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Lancet ; 396(10254): 854-866, 2020 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-32910907


Asthma is a complex disease that often starts in childhood. Genomic and environmental factors as well as aberrant immune maturation early in life can contribute to the onset of disease, with great disparity over time and geographical regions. Epidemiological studies have scrutinised environmental exposures and attempted to translate these exposures into prevention strategies. Some approaches for patients with asthma have been successful (eg, smoking ban, the Finnish Asthma Programme), and primary prevention of wheeze in pre-school children (age 0-5 years) by the supplementation of vitamin D or fish oil, or both, to pregnant women seems promising. Several recent prevention initiatives are based on strong asthma-protective environmental microbial exposures associated with traditional rural lifestyles. Preclinical studies with various bacterial lysates, bacterial and dietary metabolites, or helminthic compounds have yielded promising results that await translation into clinical practice. Given the immense societal and individual burden of asthma, there is an urgent need to further develop novel strategies to eradicate the disease.

Asma/epidemiologia , Asma/prevenção & controle , Prevenção Primária/métodos , Asma/dietoterapia , Asma/imunologia , Pré-Escolar , Suplementos Nutricionais/provisão & distribução , Exposição Ambiental/efeitos adversos , Feminino , Finlândia/epidemiologia , Óleos de Peixe/administração & dosagem , Óleos de Peixe/provisão & distribução , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Prevalência , Fatores de Proteção , Fatores de Risco , Prevenção do Hábito de Fumar/métodos , Vitamina D/administração & dosagem , Vitamina D/provisão & distribução
PLoS One ; 15(7): e0236159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702053


Asthma is a common chronic inflammatory disease. Although effective asthma therapies are available, part of asthmatic population do not respond to these treatment options. In this work we present the result of development of CPL302-253 molecule, a selective PI3Kδ inhibitor. This molecule is intended to be a preclinical candidate for dry powder inhalation in asthma treatment. Studies we performed showed that this molecule is safe and effective PI3Kδ inhibitor that can impact many immune functions. We developed a short, 15-day HDM induced asthma mouse model, in which we showed that CPL302-253 is able to block inflammatory processes leading to asthma development in vivo.

Antiasmáticos/administração & dosagem , Antiasmáticos/farmacologia , Asma/tratamento farmacológico , Asma/prevenção & controle , Classe I de Fosfatidilinositol 3-Quinases/antagonistas & inibidores , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/farmacologia , Administração por Inalação , Animais , Antiasmáticos/uso terapêutico , Linhagem Celular , Inaladores de Pó Seco , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Camundongos
PLoS Med ; 17(7): e1003145, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32692744


BACKGROUND: Guidelines recommend stepping down asthma treatment to the minimum effective dose to achieve symptom control, prevent adverse side effects, and reduce costs. Limited data exist on asthma prescription patterns in a real-world setting. We aimed to evaluate the appropriateness of doses prescribed to a UK general asthma population and assess whether stepping down medication increased exacerbations or reliever use, as well as its impact on costs. METHODS AND FINDINGS: We used nationwide UK primary care medical records, 2001-2017, to identify 508,459 adult asthma patients managed with preventer medication. Prescriptions of higher-level medication: medium/high-dose inhaled corticosteroids (ICSs) or ICSs + add-on medication (long-acting ß2-agonist [LABA], leukotriene receptor antagonist [LTRA], theophylline, or long-acting muscarinic antagonist [LAMA]) steadily increased over time (2001 = 49.8%, 2017 = 68.3%). Of those prescribed their first preventer, one-third were prescribed a higher-level medication, of whom half had no reliever prescription or exacerbation in the year prior. Of patients first prescribed ICSs + 1 add-on, 70.4% remained on the same medication during a mean follow-up of 6.6 years. Of those prescribed medium/high-dose ICSs as their first preventer, 13.0% already had documented diabetes, cataracts, glaucoma, or osteopenia/osteoporosis. A cohort of 125,341 patients were drawn to assess the impact of stepping down medication: mean age 50.4 years, 39.4% males, 39,881 stepped down. Exposed patients were stepped down by dropping their LABAs or another add-on or by halving their ICS dose (halving their mean-daily dose or their inhaler dose). The primary and secondary outcomes were, respectively, exacerbations and an increase in reliever prescriptions. Multivariable regression was used to assess outcomes and determine the prognostic factors for initiating stepdown. There was no increased exacerbation risk for each possible medication stepdown (adjusted hazard ratio, 95% CI, p-value: ICS inhaler dose = 0.86, 0.77-0.93, p < 0.001; ICS mean daily = 0.80, 0.74-0.87, p < 0.001; LABA = 1.01, 0.92-1.11, p = 0.87, other add-on = 1.00, 0.91-1.09, p = 0.79) and no increase in reliever prescriptions (adjusted odds ratio, 95% CI, p-value: ICS inhaler dose = 0.99, 0.98-1.00, p = 0.59; ICS mean daily = 0.78, 0.76-0.79, p < 0.001; LABA = 0.83, 0.82-0.85, p < 0.001; other add-on = 0.86, 0.85-0.87, p < 0.001). Prognostic factors to initiate stepdown included medication burden, but not medication side effects. National Health Service (NHS) indicative prices were used for cost estimates. Stepping down medication, either LABAs or ICSs, could save annually around £17,000,000 or £8,600,000, respectively. Study limitations include the possibility that prescribed medication may not have been dispensed or adhered to and the reason for stepdown was not documented. CONCLUSION: In this UK study, we observed that asthma patients were increasingly prescribed higher levels of treatment, often without clear clinical indication for such high doses. Stepping down medication did not adversely affect outcomes and was associated with substantial cost savings.

Antiasmáticos/administração & dosagem , Antiasmáticos/economia , Asma/tratamento farmacológico , Administração por Inalação , Corticosteroides/administração & dosagem , Corticosteroides/economia , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/economia , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Adulto , Asma/prevenção & controle , Custos de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Reino Unido
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(2): 178-189, 2020 Apr 28.
Artigo em Chinês | MEDLINE | ID: mdl-32385023


Objective To systematically review the effects of probiotic supplementation on the prevention and treatment of asthma. Methods A computerized literature search was conducted in CNKI,CBM,VIP,Wanfang,PubMed,Embase,Cochrane Library,and Web of Science from their inception to February,2019 to collect all relevant studies. Cochrane Collaboration's risk of bias tool was used to assess the methodological quality of the included studies. Results Twelve studies were included in the systematic review of the value of probiotics in asthma prevention. The results showed that probiotic supplementation was not significantly associated with a lower risk of asthma (RR=0.95,95%CI=0.82-1.11) or wheeze (RR=0.99,95%CI=0.88-1.11). Subgroup analyses based on interventions did not show significant differences. Six studies were included in the systematic review of the role of probiotics in asthma treatment. The results showed that probiotic supplementation improved pulmonary function and asthma control in asthmatic patients. However,more studies are needed to validate this effect. Moreover,further studies are needed to clarify the effect of probiotics on the immune markers and the use of asthmatic drugs in asthmatic patients. Conclusions Based on the currently available literature,probiotic supplementation can not prevent asthma or wheeze. However,it may improve pulmonary function and asthma control in asthmatic patients,although further studies are needed.

Asma/prevenção & controle , Asma/terapia , Probióticos/uso terapêutico , Humanos
PLoS One ; 15(5): e0226233, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379832


Allergic asthma is the most common phenotype of the pathology, having an early-onset in childhood and producing a Th2-driven airways remodeling process that leads to symptoms and pathophysiological changes. The avoidance of aeroallergen exposure in early life has been shown to prevent asthma, but without repeated success and with the underlying preventive mechanisms at the beginning of asthma far to be fully recognized. In the present study, we aimed to evaluate if neonatal LPS-induced boost in epithelial host defenses contribute to prevent OVA-induced asthma in adult mice. To this, we focused on the response of bronchiolar club cells (CC), which are highly specialized in maintaining the epithelial homeostasis in the lung. In these cells, neonatal LPS administration increased the expression of TLR4 and TNFα, as well as the immunodulatory/antiallergic proteins: club cell secretory protein (CCSP) and surfactant protein D (SP-D). LPS also prevented mucous metaplasia of club cells and reduced the epidermal growth factor receptor (EGFR)-dependent mucin overproduction, with mice displaying normal breathing patterns after OVA challenge. Furthermore, the overexpression of the epithelial Th2-related molecule TSLP was blunted, and normal TSLP and IL-4 levels were found in the bronchoalveolar lavage. A lower eosinophilia was detected in LPS-pretreated mice, along with an increase in phagocytes and regulatory cells (CD4+CD25+FOXP3+ and CD4+IL-10+), together with higher levels of IL-12 and TNFα. In conclusion, our study demonstrates stable asthma-preventive epithelial effects promoted by neonatal LPS stimulation, leading to the presence of regulatory cells in the lung. These anti-allergic dynamic mechanisms would be overlaid in the epithelium, favored by an adequate epidemiological environment, during the development of asthma.

Asma/imunologia , Bronquíolos/efeitos dos fármacos , Bronquíolos/imunologia , Citocinas/metabolismo , Epitélio/imunologia , Imunidade Inata , Lipopolissacarídeos/imunologia , Lipopolissacarídeos/farmacologia , Alérgenos/imunologia , Animais , Animais Recém-Nascidos , Asma/prevenção & controle , Modelos Animais de Doenças , Epitélio/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Ovalbumina/imunologia , Ovalbumina/farmacologia , Linfócitos T Reguladores/efeitos dos fármacos , Linfócitos T Reguladores/imunologia
Ann Allergy Asthma Immunol ; 125(2): 156-162, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32454096


OBJECTIVE: To summarize the recent evidence in the treatment of viral-induced wheezing in the infant and preschool aged child. DATA SOURCES: Published literature obtained through PubMed database searches. STUDY SELECTIONS: Studies relevant to phenotypes and treatment of wheezing illnesses in infants and preschool children were included. RESULTS: Recurrent wheezing in preschool children is common and is frequently triggered by viral respiratory tract infections. Certain phenotypes may respond to treatments differently, depending on the risk factors identified. Inhaled corticosteroids, administered continuously or intermittently, reduce the risk of virus-induced wheezing episodes. The use of leukotriene modifying agents may have a role in wheezing episodes in a select group of preschool children. Early administration of azithromycin reduces the risk of severe lower respiratory tract illnesses in children. The effect of oral corticosteroids on wheezing episodes in young children varies by degree of episode severity. CONCLUSION: Recurrent viral-induced wheezing illnesses has been the focus of many clinical trials, which now provide an increasingly robust evidence base for management. Additional research is needed to define optimal strategies, to best match therapies to specific phenotypes and endotypes, and will eventually begin to include therapies directed specifically at the viral triggers.

Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/prevenção & controle , Viroses/tratamento farmacológico , Asma/etiologia , Pré-Escolar , Humanos , Imunomodulação , Lactente , Fenótipo , Recidiva , Sons Respiratórios/etiologia , Risco , Viroses/complicações
Acta Med Port ; 33(4): 269-274, 2020 Apr 01.
Artigo em Português | MEDLINE | ID: mdl-32238241


INTRODUCTION: Asthma affects more than 339 million people worldwide. In the Community of Portuguese Speaking Countries, in 2016, its prevalence ranged from 9.5% (Portugal) to 3.91% (Brazil). Chronic disease management programs aim to improve the health status of patients with chronic disease and reduce associated costs. The objective of this study is to identify models of asthma asthma 'management and control' that are that are implemented in the Community of Portuguese Speaking Countries (CPLP), and analyse them through the integrated disease management model. MATERIAL AND METHODS: A rapid review of the PubMed indexed scientific literature and grey literature on 'management and control of asthma' in the countries of the Community of Portuguese-Speaking Countries was carried out. RESULTS: Portugal, Brazil and Mozambique presented publications on 'management and control of asthma', at different stages of implementation. Clinical management and organization and service delivery are the dimensions of integrated disease management most addressed in publications. DISCUSSION: The implementation of asthma management and control programs is influenced by health systems, care delivery structures, and the surrounding political and social environment. The dimensions of funding and information systems are the most difficult to implement given the degree of economic, social and technological development of most countries under study. CONCLUSION: Only Portugal, Brazil and Mozambique adopted asthma integrated disease management as the main form of asthma management and control. The programs developed by these countries can constitute a model for asthma integrated disease management in the other countries under study.

Asma/terapia , Gerenciamento Clínico , Asma/prevenção & controle , Brasil , Financiamento da Assistência à Saúde , Humanos , Sistemas de Informação , Idioma , Moçambique , Portugal , Desenvolvimento de Programas
Arch. argent. pediatr ; 118(2): 145-149, abr. 2020. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1100495


Las guías para el manejo del asma promueven la educación sanitaria como un escalón más en su terapéutica. Se creó el programa Educación Sanitaria del Niño Asmático y su Familia. El objetivo fue evaluar el impacto del Programa sobre el bienestar del niño asmático y su familia.Estudio retrospectivo, descriptivo, durante 3 años, que analizó características epidemiológicas, impacto y satisfacción de las familias. Se incluyeron 386 pacientes. Asma controlada al corte: el 78 %. Descendieron el uso de beta-2-adrenérgicos y las admisiones hospitalarias (p < 0,05), el uso de corticoides orales y consultas en Urgencias (p < 0,001). Evaluó el Programa como excelente el 98 %; comprendió y aceptó la enfermedad el 99 %; reconoció el inicio de crisis y comenzó el tratamiento el 96 %; aplicó bien la terapia inhalatoria el 92 %. El Programa tuvo alto impacto en el control del asma. Constituyó un modelo útil para replicar.

Guidelines for management establish health education as part of asthma care. A Health Education Program for Asthmatic Children and Families was started in our institution. This descriptive retrospective study was designed in order to evaluate the Program impact in children and family satisfaction; 386 children were enrolled. Their asthma was properly controlled in 78 %. There was a significant decrease (p < 0.05) of rapid action beta 2 agonists use and hospital admissions, and a highly significant decrease (p < 0.001) of corticosteroids use and emergency visits. Educational content was found to be excellent in 98 %; 99 % understood and accepted the condition; 96 % were able to recognize early symptoms and started home treatment; 92 % correctly managed inhalation technique. The Program had a high impact on children asthma control, with a significant decrease in emergency visits, admissions, and drug use, becoming a useful model

Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Asma/epidemiologia , Avaliação de Programas e Projetos de Saúde , Educação em Saúde , Pacientes Ambulatoriais , Asma/prevenção & controle , Educação de Pacientes como Assunto , Epidemiologia Descritiva , Inquéritos e Questionários , Estudos Retrospectivos
Londres; National Institute for Health and Care Excellence; Apr. 3, 2020. 12 p.
Monografia em Inglês | BIGG | ID: biblio-1097094


The purpose of this guideline is to maximise the safety of adults and children with severe asthma during the COVID-19 pandemic, while protecting staff from infection. It will also enable services to make the best use of NHS resources.

Humanos , Pneumonia Viral/prevenção & controle , Asma/diagnóstico , Asma/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Betacoronavirus
Allergol. immunopatol ; 48(2): 116-123, mar.-abr. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-191813


INTRODUCTION AND OBJECTIVES: Although patient centred communication is associated with patients' daily medication adherence, the exact communication phenomena promoting high treatment adherence remain elusive. PATIENTS AND METHODS: We used conversation analysis of videotaped follow-up consultations of seven outpatients (4-13 years of age) with chronic asthma and their caregivers, consulting two paediatric respiratory physicians in a practice in which high treatment adherence has been documented, to explore the language paediatricians use to promote their patients' adherence to daily controller medication. RESULTS: Starting the consultation with the patient's (and caregivers') agenda commonly resulted in presentation of issues new to the physician. Information was mostly provided in response to patient/caregiver questions, prompting the delivery of specific information tailored to the patient's and caregivers' needs. Although patients and caregivers showed resistance in response to unsolicited information and advice, they always accepted the doctor's explicit request for agreement with proposed treatment. The doctor's description of favourable treatment results in most patients prompted caregivers' willingness to accept treatment proposals. CONCLUSIONS: Paediatricians with a documented success in achieving adherence to controller medication in their patients with asthma tend to start consultations with the patient's agenda, provide information in response to questions, offer reassurance on overall treatment effectiveness, and seek explicit agreement with a treatment proposal

No disponible

Humanos , Criança , Adolescente , Cooperação e Adesão ao Tratamento , Asma/terapia , Relações Médico-Paciente , Comunicação , Asma/prevenção & controle , Cuidadores
Artigo em Inglês | MEDLINE | ID: mdl-32233791
Rev. clín. esp. (Ed. impr.) ; 220(2): 86-93, mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186417


Introducción: Aunque las guías de práctica clínica recomiendan un ajuste continuado del tratamiento del asma, reduciendo la medicación de mantenimiento cuando se alcanza el control (step-down), existen pocos estudios de práctica clínica habitual orientados a recabar información de los factores que condicionan su fracaso. Objetivo: Determinar los factores que condicionan en la práctica clínica habitual el fracaso del step-down en los pacientes asmáticos moderados-graves controlados con una combinación de glucocorticoides inhalados/agonistas beta-2 adrenérgicos de acción larga. Método: Estudio multicéntrico retrospectivo sobre 374 pacientes con asma moderada-grave controlada con glucocorticoides inhalados/agonistas beta-2 adrenérgicos de acción larga en quienes el facultativo indicó en 2016 un step-down. Resultados: El step-down fracasó en el 41,7%. Los factores relacionados con el fracaso fueron: la mayor edad del paciente (p=0,006), la presencia de 2 o más comorbilidades (p=0,016), el mayor nivel de gravedad (persistente grave vs. persistente moderada) (p<0,001), la mayor edad al diagnóstico (>40 años) (p=0,045), cuanto más alto es el escalón terapéutico previo (p=0,003) y posterior al cambio (p<0,001), cuanto menor sea el tiempo de mejoría/control previo al cambio (p=0,019), el FEV1 más bajo (p=0,001) y un peor Asthma Control Test o Asthma Control Questionnaire antes del step-down (p<0,001). El análisis de regresión logística mostró que existe una mayor probabilidad (odds ratio [IC 95%] de fracaso del step-down en los pacientes más añosos: OR 0,983 [0,969-0,997], con asma grave vs. moderada: OR 0,537 [0,292-0,985] y mayor probabilidad de éxito si llevan más de 6 meses con la enfermedad controlada: OR 2,253 [1,235-4,112]). Conclusión: En condiciones de práctica clínica habitual el step-down fracasa en un porcentaje alto de pacientes y se recomienda indicarlo cuando el paciente lleve más de 6 meses controlado

Background: Although the clinical practice guidelines recommend continuous adjustment of asthma treatment and reducing the maintenance drugs when achieving control (step-down), there are few studies of standard clinical practice aimed at collecting information on the factors that determine step-down failure. Objective: To determine the factors that determine step-down failure in standard clinical practice of patients with moderate-severe asthma controlled by a combination of inhaled glucocorticoids and long-acting beta agonists. Methods: A multicentre retrospective study included 374 patients with moderate-severe asthma controlled with inhaled glucocorticoids and long-acting beta agonists for whom the physician indicated a step-down in 2016. Results: The step-down failed in 41.7% of the patients. The following factors were related to failure: greater patient age (P=.006), presence of at least 2 comorbidities (P=.016), greater severity level (severe persistent vs. moderate persistent) (P<.001), greater age at diagnosis (>40 years) (P=.045), the higher the therapeutic step before (P=.003) and after the change (P<.001), the shorter the time of improvement/control prior to the change (P=.019), lower FEV1 (P=.001) and a poorer Asthma Control Test score or Asthma Control Questionnaire score before the step-down (P<.001). The logistic regression analysis showed a higher probability of step-down failure in the more elderly patients (OR, 0.983; 95% CI 0.969-0.997) and those with severe asthma compared to those with moderate asthma (OR, 0.537; 95% CI 0.292-0.985), as well as an increased probability of success if the patients had the disease controlled for more than 6 months (OR, 2.253; 95% CI 1.235-4.112). Conclusion: In standard clinical practice conditions, step-down fails in a high percentage of patients, and the suggestion is to indicate step-down when the patient has had more than 6 months of disease control

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Glucocorticoides/uso terapêutico , Asma/tratamento farmacológico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Asma/prevenção & controle , Exacerbação dos Sintomas , Comorbidade , Rinite Alérgica/epidemiologia , Pólipos Nasais/epidemiologia , Antagonistas de Leucotrienos/uso terapêutico
Medicine (Baltimore) ; 99(5): e18962, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000423


OBJECTIVE: Acupoint herbal patching (AHP) is an external therapy of Traditional Chinese Medicine. This systematic review and meta-analysis sought to evaluate whether AHP during Sanfu Days has additional benefits in children with asthma. METHODS: A comprehensively electronic literature search was performed in the Cochrane Library, PubMed, Embase, CNKI, VIP, and WanFang databases from their inception to March 2019. Randomized controlled trials that evaluated the AHP during Sanfu Days treatment for pediatric asthma were included. The main outcome measures were frequency of acute asthma attack, relapse of asthma, and pulmonary function. RESULTS: Eleven trials involving 882 children with asthma were identified. White mustard seed, rhizoma corydalis, and radix kansui were the most frequently used herbs. Adjunctive treatment with AHP significantly reduced the frequency of acute asthma attack (mean difference [MD] -1.62 times/year; 95% confidence intervals [CI] -2.13 to -1.11). Moreover, AHP improved the peak expiratory flow (standardized mean differences [SMD] 0.61; 95% CI 0.39-0.82) and forced expiratory volume in 1 s (SMD 0.48; 95% CI 0.31-0.66). CONCLUSIONS: Application of AHP during Sanfu Days has additional benefits in reducing the frequency of acute attack and improving pulmonary function in children with asthma. However, the current findings should be interpreted with caution owing to the methodological flaws of the analyzed trials.

Pontos de Acupuntura , Asma/prevenção & controle , Medicamentos de Ervas Chinesas/uso terapêutico , Criança , Humanos
N Engl J Med ; 382(6): 525-533, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32023372


BACKGROUND: We previously reported the results of a trial of prenatal vitamin D supplementation to prevent asthma and recurrent wheeze in young children, which suggested that supplementation provided a protective effect at the age of 3 years. We followed the children through the age of 6 years to determine the course of asthma and recurrent wheeze. METHODS: In this follow-up study, investigators and participants remained unaware of the treatment assignments through the children's sixth birthday. We aimed to determine whether, when maternal levels of 25-hydroxyvitamin D were taken into account, children born to mothers who had received 4400 IU of vitamin D3 per day during pregnancy (vitamin D group) would have a lower incidence of asthma and recurrent wheeze at the age of 6 years than would those born to mothers who had received 400 IU of vitamin D3 per day (control group). Time-to-event methods were used to compare the treatment groups with respect to time to the onset of asthma or recurrent wheeze. Multivariate methods were used to compare longitudinal measures of lung function between the treatment groups. RESULTS: There was no effect of maternal vitamin D supplementation on asthma and recurrent wheeze in either an intention-to-treat analysis or an analysis with stratification according to the maternal 25-hydroxyvitamin D level during pregnancy. There was no effect of prenatal vitamin D supplementation on most of the prespecified secondary outcomes. We found no effects of prenatal supplementation on spirometric indexes. Although there was a very small effect on airway resistance as measured by impulse oscillometry, this finding was of uncertain significance. CONCLUSIONS: Vitamin D supplementation during the prenatal period alone did not influence the 6-year incidence of asthma and recurrent wheeze among children who were at risk for asthma. (Funded by the National Heart, Lung, and Blood Institute; VDAART number, NCT00920621.).

Resistência das Vias Respiratórias/efeitos dos fármacos , Asma/prevenção & controle , Suplementos Nutricionais , Cuidado Pré-Natal , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Asma/epidemiologia , Criança , Feminino , Seguimentos , Humanos , Incidência , Análise de Intenção de Tratamento , Pulmão/efeitos dos fármacos , Pulmão/embriologia , Gravidez , Sons Respiratórios/efeitos dos fármacos , Espirometria , Vitamina D/análogos & derivados , Vitamina D/sangue
Curr Allergy Asthma Rep ; 20(3): 8, 2020 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-32103354


PURPOSE OF REVIEW: It is well known that combination of sensitization and exposure to inhaled environmental allergens is related to both the development and elicitation of symptoms of asthma and that avoidance of allergens would exert beneficial effects in the prevention and control of the disease. Other important factors include the relevance of other allergens, exposure to sensitizing agents also outside patient's home, exposure to irritants (like chemical air pollutants), and the involvement of the patient with a correct education. It is also likely that clinical phase of allergic airway disease and the degree of airways remodeling represent relevant factors for the clinical outcome of allergen avoidance procedure. We reviewed existing evidence on prevention of asthma through allergen avoidance. RECENT FINDINGS: The management of respiratory allergy is a complex strategy (including prevention, drugs, immunological, and educational interventions). In addition, it is difficult in real life to distinguish the efficacy of single interventions. However, a combined strategy is likely to produce clinical results. A combined strategy is likely to produce satisfactory management of asthma. Allergens are an important trigger factor for the development of symptoms of respiratory allergy, and avoidance measures are able to reduce allergen levels. It is likely that clinical phase of allergic airway disease and the degree of airways remodeling represents relevant factors for the clinical outcome of allergen avoidance procedures. Considering the management of respiratory allergy is a complex strategy; it is difficult in real life to distinguish the efficacy of single interventions. However, further studies better quantifying the effects of allergens are needed.

Alérgenos/efeitos adversos , Asma/prevenção & controle , Expossoma , Prevenção Primária/métodos , Poluentes Atmosféricos , Animais , Asma/etiologia , Humanos , Hipersensibilidade/etiologia
Enferm. glob ; 19(57): 1-14, ene. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193645


INTRODUCCIÓN: El asma aparece como una enfermedad inflamatoria crónica de las vías respiratorias y se caracteriza por episodios de obstrucción bronquial reversible pudiendo ser desencadenada por varios factores. Se constituye como la enfermedad infantil más común, una importante causa de internamiento hospitalario y un problema de salud pública. Las directrices internacionales sobre la gestión del asma reconocen que el tratamiento reside en el control actual y en el riesgo de exacerbaciones, basándose en la gestión de los síntomas. En cuanto a la percepción del control del asma infantil, existen discrepancias entre la percepción de los cuidadores y las indicaciones internacionales. OBJETIVOS: Describir y analizar los datos clínicos, sociodemográficos y factores asociados al control del asma infantil. METODOLOGÍA: Estudio metodológico, cuantitativo y transversal, en una muestra de niños, entre los 6 y los 11 años, con asma y cuidadores. El control del asma ha sido evaluado por el instrumento Childhood Asthma Control Test. RESULTADOS: La muestra fue compuesta por 60 niños y cuidadores. 12% (n = 7) de los niños presentan asma no controlada y 53% (n = 32) asma parcialmente controlada. En el 38% (n = 23) de los cuidadores existieron discrepancias entre el grado clasificado mediante las pautas internacionales y su percepción. El análisis de Regresión Logística confirma que los niños con necesidades de terapia inhalatoria de rescate presentan 7 veces mayor probabilidad de que el asma no esté controlada. CONCLUSIÓN: Resulta perentoria la necesidad de aprehender la complejidad de los factores que interfieren en el control del asma, existiendo necesidad de programas de intervención de gestión de síntomas centrados en los cuidadores, en el niño y en las necesidades identificadas

INTRODUÇÃO: A asma apresenta-se como uma doença crónica e inflamatória das vias aéreas caracterizada por episódios de obstrução brônquica reversível podendo ser desencadeada por diversos fatores. Constitui-se como a doença infantil mais comum, uma importante causa de internamento hospitalar e um problema de saúde pública. As diretrizes internacionais sobre a gestão da asma reconhecem que o tratamento reside no controlo atual e no risco de exacerbações, sendo baseados na gestão de sintomas. Relativamente à perceção do controlo da asma infantil, existem discrepâncias entre a perceção dos cuidadores e as indicações internacionais. OBJETIVOS: Descrever e analisar os dados clínicos, sociodemográficos e fatores associados ao controlo da asma infantil. METODOLOGIA: Estudo metodológico, quantitativo e transversal, numa amostra de crianças, entre os 6 e os 11 anos, com asma e cuidadores. O controlo da asma foi avaliado pelo instrumento Childhood Asthma Control Test. RESULTADOS: A amostra foi composta por 60 crianças e cuidadores. 12% (n=7) das crianças apresentam asma não controlada e 53% (n=32) asma parcialmente controlada. Em 38% (n=23) dos cuidadores existiram discrepâncias entre o grau classificado mediante as guidelines internacionais e a sua perceção. A análise de Regressão Logística confirma que as crianças com necessidades de terapêutica inalatória de resgate apresentam 7 vezes maior probabilidade da asma estar não controlada. CONCLUSÃO: Torna-se perentório a necessidade de apreensão da complexidade dos fatores que interferem no controlo da asma, existindo necessidade de programas de intervenção de gestão de sintomas centrados nos cuidadores, na criança e nas necessidades identificadas

INTRODUCTION: Asthma is an airways chronic and inflammatory disease characterized by episodes of reversible bronchial obstruction and can be triggered by several factors. It is the most common childhood disease, an important hospitalization cause and a public health problem. International guidelines of asthma management recognize that treatment based on current management and exacerbations risk, which are based on symptom management. Regarding the control perception of childhood asthma, there are discrepancies between the caregiver's perception and the international indications. OBJECTIVES: To describe and analyze the clinical, sociodemographic and factors associated with childhood asthma control. METHODOLOGY: Methodological, quantitative and transversal study, in a sample of 60 children, between 6 and 11 years, and caregivers. Asthma control was evaluated by the instrument childhood Asthma Control Test. RESULTS: The sample consisted of 60 children and caregivers. 12% (n = 7) of the children had uncontrolled asthma, 53% (n = 32) partly controlled asthma. In 38% (n = 23) of the caregivers there were discrepancies between the grade classified through the international guidelines and their perception. Logistic Regression analysis confirms that children with inhalational rescue therapy needs 7 times more likely asthma to be uncontrolled. CONCLUSION: The complexity of the factors that interfere in the control of asthma is urgent and there is a need for symptom management intervention programs focused on the caregivers, the child and the identified needs

Humanos , Masculino , Feminino , Criança , Asma/prevenção & controle , Cuidadores/educação , Antiasmáticos/administração & dosagem , Cuidados de Enfermagem/métodos , Asma/enfermagem , Asma/fisiopatologia , Estudos Transversais , Índice de Gravidade de Doença , Administração por Inalação , Avaliação de Sintomas/métodos , Psicometria/instrumentação
PLoS One ; 15(1): e0227983, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31971974


Previously those with asthma were often advised to avoid strenuous exercise because of fear for exercise-induced asthmatic reactions, but recent findings suggest many beneficial effects on health related to exercise. We elaborated on the relation between regular exercise and asthma control among adults. This was a population-based cross-sectional Northern Finnish Asthma Study (NoFAS), in which altogether 1922 adult subjects 17-73 years old living in Northern Finland answered the NoFAS questionnaire. The determinant of interest was the total amount of regular exercise during leisure time, measured in hours per week and categorized into no, low (>0≤2h per week), medium (>2 ≤5h), high (>5≤10h) and very high (>10h) exercise categories. The outcome of interest was asthma control, which was assessed based on the Asthma Control Test (ACT). As statistical methods we applied analysis of variance (ANOVA) and Poisson regression. ACT score increased gradually, i.e. asthma control improved, with an increasing amount of exercise from no exercise (mean ACT = 19.4; difference from the reference: -1.57, 95% CI -2.12 to -1.01) to high exercise reference category (mean = 21.0), but was slightly lower (mean = 20.3; -0.64, 95% CI -1.27 to -0.02) in the very high exercise category. Such non-linear relation was present both in women and in men. In conclusion, we provide evidence that moderate to high regular exercise improves asthma control among adults with asthma. Advice about regular exercise should be included as an important part of asthma management for adults.

Asma/prevenção & controle , Asma/fisiopatologia , Exercício Físico/fisiologia , Adulto , Idoso , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade
Biochem Pharmacol ; 173: 113790, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31911090


Atopic diseases (atopic dermatitis, asthma and allergic rhinitis) affects a huge number of people around the world and their incidence rate is on rise. Atopic dermatitis (AD) is more prevalent in paediatric population which sensitizes an individual to develop allergic rhinitis and asthma later in life. The complex pathogenesis of these allergic diseases though involves numerous cellular signalling pathways but redox imbalance has been reported to be critical for induction/perpetuation of inflammatory process under such conditions. The realm of complementary and alternative medicine has gained greater attention because of the reported anti-oxidant/anti-inflammatory properties. Several case studies of treating atopic diseases with homeopathic remedies have provided positive results. Likewise, pre-clinical studies suggest that various natural compounds suppress allergic response via exhibiting their anti-oxidant potential. Despite the reported beneficial effects of phytochemicals in experimental model system, the clinical success has not been documented so far. It appears that poor absorption and bioavailability of natural compounds may be one of the reasons for realizing their full potential. The current paper throws light on impact of phytochemicals in the redox linked cellular and signalling pathways that may be critical in manifestation of atopic diseases. Further, an effort has been made to identify the gaps in the area so that future strategies could be evolved to exploit the medicinal value of various phytochemicals for an improved efficiency.

Asma/prevenção & controle , Dermatite Atópica/prevenção & controle , Hipersensibilidade/prevenção & controle , Compostos Fitoquímicos/uso terapêutico , Asma/imunologia , Asma/patologia , Catecóis/química , Catecóis/uso terapêutico , Curcumina/química , Curcumina/uso terapêutico , Dermatite Atópica/imunologia , Dermatite Atópica/patologia , Álcoois Graxos/química , Álcoois Graxos/uso terapêutico , Flavonoides/química , Flavonoides/uso terapêutico , Ginsenosídeos/química , Ginsenosídeos/uso terapêutico , Humanos , Hipersensibilidade/imunologia , Hipersensibilidade/patologia , Estrutura Molecular , Compostos Fitoquímicos/química , Resveratrol/química , Resveratrol/uso terapêutico
Einstein (Sao Paulo) ; 18: eAO4936, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31721896


OBJECTIVE: To investigate the effect of levels of physical activity on asthma control in children. METHODS: A cross-sectional study, including public school students aged 8 to 12 years, of both sexes, with asthma, from a capital and a medium-sized cities in Southern Brazil. At home, the students answered the questionnaire on levels of physical activity and disease control. RESULTS: A total of 482 schoolchildren with asthma participated in the study, with mean age of 10.9±2.2 years, and 253 (52%) were girls. Regarding disease control, 50% had controlled asthma, and 67% were considered sedentary. Schoolchildren with controlled asthma were more active than those with uncontrolled asthma (p=0.032). Active schoolchildren were more likely to have asthma controlled (OR=1.5; 95%CI: 1.04-2.25). CONCLUSION: The results demonstrated an association between physical activity levels and asthma control. More active schoolchildren were more likely to have asthma controlled.

Asma/prevenção & controle , Exercício Físico/fisiologia , Estudantes/estatística & dados numéricos , Adolescente , Brasil , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Comportamento Sedentário , Fatores Socioeconômicos , Inquéritos e Questionários