Asthma and Obesity in Children Are Independently Associated with Airway Dysanapsis.

BACKGROUND: An increase in the prevalence of overweight and asthma has been observed. Both conditions affect negatively lung function in adults and children. The aim of this study was to analyze the effect of overweight and asthma on lung function in children. METHODS: We designed a case-control study of healthy and asthmatic subjects nested within an epidemiological asthma prevalence study in children between 8 and 16 years of age. The effect of asthma and overweight on lung function was assessed by impulse oscillometry and spirometry obtained at baseline and 10-15 min after salbutamol. RESULTS: 188 children were recruited, 114 (61%) were asthmatics and 72 (38%) were overweight or obese. Children with asthma and overweight had a higher FVC (+1.16 z scores, p < 0.001) and higher FEV1 (+0.79 z scores, p = 0.004) and lower FEV1/FVC (-0.54 z scores, p = 0.008) when compared to healthy controls. Compared to normal weight asthmatics, the overweight had higher FVC (+0.78 z scores, p = 0.005) and lower FEV1/FVC (-0.50 z scores, p = 0.007). In the multivariate analysis, overweight was associated with an increase of 0.71 and 0.44 z scores in FVC and FEV1, respectively, and a reduction in FEV1/FVC by 0.40 z scores (p < 0.01 for all). Overweight had no effect on maximal flows and airway resistance at baseline, and this was not modified by inhalation of a bronchodilator. Asthma was also associated with higher post-BD FVC (0.45 z scores, p = 0.012) and FEV1 (0.35 z scores, p = 0.034) but not with FEV1/FVC and FEF25-75%. Two-way analysis of variance did not detect any interaction between asthma and overweight on lung function variables before or after bronchodilator. CONCLUSION: Our results suggest that asthma and overweight are independently associated with airway dysanaptic growth in children which can be further scrutinized using impulse oscillometry. Overweight contributed more to the reduction in FEV1/FVC than asthma in children without increasing airway resistance. Spirometry specificity and sensitivity for obstructive diseases may be reduced in populations with high prevalence of overweight. Adding impedance oscillometry to spirometry improves our understanding of the ventilatory abnormalities in overweight children.

Mais um passo importante da Scientia Medica: [editorial] / One further important step for Scientia Medica: [editorial]

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Bronquiolite viral aguda: condutas atuais e suas implicações / Acute viral bronchiolitis: actually conducts and Its implications

A broquiolite viral aguda é a doença do trato respiratório inferior mais comum em lactentes e uma das principais causas de internação hospitalar nesta faixa etária, usualmente ocorrendo nos meses de outono, inverno e primavera. ocorre com maior freqüência em crianças de até um ano de idade e é mais grave nos primeiros seis meses de vida e em prematuros.em razão da prevalência elevada desta doença e sua potencial morbidade, existe de forma em relação a sua terapêutica ideal. neste trabalho, os autores discutem de forma atualizada e crítica as condutas comumente utilizadas em broquiolite viral aguda na prática médica.

Asma aguda na infância / Acute asthma in children

A asma brônquica é uma das doenças crônicas mais comuns na infância. Entretanto, a despeito de todo o conhecimento adquirido nos últimos anos sobre a fisiopatologia e tratamento da doença, as crises agudas são ainda responsáveis por muitos óbitos pediátricos. Segundo estatísticas recentes, 80 por cento destes óbitos seriam evitáveis, sendo essencial a adoção de orientação adequada e intervenção precoce para a redução desta mortalidade