Fábio Chigres Kuschnir

Environmental and socio‐demographic factors associated to asthma in adolescents in Rio de Janeiro, Brazil

Although asthma is of frequent occurence, little is known about the factors associated with this disease in Brazil. We studied the association between asthma, environmental and socio‐demographic factors in adolescents in Nova lguacu, Rio de Janeiro State. Cross‐sectional study using the questionnaires about asthma and environmental factors from the International Study of Asthma and Allergies in Childhood (ISAAC). We performed bivariate analyses between asthma and the factors studied using prevalence ratio (PR), confidence intervals of 95% (95% Cl) and Chi‐squared test. Factors associated to asthma in a bivariate analysis were studied using logistic regression and odds ratio (OR). We included 3,033 students, aged 13–14 yrs, selected from 37 schools. The prevalence of asthma was 13.1%. Being female (OR = 1.40; 95%Cl:1.11–1.77), the presence of a mother who smokes (OR = 1.32; 95%Cl:1.04–1.66), a cat in the domicile (OR = 1.32; 95%Cl:1.04–1.69), being the firstborn (OR = 1.34; 95%Cl:1.07–1.68), frequent use of paracetamol (OR = 1.45; 95%Cl: 1.15–1.84), the presence of rhinitis (OR = 5.15; 95%:3.89–6.82) and eczema (OR = 2.35; 95%Cl:1.73–3.19) were independently associated to asthma. Environmental and socio‐demographic factors were associated to asthma in adolescents in Rio de Janeiro, irrespective of the presence of others allergic diseases. Interventions acting on these factors may decrease the occurence of asthma in this population.

Validity and Reproducibility of the Asthma Core International Study of Asthma and Allergies in Childhood (ISAAC) Written Questionnaire Obtained by Telephone Survey

Objective. To assess the reproducibility and validity of the International Study of Asthma and Allergies in Childhood (ISAAC) asthma written questionnaire (IAWQ) for 6- to 7-year-old children administered to their parents/caregivers through a telephone interview. Methods. Our study included 100 children selected from three health units in Rio de Janeiro, Brazil. In total, 50 asthmatic and 50 non-asthmatic children were evaluated; all participants were required to own a household telephone line. Initially, telephone interviews were conducted with the parents/caregivers using the IAWQ. After 2 weeks, parents/caregivers were invited to complete the IAWQ under supervision provided by the researchers. After fifteen days, the telephone interviews were repeated. The reproducibility between the two telephone interviews was assessed using kappa (κ) coefficients; the construct validity was assessed by comparing the answers obtained in the initial telephone interview in both groups according to the clinical diagnosis of asthma performed by a specialist using sensitivity and specificity coefficients. Results. Overall, data from 75 children (39 asthmatics) were analyzed, as 25 patients were excluded from the study (11 did not answer phone calls and the responding parents/caregivers for 14 patients were not the same in all study phases). Perfect agreement was observed for the indicator “wheezing in the last 12 months” (κ = 1), while substantial agreement was observed for the “wheezing with exercise,” “speech limited by wheezing,” and “asthma ever” indicators (κ range, 0.7–0.8). The sensitivity and specificity for “wheezing within the last 12 months” were 64.1% (95% confidence interval (CI), 47.2–78.8) and 88.9% (95% CI, 73.9–96.9), respectively. For the “asthma ever” indicator, the sensitivity and specificity were 87.2% (95% CI, 77.6–95.7) and 100% (95% CI, 90.3–1), respectively. Questionnaire specificity was high for all asthma severity indicators. Conclusions. The IAWQ for children aged 6–7 years adapted for telephone interviews showed good reproducibility and adequate validity with an ability to distinguish between asthmatic and non-asthmatic participants. Thus, this method could be utilized in epidemiological studies on childhood asthma in locations where telephone lines are available.

Association of overweight with asthma prevalence in adolescents in Rio de Janeiro, Brazil.

Objective: To evaluate the relationship between asthma and overweight in adolescents. Methods: Cross-sectional study including 13–14-year-old adolescents in Rio de Janeiro, Brazil. Asthma was defined according to the International Study of Asthma and Allergies in Childhood (ISAAC). Body Mass Index (BMI) was calculated; overweight was defined as BMI ≥ 85th percentile. The distribution of asthma and associated symptoms were compared according weight category using the χ2 test for linear trend. The association between asthma and overweight, controlling for confounding variables, was studied using odds ratios (OR), confidence intervals (95% CI) and logistic regression, stratified by sex. Results: 2,858 (50.1% female) adolescents were studied; 458 (16.1%) were overweight and 13.3% asthmatic. Average BMI was higher among asthmatics (p = 0.01). When stratified, this difference remained only among girls (p = 0.03). Asthma prevalence increased with higher BMI (p = 0.02). Asthma was associated to overweight (OR = 1.51; 95% CI: 1.07–2.13), irrespective of sedentary lifestyle, smoking mother and presence of dog in the domicile, but only among the girls. Conclusions: In Rio de Janeiro adolescents, we found a positive association between asthma and overweight, exclusively among girls. This suggests that health policies related to asthma and overweight/obesity in this age group need to take sex into consideration.

ERICA: prevalence of asthma in Brazilian adolescents

ABSTRACT OBJECTIVE To describe the prevalence of asthma and physician-diagnosed asthma in Brazilian adolescents. METHODS Cross-sectional, national, school-based study with adolescents from 12 to 17 years old, participants in the Study of Cardiovascular Risks in Adolescents (ERICA). The study stratified the sample by region and grouped according to schools and classes with representativeness to the set of cities with more than 100,000 inhabitants of the Country, macro-regions, capitals, and Federal District. A questionnaire collected data through a self-filled in method. We calculated the prevalences and their confidence intervals of 95% (95%CI) according to sex, age group, type of school and skin color. RESULTS Between 2013 and 2014, 74,589 adolescents were evaluated, 55.3% of the female sex. The total prevalence of active asthma was of 13.1% (95%CI 12.1-13.9), being higher in girls (14.8%; 95%CI 13.7-16.0) when compared to boys (11.2%; 95%CI 10.3-12.2) in all geographical strata examined. It was also higher between students of private schools (15.9%; 95%CI 14.2-17.7) when compared to public ones (12.4%; 95%CI 11.4-13.4). It was higher in the Southeast region (14.5%; 95%CI 12.9-16.1), and in the city of Sao Paulo (16.7%; 95%CI 14.7-18.7). The lowest prevalence was observed in North region (9.7%; 95%CI 9.7-10.5), and in Teresina (6.3%; 95%CI 4.9-7.7). The prevalence of physician-diagnosed asthma was of 8.7% (95%CI 8.2-9.1); higher in the North region (13.5%; 95%CI 12.7-14.2), and in Porto Alegre (19.8%; 95%CI 17.5-22.3). It was lower in the Midwest (6.9%; 95%CI 6.0-7.8), and in Cuiaba (4.8%; 95%CI 3.8-5.9). We found no significant difference in the expression of this rate between the sexes, as well as in other variables evaluated by the study. CONCLUSIONS The prevalence of asthma in Brazilian adolescents is high. Rates of active asthma and physician-diagnosed asthma vary widely in different regions and capitals evaluated by the ERICA. These results may assist in the preparation of preventive programs and policies on health and a better understanding of the factors associated with asthma in this age group.

Prevalence and severity of asthma and related symptoms in 6- to 7-year-old schoolchildren of Rio de Janeiro using of the ISAAC questionnaire by telephone survey.

Abstract Objective: To evaluate the prevalence and severity of asthma and its association with sex in 6- to 7-year-old schoolchildren from the city of Rio de Janeiro (RJ), obtained by a telephone survey. Methods: A cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) Written Questionnaire for Asthma adapted and validated by telephone interviews was conducted. The random sample was recruited systematically, without replacement, taking into account the proportion of school classes and students in each regional coordination of the Municipal Secretariat of Education, which supplied the students’ telephone numbers. The data were collected by a polling company from May to July 2010. Prevalence ratios (PRs) and 95% confidence intervals (95% CI) were compared using the difference in proportions test suitable for large samples to analyze the association between asthma and sex. Results: In total, 3216 interviews from parents/caregivers of children were analyzed; 51.4% of the children were males. Mothers were the primary respondents (71.9%). The prevalence rates of “wheezing ever” and “wheezing in the last 12 months” were 52.2% and 20.9%, respectively, and were significantly higher among boys (PR: 1.10, 95% CI: 1.03–1.18 and PR: 1.27, 95% CI: 1.10–1.45). The same pattern was observed for “asthma ever” (PR: 1.44, 95% CI: 1.12–1.85) and for “severe asthma” (PR: 1.42, 95% CI: 1.11–1.82). Conclusion: The prevalence of asthma was high among RJ’s students. Most of the indicators of the disease were more prevalent among boys. Our results were similar to those observed in other Brazilian and international centers using the traditional ISAAC protocol. The use of this method can be an alternative for epidemiological studies of childhood asthma especially in areas where the telephone coverage is high.

Guia prático de atualização - prevenção de doenças alérgicas

The authors present in the form of questions and answers an update text on various allergic diseases of childhood.

ERICA: smoking is associated with more severe asthma in Brazilian adolescents

OBJECTIVE To investigate the association between smoking and asthma, and possible associated factors in Brazilian adolescents. METHODS A cross-sectional, national, school-based study with adolescents aged 12-17 years, participants in the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA). A total of 66,394 participants answered a self-administered questionnaire with questions about asthma, smoking, lifestyle and sociodemographic variables. Bivariate analysis between Current Asthma (CA) and Severe Asthma (SA) and the other study variables were performed using Chi-squared. Then, the crude and adjusted Prevalence Ratios (PR), and respective 95% Confidence Intervals (95% CI) of current asthma/severe asthma and smoking variables, corrected for sociodemographic and lifestyle variables, were estimated using generalized linear models with Poisson regression, logit link, and robust variance. RESULTS The prevalence of current asthma and severe asthma were significantly higher in adolescents who were exposed to: experimentation (current asthma: PR=1.78, 95% CI: 1.51-2.09; severe asthma: PR=2.01; 95% CI: 1.35-2.98); current smoking (current asthma: PR=2.08, 95% CI: 1.65-2.64; severe asthma: PR=2.29; 95% CI: 1.38-3.82); regular smoking (current asthma: PR=2.25, 95% CI: 1.64-3.07; severe asthma: PR: 2.41; 95% CI: 1.23-4.73); and passive smoking (current asthma: PR=1.47, 95% CI: 1.27-1.67; severe asthma: PR=1.66; 95% CI: 1.19-2.32); these associations remained significant after adjustment. CONCLUSIONS Asthma and smoking were significantly associated in Brazilian adolescents, regardless of the sociodemographic and lifestyle factors, notably in those with more severe disease.

Conhecimento sobre asma de pediatras de hospitais públicos do Rio de Janeiro

1. Clínica de Alergia da Policlínica Geral do Rio de Janeiro, Faculdade de Medicina de Petrópolis Petrópolis, RJ, Brasil. 2. Faculdade de Medicina. Departamento de Pediatria. Instituto de Puericultura e Pediatria Martagão Gesteira. Universidade Federal do Rio de Janeiro (UFRJ) Rio de Janeiro, RJ, Brasil. 3. Faculdade de Ciência Médicas. Departamento de Pediatria, Universidade do Estado do Rio de Janeiro (UERJ) Rio de Janeiro, RJ, Brasil.

Os primeiros passos dos Arquivos de Asma, Alergia e Imunologia

325 Arq Asma Alerg Imunol. 2017;1(4):325-6. Os primeiros passos dos Arquivos de Asma, Alergia e Imunologia (AAAI) foram dados, e criaram um forte alicerce para o desenvolvimento e crescimento de nossa revista. Em 2017, o início de nossa jornada, a AAAI publicou 64 artigos divididos em 4 números, com versão impressa e digital, além de um suplemento em versão digital com os resumos dos estudos apresentados no XLIV Congresso Nacional da Associação Brasileira de Alergia e Imunologia (ASBAI). Foram 9 editoriais, 7 artigos especiais, 11 artigos de revisão, 20 artigos originais, 10 comunicações clínicas ou experimentais breves, 5 cartas ao editor e 2 imagens em alergia e imunologia. Os associados da ASBAI foram os autores de mais de 90% dos estudos publicados, os quais abrangeram os diversos temas de nossa especialidade, como doenças atópicas, urticária/angioedema/ anafilaxia, imunodeficiências, reações adversas a medicamentos, alergia alimentar, imunoterapia, imunomodulação e vacinas. A versão impressa foi distribuída para cerca de 1.700 associados, além de instituições de saúde e ensino, e a versão digital foi acessada cerca de 350.000 vezes, seja na forma de HTML ou PDF. Tudo isso só foi possível em decorrência da estrutura criada, composta por um Corpo Editorial e um Grupo de Revisores de notoriedade acadêmica, ambos com componentes nacionais e estrangeiros, além do apoio incondicional da Diretoria da ASBAI.

Clinical and immunologic profile of children and adolescents submitted to cow milk oral immunotheray (OIT)

Results The mean age was 8.73 years (min: 4, Max: 19), and 9 were females. The symptoms started before 1 year old in 93% of the sample and in 50% before 6 months. Urticaria was the most frequent manifestation in the 1st contact (60%), some progressing to anaphylaxis: the initial event in 40% of cases. Half of the patients responded to minimal amounts of LV, mainly (60%) in raw state. Symptoms appeared in less than 1 hour in 96%. Until the beginning of treatment 73% have had 1-5 episodes of anaphylaxis. About 75% of patients have associated respiratory allergy and 33% had some anaphylactic event in the last 12 months. The specific IgE levels were elevated in 93% of the sample: For full LV the mean level was 50.2 KU/L and the median 41 KU/L (Min: 1.4 KU/l and Max: >100 KU/L); for casein, the mean was 40 KU/L, and the median 28.4 KU/L (0.8 >100). For a-lacto albumin and b-lacto globulin, these values were respectively: 23.1 KU/L, 12.1 KU/L (0.4 82) and 9.94 KU/L, 4:46 KU/L (0.7 31.4).