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Antila MA, Souza-Machado A, Gregório MG, Cruz ÁA, Angelini L, Beekman MJHI, Zonzin GA, Rabahi MF. Overprescription of short-acting β2 agonists: reflections from the SABINA study in Brazil. J Bras Pneumol 2024; 50:e20230174. [PMID: 38422337 PMCID: PMC11095926 DOI: 10.36416/1806-3756/e20230174] [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: 03/30/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To assess prescription patterns for short-acting b2 agonists (SABAs) and other asthma medications in asthma patients treated by specialists and participating in the SABA use IN Asthma (SABINA) study in Brazil. METHODS This was an observational, cross-sectional study conducted at five sites in different regions of Brazil. The primary endpoints were to record SABA prescriptions and obtain data on over-the-counter (OTC) SABA purchases at the pharmacy. RESULTS Data on 218 asthma patients were analyzed. Of those 218 patients, 80.3% were prescribed SABAs in addition to their maintenance therapy, with a mean of 11.2 SABA canisters in the previous 12 months. Of those patients, 71.4% were prescribed ≥ 3 canisters and 42.2% were prescribed ≥ 10 canisters. None of the patients were prescribed SABA monotherapy. A total of 14.2% of the patients reported purchasing SABAs OTC at a pharmacy without a prescription. Of those, 48.4% purchased ≥ 3 SABA canisters. A fixed-dose combination of an inhaled corticosteroid and a long-acting b2 agonist was prescribed to 95.0% of the patients. In the year before the study visit, 45.0% of the patients received at least one course of oral corticosteroid burst treatment. Asthma was well controlled in 43.1% of the patients, partly controlled in 34.9%, and uncontrolled in 22.0%. Patients reported a mean of 1.1 severe asthma exacerbations, with 49.1% experiencing 1 or more severe exacerbations. CONCLUSIONS Overprescription and OTC purchases of SABAs are common in Brazil, possibly leading to the need for courses of oral corticosteroids. The health care community should collaborate to implement evidence-based recommendations and promote health education to improve asthma management in Brazil.
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Affiliation(s)
| | - Adelmir Souza-Machado
- . Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador (BA) Brasil
- . Fundação ProAR, Brasil
| | | | - Álvaro A Cruz
- . Fundação ProAR, Brasil
- . Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil
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Santana CVN, Pimentel Pinheiro G, Lima GS, Fernandes JS, Cruz ÁA. Another case of preventable death from asthma. J Asthma 2023; 60:2248-2251. [PMID: 37417790 DOI: 10.1080/02770903.2023.2234981] [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: 04/13/2023] [Accepted: 07/05/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Asthma prevalence is 262 million globally, with more than 1,000 deaths each day, most of them preventable. We were performing a longitudinal study, in Brazil, with the objective to following up patients who had a severe asthma attack and attended an emergency room (ATTACK Study). Here we present a case of a 28-year-old woman presenting what was considered moderate asthma, enrolled in ATTACK, who subsequently died of asthma. CASE STUDY The patient was initially evaluated at an emergency room (ER) with uncontrolled asthma and no regular treatment. She had an asthma diagnosis just before this visit to the ER, despite presenting symptoms of asthma since childhood. She was subsequently evaluated by a specialist, who prescribed a treatment with regular inhaled corticosteroid and an inhaled bronchodilator, if necessary. The patient was systematically monitored by telephone for six months. RESULTS The patient did not adhere to the treatment, in spite of repeated warnings, and 6 months later had an asthma attack resulting in her death. CONCLUSION It is important to prioritize asthma in primary health care, including building capacity health care professionals for early diagnosis, asthma management, and to educate patients with asthma patients for the identification of worsening and signs of severity, to manage the exacerbations according to a written asthma plan. This may reduce the number of premature and preventable asthma deaths.
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Affiliation(s)
| | - Gabriela Pimentel Pinheiro
- ProAR Foundation, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | | | - Jamille Souza Fernandes
- ProAR Foundation, Salvador, Brazil
- Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
| | - Álvaro A Cruz
- ProAR Foundation, Salvador, Brazil
- Universidade Federal da Bahia, Salvador, Brazil
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Maspero JF, Cruz AA, Beltran CFP, Ali Munive A, Montero-Arias F, Hernandez Pliego R, Farouk H. The use of systemic corticosteroids in asthma management in Latin American countries. World Allergy Organ J 2023; 16:100760. [PMID: 37179538 PMCID: PMC10172569 DOI: 10.1016/j.waojou.2023.100760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/17/2023] [Accepted: 03/05/2023] [Indexed: 04/05/2023] Open
Abstract
The stepwise treatment approach recommended by the Global Initiative for Asthma (GINA) includes systemic corticosteroids (SCS) suggested as a final step if asthma is severe and/or difficult to treat. Yet, despite the effectiveness of SCS, they are also associated with potentially irreversible adverse outcomes such as type 2 diabetes, adrenal suppression, and cardiovascular disease. Based on recent data indicating that the risk of developing these conditions can increase after as few as 4 short-term (burst) courses of SCS, even patients with mild asthma who receive SCS occasionally for exacerbations are also at risk of these events. As a result, recent updates by GINA and the Latin American Thoracic Society recommend decreasing SCS use by optimizing administration of non-SCS therapies and/or increasing the use of alternatives, such as biologic agents. Recent and ongoing studies characterizing treatment patterns among patients with asthma have revealed alarming trends suggesting the widespread overuse of SCS around the world. In Latin America, asthma prevalence is approximately 17%, and data suggest that the majority of patients have uncontrolled disease. In this review, we summarize currently available data on asthma treatment patterns in Latin America, which indicate that SCS are prescribed to 20-40% of patients with asthma considered to be well controlled and over 50% of patients with uncontrolled disease. We also offer potential strategies to help reduce SCS use for asthma in everyday clinical practice.
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Affiliation(s)
- Jorge F. Maspero
- Fundación Cidea Allergy and Respiratory Research Unit, Buenos Aires, Argentina
- Corresponding author. Allergy and Respiratory Medicine, Fundacion Cidea Paraguay 2035, 3º Cuerpo 2º Subsuelo C1121ABE, Ciudad Aut. de Buenos Aires, Argentina
| | - Alvaro A. Cruz
- Fundação ProAR and Federal University of Bahia, Bahia, Brazil
| | | | | | | | | | - Hisham Farouk
- Respiratory and Immunology, International Region, AstraZeneca, United Arab Emirates
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Nascimento OA, Cançado JED, Gazzotti MR, dos Santos FM, Saturnino LTM, da Silva DO, Gomes ALBB, Viana KP, Alfonso-Cristancho R, Rodrigues CS. The economic impact of asthma on private healthcare system in Brazil: Economic impact of asthma in Brazil. Medicine (Baltimore) 2023; 102:e33077. [PMID: 36961140 PMCID: PMC10036068 DOI: 10.1097/md.0000000000033077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/02/2023] [Indexed: 03/25/2023] Open
Abstract
To assess healthcare resource utilization and costs of patients with asthma in Brazilian Supplementary Healthcare System, focusing on hospitalization data. Retrospective cohort study, using data from an administrative database of a private company (Orizon). Patients aged ≥ 12 years with at least one record of emergency visit/hospitalization in the database with the ICD-10 J45 between January/2010 and June/2015 were included and followed until June/2016, death or inactivation of health plan. Sociodemographic characteristics, emergency visit and hospital admission per patient per year (exacerbation rate), physician visit with a procedure, exams, length of hospitalization (with/without intensive care unit (ICU)), and in-hospital treatments were assessed. A total of 54,568 patients were included in this analysis. Regarding resource utilization, emergency visit and hospital admission rates of 0.34 and 0.04 per person-year were observed, respectively. Mean length of hospital stay were 8.82 (SD = 36.48), 5.24 (SD = 19.06) and 19.53 (63.89) days for hospitalizations in general, without and with ICU, respectively. An exacerbation rate of 0.36 per person year was observed with a mean cost per episode of 3178 Brazilian Real (BRL) (SD = 31,667). Mean cost related to emergency department visits was estimated at 293 BRL (SD = 328). Hospitalization costs were stratified by the need of ICU and values observed were of 9307 BRL (SD = 18,979) without ICU, and 75,252 BRL (SD = 174,248) with ICU need. Asthma exacerbations may cost ~75,000 BRL for an ICU-dependent event in the Supplementary Healthcare System. To improve disease control may reduce disease burden for both healthcare system and patients.
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Affiliation(s)
- Oliver A. Nascimento
- GlaxoSmithKline, Rio DE Janeiro, Brazil
- Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo – EPM/UNIFESP, São Paulo (SP), Brasil
- Faculdade de Medicina São Leopoldo Mandic, Campinas (SP), Brasil
| | | | - Mariana Rodrigues Gazzotti
- GlaxoSmithKline, Rio DE Janeiro, Brazil
- Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo – EPM/UNIFESP, São Paulo (SP), Brasil
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Adinkrah E, Najand B, Young-Brinn A. Parental Education and Adolescents' Asthma: The Role of Ethnicity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020267. [PMID: 36832395 PMCID: PMC9955909 DOI: 10.3390/children10020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
While high parental education is associated with better health, this association may be weaker for ethnic minority than for ethnic majority families. It is unknown whether the association between parental education and adolescents' asthma also varies by ethnicity. AIM To study the association between parental education and adolescents' asthma overall and by ethnicity. METHODS The current study used data from the Population Assessment of Tobacco and Health (PATH)-Adolescents study. All participants were 12 to 17-year-old non-smokers (n = 8652). The outcome of interest was adolescents' asthma. The predictor of interest was baseline parental education, the covariates were age, sex, and number of parents present at baseline, and the moderator was ethnicity. RESULTS According to logistic regression analyses, higher parental education was predictive of adolescents' asthma; however, this association was weaker for Latino than non-Latino adolescents (OR 1.771; CI 1.282-2.446). We did not find a significant difference in the effect of parental education on asthma of White and African American adolescents. Our stratified models also showed that higher parental education was associated with lower asthma for non-Latino but not for Latino adolescents. CONCLUSION The effect of high parental education on adolescents' asthma prevalence differs between Latino and non-Latino families, with Latino families showing weaker protective effects of parental education on adolescents' asthma. Future research should test the role of exposure to environmental pollutants, neighborhood quality, and prevalence of smoking in social network members as well as other contextual factors at home, in school, and in the neighborhood that may increase prevalence of asthma in Latino adolescents regardless of their parental education. Given that these potential causes are multi-level, potential causes of such disparities should be tested in future multi-level research.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
- Correspondence:
| | - Babak Najand
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Angela Young-Brinn
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
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da Luz Moreira A, de Campos Lobato LF, de Lima Moreira JP, Luiz RR, Elia C, Fiocchi C, de Souza HSP. Geosocial Features and Loss of Biodiversity Underlie Variable Rates of Inflammatory Bowel Disease in a Large Developing Country: A Population-Based Study. Inflamm Bowel Dis 2022; 28:1696-1708. [PMID: 35089325 DOI: 10.1093/ibd/izab346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The epidemiology of inflammatory bowel disease (IBD) in developing countries may uncover etiopathogenic factors. We investigated IBD prevalence in Brazil by investigating its geographic, spatial, and temporal distribution, and attempted to identify factors associated with its recent increase. METHODS A drug prescription database was queried longitudinally to identify patients and verify population distribution and density, race, urbanicity, sanitation, and Human Development Index. Prevalence was calculated using the number of IBD patients and the population estimated during the same decade. Data were matched to indices using linear regression analyses. RESULTS We identified 162 894 IBD patients, 59% with ulcerative colitis (UC) and 41% with Crohn's disease (CD). The overall prevalence of IBD was 80 per 100 000, with 46 per 100 000 for UC and 36 per 100 000 for CD. Estimated rates adjusted to total population showed that IBD more than triplicated from 2008 to 2017. The distribution of IBD demonstrated a South-to-North gradient that generally followed population apportionment. However, marked regional differences and disease clusters were identified that did not fit with conventionally accepted IBD epidemiological associations, revealing that the rise of IBD was variable. In some areas, loss of biodiversity was associated with high IBD prevalence. CONCLUSIONS When distribution is considered in the context of IBD prevalence, marked regional differences become evident. Despite a background of Westernization, hotspots of IBD are recognized that are not explained by population density, urbanicity, sanitation, or other indices but apparently are explained by biodiversity loss. Thus, the rise of IBD in developing countries is not uniform, but rather is one that varies depending on yet unexplored factors like geoecological conditions.
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Affiliation(s)
- Andre da Luz Moreira
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Ronir Raggio Luiz
- Institute of Collective Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Celeste Elia
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Claudio Fiocchi
- Department of Immunity & Inflammation, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heitor Siffert Pereira de Souza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Department of Clinical Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Asthma control, social jetlag, and sleep impairment in high school adolescents. Sleep Med 2022; 99:34-40. [DOI: 10.1016/j.sleep.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022]
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Nakamuta JS, Puglia ALP, Meireles P, Blanco DC, Lima MA, Birck MG, Braga MC, Oliveira RWD, Julian GS, Forestiero FJ. Asthma control in Brazil: a systematic review. J Asthma 2022; 60:868-880. [PMID: 35896311 DOI: 10.1080/02770903.2022.2107537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objectives: To explore asthma control in patients undergoing pharmacotherapy on studies in the last 20 years in Brazil. Asthma is a chronic airway inflammation disease with a high prevalence worldwide. Even with a variety of drug treatment improvements, attaining asthma control is challenging, since it should have a personalized approach. In Brazil, studies on the prevalence of asthma control are scarce and usually from a small sample size.Data Sources: A systematic review was performed to assess asthma control in Brazilian population. Terms related to "asthma", "asthma control" and "Brazil" were used in the search strategies in PubMed, BVSalud, Embase and Cochrane Library, including Brazilian Journal of Allergy and Immunology as data sources. A narrative synthesis was performed to report key outcome.Study Selections: In total, 23 studies were included. Most of them were conducted in the Southeastern and Northeast regions, in a short duration.Results: Pediatric and non-pediatric population were assessed, with a higher proportion of female. In pediatric population, those with poorly controlled asthma usually had severe or persistent disease. In elderly, an increased asthma severity was found, although proper treatment might be effective. Most studies (70%) also described exacerbations, hospitalizations (48%), quality of life (39%), and emergency visits (30%). Despite heterogeneity of outcomes and population, studies show an important prevalence of uncontrolled asthma even in patients being treated, with better disease control with treatment improvements.Conclusions: Studies in Brazil have shown that asthma control remains a challenge and there is still a need for improvement on disease management.
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Affiliation(s)
| | | | | | | | - Marina Andrade Lima
- Departamento de Pesquisas Clínicas, Hospital Dia do Pulmão, Blumenau, Brazil
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Leal LF, Tavares NUL, Borges RB, Mengue SS, Fagondes SC, Masarwa R, Pizzol TDSD. Prevalence of chronic respiratory diseases and medication use among children and adolescents in Brazil - a population based cross-sectional study. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-93042022000100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil),a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting β2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population.
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Gianfrancesco L, Malheiro APG, Matsunaga NY, Oliveira MS, Grotta MB, Morcillo AM, Ribeiro JD, Toro AADC. Are there differences in the physical activity level and functional capacity among children and adolescents with and without asthma? J Pediatr (Rio J) 2021; 97:295-301. [PMID: 32521233 PMCID: PMC9432013 DOI: 10.1016/j.jped.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the physical activity level, using two tools, and the functional capacity of children and adolescents with asthma and with different levels of disease control, and to compare them to those of individuals without asthma. METHODS Cross-sectional study with children and adolescents with (asthma group, AG) and without asthma (WAG), aged from 7 to 17 years. All participants performed the six-minute walk test (6MWT), the Glittre Activities of Daily Living test (Glittre-ADL), the International Physical Activity Questionnaire (IPAQ), and daily record of steps on a pedometer. RESULTS The study included 145 individuals with asthma and 173 individuals without asthma. The WAG walked a greater distance in the 6MWT and performed the Glittre-ADL in less time than the AG. Individuals with uncontrolled, partially controlled, and controlled asthma presented the same functional capacity. A difference was observed in the IPAQ classification, with 13.9% of participants from the WAG being sedentary, compared with 26.2% in the AG. The mean quantity of steps measured by the pedometer was higher in the WAG. CONCLUSION There was a difference in the performance of individuals with and without asthma in the physical activity and functional capacity tests. The AG presented worse performance in the physical activity tests and, regardless of the level of asthma control, presented worse functional capacity.
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Affiliation(s)
- Lívea Gianfrancesco
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Ana Paula Gaban Malheiro
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Natasha Yumi Matsunaga
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Marina Simões Oliveira
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Milena Baptistella Grotta
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - André Moreno Morcillo
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - José Dirceu Ribeiro
- Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - Adyléia Aparecida Dalbo Contrera Toro
- Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil.
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Fiuza BSD, Fonseca HF, Meirelles PM, Marques CR, da Silva TM, Figueiredo CA. Understanding Asthma and Allergies by the Lens of Biodiversity and Epigenetic Changes. Front Immunol 2021; 12:623737. [PMID: 33732246 PMCID: PMC7957070 DOI: 10.3389/fimmu.2021.623737] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Exposure to different organisms (bacteria, mold, virus, protozoan, helminths, among others) can induce epigenetic changes affecting the modulation of immune responses and consequently increasing the susceptibility to inflammatory diseases. Epigenomic regulatory features are highly affected during embryonic development and are responsible for the expression or repression of different genes associated with cell development and targeting/conducting immune responses. The well-known, "window of opportunity" that includes maternal and post-natal environmental exposures, which include maternal infections, microbiota, diet, drugs, and pollutant exposures are of fundamental importance to immune modulation and these events are almost always accompanied by epigenetic changes. Recently, it has been shown that these alterations could be involved in both risk and protection of allergic diseases through mechanisms, such as DNA methylation and histone modifications, which can enhance Th2 responses and maintain memory Th2 cells or decrease Treg cells differentiation. In addition, epigenetic changes may differ according to the microbial agent involved and may even influence different asthma or allergy phenotypes. In this review, we discuss how exposure to different organisms, including bacteria, viruses, and helminths can lead to epigenetic modulations and how this correlates with allergic diseases considering different genetic backgrounds of several ancestral populations.
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Affiliation(s)
| | | | - Pedro Milet Meirelles
- Instituto de Biologia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia em Estudos Interdisciplinares e Transdisciplinares em Ecologia e Evolução (IN-TREE), Salvador, Brazil
| | - Cintia Rodrigues Marques
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brazil
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Victo ERD, Ferrari G, Matsudo VKR, Pires CAM, Araújo TL, Katzmarzyk PT, Solé D. NUTRITIONAL STATUS, PHYSICAL ACTIVITY, SEDENTARY BEHAVIOR, DIET, AND LIFESTYLE IN CHILDHOOD: AN ANALYSIS OF RESPIRATORY DISEASES IN ADOLESCENCE. ACTA ACUST UNITED AC 2020; 39:e2020007. [PMID: 33263695 PMCID: PMC7695122 DOI: 10.1590/1984-0462/2021/39/2020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/14/2020] [Indexed: 11/21/2022]
Abstract
Objective: To evaluate the association between nutritional status, physical activity, sedentary behavior, diet, and lifestyle in childhood with respiratory diseases during adolescence. Methods: Prospective study conducted in São Caetano do Sul, São Paulo - Brazil, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). During childhood, indicators of lifestyle (body composition, physical activity, sedentary behavior, diet) and family environment were measured in 2012 and 2013. After five years, participants answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire for the diagnosis of respiratory diseases (asthma and/or rhinitis). Analyses were determined by logistic regression. Results: A total of 168 schoolchildren (56% boys) were evaluated, and the prevalence of asthma and rhinitis accounted for 15.5 and 25.6%, respectively. Whole milk consumption (Odds Ratio [OR]=1.24; 95% confidence interval [95%CI] 1.03-1.49), having a television in the bedroom (OR=0.29; 95%CI 0.12-0.71), and attending physical education classes ≥2 times/week (OR=0.30; 95%CI 0.11-0.81) in childhood were associated with the presence of asthma in adolescence. Factors significantly associated with rhinitis were as follows: female participants (OR=2.45; 95%CI 1.20-4.98) and whole milk consumption (OR=1.21; 95%CI 1.04-1.40). Conclusions: Higher consumption of whole milk, not having a television in the bedroom, few physical education classes, and being a girl were factors associated with respiratory diseases. Public policies should be directed toward a healthier lifestyle and the prevention of respiratory diseases.
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Affiliation(s)
- Eduardo Rossato de Victo
- Discipline of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Gerson Ferrari
- Laboratory of Sciences of Physical Activity, Sports and Health, Faculty of Medical Sciences, Universidad de Santiago de Chile, Santiago, Chile
| | | | - Carlos André Miranda Pires
- Center for research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, Universidade de Coimbra, Portugal
| | - Timóteo Leandro Araújo
- Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul, São Caetano do Sul, SP, Brazil
| | | | - Dirceu Solé
- Discipline of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Zacaron D, Roncada C, Molin RSD, Jones MH, Pitrez PC. Prevalence and impact of asthma in schoolchildren in the city of Caxias do Sul-RS. J Pediatr (Rio J) 2020; 96:479-486. [PMID: 30898494 PMCID: PMC9432107 DOI: 10.1016/j.jped.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the prevalence and impact of asthma in schoolchildren from the city of Caxias do Sul, RS, Brazil. METHODS Cross-sectional observational and case-control study with children and adolescents between 7 and 15 years old, from public schools in Caxias do Sul, RS. The study is composed of two phases: Phase I analyzed the prevalence of asthma in the delimited population, investigating 1915 schoolchildren; Phase II quality of life questionnaires, asthma control and classification (for the asthmatic group), physical activity, school performance, pulmonary function tests and anthropometric measures were applied to 266 asthmatics and 288 controls. RESULTS The estimated prevalence of asthma was 16.1%. In the comparison between asthmatics and nonasthmatics premature birth (p<0.001) and diagnosis of another chronic disease at birth (p<0.001) were found. Regarding pulmonary function, significant differences were found in the values between groups in FEV1, FEV1/FVC and forced expiratory flow in the 25 and 75% (FEF25-75%), being that asthmatics presented lower values. Among asthmatics, 133 (50.8%) did not have the disease controlled. In the anthropometric variables, significant differences were observed, with higher values in controls, in the the waist-to-height ratio (p=0.009) and in the perception of health (p<0.001). Quality of life is lower in asthmatics in the physical well-being domain (p=0.001) and in the total score (p=0.016). The total school performance score did not present a statistically significant difference between the groups. CONCLUSION The prevalence of asthma is similar to that of other industrialized urban centers and may negatively affect some areas of the development of schoolchildren.
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Affiliation(s)
- Daniel Zacaron
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Saúde da Criança, Porto Alegre, RS, Brazil; Centro Universitário da Serra Gaúcha (FSG), Educação Física, Caxias do Sul, RS, Brazil.
| | - Cristian Roncada
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Saúde da Criança, Porto Alegre, RS, Brazil; Centro Universitário da Serra Gaúcha (FSG), Grupo de Pesquisa e Estudo em Saúde e Performance (GEPESP), Caxias do Sul, RS, Brazil
| | - Rossano Sartori Dal Molin
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Saúde da Criança, Porto Alegre, RS, Brazil
| | - Marcus Herbert Jones
- Universidade Federal do Rio Grande do Sul (UFRGS), Pneumologia Pediátrica, Porto Alegre, RS, Brazil; Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, RS, Brazil
| | - Paulo Condessa Pitrez
- Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, RS, Brazil
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Zacaron D, Roncada C, Molin RSD, Jones MH, Pitrez PC. Prevalence and impact of asthma in schoolchildren in the city of Caxias do Sul‐RS. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Bezerra de Menezes M, Ponte EV, Bertagni Mingotti CF, Carvalho Pinto RM, Bagatin E, Bião Lima V, Vianna EO, Cruz ÁA. Provision of inhaled corticosteroids is associated with decrease in hospital admissions in Brazil: A longitudinal nationwide study. Respir Med 2020; 166:105950. [PMID: 32250873 DOI: 10.1016/j.rmed.2020.105950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe trends of hospital admissions due to asthma from 2008 to 2015 and to evaluate their relationship with trends of inhaled corticosteroids (ICS) provision by the government in Brazil. METHODS We used Brazilian Government data to calculate hospital admission rates due to asthma, number of physicians, number of hospital beds, number of subjects that received ICS per 100,000 inhabitants in Brazil and in each of its municipalities for each year of the study. We performed Poisson Multilevel Regression Analyses to evaluate the relationship between the trends of hospital admission rates due to asthma with the trends of the number of subjects that had been receiving ICS during the study period. The analyses were adjusted for the number of physicians and hospital beds. FINDINGS The number of patients who received ICS/100,000 inhabitants increased from 2008 to 2015 (943.9-1988.5). Hospital admissions/100,000 inhabitants decreased in patients aged 5-14 years (148.3-110.9) and in patients aged 15-39 years (59.9-32.3); the reduction was greater in municipalities in which ICS provision increased. The number of physicians/100,000 inhabitants increased and the number of hospital beds/100,000 inhabitants decreased in the study period. The increase in the number of physicians and in the number of subjects that received ICS were associated with reduction in hospital admissions. CONCLUSION We found that provision of ICS by the Brazilian Government was associated with a decrease of hospital admissions for asthma in the municipalities and country levels from 2008 to 2015.
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Affiliation(s)
| | | | | | | | - Ericson Bagatin
- Medical School of Jundiaí. State University of Campinas, Brazil.
| | | | - Elcio Oliveira Vianna
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
| | - Álvaro A Cruz
- ProAR - Faculdade de Medicina da Bahia, Federal University of Bahia, Brazil.
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Pizzichini MMM, Carvalho-Pinto RMD, Cançado JED, Rubin AS, Cerci Neto A, Cardoso AP, Cruz AA, Fernandes ALG, Blanco DC, Vianna EO, Cordeiro Junior G, Rizzo JA, Fritscher LG, Caetano LSB, Pereira LFF, Rabahi MF, Oliveira MAD, Lima MA, Almeida MBD, Stelmach R, Pitrez PM, Cukier A. 2020 Brazilian Thoracic Association recommendations for the management of asthma. J Bras Pneumol 2020; 46:e20190307. [PMID: 32130345 PMCID: PMC7462684 DOI: 10.1590/1806-3713/e20190307] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/07/2019] [Indexed: 02/06/2023] Open
Abstract
The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
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Affiliation(s)
| | - Regina Maria de Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Adalberto Sperb Rubin
- . Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS) Brasil
- . Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Alcindo Cerci Neto
- . Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
- . Pontifícia Universidade Católica do Paraná - PUCPR - Londrina (PR) Brasil
| | | | - Alvaro Augusto Cruz
- . Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
- . Fundação ProAR, Salvador (BA) Brasil
| | | | - Daniella Cavalet Blanco
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS), Brasil
| | - Elcio Oliveira Vianna
- . Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Gediel Cordeiro Junior
- . Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte (MG), Brasil
- . Hospital Júlia Kubitschek, Belo Horizonte (MG), Brasil
| | | | - Leandro Genehr Fritscher
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS), Brasil
| | | | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás - UFG - Goiânia (GO) Brasil
| | | | | | | | - Rafael Stelmach
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Alberto Cukier
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Roman R, Lima KM, Fontoura Moreira MA, Umpierre RN, Hauser L, Rados DV, Vigo A, Gonçalves MR, Mengue SS, Harzheim E. Distance Education to Improve the Quality of Asthma Treatment in Primary Health Care. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2019. [DOI: 10.5712/rbmfc14(41)2065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: The mere dissemination of standard care recommendations has been insufficient to improve clinical results in patients with asthma. The objective of the present study was to evaluate the clinical effectiveness of a multifaceted asthma distance education for primary care providers. Methods: Cluster randomized controlled trial. Full primary care teams were included if they had access to telehealth support and free basic asthma treatment. Before randomization, selected teams indicated asthma patients between 5-45 years old for inclusion. The intervention group received three interactive online sessions, printed educational material, reminders, booklet for patients, and frequent stimulus to use consulting services. The control group received no intervention. Symptomfree days per two weeks was the primary result. Controlled asthma, unscheduled asthma doctor visits, and preventive inhaled corticosteroid use were the secondary results. Six months after intervention, the results were compared with baseline data using generalized estimating equations for repeated measures and clustering effect. Results: Were enrolled 71 primary care teams and 443 individuals. Most patients (60.3%) were female, and 44% were younger than 12 years old. The attendance of interactive sessions by the teams was 50%. The odds ratio (OR) for additional symptom-free day was 1.31 (95%CI 0.61-2.82; p=0.49). For the secondary results, the results were: controlled asthma OR 1.29 (95%CI 0.89-1.87; p=0.18); unscheduled asthma doctor visits OR 0.81 (95%CI 0.60-1.10; p=0.17); and preventive inhaled corticosteroid use OR 1.02 (95%CI 0.71-1.47; p=0.91). Conclusions: Multifaceted distance education in asthma care for primary care providers was not effective to improve patients’ results. Telemedicine needs to deal with significant obstacles in professional education. ClinicalTrials.gov registry: NCT01595971.
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18
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Pastorino AC. RISK FACTORS FOR ASTHMA: THE CONTRIBUTION OF THE BRAZILIAN NATIONAL RESEARCH ON HEALTH OF SCHOOLCHILDREN. ACTA ACUST UNITED AC 2019; 37:396-397. [PMID: 31621788 PMCID: PMC6821477 DOI: 10.1590/1984-0462/;2019;37;4;00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 11/22/2022]
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19
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Elias BC, Silva JB, Mais LA, Warkentin S, Konstantyner T, Solé D. FACTORS ASSOCIATED WITH ASTHMA IN BRAZILIAN ADOLESCENTS: NATIONAL ADOLESCENT SCHOOL-BASED HEALTH SURVEY (PENSE-2012). ACTA ACUST UNITED AC 2019; 37:406-413. [PMID: 31340242 PMCID: PMC6821479 DOI: 10.1590/1984-0462/;2019;37;4;00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/27/2018] [Indexed: 11/30/2022]
Abstract
Objective: To identify factors associated with asthma in Brazilian adolescents. Methods: Cross-sectional study based on data from the 2012 National Adolescent
School-based Health Survey (PeNSE), a Brazilian survey applied by a
self-reported questionnaire in a representative sample of
9th-grade students. Descriptive and inferential analysis was made
based on the demographic, socioeconomic, clinical, food consumption and
environmental characteristics potentially associated with asthma.
Adolescents who presented wheezing in the last 12 months were considered
asthmatic. A multiple logistic regression model was adjusted for confounding
factors. Significance was defined as p≤0.05. Results: A total of 106,983 adolescents were studied. The prevalence of asthma was
23.2%. The final model was composed of 11 variables that were independently
associated with asthma: female sex (OR=1.17), <14 years old (OR=1.12),
not living with parents (OR=1.06), the highest number of days consuming
ultra-processed foods (OR=1.16), lunch or dinner time without presence of
parents or guardians (OR=1.13), meals in front of the TV or while studying
(OR=1.18), not having breakfast frequently (OR=1.22), having smoked
cigarettes (OR=1.36), having tried alcoholic beverage (OR=1.37), having used
illicit drugs (OR=1.29) and having sought health care in the last year
(OR=1.67). Conclusions: The results of the present study reinforce the multifactorial characteristic
of asthma diagnosis. Prevention and control strategies should focus on
groups of adolescents living in inadequate conditions when it comes to
family dynamics, food consumption and behavior (drug use).
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Affiliation(s)
| | | | | | | | | | - Dirceu Solé
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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20
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Marques GÁ, Wendt A, Wehrmeister FC. Temporal evolution of and factors associated with asthma and wheezing in schoolchildren in Brazil. J Bras Pneumol 2019; 45:e20180138. [PMID: 31271601 PMCID: PMC6715041 DOI: 10.1590/1806-3713/e20180138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/23/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the evolution of the prevalence of asthma and wheezing among schoolchildren in Brazil from 2012 to 2015, as well as to identify factors associated with both conditions. METHODS This was a cross-sectional study using data from the Brazilian National School-Based Adolescent Health Survey for 2012 and 2015. To characterize the evolution of the prevalence of asthma and wheezing, we used linear regression with weighted-least-squares estimation and presented the annual percent change (APC). RESULTS During the study period, there was a reduction in the prevalence of wheezing, from 23.2% in 2012 to 22.4% in 2015 (APC, -0.27). The prevalence of asthma increased from 12.4% in 2012 to 16.0% in 2015 (APC, 1.20). The increase in the prevalence of asthma was greatest in the southern region of the country (APC, 2.17). Having any history of smoking and having consumed alcohol in the last 30 days were factors that influenced the prevalence of wheezing and the prevalence of a self-reported diagnosis of asthma during the two years evaluated. CONCLUSIONS There has been an increase in the prevalence of asthma in recent years in Brazil. Our data underscore the importance of improving health strategies and policies aimed at the control of asthma.
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Affiliation(s)
- Gabriela Ávila Marques
- . Universidade Católica de Pelotas, Pelotas (RS) Brasil
- . Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas (RS) Brasil
| | - Andrea Wendt
- . Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas (RS) Brasil
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Silva MDJ, de Santana MBR, Tosta BR, Espinheira RP, Alcantara-Neves NM, Barreto ML, Figueiredo CA, Costa RDS. Variants in the IL17 pathway genes are associated with atopic asthma and atopy makers in a South American population. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2019; 15:28. [PMID: 31168303 PMCID: PMC6489266 DOI: 10.1186/s13223-019-0340-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/10/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Asthma is a complex disorder with multiple phenotypes which can influence its severity and response to treatment. The TH17 lymphocytes producing IL-17A and IL17-F cytokines, may have a role on asthma inflammation. The aim of our study was to evaluate the association between genetic variants in IL17 pathway genes with asthma and atopy markers. MATERIALS AND METHODS Genotyping was performed using a commercial panel in 1245 participants of SCAALA cohort. The study included 91 SNVs in IL-17 pathway genes. Logistic regressions for asthma and atopy markers were performed using PLINK 1.9. In silico analyses were performed using rSNPbase, RegulomeDB, and Gtex portal for in silico gene expression. RESULTS AND DISCUSSION The T allele of rs1974226 in IL17A was positively associated with asthma (OR: 1.37; 95% CI 1.02-1.82). Also, the T allele of rs279548 was positively associated with asthma (OR: 1.30; 95% CI 1.02-1.64), atopy (OR: 1.62; 95% CI 1.05-2.50) and increased expression of the IL17RC in lung and whole blood tissues. The others genetic variants in the IL17 pathways genes were associated with both protection and risk for asthma development as well as with IgE levels. CONCLUSION The genetic variants in IL-17-related genes are associated with the atopic asthma phenotype and IgE production.
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Affiliation(s)
- Milca de J. Silva
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Maria B. R. de Santana
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Bruna R. Tosta
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Roberta P. Espinheira
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Neuza Maria Alcantara-Neves
- Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | | | - Camila Alexandrina Figueiredo
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Ryan dos S. Costa
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia Brazil
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Santos FMD, Viana KP, Saturnino LT, Lazaridis E, Gazzotti MR, Stelmach R, Soares C. Trend of self-reported asthma prevalence in Brazil from 2003 to 2013 in adults and factors associated with prevalence. ACTA ACUST UNITED AC 2019; 44:491-497. [PMID: 30726325 PMCID: PMC6459747 DOI: 10.1590/s1806-37562017000000328] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 07/08/2018] [Indexed: 12/29/2022]
Abstract
Objectives: To determine the trend of self-reported asthma diagnosed prevalence and to describe the factors associated with asthma in Brazilian adults. Method: Epidemiological cross-sectional study based on databases analysis from three national household surveys: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 and Pesquisa Nacional de Saúde (PNS) 2013. Participants between 18-45 years old were included. Trend analysis of asthma diagnosed prevalence was conducted using a logistic general linear model. A hierarchical logistic regression model was used to select factors significantly associated with asthma prevalence. Results: Asthma diagnosed prevalence was 3.6% (2003), 3.7% (2008) and 4.5% (2013), showing a statistically significant increased trend. Asthma diagnosed prevalence also increased when analysed by gender (annual change for men: 2.47%, p < 0.003; women: 2.16%, p < 0.001), urban area (annual change for urban: 2.15%, p < 0.001; rural: 2.69%, p = 0.072), healthcare insurance status (annual change without healthcare insurance: 2.18%, p < 0.001; with healthcare insurance: 1.84%, p = 0.014), and geographic regions (annual change North: 4.68%, p < 0.001; Northeast: 4.14%, p < 0.001; and Southeast: 1.84%, p = 0.025). Female gender, obesity, living in urban areas and depression were associated with asthma diagnosed prevalence. Discussion: PNAD and PNS surveys allow for a very large, representative community-based sample of the Brazilian adults to investigate the asthma prevalence. From 2003 to 2013, the prevalence of self-reported physician diagnosis of asthma increased, especially in the North and Northeast regions. Gender, region of residence, household location (urban/rural), obesity, and depression diagnosis seem to play significant roles in the epidemiology of asthma in Brazil.
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Affiliation(s)
| | | | | | | | | | - Rafael Stelmach
- . Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Ribeiro-Silva RC, Malta DC, Rodrigues LC, Ramos DO, Fiaccone RL, Machado DB, Barreto ML. Social, Environmental and Behavioral Determinants of Asthma Symptoms in Brazilian Middle School Students-A National School Health Survey (Pense 2012). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122904. [PMID: 30572563 PMCID: PMC6313389 DOI: 10.3390/ijerph15122904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
Biological and psychosocial factors are recognized contributors to the worldwide burden of asthma. However, the relationship between psychosocial factors and asthma symptoms among students in low- and middle-income countries remains underexplored. We aimed to identify socioeconomic, environmental, psychosocial, family-related and lifestyle factors associated with the self-reporting of asthma symptoms in Brazilian adolescents. This is a cross-sectional study using data from the 2012 PeNSE survey (n = 109,104). We analyzed the following variables: socioeconomic conditions, demographic characteristics, lifestyle, family context and dynamics, psychosocial indicators, smoking, and exposure to violence. Our outcome variable was the self-report of asthma symptoms in the past 12 months. The prevalence of wheezing was 22.7% (21.5–23.9). After adjusting for sex, age and the variables from higher hierarchical levels, exposure to violence (feeling unsafe at school, being frequently bullied, being exposed to fights with firearms) and physical aggression by an adult in the family were the environmental factors that showed the strongest associations with self-reporting of asthma symptoms. For psychosocial indicators of mental health and social integration, feelings of loneliness and sleeping problems were the strongest factors, and among individual behavioral factors, the largest associations were found for tobacco consumption. Our findings were consistent with previous studies, showing an association between self-reported asthma symptoms and socio-economic status, family context and dynamics, psychosocial indicators of mental health, exposure to violence and social integration, as well as a sedentary lifestyle and tobacco use.
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Affiliation(s)
| | - Deborah C Malta
- School of Nursery, Federal University of Minas Gerais, Belo Horizonte 30.130-100, Brazil.
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Dandara O Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Institute Gonçalo Moniz (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador 41.745-715, Brazil.
| | - Rosemeire L Fiaccone
- Institute of Mathematics and Statistics, Federal University of Bahia, Salvador 40.170-110, Brazil.
| | - Daiane B Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Institute Gonçalo Moniz (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador 41.745-715, Brazil.
| | - Maurício L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Institute Gonçalo Moniz (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador 41.745-715, Brazil.
- Institute of Collective Health (ISC), Federal University of Bahia, Salvador 40110-040, Brazil.
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Bousquet J, Mohammad Y, Bedbrook A, To T, McGihon R, Bárbara C, Melo-Gomes E, Rosado-Pinto J, Simão P, George F, Punturieri A, Kiley JP, Nunes E, Cossa A, Camargos P, Stelmach R, Cruz AA, Rostan MV, Yañez A, González-Díaz SN, Urrutia-Pereira M, Calderon MA, Gómez RM, German Z, Kolek V, Špičák V, Lan LTT, Hurd S, Lenfant C, Yorgancioglu A, Gemicioğlu B, Ekinci B, Ozkan Z, Abou Al-Zahab B, Dmeirieh A, Shifa R, Faroun H, AlJaber A, Halloum R, Fatmeh Y, Alzein A, Aloush J, Dib G, Shaaban R, Arrais M, do Céu Teixeira M, Conceição C, Ferrinho P. Country activities of Global Alliance against Chronic Respiratory Diseases (GARD): focus presentations at the 11th GARD General Meeting, Brussels. J Thorac Dis 2018; 10:7064-7072. [PMID: 30746253 DOI: 10.21037/jtd.2018.12.84] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jean Bousquet
- WHO Collaborating Center for Rhinitis and Asthma, Montpellier, France.,MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM, VIMA: Ageing and Chronic Diseases. Epidemiological and Public Health Approaches, U1168, Paris, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Yvelines, France.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
| | - Yousser Mohammad
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria.,Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Anna Bedbrook
- WHO Collaborating Center for Rhinitis and Asthma, Montpellier, France.,MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Teresa To
- The Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
| | - Rachel McGihon
- The Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
| | - Cristina Bárbara
- Instituto de Saúde Ambiental, Faculty of Medicine, University of Lisbon, Portugal
| | | | - José Rosado-Pinto
- Global Alliance against Chronic Respiratory Diseases (GARD) Portugal Coordinator, Serviço de Imunoalergologia, Hospital da Luz, Lisboa, Portugal
| | - Paula Simão
- Directorate-General of Health, Lisbon, Portugal
| | | | - Antonello Punturieri
- Division of Lung Diseases, NHLBI/National Institutes of Health, Bethesda, Maryland, USA
| | - James P Kiley
- Division of Lung Diseases, NHLBI/National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabete Nunes
- Department of Pulmonology, Maputo Central Hospital, Maputo, Mozambique
| | - Anilsa Cossa
- Department of Pulmonology, Maputo Central Hospital, Maputo, Mozambique
| | - Paulo Camargos
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Anahí Yañez
- Investigaciones en Alergia y Enfermedades Respiratorias (INAER), Buenos Aires, Argentina
| | | | | | - Moïses A Calderon
- Imperial College London, London, U.K.Royal Brompton Hospital, London, UK.,Universidad de Costa Rica, San Jose, Costa Rica
| | - René Maximiliano Gómez
- Fundación Ayre, Salta, Argentina.,School of Health Sciences, Catholic University of Salta, Argentina.,Argentinean Association of Allergy & Clinical Immunology (AAAeIC), Salta, Argentina
| | - Zachary German
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island, USA
| | - Vítězslav Kolek
- Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Václav Špičák
- Department of Pediatrics, Hospital Na Bulovce, Prague, Czech Republic
| | - Le Thi Tuyet Lan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Suzanne Hurd
- Global Initiative for Asthma (GINA), the Global Initiative for Chronic Obstructive Lung Disease (GOLD), Vancouver, WA, USA
| | - Claude Lenfant
- Global Initiative on Obstructive Lung Disease (GOLD), Gaithersburg, MD, USA
| | | | - Bilun Gemicioğlu
- Department of Chest Diseases, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Banu Ekinci
- Department of Chronic Diseases and Elderly, Directorate General of Public Health, Ankara, Turkey
| | - Zubeyda Ozkan
- Department of Chronic Diseases and Elderly, Directorate General of Public Health, Ankara, Turkey
| | | | | | | | | | - Aicha AlJaber
- National Professional Officer at WHO office in Syria, Damascus, Syria
| | - Ramsa Halloum
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | - Yassine Fatmeh
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | | | | | - Ghazal Dib
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | - Rafea Shaaban
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | | | | | - Cláudia Conceição
- Instituto de Higiene Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
| | - Paulo Ferrinho
- Instituto de Higiene Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
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Ribeiro-Silva RDC, Barreto ML, Ramos D, Cruz AA, Oliveira-Campos M, Malta DC. Asthma trend in adolescence in Brazil: results of the National Adolescent School-based Health Survey (PeNSE 2012-2015). REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180017. [PMID: 30517468 DOI: 10.1590/1980-549720180017.supl.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the evolution of asthma indicators in the editions of the National School Health Survey (PeNSE 2012 and 2015). METHODS Cross-sectional study including Brazilian 9th grade students from public and private schools. Wheezing was assessed through the question: "In the past 12 months, did you have wheezing (or chirping) chest? (yes/no)", and to assess lifetime presence of asthma, the question was "Have you ever had asthma? (yes/no)". RESULTS Of the students, 23,52% reported wheezing or chirping chest in the past 12 months, with prevalences ranging from 16,80% (in Salvador, Bahia) to 27,43% (in Porto Alegre, Rio Grande do Sul). Lifetime presence of asthma was reported by 17,92% of the students, ranging from 13,98% (in Campo Grande, Mato Grosso do Sul) to 30,35% (in Porto Alegre, Rio Grande do Sul). There was also a decrease in the prevalence of self-report of wheezing/chirping chest in the last 12 months between the two editions of the survey (2012/2015) in 20 of the 27 Brazilian state capitals, especially in Belo Horizonte, Florianópolis, Cuiabá and Goiânia. However, prevalence of lifetime diagnostic of asthma increased from 2012 to 2015 in 26 of the 27 Brazilian state capitals. CONCLUSION There was a decrease in the prevalence of self-report of asthma symptoms and an increase of self-reported lifetime presence of asthma. Certainly, monitoring indicators of asthma prevalence is of high importance for health knowledge and the development of public policies.
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Affiliation(s)
| | - Maurício Lima Barreto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia - Salvador (BA), Brasil.,Centro de Integração de Dados e Conhecimentos para Saúde, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz - Salvador (BA), Brasil
| | - Dandara Ramos
- Centro de Integração de Dados e Conhecimentos para Saúde, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz - Salvador (BA), Brasil
| | - Alvaro Augusto Cruz
- Núcleo de Excelência em Asma, Universidade Federal da Bahia - Salvador (BA), Brasil
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Pinheiro GP, Souza-Machado CD, Fernandes AGO, Mota RCL, Lima LL, Vasconcellos DDS, Luz Júnior IPD, Silva YRDS, Lima VB, Oliva STD, Mello LMD, Couto RD, Chatkin JM, Cruz CMS, Cruz ÁA. Self-reported smoking status and urinary cotinine levels in patients with asthma. ACTA ACUST UNITED AC 2018; 44:477-485. [PMID: 30304204 PMCID: PMC6459745 DOI: 10.1590/s1806-37562017000000018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/26/2018] [Indexed: 11/21/2022]
Abstract
Objective: To determine the frequency of active smoking among patients with asthma and individuals without asthma by self-report and urinary cotinine measurement. Methods: This was a cross-sectional study conducted in the city of Salvador, Brazil, and involving 1,341 individuals: 498 patients with severe asthma, 417 patients with mild-to-moderate asthma, and 426 individuals without asthma. Smoking status was determined by self-report (with the use of standardized questionnaires) and urinary cotinine measurement. The study variables were compared with the chi-square test and the Kruskal-Wallis test. Results: Of the sample as a whole, 55 (4.1%) reported being current smokers. Of those, 5 had severe asthma, 17 had mild-to-moderate asthma, and 33 had no asthma diagnosis. Of the 55 smokers, 32 (58.2%) were daily smokers and 23 (41.8%) were occasional smokers. Urinary cotinine levels were found to be high in self-reported nonsmokers and former smokers, especially among severe asthma patients, a finding that suggests patient nondisclosure of smoking status. Among smokers, a longer smoking history was found in patients with severe asthma when compared with those with mild-to-moderate asthma. In addition, the proportion of former smokers was higher among patients with severe asthma than among those with mild-to-moderate asthma. Conclusions: Former smoking is associated with severe asthma. Current smoking is observed in patients with severe asthma, and patient nondisclosure of smoking status occurs in some cases. Patients with severe asthma should be thoroughly screened for smoking, and findings should be complemented by objective testing.
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Affiliation(s)
- Gabriela Pimentel Pinheiro
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Carolina de Souza-Machado
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Escola de Enfermagem, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | | | - Liranei Limoeiro Lima
- . Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | - Ives Pereira da Luz Júnior
- . Laboratório de Química Analítica e Ambiental, Instituto de Química, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | - Valmar Bião Lima
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Programa de Pós-Graduação em Medicina em Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Sérgio Telles de Oliva
- . Departamento de Química Analítica, Instituto de Química, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Luane Marques de Mello
- . Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Ricardo David Couto
- . Laboratório de Bioquímica Clínica, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - José Miguel Chatkin
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Constança Margarida Sampaio Cruz
- . Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública, Salvador (BA) Brasil.,. Obras Sociais Irmã Dulce, Hospital Santo Antônio, Salvador (BA) Brasil
| | - Álvaro Augusto Cruz
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
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Melo B, Rezende L, Machado P, Gouveia N, Levy R. Associations of ultra-processed food and drink products with asthma and wheezing among Brazilian adolescents. Pediatr Allergy Immunol 2018; 29:504-511. [PMID: 29679410 DOI: 10.1111/pai.12911] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although both consumptions of ultra-processed products and asthma are common during adolescence, the epidemiological evidence in regarding their association is unclear. We investigated the associations of ultra-processed products consumption with asthma and wheezing in a representative sample of Brazilian adolescents. METHODS We used data from a representative sample of 109 104 Brazilian adolescents enrolled in the National Survey of School Health, 2012. The consumption of ultra-processed products was based on the weekly consumption (0-2, 3-4, ≥5 d/wk) of sweet biscuits, salty biscuits, ultra-processed meats, sweets/candies, soft drinks, and packaged snacks over the previous 7 days. We also calculated an ultra-processed consumption score by adding partial scores corresponding to weekly frequency intake of each ultra-processed product. The ultra-processed consumption score ranged from 0 to 42, the higher score, the higher the intake of these products. The presence of wheezing in the previous 12 months and asthma at any time in the past was self-reported. RESULTS The adjusted odds ratios of asthma comparing the extreme categories ranged from 1.08 (95% CI 1.03-1.13) for sweets/candies to 1.30 (1.21-1.40) for ultra-processed meats. Similar magnitude of associations was found for wheezing outcome. The ultra-processed consumption score was positively associated with the presence of asthma and wheezing in a dose-response manner. The adjusted OR of asthma and wheezing comparing highest to lowest quintile of ultra-processed consumption score was 1.27 (95% CI 1.15-1.41) and 1.42 (1.35-1.50), respectively. CONCLUSIONS The consumption of ultra-processed products was positively associated with the presence of asthma and wheezing in adolescents.
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Affiliation(s)
- B Melo
- Programa de Formação em Pesquisa, Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - L Rezende
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - P Machado
- Programa de Pós-Graduação em Nutrição em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | - N Gouveia
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - R Levy
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Curricular intervention increases adolescents’ knowledge about asthma: a randomized trial. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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29
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Coelho ACC, Souza-Machado CD, Oliveira TSD, Santos TNND, Cruz ÁA, Souza-Machado A. Curricular intervention increases adolescents' knowledge about asthma: a randomized trial. J Pediatr (Rio J) 2018; 94:325-334. [PMID: 28888614 DOI: 10.1016/j.jped.2017.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a curricular intervention concerning the knowledge about asthma among adolescents from a public school. METHODS This was a randomized, controlled trial study on a curricular intervention in asthma, carried out with asthmatic and non-asthmatic adolescents. The study participants were divided into a curricular intervention group for asthma (IG), and a control group with traditional curriculum (CG). Topics related to asthma were included in the curriculum, such as the disease concept, triggering factors, treatment, symptoms, action plan, and beliefs in popular myths about the disease. These topics were evaluated through a questionnaire with scores ranging from 0 to 20 points, expressed by the mean score. The acquisition of knowledge was evaluated 90 days and 540 days after the start of the intervention (baseline), by applying the mixed linear model for analysis of associations. RESULTS 181 students participated in the study (IG=101 and CG=80). As shown by their scores before the intervention; the students were unaware about asthma (IG: x¯=10.7±2.9vs. CG: x¯=11.5±2.7 points), its treatment (IG: x¯=1.6±0.9vs. CG: x¯=1.6±0.8 points), and reported beliefs in popular myths about the disease (IG: x¯=1.5±1.1vs. CG: x¯=1.7±1.1 points). After the intervention, the IG showed higher overall knowledge (GI: x¯=15.5±3.1 points), as well as knowledge about the treatment (GI: x¯=2.5±1.0 points), and two times more knowledge in the field "beliefs in popular myths about the disease" when compared to the CG. A greater probability of achieving satisfactory knowledge about asthma was noted in the IG (RR=3.5), with NTT=2.0. CONCLUSION The inclusion of the asthma topic in the curriculum improved knowledge about the disease in a subgroup of students.
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Affiliation(s)
- Ana Carla C Coelho
- Universidade Federal da Bahia (UFBA), Escola de Enfermagem, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina da Bahia, Programa de Pós-graduação em Medicina e Saúde (PPgMS), Salvador, BA, Brazil.
| | - Carolina de Souza-Machado
- Universidade Federal da Bahia (UFBA), Escola de Enfermagem, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina da Bahia, Programa de Pós-graduação em Medicina e Saúde (PPgMS), Salvador, BA, Brazil
| | - Thiara S de Oliveira
- Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil
| | - Tássia Natalie N Dos Santos
- Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil
| | - Álvaro A Cruz
- Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade Medicina, Salvador, BA, Brazil
| | - Adelmir Souza-Machado
- Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina da Bahia, Programa de Pós-graduação em Medicina e Saúde (PPgMS), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Instituto de Ciências da Saúde (ICS), Departamento de Biomorfologia, Salvador, BA, Brazil
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Abstract
PURPOSE OF REVIEW The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. RECENT FINDINGS Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. SUMMARY Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under diagnosis, under treatment, exposure to air pollution, and unhygienic living conditions may contribute to a higher frequency and severity of symptoms of asthma among the poor. Proper diagnosis and treatment with controller medications for asthma is feasible and cost-effective in low-resource settings.
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Fernandes SDSC, Andrade CRD, Alvim CG, Camargos PAM, Ibiapina CDC. Epidemiological trends of allergic diseases in adolescents. J Bras Pneumol 2018; 43:368-372. [PMID: 29160383 PMCID: PMC5790655 DOI: 10.1590/s1806-37562016000000255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 05/04/2017] [Indexed: 01/07/2023] Open
Abstract
Objective: To assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in adolescents in the city of Belo Horizonte, Brazil, in 2012 by administering the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as to compare the observed prevalences with those found in studies performed 10 years earlier and employing the same methodology used here. Methods: This was a cross-sectional study conducted between May and December of 2012 and involving adolescents in the 13- to 14-year age bracket. Participants were randomly selected from among adolescents studying at public schools in Belo Horizonte and completed the ISAAC questionnaire. Proportions were calculated in order to assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in the sample as a whole, and the chi-square goodness-of-fit test was used in order to compare the prevalences observed in 2012 with those found in 2002. Results: The prevalences of symptoms of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in 2012 were 19.8%, 35.3%, and 16.3%, respectively, being significantly higher than those found in 2002 (asthma, p = 0.006; allergic rhinitis, p < 0.01; and allergic rhinoconjunctivitis, p = 0.002). Conclusions: The prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis among adolescents in 2012 were found to be high, having increased in comparison with those found 10 years earlier, despite efforts in prevention, diagnosis, and treatment.
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Affiliation(s)
| | - Cláudia Ribeiro de Andrade
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Cristina Gonçalves Alvim
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | | | - Cássio da Cunha Ibiapina
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
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32
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Cruz AA, Camargos PA, Urrutia-Pereira M, Stelmach R. Global Alliance against Chronic Respiratory Diseases (GARD) Brazil success case: overcoming barriers. J Thorac Dis 2018; 10:534-538. [PMID: 29600090 DOI: 10.21037/jtd.2018.01.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Alvaro A Cruz
- ProAR, Federal University of Bahia, Bahia, Brazil.,Global Alliance against Chronic Respiratory Diseases (GARD)/WHO
| | - Paulo A Camargos
- Global Alliance against Chronic Respiratory Diseases (GARD)/WHO.,Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marilyn Urrutia-Pereira
- Global Alliance against Chronic Respiratory Diseases (GARD)/WHO.,Department of Medicine, Universidade Federal do Pampa, Bagé, RS, Brazil
| | - Rafael Stelmach
- Global Alliance against Chronic Respiratory Diseases (GARD)/WHO.,Hospital da Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
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Affiliation(s)
- Rafael Stelmach
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Álvaro Augusto Cruz
- . Coordenador do Núcleo de Excelência em Asma, Universidade Federal da Bahia, Salvador (BA) Brasil
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Pitrez PM, de Souza RG, Roncada C, Heinzmann-Filho JP, Santos G, Pinto LA, Jones MH, Stein RT. Impact of omalizumab in children from a middle-income country with severe therapy-resistant asthma: A real-life study. Pediatr Pulmonol 2017; 52:1408-1413. [PMID: 29027379 DOI: 10.1002/ppul.23845] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/01/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Severe asthma in children is a global health problem. Severe therapy-resistant asthma (STRA) in children is a major clinical challenge due to persistent symptoms despite high doses of corticosteroids and results in high public health costs. Omalizumab (anti-IgE monoclonal antibody) has been described as an effective add-on therapy in these patients. The characteristics of children with STRA from low- and middle-income countries have scarcely been reported, and no real-life study has been published on the effects of omalizumab in this group of patients. The aim of our study is to report the first clinical real-life experiences with omalizumab in Brazilian children with STRA. METHODS Children (6-18 years old) from a referral center who were diagnosed with STRA were included in this retrospective study based on our clinical databases. The included children had undergone at least 6 months of omalizumab treatment and fulfilled the following initial criteria: 1) >6 years old; 2) a positive skin-prick test for at least one aeroallergen; and 3) a serum total IgE level between 30 and 1500 IU/mL. Clinical and lung function variables were analyzed before and after treatment. RESULTS Fourteen children (mean age: 11.9 years; percentage female: 72%) were included in this study. Omalizumab treatment significantly increased control of the disease according to a standardized questionnaire administered at every visit (P < 0.0001), ceased hospitalizations in 70% (P = 0.02) of patients, and allowed 8/9 (89%) patients to be weaned off oral steroids (P = 0.004). CONCLUSIONS In this retrospective report, the use of omalizumab in Brazilian children with STRA significantly improved disease control, decreased hospitalizations, and allowed suspension of continuous oral corticosteroids.
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Affiliation(s)
- Paulo M Pitrez
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo G de Souza
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cristian Roncada
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joao P Heinzmann-Filho
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovana Santos
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo A Pinto
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcus H Jones
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato T Stein
- Laboratory of Pediatric Respirology, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Fiuza BSD, Silva MDJ, Alcântara-Neves NM, Barreto ML, Costa RDS, Figueiredo CA. Polymorphisms in DENND1B gene are associated with asthma and atopy phenotypes in Brazilian children. Mol Immunol 2017; 90:33-41. [PMID: 28668455 DOI: 10.1016/j.molimm.2017.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/05/2017] [Accepted: 06/14/2017] [Indexed: 12/21/2022]
Abstract
Asthma is a heterogeneous disease associated with a complex basis involving environmental factors and individual variabilities. The DENN Domain Containing 1B (DENND1B) gene has an important role on T cell receptor (TCR) down-regulation on Th2 cells and studies have shown that mutations or loss of this factor can be associated with increased Th2 responses and asthma. The aim of this work is to evaluate the association of polymorphisms in the DENND1B with asthma and allergy markers phenotypes in Brazilian children. Genotyping was performed using a commercial panel from Illumina (2.5 Human Omni bead chip) in 1309 participants of SCAALA (Social Change, Asthma, Allergy in Latin American) program. Logistic regressions for asthma and atopy markers were performed using PLINK software 1.9. The analyzes were adjusted for sex, age, helminth infections and ancestry markers. The DENND1B gene was associated with different phenotypes such as severe asthma and atopic markers (specific IgE production, skin prick test and IL-13 production). Among the 166 SNPs analyzed, 72 were associated with asthma and/or allergy markers. In conclusion, polymorphisms in the DENND1B are significantly associated with development of asthma and atopy and these polymorphisms can influence DENND1B expression and consequently, asthma.
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Affiliation(s)
- Bianca S D Fiuza
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia (ICS), Bahia, Brazil
| | - Milca de J Silva
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia (ICS), Bahia, Brazil
| | - Neuza M Alcântara-Neves
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia (ICS), Bahia, Brazil
| | | | - Ryan Dos S Costa
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia (ICS), Bahia, Brazil
| | - Camila A Figueiredo
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia (ICS), Bahia, Brazil.
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School intervention in asthma for adolescents: it is time to act. Paediatr Respir Rev 2017; 23:50-52. [PMID: 27592297 DOI: 10.1016/j.prrv.2016.08.001] [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: 05/30/2016] [Accepted: 08/01/2016] [Indexed: 11/20/2022]
Abstract
Asthma is a public health problem that is responsible for significant symptomatology and in extreme cases, premature deaths among adolescents. Lack of knowledge of the disease contributes to both its morbidity and mortality. In this manuscript, we discuss school interventions in asthma, in particular their impacts on improving knowledge of the disease and their ability to both make the school environment safer and reduce morbidity indicators. These interventions have been successful when implemented in higher income countries. Thus, to address the lack of interventions in low and middle income countries, we present an example of an alternative asthma intervention in the school curriculum developed in South America. The model has been proven to be both feasible and relatively inexpensive. It is easily structured by utilizing the staff of the school itself and is capable of being adapted to other countries.
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Fu QL, Du Y, Xu G, Zhang H, Cheng L, Wang YJ, Zhu DD, Lv W, Liu SX, Li PZ, Shi JB, Ou CQ. Prevalence and Occupational and Environmental Risk Factors of Self-Reported Asthma: Evidence from a Cross-Sectional Survey in Seven Chinese Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111084. [PMID: 27827944 PMCID: PMC5129294 DOI: 10.3390/ijerph13111084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/16/2016] [Accepted: 10/27/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Asthma is one of the most common chronic diseases and associated with significant morbidity and mortality. However, few data on occupational and environmental risk factors of asthma are available, particularly in Asian adults. Based on a national cross-sectional survey, we assessed the prevalence and risk factors of asthma in Chinese adults. METHODS A total of 9974 participants aged 15 years and over in seven Chinese cities were selected using a stratified four-stage random sampling. All participants were interviewed face-to-face in their homes using a standardized self-administered questionnaire. Multivariate logistic regression analyses were adopted to determine various risk factors for asthma. RESULTS The prevalence of self-reported lifetime asthma was 2.46% among the entire adult population, 3.02% among males and 1.93% among females. The prevalence varied by age group, ethnicity, marital status, education, and floor space per person (p < 0.05). After adjusting for socio-demographic variables and smoking, we found independent occupational and environmental determinants of asthma, including a clearance-related job (OR = 2.28, 95%CI: 1.07-4.89), occupational exposure to industrial or occupational poisonous gas (OR = 4.21, 95%CI: 2.43-7.30), having large amounts of carpet in the workplace (OR = 2.61, 95%CI: 1.20-5.69) and using coal for cooking (OR = 2.65, 95%CI: 1.26-5.57). CONCLUSIONS Asthma is a serious public health problem in China. Our study provides important updated information on the prevalence of asthma and its associated risk factors, which may help us better understand the epidemiology of asthma and prevent this disorder.
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Affiliation(s)
- Qing-Ling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
| | - Yue Du
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China.
| | - Geng Xu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
| | - Hua Zhang
- Department of Otorhinolaryngology, The First Affiliated Hospital, Xinjiang Medical University, Urumchi 830054, China.
| | - Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
| | - Yan-Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Dong-Dong Zhu
- Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China.
| | - Wei Lv
- Department of Otolaryngology, Peking Union Medical College Hospital, Beijing 100032, China.
| | - Shi-Xi Liu
- Department of Otorhinolaryngology, West China Hospital of Medicine, Sichuan University, Chengdu 610041, China.
| | - Pei-Zhong Li
- Department of Otorhinolaryngology, Affiliated Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223300, China.
| | - Jian-Bo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China.
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Martins SM, Salibe-Filho W, Tonioli LP, Pfingesten LE, Braz PD, McDonnell J, Williams S, do Carmo D, de Sousa JC, Pinnock H, Stelmach R. Implementation of 'matrix support' (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study. NPJ Prim Care Respir Med 2016; 26:16047. [PMID: 27536853 PMCID: PMC4989903 DOI: 10.1038/npjpcrm.2016.47] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 11/08/2022] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented 'matrix support': a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157-87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems.
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Affiliation(s)
- Sonia Maria Martins
- Department of Community Health of the Faculty of Medicine of ABC (FMABC), São Bernardo do Campo, São Paulo, Brazil
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
| | - William Salibe-Filho
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
- Pulmonology Service of the University São Camilo Medical School, São Paulo, Brazil
| | - Luís Paulo Tonioli
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
| | - Luís Eduardo Pfingesten
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
| | - Patrícia Dias Braz
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
- PHC Division-Health Secretary, São Bernardo do Campo, São Paulo, Brazil
| | - Juliet McDonnell
- International Primary Care Respiratory Group (IPCRG), Westhill, Scotland, UK
| | - Siân Williams
- International Primary Care Respiratory Group (IPCRG), Westhill, Scotland, UK
| | - Débora do Carmo
- Specialized Department, São Bernardo do Campo, São Paulo, Brazil
| | - Jaime Correia de Sousa
- Community Health, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal, Horizonte Family Health Unit, Matosinhos, Portugal
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rafael Stelmach
- Pulmonary Division-Heart Institute (InCor)—Hospital da Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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Dias CS, Dias MAS, Friche AADL, Almeida MCDM, Viana TC, Mingoti SA, Caiaffa WT. Temporal and Spatial Trends in Childhood Asthma-Related Hospitalizations in Belo Horizonte, Minas Gerais, Brazil and Their Association with Social Vulnerability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E704. [PMID: 27420078 PMCID: PMC4962245 DOI: 10.3390/ijerph13070704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/23/2016] [Accepted: 07/01/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Asthma is a multifactorial disease and a serious public health problem. Environmental factors and poverty are the main determinants of this disease. OBJECTIVE To describe the spatial and temporal distribution of asthma-related hospitalizations and identify the areas with the highest prevalence of and vulnerability to severe asthma in a major Brazilian city. METHODS An ecological study of hospitalizations for asthma from 2002 to 2012, in children and adolescents under 15 years of age, living in Belo Horizonte, Southeast Brazil. All events were geocoded by residence address using Hospital Information System data. The socioeconomic vulnerability of residence address was ranked using the Health Vulnerability Index. Raster surfaces were generated and time-series plots were constructed to determine spatial and time trends in the frequency of asthma-related hospitalizations, respectively. RESULTS Asthma-related hospitalization rates were highest in children aged 0-4 years and in boys. There was a decreasing trend in the number of asthma-related hospitalizations across the study period. Approximately 48% of all hospitalizations were children living in health vulnerable areas. Seasonal trends showed a hospitalization peak in March, April, and May, coinciding with the post-rainy period. CONCLUSION Our findings suggest that social and environmental factors may be determinants of disparities in severe asthma.
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Affiliation(s)
- Cláudia Silva Dias
- Department Physiotherapy, Pontifical Catholic University of Minas Gerais (PUC Minas), Belo Horizonte 30535610, Brazil.
- Belo Horizonte Observatory for Urban Health (OSUBH), School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130100, Brazil.
| | - Maria Angélica Salles Dias
- Belo Horizonte Observatory for Urban Health (OSUBH), School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130100, Brazil.
| | - Amélia Augusta de Lima Friche
- Belo Horizonte Observatory for Urban Health (OSUBH), School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130100, Brazil.
| | - Maria Cristina de Mattos Almeida
- Belo Horizonte Observatory for Urban Health (OSUBH), School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130100, Brazil.
| | - Thaís Claudino Viana
- Belo Horizonte Observatory for Urban Health (OSUBH), School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130100, Brazil.
| | - Sueli Aparecida Mingoti
- Belo Horizonte Observatory for Urban Health (OSUBH), School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130100, Brazil.
- Institute of Exact Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte 31270901, Brazil.
| | - Waleska Teixeira Caiaffa
- Belo Horizonte Observatory for Urban Health (OSUBH), School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130100, Brazil.
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Brandão HV, Vieira GO, de Oliveira Vieira T, Camargos PA, de Souza Teles CA, Guimarães AC, Cruz AA, Cruz CMS. Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort. BMC Pediatr 2016; 16:57. [PMID: 27121021 PMCID: PMC4848802 DOI: 10.1186/s12887-016-0594-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 04/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have evaluated the association between delivery by cesarean section (CS) and asthma, allergic rhinitis and chronic rhinitis and whether this association is different in children with and without a family history of asthma. This study aims to investigate whether children born by CS have a higher chance to develop asthma, allergic rhinitis and chronic rhinitis and to evaluate the influence of parental history of asthma on these associations. METHODS This is a cross-sectional study of 672 children nested in a birth cohort evaluated at 6-years of age. Asthma and chronic/allergic rhinitis were identified by means of the mother's responses to the ISAAC questionnaire. The association between CS, asthma, chronic rhinitis and allergic rhinitis was evaluated by multivariable logistic regression. The evidence of effect modification of parental history of asthma on the association CS and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders. RESULTS Asthma was not associated with birth by CS irrespective of parental history of asthma (odds ratio (OR) 1.03; 95 % CI 0.61-1.74). Chronic rhinitis and allergic rhinitis were both significantly associated with birth by CS but only in the subgroup of children with by parental history of asthma (OR 1.56; 95 % CI 1.04-2.34) and (OR 1.60; 95 % CI 1.01-2.55) respectively, after adjustment for confounders. The parental history of asthma was a effect modifier in the association between CS, chronic rhinitis and allergic rhinitis (p for effect modification = 0.10 and 0.02, respectively). CONCLUSION CS increases the risk of chronic rhinitis and allergic rhinitis in children at 6 years of age with parental history of asthma. Health professionals must be alerted with regard to the increased risk of allergic rhinitis and made aware this is another reason to avoid unnecessary CS.
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Affiliation(s)
- Heli Vieira Brandão
- Doctorate student of Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
- , Rua Marechal Castelo Branco 597, Capuchinhos, Feira de Santana, Bahia CEP: 44076-020, Brazil.
| | | | | | - Paulo Augusto Camargos
- Full Professor of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Alvaro Augusto Cruz
- Head of the Center of Excellence in Asthma of the Federal University of Bahia, Salvador, Brazil
| | - Constança Margarida Sampaio Cruz
- Adjunct Professor of Escola Bahiana de Medicina and Saúde Pública. Coordinator of Multidisciplinary Research of Hospital Santo Antonio, Obras Sociais Irmã Dulce, Salvador, Brazil
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Pontes MV, Ribeiro TCM, Ribeiro H, de Mattos AP, Almeida IR, Leal VM, Cabral GN, Stolz S, Zhuang W, Scalabrin DMF. Cow's milk-based beverage consumption in 1- to 4-year-olds and allergic manifestations: an RCT. Nutr J 2016; 15:19. [PMID: 26920136 PMCID: PMC4769487 DOI: 10.1186/s12937-016-0138-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/18/2016] [Indexed: 12/31/2022] Open
Abstract
Background Nutrients such as docosahexaenoic acid (DHA), prebiotics and β-glucan have been associated with reduced incidence of respiratory illnesses and allergic manifestations (AM). Our objective was to assess if consumption of a cow’s milk-based beverage with these and other nutrients supports respiratory, gastrointestinal, and skin health in otherwise well-nourished, healthy children. Methods In this double-blind, randomized, controlled trial, healthy children (1–4 years of age) from two daycare centers in Brazil were fed three servings/day of a cow’s milk-based beverage (CMBB; n = 125) containing DHA, the prebiotics polydextrose (PDX) and galactooligosaccharides (GOS), β-glucan, and other key nutrients, or a control cow’s milk-based beverage (control; n = 131) for up to 28 weeks. Occurrence of respiratory infections, diarrheal disease and AM was assessed by study pediatricians and the number of episodes were analyzed with the Cochran-Mantel-Haenszel test and the Andersen-Gill model. Results The CMBB group had fewer episodes of AM, which included allergic rhinitis or conjunctivitis, wheezing, allergic cough, eczema and urticaria, compared to the control group (p = 0.021). The hazard ratio for increased number of episodes of AM was lower in the CMBB group compared to control (HR, 0.64; 95 % CI 0.47–0.89; p = 0.007). There was no difference in the incidence of respiratory infections and diarrheal disease between groups. Conclusion A cow’s milk-based beverage containing DHA, PDX/GOS, and yeast β-glucan, and supplemented with micronutrients, including zinc, vitamin A and iron, when consumed 3 times/day for 28 weeks by healthy 1- to 4-year-old children was associated with fewer episodes of allergic manifestations in the skin and the respiratory tract. Trial registration registration number: NCT01431469
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Affiliation(s)
- M V Pontes
- Federal University of Bahia, Salvador, Bahia, Brazil.
| | - T C M Ribeiro
- Federal University of Bahia, Salvador, Bahia, Brazil.
| | - H Ribeiro
- Federal University of Bahia, Salvador, Bahia, Brazil.
| | - A P de Mattos
- Federal University of Bahia, Salvador, Bahia, Brazil.
| | - I R Almeida
- Federal University of Bahia, Salvador, Bahia, Brazil.
| | - V M Leal
- Federal University of Bahia, Salvador, Bahia, Brazil.
| | - G N Cabral
- Federal University of Bahia, Salvador, Bahia, Brazil.
| | - S Stolz
- Mead Johnson Pediatric Nutrition Institute, Evansville, IN, USA.
| | - W Zhuang
- Mead Johnson Pediatric Nutrition Institute, Evansville, IN, USA.
| | - D M F Scalabrin
- Mead Johnson Pediatric Nutrition Institute, Evansville, IN, USA.
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Kuschnir FC, Gurgel RQ, Solé D, Costa E, Felix MMR, de Oliveira CL, de Vasconcellos MTL, Kuschnir MCC. ERICA: prevalence of asthma in Brazilian adolescents. Rev Saude Publica 2016; 50 Suppl 1:13s. [PMID: 26910542 PMCID: PMC4767043 DOI: 10.1590/s01518-8787.2016050006682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 10/29/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe the prevalence of asthma and physician-diagnosed asthma in Brazilian adolescents. METHODS Cross-sectional, national, school-based study with adolescents from 12 to 17 years old, participants in the Study of Cardiovascular Risks in Adolescents (ERICA). The study stratified the sample by region and grouped according to schools and classes with representativeness to the set of cities with more than 100,000 inhabitants of the Country, macro-regions, capitals, and Federal District. A questionnaire collected data through a self-filled in method. We calculated the prevalences and their confidence intervals of 95% (95%CI) according to sex, age group, type of school and skin color. RESULTS Between 2013 and 2014, 74,589 adolescents were evaluated, 55.3% of the female sex. The total prevalence of active asthma was of 13.1% (95%CI 12.1-13.9), being higher in girls (14.8%; 95%CI 13.7-16.0) when compared to boys (11.2%; 95%CI 10.3-12.2) in all geographical strata examined. It was also higher between students of private schools (15.9%; 95%CI 14.2-17.7) when compared to public ones (12.4%; 95%CI 11.4-13.4). It was higher in the Southeast region (14.5%; 95%CI 12.9-16.1), and in the city of Sao Paulo (16.7%; 95%CI 14.7-18.7). The lowest prevalence was observed in North region (9.7%; 95%CI 9.7-10.5), and in Teresina (6.3%; 95%CI 4.9-7.7). The prevalence of physician-diagnosed asthma was of 8.7% (95%CI 8.2-9.1); higher in the North region (13.5%; 95%CI 12.7-14.2), and in Porto Alegre (19.8%; 95%CI 17.5-22.3). It was lower in the Midwest (6.9%; 95%CI 6.0-7.8), and in Cuiaba (4.8%; 95%CI 3.8-5.9). We found no significant difference in the expression of this rate between the sexes, as well as in other variables evaluated by the study. CONCLUSIONS The prevalence of asthma in Brazilian adolescents is high. Rates of active asthma and physician-diagnosed asthma vary widely in different regions and capitals evaluated by the ERICA. These results may assist in the preparation of preventive programs and policies on health and a better understanding of the factors associated with asthma in this age group.
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Affiliation(s)
- Fábio Chigres Kuschnir
- Departamento de Pediatria. Faculdade de Ciências Médicas. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | | | - Dirceu Solé
- Disciplina de Alergia Imunologia Clínica e Reumatologia. Departamento de Pediatria. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Eduardo Costa
- Departamento de Medicina Interna. Faculdade de Ciências Médicas. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | - Mara Morelo Rocha Felix
- Programa de Pós-Graduação em Ciências Médicas. Faculdade de Ciências Médicas. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | - Cecília Lacroix de Oliveira
- Departamento de Nutrição Aplicada. Instituto de Nutrição. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | | | - Maria Cristina Caetano Kuschnir
- Núcleo de Estudos de Saúde do Adolescente. Faculdade de Ciências Médicas. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
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Roncada C, de Oliveira SG, Cidade SF, Sarria EE, Mattiello R, Ojeda BS, Dos Santos BRL, Gustavo ADS, Pinto LA, Jones MH, Stein RT, Pitrez PM. Burden of asthma among inner-city children from Southern Brazil. J Asthma 2016; 53:498-504. [PMID: 26787296 DOI: 10.3109/02770903.2015.1108438] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the impact of asthma in a population of inner-city Brazilian children. METHODS In a cross-sectional study, we selected children with asthma and healthy controls from public schools (8-16 years) from a capital city of Southern Brazil. Divided into three phases, questionnaires were administered, assessing lung function, body mass index and allergic sensitization. RESULTS From 2500 children initially included in the study (48.4% males; mean age of 11.42 ± 2.32 years), asthma prevalence was detected in 28.6% (715/2500). The disease was not controlled in 42.7% (305/715) of the children, with 7.6% of hospitalization rate. School absenteeism (at least one day of missing school because of asthma) and sedentary behavior were high (57.1 and 67.2%, respectively), with 47.9% of subjects requiring oral steroids in the previous year, and physical well-being significantly lower than controls, directly interfering with quality of life, and therefore in the daily activities of these students. Moreover, 38% of the parents admitted to being non-adherent to treatment with their children and 31.1 and 53.6%, respectively, believed that rescue medication and exercise might be harmful. CONCLUSIONS The burden of asthma in Brazilian children seems to be substantial. New international guidelines with a special focus in developing countries settings, with more pragmatic approaches, should be a priority for discussion and implementation actions.
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Affiliation(s)
- Cristian Roncada
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
| | - Suelen Goecks de Oliveira
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
| | - Simone Falcão Cidade
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
| | - Edgar Enrique Sarria
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
| | - Rita Mattiello
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
| | - Beatriz Sebben Ojeda
- b School of Nursery, Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil
| | - Beatriz Regina Lara Dos Santos
- b School of Nursery, Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil
| | - Andréia da Silva Gustavo
- b School of Nursery, Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil
| | - Leonardo Araújo Pinto
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
| | - Marcus Herbert Jones
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
| | - Renato Tetelbom Stein
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
| | - Paulo Márcio Pitrez
- a Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre - RS , Brazil , and
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