medicine, Information, and Health Sciences (MEDCIDS), Faculdade de Medicina Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of Community Medicine, Information, and Health Sciences (MEDCIDS), Faculdade de Medicina Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Ana Ferreira
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Arrobas
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Mendes
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Marta Drummond
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
- Pulmonology Department, Faculty of Medicine University of Porto, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Wanda Videira
- Pulmonology Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | | | | | | | | | - Ana Todo-Bom
- Immunoallergology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Immunoallergology Department, Faculdade de Medicina, Universidade do Coimbra, Coimbra, Portugal
| | - Anna Sokolova
- Immunology and Allergy Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - António Costa
- Pulmonology Department, Hospital da Senhora da Oliveira, Guimarães EPE, Guimarães, Portugal
| | | | - Carla Chaves Loureiro
- Department of Pediatrics, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cecília Longo
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Cecília Pardal
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Célia Costa
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Cíntia Cruz
- Immunology and Allergy Department, Centro Hospital de Setúbal, EPE, Setúbal, Portugal
| | - Cláudia Chaves Loureiro
- Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Portugal
- Centre of Pulmonology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cristina Lopes
- Immunology and Allergy Department, Hospital Pedro Hispano Unidade Local de Saúde Matosinhos, EPE, Matosinhos, Portugal
- Immunology Dpeartment, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Duarte Mesquita
- Novartis Farma-Produtos Farmacêuticos, S.A., Porto Salvo, Portugal
| | - Emília Faria
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eunice Magalhães
- Pulmonology Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Fernando Menezes
- Pulmonology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Filipa Todo-Bom
- Pulmonology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Francisca Carvalho
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Frederico S. Regateiro
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Helena Falcão
- Immunology and Allergy Department, Centro Hospitalar do Porto, EPE, Porto, Portugal
| | - Ivone Fernandes
- Pulmonology Department, Centro Hospital de Setúbal, EPE, Setúbal, Portugal
| | - João Gaspar-Marques
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Jorge Viana
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Immunology and Allergy Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - José Manuel Silva
- Pulmonology Department, Unidade Local de Saúde da Guarda, EPE, Guarda, Portugal
| | - Laura Simão
- Pulmonology Department, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, Portugal
| | - Leonor Almeida
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
| | - Lígia Fernandes
- Pulmonology Department, Hospital Distrital Figueira da Foz, EPE, Figueira da Foz, Portugal
| | | | - Mafalda van Zeller
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Pulmonology Department, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Márcia Quaresma
- Department of Pediatrics, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | | | - Natália André
- Pulmonology Department, Centro Hospitalar do Oeste, Torres Vedras, Portugal
| | - Nuno Cortesão
- Pulmonology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Paula Leiria-Pinto
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Paula Pinto
- Pulmonology Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
- ISAMB, Instituto de Saúde Ambiental Faculdade de Medicina de Lisboa. Lisboa, Portugal
| | - Paula Rosa
- Pulmonology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Pedro Carreiro-Martins
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Rita Gerardo
- Pulmonology Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
| | - Rui Silva
- Immunology and Allergy Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | - Susana Lucas
- Pulmonology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Teresa Almeida
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa Calvo
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
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Omalizumab for Severe Asthma: Beyond Allergic Asthma. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3254094. [PMID: 30310816 PMCID: PMC6166383 DOI: 10.1155/2018/3254094] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
Abstract
Different subsets of asthma patients may be recognized according to the exposure trigger and the frequency and severity of clinical signs and symptoms. Regarding the exposure trigger, generally asthma can be classified as allergic (or atopic) and nonallergic (or nonatopic). Allergic and nonallergic asthma are distinguished by the presence or absence of clinical allergic reaction and in vitro IgE response to specific aeroallergens. The mechanisms of allergic asthma have been extensively studied with major advances in the last two decades. Nonallergic asthma is characterized by its apparent independence from allergen exposure and sensitization and a higher degree of severity, but little is known regarding the underlying mechanisms. Clinically, allergic and nonallergic asthma are virtually indistinguishable in exacerbations, although exacerbation following allergen exposure is typical of allergic asthma. Although they both show several distinct clinical phenotypes and different biomarkers, there are no ideal biomarkers to stratify asthma phenotypes and guide therapy in clinical practice. Nevertheless, some biomarkers may be helpful to select subsets of atopic patients which might benefit from biologic agents, such as omalizumab. Patients with severe asthma, uncontrolled besides optimal treatment, notwithstanding nonatopic, may also benefit from omalizumab therapy, although currently there are no randomized double-blind placebo controlled clinical trials to support this suggestion. However, omalizumab discontinuation according to each patient's response to therapy and pharmacoeconomical analysis are questions that remain to be answered.
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Sá-Sousa A, Pereira AM, Almeida R, Araújo L, Couto M, Jacinto T, Freitas A, Bousquet J, Fonseca JA. Adult Asthma Scores-Development and Validation of Multivariable Scores to Identify Asthma in Surveys. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:183-190.e6. [PMID: 30031106 DOI: 10.1016/j.jaip.2018.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/11/2018] [Accepted: 06/30/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND One of the questions in epidemiology is the identification of adult asthma in studies. OBJECTIVE To develop and validate multivariable scores for adult asthma identification in epidemiological studies and to explore cutoffs to rule in/rule out asthma, compared with asthma diagnosed by a physician after clinical examination and diagnostic tests, blinded to the self-administered questions. METHODS We analyzed data (n = 711 adults) from a nationwide population-based study. The predictors were self-administered questions identified in a literature review (the Adult Asthma Epidemiological Score [A2 score]) and from the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire (the GA2LEN Asthma Epidemiological Score [GA2LEN score]). Scores were developed using exploratory factor analysis. Internal consistency, discriminative power, and diagnostic accuracy were assessed. RESULTS The A2 score comprises 8 questions (including "Did a physician confirm you had asthma?") and the GA2LEN score comprises 6 questions (including "Have you ever had asthma?"). Both had high Cronbach α (0.89 and 0.85, respectively, for the A2 score and the GA2LEN score) and good area under the receiver-operating characteristic curve (90.4% and 89.0%). The scoring is the sum of positive answers. Asthma is present (rule in) for scores of 4 or more (specificity, 99.2%; PPV, 93.3% and 91.7%; accuracy, 89.4% and 87.4%, respectively, for the A2 score and the GA2LEN score). Asthma is excluded (rule out) for A2 scores of 0 to 1 and a GA2LEN score of 0 (sensitivity, 93.1%; NPV, 98.2% and 98.0%; accuracy 89.4% and 82.8%, respectively, for the A2 score and the GA2LEN score). CONCLUSIONS These practical scores can be used to rule in/rule out asthma in epidemiological studies and clinical screening/triage settings. They may help physicians in primary care or other specialties to screen patients with asthma using a simple score with a high level of discrimination and to identify the best candidates to be referred for a diagnostic workup. Moreover, their use may contribute to reducing the inconsistencies of operational definitions of asthma across studies and surveys.
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Affiliation(s)
- Ana Sá-Sousa
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Margarida Pereira
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Luís Araújo
- MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal; Immunology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Mariana Couto
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Tiago Jacinto
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Department of Cardiovascular and Respiratory Sciences, Escola Superior de Saúde, Politécnico do Porto, Porto, Portugal
| | - Alberto Freitas
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Jean Bousquet
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - João A Fonseca
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal.
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Sá A, Peleteiro B. The effect of chronic disease family history on the adoption of healthier lifestyles. Int J Health Plann Manage 2018; 33:e906-e917. [PMID: 29968422 DOI: 10.1002/hpm.2561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/27/2022] Open
Abstract
AIM To determine the influence of family history (FH) and personal history (PH) of chronic disease (CD) in the adoption of healthy lifestyles. METHODS This cross-sectional study was based on the EPIPorto cohort (n = 1588). Participants were grouped taking into account FH and PH of CD, such as diabetes, myocardial infarction, stroke, asthma, and cancer, and if at least one of the first-degree relatives had died from the CD. Age-, sex-, and education-adjusted odds ratios and corresponding 95% confidence intervals were computed using multinomial logistic regression. RESULTS Subjects with PH and FH of CD were more likely to follow recommendations regarding salt intake but less likely regarding obesity measures. Overall, similar results were observed when repeating the analyses according to the type of CD, particularly in those with diabetes. CONCLUSIONS Recommendations towards healthier lifestyles are not followed by individuals with history of CD, at least in what concerns obesity measures. Our study suggests reducing obesity as a major target for interventions in these groups of individuals.
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Affiliation(s)
- Alexandre Sá
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - Bárbara Peleteiro
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina Universidade do Porto, Porto, Portugal
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Abreu L, Nunes JA, Taylor P, Silva S. The Role of Distributed Health Literacy in Asthma Integrated Care: A Public Medical Context from Portugal. Int J Integr Care 2018; 18:18. [PMID: 30127702 PMCID: PMC6095081 DOI: 10.5334/ijic.3301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/14/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Improvements in asthma integrated care might be achieved through in-depth knowledge about how health literacy is dispersed through a group. This study intends to map out health literacy mediators (those who makes his/her literacy skills available to others for them to accomplish specific literacy purposes) and how they enable self-management skills in patients with asthma. METHODS Twenty interviews were conducted in a Primary Care Center of Porto using the McGill Illness Narrative Interview. Data were thematically analyzed as case-based and process-tracing-oriented. RESULTS Interviewees with a dense network of mediators revealed a low impact of asthma on their lives, dependence on primary care physician for instrumental support and dependence on family members to provide emotional/pragmatic support. Interviewees who relied on a restricted network of mediators (belonging to formal sources of health services and providing informational support) described episodes of crisis as disruptive and demonstrated a reactive approach to self-management skills. CONCLUSIONS The roles performed by core health mediators (health professionals, family/friends, media) in support of asthma management varied according to patients' narratives of minimization/disruption, connected to dense/restricted social networks. To clarify the boundaries of responsibility-shifting and to enrich support provided by formal sources of health services and peer education groups is needed.
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Affiliation(s)
- Liliana Abreu
- ISPUP-EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n˚ 135, 4050-600 Porto, PT
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, Porto, PT
- Faculdade de Medicina, Universidade do Porto, Porto, PT
| | - João Arriscado Nunes
- Center for Social Studies and School of Economics of the University of Coimbra, PT
| | - Peter Taylor
- Science, Technology and Values Program, University of Massachusetts, Boston, US
| | - Susana Silva
- ISPUP-EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n˚ 135, 4050-600 Porto, PT
- Faculdade de Medicina, Universidade do Porto, Porto, PT
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Fazlollahi MR, Najmi M, Fallahnezhad M, Sabetkish N, Kazemnejad A, Bidad K, Shokouhi Shoormasti R, Mahloujirad M, Pourpak Z, Moin M. The prevalence of asthma in Iranian adults: The first national survey and the most recent updates. CLINICAL RESPIRATORY JOURNAL 2018; 12:1872-1881. [PMID: 29227026 DOI: 10.1111/crj.12750] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The worldwide increase in the prevalence of asthma has made it a major public-health concern. We aimed to identify the prevalence of asthma and asthma symptoms in adults living in urban and rural areas of Iran as a populated country with about 80 millions of residents. METHODS This cross-sectional study was conducted to estimate the prevalence of asthma in adults between 20 and 44 years old in all provinces of Iran. Data were collected by personal interview via a standardized questionnaire [European Community Respiratory Health Survey (ECRHS)] between November 2015 and February 2016. RESULTS A total of 24 344 individuals were enrolled. The prevalence of asthma was 8.9% [95% confidence interval (CI): 8.5-9.3]. The most common asthma symptoms were wheezing (14.2%, n = 3465), nocturnal cough (13.3%, n = 3234) and chest tightness (11.3%, n = 2760). Additionally, the prevalence of current asthma (taking asthma medications or asthma attack) was estimated to be 4.7% (n = 1155). Asthma was significantly more prevalent in males compared to females (P = .002), while no significant relationship was detected between gender and asthma after adjusted analysis with other variables. The prevalence of asthma was significantly higher in older participants (P < .001) and individuals with low educational level (P < .001). Interestingly, there was no significant relationship between asthma and area of residency (P = .8). CONCLUSIONS The prevalence of asthma in Iran was similar to other Asian and European countries. However, repeated national surveys are required to determine the trend of asthma prevalence in Iran in comparison to other countries.
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Affiliation(s)
- Mohammad Reza Fazlollahi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Najmi
- Center of Non-communicable Diseases Management, Deputy for health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mojtaba Fallahnezhad
- Razi Science Researchers Institute, Tehran, Iran.,Health Department of Zanjan University of Medical Sciences, Zanjan, Iran
| | - Nastaran Sabetkish
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Katayoon Bidad
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Mahloujirad
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Pourpak
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Moin
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Barbosa JP, Ferreira-Magalhães M, Sá-Sousa A, Azevedo LF, Fonseca JA. Cost of asthma in Portuguese adults: A population-based, cost-of-illness study. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:323-330. [PMID: 28807558 DOI: 10.1016/j.rppnen.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/01/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Asthma is one of the most frequent chronic diseases, putting a considerable economic burden on societies and individuals. We aimed to estimate the total cost of adult asthma in Portugal, as well as the extent to which direct and indirect costs are influenced by the level of asthma control. METHODS A nationwide, prevalence-based, cost-of-illness study using a bottom-up approach to calculate direct and indirect costs of asthma was conducted, using participant data from the Portuguese National Asthma Survey (INAsma). Direct (healthcare service usage, diagnostic tests and treatment) and indirect (absenteeism and transportation) costs were measured. Decision analytic modelling was used to perform multivariate deterministic sensitivity analysis. RESULTS On average, each adult costs 708.16€ (95%CI: 594.62-839.30) a year, with direct costs representing 93% (658.46€; 95%CI: 548.99-791.29) and indirect costs representing 7% (49.70€; 95%CI: 32.08-71.56). This amounts to a grand total of 386,197,211.25€ (95%CI: 324,279,674.31-457,716,500.18), with direct costs being 359,093,559.82€ (95%CI: 299,391,930.03-431,533,081.07). Asthma direct costs are 2.04% of the total Portuguese healthcare expense in 2010. The major cost domains were acute care usage (30.7%) and treatment (37.4%). Asthma control was significantly associated with higher costs throughout several domains, most notably in acute medical care. CONCLUSIONS Asthma in adults poses a significant economic burden on the Portuguese healthcare system, accounting for over 2% of the total healthcare expenditure in Portugal in 2010. It is important to note that a considerable portion of this burden might be eased by improving asthma control in patients, as uncontrolled patients' costs are more than double those of controlled asthma patients.
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Affiliation(s)
- J P Barbosa
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal.
| | - M Ferreira-Magalhães
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar de São João, Porto, Portugal
| | - A Sá-Sousa
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - L F Azevedo
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - J A Fonseca
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Serious fungal infections in Portugal. Eur J Clin Microbiol Infect Dis 2017; 36:1345-1352. [PMID: 28188492 DOI: 10.1007/s10096-017-2930-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 12/27/2022]
Abstract
There is a lack of knowledge on the epidemiology of fungal infections worldwide because there are no reporting obligations. The aim of this study was to estimate the burden of fungal disease in Portugal as part of a global fungal burden project. Most published epidemiology papers reporting fungal infection rates from Portugal were identified. Where no data existed, specific populations at risk and fungal infection frequencies in those populations were used in order to estimate national incidence or prevalence, depending on the condition. An estimated 1,510,391 persons develop a skin or nail fungal infection each year. The second most common fungal infection in Portugal is recurrent vulvovaginal candidiasis, with an estimated 150,700 women (15-50 years of age) suffering from it every year. In human immunodeficiency virus (HIV)-infected people, oral or oesophageal candidiasis rates were estimated to be 19.5 and 16.8/100,000, respectively. Candidaemia affects 2.19/100,000 patients, in a total of 231 cases nationally. Invasive aspergillosis is less common than in other countries as chronic obstructive pulmonary disease (COPD) is uncommon in Portugal, a total of 240 cases annually. The estimated prevalence of chronic pulmonary aspergillosis after tuberculosis (TB) is 194 cases, whereas its prevalence for all underlying pulmonary conditions was 776 patients. Asthma is common (10% in adults) and we estimate 16,614 and 12,600 people with severe asthma with fungal sensitisation and allergic bronchopulmonary aspergillosis, respectively. Sixty-five patients develop Pneumocystis pneumonia in acquired immune deficiency syndrome (AIDS) and 13 develop cryptococcosis. Overall, we estimate a total number of 1,695,514 fungal infections starting each year in Portugal.
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Remelhe M, Teixeira PM, Lopes I, Silva L, Correia de Sousa J. The modified patient enablement instrument: a Portuguese cross-cultural adaptation, validity and reliability study. NPJ Prim Care Respir Med 2017; 27:16087. [PMID: 28079863 PMCID: PMC5228497 DOI: 10.1038/npjpcrm.2016.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/16/2022] Open
Abstract
Enabling patients with asthma to obtain the knowledge, confidence and skills they need in order to assume a major role in the management of their disease is cost effective. It should be an integral part of any plan for long-term control of asthma. The modified Patient Enablement Instrument (mPEI) is an easily administered questionnaire that was adapted in the United Kingdom to measure patient enablement in asthma, but its applicability in Portugal is not known. Validity and reliability of questionnaires should be tested before use in settings different from those of the original version. The purpose of this study was to test the applicability of the mPEI to Portuguese asthma patients after translation and cross-cultural adaptation, and to verify the structural validity, internal consistency and reproducibility of the instrument. The mPEI was translated to Portuguese and back translated to English. Its content validity was assessed by a debriefing interview with 10 asthma patients. The translated instrument was then administered to a random sample of 142 patients with persistent asthma. Structural validity and internal consistency were assessed. For reproducibility analysis, 86 patients completed the instrument again 7 days later. Item-scale correlations and exploratory factor analysis were used to assess structural validity. Cronbach’s alpha was used to test internal consistency, and the intra-class correlation coefficient was used for the analysis of reproducibility. All items of the Portuguese version of the mPEI were found to be equivalent to the original English version. There were strong item-scale correlations that confirmed construct validity, with a one component structure and good internal consistency (Cronbach’s alpha >0.8) as well as high test–retest reliability (ICC=0.85). The mPEI showed sound psychometric properties for the evaluation of enablement in patients with asthma making it a reliable instrument for use in research and clinical practice in Portugal. Further studies are needed to confirm its responsiveness.
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Affiliation(s)
- Mafalda Remelhe
- School of Health Sciences, University of Minho, Braga, Portugal
| | - Pedro M Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | | | - Luís Silva
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,Horizonte Family Health Unit, Porto, Portugal
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,Horizonte Family Health Unit, Porto, Portugal
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Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract 2017; 3:1. [PMID: 28078100 PMCID: PMC5219738 DOI: 10.1186/s40733-016-0029-3] [Citation(s) in RCA: 442] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 12/10/2016] [Indexed: 11/24/2022] Open
Abstract
In recent decades, both asthma prevalence and incidence have been increasing worldwide, not only due to the genetic background, but mainly because of the effect of a wide number of environmental and lifestyle risk factors. In many countries noncommunicable diseases, like asthma, are not yet considered a healthcare priority. This review will analyze and discuss disparities in asthma management in several countries and regions, such as access to healthcare human resources and medications, due to limited financial capacity to develop strategies to control and prevent this chronic disease. This review tries to explore the social and economic burden of asthma impact on society. Although asthma is generally accepted as a costly illness, the total costs to society (direct, indirect and intangible asthma costs) are difficult to estimate, mainly due to different disease definitions and characterizations but also to the use of different methodologies to assess the asthma socio-economic impact in different societies. The asthma costs are very variables from country to country, however we can estimate that a mean cost per patient per year, including all asthmatics (intermittent, mild, moderate and severe asthma) in Europe is $USD 1,900, which seems lower than USA, estimated mean $USD 3,100.
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Affiliation(s)
- Carlos Nunes
- Algarve Immunoallergy Center, Portimão, Portugal
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40
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Araújo D, Padrão E, Morais-Almeida M, Cardoso J, Pavão F, Leite RB, Caldas AC, Marques A. Asthma-chronic obstructive pulmonary disease overlap syndrome - Literature review and contributions towards a Portuguese consensus. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:90-99. [PMID: 28089081 DOI: 10.1016/j.rppnen.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/05/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Phenotypic overlap between the two main chronic airway pulmonary diseases, asthma and chronic obstructive pulmonary disease (COPD), has been the subject of debate for decades, and recently the nomenclature of asthma-COPD overlap syndrome (ACOS) was adopted for this condition. The definition of this entity in the literature is, however, very heterogeneous, it is therefore important to define how it applies to Portugal. METHODS A literature review of ACOS was made in a first phase resulting in the drawing up of a document that was later submitted for discussion among a panel of chronic lung diseases experts, resulting in reflexions about diagnosis, treatment and clinical guidance for ACOS patients. RESULTS There was a consensus among the experts that the diagnosis of ACOS should be considered in the concomitant presence of: clinical manifestations characteristic of both asthma and COPD, persistent airway obstruction (post-bronchodilator FEV1/FVC<0.7), positive response to bronchodilator test (increase in FEV1 of ≥200mL and ≥12% from baseline) and current or past history of smoking or biomass exposure. In reaching diagnosis, the presence of peripheral eosinophilia (>300eosinophils/μL or >5% of leukocytes) and previous history of atopy should also be considered. The recommended first line pharmacological treatment in these patients is the ICS/LABA association; if symptomatic control is not achieved or in case of clinical severity, triple therapy with ICS/LABA/LAMA may be used. An effective control of the exposure to risk factors, vaccination, respiratory rehabilitation and treatment of comorbidities is also important. CONCLUSIONS The creation of initial guidelines on ACOS, which can be applied in the Portuguese context, has an important role in the generation of a broad nationwide consensus. This will give, in the near future, a far better clinical, functional and epidemiological characterization of ACOS patients, with the ultimate goal of achieving better therapeutic guidance.
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Affiliation(s)
- D Araújo
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
| | - E Padrão
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - M Morais-Almeida
- Coordinator of Allergy Center of CUF Hospitals, Lisbon, Portugal
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal; Nova Medical School, Lisbon, Portugal
| | - F Pavão
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
| | - R B Leite
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Faculty of Health, Medicine and Life Sciences, Maastricht University, Portugal
| | - A C Caldas
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
| | - A Marques
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Araújo V, Teixeira PM, Yaphe J, Correia de Sousa J. The respiratory research agenda in primary care in Portugal: a Delphi study. BMC FAMILY PRACTICE 2016; 17:124. [PMID: 27580592 PMCID: PMC5006266 DOI: 10.1186/s12875-016-0512-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/13/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND A research agenda can help to stimulate and guide research. The International Primary Care Respiratory Group (IPCRG) published a Research Needs Statement (RNS) in 2010 in which 145 research questions were identified. In 2012, priorities for respiratory research were established, based on these questions. To date, there has been no statement on primary care respiratory research needs in Portugal. The aim of the study was to develop a national consensus on research priorities in respiratory diseases in primary care in Portugal and to assess the applicability of the priorities for respiratory research set by the IPCRG. METHOD We conducted a Delphi study by electronic mail with a panel of experts on respiratory disease from primary and secondary care in Portugal. In the first round, the research needs in respiratory disease in Portugal were identified. In the second round, 196 research questions in six disease areas, derived from the first round and from the IPCRG Respiratory needs statement, were prioritised on a five-point Likert-type scale. In the third round, the questions were prioritized again with feed-back provided on the median scores for each item in the second round. Consensus was considered to have been reached when 80 % of the participants gave a score of 4 or 5 out of five on a given item. RESULTS The 40 experts identified 121 respiratory research questions in Round 1 and expressed their views on 196 questions in Rounds 2 and 3. Twelve research questions (6 %) reached consensus. There were five questions in the asthma domain on early diagnosis, pulmonary function tests, the use of inhalers, and adherence to treatment. There were four questions in the chronic obstructive pulmonary disease domain on vaccinations, on routine monitoring and evaluation of treatment, on diagnosis, and on adherence to treatments. There was one question in the smoking domain on the effects of brief counselling. There were two questions on respiratory tract infections on the treatment of children and on the prescription of antibiotics. An additional 23 research questions (12 %) achieved consensus between 75 and 79 %. CONCLUSION The results reflect the Portuguese reality in response the international agenda for research on respiratory diseases published by the IPCRG. They can support the development of future respiratory disease research in Portugal.
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Affiliation(s)
- Vera Araújo
- School of Health Sciences, University of Minho, Braga, Portugal
| | - Pedro M. Teixeira
- ICVS/3B’s - PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - John Yaphe
- ICVS/3B’s - PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Jaime Correia de Sousa
- ICVS/3B’s - PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- Horizonte Family Health Unit, Matosinhos, Porto Portugal
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Morais-Almeida M, Pité H, Pereira AM, Ferreira-Magalhães M, Fonseca JA. Asthma prevalence in Portuguese preschool children: More scientific evidence…. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:362-364. [PMID: 27423375 DOI: 10.1016/j.rppnen.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- M Morais-Almeida
- Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal; CINTESIS, Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal.
| | - H Pité
- Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal; CEDOC, Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - A M Pereira
- CINTESIS, Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal; Allergy Unit, CUF Porto Institute & Hospital, Porto, Portugal
| | - M Ferreira-Magalhães
- CINTESIS, Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal; Paediatric Department, Centro Hospitalar de S. João, Porto, Portugal; Paediatric Department, Faculty of Medicine, Porto University, Porto, Portugal
| | - J A Fonseca
- CINTESIS, Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal; Allergy Unit, CUF Porto Institute & Hospital, Porto, Portugal
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Wang XD, Zheng M, Lou HF, Wang CS, Zhang Y, Bo MY, Ge SQ, Zhang N, Zhang L, Bachert C. An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011. Allergy 2016; 71:1170-80. [PMID: 26948849 PMCID: PMC5074323 DOI: 10.1111/all.12874] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prevalence of allergic rhinitis (AR) has increased worldwide in recent decades. This study was conducted to investigate the prevalence of self-reported AR and profiles of AR-related comorbidities in the adult population of China over time. METHODS This study surveyed residents of 18 major cities in mainland China. Telephone interviews were conducted with study participants after sampling target telephone numbers by random digit dialing. The questions asked during telephone interviews were based on those included in validated questionnaires and focused on topics regarding AR, nonallergic rhinitis (NAR), acute/chronic rhinosinusitis (ARS/CRS), asthma, and atopic dermatitis (AD). RESULTS During 2011, a total of 47 216 telephone interviews were conducted, and the overall response rate was 77.5%. When compared with the AR prevalence in 11 cities surveyed in 2005, there was a significant increase in self-reported adult AR in eight of those cities (P < 0.01). In 2011, the standardized prevalence of self-reported adult AR in the 18 cities was 17.6%. The concentration of SO2 was positively correlated with the prevalence of AR (r = 0.504, P = 0.033). A multiple regression model showed that the absolute change in household yearly income was significantly associated with the change in the prevalence of AR (R(2) = 0.68), after adjusting for PM10 , SO2 , NO2, temperature, and humidity. The overall prevalences of NAR, ARS, CRS, asthma, and AD in the general population were 16.4%, 5.4%, 2.1%, 5.8%, and 14%, respectively. CONCLUSION During a 6-year period, there was a significant increase in the prevalence of self-reported AR in the general Chinese adult population. The incidence of AR being accompanied by rhinosinusitis, asthma, or AD was significantly higher among individuals having self-reported AR compared with the general population.
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Affiliation(s)
- X D Wang
- Department of Otolaryngology - Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - M Zheng
- Department of Otolaryngology - Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - H F Lou
- Department of Otolaryngology - Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - C S Wang
- Department of Otolaryngology - Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Y Zhang
- Department of Otolaryngology - Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - M Y Bo
- Department of Otorhinolaryngology, The Affiliated Hospital of Logistics, University of Chinese People's Armed Police Forces, Tianjin, China
| | - S Q Ge
- Department of Epidemiology and Biostatistics, School of public health, Capital Medical University, Beijing, China
| | - N Zhang
- Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium
| | - L Zhang
- Department of Otolaryngology - Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - C Bachert
- Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium
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Ferreira-Magalhães M, Sá-Sousa A, Morais-Almeida M, Pité H, Azevedo LF, Azevedo MI, Bugalho-Almeida A, Fonseca JA. Asthma-like symptoms, diagnostic tests, and asthma medication use in children and adolescents: a population-based nationwide survey. J Asthma 2016; 53:269-76. [PMID: 26444577 DOI: 10.3109/02770903.2015.1095926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to estimate the prevalence of asthma-like symptoms, current asthma (CA), asthma diagnostic tests, and inhaled medication use in a nationwide pediatric population (<18 years). METHODS Pediatric-specific data from a cross-sectional, population-based telephone survey (INAsma study) in Portugal were analyzed. CA was defined as lifetime asthma and (1) wheezing, (2) waking with breathlessness, or (3) asthma attack in the previous 12 months, and/or (4) taking asthma medication at the time of the interview. RESULTS In total, 716 children were included. The prevalence of asthma-like symptoms was 39.4% [95% confidence interval (95% CI): 35.7-43.3]. The most common symptoms were waking with cough (30.9%) and wheezing (19.1%). The prevalence of CA was 8.4% (95% CI: 6.6-10.7). Among children with CA, 79.9% and 52.9% reported prior allergy testing and pulmonary function testing (PFT), respectively. Inhaled medication use in the previous 12 months was reported by 67.6% (reliever inhalers, 40.1%; controller inhalers, 41.5%). Those who only used inhaled reliever medications experienced more asthma attacks [odds ratio (OR): 2.69]. Significantly fewer children with CA living in rural areas than those living in urban areas had undergone PFT or used inhaled medication (OR: 0.06 for PFT, 0.20 for medication]. CONCLUSIONS The prevalence of CA in the Portuguese pediatric population was 8.4%. Only half of children with CA had ever undergone PFT; more than half did not use controller inhalers, and those who only used reliever inhalers reported more asthma attacks. These findings suggest that asthma management has been substandard, mainly in rural areas.
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Affiliation(s)
- Manuel Ferreira-Magalhães
- a Pediatric Department , Centro Hospitalar de S. João , Porto , Portugal .,b Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto University , Porto , Portugal .,c Pediatric Department , Faculty of Medicine, Porto University , Porto , Portugal
| | - Ana Sá-Sousa
- b Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto University , Porto , Portugal
| | - Mário Morais-Almeida
- d Allergy Centre, CUF Descobertas and CUF Infante Santo Hospital , Lisbon , Portugal .,e Sociedade Portuguesa de Alergologia e Imunologia Clínica , Lisbon , Portugal
| | - Helena Pité
- d Allergy Centre, CUF Descobertas and CUF Infante Santo Hospital , Lisbon , Portugal .,f CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa , Lisboa , Portugal
| | - Luis Filipe Azevedo
- b Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto University , Porto , Portugal .,g Health Information and Decision Sciences Department (CIDES), Faculty of Medicine, Porto University , Porto , Portugal , and
| | - Maria Inês Azevedo
- a Pediatric Department , Centro Hospitalar de S. João , Porto , Portugal .,c Pediatric Department , Faculty of Medicine, Porto University , Porto , Portugal
| | | | - João Almeida Fonseca
- b Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto University , Porto , Portugal .,g Health Information and Decision Sciences Department (CIDES), Faculty of Medicine, Porto University , Porto , Portugal , and.,h Allergy Unit, CUF Porto Institute & Hospital , Porto , Portugal
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Pereira AM, Morais-Almeida M, Santos N, Nunes C, Bousquet J, Fonseca JA. Severity of rhinitis and wheezing is strongly associated in preschoolers: A population-based study. Pediatr Allergy Immunol 2015; 26:618-27. [PMID: 26110374 DOI: 10.1111/pai.12430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND In preschool children, no study assessed the relation between wheezing and rhinitis severity. Our aims were to estimate the prevalence of current wheezing (CW) in preschoolers and to study the association between CW and current rhinitis (CR), considering its severity/persistency. METHODS This is a cross-sectional, nationwide, population-based study including a representative sample of 5003 Portuguese children aged 3-5 years. Data were collected by a face-to-face interview with caregivers using an adapted ISAAC questionnaire. CW was defined as presence of ≥1 wheezing episode in the previous 12 months. Rhinitis severity/persistency was classified according to Allergic Rhinitis and its Impact on Asthma. RESULTS Current wheezing prevalence was 24.5% [95% CI 23.3-25.7]; 9.4% of the participants had ≥4 wheezing episodes in the previous year. Children with CR had an odds ratio (OR) of 4.0 [95% CI 3.4-4.5] for CW; it was highest for children with moderate-severe persistent rhinitis (11.5 [95% CI 8.1-16.3]), even after adjusting for possible confounders. Wheezers with CR reported more wheezing treatment use (p = 0.024) than those without CR. There was a trend for a higher number of wheezing episodes with more persistent and severe nasal disease - 48.4% of children with moderate-severe persistent rhinitis had >4 wheezing episodes vs. 28.9% in moderate-severe intermittent, 20.0% in mild persistent, 10.8% in mild intermittent, and 3.6% in those without CR; p < 0.001. CONCLUSIONS Current wheezing was present in almost 25% of preschool children and was strongly associated with rhinitis, especially moderate-severe persistent disease. Preschoolers with both CW and rhinitis seem to have a more severe phenotype, emphasizing the need for concurrent evaluation of nasal and bronchial symptoms even in small children.
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Affiliation(s)
- Ana Margarida Pereira
- Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.,Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,Allergy Unit, CUF-Porto Hospital & Institute, Porto, Portugal
| | - Mário Morais-Almeida
- Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.,Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal
| | - Natacha Santos
- Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.,Allergy and Clinical Immunology Department, Centro Hospitalar S. João E.P.E., Porto, Portugal
| | - Carlos Nunes
- Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal.,Algarve Immunoallergy Center, Portimão, Portugal
| | - Jean Bousquet
- Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France
| | - João Almeida Fonseca
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,Allergy Unit, CUF-Porto Hospital & Institute, Porto, Portugal.,Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal.,CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal
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Ferreira-Magalhães M, Pereira AM, Sa-Sousa A, Morais-Almeida M, Azevedo I, Azevedo LF, Fonseca JA. Asthma control in children is associated with nasal symptoms, obesity, and health insurance: a nationwide survey. Pediatr Allergy Immunol 2015; 26:466-73. [PMID: 25939454 DOI: 10.1111/pai.12395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to estimate the prevalence of asthma control and determinants of poor control in the Portuguese pediatric population (<18 years); secondarily, we described asthma-related healthcare services and medication use. METHODS Data of 98 children with current asthma, from the second phase of a nationwide population-based telephone survey (INAsma study), were analyzed. Asthma control definition was based on GINA criteria, grouping partially controlled and uncontrolled asthma as 'not-controlled asthma' (NCA). We used multivariate logistic regression to study factors associated with NCA and with unscheduled medical visits for asthma. RESULTS About half of the children had NCA (49%, 95% CI 39-59%). In the multivariate model, risk factors for NCA were as follows: substantial nasal symptoms (a OR 6.80), overweight/obesity (a OR 3.44), and not having health insurance (a OR 3.78). All the children with NCA had nasal symptoms, and the lack of asthma control was also associated with the increasing number of nasal symptoms (p < 0.001). In the previous year, 90% (95% CI 84-96%) of children with current asthma had healthcare visits and 67% (95% CI 58-77%) used medication for asthma. The risk of unscheduled medical visits was higher in children with nasal symptoms (a OR 3.63) and in those without health insurance (a OR 2.79), and lower in adolescents (a OR 0.19). CONCLUSIONS Half of the children with asthma were poorly controlled. Nasal symptoms and obesity are important determinants of asthma control. Children without health insurance are at greater risk of poor asthma outcomes; this association is reported for the first time in a European country.
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Affiliation(s)
- Manuel Ferreira-Magalhães
- Department of Pediatrics, Centro Hospitalar de S. João, Porto, Portugal.,CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Pediatrics - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, CUF Institute & Hospital, Porto, Portugal
| | - Ana Sa-Sousa
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mário Morais-Almeida
- Allergy and Clinical Immunology Division Unit, CUF Descobertas and CUF Infante Santo Hospital, Lisbon, Portugal.,Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal
| | - Inês Azevedo
- Department of Pediatrics, Centro Hospitalar de S. João, Porto, Portugal.,Department of Pediatrics - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal
| | - João Almeida Fonseca
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, CUF Institute & Hospital, Porto, Portugal.,Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal
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Ferreira-Magalhães M, Sá-Sousa A, Morais-Almeida M, Azevedo LF, Azevedo I, Pereira AM, Fonseca JA. High prevalence of hospitalisation for asthma in a population-based paediatric sample. Arch Dis Child 2015; 100:507-8. [PMID: 25568081 DOI: 10.1136/archdischild-2014-307675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/04/2022]
Affiliation(s)
- Manuel Ferreira-Magalhães
- Paediatric Department, Centro Hospitalar de S. João, Porto, Portugal CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal Paediatric Department-Faculty of Medicine, Porto University, Porto, Portugal
| | - Ana Sá-Sousa
- CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal
| | - Mário Morais-Almeida
- Allergy and Clinical Immunology Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Luís Filipe Azevedo
- CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal Health Information and Decision Sciences Department-Faculty of Medicine, Porto University, Porto, Portugal
| | - Inês Azevedo
- Paediatric Department, Centro Hospitalar de S. João, Porto, Portugal Paediatric Department-Faculty of Medicine, Porto University, Porto, Portugal
| | - Ana Margarida Pereira
- CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal Allergy Unit, Instituto & Hospital CUF, Porto, Portugal
| | - João Almeida Fonseca
- CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal Health Information and Decision Sciences Department-Faculty of Medicine, Porto University, Porto, Portugal Allergy Unit, Instituto & Hospital CUF, Porto, Portugal
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Sá-Sousa A, Amaral R, Morais-Almeida M, Araújo L, Azevedo LF, Bugalho-Almeida A, Bousquet J, Fonseca JA. Asthma control in the Portuguese National Asthma Survey. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:209-13. [PMID: 25926249 DOI: 10.1016/j.rppnen.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We aimed (1) to measure asthma control using a structure-questionnaire and patient self-perception of asthma-control in the Portuguese National Asthma Survey (INAsma) and (2) to study the relationship between asthma control and asthma-related quality of life. METHODS We analyze data of asthma patients from a cross-sectional, nationwide telephone interview study - INAsma. Controlled asthma was defined as CARAT global score >24 or CARAT lower airways score ≥16. Mini-AQLQ was used to measure quality of life. RESULTS Two hundred and seven (56.9% [95%CI: 51.8-62.0]) of the 364 patients had controlled asthma. Most patients with non-controlled asthma (88%) perceived their disease as controlled. Patients with controlled asthma presented higher mini-AQLQ scores (median, P25-P75; 6.6, 6.0-6.9) than those with non-controlled asthma (4.9, 3.7-5.7) (p<0.001) and a significant positive correlation between CARAT and mini-AQLQ scores was observed (r=0.706; p<0.001). CONCLUSION More than half of the Portuguese patients presented controlled asthma and showed significantly better asthma-related quality of life. Almost 9 out of 10 patients with non-controlled disease have poor perception of their asthma control, which may hinder them from seeking better asthma control.
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Affiliation(s)
- A Sá-Sousa
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal
| | - R Amaral
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal
| | - M Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal
| | - L Araújo
- Immunology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
| | - L F Azevedo
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - A Bugalho-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal; Comissão de Acompanhamento do Programa Nacional de Controlo da Asma, Lisbon, Portugal
| | - J Bousquet
- Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire Montpellier, Montpellier, France; Centre de recherche en Epidémiologie et Santé des Populations - CESP Inserm U1018, Villejuif, France
| | - J A Fonseca
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal.
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Pereira Barbosa M, Bugalho de Almeida A, Pereira C, Chen CW, Georgiou P, Peachey G. Real-life efficacy and safety of omalizumab in Portuguese patients with persistent uncontrolled asthma. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:151-6. [PMID: 25926246 DOI: 10.1016/j.rppnen.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/23/2014] [Accepted: 07/19/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The real life effectiveness, safety and the use of omalizumab for Portuguese patients with uncontrolled persistent allergic asthma are not sufficiently well known. The objective of this report was to make an evaluation, in a post-marketing, non-interventional, observational registry, of the Portuguese population included in the eXpeRience study. METHODS The methods used in this report are the same as the global eXpeRience ones, applied to a Portuguese sub-population. Patients with uncontrolled allergic asthma who had started omalizumab within the previous 15 weeks were enrolled and received omalizumab add-on therapy for 24 months. The physicians' global evaluation of treatment effectiveness (GETE), asthma symptoms and control (ACT score), quality of life (mini-AQLQ score), exacerbations, and serious adverse events (SAE) were reported. RESULTS Of the 943 patients recruited in the eXpeRience registry, 62 patients were from Portugal. 62.1% of them were observed to be responders with good/excellent GETE assessment at Week 16. Clinically meaningful improvements in asthma control (ACT score) and quality of life (mini-AQLQ score) were observed with omalizumab therapy at Months 12 (mean change: +7.7 [n=35]; +2.1 [n=20], respectively) and 24 (mean change: +7.0 [n=26]; +2.7 [n=13], respectively). Asthma symptoms and rescue medication usage were reduced to ≤1 day/week at Month 24 from a baseline of ≥3.5 days/week. The proportion of patients with no clinically significant exacerbations increased from 6.5% during pre-treatment (n=62) to 50% at Month 12 (n=54) and 60% at Month 24 (n=45). CONCLUSION The findings from the Portugal subpopulation of eXpeRience registry confirm that omalizumab add-on therapy is efficacious and well tolerated in the management of uncontrolled persistent allergic asthma. Another pertinent issue is the fact that the Portuguese subpopulation response is similar to the international population average of the study.
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Affiliation(s)
- M Pereira Barbosa
- Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - A Bugalho de Almeida
- Clínica Universitária de Pneumologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - C Pereira
- Novartis Farma - Produtos Farmaceuticos S.A., Avenida Professor Doutor Cavaco Silva, n.° 10E, Taguspark, 2740-255 Porto Salvo, Portugal.
| | - C-W Chen
- Novartis Pharmaceuticals Corporation, One Health Plaza East Hanover, NJ 07936-1080, USA
| | - P Georgiou
- Novartis Pharmaceuticals UK Limited, Wimblehurst Road Horsham, West Sussex RH12 5AB, UK
| | - G Peachey
- Novartis Pharmaceuticals UK Limited, Wimblehurst Road Horsham, West Sussex RH12 5AB, UK
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Cantarelli P, Debin M, Turbelin C, Poletto C, Blanchon T, Falchi A, Hanslik T, Bonmarin I, Levy-Bruhl D, Micheletti A, Paolotti D, Vespignani A, Edmunds J, Eames K, Smallenburg R, Koppeschaar C, Franco AO, Faustino V, Carnahan A, Rehn M, Colizza V. The representativeness of a European multi-center network for influenza-like-illness participatory surveillance. BMC Public Health 2014; 14:984. [PMID: 25240865 PMCID: PMC4192744 DOI: 10.1186/1471-2458-14-984] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/11/2014] [Indexed: 11/24/2022] Open
Abstract
Background The Internet is becoming more commonly used as a tool for disease surveillance. Similarly to other surveillance systems and to studies using online data collection, Internet-based surveillance will have biases in participation, affecting the generalizability of the results. Here we quantify the participation biases of Influenzanet, an ongoing European-wide network of Internet-based participatory surveillance systems for influenza-like-illness. Methods In 2011/2012 Influenzanet launched a standardized common framework for data collection applied to seven European countries. Influenzanet participants were compared to the general population of the participating countries to assess the representativeness of the sample in terms of a set of demographic, geographic, socio-economic and health indicators. Results More than 30,000 European residents registered to the system in the 2011/2012 season, and a subset of 25,481 participants were selected for this study. All age classes (10 years brackets) were represented in the cohort, including under 10 and over 70 years old. The Influenzanet population was not representative of the general population in terms of age distribution, underrepresenting the youngest and oldest age classes. The gender imbalance differed between countries. A counterbalance between gender-specific information-seeking behavior (more prominent in women) and Internet usage (with higher rates in male populations) may be at the origin of this difference. Once adjusted by demographic indicators, a similar propensity to commute was observed for each country, and the same top three transportation modes were used for six countries out of seven. Smokers were underrepresented in the majority of countries, as were individuals with diabetes; the representativeness of asthma prevalence and vaccination coverage for 65+ individuals in two successive seasons (2010/2011 and 2011/2012) varied between countries. Conclusions Existing demographic and national datasets allowed the quantification of the participation biases of a large cohort for influenza-like-illness surveillance in the general population. Significant differences were found between Influenzanet participants and the general population. The quantified biases need to be taken into account in the analysis of Influenzanet epidemiological studies and provide indications on populations groups that should be targeted in recruitment efforts. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-984) contains supplementary material, which is available to authorized users.
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Affiliation(s)
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- INSERM, UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 27 rue Chaligny, 75012 Paris, France.
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