Heli Vieira Brandão

Hospitalizations for asthma: impact of a program for the control of asthma and allergic rhinitis in Feira de Santana, Brazil

OBJECTIVE To evaluate the impact of the Programa de Controle da Asma e Rinite Alérgica em Feira de Santana (ProAR-FS, Program for the Control of Asthma and Allergic Rhinitis in Feira de Santana) on the frequency of hospitalizations for asthma in patients monitored at a referral center for one year. METHODS This was a historical control study involving 253 consecutive patients with asthma, ages ranging from 4 to 76 years. We compared the frequency of hospital admissions and visits to the emergency room (ER) in the 12 months prior to and after their admission to the ProAR-FS. During the program, patients received free treatment, including inhaled medications and education on asthma. Demographic and socioeconomic aspects were also assessed. RESULTS There was a significant reduction in the number of hospitalizations (465 vs. 21) and of visits to the ER (2,473 vs. 184) after their admission to ProAR-FS (p < 0.001 for both). Of the 253 patients who had been hospitalized and had had ER visits within the year prior to the admission to ProAR-FS, only 16 were hospitalized and 92 visited the ER during the follow-up year, representing a reduction of 94% and 64%, respectively. CONCLUSIONS Implementing a referral center for the treatment of asthma and rhinitis in the Unified Health Care System, with the free distribution of inhaled corticosteroids and the support of an education program, is a highly effective strategy for the control of asthma.

Fatores de risco para visitas à emergência por exacerbações de asma em pacientes de um programa de controle da asma e rinite alérgica em Feira de Santana, BA

OBJECTIVE: To determine the risk factors for ER visits due to asthma exacerbations in patients monitored at a referral center. METHODS: Prospective cohort study of 253 outpatients (children and adults) with asthma who were monitored for 12 months at the Referral Center of the Program for the Control of Asthma and Allergic Rhinitis in the city of Feira de Santana, Brazil. RESULTS: Exacerbations were common, and 36.5% of the patients sought ER treatment within the twelve-month period. The risk factors for asthma exacerbations were being over 20 years of age (OR = 1.34: (95% CI: 1.06-1.70), residing in an urban area (OR = 1.19; 95% CI: 1.06-1.33); having a low level of education (OR = 1.53: 95% CI: 1.00-2.39); having severe asthma (OR = 1.65; 95% CI: 1.24-2.18); and having chronic rhinitis (OR = 2.20; 95% CI: 1.00-4.80). CONCLUSIONS: In this cohort, having chronic rhinitis, having asthma that is more severe and having a low level of education were the main risk factors for ER visits due to asthma exacerbations. These results are similar to those reported for asthma patients who are receiving no regular treatment.

Fatores preditores de hospitalização por asma em crianças e adolescentes participantes de um programa de controle da asma

OBJECTIVE: To determine the clinical characteristics and the predictors of hospital admission due to asthma among children and adolescents with asthma under treatment at a referral center. METHODS: A retrospective cohort study comprising 151 children and adolescents with asthma, referred from the Unified Health Care System and enrolled in the Asthma and Allergic Rhinitis Control Program in the city of Feira de Santana, Brazil, followed for a period of 12 months and receiving asthma medication at no cost. The chi-square test was used in order to determine the associations between the studied variables and the occurrence of hospital admissions, whereas the Mann-Whitney test was used for the comparison between the groups of hospitalized patients and nonhospitalized patients. The level of significance was set at p < 0.05. Univariate analysis with logistic regression was performed in order to determine the predictors of hospital admission. RESULTS: Of the 151 patients evaluated, 8 (5.2%) were hospitalized, in a total of 12 hospital admissions. In the univariate analysis, the only variable found to be a predictive factor was greater asthma severity (OR = 13.3; 95% CI: 2.55-70.1). CONCLUSIONS: The fact that, in our study sample, the principal predictor of hospital admission was greater asthma severity, calls for special attention being given to the care of these patients.OBJECTIVE To determine the clinical characteristics and the predictors of hospital admission due to asthma among children and adolescents with asthma under treatment at a referral center. METHODS A retrospective cohort study comprising 151 children and adolescents with asthma, referred from the Unified Health Care System and enrolled in the Asthma and Allergic Rhinitis Control Program in the city of Feira de Santana, Brazil, followed for a period of 12 months and receiving asthma medication at no cost. The chi-square test was used in order to determine the associations between the studied variables and the occurrence of hospital admissions, whereas the Mann-Whitney test was used for the comparison between the groups of hospitalized patients and nonhospitalized patients. The level of significance was set at p < 0.05. Univariate analysis with logistic regression was performed in order to determine the predictors of hospital admission. RESULTS Of the 151 patients evaluated, 8 (5.2%) were hospitalized, in a total of 12 hospital admissions. In the univariate analysis, the only variable found to be a predictive factor was greater asthma severity (OR = 13.3; 95% CI: 2.55-70.1). CONCLUSIONS The fact that, in our study sample, the principal predictor of hospital admission was greater asthma severity, calls for special attention being given to the care of these patients.

A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts

Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.

Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort,

OBJECTIVE To verify whether the occurrence of acute viral bronchiolitis in the first year of life constitutes a risk factor for asthma at age 6 considering a parental history of asthma. METHODS Cross-sectional study in a cohort of live births. A standardized questionnaire of the International Study of Asthma and Allergies in Childhood was applied to the mothers to identify asthma in children at the age of 6 years. Acute viral bronchiolitis diagnosis was performed by maternal report of a medical diagnosis and/or presence of symptoms of coryza accompanied by cough, tachypnea, and dyspnea when participants were 3, 6, 9, and 12 months. Socioeconomic, environmental data, parental history of asthma, and data related to pregnancy were collected in the first 72h of life of the newborn and in prospective home visits by trained interviewers. The association between acute viral bronchiolitis and asthma was evaluated by logistic regression analysis and potential modifier effect of parental history was verified by introducing an interaction term into the adjusted logistic regression model. RESULTS Prevalence of acute viral bronchiolitis in the first year of life was 68.6% (461). The occurrence of acute viral bronchiolitis was a risk factor for asthma at 6 years of age in children with parental history of asthma OR: 2.66, 95% CI (1.10-6.40), modifier effect p=0.002. Parental history of asthma OR: 2.07, 95% CI (1.29-3.30) and male gender OR: 1.69, 95% CI, (1.06-2.69) were other identified risk factors for asthma. CONCLUSION Acute viral bronchiolitis in the first year of life is a risk factor for asthma in children with parental history of asthma.

Prevalência e gravidade de asma, rinite e eczema entre crianças e adolescentes de Feira de Santana, BA, por questionário do International Study of Asthma and Allergies in Childhood (ISAAC)

Objetivo: Determinar a prevalencia e gravidade de asma, rinite e eczema entre escolares de 6-7 anos e adolescentes de 13-14 anos residentes em Feira de Santana, BA. Metodos: Estudo de corte transversal. Questionarios padronizados do International Study of Asthma and Allergies in Childhood (ISAAC) foram respondidos pelos pais de escolares em residencia e devolvidos as escolas, e pelos adolescentes em sala de aula. Na analise estatistica utilizou-se o teste do qui-quadrado. Resultados: A prevalencia de sintomas de asma, rinite e eczema atopico nos ultimos 12 meses em escolares foi de 19,1% (118); 40,7% (251) e 7,8% (48) respectivamente; e em adolescentes foi de 23,9% (247); 38,7% (400) e 11% (114). Rinite esteve associada de forma significante a asma em escolares, com com razao de prevalencia RP 2,16 IC95% (1,83-2,56) e em adolescentes, com RP 1,53 IC95% (1,31-1,78). Eczema tambem mostrou associacao significante com asma em escolares, com RP 2,15 IC95% (1,22-3,78) e em adolescentes RP 3,29 IC95% (2,35-4,62). Asma grave foi observada em 7,1% e 7,4% dos escolares e adolescentes, enquanto que rinite grave ocorreu em 25,8% e 21,6% de escolares e adolescentes, respectivamente. Conclusoes: A prevalencia de asma e rinite foi elevada entre escolares e adolescentes de Feira de Santana, BA. Em concordância com estudos previos, a asma permanece subdiagnosticada. Houve elevada frequencia de asma e rinite graves. Acoes por orgaos publicos e privados de saude sao necessarias para o controle destas doencas. (AU) Objective: To determine the prevalence and severity of asthma, rhinitis, and eczema in schoolchildren aged 6-7 years and adolescents aged 13-14 years living in Feira de Santana, state of Bahia, north eastern Brazil. In this cross-sectional study, parents of childrenaged 6-7 years answered standardized questionnaires of the International Study of Asthma andAllergies in Childhood (ISAAC) in their homes, where as adolescents answered questionnaires inthe classroom. The chi-square test was used for statistical analysis. Results: The prevalence ofasthma, rhinitis, and eczema over the past 12 months among schoolchildren was 19.1% (118),40.7% (251), and 7.8% (48), respectively; and among adolescents, 23.9% (247), 38.7% (400), and11% (114), respectively. Rhinitis was significantly associated with asthma, with a prevalence ratio (PR) of 2.16 and a 95% confidence interval (95%CI) of 1.83-2.56 among schoolchildren, andRP = 1.53 and 95%CI = 1.31‑1.78 among adolescents. Eczema also showed significant association with asthma among both schoolchildren (RP = 2.15, 95%CI = 1.22-3.78) and adolescents(RP = 3.29, 95%CI = 2.35‑4.62). Severe asthma was observed in 7.1 and 7.4% of schoolchildren andadolescents, respectively, whereas severe rhinitis was present in 25.8 and 21.6%. Conclusions: Prevalence of asthma and rhinitis was high among schoolchildren and adolescents living in Feirade Santana, Bahia. In line with previous studies, asthma remained underdiagnosed. There wasa high frequency of severe asthma and rhinitis. Policies established by public and private health agencies are warranted to improve control of these diseases. (AU)