Maria Jussara Fernandes Fontes

Adherence rate to inhaled corticosteroids and their impact on asthma control

Background:  Poor asthma control is associated to high morbidity. The objective of this study was to assess the association between adherence rates to beclomethasone dipropionate (BDP) and the degree of asthma control.

Quality of Life in Asthmatic Adolescents: An Overall Evaluation of Disease Control

Objective. to evaluate the relative impact of reported symptoms, school absenteeism, hospital admission, medical visits, and the presence of emotional and behavioral disorders on the health-related quality of life (HRQL) of low income asthmatic adolescents. Methods. Asthmatic adolescents were randomly selected among public schools in Belo Horizonte/MG, Brazil. Asthma severity was rated according to the Global Initiative for Asthma (GINA) classification. Emotional and behavior disorders (EBDs) were evaluated through the Strengths and Difficulties Questionnaire. HRQL was assessed through the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). PAQLQ score was analyzed for each intervening variable. Multivariate regression analysis was conducted. Results. One hundred and forty-six adolescents participated in the present study, 45% being male and age ranging from 14 to 16 years old. Mean PAQLQ score was 5.7 ± 1.3 SD, with no significant difference regarding sociodemographic characteristics, except for gender (p = 0.001). The regression equation of the final model for the multivariate analysis was as follows: Mean PAQLQ score = 1.88 (Constant) − 0.42 gender + 1.14 nighttime symptoms + 0.69 medical visits in the past 12 months + 0.95 EBDs. Therefore, if the other variables remained constant, PAQLQ score: reduced in 0.42 points for females (p = 0.01); increased in 1.14 when there were no nighttime symptoms (p < 0.01); increased in 0.69 when there was no medical visit for respiratory problems within the past 12 months (p < 0.01); and increased in 0.95 when no EBDs were present (p < 0.01). This model was able to explain approximately half of the variation found in PAQLQ score (R-Sq = 49.4%). Conclusions. HRQL of asthmatic adolescents is influenced by the complex interaction among several factors: the severity of clinical symptoms, morbidity, gender, and the psychological resources available so as to deal with such difficulties. A careful evaluation of HRQL is essential in order to capture feelings and subjective perceptions, which are not investigated by the conventional evaluation of asthma control.

Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test

OBJECTIVES Acute pharyngitis is one of the most common diseases in pediatric practice, and the most common bacterial etiology is group A beta-hemolytic streptococcus (GABHS). Correct diagnosis and treatment are primarily of importance to the prevention of non-suppurative sequelae. Rapid tests for detecting the antigen of group A streptococcus are a useful tool for the diagnosis of streptococcal pharyngotonsillitis, due to the speed of results, accuracy and low cost; however, in our country they are little used and have been little studied. The objective of this study was to evaluate the accuracy of a GABHS rapid antigen detection test kit, in comparison with oropharynx swab culture. METHODS Children aged 1 to 18 years with clinical diagnoses of acute pharyngitis were chosen at public emergency and private clinical services in Belo Horizonte, Minas Gerais, Brazil, with children being excluded if they had taken antibiotics within 30 days of their consultation. The final sample consisted of 229 patients, each of whom had two oropharynx swabs taken, one for rapid GABHS testing and the other to be sent for culture. RESULTS We observed sensitivity of 90.7%, specificity of 89.1%, a positive predictive value of 72.1%, a negative predictive value of 96.9% and a positive likelihood ratio of 9.0 for the rapid test used here, compared with culture. CONCLUSIONS The rapid test studied exhibited a good correlation with culture and is, therefore, of great use in clinical practice for detection of GABHS.

O impacto da asma, da rinite alérgica e da respiração oral na qualidade de vida de crianças e adolescentes

BACKGROUND: quality of life for patient with breathing illnesses. PURPOSE: to review specialized literature focusing on the impact of asthma, allergic rhinitis and mouth breathing on patients life quality, the relationship between these illnesses and measures that can reduce this impact. CONCLUSION: it is a consensus in the specialized literature that there is a relationship between these illnesses. Asthma, allergic rhinitis and mouth breathing affect the persons life quality not only producing breathing disorder but also causing behavioral, functional and physical damage. Controlling these illnesses is a usual subject in the specialized literature. New therapeutic proposals include the involvement of multiprofessional teams. There are health programs whose goals are not only the improvement of respiratory condition. They also propose measures that analyze life quality and make possible patients global evaluation.

Impact of an asthma management program on hospitalizations and emergency department visits

OBJECTIVES To assess the frequency of hospitalizations and emergency department visits of children and adolescents before and after the enrollment in an asthma program. METHODS Medical records of 608 asthmatics younger than 15 years were assessed retrospectively. The frequency of hospitalizations and emergency department visits caused by exacerbations were evaluated before and after enrollment in an asthma program. Patients were treated with medications and a wide prophylactic management program based on the Global Initiative for Asthma (GINA). The before asthma program (BAP) period included 12 months before enrollment, whereas the after asthma program (AAP) period ranged from 12 to 56 months after enrollment. RESULTS In the BAP period, there were 895 hospitalizations and 5,375 emergency department visits, whereas in the AAP period, there were 180 and 713, respectively. This decrease was significant in all statistical analyses (p = 0.000). CONCLUSIONS Compliance with the GINA recommendations led to a significant decrease in the frequency of hospitalizations and emergency department visits in children and adolescents with asthma.

Asthma and allergic rhinitis co-morbidity: a cross-sectional questionnaire study on adolescents aged 13-14 years

AIMS There is scarce epidemiological population-based data on the prevalence of asthma and allergic rhinitis (AR) co-morbidity in adolescents. The aim was to verify asthma and AR prevalence rates in order to emphasise asthma/AR co-morbidity. METHODS Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in adolescents aged 13-14 years, chosen randomly from public schools in Belo Horizonte, Brazil. RESULTS A total of 3262 students were identified, 3083 (47.3% males) of whom completed the questionnaire (response rate 94.7%). The prevalence of symptoms related to asthma and AR co-morbidity was 8.4% (95% CI, 8.09-10.25). Among asthmatic adolescents, symptoms of AR were reported in 46.5% (95% CI, 42.60-52.08%). CONCLUSIONS There is a high prevalence of adolescent asthma and AR co-morbidity in this area of Brazil. This co-morbidity is an important health issue that requires strategic application of primary health care facilities to achieve adequate control of both asthma and allergic rhinitis.

Diagnóstico precoce das faringoamigdalites estreptocócicas: avaliação pelo teste de aglutinação de partículas de látex

OBJECTIVES: Acute pharyngitis is one of the most common diseases in pediatric practice, and the most common bacterial etiology is group A beta-hemolytic streptococcus (GABHS). Correct diagnosis and treatment are primarily of importance to the prevention of non-suppurative sequelae. Rapid tests for detecting the antigen of group A streptococcus are a useful tool for the diagnosis of streptococcal pharyngotonsillitis, due to the speed of results, accuracy and low cost; however, in our country they are little used and have been little studied. The objective of this study was to evaluate the accuracy of a GABHS rapid antigen detection test kit, in comparison with oropharynx swab culture. METHODS: Children aged 1 to 18 years with clinical diagnoses of acute pharyngitis were chosen at public emergency and private clinical services in Belo Horizonte, Minas Gerais, Brazil, with children being excluded if they had taken antibiotics within 30 days of their consultation. The final sample consisted of 229 patients, each of whom had two oropharynx swabs taken, one for rapid GABHS testing and the other to be sent for culture. RESULTS: We observed sensitivity of 90.7%, specificity of 89.1%, a positive predictive value of 72.1%, a negative predictive value of 96.9% and a positive likelihood ratio of 9.0 for the rapid test used here, compared with culture. CONCLUSIONS: The rapid test studied exhibited a good correlation with culture and is, therefore, of great use in clinical practice for detection of GABHS.

Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy

A morbidade associada a asma e elevada,principalmente nos paises em desenvolvimento, e as falhas naadesaoaousodecorticoideinalatoriocontribuemparaestaelevacao.Este estudo objetiva comparar as taxas de adesao ao uso debeclometasonarelatadaspelosresponsaveiseasmensuradaspelosregistros de dispensacao farmaceutica do medicamento.

Comparação entre três equações de referência para a espirometria em crianças e adolescentes com diferentes índices de massa corpórea

OBJECTIVE To compare FEV1 and FVC, calculated using three sets of reference equations (devised by Polgar & Promadhat, Hsu et al. and Mallozi in 1971, 1979 and 1995, respectively) and to determine whether the three are similar in predicting lung function in children and adolescents with distinct body mass indices (BMIs). METHODS The individuals were separated into four groups in accordance with the reference standards of the National Center for Health Statistics: underweight (UW), normal weight (NW), overweight (OW), and obese (OB). All were then submitted to spirometry. RESULTS We evaluated 122 healthy children and adolescents, aged 7-14 years. The FVC values predicted for NW females and UW males through the use of the Hsu et al. equation were significantly higher than the measured values, as were the FEV1 values for UW females and males predicted via the Polgar & Promadhat and Hsu et al. equations. In NW females, the FEV1 values predicted via the Polgar & Promadhat equation were significantly higher than were the measured values. CONCLUSIONS In individuals with distinct BMIs, the measured FVC and FEV1 values were not equivalent to those predicted via the Polgar & Promadhat and Hsu et al. equations. The same was not true for the Mallozi equations. The BMI was not a relevant factor for the predictive index of these equations; therefore, the Mallozi equations can be used without alteration for children and adolescents with distinct BMIs.

Wheezy Child Program: The Experience of the Belo Horizonte Pediatric Asthma Management Program

BackgroundUntil 1994, assistance provided by the Municipal Public Health System to children with asthma in Belo Horizonte, Brazil, was ineffective because it focused only on treating exacerbations. This scenario motivated the implementation of the Wheezy Child Program.ObjectivesThe main objectives were to reduce emergency room visits and hospitalizations.MethodsThe strategies adopted were as follows: continued medical education for pediatricians, reorganization of public assistance into different levels of complexity regarding asthma care, and free dispensation of inhaled beclomethasone, albuterol, and valved spacers. A partnership between the Pediatric Pulmonology staff of the Federal University of Minas Gerais and the Belo Horizonte Municipal Health Authority made these strategies come to fruition, especially through the training of health workers and the devising of protocol after GINA guidelines.ResultsOf 2149 patients with a history of hospitalization after program admission, only 453 were re-admitted in the 6 to 12 months after, a reduction of 79%. There was a 300% increase in the use of aerosol and a reduction to 50% in the use of oxygen-driven nebulizers (P < 0.001) in the management of exacerbations. For patients enrolled in the program with moderate and severe persistent asthma, the median adherence rate was 50%.ConclusionsThe Wheezy Child Program has significantly reduced hospitalizations and emergency room visits, has improved quality of life, and has shown that programs of this kind are feasible in low- to middle-income countries. More than 30,000 children have been assisted by the program, and now it seeks to optimize asthma control and increase adherence rates.