Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - EIP on AHA Twinning Reference Site (GARD research demonstration project).

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.

Prevalence of asthma and associated factors in adolescents living in Belem (Amazon region), Para, Brazil.

BACKGROUND: The prevalence of asthma in the Brazilian Amazon region is unknown. We studied the prevalence of asthma and associated factors in adolescents (13-14 years old) living in Belem, a large urban centre in this region. METHODS: 3725 adolescents were evaluated according to the International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a random sample of them (126 asthmatics and 254 non-asthmatics) were assessed for possible risk factors by a supplementary questionnaire (ISAAC Phase II) and skin prick tests with aeroallergens. The association between asthma and associated factors was determined by logistic regression analysis. RESULTS: 3708 adolescents were enrolled, 48% were male. The prevalence of asthma in the last 12 months (identified as asthmatics) and the medical diagnosis of asthma were 20.7% and 29.3%, respectively. Risk factors significantly associated with asthma were: previous diagnosis of tuberculosis (odds ratio [OR]=38.9; 95% confidence interval [95% CI]: 4.6-328.0) and measles (OR=4.7; 95% CI: 2.3-9.8), breastfeeding for any length of time (OR=4.2; 95% CI: 1.1-15.2), current rhinitis (OR=3.2; 95% CI: 1.8-5.9), exposure to smokers (OR=2.4; 95% CI: 1.2-4.5), moisture in home (OR=1.8; 95% CI: 1.1-3.2) and rhinitis diagnosed by physician (OR=1.7; 95% CI: 1.2-2.9). Sensitisation to at least one aeroallergen was significantly higher among asthmatic adolescents (86.5% vs. 32.4%; p<0.0001). CONCLUSIONS: The prevalence of asthma was similar to that observed in other Brazilian centres. Physician-diagnosed asthma was more frequent than the presence of symptoms suggestive of asthma. Infectious diseases, nutritional and environmental factors, as well as concomitant allergic rhinitis, were the main risk factors associated with the development of asthma in these adolescents.

Specific and non-specific nasal provocation tests in children with perennial allergic rhinitis.

BACKGROUND: nasal provocation tests (NPT) have been extensively used in clinical practice to evaluate chronic rhinopathies, mainly allergic rhinitis (AR). METHODS: we submitted 10 perennial AR children (aged from six to 15 years) to histamine (H), Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis (Bt) NPT. All children were sensitized (positive skin prick test, mean wheal > 3 mm) to both mites. Dp and Bt specific NPT were realized in two occasions, apart one week, always preceeded 24 hours by H challenge. Increased concentrations were applied to the nasal mucosa during each NPT: H (0,03 to 16 mg/ml), Dp (1/100,000 to 1 /2.5) and Bt (1/125,000 to 1/10). NPT were evaluated by clinical and rhinomanometric parameters (total score, TS), and by lung function tests. NPT was considered positive, when total nasal resistance (TNR) doubled in relation to basal value. RESULTS: H NPT was positive twice in 8/10 patients. Concordance between H concentration that induces a positive NPT measured by TNR or TS was observed. Regarding to specific NPT, 90 % of patients were positive to Dp and 60 % to Bt. There was no concordance between the allergen concentration that induces a positive SPT and a positive NPT, considering the different concentrations. There were no modification in lung function tests during both specific and non-specific provocation tests. CONCLUSIONS: NPT with H is an objective and reproducible method which allow evaluate nasal reactivity. Specific NPT have restricted indications, mainly when there where doubts about AR's etiology.

[Effect of inhaled terbutaline sulphate (dry powder, Turbuhaler and nebulizer solution) in children with acute asthma]. / Estudo dos efeitos do sulfato de terbutalino inalado, sob a forma de pó seco (TurbuhalerR) e solução para nebulização em crianças com asma aguda.

Forty seven children (6-14 years), with an acute mild or moderate attack of asthma (clinical score 3 or FEV1 > 50% of the predicted), were treated with terbutaline sulphate, by inhalation route with a dry powder inhaler (Turbuhaler - 0,5 mg - group T; N=27, or by a nebulizer 1% solution-in saline-compressed air (6 l/min.) group S; N=20. The children were evaluated at 5, 15, 25 and 30 minutes after the initial treatment. In both groups a significant fall of the clinical score (starting at 15 minutes) (p < 0.05) and a significant improvement of the FEV(1), VC and FEF25-75% (starting at 5 minutes), were observed (p < 0.05). There were no significant changes in heart rates, respiratory rates and blood pressure (p > 0.05). At the end of the first treatment, the number of patients with a FEV(1) < 80% was similar in both groups (T = 13/27 and S = 10/20). The same treatment was repeated, and all the children showed a marked improvement, except for one boy of the group T was hospitalized. In conclusion, children with mild or moderate acute attacks of asthma can be treated up to a week with an inhalation of dry powder, resulting in adequate bronchodilatation without important side effects.