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

BACKGROUND: To estimate the direct and indirect costs of severe asthma and the economic impact of its management to low-income families in Salvador, Brazil. METHODS: One hundred and ninety-seven patients with severe asthma and referred to a state-funded asthma center providing free treatment were evaluated. At registration, they were asked about family cost-events in the previous year and had a baseline assessment of lung function, symptoms and quality of life. During the subsequent year, they were reassessed prospectively. RESULTS: One hundred-eighty patients concluded a 12-month follow-up. Eighty-four percent were female patients, and the median family income was US$ 2955/year. Forty-seven percent of family members had lost their jobs because of asthma. Total cost of asthma management took 29% of family income. After proper treatment, asthma control scores improved by 50% and quality of life by 74%. The income of the families increased by US$ 711/year, as their members went back to work. The total cost of asthma to the families was reduced by a median US$ 789/family/year. Consequently, an annual surplus of US$ 1500/family became available. CONCLUSIONS: Family costs of severe asthma consumed over one-fourth of the family income of the underprivileged population in a middle-income country. Adequate management brings major economic benefit to individuals and families.

Spermatogonial morphology, kinetics and niches in hamsters exposed to short- and long-photoperiod.

Previous studies have shown that under short photoperiod exposure spermatogenesis in golden hamster regresses leading to sexual inactivity. It is known that this regression is related to changes in somatic and germ cells (spermatocytes and spermatids). However, the photoperiod effects on spermatogonial biology have not been studied in detail yet. In this regard, this study was carried out to investigate the morphology, kinetics and niches of different spermatogonial types in golden hamsters under long- and short-photoperiod. Six spermatogonial generations such as type A undifferentiated (A(und)), type A differentiating (A(1), A(2), A(3)), intermediate (In) and type B spermatogonia were characterized, and were morphologically similar irrespective of the photoperiod exposure. The short photoperiod was inhibitory to A(und) spermatogonia and preleptotene but had no effect on the number of differentiating (A(1) to B) spermatogonia. In golden hamsters exposed to stimulatory-photoperiod, the interstitial components were positioned mainly in triangular areas around the seminiferous tubules and, in this situation, the A(und) spermatogonia were clearly positioned in niches (p < 0.05) in all stages studied. On the other hand, during the inhibitory-photoperiod where the seminiferous tubules have smaller diameter, the interstitial components were more homogenously distributed and the triangular areas were not clearly observed. In this case, the niches were identified only at stage VII (p < 0.05), although there was a trend of being positioned in niches area in all the stages studied. Thus, these findings suggest that the A(und) spermatogonia location in the seminiferous epithelium and the niche position are directly related to the position of the interstitial components.

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. METHODS: Five hundred and fifty-seven patients with severe asthma were enrolled. During 1 year of follow-up, each patient was evaluated every 3 months with a record of emergency room visits and supply of topical corticosteroids for asthma and rhinitis. In the 1 year of follow-up visit, the patients were checked for rhinitis diagnosis, severity and answered questionnaires for asthma symptoms and quality of life. RESULTS: Eighty-two (15%) patients had no rhinitis, 299 (54%) had mild rhinitis and 176 (31%) moderate/severe rhinitis. In logistic regression models, moderate/severe rhinitis was a predictor for any emergency room visit in the follow-up period [3.83 (2.00-7.35)], for the presence of uncontrolled asthma after 1 year of follow-up [12.68 (1.73-92.85)], for <10% improvement of the airway obstruction [2.94 (1.48-5.85)] and <50% reduction in the number of emergency room visits [2.90 (1.02-8.26)] in the year of follow-up. It was also associated with a smaller chance of more than 90% reduction in the number of emergency room visits in the year of follow-up [0.27 (0.12-0.60)]. In a multivariate linear regression model, severity of rhinitis was positively correlated with a score of asthma severity and inversely correlated to an index of quality of life. CONCLUSIONS: In a population with severe asthma, moderate/severe rhinitis is a strong predictor for greater severity of asthma.