Ana Todo-Bom

Prevalence of asthma in Portugal - The Portuguese National Asthma Survey

BackgroundAsthma is a frequent chronic respiratory disease in both children and adults. However, few data on asthma prevalence are available in Portugal. The Portuguese National Asthma Survey is the first nationwide study that uses standardized methods. We aimed to estimate the prevalence of current asthma in the Portuguese population and to assess the association between ‘Current asthma’ and comorbidities such as upper airways disease.MethodsA cross-sectional, population-based, telephone interview survey including all municipalities of Portugal was undertaken. Participants were randomly selected to answer a questionnaire based on the Portuguese version of the GA2LEN survey. ‘Current asthma’ was defined as self-reported lifetime asthma and at least one of 3 symptoms in the last 12u2009months: wheezing, waking with breathlessness or having an asthma attack.ResultsData were obtained for 6 003 respondents, with mean age of 38.9 (95%CI 38.2-39.6) years and 57.3% females. In the Portuguese population, the prevalence of ‘Current asthma’ was 6.8% (95%CI 6.0-7.7) and of ‘Lifetime asthma’ was 10.5% (95%CI 9.5-11.6) Using GA2LEN definition for asthma, our prevalence estimate was 7.8% (95%CI 7.0-8.8). Rhinitis had a strong association with asthma (Adjusted OR 3.87, 95%CI 2.90-5.18) and the association between upper airway diseases and asthma was stronger in patients with both rhinitis and sinusitis (Adjusted OR 13.93, 95%CI 6.60-29.44).ConclusionsCurrent asthma affects 695 000 Portuguese, with a prevalence of 6.8%. People who reported both rhinitis and sinusitis had the highest risk of having asthma.

Epidemiology of rhinitis in Portugal: evaluation of the intermittent and the persistent types

Background:u2002 The prevalence of rhinitis is rapidly increasing in recent years and has become a major public health problem in developed countries. A new classification of allergic rhinitis has been proposed by the allergic rhinitis and its impact on asthma group. In this study we aimed to evaluate the prevalence of rhinitis, including different rhinitis subtypes and to describe the severity, rate of diagnosis and use of medication in this pathology.

Prevalence and classification of rhinitis in the elderly: a nationwide survey in Portugal.

Nationwide epidemiologic data on rhinitis in the elderly do not exist. This study aimed to estimate the prevalence of rhinitis in the population aged 65 years or above in mainland Portugal and to characterize and classify rhinitis in this age group.

Avaliação da inflamação das vias aéreas. Vias áreas superiores e compartimento broncopulmonar

Resumo Faz-se uma revisao sobre metodos de avaliacao da inflamacao nas vias aereas que contribuam para o diagnostico, terapeutica e prognostico de patologias como a rinossinusite e a asma. Serao tambem considerados metodos susceptiveis de fornecer informacao relevante sobre inflamacao na DPOC. A inflamacao cronica das vias aereas condiciona fenomenos obstrutivos objectivados na funcao respiratoria basal, na hiperreactividade bronquica e nasal e em quadros clinicos de dificuldade respiratoria. A tomografia computorizada informa sobre as dimensoes do lumen, a espessura das paredes bronquicas e os indices de densidade pulmonar, alteracoes que decorrem da inflamacao e remodelacao das vias aereas. Um processo inflamatorio localizado nas vias respiratorias e susceptivel de ser detectado por modificacoes em marcadores sistemicos de inflamacao. Os metodos directos recorrem a analise imunoistoquimica de tecidos e de fluidos em condicoes basais ou apos estimulacao. Os eosinofilos aumentam em biopsias, lavados nasais e broncoalveolares na asma e na rinite e modificam-se com a terapeutica. Ocorrem alteracoes nas proteinas e expressao de RNAm de mediadores envolvidos na activacao celular. A expectoracao induzida identifica inflamacao eosinofilica que se relaciona inversamente com a funcao ventilatoria. Em cada ciclo respiratorio o ar e enriquecido em compostos volateis produzidos no decurso da respiracao celular. A FENO e o biomarcador mais estudado e os seus niveis estao elevados na asma. No condensado do ar expirado identificam-se especies reactivas de oxigenio, derivados de membrana, citocinas e quimiocinas pro-inflamatorias. Se a avaliacao nao invasiva da inflamacao for fidedigna e reprodutivel, sera imprescindivel na monitorizacao das doencas das vias aereas.

A intervenção da célula epitelial na asma

Resumo Faz-se uma revisao da intervencao da celula epitelial bronquica na fisiopatologia da asma. O epitelio que reveste as vias respiratorias actua como uma barreira fisica, separando o meio externo do meio interno pul-monar, controla a permeabilidade intercelular e transcelular, e, deste modo, a acessibilidade dos agressores inalantes as celulas apresentadoras de antigenio en-volvidas na resposta imunoinflamatoria. As celulas epiteliais unidas por tight junctions contribuem para a integridade das vias aereas e expressam poliovirus re - ceptor–related protein (PRR), toll like receptors (TLR) e protease-activated receptors (PAR), que reconhecem agentes bacterianos e alergenios. A sua disfuncao transforma-as em fonte de mediadores intervenientes na inflamacao. A interaccao bidireccional entre, por um lado, o epitelio e os elementos constitutivos do bronquio e por outro, as particulas inaladas, tem subjacente a forma-cao de uma unidade, com identidade propria desig-nada EMTU – epithelial mesenchymal trophic unit. Esta extensa intervencao coloca a celula epitelial no centro de accao da cronicidade e remodelacao do pro-cesso asmatico. As doencas infecciosas e o stress ambiental sao capazes de induzir alteracoes a nivel da celula epitelial suscep-tiveis de modificar a sua resposta a estimulacoes futu-ras, nomeadamente a ampliar a resposta a outras agressoes infecciosas por accao sinergica das vias de sinalizacao. O epitelio bronquico tem assim funcoes de barreira que lhe permite exercer uma permeabilidade selectiva, a nivel intracelular e transcelular, e ainda metabolica-mente activo pelas capacidade de produzir mediadores quimiotacticos e citocinas envolvidos no recrutamento e na activacao celular, com repercussao na broncomo-tricidade e na remodelacao da parede bronquica. Rev Port Pneumol 2009; XV (3): 461-472

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.

Metabolomic applied to omalizumab effect in severe asthmatics – a preliminary result

Conclusions Beeing alkanes end-compounds in the sequence of oxidation reactions, it can indicate that oxidative state is at a higher extent before treatment, when compared to urine profile after treatment. In spite of being a case-study, the results suggest that the urinary volatile profiles obtained