Seguimiento de niños con diagnóstico de asma grave antes y durante la pandemia por COVID-19 / Follow-up of children diagnosed with severe asthma before and during the COVID-19 pandemic

En la pandemia por COVID-19 se exploraron estrategias de atención para garantizar el seguimiento de niños con asma grave. Estudio prospectivo, observacional, comparativo. Se incluyeron pacientes del programa de asma grave de un hospital pediátrico de tercer nivel (n 74). Se evaluó el grado de control, exacerbaciones y hospitalizaciones durante un período presencial (PP), marzo 2019-2020, y uno virtual (PV), abril 2020-2021. En el PP, se incluyeron 74 pacientes vs. 68 (92 %) del PV. En el PP, el 68 % (46) de los pacientes presentaron exacerbaciones vs. el 46 % (31) de los pacientes en el PV (p 0,003). En el PP, se registraron 135 exacerbaciones totales vs. 79 en el PV (p 0,001); hubo una reducción del 41 %. En el PP, el 47 % (32) de los pacientes tuvieron exacerbaciones graves vs. el 32 % (22) de los pacientes en el PV (p 0,048). Hubo 91 exacerbaciones graves en el PP vs. 49 en el PV (p 0,029), reducción del 46 %. No hubo diferencias en las hospitalizaciones (PP 10, PV 6; p 0,9). La telemedicina fue efectiva para el seguimiento de pacientes con asma grave

During the COVID-19 pandemic, health care strategies were explored to ensure the follow-up of children with severe asthma. This was a prospective, observational, and comparative study. Patients in the severe asthma program of a tertiary care children's hospital were included (n: 74). The extent of control, exacerbations, and hospitalizations during an in-person period (IPP) (March 2019­2020) and an online period (OP) (April 2020­2021) was assessed. A total of 74 patients were enrolled in the IPP compared to 68 (92%) in the OP. During the IPP, 68% (46) of patients had exacerbations versus 46% (31) during the OP (p = 0.003). During the IPP, 135 total exacerbations were recorded compared to 79 during the OP (p = 0.001); this accounted for a 41% reduction. During the IPP, 47% (32) of patients had severe exacerbations versus 32% (22) during the OP (p = 0.048). A total of 91 severe exacerbations were recorded during the IPP compared to 49 during the OP (p = 0.029); the reduction was 46%. No differences were observed in terms of hospitalization (IPP: 10, OP: 6; p = 0,9). Telemedicine was effective for the follow-up of patients with severe asthma.

Overprescription of short-acting β2 agonists: reflections from the SABINA study in Brazil / Prescrição excessiva de β2-agonistas de curta duração: reflexões a partir do estudo SABINA no Brasil

ABSTRACT Objective: To assess prescription patterns for short-acting b2 agonists (SABAs) and other asthma medications in asthma patients treated by specialists and participating in the SABA use IN Asthma (SABINA) study in Brazil. Methods: This was an observational, cross-sectional study conducted at five sites in different regions of Brazil. The primary endpoints were to record SABA prescriptions and obtain data on over-the-counter (OTC) SABA purchases at the pharmacy. Results: Data on 218 asthma patients were analyzed. Of those 218 patients, 80.3% were prescribed SABAs in addition to their maintenance therapy, with a mean of 11.2 SABA canisters in the previous 12 months. Of those patients, 71.4% were prescribed ≥ 3 canisters and 42.2% were prescribed ≥ 10 canisters. None of the patients were prescribed SABA monotherapy. A total of 14.2% of the patients reported purchasing SABAs OTC at a pharmacy without a prescription. Of those, 48.4% purchased ≥ 3 SABA canisters. A fixed-dose combination of an inhaled corticosteroid and a long-acting b2 agonist was prescribed to 95.0% of the patients. In the year before the study visit, 45.0% of the patients received at least one course of oral corticosteroid burst treatment. Asthma was well controlled in 43.1% of the patients, partly controlled in 34.9%, and uncontrolled in 22.0%. Patients reported a mean of 1.1 severe asthma exacerbations, with 49.1% experiencing 1 or more severe exacerbations. Conclusions: Overprescription and OTC purchases of SABAs are common in Brazil, possibly leading to the need for courses of oral corticosteroids. The health care community should collaborate to implement evidence-based recommendations and promote health education to improve asthma management in Brazil.

RESUMO Objetivo: Avaliar os padrões de prescrição de short-acting b2 agonists (SABAs, b2-agonistas de curta duração) e outros medicamentos para asma em pacientes tratados por especialistas e participantes do estudo SABA use IN Asthma (SABINA) no Brasil. Métodos: Trata-se de um estudo transversal observacional realizado em cinco locais em diferentes regiões do Brasil. Os desfechos primários foram registrar as prescrições de SABAs e obter dados a respeito da compra de SABAs sem receita médica na farmácia. Resultados: Foram analisados dados a respeito de 218 pacientes com asma. Dos 218 pacientes, 80,3% receberam prescrição de SABA além da terapia de manutenção, com uma média de 11,2 frascos de SABA nos 12 meses anteriores. Destes, 71,4% receberam prescrição de ≥ 3 frascos e 42,2% receberam prescrição de ≥ 10 frascos. Nenhum dos pacientes recebeu prescrição de monoterapia com SABA. Do total de pacientes, 14,2% relataram que compraram SABAs sem receita médica na farmácia. Destes, 48,4% compraram ≥ 3 frascos de SABA. Foram prescritas doses fixas combinadas de corticosteroide inalatório e b2-agonista de longa duração para 95,0% dos pacientes. No ano anterior à visita do estudo, 45,0% dos pacientes receberam pelo menos um ciclo de tratamento de curta duração com corticosteroide oral. A asma estava bem controlada em 43,1% dos pacientes, parcialmente controlada em 34,9% e não controlada em 22,0%. Os pacientes relataram uma média de 1,1 exacerbações graves da asma, sendo que 49,1% apresentaram uma ou mais exacerbações graves. Conclusões: A prescrição excessiva e a compra de SABAs sem receita médica são comuns no Brasil e possivelmente levam à necessidade de uso de corticosteroides orais. A comunidade de profissionais de saúde deve colaborar para implantar recomendações baseadas em evidências e promover a educação em saúde para melhorar o manejo da asma no Brasil.

Serum interleukin-33 combined with FEF75% z-score and FeNO improves the diagnostic accuracy of asthma in children

Abstract Objective To investigate the diagnostic efficacy of serum IL-33 single indicator and combined indicators for asthma in children. Methods 132 children were initially diagnosed with asthma during acute exacerbation and 100 healthy children were included. Serum IL-33 concentration differences were compared between asthmatic and normal children. Correlations between IL-33 with pulmonary function parameters, FeNO, peripheral blood EOS counts and serum total IgE were analyzed in asthmatic children. ROC curves were used to assess IL-33 diagnostic efficacy and its combined indicators. To prevent overfitting of the predictive model, the hold-out cross-validation method was used. Results (1) Serum IL-33 concentrations were significantly higher in children with asthma than in normal children (p < 0.001). (2) IL-33 concentration was negatively correlated with FVC z-score, FEV1 z-score and FEF75% z-score in asthmatic children (p < 0.05). (3) The area under the ROC curve of IL-33 was 0.821, which was higher than those of FeNO, FVC z-score, and FEV1 z-score. (4) Cross-validation of the combined indicators showed that IL-33 significantly improved asthma diagnostic efficacy. The combination of IL-33, FEF75% z-score, and FeNO showed the highest diagnostic efficacy, with the AUC, sensitivity, and specificity of the combined indicator being 0.954, 90.1%, and 89. 0%, respectively, and good extrapolation of the predictive model. Conclusion Serum IL-33 is higher in children with asthma and increases with the severity of pulmonary ventilation obstruction. A single indicator of serum IL-33 demonstrates moderate diagnostic accuracy, and its combination with FEF75% z-score and FeNO significantly improves the diagnostic accuracy in childhood asthma.

Maternal overweight and obesity before pregnancy as predictors of childhood asthma in children under five years: a retrospective cohort in Peru / Sobrepeso y obesidad materna antes del embarazo como predictores de asma infantil en menores de cinco años: una cohorte retrospectiva en Perú

Abstract Objectives: to estimate the role of maternal overweight and obesity before pregnancy as predictors of childhood asthma in a population of Peruvian children under five years. Methods: we carried out a retrospective cohort study of children aged five years or less and their mothers from the Regional Hospital of Ayacucho and the María Auxiliadora Hospital in Lima, Peru. We included children who were born between 2013 and 2014 and follow them up until 2018 and 2019, respectively. The diagnosis of overweight and obesity of the mother before pregnancy and asthma in the child were registered in their clinical histories. Crude (cRR) and adjusted relative risks (aRR) and 95% confidence intervals (CI95%) were obtained using a generalized lineal model of the Poisson family with link log and robust variances. Results: we evaluated 431 medical records and found that 20.9% of the children had asthma, 26.7% of the mothers were overweight, and 20.2% were obese before pregnancy. In the adjusted regression model, overweight (aRR=2.94; CI95%= 1.54-5.60) and maternal obesity (aRR=5.10; CI95%= 2.73-9.51) were predictors of an increased risk of childhood asthma. Conclusions: maternal overweight and maternal obesity increased the risk of her children developing asthma threeand five-fold, respectively.

Resumen Objetivos: estimar el papel del sobrepeso y la obesidad materna antes del embarazo como predictores de asma infantil en una población de niños peruanos menores de cinco años. Métodos: realizamos un estudio de cohorte retrospectivo de niños de cinco años o menos y sus madres del Hospital Regional de Ayacucho y del Hospital María Auxiliadora de Lima, Perú. Se incluyeron niños nacidos entre 2013 y 2014 y se les dio seguimiento hasta 2018 y 2019, respectivamente. El diagnóstico de sobrepeso y obesidad de la madre antes del embarazo y asma en el niño fueron registrados en sus historias clínicas. Los riesgos relativos crudos (cRR) y ajustados (RRa) y los intervalos de confianza del 95% (IC95%) se obtuvieron mediante un modelo lineal generalizado de la familia de Poisson con log de enlace y varianzas robustas. Resultados: se evaluaron 431 historias clínicas y se encontró que el 20,9% de los niños tenían asma, el 26,7% de las madres tenían sobrepeso y el 20,2% eran obesas antes del embarazo. En el modelo de regresión ajustada, el sobrepeso (aRR=2,94; IC95%= 1,54-5,60) y obesidad materna (RRa=5,10; IC95%= 2,73-9,51) fueron predictores de un mayor riesgo de asma infantil. Conclusiones: el sobrepeso materno y la obesidad materna aumentaron tres y cinco veces el riesgo de que sus hijos desarrollaran asma, respectivamente.

Mapping the literature on the qualitative approach to childhood asthma from 1996 to 2018: a bibliometric analysis / Mapeo de la literatura sobre el enfoque cualitativo del asma infantil desde 1996 hasta 2018: un análisis bibliométrico

Resumo Objectives: to describe the scientific production of qualitative studies in childhood asthma. Methods: bibliometric analysis. Articles were from Web of Science, Scopus, Cochrane, and PubMed (1996-2018), using the search terms asthma, children, qualitative research, qualitative study, qualitative analysis, ethnographic, phenomenology and narrative. Results: 258 articles were retrieved from 143 journals, representing 1.2% of scientific articles on childhood asthma. The growth rate was high. Authorship included 969 authors (85.3% occasional) from 279 institutions. 94.2% were co-authored and 3.5% were international collaborations. The greatest number of articles were from the United States (45.3%), United Kingdom (17.4%) and Canada (7.4%). The categories with the highest number of articles were Nursing & Public, Environmental & Occupational Health (18.2%), Respiratory System (10.1%) and Allergy (7.7%). 99.7% of the articles were in English. Conclusion: these results show a lack of consolidation of the literature based on qualitative studies on childhood asthma with a high percentage of occasional authors and limited international collaboration, indicating a need to strengthen this approach.

Resumen Objetivos: describir la producción científica de los estudios cualitativos sobre el asma infantil. Métodos: análisis bibliométrico. Los artículos procedían de Web of Science, Scopus, Cochrane y PubMed (1996-2018), utilizando los términos de búsqueda asthma, children, qualitative research, qualitative study, qualitative analysis, ethnographic, phenomenology y narrative. Resultados: se recuperaron 258 artículos de 143 revistas, lo que representa el 1,2% de los artículos científicos sobre asma infantil. La tasa de crecimiento fue elevada. La autoría incluyó 969 autores (85,3% ocasionales) de 279 instituciones. El 94,2% fueron coautores y el 3,5% colaboraciones internacionales. El mayor número de artículos procedió de Estados Unidos (45,3%), Reino Unido (17,4%) y Canadá (7,4%). Las categorías con mayor número de artículos fueron Enfermería y Salud Pública, Ambiental y Ocupacional (18,2%), Aparato Respiratorio (10,1%) y Alergia (7,7%). El 99,7% de los artículos estaban en inglés. Conclusión: estos resultados muestran una falta de consolidación de la literatura basada en estudios cualitativos sobre el asma infantil, con un alto porcentaje de autores ocasionales y una limitada colaboración internacional, lo que indica la necesidad de reforzar este enfoque.

Risk factors and determinants of pulmonary function impairments in chronic respiratory diseases in Ethiopia: A hospital-based cross-sectional study

Introduction: Chronic respiratory diseases (CRDs) are diseases of the lung airways and parenchyma. Globally, they are the leading causes of morbidity and mortality. This study aimed to characterize the common CRDs, along with their lung function and possible determinants in symptomatic patients attending Bishoftu General Hospital, Ethiopia. Methods: A cross-sessional study was conducted at the outpatient of Bishoftu Hospital, Ethiopia from June 2019 to March 2020. Consecutive adult patients aged 18 and above with CRDs (≥8 weeks) were recruited. Questionnaires were used to collect data on demographics, symptoms, diagnoses, and putative risk factors. Lung function was measured by spirometry. Result: A total of 170 participants were recruited, the majority 102(60.0%) were female. The mean age was 49 years (SD=16). The most common symptoms were wheezing in the last twelve months 156 (91.8%), cough 138 (81.2%), and severe exertional breathlessness 137 (80.6%). Thirty-nine (22.9%) were either active or passive smokers. Half of the patients (50.3%) were exposed daily to vapors, dust, gases, or fumes and 58 (34.3%) were exposed to biomass smoke. In total, 138 (81.2%) had a positive allergen skin prick test. Chronic bronchitis (49.1%) and asthma (36.1%) were the most common clinical diagnoses. Classification of lung function revealed 23 (15%) normal, 29 (19%) obstructive, 36(23.5%) restrictive and 61(39.9%) mixed patterns. Airflow obstruction was independently associated with increasing age (p<0.05), exertional breathlessness (p<0.001), previous history of asthma (p<0.05), BMI (p<0.05), and doctor-diagnosed chronic obstructive pulmonary disease (p<0.001) and asthma (p<0.05). Conclusion: This study shows a high burden of abnormal lung function in patients attending clinics because of CRDs symptoms. These findings support the critical need for spirometry services to determine lung abnormality in patients with chronic respiratory symptoms.

Análisis bibliométrico de la producción científica cubana sobre asma en Scopus

Introducción: El asma es una entidad con alta prevalencia a nivel mundial y en Cuba, que ha suscitado nuevas investigaciones. Objetivo: Caracterizar la producción científica cubana sobre asma en la base de datos Scopus. Materiales y métodos: Se realizó un estudio observacional, descriptivo y bibliométrico de los artículos publicados sobre asma en Scopus con autores cubanos, desde 1973 hasta 2021. Para la recuperación de los registros se empleó una fórmula de búsqueda. Para el análisis de los datos se usaron los software Bibexcel y VOSviewer. Resultados: Se publicaron 154 investigaciones sobre asma, con predominio de artículos originales (136) y de revisión (12). Las áreas más productivas fueron Medicina (144) e Inmunología y Microbiología (34). Los artículos fueron publicados en 48 revistas; de ellas, 11 fueron cubanas, con la Revista Cubana de Medicina como la más productiva. México aportó el mayor número de colaboraciones (10). El Hospital Clínico Quirúrgico Docente General Calixto García (15) fue el más productivo. Se identificaron tres clústeres de palabras clave, con "human", "asthma" y "Cuban" como términos centrales y de mayor ocurrencia. Conclusiones: Existió una baja producción científica sobre asma, centrada principalmente en artículos originales, en el área de Medicina y en revistas nacionales. Se evidenció colaboración internacional. Los ejes principales de investigación fueron el diagnóstico, tratamiento, investigación básica en modelos animales, nuevas terapéuticas, factores de riesgo y prevención.

Introduction: Asthma is an entity with high prevalence worldwide and in Cuba, which has prompted new research. Objective: To characterize Cuban scientific production on asthma in the Scopus database. Materials and methods: An observational, descriptive and bibliometric study was carried out on articles on asthma published in Scopus by Cuban authors, from 1973 to 2021. A search formula was used to retrieve the records. Bibexcel and VOSviewer were used for data analysis. Results: 154 research papers on asthma were published; with a predominance of original (136) and review articles (12). The most productive areas were Medicine (144) and Immunology and Microbiology (34). Articles were published in 48 journals, of which 11 were Cuban, with the Revista Cubana de Medicina (Cuban Journal of Medicine) being the most productive. Mexico contributed the highest number of collaborations (10). The Teaching Hospital General Calixto García (15) was the most productive. 3 key word clusters were identified, with "human", "asthma" and "Cuban" as central and most occurring terms. Conclusions: There was a low scientific production on asthma, mainly focused on original articles, in the area of Medicine and in national journals. International collaboration was evident. The main areas of research were diagnosis, treatment, basic research in animal models, new therapeutics, risk factors and prevention.

Regulation of Immune Balance by Traditional Chinese Medicine in Treatment of Cough Variant Asthma： A Review / 中国实验方剂学杂志

Cough variant asthma （CVA） is a chronic respiratory disease with cough as its main symptom. The occurrence of CVA is closely related to non-specific airway inflammation， and its pathogenesis involves environmental， genetic， immune， and other factors. In recent years， the advantages of traditional Chinese medicine （TCM） in the treatment of CVA have attracted the attention of experts and scholars in China and abroad， especially its prominent role in regulating immune balance， relieving cough symptoms in CVA patients， and reducing recurrence. T Helper cells 1 （Th1）， T helper cells 2 （Th2）， T helper cells 17 （Th17）， and regulatory T cells （Treg） are derived from CD4+ T cells. Immune imbalance of Th1/Th2 and Th17/Treg is a new hotspot in the pathogenesis of CVA and a potential key target in the treatment of CVA by TCM. Th cell subsets are in dynamic balance under physiological conditions， maintaining respiratory immune homeostasis in which pro-inflammatory cytokines and anti-inflammatory cytokines are balanced. Immature helper T cells （Th0） can be differentiated into Th1， Th2， Th17， Treg， and other cell subsets due to cytokine types in the microenvironment in the stage of CVA maturation. The proliferation of Th2 cells leads to eosinophilic airway inflammation. Excessive differentiation of Th17 cells induces neutrophil airway inflammation. Th1/Th2 and Th17/Treg cells are mutually restricted in number and function， and the immune imbalance of Th1/Th2 and Th17/Treg is easy to aggravate the generation of inflammatory response. Restoring immune balance is particularly important for the airway anti-inflammatory therapy of CVA. In this paper， the imbalance of Th1/Th2 and Th17/Treg and the pathogenesis of CVA were systematically expounded. Meanwhile， the latest research on the regulation of immune imbalance by TCM compound， single TCM， and its effective ingredients in the treatment of CVA was reviewed. It provides ideas and references for revealing the scientific connotation of TCM regulating immune balance therapy of CVA， as well as the development of clinical treatment and basic research of CVA.

Effects of Guben Fangxiao Beverage （固本防哮饮） on Lung Tissue Oxidative Stress and AMPK/Nrf2/HO-1 Pathway in Mice with Bronchial Asthma in Remission / 中医杂志

ObjectiveTo investigate the possible mechanism of Guben Fangxiao Beverage （固本防哮饮） for the prevention and treatment of chronic airway inflammation during asthma remission. MethodsThirty-six female Balb/c mice were randomly divided into normal group， model group， low-， medium-， and high-dose of Guben Fangxiao Beverage group and montelukast sodium group， with 6 mice in each group. Except for the normal group， ovalbumin and respiratory syncytial virus were used in other groups to establish a mouse model of bronchial asthma in remission stage. After molding， the low-， medium-， and high-dose groups of Guben Fangxiao Beverage were respectively given 12， 24， and 36 g/（kg·d）， the montelukast sodium group was given montelukast sodium granule 2.6 mg/（kg·d）， and the mice in the normal group and model group were given 20 ml of double-distilled water， all by gavage， once a day for 28 days. The levels of interleukin 4 （IL-4） and interleukin 5 （IL-5） in the lung tissue of mice were detected； HE staining was used to observe the pathology of the lung tissue and to score the inflammation； DHE staining was used to observe the level of reactive oxygen species （ROS） in the lung tissue， and the activities of mitochondrial respiratory chain complexes Ⅰ， Ⅱ， Ⅲ， Ⅳ， and Ⅴ in the lung tissue were detected； the levels of serum superoxide dismutase （SOD）， catalase （CAT）， malondialdehyde （MDA） and adenosine triphosphate （ATP） were detected； the protein expression levels of phosphorylated adenosine monophosphate-activated protein kinase （p-AMPK）， nuclear factor erythroid 2-related factor 2 （Nrf2）， haem oxygenase 1 （HO-1） and cAMP responsive element binding protein （CREB） in the lung tissues of the model group were detected by Western blot. ResultsCompared with the normal group， the histopathological results of the lungs of mice in the model group showed an increase in inflammatory cells around the airways and an increase in inflammatory score； DHE staining showed an increase in the level of ROS， and an increase in the levels of IL-4 and IL-5 in the lung tissues； the levels of serum SOD， CAT， and ATP were reduced， and the level of MDA was elevated； the activities of the mitochondrial respiratory chain complexes Ⅰ， Ⅱ， Ⅲ， Ⅳ， and Ⅴ of the lung tissues were reduced， and the activities of p-AMPK， Nrf2， CREB protein expression decreased （P＜0.05）. Compared with the model group， the lung tissue inflammatory cells and inflammation scores of mice in each Guben Fangxiao Beverage dose group and montelukast sodium group were reduced； the levels of ROS， IL-4 and IL-5 in the lung tissue were reduced； the levels of CAT and ATP in the serum increased， and the content of MDA was reduced； and the activities of mitochondrial respiratory chain complexes Ⅰ and Ⅱ， as well as the expression of CREB protein， were elevated in the lung tissue （P＜0.05）. Compared with the high-dose group， the MDA level of the medium-dose Guben Fangxiao Beverage group decreased （P＜0.05）. The activity of mitochondrial respiratory chain complex V in the medium-dose group was higher than that in the montelukast sodium group， and the activity of mitochondrial respiratory chain complex Ⅳ in the medium- and high-dose groups was higher than that in the low-dose group （P＜0.05）. ConclusionGuben Fangxiao Beverage can inhibit oxidative stress and improve mitochondrial function to relieve chronic airway inflammation in bronchial asthma model mice during asthma remission， and its mechanism may be related to the activation of AMPK/Nrf2/HO-1 signaling pathway.

Comparison on Ameliorating Effect of Arisaematis Rhizoma and Arisaematis Rhizoma Preparatum on Allergic Asthma in Rats / 中国实验方剂学杂志

ObjectiveTo investigate the therapeutic effects and difference in the effects of Arisaematis Rhizoma （AR） before and after processing （i.e.， Arisaematis Rhizoma Preparatum， ARP） with Zingiberis Rhizoma Recens-Alumen on allergic asthma in rats and to provide a basis for the theory of processing improving the efficacy. MethodA rat model of allergic asthma was established in 70 SD rats by intraperitoneal injection of ovalbumin （OVA）-aluminum hydroxide. The rats were administrated with the aqueous extracts of AR （1.2， 0.3 g∙kg-1） and ARP （1.2， 0.3 g∙kg-1） aqueous extracts by gavage， and montelukast sodium （0.001 g∙kg-1） was used as the positive drug. The T helper cell type 1/type 2 （Th1/Th2） ratio in the serum and bronchoalveolar lavage fluid （BALF） and percentages of inflammatory cells in BALF were determined. Polymerase chain reaction （PCR） was employed to determine the mRNA level of mucin 5AC （MUC5AC） in the lung tissue. The pathological changes in the lung tissue were observed by hematoxylin-eosin （HE） staining and PAS staining. Immunohistochemical assay was employed to measure the expression of c-Jun amino-terminal kinase （JNK）， extracellular signal regulated protein kinase （ERK）， and p38 mitogen-activated protein kinase （p38 MAPK） in rat lung tissue. Western blot was employed to determine the protein levels of ERK， p-ERK， JNK， p-JNK， p38， p-p38 in the lung tissue. The effects of AR and ARP were compared based on overall desirability. ResultCompared with the blank group， the levels of interleukin-12 （IL-12） and γ interferon （IFN-γ） in serum and BALF of rats in the model group were significantly lower （P<0.05， P<0.01）， and the levels of interleukin-4 （IL-4）， interleukin-5 （IL-5） and interleukin-13 （IL-13） were significantly higher （P<0.05， P<0.01）. Compared with the model group， the serum and BALF contents of IL-12 and IFN-γ in rats in the montelukast sodium group， high-dose AR group and high-dose ARP group were significantly higher （P<0.05， P<0.01）， and the contents of IL-4， IL-5 and IL-13 were significantly lower （P<0.05， P<0.01）， and the serum contents of IFN-γ in rats in the low-dose AR group and low-dose ARP group were in BALF was significantly higher （P<0.05） and IL-4 and IL-13 were significantly lower （P<0.05， P<0.01）， the percentages of macrophages， lymphocytes， neutrophils， and eosinophils were reduced in BALF， and the expression of JNK/ERK/p38 MAPK signaling pathway and MUC5AC protein was inhibited in lung tissues. Overall assessment of the normalized analysis revealed that the ARP group was slightly more potent than the AR group after administration of the same dose. ConclusionAR and ARP can effectively treat allergic asthma by inhibiting JNK/ERK/p38 MAPK signaling pathway， and the effect is better after concoction， which can provide data support for its "concoction efficiency".

Sensibilización cutánea a aero alérgenos en niños con rinitis y asma / Skin sensitization to aero-allergens in children with rhinitis and asthma

Introducción: Las enfermedades alérgicas son muy comunes en la población pediátrica. Entre las causas frecuentes se encuentran los aeroalérgenos del ambiente, y la identificación de estos es de gran ayuda tanto para el diagnóstico como para el tratamiento. Objetivos: Determinar la frecuencia de aeroalérgenos, por medio de la determinación de Inmunoglobulina E (IgE) específica a alérgenos comunes por la prueba de sensibilidad cutánea en pacientes pediátricos con síntomas de asma y rinitis alérgica. Materiales y Métodos: Diseño observacional, descriptivo, prospectivo, transversal, población de pacientes de 4 a 17 años con síntomas compatibles con asma y rinitis alérgica que acudieron a un centro asistencial pediátrico en el periodo de estudio. Se realizó por medio de las Pruebas de punción cutánea (PCP). Resultados: La edad media de los pacientes fue de 8 años, 57% pacientes de sexo masculino y 43% de sexo femenino. El 53% de los pacientes presenta rinitis y asma, 45% solo rinitis y el 2% solo asma. El 79% de los pacientes presentó reacción positiva de sensibilización alérgica por medio de la PCP. Teniendo en cuenta la sensibilización por tipo de aeroalérgenos se tuvo que el 64% de los pacientes tuvo reacción positiva a ácaros, 19% a animales 18% a cucarachas, 8% a pólenes y 6% a hongos. Conclusión: La gran mayoría de pacientes con asma padecía rinitis alérgica concomitante y los ácaros del polvo fueron los aeroalérgenos más frecuentemente determinados en las pruebas cutáneas de alergia en niños con asma y rinitis de nuestra población.

Introduction: Allergic diseases are very common in the pediatric population. Among the frequent causes are aeroallergens from the environment and the identification of these is a great help for diagnosis and treatment. Objectives: To determine the frequency of aeroallergens, through the determination of Immunoglobulin E (IgE) specific to common allergens by the skin sensitivity test in pediatric patients with symptoms of asthma and allergic rhinitis. Materials and Methods: Observational, descriptive, prospective, cross-sectional design, population of patients from 4 to 17 years old with symptoms compatible with asthma and allergic rhinitis who attended a pediatric care center during the study period. It was carried out by means of Skin Puncture Tests (PCP). Results: The mean age of the patients was 8 years, 57% male patients and 43% female. 53% of the patients presented Rhinitis and Asthma, 45% only Rhinitis and 2% only Asthma. 79% of the patients presented a positive allergic sensitization reaction through PCP. Taking into account the sensitization by type of aeroallergens, 64% of the patients had a positive reaction to mites, 19 % to animals 18% to cockroaches, 8% to pollens and 6% to fungi. Conclusion: The vast majority of patients with asthma suffered from concomitant allergic rhinitis and dust mites were the most frequently determined aeroallergens in allergic skin tests in children with asthma and rhinitis in our population.

High-flow nasal cannula and non-invasive mechanical ventilation in pediatric asthma exacerbation: two-year prospective observational study in intensive care / Cánula nasal de alto flujo y ventilación no invasiva en asma pediátrico grave: estudio observacional prospectivo de dos años de duración en cuidados intensivos

Abstract Background: Asthma is a common cause of admission to the pediatric intensive care unit (PICU). We described and analyzed the therapies applied to children admitted to a tertiary PICU because of asthma. Later, we evaluated high-flow nasal cannula (HFNC) use in these patients and compared their evolution and complications with those who received non-invasive ventilation. Methods: We conducted a prospective observational study (October 2017-October 2019). Collected data: epidemiological, clinical, respiratory support therapy needed, complementary tests, and PICU and hospital stay. Patients were divided into three groups: (1) only HFNC; (2) HFNC and non-invasive mechanical ventilation (NIMV); and (3) only NIMV. Results: Seventy-six patients were included (39 female). The median age was 2 years and 1 month. The median pulmonary score was 5. The median PICU stay was 3 days, and the hospital stay was 6 days. Children with HNFC only (56/76) had fewer PICU days (p = 0.025) and did not require NIMV (6/76). Children with HFNC had a higher oxygen saturation/fraction of inspired oxygen ratio ratio (p = 0.025) and lower PCO2 (p = 0.032). In the group receiving both therapies (14/76), NIMV was used first in all cases. No epidemiologic or clinical differences were found among groups. Conclusion: HFNC was a safe approach that did not increase the number of PICU or hospital days. On admission, normal initial blood gases and the absence of high oxygen requirements were useful in selecting responders to HFNC. Further randomized and multicenter clinical trials are needed to verify these data.

Resumen Introducción: El asma es una causa frecuente de ingreso en la unidad de cuidados intensivos pediátricos (UCIP). En este, cuadro el uso de cánula nasal de alto flujo (CNAF) se ha visto extendido. En este trabajo se describe el tratamiento global en la UCIP ante el ingreso por asma en un hospital monográfico pediátrico y se evalúa la respuesta al uso de la CNAF, comparando la evolución de los pacientes con aquellos que recibieron ventilación no invasiva (VNI). Métodos: Se llevó a cabo un estudio observacional prospectivo (de octubre del 2017 a octubre del 2019). Se describieron epidemiología, clínica, tratamiento y soporte respiratorio. Para la comparación se crearon tres grupos de pacientes: 1) solo CNAF; 2) CNAF y VNI; y 3) solo VNI. Resultados: Se incluyeron 76 pacientes. La mediana de edad fue de dos años y un mes; la mediana de índice pulmonar fue 5. La mediana de ingreso en UCIP fue de tres días y de ingreso hospitalario, seis días. Los niños con solo CNAF (56/76) mostraron menos días de UCIP (p = 0.025) y no requirieron VNI (6/76). También mostraron mayor SatO2/FiO2 (saturación de oxígeno/fracción de oxígeno inspirado) (p = 0.025) y menor nivel de PCO2 (presión parcial de CO2) (p = 0.032). La VNI se utilizó primero siempre en el grupo que recibió ambas modalidades (14/76). No se encontraron diferencias epidemiológicas o clínicas entre grupos. Conclusiones: En nuestra serie, el uso de CNAF no aumentó los días de ingreso en la UCIP ni de hospital. Tampoco requirió cambio a VNI. Al ingreso, una gasometría normal y bajo requerimiento de oxígeno permitieron seleccionar a los pacientes respondedores. Se necesitan más ensayos multicéntricos clínicos aleatorizados para verificar estos datos.

Análisis comparativo de la Iniciativa Global para el Asma y las guías sudamericanas para el diagnóstico, manejo y prevención del asma en pacientes pediátricos

Fundamento: el asma es una enfermedad inflamatoria crónica con una alta prevalencia en Sudamérica, por lo que requiere un diagnóstico adecuado, manejo óptimo y medidas de prevención respaldados por evidencia científica constantemente actualizada. Objetivo: realizar un análisis comparativo entre la Iniciativa Global para el Asma y las guías sudamericanas para el diagnóstico, manejo y prevención del asma en pacientes pediátricos. Métodos: estudio de tipo observacional descriptivo que compara la guía Iniciativa Global para el Asma del año 2023 con guías nacionales de los países sudamericanos Colombia, Argentina, Chile, Uruguay, Venezuela y Perú, en los siguientes parámetros: recomendaciones diagnósticas, recomendaciones en el manejo y estrategias de prevención. Resultados: se encontraron diferencias en las recomendaciones de prevención y educación en las guías analizadas, mientras que la Iniciativa Global para el Asma y algunas guías sudamericanas mencionan medidas de prevención, otras guías no las mencionan o tienen información limitada al respecto. En los exámenes auxiliares, todas las guías mencionan la realización de espirometría para evaluar la función pulmonar, pero existen diferencias con la inclusión de otros exámenes, como el test de alergia o la medición de óxido nítrico exhalado. Conclusiones: se requiere una mayor estandarización y actualización de las guías sudamericanas para garantizar un manejo adecuado y consistente del asma en la región.

Foundation: Asthma is a chronic inflammatory disease with a high prevalence in South America, which requires proper diagnosis, optimal management and prevention measures supported by constantly updated scientific evidence. Objective: to carry out a comparative analysis between the Global Initiative for Asthma and the South American guidelines for the diagnosis, management and prevention of asthma in pediatric patients. Methods: descriptive observational study that compares the 2023 Global Initiative for Asthma guideline with national guidelines from the South American countries Colombia, Argentina, Chile, Uruguay, Venezuela and Peru, in the following parameters: diagnostic recommendations, management recommendations and prevention strategies. Results: differences were found in prevention and education recommendations in the guides analyzed, while the Global Initiative for Asthma and some South American guides mention prevention measures, other guides do not mention them or have limited information in this regard. In auxiliary tests, all guidelines mention performing spirometry to evaluate lung function, but there are differences with the inclusion of other tests, such as the allergy test or the measurement of exhaled nitric oxide. Conclusions: Greater standardization and updating of South American guidelines is required to guarantee adequate and consistent management of asthma in the region.

Beneficios que reciben los pacientes asmáticos tras la aplicación de un tratamiento fisioterapéutico y rehabilitador

El asma bronquial sigue siendo la enfermedad crónica más frecuente en la infancia. Su prevalencia continúa aumentando a pesar de que en la actualidad se disponen de eficaces manuales terapéuticos para el correcto manejo de los principales síntomas de la enfermedad. El tratamiento no farmacológico de este padecimiento se fundamenta en tres pilares esenciales: la educación sobre la enfermedad, las guías para profesionales y pacientes y la fisioterapia respiratoria. Los pacientes que tienen un tratamiento fisioterapéutico y rehabilitador de manera habitual, tienen una mejoría significativa en el control del asma, especialmente si estos se practican bajo la supervisión de un fisioterapeuta. Los beneficios que los pacientes asmáticos logran con la fisioterapia y la rehabilitación son numerosos y uno de los efectos más importante es el impacto positivo sobre la calidad de vida.

Bronchial asthma continues to be the most common chronic disease in childhood. Its prevalence continues to increase despite the fact that effective therapeutic manuals are currently available for the correct management of the main symptoms of the disease. The non-pharmacological treatment of this condition is based on three pillars: education about the disease, guides for professionals and patients, and respiratory physiotherapy. Patients who have regular physiotherapy and rehabilitation treatment have a significant improvement in asthma control, especially if these are practiced under the supervision of a physiotherapist. The benefits that asthmatic patients achieve with physiotherapy and rehabilitation are numerous and one of the most important effects is the positive impact on quality of life.

Asociación entre severidad del asma bronquial, nivel de control y calidad de vida en niños

Fundamento el asma bronquial es una de las enfermedades crónicas de mayor prevalencia en la infancia. Las guías para el diagnóstico y tratamiento se rigen según severidad, nivel de control y calidad de vida, sin embargo, no existen evidencias que demuestren su asociación estadística. Objetivo medir el grado de asociación entre la severidad del asma bronquial, nivel de control y calidad de vida en niños. Métodos estudio de corte transversal, realizado en el periodo enero-diciembre de 2022, en una muestra de 189 pacientes con diagnóstico confirmado de asma bronquial. Se analizaron las variables: edad, sexo, severidad, nivel de control y calidad de vida. Se calcularon estadígrafos, frecuencia absoluta, porcentaje, media aritmética y desviación estándar. Para medir asociación se utilizó la prueba de Chi cuadrado (p<0,01) y para evaluar la fuerza de la asociación el coeficiente de V-Cramer. Resultados la edad media resultó 9,17 años (DE ± 0,67). Predominaron los varones, representativos del 53,54 %. Prevalecieron el asma intermitente (39,15 %), el nivel de control parcial (59,79 %) y la calidad de vida alta (50,26 %). Al relacionar severidad con nivel de control, el estadígrafo de asociación indicó X2=190,461 (VC= 0,662); en el caso de severidad y calidad de vida, X2=252,673 (VC=0,762); y entre nivel de control y calidad de vida, X2=66,733 (VC=0,401). Conclusiones existió asociación fuerte entre severidad del asma bronquial-nivel de control y entre la severidad del asma-calidad de vida; así como asociación moderada entre nivel de control-calidad de vida.

Foundation bronchial asthma is one of the most prevalent chronic diseases in childhood. The guidelines for diagnosis and treatment are governed by severity, level of control and quality of life, however, there is no evidence that demonstrates its statistical association. Objective to measure the association degree between the severity of bronchial asthma, control level and quality of life in children. Methods cross-sectional study, carried out from January to December 2022, in a sample of 189 patients with a bronchial asthma confirmed diagnosis. The analyzed variables were: age, sex, severity, level of control and quality of life. Statisticians, absolute frequency, percentage, arithmetic mean and standard deviation were calculated. The Chi-square test (p<0.01) was used to measure association and the V-Cramer coefficient was used to evaluate the strength of the association. Results the mean age was 9.17 years (SD ± 0.67). Males predominated, representing 53.54%. Intermittent asthma (39.15%), partial control level (59.79%) and high quality of life (50.26%) prevailed. When relating severity with level of control, the association statistician indicated X2=190.461 (VC= 0.662); in the case of severity and quality of life, X2=252.673 (VC=0.762); and between level of control and quality of life, X2=66.733 (VC=0.401). Conclusions there was a strong association between severity of bronchial asthma-level of control and between severity of asthma-quality of life; as well as a moderate association between level of control-quality of life.

Treating asthma in patients with enuresis: repercussions on urinary symptoms

ABSTRACT Background: Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. Objective: This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. Materials and Methods: Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. Results: At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. Discussion: Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. Conclusion: Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.

Neumorraquis y neumomediastino espontáneo asociado a crisis asmática en el adulto

Introducción: la forma más frecuente del síndrome de fuga de aire en la crisis asmática es el neumomediastino, siendo habitualmente de curso benigno. La neumorraquis es una complicación poco descrita en la literatura. Presentamos el caso clínico de un paciente de 35 años, portador de asma intermitente, y que ingresa a terapia intensiva por crisis bronco obstructiva severa, enfisema subcutáneo cervical y cara anterior de tórax. La tomografía de tórax demostró neumomediastino extenso y neumorraquis. No se documentó neumotórax ni compromiso hemodinámico por la crisis. Presentó evolución satisfactoria con ventilación mecánica invasiva, broncodilatadores y corticoides sistémicos.

A case report: Pneumomediastinum is the most common form of air leak syndrome in asthmatic crisis and is usually benign in nature. Pneumorrhachis is a complication that is rarely described in the literature. We present the clinical case of a 35-year-old patient with intermittent asthma who was admitted to the Intensive Care Unit due to a severe bronchoobstructive crisis, cervical subcutaneous emphysema, and anterior chest wall emphysema. Chest computed tomography revealed extensive pneumomediastinum and pneumorrhachis Pneumothorax or hemodynamic compromise due to the crisis was not documented. The patient showed a satisfactory outcome with invasive mechanical ventilation, bronchodilators, and systemic corticosteroids.

Relato de caso: O pneumomediastino é a forma mais comum de síndrome de presença de ar no mediastino em crises de asma, geralmente com curso benigno. A pneumorráquis é uma complicação raramente descrita na literatura. Apresentamos o caso clínico de um paciente de 35 anos, com asma intermitente, admitido na Unidade de Cuidados Intensivos por crise bronco-obstrutiva grave, enfisema subcutâneo cervical e de parede torácica anterior. A tomografia de tórax mostrou extenso pneumomediastino e pneumorraque. Não se observou pneumotórax ou comprometimento hemodinâmico devido à crise. Apresentou evolução satisfatória com ventilação mecânica invasiva, broncodilatadores e corticoides sistêmicos.

Asma em adolescentes: o que o estudo ERICA nos mostrou? / Asthma in adolescents: what did ERICA study show us?

A asma é uma doença heterogênea caracterizada pela história de sintomas respiratórios que variam de intensidade e ao longo do tempo. Devido à sua alta prevalência, constitui um problema mundial de saúde pública, atingindo todas as faixas etárias, em especial crianças e adolescentes. O objetivo deste artigo foi analisar as produções científicas sobre asma baseadas no Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Trata-se de uma revisão narrativa incluindo os artigos originais sobre asma baseados nos dados do ERICA, publicados em periódicos indexados em inglês e português. O ERICA foi um estudo multicêntrico nacional realizado em 2013 e 2014, que investigou a prevalência de asma e fatores de risco cardiovascular, incluindo obesidade, diabetes mellitus, hipertensão arterial sistêmica, dislipidemia, tabagismo, sedentarismo, hábitos alimentares inadequados, e a associação entre esses fatores, em adolescentes de 12 a 17 anos, estudantes de escolas públicas e privadas de municípios brasileiros com mais de 100.000 habitantes. Nos cinco estudos selecionados, foi possível demonstrar que a prevalência de asma foi significativamente maior entre adolescentes do sexo feminino em todas as capitais e macrorregiões do Brasil, com predomínio da doença na região Sudeste do nosso país. Além disso, a asma esteve fortemente associada ao tabagismo (passivo e ativo) e foi associada à duração curta do sono. Por outro lado, não esteve associada com os níveis séricos de vitamina D. Em relação aos parâmetros metabólicos, foi observado que a síndrome metabólica e alguns de seus componentes, como a circunferência abdominal, estiveram significativamente associados à asma grave em adolescentes brasileiros.

Asthma is a heterogeneous disease characterized by a history of respiratory symptoms that vary in intensity and over time. Due to its high prevalence, asthma is considered a global public health problem affecting all age groups, especially children and adolescents. This study aimed to analyze scientific papers on asthma based on the Study of Cardiovascular Risks in Adolescents (ERICA). We provide a narrative review of original articles on asthma based on ERICA data published in indexed journals in English and Portuguese. ERICA was a national multicenter study conducted in 2013 and 2014 that investigated the prevalence of asthma and cardiovascular risk factors, including obesity, diabetes mellitus, systemic arterial hypertension, dyslipidemia, smoking, sedentary lifestyle, and inadequate eating habits, and the association between these factors in adolescents aged 12 to 17 years, students from public and private schools in Brazilian cities of more than 100,000 population. In the 5 selected studies, the prevalence of asthma was significantly higher in female adolescents in all capitals and macro-regions of Brazil, occurring predominantly in the southeast region of the country. In addition, asthma was strongly associated with smoking (passive and active) as well as with short sleep duration, but not with serum vitamin D levels. Regarding metabolic parameters, metabolic syndrome and some of its components, such as waist circumference, were significantly associated with severe asthma in Brazilian adolescents.

Baker's rhinitis and asthma with concomitant wheat anaphylaxis: a rare overlap of clinical entities / Rinite e asma do padeiro com anafilaxia após ingestão de trigo: um caso raro de sobreposição de entidades clínicas

Wheat is one of the fundamental sources of food worldwide. Baker's asthma and occupational rhinitis are both frequent and can be attributable to work exposure in bakers. However, the association between baker's asthma and wheat allergy is very rare. The authors report the case of a bakery worker who developed baker's asthma and occupational rhinitis after years of working in a bakery and later developed anaphylactic reactions after wheat ingestion.

O trigo é uma das fontes alimentares mais importantes em todo o mundo. A asma do padeiro e a rinite ocupacional são frequentes e podem ser atribuídas à exposição a farinhas em padeiros. No entanto, a associação entre asma do padeiro e alergia alimentar ao trigo é muito rara. Os autores descrevem um caso em que um trabalhador de panificação desenvolveu asma do padeiro e rinite ocupacional após anos trabalhando em uma padaria, e posteriormente desenvolveu reações anafiláticas após a ingestão de trigo.

O uso de métodos contraceptivos hormonais em pacientes com asma: repercussões clínicas / The use of hormonal contraceptives methods in patients with asthma: clinical repercussions

Objetivo: Analisar o uso dos contraceptivos hormonais em mulheres com asma e a escolha desses métodos contraceptivos para essa população, com avaliação de eventuais repercussões sobre novos episódios de asma e sibilos. Métodos: Foram selecionados estudos longitudinais, ensaios clínicos, revisões sistemáticas e metanálises. As plataformas consultadas foram PubMed, Embase, Cochrane e SciELO, com a utilização dos descritores: "contracepção", "contracepção hormonal", "sistema intrauterino liberador de levonorgestrel" e "asma". Resultados: Dois grandes estudos demonstraram que o uso de contraceptivos hormonais esteve associado à redução do risco de novos episódios de asma. Uma revisão sistemática concluiu que os resultados para o uso de contraceptivos hormonais para mulheres com asma foram mistos, com aumento ou redução dos seguintes riscos: novo episódio de asma e aumento da frequência das crises e dos sibilos. O uso da contracepção hormonal em pacientes obesas portadoras de asma é controverso. Conclusão: Os resultados para o uso de contraceptivos hormonais em mulheres com asma são inconsistentes, com relatos de aumento ou de redução do risco de novos episódios. O uso do método contraceptivo deve ser discutido individualmente, levando-se em consideração outros fatores de risco associados e o desejo da mulher. A paciente deverá ser orientada se houver piora dos sintomas clínicos de asma na vigência do uso de qualquer método contraceptivo hormonal.

Objective: To analyze the use of hormonal contraceptives in women with asthma and the choice of this contraceptive method for this population, evaluating possible repercussions on new episodes of asthma and wheezing. Methods: Longitudinal studies, clinical trials, systematic reviews and meta-analyses were selected. Platforms consulted: PubMed, Embase, Cochrane, SciELO, using the descriptors: "contraception", "hormonal contraception", "levonorgestrel-releasing intrauterine system" and "asthma". Results: Two large studies demonstrated that the use of hormonal contraceptives was associated with a reduced risk of new episodes of asthma. A systematic review concluded that the results for the use of hormonal contraceptives for women with asthma were mixed, with increased or decrease in the following risks: new asthma episodes, increased frequency and wheezing. The use of hormonal contraception in obese patients with asthma is controversial. Conclusion: The results for the use of hormonal contraceptives in women with asthma are inconsistent, with reports of increased or reduced risk of new episodes. The use of the contraceptive method should be discussed individually, taking into account other associated risk factors and the woman's desire. The patient will be advised if there is a worsening of the clinical symptoms of asthma while using any hormonal contraceptive method.