Association between COPD and hearing loss with impaired speech recognition: a cross-sectional study.

INTRODUCTION: Studies have identified a greater risk of sensory neural hearing loss in individuals with COPD compared to healthy individuals, but it is unclear whether they are at increased risk of hearing loss with impaired speech recognition. The aim of this study was to assess whether COPD is associated with hearing loss that affects speech recognition. METHODS: This is a case-control study. We screened individuals from health facilities in the municipality of Jundiai. We enrolled a test group of individuals with COPD and an age-matched control group composed of individuals with asthma. The selected individuals attended an appointment with a chest physician, responded questionnaires and underwent tonal and speech audiometry. Adjusted binary logistic regression analysis evaluated whether COPD was associated with reduced speech recognition. RESULTS: We enrolled 36 individuals with COPD and 72 with asthma. Individuals with COPD were more likely to have a reduced speech recognition compared to asthmatic individuals [Reduced recognition of three-syllable words: adjusted OR 3.72, 95 CI (1.38 - 10.02)] [Reduced recognition of monosyllable words: adjusted OR 4.74, 95 CI (1.52 - 14.76)]. CONCLUSION: We conclude that individuals with COPD from primary and secondary healthcare facilities have at least 38% greater risk of hearing loss with reduced speech recognition compared to an age-matched control group of individuals with asthma recruited from the same facilities. We recommend that longitudinal studies evaluate whether regular screening could contribute to the prevention or early treatment of hearing loss in individuals with moderate-severe COPD.

Severe asthma and eligibility for biologics in a Brazilian cohort.

OBJECTIVE: This study aims to describe the eligibility for biologic therapies for severe asthma (SA) in a cohort of patients attending the Program for Control of Asthma (ProAR) in Bahia, Brazil. METHODS: Data from SA patients (≥18 years old) attending the ProAR, that were included in a case-control study conducted from 2013 to 2015, were used to reassess patients according to a modified ERS/ATS 2014 SA criteria. Patients were then classified according to the eligibility for SA biological therapy based on current prescription labels. RESULTS: From 544 patients in the cohort, 531 (97.6%) were included and 172 (32.4%) were identified as SA patients according to the ERS/ATS 2014 modified criteria. Of these 172 patients, 69 (40.1%) were ineligible for any of the biologicals approved for asthma (omalizumab, mepolizumab, reslizumab and benralizumab), 60 (34.9%) patients were eligible for one of the biological therapies, and 10 (5.8%) patients were eligible for all biological therapies. CONCLUSIONS: More than half of patients with SA were eligible for biologic therapy in our study, but none of them received this form of treatment. Almost half of them were not eligible to any of the approved biologics, however. The variability and overlap in patients' eligibility highlight the importance of evaluating each patient individually for a more personalized treatment approach. While there is a need to increase access for some of those eligible that may really need a biologic treatment, continuous efforts are required to develop alternatives to those who are not eligible.

Lung Cancer Mortality and the Availability of Chest Computerized Tomography: A Longitudinal Nationwide Study.

Lung-cancer screening with chest computerized tomography (CT) is not easy to introduce in low-medium resource countries due to cost issues. We investigated whether the increasing availability of chest CT exams in Brazil, in spite of no lung-cancer screening protocol, was associated with lung-cancer death rate along 10-year follow-up. We performed regressions to estimate the rate ratio between chest CT exams and lung-cancer deaths per 105 inhabitants. We stratified data per municipality. Regressions were adjusted for physicians and hospital beds per 105 inhabitants and per capita gross domestic product. Increasing availability of chest CT exams predicted decreasing lung-cancer death rate.

Greater Access to Long Acting Beta2 Agonists Is Associated with Less Hospital Admissions Due to COPD: A Longitudinal Nation-Wide Study.

PURPOSE: Long Acting Beta2 Agonists (LABA) prevent COPD exacerbations in strictly standardized clinical trials. Our aim was to evaluate the relationship between the amount of LABA provided by the government and the trend in COPD hospital admission (HA) rate in Brazil. METHODS: This is a longitudinal large-scale real-life study. We calculated COPD HA rate and the number of subjects per 105 inhabitant who received LABA supplied by the government in each Brazilian municipality, between years 2004 and 2013. We used Poisson Multilevel Regression analysis to calculate the rate ratio between LABA dispensation rate and COPD HA rate. RESULTS: In Brazil, COPD HA rate reduced 59% among subjects between 40 and 59 years of age and 60% among subjects older than 59 years of age. Most of the 5506 Brazilian municipalities reduced COPD HA rate [4149 (75%) municipalities & 1357 (25%) municipalities]. The dispensation of LABA was greater among municipalities that reduced COPD HA rate. In the 40-59 age group, the gap in LABA dispensation between the two groups of municipalities increased during the study period from 90.40 to 614.28 subjects per 105 inhabitants. In the > 59 age group, the gap in LABA dispensation increased from 35.87 to 912.99 subjects per 105 inhabitants. For each one hundred subjects who received LABA there was less one HA (RR 0.99, 95 CI 0.99-0.99). CONCLUSIONS: COPD HA rate reduced in Brazil. LABA dispensation growth was associated with COPD HA rate reduction.

Irreversible airway obstruction in asthma: A risk factor for severe exacerbations in spite of proper treatment.

OBJECTIVES: To evaluate whether irreversible airway obstruction (IAO) related to asthma is a risk factor for lack of symptoms control, poor quality of life and exacerbations. METHODS: We evaluated consecutive outpatients with asthma in a one-year cohort study. We excluded subjects with smoke history > 9 pack-years. Definition of IAO was post bronchodilator FEV1/CVF ratio below the lower limit of normality. Subjects received high dose of inhaled medications for asthma. We used logistic regression models, adjusted for the treatment offered during the study, to evaluate whether IAO related to asthma is a risk factor for symptoms control, quality of life, any emergency room visit, number of emergency room visits and hospital admission. RESULTS: We enrolled 248 subjects in the study. IAO was not a risk factor for poor symptoms control [OR 1.354, 95 CI (0.632-2.899)] or worse asthma related quality of life [OR 0.705, 95 CI (0.413-1.204)]. Subjects with IAO had higher odds of any emergency room visit [OR 2.214, 95 CI (1.300-3.768)] and hospital admission [OR 8.530, 95 CI (1.517-47.978)] and lower odds to reduce emergency room visits in the course of the follow-up period [OR 0.452, 95 CI (0.265-0.769)]. IAO did not predict the number of emergency room visits [OR 1.53, 95 CI (0.71-3.30). CONCLUSION: IAO is not a risk factor for poor symptoms control or poor quality of life, in a setting of proper treatment. It is a risk factor for emergency room visit and hospital admission. Subjects with IAO have poor response to treatment.

Age is not associated with hospital admission or uncontrolled symptoms of asthma if proper treatment is offered.

BACKGROUND: Aging modifies immune response and respiratory physiology. Few studies evaluate the effect of age on asthma. The aim of our study was to evaluate whether age is associated with uncontrolled symptoms and hospital admissions due to asthma in a setting where patients were receiving proper treatment. METHODS: We enrolled 401 patients with uncontrolled asthma who were inhaled corticosteroid-naive. The follow-up period was 1 year. They received medications for asthma, performed spirometry, a symptoms questionnaire, and all emergency room visits and hospital admissions due to asthma were reported. The primary end point was hospital admission during the follow-up period. RESULTS: Baseline data demonstrated that subjects >55 years of age had a later onset of asthma and a longer duration of symptoms. Adjusted logistic regression models demonstrated that older age at enrollment did not predict asthma control in the follow-up: hospital admission due to asthma [odds ratio (OR) 1.7 and 95% confidence interval (CI) 0.6-4.7], symptoms score (OR 0.6 and 95% CI 0.3-1.1) and emergency room visits due to asthma (OR 0.9 and 95% CI 0.6-1.3). Older age was associated with worse lung function (OR 1.8 and 95% CI 1.1-3.3). CONCLUSION: This study allows us to conclude that older age is associated with a later onset of asthma and a longer duration of symptoms. Age does not predict hospital admissions or poor control of asthma symptoms if proper treatment is offered. It does, however, predict worse lung function.

Reduced asthma morbidity in endemic areas for helminth infections: a longitudinal ecological study in Brazil.

OBJECTIVE: The aim of this study was to evaluate whether endemic areas for helminth infections in Brazil have lower rates of hospital admission due to asthma and whether reduction in helminth endemicity impacts on asthma morbidity. METHODS: This was a country-wide ecological study in Brazil. Government databases were the source of information. A cross-sectional analysis accessed the risk of a municipality having high rates of hospital admissions due to asthma according to its records of hospital admissions due to Schistossoma mansoni or intestinal helminth infections. A longitudinal analysis accessed the effect of prevention of helminth infection on asthma morbidity. Data were adjusted for the rates of hospital admissions due to influenza, pneumonia, diarrhea, per capita income, Gini index, number of physicians, proportion of literate inhabitants, urbanization and hospital beds. RESULTS: Hospitalization rates due to asthma in the age range of 5-24 years were lower in municipalities endemic for S. mansoni [adjusted OR: 0.992, CI: 0.989-0.994] or for intestinal helminth infections [adjusted OR: 0.994, CI: 0.990-0.997]. Similar results were observed for the age range of 25-64 years. In the longitudinal analysis, municipalities that reduced hospitalizations due to S. mansoni had smaller odds to decrease hospital admissions due to asthma among young populations [adjusted OR: 0.43, CI: 0.22-0.82]. CONCLUSION: We conclude that populations exposed to helminths have lower asthma morbidity. Reduction of helminth infection prevalence in low-income populations was associated with a smaller decline in asthma morbidity.

Evaluating the relationship between the type of rescue medication and the adequacy of asthma maintenance therapy.

INTRODUCTION: Current guidelines incorporate the option of a rapid onset bronchodilator (ROB) plus an inhaled corticosteroid (ICS) for the relief of asthma symptoms, but there is doubt whether the combined therapy for relief could lead to suboptimal maintenance therapy since individuals might prefer it to the maintenance therapy. The objective of this study was to assess whether the type of rescue medication that the individual with asthma has available is associated with suboptimal maintenance therapy. METHODS: This cross-sectional study included non-smokers with asthma, ≥12 years old. The individuals attended an appointment with a physician, responded questionnaires and performed a spirometry. Adjusted regression analysis evaluated whether the type of rescue medication was associated with suboptimal maintenance therapy. RESULTS: We enrolled 953 individuals, of which 221 reported having no rescue medication, 171 carried any ROB + ICS for symptoms relief and 561 carried SABA alone to rescue. The frequency of suboptimal maintenance therapy was not different between individuals carrying the combination and those carrying SABA alone for symptoms relief, but individuals who reported having no rescue medication had less suboptimal maintenance therapy (P < 0.01). CONCLUSIONS: The frequency of suboptimal maintenance therapy for asthma was similar between individuals carrying any ROB + ICS for symptoms relief and those carrying SABA alone to rescue, whilst it was less frequent in the group that reported not having any reliever medication. Data from this study indicate that recent changes in asthma guidelines regarding the use of rescue medication have little risk of impairing maintenance therapy.

Evaluating the effect of antidepressants on the relationship between depression and asthma.

BACKGROUND: It is unclear if depression is associated with impaired lung function in subjects with asthma, while few studies evaluated the effect of antidepressants on the relationship between depression and asthma. We designed this study to investigate if subjects with concomitant asthma and depression not taking antidepressants have worse asthma outcomes compared to asthmatic subjects without depression, and to evaluate whether antidepressants modify this association. METHODS: This is a cross-sectional study. We included non-smokers with asthma, 18 years old or above. Study subjects attended an appointment with a chest physician, answered study questionnaires and underwent a spirometry test. We performed crude and adjusted binary logistic regression analyses. RESULTS: We enrolled 309 subjects with asthma, of whom 48 with depression taking antidepressants, 52 with depression not taking antidepressants, and 209 without depression (control group). Asthmatic subjects with depression who had not used antidepressants before enrollment were more likely to have uncontrolled symptoms of asthma [adjusted OR 3.10, 95CI (1.56-6.15)] and airway obstruction [adjusted OR 2.41, 95CI (1.24-4.69)] compared to the control group. Subjects who had used antidepressants had higher odds of uncontrolled symptoms of asthma [adjusted OR 3.02, 95CI (1,50-6.07)], but similar odds of airway obstruction [adjusted OR 1.24, 95CI (0.87-1.77)] compared to the control group. CONCLUSIONS: Non-treated depression is associated with airway obstruction in subjects with asthma, but antidepressants modify this association. Thus, we recommend regular screening of depression in subjects with asthma, and prescription of antidepressants whenever depression symptoms justify pharmacological therapy.

Atopy is not associated with poor control of asthma.

INTRODUCTION: Atopy is part of the immunopathology of allergic diseases; however, the effect of atopy on the prognosis of asthma in adult patients is not established yet. The aim of this study is to investigate whether there is an association between lack of control of asthma and sensitization to aeroallergens. The relation between rhinitis severity and atopy was also investigated. METHODS: Six hundred and thirty-nine patients aged ≥ 20 years with uncontrolled and untreated asthma were enrolled. They were followed for 1 year, received inhaled corticosteroids combined with long-acting beta-2 agonists, performed spirometry, skin prick test to aeroallergens, and reported emergency room visits due to asthma. Questionnaires (Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ)) were applied to evaluate asthma symptoms and quality of life. Rhinitis diagnosis and severity were evaluated. RESULTS: Baseline data demonstrated that atopic patients were younger and had earlier onset of asthma. Gender, body mass index, and lung function were similar between atopic and nonatopic patients. Low schooling had a borderline association with nonatopic asthma. Follow-up data demonstrated that there was no significant difference between atopic and nonatopic patients in asthma symptoms, quality of life, frequency of patients with uncontrolled asthma, emergency room visit, hospital admission, airway obstruction, nor response to treatment. Rhinitis severity was also similar between atopic and nonatopic individuals. CONCLUSIONS: In conclusion, positive skin prick test to common aeroallergens was not found to be predictor of asthma control among adults.

Evaluating the effect of childhood and adolescence asthma on the household economy.

OBJECTIVE: To evaluate the relationship between asthma control, family income and family costs of asthma in a population of children-adolescents; to detail the family costs of asthma in this age range; and to compare asthma costs for the families of children-adolescents and adults. METHODS: The authors invited asthmatic subjects who attended a scheduled spirometry test at the Jundiaí School of Medicine (FMJ). The FMJ performs all spirometry tests requested by staff physicians who serve at the public healthcare system in the municipality. Volunteers responded to the ACQ, the Asthma Family Costs Questionnaire and underwent a spirometry test. RESULTS: The authors included 342 children-adolescents. Families of children-adolescents taking maintenance therapy and families of those reporting uncontrolled asthma symptoms were more likely to report any expenditure with asthma during the preceding month. In this age range, the smallest expenditures were on diagnostic tests and medical consultations, while home expenditures to avoid asthma triggers were the highest ones. As compared to adults' families, the children and adolescents families reported a greater proportion of income committed with asthma. Expenditures with transportation to healthcare facilities for asthma care were greater in the families of children-adolescents as compared to the values reported by the adults' families; in contrast, loss of income due to asthma was smaller in the families of children-adolescents. CONCLUSIONS: Children-adolescents' asthma affects the household economy. The authors believe researchers should assess this outcome when designing studies about asthma. Finally, the study's data support the necessity of public policies in low-resource communities to minimize the economic impact of children and adolescents' asthma.

Hospital admission rate in children and adolescents with mild persistent asthma.

INTRODUCTION: The health and financial burden of mild-persistent asthma has been poorly investigated. OBJECTIVE: Our aim was to compare the rate of hospital admissions that have occurred during the preceding year between children and adolescents with current mild-persistent (MP) and moderate-severe (MS) asthma. METHODS: We screened children and adolescents with asthma at eight outpatient clinics. The inclusion criteria were asthma diagnosis, age from 6 to 18 years and follow-up with a physician during the preceding 6 months. Subjects answered standardized questionnaires and underwent spirometry. RESULTS: We enrolled 220 MP and 102 MS asthmatic subjects. The proportion of subjects with HA during the preceding year was similar between MP and MS asthma groups (7% vs. 7%; p = .89). Symptoms score and the financial values spent by the family in the care of asthma were lower in MP asthma as compared with MS asthma group (asthma control questionnaire score 0.7 [0.3-1.0) vs. 2.0 [1.1-2.5]; p < .01) (asthma expenses in USD 13 [2-43] vs. 28 [10-83]; p < .01). The frequency of subjects using inhaled corticosteroids maintenance therapy was lower in the MP asthma group as compared with the MS asthma group (54% vs. 100%; p < .01). CONCLUSION: We conclude that the frequency of hospital admissions that have occurred during the preceding year was similar between subjects with current MP and MS asthma. Symptoms score and the financial values spent by the family in the care of asthma were lower in the MP asthma group.

Evaluating the FEV1/FVC ratio in the lower range of normality as a marker of worse clinical outcomes in asthmatic subjects without airway obstruction.

BACKGROUND: We should continually improve tools for evaluating asthma. The aim of this study was to evaluate whether the FEV1/FVC ratio in the lower range of normality is associated with worse outcomes in asthmatics without airway obstruction. METHODS: We screened asthmatics at eight clinics. Subjects answered the Asthma Control Questionnaire and underwent spirometry. We assigned individuals without airway obstruction in three groups according to the post bronchodilator FEV1/FVC ratio: lower range of normality, intermediary range of normality and upper range of normality. Asthma outcomes were hospital admission due to asthma during the preceding year, non-controlled asthma symptoms and moderate-high inhaled maintenance therapy need. RESULTS: In subjects from six to 18 years old, the rate of hospital admission was higher in the group with FEV1/FVC ratio in the lower range of normality as compared with the other two groups but the frequency of non-controlled symptoms of asthma and moderate-high dose of inhaled maintenance therapy need was similar. From 19 to 59 years old, the rate of moderate-high inhaled maintenance therapy need was higher in the group with FEV1/FVC ratio in the lower range of normality as compared with the other two groups, but the frequency of hospital admissions and non-controlled symptoms of asthma was similar. Above 59 years old, there was no difference in clinical asthma outcomes between lung function groups. CONCLUSIONS: FEV1/FVC ratio in the lower range of normality is a marker of worse clinical outcomes in asthmatics without airway obstruction.

Provision of inhaled corticosteroids is associated with decrease in hospital admissions in Brazil: A longitudinal nationwide study.

OBJECTIVE: To describe trends of hospital admissions due to asthma from 2008 to 2015 and to evaluate their relationship with trends of inhaled corticosteroids (ICS) provision by the government in Brazil. METHODS: We used Brazilian Government data to calculate hospital admission rates due to asthma, number of physicians, number of hospital beds, number of subjects that received ICS per 100,000 inhabitants in Brazil and in each of its municipalities for each year of the study. We performed Poisson Multilevel Regression Analyses to evaluate the relationship between the trends of hospital admission rates due to asthma with the trends of the number of subjects that had been receiving ICS during the study period. The analyses were adjusted for the number of physicians and hospital beds. FINDINGS: The number of patients who received ICS/100,000 inhabitants increased from 2008 to 2015 (943.9-1988.5). Hospital admissions/100,000 inhabitants decreased in patients aged 5-14 years (148.3-110.9) and in patients aged 15-39 years (59.9-32.3); the reduction was greater in municipalities in which ICS provision increased. The number of physicians/100,000 inhabitants increased and the number of hospital beds/100,000 inhabitants decreased in the study period. The increase in the number of physicians and in the number of subjects that received ICS were associated with reduction in hospital admissions. CONCLUSION: We found that provision of ICS by the Brazilian Government was associated with a decrease of hospital admissions for asthma in the municipalities and country levels from 2008 to 2015.

Rural to urban migration contributes to the high burden of asthma in the urban area.

INTRODUCTION: It is unknown whether rural-urban migration contributes to worse the burden of asthma in the cities. OBJECTIVES: The aim of this study was to evaluate whether subjects with asthma that migrated from rural areas to a large urban center in Brazil have more severe disease than asthmatic subjects that was born and always lived in the urban area. METHODS: This is a case-control study. We enrolled two groups of subjects with asthma currently living in a large urban center in Brazil: 486 subjects with moderate-severe asthma and 432 subjects with mild asthma. RESULTS: Rural-urban migrants had higher odds of moderate-severe asthma [adjusted OR 1.57, 95% CI (1.18-2.01)] and uncontrolled symptoms of asthma [adjusted OR 1.80, 95% CI (1.16-2.76)] than urban-born subjects. CONCLUSIONS: Rural-urban migrants in Brazil have more severe asthma than urban-born subjects. Our results suggest that rural-urban migration is associated with the high burden of asthma in the urban area.

Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment?

OBJECTIVE: To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. METHODS: This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. RESULTS: 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). CONCLUSIONS: Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.

Urbanization is associated with increased asthma morbidity and mortality in Brazil.

INTRODUCTION: Previous cross-sectional studies could establish an association between prevalence of self-reported wheeze and urban-rural environment, but the impact of urbanization on meaningful outcomes of asthma for public health is not established yet. OBJECTIVES: Evaluate the effect of urbanization on asthma burden. METHODS: A time series study of 5,505 Brazilian municipalities. The unit of analysis was the municipality. Two time frames were evaluated: from 1999 to 2001 and from 2009 to 2011. Trends from the first to the second time frame were evaluated. Governmental databases were the source of information. Multivariate binary logistic regression models were used. RESULTS: In the age range from 5 to 24 years old, municipalities with increase in the proportion of individuals living in urban area had lower odds to reduce hospital admission rate from asthma (OR: .93) and lower odds to reduce death rate from asthma (OR: .88). In the age range from 25 to 39 years old, municipalities with increase in the proportion of individuals living in urban area had lower odds to reduce hospital admission rate from asthma (OR: .93) and lower odds to reduce death rate from asthma (OR: .82). Municipalities that increased access to physicians and that supplied inhaled corticosteroids free of charge for asthma since year 2003 had increased odds to reduce hospital admission and death rates from asthma. CONCLUSIONS: Increase in urban population was associated with lower odds to reduce hospital admission and death rates from asthma in children and young adults living in a transition society.

Obesity and asthma: clinical and laboratory characterization of a common combination.

OBJECTIVE: To evaluate the relationship between obesity and asthma. METHODS: This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. RESULTS: Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). CONCLUSIONS: Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.

Eosinophilic asthma, according to a blood eosinophil criterion, is associated with disease severity and lack of control among underprivileged urban Brazilians.

BACKGROUND: Asthma is a syndrome with multiple phenotypes. Peripheral blood eosinophil counts might be the ideal biomarker to identify subjects with eosinophilic asthma. It is available, inexpensive, and it is associated with eosinophilia in sputum. OBJECTIVE: The aim of this study was to evaluate whether blood eosinophilia is associated with asthma severity and to evaluate whether blood eosinophilia is associated with lack of control of asthma symptoms and airway obstruction. METHODS: Case control study. The cases were subjects recruited from a cohort of patients with severe asthma, in Salvador-BR, demanding continuous inhaled corticosteroids and LABA. There were two control groups: 1) subjects with mild/moderate asthma, 2) subjects with no asthma. Subjects enrolled in the study answered questionnaires, had their blood and stool samples collected, performed spirometry and SPT. We established a cutoff ≥ 260 cells/mm3 for blood eosinophilia. RESULTS: We evaluated 544 subjects in the case group, 452 subjects with mild to moderate asthma and 450 subjects with no asthma. The subjects of the case group had higher odds of presenting the eosinophilic phenotype in comparison to subjects with mild to moderate asthma [OR 1.60 95CI(1.19-2.16)] and no asthma [OR 3.93; 95CI(2.90-5.33)]. The eosinophilic phenotype, according to blood count, is associated with uncontrolled asthma [OR 1.56; 95CI(1.06-2.28)], but it is not associated with airway obstruction [OR 0.87; 95CI(0.61-1.24)]. CONCLUSION: We conclude that the blood eosinophilia is a biomarker associated with asthma severity and poor symptom control, but we found no association with reduced lung function.