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1.
Artigo em Chinês | MEDLINE | ID: mdl-33040502

RESUMO

Objective:To observe the secondary prevention efficacy of subcutaneous immunotherapy in children with allergic rhinitis(AR) and cough variant asthma(CVA) and to analyze its effect on the levels of serum sIgG4, IL-27 and IL-33. Method:The clinical data of 112 children aged 5-12 years with AR and CVA were retrospectively analyzed and divided into control group(52 cases) and SCIT group(60 cases). The patients were followed up for 3 years. The control group was received symptomatic treatment only, and the SCIT group was received SCIT on the basis of the control group. The numbers of cases of the two groups of children who produced new allergens and developed CA were analyze during the 3-year treatment. Changes in serum sIgG4, IL-27, IL-33 levels, TNSS, DCSS, NCSS, TRMS, TCMS, VAS score, and FEV1% before and after treatment were analyzed. Result:During the treatment, 4 patients(6.67%) in the SCIT group produced the new allergen, and 20 patients(38.46%) in the control group(χ²=16.73, P<0.05). There were only 3 cases(5.00%) in the SCIT group, which developed into CA, while 15 cases(28.85%) in the control group. The difference between the groups was statistically significant(χ²=11.74, P<0.05). Compared with baseline, serum levels of sIgG4 and IL-27 in both groups were significantly increased after 3 years of treatment(P<0.05), while serum levels of IL-33 were significantly decreased(P<0.05). After 3 years of treatment, serum levels of sIgG4 and IL-27 in the SCIT group were significantly higher than those in the control group, and serum levels of IL-33 were significantly lower than those in the control group(P<0.05). Compared with baseline, TNSS, DCSS, NCSS, TRMS, TCMS, VAS, and FEV1% in both groups were significantly improved at 1, 2, and 3 years of treatment(P<0.05). There was no significant difference in TNSS, DCSS, NCSS, TRMS, TCMS, VAS and FEV1% between the two groups at baseline(P>0.05), while after 1, 2 and 3 years of treatment the above indicators in the SCIT group were significantly better than those in the control group(P<0.05). Conclusion:SCIT treatment can prevent AR with CVA patients from producing new allergens and developing into CA, and improve serum sIgG4 and IL-27 and IL-33 levels.


Assuntos
Asma , Interleucina-27 , Rinite Alérgica , Asma/terapia , Criança , Pré-Escolar , Tosse , Humanos , Imunoterapia , Injeções Subcutâneas , Interleucina-33 , Estudos Retrospectivos , Rinite Alérgica/terapia , Prevenção Secundária
2.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32917845

RESUMO

OBJECTIVES: To explore and define contemporary trends in the use of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) in the treatment of children with asthma. METHODS: We performed a serial cross-sectional analysis using data from the Pediatric Health Information System. We examined 2014-2018 admission abstracts from patients aged 2 to 17 years who were admitted to member hospitals with a primary diagnosis of asthma. We report temporal trends in IMV use, NIV use, ICU admission, length of stay, and mortality. RESULTS: Over the study period, 48 hospitals reported 95 204 admissions with a primary diagnosis of asthma. Overall, IMV use remained stable at 0.6% between 2014 and 2018 (interquartile range [IQR]: 0.3%-1.1% and 0.2%-1.3%, respectively), whereas NIV use increased from 1.5% (IQR: 0.3%-3.2%) to 2.1% (IQR: 0.3%-5.6%). There was considerable practice variation among centers, with NIV rates more than doubling within the highest quartile of users (from 4.8% [IQR: 2.8%-7.5%] to 13.2% [IQR: 7.4%-15.2%]; P < .02). ICU admission was more common among centers with high NIV use, but centers with high NIV use did not differ from lower-use centers in mortality, IMV use, or overall average length of stay. CONCLUSIONS: The use of IMV is at historic lows, and NIV has replaced it as the primary mechanical support mode for asthma. However, there is considerable variability in NIV use. Increased NIV use was not associated with a change in IMV rates, which remained stable. Higher NIV use was associated with increased ICU admissions. NIV's precise contribution to the cost and quality of care remains to be determined.


Assuntos
Asma/terapia , Ventilação não Invasiva/tendências , Respiração Artificial/tendências , Adolescente , Asma/mortalidade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/tendências , Tempo de Internação/tendências , Masculino , Fatores de Tempo
4.
Lancet Respir Med ; 8(10): 1045-1056, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32910899

RESUMO

Asthma is an inflammatory airway disease that is estimated to affect 339 million people globally. The symptoms of about 5-10% of patients with asthma are not adequately controlled with current therapy, and little success has been achieved in developing drugs that target the underlying mechanisms of asthma rather than suppressing symptoms. Over the past 3 years, well powered genetic studies of asthma have increased the number of independent asthma-associated genetic loci to 128. In this Series paper, we describe the immense progress in asthma genetics over the past 13 years and link asthma genetic variants to possible drug targets. Further studies are needed to establish the functional significance of gene variants associated with asthma in subgroups of patients and to describe the biological networks within which they function. The genomics-guided discovery of plausible drug targets for asthma could pave the way for the repurposing of existing drugs for asthma and the development of new treatments.


Assuntos
Asma/genética , Asma/terapia , Terapia de Alvo Molecular , Descoberta de Drogas , Estudo de Associação Genômica Ampla , Humanos
5.
Praxis (Bern 1994) ; 109(12): 985-990, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32933396

RESUMO

Physical and Clinical Aspects of Inhalation Therapy for Asthma and COPD Abstract. Inhalations form the basis of the medicinal treatment of respiratory diseases. In recent years, therapy has become more complex for patients, but also for medical professionals, as new systems have come onto the market. The knowledge required for this shall be conveyed in this article.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Terapia Respiratória , Administração por Inalação , Asma/terapia , Humanos , Nebulizadores e Vaporizadores , Doença Pulmonar Obstrutiva Crônica/terapia
6.
Cochrane Database Syst Rev ; 9: CD011293, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32926419

RESUMO

BACKGROUND: Asthma is a common long-term respiratory disease affecting approximately 300 million people worldwide. Approximately half of people with asthma have an important allergic component to their disease, which may provide an opportunity for targeted treatment. Sublingual immunotherapy (SLIT) aims to reduce asthma symptoms by delivering increasing doses of an allergen (e.g. house dust mite, pollen extract) under the tongue to induce immune tolerance. Fifty-two studies were identified and synthesised in the original Cochrane Review in 2015, but questions remained about the safety and efficacy of sublingual immunotherapy for people with asthma. OBJECTIVES: To assess the efficacy and safety of sublingual immunotherapy compared with placebo or standard care for adults and children with asthma. SEARCH METHODS: The original searches for trials from the Cochrane Airways Group Specialised Register (CAGR), ClinicalTrials.gov, WHO ICTRP, and reference lists of all primary studies and review articles found trials up to 25 March 2015. The most recent search for trials for the current update was conducted on 29 October 2019. SELECTION CRITERIA: We included parallel randomised controlled trials, irrespective of blinding or duration, that evaluated sublingual immunotherapy versus placebo or as an add-on to standard asthma management. We included both adults and children with asthma of any severity and with any allergen-sensitisation pattern. We included studies that recruited participants with asthma, rhinitis, or both, providing at least 80% of trial participants had a diagnosis of asthma. We selected outcomes to reflect recommended outcomes for asthma clinical trials and those most important to people with asthma. Primary outcomes were asthma exacerbations requiring a visit to the emergency department (ED) or admission to hospital, validated measures of quality of life, and all-cause serious adverse events (SAEs). Secondary outcomes were asthma symptom scores, exacerbations requiring systemic corticosteroids, response to provocation tests, and dose of inhaled corticosteroids (ICS). DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results for included trials, extracted numerical data, and assessed risk of bias, all of which were cross-checked for accuracy. Any disagreements were resolved by discussion. We analysed dichotomous data as odds ratios (ORs) or risk differences (RDs) using study participants as the unit of analysis; we analysed continuous data as mean differences (MDs) or standardised mean differences (SMDs) using random-effects models. We considered the strength of evidence for all primary and secondary outcomes using the GRADE approach. MAIN RESULTS: Sixty-six studies met the inclusion criteria for this update, including 52 studies from the original review. Most studies were double-blind and placebo-controlled, varied in duration from one day to three years, and recruited participants with mild or intermittent asthma, often with comorbid allergic rhinitis. Twenty-three studies recruited adults and teenagers; 31 recruited only children; three recruited both; and nine did not specify. The pattern of reporting and results remained largely unchanged from the original review despite 14 further studies and a 50% increase in participants studied (5077 to 7944). Reporting of primary efficacy outcomes to measure the impact of SLIT on asthma exacerbations and quality of life was infrequent, and selective reporting may have had a serious effect on the completeness of the evidence; 16 studies did not contribute any data, and a further six studies could only be included in a post hoc analysis of all adverse events. Allocation procedures were generally not well described; about a quarter of the studies were at high risk of performance or detection bias (or both); and participant attrition was high or unknown in around half of the studies. The primary outcome in most studies did not align with those of interest to the review (mostly asthma or rhinitis symptoms), and only two small studies reported our primary outcome of exacerbations requiring an ED or hospital visit; the pooled estimate from these studies suggests SLIT may reduce exacerbations compared with placebo or usual care, but the evidence is very uncertain (OR 0.35, 95% confidence interval (CI) 0.10 to 1.20; n = 108; very low-certainty evidence). Nine studies reporting quality of life could not be combined in a meta-analysis and, whilst the direction of effect mostly favoured SLIT, the effects were often uncertain and small. SLIT likely does not increase SAEs compared with placebo or usual care, and analysis by risk difference suggests no more than 1 in 100 people taking SLIT will have a serious adverse event (RD -0.0004, 95% CI -0.0072 to 0.0064; participants = 4810; studies = 29; moderate-certainty evidence). Regarding secondary outcomes, asthma symptom and medication scores were mostly measured with non-validated scales, which precluded meaningful meta-analysis or interpretation, but there was a general trend of SLIT benefit over placebo. Changes in ICS use (MD -17.13 µg/d, 95% CI -61.19 to 26.93; low-certainty evidence), exacerbations requiring oral steroids (studies = 2; no events), and bronchial provocation (SMD 0.99, 95% CI 0.17 to 1.82; low-certainty evidence) were not often reported. Results were imprecise and included the possibility of important benefit or little effect and, in some cases, potential harm from SLIT. More people taking SLIT had adverse events of any kind compared with control (OR 1.99, 95% CI 1.49 to 2.67; high-certainty evidence; participants = 4251; studies = 27), but events were usually reported to be transient and mild. Lack of data prevented most of the planned subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS: Despite continued study in the field, the evidence for important outcomes such as exacerbations and quality of life remains too limited to draw clinically useful conclusions about the efficacy of SLIT for people with asthma. Trials mostly recruited mixed populations with mild and intermittent asthma and/or rhinitis and focused on non-validated symptom and medication scores. The review findings suggest that SLIT may be a safe option for people with well-controlled mild-to-moderate asthma and rhinitis who are likely to be at low risk of serious harm, but the role of SLIT for people with uncontrolled asthma requires further evaluation.


Assuntos
Asma/terapia , Imunoterapia Sublingual/métodos , Adolescente , Adulto , Animais , Criança , Progressão da Doença , Hospitalização/estatística & dados numéricos , Humanos , Placebos/uso terapêutico , Pólen , Pyroglyphidae , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Rinite Alérgica/terapia , Imunoterapia Sublingual/efeitos adversos
7.
Clin Nurse Spec ; 34(5): 222-230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32796383

RESUMO

PURPOSE: Social determinants of health (SDoHs) influence how well a family manages children's asthma. The aim of this study was to examine the influence of SDoHs on family asthma management. DESIGN: A cross-sectional exploratory study was conducted with 292 children in grades 2 to 5 who had current asthma and their parents to examine associations between SDoHs and the families' asthma management, quality of life, and healthcare utilization. METHODS: Data were collected from both child and parent. Social determinants of health include the child's race/ethnic group, age, gender, and asthma severity and the family's socioeconomic status and language spoken in the home, and the school was the community-level variable. Parents and children completed asthma management and quality-of-life scales and parents reported on the children's emergency department visits and hospitalizations for asthma. RESULTS: Worse quality of life was reported by families with lower socioeconomic status and African American children. Asthma severity was associated with parents' asthma management but not children's asthma self-management. Families who spoke Spanish at home had the lowest socioeconomic status yet performed significantly more asthma management than English-speaking families. CONCLUSIONS: The findings highlight factors the clinical nurse specialist should address in educational interventions.


Assuntos
Asma/terapia , Autogestão , Determinantes Sociais da Saúde , Adulto , Asma/enfermagem , Criança , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Enfermeiras Clínicas , Relações Pais-Filho , Qualidade de Vida
8.
Tuberk Toraks ; 68(2): 141-147, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32755114

RESUMO

There are limited data about the coexistence of asthma and the Coronavirus disease-2019 (COVID-19). The COVID-19 pandemic is a new disease for the whole world. In this study, we aimed to examine the published case series with the COVID-19 and asthma coexistence, by reviewing existing studies and other publications. We discussed the suggestions of guidelines such as The Global Initiative for Asthma (GINA), The National Institute for Health and Care Excellence (NICE), and the Canadian Respiratory Guideline about the management of asthma during the COVID-19 pandemic and the experiences of different countries. We analyzed the publications, reports, and expert opinions about asthma and COVID-19, that were released and expressed from the onset of the disease in Wuhan. In this review, we aimed to summarize the approach to patients with asthma during the pandemic and to make recommendations concerning it.


Assuntos
Asma/terapia , Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Asma/epidemiologia , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Guias como Assunto , Humanos , Pandemias , Pneumonia Viral/epidemiologia
9.
BMJ ; 370: m2521, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32816816

RESUMO

OBJECTIVE: To compare the different self-management models (multidisciplinary case management, regularly supported self-management, and minimally supported self-management) and self-monitoring models against usual care and education to determine which are most effective at reducing healthcare use and improving quality of life in asthma. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Medline, the Cochrane Library, CINAHL, EconLit, Embase, Health Economics Evaluations Database, NHS Economic Evaluation Database, PsycINFO, and ClinicalTrials.gov from January 2000 to April 2019. REVIEW METHODS: Randomised controlled trials involving the different self-management models for asthma were included. The primary outcomes were healthcare use (hospital admission or emergency visit) and quality of life. Summary standardised mean differences (SMDs) and 95% credible intervals were estimated using bayesian network meta-analysis with random effects. Heterogeneity and publication bias were assessed. RESULTS: From 1178 citations, 105 trials comprising 27 767 participants were included. In terms of healthcare use, both multidisciplinary case management (SMD -0.18, 95% credible interval -0.32 to -0.05) and regularly supported self-management (-0.30, -0.46 to -0.15) were significantly better than usual care. For quality of life, only regularly supported self-management (SMD 0.54, 0.11 to 0.96) showed a statistically significant benefit compared with usual care. For trials including adolescents/children (age 5-18 years), only regularly supported self-management showed statistically significant benefits (healthcare use: SMD -0.21, -0.40 to -0.03; quality of life: 0.23, 0.03 to 0.48). Multidisciplinary case management (SMD -0.32, -0.50 to -0.16) and regularly supported self-management (-0.32, -0.53 to -0.11) were most effective at reducing healthcare use in patients with symptoms of severe asthma at baseline. CONCLUSIONS: This network meta-analysis indicates that regularly supported self-management reduces the use of healthcare resources and improves quality of life across all levels of asthma severity. Future healthcare investments should provide support that offer reviews totalling at least two hours to establish self-management skills, reserving multidisciplinary case management for patients with complex disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO number CRD42019121350.


Assuntos
Asma/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Autogestão , Humanos , Metanálise em Rede
10.
PLoS One ; 15(8): e0237769, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817718

RESUMO

Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991-1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999-2003, and ECRHS III in 2010-2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protective causal effect of physical activity on lung function (overall difference in mean ß (95% CI), comparing active versus non-active individuals: 58 mL (21-95) for forced expiratory volume in one second and 83 mL (36-130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.


Assuntos
Asma/terapia , Exercício Físico , Pulmão/fisiologia , Infecções Respiratórias/terapia , Adolescente , Adulto , Asma/etiologia , Asma/fisiopatologia , Peso Corporal/fisiologia , Dieta , Feminino , Volume Expiratório Forçado/fisiologia , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Fumantes , Fumar/efeitos adversos , Capacidade Vital/fisiologia , Adulto Jovem
12.
Cochrane Database Syst Rev ; 8: CD012977, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32767571

RESUMO

BACKGROUND: Asthma is an illness that commonly affects adults and children, and it serves as a common reason for children to attend emergency departments. An asthma exacerbation is characterised by acute or subacute worsening of shortness of breath, cough, wheezing, and chest tightness and may be triggered by viral respiratory infection, poor compliance with usual medication, a change in the weather, or exposure to allergens or irritants. Most children with asthma have mild or moderate exacerbations and respond well to first-line therapy (inhaled short-acting beta-agonists and systemic corticosteroids). However, the best treatment for the small proportion of seriously ill children who do not respond to first-line therapy is not well understood. Currently, a large number of treatment options are available and there is wide variation in management. OBJECTIVES: Main objective - To summarise Cochrane Reviews with or without meta-analyses of randomised controlled trials on the efficacy and safety of second-line treatment for children with acute exacerbations of asthma (i.e. after first-line treatments, titrated oxygen delivery, and administration of intermittent inhaled short-acting beta2-agonists and oral corticosteroids have been tried and have failed) Secondary objectives - To identify gaps in the current evidence base that will inform recommendations for future research and subsequent Cochrane Reviews - To categorise information on reported outcome measures used in trials of escalation of treatment for acute exacerbations of asthma in children, and to make recommendations for development and reporting of standard outcomes in future trials and reviews - To identify relevant randomised controlled trials that have been published since the date of publication of each included review METHODS: We included Cochrane Reviews assessing interventions for children with acute exacerbations of asthma. We searched the Cochrane Database of Systematic Reviews. The search is current to 28 December 2019. We also identified trials that were potentially eligible for, but were not currently included in, published reviews. We assessed the quality of included reviews using the ROBIS criteria (tool used to assess risk of bias in systematic reviews). We presented an evidence synthesis of data from reviews alongside an evidence map of clinical trials. Primary outcomes were length of stay, hospital admission, intensive care unit admission, and adverse effects. We summarised all findings in the text and reported data for each outcome in 'Additional tables'. MAIN RESULTS: We identified 17 potentially eligible Cochrane Reviews but extracted data from, and rated the quality of, 13 reviews that reported results for children alone. We excluded four reviews as one did not include any randomised controlled trials (RCTs), one did not provide subgroup data for children, and the last two had been updated and replaced by subsequent reviews. The 13 reviews included 67 trials; the number of trials in each review ranged from a single trial up to 27 trials. The vast majority of comparisons included between one and three trials, involving fewer than 100 participants. The total number of participants included in reviews ranged from 40 to 2630. All studies included children; 16 (24%) included children younger than two years of age. Most of the reviews reported search dates older than four years. We have summarised the published evidence as outlined in Cochrane Reviews. Key findings, in terms of our primary outcomes, are that (1) intravenous magnesium sulfate was the only intervention shown to reduce hospital length of stay (high-certainty evidence); (2) no evidence suggested that any intervention reduced the risk of intensive care admission (low- to very low-certainty evidence); (3) the risk of hospital admission was reduced by the addition of inhaled anticholinergic agents to inhaled beta2-agonists (moderate-certainty evidence), the use of intravenous magnesium sulfate (high-certainty evidence), and the use of inhaled heliox (low-certainty evidence); (4) the addition of inhaled magnesium sulfate to usual bronchodilator therapy appears to reduce serious adverse events during hospital admission (moderate-certainty evidence); (5) aminophylline increased vomiting compared to placebo (moderate-certainty evidence) and increased nausea and nausea/vomiting compared to intravenous beta2-agonists (low-certainty evidence); and (6) the addition of anticholinergic therapy to short-acting beta2-agonists appeared to reduce the risk of nausea (high-certainty evidence) and tremor (moderate-certainty evidence) but not vomiting (low-certainty evidence). We considered 4 of the 13 reviews to be at high risk of bias based on the ROBIS framework. In all cases, this was due to concerns regarding identification and selection of studies. The certainty of evidence varied widely (by review and also by outcome) and ranged from very low to high. AUTHORS' CONCLUSIONS: This overview provides the most up-to-date evidence on interventions for escalation of therapy for acute exacerbations of asthma in children from Cochrane Reviews of randomised controlled trials. A vast majority of comparisons involved between one and three trials and fewer than 100 participants, making it difficult to assess the balance between benefits and potential harms. Due to the lack of comparative studies between various treatment options, we are unable to make firm practice recommendations. Intravenous magnesium sulfate appears to reduce both hospital length of stay and the risk of hospital admission. Hospital admission is also reduced with the addition of inhaled anticholinergic agents to inhaled beta2-agonists. However, further research is required to determine which patients are most likely to benefit from these therapies. Due to the relatively rare incidence of acute severe paediatric asthma, multi-centre research will be required to generate high-quality evidence. A number of existing Cochrane Reviews should be updated, and we recommend that a new review be conducted on the use of high-flow nasal oxygen therapy. Important priorities include development of an internationally agreed core outcome set for future trials in acute severe asthma exacerbations and determination of clinically important differences in these outcomes, which can then inform adequately powered future trials.


Assuntos
Antiasmáticos/uso terapêutico , Asma/terapia , Broncodilatadores/uso terapêutico , Progressão da Doença , Revisões Sistemáticas como Assunto , Doença Aguda , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Aminofilina/administração & dosagem , Aminofilina/efeitos adversos , Antiasmáticos/administração & dosagem , Antibacterianos/uso terapêutico , Asma/tratamento farmacológico , Viés , Broncodilatadores/administração & dosagem , Criança , Pré-Escolar , Antagonistas Colinérgicos/uso terapêutico , Hélio , Humanos , Lactente , Tempo de Internação , Antagonistas de Leucotrienos/uso terapêutico , Sulfato de Magnésio/administração & dosagem , Sulfato de Magnésio/efeitos adversos , Sulfato de Magnésio/uso terapêutico , Náusea/induzido quimicamente , Náusea/prevenção & controle , Oxigênio/administração & dosagem , Respiração com Pressão Positiva , Ensaios Clínicos Controlados Aleatórios como Assunto , Vômito/induzido quimicamente , Trabalho Respiratório/efeitos dos fármacos
13.
Brasília; Fiocruz Brasília;Instituto de Saúde de São Paulo; ago. 11, 2020. 35 p.
Não convencional em Português | LILACS, Coleciona SUS, MOSAICO - Saúde integrativa, PIE | ID: biblio-1118192

RESUMO

A acupuntura se caracteriza pela estimulação de pontos cutâneos específicos por meio do uso de agulhas. A auriculoterapia consiste na estimulação mecânica de pontos específicos do pavilhão auricular com esferas de aço, ouro, prata, plástico, agulhas ou sementes de mostarda. A acupuntura é recomendada para promoção, manutenção e recuperação da saúde, bem como prevenção de agravos e doenças. Além disso, parece propiciar a liberação de neurotransmissores e outras substâncias responsáveis pela promoção da analgesia. A auriculoterapia promove a regulação psíquico orgânica do indivíduo. Ambas as prá ticas foram incorporadas no SUS mediante Portaria nº 971, de 03 de maio de 2006. Qual é a eficácia e a segurança da acupuntura e da auriculoterapia para o tratamento de asma em adultos e/ou idosos? As buscas foram realizadas em sete bases de dados sem restrição de ano de publicação. Os critérios de inclusão foram: revisões sistemáticas em inglês, português e espanhol que avaliaram os efeitos da acupuntura e auriculoterapia no tratamento de asma na população adulta e idosa. A avaliação da qualidade metodológica foi realizada por meio da ferramenta AMSTAR 2, feita por uma pesquisadora e revisada por outra. Nesta revisão rápida, produzida em cinco dias, foram utilizados atalhos metodológicos, de maneira que apenas o processo de seleção foi realizado em duplicidade e de forma independente. De 142 relatos recuperados nas bases de dados, foram incluídas cinco revisões sistemáticas que atenderam aos critérios de elegibilidade. A pergunta de pesquisa incluiu acupuntura e auriculoterapia, o que orientou as buscas de evidências. No entanto, não foram identificados estudos sobre auriculoterapia e a maioria das revisões analisou um tipo específico de acupuntura, denominada farmacopuntura, uma técnica que combina acupuntura com injeção de ervas medicinais. De maneira geral, a farmacopuntura combinada ou não a outros tratamentos, mostrou melhores resultados, em relação a seus comparadores, nos seguin tes desfechos: taxa de resposta e melhora dos sintomas de adultos com asma, melhora da Capacidade Vital Forçada (CVF), do Volume Expiratório Forçado em 1 segundo (VEF1), da relação VEF1/CVF e no Pico de Fluxo Expiratório (PFE). Os resultados sobre acupuntura foram melhores com relação a taxa de melhora dos sintomas de asma e do VEF1. Duas revisões avaliaram a segurança das intervenções, com relatos sobre ocorrência de eventos adversosleves com o uso da farmacopuntura. Esta revisão identificou alguns benefícios da acupuntura e farmacopuntura como tratamento adjuvante em pessoas com asma. No entanto, é necessário interpretar estes resultados com cautela, devido à diversidade de terapias utilizadas nos estudos primários e à qualidade metodológica das revisões sistemáticas, avaliadas como de confiança baixa ou criticamente baixa.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Asma/terapia , Terapia por Acupuntura/métodos , Resultado do Tratamento , Acupuntura/métodos
14.
MMWR Morb Mortal Wkly Rep ; 69(26): 809-814, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32614807

RESUMO

Asthma and chronic obstructive pulmonary disease (COPD) are respiratory conditions associated with a significant economic cost among U.S. adults (1,2), and up to 44% of asthma and 50% of COPD cases among adults are associated with workplace exposures (3). CDC analyzed 2011-2015 Medical Expenditure Panel Survey (MEPS) data to determine the medical expenditures attributed to treatment of asthma and COPD among U.S. workers aged ≥18 years who were employed at any time during the survey year. During 2011-2015, among the estimated 166 million U.S. workers, 8 million had at least one asthma-related medical event,* and 7 million had at least one COPD-related medical event. The annualized total medical expenditures, in 2017 dollars, were $7 billion for asthma and $5 billion for COPD. Private health insurance paid for 61% of expenditures attributable to treatment of asthma and 59% related to COPD. By type of medical event, the highest annualized per-person asthma- and COPD-related expenditures were for inpatient visits: $8,238 for asthma and $27,597 for COPD. By industry group, the highest annualized per-person expenditures ($1,279 for asthma and $1,819 for COPD) were among workers in public administration. Early identification and reduction of risk factors, including workplace exposures, and implementation of proven interventions are needed to reduce the adverse health and economic impacts of asthma and COPD among workers.


Assuntos
Asma/economia , Gastos em Saúde/estatística & dados numéricos , Doenças Profissionais/economia , Doença Pulmonar Obstrutiva Crônica/economia , Adolescente , Adulto , Idoso , Asma/epidemiologia , Asma/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Doenças Profissionais/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
15.
Zhonghua Yi Xue Za Zhi ; 100(26): 2023-2027, 2020 Jul 14.
Artigo em Chinês | MEDLINE | ID: mdl-32654447

RESUMO

Objective: To investigate the efficacy and safety of bronchial thermoplasty (BT) in severe asthma patients with the first second forced expiratory volume (FEV(1)) as a percentage of the predicted value (FEV(1)%pred) <60%. Methods: A retrospective analysis was performed on 75 patients with asthma who were treated with BT at Shenzhen University Hospital of the Chinese Academy of Sciences from January 2016 to January 2018. The patients were divided into two groups based on the FEV(1)%pred before treatment: FEV(1)%pred <60% group (39 cases) and FEV(1)%pred ≥60% group (36 cases). Comparative analysis of glucocorticoid consumption, times of acute attack, asthma control test (ACT) score, changes in lung function, and adverse reactions at 3 weeks after treatment were performed between the two groups of patients. Results: Before BT treatment, the consumption of oral prednisone, the amount of budesonide inhaled, and the times of acute attack [M (Q(1), Q(3))] in the FEV(1)%pred <60% group were significantly greater than those in the FEV(1)%pred ≥60% group, and the ACT score was significantly lower than the FEV(1)%pred ≥60% group [10.00 (0, 20.00) vs 0(0, 3.75) mg/d, 960 (320, 960) vs 320 (320, 640) µg/d, 5(4, 8) vs 4 (4, 5) times/year, 13 (9, 15) vs 17 (13, 19) scores] (all P<0.05). Except that the oral prednisone dosage in the FEV(1)%pred<60% group was still higher 1 year after treatment [0 (0, 5.00) vs 0 (0, 0) mg/d] (P=0.009), there was no significant difference in the remaining indicators between the two groups 1 year after treatment and 2 years after treatment (all P>0.05). After 1 year and 2 years of treatment, all indicators in the two groups were better than before treatment (all P<0.05). The inhaled budesonide amount and the times of acute exacerbation in the FEV(1)%pred <60% group 2 years after treatment were less than those 1 year after treatment [320 (320, 320) vs 320 (320, 640) µg/d, 0 (0, 0) vs 0(0, 1) times/year] (all P<0.05), and there was no significant difference in the remaining indicators. In the FEV(1)%pred ≥60% group, there was no significant difference between 2 years after treatment and 1 year after treatment in the above indicators except the amount of inhaled budesonide (all P>0.05). In the FEV(1)%pred <60% group, FEV(1) and the FEV(1)%pred were significantly lower than the FEV(1)%pred ≥60% group before treatment, 1 year after treatment and 2 years after treatment [FEV(1):(1.21±0.41) vs (2.26±0.80)L, (1.84±0.73) vs (2.30±0.78)L, (1.70±0.66) vs (2.38±0.76)L; FEV(1)%pred:46.2 (38.5, 53.7)% vs 80.8(66.5, 93.6)%, 60.1 (48.2, 71.6)% vs 87.4 (68.5, 96.5)%, 58.5 (48.6, 74.8)% vs 86.6 (73.0, 97.3)%] (all P<0.05). In the FEV(1)%pred <60% group, FEV(1) and FEV(1)%pred 1 year after treatment and 2 years after treatment were all increased compared with before treatment (all P<0.05). In the FEV(1)%pred ≥60% group, there was no statistical difference in FEV(1) at each time point before and after treatment (all P>0.05), but the FEV(1)%pred at 2 years after treatment was higher than before treatment (P<0.05). There were no significant differences in adverse events between the two groups (all P>0.05). Conclusion: BT can significantly improve the lung function, reduce the times of acute attack and the dosage of glucocorticoids in severe asthma patients with FEV(1)% pred<60%, which is safe and effective.


Assuntos
Asma , Termoplastia Brônquica , Asma/terapia , Termoplastia Brônquica/efeitos adversos , Volume Expiratório Forçado , Humanos , Estudos Retrospectivos , Resultado do Tratamento
16.
Respir Med ; 171: 106084, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32658837

RESUMO

INTRODUCTION: The prevalence of asthma in patients hospitalized with SARS-CoV-2 has been studied and varies widely in the different series. However, the prevalence in SARS-infected patients not requiring hospitalization is not known. The objective of this study was to analyze the presence of asthma in a consecutive series of patients who tested positive in the RT-PCR assay for SARS-CoV-2 and did not require hospital admission. METHODS AND RESULTS: A total of 218 patients (58% of those who tested positive) did not require hospitalization; they had a median age of 45 years (IQR 34-57) and 57% were female. Six patients (2.8%) had a previous diagnosis of asthma. Only one patient developed a mild aggravation of asthma symptoms associated with SARS-CoV-2 infection. CONCLUSIONS: Few patients with asthma were infected by SARS-CoV-2, and this infection was not a significant cause of asthma exacerbation.


Assuntos
Asma , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/epidemiologia , Asma/terapia , Asma/virologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Prevalência , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Espanha/epidemiologia , Avaliação de Sintomas/métodos
17.
Zhen Ci Yan Jiu ; 45(6): 495-503, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32643888

RESUMO

OBJECTIVE: To overview the systematic review/meta-analysis on acupoint application for bronchial asthma. METHODS: A computerized retrieval was performed from 6 databases, named CNKI, CBM, VIP, WF, PubMed and Cochrane Library. The time of retrieval was from the establishment of the database to April 1, 2019. According to the inclusion and exclusion criteria, the two researchers independently selected articles and extracted data. In case of disagreement, a third party was adopted to solve it. Using AMSTAR2, PRISMA and GRADE, the literature quality and evidence grade were assessed. RESULTS: A total of 19 articles relevant with systematic evaluation/meta-analysis were included, 16 articles of which were in Chinese and 3 articles in English, published in the period from 2007 to 2018. Forty-two outcome indicators were included. It was found that the quality of methodology was very low, the quality of literature report has some or serious flaws and the quality level of evidence is mostly low or very low. CONCLUSION: Currently, regarding the articles of systematic review/meta-analysis on acupoint application for bronchial asthma, it is quite low in methodological quality and literature report quality and is not high in the grade of outcome indicators. The clinical research should be intensively specified in association with the characteristics of traditional Chinese medicine so as to provide more reliable clinical evidence.


Assuntos
Pontos de Acupuntura , Asma , Asma/terapia , Bases de Dados Factuais , Humanos , Medicina Tradicional Chinesa , PubMed
18.
Pediatr Clin North Am ; 67(4): 623-627, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650858

RESUMO

Pediatric patients with uncontrolled asthma often live in underserved areas such as rural communities where few pediatric asthma specialists exist. There are significant costs associated with acute asthma exacerbations, which are increasingly prevalent in these high-risk populations. Telemedicine is a viable option when addressing barriers in access to care and cost-efficiency. Implementing telemedicine in schools and other local community settings, as well as implementing innovative technology such as smartphone applications, can reduce the burden of asthma; increase patient satisfaction; and, most importantly, improve pediatric asthma outcomes.


Assuntos
Asma/terapia , Telemedicina/métodos , Criança , Assistência à Saúde , Humanos , Aplicativos Móveis , População Rural , Instituições Acadêmicas , Exacerbação dos Sintomas , Telemedicina/economia
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