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1.
BMC Pulm Med ; 20(1): 88, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293381

RESUMO

BACKGROUND: Surprisingly little is known about asthma control among asthmatics who smoke. The aim of this cross-sectional study was to investigate asthma symptom control according to the GINA guidelines among asthmatics with a clinically significant smoking history. METHODS: One hundred ninety asthmatics from primary care in Finland were investigated. The patients were current or previous cigarette smokers with a history of 10 or more pack-years. They completed a questionnaire including questions on asthma symptoms and reliever use so that their level of asthma symptom control (well controlled, partly controlled, or uncontrolled) according to GINA could be determined. RESULTS: Sixty-six (34.7%) patients had their asthma well controlled, 81 (42.6%) had their asthma partly controlled, and 43 (22.6%) had uncontrolled asthma. Current smokers had uncontrolled asthma more often than ex-smokers, OR 2.54 (95% CI 1.25-5.14, p = 0.01). Patients with moderate to severe asthma exacerbation during the previous year had uncontrolled asthma more often than patients without an exacerbation, OR 2.17 (95% CI 1.06-4.47, p = 0.04), and patients with FEV1 <  80% of predicted had uncontrolled asthma more often than patients with FEV1 > 80% of predicted, OR 2.04 (95% CI 1.02-4.08, p = 0.04). CONCLUSIONS: Asthmatic patients with a clinically significant smoking history often do not have well controlled asthma. Poor asthma symptom control was associated with current smoking status, history of exacerbations and impaired lung function. Therefore, every attempt should be made to help asthmatics who smoke to quit smoking.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/fisiopatologia , Fumar Cigarros/efeitos adversos , Fumantes , Idoso , Fumar Cigarros/fisiopatologia , Estudos Transversais , Progressão da Doença , Feminino , Finlândia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Índice de Gravidade de Doença , Inquéritos e Questionários
2.
NPJ Prim Care Respir Med ; 25: 15047, 2015 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-26182124

RESUMO

BACKGROUND: The overlap between asthma and chronic obstructive pulmonary disease (COPD) is an important clinical phenomenon. However, the prevalence of asthma-COPD overlap syndrome (ACOS) is not known. AIMS: To investigate the prevalence of ACOS among asthmatic patients with a smoking history, and evaluate the factors predicting ACOS in this patient group. METHODS: We investigated 190 primary care asthma patients with no previous diagnosis of COPD, but who were either current or ex-smokers, with a smoking history of at least 10 pack-years. Spirometry was performed on all the patients while they were taking their normal asthma medication. Patients were considered to have ACOS if their postbronchodilator forced expiratory volume in 1 s/forced vital capacity was < 0.70. RESULTS: Fifty-two (27.4%) of the patients were found to have ACOS. Age ⩾ 60 years and smoking for ⩾ 20 pack-years were the best predictors of ACOS. If both of these criteria were met, the odds ratio (95% confidence interval) for ACOS was 6.08 (2.11-17.49), compared with the situation where neither of these criteria were fulfilled. CONCLUSIONS: There is a high prevalence of ACOS among primary health care asthmatics with a positive smoking history but no previous diagnosis of COPD. In this population, age over 60 years and a smoking history of more than 20 pack-years were the best predictors of ACOS.


Assuntos
Asma/epidemiologia , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar/epidemiologia , Adulto , Fatores Etários , Idoso , Asma/tratamento farmacológico , Asma/fisiopatologia , Broncodilatadores/uso terapêutico , Estudos de Coortes , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Espirometria , Síndrome , Capacidade Vital , Adulto Jovem
3.
Orv Hetil ; 143(9): 455-9, 2002 Mar 03.
Artigo em Húngaro | MEDLINE | ID: mdl-12013687

RESUMO

INTRODUCTION: The mechanism for adverse reactions to foods in the gastrointestinal tract are poorly understood. Previous studies of other atopic diseases and animal models suggest that lymphocytes and cytokines may be implicated in the pathogenesis of food allergy. AIM: The authors investigated the expression of interleukin-4, interferon-gamma and other lymphocyte markers of patients with cereal allergy (wheat, rye, oats) and of controls. PATIENTS/METHOD: Expressions of cytokines and lymphocyte markers on duodenal mucosa of nine patients (mean age 38.3 years, range 18-50 years, 8 women and one man) and nine controls (mean age 36 years, range 24-54 years, 6 women, 3 men) by means of immunohistochemistry were investigated. RESULTS: The mucosal structure on every biopsy specimens was normal. Despite the normal structure the expression of Ki-67 intranuclear proliferation marker was higher in patients with cereal allergy. Expression of interleukin-4 was markedly elevated in the food allergy group, however, interferon-gamma density showed no inter-group difference. The densities of CD4 (1251 vs. 1053 cells/mm2) and HLA-DR positive cells (1227 vs. 1064 cells/mm2) in the lamina propria of cereal allergy group were significantly elevated when compared with controls (P = 0.05 and P = 0.04, respectively). The densities of CD3, CD8, TCR alpha/beta and gamma/delta, HLA-DP, IgA, IgA1, IgA2-containing cells did not differ in the two groups studied. CONCLUSIONS: The authors results suggest that, despite the normal mucosal structure, the increased expression of CD4 and HLA-DR positive cells show a sign of inflammation in duodenal biopsies of patients with cereal allergy. Moreover, increased density of IL-4 may suggest its role in the pathogenesis of cereal hypersensitivity.


Assuntos
Duodeno/imunologia , Grão Comestível , Hipersensibilidade Alimentar/imunologia , Interferon gama/análise , Interleucina-4/análise , Linfócitos/imunologia , Adulto , Biomarcadores/análise , Biópsia , Antígenos CD4/análise , Estudos de Casos e Controles , Grão Comestível/imunologia , Feminino , Antígenos HLA-DR/análise , Humanos , Imunoglobulina A/análise , Mucosa Intestinal/imunologia , Masculino , Pessoa de Meia-Idade , Hipersensibilidade a Trigo/imunologia
4.
Prim Care Respir J ; 17(4): 232-7, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18830521

RESUMO

AIMS: COPD is an underdiagnosed disease. This study was undertaken to assess the value of microspirometry in detecting reduced FEV1 values in cigarette smokers, i.e., subjects at high risk for COPD. METHODS: A total of 611 smokers or ex-smokers with a smoking history >20 years and no previously-diagnosed lung disease were recruited (389 male, age 27-83 years, mean age 56 years, mean smoking history 35 pack years, 19% ex-smokers). RESULTS: An FEV1 < 80% predicted on microspirometry was found in 44.6% of cases. The mean FEV1 was 2.8 litres (80.6% predicted, range 26-121%). This correlated well with values obtained from full spirometry (R=0.965, p<0.0001). Detailed questionnaire responses revealed that almost half of the subjects (48.2%) reported chronic cough and sputum production and 39.8% reported breathlessness during exercise. CONCLUSIONS: Microspirometry finds a considerable number of smokers or ex-smokers with reduced FEV1 values. Microspirometry is quick to perform. All smokers with reduced microspirometry FEV1 values would benefit from smoking cessation, and all patients with reduced FEV1 values need to be considered for full spirometry to confirm if they actually have COPD.


Assuntos
Volume Expiratório Forçado/fisiologia , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Fumar/fisiopatologia , Espirometria/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Finlândia , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Reprodutibilidade dos Testes , Fatores de Risco , Fumar/efeitos adversos
5.
Ann Allergy Asthma Immunol ; 100(4): 338-42, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18450119

RESUMO

BACKGROUND: Lactobacillus rhamnosus GG (LGG) has demonstrated promising results in the treatment and prevention of atopic eczema. OBJECTIVE: To study the effects of LGG on the oral immune response in adolescents and adults with birch pollen allergy combined with oral allergy syndrome. METHODS: Patients received either LGG (n = 19) or a placebo (n = 19) for 5.5 months (from February 8 to August 6, 1999), starting 2.5 months before the birch pollen season. An oral apple challenge test was performed before, during, and after the pollen season. Saliva samples were collected before and after the challenges, and serum samples were collected before the challenges. Total IgA, IgG, and IgM and rBet v1 and rMal dl specific IgA, IgG, IgG1, and IgG4 levels were measured from saliva with an enzyme-linked immunosorbent assay (ELISA). Serum rBet v1 specific IgE ELISA and birch radioallergosorbent testing were performed. RESULTS: After 5.5 months, rBet v1 and rMal dl specific IgA levels had increased from baseline in the LGG compared with the placebo group (delta rBet v1 IgA, 0.319 vs. -0.136 relative units; P = .02; delta rMal d1 IgA, 0.097 vs -0.117, P = .02). rBet v1 specific IgE serum levels did not differ between the groups. In the LGG group, rBet v1 specific IgE levels correlated positively with stimulated total IgA (P = .04) and IgG (P = .003) in saliva. In the placebo group, rBet vl specific IgE levels correlated negatively with stimulated rBet v1 and rMal d1 IgA levels (P = .009 for both) and IgG (P = .02 and P = .03, respectively). CONCLUSION: LGG showed immunostimulating effects on oral mucosa seen as increased allergen specific IgA levels in saliva.


Assuntos
Alérgenos/imunologia , Antígenos de Plantas/imunologia , Imunoglobulina A/imunologia , Lacticaseibacillus rhamnosus/imunologia , Proteínas de Plantas/imunologia , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/prevenção & controle , Adolescente , Adulto , Especificidade de Anticorpos , Betula/imunologia , Método Duplo-Cego , Feminino , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/prevenção & controle , Humanos , Imunoglobulina A/biossíntese , Imunoglobulina A/sangue , Isotipos de Imunoglobulinas/sangue , Isotipos de Imunoglobulinas/imunologia , Masculino , Malus/imunologia , Saliva/imunologia , Estatísticas não Paramétricas
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