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- ItemSomente MetadadadosAcupuncture reduces immune-mediated pulmonary inflammatory lesions induced in rats(Karger, 2009-01-01) Katsuya, Elizabeth Marie [UNIFESP]; Pedreira de Castro, Maria Alice [UNIFESP]; Carneiro, Celia Regina Whitaker [UNIFESP]; Yamamura, Ysao [UNIFESP]; Silveira, Vera Lucia Flor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: the aim of this report was to experimentally demonstrate the biological actions of acupuncture in an animal model of immune-mediated inflammation associated with a deposition of collagen. Materials and Methods: Male Wistar rats were sensitized by a subcutaneous implant of heat-solidified hen egg-white and divided into 4 groups: acupuncture, sham acupuncture, immobilized, and control. Acupuncture was initiated the day after sensitization and repeated twice a week for 3 weeks. the dorsal acupoints chosen were GV-14 and BL-13, the ventral acupuncture points were LU-1, CV-17, ST-36 and SP-6. the dorsal points were stimulated manually and the ventral ones by electroacupuncture. On day 14, animals were challenged through the tail vein with Sepharose (R) beads coupled with ovalbumin. One week later, animals were bled, plasma corticosterone concentrations were measured and the lungs were removed for histological evaluation. Results: Measurement of the areas of pulmonary lesion on hematoxylin-eosin stained slides showed a significant decrease (p < 0.05) in the inflammatory infiltrate in the acupuncture group, compared to the other 3 groups. Utilization of Litt and Picrosirius staining methods, in order to better visualize the infiltrate of eosinophils and the deposition of collagen, respectively, showed that both were much less intense in the acupuncture group. Corticosterone plasma levels were similar in all groups. Conclusion: Point-specific acupuncture treatment effectively reduced the inflammatory process and the deposition of collagen around ovalbumin-Sepharose beads intravenously embolized to the lungs of rats previously sensitized with the same protein that was administered subcutaneously.
- ItemAcesso aberto (Open Access)Adaptação e validação do Pediatric Asthma Quality of Life Questionnaire (PAQLQ-A) em crianças e adolescentes brasileiros com asma(Sociedade Brasileira de Pediatria, 2005-02-01) La Scala, Cintia Sayuri Kurokawa [UNIFESP]; Naspitz, Charles Kirov [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: To translate the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) into Portuguese and adapt it to the Brazilian context, for use in children and adolescents with asthma and to validate the adapted version of the questionnaire (PAQLQ-A). METHODS: Children and adolescents (7 to 17 years old) with asthma answered the PAQLQ-A on admission and were assessed using a clinical severity score. According to this score, patients were classified as mild (< 2) or moderate/severe (> 2). They were reassessed on at least two occasions at an interval of 2 to 4 weeks. Furthermore, patients in whom asthma was properly controlled were classified as stable, and those in whom it could not be controlled, as unstable. RESULTS: The reproducibility of the PAQLQ-A was evaluated in stable patients by comparing the mean domain scores: symptoms, emotions, activities, and the overall clinical severity score on two predefined occasions with an interval of 15 to 30 days in between. Responsiveness was evaluated among unstable patients. The mean domain scores and the overall score were different on both occasions, and so was the clinical severity score. The validity of the questionnaire was determined by the application of Cronbach's alpha reliability coefficient (a = 0.909). CONCLUSIONS: The translation of the PAQLQ into Portuguese did not modify the framework of the original questionnaire; the PAQLQ-A is easy to use, with easy reproducibility, constituting a valuable instrument for the evaluation of the quality of life in children and adolescents with asthma.
- ItemSomente MetadadadosAir pollution and its relationship to lung function among adolescents from Taubate, Sao Paulo, Brazil(Elsevier Doyma Sl, 2018) Toledo, M. Froio; Saraiva-Romanholo, B. Mangueira; Oliveira, R. Carvalho; Silva, L. Ferraz da; Solé, Dirceu [UNIFESP]Background: This paper sought to evaluate individual exposure to air pollution by quantifying the carbon in alveolar macrophages (AMs) and its relationship to lung function. We also examined the proximity of participants' residences to the Presidente Dutra highway (PDH) in adolescents with asthma from Taubate, Sao Paulo, Brazil. Methods: This descriptive study examined fifty 13- to 14-year-old adolescents with asthma identified by the International Study of Asthma and Allergies in Childhood (ISAAC) in Taubate. These adolescents underwent spirometry and sputum induction via the inhalation of 3% hypertonic saline (HSS). Sputum was collected after each nebulisation, and forced expiratory flow in one second (FEV1) was measured. The collected sputum was stored and transported to the laboratory
- ItemAcesso aberto (Open Access)Allergy immunotherapy across the life cycle to promote active and healthy ageing: from research to policies(Biomed Central Ltd, 2016) Calderon, M. A.; Demoly, P.; Casale, T.; Akdis, C. A.; Bachert, C.; Bewick, M.; Bilo, B. M.; Bohle, B.; Bonini, S.; Bush, A.; Caimmi, D. P.; Canonica, G. W.; Cardona, V.; Chiriac, A. M.; Cox, L.; Custovic, A.; De Blay, F.; Devillier, P.; Didier, A.; Di Lorenzo, G.; Du Toit, G.; Durham, S. R.; Eng, P.; Fiocchi, A.; Fox, A. T.; van Wijk, R. Gerth; Gomez, R. M.; Haathela, T.; Halken, S.; Hellings, P. W.; Jacobsen, L.; Just, J.; Tanno, L. K.; Kleine-Tebbe, J.; Klimek, L.; Knol, E. F.; Kuna, P.; Larenas-Linnemann, D. E.; Linneberg, A.; Matricardi, M.; Malling, H. J.; Moesges, R.; Mullol, J.; Muraro, A.; Papadopoulos, N.; Passalacqua, G.; Pastorello, E.; Pfaar, O.; Price, D.; Rodriguez del Rio, P.; Rueff, R.; Samolinski, B.; Scadding, G. K.; Senti, G.; Shamji, M. H.; Sheikh, A.; Sisul, J. C.; Solé, Dirceu [UNIFESP]; Sturm, G. J.; Tabar, A.; Van Ree, R.; Ventura, M. T.; Vidal, C.; Varga, E. M.; Worm, M.; Zuberbier, T.; Bousquet, J.Allergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Sante). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.
- ItemAcesso aberto (Open Access)Alterações da variabilidade da frequência cardíaca em adultos asmáticos: revisão narrativa(Universidade Federal de São Paulo, 2022-01-28) Mariano, Karen dos Santos [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; http://lattes.cnpq.br/0334734747375995; Universidade Federal de São Paulo (UNIFESP)A variabilidade da frequência cardíaca (VFC) é uma análise barata, de fácil utilização e que vem sendo muito utilizada na asma. Atualmente existem diversos estudos que realizam essa análise da VFC em asmáticos, para melhor entendimento da doença e sua gravidade. Estudos apontam que, em asmáticos, a atividade parassimpática aumentada é responsável pela broncoconstrição e aumento de secreção presentes da etiologia da asma. Porém, ensaios clínicos mostram resultados controversos em que, a atividade simpática está aumentada e a parassimpática diminuída, por conta disso o presente estudo emerge como uma revisão narrativa com o objetivo de identificar os artigos dos últimos vinte anos realizados com asmáticos adultos. Para filtrar esses artigos foram utilizados os descritores Cronotropismo cardíaco AND Asma, Heart Rate Variability AND Asthma, Heart Rate Variability / Variabilidade Cardíaca, frequência cardíaca AND asma, também foram excluídos os artigos que não se enquadraram nos critérios inclusão. Os artigos foram classificados em situações como repouso, durante situação de estresse e sono, gravidade da doença e atividade física. Observamos que a maioria dos artigos sinalizam para uma atividade parassimpática elevada em pacientes com asma não controlada, porém existem estudos que possuem divergência. Essa diferença de resultados pode se dar, provavelmente, por conta das diferenças individuais de equilíbrio do SNA nos grupos estudados ou por métodos de análise inadequados.
- ItemAcesso aberto (Open Access)Ansiedade e depressão em pacientes com asma: impacto no controle da asma(Sociedade Brasileira de Pneumologia e Tisiologia, 2011-02-01) Vieira, Aline Arlindo [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Dracoulakis, Samir [UNIFESP]; Caetano, Lilian Ballini [UNIFESP]; Fernandes, Ana Luisa Godoy [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: There is evidence that asthma is associated with an increase in psychiatric symptoms and mental disorders. This association can make it difficult to achieve asthma control. The purpose of this study was to determine whether the level of asthma control is associated with anxiety and depression. METHODS: A crosssectional study involving 78 patients with confirmed moderate or severe asthma and under regular treatment at the Asthma Outpatient Clinic of the Federal University of São Paulo Hospital São Paulo, in the city of São Paulo, Brazil. The patients were divided into two groups by asthma control status, as assessed by the asthma control test, and were subsequently compared in terms of demographic, clinical, and spirometric data, as well as scores for asthma quality of life and hospital anxiety/depression. RESULTS: The sample was predominantly female. Of the 78 patients, 49 (63%) were classified as having uncontrolled asthma. The prevalence of anxiety and of anxiety+depression was significantly higher among patients with uncontrolled asthma than among those with controlled asthma (78% and 100%; p = 0.04 and p = 0.02, respectively), whereas there were no differences between the two groups in terms of the prevalence of depression, spirometry results, or quality of life score. CONCLUSIONS: In this sample, the prevalence of anxiety symptoms was higher in the patients with uncontrolled asthma than in those with controlled asthma.In the evaluation of asthma patients, the negative impact of mood states ought to be taken into consideration when asthma control strategies are being outlined.
- ItemAcesso aberto (Open Access)Asma e doenças alérgicas em escolares de população ribeirinha da região leste da Amazônia(Universidade Federal de São Paulo (UNIFESP), 2011-05-25) Freitas, Marly Sarmanho de Souza [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: epidemiological studies have focused on possible association between helminth infection and the development of asthma and/or allergies. Objectives: to evaluate the association between helminth infection and asthma and its relation to serum levels of total and specific IgE for A. lumbricoides and aeroallergens, besides evaluating possible relation between BCG scar and allergic sensitization. Methods: cross sectional study in 400 schoolchildren from two Amazon Islands. A standardized written questionnaire (asthma module) from International Study of Asthma, Allergies in Childhood protocol was administered and asthmatic children were those with current wheezing. The following procedures were done: skin prick test (positive test with papule mean diameter > 3mm); blood samples for assessment of serum levels of total and specific IgE for A. lumbricoides and aeroallergens (positive those with levels > 0.36 kU/L); feces samples for helminths examination (positive = infected with at least one helminth); mean diameter of BCG vaccine scar measurement. Analyses were assessed for both islands together and non-parametric tests were applied obtaining 5% of significance level. Results: there was no significant difference between infected and non-infected children with helminths related to asthma expression, save for having physician-diagnosed asthma that was more frequent in helminths infected children. Serum levels of total and specific IgE for A. lumbricoides were higher in infected children. Significant correlations between serum levels of total and specific IgE for aeroallergens to Periplaneta americana and Ascaris lumbricoides among those infected and among those non-infected was for B. germanica e B. tropicalis. Significant correlation between papule mean diameter and serum level of specific IgE for D. pteronyssinus e B. tropicalis among those not infected. Mean diameter of BCG vaccine wasn´t different among children with asthma and those without, as well as there was no correlation between serum levels of total and specific IgE. Conclusions: parasite infections are not associated with either asthma expression or to allergic sensitization, but positive association was verified between physician-diagnosed asthma and helminth infection. More studies are necessary to clarify helminth infection role on asthma and allergic diseases.
- ItemAcesso aberto (Open Access)Asma e obesidade: determinação de um perfil inflamatório e funcional em mulheres obesas asmáticas(Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Rosa, Gilvandro De Almeida [UNIFESP]; Fernandes, Ana Luisa Godoy [UNIFESP]; Araújo, Leila [UNIFESP]; http://lattes.cnpq.br/0379775988338724; http://lattes.cnpq.br/4204795300182038; Universidade Federal de São Paulo (UNIFESP)Introduction: Asthma and obesity are two chronic diseases, difficult to manage and of high and increasing prevalence in several countries of all continents; in Brazil the two diseases are a serious health problem, causing high costs for public health. About two decades ago, some studies have shown a higher prevalence of asthma among obese, especially among obese women. Some affirm that the fact is due to the particular physical-structural alterations of the obese ones, leading to the collapse of the bronchi, leading to the bronchial hyper-reactivity. Others, however, suggest that adipose tissue has been described in the last twenty years as an endocrine tissue, demonstrating the production of lipidectin (adipokine and adipoctin), as well as other inflammatory mediators, including various types of interleukins and Tumor Necrosis Factor (TNF). This excess of inflammatory mediators, in the obese, would play an important role in the chronic inflammatory process in the obese, in which one of the target organs would be the lung. Method: Our work studied 73 obese women (51 asthmatic obese and 22 non-asthmatic obese women), who underwent clinical interviews - Application of the ACQ questionnaires from the Global Initiative for Asthma (GINA) and the International Study for Asthma and Athopy in Chilhoold (ISAAC), spirometry, methacholine bronchial provocation test, blood collection for laboratory tests, and for dosage of inflammatory mediators, aeroallergens (prick-test) skin test, nasal swab cytology and induced sputum. Objective: to determine the functional and inflammatory profile of asthma in obesity. Results: Groups were demographically similar (age, BMI and past smoking). However, completely different in the cytology of nasal swab and induced sputum, prick test, total serum IgE, spirometric values and bronchial provocation test with methacholine. At the dosages of leptin that was four times higher in the asthmatic obese group. Conclusion: We conclude that obese asthmatic follows the Th2 inflammatory pattern with high IgE; however, hyperlipectinemia may interfere with the inflammatory process. The phenotype of bronchial asthma in obese individuals would be represented predominantly by a Th2 response, with production of high levels of serum leptin, which may exacerbate or induce this inflammatory response.
- ItemAcesso aberto (Open Access)Aspergilose broncopulmonar alérgica com imagem radiológica em dedo de luva(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-10-01) Kalil, Marta Elizabeth; Fernandes, Ana Luisa Godoy [UNIFESP]; Curzel, Aline Cristiane Da Silva; Cortez, Márcio Zamuner; Lima, Gláucia Cristina Godinho Alves; Pontifícia Universidade Católica de São Paulo Centro de Ciências Médicas e Biológicas; Universidade Federal de São Paulo (UNIFESP); Pontifícia Universidade Católica de São Paulo Faculdade de Medicina; Conjunto Hospitalar de SorocabaAllergic bronchopulmonary aspergillosis is a lung disease occurring in patients with asthma or cystic fibrosis, triggered by a hypersensitivity reaction to the presence of Aspergillus fumigatus in the airways. We report herein the case of a patient presenting a clinical profile suggestive of asthma and meeting the clinical, laboratory testing and radiological criteria for a diagnosis of allergic bronchopulmonary aspergillosis. The importance of such findings is that early diagnosis can reduce the risk of respiratory exacerbations and fibrosis.
- ItemSomente MetadadadosAssessment of sleep bruxism, orthodontic treatment need, orofacial dysfunctions and salivary biomarkers in asthmatic children(Elsevier B.V., 2015-05-01) Amato, Juliana Neide; Tuon, Rogerio Antonio; Castelo, Paula Midori [UNIFESP]; Duarte Gaviao, Maria Beatriz; Barbosa, Tais de Souza; Universidade Estadual de Campinas (UNICAMP); Municipal Govt Piracicaba; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the sleep bruxism, malocclusions, orofacial dysfunctions and salivary levels of cortisol and alpha-amylase in asthmatic children.Design: 108 7-9-yr-old children were selected from Policlinic Santa Teresinha Doutor Antonio Haddad Dib (asthmatics, n = 53) and from public schools (controls, n = 55), Piracicaba, SP, Brazil. Sleep bruxism diagnosis was confirmed by parental report of grinding sounds and the presence of shiny and polish facets on incisors and/or first permanent molars. the index of orthodontic treatment need was used for occlusion evaluation. Orofacial dysfunctions were evaluated using the nordic orofacial test-screening (NOT-S). Salivary cortisol and alpha-amylase were expressed as awakening response (AR), calculated as the difference between levels immediately after awakening and 30 min after waking, and diurnal decline (DD), calculated as the difference between levels at 30 min after waking and at bedtime. Data were analyzed using Shapiro-Wilk/Kolmogorov-Smirnov, Chi-square, unpaired t test/Mann-Whitney and paired t/Wilcoxon tests.Results: Sleep bruxism was more prevalent in children with asthma than controls (47.2% vs. 27.3%, p < 0.05). Asthmatics had higher scores of NOT-S total and interview (p < 0.05). Dysfunctions on sensory function and chewing and swallowing were more frequent in asthmatics (p < 0.05). Salivary cortisol AR on weekend was significantly higher for asthmatics (p < 0.05). Salivary cortisol DD was significantly higher on weekday than weekend for controls (p < 0.05). There were no significant differences in alpha-amylase values in and between groups.Conclusions: the presence of asthma in children was associated with sleep bruxism, negative perception of sensory, chewing and swallowing functions, and higher concentrations of salivary cortisol on weekend. (C) 2015 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Associação entre hormônios sexuais e asma(Universidade Federal de São Paulo (UNIFESP), 2016-06-29) Baldacara, Raquel Prudente de Carvalho [UNIFESP]; Silva, Ivaldo da [UNIFESP]; http://lattes.cnpq.br/9948402316193744; Universidade Federal de São Paulo (UNIFESP)A relationship between oral contraceptive (OC) use and asthma is controversial and has been observed in previous researches. The objective of this study was to assess the relationship between combined OC use and pulmonary function in Brazilian women with or without asthma, in addition to evaluate the cytokines to verify the inflammatory process of asthma. This was case-control study involving women with and without asthma who were or not using combined OC. Seventy women were recruited from the Family Health Clinic or from the universities and 7 were excluded. Sixty-three patients were divided into four groups (I:-no asthma and no OC use; II:- no asthma and OC use; - III:- asthma and no OC use; and, IV: asthma and OC use). MANOVA (multivariate analysis of variance) were conducted. First one to evaluate the relationship between combined oral contraceptive (OC) use and changes in pulmonary function (FVC, FEV1, FEV1/FVC%) in women with or without asthma. The second MANOVA evaluated the influence of sex hormones on the immune system through the alteration of cytokins expression (IL-4, IL-5, and TNF-?). There was a lack of evidence regarding OC use?s effect on the spirometric parameters (Wilk?s ? = 0.850, F=0.757, p=0.647, ?²=0.053) and on cytokins levels (Wilk?s ? = 0.909, F=0.533, p=0.848, ?²=0.031), even when controlled by covariates. Therefore, this study returned lack of evidences concerning the relation between the use of OC use and alteration in spirometric parameters as well in cytokins dosages.
- ItemAcesso aberto (Open Access)Association between asthma and female sex hormones(Associacao Paulista Medicina, 2017) de Carvalho Baldacara, Raquel Prudente; Silva, Ivaldo [UNIFESP]CONTEXT AND OBJECTIVE: The relationship between sex hormones and asthma has been evaluated in several studies. The aim of this review article was to investigate the association between asthma and female sex hormones, under different conditions (premenstrual asthma, use of oral contraceptives, menopause, hormone replacement therapy and pregnancy). DESIGN AND SETTING: Narrative review of the medical literature, Universidade Federal do Tocantins (UFT) and Universidade Federal de Sao Paulo (Unifesp). METHODS: We searched the CAPES journal portal, a Brazilian platform that provides access to articles in the MEDLINE, PubMed, SciELO, and LILACS databases. The following keywords were used based on Medical Subject Headings: asthma, sex hormones, women and use of oral contraceptives. RESULTS: The associations between sex hormones and asthma remain obscure. In adults, asthma is more common in women than in men. In addition, mortality due to asthma is significantly higher among females. The immune system is influenced by sex hormones: either because progesterone stimulates progesterone-induced blocking factor and Th2 cytokines or because contraceptives derived from progesterone and estrogen stimulate the transcription factor GATA-3. CONCLUSIONS: The associations between asthma and female sex hormones remain obscure. We speculate that estrogen fluctuations are responsible for asthma exacerbations that occur in women. Because of the anti-inflammatory action of estrogen, it decreases TNF-alpha production, interferon-gamma expression and NK cell activity. We suggest that further studies that highlight the underlying physiopathological mechanisms contributing towards these interactions should be conducted.
- ItemAcesso aberto (Open Access)Asthma and Rhinitis in South America: How Different They are From Other Parts of the World(Korean Acad Asthma Allergy & Clinical Immunology, 2012-03-01) Chong Neto, Herberto Jose; Rosario, Nelson Augusto; Sole, Dirceu [UNIFESP]; Latin Amer ISAAC Grp; Univ Fed Parana; Universidade Federal de São Paulo (UNIFESP)Asthma and rhinitis epidemiology has wide variations around the world. the aim of this review was verify the prevalence of asthma and rhinitis in South America and report differences from other regions of the world. We reviewed studies with International Study of Asthma and Allergies in Childhood (ISAAC) methodology in South America, Phases I and III. in South America the ISAAC Phase I ranked four countries among top ten in prevalence of asthma and three countries among top ten in prevalence of rhinoconjunctivitis. ISAAC Phase III showed little changes in asthma and rhinitis prevalence in South American countries. the prevalence increases of asthma and rhinitis in South American centers indicate that the burden of both is continuing to rise, but the differences in prevalence are lessening.
- ItemAcesso aberto (Open Access)Atopy, passive smoking, respiratory infections and asthma among children from kindergarten and elementary school(Associação Paulista de Medicina - APM, 2002-07-01) Ribeiro, Sandra Aparecida [UNIFESP]; Furuyama, Tatiana [UNIFESP]; Schenkman, Simone [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT: It has been demonstrated that children exposed to parents who smoke have more respiratory infections and asthma. OBJECTIVE: To study the association of both respiratory infections and asthma attacks with atopy, passive smoking and time spent daily at school, among children aged 4 to 9 years old from a kindergarten and elementary school in the city of São Paulo between May and July of 1996. TYPE OF STUDY: Descriptive study. SETTING: A kindergarten and elementary school with linkages to Universidade Federal de São Paulo (UNIFESP)/Escola Paulista de Medicina. PARTICIPANTS: 183 children between 4 and 9 years old. MAIN MEASUREMENTS: A questionnaire consisting of 31 questions was answered by the parents of 183 children, and skin tests for inhaled antigens were performed on 88 children whose parents had given prior agreement for the procedure. RESULTS: Among the children, 51% had had respiratory infections during the preceding 3 months and 25.7% were asthmatic, of whom 52.1% had had one or more asthma attacks during the preceding 3 months. Children exposed to passive smoking did not have more respiratory infections or asthma attacks in comparison with those not exposed. We observed a significant association between atopic disorders in parents and children who were not exposed to passive smoking. There were also associations between atopic disorders in parents and asthma attacks in their infants, and between such disorders and a higher incidence of respiratory infections in the infants during the preceding 3 months. However, the presence of two or more positive skin tests for allergies did not have a correlation with respiratory infections and asthma attacks in this sample. In addition to this, children who studied full time at school did not have a higher occurrence of respiratory infections and asthma attacks. CONCLUSIONS: The presence of respiratory infections and asthma was associated with atopic parents but not with the presence of two or more positive skin tests for allergies among the children. Also, respiratory infections and asthma attacks were not associated with smoking parents or with the length of time spent by the children at school.
- ItemAcesso aberto (Open Access)Avaliação da capacidade funcional e nível de atividade física na vida diária em mulheres asmáticas e saudáveis(Universidade Federal de São Paulo (UNIFESP), 2020-10-05) Silva, Janaina Bandeira da [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; http://lattes.cnpq.br/0334734747375995; http://lattes.cnpq.br/8282880984781588; Universidade Federal de São Paulo (UNIFESP)Introdução: A asma é uma doença inflamatória crônica das vias aéreas que cursa com limitação variável do fluxo aéreo expiratório. O exercício físico tem efeitos benéficos no controle da doença, sendo capaz de reduzir a inflamação sistêmica e das vias aéreas. Indivíduos asmáticos podem ter uma menor tolerância ao exercício, devido a diversos fatores, entre eles o grau de obstrução ao fluxo aéreo e a inatividade física. Com isso, é comum que estes indivíduos adotem um estilo de vida sedentário. Objetivos: Comparar a capacidade funcional e as respostas fisiológicas ao exercício além de avaliar o nível de atividade física na vida diária (NAFVD) entre adultos asmáticos e seus congêneres controles. Métodos: Este foi um estudo transversal analítico que avaliou mulheres asmáticas e grupo controle. Os participantes foram submetidos ao protocolo que consistiu em avaliação inicial e antropométrica, espirometria, teste de controle da asma (ACT), questionário de controle da asma (ACQ), avaliação do ISWT e o questionário internacional de atividade física (IPAQ). Para o ISWT foram realizadas duas repetições do protocolo buscando minimizar o efeito aprendizado e a maior distância percorrida nos dois testes foi submetida à análise. Resultados: Foram avaliadas 22 mulheres asmáticas e 22 mulheres saudáveis com idade entre 18 a 40 anos. As variáveis espirométricas analisadas apresentaram valores inferiores para o grupo asmático (GA) quando comparado ao grupo saudável (GS) (p<0,001). A distância percorrida no ISWT foi maior no GS quando comparado ao GA (614±78m e 515±133m, respectivamente; p=0,005). A pontuação obtida no questionário ACQ e a frequência cardíaca final obtida no ISWT apresentaram correlação inversa com os dias de prática de atividade física moderada (IPAQ) (r=-0,453, p=0,068; r=0,530, p=0,029, respectivamente). Conclusão: Nos indivíduos asmáticos avaliados neste estudo, encontramos um nível reduzido de capacidade funcional e associação do baixo NAFVD com pior o nível de controle da asma. Com isso, podemos sugerir a importância de detectar clinicamente uma baixa atividade física habitual em pacientes asmáticos e orientar a prática de atividade física, buscando assim contribuir com um melhor prognóstico e tratamento da doença.
- ItemSomente MetadadadosAvaliação da correlação entre o controle clínico da asma, os valores de função pulmonar e o grau de inflamação das vias aéreas em crianças e adolescentes com asma(Universidade Federal de São Paulo (UNIFESP), 2014-11-28) Chaves, Danielle Maria de Souza [UNIFESP]; Wandalsen, Gustavo Falbo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: to evaluate in children and adolescents relations among four asthma characteristics: values of exhaled nitric oxide (FeNO), lung function, bronchodilator response (BR) and the degree of asthma control; to describe FeNO values in this population of asthmatics and to study the influence of clinical, demographic and functional aspects. Methods: cross-sectional evaluation of 147 children and adolescents with asthma followed in a reference out-patient clinic measuring FeNO values, spirometry, BR, asthma control questionnaire (ACT or C-ACT) and clinical data. Results: median age was 12.2 years (6 to 18 years) and 92 were males. Median from the time since the last asthma exacerbation was three months. Median of BMI z score was 0.73z and 122 patients had some associated disease, predominating allergic rhinitis (101 patients) and atopic dermatitis (42 patients). Ninety nine patients were in regular use of asthma control medication for at least one month. Seventy three (50%) patients had some abnormality in lung function and 34 (24%) showed positive BR (FEV1 increase of ? 12%). Uncontrolled asthma (ACT or C-ACT ? 19) was observed in 45 (31%) cases. In the total group we observed moderate correlations only between BR values and: FEV1 (r= -0.46), FEV1/FVC (r= -0.44) and FEF25-75% (r= -0.33). Among patients without regular control treatment, FeNO values correlated significantly with FEV1/FVC (r= -0.34), FEF25-75% (r= -0.34) and ACT/C-ACT (r= -0.25). Correlations observed in patients with regular asthma control treatment were, in general, weaker than those founded in patients without control treatment. In this group, FeNO values correlated significantly only with FEV1/FVC values (r= -0.18). FeNO values ranged from 1ppb to 196ppb (median 29.9ppb) and abnormal values (> 25ppb) were found in 81 (55%) patients. Those in regular use of asthma control medication had lower values than those without it (median: 23.5ppb vs 37.0ppb; p=0.006). FeNO values correlated significantly with time since the last asthma exacerbation (r= -0.24; p=0.02) and age (r= 0.19; p=0.009). Patients, when separated according to GINA steps of treatment, showed significantly different values of FeNO (p=0.04). Patients with abnormal lung function had higher BR values (median: 9% vs 5%; p<0.01) and lower values of ACT/C-ACT (median: 20 vs 22; p=0.01). Patients with positive BR had lower values of FEV1 (median: 76% vs 95%; p<0.001), FEV1/FVC (median: 76% vs 90%; p<0.001) and FEF25-75% (median: 59% vs 88%; p<0.001) than those without positive BR response. FeNO values were higher among patients with BR response (median: 45.3ppb vs 25.4ppb; p=0.01). Patients with uncontrolled asthma showed larger BR (median: 8% vs 5%; p=0.01) but without differences in FeNO values and lung function. Conclusions: FeNO, lung function, BR and asthma control scores are variables that did not correlate strongly, probably because they represent different domains of the disease. Correlations between FeNO values and these variables were stronger among asthmatics without regular control treatment. FeNO values showed a large variability and correlated significantly with age (positive) and time since the last asthma exacerbation (negative)
- ItemAcesso aberto (Open Access)Avaliação da rinussinusite bacteriana aguda em pacientes asmáticos com base em parâmetros clínicos, exame otorrinolaringológico e estudo de imagem(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-06-01) Faure, Alecsandra Calil Moises [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]; Fernandes, Artur da Rocha Correa [UNIFESP]; Fernandes, Ana Luisa Godoy [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. METHODS: A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. RESULTS: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. CONCLUSIONS: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.
- ItemAcesso aberto (Open Access)Avaliação de critérios para o diagnóstico de asma através de um questionário epidemiológico(Sociedade Brasileira de Pneumologia e Tisiologia, 2009-03-01) Wandalsen, Neusa Falbo [UNIFESP]; Gonzalez, Cássia; Wandalsen, Gustavo Falbo [UNIFESP]; Solé, Dirceu [UNIFESP]; Faculdade de Medicina do ABC Departamento de Pediatria; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate criteria for the diagnosis of asthma in an epidemiological survey. METHODS: Adolescents (13-14 years of age) and legal guardians of schoolchildren (6-7 years of age) in the city of Santo André, Brazil, completed the International Study of Asthma and Allergies in Childhood (ISAAC) standard written questionnaire. Affirmative responses regarding wheezing within the last 12 months, asthma ever, bronchitis ever (question added at the end of the questionnaire), as well as the overall ISAAC score above the predefined cutoff points, were considered indicative of asthma. RESULTS: The legal guardians of 2,180 schoolchildren and 3,231 adolescents completed the questionnaires properly. Depending on the criterion adopted, the prevalence of asthma ranged from 4.9% to 26.8% for the schoolchildren and from 8.9% to 27.9% for the adolescents. The criteria with the lowest and highest prevalences were, respectively, physician-diagnosed asthma and physician-diagnosed bronchitis. When compared with other criteria, physician-diagnosed bronchitis showed concordance levels between 71.9% and 79.4%, positive predictive values between 0.16 and 0.63 and poor concordance (kappa: 0.21-0.46). Strong concordance levels were found only between wheezing within the last 12 months and the overall ISAAC score (kappa: 0.82 and 0.98). CONCLUSIONS: The prevalence of asthma varied significantly, depending on the criterion adopted, and there was poor concordance among the criteria. Wheezing within the last 12 months and the overall ISAAC score are the best criteria for the diagnosis of asthma, whereas the question regarding bronchitis ever did not improve the questionnaire. Modifications in this instrument can make it difficult to draw comparisons and should therefore be carefully evaluated.
- ItemSomente MetadadadosAvaliação de um programa de atenção a crianças portadoras de chiado no peito, nas unidades básicas de Saúde do Jardim S. Emília e do Jardim S. Eduardo, município do Embu-SP, de maio/88 a julho/93(Universidade Federal de São Paulo (UNIFESP), 1995) Ventura, Renato Nabas [UNIFESP]; Naspitz, Charles Kirov [UNIFESP]
- ItemSomente MetadadadosAvaliação do efeito do Deidrodieugenol extraído das folhas de Nectandra leucantha (Lauraceae) em modelo experimental de asma grave(Universidade Federal de São Paulo (UNIFESP), 2020-04-17) Ponci, Vitor [UNIFESP]; Lago, João Henrique Ghilardi [UNIFESP]; Universidade Federal de São PauloAsthma is a chronic disease with high global prevalence, affecting around 235 million people around the globe. In Brazil, a 10% prevalence is estimated, with approximately 2.500 deaths per year, according to DATASUS national database. Asthma control is based on corticosteroid therapy, however portions of asthmatic patients do not respond well to this treatment, originating the difficult-to-control severe asthma phenotype. These patients have elevated airway hyperresponsiveness, higher frequency of exacerbations and remodeling and are responsible for a significant portion of total healthcare costs with asthma due to hospitalizations, specially the mixed-granulocytic endotype. For this endotype of asthma, there is a significant contribution of neutrophils, besides the elevated concentration of eosinophils as well and no specific therapy available. The aim of this study was to isolate, from the leaves of Nectandra leucantha, the neolignoid dehydrodieugenol, which structure was defined through nuclear magnetic resonance and mass spectra analysis, allied with the validation of a synthetic approach for the acquisition of dehydrodieugenol from eugenol as starting material to evaluate its antiasthmatic potential in a mice model of mixed-granulocytic asthma. Dehydrodieugenol was administered intraperitoneally in three different regimen doses (10 mg/kg for 8 days, 10 mg/kg for 4 days and 20 mg/kg for 4 days) in ovalbumin-sensitized BALB/C male mice in order to find the most efficacious dose regimen to further evaluate its potential regarding improvement in lung function and inflammatory parameters in comparison to positive control dexamethasone (5 mg.kg-1, i.p.). Based on dose-response analysis, dehydrodieugenol (20 mg.kg–1) for 4 days of treatment was the only dose regimen that resulted in significant reduction on both eosinophils (ΔBISxOVA=6,09.104/mL; P<0,05) and neutrophils (ΔBISxOVA=2,40.104/mL; P<0,001) on bronchoalveolar lavage fluid in ovalbuminsensitized mice with no statistically difference from dexamethasone (P>0,05). As for lung function parameters, dehydrodieugenol (20 mg.kg–1) significantly reduced airway (ΔRawBISxOVA = 1,67 cmH2O.s/mL, P<0,05) and tissue (ΔGtis BISxOVA = 4,60 cmH2O.s/mL; P<0,05) resistance in comparison to ovalbumin group, with similar efficacy to positive control dexamethasone. Airway hyperresponsiveness to intravenous methacholine was reduced with dehydrodieugenol but was inferior to dexamethasone in higher doses. No changes were observed on elastance in any group. Dehydrodieugenol showed good overall safety profile, without any deaths or concerns observed during the protocol and no change in liver, thymus or spleen mass compared to saline control group. Moreover, its production has low costs and few steps, making it possible to produce in larger scales. Thus, dehydrodieugenol (20 mg.kg–1) showed great antiasthmatic potential for the treatment of mixed-granulocytic asthma, for the substitution or combination therapy with corticosteroids, in order to reduce the risk of adverse events related to its chronic use, and can be obtained in few steps through the chemical preparation from eugenol.