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Alzahrani SJM, Alzahrani HAK, Alghamdi SMM, Alzahrani ANA. Health-Related Quality of Life of Asthmatic Patients in Al-Baha City, Saudi Arabia. Cureus 2024; 16:e53601. [PMID: 38449957 PMCID: PMC10915697 DOI: 10.7759/cureus.53601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction According to disability-adjusted life years (DALY), bronchial asthma (BA) is rated 28th among the top causes of disease burden globally and among the most significant reasons for years lived with disability. Internationally, 300 million people have asthma, and another 100 million individuals may develop it by 2025. In Al-Baha City, where environmental factors such as dust and pollen levels can exacerbate asthma symptoms, understanding and addressing the health-related quality of life of asthmatic patients is crucial. Understanding the health-related quality of life of asthmatic patients can inform public health policies and initiatives aimed at reducing environmental triggers and promoting better asthma management in the city. Objectives The study aims to assess the impact of asthma regarding physical, emotional, and social activities that affect health-related quality of life. Subjects and methods A cross-sectional study was conducted from January 2023 to May 2023 at King Fahad Hospital in Al-Baha City, Saudi Arabia. The study used a Mini Asthma Quality of Life Questionnaire that measures physical, emotional, and social activities that affect health-related quality of life. Results One hundred and fifty-one out of 185 participants responded, yielding a response rate of 81.6%. The average age of the participants was 52, with a standard deviation of 15.4 years. Participants' responses regarding symptoms related to the environment during the last two weeks indicated "all the time" experiencing feeling bothered by or having to avoid cigarette smoke (n=104, 69%) and dust (n=92, 61%) in the environment. Moreover, considering emotion-related symptoms, 54% reported they did not feel afraid of not having their asthma medication available. Similarly, 46% reported never feeling frustrated because of asthma, whereas 3.3% of the participants documented hardly ever feeling frustrated. Regarding social activity limitations, 44 individuals (29%) reported no limits in these activities, while 43 (28%) reported being completely limited. While there were limitations in work-related activities, 42 participants (28%) reported no restrictions, whereas 34 (23%) reported being completely limited. Conclusion The study findings highlight a concern about suboptimal asthma control and the need to attain more satisfactory levels of asthma management.
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Affiliation(s)
- Saleh Jamman M Alzahrani
- Department of Internal Medicine (Pulmonology and Pulmonary Rehabilitation), King Fahad Hospital, Al-Baha, SAU
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Mallick I, Panchal P, Kadam S, Mohite P, Scheele J, Seiz W, Agarwal A, Sharma OP. In-silico identification and prioritization of therapeutic targets of asthma. Sci Rep 2023; 13:15706. [PMID: 37735578 PMCID: PMC10514284 DOI: 10.1038/s41598-023-42803-w] [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: 03/01/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
Asthma is a "common chronic disorder that affects the lungs causing variable and recurring symptoms like repeated episodes of wheezing, breathlessness, chest tightness and underlying inflammation. The interaction of these features of asthma determines the clinical manifestations and severity of asthma and the response to treatment" [cited from: National Heart, Lung, and Blood Institute. Expert Panel 3 Report. Guidelines for the Diagnosis and Management of Asthma 2007 (EPR-3). Available at: https://www.ncbi.nlm.nih.gov/books/NBK7232/ (accessed on January 3, 2023)]. As per the WHO, 262 million people were affected by asthma in 2019 that leads to 455,000 deaths ( https://www.who.int/news-room/fact-sheets/detail/asthma ). In this current study, our aim was to evaluate thousands of scientific documents and asthma associated omics datasets to identify the most crucial therapeutic target for experimental validation. We leveraged the proprietary tool Ontosight® Discover to annotate asthma associated genes and proteins. Additionally, we also collected and evaluated asthma related patient datasets through bioinformatics and machine learning based approaches to identify most suitable targets. Identified targets were further evaluated based on the various biological parameters to scrutinize their candidature for the ideal therapeutic target. We identified 7237 molecular targets from published scientific documents, 2932 targets from genomic structured databases and 7690 dysregulated genes from the transcriptomics and 560 targets from genomics mutational analysis. In total, 18,419 targets from all the desperate sources were analyzed and evaluated though our approach to identify most promising targets in asthma. Our study revealed IL-13 as one of the most important targets for asthma with approved drugs on the market currently. TNF, VEGFA and IL-18 were the other top targets identified to be explored for therapeutic benefit in asthma but need further clinical testing. HMOX1, ITGAM, DDX58, SFTPD and ADAM17 were the top novel targets identified for asthma which needs to be validated experimentally.
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Affiliation(s)
- Ishita Mallick
- Innoplexus Consulting Pvt. Ltd, 7th Floor, Midas Tower, Next to STPI Building, Phase 1, Hinjewadi Rajiv Gandhi Infotech Park, Hinjawadi, Pune, Maharashtra, 411057, India
| | - Pradnya Panchal
- Innoplexus Consulting Pvt. Ltd, 7th Floor, Midas Tower, Next to STPI Building, Phase 1, Hinjewadi Rajiv Gandhi Infotech Park, Hinjawadi, Pune, Maharashtra, 411057, India
| | - Smita Kadam
- Innoplexus Consulting Pvt. Ltd, 7th Floor, Midas Tower, Next to STPI Building, Phase 1, Hinjewadi Rajiv Gandhi Infotech Park, Hinjawadi, Pune, Maharashtra, 411057, India
| | - Priyanka Mohite
- Innoplexus Consulting Pvt. Ltd, 7th Floor, Midas Tower, Next to STPI Building, Phase 1, Hinjewadi Rajiv Gandhi Infotech Park, Hinjawadi, Pune, Maharashtra, 411057, India
| | - Jürgen Scheele
- Innoplexus AG, Frankfurter Str. 27, 65760, Eschborn, Germany
| | - Werner Seiz
- Innoplexus AG, Frankfurter Str. 27, 65760, Eschborn, Germany
| | - Amit Agarwal
- Innoplexus Consulting Pvt. Ltd, 7th Floor, Midas Tower, Next to STPI Building, Phase 1, Hinjewadi Rajiv Gandhi Infotech Park, Hinjawadi, Pune, Maharashtra, 411057, India
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Pitrez PM. The challenges of asthma care in low- and middle-income countries: what's next? J Bras Pneumol 2023; 49:e20230215. [PMID: 37493795 PMCID: PMC10578922 DOI: 10.36416/1806-3756/e20230215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- Paulo Márcio Pitrez
- . Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre (RS) Brasil
- . Scientific Committee, Global Initiative for Asthma - GINA - Bethesda (MD) USA
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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: 0] [Impact Index Per Article: 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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Walid Al-Qerem, Jarab A, Abu Heshmeh SR, Ling J. Variables associated with asthma control among adult patients. J Asthma 2022; 60:1290-1298. [PMID: 36336819 DOI: 10.1080/02770903.2022.2144351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective: Asthma is one of the most prevalent chronic diseases with a substantial impact on the health status of affected patients. Further research is necessary to identify factors contributing to poor asthma control. The current study aimed to investigate the factors associated with poor asthma control among adult asthmatic patients.Methods: In this case-control study, the Asthma Control Test (ACT) was translated into Arabic and distributed to adults with asthma attending two hospitals in Jordan to evaluate the degree of asthma control. The following variables were collected for each patient: sociodemographic information, comorbidities, appropriate use of inhaler technique, spirometric measurements, and medications use. Binary regression was used to evaluate factors associated with asthma control.Results: A total of 314 participants with a mean age of 51.47 years (±16.37) completed the study. ACT score had a mean of 16.68 (±4.86). The majority of asthmatic patients had insufficiently controlled asthma (64.6%). Binary regression results showed that previous respiratory infection history (p = 0.014, OR = 0.473 (95%CI 0.261-0.857)), higher exposure to irritants (p = 0.010, OR = 0.747 (95%CI 0.598-0.933)) decreased the odds of being in the controlled asthma group. Patients receiving inhaled corticosteroids (ICS) had higher odds of being in the controlled asthma group (p = 0.039, OR = 2.372 (95%CI 1.043-5.392)).Conclusions: The majority of asthma patients had insufficiently managed disease. The main factors that contributed to poor asthma control were respiratory infection history, increased exposure to asthma symptoms triggers, and ICS nonuse.
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Affiliation(s)
- Walid Al-Qerem
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan
| | - Anan Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
- Collage of Pharmacy, Al Ain University, Abu Dhabi, UAE
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Chester Road, Sunderland, SR1 3SD, United Kingdom
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McRae N, Gennings C, Rivera Rivera N, Tamayo-Ortiz M, Pantic I, Amarasiriwardena C, Schnaas L, Wright R, Tellez-Rojo MM, Wright RO, Rosa MJ. Association between prenatal metal exposure and adverse respiratory symptoms in childhood. ENVIRONMENTAL RESEARCH 2022; 205:112448. [PMID: 34848207 PMCID: PMC8768059 DOI: 10.1016/j.envres.2021.112448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Manganese and lead have been cross-sectionally associated with adverse respiratory outcomes in childhood but there is limited data on their combined effects starting in utero. We examined associations between in utero exposure to metals and childhood respiratory symptoms. METHODS We assessed 633 mother-child dyads enrolled in the Programming Research in Obesity, Growth, Environment, and Social Stressors (PROGRESS) birth cohort in Mexico City. Blood manganese (BMn) and lead (BPb) were measured in mothers at 2nd and 3rd trimester. Ever wheeze, current wheeze and asthma diagnosis were ascertained at 4-5 and 6-7 year visits through the International Study of Asthma and Allergies in Childhood survey. Logistic mixed model regression was used to assess the association between prenatal metals and respiratory outcomes in children across the 4-5 and 6-7 year visits. Covariates included mother's age, education and asthma, environmental tobacco smoke, child's sex and assessment time. RESULTS In adjusted models, higher 2nd trimester BPb had a significant association with elevated odds of ever wheeze (Odds Ratio (OR): 1.97, 95% CI: 1.05, 3.67). BMn at 2nd trimester was associated with decreased (OR: 0.06, 95% CI: 0.01, 0.35) odds of current wheeze. We did not find any statistically significant associations with 3rd trimester blood metals. CONCLUSION Prenatal exposure to Pb was associated with higher odds of ever wheeze while Mn was negatively associated with odds of current wheeze. These findings underscore the need to consider prenatal metal exposure, including low exposure levels, in the study of adverse respiratory outcomes.
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Affiliation(s)
- Nia McRae
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nadya Rivera Rivera
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Ivan Pantic
- Department of Developmental Neurobiology, National Institute of Perinatology, Mexico City, Mexico
| | - Chitra Amarasiriwardena
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lourdes Schnaas
- Department of Developmental Neurobiology, National Institute of Perinatology, Mexico City, Mexico
| | - Rosalind Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Kravis Children's Hospital, Department of Pediatrics, Division of Pediatric Pulmonology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martha M Tellez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria José Rosa
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low- and middle-income countries: case for change. Eur Respir J 2022; 60:13993003.03179-2021. [PMID: 35210321 PMCID: PMC9474897 DOI: 10.1183/13993003.03179-2021] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Asthma is the most common non-communicable disease in children, and among the most common in adults. The great majority of people with asthma live in low- and middle-income countries (LMICs), where they suffer disproportionately high asthma-related morbidity and mortality. Essential inhaled medications, particularly those containing inhaled corticosteroids (ICS), are often unavailable or unaffordable, and this explains much of the global burden of preventable asthma morbidity and mortality.Guidelines developed for LMICs are generally based on the outdated assumption that patients with asthma symptoms <1-3 times/week do not need (or benefit from) ICS. Even when ICS is prescribed, many patients manage their asthma with oral or inhaled short-acting beta2 agonist (SABA) alone, due to issues of availability and affordability. A single ICS-formoterol inhaler-based approach to asthma management for all severities of asthma, from mild to severe, starting at diagnosis, might overcome SABA overuse/over-reliance and reduce the burden of symptoms and severe exacerbations. However, ICS-formoterol inhalers are currently very poorly available or unaffordable in LMICs. There is a pressing need for pragmatic clinical trial evidence of the feasibility and cost-effectiveness of this and other strategies to improve asthma care in these countries.The global health inequality in asthma care that deprives so many children, adolescents and adults of healthy lives and puts them at increased risk of death - despite the availability of highly effective therapeutic approaches - is unacceptable. A World Health Assembly Resolution on universal access to affordable effective asthma care is needed to focus attention and investment on addressing this need.
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Affiliation(s)
- K Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, United Kingdom (2) Department of Medicine, University of Cambridge, Cambridge, UK
| | - H K Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - P M Pitrez
- Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - E D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Mulugeta T, Ayele T, Zeleke G, Tesfay G. Asthma control and its predictors in Ethiopia: Systematic review and meta-analysis. PLoS One 2022; 17:e0262566. [PMID: 35025962 PMCID: PMC8758033 DOI: 10.1371/journal.pone.0262566] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Determining the status of asthma control and identifying risk factors for poor asthma control is a key strategy for curbing the negative health impacts and the financial burden of the disease. Therefore, this review was aimed to determine the rate of asthma control and assess the predictors of uncontrolled asthma in Ethiopia. METHODS PubMed, Web of Science, and Google Scholar searches were performed using key terms; "asthma, bronchial asthma, control, controlled, uncontrolled and Ethiopia" up to October 16, 2020. University repositories were also searched to retrieve gray literature. The results were presented as a prevalence rate with a 95% confidence interval (CI). Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity in the outcomes. RESULTS From 1,388 patients, based on the Global Initiative for Asthma (GINA) symptom control, the rate of the uncontrolled asthma was 45.0% (95% CI 34.0% - 56.0%) with a considerable heterogeneity between the studies; (I2: 94.55, p< 0.001). About 19.0% (95% CI 10.0% - 29.0%); (I2: 96.04, p< 0.001) of the asthma patients had a well-controlled asthma. Moreover, 36.0% (95% CI 22.0% - 50.0%), (I2: 97.11, p< 0.001) of patients had a partly controlled asthma. Similarly, based on the asthma control test (ACT), the rate of well-controlled asthma was 22.0% (95% CI 3% - 42.0%), with considerable heterogeneity between the studies; (I2: 97.75, p< 0.001). The most frequent predictors of uncontrolled asthma were incorrect inhalation techniques, frequent SABA use, moderate/severe persistent asthma, history of exacerbations, presence of comorbidities, use of oral corticosteroids, and irregular follow-up. CONCLUSION The rate of uncontrolled asthma in Ethiopia was high. Several factors are associated with uncontrolled asthma. Comprehensive asthma educations at each follow-up visit should be strengthened to minimize the morbidity and the cost of uncontrolled asthma.
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Affiliation(s)
- Temesgen Mulugeta
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
- * E-mail:
| | - Teshale Ayele
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getandale Zeleke
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Gebremichael Tesfay
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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Bassam M, Behbehani N, Farouk H, Alsayed M, Montestruc F, Al-Jahdali H, Iqbal MN, Al Zaabi A. Adherence to medication among adult asthma patients in the Middle East and North Africa: results from the ESMAA study. Respir Med 2020; 176:106244. [PMID: 33253971 DOI: 10.1016/j.rmed.2020.106244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Low levels of adherence to asthma medication is reported in many countries worldwide. Improved knowledge of adherence in the Middle East and North Africa (MENA) is needed to address this major public healthcare burden. OBJECTIVE Assess the level of adherence in patients attending a routine consultation and the relationship between adherence, patient/disease characteristics, disease control, and quality of life. METHODS A large-scale cross-sectional epidemiological study was performed on adults suffering from asthma for at least 1 year and without an acute asthma episode within 4 weeks. Adherence was assessed using the MMAS-4 questionnaire©. Predictive factors of adherence were analyzed with logistic regressions. RESULTS Overall 7203 eligible patients were included in 577 sites. Mean age was 45.4 years (±14.7), 57.2% were female, mean BMI was 28.5 kg/m2 (±6.0), and 11% were active smokers. Good adherence was observed in 23.6% with a country effect (p < 0.001). Higher age, higher SF-8 Mental component score, and high level of control were associated with good adherence (p < 0.001). Patients treated with a fixed combination (ICS + LABA) have better adherence and patients treated with short-acting beta agonist alone have a lower adherence. Good adherence has been noted in 528 uncontrolled patients suggesting the existence of a subgroup difficult to treat and who have severe asthma. CONCLUSIONS Asthma adherence in the MENA is unsatisfactory with less than one quarter of asthma patients having good adherence. This finding highlights the need to improve access to treatment, ensure better control follow-up and improved education among healthcare providers and patients.
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Affiliation(s)
- Mahboub Bassam
- University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates.
| | - Naser Behbehani
- Department of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait.
| | - Hisham Farouk
- AstraZeneca, Ibn Sina Building, Dubai Healthcare City, PO Box 505070, Dubai, United Arab Emirates
| | - Mohamed Alsayed
- AstraZeneca, Ibn Sina Building, Dubai Healthcare City, PO Box 505070, Dubai, United Arab Emirates
| | | | - Hamdan Al-Jahdali
- King Saud University for Health Sciences/McGill University/Sleep Disorders Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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Shimizu Y, Shiobara T, Arai R, Chibana K, Takemasa A. Real-life effectiveness of fluticasone furoate/vilanterol after switching from fluticasone/salmeterol or budesonide/formoterol therapy in patients with symptomatic asthma: Relvar Ellipta for Real Asthma Control Study (RERACS study). J Thorac Dis 2020; 12:1877-1883. [PMID: 32642091 PMCID: PMC7330400 DOI: 10.21037/jtd-19-3913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background This study evaluated the efficacy of switching therapy from fluticasone propionate/salmeterol (FP/SM) or budesonide/formoterol (BD/FM) to fluticasone furoate and vilanterol (FF/VI) at the equivalent corticosteroid dose in a real-world setting. Methods A prospective, 3-month, open-label, parallel group, switching therapy trial was performed in symptomatic asthma patients under routine management. Patients using 1 puff of FP 250 µg/SM 50 µg b.i.d or 2 puffs of BD 160 µg/FM 4.5 µg b.i.d were switched to FF 100 µg/VI 25 µg once daily, while patients using 1 puff of FP 500 µg/SM 50 µg b.i.d or 4 puffs of BD 160/FM b.i.d was switched to FF 200 µg/VI 25 µg once daily. The primary outcome was improvement of the predicted forced expiratory volume in 1 second % (%FEV1), while secondary outcomes were improvement of asthma symptoms evaluated by the asthma control test (ACT) and fractional exhaled nitric oxide (FeNO). Results The %FEV1 was improved at 4 weeks after switching, and the improvement was maintained until 12 weeks. ACT also improved after switching. Patients with ACT <20 before switching showed greater improvement of symptoms at 4 weeks and 62% had an ACT score >20. FeNO decreased from 8 weeks. Conclusions In symptomatic asthma patients showing insufficient control, improvement of asthma was obtained by switching to FF/VI at the equivalent corticosteroid dose accompanied with the improvement of biomarkers. FF/VI can be a useful option for better control of asthma because of its high efficacy, long duration of action, and delivery via a single-action device.
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Affiliation(s)
- Yasuo Shimizu
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Taichi Shiobara
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Ryo Arai
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kazuyuki Chibana
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Akihiro Takemasa
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
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11
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Alith MB, Gazzotti MR, Nascimento OA, Jardim JR. Impact of asthma control on different age groups in five Latin American countries. World Allergy Organ J 2020; 13:100113. [PMID: 32256940 PMCID: PMC7118313 DOI: 10.1016/j.waojou.2020.100113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Asthma is a chronic airway inflammatory condition of the airway and is classified as controlled, partially controlled, and uncontrolled. Patients with uncontrolled asthma are at greater risk for hospitalizations and visits to emergencies, and the condition has greater impact on their daily lives. The aim of this study was to evaluate asthma control, the use of health resources, and asthma's impact on the activities of daily living of patients with different age groups in 5 Latin American countries. Methods This was a retrospective analysis of The Latin America Asthma Insights and Management (LA AIM) study carried out in Argentina, Brazil, Mexico, Venezuela, and Puerto Rico. Asthmatics were splited into 3 age groups: 12–17, >17–40 and > 40 years old. An interview face to face was carried out and patients answered a questionnaire of 53 questions related to 5 main domains of asthma: symptoms, impact of asthma on daily living activities, patients' perceptions of asthma control, exacerbations, and treatment/medication. Results A total of 2167 asthmatics were interviewed. There was a low percentage of controlled patients (mean 9%) in all 3 groups with no particular difference among the five countries, but Venezuelan patients had a 71% chance of having uncontrolled asthma (p < 0.001). Conclusion In the 3 age groups, patients experienced poor asthma control, with no significant differences among the countries. Patients who used control medication had a greater chance of controlling their asthma, and those who had emergency health care visits had a greater chance of having uncontrolled asthma.
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Affiliation(s)
- Marcela Batan Alith
- Pulmonary Rehabilitation Center of Escola Paulista de Medicina of Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Hospital Universitário da USP, Brazil
| | - Mariana Rodrigues Gazzotti
- Pulmonary Rehabilitation Center of Escola Paulista de Medicina of Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil
| | - Oliver Augusto Nascimento
- Pulmonary Rehabilitation Center of Escola Paulista de Medicina of Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Respiratory Division of EPM/Unifesp, São Paulo, Brazil
| | - José Roberto Jardim
- Pulmonary Rehabilitation Center of Escola Paulista de Medicina of Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Respiratory Division of EPM/Unifesp, São Paulo, Brazil
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12
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Haouichat H, Benali R, Benyounes A, Berrabah Y, Douagui H, Guermaz M, Lellou S, Montestruc F, Moumeni A, Skander F, Taleb A, Taright S, Zidouni N. [Asthma control in adult Algerian patients. Comparison with other North African and Middle-East countries]. Rev Mal Respir 2019; 37:15-25. [PMID: 31899022 DOI: 10.1016/j.rmr.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Lack of recent data on asthma control in Algeria led to this study whose results were compared with those of the same study conducted in the Middle East and North Africa (MENA). METHOD This cross-sectional epidemiological study was performed in adults who had been diagnosed with asthma for at least one year and without exacerbation within the last 4 weeks. Asthma control was assessed using the 2012 Global Initiative for Asthma (GINA) criteria and the Asthma control test (ACT) questionnaire. RESULTS We studied 984 patients mainly managed by specialist physicians; 61% female, mean age 45 years, body mass index 27kg/m2, active smokers 2%. Medication was prescribed in 92% with 78% receiving inhaled corticosteroids alone or with add-on therapies. Good adherence was observed in 27%. Asthma control was observed in 34.6% vs. 28.6% in other countries (P < 0.001). Low level of education, absence of medical insurance, lack of physical exercise, and-long duration of the disease were significantly associated with uncontrolled asthma. CONCLUSION Poor control of asthma is still observed in Algeria despite a high level of specialist involvement. Except for adherence, known predictive factors of poor asthma control have been observed. Quality improvement training of health care professionals and patient education are probably the main issues to be addressed.
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Affiliation(s)
| | - R Benali
- Service de pneumologie, CHU d'Annaba, Annaba, Algérie
| | | | - Y Berrabah
- Service de pneumologie, CHU d'Oran, Oran, Algérie
| | - H Douagui
- Service de pneumologie, CHU Beni-Messous, Alger, Algérie
| | - M Guermaz
- Service de pneumologie, CHU d'Oran, Oran, Algérie
| | - S Lellou
- Service de pneumologie, Oran EHU, Oran, Algérie
| | - F Montestruc
- eXYSTAT, 92240 Malakoff, France; Clinica Group, Alger, Algérie
| | - A Moumeni
- Service de pneumologie, CHU de Setif, Setif, Algérie
| | - F Skander
- Service de pneumologie, CHU Beni-Messous, Alger, Algérie
| | - A Taleb
- Service de pneumologie, CHU de Sidi Bel Abbès, Bel Abbès, Algérie
| | - S Taright
- Service de pneumologie, CHU Mustapha-Pacha, Alger, Algérie
| | - N Zidouni
- Service de pneumologie, CHU Beni-Messous, Alger, Algérie
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13
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Haouichat H, Benali R, Benyounes A, Berrabah Y, Douagui H, Guermaz M, Lellou S, Montestruc F, Moumeni A, Skander F, Taleb A, Taright S, Zidouni N. RETRAIT : Contrôle de l’asthme chez l’adulte en Algérie. Comparaison avec les autres pays d’Afrique du Nord et du Moyen Orient. Rev Mal Respir 2019:S0761-8425(19)30037-3. [PMID: 31010753 DOI: 10.1016/j.rmr.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Affiliation(s)
| | - R Benali
- Service de pneumologie, CHU d'Annaba, Annaba, Algérie
| | | | - Y Berrabah
- Service de pneumologie, CHU d'Oran, Oran, Algérie
| | - H Douagui
- Service de pneumologie, CHU Beni-Messous, Alger, Algérie
| | - M Guermaz
- Service de pneumologie, CHU d'Oran, Oran, Algérie
| | - S Lellou
- Service de pneumologie, Oran EHU, Oran, Algérie
| | - F Montestruc
- eXYSTAT Malakoff, 92240 Malakoff, France; Clinica Group, Alger, Algérie
| | - A Moumeni
- Service de pneumologie, CHU de Setif, Setif, Algérie
| | - F Skander
- Service de pneumologie, CHU Beni-Messous, Alger, Algérie
| | - A Taleb
- Service de pneumologie, CHU de Sidi Bel Abbès, Bel Abbès, Algérie
| | - S Taright
- Service de pneumologie, CHU Mustapha-Pacha, Alger, Algérie
| | - N Zidouni
- Service de pneumologie, CHU Beni-Messous, Alger, Algérie
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14
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Al-Jahdali H, Wali S, Salem G, Al-Hameed F, Almotair A, Zeitouni M, Aref H, Nadama R, Algethami MM, Al Ghamdy A, Dihan T. Asthma control and predictive factors among adults in Saudi Arabia: Results from the Epidemiological Study on the Management of Asthma in Asthmatic Middle East Adult Population study. Ann Thorac Med 2019; 14:148-154. [PMID: 31007767 PMCID: PMC6467022 DOI: 10.4103/atm.atm_348_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT: Asthma control is suboptimal in the Middle East and North Africa (MENA). AIMS: The aim of this study is to assess the level of asthma control in Saudi patients as per the Global Initiative for Asthma 2012 classification and explore its potential predictive factors. SETTINGS AND DESIGN: Epidemiological Study on the Management of Asthma in Asthmatic Middle East Adult Population (ESMAA) is a multicentric, descriptive, epidemiological study assessing asthma management in the MENA region. In this article, we report the results of patients from Saudi Arabia included in the ESMAA study. METHODS: Adult patients diagnosed with asthma at least 1 year before study entry were considered for inclusion. Asthma control level and its predictive factors were explored. Treatment adherence and quality of life (QoL) were assessed by MMAS-4© and Short Form 8 Health Survey QoL questionnaires, respectively. STATISTICAL ANALYSIS USED: Descriptive statistics were done considering two-sided 95% confidence intervals. Logistic regression was used to explore the potential predictive factors of asthma control. All statistical tests were two-sided, and P < 0.05 was considered statistically significant. RESULTS: Data of 1009 patients from Saudi Arabia were analyzed. Less than one-third of patients (30.1%) were found to have controlled asthma with significantly higher QoL. High level of asthma control was reported among male patients and those with high educational level, while age, body mass index, and adherence to treatment were found to have no effect on asthma control. CONCLUSIONS: Asthma control remains suboptimal among Saudi population. This needs huge efforts to achieve acceptable levels of control and better QoL for asthma patients. Further studies are still needed in Saudi Arabia and the Middle East region.
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Affiliation(s)
- Hamdan Al-Jahdali
- McGill University, Québec, Canada.,King Saud University for Health Sciences, Riyadh, KSA.,Division of Pulmonary, Sleep Disorders Center, King Abdulaziz Medical City, Riyadh, KSA
| | - Siraj Wali
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, KSA
| | - Gamal Salem
- King Abdulaziz Airbase Hospital, Dharan, KSA.,Ain Shams University, Cairo, Egypt
| | - Fahad Al-Hameed
- Department of ICU and Pulmonary, College of Medicine, King Saud ben Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, KSA
| | | | | | - Hassan Aref
- Pulmonary Division, Suliman Fakeeh Hospital, Jeddah, KSA.,Faculty of Medicine, Cairo University, Giza, Egypt
| | - Rufai Nadama
- Pulmonary Division, King Khalid University Hospital, Riyadh, KSA
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Alzaabi A, Idrees M, Behbehani N, Khaitov MR, Tunceli K, Urdaneta E, Awad N, Safwat M. Cross-sectional study on Asthma Insights and Management in the Gulf and Russia. Allergy Asthma Proc 2018; 39:430-436. [PMID: 30326990 DOI: 10.2500/aap.2018.39.4180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Asthma is a chronic and complex lung disease that is not completely understood. It involves airway inflammation, reversible airflow obstruction, and bronchial hyperresponsiveness. The most common symptoms are recurrent wheezing, chest tightness, shortness of breath, and coughing. Objective: The Asthma Insights and Management study gathered information on the burden of asthma in the Gulf region (United Arab Emirates, Kuwait, Saudi Arabia) and Russia. Methods: This was a cross-sectional, multinational, noninterventional, two-phase study that collected data from patients ages ≥ 12 years, through interviews and a survey questionnaire. Phase 1 consisted of survey questions focused on estimating the asthma prevalence in the community. Phase 2 was designed to assess the level of asthma control, asthma-related perceptions and behaviors, and presentation patterns. Data were summarized by using descriptive analyses. Results: Analysis of data of 711 patients revealed that the prevalence of asthma among patients who lived in the community was 7.9% and that 66% subjectively perceived their asthma as being controlled. However, 97% of the patients' asthma were partially controlled or uncontrolled based on the Global initiative for Asthma control classification. Troubling symptoms were daytime coughing (33.3%) and shortness of breath (20.3%). With respect to medications for asthma, 76.2% of the patients reported the use of quick relief medication and 80.8% of maintenance medication during the past 4 weeks. Asthma exacerbation in the past year was reported by 40% of adults and adolescents in the study. Conclusion: The results showed that a significant proportion of the patients experienced bothersome symptoms and that many had a lack of knowledge about asthma control and treatment recommendations, which indicated that there is a need for improvements in patient education and asthma care in the Gulf and Russia regions.
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Affiliation(s)
- Ashraf Alzaabi
- From the Division of Respirology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Majdy Idrees
- Pulmonary Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Musa R. Khaitov
- Immunology Department, National Research Center Institute of Immunology, Federal Medical Biological Agency, Moscow, Russia
| | - Kaan Tunceli
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey
| | - Eduardo Urdaneta
- Global Medical Affairs, Merck & Co. Inc., Kenilworth, New Jersey
| | - Nancy Awad
- Real-World & Analytics Solutions, IQVIA, Dubai, United Arab Emirates
| | - Mohamed Safwat
- Real-World & Analytics Solutions, IQVIA, Dubai, United Arab Emirates
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Ortiz-Rivera MC. Asthma-related health services and asthma control among women in Puerto Rico. SAGE Open Med 2018; 6:2050312117745903. [PMID: 29780586 PMCID: PMC5952275 DOI: 10.1177/2050312117745903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/09/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives: This study evaluates social, behavioral, and environmental determinants to differentiate between active and inactive asthma and how predisposing, enabling, and need factors elucidate asthma-related health services and asthma control among women in Puerto Rico. Methods: This study analyzed secondary cross-sectional data from a subsample of 625 adult females who participated in the Asthma Call Back Survey in Puerto Rico. Logistic and multinomial regression analyses were conducted to examine associations between explanatory variables and asthma outcomes. Results: In total, 63% of women reported active asthma, from which 37.9% have not well controlled or very poorly controlled asthma. Women with active asthma were significantly more likely to be out of work, have middle income (US$25,000–<US$35,000), and be obese (≥30 kg/m2). Perceived need of health status is a good predictor to know the odds ratio of women to use emergency room. Women with poorly controlled asthma were significantly associated with increased units of physician urgent visits and emergency room visits. Conclusion: The findings confirmed significant determinants for active asthma and adds information on odds ratio for sensitive subgroups that utilize asthma-related health services in higher proportion than their counterparts. These associations suggest a development of asthma management plan targeting women to control the condition and reduce health-care utilization.
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Tarraf H, Al-Jahdali H, Al Qaseer AH, Gjurovic A, Haouichat H, Khassawneh B, Mahboub B, Naghshin R, Montestruc F, Behbehani N. Asthma control in adults in the Middle East and North Africa: Results from the ESMAA study. Respir Med 2018; 138:64-73. [PMID: 29724395 DOI: 10.1016/j.rmed.2018.03.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Low levels of asthma control are reported in many countries worldwide. Improved knowledge of asthma control in the Middle East and Africa and predictive factors is needed to address this major public healthcare burden. OBJECTIVE To assess the level of asthma control in patients attending a routine consultation for asthma in the Middle East and North Africa, and the relationship between level of control and patient and disease characteristics, adherence, and quality of life (QoL). METHODS A large-scale cross-sectional epidemiological study (ESMAA: Assessment of Asthma Control in Adult Asthma Population in the Middle East and North Africa) was performed in adults suffering from asthma for at least 1 year and without an acute asthma episode within 4 weeks. Asthma control was assessed per the 2012 GINA guidelines and the ACT questionnaire. QoL and adherence were assessed with the SF-8 and Morisky questionnaires respectively. Predictive factors of asthma control were analysed with univariate and multivariate logistic regressions analyses. RESULTS Overall 7236 eligible patients were included in 577 sites between June 2014 and December 2015 (median 10 patients/site). Mean age was 45 years (±14), 57% were female, mean BMI was 28.5 kg/m2 (±6.0), and 11% were active smokers. Reliever medication was prescribed in 96% of patients with 65% having fixed-dose combined inhaled corticosteroid plus long-acting beta agonists. Good medication adherence was reported in 24% of patients. Among 7179 patients evaluable for GINA, asthma was controlled in 29.4% (95% CI, 28.4%-30.5%), partly controlled in 29.1% (95% CI, 28.1%-30.2%), and uncontrolled in 41.5% (95% CI, 40.3% to 42.6). The mean global ACT score was 17.8 (±5.0), with 16% of patients considering their asthma as controlled. Poor medication adherence, active smoking, absence of medical insurance, lower level of education, or diagnosis at least 5 years earlier were significantly associated with uncontrolled asthma in multivariate analyses (p < 0.001). CONCLUSIONS Asthma control in the Middle East and North Africa is unsatisfactory with less than one-third of asthma patients having controlled disease, highlighting the need to improve treatment access and medication adherence, along with better follow-up and education among healthcare providers and patients.
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Affiliation(s)
- Hesham Tarraf
- Cairo University, 22 Talaat Harb St, City Centre, Cairo, Egypt.
| | - Hamdan Al-Jahdali
- King Saud University for Health Sciences/McGill University/Sleep Disorders Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | | | - Anamarija Gjurovic
- AstraZeneca, Ibn Sina Building, Dubai Healthcare City, PO Box 505070, Dubai, United Arab Emirates.
| | - Houria Haouichat
- Service de Pneumologie, Hôpital Central de l'Armée, BP 244, Kouba, Algeria.
| | | | - Bassam Mahboub
- University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates.
| | - Roozbeh Naghshin
- Rasoul Akram Hospital/Tehran, Hazrat-e Rasool General Hospital, Niyayesh St, Satarkhan St, Tehran, Iran.
| | | | - Naser Behbehani
- Department of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait.
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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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Abstract
Objectives: To explore the determinants of uncontrolled asthma in Saudi Arabia. Methods: A consecutive series of adult asthma patients attending 3 pulmonary primary care clinics in Riyadh, Saudi Arabia for a scheduled appointment were interviewed. A multiple logistic regression analysis was used. Results: The proportion of patients with uncontrolled asthma was 68.1% (177/260). Daily tobacco smoking or monthly household income less than 15,000 Saudi Arabian Riyals were associated with a 4.6 (95% confidence interval [CI]=1.3-16.4) and 3.4 (95% CI=1.8-6.6) times increase in the odds of having uncontrolled asthma. Patients with less than a graduate degree (odds ratio [OR]=3.1; 95% CI=1.0-9.5) or patients who were unemployed, disabled, or too ill to work (OR=3.1; 95% CI=1.4-6.9) had poorer asthma control. Having heartburn during the past 4 weeks decreased the odds of asthma control by 2.5 (95% CI=1.3-4.9), and having chronic sinusitis during the past 4 weeks decreased the odds of asthma control by 2.0 (95% CI=1.0-4.0) times. Being female (OR=2.0; 95% CI=1.0-4.0) or ≥35 years of age (OR=2.0; 95% CI=1.0-3.9) was also associated with having uncontrolled asthma. Conclusion: Our findings suggest that most respondents had uncontrolled asthma. Less modifiable socio-demographic factors (for example, income, education, occupation, gender, and age) significantly increased the odds of having uncontrolled asthma. However, modifiable risk factors such as tobacco smoking and clinical factors such as heartburn and chronic sinusitis could also be targeted for intervention.
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Affiliation(s)
- Abdulaziz A BinSaeed
- Department of Family and Community Medicine (34), College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. Fax. +966 (11) 4671967. E-mail.
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Chérrez Ojeda I, Calderon JC, Mori J, Colombaro D, Braido F, Soria E, Cherrez A. Patient-physician relationship in the management of asthma: Multicentric approach in Latin America. J Asthma 2016; 53:751-60. [PMID: 27042878 DOI: 10.3109/02770903.2016.1145691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate and compare how Latin American physicians rate themselves on the use of communication strategies in the management of asthma patients, and to explore their personal experience and opinions on asthma treatment. METHODS A cross-sectional survey of physicians attending international medical conferences in Latin America was conducted. Participants rated themselves on frequency of use of 24 communication strategies using a 5-point Likert scale. For statistical analysis, self-rating responses were divided into two classes: very likely to (always or often on a Likert scale) and not very likely to (sometimes, seldom or never on a Likert scale). Participants also answered 4 multiple choice questions about management of asthma patients. Overall responses were analyzed using descriptive statistics and Chi-square. Multivariate logistic regression analysis was performed to evaluate self-ratings by country, gender, practice area (GP or specialist) and age. RESULTS A total of 304 physicians from Ecuador, Argentina and Peru responded. Overall, the majority of respondents rated themselves very likely to use 21 of the 24 communication strategies. Some significant differences were observed in self-ratings among physicians from different countries, between males and females, between GPs and specialists and between younger and older physicians. Responses to the multiple choice questions showed that 79.6% of the respondents believed that most or almost all patients can achieve asthma control. CONCLUSIONS A high percentage of the Latin American physicians surveyed rated themselves very likely to use good communication strategies when managing asthma patients and felt that asthma control can be achieved in most or almost all patients.
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Affiliation(s)
- Iván Chérrez Ojeda
- a School of Medicine, Universidad de Especialidades Espíritu Santo , Guayaquil , Ecuador.,b Respiralab , Guayaquil , Ecuador
| | | | | | | | - Fulvio Braido
- e Allergy and Respiratory Diseases Department , University of Genoa , Genoa , Italy
| | - Edwin Soria
- f Corporacion Medica del Sur , Quito , Ecuador
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Prenatal and postnatal stress and wheeze in Mexican children: Sex-specific differences. Ann Allergy Asthma Immunol 2016; 116:306-312.e1. [PMID: 26822280 DOI: 10.1016/j.anai.2015.12.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Increasing evidence links early-life exposure to psychosocial stress with adverse childhood respiratory outcomes. The influence of exposure timing has not been completely elucidated. OBJECTIVE To examine the association between prenatal and postnatal maternal stress and wheeze in 417 children enrolled in a prospective birth cohort in Mexico City. METHODS Maternal negative life event (NLE) scores were ascertained in the second or third trimester of pregnancy and at the 48-month postnatal visit. Children's respiratory outcomes, caregiver report of ever wheeze, and wheeze in the past 12 months were obtained from the International Study of Asthma and Allergies in Childhood survey administered at 48 months. Associations between prenatal and postnatal NLE scores and wheeze were analyzed using a modified Poisson regression approach adjusting for covariates. RESULTS In separate models, higher maternal psychosocial stress during pregnancy (relative risk [RR], 1.12; 95% CI, 1.00-1.26) and postnatally (RR, 1.21; 95% CI, 1.08-1.35) were associated with increased risk of wheeze in the past 12 months with an evident exposure-response relationship. There was a significant interaction between postnatal stress and sex in relation to current wheeze. In a sex-stratified model, the association between postnatal stress and risk of wheeze in the past 12 months was stronger in girls (RR, 1.35; 95% CI, 1.13-1.61) than in boys (RR, 1.11; 95% CI, 0.97-1.27) (P for interaction = .04). CONCLUSION Prenatal and postnatal stress in mothers was associated with wheeze in preschool-aged children, and the effect of postnatal stress was stronger in girls. Understanding the temporal- and sex-specific effects of stress may better inform prevention strategies.
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Ferreira-Magalhães M, Pereira AM, Sa-Sousa A, Morais-Almeida M, Azevedo I, Azevedo LF, Fonseca JA. Asthma control in children is associated with nasal symptoms, obesity, and health insurance: a nationwide survey. Pediatr Allergy Immunol 2015; 26:466-73. [PMID: 25939454 DOI: 10.1111/pai.12395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to estimate the prevalence of asthma control and determinants of poor control in the Portuguese pediatric population (<18 years); secondarily, we described asthma-related healthcare services and medication use. METHODS Data of 98 children with current asthma, from the second phase of a nationwide population-based telephone survey (INAsma study), were analyzed. Asthma control definition was based on GINA criteria, grouping partially controlled and uncontrolled asthma as 'not-controlled asthma' (NCA). We used multivariate logistic regression to study factors associated with NCA and with unscheduled medical visits for asthma. RESULTS About half of the children had NCA (49%, 95% CI 39-59%). In the multivariate model, risk factors for NCA were as follows: substantial nasal symptoms (a OR 6.80), overweight/obesity (a OR 3.44), and not having health insurance (a OR 3.78). All the children with NCA had nasal symptoms, and the lack of asthma control was also associated with the increasing number of nasal symptoms (p < 0.001). In the previous year, 90% (95% CI 84-96%) of children with current asthma had healthcare visits and 67% (95% CI 58-77%) used medication for asthma. The risk of unscheduled medical visits was higher in children with nasal symptoms (a OR 3.63) and in those without health insurance (a OR 2.79), and lower in adolescents (a OR 0.19). CONCLUSIONS Half of the children with asthma were poorly controlled. Nasal symptoms and obesity are important determinants of asthma control. Children without health insurance are at greater risk of poor asthma outcomes; this association is reported for the first time in a European country.
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Affiliation(s)
- Manuel Ferreira-Magalhães
- Department of Pediatrics, Centro Hospitalar de S. João, Porto, Portugal.,CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Pediatrics - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, CUF Institute & Hospital, Porto, Portugal
| | - Ana Sa-Sousa
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mário Morais-Almeida
- Allergy and Clinical Immunology Division Unit, CUF Descobertas and CUF Infante Santo Hospital, Lisbon, Portugal.,Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal
| | - Inês Azevedo
- Department of Pediatrics, Centro Hospitalar de S. João, Porto, Portugal.,Department of Pediatrics - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal
| | - João Almeida Fonseca
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, CUF Institute & Hospital, Porto, Portugal.,Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal
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Stelmach R, Cerci Neto A, Fonseca ACDCF, Ponte EV, Alves G, Araujo-Costa IN, Lasmar LMDLBF, Castro LKKD, Lenz MLM, Silva P, Cukier A, Alves AM, Lima-Matos AS, Cardoso ADRO, Fernandes ALG, São-José BPD, Riedi CA, Schor D, Peixoto DM, Brandenburg DD, Camillo EGDS, Serpa FS, Brandão HV, Lima JAB, Pio JE, Fiterman J, Anderson MDF, Cardoso MDSDL, Rodrigues MT, Pereira MNEU, Antila M, Martins SM, Guimarães VGT, Mello YAM, Andrade WCCD, Salibe-Filho W, Caldeira ZMDR, Cruz-Filho ÁASD, Camargos P. A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts. J Bras Pneumol 2015; 41:3-15. [PMID: 25750669 PMCID: PMC4350820 DOI: 10.1590/s1806-37132015000100002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/17/2014] [Indexed: 11/22/2022] Open
Abstract
Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.
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Affiliation(s)
- Rafael Stelmach
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology, Heart Institute, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - HC-FMUSP, University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Alcindo Cerci Neto
- State University at Londrina, Londrina, Brazil. (Paraná) State University at Londrina; and Coordinator. Programa Respira Londrina (Breathe, Londrina Program), Londrina, Brazil
| | | | - Eduardo Vieira Ponte
- Jundiaí School of Medicine, Jundiaí, Brazil. Jundiaí School of Medicine, Jundiaí, Brazil
| | - Gerardo Alves
- Fortaleza Municipal Department of Health, Fortaleza, Brazil. Programa de Atenção Integral à Criança e Adulto com Asma de Fortaleza - PROAICA, Integrated Asthma Management Program for Chidren and Adults in Fortaleza - Fortaleza Municipal Department of Health, Fortaleza, Brazil
| | - Ildely Niedia Araujo-Costa
- University Hospital, Federal University of Maranhão, São Luís, Brazil. Asthma Patient Care Program, Federal University of Maranhão University Hospital, São Luís, Brazil
| | - Laura Maria de Lima Belizário Facury Lasmar
- Federal University of Minas Gerais, Belo Horizonte, Brazil. Federal University of Minas Gerais; and Pediatric Pulmonologist. Centro Multidisciplinar para Asma de Difícil Controle - CEMAD, Multidisciplinary Center for the Treatment of Difficult-to-Control Asthma - and Programa Criança que Chia (Wheezing Child Program), Belo Horizonte City Hall, Belo Horizonte, Brazil
| | - Luci Keiko Kuromoto de Castro
- Programa Respira Londrina, Londrina, Brazil. Programa Respira Londrina (Breathe, Londrina Program), Londrina, Brazil
| | - Maria Lucia Medeiros Lenz
- Conceição Hospital Group, Porto Alegre, Brazil. Asthma Program, Conceição Hospital Group, Porto Alegre, Brazil
| | - Paulo Silva
- Asthma Patient Management Program, Montenegro, Brazil. Asthma Patient Management Program - RESPIRAÇÃO - Montenegro, Brazil
| | - Alberto Cukier
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology. Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Alexssandra Maia Alves
- Fortaleza Municipal Department of Health, Fortaleza, Brazil. Fortaleza Municipal Department of Health, Fortaleza, Brazil
| | - Aline Silva Lima-Matos
- Bahia State Asthma Control Program, Salvador, Brazil. Programa para Controle da Asma na Bahia - ProAR, Bahia State Asthma Control Program - Salvador, Brazil
| | - Amanda da Rocha Oliveira Cardoso
- Goiânia Municipal Department of Health, Goiânia, Brazil. Programa Catavento (Pinwheel Program), Goiânia Municipal Department of Health, Goiânia, Brazil
| | - Ana Luisa Godoy Fernandes
- Federal University of São Paulo, Paulista School of Medicine, Department of Pulmonology, São Paulo, Brazil. Department of Pulmonology, Federal University of São Paulo Paulista School of Medicine, São Paulo, Brazil
| | - Bruno Piassi de São-José
- Federal University of Minas Gerais, Hospital das Clínicas, Belo Horizonte, Brazil. Pulmonology Outpatient Clinic, Federal University of Minas Gerais Hospital das Clínicas, Belo Horizonte, Brazil
| | - Carlos Antônio Riedi
- Federal University of Paraná, Curitiba, Brazil. Federal University of Paraná, Curitiba, Brazil
| | - Deborah Schor
- Federal University of Pernambuco, Hospital das Clínicas, Recife, Brazil. Allergy Outpatient Clinic, Recife Allergology Center; and Volunteer Preceptor. Asthma Outpatient Clinic, Federal University of Pernambuco Hospital das Clínicas, Recife, Brazil
| | - Décio Medeiros Peixoto
- Federal University of Pernambuco, Mother and Child Department, Recife, Brazil. Mother and Child Department, Federal University of Pernambuco, Recife, Brazil
| | - Diego Djones Brandenburg
- Porto Alegre Hospital de Clínicas, Montenegro, Brazil. Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil and Asthma Patient Management Program - RESPIRAÇÃO - Montenegro, Brazil
| | | | - Faradiba Sarquis Serpa
- School of Medical Sciences, Santa Casa de Misericórdia de Vitória, Vitória, Brazil. Asthma Program, Santa Casa de Misericórdia de Vitória School of Medical Sciences, Vitória, Brazil
| | - Heli Vieira Brandão
- Bahia State University at Feira de Santana, Department of Pediatrics, Feira de Santana, Brazil. Department of Pediatrics, Bahia State University at Feira de Santana; and Coordinator. Feira de Santana Asthma and Allergic Rhinitis Control Program, Feira de Santana, Brazil
| | - João Antonio Bonfadini Lima
- Porto Alegre Municipal Department of Health, Porto Alegre, Brazil. Asthma Program, Porto Alegre Municipal Department of Health, Porto Alegre, Brazil
| | - Jorge Eduardo Pio
- Rio de Janeiro Municipal Department of Health, Rio de Janeiro, Brazil. Rio de Janeiro Municipal Department of Health, Rio de Janeiro, Brazil
| | - Jussara Fiterman
- Pontifical Catholic University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Pontifical Catholic University of Rio Grande do Sul - School of Medicine, Porto Alegre, Brazil
| | - Maria de Fátima Anderson
- Brazilian Association of Asthma Patients, Rio de Janeiro, Brazil. Associação Brasileira de Asmáticos - ABRA, Brazilian Association of Asthma Patients - Rio de Janeiro, Brazil
| | - Maria do Socorro de Lucena Cardoso
- Federal University of Amazonas, Manaus, Brazil. Programa de Assistência e Controle da Asma - PACA, Asthma Care and Control Program - and Associate Professor. Universidade Federal do Amazonas - UFAM, Federal University of Amazonas - Manaus, Brazil
| | - Marcelo Tadday Rodrigues
- Santa Casa Sisters of Mercy, Hospital of Porto Alegre, Porto Alegre, Brazil. Universidade de Santa Cruz do Sul - UNISC, University of Santa Cruz do Sul - Santa Cruz do Sul, Brazil; and Pulmonologist. Pereira Filho Ward, Irmandade da Santa Casa de Misericórdia de Porto Alegre - ISCMPA, Santa Casa Sisters of Mercy Hospital of Porto Alegre - Porto Alegre, Brazil
| | - Marilyn Nilda Esther Urrutia Pereira
- Uruguaiana Municipal Department of Health, Uruguaiana, Brazil. Programa Infantil de Prevenção de Asma - PIPA, Children's Asthma Prevention Program - Uruguaiana Municipal Department of Health, Uruguaiana, Brazil
| | - Marti Antila
- Sorocaba Municipal Asthma Program, Sorocaba, Brazil. Sorocaba Municipal Asthma Program, Sorocaba, Brazil. Physician. Programa Respira Rio, Rio de Janeiro, Brazil. Programa Respira Rio (Breathe, Rio Program), Rio de Janeiro, Brazil
| | - Sonia Maria Martins
- Brazilian Society of Family and Community Medicine, Rio de Janeiro, Brazil. Grupo de Trabalho de Problemas Respiratórios - GRESP, Working Group on Respiratory Problems - Sociedade Brasileira de Medicina de Família e Comunidade - SBMFC, Brazilian Society of Family and Community Medicine - Rio de Janeiro, Brazil
| | - Vanessa Gonzaga Tavares Guimarães
- Brasília Mother and Child Hospital, Brasília, Brazil. Programa de Atendimento ao Paciente Asmático do Distrito Federal - PAPA-DF, Asthma Patient Management Program in the Federal District of Brasília - and Supervisor. Residency Program in Pediatric Allergy and Immunology, Brasília Mother and Child Hospital, Brasília, Brazil
| | - Yara Arruda Marques Mello
- Associação Brasileira de Asmáticos, São Paulo, Brazil. Department of Allergy and Immunology, Edmundo Vasconcelos Hospital Complex; and Director. Associação Brasileira de Asmáticos-São Paulo - ABRA, Brazilian Association of Asthma Patients-SP - São Paulo, Brazil
| | - Wenderson Clay Correia de Andrade
- Itabira Municipal Department of Health, Itabira, Brazil. Projeto Respirai (Breathe Project), Itabira Municipal Department of Health, Itabira, Brazil
| | - William Salibe-Filho
- São Camilo University Center, School of Medicine, São Paulo, Brazil. Department of Pulmonology, ABC School of Medicine, Santo André, Brazil; and Professor. São Camilo University Center School of Medicine, São Paulo, Brazil
| | - Zelina Maria da Rocha Caldeira
- Associação Brasileira de Asmáticos, São Paulo, Brazil. Niterói Municipal Health Foundation, Niterói, Brazil. Pediatrician and Director of Government Policy and International Relations. Associação Brasileira de Asmáticos-São Paulo - ABRA, Brazilian Association of Asthma Patients-SP - São Paulo, Brazil
| | - Álvaro Augusto Souza da Cruz-Filho
- Federal University of Bahia, School of Medicine, Salvador, Brazil. Federal University of Bahia School of Medicine; and Coordinator. Center of Excellence in Asthma, Salvador, Brazil
| | - Paulo Camargos
- Federal University of Minas Gerais, Department of Pediatrics, Belo Horizonte, Brazil. Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
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