Why despite the lower prevalence, is asthma more severe in the semiarid region?

Introduction and objectives: Asthma is a chronic inflammatory disease which is very prevalent throughout the world, and climatic factors, especially air humidity, have been considered fundamental to its development. This study aims to evaluate the relationship between the climate factor and the severity of asthma episodes in the semiarid region, comparing it to the coast and an intermediate climate region, considering the use of medication as an intervening factor. Materials and methods: Ecological study in cities with different climatic conditions (semiarid, intermediate region and Coast). Prevailing data was obtained from the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. We evaluated the temperature, humidity and use of drugs for asthma/100,000 inhabitants. Results: The prevalence of asthma was lower in the semiarid (14%; 95% CI = 12.1-15.7) than the intermediate region (19.1%; 95% CI = 17.7-20.6) and coast (17.9%; 95% CI = 16.6-19.2). Episodes of severe asthma attacks were surprisingly higher in semiarid (10.4%; 95% CI=8.9-11.9) when compared to coast (4.1%; 95% CI = 3.4-4.9) and intermediate region (5.0%; 95% CI = 4.3-5.8). In the semiarid region, the humidity was lower and the temperature higher than the other cities evaluated. The dispensing of medications was lower in the semiarid region. Conclusions: Temperature and humidity may have contributed to a lower prevalence and greater severity of asthma in the semiarid region. The dispensing of medications was lower in the semiarid region, indicating that access to both relief and control drugs was lower in this city. The possibility of lack of health care in the semiarid region can also be another explanatory factor associated

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Immunomodulation of allergic response in children and adolescents: What we can learn from lymphatic filarial infection

Background: Although it is well known that allergic diseases involve a strong Th2 immune response, with production of high levels of specific IgE allergen, knowledge on the association between filarial infection and allergies, among paediatric patients is scarce. Objective: To evaluate the allergic response patterns in cases of filarial infection by comparing peripheral eosinophils, total IgE levels, immediate hypersensitivity and cytokine levels in children and adolescents in Brazil. Methods: This was an exploratory study with three groups: (I) with filarial infection and without allergic diseases; (II) without filarial infection and with allergic diseases; and (III) without filarial infection and without allergic diseases. The prick test and specific IgE tests for aeroallergens were performed using five antigens. Peripheral eosinophils and total IgE were also evaluated. IL-4 and IL-5 were determined using whole-blood culture stimulated by three antigens. Results: Eosinophilia and elevated levels of total IgE (≥ 400IU/dl) were observed in all groups. The prick test was positive in 56.6% of the cases. Group I presented hypersensitive responses similar to the allergic disease groups. In the whole-blood culture stimulated by Dermatophagoides pteronyssinus, average IL-4 production did not differ significantly among the groups, but IL5 production resulting from stimulation was greater in the allergic disease groups (p < 0.05). Conclusions: The allergic response pattern in group with filarial infection was similar to that of the groups with and without allergic diseases, but the response to IL-5 in the culture stimulated by D. pteronyssinus was an exclusive characteristic of the allergic group (AU)

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Inhaled beclomethasone in pregnant asthmatic women - A systematic review

The aim of this study was to systematically review the safety and efficacy of inhaled beclomethasone for asthma treatment in pregnant women. We performed a systematic review in Medline, LILACS and SciELO electronic databases in December 2012. A total of 3433 articles were found by using the keywords asthma, pregnancy and beclomethasone. Among these, 1666 were from Medline, via PubMed, and 1767 were from LILACS and SciELO. Nine of these articles were selected. Only one paper suggested an increased foetal risk for congenital malformations, and one other for offspring endocrine and metabolic disturbances. Data are mostly reassuring, supporting the use of glucocorticoid inhalants during pregnancy, and we found no evidence of inferiority in relation to efficacy and safety of beclomethasone compared to other drugs used in pregnant asthmatic women

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Prevalence of symptoms of asthma, rhinitis, and atopic eczema among adolescents living in urban and rural areas in different regions of Brazil / Prevalencia de sintomas de asma, rinitis y eccema atópico en adolescentes que viven en áreas urbana y rural en diferentes regiones de Brasil

Background: In Brazil, studies evaluating the prevalence of asthma and allergic diseases among children living in rural area compared to urban area are rare. Some authors identified as risk factors for higher prevalence of current wheezing to have a family history of asthma, to have contact with pets, and being student in an urban school. The International Study of Asthma and Allergies in Childhood (ISAAC) phase 3 has shown higher prevalence of wheezing, nasal symptoms and cutaneous rash in the last 12 months in centers from Northern (N) and Northeastern (NE) regions of Brazil. Objective: To evaluate if adolescents with similar genetic background, living in a rural area are protected against the development of symptoms of asthma, rhinitis, and atopic eczema when compared to those living in an urban area in the same region of the country. Subjects and Method: Adolescents (13-14 year-old) living in Caruaru (Pernambuco) and in Santa Maria (Rio Grande do Sul) were enrolled in this study (2002-2003). The adolescents filled in the ISAAC written questionnaire (WQ), previously translated and validated to the Brazilian culture (30-32). Data obtained were transcribed manually into a database (Epi-Info) supplied by ISAAC's coordinators and were statistically analyzed by the SSPS-12 software. Results: The prevalence of asthma related symptoms were higher among those adolescents living in the urban centers in comparison to the rural ones. These differences were significant for wheezy ever, wheezy in the last 12 months, asthma ever, and wheezy with exercise in Caruaru and for wheezy ever and asthma ever, in Santa Maria. Comparing urban areas, the prevalence of asthma related symptoms in Caruaru was higher than in Santa Maria, except for wheezy ever and wheezy with exercise. The opposite was observed comparing rural areas: the prevalence of asthma (except for nocturnal cough) was higher in Santa Maria despite lesser severity of symptoms in this city

Antecedentes: En Brasil son pocos los estudios encaminados a evaluar la prevalencia del asma y las enfermedades alérgicas en los niños en el área rural y la población urbana. Algunos autores han identificado los factores de riesgo de mayor prevalencia de dificultad respiratoria recidivante, el tener antecedentes familiares de asma, tener contacto con animales domésticos y ser estudiante en una escuela del área urbana. La fase 3 del Estudio Internacional del Asma y Alergias en la Infancia (ISAAC) ha mostrado la prevalencia de dificultad respiratoria más elevada, síntomas nasales y exantema en los 12 últimos meses, en centros de las regiones Norte (N) y Noreste (NE) de Brasil. Objetivo: Evaluar si los adolescentes con antecedentes genéticos similares, viviendo en un área rural, están protegidos frente al desarrollo de síntomas de asma rinitis y eccema atópico, en comparación con los que viven en área urbana en la misma región del país. Sujetos y método: Se incluyeron adolescentes (13-14 años) viviendo en Caruaru (Pernambuco) y Santa María (Río Grande do Sul) (2002-2003). Los adolescentes cumplimentaron el cuestionario escrito de ISAAC (WQ), previamente traducido y validado para la cultura brasileña. Los datos obtenidos se transcribieron manualmente en la base de datos (Epi-Info) suministrado por los coordinadores del ISAAC y se analizaron estadísticamente por el software SSPS-12. Resultados: La prevalencia de asma y síntomas relacionados, fueron más elevados entre los adolescentes que viven en el medio urbano en comparación con los del ámbito rural. Estas diferencias fueron significativas para la dificultad respiratoria alguna vez, dificultad respiratoria en los 12 últimos meses, asma alguna vez y dificultad respiratoria por ejercicio en Caruaru y para dificultad respiratoria alguna vez y asma alguna vez, en Santa María. Comparando las áreas urbanas, la prevalencia de síntomas sugestivos de asma, en Caruaru fueron más elevados que en Santa María, excepto para la dificultad respiratoria alguna vez y dificultad respiratoria por ejercicio. Lo contrario se observó comparando las áreas rurales: la prevalencia de asma (excepto la tos nocturna) fue más elevada en Santa María a pasar de la menor gravedad de los síntomas en esta ciudad