Fluticasone/formoterol dry powder versus budesonide/formoterol in adults and adolescents with uncontrolled or partly controlled asthma.

UNLABELLED: This 12-week study compared the efficacy and safety of a fixed combination of fluticasone propionate plus formoterol (FL/F) 250/12 µg b.i.d. administered via a dry powder inhaler (DPI) (Libbs Farmacêutica, Brazil) to a combination of budesonide plus formoterol (BD/F) 400/12 µg b.i.d. After a 2-week run-in period (in which all patients were treated exclusively with budesonide plus formoterol), patients aged 12-65 years of age (N = 196) with uncontrolled asthma were randomized into an actively-controlled, open-labeled, parallel-group, multicentre, phase III study. The primary objective was to demonstrate non-inferiority, measured by morning peak expiratory flow (mPEF). The non-inferiority was demonstrated. A statistically significant improvement from baseline was observed in both groups in terms of lung function, asthma control, and the use of rescue medication. FL/F demonstrated a statistical superiority to BD/F in terms of lung function (FEV(1)) (p = 0.01) and for asthma control (p = 0.02). Non-significant between-group differences were observed with regards to exacerbation rates and adverse events. In uncontrolled or partly controlled asthma patients, the use of a combination of fluticasone propionate plus formoterol via DPI for 12-weeks was non-inferior and showed improvements in FEV(1) and asthma control when compared to a combination of budesonide plus formoterol. ( CLINICAL TRIAL NUMBER: ISRCTN60408425).

Exercise-induced bronchospasm in obese adolescents.

BACKGROUND: Assess the frequency and severity of exercise-induced bronchospasm (EIB) in obese adolescents. METHODS: A cross-sectional descriptive study involving 80 adolescents of both genders, aged 10-16 years-old, divided into four groups according to clinical history of asthma and/or allergic rhinitis and body mass index as follows: asthmatic obese (n = 18); asthmatic non-obese (n = 21); obese non-asthmatic (n = 26); and healthy individuals (n = 15). An exercise bronchoprovocation test was used for EIB diagnosis, considered positive when the forced expiratory volume in one second (FEV(1)) decreased > or = 15% in relation to pre-exercise FEV(1). Maximum percent fall in FEV(1) (MF%FEV(1)) and area above the curve (AAC(0-30)) were calculated to evaluate EIB severity and recovery. RESULTS: No significant difference was found in EIB frequency between asthmatic obese (50.0%) and asthmatic non-obese (38.0%) individuals or between obese non-asthmatics (11.5%) and healthy individuals (6.7%). However, the MF%FEV(1) and AAC(0-30) were significantly greater in the asthmatic obese group compared to the asthmatic non-obese (37.7% and 455 vs 24.5% and 214, p<0.03). CONCLUSIONS: Obesity did not contribute to increased EIB frequency in asthmatics and non-asthmatics. However, obesity did contribute to increased EIB severity and recovery among asthmatics.

Exercise-induced bronchospasm in obese adolescents

Background Assess the frequency and severity of exercise-induced bronchospasm (EIB) in obese adolescents. Methods A cross-sectional descriptive study involving 80 adolescents of both genders, aged 10-16 years-old, divided into four groups according to clinical history of asthma and/or allergic rhinitis and body mass index as follows: asthmatic obese (n=18); asthmatic non-obese (n=21); obese non-asthmatic (n=26); and healthy individuals (n=15). An exercise bronchoprovocation test was used for EIB diagnosis, considered positive when the forced expiratory volume in one second (FEV1) decreased ≥15% in relation to pre-exercise FEV1. Maximum percent fall in FEV1 (MF%FEV1) and area above the curve (AAC0_30) were calculated to evaluate EIB severity and recovery. Results No significant difference was found in EIB frequency between asthmatic obese (50.0%) and asthmatic non-obese (38.0%) individuals or between obese non-asthmatics (11.5%) and healthy individuals (6.7%). However, the MF%FEV1 and AAC0_30 were significantly greater in the asthmatic obese group compared to the asthmatic non-obese (37.7% and 455 vs 24.5% and 214, p<0.03). Conclusions Obesity did not contribute to increased EIB frequency in asthmatics and non-asthmatics. However, obesity did contribute to increased EIB severity and recovery among asthmatics (AU)

Prevalence of symptoms of asthma, rhinitis, and atopic eczema in Brazilian adolescents related to exposure to gaseous air pollutants and socioeconomic status.

OBJECTIVES: To evaluate the relationship between exposure to gaseous air pollutants (ozone [O3], carbon monoxide [CO], nitrogen dioxide [NO2], and sulfur dioxide [SO2]) socioeconomic status and the prevalence of symptoms of asthma, rhinitis and atopic eczema in adolescents. SUBJECTS AND METHODS: A sample of 16 209 adolescents from São Paulo West (SPW), São Paulo South (SPS), Santo André (SA), Curitiba (CR), and Porto Alegre (PoA) were enrolled. Data on air pollutants and socioeconomic status were compared to prevalence of symptoms with the Spearman correlation coefficient. RESULTS: Socioeconomic status was quite similar in all cities. The levels of O3 in SPW, SPS, and SA, and of CO in SA were higher than the acceptable ones. In relation to O3 and CO exposures, adolescents from SPW and SA had a significant risk of current wheezing, whereas living in SPW was associated with a high risk of rhinoconjunctivitis, eczema, and flexural eczema and living in CR to rhinitis. Exposure to NO2 was associated with a high risk of current wheezing in SPW and SA, and of severe asthma in SPW and PoA. Exposure to SO2 was associated with a high risk of current wheezing in SPW and SA, severe asthma in SPW and PoA, and nighttime cough, eczema, flexural eczema and severe eczema in SPW. Living in SPW, CR, or PoA was associated with a high risk of rhinitis, rhinoconjunctivitis, and severe rhinitis. CONCLUSIONS: Although we did not detect a characteristic pattern for all symptoms evaluated or a specific air pollutant, our data suggest a relationship between higher exposure to photochemical pollutants and high prevalence or risk of symptoms of asthma, rhinitis, and atopic eczema.

Prevalence of rhinitis and related-symptoms in schoolchildren from different cities in Brazil.

By using the standard written questionnaire (WQ), designed for the International Study of Asthma and Allergies in Childhood (ISAAC) we determined the prevalence of rhinitis and its related-symptoms, in Brazilian children and adolescents, living in different cities of the country. The WQ was answered by the parents of 11,403 children aged 6-7 years from five Brazilian cities: Porto Alegre (South, N = 2,846), São Paulo (Southeast, N = 3,005) Uberlândia (Southeast, N = 2,991), Itabira (Southeast, N = 1,151) and Recife (Northeast, N = 1,410). The WQ was also applied to 20,587 adolescents (13-14 years old) living in: Porto Alegre (South, N = 3,195), Curitiba (South, N = 3,004), São Paulo (Southeast, N = 3,008), Uberlândia (Southeast, N = 2,998), Itabira (Southeast, N = 2,134), Salvador (Northeast, N = 3,162) and Recife (Northeast, N = 3,086). The mean response rates were 75% and 95%, for the 6-7 year-old children and for the adolescents, respectively. The data was transcribed to a database (Epi-Info) and analyzed regarding the answers to questions of rhinitis module. The mean prevalence of rhinitis (affirmative response to question 2) was 26.6% and 34.2% in the groups of 6-7 and 13-14 year-old, respectively. Applying the criteria that evaluate the association between nasal and ocular symptoms (affirmative response to question 3) the mean prevalence of allergic rhinitis were 12.8% for the 6-7 year-old children and 18.0% for the adolescents. In conclusion, the prevalence of rhinitis and its related symptoms among children and adolescents living in different Brazilian cities was as high as the prevalence observed in other areas of the world.

International Study of Asthma and Allergies in Childhood (ISAAC): prevalence of asthma and asthma-related symptoms among Brazilian schoolchildren.

We have studied the prevalence of asthma and its symptoms using a standard written questionnaire (WQ) designed for the International Study of Asthma and Allergies in Children (ISAAC). The WQ (questions 1 through 8 related to asthma) was applied to 13,604 children aged 6-7 years from six Brazilian cities: Porto Alegre (South, N = 2,976), Curitiba (South, N = 1,664), São Paulo (Southeast, N = 3,005), Uberlândia (Southeast, N = 3,002), Itabira (Southeast, N = 1,551) and Recife (Northeast, N = 1,406). At the age of 13-14 years the WQ was applied to 20,554 schoolchildren living in Porto Alegre (South, N = 3,198), Curitiba (South, N = 3,008), São Paulo (Southeast, N = 3,008), Uberlândia (Southeast, N = 3,001), Itabira (Southeast, N = 2,134), Salvador (Northeast, N = 3,119) and Recife (Northeast, N = 3,086). The parents of the younger children answered the WQ, whereas the adolescents answered the questionnaire themselves. The response rates were 72% and 93% for the 6-7-year-old children and for the 13-14-year-old children, respectively. There was a slight predominance of male children in the population studied. In the group of 6-7-year-olds, the prevalence of physician diagnosed asthma was 7.3% for boys and 4.9% for girls: in the group of 13-14-year-olds the rates were 9.8% and 10.2%, respectively. Asthma severity was similar for both age groups, and wheezing following exercise was more frequent among the adolescents. In keeping with studies from other parts of the world, comparison between reported symptoms and diagnosed asthma revealed a significantly lower frequency of diagnosed asthma, suggesting that in the study population, asthma is underdiagnosed.

[The use of clinical score to estimate the severity of an acute attack of asthma] / Uso de escore clínico para a avaliação da gravidade da crise de asma.

OBJECTIVE: To identify patients with acute asthma who require intensive care, using a clinical score.METHODS: Retrospective analysis of 299 patients who were admitted to the hospital for acute asthma, between 1993 and 1996. Two groups were selected: group I (GI) with 26 patients admitted to the Intensive Care Unit; group II (GII) with 52 patients admitted to the Emergency Room, matched by age and sex with those of GI. A clinical score to assess the groups had the following items: heart rate, respiratory rate, retractions, cyanosis, alertness level, previous treatment, previous hospitalization, and duration of attack. The score ranged from 0 to 2 points for each of those, summing up 11 points.RESULTS: The clinical parameters that discriminated well the 2 groups were: retractions (p<0.001), cyanosis (p<0.01) and alertness level (p<0.005). Through a discriminate analysis of the clinical score components, 22/26 patients were recognized as GI and 40/52 patients were recognized as GII, showing an accuracy of 85% and 77% respectively for GI and GII.CONCLUSION: The clinical score was useful to discriminate patients with severe attack of asthma who might require intensive care, and should be employed at hospital admission.

[Prevalence of asthma in schoolchildren in Curitiba - ISAAC] / Prevalência de asma em escolares de Curitiba - projeto ISAAC (International Study of Asthma and Allergies in Childhood).

OBJECTIVE: To verify the prevalence of asthma in schoolchildren from Curitiba.METHOD: A written questionnaire of asthma symptoms (ISAAC-International Study of Asthma and Allergies in Childhood) was applied to children ages 6-7 years and adolescents 13-14 years registered in 32 public schools.RESULTS: 3,200 questionnaires were applied to 13-14 year-old adolescents, and 2,863 questionnaires to 6-7 year-old children. The questionnaire should be answered by the parents of 6-7 year-old children (group I) and by the adolescents themselves (13-14 year-old, group II). The rate of questionnaires returned was 58% for group I and 92% for group II. A presumptive diagnosis of asthma was based on having had 4 or more attacks of wheezing in the last 12 months, or 1-3 wheezing episodes in addition to night awakening for wheezing, nocturnal cough and wheezing after exercise. Under these criteria there were 15.7% asthmatics in group I and 11.6% in group II. Symptoms of rhinoconjunctivitis were found in 38% and 36%, and eczema in 11% and 10% for groups I and II, respectively. Among those with presumed asthma, over 70% denied having had asthma. The question "have you ever had asthma" although specific is not sensitive enough.CONCLUSION: The prevalence of asthma in Curitiba was 15.7% for children 6-7 years old and 11.6% for adolescents 13-14 years. The question "have you ever had asthma" did not contribute to defining cases with asthma.

[Evaluation of the complement system and immunoglobulin G levels in cord blood. Relationship with gestational age and intrauterine growth]. / Avaliação do sistema complemento e da imunoglobulina G no sangue do cordão umbilical de recém-nascidos. Relação com a idade gestacional e adequação do crescimento intra-uterino.

OBJECTIVE: To evaluate the complement system in cord blood and its relationship with the degree of maturation and intrauterine growth. METHODS: Serum levels of C(3), C(4) and CH(50) were measured in premature, small for gestational age and appropriate for gestational age newborns. The activation of complement system was searched by clivage product determination C(3d) and C(4d). Serum IgG levels were also determined in all children. RESULTS: The levels of C(3), C(4), CH(50) and IgG were significantly lower in preterm (p < 0,001); C(4) and IgG values were also significantly lower in small for date than those in normal newborn. C(3d) and C(4d) were not detected, indicating that the complement system had not been activated. CONCLUSIONS: The lower complement component levels and IgG in newborn are related to gestational age as well as to intrauterine growth.

[Hypodense eosinophils in blood of pediatric patients with asthma]. / Eosinófilos hipodensos no sangue de pacientes pediátricos com asma.

OBJECTIVE: Determine the number of circulating hypodense eosinophils in the blood of atopic asthmatics. METHODS: The hypothesis was that hypodense eosinophils, the activated cells, were higher in asthmatics than in non-atopic children. Granulocytes were separated from mononuclear cells by Ficoll-hypaque. Gradients of density were generated through dilutions of Percoll for fractionations of cells. RESULTS: Asthmatics had blood eosinophilia (768 +/- 75/mcl) when compared to normal control (200 +/- 28/mcl), and higher mean hypodense eosinophils (39%) as compared to normal children (11.7%). CONCLUSION: Eosinophils accumulate in asthmatic, especially the low density activated variant, suggesting its active role in the allergic inflammatory process.

[Peripheral blood eosinophils and serum level of eosinophil cationic protein in asthmatics]. / Contagem de eosinófilos circulantes e níveis séricos de proteína catiônica eosinofílica em asmáticos.

OBJECTIVE: Determine the number of circulating eosinophils and serum eosinophil cationic protein levels in asthmatics, and the relationship between them. METHODS: We studied 26 atopic asthmatics aged 7-16 years divided in two groups according to severity of asthma. Eosinophil counts were obtained by multiplying leukocyte number by eosinophil percent. Serum eosinophil cationic protein levels were determined by fluoroenzymatic method, CAP System, Pharmacia Diagnostics. RESULTS: Asthmatics had eosinophil counts (810 +/- 103/mcl) significantly higher than non atopic children (158 +/- 30/mcl). Mean eosinophil cationic protein levels were higher in severe asthmatics (p < 0,001) and correlated with eosinophil counts. CONCLUSIONS: Serum eosinophil cationic protein levels could be useful in assessing the allergic inflammation and probably reflect the activation of eosinophils.

[Bronchodilators in asthma: bypassing controversies]. / Broncodilatadores na asma: contornando controvérsias.

Inhaled bronchodilators are used in acute asthma for relief of airway obstruction. Continuous monotherapy with beta 2 adrenergic can increase hyperresponsiveness because these drugs do not control inflammation. Asthma mortality and morbidity have been related to an increased beta 2-agonists use. Epidemiologic data however do not show a cause/effect relationship. Until controversies are cleared on, beta 2-agonists should be used for relieving acute asthma attacks, for preventing exercise-induced bronchospasm and eventually on an as needed basis. Long acting beta 2-agonists can be effective in moderate/severe asthma. Daily short acting beta 2 use by inhalation, a partial clinical response and its overuse in acute asthma suggest the need for antiinflammatory treatment.

[Allergy skin testing after topical anesthesia]. / Efeito da anestesia tópica sobre as reações imediatas aos testes cutâneos com alérgeno.

Immediate skin test reactions are the hallmark of atopic diseases. EMLA (eutectic mixture of local anesthetics) is a local anesthetic that reduces the pain and apprehension for skin testing. We studied EMLA effects on the skin prick test with allergen and histamine. Reactions were evaluated by means of wheal and flare crossed diameters, speed of reaction and local temperature changes. One hour occlusion dressing with EMLA significantly delayed the beginning of reaction with antigen (129%) and histamine (101%). It decreased wheal diameter (33% and 15%) as well as local temperature variation (55% and 80%) respectively with antigen and histamine. Local anesthesia with EMLA probably interferes with histamine action and reduces the immediate skin test reaction. Therefore, it should not be used to reduce the pain of allergy skin testing.

[Abnormal sweat test in patient with Diabetes Insipidus unresponsive to ADH]. / Teste do suor anormal em paciente com Diabetes Insipidus resistente ao hormônio antidiurético.

Increased sweat concentrations (92, 76 and 80 mEq/l) were observed in a 7-year-old boy with pitressin-resistant diabetes insipidus. All previous observations of elevated sweat electrolytes in diabetes insipidus have been in infants less than 10 months of age. The sweat test is an exceptionally reliable, sensitive and specific test for the diagnosis of Cystic Fibrosis. Pitressin-resistant diabetes insipidus is one of the diseases associated with elevated sweat test results.

Avaliacao de imunoensaio enzimatico e testes cutaneos no diagnostico da "larva migrans" visceral. / Enzymatic immunoassay evaluation and skin tests in the diagnosis of visceral larva migrans

Varios metodos tem sido empregados no diagnostico laboratorial de larva migrans visceral, entre os quais o de imunoensaio enzimatico (ELISA) tem maior aceitacao. No presente trabalho foram preparados antigenos larvarios e do verme adulto de Toxocara canis. Os antigenos foram avaliados quanto a sua utilidade diagnostica atraves de testes cutaneos por puntura e de ELISA.Foram selecionados, alem de pacientes com suspeita clinica de larva migrans visceral individuos com enteroparasitos e um grupo de lactentes normais e nao-parasitados. Os resultados mostraram que os testes cutaneos nao tem sensibilidade, a ao teste de ELISA falta especialidade o suficiente para distinguir pacientes com infeccao por Toxocara canis de outras infeccoes parasitarias