Eduardo Vieira Ponte

Lack of control of severe asthma is associated with co-existence of moderate-to-severe rhinitis.

Background:  Retrospective studies provide evidence that rhinitis is associated with more severe asthma. The aim of this study was to evaluate prospectively whether rhinitis is a predictor of increased asthma severity.

Rapid reduction in hospitalisations after an intervention to manage severe asthma

Asthma is the third cause of hospitalisations due to clinical illnesses in Brazil. The Programme for Control of Asthma in Bahia (ProAR) leads an initiative in Salvador City (Brazil) to manage severe asthma for free. The aim of this study was to identify trends in asthma hospitalisation in the entire city and to evaluate the impact of ProAR. Information on asthma hospitalisations from 1998 to 2006 was collected. We analysed trends in Salvador (2.8 million inhabitants) before and after ProAR, taking pneumonia and myocardial infarction into account for local comparison. As an external control we obtained information on asthma from Recife, which is the most comparable Brazilian city. In Salvador, asthma hospital admissions declined by 82.3% (1998–2006). A greater proportion of this reduction (74%) occurred after 2003, in parallel with the implementation of ProAR. The reduction in asthma admissions in Recife was smaller. The rates of hospitalisation in 2006 were 2.25 per 10,000 inhabitants in Salvador and 17.06 in Recife. In Salvador, we found an inverse correlation between the provision of medication for asthma and hospitalisation (-0.801; p<0.0001). A rapid reduction in asthma admissions in the entire city of Salvador was associated with ProAR, a public health intervention targeting severe asthma.

Avaliação do questionário de controle da asma validado para uso no Brasil

OBJETIVO: Avaliar se a versao em lingua portuguesa do Asthma Control Questionnaire (ACQ, Questionario de Controle da Asma) e um instrumento valido para medir o controle da asma em pacientes adultos ambulatoriais no Brasil. METODOS: Foram avaliados 278 pacientes ambulatoriais com diagnostico de asma. Todos os pacientes, durante a primeira visita, responderam ao questionario, foram submetidos a espirometria e avaliados clinicamente por um medico para a caracterizacao do controle da doenca. Foram analisadas as versoes do questionario com 5, 6 e 7 questoes, utilizando dois escores distintos (0,75 e 1,50) como pontos de corte. RESULTADOS: Dos 278 pacientes, 77 (27,7%) tinham asma intermitente, 39 (14,0%) asma persistente leve, 40 (14,4%) asma persistente moderada e 122 (43,9%) asma persistente grave. A sensibilidade do questionario para identificar asma nao-controlada variou de 77% a 99% e a especificidade variou de 36% a 84%. O valor preditivo positivo variou de 73% a 90%, e o valor preditivo negativo variou de 67% a 95%. A razao de verossimilhanca positiva variou de 1,55 a 4,81, e a razao de verossimilhanca negativa variou de 0,03 a 0,27. Nas versoes do ACQ com 5 e 6 questoes, o coeficiente de correlacao intraclasse foi de 0,92, e estas versoes foram responsivas a mudancas no quadro clinico dos pacientes. CONCLUSOES: O ACQ, nas suas tres versoes, teve boa capacidade de discriminar individuos com asma nao-controlada daqueles com asma controlada. As versoes com 5 e 6 questoes apresentaram tambem boa reprodutibilidade e responsividade. Trata-se, portanto, de um instrumento valido para avaliacao do controle da asma em pacientes adultos ambulatoriais no Brasil.

Impacto de um programa para o controle da asma grave na utilização de recursos do Sistema Único de Saúde

OBJECTIVE: To quantify the use of health care resources among patients enrolled in the Bahia State Asthma and Allergic Rhinitis Control Program. METHODS: As of January of 2006, 1405 patients had enrolled in the program, which is carried out in four referral centers in the city of Salvador. These patients formed the basis of this retrospective/prospective, observational cohort study. The preliminary analysis involved 269 consecutive patients, all above the age of 12 and diagnosed with severe asthma. After being seen by pulmonologists, nurses, pharmacologists and psychologists, the patients received inhaled asthma medications. Based on patient interviews and charts, the year preceding enrollment in the program was compared with the first year enrolled in the program in terms of the following quantifiable parameters: hospital admissions; emergency room visits; courses of oral corticosteroids; and days of school/work missed due to asthma attacks. RESULTS: In this sample of patients with severe asthma, enrollment in the program resulted in significant reductions in the number of emergency room visits and hospital admissions (of 85% and 90%, respectively). There were also reductions in the number of school/work days missed due to asthma attacks and in the number of courses of oral corticosteroids (of 86% and 67%, respectively). CONCLUSION: A program designed to control severe asthma in referral outpatient clinics and including pharmacological services at no charge can lead to a pronounced reduction in the demand for Unified Health Care System resources.

Gene Encoding Duffy Antigen/Receptor for Chemokines Is Associated with Asthma and IgE in Three Populations

RATIONALE Asthma prevalence and severity are high among underserved minorities, including those of African descent. The Duffy antigen/receptor for chemokines is the receptor for Plasmodium vivax on erythrocytes and functions as a chemokine-clearing receptor. Unlike European populations, decreased expression of the receptor on erythrocytes is common among populations of African descent, and results from a functional T-46C polymorphism (rs2814778) in the promoter. This variant provides an evolutionary advantage in malaria-endemic regions, because Duffy antigen/receptor for chemokines-negative erythrocytes are more resistant to infection by P. vivax. OBJECTIVES To determine the role of the rs2814778 polymorphism in asthma and atopy as measured by total serum IgE levels among four populations of African descent (African Caribbean, African American, Brazilian, and Colombian) and a European American population. METHODS Family-based association tests were performed in each of the five populations to test for association between the rs2814778 polymorphism and asthma or total IgE concentration. MEASUREMENTS AND MAIN RESULTS Asthma was significantly associated with the rs2814778 polymorphism in the African Caribbean, Colombian, and Brazilian families (P < 0.05). High total IgE levels were associated with this variant in African Caribbean and Colombian families (P < 0.05). The variant allele was not polymorphic among European Americans. CONCLUSIONS Susceptibility to asthma and atopy among certain populations of African descent is influenced by a functional polymorphism in the gene encoding Duffy antigen/receptor for chemokines. This genetic variant, which confers resistance to malarial parasitic infection, may also partially explain ethnic differences in morbidity of asthma.

Cost-effectiveness analysis of a state funded programme for control of severe asthma

BackgroundAsthma is one of the most common chronic diseases and a major economical burden to families and health systems. Whereas efficacy of current therapeutical options has been clearly established, cost-effectiveness analysis of public health interventions for asthma control are scarce.Methods81 patients with severe asthma (12–75 years) joining a programme in a reference clinic providing free asthma medication were asked retrospectively about costs and events in the previous 12 months. During 12 months after joining the programme, information on direct and indirect costs, asthma control by lung function, symptoms and quality of life were collected. The information obtained was used to estimate cost-effectiveness of the intervention as compared to usual public health asthma management. Sensitivity analysis was conducted.Results64 patients concluded the study. During the 12-months follow-up within the programme, patients had 5 fewer days of hospitalization and 68 fewer visits to emergency/non scheduled medical visits per year, on average. Asthma control scores improved by 50% and quality of life by 74%. The annual saving in public resources was US

Validação do Teste de Controle da Asma em português para uso no Brasil

387 per patient. Family annual income increased US

The economic impact of severe asthma to low-income families.

512, and family costs were reduced by US

Polymorphisms in the sialic acid-binding immunoglobulin-like lectin-8 (Siglec-8) gene are associated with susceptibility to asthma

733.ConclusionA programme for control of severe asthma in a developing country can reduce morbidity, improve quality of life and save resources from the health system and patients families.

Skin test reactivity and Der p-induced interleukin 10 production in patients with asthma or rhinitis infected with Ascaris

OBJECTIVE To develop and validate a Portuguese-language version of the Asthma Control Test (ACT) for use in Brazil. METHODS The study comprised 290 asthma outpatients over 12 years of age. The patients completed the ACT questionnaire and had an appointment with a pulmonologist in order to assess asthma control in two visits. In the first visit, the patients also underwent spirometry. The second visit took place at least four weeks later. RESULTS We found that a cut-off score of 18 points-to differentiate between subjects with controlled asthma and those with uncontrolled asthma-had a sensitivity of 93%, a specificity of 74%, a negative predictive value of 86% and a positive predictive value of 85%. The positive and negative likelihood ratios were 3.58 and 0.09, respectively. The questionnaire has an outstanding capacity to differentiate uncontrolled asthma from controlled asthma, with an area under the ROC curve of 0.904. The patients whose symptoms remained stable between the two visits had similar scores, demonstrating good test-retest reproducibility, with an intraclass correlation coefficient of 0.93. The patients whose symptoms improved in the second visit had significantly higher scores, demonstrating good responsiveness of the questionnaire in the identification of changes in disease control. CONCLUSIONS The Portuguese-language version of the ACT showed good test-retest reproducibility and was capable of discriminating the levels of asthma control and detecting changes in asthma control in a population of patients with a low level of education and low family income at a public health facility in Brazil.