Caracterización del lactante sibilante recurrente hospitalizado y utilidad del estudio internacional de sibilancias / Characterization of hospitalized Infants with recurrent wheezing and evaluation of the International Study of Wheezing

Antecedentes: La sibilancia es un trastorno muy frecuente en la infancia que contabiliza alta demanda de consulta médica y atención en los servicios de emergencia. Tiene relativa- mente altas tasas de hospitalización y está relacionado con la mortalidad infantil inducida por infecciones respiratorias. Objetivo: Esta- blecer las características clínicas y epidemioló- gicas de los lactantes hospitalizados en el Mario Catarino Rivas durante el período 15 de junio a 16 de septiembre del 2015 y determinar la utilidad del cuestionario Estudio Internacio- nal de las Sibilancias en el Lactante (EISL) modi- cado aplicado a padres/responsables. Pacien- tes y Métodos: Estudio descriptivo transversal no experimental. Los padres de 100 niños con edades comprendidas entre 6 y 18 meses hospitalizados en la sala lactantes respondie- ron a través de una entrevista directa el cues- tionario EISL modi cado. Para las característi- cas de los lactantes, se utilizaron frecuencias, porcentajes y medidas de tendencia central, para valorar la utilidad del test, se calculó con abilidad y validez total. Los datos se anali- zaron con SPSS versión 21.0 y Excel. Resulta- dos: la prevalencia de sibilancias recurrentes encontrada fue del 31% (n=31); con abilidad del cuestionario se valoró con el α cronba- ch=0.841 y KR-20=0.8333; validando el instru- mento con validez de contenido: juicio de expertos 0.88, validez de criterio: rxy≥0.83, validez de constructo: KMO=0.68; la validez total fue de 0.79 Conclusiones: la prevalencia de sibilancias es más alta que lo reportado en la literatura para América Latina; el cuestionario acortado EISL es válido estadísticamente para ser aplicado en el Hospital Mario Catarino Rivas en Lactantes...(AU)

Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil / Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil / Patrón dietético, asma y sibilancias atópicas y no atópicas en niños y adolescentes: estudio SCAALA, Salvador, Bahía, Brasil

Avaliou-se, em estudo transversal, a influência do padrão alimentar sobre a ocorrência de sibilo e asma atópica e não atópica em 1.168 crianças e adolescentes em Salvador, Bahia, Brasil. Sibilo e sintomas de asma nos últimos 12 meses foram obtidos por meio do questionário ISAAC. Atopia foi definida pela presença de IgE específica a aerolérgenos. Questionário de frequência alimentar foi usado para definir padrões alimentares. Empregou-se regressões logística e logística politômica multivariadas. O consumo de pescados reduziu a ocorrência de sibilo em 27% (IC95%: 0,56-0,94) e asma em 37% (IC95%: 0,47-0,83); asma não atópica em 51% (IC95%: 0,31-0,79) e sibilo não atópico em 38% (IC95%: 0,46-0,83). O maior tercil do padrão alimentar reduziu o sibilo em 27% (IC95%: 0,57-0,95), sibilo atópico em 46% (IC95%: 0,30-0,98), asma em 36% (IC95%: 0,49-0,83) e asma atópica em 50% (IC95%: 0,28-0,89). O consumo de pescados pode conferir efeito protetor para sibilo e asma não atópica e o padrão alimentar para sibilo e asma atópica.

A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Este estudio transversal se llevó a cabo para estudiar la influencia de los hábitos alimentarios en la aparición del asma y sibilancias atópicas y no atópicas en una muestra de 1.168 niños y adolescentes en Salvador, Bahía, Brasil. Las sibilancias y síntomas de asma en los últimos 12 meses se han obtenido a partir del cuestionario ISAAC. Se identificó la presencia de IgE específica de alérgeno aéreo. Se utilizó un cuestionario de frecuencia de alimentos para definir hábitos alimentarios. Se aplicó la regresión logística y el modelo logístico multinomial. El consumo de pescado redujo las sibilancias en un 27% (IC95%: 0,56-0,94) y el asma en un 37% (IC95%: 0,47-0,83), las sibilancias atópicas en un 51% (IC95%: 0,31-0,79) y no atópicas en un 38% (IC95%: 0,46-0,83). El tercil más alto de los hábitos alimentarios reduce sibilancias en un 27% (IC95%: 0,57-0,95), sibilancias atópicas en un 46% (IC95%: 0,30-0,98), el asma en un 36% (IC95%: 0,49-0,83) y un 50% en el asma atópico (IC95%: 0,28-0,89). El consumo de pescado puede promover un efecto protector, dentro el patrón de dieta, contra sibilancias atópicas y no atópicas y asma.

Cómo manejamos al niño con sibilancias recurrentes / How to handle a child with recurrent wheeze

1º confirmar su presencia2º identificar el patrón de síntomas3º evaluar la severidad4º identificar factores disparadores5º descartar otras situaciones sibilantes o patologías asociadasRecomendaciones definición y fenotipos * Para utilidad practica en la clínica asistencial las sibilancias deberían ser clasificadas como episódicas (virales) o sibilancias por múltiples disparadores o estímulosEl uso de términos transitoria de comienzo tardío y sibilancias persistentesse deberían limitar a estudios de cohorte y son poco aplicables a laclínica asistencialEl término asma quizás no se adecue a la mayoría de las sibilancias debidoa la dificultad en probar la inflamación subyacente.

Th-1 and Th-2 cytokine production in infants with virus-associated wheezing

Wheezing associated with respiratory viral infections in infancy is very common and results in high morbidity worldwide. The Th1/Th2 pattern of immune response in these patients remains unclear and previous studies have shown controversial results. The aim of the present study was to compare the type of Th1/Th2 cytokine response between infants with acute bronchiolitis, recurrent wheezing and upper respiratory infections from a developing country. Infants younger than 2 years of age admitted to Hospital São Lucas, Porto Alegre, RS, Brazil, between May and November 2001, with an acute episode of wheezing associated with viral respiratory infection were selected. Subjects with upper respiratory infections from the emergency department were selected for the control group. Interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) levels from nasal aspirates were determined by ELISA from peripheral mononuclear cell cultures. Twenty-nine subjects with acute bronchiolitis, 18 with recurrent wheezing and 15 with upper respiratory infections were enrolled. There were no differences in family history of atopy or parental smoking between groups. Oxygen requirement was similar for the acute bronchiolitis and recurrent wheezing groups. The percentage of positive tests for the cytokines studied and the IFN-gamma/IL-4 ratio was similar for all groups. Comparison of the polarized Th1/Th2 cytokine results for the various groups showed no specific pattern of cytokine production. Infants with wheezing from a developing country do not show any specific predominant pattern of Th1/Th2 cytokine production, suggesting that multiple factors may be involved in the pathogenesis of this illness.

High Body Mass Index is Associated with Wheezing Among Older Adults Living in High-Altitude Area in Korea

Although the association between obesity and asthma has been well documented, the nature of this association has yet to be clarified. The aim of this study was to examine the association of body mass index (BMI), lipid profiles, and atopy, wheezing, and lung function in older adults living in a rural area in Korea. BMI (kg/m2), lipid profiles, skin prick test, spirometry, and questionnaire including airway symptoms were obtained in a cross-sectional survey in 707 (259 males and 448 females) older adults (aged 50 to 93; mean, 65.7 yr) living in a high-altitude rural area in Korea. The prevalence of self-reported wheezing was 17.1% (121/707). The prevalence of atopy was 13.8%. The mean of BMI was 23.3+/-0.13 (14.6-32.8). The BMI was higher in females than in males (23.8+/-0.16 vs 22.4+/-0.17; p or = 25 than in group with BMI<25 [57/201 (28.3%) vs 64/505 (12.6%), p<0.01]. The BMI was higher in group with wheezing than in group without wheezing (24.3+/-0.34 vs 23.1+/-0.13, p<0.01). No association between BMI and atopy was found. These findings suggest that BMI associated with wheezing in older adults.

Serum immunoglobulins and immunoglobulin G subclasses with recurrent wheezing.

In this study serum immunoglobulins (Ig) and IgG subclasses were measured in 42 patients (ranging 9 month-6 year) with recurrent wheezing and in 37 healthy children determined the relationship between serum Igs and recurrent wheezing. Patients were divided into two groups according to the age [9 month-2 year (n: 15), and 2-6 year (n: 27)]. In the patients placed in 9-24 month age group, serum IgG4 level was found to be lower than controls (p < 0.05). But there was not a significant difference in mean serum concentrations of total IgG, IgA, IgM, IgE, IgG1, IgG2 and IgG3 subclasses between the groups (P > 0.05). In the 25 month-6 year age group the mean IgE level was increased compared to the control while IgG3 and IgG4 levels were decreased (p < 0.05). On the other hand, in the 9-24 month age group there was no significant difference between the patients and controls for IgG subclasses deficiency (P > 0.05). However, significant difference in IgG subclasses deficiency was present between the patients and controls in the 25 month-6 year group (P < 0.001). In conclusion, our findings suggest that wheezing in childhood may be associated with low IgG3 and/or IgG4, and in older children high IgE level may be a part of pathogenetic mechanism in patients with recurrent wheezing.

IgG subclasses in wheezing infants.

The wheezing infant is a common but difficult patient to approach diagnostically. The prevalence of IgG subclass antibody deficiency in wheezing infants is still controversial. We studied serum concentration of IgG subclasses in 38 wheezing infants (aged 6-24 months who had not received systemic steroids before investigation) and in 30 healthy age matched control (aged 6-24 months). The prevalence of one or more IgG subclass deficiency was 31.6% in wheezing infants and 26.7% in controls. There was no significant difference in prevalence of IgG subclass deficiency between patients and controls (p > 0.05). The mean concentration of IgG subclasses in patients were compared with controls. There was no significant difference in mean serum concentration of IgG1, G2 and G3 subclasses. But there was a trend towards higher concentrations of IgG4 in wheezing infants and this difference for IgG4 was significant (p < 0.01). However, IgG subclass deficiency was found in 25% and 36.4% of wheezing infants who had experienced from two to four and five or more wheezing episodes in two years, respectively (p > 0.05). These findings suggest that wheezing in infancy is not associated with IgG subclass deficiency and in wheezing infants low IgG subclass levels do not increase the frequency of wheezing.