ABSTRACT
Introdução: a asma é uma doença heterogênea, caracterizada por inflamação crônica das vias aéreas inferiores, associada a diferentes fenótipos. O omalizumabe é utilizado em adição ao tratamento quando não se obtém o controle adequado da asma. Este estudo mostra o perfil epidemiológico e a adesão ao tratamento dos pacientes acompanhados no Ambulatório de Especialidades do Hospital Universitário da Universidade Estadual de Londrina (AEHU-UEL) em uso de omalizumabe em um período de 12 meses. Método: realizado um estudo transversal retrospectivo através de dados secundários de prontuário avaliando pacientes com diagnóstico de asma alérgica grave em uso de omalizumabe nos 12 meses prévios ao recrutamento. Resultados: foram selecionados 40 pacientes que preencheram os critérios de inclusão. A média de idade foi de 51,4 anos, com predomínio de mulheres (70%), brancos (48%), não tabagistas (90%), com sobrepeso ou obesidade (75%) e diagnóstico de asma na infância (45%). O tempo médio de tratamento foi de 8,1 anos (DP 0,8). Havia comorbidades em 85% dos pacientes, com predomínio de rinite (62,5%) e DRGE (40%). Houve exacerbação em 29 pacientes levando a 8 internações (27,5%); 93% dos exacerbadores apresentaram faltas. Conclusão: a amostra é comparável a outros estudos de vida real nos achados epidemiológicos (idade, sexo, fenótipo, tempo de diagnóstico, controle da doença e tabagismo). O elevado número de faltas, assim como frequência de DRGE e outras comorbidades e a baixa adesão à terapêutica, podem justificar o elevado número de exacerbações e maior dificuldade de controle.(AU)
Introduction: asthma is a hetereogeneous disease, characterized by chronic inflammation of the lower airways associated with different phenotypes. Omalizumab is used in addition to treatment when adequate asthma control is not achieved. This study shows the epidemiological profile and the adherence to the treatment of patients followed at the Medical Clinic of the State University Hospital of Londrina (AEHU-UEL) using omalizumab in the last 12 months. Methods: severe allergic asthma patients using omalizumab in the last 12 months were evaluated by means of secondary medical records. Results: forty patients were included and had complete medical record. The average age was 51.4 years mostly women (70%), white (48%), non-smoker (90%), overweight or obese (75%) and childhood asthma diagnosis (45%). The average treatment time was 8.1 years (SD0.8). There were co-morbidities in 85% of the patients, mainly rhinitis in 62.5% and GERD in 40%. There were exacerbations in 29 patients, leading to 8 hospitalizations (27.5%), 93% of exacerbators was missed at least one time. Strong association with rhinitis (p=0.07), and no disease control (p=0.22). Conclusion: the sample is comparable to other real-life studies in almost all epidemiological findings (age, sex, phenotype, time of diagnosis, disease control and smoking). The high number of absences and frequency of GERD and other comorbidities, and poor adhesion, may justify the high number of exacerbations and more difficulty to control the disease. (AU)
Subject(s)
Humans , Asthma , Disease , Omalizumab , Phenotype , Association , Diagnosis , Hospitalization , InflammationABSTRACT
Se estudiaron 45 pacientes asmáticos adultos de difícil manejo, de más de 5 años de evolución, 37 de ellos esteroide dependientes y 8 no dependientes, con asma alérgica o intrínseca y algunos con infecciones respiratorias recurrentes de predominio viral. Por nefelometría se midieron los niveles séricos de las Igs G, M y A, y por ELISA se determinó la IgE total. Se encontraron 4 pacientes con deficiencia de IgG total, en el grupo de los esteroide dependientes. Mediante ELISA tlpo sandwich y con anticuerpos monoclonales específicos para las subclases de IgG se investigaron los niveles séricos de IgG1, 2, 3 y 4. En el 55.6 por ceinto de los enfermos se encontraron una O más deficiencias de subclases. No hubo diferencias significativas entre los grupos esteroide y no esteroide dependientes, ni entre los asmáticos alérgicos e intrínsecos, ni entre los con infección recurrente o sin ella. Predominó la deficiencia de IgG1; en total el 46.7 por ciento de los pacientes tenían deficiencia aislada o combinada de IgG1, el 31.1 por ciento de IgG2, el 24.4por ciento de IgG3 y el 17.8 por ciento de Igd4. La alta incidencia de deficiencia de subclases podría deberse a la acción de los esteroides o a una alteración en la regulación de la síntesis de Igs producida por un defecto Inmune primario. Esta deficiencia sería la responsable del comportamiento agresivo de la enfermedad
We studied 45 adult asthmatic patients with difficult to care disease and who had more than five years of evolution; they suffered from elther allergic or intrinsic asthma and some had experienced recurrent respiratory tract infections. predominantly of viral etiology. Serum levels of IgA, IgG and IgM were measured by nephelometry and total lgE was determined by an Enzyme-Linked immunosorbent Assay (ELISA). Total lgG deficiency was found in four steroid. dependent patients. Serum levels of IgG subclasses 1 to 4 were measured by means of a sandwich-like ELISA with specific monoclonal antibodies. One or more subclass deficiencies were present In 55.6% of the patients. Significant differences were not found between the following groups: steroid and nonsteroid dependent patients; allergic or intrinsic, asthma; and individuals with or without history of infection. IgG 1 deficiency was the most commonly found: It was present in 46.7% of the patients, either as an isolated disorder or combined with alteration of other subclasses. Deficiency of other subclasses was present in the following proportions: 31.1% for IgG2; 24.4% for IgG3 and 17.8 for IgG4. The high incidence of subclass deficiency may be due to steroid action or to primary Immune defects leading to disorders of IgG synthesis. Such situation might be responsible for the aggressive behavior of the disease