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Pitrez PM, Giavina-Bianchi P, Rizzo JÂ, Souza-Machado A, Garcia GF, Pizzichini MMM. An expert review on breaking barriers in severe asthma in Brazil: Time to act. Chron Respir Dis 2021; 18:14799731211028259. [PMID: 34167379 PMCID: PMC8236765 DOI: 10.1177/14799731211028259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
Currently, Brazil lacks a national asthma management program and is burdened with nearly 200,000 hospitalizations due to the disease per year and approximately 5 deaths per day. The purpose of this article was to analyze the current issues surrounding severe asthma in Brazil, as the status of diagnosis and treatment is largely unknown, and to provide feasible recommendations to elicit imminent action. A panel of Brazilian medical experts in the field of severe asthma was provided with a series of relevant questions to address prior to a multi-day conference. Within this conference, each narrative was discussed and edited by the entire group. Through numerous rounds of discussion consensus was achieved. In order to overcome barriers to adequate asthma treatment, this panel recommends specific initiatives that can be implemented in the short-term to decrease the burden of severe asthma in Brazil. With increasing healthcare costs and limited resources globally, there is an opportunity to implement these recommendations in other countries in order to achieve adequate asthma care. Severe asthma is a heterogeneous and complex disease with various phenotypes that requires strict attention for diagnosis and management. Although this disease affects only a small proportion of the population with asthma, it poses a great burden to healthcare systems. Thus, barriers to diagnosis, treatment, and management should be overcome as quickly and efficiently as possible.
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Affiliation(s)
- Paulo Márcio Pitrez
- Pediatric Pulmonology Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Ângelo Rizzo
- Head Pneumology Department, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Adelmir Souza-Machado
- Institute of Health Sciences, Federal University of Bahia Coordinator of Program for Asthma Control in Bahia (ProAR), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Guilherme Freire Garcia
- Clinical Guidelines Coordinator of the Fundação Hospitalar de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
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Bezerra de Menezes M, Ponte EV, Bertagni Mingotti CF, Carvalho Pinto RM, Bagatin E, Bião Lima V, Vianna EO, Cruz ÁA. Provision of inhaled corticosteroids is associated with decrease in hospital admissions in Brazil: A longitudinal nationwide study. Respir Med 2020; 166:105950. [PMID: 32250873 DOI: 10.1016/j.rmed.2020.105950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe trends of hospital admissions due to asthma from 2008 to 2015 and to evaluate their relationship with trends of inhaled corticosteroids (ICS) provision by the government in Brazil. METHODS We used Brazilian Government data to calculate hospital admission rates due to asthma, number of physicians, number of hospital beds, number of subjects that received ICS per 100,000 inhabitants in Brazil and in each of its municipalities for each year of the study. We performed Poisson Multilevel Regression Analyses to evaluate the relationship between the trends of hospital admission rates due to asthma with the trends of the number of subjects that had been receiving ICS during the study period. The analyses were adjusted for the number of physicians and hospital beds. FINDINGS The number of patients who received ICS/100,000 inhabitants increased from 2008 to 2015 (943.9-1988.5). Hospital admissions/100,000 inhabitants decreased in patients aged 5-14 years (148.3-110.9) and in patients aged 15-39 years (59.9-32.3); the reduction was greater in municipalities in which ICS provision increased. The number of physicians/100,000 inhabitants increased and the number of hospital beds/100,000 inhabitants decreased in the study period. The increase in the number of physicians and in the number of subjects that received ICS were associated with reduction in hospital admissions. CONCLUSION We found that provision of ICS by the Brazilian Government was associated with a decrease of hospital admissions for asthma in the municipalities and country levels from 2008 to 2015.
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Affiliation(s)
| | | | | | | | - Ericson Bagatin
- Medical School of Jundiaí. State University of Campinas, Brazil.
| | | | - Elcio Oliveira Vianna
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
| | - Álvaro A Cruz
- ProAR - Faculdade de Medicina da Bahia, Federal University of Bahia, Brazil.
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Emilio CC, Mingotti CFB, Fiorin PR, Lima LA, Muniz RL, Bigotto LH, Marchi E, Ponte EV. Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment? ACTA ACUST UNITED AC 2019; 45:e20180052. [PMID: 30758430 PMCID: PMC6534401 DOI: 10.1590/1806-3713/e20180052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. METHODS This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. RESULTS 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). CONCLUSIONS Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.
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Affiliation(s)
| | | | - Paula Regina Fiorin
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Leydiane Araujo Lima
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Raisa Lemos Muniz
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Luis Henrique Bigotto
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Evaldo Marchi
- . Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Eduardo Vieira Ponte
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
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Carvalho-Pinto RMD, Agondi RC, Giavina-Bianchi P, Cukier A, Stelmach R. Omalizumab in patients with severe uncontrolled asthma: well-defined eligibility criteria to promote asthma control. ACTA ACUST UNITED AC 2019; 43:487-489. [PMID: 29340498 PMCID: PMC5792049 DOI: 10.1590/s1806-37562017000000012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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
| | - Rosana Câmara Agondi
- . Disciplina de Imunologia Clínica e Alergia, Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Pedro Giavina-Bianchi
- . Disciplina de Imunologia Clínica e Alergia, Departamento de Clínica Médica, 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
| | - Rafael Stelmach
- . 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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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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Solé D, Aranda CS, Wandalsen GF. Asthma: epidemiology of disease control in Latin America - short review. Asthma Res Pract 2017; 3:4. [PMID: 28507765 PMCID: PMC5427548 DOI: 10.1186/s40733-017-0032-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
Asthma is reported as one of the most common chronic diseases in childhood, impairing the quality of life of patients and their families and incurring high costs to the healthcare system and society. Despite the development of new drugs and the availability of international treatment guidelines, asthma is still poorly controlled, especially in Latin America. Original and review articles on asthma control or epidemiology with high levels of evidence have been selected for analysis among those published in PubMed referenced journals during the last 20 years, using the following keywords: "asthma control" combined with "Latin America", " epidemiology", "prevalence", "burden", "mortality", "treatment and unmet needs", "children", "adolescents", and "infants". There was a high prevalence and severity of asthma during the period analyzed, especially in children and adolescents. Wheezing in infants was a significant reason for seeking medical care in Latin American health centers. Moreover, the frequent use of quick-relief bronchodilators and oral corticosteroids by these patients indicates the lack of a policy for providing better care for asthmatic patients, as well as poor asthma control. Among adults, studies document poor treatment and control of the disease, as revealed by low adherence to routine anti-inflammatory medications and high rates of emergency care visits and hospitalization. In conclusion, although rare, studies on asthma control in Latin America repeatedly show that patients are inadequately controlled and frequently overestimate their degree of asthma control according to the criteria used by international asthma treatment guidelines. Additional education for doctors and patients is essential for adequate control of this illness, and therefore also for reduction of the individual and social burden of asthma.
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Affiliation(s)
- Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo, Rua dos Otonis, 725 - Vila Clementino, 04025-002 São Paulo, Brazil
| | - Carolina Sanchez Aranda
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo, Rua dos Otonis, 725 - Vila Clementino, 04025-002 São Paulo, Brazil
| | - Gustavo Falbo Wandalsen
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo, Rua dos Otonis, 725 - Vila Clementino, 04025-002 São Paulo, Brazil
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Urrutia-Pereira M, Avila J, Solé D. The Program for the Prevention of Childhood Asthma: a specialized care program for children with wheezing or asthma in Brazil. J Bras Pneumol 2016; 42:42-7. [PMID: 26982040 PMCID: PMC4805386 DOI: 10.1590/s1806-37562016000004480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/18/2015] [Indexed: 02/18/2023] Open
Abstract
Objective : To present the Programa Infantil de Prevenção de Asma (PIPA, Program for the Prevention of Childhood Asthma) and the characteristics of the patients followed in this program. Methods : Implemented in the city of Uruguaiana, Brazil, PIPA has as its target population children and adolescents (< 18 years of age) with asthma or suspected asthma. Patients either enroll in PIPA spontaneously or are referred by pediatricians or primary care physicians. In this retrospective study, we use a standardized protocol to assess PIPA patients. Results : By the end of the study period, 646 patients were being followed. Of those, 298 (46.1%) were ≤ 3 years of age. In this group of patients, recurrent wheezing was identified in 60.7%, and the first episode of wheezing occurred in the first six months of life in 86.0%. Severe wheezing was identified in 29.5% and 45.4% in the children ≤ 3 and > 3 years of age, respectively. Physician-diagnosed asthma was reported in 26.5% and 82.2%, respectively. In the sample as a whole, the prevalence of passive smoking was high (> 36%), occurring during pregnancy in > 15%; > 40% of the patients had been born by cesarean section; and 30% had a mother who had had < 8 years of schooling. Conclusions : A prevention program for children with asthma is an effective strategy for controlling the disease. Knowledge of local epidemiological and environmental characteristics is essential to reducing the prevalence of the severe forms of asthma, to improving the use of health resources, and to preventing pulmonary changes that could lead to COPD in adulthood.
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Affiliation(s)
| | - Jennifer Avila
- Secretaria Municipal de Saúde, Prefeitura Municipal de Uruguaiana, Uruguaiana, RS, Brasil
| | - Dirceu Solé
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Melo J, Moreno A, Ferriani V, Araujo AC, Vianna E, Borges M, Roxo P, Gonçalves M, Mello L, Parreira R, Silva J, Stefanelli P, Panazolo L, Cetlin A, Queiroz L, Araujo R, Dias M, Aragon D, Domingos N, Arruda LK. University and public health system partnership: A real-life intervention to improve asthma management. J Asthma 2016; 54:411-418. [PMID: 27715349 DOI: 10.1080/02770903.2016.1218012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Asthma is under-diagnosed in many parts of the world. We aimed to assess the outcome of a capacitating program on asthma for non-specialist physicians and other healthcare professionals working in the public system in Ribeirão Preto, Brazil. METHODS A group of 16 asthma specialists developed a one-year capacitating program in 11 healthcare clinics in the Northern District of the city, which included lectures on asthma, training on inhalation device use and spirometry, and development of an asthma management protocol. Researchers visited one health unit 2-4 times monthly, working with doctors on patients' care, discussing cases, and delivering lectures. Asthma education was also directed to the general population, focusing on recognition of signs and symptoms and long-term treatment, including production of educational videos available on YouTube. Outcome measures were the records of doctors' prescriptions of individual asthma medications pre- and post-intervention. RESULTS Prior to the program, 3205 units of inhaled albuterol and 2876 units of inhaled beclomethasone were delivered by the Northern District pharmacy. After the one-year program, there was increase to 4850 units (51.3%) for inhaled albuterol and 3526 units (22.6%) for inhaled beclomethasone. The albuterol increase followed the recommendation given to the non-specialist doctors by the asthma experts, that every patient with asthma should have inhaled albuterol as a rescue medication, by protocol. No increase was observed in other districts where no capacitating program was conducted. CONCLUSION A systematic capacitating program was successful in changing asthma prescription profiles among non-specialist doctors, with increased delivery of inhaled albuterol and beclomethasone.
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Affiliation(s)
- Janaina Melo
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Adriana Moreno
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Virginia Ferriani
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Ana Carla Araujo
- c Department of Medicine , University of Ribeirão Preto UNAERP , Ribeirão Preto , Brazil
| | - Elcio Vianna
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marcos Borges
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Pérsio Roxo
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marcos Gonçalves
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Luane Mello
- d Department of Social Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Rosa Parreira
- e Department of Pediatrics , Barão de Mauá University Center , Ribeirão Preto , Brazil
| | - Jorgete Silva
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Patricia Stefanelli
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Larissa Panazolo
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Andrea Cetlin
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Luana Queiroz
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Rosângela Araujo
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marina Dias
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Davi Aragon
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Nélio Domingos
- f Health Secretariat of Municipal Government of the City of Ribeirão Preto , Ribeirão Preto , Brazil
| | - L Karla Arruda
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
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