Trend of self-reported asthma prevalence in Brazil from 2003 to 2013 in adults and factors associated with prevalence

Determinants of asthma among adults in Tigray, Northern Ethiopia: a facility-based case-control study

Background

Asthma is a public health concern affecting millions of productive age groups. Several studies were conducted on the determinants of asthma in children. However, little is known about the determinants of asthma among adults in Ethiopia. Understanding the determinants of asthma among adults can help reduce its burden. This study was aimed at identifying determinant factors for developing asthma among adults in Tigray hospitals.

Methods

A facility-based, unmatched case-control study design was conducted from January 1 to April 26, 2019. A total of 698 participants (228 cases and 470 controls) completed their guided interviews using structured and pretested questionnaires by trained data collectors. A modified standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) was used to collect the data. The case definition was patients having asthma, and the control definition was patients without asthma. Data were entered and cleaned using Epi Data Manager Version 3.1 software and imported to statistical packages for social sciences Version 25 software for analysis. To identify asthma determinants, bivariate and multivariable logistic regression models were fitted.

Results

The response rate for both cases and controls was 95.9%. The odds of developing asthma was nearly twice higher among those who resided in urban (AOR = 1.68; 95% CI [1.13-2.50]), more than twice higher among those who have income less than 1000 ETB (AOR = 2.3; 95% CI [1.17-4.56]), twice higher among those who had history of skin allergy (AOR = 2.09; 95% CI [1.14-3.86]), over four times higher among those with family history of asthma (AOR = 4.26; 95% CI [2.63-6.91]), three times higher among those having house dust or smoke exposure (AOR = 3.01; 95% CI [1.96-4.64]), over five times higher among those lifetime firewood users (AOR = 5.39; 95% CI [3.34-8.72]), door opening while cooking (AOR = 0.35; 95% CI [0.26-0.55]), nearly two times higher among those having house dampness (AOR = 1.98; 95% CI [1.069-3.68]), over seven times higher among pet owners (AOR = 7.46; 95% CI [4.04-13] and almost twice higher among those who were physically inactive (AOR = 1.75; 95% CI [1.11-2.85]).

Conclusion

Asthma has been associated with urbanization, low income, a history of allergic diseases, indoor smoke or dust, firewood use, pet ownership, and a sedentary lifestyle. The community should be informed about the known risks and implement preventive steps like opening a door while cooking to lower the risk of asthma.

[Self-reported morbidities and lifestyles of agricultural and non-agricultural workers in Brazil: a comparative analysis between 2013 and 2019]

Differences in the profiles of illness and lifestyles among agricultural and non-agricultural workers were investigated using data from the National Health Survey (Brazilian acronym PNS) of 2013 and 2019. The prevalence and 95% CIs were calculated for the following variables: self-reported morbidities, poor self-rated health, limitations of usual activities, number of NCD, major or minor depression and lifestyles. The Poisson model was used to calculate crude and adjusted prevalence ratios, by gender and age. The sample weights and the conglomerate effect in 2013 and 2019 were considered in the analyses. A total of 33,215 non-agricultural workers and 3,797 agricultural workers were evaluated in 2013, whereas 47,849 non-agricultural workers and 4,751 agricultural workers were assessed in 2019. Agricultural workers are more susceptible to poor self-rated health, chronic back problems, excessive physical activity at work, smoking and lower consumption of vegetables and fruit. On the other hand, non-agricultural workers revealed a higher prevalence of asthma/bronchitis, depression and diabetes mellitus and greater consumption of candies and soft drinks. Differentiated NCD prevention and treatment actions for both groups of workers need to be prioritized.

The economic impact of asthma on private healthcare system in Brazil: Economic impact of asthma in Brazil

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.

Geosocial Features and Loss of Biodiversity Underlie Variable Rates of Inflammatory Bowel Disease in a Large Developing Country: A Population-Based Study

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.

Asthma in the Americas: An Update: A Joint Perspective from the Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, and American Thoracic Society

Asthma affects a large number of people living in the Americas, a vast and diverse geographic region comprising 35 nations in the Caribbean and North, Central, and South America. The marked variability in the prevalence, morbidity, and mortality from asthma across and within nations in the Americas offers a unique opportunity to improve our understanding of the risk factors and management of asthma phenotypes and endotypes in children and adults. Moreover, a better assessment of the causes and treatment of asthma in less economically developed regions in the Americas would help diagnose and treat individuals migrating from those areas to Canada and the United States. In this focused review, we first assess the epidemiology of asthma, review known and potential risk factors, and examine commonalities and differences in asthma management across the Americas. We then discuss future directions in research and health policies to improve the prevention, diagnosis, and management of pediatric and adult asthma in the Americas, including standardized and periodic assessment of asthma burden across the region; large-scale longitudinal studies including omics and comprehensive environmental data on racially and ethnically diverse populations; and dissemination and implementation of guidelines for asthma management across the spectrum of disease severity. New initiatives should recognize differences in socioeconomic development and health care systems across the region while paying particular attention to novel or more impactful risk factors for asthma in the Americas, including indoor pollutants such as biomass fuel, tobacco use, infectious agents and the microbiome, and psychosocial stressor and chronic stress.

Obesity, Inflammation, and Severe Asthma: an Update

Purpose of Review

Obesity-associated difficult asthma continues to be a substantial problem and, despite a move to address treatable traits affecting asthma morbidity and mortality, it remains poorly understood with limited phenotype-specific treatments. The complex association between asthma, obesity, and inflammation is highlighted and recent advances in treatment options explored.

Recent Findings

Obesity negatively impacts asthma outcomes and has a causal link in the pathogenesis of adult-onset asthma. Imbalance in the adipose organ found in obesity favours a pro-inflammatory state both systemically and in airways. Obesity may impact currently available asthma biomarkers, and obesity-associated asthma specific biomarkers are needed. Whilst surgical weight loss interventions are associated with improvements in asthma control and quality of life, evidence for pragmatic conservative options are sparse. Innovative approaches tackling obesity-mediated airway inflammation may provide novel therapies.

Summary

The immunopathological mechanisms underlying obesity-associated asthma require further research that may lead to novel therapeutic options for this disease. However, weight loss appears to be effective in improving asthma in this cohort and focus is also needed on non-surgical treatments applicable in the real-world setting.

Temperature variability and asthma hospitalisation in Brazil, 2000-2015: a nationwide case-crossover study

BACKGROUND

Both cold and hot temperature have been associated with the onset of asthma, but it remains largely unknown about the risk of asthma hospitalisation associated with short-term temperature fluctuation or temperature variability (TV).

OBJECTIVE

To explore the association between short-term exposure to TV and asthma hospitalisation in Brazil.

METHODS

Data for asthma hospitalisation and weather conditions were collected from 1816 Brazilian cities between 2000 and 2015. TV was calculated as the SD of all daily minimum and maximum temperatures within 0-7 days prior to current day. A time-stratified case-crossover design was performed to quantify the association between TV and hospitalisation for asthma.

RESULTS

A total of 2 818 911 hospitalisations for asthma were identified during the study period. Each 1°C increase in 0-7 days' TV exposure was related to a 1.0% (95% CI 0.7% to 1.4%) increase in asthma hospitalisations. The elderly were more vulnerable to TV than other age groups, while region and season appeared to significantly modify the associations. There were 159 305 (95% CI 55 293 to 2 58 054) hospitalisations, US$48.41 million (95% CI US$16.92 to US$78.30 million) inpatient costs at 2015 price and 450.44 thousand inpatient days (95% CI 156.08 to 729.91 thousand days) associated with TV during the study period. The fraction of asthma hospitalisations attributable to TV increased from 5.32% in 2000 to 5.88% in 2015.

CONCLUSION

TV was significantly associated with asthma hospitalisation and the corresponding substantial health costs in Brazil. Our findings suggest that preventive measures of asthma should take TV into account.

Prevalence of asthma symptoms and associated factors in adolescents and adults in southern Brazil: A Global Asthma Network Phase I study

Background

The Global Asthma Network (GAN) aims to find out the current status of the prevalence and severity of asthma, rhinitis, and eczema using global surveillance to achieve worldwide recognition and improve the management of asthma, especially in low- and middle-income countries. The aim of this study was to verify the associated factors for asthma in adolescents and their respective parents/caregivers.

Methods

Adolescents (13–14 years old; n = 1058) and their respective parents/caregivers (mean age = 42.1 years, n = 896) living in the town of Uruguaiana, Southern Brazil fulfilled the standardized questionnaire.

Results

Although the prevalence of wheezing in the past 12 months was higher among adults than adolescents (18.4% vs. 15.8%, respectively), adolescents showed more severe wheezing and worse control over the disease revealed by higher consumption of short-acting beta-2 agonists; going to the emergency room; hospitalization in the last year and dry night cough. Smoking and paracetamol use were associated with risk for developing asthma symptoms and consuming seafood/fish was protective. For the adults smoking (10 or more cigarettes/day) and exposure to mould in the house were associated with risk for asthma symptoms.

Conclusions

Adolescents have a high prevalence of asthma symptoms and few have an action plan. Adults do not have their disease under control and they use more relief than preventive medication. Differences in associated factors could determine the outcomes in asthma control among adolescents and their parents.

Longitudinal Association Between Diet Quality and Asthma Symptoms in Early Adult Life in a Brazilian Birth Cohort

Background

The role of diet in the etiology of asthma is still inconclusive. This paper evaluated the longitudinal association between diet quality and chest wheezing in young adults.

Methods

This is a longitudinal study with follow-up information from 18- and 22-year-olds (18y and 22y) of the 1993 Pelotas (Brazil) Birth Cohort. Chest wheezing occurrence and number of events in the last year were reported at 22y. Diet quality was measured with a revised version of the Healthy Eating Index (IQD-R) for the Brazilian population at 18y and 22y by food frequency questionnaire referring to the last 12 months. The diet quality continuity was classified as good (always 1st IQD-R tertile), intermediate (always 2nd tertile/change tertile) and poor (always 3rd tertile).

Results

A total of 2986 young individuals were evaluated; 51.4% were female. Prevalence of wheezing at 22y was 10.1% (95% CI: 9.1–11.2), and of these patients, 10% reported at least one event in the past year. Better IQD-R score, both at 18y and at 22y, the lower the odds of wheezing in the past year. Regarding the diet quality continuity from 18y to 22y, staying on a poor diet increased by more than three-fold the odds of chest wheezing (OR=3.28; 95% CI: 1.84–5.84) and of wheezing events (OR=3.32; 95% CI: 1.89–5.85) compared to staying on a good diet, after adjustment for confounding variables.

Conclusion

The overall quality of the diet seems to be more important than the individual components in the effect on asthma symptoms. Low-quality diet persistence increased the odds of chest wheezing and the number of events.

Prevalence and associated factors of bronchial asthma among adult patients in Debre Berhan Referral Hospital, Ethiopia 2018: a cross-sectional study

Objective

Bronchial asthma is one of the major public health challenges throughout the world that negatively impact patients, families and community. The objective of this study was to assess the prevalence and associated risk factors of bronchial asthma among patients in adult emergency department of Debre Berhan Referral Hospital. A hospital based cross-sectional study design was used among 257 study participants. A systematic sampling technique was used to select the study participants. Data was collected by using pretested and structured questionnaire and analyzed by using SPSS version 20.0. Both bivariate and multivariate logistic regression model was used to identify the predictors of asthma.

Results

Prevalence of bronchial asthma among adult patients was 29.6%. Being an urban resident (AOR: 1.5: 95% CI 1.3–3.9), income of household less than 1000 EBr/month (AOR: 1.7: 95% CI 1.6–4.1), having family history of asthma (AOR: 2.7: 95% CI 1.3–5.8), and presence of vermin in the house (AOR: 2.4: 95% CI 1.2–4.7) were significantly associated with bronchial asthma. The authors concluded that the prevalence of bronchial asthma among adult patients was high. Therefore, educational program about the risk factors and preventive measures of asthma is highly recommended.