Total control of asthma: an evaluation in patients of a tertiary hospital.

BACKGROUND: Asthma control is an important goal of international asthma guidelines, but in most reports total control is reached in a small proportion of cases. OBJECTIVE: To know the degree of asthma control, the percentage of ER visits and hospitalizations in the last month and in the last year, and the type of pharmacologic treatment for asthma in a tertiary hospital. PATIENTS AND METHOD: This is an observational study in asthmatic patients from 12 to 60 years old, with more than one year of treatment, who answered the questionnaire of Asthma Control Test (ACT). RESULTS: A total of 204 patients were included, 116 women and 88 men, with an average age of 24 years. We observed that 19 patients (9.3%) were in total control of asthma: scored 25 ACT points, 88 patients (43.1%) scored 20-24 points (non total control) and 97 patients (47.5%) less than 20 points (asthma not controlled). According to the asthma severity index, 125 patients had intermittent symptoms (61.3%), and persistent symptoms were present in 79 patients. In the previous month 8.3% of patients had ER visits and 2.9% were hospitalized; in the previous year the ER visits and hospitalizations percentages were 33.3% and 14.2%, respectively. Inhaled steroids were used by 12.2% of the patients, long-action beta2 agonists by 9.8% and daily short action beta2 agonists by 28%. CONCLUSIONS: Total control of asthma was observed in less than 10% of our patients-sample; the majority of them had intermittent asthma; the pattern of medication was inadequate, with misuse of inhaled steroids and an elevated use of inhaled rescue medications.

The puzzle of asthma treatment: animal models to genetic studies.

The recognition that asthma is an inflammatory disease opens a new field to find effective models for the evaluation and development of new drugs. In this scenario, many novel candidate molecules have been shown to work perfectly in animal models, but not in clinical studies. Ancillary models are reviewed in association with the findings obtained in either transgenic or knockout mice. In parallel, genetic studies in animal models and human populations have identified several genes that are asthma-related. Knowledge of these recent findings, in parallel with pharmacogenomic studies will be necessary to direct new strategies for the development of novel drugs to treat subgroups of patients with asthma.

Childhood asthma and allergic rhinitis: the role of leukotrienes.

Research in the past two decades has shown that patients with asthma and rhinitis have inflammation of the involved tissues. This perception has been reflected in recent treatment guidelines, which stress the decreased use of symptom-based therapy and increased use of antiinflammatory therapies to control underlying inflammation. Corticosteroids are the most effective drugs currently in use; however, their use may be limited by potential problems with safety and patient/family adherence, which includes the "fear factor." In addition, the use of high doses of topical corticosteroids (especially when used in both the nose and airways) may have adverse effects when used continuously for long periods. The inflammatory response is complex, involving numerous inflammatory mediators and cells that interact in complicated and interrelated pathways. This provides researchers with numerous interactions at which molecular intervention may result in the attenuation of inflammation, and thus clinical disease. The leukotrienes, a group of important inflammatory mediators, cause vascular leakage and tissue edema; they also promote mucus secretion and a potent bronchoconstriction in patients with asthma. Currently a number of antileukotriene drugs have been developed and preliminary research indicates that they may provide clinicians with a non-steroidal antiinflammatory therapy that may provide steroid-sparing effects. This review examines the leukotrienes and the effects of antileukotriene agents in patients with asthma and allergic rhinitis.