Sibilância em lactentes: o que mudou? / Wheezing in infants: what has changed?

O objetivo deste artigo foi avaliar a prevalência e fatores de risco para sibilância recorrente e asma em lactentes. Foi realizada pesquisa de artigos originais, revisões, consensos indexados e publicações on-line, nos últimos 15 anos, nos bancos de dados PubMed, MEDLINE, LILACS e SciELO. Conhecer a prevalência de sibilância recorrente e os fatores a ela associados é imprescindível, visto a sibilância recorrente ser uma das principais manifestações clínicas da asma na infância, sendo inclusive considerada por alguns autores como sinônimo desta doença, somado ao fato de que alguns dos fatores associados à sibilância no primeiro ano de vida também o são ao desenvolvimento de asma em crianças e adolescentes. A realização e aprofundamento de pesquisas sobre a sibilância e a asma na infância se fazem necessárias, e podem colaborar com a implantação de políticas públicas de saúde e programas educacionais objetivando o diagnóstico precoce de asma, e a adoção de medidas preventivas que favoreçam seu controle e evolução.

The objective of this study was to evaluate the prevalence and risk factors of recurrent wheezing and asthma in infants. MEDLINE (via PubMed), LILACS, and SciELO databases were searched for original articles, reviews, indexed guidelines, and online resources published in the past 15 years. It is essential to know the prevalence of recurrent wheezing and its associated factors, since recurrent wheezing is one of the main clinical manifestations of childhood asthma, being considered by some authors a synonym of this disease. Also, some factors associated with wheezing in the first year of life may influence the development of asthma in children and adolescents. Further research on wheezing and asthma in childhood is needed and may contribute to the implementation of public health policies and educational programs aimed at the early diagnosis of asthma and to the adoption of preventive measures to improve asthma control and reduce disease burden.

[Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil]. / Prevalência e características clínicas da sibilância em crianças no primeiro ano de vida, residentes na cidade de Cuiabá, Mato Grosso, Brasil.

OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in 12-15 months old infants in the city of Cuiabá, Mato Grosso State, Midwest Brazil. METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the "Estudio Internacional de Sibilancia en Lactantes" (EISL) - phase 3 at primary health care clinics at the same day of children vaccination or at home, from August 2009 to November 2010. RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beginning at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥ 3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled ß2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization, neverthless no differences between occasional and recurrent wheezing infants were found. CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those found in other Brazilian studies Recurrent wheezing had early onset and high morbity.

Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil / Prevalência e características clínicas da sibilância em crianças no primeiro ano de vida, residentes na cidade de Cuiabá, Mato Grosso, Brasil

OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil. METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactantes (EISL) - phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010. RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress, and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization; neverthless, no differences between occasional and recurrent wheezing infants were found. CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those observed in other Brazilian studies. Recurrent wheezing had early onset and high morbity...

OBJETIVO: Determinar a prevalência e as características clínicas da sibilância em lactentes (12-15 meses) residentes em Cuiabá (MT). MÉTODOS: Pais e/ou responsáveis pela criança foram entrevistados e responderam ao questionário escrito padronizado do "Estudio Internacional de Sibilancia en Lactantes" (EISL) - fase 3, em unidades básicas de saúde por ocasião da vacinação de rotina ou durante visitas nos domicílios de crianças matriculadas nos programas de saúde da família no período de agosto de 2009 a novembro de 2010. RESULTADOS: 1060 pais e/ou responsáveis responderam ao questionário escrito, sendo 514 (48,5%) lactentes do sexo masculino. Dos lactentes, 294 (27,7%) tiveram pelo menos um episódio de sibilância no primeiro ano de vida, com início aos 5,8±3,0 meses e predomínio em meninos. A prevalência de sibilância ocasional (<3 episódios de sibilância) foi 15% e a recorrente (≥3 episódios) foi 12,7%. Entre estes, o uso de broncodilatador inalado, corticosteroide oral, antileucotrieno, presença de sintomas noturnos, dificuldade para respirar e internação por sibilância foram significantemente mais frequentes. Diagnóstico médico de asma foi evidenciado em 28 (9,5%) dos lactentes sibilantes. Dos lactentes sibilantes, 80 (27,7%) relataram ocorrência prévia de pneumonia, sendo que 33 (11,2%) necessitaram internação para tratamento, porém não houve diferença entre os grupos de sibilantes. CONCLUSÃO: A prevalência de sibilância recorrente em lactentes foi mais baixa em comparação a outros estudos brasileiros, assim como o diagnóstico médico de asma. Sibilância recorrente teve início precoce e alta morbidade...

[Asthma prevalence and risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil]. / Prevalência e fatores de risco para asma em adolescentes de 13 a 14 anos do Município de Cuiabá, Mato Grosso, Brasil.

The objective of this study was to estimate the prevalence of active asthma and identify associated risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil. A cross-sectional population-based and a subsequently a nested case-control study was conducted in 2008 using the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). Risk factor analysis used the chi-square test, Fisher's exact test, and binary logistic regression. Variables with p < 0.20 in the bivariate analysis entered the logistic regression model, with six variables remaining in the final model (p < 0.05). Prevalence of active asthma was 19.1%. Risk factors for active asthma (p = 0.01) were: smoking during pregnancy, exclusive breastfeeding < 6 months, family income < 3 minimum wages, female gender, pets currently in the home, and absence of fish in the diet. Prevalence of active asthma was high, but with a significant reduction compared to 1998.

Prevalência e fatores de risco para asma em adolescentes de 13 a 14 anos do Município de Cuiabá, Mato Grosso, Brasil / Asthma prevalence and risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil

Estimar a prevalência de asma ativa e identificar possíveis fatores de risco associados em adolescentes de 13 a 14 anos, residentes na cidade de Cuiabá, Mato Grosso, Brasil. Estudo transversal de base populacional sendo posteriormente aninhado a estudo caso-controle, realizado em 2008, utilizando o protocolo do International Study of Asthma and Allergies in Childhood (ISAAC). A análise dos possíveis fatores de risco foi realizada pelo teste do qui-quadrado, teste exato de Fisher e por regressão binária logística. As variáveis com p < 0,20 na análise bivariada entraram no modelo de regressão logística, permanecendo no modelo final seis variáveis (p < 0,05). A prevalência de asma ativa foi de 19,1%. Os fatores de risco para asma ativa (p = 0,01) foram: tabagismo na gestação, seio materno exclusivo < 6 meses, renda familiar < 3 salários mínimos, sexo feminino, animais em casa no presente e ausência de peixe na dieta. A prevalência de asma ativa foi alta com redução significante à encontrada em 1998.

The objective of this study was to estimate the prevalence of active asthma and identify associated risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil. A cross-sectional population-based and a subsequently a nested case-control study was conducted in 2008 using the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). Risk factor analysis used the chi-square test, Fisher's exact test, and binary logistic regression. Variables with p < 0.20 in the bivariate analysis entered the logistic regression model, with six variables remaining in the final model (p < 0.05). Prevalence of active asthma was 19.1%. Risk factors for active asthma (p = 0.01) were: smoking during pregnancy, exclusive breastfeeding < 6 months, family income < 3 minimum wages, female gender, pets currently in the home, and absence of fish in the diet. Prevalence of active asthma was high, but with a significant reduction compared to 1998.