RESUMO
BACKGROUND: Although previous data suggest that intranasal fluticasone furoate (FF) improves ocular symptoms of allergic rhinitis (AR), it presents serious limitations that question its results and conclusions. Therefore, an independent systematic review with meta-analysis is required to confirm and clarify the magnitude of the effect of FF. METHODS: This review compared the efficacy of intranasal FF to placebo on ocular and nasal symptoms in patients with AR. Primary outcomes were reflective and instantaneous total ocular symptom scores (rTOSS and iTOSS), and reflective and instantaneous total nasal symptom scores (rTNSS and iTNSS). Secondary outcomes included the assessment of response to therapy, quality of life (QoL), and adverse effects. RESULTS: Sixteen trials (5.348 patients) were selected. Seven studies included seasonal AR patients and nine studies, perennial AR patients. Intranasal FF significantly improved rTOSS and iTOSS scores compared with placebo in patients with seasonal (weighted mean difference [WMD] -0.54, 95% CI, -0.70 to -0.37, and -0.59, 95% CI, -0.76 to -0.43) and perennial AR (-0.33, 95% CI, -0.31 to -0.05, and -0.38, 95% CI, -0.69 to -0.07). Intranasal FF was also significantly more effective in improving rTNSS and iTNSS scores in seasonal (WMD=-1.14, 95% CI, -1.57 to -0.72, and -1.32, 95% CI, -1.64 to -1.01) and perennial AR patients (-0.83, 95% CI, -1.08 to -0.59, and -0.90, 95% CI, -1.33 to -0.48). Finally, there were greater improvements in response to therapy and QoL with a favourable safety profile. CONCLUSIONS AND CLINICAL RELEVANCE: Intranasal FF showed a consistent ocular and nasal efficacy along with improvement in QoL in AR patients. This review provides significant evidence that treatment with FF nasal spray at a dose of 110 mcg once daily is effective in relieving ocular and nasal symptoms in adolescents and adults with AR.
Assuntos
Androstadienos/administração & dosagem , Androstadienos/uso terapêutico , Antialérgicos/administração & dosagem , Antialérgicos/uso terapêutico , Sprays Nasais , Rinite Alérgica Sazonal/tratamento farmacológico , Administração Intranasal , Humanos , PlacebosRESUMO
OBJECTIVES: To determine the level and cost of unscheduled health care resource use in adults and children across all asthma symptom severities in Latin America. METHODS: The level and cost of health care resource use were analysed for 2074 patients with asthma included in the Asthma Insights and Reality in Latin America (AIRLA) survey from 10 Latin American countries. Health care resource use was multiplied by country-specific unit costs to estimate average per-patient annual costs. Patients were classified as adults (> or = 16 years) or children (<16 years), with disease severity categorized using a symptom severity index. RESULTS: Persistent asthma symptoms were experienced by 53.1% of patients (50.1% of children and 54.6% of adults). In the year preceding the survey, 57.1% of patients required unscheduled health care resource use and 45.1% reported at least 1 emergency hospital contact. The percentage of patients reporting unscheduled health care resource use was greatest amongst those with severe persistent symptoms (71.9%) but it was also high in those with mild intermittent symptoms (45.7%). An average of 73.2% of annual costs of asthma-related health care for the 10 countries was due to unscheduled health care. Expenditure on unscheduled care was greatest amongst both adults and children with severe persistent asthma symptoms (US $558 and US $769, respectively). Adults and children with mild intermittent symptoms also incurred considerable unscheduled costs (US $204 and US $215, respectively). CONCLUSIONS: Poorly controlled asthma imposes a considerable cost burden driven by unscheduled health care resource use in Latin America. Treatments to control asthma and reduce the need for unscheduled health care could reduce this cost in both adults and children.
Assuntos
Asma/economia , Asma/terapia , Atenção à Saúde/economia , Adolescente , Adulto , Feminino , Custos de Cuidados de Saúde , Humanos , América Latina , Masculino , Adulto JovemRESUMO
BACKGROUND: The EAGLE project database was analysed to assess the characteristics of patients with severe (SA) who required hospitalisation as a result of an acute episode during the period 1994-2004, and the relationship with asthma severity. METHODS: A total od 2593 clinical records corresponding to an equal number of patients hospitalised for acute asthma (15-69 years), with sufficient information to characterize their asthma severity in agreement with GNA criteria were identified (727 patients with SA compared with 1866 patients with non-severe asthma). RESULTS: Patients with SA were older, displayed a greater predominance of female asthmatics, lower antecedents of atopy, and a higher frequency of previous hospitalisations compared with non-severe asthmatics (86.1% vs. 50.5%, p< or = 0.01). Additionally, SA patients showed more severe exacerbations characterized by acidosis, significant spirometric deterioration, greater length of hospital stay (9.4 days vs. 7.0 days), as well as a higher frequency of intubation (16.8% vs. 2.1%), intensive care unit admission (11.3% vs.4.9%), cardiopulmonary arrest (5.5% vs. 1.3%), and asthma deaths (2.1% vs. 0.4%) (all < or = 0.01) compared wit non-severe patients. CONCLUSIONS: This study suggests that SA patients have greater morbidity and a disproportionate need for health care as a result of more severe exacerbations. However, non-severe asthmatics can also still present acute severe episodes (although with a lower frequency) with risk of life.
Assuntos
Asma/epidemiologia , Asma/fisiopatologia , Hospitalização , Acidose Respiratória , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Antiasmáticos/uso terapêutico , Asma/terapia , Broncodilatadores/uso terapêutico , Estudos de Casos e Controles , Progressão da Doença , Feminino , Parada Cardíaca , Humanos , Intubação , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores Sexuais , Espanha , Espirometria , Análise de SobrevidaRESUMO
Asthma is a global public health problem. Even though the prevalence is variable in different parts of the world, including Latin America, asthma morbility is high, particularly in countries with emerging economies. Asthma mortality is unacceptable, especially since it has been estimated that a high percentage of asthma deaths could be prevented. Fortunately, most patients suffer mild persistent asthma, however, there is evidence that asthma is many times underdiagnosed and undertreated. Primary care physicians, family doctors and paediatricians have to deal with the majority of asthma patients together with different medical conditions; such as heart problems, diabetes, and infectious, etcetera. In order to help these physicians in the process of decision making, guidelines have been developed. There are many asthma guidelines; they range from opinion based guidelines (in the past) to a current more evidence based approach. Among GINA, Global Initiative for Asthma, is the most comprehensive and widespread all around the world. More than a guideline, GINA is actually a programme directed at asthma specialists, other health care providers and patients and their families.
Assuntos
Asma , Guias de Prática Clínica como Assunto , Asma/diagnóstico , Asma/terapia , Humanos , Cooperação Internacional , MéxicoRESUMO
El Plan de Educación a través de información clara y precisa tiende a disminuir la frecuencia de las exacerbaciones, consecuentemente la disminución de la sintomatología clínica, mayor cumplimiento del tratamiento, y mejorar la calidad de vida. Objetivos: Evaluar el nivel de información previa de los pacientes que pertenecen al programa y el nivel de captación de la información brindada, para determinar el grado de efectividad del proceso educativo. Material y Métodos: Se encuestaron 50 pacientes con asma de bajo nivel socieconómico que pertenecen al programa. Fue administrado un cuestionario elaborado por nosotros, compuesto de 10 preguntas, en dos momentos: uno previo a la reunión informativa a cargo del equipo interdisciplinario, y otro posterior a ella. Se analizaron los datos a través de técnicas de estadística descriptiva e inferencial; para esta última se aplicó el Test de Significación Normal. Resultados: Los porcentajes promedios de respuestas correctas antes y después de la información fueron respectivamente: 65,4 por ciento y 89,8 por ciento, determinando una diferencia estadísticamente significativa (p < 0,005). Conclusiones: El nivel de captación de la información fue muy bueno, en aquellas preguntas que el conocimiento previo era significativamente menor, superó la diferencia promedio de respuestas correctas, y ratifica nuestra experiencia clínica: el desconocimiento y/o la negación de los aspectos emocionales intervinientes en esta enfermedad
Assuntos
Humanos , Criança , Asma , Estudo de Avaliação , Educação de Pacientes como Assunto , Educação em Saúde/tendências , Avaliação Educacional/estatística & dados numéricos , Estudo de AvaliaçãoRESUMO
El Plan de Educación a través de información clara y precisa tiende a disminuir la frecuencia de las exacerbaciones, consecuentemente la disminución de la sintomatología clínica, mayor cumplimiento del tratamiento, y mejorar la calidad de vida. Objetivos: Evaluar el nivel de información previa de los pacientes que pertenecen al programa y el nivel de captación de la información brindada, para determinar el grado de efectividad del proceso educativo. Material y Métodos: Se encuestaron 50 pacientes con asma de bajo nivel socieconómico que pertenecen al programa. Fue administrado un cuestionario elaborado por nosotros, compuesto de 10 preguntas, en dos momentos: uno previo a la reunión informativa a cargo del equipo interdisciplinario, y otro posterior a ella. Se analizaron los datos a través de técnicas de estadística descriptiva e inferencial; para esta última se aplicó el Test de Significación Normal. Resultados: Los porcentajes promedios de respuestas correctas antes y después de la información fueron respectivamente: 65,4 por ciento y 89,8 por ciento, determinando una diferencia estadísticamente significativa (p < 0,005). Conclusiones: El nivel de captación de la información fue muy bueno, en aquellas preguntas que el conocimiento previo era significativamente menor, superó la diferencia promedio de respuestas correctas, y ratifica nuestra experiencia clínica: el desconocimiento y/o la negación de los aspectos emocionales intervinientes en esta enfermedad (AU)
Assuntos
Humanos , Criança , Asma , Estudo de Avaliação , Educação de Pacientes como Assunto , Educação em Saúde/tendências , Avaliação Educacional/estatística & dados numéricos , Estudo de AvaliaçãoRESUMO
There are not enough data concerning asthma mortality in Latin America. The Latin American Society of Allergy and Immunology coordinated this project to provide reliable data for gaining knowledge about our present situation, which is a condition indispensable to changing it. The following countries participated in this study: Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Paraguay, Peru, Uruguay and Venezuela. A uniform protocol was designed in Santa Fe, Argentina. Asthma mortality rates were analyzed in accordance with two variables: age-adjusted rates (5-34) and total death rates. The total population studied was 107, 122, 529 inhabitants. The highest death rates were found in Uruguay and Mexico (5.63), and the lowest in Paraguay (0.8) and Colombia (1.35). Age-adjusted (5-34) rates were higher in Costa Rica (1.38) and lower in Chile (0.28). Regarding sex, the analysis of the information provided by seven countries showed a predominance of females (51.8%) over males (48.18%). In the southern Latin American countries such as Chile, Uruguay, Paraguay and Argentina, which have marked climatic differences, deaths occurred mainly in the winter. It is important to emphasize that, in most countries, deaths from asthma occurred at home: Chile (60.7%), Argentina (63.4%) and Paraguay (88%). However, in Uruguay, 58.6% occurred during hospitalization. Mortality rates from bronchial asthma are high in most of the Latin American countries studied, even though further studies are needed. Asthma is a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that can be severe and sometimes fatal. The health ministries of each country do not believe asthma is a significant issue. Therefore, we should provide them with sound epidemiological studies to convince them to change their attitude toward this disease.
Assuntos
Asma/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores SexuaisAssuntos
Asma/epidemiologia , Asma/mortalidade , Criança , Feminino , Humanos , América Latina/epidemiologia , Masculino , PrevalênciaRESUMO
Little information is available on mite allergen levels and rates of sensitization to domestic mites in South America. The purpose of this study was to establish the rate of sensitization to domestic mites in asthmatics and measure mite allergen levels in pillows and mattresses of mite allergic individuals in Santa Fe, Argentina. Dust samples were collected from the pillows and mattresses of 56 asthmatics (24 females and 32 males, mean age 17.6 +/- 11.5 years), who had been previously skin tested with standardized extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae and (1:50 w/v) extracts of Aleuroglyphus ovatus, Blomia tropicalis, Chortoglyphus arcuatus. A wheal > or = 3 mm was considered positive. Sensitization to Lepidoglyphus destructor and Euroglyphus maynei was determined by RAST and considered positive when a serum bound > or = 1% of the total counts added. Forty six individuals had a positive skin test to D. pteronyssinus, 43 to D. farinae, 27 to A. ovatus, 38 to B. tropicalis, 27 to C. arcuatus; 38 of 54 individuals had a positive RAST to E. maynei and 22 of 54 to L. destructor. The mean Group 1 (Der p 1 + Derf 1) level in pillows (n = 48) was 6.7 micrograms/g (1-55.4) and in mattresses (n = 52) 4.3 micrograms/g (1-38.8). There is a high degree of sensitization to domestic mites among asthmatics in Santa Fe. High mite allergen levels (> 2 micrograms/g) can be detected very often in pillows and mattresses.
Assuntos
Alérgenos/efeitos adversos , Glicoproteínas/imunologia , Hipersensibilidade/etiologia , Ácaros/imunologia , Adolescente , Adulto , Animais , Antígenos de Dermatophagoides , Argentina , Roupas de Cama, Mesa e Banho , Criança , Feminino , Humanos , Masculino , População UrbanaRESUMO
El asma bronquial es una enfermedad multifactorial donde tienen cabida los factores hereditarios, mecanismos inmunológicos, procesos infecciosos y la variable psicológica en el proceso de modulación de la enfermedad. Los objetivos fueron: 1. Determinar cuantitativamente el porcentaje de participación del compromiso emocional. 2. Correlacionar el perfil psicológico del grupo estudiado (n=36), con el grado de compromiso emocional del perfil psicológico familiar de estos pacientes. 3. Evaluar si el grado de compromiso orgánico coincide con la severidad del compromiso emocional. Se estudió 36 pacientes con asma de más de 3 años de evolución. Edades: 4 a 12 años (X=8,3 años). Se realizó psicodiagnóstico: a. Entrevista operativa semiabierta con ambos padres; b. Entrevista pautada con ambos padres: (Historia clínica especialmente diseñada); c. Batería de tests: 1. Santuchi-Bender; 2. Casa pintada; 3. Figura humana; 4. Familia; 5. Desiderativo; 6. CAT; 7. Nemi y Raven. Se evaluó los indicadores emocionales con la Tabla de Lic. Baravalle y cols. Se evaluó los indicadores orgánicos de acuerdo a Consenso Argentino de Pediatría para el Diagnóstico y Tratamiento del Asma Bronquial Infantil (Sociedad Argentina de Pediatría). Resultados: Los obtenidos estadísticamente evidenciaron un compromiso más acentuado al cuantificar el perfil psicológico de la familia (86 por ciento) que el perfil psicológico del niño (75 por ciento). El compromiso emocional de mayor severidad que el orgánico. Conclusiones: Esto plantea la evaluación del factor emocional en todos los niños que presentan asma moderado o intenso, e indica la necesidad de modificar pautas en la estrategia terapéutica integral del niño con asma, que incluyan su grupo familiar.