Trayectorias de función pulmonar en asma persistente: del preescolar al escolar / Lung function trajectories in persistent asthma: from preschool to schoolchildren

Introducción: Se han informado patrones de deterioro temprano de la función pulmonar en el asma pediátrica. Nuestro objetivo fue identificar las trayectorias de la función pulmonar en la espirometría, desde la edad preescolar hasta la edad escolar. Materiales: Estudio prospectivo realizado entre el 2016 y el 2021. Se reclutaron pacientes con asma persistente a quienes se les realizó oscilometría de impulso (IOS)-espirometría al inicio y después de 3 años. La espirometría anormal se definió de acuerdo con las guías ATS/ERS. Métodos: se utilizó χ2 y ANOVA para comparar las características clínicas y promedios de parámetros de la espirometría e IOS entre trayectorias. Resultados: 86 pacientes, promedio de edad 5,3 y 8,3 años en su primera y segunda evaluación. El 70,9% de los pacientes mantuvo la espirometría normal en ambas evaluaciones (trayectoria 1), el 9,3% presentó espirometría preescolar anormal que normalizó en la edad escolar (trayectoria 2) y el 19,8% espirometría en anormal en ambas evaluaciones (trayectoria 3). La trayectoria 3 registró menor peso promedio al nacer (2,4 kg vs 3,02 kg p = 0,04), mayor promedio de exacerbaciones (5,3 vs 2,01 p = 0,00002), mayor promedio de hospitalizaciones (0,61 vs 0,16 p = 0,04), parámetros promedio más bajos en espirometría (relación VEF1/CVF %, relación VEF0,75/CVF %, VEF0,75 L, VEF0,5 L), promedios más bajos en X5 kPa/Ls y más altos en AX kPa/Ls, que la trayectoria 1. Conclusiones: La trayectoria 1 fue la más frecuente, con persistencia de función pulmonar normal. La trayectoria 3, la segunda más frecuente, inició seguimiento con función pulmonar disminuida en la espirometría y disfunción de vía aérea pequeña en el IOS que se mantuvo en la edad escolar. Los niños que siguieron la trayectoria 3 tuvieron menor peso al nacer, más exacerbaciones y hospitalizaciones que los niños de la trayectoria 1.

Introduction: Patterns of early decline in lung function have been reported in pediatric asthma. Our objective was to identify pulmonary function trajectories in spirometry, from preschool age to school age. Materials: Prospective study conducted between 2016 and 2021. Patients with persistent asthma who underwent impulse oscillometry (IOS)-spirometry at baseline and after 3 years were recruited. Abnormal spirometry was defined according to ATS/ERS guidelines. Methods: χ2 and ANOVA was used to compare clinics characteristics and means of IOS-spirometry parameters between trajectories. Results: 86 patients, mean age of 5,3 and 8,3 years in their first and second evaluation. 70.9% of the patients maintained normal spirometry in both evaluations (Track 1), 9.3% presented abnormal preschool spirometry that normalized at school age (Track 2) and 19.8% abnormal spirometry in both evaluations (Track 3). Trajectory 3 had a lower average birth weight (2,4 kg vs 3,02 kg p = 0,04), higher average of exacerbations (5,3 vs 2,01 p = 0,00002), higher average of hospitalizations (0,61 vs 0,16 p = 0,04), lowest averages parameters in spirometry (FEV1/FVC % ratio, FEV0,75/FVC % ratio, FEV0,75 L, FEV0,5 L), lower average in X5 kPa/Ls and higher in AX kPa/Ls, than trajectory 1. Conclusions: Trajectory 1 was the most common, with persistent normal lung function. Trajectory 3, the second most frequent, started follow-up with decreased lung function in spirometry and small airway disfunction in the IOS that were maintained at school age. Children who followed trajectory 3 had lower birth weight, more exacerbations, and hospitalizations than children in trajectory 1.

Relationship between atherogenic index of plasma and childhood asthma / 中国当代儿科杂志

OBJECTIVES@#To explore the relationship between atherogenic index of plasma (AIP) and childhood asthma.@*METHODS@#This retrospective study included 86 children with asthma admitted to the Changzhou Second People's Hospital Affiliated to Nanjing Medical University from July 2020 to August 2022 as the asthma group and 149 healthy children undergoing physical examination during the same period as the control group. Metabolic parameters including total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and blood glucose, as well as general information of the children such as height, weight, body mass index, presence of specific dermatitis, history of inhalant allergen hypersensitivity, family history of asthma, and feeding history, were collected. Multivariable logistic regression analysis was used to study the relationship between AIP, triglycerides, and high-density lipoprotein cholesterol and asthma. The value of AIP, triglycerides, and high-density lipoprotein cholesterol for predicting asthma was assessed using receiver operating characteristic (ROC) curve analysis.@*RESULTS@#The AIP and triglyceride levels in the asthma group were significantly higher than those in the control group, while high-density lipoprotein cholesterol was significantly lower (P<0.05). However, there was no significant difference in total cholesterol and low-density lipoprotein cholesterol between the two groups (P>0.05). Before and after adjusting for height, weight, presence of specific dermatitis, history of inhalant allergen hypersensitivity, family history of asthma, feeding method, and blood glucose, multivariable logistic regression analysis showed that AIP, triglycerides, and high-density lipoprotein cholesterol were associated with asthma (P<0.05). ROC curve analysis showed that the optimal cutoff value for predicting asthma with AIP was -0.333, with a sensitivity of 80.2%, specificity of 55.0%, positive predictive value of 50.71%, and negative predictive value of 82.85%. The area under the curve (AUC) for AIP in predicting asthma was significantly higher than that for triglycerides (P=0.009), but there was no significant difference in AUC between AIP and high-density lipoprotein cholesterol (P=0.686).@*CONCLUSIONS@#AIP, triglycerides, and high-density lipoprotein cholesterol are all associated with asthma. AIP has a higher value for predicting asthma than triglycerides and comparable value to high-density lipoprotein cholesterol.

Effect of maternal exposure to lipopolysaccharide during pregnancy on allergic asthma in offspring in mice / 中华儿科杂志

Objective: To investigate the effect of maternal exposure to lipopolysaccharide during pregnancy on allergic asthma in offspring in mice. Methods: Animal experimental research was carried out from June 2019 to June 2021.Pregnant C57BL/6J mice were randomly divided into 2 groups by intraperitoneal injection with 7 μg/kg lipopolysaccharide (LPS) or phosphate buffered saline (PBS) at day 15.5 of gestation. After birth, 6 offspring were randomly chosen from each group at the age of 4 weeks, and stimulated with house dust mites (HDM) or PBS, further divided into 4 groups, such as LPS+PBS group, LPS+HDM group, PBS+PBS group, PBS+HDM group, with 3 mice in each group. The cough and wheezing were observed, the histological changes in lung tissue were examined after HE staining, and the expression of inflammatory factors including interleukin (IL)-4, IL-6, IL-17A, IL-23, interferon (IFN)-α and IFN-β in the lung tissue were detected by high-throughput liquid protein chip detection. T test or rank sum test was used for the comparison among these groups. Results: The asthma-like airway inflammation was more obvious in PBS+HDM group after stimulated by HDM than that in PBS+PBS group, nevertheless, this manifestation in LPS+HDM group was milder than that in PBS+HDM group. HE staining showed that inflammatory cell aggregation in the lung tissue in PBS+HDM group was significantly higher than that in PBS+PBS group (4.0 (3.5, 4.0) vs. 0 (0, 0.5), Z=2.02, P=0.043), while it was much lower in LPS+HDM group compared to PBS+HDM group (1.0 (0.5, 1.5) vs. 4.0 (3.5, 4.0), Z=1.99, P=0.046). High-throughput liquid protein chip detection of lung tissue showed that IL-6, IL-23 and IFN-β levels were significantly higher in PBS+HDM group when compared to those in PBS+PBS group ((114±3) vs. (94±4) ng/L, (210±4) vs. (173±7) ng/L, (113±2) vs. (94±4) ng/L, t=4.37, 4.84, 3.96, all P<0.05), while the levels of IL-6, IL-23, IFN-α, IFN-β in LPS+HDM group were significantly lower than those in PBS+HDM group ((87±5) vs. (114±3) ng/L, (171±7) vs. (210±4) ng/L, (16.1±0.6) vs. (20.9±0.3) ng/L, (95±1) vs. (113±2) ng/L, t=5.07, 5.07, 7.28, 7.47, all P<0.05). Conclusions: Prenatal low dose LPS exposure can reduce offspring's airway inflammatory reactions and prevent the development of allergic disease. Maternal infection during pregnancy may affect the occurrence and development of allergic asthma in offspring.

Short-term effects and seasonal variation of ozone on daily hospital outpatient visits for childhood asthma in Lanzhou / 北京大学学报(医学版)

OBJECTIVE@#To analyze the effects of ozone (O3) concentrations measured with different approaches across different seasons on the total number of childhood asthma-related clinical visits, as well as the differentiation of such effects across different groups of patients.@*METHODS@#The outpatient data of three grade A tertiary hospitals in Lanzhou City spanning from 1 January 2014 to 31 December 2017, as well as air pollution and meteorological data during the same period were collected. Considering the nonlinear relationship between O3 concentrations and the total number of childhood asthma-related clinical visits and meteorological factors, a generalized additive temporal sequence model was employed to analyze the short-term association between changes in O3 concentrations and the total number of childhood asthma-related clinical visits. Taking into account of the variations in O3 concentrations within 1 day, this study adopted different measurement approaches to address the three types of O3 exposures, namely, the maximum 1 h daily concentration (O3max1h), the maximum 8 h daily concentration (O38h) and the mean 24 h daily concentration (O324h) as the short term exposure indicators to O3, followed by a model-based analysis.@*RESULTS@#The increase in short-term exposure levels to O3 in summer had a significant effect on the increase in the total number of childhood asthma-related clinical visits. With lag0 for the current day, every 10 μg/m3 increase in atmospheric concentration of O3max1h was associated with an increase in the total number of childhood asthma-related clinical visits by 3.351% (95%CI: 1.231%-5.516%); for every 10 μg/m3 increase in O38h concentration, the total number of childhood asthma-related clinical visits increased by 3.320% (95%CI: 0.197%-3.829%); for every 10 μg/m3increase in O324h concentration, the total number of childhood asthma-related clinical visits in summer increased by 6.600% (95%CI: 0.914%-12.607%); moreover, an increase in exposure to O3max1h also led to a significant rise in the total number of childhood asthma-related clinical visits among the males.@*CONCLUSION@#The increase in short-term exposure levels to O3 in summer in Lanzhou City has a significant effect on the increase in the total number of childhood asthma-related clinical visits; O3max1h is more closely correlated with the increase in the total number of childhood asthma-related clinical visits.

Prevalence of allergic diseases and their symptoms in schoolchildren according to the birth mode / Prevalencia de enfermedades alérgicas y síntomas en escolares de acuerdo con la vía de nacimiento

Abstract Background: The relationship between birth by cesarean section (CS) and allergic diseases’ prevalence continues to be controversial. We aimed to investigate if being born by CS is associated with the prevalence of allergic diseases and their symptoms in schoolchildren. Methods: This study included children between 6 and 7 years of age, selected by population-based sampling. We investigated the presence of allergic diseases and their symptoms, family history of asthma, smoking in parents, breastfeeding, exposure to pets, the season of birth, number of siblings, consumption of unpasteurized cow’s milk, and mode of birth. Results: We included 1003 subjects (526 girls), of which 44.2% were born through CS. The prevalence of allergic diseases did not differ according to birth mode. Asthma in either parent, current smoking by the mother, breastfeeding, and unpasteurized cow’s milk consumption were associated with wheezing at some time in life. Conclusions: No association between CS birth mode and allergic diseases and their symptoms was found.

Resumen Introducción: La relación entre el nacimiento por operación cesárea y las enfermedades alérgicas es controversial. El objetivo del presente estudio fue investigar si el nacimiento por cesárea se asocia con la prevalencia de las enfermedades alérgicas y sus síntomas en escolares. Métodos: Estudio transversal que incluyó una muestra probabilística de niños de 6 a 7 años. Se registraron la presencia de enfermedades alérgicas y sus síntomas, la historia familiar de asma, el tabaquismo en los padres, la alimentación al seno materno, la exposición a mascotas, la estación de nacimiento, el número de hermanos, el consumo de leche no pasteurizada de vaca y la vía de nacimiento. Resultados: Se incluyeron 1003 sujetos (526 niñas), de los cuales el 44.2% nacieron por cesárea. La prevalencia de enfermedades alérgicas no difirió según la vía de nacimiento. El antecedente de asma en alguno de los progenitores, el tabaquismo actual en la madre, la lactancia materna y el consumo de leche no pasteurizada de vaca se asociaron con sibilancias presentes alguna vez en la vida. Conclusiones: No se demostró asociación entre el nacimiento por cesárea y las enfermedades alérgicas y sus síntomas.

Early life blood lead levels and asthma diagnosis at age 4-6 years

The USA has a high burden of childhood asthma. Previous studies have observed associations between higher blood lead levels and greater hypersensitivity in children. The objective of the present study was to estimate the association between blood lead concentrations during early childhood and an asthma diagnosis between 48 and 72 months of age amongst a cohort with well-characterized blood lead concentrations. Blood lead concentrations were measured at 6, 12, 18, 24, 36, and 48 months of age in 222 children. The presence of an asthma diagnosis between 48 and 72 months was assessed using a questionnaire which asked parents or guardians whether they had been told by a physician, in the past 12 months, that their child had asthma. Crude and adjusted risk ratios (RR) of an asthma diagnosis were estimated for several parameterizations of blood lead exposure including lifetime average (6 to 48 months) and infancy average (6 to 24 months) concentrations. After adjustment for child sex, birthweight, daycare attendance, maternal race, education, parity, breastfeeding, income, and household smoking, age-specific or composite measures of blood lead were not associated with asthma diagnosis by 72 months of age in this cohort.

Contaminación atmosférica y asma en niños / Outdoor air pollution and asthma in children

El asma en niños es una condición prevalente y con un significativo impacto en la calidad de vida del niño y su cuidador. Un alto porcentaje de los niños están expuestos a la contaminación atmosférica, lo que se traduce en un significativo impacto en su salud respiratoria. Los niños son un grupo especialmente vulnerable por razones fisiológicas, medioambientales y de comportamientos propios de la edad. Existe suficiente evidencia que algunos contaminantes atmosféricos son capaces de aumentar los síntomas de asma y desencadenar exacerbaciones en niños asmáticos. También existe evidencia creciente que la exposición prolongada y precoz a contaminantes atmosféricos pueden aumentar el riesgo de desarrollar asma, especialmente los contaminantes relacionados con el tráfico vehicular. Estos efectos adversos disminuyen cuando disminuye la contaminación atmosférica producto de las regulaciones ambientales. Estudios sobre la carga atribuible estiman que un 13% de los nuevos niños asmáticos pueden deberse a la contaminación atmosférica. El sistema respiratorio y el sistema inmunológico del niño están en desarrollo, por lo que exposiciones a contaminantes atmosféricos pueden tener consecuencias de largo plazo. Existen varios mecanismos identificados que apoyan los resultados de los estudios epidemiológicos destacando el daño por estrés oxidativo. Los médicos que atienden niños tienen que tomar en cuenta este conocimiento e incorporarlo a su práctica clínica.

Asthma in children is a prevalent condition with a significant impact on the quality of life of the child and their caregiver. A high percentage of children are exposed to air pollution, which has a significant impact on their respiratory health. Children are a particularly vulnerable group for age-specific physiological, environmental and behavioral reasons. There is sufficient evidence that some air pollutants are capable of increasing asthma symptoms and triggering exacerbations in asthmatic children. There is also growing evidence that early and prolonged exposure to air pollutants can increase the risk of developing asthma, especially traffic-related air pollution. These adverse effects decrease when atmospheric pollution decreases as a result of environmental regulations. Studies on attributable burden estimate that 13% of new asthmatics in children may occur due to air pollution. The respiratory system and the immune system of the child are developing, so exposure to air pollutants can have long-term consequences. There are several identified mechanisms that support the results of epidemiological studies highlighting damage from oxidative stress. Physicians caring for children need to take this knowledge into account and incorporate it into their clinical practice.

Impacto de la contaminación aérea por incendios forestales en la morbimortalidad de la población expuesta / Impact of air pollution by forest fires and the morbidity of the exposed population

La exposición a las emanaciones de incendios forestales es un importante problema de salud pública nacional e internacional. El cambio climático que conlleva sequía y aumento de la temperatura estival aumenta el riesgo y magnitud de los episodios de incendios forestales, generándose grandes incendios cuyas emanaciones pueden afectar a poblaciones distanciadas del epicentro. La asociación entre la exposición a las emanaciones de los incendios forestales, el aumento de las concentraciones de material particulado aéreo y la morbilidad respiratoria (exacerbación de asma y enfermedades respiratorias crónicas) ha sido evidenciada en diversos estudios. Sin embargo, es difícil realizar un metaanálisis de ellos, ya que la metodología empleada es muy disímil. Entre los principales mecanismos de morbilidad se encontrarían: la producción de citoquinas proinflamatorias, la activación endotelial y la disfunción del sistema nervioso autónomo. Ante la exposición al humo de incendios forestales, se produce daño tisular, aumento de los mecanismos protrombóticos, aumento de la presión arterial y cambios en el ritmo cardiaco, que explicaría los efectos cardiovasculares. Los sujetos con patología cardiovascular preexistente podrían tener mayor riesgo cardiovascular; sin embargo, existen factores confundentes en esta asociación. Por otra parte, el posible riesgo cancerígeno con la exposición a estas emanaciones requiere mayores estudios poblacionales.

Exposure to forest fire fumes is a major national and international public health issue. Climate change that leads to drought and increased summer temperature increases the risk and magnitude of wildfires episodes, generating mega-fires whose fumes not only affect the boundary population, but they may become transcontinental. Association between exposure to forest fire fumes, mainly increased concentrations of air born particulate matter and respiratory morbidity (exacerbation of asthma and chronic respiratory diseases) has been evidenced by diverse studies. However, it is difficult to carry out meta-analysis with them since the methodology used is dissimilar. Among the main causes of morbidity have been postulated the production of pro-inflammatory cytokines, endothelial activation and dysfunction of the autonomic nervous system. Occurrence of tissue damage, increased prothrombotic mechanisms, increased blood pressure and changes in heart rate, would explain the cardiovascular effects associated with exposure to smoke from these fires. However, epidemiological outcomes have not been entirely consistent, as the association between cardiovascular morbidity and exposure to wildfire fumes may be mixed with confounding factors. Despite this, patients with pre-existing cardiovascular pathology may be at increased risk. Finally, the potential risk of carcinogen with exposure to these fumes requires further population studies.

Body mass index, asthma, and respiratory symptoms: a population-based study / Índice de massa corpórea, asma e sintomas respiratórios: um estudo de base populacional

ABSTRACT Objective: To estimate the prevalence of respiratory symptoms and asthma, according to body mass index (BMI), as well as to evaluate factors associated with physician-diagnosed asthma, in individuals ≥ 40 years of age. Methods: This was a population-based cross-sectional study conducted in Florianópolis, Brazil, with probability sampling. Data were collected during home visits. Demographic data were collected, as were reports of physician-diagnosed asthma, respiratory symptoms, medications in use, and comorbidities. Anthropometric measurements were taken. Individuals also underwent spirometry before and after bronchodilator administration. Individuals were categorized as being of normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≥ BMI < 30 kg/m2), or obese (BMI ≥ 30 kg/m2). Results: A total of 1,026 individuals were evaluated, 274 (26.7%) were of normal weight, 436 (42.5%) were overweight, and 316 (30.8%) were obese. The prevalence of physician-diagnosed asthma was 11.0%. The prevalence of obesity was higher in women (p = 0.03), as it was in respondents with ≤ 4 years of schooling (p < 0.001) or a family income of 3-10 times the national minimum wage. Physician-diagnosed asthma was more common among obese individuals than among those who were overweight and those of normal weight (16.1%, 9.9%, and 8.0%, respectively; p = 0.04), as were dyspnea (35.5%, 22.5%, and 17.9%, respectively; p < 0.001) and wheezing in the last year (25.6%, 11.9%, and 14.6%, respectively; p < 0.001). These results were independent of patient smoking status. In addition, obese individuals were three times more likely to report physician-diagnosed asthma than were those of normal weight (p = 0.005). Conclusions: A report of physician-diagnosed asthma showed a significant association with being ≥ 40 years of age and with having a BMI ≥ 30 kg/m2. Being obese tripled the chance of physician-diagnosed asthma.

RESUMO Objetivo: Estimar a prevalência de sintomas respiratórios e asma de acordo com o índice de massa corpórea (IMC) em indivíduos com idade ≥ 40 anos e avaliar os fatores associados ao relato de diagnóstico médico de asma. Métodos: Estudo transversal de base populacional realizado no município de Florianópolis (SC), com coleta domiciliar de dados e processo de amostragem probabilístico. Foram coletadas informações demográficas, assim como sobre relato de diagnóstico médico de asma, sintomas respiratórios, medicações em uso e comorbidades. Também foram realizadas medidas antropométricas e espirometria pré- e pós-broncodilatador. O IMC foi categorizado em normal (IMC < 25 kg/m2), sobrepeso (25 kg/m2 ≥ IMC < 30 kg/m2) e obesidade (IMC ≥ 30 kg/m2). Resultados: Foram avaliados 1.026 indivíduos, 274 (26,7%) com IMC normal, 436 (42,5%) com sobrepeso e 316 (30,8%) obesos. A prevalência de diagnóstico médico de asma foi de 11,0%. A prevalência de obesidade foi maior em mulheres (p = 0,03) e em entrevistados com escolaridade < 4 anos (p < 0,001) ou com renda familiar entre 3-10 salários mínimos. Obesos, quando comparados com aqueles com sobrepeso e peso normal, relataram mais frequentemente diagnóstico médico de asma (16,1%, 9,9% e 8,0%, respectivamente; p = 0,04), dispneia (35,5%, 22,5% e 17,9%, respectivamente; p < 0,001) e sibilos no último ano (25,6%, 11,9% e 14,6%, respectivamente; p < 0,001). Esses resultados foram independentes do status tabágico. Além disso, obesos tinham uma chance três vezes maior de relato de diagnóstico médico de asma do que não obesos (p = 0,005). Conclusões: Houve associação significativa entre o relato de diagnóstico médico de asma em indivíduos com idade ≥ 40 anos e IMC ≥ 30 kg/m2. Ser obeso triplicou a chance de diagnóstico médico de asma.

Increased expression of pendrin in eosinophilic chronic rhinosinusitis with nasal polyps / Expressão aumentada de pendrina na rinossinusite crônica eosinofílica com pólipos

Abstract Introduction: Chronic rhinosinusitis with nasal polyps is a heterogeneous disease and appropriate diagnostic algorithms in individual cases are necessary for effective medical treatment. Objective: The purpose of this study was to clarify the relationship between the pendrin expression of nasal polyps and clinical and pathological characteristic features of eosinophilic chronic rhinosinusitis. Methods: A total of 68 patients were classified into eosinophilic chronic rhinosinusitis or non-eosinophilic chronic rhinosinusitis groups according to the degree of eosinophilic infiltration into the nasal polyps. Clinical, hematological, and immunohistochemical analyses were performed and statistically compared between both groups. Results: Thirty-eight were classified into eosinophilic chronic rhinosinusitis and 30 into non-eosinophilic chronic rhinosinusitis groups. There were no significant differences in age distribution, sex ratio, prevalence of asthma, or any other complications between the groups. The mean Lund-Mackay score and the number of serum eosinophils was significantly higher in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. The pendrin expression was more frequently detected in the epithelial surface layer of nasal polyps in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. In addition, mucin 5AC was more widely expressed in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis. Conclusion: Increased expression of pendrin and mucin 5AC in the nasal polyps would be associated with development of eosinophilic chronic rhinosinusitis. This finding could allow the development of a novel therapeutic agent targeted specifically to patients with eosinophilic chronic rhinosinusitis.

Resumo Introdução: A rinossinusite crônica com pólipos nasais é uma doença heterogênea e algoritmos diagnósticos apropriados em casos individuais são necessários para um tratamento médico eficaz. Objetivo: O objetivo deste estudo foi esclarecer a relação entre a expressão da pendrina de pólipos nasais e propriedades clínicas e patológicas características da rinossinusite crônica eosinofílica. Método: Um total de 68 pacientes foram classificados como tendo rinossinusite crônica eosinofílica ou rinossinusite crônica não eosinofílica de acordo com o grau de infiltração eosinofílica nos pólipos nasais. Análises clínicas, hematológicas e imunohistoquímicas foram realizadas e comparadas estatisticamente entre os dois grupos. Resultados: Entre os pacientes, 38 apresentavam rinossinusite crônica eosinofílica e constituíram o grupo 1; 30 tinham rinossinusite crônica não eosinofílica e constituíram o grupo 2. Não houve diferenças significantes na distribuição etária, razão entre os sexos, prevalência de asma ou qualquer outra complicação entre os grupos. O escore médio de Lund-Mackay e o número de eosinófilos séricos foram significantemente maiores no grupo com rinossinusite crônica eosinofílica do que no grupo com rinossinusite crônica não eosinofílica. A expressão da pendrina foi mais frequentemente detectada na camada epitelial superficial dos pólipos nasais na rinossinusite crônica eosinofílica do que no grupo com rinossinusite crônica não eosinofílica. Além disso, mucina 5AC foi mais amplamente expressa na rinossinusite crônica eosinofílica do que na rinossinusite crônica não eosinofílica. Conclusão: O aumento da expressão da pendrina e mucina 5AC nos pólipos nasais estaria associado ao desenvolvimento de rinossinusite crônica eosinofílica. Esse achado pode permitir o desenvolvimento de um novo agente terapêutico voltado especificamente para pacientes com rinossinusite crônica eosinofílica.

Vitamina D y asma / Vitamin D and asthma

The main source of Vitamin D is the bioconversion of 7-dehydrocholesterol to cholecalciferol, however, the level of sun exposition has been drastically reduced during the last decades, so it is not unusual to find a high deficit of Vitamin D in the population. There is evidence to suggest that the deficit of Vitamin D is associated with a worse evolution of asthma and a greater risk of serious exacerbations. Possibly prenatal Vitamin D supplementation to pregnant mothers reduces the risk of wheezing and asthma in the offspring, and supplementation to asthmatic children could improve the evolution of the disease.

La principal fuente de Vitamina D es la bioconversión del 7-dehidrocolesterol a colecalciferol, sin embargo, el nivel de exposición solar se ha reducido drásticamente durante las últimas décadas, por lo que no es extraño encontrar un déficit elevado de Vitamina D en la población. Existe evidencia que sugiere que el déficit de Vitamina D se asocia a peor evolución del asma y mayor riesgo de exacerbaciones graves. Posiblemente la suplementación prenatal de Vitamina D a madres embarazadas reduzca el riesgo de sibilancias y asma en los hijos que nacerán, y la suplementación a niños asmáticos podría mejorar la evolución de la enfermedad.

Factors associated with asthma in brazilian adolescents: national adolescent school-based health survey (pense-2012) / Fatores associados à asma em adolescentes brasileiros: pesquisa nacional de saúde do escolar (pense), 2012

ABSTRACT Objective: To identify factors associated with asthma in Brazilian adolescents. Methods: Cross-sectional study based on data from the 2012 National Adolescent School-based Health Survey (PeNSE), a Brazilian survey applied by a self-reported questionnaire in a representative sample of 9th-grade students. Descriptive and inferential analysis was made based on the demographic, socioeconomic, clinical, food consumption and environmental characteristics potentially associated with asthma. Adolescents who presented wheezing in the last 12 months were considered asthmatic. A multiple logistic regression model was adjusted for confounding factors. Significance was defined as p≤0.05. Results: A total of 106,983 adolescents were studied. The prevalence of asthma was 23.2%. The final model was composed of 11 variables that were independently associated with asthma: female sex (OR=1.17), <14 years old (OR=1.12), not living with parents (OR=1.06), the highest number of days consuming ultra-processed foods (OR=1.16), lunch or dinner time without presence of parents or guardians (OR=1.13), meals in front of the TV or while studying (OR=1.18), not having breakfast frequently (OR=1.22), having smoked cigarettes (OR=1.36), having tried alcoholic beverage (OR=1.37), having used illicit drugs (OR=1.29) and having sought health care in the last year (OR=1.67). Conclusions: The results of the present study reinforce the multifactorial characteristic of asthma diagnosis. Prevention and control strategies should focus on groups of adolescents living in inadequate conditions when it comes to family dynamics, food consumption and behavior (drug use).

RESUMO Objetivo: Identificar fatores associados à asma em adolescentes brasileiros. Métodos: Estudo transversal baseado em dados da Pesquisa Nacional de Saúde do Escolar (PeNSE-2012), que foi um inquérito brasileiro realizado por meio de questionário autoaplicável em amostra representativa de alunos do 9º ano do ensino fundamental. Foi realizada análise descritiva e inferencial das características demográficas, socioeconômicas, clínicas, alimentares e ambientais potencialmente ligadas à asma. Foram considerados com asma os adolescentes que apresentaram chiado no peito nos últimos 12 meses. Um modelo logístico múltiplo foi ajustado para controle do confundimento. O valor p≤0,05 foi eleito para determinar associação estatisticamente significante. Resultados: Foram estudados 106.983 adolescentes. A prevalência de asma foi de 23,2%. O modelo final foi composto de 11 variáveis, que se associaram à asma de forma independente e estatisticamente significante (p<0,001): sexo feminino (OR=1,17), idade inferior a 14 anos (OR=1,12), não morar com os pais (OR=1,06), o maior número de dias de consumo de alimentos ultraprocessados (OR=1,16), almoçar ou jantar sem a presença dos pais ou responsáveis (OR=1,13), realizar as refeições em frente à TV ou estudando (OR=1,18), não tomar café da manhã com frequência (OR=1,22), ter fumado cigarro (OR=1,36), ter experimentado bebida alcoólica (OR=1,37), ter usado droga ilícita (OR=1,29) e ter procurado serviço de saúde no último ano (OR=1,67). Conclusões: Os resultados do presente estudo reforçam a característica multifatorial de determinação da asma. Estratégias de prevenção e controle devem focar grupos de adolescentes que vivem em condições inadequadas do ponto de vista familiar, alimentar e comportamental (uso de drogas).

Corticosteroides inhalados en pacientes con asma leve intermitente / Inhaled corticosteroids in mild intermittent asthma

Una joven de 23 años con asma leve intermitente se presenta a la consulta médica. Se plantea cuál es la mejor alternativa para su tratamiento: el uso de broncodilatadores de acción corta a demanda (SABA, por sus iniciales en inglés) o de broncodilatadores de acción rápida en asociación con corticoides inhalatorios (ICS/FABA, por sus iniciales en inglés) a demanda. Tras revisar la bibliografía se encontraron una revisión sistemática y dos ensayos clínicos que indican que los ICS/FABA serían superiores a los SABA; sin embargo este efecto fue solamente estudiado en casos de asma persistente.Es importante discutir estos hallazgos con los pacientes, junto a sus implicancias económicas, incorporando sus valores y preferencias a la hora de tomar una decisión terapéutica. (AU)

A 23-year-old woman with mild intermittent asthma comes to the doctor's office. The best alternative for treatment is considered: the use of short-acting bronchodilators on demand (SABA) or fast-acting bronchodilators in association with inhaled corticosteroids (ICS/FABA) on demand. After a literature search, a systematic review and two clinical trials werefound, which indicate that the ICS/FABA would be superior to the SABA; however, this effect was only studied in cases of persistent asthma. It is important to discuss these findings with the patients, alongside with their economic implications,incorporating their values and preferences when making a therapeutic decision.

Relación del reflujo gastroesofágico y manifestaciones respiratorias, desde el punto de vista de la gastroenterología pediátrica / Relationship between gastroesophageal reflux and respiratory manifestations, from the pediatric gastroenterologist point of view

Gastroesophageal reflux is a frequent condition in the daily life of infants and older children. When reflux causes symptoms, it is called gastroesophageal reflux disease. Different extraesophageal symptoms have been frequently attributed to gastroesophageal reflux, however, new diagnostic techniques available, such as pHmetry with impedance measurement, have allowed us to evaluate and eventually dismiss such relationships. In this article we review the relationship between gastroesophageal reflux and laryngeal pathology, chronic cough, asthma and aspiration. In general terms, the empirical treatment of a presumed reflux is not recommended in asymptomatic patients, in whom its presence is not demonstrated by techniques such as pHmetry with impedance, given that therapeutic response is low and similar to placebo, with potential adverse effects.

El reflujo gastroesofágico es una condición frecuente en la vida diaria de lactantes y niños mayores. Cuando produce síntomas, se denomina enfermedad por reflujo gastroesofágico. Se ha atribuido frecuentemente diferentes síntomas extraesofágicos al reflujo, sin embargo, nuevas técnicas diagnósticas disponibles, como la pHmetría con medición de impedanciometría, han permitido evaluar y eventualmente descartar tales asociaciones. En este artículo se revisa la relación entre el reflujo gastroesofágico y patología laríngea, tos crónica, asma y aspiración. En términos generales, no se recomienda el tratamiento empírico de un supuesto reflujo en pacientes asintomáticos, en quienes tampoco esté demostrada su presencia por técnicas como la pHmetría con impedanciometría, dado que la respuesta terapéutica es baja y similar a placebo, con potenciales efectos adversos.

ERICA: smoking is associated with more severe asthma in Brazilian adolescents / ERICA: tabagismo está associado a asma mais grave em adolescentes brasileiros

Abstract Objective: To investigate the association between smoking and asthma, and possible associated factors in Brazilian adolescents. Methods: A cross-sectional, national, school-based study with adolescents aged 12-17 years, participants in the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA). A total of 66,394 participants answered a self-administered questionnaire with questions about asthma, smoking, lifestyle and sociodemographic variables. Bivariate analysis between Current Asthma (CA) and Severe Asthma (SA) and the other study variables were performed using Chi-squared. Then, the crude and adjusted Prevalence Ratios (PR), and respective 95% Confidence Intervals (95% CI) of current asthma/severe asthma and smoking variables, corrected for sociodemographic and lifestyle variables, were estimated using generalized linear models with Poisson regression, logit link, and robust variance. Results: The prevalence of current asthma and severe asthma were significantly higher in adolescents who were exposed to: experimentation (current asthma: PR = 1.78, 95% CI: 1.51-2.09; severe asthma: PR = 2.01; 95% CI: 1.35-2.98); current smoking (current asthma: PR = 2.08, 95% CI: 1.65-2.64; severe asthma: PR = 2.29; 95% CI: 1.38-3.82); regular smoking (current asthma: PR = 2.25, 95% CI: 1.64-3.07; severe asthma: PR: 2.41; 95% CI: 1.23-4.73); and passive smoking (current asthma: PR = 1.47, 95% CI: 1.27-1.67; severe asthma: PR = 1.66; 95% CI: 1.19-2.32); these associations remained significant after adjustment. Conclusions: Asthma and smoking were significantly associated in Brazilian adolescents, regardless of the sociodemographic and lifestyle factors, notably in those with more severe disease.

Resumo: Objetivo: Investigar a associação entre asma, tabagismo e possíveis fatores associados em adolescentes brasileiros. Métodos: Estudo transversal, nacional, de base escolar, envolveu adolescentes com 12 a 17 anos, participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Os 66.394 participantes responderam questionários autopreenchíveis com questões sobre asma, tabagismo, estilo de vida e dados sociodemográficos. Foram realizadas análises bivariadas entre asma ativa e asma grave e demais variáveis do estudo, com o uso de χ2. Em seguida, foram estimadas as razões de prevalência (RP) brutas e ajustadas e seus respectivos intervalos de confiança de 95% (IC 95%), entre asma ativa/asma grave e variáveis de tabagismo, corrigidas pelas variáveis sociodemográficas e de estilo de vida, através de modelos lineares generalizados com regressão de Poisson, função de ligação logarítmica e variância robusta. Resultados: A prevalência de asma ativa e asma grave foi significativamente mais elevada naqueles expostos a experimentação (asma ativa: RP = 1,78; IC 95%: 1,51-2,09; asma grave: RP = 2,01; IC 95%: 1,35-2,98); tabagismo atual (asma ativa: RP = 2,08; IC 95%: 1,65-2,64; asma grave: RP = 2,29; IC 95%: 1,38-3,82); tabagismo frequente (asma ativa: RP = 2,25; IC 95%: 1,64-3,07; AG = 2,41; IC 95%: 1,23-4,73) e tabagismo passivo (asma ativa: RP = 1,47; IC 95%: 1,27-1,67; asma grave: RP = 1,66; IC 95%: 1,19-2,32). As associações permaneceram significativas após ajuste. Conclusão: A asma e o tabagismo se associaram de modo significativo em adolescentes brasileiros independente de fatores sociodemográficos e estilo de vida, especialmente naqueles com doença mais grave.

¿Existe asociación entre asma y adiposidad en la población adulta chilena? / Association between adiposity and asthma

Background: In people with asthma, adiposity is associated with more symptoms and less control of the disease whereas on those without asthma adiposity is associated with a higher risk of developing the disease. Aim: To investigate the association between asthma and adiposity markers in Chilean adults. Material and Methods: Data from 5,499 adults older than 15-years-old from the Chilean National Health Survey 20162017 were analyzed. Quintiles of body-mass index (BMI) and waist circumference (WC) were used as a proxy of adiposity. The association between asthma and quintiles of BMI and WC was determined by logistic regression. Results: A higher BMI and WC was associated with a higher odds for asthma. This trend remained significant even after adjusting the models for socio-demographic factors, physical activity and smoking (Odds Ratio [OR] BMI: 1.13 [95% confidence intervals (CI): 1.04; 1.22], p < 0.01 and OR WC: 1.15 [95% IC: 1.06; 1.25], p < 0.01). Conclusions: A higher BMI and WC were positively associated with asthma.

Intervención ambiental en las enfermedades respiratorias / Environmental intervention in respiratory disease

En los últimos años hubo un aumento significativo en la prevalencia de las enfermedades alérgicas pese a los avances en la comprensión de la patogénesis, la divulgación de guías para su control y tratamiento y la aparición de nuevos fármacos. La raz ón para este aumento no está totalmente estable cida, pero se considera que múltiples factores ambientales podrían estar involucrados en ello. El aire inspirado contiene numerosos agentes nocivos además de alérgenos ambientales; el asma y la rinitis alérgica son las principales expresiones clínicas respiratorias inmediatas posteriores a su inhalación. En la antropósfera, el entorno de la superficie terrestre habitada por los humanos, se han alterado los equilibrios naturales por la emisión de múltiples sustancias y se ha producido un creciente cambio climático. Este fenómeno global influye en la calidad del aire y consecuentemente en el desarrollo de enfermedades respiratorias. Dado que la bibliografía sobre el tema del control ambiental es muy amplia, y en ocasiones difícil de interpretar para poder realizar indicaciones precisas, válidas y sencillas de cumplir por parte de los pacientes, cuatro sociedades científicas de la República Argentina, dedicadas a este tipo de enfermedades, elaboraron un documento con información de fácil acceso a todo profesional médico que trate asma y/o rinitis, que expone medidas prácticas para los enfermos y alerta a los distintos actores involucrados en la salud pública acerca de las necesidades insatisfechas en este tema tan complejo, a fin de poder elaborar una agenda para su posible resolución.

In recent years there has been a significant increase in the prevalence of allergic diseases despite advances in the understanding of the pathogenesis, the dissemination of guidelines for its management and the emergence of new drugs. The reasons for this increase are not fully established, but it is suggested that multiple environmental factors may be involved. Inhaled air contains numerous harmful agents in addition to environmental allergens. The main immediate respiratory clinical expression after inhaling this contaminated air is asthma and rhinitis. The activity of human beings has altered the outdoor environment by the emission of multiple pollutants and has produced an increasing climate change. It also has a notable impact on the development of respiratory pathology and the modification of air quality. The bibliography on the subject of environmental control is very broad and sometimes difficult to interpret. In order to be able to make precise, valid and simple indications for patients to accomplish with, four scientific societies of the Argentine Republic that deal with this type of diseases, have elaborated a document that contains information of easy access to all medical personal involved in the treatment of patients with asthma and / or rhinitis, that provides practical measures for the patients and the different public health systems about unmet needs in this complex issue.

Temporal evolution of and factors associated with asthma and wheezing in schoolchildren in Brazil / Evolução temporal e fatores associados a asma e sibilância em escolares no Brasil

ABSTRACT Objective: To estimate the evolution of the prevalence of asthma and wheezing among schoolchildren in Brazil from 2012 to 2015, as well as to identify factors associated with both conditions. Methods: This was a cross-sectional study using data from the Brazilian National School-Based Adolescent Health Survey for 2012 and 2015. To characterize the evolution of the prevalence of asthma and wheezing, we used linear regression with weighted-least-squares estimation and presented the annual percent change (APC). Results: During the study period, there was a reduction in the prevalence of wheezing, from 23.2% in 2012 to 22.4% in 2015 (APC, −0.27). The prevalence of asthma increased from 12.4% in 2012 to 16.0% in 2015 (APC, 1.20). The increase in the prevalence of asthma was greatest in the southern region of the country (APC, 2.17). Having any history of smoking and having consumed alcohol in the last 30 days were factors that influenced the prevalence of wheezing and the prevalence of a self-reported diagnosis of asthma during the two years evaluated. Conclusions: There has been an increase in the prevalence of asthma in recent years in Brazil. Our data underscore the importance of improving health strategies and policies aimed at the control of asthma.

RESUMO Objetivo: Estimar a evolução da prevalência de asma e sibilância em escolares brasileiros nos anos de 2012 e 2015, bem como verificar fatores associados a ambas. Métodos: Estudo transversal utilizando dados da Pesquisa Nacional de Saúde do Escolar nos anos de 2012 e 2015. Para verificar a evolução das prevalências de asma e sibilância foi utilizada a regressão linear ponderada pelos quadrados mínimos da variância e apresentada a variação percentual anual (VPA). Resultados: Foi encontrada uma redução da prevalência de sibilância (de 23,2% em 2012 para 22,4% em 2015; VPA: −0,27). A prevalência de asma aumentou de 12,4% em 2012 para 16,0% em 2015 (VPA: 1,20). O maior aumento na prevalência de asma ocorreu na região Sul do país (VPA: 2,17). Ter fumado alguma vez na vida e ter ingerido álcool nos últimos 30 dias foram fatores que influenciaram tanto na prevalência de sibilância quanto na prevalência de diagnóstico referido de asma nos dois anos da pesquisa. Conclusões: Este estudo evidenciou o aumento na prevalência de asma nos últimos anos. Esses dados ressaltam a importância de melhoria das estratégias e políticas de saúde voltadas para o controle da asma.