1
|
Pinheiro DHA, Souza JVHD, Justo AFO, Carvalho-Pinto RM, Lima FFD, Carvalho CRF. Asthma in the Brazilian Unified Health Care System: an epidemiological analysis from 2008 to 2021. J Bras Pneumol 2024; 50:e20230364. [PMID: 38808826 PMCID: PMC11185155 DOI: 10.36416/1806-3756/e20230364] [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: 11/16/2023] [Accepted: 03/13/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To analyze the number of hospitalizations, the length of hospital stay, and mortality due to asthma, as well as the costs to the Unified Health Care System in Brazil between 2008 and 2021. METHODS This was a cross-sectional epidemiological study using data from the Information Technology Department of the Brazilian Unified Health Care System. Proportional hospitalization and death rates were estimated per 100,000 population by age, microregion, and year. RESULTS The number of hospitalizations and deaths due to asthma decreased from 2008 to 2021 (205,392 vs. 55,009 and 822 vs. 327, respectively). In addition, a between-sex difference was observed in asthma-related hospitalizations in 2008, and more men were hospitalized in 2021 (51.8%). Asthma mortality rates were similar for both sexes (50.0% each) in 2008, and a slight increase was observed in women's deaths in 2021 (52.9%). Even so, approximately one death/day and more than 55,000 hospitalizations were observed yearly, with a mean length of hospital stay of three days. Additionally, the Southeast region allocated more financial resources to asthma-related hospitalizations. CONCLUSIONS Our results showed that the number of deaths and hospitalizations due to asthma substantially declined during the study period.
Collapse
Affiliation(s)
- David Halen Araújo Pinheiro
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP) Brasil
| | | | - Alberto Fernando Oliveira Justo
- . Laboratório de Fisiopatologia do Envelhecimento, Departamento de Clínica Médica, Universidade de São Paulo - USP - São Paulo (SP) Brasil
| | - Regina Maria Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clinicas Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Fabiano Francisco de Lima
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP) Brasil
| | - Celso R F Carvalho
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP) Brasil
| |
Collapse
|
2
|
da Silva NC, Malagutti BC, Ladeira JMCD, Grotta MB, Toro AADC. Pathophysiology of non-cystic fibrosis bronchiectasis in children and adolescents with asthma: A protocol for systematic review and meta-analysis. PLoS One 2024; 19:e0294921. [PMID: 38635522 PMCID: PMC11025797 DOI: 10.1371/journal.pone.0294921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/12/2023] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The pathophysiological mechanisms by which asthma and bronchiectasis are associated are still unclear. The association of these two diseases can result in more severe symptoms and a greater number of exacerbations. OBJECTIVE The aim of this systematic review is to collect evidence of the pathophysiology of non-cystic fibrosis bronchiectasis with associated asthma in children and adolescents, aged 6-18 years old. METHODS A systematic and comprehensive search will be performed using eight main databases, PubMed, PubMed PMC, BVS/BIREME, Scopus, EMBASE, Cochrane Library, Scielo and Web of Science. Articles will be searched from the earliest available time to July 2023. The studied population will be composed of children and adolescents with asthma and non-cystic fibrosis bronchiectasis. From the data obtained, all articles found will be transferred to the Rayyan platform. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Checklist (PRISMA P-2015). In addition, if sufficient data are available, a meta-analysis will be conducted. Two independent reviewers will conduct the studies selection, data extraction, and risk of bias assessment. The outcome measures will be to analyze if non-cystic fibrosis bronchiectasis is related to a specific inflammatory profile. DISCUSSION A systematic review will provide better knowledge about the etiopathogenesis and causes of the association between asthma and bronchiectasis and its role in the severity and control of asthma. Identifying, selecting and critically evaluating studies on asthma and bronchiectasis, would be possible to illuminate the characteristics of children and adolescents with associated diagnoses and provide information to help individualized treatments in order to control and prevent complications. The findings of this study will be published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in July 2023 (registration number CRD42023440355).
Collapse
Affiliation(s)
- Natali Caroline da Silva
- Postgraduate Program in Child and Adolescent Health of the School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | - Joelia Maria Costa Dias Ladeira
- Postgraduate Program in Child and Adolescent Health of the School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Milena Baptistella Grotta
- Center of Integration in Pediatrics (CIPED) of the School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Adyleia Aparecida Dalbo Contrera Toro
- Center of Integration in Pediatrics (CIPED) of the School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| |
Collapse
|
3
|
Furukawa LH, Garcia LDCE, Pieta MP, Castro MÂD, Pinto LA, Pitrez PM. Diagnosis and treatment of asthma in childhood: an overview of guidelines. J Bras Pneumol 2024; 50:e20240051. [PMID: 38536970 PMCID: PMC11095921 DOI: 10.36416/1806-3756/e20240051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Affiliation(s)
- Laissa Harumi Furukawa
- . Grupo de Pesquisa em Epidemiologia e Genética das Doenças Respiratórias da Infância, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Laura de Castro E Garcia
- . Grupo de Pesquisa em Epidemiologia e Genética das Doenças Respiratórias da Infância, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Marina Puerari Pieta
- . Grupo de Pesquisa em Epidemiologia e Genética das Doenças Respiratórias da Infância, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Miguel Ângelo de Castro
- . Grupo de Pesquisa em Epidemiologia e Genética das Doenças Respiratórias da Infância, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Leonardo Araújo Pinto
- . Grupo de Pesquisa em Epidemiologia e Genética das Doenças Respiratórias da Infância, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
- . Programa de Pós-Graduação em Medicina: Pediatria, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Paulo M Pitrez
- . Pavilhão Pereira Filho, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| |
Collapse
|
4
|
Antila MA, Souza-Machado A, Gregório MG, Cruz ÁA, Angelini L, Beekman MJHI, Zonzin GA, Rabahi MF. Overprescription of short-acting β2 agonists: reflections from the SABINA study in Brazil. J Bras Pneumol 2024; 50:e20230174. [PMID: 38422337 PMCID: PMC11095926 DOI: 10.36416/1806-3756/e20230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To assess prescription patterns for short-acting b2 agonists (SABAs) and other asthma medications in asthma patients treated by specialists and participating in the SABA use IN Asthma (SABINA) study in Brazil. METHODS This was an observational, cross-sectional study conducted at five sites in different regions of Brazil. The primary endpoints were to record SABA prescriptions and obtain data on over-the-counter (OTC) SABA purchases at the pharmacy. RESULTS Data on 218 asthma patients were analyzed. Of those 218 patients, 80.3% were prescribed SABAs in addition to their maintenance therapy, with a mean of 11.2 SABA canisters in the previous 12 months. Of those patients, 71.4% were prescribed ≥ 3 canisters and 42.2% were prescribed ≥ 10 canisters. None of the patients were prescribed SABA monotherapy. A total of 14.2% of the patients reported purchasing SABAs OTC at a pharmacy without a prescription. Of those, 48.4% purchased ≥ 3 SABA canisters. A fixed-dose combination of an inhaled corticosteroid and a long-acting b2 agonist was prescribed to 95.0% of the patients. In the year before the study visit, 45.0% of the patients received at least one course of oral corticosteroid burst treatment. Asthma was well controlled in 43.1% of the patients, partly controlled in 34.9%, and uncontrolled in 22.0%. Patients reported a mean of 1.1 severe asthma exacerbations, with 49.1% experiencing 1 or more severe exacerbations. CONCLUSIONS Overprescription and OTC purchases of SABAs are common in Brazil, possibly leading to the need for courses of oral corticosteroids. The health care community should collaborate to implement evidence-based recommendations and promote health education to improve asthma management in Brazil.
Collapse
Affiliation(s)
| | - Adelmir Souza-Machado
- . Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador (BA) Brasil
- . Fundação ProAR, Brasil
| | | | - Álvaro A Cruz
- . Fundação ProAR, Brasil
- . Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil
| | | | | | | | | |
Collapse
|
5
|
Lima VBD, Vazquez VS, Campos ACP, Santos LMD, Cruz ÁA. Exposure to intimate partner violence and lack of asthma control in adults: a cross-sectional study. SAO PAULO MED J 2023; 141:e2022336. [PMID: 37311135 DOI: 10.1590/1516-3180.2022.0336.r2.30032023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Asthma is a chronic airway disease that affects 339 million people worldwide. It is a heterogeneous disease with different risks, including in family environments, where intimate partner violence occurs. OBJECTIVE This study aimed to investigate the possible association between psychosocial factors and asthma control in adults exposed to intimate partner violence. DESIGN AND SETTING This cross-sectional study was conducted at a Brazilian public higher education institution in Salvador, Bahia, Brazil. METHODS The study population consisted of adults clinically diagnosed with severe asthma and those with mild/moderate asthma identified at an asthma referral outpatient clinic. The sample comprised 492 participants who underwent clinical evaluation and completed questionnaires to assess asthma control, depression, stress, and resilience. The Conflict Tactics Scale, which measures tactics for managing marital conflicts, was used to estimate the level of intimate partner violence. RESULTS Of the 492 participants, 76.2% were women and 91% self-referenced color black/brown, 37.8% reported low family income, 87.4% reported low education level, 71.7% reported high stress, 32.5% reported low resilience, 18.5% reported moderate or severe depression, 83.3% reported resolute negotiation, 49.4% reported major psychological aggression, 19.6% reported major physical aggression, 15.5% reported major injury, and 7.3% reported major sexual coercion. Regression analysis revealed that sex was an effect modifier. CONCLUSION Women in situations of social vulnerability, with low income and poor education, with depression, severe asthma, and those who used aggression to resolve marital conflicts had a profile associated with a lack of asthma control.
Collapse
Affiliation(s)
- Valmar Bião de Lima
- BSc. Statistician and Researcher, Programa de Controle da Asma na Bahia (ProAR), Salvador (BA), Brazil; and Doctoral Student, Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Vanessa Serva Vazquez
- PhD. Psychologist and Researcher, Programa de Controle da Asma na Bahia (ProAR),, Salvador (BA), Brazil
| | - Ana Clara Paixão Campos
- PhD. Doctoral Student, Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Letícia Marques Dos Santos
- PhD. Psychologist, Postgraduate Program in Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil; and Associate Professor, Instituto de Humanidades Artes e Ciências (IHCA), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Álvaro Augusto Cruz
- PhD. Physician, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil; CNPq Researcher 1 B, founder of the Program for the Control of Asthma in Bahia (ProAR) and Executive Director of the ProAR Foundation, Salvador (BA), Brazil
| |
Collapse
|
6
|
Lourenco CB, Martins F, Fiss E, Grumach AS. Impact of asthma control on quality of life in an outpatient setting in Brazil. J Asthma 2023; 60:794-801. [PMID: 35787225 DOI: 10.1080/02770903.2022.2097092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The goal of asthma therapy is asthma control. As a chronic disease, asthma may cause considerable physical, emotional and social restrictions impacting quality of life. The aim of this study was to analyze control of asthma symptoms in an outpatient setting in Brazil and its impact on quality of life. METHODS A pilot cross-sectional study was performed in two public centers in the metropolitan region of São Paulo, Brazil. Control of asthma symptoms was assessed according to GINA guidelines, and quality of life was analyzed by the Mini Quality of Life Questionnaire (mini-AQLQ). RESULTS A total of 47 adult patients with asthma were analyzed. Asthma was controlled in 8 patients (17.0%), partially controlled in 26 patients (55.3%) and uncontrolled in 13 patients (27.7%). Patients with controlled asthma showed better mini-AQLQ scores (4.99 ± 1.10) as compared to those with partly controlled (3.66 ± 1.10) and uncontrolled asthma (2.59 ± 0.64; p < 0.001 for both). Most patients (85.1%) were taking inhaled corticosteroids (ICS) and long-acting bronchodilators (LABA) as controller treatment. CONCLUSIONS Better asthma control had a positive impact on Health-Related Quality of Life (HRQoL) contributing to a better disease management. Few patients reached full asthma control in our specialty ambulatory center, suggesting further initiatives are required to improve the quality of asthma care in Brazil.
Collapse
Affiliation(s)
| | - Franco Martins
- Discipline of Pulmonology, Faculdade de Medicina, Centro Universitário Saúde ABC, Santo Andre, Brazil
| | - Elie Fiss
- Discipline of Pulmonology, Faculdade de Medicina, Centro Universitário Saúde ABC, Santo Andre, Brazil
| | - Anete Sevciovic Grumach
- Clinical Immunology, Faculdade de Medicina, Centro Universitário Saúde ABC, Santo Andre, Brazil
| |
Collapse
|
7
|
Nascimento OA, Cançado JED, Gazzotti MR, dos Santos FM, Saturnino LTM, da Silva DO, Gomes ALBB, Viana KP, Alfonso-Cristancho R, Rodrigues CS. The economic impact of asthma on private healthcare system in Brazil: Economic impact of asthma in Brazil. Medicine (Baltimore) 2023; 102:e33077. [PMID: 36961140 PMCID: PMC10036068 DOI: 10.1097/md.0000000000033077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/02/2023] [Indexed: 03/25/2023] Open
Abstract
To assess healthcare resource utilization and costs of patients with asthma in Brazilian Supplementary Healthcare System, focusing on hospitalization data. Retrospective cohort study, using data from an administrative database of a private company (Orizon). Patients aged ≥ 12 years with at least one record of emergency visit/hospitalization in the database with the ICD-10 J45 between January/2010 and June/2015 were included and followed until June/2016, death or inactivation of health plan. Sociodemographic characteristics, emergency visit and hospital admission per patient per year (exacerbation rate), physician visit with a procedure, exams, length of hospitalization (with/without intensive care unit (ICU)), and in-hospital treatments were assessed. A total of 54,568 patients were included in this analysis. Regarding resource utilization, emergency visit and hospital admission rates of 0.34 and 0.04 per person-year were observed, respectively. Mean length of hospital stay were 8.82 (SD = 36.48), 5.24 (SD = 19.06) and 19.53 (63.89) days for hospitalizations in general, without and with ICU, respectively. An exacerbation rate of 0.36 per person year was observed with a mean cost per episode of 3178 Brazilian Real (BRL) (SD = 31,667). Mean cost related to emergency department visits was estimated at 293 BRL (SD = 328). Hospitalization costs were stratified by the need of ICU and values observed were of 9307 BRL (SD = 18,979) without ICU, and 75,252 BRL (SD = 174,248) with ICU need. Asthma exacerbations may cost ~75,000 BRL for an ICU-dependent event in the Supplementary Healthcare System. To improve disease control may reduce disease burden for both healthcare system and patients.
Collapse
Affiliation(s)
- Oliver A. Nascimento
- GlaxoSmithKline, Rio DE Janeiro, Brazil
- Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo – EPM/UNIFESP, São Paulo (SP), Brasil
- Faculdade de Medicina São Leopoldo Mandic, Campinas (SP), Brasil
| | | | - Mariana Rodrigues Gazzotti
- GlaxoSmithKline, Rio DE Janeiro, Brazil
- Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo – EPM/UNIFESP, São Paulo (SP), Brasil
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Baldo DC, Romaldini JG, Pizzichini MMM, Cançado JED, Dellavance A, Stirbulov R. Periostin as an important biomarker of inflammatory phenotype T2 in Brazilian asthma patients. J Bras Pneumol 2023; 49:e20220040. [PMID: 36753209 PMCID: PMC9970379 DOI: 10.36416/1806-3756/e20220040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the laboratory performance of periostin associated with a panel of biomarkers to identify the inflammatory phenotype of Brazilian asthma patients. METHODS We evaluated 103 Brazilian individuals, including 37 asthmatics and 66 nonasthmatic controls. Both groups underwent analyses for serum periostin, eosinophil levels in the peripheral blood, the fraction of exhaled nitric oxide (FeNO), total serum IgE, urinary leukotriene E4, and serum cytokines. RESULTS Higher levels of periostin (p = 0.005), blood eosinophils (p = 0.012), FeNO (p = 0.001), total IgE (p < 0.001), and IL-6 (p ≤ 0.001) were found in the asthmatic patients than the controls. Biomarker analyses by the ROC curve showed an AUC greater than 65%. Periostin (OR: 12,550; 95% CI: 2,498-63,063) and IL-6 (OR: 7,249; 95% CI: 1,737-30,262) revealed to be suitable asthma inflammation biomarkers. Blood eosinophils, FeNO, total IgE, IL-6, TNF, and IFN-g showed correlations with clinical severity characteristics in asthmatic patients. Periostin showed higher values in T2 asthma (p = 0.006) and TNF in non-T2 asthma (p = 0.029). CONCLUSION The panel of biomarkers proposed for the identification of the inflammatory phenotype of asthmatic patients demonstrated good performance. Periostin proved to be an important biomarker for the identification of T2 asthma.
Collapse
Affiliation(s)
- Danielle Cristiane Baldo
- . Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo (SP), Brasil.,. Grupo Fleury, Pesquisa e Desenvolvimento, São Paulo (SP), Brasil
| | | | | | | | | | - Roberto Stirbulov
- . Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo (SP), Brasil
| |
Collapse
|
9
|
Endrigue TC, Lunardi AC, Freitas PD, Silva RA, Mendes FAR, França-Pinto A, Carvalho-Pinto RM, Carvalho CRF. Characteristics of individuals with moderate to severe asthma who better respond to aerobic training: a cluster analysis. J Bras Pneumol 2023; 49:e20220225. [PMID: 36753210 PMCID: PMC9970378 DOI: 10.36416/1806-3756/e20220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/31/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To determine the characteristics of individuals with asthma who are responsive to aerobic training. METHODS This post hoc analysis of pooled data from previous randomized controlled trials involved 101 individuals with moderate to severe asthma who underwent aerobic training. Participants underwent a maximal cardiopulmonary exercise test and completed the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire before and after a 24-session aerobic training program. Better and worse responders to aerobic training were identified by cluster analysis. RESULTS Two clusters were identified according to the improvement in peak VO2 after aerobic training (better and worse responders). Characteristics of the better responder group were being older, being female, having higher BMI, and having higher cardiac reserve at baseline when compared with the worse responder group. Also, better responders had worse clinical control, worse quality of life, and lower physical capacity at baseline. After training, worse responders, in comparison with better responders, showed half the improvement in Δpeak VO2 (7.4% vs. 13.6%; 95% CI, -12.1 to -0.92%; p < 0.05) and worse asthma control. A weak, negative, but significant association (r = -0.35; p < 0.05) was observed between clinical control and aerobic fitness only in the better responder group. Both groups showed significant improvement in quality of life. CONCLUSIONS Obese individuals with worse exercise capacity, clinical control, and quality of life showed improvement with aerobic training. Moreover, worse responders also improved with training, but to a lesser extent.
Collapse
Affiliation(s)
- Tiago C Endrigue
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Adriana C Lunardi
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Patrícia D Freitas
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ronaldo A Silva
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Felipe A R Mendes
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Andrezza França-Pinto
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Regina M Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Celso R F Carvalho
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| |
Collapse
|
10
|
Vukoja M, Kopitovic I, Lazic Z, Milenkovic B, Stankovic I, Tomic-Spiric V, Zvezdin B, Hromis S, Cekerevac I, Ilic A, Vukcevic M, Dimic-Janjic S, Stjepanovic M. Diagnosis and treatment of adult asthma patients in Serbia: a 2022 experts group position statement. Expert Rev Respir Med 2022; 16:1133-1144. [PMID: 36448775 DOI: 10.1080/17476348.2022.2153674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Asthma is the most common non-communicable chronic lung condition across all ages. Epidemiological data indicate that many asthma patients in Serbia remain undiagnosed and untreated. The implementation of recent global advances in asthma management is limited due to the lack of a systematic approach, drug availability and regulatory affairs. In addition, the global coronavirus disease pandemic has posed a significant challenge, particularly in resource-limited settings. AREAS COVERED In this paper, we propose an algorithm for treating adult asthma patients in Serbia. We performed PubMed database search on published asthma clinical trials and guidelines from 1 January 2015 to 10 March 2020. The consensus process incorporated a modified Delphi method that included two rounds of e-mail questionnaires and three rounds of national asthma expert meetings. We focus on 1) objective diagnosis of asthma, 2) the implementation of up-to-date therapeutic options, and 3) the identification and referral of severe asthma patients to newly established severe asthma centers. EXPERT OPINION Regional specificities and variations in healthcare systems require the adaptation of evidence-based knowledge. Practical, clinically oriented algorithms designed to overcome local barriers in healthcare delivery may facilitate timely and adequate asthma diagnosis and the local implementation of current advances in asthma management.
Collapse
Affiliation(s)
- Marija Vukoja
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Kopitovic
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zorica Lazic
- Pulmonary Department, University Clinical Centre Kragujevac, Kragujevac, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Branislava Milenkovic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Ivana Stankovic
- Department for Asthma and Chronic Obstructive Pulmonary Diseases, Clinic for Lung Diseases, University Clinical Centre of Nis, Nis, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Vesna Tomic-Spiric
- Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia.,Diagnostic-polyclinic Department, Clinic of Allergology and Immunology, University Clinical Center of Serbia
| | - Biljana Zvezdin
- Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department for Allergy and Obstructive Pulmonary Diseases, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Sanja Hromis
- Department for Allergy and Obstructive Pulmonary Diseases, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Nursing, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Cekerevac
- Pulmonary Department, University Clinical Centre Kragujevac, Kragujevac, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Ilic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Miodrag Vukcevic
- Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia.,Pulmonary Department, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Mihailo Stjepanovic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| |
Collapse
|
11
|
Pedrozo-Pupo JC, Pacheco Gallego MC, Baños Álvarez IDJ, Jaller Raad RA, Caballero Pinilla AC, Reynales Londoño H, Bernal Villada L, Beekman M. A Cross-Sectional Study on Prescription Patterns of Short-Acting β 2-Agonists in Patients with Asthma: Results from the SABINA III Colombia Cohort. J Asthma Allergy 2022; 15:1167-1178. [PMID: 36051434 PMCID: PMC9427209 DOI: 10.2147/jaa.s365009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/20/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Overuse of short-acting β2-agonists (SABAs) for asthma is associated with a significant increase in exacerbations and healthcare resource use. However, limited data exist on the extent of SABA overuse outside of Europe and North America. As part of the multi-country SABA use IN Asthma (SABINA) III study, we characterized SABA prescription patterns in Colombia. Patients and Methods This observational, cross-sectional cohort study of SABINA III included patients (aged ≥12 years) with asthma recruited from seven sites in Colombia. Demographics, disease characteristics (including investigator-defined asthma severity guided by the 2017 Global Initiative for Asthma report), and asthma treatments prescribed (including SABAs and inhaled corticosteroids [ICS]) in the 12 months preceding the study were recorded using electronic case report forms during a single study visit. Results Of 250 patients analyzed, 50.4%, 33.2%, and 16.4% were enrolled by pulmonologists, general medicine practitioners, and allergists, respectively. Most patients were female (74.0%) and had moderate-to-severe asthma (67.6%). Asthma was partly controlled or uncontrolled in 57.6% of patients, with 15.6% experiencing ≥1 severe exacerbation 12 months before the study visit. In total, 4.0% of patients were prescribed SABA monotherapy and 55.6%, SABA in addition to maintenance therapy. Overall, 39.2% of patients were prescribed ≥3 SABA canisters in the 12 months before the study visit; 25.2% were prescribed ≥10 canisters. Additionally, 17.6% of patients purchased SABAs over the counter, of whom 43.2% purchased ≥3 canisters. Maintenance medication in the form of ICS or ICS/long-acting β2-agonist fixed-dose combination was prescribed to 36.0% and 66.8% of patients, respectively. Conclusion Our findings suggest that prescription/purchase of ≥3 SABA canisters were common in Colombia, highlighting a public health concern. There is a need to improve asthma care by aligning clinical practices with the latest evidence-based treatment recommendations to improve asthma management across Colombia.
Collapse
Affiliation(s)
- John Carlos Pedrozo-Pupo
- PREVICARE LTDA. Programa de Medicina, Facultad de Ciencias de la Salud, Universidad del Magdalena, Santa Marta, Colombia
| | - Manuel Conrado Pacheco Gallego
- División de Neumología y Endoscopia Respiratoria, Departamento de Medicina Interna, Universidad Tecnológica de Pereira, Universidad Visión de las Américas, RESPIREMOS Centro de Neumología y Endoscopia Respiratoria, Pereira, Colombia
| | | | - Rodolfo Antonio Jaller Raad
- Department of Allergy and Immunology, Centro de Investigación Médico Asistencial S.A.S, Barranquilla, Colombia
| | - Andrea Carolina Caballero Pinilla
- Centro de Investigación Clínica, Caja de Compensación Familiar CAFAM, Sede Centro de Atención en Salud CAFAM Floresta, Bogotá, Colombia
| | | | | | - Maarten Beekman
- Respiratory & Immunology AstraZeneca, The Hague, the Netherlands
| |
Collapse
|
12
|
Mustafa G. How Do Pediatricians Diagnose Asthma in Tertiary Care Hospitals? Cureus 2022; 14:e29768. [PMID: 36324352 PMCID: PMC9618029 DOI: 10.7759/cureus.29768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE There is a lot of disparity in the guidelines and the practice of pediatricians globally for diagnosing asthma in children. To find out if pediatricians are diagnosing asthma in children according to best standard practices. METHODOLOGY A cross-sectional study was conducted at tertiary care hospitals' emergency and outpatient departments (OPDs). All the parents accompanying the asthmatic children to the emergency or outpatient departments of the tertiary care hospitals were asked questions regarding the diagnosis of their children's asthma on a prescribed performa. This performa had all the components of the best standard practices for the diagnosis of asthma in children. The data were entered into SPSS version 27 (SPSS Inc., Chicago, IL) and analyzed. RESULTS Among the 234 children, the diagnosis of asthma was based on only one component out of three, i.e., recurrence (100%) of symptoms or signs. The objective measurement of the second component, i.e., reversibility with a peak flow meter (PFM) or spirometry, was assessed in only 6% of children. The third component, i.e., the presence of inflammation, was not assessed at all (0.0%). CONCLUSIONS The diagnosis of asthma in children lacks precision. This is far from the evidence-based best standard practices. There is a need to provide motivation, training, and equipment to the staff.
Collapse
Affiliation(s)
- Ghulam Mustafa
- Pediatric Medicine, College of Medicine Shaqra University, Shaqra, SAU
- Pediatric Medicine, Nishtar Medical University, Multan, PAK
| |
Collapse
|
13
|
Nakamuta JS, Puglia ALP, Meireles P, Blanco DC, Lima MA, Birck MG, Braga MC, Oliveira RWD, Julian GS, Forestiero FJ. Asthma control in Brazil: a systematic review. J Asthma 2022; 60:868-880. [PMID: 35896311 DOI: 10.1080/02770903.2022.2107537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objectives: To explore asthma control in patients undergoing pharmacotherapy on studies in the last 20 years in Brazil. Asthma is a chronic airway inflammation disease with a high prevalence worldwide. Even with a variety of drug treatment improvements, attaining asthma control is challenging, since it should have a personalized approach. In Brazil, studies on the prevalence of asthma control are scarce and usually from a small sample size.Data Sources: A systematic review was performed to assess asthma control in Brazilian population. Terms related to "asthma", "asthma control" and "Brazil" were used in the search strategies in PubMed, BVSalud, Embase and Cochrane Library, including Brazilian Journal of Allergy and Immunology as data sources. A narrative synthesis was performed to report key outcome.Study Selections: In total, 23 studies were included. Most of them were conducted in the Southeastern and Northeast regions, in a short duration.Results: Pediatric and non-pediatric population were assessed, with a higher proportion of female. In pediatric population, those with poorly controlled asthma usually had severe or persistent disease. In elderly, an increased asthma severity was found, although proper treatment might be effective. Most studies (70%) also described exacerbations, hospitalizations (48%), quality of life (39%), and emergency visits (30%). Despite heterogeneity of outcomes and population, studies show an important prevalence of uncontrolled asthma even in patients being treated, with better disease control with treatment improvements.Conclusions: Studies in Brazil have shown that asthma control remains a challenge and there is still a need for improvement on disease management.
Collapse
Affiliation(s)
| | | | | | | | - Marina Andrade Lima
- Departamento de Pesquisas Clínicas, Hospital Dia do Pulmão, Blumenau, Brazil
| | | | | | | | | | | |
Collapse
|
14
|
Athanazio R, Stelmach R, Antila M, Souza-Machado A, Arruda LK, Cerci Neto A, Serpa FS, Blanco DC, Lima M, Bianchi Júnior P, Penha M, Rabahi MF. Prevalence of the eosinophilic phenotype among severe asthma patients in Brazil: the BRAEOS study. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20210367. [PMID: 35830052 PMCID: PMC9262440 DOI: 10.36416/1806-3756/e20210367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
Abstract
Objective: To assess the prevalence of the eosinophilic and allergic phenotypes of severe asthma in Brazil, as well as to investigate the clinical characteristics of severe asthma patients in the country. Methods: This was a cross-sectional study of adult patients diagnosed with severe asthma and managed at specialized centers in Brazil. The study was conducted in 2019. Results: A total of 385 patients were included in the study. Of those, 154 had a blood eosinophil count > 300 cells/mm3 and 231 had a blood eosinophil count of ≤ 300 cells/mm3. The median age was 54.0 years, and most of the patients were female, with a BMI of 29.0 kg/m2 and a history of allergy (81.6%). The prevalence of patients with a blood eosinophil count > 300 cells/mm3 was 40.0% (95% CI: 35.1-44.9), and that of those with a blood eosinophil count > 300 cells/mm3 and a history of allergy was 31.9% (95% CI: 27.3-36.6). Age and BMI showed positive associations with a blood eosinophil count > 300 cells/mm3 (OR = 0.97, p < 0.0001; and OR = 0.96, p = 0.0233, respectively), whereas the time elapsed since the onset of asthma symptoms showed an increased association with a blood eosinophil count > 300 cells/mm3 (OR = 1.02, p = 0.0011). Conclusions: This study allowed us to characterize the population of severe asthma patients in Brazil, showing the prevalence of the eosinophilic phenotype (in 40% of the sample). Our results reveal the relevance of the eosinophilic phenotype of severe asthma at a national level, contributing to increased effectiveness in managing the disease and implementing public health strategies.
Collapse
Affiliation(s)
- Rodrigo Athanazio
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rafael Stelmach
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Martti Antila
- . Consultoria Médica e Pesquisa Clínica - CMPC - Sorocaba (SP) Brasil
| | - Adelmir Souza-Machado
- . Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador (BA) Brasil
| | - L Karla Arruda
- . Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | | | - Faradiba Sarquis Serpa
- . Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória (ES) Brasil
| | - Daniela Cavalet Blanco
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Marina Lima
- . Hospital Dia do Pulmão, Blumenau (SC) Brasil
| | - Pedro Bianchi Júnior
- . Divisão de Imunologia Clínica e Alergia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Marcelo Fouad Rabahi
- . Departamento de Clínica Médica-Pneumologia, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia (GO) Brasil
| |
Collapse
|
15
|
Pizzichini MMM, Carvalho-Pinto RMD, Pizzichini E. Celebrating World Asthma Day in Brazil: lessons learned from the pandemic. Can we do better? J Bras Pneumol 2022; 48:e20220147. [PMID: 35703620 PMCID: PMC9262445 DOI: 10.36416/1806-3756/e20220147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Regina Maria de Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Emilio Pizzichini
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| |
Collapse
|
16
|
Forno E, Brandenburg DD, Castro-Rodriguez JA, Celis-Preciado CA, Holguin F, Licskai C, Lovinsky-Desir S, Pizzichini M, Teper A, Yang C, Celedón JC. 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. Ann Am Thorac Soc 2022; 19:525-535. [PMID: 35030062 PMCID: PMC8996271 DOI: 10.1513/annalsats.202109-1068cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/14/2022] [Indexed: 11/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine and Pediatric Asthma Center, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Diego D. Brandenburg
- Department of Pediatrics, Pediatric Pulmonology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos A. Celis-Preciado
- Pulmonary Unit, Internal Medicine Department, Hospital Universitario San Ignacio and Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Fernando Holguin
- Division of Pulmonary Sciences and Critical Care, University of Colorado Denver, Denver, Colorado
| | - Christopher Licskai
- Department of Medicine, Western University Canada, Schulich School of Medicine and Dentistry, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary Medicine, Columbia University Irving Medical Center, New York, New York
| | - Marcia Pizzichini
- Post-Graduate Program of Medical Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Alejandro Teper
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina; and
| | - Connie Yang
- Division of Respiratory Medicine, University of British Columbia, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine and Pediatric Asthma Center, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
17
|
Busse WW, Kraft M. Current unmet needs and potential solutions to uncontrolled asthma. Eur Respir Rev 2022; 31:210176. [PMID: 35082128 PMCID: PMC9488919 DOI: 10.1183/16000617.0176-2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022] Open
Abstract
Despite the availability of effective inhaled therapies, many patients with asthma have poor asthma control. Uncontrolled asthma presents a significant burden on the patient and society, and, for many, remains largely preventable. There are numerous reasons why a patient may remain uncontrolled despite access to therapies, including incorrect inhaler technique, poor adherence to treatment, oversight of triggers and suboptimal medical care. Shared decision-making, good patient-clinician communication, supported self-management, multidisciplinary patient education, new technology and risk stratification may all provide solutions to this major unmet need in asthma. Novel treatments such as biologics could benefit patients' lives, while the investigations into biomarkers, non-Type 2 asthma, treatable traits and disease modification give an exciting glimpse into the future of asthma care.
Collapse
Affiliation(s)
- William W Busse
- Dept of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Monica Kraft
- University of Arizona College of Medicine, Tucson, AZ, USA
| |
Collapse
|
18
|
Muchão FP, Souza AVD, Souza JME, Silva LVRFD. Association between beta-2 adrenergic receptor variants and clinical outcomes in children and adolescents with acute asthma. EINSTEIN-SAO PAULO 2022; 20:eAO6412. [PMID: 35352766 PMCID: PMC8932728 DOI: 10.31744/einstein_journal/2022ao6412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate whether different genotypes of p.Arg16Gly, p.Gln27Glu, p.Arg19Cys and p.Thr164Ile variants interfere in response to treatment in children and adolescents with moderate to severe acute asthma. Methods This sample comprised patients aged 2 to 17 years with a history of at least two wheezing episodes and current moderate to severe asthma exacerbation. All patients received multiple doses of albuterol and ipratropium bromide delivered via pressurized metered-dose inhaler with holding chamber and systemic corticosteroids. Hospital admission was defined as the primary outcome. Secondary outcomes were changes in forced expiratory volume in the first second after 1 hour of treatment, and for outpatients, length of stay in the emergency room. Variants were genotyped by sequencing. Results A total of 60 patients were evaluated. Hospital admission rates were significantly higher in carriers of the genotype AA relative to those with genotype AG or GG, within the p.Arg16Gly variant (p=0.03, test χ2, alpha=0.05). Secondary outcomes did not differ between genotypes. Conclusion Hospital admission rates were significantly higher among carriers of the genotype AA within the p.Arg16Gly variant. Trial registration: ClinicalTrials.gov: NCT01323010
Collapse
|
19
|
Leal LF, Tavares NUL, Borges RB, Mengue SS, Fagondes SC, Masarwa R, Pizzol TDSD. Prevalence of chronic respiratory diseases and medication use among children and adolescents in Brazil - a population based cross-sectional study. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-93042022000100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil),a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting β2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population.
Collapse
|
20
|
Mara de Oliveira1,2 J, Mitsie Chibana Soares3 F, Pitta2 F, Couto Furlanetto1,2 K. Adults with asthma treated with add-on omalizumab report less limitation in activities of daily living. J Bras Pneumol 2022; 48:e20210321. [PMID: 35293486 PMCID: PMC8964268 DOI: 10.36416/1806-3756/e20210321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Joice Mara de Oliveira1,2
- 1. Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Pitágoras-Unopar, Londrina (PR), Brasil. 2. Laboratório de Pesquisa em Fisioterapia Respiratória, Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina (PR), Brasil
| | | | - Fabio Pitta2
- 2. Laboratório de Pesquisa em Fisioterapia Respiratória, Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina (PR), Brasil
| | - Karina Couto Furlanetto1,2
- 1. Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Pitágoras-Unopar, Londrina (PR), Brasil. 2. Laboratório de Pesquisa em Fisioterapia Respiratória, Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina (PR), Brasil
| |
Collapse
|
21
|
Santos VCHD, Moreira MAF, Rosa AVD, Sobragi SM, Silva CAJD, Dalcin PTR. Association of quality of life and disease control with cigarette smoking in patients with severe asthma. Braz J Med Biol Res 2022; 55:e11149. [PMID: 35019032 PMCID: PMC8851907 DOI: 10.1590/1414-431x2021e11149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
More information is needed on asthma control and health-related quality of life (HRQoL) in smokers with severe asthma. The main study objective was to characterize the association of HRQoL and disease control with cigarette smoking in individuals with severe asthma. A secondary objective was to analyze subject characteristics according to asthma onset: asthma that developed before smoking initiation versus asthma that developed after smoking initiation. This cross-sectional study included subjects with severe asthma aged 18-65 years. HRQoL was assessed using the Asthma Quality of Life Questionnaire (AQLQ) and asthma control was assessed using the Asthma Control Test (ACT) and Global Initiative for Asthma (GINA) criteria. Of the 87 patients studied, 58 (66.7%) were classified as asthmatics who had never smoked and 29 (33.3%) as asthmatics with smoking exposure. The proportion of subjects with uncontrolled asthma was higher in the asthma and smoking group (GINA criteria: P=0.032 and ACT criteria: P=0.003. There were no between-group differences in overall AQLQ score (P=0.475) or AQLQ domain scores (P>0.05). Fifty-eight subjects (66.7%) were nonsmokers, 20 (23%) had asthma onset before smoking, and 9 (10.3%) had asthma onset after smoking. Asthma onset before smoking was associated with uncontrolled asthma (P=0.013). In subjects with severe asthma, smoking was associated with a higher rate of uncontrolled disease but not with HRQoL scores.
Collapse
Affiliation(s)
- V C H Dos Santos
- Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Fundação Hospitalar Getúlio Vargas, Sapucaia do Sul, RS, Brasil
| | - M A F Moreira
- Serviço de Pneumologia, Hospital das Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - A V da Rosa
- Curso de Graduação, Faculdade de Fisioterapia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - S M Sobragi
- Curso de Graduação, Faculdade de Fisioterapia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - C A J da Silva
- Curso de Graduação, Faculdade de Fisioterapia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - P T R Dalcin
- Programa de Pós-Graduação em Ciências Pneumológicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Serviço de Pneumologia, Hospital das Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| |
Collapse
|
22
|
Silva RAD. People with asthma: care during the COVID-19 pandemic and the importance of regular exercise for the immune system. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220021121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
23
|
de Carvalho-Pinto RM, Cançado JED, Pizzichini MMM, Fiterman J, Rubin AS, Cerci A, Cruz ÁA, Fernandes ALG, Araujo AMS, Blanco DC, Cordeiro G, Caetano LSB, Rabahi MF, de Menezes MB, de Oliveira MA, Lima MA, Pitrez PM. 2021 Brazilian Thoracic Association recommendations for the management of severe asthma. J Bras Pneumol 2021; 47:e20210273. [PMID: 34932721 PMCID: PMC8836628 DOI: 10.36416/1806-3756/e20210273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/05/2021] [Indexed: 12/20/2022] Open
Abstract
Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.
Collapse
Affiliation(s)
- Regina Maria de Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração − InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - Jussara Fiterman
- . Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS) Brasil
| | - Adalberto Sperb Rubin
- . Universidade Federal de Ciências da Saúde de Porto Alegre − UFCSPA − Porto Alegre (RS) Brasil
- . Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Alcindo Cerci
- . Universidade Estadual de Londrina − UEL − Londrina (PR) Brasil
- . Pontifícia Universidade Católica do Paraná − PUCPR − Londrina (PR) Brasil
| | - Álvaro Augusto Cruz
- . Universidade Federal da Bahia − UFBA − Salvador (BA) Brasil
- . Fundação ProAR, Salvador (BA) Brasil
| | | | - Ana Maria Silva Araujo
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro − IDT/UFRJ − Rio de Janeiro (RJ) Brasil
| | - Daniela Cavalet Blanco
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS), Brasil
| | - Gediel Cordeiro
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
- . Hospital Madre Teresa, Belo Horizonte (MG) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás − UFG − Goiânia (GO) Brasil
| | - Marcelo Bezerra de Menezes
- . Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | | | | | | |
Collapse
|
24
|
Elmehy DA, Abdelhai DI, Elkholy RA, Elkelany MM, Tahoon DM, Elkholy RA, Soliman NA, Saad MAH, El-Ebiary AA, Gamea GA. Immunoprotective inference of experimental chronic Trichinella spiralis infection on house dust mites induced allergic airway remodeling. Acta Trop 2021; 220:105934. [PMID: 33895144 DOI: 10.1016/j.actatropica.2021.105934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 12/18/2022]
Abstract
Allergic bronchial asthma is characterized by chronic inflammation of the respiratory airways mediated by T-helper 2 (Th2), Th17 and their cytokines. Although most asthmatic patients suffer from allergic airway remodeling (AAR), aggressive anti-allergic treatment failed to reverse it. The hygiene hypothesis illuminated the counter relationship between allergy and helminthic infections. The immune system is modulated by Trichinella spiralis (T. spiralis) infection to maintain homeostasis. Therefore, this work aimed to investigate the impact of chronic T. spiralis infection on induced AAR in C57BL/6 mice sensitized by house dust mites (HDM) allergens. Forty mice were divided into 3 groups: I (10 healthy mice), IΙ (15 HDM sensitized mice), and ΙΙI (15 T. spiralis chronically infected mice and sensitized with HDM allergens). The assessment aimed to evaluate the effects of regulatory CD4+CD25+FOXP3+ cells (Tregs) and their cytokines comparative to hypersensitivity mediated cytokines. Chronic T. spiralis infection effectively prevented the host's AAR. This result was evidenced by upregulated Tregs in blood by flow cytometric analysis and increased interleukin-10 (IL-10) levels in bronchoalveolar lavage (BAL) by Enzyme linked immunosorbent assay (ELISA) as well as improved lung histopathological changes. Also, serum HDM specific immunoglobulin E (IgE), BAL eosinophils, BAL IL-5 levels, and IL-17 gene expression in lung tissues were significantly reduced in T. spiralis chronically infected mice. In conclusion, the immune response in chronic T. spiralis infection could provide a promising mechanistic tool for protection against AAR, which paves the way for innovative preventive measures of other immunological disorders.
Collapse
Affiliation(s)
- Dalia A Elmehy
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Dina I Abdelhai
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rasha A Elkholy
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Maram M Elkelany
- Histology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina M Tahoon
- Pharmacology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Reem A Elkholy
- Pharmacology Department, Faculty of Medicine, Tanta University, Tanta, Egypt; Pharmacology Department, School of Medicine, Badr University, Cairo, Egypt
| | - Nema A Soliman
- Medical Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Marwa A Hasby Saad
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmad A El-Ebiary
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ghada A Gamea
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
25
|
Gianfrancesco L, Malheiro APG, Matsunaga NY, Oliveira MS, Grotta MB, Morcillo AM, Ribeiro JD, Toro AADC. Are there differences in the physical activity level and functional capacity among children and adolescents with and without asthma? J Pediatr (Rio J) 2021; 97:295-301. [PMID: 32521233 PMCID: PMC9432013 DOI: 10.1016/j.jped.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the physical activity level, using two tools, and the functional capacity of children and adolescents with asthma and with different levels of disease control, and to compare them to those of individuals without asthma. METHODS Cross-sectional study with children and adolescents with (asthma group, AG) and without asthma (WAG), aged from 7 to 17 years. All participants performed the six-minute walk test (6MWT), the Glittre Activities of Daily Living test (Glittre-ADL), the International Physical Activity Questionnaire (IPAQ), and daily record of steps on a pedometer. RESULTS The study included 145 individuals with asthma and 173 individuals without asthma. The WAG walked a greater distance in the 6MWT and performed the Glittre-ADL in less time than the AG. Individuals with uncontrolled, partially controlled, and controlled asthma presented the same functional capacity. A difference was observed in the IPAQ classification, with 13.9% of participants from the WAG being sedentary, compared with 26.2% in the AG. The mean quantity of steps measured by the pedometer was higher in the WAG. CONCLUSION There was a difference in the performance of individuals with and without asthma in the physical activity and functional capacity tests. The AG presented worse performance in the physical activity tests and, regardless of the level of asthma control, presented worse functional capacity.
Collapse
Affiliation(s)
- Lívea Gianfrancesco
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Ana Paula Gaban Malheiro
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Natasha Yumi Matsunaga
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Marina Simões Oliveira
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Milena Baptistella Grotta
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - André Moreno Morcillo
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - José Dirceu Ribeiro
- Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - Adyléia Aparecida Dalbo Contrera Toro
- Universidade Estadual de Campinas (Unicamp), Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil.
| |
Collapse
|
26
|
Pitrez PM, Giavina-Bianchi P, Rizzo JÂ, Souza-Machado A, Garcia GF, Pizzichini MMM. An expert review on breaking barriers in severe asthma in Brazil: Time to act. Chron Respir Dis 2021; 18:14799731211028259. [PMID: 34167379 PMCID: PMC8236765 DOI: 10.1177/14799731211028259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
Currently, Brazil lacks a national asthma management program and is burdened with nearly 200,000 hospitalizations due to the disease per year and approximately 5 deaths per day. The purpose of this article was to analyze the current issues surrounding severe asthma in Brazil, as the status of diagnosis and treatment is largely unknown, and to provide feasible recommendations to elicit imminent action. A panel of Brazilian medical experts in the field of severe asthma was provided with a series of relevant questions to address prior to a multi-day conference. Within this conference, each narrative was discussed and edited by the entire group. Through numerous rounds of discussion consensus was achieved. In order to overcome barriers to adequate asthma treatment, this panel recommends specific initiatives that can be implemented in the short-term to decrease the burden of severe asthma in Brazil. With increasing healthcare costs and limited resources globally, there is an opportunity to implement these recommendations in other countries in order to achieve adequate asthma care. Severe asthma is a heterogeneous and complex disease with various phenotypes that requires strict attention for diagnosis and management. Although this disease affects only a small proportion of the population with asthma, it poses a great burden to healthcare systems. Thus, barriers to diagnosis, treatment, and management should be overcome as quickly and efficiently as possible.
Collapse
Affiliation(s)
- Paulo Márcio Pitrez
- Pediatric Pulmonology Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Ângelo Rizzo
- Head Pneumology Department, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Adelmir Souza-Machado
- Institute of Health Sciences, Federal University of Bahia Coordinator of Program for Asthma Control in Bahia (ProAR), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Guilherme Freire Garcia
- Clinical Guidelines Coordinator of the Fundação Hospitalar de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
| | | |
Collapse
|