Asthma exacerbations in a subtropical area and the role of respiratory viruses: a cross-sectional study.

BACKGROUND: Multiple factors are involved in asthma exacerbations, including environmental exposure and viral infections. We aimed to assess the association between severe asthma exacerbations, acute respiratory viral infections and other potential risk factors. METHODS: Asthmatic children aged 4-14 years were enrolled for a period of 12 months and divided into two groups: those with exacerbated asthma (group 1) and non-exacerbated asthma (group 2). Clinical data were obtained and nasopharyngeal samples were collected through nasopharyngeal aspirate or swab and analysed via indirect fluorescent immunoassays to detect influenza A and B viruses, parainfluenza 1-3, adenovirus and respiratory syncytial virus. Rhinovirus was detected via molecular assays. Potential risk factors for asthma exacerbation were identified in univariate and multivariate analyses. RESULTS: In 153 children (group 1: 92; group 2: 61), median age 7 and 8 years, respectively, the rate of virus detection was 87.7%. There was no difference between groups regarding the frequency of virus detection (p = 0.68); however, group 1 showed a lower frequency (19.2%) of inhaled corticosteroid use (91.4%, p < 0.01) and evidence of inadequate disease control. In the multivariate analysis, the occurrence of three or more visits to the emergency room in the past 12 months (IRR = 1.40; p = 0.04) and nonadherence to inhaled corticosteroid (IRR = 4.87; p < 0.01) were the only factors associated with exacerbation. CONCLUSION: Our results suggest an association between asthma exacerbations, poor disease control and nonadherence to asthma medication, suggesting that viruses may not be the only culprits for asthma exacerbations in this population.

Environmental and behavioral factors associated with household transmission of SARS-CoV-2 in children and adolescents.

Objective: To analyze the association between risk behaviors and environmental factors and SARS-CoV-2 infection in children and adolescents in the family environment. Methods: Cross-sectional study. A total of 267 children and adolescents aged 5-19 years who have contact with COVID-19-positive essential workers were tested between June and October 2020. Behavioral and environmental variables associated with SARS-CoV-2 infection were investigated. Association between these variables was performed using Poisson regression. Results: SARS-CoV-2 prevalence was 25.1%. Following the confirmation of COVID-19 diagnosis of the index case, 92.1% of adults reported hand hygiene and 83.5% showed habits of respiratory etiquette. However, 12.7% wore masks in common areas of the residence before COVID-19. Sharing common objects was a risk factor for SARS-CoV-2 infection in the sample. Conclusion: Sharing objects among family members was identified as a risk factor associated with SARS-CoV-2 infection in children and adolescents who lived with infected adults. There was high frequency of hand hygiene and low prevalence of mask use.

Analysis of the trend of hospitalizations for asthma in children and adolescents in Brazil.

OBJECTIVE: To analyze the trend of hospitalizations for asthma in children and adolescents by region and age group in Brazil, from 2008 to 2017. METHOD: This is a time-series study with secondary data regarding hospitalizations for asthma in children and adolescents, according to age, region, and gender. Descriptive statistics procedures were used with measures of central tendency to calculate the variation between the periods of 2008 and 2017. Rates of hospitalizations were calculated specifically by age group and region. Time trend analysis was performed by simple linear regression, considered as stationary (p>0.05), declining (p<0.05 and negative regression coefficient), or ascending (p<0.05) and positive regression coefficient). RESULTS: The present study identified a higher proportion of hospitalizations for asthma in Brazil in children aged 5-9 years. Regarding gender, there were more hospitalizations in boys. The region that presented the highest proportion of hospitalizations, in all age groups investigated, was the Northeast. As for the trend analysis, this article showed that, in Brazil, there was a trend toward a reduction in hospitalization rates for asthma. CONCLUSION: In Brazil, there was a tendency to reduce hospitalizations for all investigated age groups. The Northeast was the only region that showed a decline in all age groups.

Circulation profile of respiratory viruses in symptomatic and asymptomatic children from Midwest Brazil.

Acute respiratory infection (ARI) is a major cause of morbidity and mortality worldwide. Most of these infections are caused by viruses. Infections pose as important triggers of acute episodes of chronic respiratory diseases (CRD). This study sought to evaluate the frequency and circulation profile of respiratory viruses among ARI symptomatic patients and completely asymptomatic children in Midwest Brazil. The study enrolled symptomatic children with and without ARI symptoms. During 1 year, 225 nasal respiratory samples were obtained from patients aged 4-14 years old. The samples were screened by multiplex nested-PCR for 16 common respiratory viruses. From 225 samples, 42 had at least one virus detected. Samples from four different patients had multiple viruses detected. The viral detection rate in symptomatic (20.1%) and asymptomatic patients (14.8%) showed no significant difference. The most frequent viruses detected were rhinovirus (28.6%), FLUA (11.9%), adenovirus (11.9%), human bocavirus (HBoV) (11.9%), and respiratory syncytial virus (RSV) antigenic group A (9.5%). Monthly detection rate was higher during the rainy season. RSVs were detected during the months with higher rainfall indexes and higher air humidity, while FLU and HBoV were detected during the winter months. The obtained results reinforce the importance of viral pathogens in pediatric population, emphasizing similar viral occurrence in symptomatic and asymptomatic children.

Utilização e eficácia de espaçadores no tratamento farmacológico de pacientes asmáticos: uma revisão integrativa / Use and effectiveness of spacers in the pharmacological treatment of patients with asthma: an integrative review / Uso y eficacia de espaciadores en el tratamiento farmacológico de pacientescon asma: una revisión integradora

Trata-se de uma revisão integrativa que objetivou analisar a produção científica, publicada entre 1999 e 2010, referente ao uso e eficácia de dispositivos inalatórios acoplados a espaçadores no tratamento da asma. A seleção dos estudos foi realizada nas bases de dados: Medical Literature Analysis and Retrieval System Online/Biblioteca Virtual em Saúde (MEDLINE/BVS) e Scientific Electronic Library Online (SciELO) e resultou em 20 artigos científicos. Foram evidenciadas diversas vantagens na utilização dos espaçadores, entre elas destaca-se a reversão mais rápida do broncoespasmo durante as crises agudas, a redução no tempo de preparo e administração das medicações, a menor evidência de efeitos colaterais e a redução de custos, especialmente quando se opta pelo uso de espaçadores artesanais. Desse modo, profissionais atuantes em programas de controle da asma, especialmente os enfermeiros envolvidos nesses serviços, precisam estar aptos a orientar os pacientes e relatar os benefícios da utilização dos espaçadores no tratamento farmacológico da asma.

This integrative review aimed to analyze the scientific production published between 1999 and 2010 on the useand effectiveness of inhaler devices connected to spacers in the treatment of asthma. Selection of studies in the Medical Literature Analysis and Retrieval System Online/Biblioteca Virtual em Saúde (MEDLINE/BVS) and Scientific Electronic Library Online (SciELO) databases yielded 20 scientific articles. Use of spacers was shown to offer a number of advantages, particularly more rapid relief of bronchospasm in acute attacks, reduced drug preparation and administration times, fewer side-effects and lower costs, especially with homemade spacers. Accordingly, personnel – especially nurses – involved in asthma control programs must be capacitated to advise patients and to report the benefits of using spacers in pharmacological treatment of asthma.

Se trata de una revisión integradora que objetivó analizar la producción científica, publicada entre 1999 y 2010, respecto al uso y efectividad de los dispositivos inhaladores acoplados a espaciadores en el tratamiento de la asma. La selección de los estudios he sido realizada en las bases de datos: Medical Literature Analysis and Retrieval System Online/ Biblioteca Virtual en Salud (MEDLINE/BVS) y Scientific Electronic Library Online (SciELO) y resultó en 20 artículoscientíficos. Fueron evidenciadas diversas ventajas en la utilización de los espaciadores, entre ellas se destaca la inversión más rápida del broncoespasmo durante los ataques agudos, la reducción del tiempo de preparación y administración de medicamentos, la más mínima evidencia de efectos secundarios y la reducción de costos, especialmente cuando se opta por el uso de espaciadores de fabricación artesanal. Así, los profesionales que participan en programas de control de la asma, sobre todo los enfermeros envueltos en esos servicios, deben ser capaces de enseñar y informar los beneficios del uso de losespaciadores en el tratamiento farmacológico de la asma.

Prevalência de asma e sintomas relacionados, em adolescentes de Goiânia / Prevalence of asthma and related symptoms in adolescents from Goiânia

Objetivo: Avaliar a prevalência da asma e dos sintomas relacionados, em adolescentes de Goiânia e comparar a freqüência dos sintomas sugestivos da doença com o seu diagnóstico. Método: Foi utilizada a primeira parte do questionário escrito sobre sintomas e diagnóstico de asma, padronizado pelo projeto ISAAC (International Study of Asthma and Allergies in Childhood), respondidos por adolescentes de 13 e 14 anos, matriculados em 28 escolas da rede pública e privada de ensino. Dos 3.000 questionários entregues, 2.916 foram respondidos em sala de aula. Foram exclídos 469 questionários finalizando a amostra de 2.447. Os resultados foram analisados pelo programa SPSS versão 8.0. O reste Kappa foi utilizado para a comparação da freqüência dos sintomas sugestivos de asma com a questão sobre o diagnóstico médico da doença e o Quiquadrado, para comparar diferenças entre os sexos. Resultados: A taxa de devolução dói de 97,2 por cento. A prevalência de asma diagnosticada foi de 10,6 por cento, mais freqüente no sexo feminino. A prevalência de tosse noturna, sibilância aos exercícios e sibilância nos últimos doze meses foi 37 por cento, 22,1 por cento e 18,5 por cento, respectivamente. Prováveis asmáticos totalizaram 17,1 por cento dos adolescentes. Conclusões: A prevalência de asma diagnosticada nos adolescentes de Goiânia foi de 10,6 por cento, estando de acordo com os valores observados em outras cidades brasileiras. Os sintomas relacionados à asma, como tosse noturna, sibilância aos exercícios e sibilância nos últimos doze meses foram mais prevalentes do que o seu dignóstico, sugerindo que a doença possa ser subdiagnosticada.