Assuntos
Eosinófilos , Contagem de Leucócitos , Lavagem Nasal , Escarro/citologia , Asma/diagnóstico , Humanos , Curva ROCRESUMO
UNLABELLED: This 12-week study compared the efficacy and safety of a fixed combination of fluticasone propionate plus formoterol (FL/F) 250/12 µg b.i.d. administered via a dry powder inhaler (DPI) (Libbs Farmacêutica, Brazil) to a combination of budesonide plus formoterol (BD/F) 400/12 µg b.i.d. After a 2-week run-in period (in which all patients were treated exclusively with budesonide plus formoterol), patients aged 12-65 years of age (N = 196) with uncontrolled asthma were randomized into an actively-controlled, open-labeled, parallel-group, multicentre, phase III study. The primary objective was to demonstrate non-inferiority, measured by morning peak expiratory flow (mPEF). The non-inferiority was demonstrated. A statistically significant improvement from baseline was observed in both groups in terms of lung function, asthma control, and the use of rescue medication. FL/F demonstrated a statistical superiority to BD/F in terms of lung function (FEV(1)) (p = 0.01) and for asthma control (p = 0.02). Non-significant between-group differences were observed with regards to exacerbation rates and adverse events. In uncontrolled or partly controlled asthma patients, the use of a combination of fluticasone propionate plus formoterol via DPI for 12-weeks was non-inferior and showed improvements in FEV(1) and asthma control when compared to a combination of budesonide plus formoterol. ( CLINICAL TRIAL NUMBER: ISRCTN60408425).
Assuntos
Antiasmáticos/administração & dosagem , Asma/prevenção & controle , Administração por Inalação , Adolescente , Adulto , Idoso , Androstadienos/administração & dosagem , Androstadienos/efeitos adversos , Antiasmáticos/efeitos adversos , Asma/fisiopatologia , Budesonida/administração & dosagem , Budesonida/efeitos adversos , Criança , Combinação de Medicamentos , Inaladores de Pó Seco , Etanolaminas/administração & dosagem , Etanolaminas/efeitos adversos , Feminino , Fluticasona , Volume Expiratório Forçado/efeitos dos fármacos , Fumarato de Formoterol , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório/efeitos dos fármacos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: It is noteworthy that there is a clear clinical, epidemiological and pathophysiological association between upper and lower airway inflammation in rhinitis and asthma. OBJECTIVE: The aim of this study was to compare the eosinophil counts in induced sputum and nasal lavage fluids in asthma, checking their association and the accuracy of nasal eosinophilia as a predictor of sputum eosinophilia by a cross-sectional study. METHODS: The clinical evaluation, asthma control questionnaire (ACQ), pre- and post-bronchodilator spirometry, nasal and sputum sample was performed. The nasal eosinophilia was analysed by a receiver operating curve and logistic regression model. RESULTS: In 140 adults, the post-bronchodilator forced expiratory volume in 1 s (FEV(1)) did not differ between patients with or without sputum eosinophilia (0.18). After adjusted for upper airway symptoms, age, ACQ score and post-bronchodilator FEV(1), sputum eosinophilia was associated with 52 times increase in odds of nasal eosinophilia, whereas each 1% increase in bronchodilator response was associated with 7% increase in odds of nasal eosinophilia. CONCLUSION: This study brings further evidence that upper airway diseases are an important component of the asthma syndrome. Furthermore, monitoring of nasal eosinophilia by quantitative cytology may be useful as a surrogate of sputum cytology in as a component of composite measurement for determining airway inflammation.
Assuntos
Asma , Eosinofilia/diagnóstico , Inflamação , Nariz/imunologia , Administração Intranasal , Adulto , Asma/diagnóstico , Asma/imunologia , Asma/fisiopatologia , Estudos Transversais , Eosinofilia/imunologia , Eosinófilos/citologia , Eosinófilos/imunologia , Feminino , Humanos , Inflamação/imunologia , Inflamação/fisiopatologia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Líquido da Lavagem Nasal , Escarro/imunologiaRESUMO
Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled). Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70) and hospitalization (US$86.30 vs US$12.88)], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2%) and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.
Assuntos
Asma/economia , Efeitos Psicossociais da Doença , Custos Diretos de Serviços/estatística & dados numéricos , Adulto , Asma/tratamento farmacológico , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled). Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70) and hospitalization (US$86.30 vs US$12.88)], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2 percent) and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Asma/economia , Efeitos Psicossociais da Doença , Custos Diretos de Serviços/estatística & dados numéricos , Asma/tratamento farmacológico , Brasil , Estudos Transversais , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
CONTEXT: Budesonide is an inhaled corticosteroid with high topical potency and low systemic activity recommended in the treatment of chronic asthma. OBJECTIVE: This study was conducted to determine the efficacy and safety of inhaled budesonide via a breath-activated, multi-dose, dry-powder inhaler. TYPE OF STUDY: Multicenter randomized parallel-group, placebo-controlled, double-blind, clinical trial. SETTING: Multicenter study in the university units. PARTICIPANTS: Adult patients with mild-to-moderate asthma that was not controlled using bronchodilator therapy alone. PROCEDURES: Comparison of budesonide 400 microg administered twice daily via a breath-activated, multi-dose, dry-powder inhaler with placebo, in 43 adult patients (aged 15 to 78 years) with mild-to-moderate asthma (FEV1 71% of predicted normal) that was not controlled using bronchodilator therapy alone. MAIN MEASUREMENTS: Efficacy was assessed by pulmonary function tests and asthma symptom control (as perceived by the patients) and the use of rescue medication. RESULTS: Budesonide 400 microg (bid) was significantly more effective than placebo in improving morning peak expiratory flow (mean difference: 67.9 l/min; P < 0.005) and FEV1 (mean difference: 0.60 l; P < 0.005) over the 8-week treatment period. Onset of action, assessed by morning peak expiratory flow, occurred within the first two weeks of treatment. CONCLUSIONS: Budesonide via a breath-activated, multi-dose, dry-powder inhaler results in a rapid onset of asthma control, which is maintained over time and is well tolerated in adults with mild-to-moderate asthma.
Assuntos
Anti-Inflamatórios/uso terapêutico , Asma/tratamento farmacológico , Budesonida/uso terapêutico , Administração por Inalação , Administração Tópica , Adolescente , Adulto , Idoso , Anti-Inflamatórios/efeitos adversos , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Budesonida/efeitos adversos , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , Glucocorticoides , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Resultado do TratamentoRESUMO
Primary and secondary data show the importance and distribution of human Chagas disease (HCD) in Northeast Brazil. Among the 27 detected vector species, Triatoma infestans, Panstrongylus megistus, Triatoma brasiliensis and Triatoma pseudomaculata are epidemiologically important. Major medical impact is attributed to T. infestans and P. megistus, the most domiciliated and vulnerable species, while the other two are native and more difficult to control. Regional differences in transmission and medical impact of HCD exist in the Northeast, where in general the disease appears to be less harmful than in other Brazilian regions like the Southeast and State of Goiás. There is a downward trend in HCD transmission and morbidity in the Northeast, its control in the region is a cause of concern because of the decommissioning of the National Health Foundation without a corresponding assimilation of its routine activities by regional and municipal institutions.
Assuntos
Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Insetos Vetores , Panstrongylus , Triatoma , Adolescente , Adulto , Animais , Brasil/epidemiologia , Doença de Chagas/mortalidade , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Densidade Demográfica , Prevalência , Características de Residência , População Rural/estatística & dados numéricos , Triatoma/classificação , Trypanosoma cruziRESUMO
Hepatic Schistosoma mansoni periovular granulomas undergo changes in size, cellular composition and appearance with time. This phenomenon, known as "immunological modulation", has been thought to reflect host immunological status. However, as modulation has not been observed outside the liver, participation of local factors, hitherto little considered, seems crucial. Components of the extracellular matrix of periovular granulomas of the mouse were particularly studied in three different organs (liver, lung and intestine) and during three periods of infection time (acute, intermediate and chronic) by means of histological, biochemical and immunofluorescence techniques, while quantitative data were evaluated by computerized morphometry, in order to investigate participation of local factors in granuloma modulation. Results confirmed modulation as a exclusively hepatic phenomenon, since pulmonary and intestinal granulomas, formed around mature eggs, did not change size and appearance with time. The matricial components which were investigated (Type I, III and IV collagens, fibronectin, laminin, proteoglycans and elastin) were found in all granulomas and in all organs examined. However, their presence was much more prominent in the liver. Elastin was only found in hepatic granulomas of chronic infection. The large amount of extracellular matrix components found in hepatic granulomas was the main change responsible for the morphological aspects of modulation. Therefore, the peculiar environment of the liver ultimately determines the changes identified in schistosomal granuloma as "modulation".
Assuntos
Granuloma/patologia , Enteropatias Parasitárias/patologia , Hepatopatias Parasitárias/patologia , Pneumopatias Parasitárias/patologia , Schistosoma mansoni/imunologia , Esquistossomose mansoni/patologia , Animais , Matriz Extracelular , Feminino , Granuloma/imunologia , Granuloma/parasitologia , Enteropatias Parasitárias/imunologia , Enteropatias Parasitárias/parasitologia , Hepatopatias Parasitárias/imunologia , Hepatopatias Parasitárias/parasitologia , Pneumopatias Parasitárias/imunologia , Pneumopatias Parasitárias/parasitologia , Masculino , Camundongos , Contagem de Ovos de Parasitas , Esquistossomose mansoni/imunologia , Esquistossomose mansoni/parasitologia , Fatores de TempoRESUMO
BACKGROUND: We wanted to determine the postoperative pulmonary complication after upper abdominal surgery in patients with pulmonary obstrutive syndrome. METHODS: We have studied 196 patients prospectively analyzed in preoperative period with spirometry and followed for observation of PPC. The patients were divided in four groups: COPD - those with chronic bronchitis or emphysema and VEF1/CVF< 70% (27 patients). ASMA - patients with obstruction of the airway in response to provoking stimuli (44 patients). CHRONIC BRONCHITIS-EMPHYSEMA - those with the clinical diagnoses of the respective diseases but VEF1/CVF > 70% (23 patients). NORMAL - patients without pulmonary disease and normal spirometry (102 patients). RESULTS: Postoperative pulmonary complication was recognized when the patient presented atelectasis with clinical or gasometric alterations; bronchospasm that needed bronchodilator therapy; respiratory failure; mechanical ventilation or orotracheal intubation more than 48 hours in postsurgery period; tracheobronchitis characterized by the presence of purulent sputum with normal x-ray; pneumonia. Patients with pulmonary obstruction had experienced higher rates of pulmonary complications (32% vs 6%, p<0.05). The presence of obstructive lung disease was associated with an increased number of ventilator days, but was not associated with longer intensive care unit or hospital stay. CONCLUSIONS: The incidence of postoperative pulmonary complications was strongly associated with the presence of pulmonary obstructive syndrome.