ABSTRACT
International surveys have demonstrated that asthma is still underdiagnosed and undertreated in many parts of the world. Despite improvements in the standard of asthma care delivered in many areas, as evidenced by improved global asthma mortality data, much information on projects and programmes undertaken in resource-limited regions of the world is not in the public domain. The aim of this report is to review projects and programmes in diverse regions around the world so that health care providers, planners and consumers may draw on the successes, failures and lessons learnt. Such real world experiences may contribute to achieving Global Initiative for Asthma goals of asthma control. Asthma projects and programmes in Argentina, Australia, Brazil, China, Japan, Mexico, Philippines, Russia, South Africa and Turkey were discussed by a group of experts in asthma care, the Advancing Asthma Care Network, from their respective countries, over a course of three satellite meetings in 2010. Collective analyses consistently identified low rates of dissemination and implementation of national and international treatment guidelines, low levels of continuing medical education and training of primary health care professionals and access and distribution of inhaled corticosteroids to be major barriers that are critical to the overall success of a national asthma management programme. In the less developed asthma programmes, under-recognition and undertreatment further limited the success of the programmes. Evidence from well-established national asthma management programmes suggests that establishment of a successful programme entails a logical progression through specific developmental stages, starting with political/stakeholder endorsement and commitment, followed by epidemiological evaluation, evaluation of disease burden, evaluation of access to care and best therapy, and finally optimisation and maintenance therapy for individual patients.
Subject(s)
Asthma/therapy , Global Health , National Health Programs , Health Surveys , Humans , International Cooperation , Practice Guidelines as Topic , Program DevelopmentABSTRACT
BACKGROUND: Although previous data suggest that intranasal fluticasone furoate (FF) improves ocular symptoms of allergic rhinitis (AR), it presents serious limitations that question its results and conclusions. Therefore, an independent systematic review with meta-analysis is required to confirm and clarify the magnitude of the effect of FF. METHODS: This review compared the efficacy of intranasal FF to placebo on ocular and nasal symptoms in patients with AR. Primary outcomes were reflective and instantaneous total ocular symptom scores (rTOSS and iTOSS), and reflective and instantaneous total nasal symptom scores (rTNSS and iTNSS). Secondary outcomes included the assessment of response to therapy, quality of life (QoL), and adverse effects. RESULTS: Sixteen trials (5.348 patients) were selected. Seven studies included seasonal AR patients and nine studies, perennial AR patients. Intranasal FF significantly improved rTOSS and iTOSS scores compared with placebo in patients with seasonal (weighted mean difference [WMD] -0.54, 95% CI, -0.70 to -0.37, and -0.59, 95% CI, -0.76 to -0.43) and perennial AR (-0.33, 95% CI, -0.31 to -0.05, and -0.38, 95% CI, -0.69 to -0.07). Intranasal FF was also significantly more effective in improving rTNSS and iTNSS scores in seasonal (WMD=-1.14, 95% CI, -1.57 to -0.72, and -1.32, 95% CI, -1.64 to -1.01) and perennial AR patients (-0.83, 95% CI, -1.08 to -0.59, and -0.90, 95% CI, -1.33 to -0.48). Finally, there were greater improvements in response to therapy and QoL with a favourable safety profile. CONCLUSIONS AND CLINICAL RELEVANCE: Intranasal FF showed a consistent ocular and nasal efficacy along with improvement in QoL in AR patients. This review provides significant evidence that treatment with FF nasal spray at a dose of 110 mcg once daily is effective in relieving ocular and nasal symptoms in adolescents and adults with AR.
Subject(s)
Androstadienes/administration & dosage , Androstadienes/therapeutic use , Anti-Allergic Agents/administration & dosage , Anti-Allergic Agents/therapeutic use , Nasal Sprays , Rhinitis, Allergic, Seasonal/drug therapy , Administration, Intranasal , Humans , PlacebosABSTRACT
OBJECTIVES: To determine the level and cost of unscheduled health care resource use in adults and children across all asthma symptom severities in Latin America. METHODS: The level and cost of health care resource use were analysed for 2074 patients with asthma included in the Asthma Insights and Reality in Latin America (AIRLA) survey from 10 Latin American countries. Health care resource use was multiplied by country-specific unit costs to estimate average per-patient annual costs. Patients were classified as adults (> or = 16 years) or children (<16 years), with disease severity categorized using a symptom severity index. RESULTS: Persistent asthma symptoms were experienced by 53.1% of patients (50.1% of children and 54.6% of adults). In the year preceding the survey, 57.1% of patients required unscheduled health care resource use and 45.1% reported at least 1 emergency hospital contact. The percentage of patients reporting unscheduled health care resource use was greatest amongst those with severe persistent symptoms (71.9%) but it was also high in those with mild intermittent symptoms (45.7%). An average of 73.2% of annual costs of asthma-related health care for the 10 countries was due to unscheduled health care. Expenditure on unscheduled care was greatest amongst both adults and children with severe persistent asthma symptoms (US $558 and US $769, respectively). Adults and children with mild intermittent symptoms also incurred considerable unscheduled costs (US $204 and US $215, respectively). CONCLUSIONS: Poorly controlled asthma imposes a considerable cost burden driven by unscheduled health care resource use in Latin America. Treatments to control asthma and reduce the need for unscheduled health care could reduce this cost in both adults and children.
Subject(s)
Asthma/economics , Asthma/therapy , Delivery of Health Care/economics , Adolescent , Adult , Female , Health Care Costs , Humans , Latin America , Male , Young AdultABSTRACT
Background: The EAGLE Project database was analysed to assess the characteristics of patients with severe asthma (SA) who required hospitalisation as a result of an acute episode during the period 19942004, and the relationship with asthma severity. Methods: A total of 2593 clinical records corresponding to an equal number of patients hospitalised for acute asthma (1569 years), with sufficient information to characterize their asthma severity in agreement with GINA criteria were identified (727 patients with SA compared with 1866 patients with non-severe asthma). Results: Patients with SA were older, displayed a greater predominance of female asthmatics, lower antecedents of atopy, and a higher frequency of previous hospitalisations compared with non-severe asthmatics (86.1% vs. 50.5%, p ≤ 0.01). Additionally, SA patients showed more severe exacerbations characterized by acidosis, significant spirometric deterioration, greater length of hospital stay (9.4 days vs. 7.0 days), as well as a higher frequency of intubation (16.8% vs. 2.1%), intensive care unit admission (11.3% vs. 4.9%), cardiopulmonary arrest (5.5% vs. 1.3%), and asthma deaths (2.1% vs. 0.4%) (all p ≤ 0.01) compared with non-severe patients. Conclusions: This study suggests that SA patients have greater morbidity and a disproportionate need for health care as a result of more severe exacerbations. However, non-severe asthmatics can also still present acute severe episodes (although with a lower frequency) with risk of life (AU)
No disponible
Subject(s)
Humans , Asthma/therapy , Hospitalization , Retrospective Studies , Severity of Illness Index , Risk Factors , Evaluation of Results of Therapeutic Interventions , Anti-Asthmatic Agents/therapeutic use , Asthma/epidemiology , Respiration, ArtificialABSTRACT
BACKGROUND: The EAGLE project database was analysed to assess the characteristics of patients with severe (SA) who required hospitalisation as a result of an acute episode during the period 1994-2004, and the relationship with asthma severity. METHODS: A total od 2593 clinical records corresponding to an equal number of patients hospitalised for acute asthma (15-69 years), with sufficient information to characterize their asthma severity in agreement with GNA criteria were identified (727 patients with SA compared with 1866 patients with non-severe asthma). RESULTS: Patients with SA were older, displayed a greater predominance of female asthmatics, lower antecedents of atopy, and a higher frequency of previous hospitalisations compared with non-severe asthmatics (86.1% vs. 50.5%, p< or = 0.01). Additionally, SA patients showed more severe exacerbations characterized by acidosis, significant spirometric deterioration, greater length of hospital stay (9.4 days vs. 7.0 days), as well as a higher frequency of intubation (16.8% vs. 2.1%), intensive care unit admission (11.3% vs.4.9%), cardiopulmonary arrest (5.5% vs. 1.3%), and asthma deaths (2.1% vs. 0.4%) (all < or = 0.01) compared wit non-severe patients. CONCLUSIONS: This study suggests that SA patients have greater morbidity and a disproportionate need for health care as a result of more severe exacerbations. However, non-severe asthmatics can also still present acute severe episodes (although with a lower frequency) with risk of life.
Subject(s)
Asthma/epidemiology , Asthma/physiopathology , Hospitalization , Acidosis, Respiratory , Acute Disease , Adolescent , Adult , Age Factors , Aged , Anti-Asthmatic Agents/therapeutic use , Asthma/therapy , Bronchodilator Agents/therapeutic use , Case-Control Studies , Disease Progression , Female , Heart Arrest , Humans , Intubation , Male , Middle Aged , Severity of Illness Index , Sex Factors , Spain , Spirometry , Survival AnalysisABSTRACT
Asthma is a global public health problem. Even though the prevalence is variable in different parts of the world, including Latin America, asthma morbility is high, particularly in countries with emerging economies. Asthma mortality is unacceptable, especially since it has been estimated that a high percentage of asthma deaths could be prevented. Fortunately, most patients suffer mild persistent asthma, however, there is evidence that asthma is many times underdiagnosed and undertreated. Primary care physicians, family doctors and paediatricians have to deal with the majority of asthma patients together with different medical conditions; such as heart problems, diabetes, and infectious, etcetera. In order to help these physicians in the process of decision making, guidelines have been developed. There are many asthma guidelines; they range from opinion based guidelines (in the past) to a current more evidence based approach. Among GINA, Global Initiative for Asthma, is the most comprehensive and widespread all around the world. More than a guideline, GINA is actually a programme directed at asthma specialists, other health care providers and patients and their families.
Subject(s)
Asthma , Practice Guidelines as Topic , Asthma/diagnosis , Asthma/therapy , Humans , International Cooperation , MexicoABSTRACT
El Plan de Educación a través de información clara y precisa tiende a disminuir la frecuencia de las exacerbaciones, consecuentemente la disminución de la sintomatología clínica, mayor cumplimiento del tratamiento, y mejorar la calidad de vida. Objetivos: Evaluar el nivel de información previa de los pacientes que pertenecen al programa y el nivel de captación de la información brindada, para determinar el grado de efectividad del proceso educativo. Material y Métodos: Se encuestaron 50 pacientes con asma de bajo nivel socieconómico que pertenecen al programa. Fue administrado un cuestionario elaborado por nosotros, compuesto de 10 preguntas, en dos momentos: uno previo a la reunión informativa a cargo del equipo interdisciplinario, y otro posterior a ella. Se analizaron los datos a través de técnicas de estadística descriptiva e inferencial; para esta última se aplicó el Test de Significación Normal. Resultados: Los porcentajes promedios de respuestas correctas antes y después de la información fueron respectivamente: 65,4 por ciento y 89,8 por ciento, determinando una diferencia estadísticamente significativa (p < 0,005). Conclusiones: El nivel de captación de la información fue muy bueno, en aquellas preguntas que el conocimiento previo era significativamente menor, superó la diferencia promedio de respuestas correctas, y ratifica nuestra experiencia clínica: el desconocimiento y/o la negación de los aspectos emocionales intervinientes en esta enfermedad
Subject(s)
Humans , Child , Asthma , Evaluation Study , Patient Education as Topic , Health Education/trends , Educational Measurement/statistics & numerical data , Evaluation StudyABSTRACT
El Plan de Educación a través de información clara y precisa tiende a disminuir la frecuencia de las exacerbaciones, consecuentemente la disminución de la sintomatología clínica, mayor cumplimiento del tratamiento, y mejorar la calidad de vida. Objetivos: Evaluar el nivel de información previa de los pacientes que pertenecen al programa y el nivel de captación de la información brindada, para determinar el grado de efectividad del proceso educativo. Material y Métodos: Se encuestaron 50 pacientes con asma de bajo nivel socieconómico que pertenecen al programa. Fue administrado un cuestionario elaborado por nosotros, compuesto de 10 preguntas, en dos momentos: uno previo a la reunión informativa a cargo del equipo interdisciplinario, y otro posterior a ella. Se analizaron los datos a través de técnicas de estadística descriptiva e inferencial; para esta última se aplicó el Test de Significación Normal. Resultados: Los porcentajes promedios de respuestas correctas antes y después de la información fueron respectivamente: 65,4 por ciento y 89,8 por ciento, determinando una diferencia estadísticamente significativa (p < 0,005). Conclusiones: El nivel de captación de la información fue muy bueno, en aquellas preguntas que el conocimiento previo era significativamente menor, superó la diferencia promedio de respuestas correctas, y ratifica nuestra experiencia clínica: el desconocimiento y/o la negación de los aspectos emocionales intervinientes en esta enfermedad (AU)
Subject(s)
Humans , Child , Asthma , Evaluation Study , Patient Education as Topic , Health Education/trends , Educational Measurement/statistics & numerical data , Evaluation StudyABSTRACT
There are not enough data concerning asthma mortality in Latin America. The Latin American Society of Allergy and Immunology coordinated this project to provide reliable data for gaining knowledge about our present situation, which is a condition indispensable to changing it. The following countries participated in this study: Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Paraguay, Peru, Uruguay and Venezuela. A uniform protocol was designed in Santa Fe, Argentina. Asthma mortality rates were analyzed in accordance with two variables: age-adjusted rates (5-34) and total death rates. The total population studied was 107, 122, 529 inhabitants. The highest death rates were found in Uruguay and Mexico (5.63), and the lowest in Paraguay (0.8) and Colombia (1.35). Age-adjusted (5-34) rates were higher in Costa Rica (1.38) and lower in Chile (0.28). Regarding sex, the analysis of the information provided by seven countries showed a predominance of females (51.8%) over males (48.18%). In the southern Latin American countries such as Chile, Uruguay, Paraguay and Argentina, which have marked climatic differences, deaths occurred mainly in the winter. It is important to emphasize that, in most countries, deaths from asthma occurred at home: Chile (60.7%), Argentina (63.4%) and Paraguay (88%). However, in Uruguay, 58.6% occurred during hospitalization. Mortality rates from bronchial asthma are high in most of the Latin American countries studied, even though further studies are needed. Asthma is a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that can be severe and sometimes fatal. The health ministries of each country do not believe asthma is a significant issue. Therefore, we should provide them with sound epidemiological studies to convince them to change their attitude toward this disease.
Subject(s)
Asthma/mortality , Adolescent , Adult , Age Factors , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Latin America/epidemiology , Male , Middle Aged , Sex FactorsSubject(s)
Asthma/epidemiology , Asthma/mortality , Child , Female , Humans , Latin America/epidemiology , Male , PrevalenceABSTRACT
Little information is available on mite allergen levels and rates of sensitization to domestic mites in South America. The purpose of this study was to establish the rate of sensitization to domestic mites in asthmatics and measure mite allergen levels in pillows and mattresses of mite allergic individuals in Santa Fe, Argentina. Dust samples were collected from the pillows and mattresses of 56 asthmatics (24 females and 32 males, mean age 17.6 +/- 11.5 years), who had been previously skin tested with standardized extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae and (1:50 w/v) extracts of Aleuroglyphus ovatus, Blomia tropicalis, Chortoglyphus arcuatus. A wheal > or = 3 mm was considered positive. Sensitization to Lepidoglyphus destructor and Euroglyphus maynei was determined by RAST and considered positive when a serum bound > or = 1% of the total counts added. Forty six individuals had a positive skin test to D. pteronyssinus, 43 to D. farinae, 27 to A. ovatus, 38 to B. tropicalis, 27 to C. arcuatus; 38 of 54 individuals had a positive RAST to E. maynei and 22 of 54 to L. destructor. The mean Group 1 (Der p 1 + Derf 1) level in pillows (n = 48) was 6.7 micrograms/g (1-55.4) and in mattresses (n = 52) 4.3 micrograms/g (1-38.8). There is a high degree of sensitization to domestic mites among asthmatics in Santa Fe. High mite allergen levels (> 2 micrograms/g) can be detected very often in pillows and mattresses.
Subject(s)
Allergens/adverse effects , Glycoproteins/immunology , Hypersensitivity/etiology , Mites/immunology , Adolescent , Adult , Animals , Antigens, Dermatophagoides , Argentina , Bedding and Linens , Child , Female , Humans , Male , Urban PopulationABSTRACT
El asma bronquial es una enfermedad multifactorial donde tienen cabida los factores hereditarios, mecanismos inmunológicos, procesos infecciosos y la variable psicológica en el proceso de modulación de la enfermedad. Los objetivos fueron: 1. Determinar cuantitativamente el porcentaje de participación del compromiso emocional. 2. Correlacionar el perfil psicológico del grupo estudiado (n=36), con el grado de compromiso emocional del perfil psicológico familiar de estos pacientes. 3. Evaluar si el grado de compromiso orgánico coincide con la severidad del compromiso emocional. Se estudió 36 pacientes con asma de más de 3 años de evolución. Edades: 4 a 12 años (X=8,3 años). Se realizó psicodiagnóstico: a. Entrevista operativa semiabierta con ambos padres; b. Entrevista pautada con ambos padres: (Historia clínica especialmente diseñada); c. Batería de tests: 1. Santuchi-Bender; 2. Casa pintada; 3. Figura humana; 4. Familia; 5. Desiderativo; 6. CAT; 7. Nemi y Raven. Se evaluó los indicadores emocionales con la Tabla de Lic. Baravalle y cols. Se evaluó los indicadores orgánicos de acuerdo a Consenso Argentino de Pediatría para el Diagnóstico y Tratamiento del Asma Bronquial Infantil (Sociedad Argentina de Pediatría). Resultados: Los obtenidos estadísticamente evidenciaron un compromiso más acentuado al cuantificar el perfil psicológico de la familia (86 por ciento) que el perfil psicológico del niño (75 por ciento). El compromiso emocional de mayor severidad que el orgánico. Conclusiones: Esto plantea la evaluación del factor emocional en todos los niños que presentan asma moderado o intenso, e indica la necesidad de modificar pautas en la estrategia terapéutica integral del niño con asma, que incluyan su grupo familiar.
Subject(s)
Child , Humans , Male , Female , Child, Preschool , Asthma/psychology , Family/psychology , Asthma/etiology , Stress, Psychological/complications , Stress, Psychological/diagnosis , Affective Symptoms/diagnosis , Affective Symptoms/psychology , Psychological Tests/statistics & numerical dataABSTRACT
El asma bronquial es una enfermedad multifactorial donde tienen cabida los factores hereditarios, mecanismos inmunológicos, procesos infecciosos y la variable psicológica en el proceso de modulación de la enfermedad. Los objetivos fueron: 1. Determinar cuantitativamente el porcentaje de participación del compromiso emocional. 2. Correlacionar el perfil psicológico del grupo estudiado (n=36), con el grado de compromiso emocional del perfil psicológico familiar de estos pacientes. 3. Evaluar si el grado de compromiso orgánico coincide con la severidad del compromiso emocional. Se estudió 36 pacientes con asma de más de 3 años de evolución. Edades: 4 a 12 años (X=8,3 años). Se realizó psicodiagnóstico: a. Entrevista operativa semiabierta con ambos padres; b. Entrevista pautada con ambos padres: (Historia clínica especialmente diseñada); c. Batería de tests: 1. Santuchi-Bender; 2. Casa pintada; 3. Figura humana; 4. Familia; 5. Desiderativo; 6. CAT; 7. Nemi y Raven. Se evaluó los indicadores emocionales con la Tabla de Lic. Baravalle y cols. Se evaluó los indicadores orgánicos de acuerdo a Consenso Argentino de Pediatría para el Diagnóstico y Tratamiento del Asma Bronquial Infantil (Sociedad Argentina de Pediatría). Resultados: Los obtenidos estadísticamente evidenciaron un compromiso más acentuado al cuantificar el perfil psicológico de la familia (86 por ciento) que el perfil psicológico del niño (75 por ciento). El compromiso emocional de mayor severidad que el orgánico. Conclusiones: Esto plantea la evaluación del factor emocional en todos los niños que presentan asma moderado o intenso, e indica la necesidad de modificar pautas en la estrategia terapéutica integral del niño con asma, que incluyan su grupo familiar. (AU)
Subject(s)
Child , Humans , Male , Female , Child, Preschool , Asthma/psychology , Family/psychology , Affective Symptoms/diagnosis , Affective Symptoms/psychology , Psychological Tests/statistics & numerical data , Stress, Psychological/complications , Stress, Psychological/diagnosis , Asthma/etiologyABSTRACT
The prevalence of positive skin prick tests to the mite species Dermatophagoides pteronyssinus, D. farinae, Blomia tropicalis, Chortoglyphus arcuatus, Lepidoglyphus destructor and Aleuroglyphus ovatus was determined in 297 asthmatic adults and children living in seven cities of five Latin American countries. A standardized protocol and a common battery of extracts were used at each site. The mean wheal diameters were measured after 15 min, and those > or = 3 mm were considered positive. Sensitization to D. pteronyssinus varied from 60.7% in Cartagena to 91.2% in São Paulo; to D. farinae from 53.3% in Córdoba to 97.2% in Caracas; to A. ovatus from 26.6% in Bogotá to 71.2% in São Paulo; to B. tropicalis from 46.5% in Mexico City to 93.7% in São Paulo; to C. arcuatus from 33.3% in Mexico City to 75% in São Paulo; and to L. destructor from 30% in Mexico City to 76.2% in São Paulo. This study reported the results of skin test sensitivities in both children and adults. The studies from São Paulo and Córdoba were confined to children and thus could be compared; there was a significantly higher prevalence of cutaneous sensitivity to mite allergens in the children of São Paulo than in those of Córdoba (p < 0.001 for all mite species). Cutaneous sensitivity to mite allergens is very common in young and adult asthmatics in Latin America, in areas both at sea level and at high altitudes. Environmental control measures should be reinforced in the treatment of asthmatics in Latin America.
Subject(s)
Asthma/immunology , Hypersensitivity/epidemiology , Mites/immunology , Adolescent , Adult , Animals , Child , Child, Preschool , Female , Humans , Latin America/epidemiology , Male , Prevalence , Skin TestsABSTRACT
Mold allergy in frequently involved in the etiopathogenesis of allergy respiratory diseases and it is important for us to determine the fungal classes that most frequently cohabit with men in our region, and under which condition of temperature and humidity they mostly develop. Mycological flora was studied bimonthly in 1989, in 8 homes from Santa Fe City, by exposing three dishes (90 mm) for 20 min. in bathrooms, kitchens and bedrooms. Afterwards, the dishes were incubated for 10 days at 28ºC. Taxonomic identification was made by microscopy of the mature sporulating colonies. Alternaria was the fungal class most frequently found (64 por ciento), followed by Cladospotium (11,4 por ciento), Aspergillus (9,2 por ciento), Curvularia (7 por ciento), Penicillium (4 por ciento), Fusarium (1,2 por ciento) and others (3,2 por ciento). Concerning the rooms, altemaria and Cladosporium were mostly found in kitchens, un like the classes Aspergillus, penicillium and Curvularia that were mostly found in bedrooms. Considering all the colonies as a whole, the totals of each room were: for kitchens 50 por ciento: for bedrooms 28,5 por ciento: and for bathrooms, 21,5 por ciento. The greatest concentration of total colonies was found to those month varied from 70 to 75 por ciento, and the average temperature was stated between 16 and 22ºC. According to the medium values for temperature and humidity in Santa Fe City, spring in the most suitable season for in home molds to develop, being the kitchen the room where a greater number of colonies was found
Subject(s)
Humans , Asthma/etiology , Fungi/pathogenicity , Allergens/immunology , Alternaria/immunology , Alternaria/isolation & purification , Alternaria/pathogenicity , Aspergillus/immunology , Aspergillus/isolation & purification , Aspergillus/pathogenicity , Cladosporium/immunology , Cladosporium/isolation & purification , Cladosporium/pathogenicity , Dust/adverse effects , Fungi/immunology , Fungi/isolation & purification , Humidity/adverse effects , Hypersensitivity/etiology , Hypersensitivity/immunologyABSTRACT
Mold allergy in frequently involved in the etiopathogenesis of allergy respiratory diseases and it is important for us to determine the fungal classes that most frequently cohabit with men in our region, and under which condition of temperature and humidity they mostly develop. Mycological flora was studied bimonthly in 1989, in 8 homes from Santa Fe City, by exposing three dishes (90 mm) for 20 min. in bathrooms, kitchens and bedrooms. Afterwards, the dishes were incubated for 10 days at 28ºC. Taxonomic identification was made by microscopy of the mature sporulating colonies. Alternaria was the fungal class most frequently found (64 por ciento), followed by Cladospotium (11,4 por ciento), Aspergillus (9,2 por ciento), Curvularia (7 por ciento), Penicillium (4 por ciento), Fusarium (1,2 por ciento) and others (3,2 por ciento). Concerning the rooms, altemaria and Cladosporium were mostly found in kitchens, un like the classes Aspergillus, penicillium and Curvularia that were mostly found in bedrooms. Considering all the colonies as a whole, the totals of each room were: for kitchens 50 por ciento: for bedrooms 28,5 por ciento: and for bathrooms, 21,5 por ciento. The greatest concentration of total colonies was found to those month varied from 70 to 75 por ciento, and the average temperature was stated between 16 and 22ºC. According to the medium values for temperature and humidity in Santa Fe City, spring in the most suitable season for in home molds to develop, being the kitchen the room where a greater number of colonies was found
Subject(s)
Humans , Asthma/etiology , Fungi/pathogenicity , Hypersensitivity/etiology , Hypersensitivity/immunology , Aspergillus/isolation & purification , Aspergillus/immunology , Aspergillus/pathogenicity , Cladosporium/isolation & purification , Cladosporium/immunology , Cladosporium/pathogenicity , Alternaria/isolation & purification , Alternaria/immunology , Alternaria/pathogenicity , Allergens/immunology , Dust/adverse effects , Humidity/adverse effects , Fungi/isolation & purification , Fungi/immunologyABSTRACT
La alergia a los ácaros del polvillo doméstico en asociación al asma es, actualmente considerado un problema de diseminación mundial. Entre el 70 al 90% de los pacientes asmáticos tienen test cutáneo positivos a extractos de ácaros, particularmente a D. pteronyssinus y D. farinae. Numerosos estudios han encontrado sensibilidad cutánea a otros Piroglífidos, tal el caso de E. maynei. En los depósitos de granos, alimentos y maderas, entre otros, se han hallado ácaros que se desiganaron "de almacenamiento" y que ahora son llamados "domésticos" ya que también se pueden encontrar en las viviendas. No conocíamos la prevalencia de sensibilidad a extractos de otros ácaros del sub-orden astigmata. En este estudio se presentan la frecuencia de sensibilización cutánea en niños asmáticos de Córdoba y niños y adultos asmáticos de Santa Fe a extractos de D. pteronyssinus, D. farinae, B. tropicalis, A. ovatus, C. arcuatus y L. destructor. Tanto en los pacientes asmáticos de Córdoba como de Santa Fe, la mayor frecuencia de sensibilización cutánea fue a D. pteronyssinus, 63.3% y 72.7% respectivamente. B. tropicalis fue el segundo alergeno hallado en Córdoba (58.3%) y D. farinae en Santa Fe (66.6%). Los extractos alergénicos de los otros ácaros estudiados arrojaron positividades entre el 6 y el 57.5% de los casos estudiados. Los ácaros del sub-orden Astigmata, no Piroglífidos, son capaces de inducir sensibilidad cutánea en niños y adultos asmáticos de nuestro país
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Mites/immunology , Allergens , Asthma/immunology , Hypersensitivity/diagnosis , Mites/classification , Allergens/isolation & purification , Asthma/etiology , Dust/adverse effects , Skin Tests/methodsABSTRACT
La alergia a los ácaros del polvillo doméstico en asociación al asma es, actualmente considerado un problema de diseminación mundial. Entre el 70 al 90% de los pacientes asmáticos tienen test cutáneo positivos a extractos de ácaros, particularmente a D. pteronyssinus y D. farinae. Numerosos estudios han encontrado sensibilidad cutánea a otros Piroglífidos, tal el caso de E. maynei. En los depósitos de granos, alimentos y maderas, entre otros, se han hallado ácaros que se desiganaron "de almacenamiento" y que ahora son llamados "domésticos" ya que también se pueden encontrar en las viviendas. No conocíamos la prevalencia de sensibilidad a extractos de otros ácaros del sub-orden astigmata. En este estudio se presentan la frecuencia de sensibilización cutánea en niños asmáticos de Córdoba y niños y adultos asmáticos de Santa Fe a extractos de D. pteronyssinus, D. farinae, B. tropicalis, A. ovatus, C. arcuatus y L. destructor. Tanto en los pacientes asmáticos de Córdoba como de Santa Fe, la mayor frecuencia de sensibilización cutánea fue a D. pteronyssinus, 63.3% y 72.7% respectivamente. B. tropicalis fue el segundo alergeno hallado en Córdoba (58.3%) y D. farinae en Santa Fe (66.6%). Los extractos alergénicos de los otros ácaros estudiados arrojaron positividades entre el 6 y el 57.5% de los casos estudiados. Los ácaros del sub-orden Astigmata, no Piroglífidos, son capaces de inducir sensibilidad cutánea en niños y adultos asmáticos de nuestro país
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Hypersensitivity/diagnosis , Asthma/immunology , Mites/immunology , Allergens/diagnosis , Asthma/etiology , Mites/classification , Allergens/isolation & purification , Dust/adverse effects , Skin Tests/methodsABSTRACT
The increase in the incidence of bronchial asthma is not necessarily accompanied by an increase in death rates; furthermore, the knowledge of the intimate physiopathogenic mechanisms of the disease, the appearance of new drugs with pharmaceutical forms that make them more available for patients, should improve the effectiveness of the treatment. In spite of that, the asthma death rate curves increase as drug sales increase. Some authors think this is caused by factors depending on the patient, the health system and, nowadays, the inappropriate use of the available drugs is thought to be one of the reasons for the increase in asthma death rates, and the use of drugs that only supply to the patient an adequate bronchodilation may mask the underlying inflammatory process, what unavoidably leads to irreversible deteriorations in the airways, with smooth muscle hypertrophy and thickening of the basal membrane. It is logical to think that children's bronchial asthma is the first stage of a progressive illness, in which the allergic factor is really meaningful, and that is why a suitable prophylaxis with early use of drugs with antiinflammatory activity may prevent the development of irreversible deteriorations of bronchial and lung parenchyma. Oral or inhalatant corticoids, disodium cromoglycate, ketotifen and nedocromil are the drugs with well-known antiinflammatory activity, though they have a different site of action, as corticoids act directly on inflammatory cells, inhibiting the activity of macrophages and particularly of eosinophils, while cromoglycate, nedocromil and ketotifen inhibit mediators release, thus stabilizing mastocyte membrane.
Subject(s)
Asthma/prevention & control , Cromolyn Sodium/therapeutic use , Ketotifen/therapeutic use , Argentina/epidemiology , Asthma/epidemiology , Asthma/mortality , Asthma/physiopathology , Cell Membrane/drug effects , Cromolyn Sodium/pharmacology , Cyclic AMP/physiology , Female , Humans , Ketotifen/pharmacology , Male , Mast Cells/drug effects , Mast Cells/ultrastructureABSTRACT
We studied 1,030 patients of both sexes, classified according to atopic and non-atopic, those suffering from bronchial asthma (AB), rhinitis (R) or associated AB and R, with ages between 3 months to 62 years. Total IgE, serum IgA and secretory IgA were determined in all of them in order to establish their values and to make the corresponding comparisons. Serum IgA did not show any difference in both groups, while secretory IgA showed lower values in atopic patients than non-atopic patients during childhood. Later on, their values reached a similar level. Total IgE values in atopics significantly differed from non-atopic values at all ages. There was a negative correlation coefficient between total IgE and secretory IgA in the 6 years old patients' group, and in adults. Our results suggest that IgE synthesis, genetically determined in atopics, may be influenced to higher levels in patients with lower secretory IgA levels. This latter factor, as we only measured total secretory non-specific IgA level, must be considered of relative importance.
