ABSTRACT
Background: Asthma is a chronic respiratory disease, and respiratory viruses are well-known triggers for asthma exacerbations. The novel coronavirus named SARS-CoV-2, which causes COVID-19, can present with pulmonary symptoms. Several studies suggest that IL-13, an allergic asthma mediator, should prevent asthma exacerbations by SARS-CoV-2. The objective of this study was to evaluate the clinical behavior of patients with asthma during the COVID-19 pandemic. Asthma is a chronic respiratory disease, and respiratory viruses are well-known triggers for asthma exacerbations.The novel coronavirus named SARS-CoV-2, which causes COVID-19, can present with pulmonary symptoms.Several studies suggest that IL-13, an allergic asthma mediator, should prevent asthma exacerbations by SARS-CoV-2. The objective of this study was to evaluate the clinical behavior of patients with asthma during the COVID-19 pandemic. Method: This was a retrospective study of electronic medical records of adult asthmatic patients, being followed up in a tertiary service and who received telephone calls for rescheduling the face-to-face consultations, during the COVID-19 pandemic period.Demographic data, asthma symptoms, frequency of atopy, presence of comorbidities and symptoms related to coronavirus infection were analyzed. Patients were classified according to their history of asthma attacks. Results: Two hundred and seven patients were included, and of them, 165 patients (79.7%) were female, with a mean age of 53.3 years and asthma duration of 35 years. Atopy was confirmed in 156 patients (81.7%). The main comorbidities were obesity (32.9%), high blood pressure (47.3%), diabetes mellitus (17.4%) and emotional stress (68.1%). Of the total, 87 patients (42%) had acute symptoms, of which 20 (9.7%) sought emergency care and 15 of 20 patients (75%) were investigated for Covid-19, all of which were negative. Of the total, only 7 patients (3.4%) exacerbated and required systemic corticosteroids. During this study, the more frequent complaints among asthmatic patients with acute respiratory symptoms were dyspnea, cough, asthenia and headache when compared to those without a crisis (p < 0.05). Conclusion: This study found that asthmatic patients had a low prevalence of asthma exacerbation during the coronavirus pandemic period. Patients with acute symptoms may have been underdiagnosed for COVID-19, due to the low demand for emergency care. Previous atopy may act as a protective factor for COVID-19 in asthmatic patients.
ABSTRACT
Background: In March 2020, the Brazilian Ministry of Health (MoH) announced COVID-19 countrywide community transmission and issued guidelines on social distancing measures. Using real life data, we aimed to analyze the impact of COVID-19 on HIV care in Brazil, and summarize the actions taken by the MoH to guarantee proper health care for people living with HIV (PLWHIV). Methods: We obtained MoH electronic records, from January-October 2019/2020, on HIV self test (HIVST), viral load (VL), CD4+ T counts (CD4), genotyping, and antiretroviral (ART) prescription, including post- (PEP) and pre-exposure (PrEP) prophylaxis. We used descriptive statistics to quantify COVID-19 impact on HIV care in Brazil and compared indicators of both years by unpaired T-tests. Results: In April 2020, PEP and PrEP dispenses fell 57% and 53%, respectively, when compared to January, and new PrEP users dropped 70%. Four months supplies provision and telemedicine resulted on 64% and 53% increase on PEP and PrEP dispenses and 288% rise on new PrEP users in October, when compared to April. The number of HIVST distributed by MoH and PLWHIV who had the first CD4 and VL before ART initiation dropped 35% and 48%, respectively, when comparing April to January 2020, reflecting the pandemic impact on HIV diagnosis. In return, MoH recommended HIVST for key/ priority populations, pregnant women, patients with TB, STI, viral hepatitis, immunossupressed, or hospitalized due to respiratory syndrome. When comparing to April, HIVST distribution raised 95% in October and the number of PLWHIV who had the first CD4 and VL before ART initiation was 56% higher, in September. When comparing 2020 to 2019, the number of PLWHIV who started ART and those that had the first CD4 and VL before ART initiation was 29% and 48% lower in April 2020, respectively;but 18% and 15% in September. Considering January-October, the proportion of PLWHIV overdue for ART dispensation raised 11% and ART dispense for 30 days dropped 53% in 2020;but increased 27% and 105%, for 60 and 90 days, respectively. The use of telemedicine, annual VL for those clinically stables, and 90-days ART supply held link to public health services and viral load suppresion. Conclusion: PLWHIV are vulnerable during COVID-19 pandemic due to compromised immune system or care continuum interruption by community containment measures. Monitoring of HIV care indicators associated to timely actions is an effective way to overcome COVID-19 pandemic challenges and guarantee proper health care for PLWHIV.