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Jayasooriya S, Stolbrink M, Khoo EM, Sunte IT, Awuru JI, Cohen M, Lam DC, Spanevello A, Visca D, Centis R, Migliori GB, Ayuk AC, Buendia JA, Awokola BI, Del-Rio-Navarro BE, Muteti-Fana S, Lao-Araya M, Chiarella P, Badellino H, Somwe SW, Anand MP, Garcí-Corzo JR, Bekele A, Soto-Martinez ME, Ngahane BHM, Florin M, Voyi K, Tabbah K, Bakki B, Alexander A, Garba BL, Salvador EM, Fischer GB, Falade AG, ŽivkoviĆ Z, Romero-Tapia SJ, Erhabor GE, Zar H, Gemicioglu B, Brandão HV, Kurhasani X, El-Sharif N, Singh V, Ranasinghe JC, Kudagammana ST, Masjedi MR, Velásquez JN, Jain A, Cherrez-Ojeda I, Valdeavellano LFM, Gómez RM, Mesonjesi E, Morfin-Maciel BM, Ndikum AE, Mukiibi GB, Reddy BK, Yusuf O, Taright-Mahi S, Mérida-Palacio JV, Kabra SK, Nkhama E, Filho NR, Zhjegi VB, Mortimer K, Rylance S, Masekela RR. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis 2023; 27:658-667. [PMID: 37608484 PMCID: PMC10443788 DOI: 10.5588/ijtld.23.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.
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Affiliation(s)
- S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield
| | - M Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E M Khoo
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - I T Sunte
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - J I Awuru
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - M Cohen
- Hospital Centro Médico, Guatemala City, Guatemala, Mexico, Asociación Latinoamericana de Tórax, Montevideo, Uruguay
| | - D C Lam
- Department of Medicine, University of Hong Kong, Hong Kong, Asian Pacific Society of Respirology, Hong Kong, China
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - D Visca
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Department of Medicine, University of Hong Kong, Hong Kong
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - A C Ayuk
- College of Medicine, University of Nigeria, Enugu, Nigeria
| | - J A Buendia
- Affiliation Departamento de Farmacologia y Tóxicologia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - B I Awokola
- Medical Research Council, The Gambia at the London School of Tropical Medicine, The Gambia
| | | | - S Muteti-Fana
- Department of Primary Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M Lao-Araya
- Division of Allergy and Clinical Immunology, Chian Mai University, Chiang Mai, Thailand
| | - P Chiarella
- Health Sciences School, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - H Badellino
- Head Pediatric Respiratory Medicine Department, Clinica Regional del Este, San Francisco, Argentina
| | - S W Somwe
- Paediatrics and Child Health, University of Lusaka, Lusaka, Zambia
| | - M P Anand
- Department of Respiratory Medicine, JSS Medical College, Mysore, India
| | - J R Garcí-Corzo
- Department of Pediatrics, Universidad Industrial de Santander, Santander, Colombia
| | - A Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Soto-Martinez
- Department of Pediatrics, Universidad de Costa Rica, San Jose, Costa Rica
| | - B H M Ngahane
- Douala General Hospital, University of Douala, Douala, Cameroon
| | - M Florin
- Institute of Pneumology M. Nasta, Bucharest, Romania
| | - K Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - K Tabbah
- College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - B Bakki
- University of Maiduguri Teaching Hospital, Maiduguri
| | - A Alexander
- Deparment of Medicine, University of Abuja, Abuja
| | - B L Garba
- Department of Paediatrics, Usmanu Danfodiyo, University Teaching Hospital, Sokoto, Nigeria
| | - E M Salvador
- Deparment of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - G B Fischer
- University of Medical Sciences, Porto Alegre, RS, Brazil
| | - A G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Zorica ŽivkoviĆ
- Dragiša Mišovic, Childrens Hsopital for Lung Disease and TB, Belgrade, Serbia
| | - S J Romero-Tapia
- Health Sciences, Academic Division, Juarez Autononous, University of Tabasco, Villahermosa, Mexico
| | - G E Erhabor
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - H Zar
- Department of Paediatrics & Child Health & SA MRC Unit on Children & Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University, Cerrahpasa, Turkey
| | - H V Brandão
- State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - X Kurhasani
- UBT Higher Education Institution, Prishtina, Kosovo
| | | | - V Singh
- MJ Rajasthan Hospital, Jaipur, India
| | | | - S T Kudagammana
- Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - M R Masjedi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J N Velásquez
- Medical School, Santander Industrial, Bucaramanga, Colombia
| | - A Jain
- Department of Community Medicine, Kasturba Medical College, Mangalore
| | | | - L F M Valdeavellano
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Francisco Morroguín University, Guatemala City, Guatemala
| | - R M Gómez
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - E Mesonjesi
- Department of Allergy and Clinical Immunology, University Hospital Centre "Mother Teresa", Tirana, Albania
| | | | - A E Ndikum
- The University of Yaounde 1, Yaounde, Cameroon
| | | | - B K Reddy
- Shishuka Children's Speciality Hospital, Bangalore, India
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - S Taright-Mahi
- Medecin Faculty, Mustapha Universitary Hospital Algiers, Algeria
| | - J V Mérida-Palacio
- Centrode Investigación de Enfermedades Alérgicas y Respiratorias SC, Mexico DF, Mexico
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - E Nkhama
- Levy Mwanawasa Medical University, School of Public Health and Environmental Sciences, Lusaka, Zambia
| | - N R Filho
- Federal University of Parana, Curitiba, PA, Brazil
| | - V B Zhjegi
- Social Medicine, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - K Mortimer
- University of Cambridge, Cambridge, Imperial College, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - S Rylance
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - R R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
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Silva WF, Castralli HA, Penha AB, Mariussi PM, Bellaver G, Zago A, Fischer GB, Salvador JC, Salles RF, Barbosa CD. HISTOPLASMOSE MEDULAR REFRATÁRIA AO TRATAMENTO: RELATO DE CASO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Castralli HA, Silva WF, Zago A, Bellaver G, Salvador JC, Salles RF, Fischer GB. CRIPTOCOCOSE DISSEMINADA EM LINFOMA NÃO HODGKIN RECIDIVADO: RELATO DE CASO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dias CF, Sarria EE, Scheffel C, Delatorre LB, Sapiro A, Baldissera M, Chiapinotto S, Mocelin HT, Fischer GB, Mattiello R. COVID-19 Prevention Policies Reduce Pediatric Hospital Mortality Due to Community-acquired Pneumonia. Arch Bronconeumol 2021; 58:197-199. [PMID: 34629613 PMCID: PMC8485709 DOI: 10.1016/j.arbres.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Carolina F Dias
- Pediatric Department, Universidade Federal do Espírito Santo, Vitória, Brazil.,Pediatric Infectious Diseases Section, Hospital Infantil e Maternidade Dr. Alzir Bernardino Alves, Vila Velha, Brazil
| | - Edgar E Sarria
- Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil
| | - Camila Scheffel
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura B Delatorre
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexander Sapiro
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Sabrina Chiapinotto
- Postgraduate Program in Pulmonology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Helena T Mocelin
- Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil.,Pediatrics Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Gilberto B Fischer
- Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil.,Pediatrics Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Pediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Rita Mattiello
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Szefler SJ, Fitzgerald DA, Adachi Y, Doull IJ, Fischer GB, Fletcher M, Hong J, García-Marcos L, Pedersen S, Østrem A, Sly PD, Williams S, Winders T, Zar HJ, Bush A, Lenney W. A worldwide charter for all children with asthma. Pediatr Pulmonol 2020; 55:1282-1292. [PMID: 32142219 PMCID: PMC7187318 DOI: 10.1002/ppul.24713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence-based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be community involvement together with the local and national development of asthma champions. We call on governments, institutions, and healthcare services to support its implementation.
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Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Pediatric Asthma Research Program, Anschutz Medical Campus, Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Dominic A Fitzgerald
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yuichi Adachi
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Iolo J Doull
- Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, UK
| | - Gilberto B Fischer
- Department of Paediatrics, Universidade Federal de Ciencias da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Monica Fletcher
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Jianguo Hong
- Department of Paediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Luis García-Marcos
- Department of Paediatrics, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia, Murcia, Spain
| | - Søren Pedersen
- Paediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | | | - Peter D Sly
- Children's Health and Environment Program and World Health Organisation Collaborating Centre for Children's Health and Environment, Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Tonya Winders
- Allergy & Asthma Network, Vienna, Virginia.,Global Allergy & Asthma Patient Platform, Vienna, Virginia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andy Bush
- Department of Paediatrics, National Heart and Lung Institute and Royal Brompton & Harefield NHS Foundation Trust, Imperial College, London, UK
| | - Warren Lenney
- Department of Child Health, Institute of Applied Clinical Science, Keele University, Keele, UK
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Pizzutti K, Perez VP, Barbiero C, d'Azevedo PA, Fischer GB, Dias C. Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture-independent methods? Pediatr Pulmonol 2020; 55:484-489. [PMID: 31738021 DOI: 10.1002/ppul.24568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 10/29/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate culture-independent procedures (immunochromatography and quantitative polymerase chain reaction [qPCR]) in the detection and susceptibility of Streptococcus pneumoniae directly from culture-negative pleural fluid (PF) in children. METHOD Detection of S. pneumoniae in PF of children with parapneumonic effusion and/or empyema by using two culture-independent methods: an immunochromatographic membrane test (IMT) which identifies the pneumococcal C antigen, and a real-time PCR test to detect pneumococcal genes lytA and pbp2b, a marker of susceptibility of β-lactam agents, in PF samples. RESULTS We tested 36 PF specimens and recorded the previous use of antimicrobials. In the final analysis, 34 samples were included. IMT and qPCR presented positive results in 23 (67.6%) and 24 (70.6%) of the samples, respectively, showing a moderate agreement (k = 0.518) between the two methods. From the 36 children included, 34 (94.4%) had antibiotic data available by the time when PFs were collected. Thirty-four (100%) children had been given treatment before PF sampling, with 33 (97%) receiving β-lactam antibiotics administered empirically. Of the 24 lytA real-time positive samples, 21 (87.5%) were also positive for pbp2b, a marker of β-lactam susceptibility. CONCLUSION The reduced sensitivity of culture for pneumococcal detection can be improved through the addition of IMT and qPCR analysis. The utility of qPCR combining detection of lytA and a marker of β-lactam susceptibility should be explored further.
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Affiliation(s)
- Kauana Pizzutti
- Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinícius P Perez
- Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Caroline Barbiero
- Pediatric Pneumology, Hospital da Criança Santo Antônio da Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro A d'Azevedo
- Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gilberto B Fischer
- Pediatric Pneumology, Hospital da Criança Santo Antônio da Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cícero Dias
- Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Sarria EE, Mundstock E, Mocelin HT, Fischer GB, Torres RR, Garbin JGM, Leal LF, de F Arend MHR, Stein R, Booij L, de Araújo RMF, Mattiello R. Health-related quality of life in post-infectious bronchiolitis obliterans: agreement between children and their proxy. J Pediatr (Rio J) 2019; 95:614-618. [PMID: 31327498 DOI: 10.1016/j.jped.2018.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the level of agreement in health-related quality of life between children with Post-infectious Bronchiolitis Obliterans and their parent (so-called proxy). METHODS Participants aged between 8and 17 years who had been previously diagnosed with Post-infectious Bronchiolitis Obliterans were regularly followed up at a pediatric pulmonology outpatient clinic. Parents or legal guardians (caregivers) of these patients were also recruited for the study. A validated and age-appropriate version of the Pediatric Quality of Life Inventory 4.0 was used for the assessment of health-related quality of life. Caregivers completed the corresponding proxy versions of the questionnaire. The correlation between self and proxy reports of health-related quality of life was determined by intra-class correlation coefficient and dependent t-tests. RESULTS The majority of participants were males (79.4%), and the average age was 11.8 years. Intra-class correlations between each of the Pediatric Quality of Life Inventory 4.0 domains and the total score were all lower than 0.6, with a range between 0.267 (poor) and 0.530 (fair). When the means of each domain and the total score of the questionnaires were compared, caregivers were observed to have a significantly lower health-related quality of life score than children, with the exception of the social domain in which the difference was not significant. However, the differences in score exceeded the critical threshold difference of four points in all other domains. CONCLUSION Proxies of children and adolescents with Post-infectious Bronchiolitis Obliterans appear to consistently perceive their children as having lower health-related quality of life than how the patients perceive themselves.
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Affiliation(s)
- Edgar E Sarria
- Universidade de Santa Cruz do Sul (Unisc), Departamento de Biologia e Farmácia, Santa Cruz do Sul, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Eduardo Mundstock
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Prefeitura de Canela, Canela, RS, Brazil
| | - Helena T Mocelin
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
| | - Gilberto B Fischer
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
| | - Renato R Torres
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - João G M Garbin
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Escola de Medicina, Porto Alegre, RS, Brazil
| | - Lisiane F Leal
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - Marcia H R de F Arend
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil
| | - Linda Booij
- Concordia University, Department of Psychology, Montreal, Canada; University of Montreal, CHU Sainte-Justine & Department of Psychiatry, Montreal, Canada
| | - Rafael M F de Araújo
- Universidade do Vale do Taquari (UNIVATES), Centro de Ciências Médicas, Lajeado, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, RS, Brazil
| | - Rita Mattiello
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil.
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Lenney W, Adachi Y, Bush A, Fischer GB, Hong J, Ostrem A, Pedersen S, Sly PD, Szefler SJ, Tilak R, Zar HJ. Asthma: moving toward a global children's charter. Lancet Respir Med 2019; 7:299-300. [PMID: 30803924 DOI: 10.1016/s2213-2600(19)30074-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sarria EE, Mundstock E, Machado DG, Mocelin HT, Fischer GB, Furlan SP, Antonello IC, Stein R, Mattiello R. Health‐related quality of life in patients with bronchiolitis obliterans. Jornal de Pediatria (Versão em Português) 2018. [DOI: 10.1016/j.jpedp.2017.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Castro-Rodriguez JA, Giubergia V, Fischer GB, Castaños C, Sarria EE, Gonzalez R, Mattiello R, Vega-Briceño LE, Murtagh P. Postinfectious bronchiolitis obliterans in children: the South American contribution. Acta Paediatr 2014; 103:913-21. [PMID: 24832610 DOI: 10.1111/apa.12689] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/18/2014] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED Postinfectious bronchiolitis obliterans (PIBO) is an infrequent chronic lung that causes irreversible obstruction and, or, obliteration of the smaller airways. This review particularly focuses on more than 30 studies from South America. CONCLUSION The initial PIBO event occurs in the early years of life and is strongly associated with adenovirus infection and the need for mechanical ventilator support. Treatment requires a multidisciplinary strategy. Multicentre studies are needed to determine progression, optimal management and long-term follow-up.
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Affiliation(s)
- Jose A. Castro-Rodriguez
- Pulmonology Unit; Departments of Pediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Veronica Giubergia
- Pulmonology Department; Hospital de Pediatria Dr Juan P. Garrahan; Buenos Aires Argentina
| | - Gilberto B. Fischer
- Department of Pediatrics; Universidade Federal de Ciencias da Saude; Porto Alegre Brazil
| | - Claudio Castaños
- Pulmonology Department; Hospital de Pediatria Dr Juan P. Garrahan; Buenos Aires Argentina
| | - Edgar E. Sarria
- Centro Infant- Instituto de Pesquisas Biomédicas; Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre Brasil
| | - Ramiro Gonzalez
- Department of Pediatrics; Clinica Las Condes; Santiago Chile
| | - Rita Mattiello
- Centro Infant- Instituto de Pesquisas Biomédicas; Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre Brasil
| | - Luis E. Vega-Briceño
- Department of Pediatrics; Clinica Alemana; Universidad del Desarrollo; Santiago Chile
| | - Patricia Murtagh
- Pulmonology Department; Hospital de Pediatria Dr Juan P. Garrahan; Buenos Aires Argentina
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Scotta MC, Mattiello R, Maróstica PJ, Jones MH, Martins LG, Fischer GB. Risk factors for need of mechanical ventilation in hildren with Influenza A(H1N1)pdm09. Jornal de Pediatria (Versão em Português) 2013. [DOI: 10.1016/j.jpedp.2013.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Scotta MC, Mattiello R, Marostica PJC, Jones MH, Martins LG, Fischer GB. Risk factors for need of mechanical ventilation in children with influenza A(H1N1)pdm09. J Pediatr (Rio J) 2013; 89:444-9. [PMID: 23845706 DOI: 10.1016/j.jped.2013.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/30/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The pandemic caused by influenza A(H1N1)pdm09 virus peaked between July and August of 2009 in southern Brazil, with the highest incidence in children and young adults. In the post-pandemic period, there was an increase in the incidence of cases during the winter months of 2011 and 2012 in Brazil, similar to seasonal influenza virus. Since infections due to pandemic influenza are still occurring, the present study aimed to investigate the risk factors for worse outcome in children. METHODS A retrospective cohort study was performed by reviewing the charts of hospitalized patients younger than 14 years with reverse transcription-polymerase chain reaction (RT-PCR) positive for influenza A(H1N1)pdm09 during the first pandemic wave in six Brazilian tertiary centers. Need for mechanical ventilation was defined as the severity of outcome; age, chronic diseases, bacterial and viral co-detection, chest radiograph findings, and use of oseltamivir were possible predictors. RESULTS In the present study, 120 patients were included. In a multivariate analysis, chronic diseases (prevalence ratio: 2.613, 95% CI: 1.267-5.386) and viral co-detection (prevalence ratio: 2.43, 95% CI: 1.203-4.905) were statistically associated with worse outcome (p<0.05). CONCLUSIONS The presence of chronic diseases as predictors reinforces previous finding. Furthermore, viral co-detection was found to be a risk factor. Further studies are necessary to confirm this association.
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Affiliation(s)
- Marcelo C Scotta
- MSc Candidate in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Pediatric Infectious Disease's Specialist, Hospital da Criança Santo Antonio, Departamento de Pediatria, Porto Alegre, RS, Brazil.
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Epifanio M, Marostica PC, Mattiello R, Feix L, Nejedlo R, Fischer GB, Stein RT. A randomized, double-blind, placebo-controlled trial of cyproheptadine for appetite stimulation in cystic fibrosis. J Pediatr (Rio J) 2012; 88:155-60. [PMID: 22544046 DOI: 10.2223/jped.2174] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 01/04/2012] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine whether the administration of cyproheptadine was able to induce weight gain in patients with cystic fibrosis. METHODS We performed a double-blind, placebo-controlled trial in two centers in Brazil. Twenty-five patients with cystic fibrosis between 5 and 18 years completed the study. Patients were randomized into two groups, to receive either cyproheptadine 4 mg three times per day for 12 weeks or placebo. All data were collected at the beginning and at the end of the study period and included weight, height and spirometry. RESULTS Average weight gain was 0.67 kg in the placebo group and 1.61 kg in the cyproheptadine group (p = 0.036). Body mass index (BMI) decreased 0.07 kg/m(2); in the placebo group and increased 0.46 kg/m(2); in the intervention group (p = 0.027). The change in BMI for age (z score) was -0.19 in the placebo group and +0.20 in the cyproheptadine group (p = 0.003). BMI z score decreased 0.19 in the placebo group and increased 0.2 in the cyproheptadine group (p = 0.003). Changes in pulmonary function were not statistically different. CONCLUSION Use of cyproheptadine in cystic fibrosis patients was well tolerated, showing a significant weight gain and a significant increase in BMI after 12 weeks. A clinically relevant effect size for weight/age (z score) and body mass index for age (z score) was found. Such findings suggest that the prescription of cyproheptadine can be an alternative approach for patients who need nutritional support for a short period of time.
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Affiliation(s)
- Matias Epifanio
- Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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14
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Abstract
Bronchiolitis Obliterans (BO) is an infrequent chronic and obstructive lung disease secondary to an insult to the terminal airway and its surroundings. In children, the most common presentation is the post-infectious variant, closely related to a severe viral infection in the first three years of life. However, the increase in the number of lung and bone-marrow transplants has also been followed by an increase in post-transplant BO. Post-transplant BO is progressive while post-infectious BO does not seem to be, but both forms share some common pathways that result in a characteristic histopathology of bronchiolar obliteration. This review covers up-to-date evidence on epidemiology, diagnosis, treatment and prognosis of post-infectious bronchiolitis obliterans, including areas of controversy that need to be addressed in future studies.
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Affiliation(s)
- Gilberto B Fischer
- Department of Paediatrics, Universidade Federal de Ciencias da Saude, Porto Alegre, Brazil.
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15
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Lukrafka JL, Fuchs SC, Moreira LB, Picon RV, Fischer GB, Fuchs FD. Performance of the ISAAC questionnaire to establish the prevalence of asthma in adolescents: a population-based study. J Asthma 2010; 47:166-9. [PMID: 20170324 DOI: 10.3109/02770900903483766] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The epidemiology of asthma has been investigated with questionnaires, such as the International Study of Asthma and Allergies in Childhood protocol. AIM To investigate the performance of the questions of the International Study of Asthma and Allergies in Childhood questionnaire to diagnose asthma in adolescents. METHODS This is a population-based cross-sectional study of adolescents in the Syndrome of Obesity and Risk Factors for Cardiovascular Disease study. The validity of the asthma symptoms of the International Study of Asthma and Allergies in Childhood protocol was assessed by calculating sensitivity, specificity, positive and negative posttest probabilities, and Youden's Index, taking as a gold standard the history of a medical diagnosis of asthma. Risk ratios (RRs) and 95% confidence intervals (CIs), adjusting for sex and age, were calculated using Cox regression model. RESULTS In total, 575 adolescents were investigated. Overall, 28.7% reported a lifetime medical diagnosis of asthma, and 40.0% reported at least one episode of wheezing. Ever wheezing had the highest sensitivity (80.6%) for the diagnosis of asthma, compared with the other ISAAC questions. Adolescents who reported ever wheezing were about 8 times more likely (adjusted RR: 8.3; 95% CI: 4.9-14.2) to have ever had asthma, independent of age and sex. Symptoms within the last 12 months (wheezing, cough without cold or respiratory infection, sleep disturbed due to wheezing, wheezing due to exercise, speech limited due to wheezing) had specificity of 92.0% or higher. Dry cough at night without cold or respiratory infection was the strongest independent predictor of asthma (adjusted RR: 8.8; 95% CI: 6.1-12.7). CONCLUSIONS Ever wheezing is the most sensitive indicator of the diagnosis of asthma but falsely identifies a portion of adolescents as asthmatic. Symptoms of asthma in the last 12 months, such as cough without cold or respiratory infection, are rarely positive in the absence of a lifetime asthma diagnosis. The combination of ever wheezing for screening and the presence of other symptoms within the past 12 months to confirm the diagnosis could be an effective strategy to identify the prevalence of asthma in communities.
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Affiliation(s)
- Janice L Lukrafka
- School of Physiotherapy, Rede Metodista de Educação do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Mattiello R, Sarria EE, Mallol J, Fischer GB, Mocelin H, Bello R, Flores JAM, Irion K, Jones Y. Post-infectious bronchiolitis obliterans: can CT scan findings at early age anticipate lung function? Pediatr Pulmonol 2010; 45:315-9. [PMID: 20205267 DOI: 10.1002/ppul.21115] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The image findings of post-infectious bronchiolitis obliterans (PIBO) have been described, however, we do not know if such findings can predict lung function (LF) deterioration with increasing patient age. AIM To assess whether computed tomography (CT) abnormalities detected at an early stage of the disease can anticipate abnormal LF a decade later in children with PIBO. METHODS We compared CT scans of 21 children with PIBO, done within their first 3 years of life, and their actual LF. To evaluate CT scans we used a modified Bhalla score and, for LF, FEV1 as percentage of predicted values. We calculated prevalence ratios (PRs) by comparing the proportion of patients with worst CT score and worst LF, with the proportion of those with best CT score and worst LF. RESULTS PR was 1.17 (CI 1.02; 1.34, P = 0.02). CONCLUSIONS The CT finding early in the life of children with PIBO, when assessed by the Bhalla, score seem to anticipate future LF status.
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Affiliation(s)
- Rita Mattiello
- Post-Grad Program in Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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17
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Prietsch SOM, Fischer GB, César JA, Lempek BS, Barbosa LV, Zogbi L, Cardoso OC, Santos AM. Acute lower respiratory illness in under-five children in Rio Grande, Rio Grande do Sul State, Brazil: prevalence and risk factors. CAD SAUDE PUBLICA 2009; 24:1429-38. [PMID: 18545768 DOI: 10.1590/s0102-311x2008000600023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 10/08/2007] [Indexed: 11/21/2022] Open
Abstract
This study aimed to determine the prevalence of acute lower respiratory illness and to identify associated factors among children less than five years of age in the city of Rio Grande, southern Brazil. Using a cross-sectional survey, a standardized household questionnaire was applied to mothers or guardians. Information was collected on household conditions, socioeconomic status, and parental smoking. Prenatal care attendance, nutritional status, breastfeeding pattern, and use of health services for the children were also investigated. Data analysis was based on prevalence ratios and logistic regression, using a conceptual framework. Among 771 children studied, 23.9% presented acute lower respiratory illness. The main risk factors were previous episodes of acute lower respiratory infection or wheezing, crowding, maternal schooling less than five years, monthly family income less than US$ 200, four or more people per room, asthma in family members, and maternal smoking. Mothers 30 years or older were identified as a protective factor. These results can help define specific measures to reduce morbidity and mortality due to acute lower respiratory illness in this setting.
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Affiliation(s)
- Silvio O M Prietsch
- Fundação Universidade Federal do Rio Grande, Rua Dr. Nascimento 396, Rio Grande, RS, Brazil.
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18
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Arrarte J, Lubianca Neto JF, Fischer GB. The effect of adenotonsillectomy on oxygen saturation in children with sleep breathing disorders. Int J Pediatr Otorhinolaryngol 2007; 71:973-8. [PMID: 17459490 DOI: 10.1016/j.ijporl.2007.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 03/12/2007] [Accepted: 03/12/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of adenotonsillectomy on the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders (SBD). METHODS A non-controlled clinical trial was performed. Thirty-one children with suspected SBD and a clinical indication for adenotonsillectomy were recruited. All of them underwent overnight oxygen saturation monitoring before and after surgery. RESULTS Twenty-seven patients completed the study. The mean age was 5.2+/-1.8 years. Eighteen (66.7%) were male. The most prevalent symptoms were: snoring (100%), respiratory pauses (96.8%), nocturnal mouth breathing (96.8%), restless sleep (80%) and drooling (74.1%). Twenty-three children (85.2%) presented grade 3 or 4 tonsillar hyperplasia. There was a significant improvement in the postoperative oxygen desaturation index (ODI) (0.65; 0.5-1.3) compared with the preoperative index (1.63; 1.1-2.4) (p<0.001). CONCLUSION Adenotonsillectomy improved the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders.
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Affiliation(s)
- Jaime Arrarte
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Pos-graduate Program, Brazil.
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19
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Solé D, Melo KC, Camelo-Nunes IC, Freitas LS, Britto M, Rosário NA, Jones M, Fischer GB, Naspitz CK. Changes in the prevalence of asthma and allergic diseases among Brazilian schoolchildren (13-14 years old): comparison between ISAAC Phases One and Three. J Trop Pediatr 2007; 53:13-21. [PMID: 17012440 DOI: 10.1093/tropej/fml044] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present study is aimed to describe the changes in the prevalence of symptoms of asthma, rhinitis and eczema among Brazilian adolescents (AD, 13-14 years old) between Phases 1 and 3 of the International Study of Asthma and Allergies in Childhood (ISAAC). The prevalence of self-reported symptoms of asthma, rhinitis and eczema in AD from five Brazilian cities (Curitiba, Porto Alegre, Recife, Salvador and São Paulo), obtained during ISAAC Phase 1 (n = 15 419) and Phase 3 (n = 15 684), was compared to determine the trend of prevalence in a 7-year interval. There was a trend to reduction in the current prevalence of wheezing and increasing of nocturnal cough when averaging figures from the five cities. The prevalence of wheezing in the last 12 months was 27.7 vs. 19.9% (p < 0.01); asthma ever 14.9 vs. 14.7% (p > 0.05); severe episode of wheezing 5.2 vs. 5.2%; nocturnal cough 32.6 vs. 34.9% (p < 0.01); exercise wheezing 23.6 vs. 23.0% (p > 0.05) and awake with wheezing 11.8 vs. 11.2% (p > 0.05). Similar things were observed with the prevalence of current symptoms of rhinitis and eczema. In Brazil, there was a small but significant mean decrease in the prevalence of two asthma-related symptoms, wheezing and nocturnal cough, though this trend was not consistent in the surveyed cities. The prevalence of asthma symptoms in Brazil, despite its mean trend to a decrease, is still one of the highest in Latin America.
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Affiliation(s)
- D Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina, São Paulo, Brazil.
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20
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Solé D, Camelo-Nunes IC, Wandalsen GF, Pastorino AC, Jacob CMA, Gonzalez C, Wandalsen NF, Rosário Filho NA, Fischer GB, Naspitz CK. Prevalence of symptoms of asthma, rhinitis, and atopic eczema in Brazilian adolescents related to exposure to gaseous air pollutants and socioeconomic status. J Investig Allergol Clin Immunol 2007; 17:6-13. [PMID: 17323857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVES To evaluate the relationship between exposure to gaseous air pollutants (ozone [O3], carbon monoxide [CO], nitrogen dioxide [NO2], and sulfur dioxide [SO2]) socioeconomic status and the prevalence of symptoms of asthma, rhinitis and atopic eczema in adolescents. SUBJECTS AND METHODS A sample of 16 209 adolescents from São Paulo West (SPW), São Paulo South (SPS), Santo André (SA), Curitiba (CR), and Porto Alegre (PoA) were enrolled. Data on air pollutants and socioeconomic status were compared to prevalence of symptoms with the Spearman correlation coefficient. RESULTS Socioeconomic status was quite similar in all cities. The levels of O3 in SPW, SPS, and SA, and of CO in SA were higher than the acceptable ones. In relation to O3 and CO exposures, adolescents from SPW and SA had a significant risk of current wheezing, whereas living in SPW was associated with a high risk of rhinoconjunctivitis, eczema, and flexural eczema and living in CR to rhinitis. Exposure to NO2 was associated with a high risk of current wheezing in SPW and SA, and of severe asthma in SPW and PoA. Exposure to SO2 was associated with a high risk of current wheezing in SPW and SA, severe asthma in SPW and PoA, and nighttime cough, eczema, flexural eczema and severe eczema in SPW. Living in SPW, CR, or PoA was associated with a high risk of rhinitis, rhinoconjunctivitis, and severe rhinitis. CONCLUSIONS Although we did not detect a characteristic pattern for all symptoms evaluated or a specific air pollutant, our data suggest a relationship between higher exposure to photochemical pollutants and high prevalence or risk of symptoms of asthma, rhinitis, and atopic eczema.
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Affiliation(s)
- D Solé
- Division of Allergy, Clinical Immunology, and Rheumatology, Department of Pediatrics, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.
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Abstract
To manage asthma in urban setting of developing countries is a challenge to the health system of developing countries. To reduce asthma morbidity (hospital admissions and emergency visits) is the main goal to be reached. It is necessary to adapt international guidelines considering the local constraints. The provision of free medication is mandatory. Education of parents and patients must be a priority of asthma programs.
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Abstract
OBJECTIVE To ascertain the effect of inhaled corticosteroid use on gain in height and weight of asthmatic pediatric outpatients. METHODS A one-year prospective cohort study was carried out with 124 asthmatic children aged 3 to 16 years who were prescribed inhaled corticosteroids for at least 12 months, evaluating z-scores for height/age, weight/age, body mass index and parental target height for current age. Exclusion criteria were: birth weight less than 2,500 g, malnutrition, chronic diseases and systemic corticoid use for more than 7 consecutive days. RESULTS The mean +/- standard deviation for z-scores for initial and final height/age were 0.06+/-1.2 and 0.01+/-1.2 (95%CI 0.05-0.11), respectively; for initial and final weight/age z-scores they were 0.6+/-1.5 and 0.5+/-1.5 (95%CI 1.84-6.6), respectively. These figures did not differ significantly (p = 0.199 and p = 0.808). There was also no loss in stature when children were stratified into well and poorly controlled asthma or into pubescent and non-pubescent groups. CONCLUSIONS In comparison with the NCHS (National Center for Health Statistics) growth curves, there was no compromise to the height or body weight of children/adolescents using inhaled corticosteroids for more than 1 year at the doses recommended for asthma prevention.
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Affiliation(s)
- Elisete E Arend
- Mestranda em Ciências Médicas: Pediatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil
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Abstract
Under-five mortality varies widely between countries, ranging from four to over 300 deaths/1000 live births. The World Summit for Children established the aim of a two-thirds reduction in worldwide child mortality by 2015. Progress toward this goal during 1990-2000 was variable between world regions. In 2000, 70% of the 1.89 million deaths of children under the age of 5 years due to acute respiratory infections occurred in developing countries. Among Latin American countries, Chile and Uruguay had the lowest percentage of deaths (5-10%), while Bolivia, Peru and Guyana had the highest (15-20%). Mortality rates due to lower respiratory infections have declined in most countries, increased in some and remained unacceptably high in others. To reach the 2015 goal of reducing mortality in the under-fives, effective interventions, such as breastfeeding and complementary feeding, Haemophilus influenzae type B vaccine, zinc supplementation and the use of antibiotics to treat pneumonia need to be implemented in all Latin American countries.
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Affiliation(s)
- Sandra C Fuchs
- Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2350 s. 415, CEP 90035003 Porto Alegre, RS, Brazil.
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Sarria E, Fischer GB, Lima JAB, Menna Barreto SS, Flôres JAM, Sukiennik R. [Interobserver agreement in the radiological diagnosis of lower respiratory tract infections in children]. J Pediatr (Rio J) 2003; 79:497-503. [PMID: 14685446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To evaluate the inter-observer agreement of radiological diagnosis of lower respiratory tract infections in children. METHODS Chest X-rays from 60 children younger than 5 years of age were evaluated by three physicians: a pediatric radiologist (PR), a pediatric pulmonologist (PP) and an experienced emergency pediatrician (EP). All children had sought an emergency room due to acute respiratory infections with apparent lower respiratory tract involvement. Observers were blinded to the original diagnostic conclusions, but clinical and laboratory data from the initial medical evaluation were provided with each film. Variables were grouped into five categories: a) film quality; b) site of abnormality; c) radiological patterns; d) other radiographic images; e) diagnosis. Inter-observer agreement was assessed using Kappa statistics, accepting prevalence-bias-adjusted values (PABAK). compare the prevalence of breastfeeding and exclusive breastfeeding during the first six months of life among pacifier and non-pacifier users. RESULTS Kappa values for each of the three observer pairs (RP vs. PP, RP vs. EP, and PP vs. PE) were 0.41, 0.43, and 0.39, respectively. The overall inter-observer agreement was moderate (0.41). Agreement on other variables was as follows: regular for "film quality" (0.30); moderate for "site of abnormality" (0.48); fair for "radiological patterns" (0.29); moderate for "other radiographic images" (0,43); and moderate for "diagnosis" (0.33). The overall intra-observer agreement was "moderate" (0.54), which is below the agreement values reported by other studies on chest X-ray variability. CONCLUSIONS Inter-observer variability is an intrinsic characteristic of the interpretation of chest X-rays, and the diagnosis of lower respiratory tract infections in children remains a challenge. Most of our results were similar to those previously reported.
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Affiliation(s)
- Edgar Sarria
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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Rubin FM, Fischer GB. [Clinical and transcutaneous oxygen saturation characteristics in hospitalized infants with acute viral bronchiolitis]. J Pediatr (Rio J) 2003; 79:435-42. [PMID: 14557844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To describe the clinical characteristics of infants with acute viral bronchiolitis (AVB) and to assess the influence of oxygen desaturation time (DT) as a prognostic test to estimate the evolution of such patients. METHODS We performed a cohort study with 111 hospitalized patients diagnosed with AVB receiving oxygen therapy through nasal prong. The outcomes were: length of admission, length of oxygen therapy and time elapsed to read 95% saturation in room air. A severity score was obtained twice a day based on clinical signs during the time when the patient required oxygen supplementation. After the supply of oxygen was interrupted, the time required for transcutaneous oxygen saturation decreased to 90% and 85%. The Chi2 test or Fisher's exact test were used to compare categorical variables. The t test or Mann-Whitney's test were used for numerical variables. Spearman's correlation was used to evaluate associations in continuous variables with asymmetric distribution. RESULTS Most patients (61.3%) were younger than 4 months. Patients with wheezing history (45%) were analyzed separately and had similar results to those of the group with AVB (p< or =0.05). Twenty-six patients (23%) had moderate or severe malnutrition. All patients were using bronchodilators; 20% were using systemic corticosteroids; and 47%, antibiotics. The median time of oxygen therapy required for a reading of 95% oxygen saturation in room air was 83 hours (IQI 55-128). The median of length of admission was 7 days (IQI 5-10.5). Little clinical variability was observed in the period studied. No significant correlations were found between the clinical scores, DT and the outcomes. CONCLUSION DT was not useful as an aid to assess AVB patients on oxygen therapy in this study. It is possible that this tool could have been more useful in patients with more clinical variability.
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Prietsch SOM, Fischer GB, César JA, Lempek BS, Barbosa LV, Zogbi L, Cardoso OC, Santos AM. [Respiratory illnesses in children younger than 5 years of age in southern Brazil: the influence of the home environment]. Rev Panam Salud Publica 2003; 13:303-10. [PMID: 12831434 DOI: 10.1590/s1020-49892003000400005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the prevalence of acute lower respiratory tract infections and the risk factors associated with living conditions among children up to 5 years of age in the city of Rio Grande, in the state of Rio Grande do Sul, Brazil. METHODS A population-based cross-sectional study was carried out with 775 children. A standardized questionnaire was administered to the mother or other caregiver at the child's home in order to collect information on housing conditions, socioeconomic status, and smoking in the home. Additional variables examined included nutritional status, duration of breast-feeding, prenatal care, and utilization of health care services. Environmental variables were analyzed individually and were also grouped together in an "environmental score" that encompassed 10 variables: type of house construction, type of floor, home heating system, type of stove, dog in the child's room, dog in the house, cat in the child's room, cat in the house, number of people per room, and maternal smoking. The grouped environmental score ranged from 0 (best) to 10 (worst). The analysis included two stages: a bivariate stage, in which the prevalence ratio was calculated for each risk factor, and a multivariate stage, with logistic regression. RESULTS The overall prevalence of acute lower respiratory tract infections was 23.9%. The main risk factors identified were: environmental score >/= 3 points, maternal schooling < 5 years, monthly family income < US$ 200, four or more people sharing the child's bedroom, and maternal smoking. Maternal age > or = 30 years was found to protect against the development of respiratory illness. CONCLUSIONS Specific programs need to be implemented to control acute respiratory illnesses in the population studied. In future studies with this population, the environmental score that we developed could be used in place of the complete set of environmental variables that we tested. This environmental score should be applied in other contexts so as to determine its external validity.
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Prietsch SOM, Fischer GB, César JA, Fabris AR, Mehanna H, Ferreira THP, Scheifer LA. [Acute disease of the lower airways in children under five years of age: role of domestic environment and maternal cigarette smoking]. J Pediatr (Rio J) 2002; 78:415-22. [PMID: 14647749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To study the prevalence of acute disease of the lower airways and the role of the domestic environment and maternal smoking. Among the recognized risk factors, passive smoking, living in crowded environments and poor housing conditions play a fundamental role in the causal chain of these diseases. METHODS A cross-sectional study was carried out in a sample of 775 children aged between 0 and 59 months living in Rio Grande, southern Brazil. Trained interviewers applied a standardized questionnaire to the mothers or guardians of these children in their homes and gathered information about maternal characteristics, housing conditions, socio-economic status of the family and smoking habits. Environmental factors were individually studied, and classified according to a score that evaluated the intensity of their association with respiratory diseases. Bivariate analyses were performed, calculating the prevalence ratios for each risk factor, as well as multivariate ones, by means of non-conditional regression analyses. RESULTS The main risks identified were: unfavorable environment (P<0.01), less than five years of maternal educational level (P=0.01), monthly family income under US$ 200 (P=0.04), crowded environments (P=0.02), smoking during pregnancy (P=0.03) and present maternal smoking (P=0.01). A thirty-year-old or older mother was identified as offering a protection factor (P=0.05). CONCLUSIONS These results indicate the need to improve the income distribution, improve the rates of educational level, and combat the smoking habit, particularly concerning mothers. The programs of control of respiratory diseases must address these critical points that represent an important risk to children's health.
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Affiliation(s)
- Silvio O M Prietsch
- Departamento Materno-Infantil, Fundação Universidade Federal de Rio Grande, Rio Grande, RS.
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Straliotto SM, Siqueira MM, Muller RL, Fischer GB, Cunha MLT, Nestor SM. Viral etiology of acute respiratory infections among children in Porto Alegre, RS, Brazil. Rev Soc Bras Med Trop 2002; 35:283-91. [PMID: 12170321 DOI: 10.1590/s0037-86822002000400002] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although acute respiratory infections (ARIs) are a major cause of child morbidity and mortality in Southern Brazil, little information is available on their seasonality and viral etiology. This study was conducted on children under 5 years of age with ARI to assess viral etiology in the State of Rio Grande do Sul, from 1990 to 1992. A total of 862 nasopharyngeal secretion (NPS) samples were tested using indirect immunofluorescence. The results showed that 316 (36.6%) NPS samples were positive: 26.2% for RSV, 6% for adenovirus, 1.7% for influenza viruses, 1.5% for parainfluenza viruses, and 1.2% for mixed infection. The mean viral prevalence rates in out-patient services, emergency wards, and in-patient hospital wards were 26.7%, 53% and 42.3%, respectively. Respiratory syncytial virus (RSV) and adenovirus accounted for 91.4 % of the viral diagnoses. RSV was more frequent in children under one year of age at the three levels of health care and was prevalent in infants under six months. Adenovirus was the most prevalent pathogen in hospitalized children, in 1992. Influenza A virus showed an increased prevalence with age among out-patient children. This study shows the annual occurrence of viral respiratory infections in the coldest months, with a significant annual variation in the frequency of RSV infection.
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Affiliation(s)
- Selir M Straliotto
- Seção de Virologia, Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, RS.
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Meyer R, Fischer GB. [Association between gastroesophageal reflux and dips in the oxygen transcutaneous saturation of the hemoglobin in infants with chronic obstructive ventilatory disease]. J Pediatr (Rio J) 2001; 77:89-95. [PMID: 14647597 DOI: 10.2223/jped.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE: To verify the association between oxygen desaturation episodes and the dips in pH in infants with chronic obstructive respiratory symptoms. METHOD: Cross-sectional study with children 24 months old or younger hospitalized for investigation of chronic obstructive respiratory symptoms from 1997 to 1999. The patients underwent esophageal pH monitoring associated with transcutaneous oxygen saturation during the night. The patients were included in the study according to their need to be hospitalized and availability of equipment. The indices used to measure this association were reflux index, total number of refluxes, number of refluxes longer than 5 minutes, Euler index, ZMD index, 24-hour mean pH, and mean pH of desaturation. RESULTS: We studied 44 children. The mean age was 7.5 months, and 20% had desaturation below 93% during pH monitoring. We used the t test to compare the occurrence of desaturation with the pH monitoring parameters. We found higher significance with the reflux index (RI), number of episodes longer than 5 minutes, ZMD index, 24-hour mean pH, and mean pH of desaturation. The bivariate analysis, taking into account possible confounding factors and RI, showed PR equal to 6.61 (IC 95% 1.67 - 26.12) for an RI higher than 4%. CONCLUSION: Oxygen saturation monitoring associated with pH monitoring may be a useful tool to establish an association between GER and respiratory problems in patients with chronic or recurrent wheeze.
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Affiliation(s)
- R Meyer
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Straliotto SM, Roitman B, Lima JB, Fischer GB, Siqueira MM. Respiratory syncytial virus (RSV) bronchiolitis: comparative study of RSV groups A and B infected children. Rev Soc Bras Med Trop 1994; 27:1-4. [PMID: 8008913 DOI: 10.1590/s0037-86821994000100001] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The grouping characteristics of 29 respiratory syncytial virus (RSV) present in nasopharyngeal cells collected from hospitalized children with bronchiolitis during the 1990 RSV season in Porto Alegre, RS, were analysed. Twenty-two were grouped as belonging to group A and 7 to group B. Cyanosis, oxygen therapy, cough, length of hospitalization and atelectasis were observed to be more frequently found within group B infected children. Other clinical signs and symptoms were similarly found in both groups.
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Affiliation(s)
- S M Straliotto
- Instituto de Pesquisas Biológicas, Hospital de Clínicas de Porto Alegre, Brasil
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Fischer GB. [Fetal diagnosis from the parents' perspective]. Jordemodern 1981; 94:189-96. [PMID: 6912853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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