Severe asthma: Comparison of different classifications of severity and control.

BACKGROUND: Criteria of asthma severity and control lack standardization. OBJECTIVE: to compare classifications of asthma severity and control, applied to patients from a severe asthma clinic. METHODS: Cross-sectional study of 473 patients followed up for ≥6 months, reclassified using three criteria: 1) the World Health Organization (WHO) 2010, 2) the American Thoracic Society (ATS) 2000, and 3) the European Respiratory Society (ERS)/ATS 2014. In order to evaluate disease control, the 2012 and 2014 Global Initiative for Asthma (GINA) classifications were compared. RESULTS: According to the definition of WHO 2010, 429 had Difficult-to-treat severe asthma and only 12 presented Treatment-resistant severe asthma. 114 patients had Refractory asthma by ATS 2000 and 88 had Severe asthma by ERS/ATS 2014. Considering the definitions of WHO 2010, only 9 out of 12 with Treatment-resistant and 64 out of 429 with Difficult-to-treat severe asthma met the criteria of ATS 2000 and ERS/ATS 2014. As for GINA classification of control, 208 (44%) of the 473 subjects were classified as having asthma controlled by the 2014 criteria, whereas only 45 (10%) patients had controlled asthma by the GINA 2012 criteria. The Kappa statistic indicates the highest agreement of the severity classification occurred between the criteria of ATS 2000 and ERS/ATS 2014 (0.64). CONCLUSION: Good agreement was found between Refractory asthma ATS 2000 and Severe asthma ERS/ATS 2014 classifications. However, poor agreement was observed between the severity rating proposed by the WHO and other classifications. The GINA control classifications of 2012 and 2014 also agreed poorly.

A proposed scheme to cope with comorbidities in asthma.

The prevalence of non-communicable chronic diseases has been on the rise and the co-occurrence of morbidities is becoming more common. Multimorbidities are found more frequently among women, those with a history of mental disorders, lower level of schooling, and unfavorable socioeconomic condition. Physical inactivity, smoking and obesity are also associated with multimorbidities. Its occurrence is directly related to the age, affecting the majority of the individuals with more than 50 years old. It is important to consider the possibility of comorbid conditions that aggravate, complicate or simulate the symptoms of the disease in the face of a patient with asthma and poor response to treatment. Among subjects with asthma, some conditions stand out as the most frequent: chronic rhinitis or rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea syndrome, obesity, and cardiovascular disorders. Comorbidities reduce the chances of optimal asthma control. It is essential to assess and manage properly these complex situations, choosing wisely preventive strategies and treatment options to avoid adverse events and optimize outcomes. Medications for asthma have the potential to worsen cardiovascular conditions, while beta-adrenergic receptor blockers and angiotensin conversion enzyme inhibitors used for cardiovascular conditions, can worsen asthma. Handling properly these cases will save lives and resources. However, there are multiple gaps in knowledge requiring investigation in this field to inform integrated care pathways and policies. It is likely information may be obtained from real life studies and electronic medical databases. Communications between the providers and patients may be facilitated by electronic technology, opening a large window for guided self-management.

Evaluation of the Impact of Physical Exercise in Reducing Pain in Women Undergoing Mammography: A Randomized Clinical Trial.

Objective: To evaluate the efficacy of exercise prior to mammography in reducing perceived postexamination pain. Methods: An open, randomized, and controlled clinical trial was conducted. The interventions consisted of warm-up and stretching exercises of the upper or lower limbs of women who consulted at Barretos Cancer Hospital, São Paulo State, Brazil. The women were divided into three groups based on the intervention and its location: upper limbs (group 1), lower limbs (group 2), and no intervention (group 0). Quantitative variables were compared between and within groups using analysis of variance and Student's t test with a 5% significance level. Relative risk (RR) calculations and their derived measurements such as efficacy, number needed to treat (NNT), absolute risk reduction (ARR), and relative risk reduction (RRR) were taken. This study was approved by the Institutional Committee of Research Ethics. Results: A total of 198 (66 per group) women were evaluated. Sociodemographic data and level of physical activity were not found to be associated with perception of pain after mammogram. However, group 1 had the greatest reduction in postprocedure perception of pain compared with groups 2 (relative risk [RR] = 3.54, 95% confidence interval [CI] = 2.12-5.51, P < 0.05) and 0 (RR = 1.92 (95% CI = 1.08-3.42, P < 0.05). Conclusions: Pre-examination upper limb exercises were most effective in reducing the perception and sensation of pain. However, women who performed lower limb exercises also had a decreased perception of pain compared with the control group.

Prevalence of Obesity in Children and Adolescents in Brazil: A Meta-analysis of Cross-sectional Studies.

BACKGROUND: Obesity in children/adolescents is a major public health problem worldwide. In Brazil there is great variability in published data on the prevalence of obesity among children/adolescents. AIMS: To show a systematic review with meta-analysis of cross-sectional studies, conducted in Brazil between 2008 and 2014. METHODS: A systematic review and meta-analysis was conducted the outcome of which was obesity (Body Mass Index ≥ 95th percentile for sex/age). A graphical presentation was done separately (Forest plot) for the results. Global and dichotomous outcomes were presented by employing, respectively the gross rates of prevalence and prevalence ratio (PR) and its confidence intervals at 95% (95% CI). The degree of heterogeneity was calculated employing the Q Cochran, while the I² test was used to describe the variation between studies. RESULTS: Twenty-one studies with a sample of 18,463 children/adolescents were included; the overall prevalence of obesity was 14.1%. Among boys it was 16.1% and in girls it was 14.95%. There was no difference in obesity prevalence between sexes (PR 1.06; 95%CI: 0.81 to 1.40; p>0.05). CONCLUSIONS: The prevalence of obesity among children and adolescents in Brazil is high and urgently needs measures to prevent consequences associated with the disease, as well as measures to reduce the impact, in the short term, the overweight and childhood obesity.