Prevalence of chronic respiratory diseases and medication use among children and adolescents in Brazil - a population based cross-sectional study / Prevalência de doenças respiratórias crônicas e uso de medicamentos entre crianças e adolescentes no Brasil - um estudo transversal de base populacional

Abstract Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil),a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting β2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population.

Resumo Objetivos: descrever a prevalência de doenças respiratórias crônicas e seu manejo farmacológico em crianças e adolescentes no Brasil. Métodos: foram analisados os dados da Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), um estudo transversal de base populacional. As pesquisas domiciliares foram realizadas entre setembro de 2013 e fevereiro de 2014. Incluímos a população com menos de 20 anos de idade com doenças respiratórias crônicas. Foi avaliada a prevalência de doença, indicação de tratamento farmacológico e seu uso. Resultados: a prevalência de doenças respiratórias crônicas em menores de 6 anos foi de 6,1% (IC95%= 5,0-7,4), 4,7% (IC95%= 3,4-6,4) naqueles 6-12 anos e 3,9% (IC95%= 2,8-5,4) em crianças com 13 anos ou mais. Crianças menores de 6 anos apresentaram uma maior prevalência de indicação de tratamento farmacológico (74,6%; IC95%= 66,0-81,7), assim como uso de medicamentos (72,6%; IC95%= 62,8-80,7). Dos usuários de inaladores, 56,6% relataram o uso com espaçador. As classes farmacológicas mais frequentemente relatadas foram β2 agonistas de curta ação (19,0%), seguidos por anti-histamínicos (17,2%). Conclusão: crianças e adolescentes que relatam doenças respiratórias crônicas residentes em áreas urbanas no Brasil parecem ser subtratados para suas condições crônicas. O tratamento farmacológico, mesmo quando indicado, não foi utilizado em sua totalidade, um achado importante para a tomada de decisão nessa população.

Asthma treatment in children and adolescents in an urban area in southern Brazil: popular myths and features / Mitos populares e características do tratamento da asma em crianças e adolescentes de zona urbana do sul do Brasil

Objective: To describe the frequency of popular myths about and features of asthma treatment in children and adolescents in an urban area in southern Brazil. Methods: The parents or legal guardians of public school students (8-16 years of age) completed a specific questionnaire regarding their understanding of asthma, asthma control, and treatment characteristics. The sample included parents or legal guardians of students with asthma (n = 127) and healthy controls (n = 124). Results: The study involved 251 parents or legal guardians, of whom 127 (68.5%) were the mothers and 130 (51.8%) were White. The mean age of these participants was 38.47 ± 12.07 years. Of the participants in the asthma and control groups, 37 (29.1%) and 26 (21.0%), respectively, reported being afraid of using asthma medications, whereas 61 (48%) and 56 (45.2%), respectively, believed that using a metered dose inhaler can lead to drug dependence. However, only 17 (13.4%) and 17 (13.7%) of the participants in the asthma and control groups, respectively, reported being afraid of using oral corticosteroids. In the asthma group, 55 students (43.3%) were diagnosed with uncontrolled asthma, only 41 (32.3%) had a prescription or written treatment plan, and 38 (29.9%) used asthma medications regularly. Conclusions: Popular myths about asthma treatment were common in our sample, as were uncontrolled asthma and inappropriate asthma management. Further studies in this field should be conducted in other developing countries, as should evaluations of pediatric asthma treatment programs in public health systems.

Objetivo: Descrever a frequência de mitos populares e as características do tratamento em asma em crianças e adolescentes em uma amostra urbana no sul do Brasil. Métodos: Foi aplicado um questionário específico, contendo perguntas sobre entendimento da doença, controle da asma e características do tratamento a pais/responsáveis de escolares da rede pública (8-16 anos de idade) com diagnóstico de asma (n = 127) e de controles saudáveis (n = 124). Resultados: Participaram do estudo 251 pais/responsáveis, com predomínio de mães como acompanhantes dos escolares (n = 127; 68,5%) e de etnia caucasiana (n = 130; 51,8%), com média de idade de 38,47 ± 12,07 anos. Sobre os mitos, 37 (29,1%) dos participantes do grupo asma e 26 (21,0%) dos do grupo controle relataram possuir receio de utilizar medicamentos para asma, e 61 (48%) e 56 (45,2%), respectivamente, acreditam que os inaladores pressurizados podem levar a dependência ao fármaco. No entanto, apenas 17 (13,4%) dos participantes do grupo asma e 17 (13,7%) dos do grupo controle relataram ter receio de utilizar corticoide oral. A ausência de controle da asma foi detectada em 55 (43,3%) dos escolares no grupo asma, apenas 41 (32,3%) possuíam uma receita ou um plano por escrito de como tratar da asma e 38 (29,9%) fazia uso contínuo de medicamentos para a doença. Conclusões: A presença de mitos populares sobre o tratamento da asma, a falta de controle da doença e seu manejo inadequado mostraram ser elevados nesta amostra. Nossos achados apontam para a necessidade de novos estudos nesse campo em países em desenvolvimento e de uma avaliação dos programas de manejo da asma pediátrica na saúde pública.

Status of inhalation therapy in bronchial asthma in adults above twelve years of age in armed forces.

OBJECTIVE: The aim of this study was to evaluate the status of inhalation therapy in bronchial asthma in terms of frequency of its use, role of general physicians and general practitioners in prescribing inhalation therapy, role of inhaled steroids and B2 agonists, concurrent use of oral drugs, technique of using inhaler devices, use of spacer devices and peak flow monitoring. MATERIAL AND METHODS: 150 patients (76 males, 74 females) of bronchial asthma over 12 years of age referred to chest clinic of a tertiary care hospital for inadequate control were interviewed on the basis of a questionnaire and screening of prescription and case records wherever available. RESULTS: 127 (84.6%) patients were on inhalation therapy and maximum number of prescriptions was by general physicians (81%). The dosages of inhaled steroids were less than 400 mg in 60 (83.3%) cases and 26 (36%) patients discontinued it after some time. All patients were on beta-2 agonist inhalers and 74 (58.3%) patients were using these on regular basis. The concurrent use of oral short acting B2 agonist and oral steroids was seen in 107 (84%) and 41 (32.2%) patients respectively. Metered dose inhalers (MDIs) were most frequently used inhaler devices in 100 (78.7%) cases followed by rotahalers in 27 (21%) cases. The technique of using MDI and rotahalers was incorrect in 64 (64%) and 7 (25.9%) cases respectively. Spacer devices were used rarely and none of the patients were monitored by peak flow rates. CONCLUSIONS: Although inhalation therapy was being prescribed in large number of patients, more so by general physicians, yet the therapy was not being effective considering the fact that the referral to chest clinic in all the cases was for uncontrolled asthma. The main reasons for ineffective inhalation therapy were, underuse of inhaled steroids, overuse of B2 agonists and incorrect use of inhaler devices. There is an urgent need to educate general physicians especially in regards to usefulness of inhaled steroids, as on demand use of B2 agonists, demonstration of correct inhalation technique to patients, use of spaces devices and peak flow monitoring.