Exercise-induced bronchoconstriction diagnosis in asthmatic children: comparison of treadmill running and eucapnic voluntary hyperventilation challenges.

BACKGROUND: Exercise-induced bronchoconstriction (EIB) occurs in up to 90% of young people with asthma and can be diagnosed using serial measurements of forced expiratory volume in 1 second (FEV1) after standardized exercise, usually treadmill running (TR). Eucapnic voluntary hyperventilation (EVH) is a guideline-recommended alternative challenge for EIB diagnosis. The 2 methods have not been compared for EIB diagnosis in this population. OBJECTIVE: To compare 2 methods of EIB diagnosis in children and adolescents with asthma. METHODS: Thirty-four children 8 to 18 years of age attending the allergy clinic of the Hospital das Clínicas (Recife, Brazil) from September through December 2013 were examined. All underwent a basal FEV1 determination followed by TR for 8 minutes or EVH for 6 minutes on consecutive days. The first challenge was chosen at random. Serial FEV1 determinations were obtained at 3, 5, 7, 10, 15, and 30 minutes after the challenge and the test result was considered positive if at least 2 consecutive FEV1 measurements decreased at least 10% below the basal value. RESULTS: Thirteen patients responded to the 2 challenges, 6 only after TR and 4 exclusively after EVH (agreement 71%, κ = 0.41). The 95% limits of agreement of FEV1 decreasing after the challenges were widely spread (mean 0.1%, limits 19.8% to -19.6%). CONCLUSION: The 2 tests cannot be used interchangeably and the reproducibility of the FEV1 response to the EVH challenge has to be properly evaluated to better understand its role in EIB diagnosis.

Effect of exercise-induced bronchospasm and parental beliefs on physical activity of asthmatic adolescents from a tropical region.

BACKGROUND: Physical activity (PA) is an essential health promotion factor. In asthmatic children and adolescents, exercise-induced bronchospasm (EIB) and parental beliefs and attitudes toward PA may be limiting issues. OBJECTIVE: To compare PA levels in asthmatic adolescents with and without EIB and the influence of mothers' beliefs of asthma worsening due to PA and attitudes in restraining their children's PA, asthma severity, severe EIB, or bronchospasm perception. METHODS: We performed a cross-sectional, hypothesis-testing study from December 1, 2008, through August 31, 2009, using the International Physical Activity Questionnaire to assesses PA levels in 134 asthmatic adolescents (10-19 years of age, 60% male) from an underprivileged community. EIB was defined as a decrease in forced expiratory volume in 1 second greater than 10% from basal 5, 15, or 30 minutes after treadmill running for 8 minutes. Subjective factors were evaluated through specific questionnaires. RESULTS: EIB was diagnosed in 46% of patients and was not associated with lower PA levels (odds ratio, 1.62; 95% confidence interval, 0.75-3.52). The other factors evaluated were also not associated with lower PA levels, although 78% of the mothers said they believe asthmatic children cannot participate in PA as much as nonasthmatic children, 44% that exercise can be harmful, and 52% that they restrained their children's PA. CONCLUSION: We found no association between EIB and low PA levels, although EIB was a frequent event that should be addressed by health care professionals, along with mother's beliefs and attitudes toward PA.

Good clinical practice recommendations in allergen immunotherapy: Position paper of the Brazilian Association of Allergy and Immunology - ASBAI.

Background: Allergen Immunotherapy (AIT) represents one of the pillars in the treatment of allergic diseases. AIT is the only therapeutic strategy with curative potential, promoting the reduction of drug use and long-term symptom control even after the end of the treatment. The European Academy of Allergy, Asthma and Immunology (EAACI) guidelines, position papers of World Allergy Organization (WAO), and the US Practice Parameters are the leading official documents that set scientific standard for the use of AIT in the world. The use of AIT in Brazil has specific regional conditions due to the pattern of allergen sensitization, as well as genetic, socioeconomic, and cultural characteristics, climate conditions, and the availability of allergenic extracts. The most prevalent house dust mites are Dermatophagoides pteronyssinus, Dermatophagoides farinae and their allergens have the highest clinical relevance. Blomia tropicalis is also very frequent. This position paper has been prepared by the Brazilian Association of Allergy and Clinical Immunology (ASBAI) Taskforce on AIT for respiratory allergy and Hymenoptera venom allergy. Objective: According to the current scientific literature adapted to the Brazilian reality, this position paper aims to establish the main recommendations for the good clinical practice parameters for AIT in Brazil. Methods: A systematic review using the Pub Med and Cochrane databases was performed, and the websites of major allergy and immunology organizations were consulted. The research was limited to English language literature and was conducted between March 30, 2002, and March 30, 2022. The terms used for the research were: Allergen Immunotherapy, sublingual immunotherapy (SLIT), subcutaneous immunotherapy (SCIT), venom-specific immunotherapy (VIT), and allergen extract. Results: The several recommendations that establish the clinical practices for AIT recommended by the main Allergy, Asthma and Immunology world organizations were analyzed and adapted to the Brazilian situation. Conclusion: This position paper establishes the main recommendations for the effective clinical practice of AIT in Brazil, using current knowledge of evidence-based medicine and precision medicine.

Validation of the Asthma Control Test in pregnant asthmatic women.

OBJECTIVE: To determine the validity of the Asthma Control Test (ACT) questionnaire for assessing pregnant asthmatic women. METHODS: The study involved 40 pregnant asthmatic women over a total of 113 medical visits. On each occasion the participants had a pulmonary function test and a clinical evaluation to assess the level of asthma control. In addition, the ACT was carried out with the obstetrician being blinded to its results. RESULTS: The most accurate cut-off point was 16, with a sensitivity of 95.4%, specificity of 68.8%, a negative predictive value of 91.7% and a positive predictive value of 80.5%. The positive and negative likelihood ratios were 3.052 and 0.067 respectively. The questionnaire was found to be highly effective for discriminating between controlled and uncontrolled asthma, with an area under the receiver operating characteristic (ROC) curve of 0.846 (95%CI: 0.748-0.92). Reliability assessed in patients with the same clinical classification resulted in an intra-class correlation coefficient of 0.86 (95%CI: 0.75-0.93). Improved clinical conditions corresponded to a significant increase in the ACT score (p < 0.005), indicating good responsiveness to changes in clinical status. CONCLUSIONS: The ACT proved to be reliable and could discriminate between levels of asthma control in pregnant women confirming its value as a useful tool for the management of asthma during pregnancy.

[Oral health among adolescents: aspects relating to hygiene, dental cavities and periodontal disease in the cities of Recife and Feira de Santana, Brazil]. / A saúde bucal de adolescentes: aspectos de higiene, de cárie dentária e doença periodontal nas cidades de Recife, Pernambuco e Feira de Santana, Bahia.

OBJECTIVE: To characterize the oral health in adolescents in the cities of Recife and Feira de Santana, Northeast Brazil by assessment of personal hygiene and dental cavities and periodontal disease. METHOD: Forty adolescents between ten and eighteen years old were assessed through an exploratory study run in Recife in 2005. In Feira de Santana, 971 adolescents (twelve years old) were examined through a cross section study in 2002. It was assessed cavity status through the number of cavitied, missing and filled teeth, visible dental plaque, bleeding gums and periodontal status. The analysis was based on Chi-Square, Kruskall-Wallis and Fisher tests, with a confidence interval of 95%. RESULTS: The most of adolescents followed oral hygiene practices three times a day. The DMTF values presented a median of 1.5 in Recife and averages of 1.89 in state schools, 2.17 in municipal schools and 2.39 in private schools in Feira de Santana. The bleeding gum in Recife presented a median of 27%, and in Feira de Santana the healthy sextant averages of 4.36, 4.08 and 5.16 in state, municipal and private schools respectively. CONCLUSION: The frequency of the dental cavities was low, with most of the adolescents reporting good habits of oral hygiene and favorable periodontal conditions.