A. Mota Pinto

Exposure to Paracetamol and Antibiotics in Early Life and Elevated Risk of Asthma in Childhood

Prospective studies on increased risk of childhood asthma due to exposure to paracetamol and antibiotics in early life have yielded contradictory results. Therefore, the aim of the present study was to investigate the association between administration of paracetamol and antibiotics in the first 12 months of life and delayed asthma symptoms later in childhood. This is a cross-sectional study that included 1,063 children from the primary schools in Coimbra, Portugal. ISAAC-based environmental and core asthma and rhinitis questionnaires were used to obtain information about childrens respiratory health and administration of paracetamol and antibiotics. We found that early paracetamol use significantly increased the risk of asthma ever (at least one episode in life) (OR = 2.9; 95 %CI:1.8-4.5), current asthma (OR = 2.4; 95 %CI:1.5-3.6), wheezing ever (OR = 2.5; 95 %CI:1.8-3.4), rhinitis ever (OR = 2.4; 95 %CI:1.7-3.3), and current rhinitis (OR = 2.8; 95 %CI:2.0-3.9). Antibiotic exposure showed a similar effect with the risk for current asthma (OR = 1.6; 95 %CI:1.0-2.5), asthma ever (OR = 2.0; 95 %CI:1.3-3.1), wheeze ever (OR = 2.3; 95 %CI:1.7-3.2), and rhinitis symptoms (OR = 1.8; 95 %CI:1.3-2.6, OR = 1.8; 95 %CI:1.3-2.6, OR = 1.9; 95 %CI:1.2-3.0 for rhinitis ever, current rhinitis, and tearing, respectively). We further found that increased frequency of paracetamol use during the last 12 months preceding the study facilitated the appearance of allergic symptoms, suggesting a dose-dependent associations. In conclusion, the study shows a significant association between exposure to paracetamol and antibiotics in the first 12 months of life and both prevalence and severity of asthma and rhinitis symptoms in children 5-9 years old.

Allergic respiratory diseases in the elderly

In industrialized countries there has been a significant increase in life expectancy, but chronic diseases are still important causes of death and disability in the elderly. Individuals over 65 years of age have a decrease in organic functions and lungs can lose more than 40% of their capacity. Although asthma and allergic rhinitis are more common in young people their prevalence in the elderly is increasing and the mortality reported in these patients is high. Asthmatic airways show an accumulation of activated eosinophils and lymphocytes determining structural changes of the bronchi. Local allergic inflammation, changes in T cell phenotypes and in apoptosis contribute to systemic inflammation. An increased risk of respiratory infections and neoplasic diseases has been recognized. These patients have increased susceptibility to atherosclerosis and cardiovascular diseases. Metabolic diseases are associated with an impairment of lung function and with systemic inflammation. Summing up older asthmatic patients have an increased risk to premature disability and death. A proper therapeutic approach to asthma can minimize this evolution. To identify the triggers is an important goal that allows reducing medication needs. Corticosteroids dampen allergic inflammation; therefore, they are the first choice in the treatment of patients with persistent asthma and rhinitis. Second-generation H1 receptor antagonists have reduced side effects and can be used if necessary. The elderly may have difficult access to health care. They should be educated about their disease and receive a written treatment plan. This information improves the quality of life, socialization and disease outcome in older people.

Determinação da neopterina e de defesas antioxidantes na asma de evolução arrastada

Asthma is a condition characterised by a chronic immunoinflammatory response to different triggers. Neopterin (NPT) is synthesised by human macrophages upon stimulation with interferon-γ and is also capable of enhancing the oxidative potential of reactive oxygen species. NPT is useful for the monitoring of cell-mediated (Th1-type) immune activation. This study analysed the behaviour of NPT in long lasting asthma, considering its role as a marker of Th1 environment. Allergic parameters (skin prick tests, Immunoglobin E (IgE), and eosinophil count) and NPT were evaluated in an asthmatic group and in a control group. We also analysed the C Reactive Protein (CRP) concentration, Total Antioxidant Status (TAS) and Superoxide Dismutase Enzyme (SOD) in both groups. A group of individuals aged over 65 years old was selected. It included 64 asthmatic patients (72 ± 5 years) and 41 healthy individuals (79 ± 7 years). Blood cell counts showed statistically different median values of eosinophils (5.42 ± 4.7 vs 2.8 ± 2.8;p<.04), IgE (493.2 ± 549.8 vs 85.3 ± 194.4UI/ml; p = .000) and NPT was non-statistically decreased (2.4 ± 2.8 vs 4.0 ± 4.7 ng/ml) in allergic asthmatic patients when compared with non-allergic asthmatic patients. Both allergic and non-allergic asthmatic patients presented a statistically significant decreased expression of TAS (0.84 ± 0.14/0.86 ± 0.11 vs 0.91 ± 0.10 mM) and SOD (584.8 ± 108.7/595.6 ± 235.9 vs 822.9 ± 179.5) when compared with normal control subjects. Our results suggest macrophage involvement in asthma pathogenesis. The deficit in antioxidant defence impacts negatively on this disease. The increase of NPT values in non-allergic asthma consolidates these affirmations and mapping this parameter should be part of the work of an analytical study panel as it may lead to allergic asthma being distinguished from nonallergic asthma. Rev Port Pneumol 2006; XII (6): 669-682

The evaluation of neopterin and antioxidants in long lasting asthma

Asthma is a condition characterised by a chronic immunoinflammatory response to different triggers. Neopterin (NPT) is synthesised by human macrophages upon stimulation with interferon-gamma and is also capable of enhancing the oxidative potential of reactive oxygen species. NPT is useful for the monitoring of cell-mediated (Th1-type) immune activation. This study analysed the behaviour of NPT in long lasting asthma, considering its role as a marker of Th1 environment. Allergic parameters (skin prick tests, Immunoglobin E (IgE), and eosinophil count) and NPT were evaluated in an asthmatic group and in a control group. We also analysed the C Reactive Protein (CRP) concentration, Total Antioxidant Status (TAS) and Superoxide Dismutase Enzyme (SOD) in both groups. A group of individuals aged over 65 years old was selected. It included 64 asthmatic patients (72+/-5 years) and 41 healthy individuals (79+/-7 years). Blood cell counts showed statistically different median values of eosinophils (5.42+/-4.7 vs 2.8+/-2.8;p<.04), IgE (493.2+/-549.8 vs 85.3+/-194.UI/ml; p=.000) and NPT was non-statistically decreased (2.4+/-2.8 vs 4.0+/-4.7 ng/ml) in allergic asthmatic patients when compared with non-allergic asthmatic patients. Both allergic and non-allergic asthmatic patients presented a statistically significant decreased expression of TAS (0.84+/-0.14/0.86+/-0.11 vs 0.91+/-0.10 mM) and SOD (584.8+/-108.7/595.6+/-235.9 vs 822.9+/-179.5) when compared with normal control subjects. Our results suggest macrophage involvement in asthma pathogenesis. The deficit in antioxidant defence impacts negatively on this disease. The increase of NPT values in non-allergic asthma consolidates these affirmations and mapping this parameter should be part of the work of an analytical study panel as it may lead to allergic asthma being distinguished from non- allergic asthma.