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1.
Arq. ciências saúde UNIPAR ; 26(1): 75-87, Jan-Abr. 2022.
Article in Portuguese | LILACS | ID: biblio-1362684

ABSTRACT

O cigarro eletrônico surgiu como uma tentativa para minimizar a dependência ao uso de tabaco, entretanto, engloba controvérsias e dúvidas acerca das reais implicações para o organismo humano. Diante disso, o presente estudo tem como objetivo realizar uma revisão da literatura a fim de relacionar o uso de cigarro eletrônico com suas consequências para os humanos. Os estudos analisados relatam experimentos in vitro e in vivo em camundongos, demonstrando menor concentração de poluentes e nocividades no cigarro eletrônico comparado ao convencional, porém, seu potencial efeito maléfico está relacionado à composição do e-líquido, à maneira do uso e à variedade de aromas presentes nos produtos. Além disso, foram verificadas lesões celulares, hiperreatividade das vias aéreas, liberação de citocinas ­ IL-8, IL-10 e TNF, redução da ação antimicrobiana de queratinócitos e potencial apoptose nas células alveolares. Foi observado também um aumento em até cinco vezes da concentração de carboxihemoglobina em comparação ao cigarro comum e um aumento na auto renovação de células de adenocarcinoma pulmonar de células não pequenas, devido à expressão de SOX2. Observa-se também que em casos de DPOC, o cigarro eletrônico não apresenta agravamentos na fisiologia respiratória, contrapondo outras ocorrências como asma, pneumonia, câncer de pulmão e doenças infecciosas que podem ser ocasionadas ou exacerbadas pelo seu uso. Contudo, pelo curto prazo de observação de seus efeitos, não é possível determinar com precisão a segurança dos cigarros eletrônicos, dessa forma, faz-se necessário que mais pesquisas longitudinais sejam desenvolvidas, auxiliando, assim, na construção de evidências sobre a segurança dos cigarros eletrônicos e na regulamentação futura do produto.


Electronic cigarettes emerged as an attempt to minimize tobacco dependence. However, its use is surrounded by controversies and doubts about the real implications for the human organism. Therefore, this study aims at performing a review of the most recent literature to corelate the use of e-cigarettes with their consequences for the human body. The analyzed studies relate in vitro and in vivo experiments on mice, demonstrating lower concentration of pollutants and harmfulness in the electronic cigarette than in conventional cigarettes. However, its potential harmful effect is related to the composition of the e-liquid, in its use and in the variety of aromas in the products. In addition, cellular lesions, airway hyperreactivity, release of IL-8, IL-10 and TNF cytokines could be observed, as well as reduced keratinocyte antimicrobial action and potential apoptosis in alveolar cells. An increase of up to five-fold the concentration of carboxyhemoglobin in comparison to ordinary cigarettes and an increase in self-renewal of non-small pulmonary adenocarcinoma cells due to the expression of SOX2 have also been related. It could also be observed that in COPD cases, e-cigarettes do not present worsening in respiratory physiology, which contrasts with other occurrences such as asthma, pneumonia, lung cancer, and infectious diseases that can be caused or exacerbated by its use. However, due to the short term of observation of the effects, the safety of e-cigarettes could not be accurately determined, thus, the need for further longitudinal research is necessary, which could be used to help build evidence about the safety of e-cigarettes and also to create future regulation of the product.


Subject(s)
Animals , Mice , Rats , Electronic Nicotine Delivery Systems/instrumentation , Lung Diseases , Pneumonia/complications , Asthma/complications , Tobacco Use Disorder/complications , Smoking , Disease , Lung Injury , Tobacco Use , Vaping , Smokers , E-Cigarette Vapor/adverse effects , Lung Neoplasms
2.
Bol. latinoam. Caribe plantas med. aromát ; 20(5): 463-481, sept. 2021. ilus, tab
Article in English | LILACS | ID: biblio-1368606

ABSTRACT

Resveratrol is a phenolic phytoconstituent found in many plants. This molecule has always caught the attention of scientists because of biological potentials such as inhibition of inflammation, oxidative stress and platelet aggregation as well as to prevent/protect against cardiovascular and neurodegenerative disease/disorders. Literature search have been conducted over resveratrol in covid-19 and asthma studies published in Pubmed and Google Scholars until 30 September 2020. The criteria used in the literature review were determined and were reviewed works on resveratrol including 368 articles and 47 articles on covid-19 and asthma, respectively. As a result of meta-analysis, TNF-α values of the studies showed a significant difference (heterogeneity) of I2=68.39% from each other in total (Cohran Q:6.33, p<0.0423). This study shows that resveratrol would have a potential to reduce ARDS symptoms, by suppressing the cytokine storm and severe inflammation caused by SARS-CoV-2, and by showing strong activity against various types of DNA/RNA viruses.


El resveratrol es un fitoconstituyente fenólico que se encuentra en muchas plantas. Esta molécula siempre ha llamado la atención de los científicos debido a sus potenciales biológicos como la inhibición de la inflamación, el estrés oxidativo y la agregación plaquetaria, así como para prevenir/proteger contra enfermedades/trastornos cardiovasculares y neurodegenerativos. Se han realizado búsquedas bibliográficas sobre resveratrol en covid-19 y estudios sobre asma publicados en Pubmed y Google Scholars hasta el 30 de septiembre de 2020. Se determinaron los criterios utilizados en la revisión bibliográfica y se revisaron trabajos sobre resveratrol que incluyen 368 artículos y 47 artículos sobre covid-19 y asma, respectivamente. Como resultado del metanálisis, los valores de TNF-α de los estudios mostraron una diferencia significativa (heterogeneidad) de I2=68,39% entre sí en total (Cohran Q: 6,33, p<0,0423). Este estudio muestra que el resveratrol podría reducir los síntomas del ARDS al suprimir la tormenta de citocinas y la inflamación severa causada por el SARS-CoV-2, y al mostrar una fuerte actividad contra varios tipos de virus de ADN/ARN.


Subject(s)
Humans , Asthma/drug therapy , Resveratrol/therapeutic use , COVID-19/drug therapy , Respiratory Distress Syndrome, Newborn/prevention & control , Asthma/complications , Transforming Growth Factor beta , Cytokine Release Syndrome , COVID-19/complications
3.
Rev. medica electron ; 43(1): 2954-2962,
Article in Spanish | LILACS, CUMED | ID: biblio-1156787

ABSTRACT

RESUMEN El asma es una enfermedad obstructiva en la que, las resistencias respiratorias se encuentran aumentadas. Los hechos responsables de este aumento de resistencias son el propio broncoespasmo, la inflamación y el remodelado de la vía aérea con reducción de su diámetro. Todavía falta mucho por conocer y estudiar, pero sabemos que la ventilación mecánica no invasiva, como nueva forma de soporte ventilatorio que ha venido tomando auge en las últimas décadas, tiene numerosos beneficios en la práctica médica. A pesar de que algunas investigaciones plantean la controversialidad del empleo de la ventilación no invasiva en el asma grave, queremos realizar con el presente trabajo un acercamiento a varios de los estudios que se han llevado a cabo donde justifican totalmente el empleo de la misma como una medida de éxito en el manejo del asma, con resultados positivos y exitosos. Donde ha probado mejorar la situación funcional y reducir las necesidades de ingreso hospitalario, aliviando el agotamiento muscular y de esta manera mejorando el trabajo respiratorio. Aún queda bastante camino por recorrer con esta variante de ventilación que ha surgido y tomado auge por todos los logros y expectativas que ha venido a cumplir (AU).


SUMMARY Asthma is an obstructive disease in which, respiratory resistances are increased. The factors responsible for this increase in resistance are bronchospasm, inflammation and remodeling of the airway with reduction of its diameter. Much remains to be known and studied, but we know that noninvasive ventilation (NIV), as a new form of ventilatory support that has been growing in recent decades, has numerous benefits in medical practice. Although some research raises the controversy about the use of NIV in severe asthma, we want to do with the present work an approach to several of the studies that have been carried out where they totally justify the use of it as a measure of success in managing asthma, with positive and successful results. Where he has tried to improve the functional situation and reduce the need for hospital admission, alleviating muscle exhaustion and thus improving breathing work. There is still enough way to go with this variant of ventilation that has emerged and taken shape for all the achievements and expectations it has come to fulfill (AU).


Subject(s)
Humans , Respiration, Artificial/methods , Asthma/complications , Risk Factors , Asthma/drug therapy , Bronchial Spasm , Catastrophic Illness
4.
J. bras. pneumol ; 47(1): e20200033, 2021. tab
Article in English | LILACS | ID: biblio-1134930

ABSTRACT

ABSTRACT Objective: To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. Methods: The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. Results: Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). Conclusions: In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.


RESUMO Objetivo: Avaliar a frequência de asthma-COPD overlap (ACO, sobreposição asma-DPOC) em pacientes com DPOC e comparar, do ponto de vista clínico, laboratorial e funcional, os pacientes com e sem essa sobreposição conforme diferentes critérios diagnósticos. Métodos: Os participantes foram submetidos à avaliação com pneumologista, espirometria e exame sanguíneo, sendo orientados a manter o registro do PFE duas vezes ao dia. O diagnóstico de ACO deu-se através dos critérios Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO), American Thoracic Society (ATS) Roundtable e Espanhol. Foram investigados os históricos de exacerbações e hospitalizações e aplicados os instrumentos COPD Assessment Test e escala Medical Research Council modificada, utilizados para a classificação de risco e sintomas da GOLD. Resultados: Entre os 51 pacientes com DPOC, 14 (27,5%), 8 (12,2%) e 18 (40,0) foram diagnosticados com ACO segundo os critérios PLATINO, ATS Roundtable e Espanhol, respectivamente. Pacientes com sobreposição significativamente apresentaram pior CVF pré-broncodilatador (1,9 ± 0,4 L vs. 2,4 ± 0,7 L), CVF pós-broncodilatador (2,1 ± 0,5 L vs. 2,5 ± 0,8 L) e VEF1 pré-broncodilatador (1,0 ± 0,3 L vs. 1,3 ± 0,5 L) quando comparados a pacientes com DPOC. Os níveis de IgE foram significativamente mais elevados em pacientes com sobreposição diagnosticados pelo critério Espanhol (363,7 ± 525,9 kU/L vs. 58,2 ± 81,6 kU/L). O histórico de asma foi mais frequente em pacientes com a sobreposição (p < 0,001 para todos os critérios). Conclusões: Nesta amostra, pacientes com ACO relataram asma prévia com maior frequência e possuíam pior função pulmonar quando comparados a pacientes com DPOC. O critério ATS Roundtable aparenta ser o mais criterioso em sua definição, enquanto os critérios PLATINO e Espanhol apresentaram maior concordância entre si.


Subject(s)
Humans , Asthma/complications , Asthma/diagnosis , Asthma/epidemiology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Spirometry , Forced Expiratory Volume , Hospitalization , Laboratories
5.
Medicina (B.Aires) ; 80(6): 710-713, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1250299

ABSTRACT

Resumen El síndrome de asma crítico es una emergencia médica que amenaza la vida y de no instaurar un tratamiento urgente, progresa a un estado de hipoxia irreversible o paro cardiorrespiratorio. La ventilación mecánica invasiva constituye uno de los pilares terapéuticos, sin embargo, también puede desarrollar injuria pulmonar por barotrauma. En ese contexto, el uso de oxigenación por membrana extracorpórea (ECMO) supone una estrategia adicional para mejorar el intercambio gaseoso y reducir el daño inducido por la ventilación mecánica. Se presenta el caso de una paciente con síndrome de asma crítico que requirió ECMO por barotrauma grave.


Abstract Critical asthma syndrome is a life-threatening medical condition that can lead to irreversible hypoxia or cardiorespiratory arrest. Invasive mechanical ventilation is one of the therapeutic pillars, however, it can also develop ventilator-induced lung injury. For this reason, the use of extracorporeal membrane oxygenation (ECMO) could be an additional strategy to improve gas exchange and reduce damage induced by mechanical ventilation. We present the case of a patient with critical asthma syndrome who required ECMO due to severe barotrauma.


Subject(s)
Humans , Young Adult , Respiratory Distress Syndrome, Newborn , Asthma/complications , Asthma/therapy , Extracorporeal Membrane Oxygenation , Respiration, Artificial
6.
Clinics ; 75: e1512, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055871

ABSTRACT

OBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.


Subject(s)
Humans , Child , Adolescent , Asthma/complications , Saline Solution, Hypertonic , Sputum , Physical Therapy Modalities , Forced Expiratory Volume , Cross-Over Studies
7.
Neumol. pediátr. (En línea) ; 14(4): 200-204, dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1087946

ABSTRACT

Obesity and bronchial asthma have suffered a sustained increase in its prevalence worldwide. The relationship between both entities has been widely studied especially in the adult population. Obesity has been shown to be a risk factor for new bronchial asthma diagnoses and vice versa; and that both alter the evolution of the other. The relationship between them is based on systemic inflammatory factors and cardiometabolic factors rather than the fat load. In this review we will focus on the pathophysiology of metabolic and immunological alterations that link both diseases.


Obesidad y asma bronquial han sufrido un aumento sostenido de su prevalencia a nivel mundial. La relación entre ambas entidades ha sido ampliamente estudiada especialmente en población adulta. Se ha demostrado que obesidad es un factor de riesgo de nuevos diagnósticos de asma bronquial y viceversa; y que ambas alteran la evolución de la otra. La relación entre ellas se sustenta en factores inflamatorios sistémicos y factores cardiometabólicos más que en la carga adiposa. En esta revisión nos centraremos en la fisiopatología de las alteraciones metabólicas e inmunológicas que ligan ambas enfermedades.


Subject(s)
Humans , Child , Asthma/epidemiology , Pediatric Obesity/epidemiology , Asthma/complications , Asthma/physiopathology , Pediatric Obesity/complications , Pediatric Obesity/physiopathology
8.
Rev. chil. enferm. respir ; 35(3): 219-224, 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058077

ABSTRACT

Existen diversos lisados bacterianos, siendo OM-85 (Broncho-Vaxom®) el que posee mayor evidencia en cuanto a su rol inmunoprotector sobre infecciones respiratorias en población pediátrica. Sus mecanismos de acción producen efectos inmunomoduladores que potencialmente podrían prevenir el asma en etapas precoces de la vida, actuar sobre la disminución de crisis y ser un aporte a la terapia convencional del asma. Este artículo expone las principales evidencias en relación con estos compuestos, con enfoque en la actualidad y el desarrollo futuro, en especial sobre OM-85.


There are several bacterial lysates, being OM-85 (Broncho-Vaxom®) the one with the greatest evidence regarding its immunoprotective role on respiratory infections in the pediatric population. Its mechanisms of action produce immunomodulatory effects that could potentially prevent asthma in early stages of life, act on the reduction of crisis and be a contribution to conventional asthma therapy. This article shows the main evidences in relation to these compounds, the current focus and future development, especially on OM-85.


Subject(s)
Humans , Respiratory Tract Infections/prevention & control , Asthma/drug therapy , Adjuvants, Immunologic/therapeutic use , Asthma/complications , Asthma/immunology , Anti-Bacterial Agents/therapeutic use
9.
Rev. habanera cienc. méd ; 17(6): 859-871, nov.-dic. 2018. tab
Article in Spanish | LILACS, CUMED | ID: biblio-991292

ABSTRACT

Introducción: Las principales alteraciones funcionales del asma bronquial son la obstrucción del flujo aéreo, su reversibilidad, variabilidad y la hiperrespuesta bronquial. Objetivo: Determinar el estado clínico-funcional en pacientes con asma que asisten por primera vez a consulta de neumología. Material y Métodos: Se realizó un estudio descriptivo transversal con 110 pacientes que asistieron por primera vez y fueron atendidos por asma en la consulta externa del Hospital Neumológico Benéfico Jurídico (HNBJ) en el año 2014-2015, se comprobó por la clínica y la espirometría la severidad de la enfermedad. Entre las variables de estudio están: edad, sexo, antecedentes patológicos familiares de asma o alergia, índice de masa corporal, gravedad o severidad del asma. Resultados: Predominó el asma de mayor gravedad entre los pacientes comprendidos entre los 40-59 años, con riesgo 4,4 veces superior en mayores de 40 años. El sexo femenino presentó 2,1 veces más riesgo. El 75,5 por ciento de pacientes tenía antecedentes patológicos familiares (APF) de asma o alergia y riesgo 3,4 veces superior de mayor gravedad. Más de la mitad presentó antecedentes patológicos personales (APP) de otras enfermedades y mayor proporción de asma de mayor gravedad. El 53.6 por ciento presentó sobrepeso u obesidad y 4,1 veces más riesgo de mayor gravedad. La mayoría de los pacientes no presentó adicción tabáquica. Conclusiones: Los pacientes mayores de 40 años, sexo femenino y con APF de asma o alergia, presentan asma de mayor gravedad. La obesidad es frecuente en pacientes asmáticos y constituye un riesgo importante de padecer asma más grave. Existe bajo porcentaje de asmáticos fumadores aunque esta condición favorece a padecer un asma más grave(AU)


Introduction: The main functional alterations in bronchial asthma are the obstruction of the air flow, its reversibility, variability, and bronchial hyper- responsiveness. Objective: To determine the clinical and functional conditions in patients with asthma who go to the outpatient pneumology service for the first time. Material and Methods: A cross-sectional descriptive study was conducted in 110 patients with asthma that were treated for the first time in the outpatient department of the Pneumology Service at the "Benéfico Jurídico" Teaching Hospital in Havana from June 1st,2014 to June 31st,2015. The severity of asthma was confirmed by clinical diagnosis and spirometric tests. The variables consisted of age, sex, family pathological antecedents of asthma or allergy, body mass index, and seriousness or severity of asthma. Results: The most serious asthma prevailed in patients aged 40 to 59 years, and the patients 40 years old and older presented 4.4 times higher risks. The female sex exhibited 2.1 times higher risks. 75.5 percent of patients with family pathological antecedents (FPA) of asthma or allergy showed 3.4 times higher risk levels for more serious conditions. More than half of patients presented personal pathological antecedents (PPA) of other diseases and a more serious asthma. 53.6 percent were overweight or obese who were 4.1 times at higher risks of suffering from more serious conditions. Most patients did not report smoking addiction. Conclusions: Asthmatic patients over 40 years showed a more serious asthma during their first visit to the outpatient pneumology service, and the female sex prevailed. Asthma or allergy, FPA and PPA were the risk factors for suffering from both asthma and more serious conditions. There is a low percentage of smoking asthmatics although this condition provokes more serious symptoms(AU)


Subject(s)
Humans , Physicians' Offices/ethics , Pulmonary Medicine/methods , Clinical Study , Asthma/complications , Asthma/diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies
10.
West Indian med. j ; 67(3): 279-282, July-Sept. 2018.
Article in English | LILACS | ID: biblio-1045853

ABSTRACT

ABSTRACT Syncope, first described by Hippocrates, can be differentiated into neurological, cardiac and non-cardiac in origin, and this differentiation is of prognostic significance. The cardiac causes of syncope, which can be structural, electrophysiological or infectious, have a relatively poor prognosis and are associated with ethnicity, geographic location and sudden cardiac death. In decreasing frequency, the cardiac causes are hypertrophic cardiomyopathy, anomalous coronary arteries, Marfan Syndrome and dilated cardiomyopathy. Electrophysiological causes include supraventricular causes, Wolf-Parkinson-White syndrome, ion channelopathies, long QT syndrome and Brugada syndrome. The index case with bronchial asthma presented with syncope. There is an increased morbidity and mortality of this specific group of patients, if undiagnosed and not optimally treated; hence the need for a high index of suspicion and early diagnosis, after exclusion of cardiac and more common neurological causes. This is the first documented case of syncope secondary to bronchial asthma in an Afro-Caribbean.


RESUMEN El síncope, primeramente, descrito por Hipócrates, se puede clasificar como neurológico, cardíaco y no cardíaco atendiendo a su origen, y esta diferenciación tiene importancia pronóstica. Las causas cardíacas del síncope - que pueden ser estructurales, electrofisiológicas o infecciosas - tienen un pronóstico relativamente pobre y se asocian con la etnicidad, la localización geográfica y la muerte cardiaca repentina. En frecuencia decreciente, las causas cardíacas son la cardiomiopatía hipertrófica, las arterias coronarias anómalas, el síndrome de Marfan y la cardiomiopatía dilatada. Las causas electrofisiológicas incluyen las causas supraventriculares, el síndrome de Wolf-Parkinson-White, las canalopatías iónicas, el síndrome de QT largo, y el síndrome de Brugada. El caso índice con asma bronquial se presentó con síncope. Hay una mayor morbilidad y mortalidad de este grupo específico de pacientes, si no se diagnostica y no se trata de forma óptima. De ahí, la necesidad de un alto índice de suspicacia y diagnóstico temprano, luego de la exclusión de las causas cardíacas y las causas neurológicas más comunes. Éste es el primer caso documentado de síncope secundario al asma bronquial en un afrocaribeño.


Subject(s)
Humans , Female , Child , Asthma/complications , Asthma/diagnosis , Syncope/etiology , Severity of Illness Index , Exercise Test
11.
Rev. bras. enferm ; 71(2): 406-412, Mar.-Apr. 2018. tab, graf
Article in English | LILACS, BDENF | ID: biblio-898441

ABSTRACT

ABSTRACT Objective: To evaluate the psychometric properties in terms of validity and reliability of the scale Self-efficacy and their child's level of asthma control: Brazilian version. Method: Methodological study in which 216 parents/guardians of children with asthma participated. A construct validation (factor analysis and test of hypothesis by comparison of contrasted groups) and an analysis of reliability in terms of homogeneity (Cronbach's alpha) and stability (test-retest) were carried out. Results: Exploratory factor analysis proved suitable for the Brazilian version of the scale (Kaiser-Meyer-Olkim index of 0.879 and Bartlett's sphericity with p < 0.001). The correlation matrix in factor analysis suggested the removal of item 7 from the scale. Cronbach's alpha of the final scale, with 16 items, was 0.92. Conclusion: The Brazilian version of Self-efficacy and their child's level of asthma control presented psychometric properties that confirmed its validity and reliability.


RESUMEN Objetivo: Evaluar las propiedades psicométricas en términos de validez y confiabilidad de la escala Self-efficacy and their child's level of asthma control: versión brasileña. Método: Estudio metodológico del cual participaron 216 padres/cuidadores de niños con asma. Se procedió a la validación del constructo (análisis factorial y testeo de hipótesis por comparación de grupos contrastados), confiabilidad en términos de homogeneidad (alfa de Cronbach) y estabilidad (test-retest). Resultados: El análisis factorial exploratorio se mostró adecuado para la versión brasileña de la escala (Kaiser-Meyer-Olkim de 0,879 y esfericidad de Bartlett con p<0,001). La matriz de correlación en el análisis factorial sugirió el retiro del ítem 07, resultando el Alfa de Cronbach final de la escala con 16 ítems de 0,92. Conclusión: La versión brasileña de la Self-efficacy and their child's level of asthma control expresó propiedades psicométricas que comprueban su validez y confiabilidad.


RESUMO Objetivo: Avaliar as propriedades psicométricas em termos de validade e confiabilidade da escala Self-efficacy and their child's level of asthma control: versão brasileira. Método: Estudo metodológico em que participaram 216 pais/cuidadores de crianças com asma. Procederam-se a validação de construto (análise fatorial e testagem de hipóteses por comparação de grupos contrastados), confiabilidade em termos de homogeneidade (alfa de Cronbach) e estabilidade (teste-reteste). Resultados: A análise fatorial exploratória mostrou-se adequada para a versão brasileira da escala (Kaiser- Meyer-Olkim de 0,879 e a esfericidade de Bartlett com p<0,001). A matriz de correlação na análise fatorial sugeriu a retirada do item 07, sendo o Alfa de Cronbach final da escala com 16 itens de 0,92. Conclusão: A versão brasileira da Self-efficacy and their child's level of asthma control apresentou propriedades psicométricas que comprovam sua validade e confiabilidade.


Subject(s)
Humans , Male , Female , Adult , Parents/psychology , Psychometrics/standards , Asthma/psychology , Self Efficacy , Psychometrics/instrumentation , Psychometrics/methods , Asthma/complications , Brazil , Pilot Projects , Surveys and Questionnaires , Reproducibility of Results , Middle Aged
12.
Arch. argent. pediatr ; 116(2): 105-111, abr. 2018. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887455

ABSTRACT

Introducción. El asma grave representa 5-7% del total de asmáticos. La OMS propuso un protocolo de seguimiento para categorizarlos como asma grave resistente al tratamiento (AGRT) o asma grave de difícil control (AGDC). Objetivo. Analizar las características clínicas, funcionales y terapéuticas de pacientes con AGRT o AGDC. Métodos. Estudio transversal, observacional y analítico para evaluar el diagnóstico, grado de control (clínico y funcional), comorbilidades, adherencia al tratamiento, técnica inhalatoria y factores ambientales en pacientes con asma grave. Resultados. Se incluyeron 69 pacientes: AGRT (n= 33) y AGDC (n= 36). El 100% del grupo con AGRT fue hospitalizado previamente por asma vs. 87,8% del grupo con AGDC (p= 0,03). El 63% del grupo AGRT requirió cuidados intensivos (UCI)), 82%, asistencia ventilatoria y uno fue traqueostomizado. En el AGDC, 54% requirió internación en la UCI , y 33%, asistencia ventilatoria (p= 0,03). La espirometría basal fue normal en el AGDC; se observó incapacidad ventilatoria obstructiva leve en el AGRT (p= 0,009). En el AGDC, hubo menor cumplimiento del tratamiento (p= 0,01). Se requirieron dosis mayores de corticoides inhalados en AGRT (p= 0,0001). Omalizumab fue indicado en AGRT (p= 0,0001). A los 6 meses de seguimiento, más del 75% de los niños en ambos grupos presentó asma controlada. Conclusiones. Se observó significativa falta de adherencia al tratamiento en el grupo AGDC. Se redujeron las dosis de tratamiento en este grupo. Se logró controlar la enfermedad en un alto porcentaje de niños con AGRT y AGDC.


Introduction. Severe asthma accounts for 5-7% of all asthma cases. The World Health Organization proposed a follow-up protocol to classify cases into severe, treatment-resistant asthma (STRA) or severe, difficult-to-control asthma (SDCA). Objective. To analyze the clinical, functional, and therapeutic characteristics of patients with STRA or SDCA. Methods. Cross-sectional, observational, and analytical study to assess the diagnosis, the extent of control (clinical and functional), comorbidities, treatment adherence, inhalation technique, and environmental factors in patients with severe asthma. Results. A total of 69 patients were included: STRA (n= 33) and SDCA (n= 36). In the group with STRA, 100% of patients had been previously hospitalized due to asthma compared to 87.8% in the group with SDCA (p= 0.03). In the group with STRA, 63% required admission to the intensive care unit (ICU); 82%, ventilatory support; and 1 patient, tracheostomy. In the group with SDCA, 54% required admission to the ICU; and 33%, ventilatory support (p= 0.03). The baseline spirometry was normal in the SDCA group; a mild obstructive ventilatory defect was observed in the STRA group (p= 0.009). In the SDCA group, treatment adherence was lower (p= 0.01). Higher inhaled corticosteroid doses were required in the STRA group (p= 0.0001). Omalizumab was indicated in the case of STRA (p= 0.0001). After 6 months of follow-up, more than 75% of children in both groups achieved asthma control. Conclusions. A significant lack of treatment adherence was observed in the SDCA group. In this group, treatment doses were reduced. Asthma was controlled in a high percentage of children with STRA and SDCA.


Subject(s)
Humans , Male , Female , Child , Adolescent , Asthma/diagnosis , Asthma/etiology , Asthma/therapy , Severity of Illness Index , Asthma/complications , Clinical Protocols , Cross-Sectional Studies , Follow-Up Studies , Patient Compliance , Treatment Outcome , Combined Modality Therapy , Hospitalization
13.
Braz. J. Pharm. Sci. (Online) ; 54(3): e00049, 2018. tab, graf
Article in English | LILACS | ID: biblio-974404

ABSTRACT

Allergic asthma is a chronic, complex inflammatory disease of the airway. Despite extensive studies on the immunomodulation of T helper (Th) cell pathways (i.e., Th1 and Th2) in asthma, little is known about the effects of Th17 pathway modulation, particularly that involving peroxisome proliferator-activated receptors (PPARs). In response, two new thiazolidinedione derivatives-namely, LPSF-GQ-147 and LPSF-CR-35 were synthesized and evaluated for their immunomodulatory effects on Th17-related cytokines, including interferon γ (IFNγ), interleukin IL-6, IL-17, and IL-22 in the peripheral blood mononuclear cells of asthmatic children. Both compounds were nontoxic even at high concentrations (i.e., 100 µM). The LPSF-CR-35 compound significantly reduced the levels of IL-17A (p = .039) and IFNγ (p = .032) at 10 µM. For IL-22 and IL-6, significant reduction occurred at 100 µM (p = .039 and p = .02, respectively). Conversely, LPSF-GQ-147 did not significantly inhibit the production of the tested cytokines, the levels of all of which were more efficiently reduced by LPSF-CR-35 than methylprednisolone, the standard compound. Real-time polymerase chain reaction assay confirmed that LPSF-GQ-147 has significant PPARγ modulatory activity. Such data indicate that both LPSF-CR-35 and LPSF-GQ-147 are promising candidates as drugs for treating inflammation and asthma


Subject(s)
Animals , Male , Rats , Asthma/complications , Child , Thiazolidinediones/analysis , Cytokines/adverse effects , Th17 Cells
14.
Arch. argent. pediatr ; 115(4): 336-342, ago. 2017. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887344

ABSTRACT

Objetivo. Determinar la concentración de vitamina D en pacientes de entre 6 y 18 años de edad sometidos a un seguimiento por asma y la relación entre la concentración de vitamina D y el control y la gravedad del asma. Materiales y métodos. Se inscribió en el estudio a pacientes con asma y voluntarios sanos de entre 6 y 18 años de edad, asignados al grupo de pacientes y al grupo de referencia, respectivamente. Se registraron las características demográficas y los hallazgos clínicos de los pacientes, y se les realizó una prueba funcional respiratoria. Se estimaron el índice de masa corporal (IMC) y la concentración de 25-hidroxi vitamina D (25(OH)D), calcio, fósforo, fosfatasa alcalina, inmunoglobulina E total y eosinófilos de todos los pacientes. La gravedad del asma y las condiciones de control se determinaron según los criterios de la Iniciativa Global para el Asma (Global Initiative for Asthma, GINA). Resultados. Se incluyó a 72 pacientes con asma y a 66 niños sanos. En comparación con el grupo de referencia, en el grupo de pacientes se detectó una menor concentración de vitamina D. En 38 (52,8%) niños del grupo de pacientes con asma se observó deficiencia de vitamina D; en este grupo, el control del asma era deficiente y la gravedad, significativamente mayor. No se observó una correlación significativa entre la concentración de vitamina D y el sexo, la obesidad, las pruebas funcionales respiratorias, las pruebas cutáneas, la concentración sérica de eosinófilos e inmunoglobulina E (IgE) total. Conclusión. La deficiencia y la insuficiencia de vitamina D fueron más frecuentes en los niños con asma, en comparación con los niños del grupo de referencia. Una menor concentración de vitamina D se asocia con un control deficiente del asma y una mayor gravedad de esta.


Background. The objective was to determine vitamin D levels in patients between the ages 6 and 18 years, followed for asthma, and the relation between vitamin D levels and asthma control and severity. Materials and Methods. Patients with asthma and healthy volunteers between the ages 6 and 18 years were enrolled into the study as patient and control groups, respectively. Patient demographic information and clinical findings were recorded; a respiratory function test was performed. Body mass index (BMI), 25(OH) D,calcium, phosphorus, alkaline phosphatase, total IgE and eosinophil levels were determined for all patients. Asthma severity and control conditions were established based on GINA (Global Initiative for Asthma) criteria. Results. Seventy two patients with asthma and 66 healthy children were included. Compared to the control group, decreased serum vitamin D levels were detected in patient group. Thirty eight (52.8%) patients in asthma patient group had vitamin D defficiency; in this group, asthma control was poor and asthma severity was significantly higher. No significant correlation was found between vitamin D levels and gender, obesity, respiratory functions, skin test, serum eosinophil and total IgE levels. Conclusion. The frequency of vitamin D deficiency and insufficiency was higher in children with asthma, compared to the controls. Lower levels of vitamin D are associated with poor asthma control and increased asthma severity.


Subject(s)
Humans , Male , Female , Child , Adolescent , Asthma/complications , Vitamin D/analogs & derivatives , Asthma/blood , Asthma/therapy , Vitamin D/blood , Vitamin D Deficiency/complications , Severity of Illness Index , Cross-Sectional Studies
15.
Säo Paulo med. j ; 135(4): 332-338, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-904090

ABSTRACT

ABSTRACT CONTEXT AND OBJECTIVE: The combined effect of obesity and asthma may lead to significant impairment of quality of life (QOL). The aim here was to evaluate the prevalence of asthma among obese individuals, characterize the severity of impairment of quality of life and measure its relationship with pulmonary function. DESIGN AND SETTING: Observational cross-sectional study in public university hospital. METHODS: Morbidly obese individuals (body mass index > 40 kg/m2) seen in a bariatric surgery outpatient clinic and diagnosed with asthma, were included. Anthropometric data were collected, the Standardized Asthma Quality of Life Questionnaire (AQLQ(S)) was applied and spirometry was performed. The subjects were divided into two groups based on the median of the score in the questionnaire (worse < 4 and better > 4) and were compared regarding anthropometric data and pulmonary function. RESULTS: Among the 4791 individuals evaluated, 219 were asthmatic; the prevalence of asthma was 4.57%. Of these, 91 individuals were called to start multidisciplinary follow-up during the study period, of whom 82 answered the questionnaire. The median score in the AQLQ(S) was 3.96 points and, thus, the individuals were classified as having moderate impairment of their overall QOL. When divided according to better or worse QOL, there was a statistically difference in forced expiratory flow (FEF) 25-75%, with higher values in the better QOL group. CONCLUSION: The prevalence of asthma was 4.57% and QOL was impaired among the asthmatic obese individuals. The worst QOL domain related to environmental stimuli and the best QOL domain to limitations of the activities. Worse QOL was correlated with poorer values for FEF 25-75%.


RESUMO CONTEXTO E OBJETIVO: O efeito combinado de obesidade e asma pode levar a um comprometimento significativo da qualidade de vida (QV). O objetivo foi avaliar a prevalência de asma entre obesos, caracterizar a gravidade do comprometimento da QV e verificar sua relação com a função pulmonar. TIPO DE ESTUDO E LOCAL: Estudo transversal observacional em hospital universitário público. MÉTODOS: Foram incluídos indivíduos obesos mórbidos (indice de massa corporal > 40 kg/m2), acompanhados num ambulatório de cirurgia bariátrica e diagnosticados com asma. Foram coletados dados antropométricos e aplicado o Standardized Asthma Quality of Life Questionnaire (AQLQ (S)), bem como a espirometria. Os indivíduos foram divididos em dois grupos com base na mediana obtida no escore do questionário (pior < 4 e melhor = 4) e os grupos foram comparados aos dados antropométricos e função pulmonar. RESULTADOS: Dos 4.791 indivíduos avaliados, 219 eram asmáticos; a prevalência de asma foi de 4,57%. Destes, 91 indivíduos foram chamados para iniciar o acompanhamento multidisciplinar no período do estudo, sendo que 82 responderam ao questionário. A pontuação mediana do AQLQ (S) foi de 3,96 pontos, portanto, classificados com prejuízo moderado na QV global. Quando divididos por melhor ou pior QV, houve diferença estatística no fluxo expiratório forçado (FEF) 25-75%, com maior valor no grupo com melhor QV. CONCLUSÃO: A prevalência da asma na população estudada foi de 4,57% e há prejuízos na QV de obesos asmáticos, sendo o pior domínio de QV relacionado aos estímulos ambientais e o melhor domínio de QV relacionado às limitações das atividades. A pior QV se relacionou a piores valores de FEF 25-75%.


Subject(s)
Humans , Male , Female , Adult , Quality of Life/psychology , Asthma/psychology , Obesity/psychology , Respiratory Function Tests , Asthma/complications , Asthma/physiopathology , Severity of Illness Index , Prevalence , Cross-Sectional Studies , Risk Factors , Obesity/complications , Obesity/physiopathology
16.
Neumol. pediátr. (En línea) ; 12(3): 114-121, jul. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-999087

ABSTRACT

Pediatric acute asthma should be considered like an indicator of poor control of this disease of high prevalence. In acute refractory asthma there is no response to initial treatment with bronchodilators and corticosteroids. Although any asthmatic exacerbation in children and adolescents can progress to severe respiratory failure, poor response to first-line treatment is less frequent. In Chile pediatric asthma has government financial protection Despite widespread clinical guidelines, exacerbations remain a high health burden due to direct and indirect costs and are associated with school attendance and poor quality of life. A stepwise approach of asthma should consider written action plans that ensure the patient and his family early recognition of a crisis, a stepwise treatment in a pre-established time line and the continuity of medical actions from emergency unit to hospital care units. The objectives are to reduce morbimortality, health´s expenses and opportunity for educational actions. This article reviews some treatment options for children and adolescents who present with moderate and severe acute asthma in the emergency unit and are admitted to intermediate units. The focus is the initial management of the first 120 minutes of acute respiratory failure. We propose an algorithm that includes pharmacological management and respiratory care with high flow oxygen therapy and noninvasive ventilation assistance


El asma agudo en pediatría se debe entender como un indicador de mal control de esta enfermedad de alta prevalencia mundial. El asma agudo refractario es aquel que no responde en forma inicial al tratamiento combinado con broncodilatadores y corticoides. Pese a que cualquier exacerbación asmática en los niños y adolescentes puede progresar a una insuficiencia respiratoria grave, la mala respuesta al tratamiento de primera línea es menos frecuente. A pesar de contar con guías clínicas y en Chile ser el asma una garantía en salud, las agudizaciones representan alta carga sanitaria vinculadas con inasistencia escolar y mala calidad de vida. El manejo del asma, incluyendo planes de acción escritos destinados al reconocimiento precoz de una crisis, el tratamiento por etapas en una línea de tiempo preestablecida según objetivos y la continuidad necesaria desde el servicio de urgencia a los cuidados en la internación, fundamentalmente en cuidados intermedios, tiene como objetivos disminuir la morbimortalidad, reducir los gastos en salud y realizar acciones educativas. Este articulo revisa algunas alternativas de tratamiento escalonado para niños y adolescentes que se presenten con asma agudo moderado y severo en los servicios de urgencia y son ingresado en unidades de intermedio, enfocado en el manejo inicial de los primeros 120 minutos de la insuficiencia respiratoria aguda. Se propone un algoritmo que incluye el manejo farmacológico y la terapia respiratoria con oxigenoterapia de alto flujo y asistencia ventilatoria no invasiva


Subject(s)
Humans , Respiratory Insufficiency/therapy , Asthma/complications , Asthma/therapy , Respiratory Insufficiency/etiology , Asthma/diagnosis , Severity of Illness Index , Nebulizers and Vaporizers , Bronchodilator Agents/therapeutic use , Prednisone/therapeutic use , Noninvasive Ventilation
17.
Rev. chil. pediatr ; 88(2): 252-257, abr. 2017. tab
Article in Spanish | LILACS | ID: biblio-844607

ABSTRACT

La deficiencia de anticuerpos específicos con inmunoglobulinas séricas y linfocitos B normales (SAD) es una inmunodeficiencia primaria caracterizada por una capacidad alterada de responder a antígenos específicos, especialmente polisacáridos. OBJETIVO: Describir las características clínicas de pacientes con SAD y destacar la asociación entre una inmunodeficiencia primaria y enfermedades alérgicas. Pacientes y Método: Estudio descriptivo en enfermos con SAD atendidos en un hospital público entre agosto de 2007 y julio de 2015. Se descartó otra inmunodeficiencia primaria o secundaria. El diagnóstico se basó en infecciones recurrentes y una respuesta anormal a la vacuna neumocócica polisacárida con medición de IgG específica para 10 serotipos de neumococo. RESULTADOS: Se incluyeron 12 pacientes, 4 varones, con una edad promedio de 6 años; predominaron las neumonías recurrentes (91,7%) y otras infecciones respiratorias e invasivas. Los 12 enfermos con SAD tenían asma asociada; 11, rinitis alérgica y otras alergias. Tres pacientes no respondieron a ninguno de los 10 serotipos contenidos en la vacuna neumocócica polisacárida y la mayoría de los que lo hicieron fue a títulos bajos. El tratamiento con vacuna neumocócica conjugada fue favorable en 11/12 enfermos. CONCLUSIÓN: En niños mayores de 2 años con infecciones respiratorias recurrentes o infecciones invasivas por S. pneumoniae con inmunoglobulinas normales recomendamos investigar SAD, más aún si tienen enfermedad alérgica asociada.


Specific antibody deficiency (SAD) with normal immunoglobulin and normal B cells is a primary immunodeficiency characterized by reduced ability to produce antibodies to specific antigens especially polysaccharides. OBJECTIVE: To describe the characteristics of patients diagnosed with SAD emphasizing the association between primary immunodeficiency and allergic diseases. PATIENTS AND METHOD: Descriptive study showing patients with SAD treated at a public hospital between August 2007 and July 2015. Other secondary or primary immunodeficiency was discarded. The diagnosis of SAD was based on recurrent infections and abnormal response to pneumococcal polysaccharide vaccine assessed by specific IgG to 10 pneumococcal serotypes. Results: Twelve patients were included, 4 males, mean age 6 years, recurrent pneumonia predominated (91.7%) as well as other respiratory and invasive infections. All patients with SAD had associated asthma, 11 had allergic rhinitis, and other allergies. Three patients did not respond to any of the 10 serotypes contained in pneumococcal polysaccharide vaccine, and those who responded were with low titers. Treatment with conjugate pneumococcal vaccine was favorable in 11/12 patients. CONCLUSION: In children older than 2 years with recurrent respiratory infections or invasive S. pneumoniae infections with normal immunoglobulin we recommend to investigate SAD, especially if they have a concurrent allergic disease.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Asthma/complications , Rhinitis, Allergic/complications , Immunologic Deficiency Syndromes/diagnosis , Asthma/immunology , Rhinitis, Allergic/immunology , Immunologic Deficiency Syndromes/complications , Immunologic Deficiency Syndromes/immunology
18.
Lima; s.n; nov. 2016.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848272

ABSTRACT

INTRODUCCIÓN: Antecedentes: El presente dictamen expone la evaluación de tecnología de la eficacia y seguridad de omalizumab en el tratamiento de pacientes con asma alérgica persistente severa no controlada con ek tratamiento estándar optimizado (refractaria). Aspectos Generales: El asma es una condición inflamatoria crónica de las vías aéreas caracterizada por producción de esputo, obstrucción del flujo aéreo y tos. Los sintomas varian en frecuencia y en gravedad, deste intermitente leve, hasta persistente severa. Existen dos forma de asma: alérgica y no alérgica. El asma alérgica es el resultado de una producción excesiva de inmunoglobulina E (IgE) en respuesta a alérgenos ambientales como los ácaros del polvo de la casa, el polen y los hongos. El asma no alérgica puede ser desencadeada por factores como la ansiedad, el estrés, el ejercício, el aire frio, el humo y la infección. Tecnología Sanitaria de Interés: El Omalizumab, también conocido como rhuMAb-E25, rhu-Mab o Xolair, es un anticuerpo IgG1 monoclonal recombinante humanizado que se une a la Ig-E. Este anticuerpo anti-IgE forma complejos con los IgE libres, y de esta manera bloquea la interacción entre la IgE y las células inflamatorias. METODOLOGÍA: Estrategia de Búsqueda: Se realizó una búsqueda de la literatura con respecto a la eficacia y seguridad de omalizumab como agente adicional al tratamiento estándar optimizado de pacientes con asma alérgica persistente severa no controlada (o refractaria) a pesar del uso de altas dosis de CE!, beta 2 agonistas de acción prolongada y corticoesteroides orales.Esta búsqueda se realizó utilizando los meta-buscadores: Translating Research into Practice (TRIPDATABASE). national Library of Medicine (Pubmed-Medline) y Health System Evidence. Adicionalmente, se amplió la búsqueda revisando la evidencia generada por grupos internacionales que realizan revisiones sistemáticas (RS), evaluación de tecnologías sanitarias (ETS) y guías de práctica clínica (GPC), tales como la Cochrane Group, The National Institute for Helath and Care Excellence (NICE), the Agency for Helath care Research and Quality (AHRQ), The Canadian Agency for Drugs and Technologies in Helath (CADTH) y The Scottish Medicines Consortium (SMC). Esta búsqueda se completó ingresando a la página web www.clinicaltrials.gov, para así poder indentificar ensayos clínicos en elaboración o queno hayan sido publicados aún, y así disminuir el riesgo de sesgo de publicación. RESULTADOS: Sinopsis de la Evidencia: Se realizó la búsqueda bibliográfica y de evidencia científica para el sustento del uso de omalizumab como agente adicional al tratamiento estándar optimizado de pacientes con asma alérgica persistente severa no controlada (o refractaria) a pesar del uso de altas dosis de CEI, beta 2 agonistas de acción prolongada y CEO. Se presenta la evidencia disponible según el tipo de publicación en los criterios de inclusión. CONCLUSIONES: El asma alérgico es resultado de una producción excesiva de inmunoglobulina E (IgE) en respuesta a alérgenos ambientales como los ácaros del polvo de la casa, el polen y los hongos. Los pacientes con asma alérgica persistente severa no controlada tienen alto riesgo de padecer excerbaciones, hospitalizaciones y menor calidad de vida. Los pacientes que recibieron omalizumab experimentaron significativamente menos eventos adversos serios como la anafilaxia y los eventos trombólicos que aquellos que recibieron palcebo. Los eventos adversos más comunes en el grupo que uso omalizumab fueron las reacciones del sitio de la inyección. Respecto a la mortalidad, no se obervaron diferencias significativas entre el grupo de omalizumab s.c y placebo. Los pacientes de interés es esta evaluación son pacientes con el mayor grado de severidad de asma alérgica, que no consiguen el control de la enfermedad a pesar del tratamiento optimizado del último escalón del manejo del asma recomendado por las GPCs internacionales, que incluyen el uso de corticoides orales. Estos pacientes ya hicieron uso de todos los agentes disponibles recomendados, y necesitan de otros agentes para controlar la enfermedad. Omalizumab puede ser considerado como un medicamento adicional al tratamiento estándar óptimo para reducir la tasa de exacerbaciones, clinicamente significativas y severas del grupo más severo de pacientes con asma alértica, evitando así el uso de los recursos de salud y la reducción de la frecuencia de CEO. El benefício en la reuucción del uso de CEO se reflejaria en menor riesgo de exposición para desarrollar un enorme número de eventos adversos asociados. En este grupo se encuentran la fractura ósea, diabetes mellitus, ulcera péptica, infarto de miocardio, ictus cerebral, cataratas, glaucoma, disturbios del sueño y del ánimo, y ganancia de peso. El Instituto de Evaluación de Tecnologías Sanitarias-IETSI, aprueba por el período de un año a partir de la fecha de publicación del presente dictamen preliminar el uso de omalizumab para el tratamiento de pacientes con asma alérgico mediado por IgE persistente severo. Asimismo, debido a que la evidencia del benefício de omalizumab en este tipo de pacientes no es robusta, se establece que el efecto del uso de este medicamento se evaluará con datos de los pacientes que hayan recibido el tratamiento por el tiempo autorizado, incluyendo evaluación económica para determinar su impacto. Esta información servirá para una reevaluació del medicamento, incluyendo una evaluación económica al terminar la vigencia de este dictamen.


Subject(s)
Humans , Asthma/drug therapy , Rhinitis, Allergic/drug therapy , Omalizumab/administration & dosage , Asthma/complications , Technology Assessment, Biomedical , Cost-Benefit Analysis , Rhinitis, Allergic/complications
19.
Rev. paul. pediatr ; 34(3): 271-280, July-Sept. 2016. tab, ilus
Article in English | LILACS | ID: lil-794967

ABSTRACT

OBJECTIVE: To assess the prevalence, spirometry findings and risk factors for asthma in schoolchildren who were very low birth weight infants with and without bronchopulmonary dysplasia. METHODS: Observational and cross-sectional study. The parents and/or tutors answered the International Study of Asthma and Allergies in Childhood questionnaire. The schoolchildren were submitted to the skin prick test and spirometry assessment. RESULTS: 54 schoolchildren who were very low birth weight infants were assessed and 43 met the criteria for spirometry. Age at the assessment (bronchopulmonary dysplasia=9.5±0.85; without bronchopulmonary dysplasia=10.1±0.86 years) and birth weight (bronchopulmonary dysplasia=916.7±251.2; without bronchopulmonary dysplasia=1171.3±190.5g) were lower in the group with bronchopulmonary dysplasia (p<0.05). The prevalence of asthma among very low birth weight infants was 17/54 (31.5%), being 6/18 (33.3%) in the group with bronchopulmonary dysplasia. There was an association between wool blanket use in the first year of life (p=0.026) with the presence of asthma at school age. The skin prick test was positive in 13/17 (76.5%) and 23/37 (62.2%) of patients with and without asthma, respectively. The schoolchildren with asthma had lower z-score values of forced expiratory flow between 25% and 75% of forced vital capacity (n=16;−1.04±1.19) when compared to the group of patients without asthma (n=27;−0.380.93) (p=0.049). There was no difference between the spirometry variables in the groups regarding the presence or absence of bronchopulmonary dysplasia. CONCLUSIONS: Very low birth weight infants with and without bronchopulmonary dysplasia showed a high prevalence of asthma (33.3% and 30.6%, respectively). Pulmonary flow in the small airways was lower in children with asthma.


OBJETIVO: Avaliar prevalência, espirometria e fatores de risco para asma em escolares que foram recém-nascidos de muito baixo peso com e sem displasia broncopulmonar. MÉTODOS: Estudo observacional e transversal. Aplicou-se aos pais e/ou responsáveis o questionário International Study of Asthma and Allergies in Childhood. Foi feito teste cutâneo de hipersensibilidade imediata e espirometria nos escolares. RESULTADOS: Avaliados 54 escolares que foram recém-nascidos de muito baixo peso e 43 preencheram critérios para espirometria. A idade na avaliação (displasia broncopulmonar=9,5±0,85; sem displasia broncopulmonar=10,1±0,86 anos) e o peso de nascimento (displasia broncopulmonar=916,7±251,2; sem displasia broncopulmonar=1.171,3±190,5 g) foram menores no grupo com displasia broncopulmonar (p<0,05). A prevalência de asma entre os recém-nascidos de muito baixo peso foi de 17/54 (31,5%); no grupo com displasia broncopulmonar, de 6/18 (33,3%). Houve associação entre uso de cobertor de lã no primeiro ano de vida (p=0,026) com presença de asma na idade escolar. O teste cutâneo de hipersensibilidade imediata foi positivo em 13/17 (76,5%) e 23/37 (62,2%) nos grupos com e sem asma, respectivamente. Os escolares com asma apresentaram menores valores em z-score do fluxo expiratório forçado entre 25% e 75% da capacidade vital forçada (n=16; −1,04±1,19) comparados com os do grupo de pacientes sem asma (n=27; −0,38±0,93) (p=0,049). Não houve diferença entre as variáveis da espirometria no grupo com relação à presença ou não de displasia broncopulmonar. CONCLUSÕES: Os recém-nascidos de muito baixo peso, com e sem displasia broncopulmonar, apresentaram prevalência elevada de asma (33,3% e 30,6%, respectivamente). Os fluxos pulmonares das pequenas vias aéreas foram menores nos escolares com asma.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Asthma/complications , Bronchopulmonary Dysplasia/complications , Infant, Very Low Birth Weight , Premature Birth , School Health Services
20.
Rev. cuba. med. gen. integr ; 32(2): 191-201, abr.-jun. 2016. tab
Article in Spanish | LILACS | ID: biblio-844954

ABSTRACT

Introducción: el humo ambiental del tabaco es un riesgo significativo para la salud de los niños pequeños. Se pretende estudiar el papel del tabaquismo pasivo en el padecimiento de asma en niños. Objetivo: identificar la presencia de tabaquismo pasivo y su asociación con la recurrencia de crisis en niños asmáticos de edad escolar. Métodos: estudio longitudinal de casos y controles (n= 320) en el servicio de Alergología del Hospital Pediátrico Universitario "William Soler" de La Habana, en el período comprendido entre febrero 2014 y enero 2015. Se aplicó una encuesta de factores ambientales a todos los sujetos participantes. La construcción y validación de la misma se realizó por un grupo de expertos. Se utilizaron medidas de resumen para variables cualitativas (porcentajes). Para valorar la asociación entre factores de riesgo se aplicó la prueba de X2 y razón de momios (Odds Ratio, OR), como medida de la fuerza de esa relación con su estimación puntual y por intervalos de confianza de 95 por ciento. Se fijó un nivel de significación de 0,05. Resultados: la exposición al humo del tabaco estuvo presente en el 75 por ciento de los niños con recurrencia de crisis de asma, con OR de 3,6; de ellos el 72,5 por ciento tenían padres fumadores, con un OR de 4,89. Conclusiones: el tabaquismo pasivo, con especial significación la presencia de padres fumadores, fue el factor de riesgo más importante para la recurrencia de las crisis de asma en el grupo de estudio(AU)


Introduction: environmental tobacco smoke is a significant risk for the health of younger children. We intend to study the role of passive smoking to asthma suffering in children. Objective: to identify the presence of passive smoking and its association with relapsing crisis in asthmatic preschool children. Methods: longitudinal case-control study (n=320) at the Allergology service of William Soler University Pediatric Hospital of Havana, in the time from February 2014 and Janu8ary 2015. We conducted an environmental factors survey to all the participant individuals. Construction and validation of such survey was carried out by a group of experts. We used summarizing measures for qualitative variables (percentages). To assess the association among risk factors we applied the chi-square test and the odds ratio, as to measure the strength of the relation with it score estimate and by confidence intervals at 95 percent. We fixed a significance level of 0.05. Results: exposition to tobacco smoke was present in 75 percent of the children with asthmatic crisis relapsing, with OR of 3.6; out of which 72.5 percent had smoking parents, with OR of 4.89. Conclusions: passive smoking, specially the presence of smoking parents, was the most important risk factor for the relapse of asthmatic crisis in the studied group(AU)


Subject(s)
Humans , Child, Preschool , Child , Asthma/complications , Tobacco Smoke Pollution/prevention & control
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