Burden of asthma among inner-city children from Southern Brazil

Association between oxidative balance score and asthma course in the American children: A cross-sectional analysis of the NHANES 2011-2018

Asthma is a common chronic respiratory disease related to oxidative stress. Oxidative balance score (OBS) could assess systemic oxidative stress status. Thus, we tried to explore the prediction value of OBS in asthma and the disease course. The data were obtained from the National Health and Nutrition Examination Survey database. Asthma and the disease course were determined by the Patient Health Questionnaire. OBS was scored by 20 dietary and lifestyle components. The receiver operating characteristic and decision curve analysis were used to assess the prediction value of OBS. Logistic regression, XG Boost, and Random Forest methods were used to obtain an optimal OBS-based model and rank the importance of OBS components. Mediation analysis was used to explore the possible interplay of OBS components on the disease course of asthma. From 2011 to 2018, 7348 participants including 6597 participants without asthma and 751 participants with asthma were enrolled. Receiver operating characteristic and decision curve analysis curves exhibited that the OBS-based model showed an improved prediction value than the OBS for the disease course of asthma. Machine learning techniques results showed that the body mass index, niacin, and selenium were the key components of OBS. Besides, niacin had a direct relation with the disease course and could also regulate the course of asthma by regulating body mass index. OBS could predict the disease course of asthma, and niacin may be the most important component of OBS in the development of asthma.

Asthma in the Brazilian Unified Health Care System: an epidemiological analysis from 2008 to 2021

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.

Family styles and quality of life in adolescents with bronchial asthma: The important role of self-esteem and perceived threat of the disease

OBJECTIVES

Analyze the relationship between family styles and quality of life (QoL) in adolescents with bronchial asthma and study the influence of self-esteem as a protective factor and threat perception as a risk factor.

METHODS

Family styles, QoL, perceived threat of the disease, and self-esteem were assessed in a total of 150 adolescents diagnosed with bronchial asthma with ages ranging from 12 to 16 years (M = 13.28; SD = 1.29), 60.7% being male. Descriptive statistics and mean comparisons were conducted according to the level of self-esteem. Relationships between variables were also studied using Pearson's correlations, and finally, the mediating role of self-esteem and the perceived threat of the disease was assessed using PROCESS.

RESULTS

Adolescents shown healthy family characteristics (high scores on affect and parental mood and low scores on psychological control) and high scores on QoL. Thirty-five percent of adolescents showed low self-esteem and a tendency to underestimate the disease. There are existing relationships between family styles and QoL; thus, healthy family characteristics (affection, parental mood, autonomy promotion) were positively associated with QoL, while psychological control was negatively associated with QoL. Disease threat and self-esteem mediated the relationship between family styles and adolescent QoL. Disease threat was negatively, and self-esteem was positively associated with QoL.

CONCLUSIONS

Self-esteem and family support are protective factors for the well-being of adolescents with bronchial asthma; however, the high perceived threat of the disease can have negative consequences for the adolescent's health and negatively impact their QoL.

Childhood overweight and obesity and abnormal birth anthropometric measures are associated with a higher prevalence of childhood asthma in pre-school age

OBJECTIVES

Childhood asthma is one of the most common non-communicable diseases in the world. Several perinatal and postnatal factors have been associated with increased risk of developing childhood asthma. The present study aims to assess whether childhood overweight and obesity and abnormal birth anthropometric measures affect the risk of developing childhood asthma in preschool age.

METHODS

In this study, 5215 preschool children at the age of 2-5 years were enrolled after applying several inclusion and exclusion criteria and they examined whether they present asthma symptoms. Non-adjusted and adjusted statistical analysis was performed to assess whether perinatal and postnatal factors increase the risk of developing childhood asthma.

RESULTS

A prevalence of 4.5% of childhood asthma was recorded. Among children diagnosed with asthma, 19.4% were affected by overweight and 13.9% were obese. Childhood overweight/obesity was indepedently associated with a 76% higher risk of childhood asthma than normal weight. Abnormal birth anthropometric measures, i.e. birth weight, length, and head circumference, were independently associated with higher odds (87%, 29%, and 23%, respectively) of childhood asthma than normal ranges.

CONCLUSIONS

This is a cross-sectional, nationally representative study which supported evidence that childhood overweight/obesity and abnormal birth anthropometric measures may independently increase the risk of childhood asthma in preschool age. Emergent health policies and strategies are recommended to promote a healthy lifestyle, preventing childhood obesity at the early stages of life.

Maternal and early childhood factors associated with asthma and obesity in children aged 6 to 7 years: a case control study

Objective

To determine the maternal and early childhood factors associated with asthma and obesity in children aged 6 to 7 years.

Methods

A case-control study conducted with children aged 6 to 7 years. Applications with questions about asthma symptoms in the last 12 months, maternal and childhood data in the first 2 years of life, and anthropometric data were collected. Children who presented asthma symptoms were considered as cases and those without asthma symptoms were considered as controls, later divided into two subgroups that were eutrophic or overweight/obesity. Logistic regression was performed to estimate the association between asthma symptoms (adequate weight and overweight/obesity) and gestational and personal factors, calculating odds ratio and 95% confidence interval (95%CI). Values of p<0.05 were considered significant.

Results

Two hundred and one children were evaluated, 25.4% had asthma symptoms, 37.2% of them were overweight/obesity. Waist circumference, triceps skinfold, and body mass index were higher in the group with overweight/obesity asthma symptoms compared to no asthma symptoms (p<0.05). Factors significantly associated with asthma and overweight/obesity symptoms included: the maternal history of asthma (odds ratio of 3.73; 95%CI: 1.10-12.6) and hypertension during pregnancy (odds ratio of 3.29; 95%CI: 1.08-9.94).

Conclusion

Maternal history of asthma and hypertension during pregnancy increased the chances of children, at 6 and 7 years of age, having symptoms of asthma and obesity.

Intervenções de fisioterapia respiratória utilizadas durante a hospitalização de crianças e adolescentes com asma

Objetivo: descrever e comparar as intervenções de fisioterapia respiratória utilizadas para asma durante a hospitalização em três grupos etários pediátricos. Além disso, buscou-se investigar os motivos de escolha dessas intervenções.Métodos: a amostra foi composta por fisioterapeutas atuantes em hospitais que reportaram atender crianças e adolescentes com asma. Os profissionais responderam a um questionário online sobre dados pessoais, acadêmicos, profissionais e relativo às intervenções de fisioterapia respiratória utilizadas em lactentes, pré-escolares e escolares/adolescentes. As intervenções foram agrupadas em nove classificações: convencionais, manuais, baseadas em volume, oscilação oral de alta frequência/pressão expiratória positiva (OOAF/PEP), exercícios ventilatórios, ventilação não invasiva, técnica de expiração forçada (TEF), aspiração de vias aéreas superiores (VAS) e outras.Resultados: foram incluídos 93 fisioterapeutas, com idade entre 31 e 40 anos (47,3%) e do sexo feminino (87,1%). As intervenções mais utilizadas nos lactentes foram a aspiração de VAS (78,5%), a aceleração do fluxo expiratório (AFE) (50,5%) e a terapia expiratória manual passiva (TEMP) (45,2%). Nos pré-escolares, predominou a tosse (75,3%), a aspiração de VAS (52,7%), a AFE (51,6%) e a TEMP/expiração lenta e prolongada (ELPr) (50,5%). Já nos escolares/adolescentes, a tosse (83,9%), os exercícios expiratórios variados (73,1%) e a ELPr (57,0%) sobressaíram-se. Houve menor utilização (p<0,01) de OOAF/PEP, de exercícios ventilatórios e de TEF nos lactentes e, também, de métodos convencionais, manuais, aspiração de VAS e outras terapias (p<0,01) nos escolares/adolescentes. Os profissionais relataram utilizar essas intervenções por serem mais eficazes na prática clínica (78,5%).Conclusão: as intervenções manuais e as técnicas de expectoração visando à desobstrução brônquica foram as mais frequentemente utilizadas, tendo relação com a faixa etária e a escolha devido à efetividade na prática clínica.

Avaliação dos níveis de alfabetismo em saúde, conhecimento em asma e qualidade de vida de pais associados ao controle da doença em crianças e adolescentes com diagnóstico de asma de centros especializados

Objetivo: avaliar o nível de conhecimento em asma, alfabetismo em saúde e qualidade de vida de cuidadores de crianças e adolescentes com diagnóstico da doença, bem como, a associação com o controle da asma, adesão ao tratamento e qualidade de vida.Métodos: estudo transversal, realizado com cuidadores e pacientes de dois centros especializados de referência no Sul do Brasil, entre março de 2018 e novembro de 2018. Participaram pais e cuidadores de crianças e adolescentes com diagnóstico de asma, com idade a partir de 18 anos. Foram aplicados os questionários: sociodemográfico, Short Assessment of Health Literacy for Portuguese-Speaking Adults, Questionário de Conhecimento em Asma Pediátrica e Paediatric Asthma Caregiver’s Quality of Life Questionnaire. Para fins estatísticos, foram utilizados o teste t, qui-quadrado e Regressão Logística Binária.Resultados: foram incluídos 125 cuidadores, sendo 89 (71,2%) mães, com idade média de 35,7±9,2 anos, 65 (52%) com ensino médio completo e 100 (80%) pertencentes à classe econômica C. Do total, 74 (59,2%) apresentaram níveis inadequados de alfabetismo em saúde e 117 (94,4%) inadequados níveis de conhecimento em asma. A asma não estava controlada em 91 (72,8%) dos pacientes, estando associado a menor qualidade de vida deles e de seus cuidadores (p<0,001). A Regressão Logística verificou se o alfabetismo em saúde, o conhecimento em asma e a qualidade de vida dos cuidadores estavam associados ao controle da asma dos pacientes, sendo esse modelo significativo [X2(4) = 22,083; p<0,001, R2Nagelkerke = 0,484]. As variáveis categóricas utilizadas como referência foram as que apresentaram maior frequência (asma não controlada e conhecimentos inadequados). O alfabetismo em saúde (OR = 3,650; IC95% = 1,335 - 9,984) e qualidade de vida (OR = 3,095; IC95% = 1,850 – 5,178) também foram significativos.Conclusão: a população analisada apresentou níveis de alfabetismo em saúde e conhecimento em asma insatisfatórios. Ainda, os níveis de controle da doença foram baixos podendo estar associados aos níveis de qualidade de vida.

Analysis of the trend of hospitalizations for asthma in children and adolescents in Brazil

OBJECTIVE

To analyze the trend of hospitalizations for asthma in children and adolescents by region and age group in Brazil, from 2008 to 2017.

METHOD

This is a time-series study with secondary data regarding hospitalizations for asthma in children and adolescents, according to age, region, and gender. Descriptive statistics procedures were used with measures of central tendency to calculate the variation between the periods of 2008 and 2017. Rates of hospitalizations were calculated specifically by age group and region. Time trend analysis was performed by simple linear regression, considered as stationary (p>0.05), declining (p<0.05 and negative regression coefficient), or ascending (p<0.05) and positive regression coefficient).

RESULTS

The present study identified a higher proportion of hospitalizations for asthma in Brazil in children aged 5-9 years. Regarding gender, there were more hospitalizations in boys. The region that presented the highest proportion of hospitalizations, in all age groups investigated, was the Northeast. As for the trend analysis, this article showed that, in Brazil, there was a trend toward a reduction in hospitalization rates for asthma.

CONCLUSION

In Brazil, there was a tendency to reduce hospitalizations for all investigated age groups. The Northeast was the only region that showed a decline in all age groups.

Seasonal and monthly variation in peak expiratory flow rate in children with asthma

Background

Although understanding the seasonal patterns of asthma deterioration is important to prevent asthma exacerbation, previous approaches have limitations in evaluating the actual trend of asthma exacerbation.

Objective

This study aimed to evaluate the seasonal and monthly variations in the peak expiratory flow rate (PEFR) among children with asthma.

Methods

A total of 89 patients with asthma were enrolled between December 2012 and March 2015. The PEFR in the morning and evening was recorded daily, and the percentage change in PEFR from baseline was calculated. Generalized estimating equation models were constructed after adjusting for age, sex, body mass index, and sensitization to house dust mites or pollen.

Results

The PEFR records of 11,222 person-days showed a significant decrease in the morning and evening in autumn than in winter by -1.9% (95% confidence interval [CI], -3.73 to -0.15) and -2.1% (95% CI, -3.80 to -0.37), respectively. The morning PEFR was significantly lower in April, August, October, and December than in January with changes of -4.2% (95% CI, -7.08 to -1.23) in April, -3.1% (95% CI, -5.79 to -0.47) in August, -3.7% (95% CI, -6.09 to -1.21) in October, and -1.9% (95% CI, -3.62 to -0.12) in December. The percentage change of evening PEFR significantly decreased by -3.3% (95% CI, -6.38 to -0.25) in April and by -3.3% (95% CI, -5.56 to -1.07) in October.

Conclusion

The PEFR in children with asthma was lower in autumn than in winter. In terms of monthly patterns, the PEFR was significantly reduced in April and October than in January. These results can serve as a basis for preventing asthma exacerbations by developing seasonal or monthly management strategies for children with asthma.

Asthmatic Symptoms in Children and Adolescents: the Role of Maternal Experiences of Racial Discrimination

Emerging evidence suggests that vicarious racial experiences of discrimination may negatively influence child health. Few studies have focus on childhood asthma symptoms and potential moderators of such relationship.

METHODS

We used two population-based cross-sectional studies from the Social Change Allergy and Asthma in Latin America project in Salvador, Brazil. A total of 1003 children and mothers interviewed in 2006 were included, of whom 873 were reached again in 2013. Vicarious racial discrimination was assessed in mothers by applying the Experiences of Discrimination scale. Data on wheeze and environmental exposures were collected with standardized questionnaires. Levels of allergen-specific IgE were measured to identify atopy. Generalized estimating equations were used to estimate the association between maternal discrimination and wheezing and asthma phenotypes. Interaction terms were evaluated to identify whether mothers' mental health and family social support modified such associations.

RESULTS

Children whose mothers reported racial discrimination had greater odds of have asthma symptoms (OR 1.75; 95% CI 1.15-2.67) and non-atopic asthma (OR 1.92; 95% CI 1.09-3.40). When we considered effect modification by social support, we found a higher ORs when the level of social support was lower (OR 2.43; 95% IC 1.19-4.97) than when the level of social support was higher (OR 1.12; CI 0.64-1.96).

CONCLUSION

Maternal discrimination was associated with asthma symptoms and with non-atopic phenotype among their children. Enjoying wider social support network appears to buffer the effect on asthmatic symptoms. Intervention on childhood asthma needs to incorporate strategies that target the family.

An expert review on breaking barriers in severe asthma in Brazil: Time to act

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.

PEDIATRIC ASTHMA: IMPACT OF THE DISEASE IN CHILDREN RECEIVING OUTPATIENT TREATMENT IN SOUTHERN BRAZIL

OBJECTIVE

To evaluate the impact of pediatric asthma on patients of a specialized outpatient clinic in Southern Brazil.

METHODS

The study included children aged 8 to 17 years old with asthma diagnosis (mild, moderate and severe) under treatment at the asthma clinic of Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil. Measurements of spirometry, quality of life, disease control and atopy tests were applied.

RESULTS

A total of 66 children were included in the study and divided into groups, according to the severity of the disease: mild, moderate or severe asthma. The results showed similarities in both the treatment and the impact of asthma between groups, except for adherence to treatment: the group with mild asthma showed least adherence to treatment, and the group with severe asthma, greater adherence (p=0.011). As to school absenteeism, the group with severe asthma showed higher frequency (p=0.012), with over 10 days per year (p=0.043). Spirometry showed lower volume/capacity for the group with moderate asthma, followed by the groups with severe and mild asthma. All groups had a high prevalence of allergic asthma, with mites as the main allergens. For quality of life (QOL), and health-related quality of life (HRQOL) levels, there were no differences between groups. In addition, the values were close to the acceptable levels for the total score and for each one of the six domains. The same occurred for the HRQOL-asthma module.

CONCLUSIONS

QOL and HRQOL present acceptable levels regardless of the severity of the disease.

Prevalence of asthma at a school-based health clinic in Nicaragua

BACKGROUND

Worldwide, it is estimated that 235-334 million people have been diagnosed with asthma. In Nicaragua, the current asthma rate for children 13-14 years of age was 15.2%.

PURPOSE

The purpose of this study was to determine the prevalence of asthma at this school-based health clinic in Managua, Nicaragua, associated symptoms or diseases, determine asthma classification, medications, and hospitalization rates.

METHODS

A retrospective chart review was performed on all pediatric patient's medical records seen in the clinic during a 5-day period (n = 105).

RESULTS

A total of 23 patients (21.9%) had asthma documented in the medical chart and were included in the analysis. Of the 23 patients, 3 (13%) patients were classified with intermittent asthma while the rest of the patients (87%) were not classified. Albuterol was prescribed for 19 (86%) of the patients with two patients who had both albuterol and QVAR® prescribed. Six (26%) patients had a family history of asthma.

DISCUSSION

This study demonstrated the prevalence of asthma in school-aged children in Nicaragua is significant and higher than previously reported. The lack of a classification of asthma prevents patients from potentially being treated appropriately.

Prevalence and impact of asthma in schoolchildren in the city of Caxias do Sul-RS

OBJECTIVE

To analyze the prevalence and impact of asthma in schoolchildren from the city of Caxias do Sul, RS, Brazil.

METHODS

Cross-sectional observational and case-control study with children and adolescents between 7 and 15 years old, from public schools in Caxias do Sul, RS. The study is composed of two phases: Phase I analyzed the prevalence of asthma in the delimited population, investigating 1915 schoolchildren; Phase II quality of life questionnaires, asthma control and classification (for the asthmatic group), physical activity, school performance, pulmonary function tests and anthropometric measures were applied to 266 asthmatics and 288 controls.

RESULTS

The estimated prevalence of asthma was 16.1%. In the comparison between asthmatics and nonasthmatics premature birth (p<0.001) and diagnosis of another chronic disease at birth (p<0.001) were found. Regarding pulmonary function, significant differences were found in the values between groups in FEV₁, FEV₁/FVC and forced expiratory flow in the 25 and 75% (FEF_25-75%), being that asthmatics presented lower values. Among asthmatics, 133 (50.8%) did not have the disease controlled. In the anthropometric variables, significant differences were observed, with higher values in controls, in the the waist-to-height ratio (p=0.009) and in the perception of health (p<0.001). Quality of life is lower in asthmatics in the physical well-being domain (p=0.001) and in the total score (p=0.016). The total school performance score did not present a statistically significant difference between the groups.

CONCLUSION

The prevalence of asthma is similar to that of other industrialized urban centers and may negatively affect some areas of the development of schoolchildren.

Comparison between the health-related quality of life of children/adolescents with asthma and that of their caregivers: a systematic review and meta-analysis

OBJECTIVE

To evaluate the health-related quality of life (HRQoL) of children/adolescents with asthma and that of their caregivers, comparing the two.

METHODS

This was a systematic review and meta-analysis based on the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, with a strategy of searching five health-related databases (MEDLINE/PubMed, EMBASE, ScienceDirect, SciELO, and LILACS). We included studies that evaluated the HRQoL of children/adolescents with asthma and that of their caregivers with the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire, respectively, using the total scores and the scores on the domains activity limitation, symptoms (children/adolescents only), and emotional function.

RESULTS

We identified 291 articles, and we evaluated 133 of those. A total of 33 articles, collectively including 4,101 subjects, were included in the meta-analysis. An analysis stratified by study design showed no differences between the HRQoL of the caregivers and that of the children/adolescents in the activity limitation domain and in the total score. However, the mean emotional function domain scores were significantly higher (better) among children/adolescents with asthma than among their caregivers in longitudinal studies-Δ = 0.82 (0.21-1.44)-and randomized clinical trials-Δ = 0.52 (0.29-0.79)-although not in cross-sectional studies-Δ = -0.20 (-0.03 to 0.43).

CONCLUSIONS

The total HRQoL scores proved to be similar between children/adolescents with asthma and their caregivers. However, the two groups differed in their perception of their emotional function, the caregivers scoring significantly lower than the children/adolescents in that domain.

Effect of physical activity on asthma control in schoolchildren

OBJECTIVE

To investigate the effect of levels of physical activity on asthma control in children.

METHODS

A cross-sectional study, including public school students aged 8 to 12 years, of both sexes, with asthma, from a capital and a medium-sized cities in Southern Brazil. At home, the students answered the questionnaire on levels of physical activity and disease control.

RESULTS

A total of 482 schoolchildren with asthma participated in the study, with mean age of 10.9±2.2 years, and 253 (52%) were girls. Regarding disease control, 50% had controlled asthma, and 67% were considered sedentary. Schoolchildren with controlled asthma were more active than those with uncontrolled asthma (p=0.032). Active schoolchildren were more likely to have asthma controlled (OR=1.5; 95%CI: 1.04-2.25).

CONCLUSION

The results demonstrated an association between physical activity levels and asthma control. More active schoolchildren were more likely to have asthma controlled.

Childhood asthma in low and middle-income countries: Where are we now?

Pediatric asthma has been increasing in LMICs (Low Middle-Income Countries), leading to an important burden for both children and national health systems. Implementing measures to achieve control are influenced by the degree of organization health systems have, the availability and affordability of essential asthma medications, and the effective implementation of asthma programs and asthma guidelines. In this review authors give an updated view of the current situation of these components of asthma management in LMICs.

Levels of knowledge about asthma of parents of asthmatic children

Objective

To evaluate the levels of knowledge about asthma of parents of school children.

Methods

A cross-sectional study was carried out with parents of children with medical diagnosis of asthma (mild, moderate and severe), followed up at an outpatient referral center for childhood asthma in the Southern region of Brazil (Asthma Group). Parents of children with asthma in remission and healthy children were also selected (Control Group). The Newcastle Asthma Knowledge Questionnaire (NAKQ) questionnaire was applied in both groups.

Results

A total of 154 parents of children participated in the study; in that, 62 (40.26%) in the Asthma Group, and 92 (59.74%) in the Control Group, with a mean age of 35.60±10.03 years. Of these, 132 (85.7%) were female, and 72 (46.8%) parents studied up to high school. The average score of level of knowledge was 18.06±4.11 points. Only 30.5% parents had acceptable levels of knowledge about asthma, which were more prevalent in the Asthma Group than in the Control Group (41.9% versus 22.8%, p=0.01). The mean score in Newcastle Asthma Knowledge Questionnaire (NAKQ) was higher in the Asthma Group (19.32±3.92 versus 17.21±4.03, p=0.001), respectively. The parents with mild and moderate asthmatic children scored more than those of severe asthma (19.5 and 19.9 versus 18.2 points, p=0.02).

Conclusion

Most parents had an unsatisfactory level of knowledge about asthma, which reinforces the need for changes in public asthma management programs.

Mite Fauna Assessment in Houses of Two distinct Socioeconomic Groups From Southern Brazil

House dust mites (HDM) are the main source of aeroallergens worldwide, yet epidemiological differences between socioeconomic factors in association with this medical condition have not been studied in the south region of Brazil. To assess the prevalence of HDM in two socioeconomically distinct populations of patients with allergic asthma or rhinitis, the differences between samples from houses of high-income families and low-income families were analyzed. Mite samples were collected between July and December 2015, in Porto Alegre, Brazil. The HDM were Dermatophagoides pteronyssinus and Dermatophagoides farinae (Hughes; Acari: Pyroglyphidae). Also, other non-pyroglyphid house mites were identified in dust samples: Tyrophagus putrescentiae (Schrank; Acari: Acaridae), Chortoglyphus arcuatus, and Cheyletus malaccensis. Identification of species was performed through morphological keys with a stereomicroscope and a phase optical microscope. A total of 104 homes was evaluated (low-income group: n = 53; high-income group, n = 51). We found a total of 721 mites, representing 11 species, in 93 (89%) houses. In the remaining houses, no mites were found. We observed no significant differences of species composition between the groups studied. However, the number of mites was significantly higher in the low-income group (P < 0.001). D. pteronyssinus was the predominant species detected, with 286 mites (39.6%). D. farinae was not detected in any sample. Our results show that living-rooms from low-income families present higher numbers of HDM.

Impact of omalizumab in children from a middle-income country with severe therapy-resistant asthma: A real-life study

BACKGROUND

Severe asthma in children is a global health problem. Severe therapy-resistant asthma (STRA) in children is a major clinical challenge due to persistent symptoms despite high doses of corticosteroids and results in high public health costs. Omalizumab (anti-IgE monoclonal antibody) has been described as an effective add-on therapy in these patients. The characteristics of children with STRA from low- and middle-income countries have scarcely been reported, and no real-life study has been published on the effects of omalizumab in this group of patients. The aim of our study is to report the first clinical real-life experiences with omalizumab in Brazilian children with STRA.

METHODS

Children (6-18 years old) from a referral center who were diagnosed with STRA were included in this retrospective study based on our clinical databases. The included children had undergone at least 6 months of omalizumab treatment and fulfilled the following initial criteria: 1) >6 years old; 2) a positive skin-prick test for at least one aeroallergen; and 3) a serum total IgE level between 30 and 1500 IU/mL. Clinical and lung function variables were analyzed before and after treatment.

RESULTS

Fourteen children (mean age: 11.9 years; percentage female: 72%) were included in this study. Omalizumab treatment significantly increased control of the disease according to a standardized questionnaire administered at every visit (P < 0.0001), ceased hospitalizations in 70% (P = 0.02) of patients, and allowed 8/9 (89%) patients to be weaned off oral steroids (P = 0.004).

CONCLUSIONS

In this retrospective report, the use of omalizumab in Brazilian children with STRA significantly improved disease control, decreased hospitalizations, and allowed suspension of continuous oral corticosteroids.

The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system

Objective:

To present official longitudinal data on the impact of asthma in Brazil between 2008 and 2013.

Methods:

This was a descriptive study of data collected between 2008 and 2013 from an official Brazilian national database, including data on asthma-related number of hospitalizations, mortality, and hospitalization costs. A geographical subanalysis was also performed.

Results:

In 2013, 2,047 people died from asthma in Brazil (5 deaths/day), with more than 120,000 asthma-related hospitalizations. During the whole study period, the absolute number of asthma-related deaths and of hospitalizations decreased by 10% and 36%, respectively. However, the in-hospital mortality rate increased by approximately 25% in that period. The geographic subanalysis showed that the northern/northeastern and southeastern regions had the highest asthma-related hospitalization and in-hospital mortality rates, respectively. An analysis of the states representative of the regions of Brazil revealed discrepancies between the numbers of asthma-related hospitalizations and asthma-related in-hospital mortality rates. During the study period, the cost of asthma-related hospitalizations to the public health care system was US$ 170 million.

Conclusions:

Although the numbers of asthma-related deaths and hospital admissions in Brazil have been decreasing since 2009, the absolute numbers are still high, resulting in elevated direct and indirect costs for the society. This shows the relevance of the burden of asthma in middle-income countries.

Asthma and Obesity in Children Are Independently Associated with Airway Dysanapsis

BACKGROUND

An increase in the prevalence of overweight and asthma has been observed. Both conditions affect negatively lung function in adults and children. The aim of this study was to analyze the effect of overweight and asthma on lung function in children.

METHODS

We designed a case-control study of healthy and asthmatic subjects nested within an epidemiological asthma prevalence study in children between 8 and 16 years of age. The effect of asthma and overweight on lung function was assessed by impulse oscillometry and spirometry obtained at baseline and 10-15 min after salbutamol.

RESULTS

188 children were recruited, 114 (61%) were asthmatics and 72 (38%) were overweight or obese. Children with asthma and overweight had a higher FVC (+1.16 z scores, p < 0.001) and higher FEV₁ (+0.79 z scores, p = 0.004) and lower FEV₁/FVC (-0.54 z scores, p = 0.008) when compared to healthy controls. Compared to normal weight asthmatics, the overweight had higher FVC (+0.78 z scores, p = 0.005) and lower FEV₁/FVC (-0.50 z scores, p = 0.007). In the multivariate analysis, overweight was associated with an increase of 0.71 and 0.44 z scores in FVC and FEV₁, respectively, and a reduction in FEV₁/FVC by 0.40 z scores (p < 0.01 for all). Overweight had no effect on maximal flows and airway resistance at baseline, and this was not modified by inhalation of a bronchodilator. Asthma was also associated with higher post-BD FVC (0.45 z scores, p = 0.012) and FEV₁ (0.35 z scores, p = 0.034) but not with FEV₁/FVC and FEF_25-75%. Two-way analysis of variance did not detect any interaction between asthma and overweight on lung function variables before or after bronchodilator.

CONCLUSION

Our results suggest that asthma and overweight are independently associated with airway dysanaptic growth in children which can be further scrutinized using impulse oscillometry. Overweight contributed more to the reduction in FEV₁/FVC than asthma in children without increasing airway resistance. Spirometry specificity and sensitivity for obstructive diseases may be reduced in populations with high prevalence of overweight. Adding impedance oscillometry to spirometry improves our understanding of the ventilatory abnormalities in overweight children.