RESUMO
BACKGROUND: An asthma score was proposed in the European Community Respiratory Health Survey (ECRHS) framework, as dichotomous definitions could be less appropriate in the study of chronic diseases. The aims of this study were to assess the value of this asthma score in comparison with other definitions of asthma in another population setting, using as criteria bronchial hyperresponsiveness (BHR) to methacholine and diagnosed asthma, and the association of these definitions to known risk factors of asthma. METHODS: We used the ECRHS questionnaire on 2063 Brazilians, aged 23-25 years, and measured their BHR. We assessed the positive and negative likelihood ratios (PLR and NLR) of the asthma score (0-8), a three question score (ECRHS definition) and single asthma symptoms in relation to BHR and diagnosed asthma. RESULTS: The PLR were relatively low for all asthma definitions with odd ratios varying from 1.47 for asthma score to 5.50 for wheeze and waking with breathlessness without a cold. The NLR were near 1. The PLR were lower for assessments using the score than for dichotomous assessments or the ECRHS definition. The PLR increased with asthma scores, but the prevalence with higher scores was too low for useful analysis. The asthma score was slightly better for identifying associations from a set of known risk factors than the other two approaches. CONCLUSION: Our study provided little support for a greater validity of this asthma score over other asthma definitions, and only marginal advantage for identifying risk factors.
Assuntos
Asma/diagnóstico , Asma/epidemiologia , Inquéritos Epidemiológicos , Cloreto de Metacolina , Índice de Gravidade de Doença , Adulto , Asma/classificação , Brasil/epidemiologia , Hiper-Reatividade Brônquica/diagnóstico , Hiper-Reatividade Brônquica/epidemiologia , Estudos de Coortes , Estudos Transversais , Dispneia/diagnóstico , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Cloreto de Metacolina/efeitos adversos , Prevalência , Sons Respiratórios/diagnóstico , Fatores de Risco , Testes Cutâneos , Inquéritos e QuestionáriosRESUMO
Objective: To evaluate the protective effect of different doses of inhaled fenoterol (F) on bronchoconstriction induced by methacholine (M). Design: randomized double-blind study. Setting: Referrence center. Participants: 9 children (aged from 7 to 15 years old), with mild or moderate asthma and allergic to D. pteronyssinus. Intervention: On the first day, the M concentration necessary to induce a 20 per cent fall in the forced expiratory volume in the first second (FEV(1); PC(20)FEV(1)) was determined using closed circuit inhalation (De Vilbiss 646). On subsequent days, the children inhaled a dose of F (25 or 50 or 100 or 220 mug) through the same circuit and, after 15 minutes the FEV(1), was measured, becoming the basal value. Bronchoprovocation was then initiated using the concentration prior to the PC(20)FEV(1) of the first day and continuing until there was a 20 per cent fall in the FEV(1). This concentration was the "new" PC(20)FEV(1). Results. F in a dose of 25 mug protected 2 of the 9 children, in a dose of 50 mg protected 4 of the 9 and in doses of 100 and 200 mug protected all children. We did not observe any relationship between the magnitude of the bronchodilation and bronchoprotection induced by the inhalation of F. Conclusions: Our results suggest that a dose of 100 mug of F is capable of inducing bronchoprotection in children with mild/moderate asthma.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Asma , Broncodilatadores/farmacologia , Broncoconstrição/efeitos dos fármacos , Broncoconstritores/efeitos adversos , Cloreto de Metacolina/efeitos adversos , Fenoterol/farmacologia , Administração por Inalação , Broncodilatadores/administração & dosagem , Método Duplo-Cego , Fenoterol/administração & dosagemRESUMO
OBJECTIVE: To evaluate the protective effect of different doses of inhaled fenoterol (F) on bronchoconstriction induced by methacholine (M). DESIGN: Randomized double-blind study. SETTING: Referrence center. PARTICIPANTS: 9 children (aged from 7 to 15 years old), with mild or moderate asthma and allergic to D. pteronyssinus. INTERVENTION: On the first day, the M concentration necessary to induce a 20% fall in the forced expiratory volume in the first second (FEV1; PC20FEV1) was determined using closed circuit inhalation (De Vilbiss 646). On subsequent days, the children inhaled a dose of F (25 or 50 or 100 or 200 micrograms) through the same circuit and, after 15 minutes the FEV1 was measured, becoming the basal value. Bronchoprovocation was then initiated using the concentration prior to the PC20FEV1 of the first day and continuing until there was a 20% fall in the FEV1. This concentration was the "new" PC20FEV1. RESULTS: F in a dose of 25 micrograms protected 2 of the 9 children, in a dose of 50 mg protected 4 of the 9 and in doses of 100 and 200 micrograms protected all children. We did not observe any relationship between the magnitude of the bronchodilation and bronchoprotection induced by the inhalation of F. CONCLUSIONS: Our results suggest that a dose of 100 micrograms of F is capable of inducing bronchoprotection in children with mild/moderate asthma.
Assuntos
Asma/tratamento farmacológico , Broncoconstrição/efeitos dos fármacos , Broncoconstritores/efeitos adversos , Broncodilatadores/administração & dosagem , Fenoterol/administração & dosagem , Cloreto de Metacolina/efeitos adversos , Administração por Inalação , Adolescente , Criança , Método Duplo-Cego , Feminino , Humanos , MasculinoAssuntos
Humanos , Hiper-Reatividade Brônquica/tratamento farmacológico , Hiper-Reatividade Brônquica/fisiopatologia , Hiper-Reatividade Brônquica/terapia , Cloreto de Metacolina , Cloreto de Metacolina/administração & dosagem , Cloreto de Metacolina/efeitos adversos , Cloreto de Metacolina , Cloreto de Metacolina/farmacocinética , Cloreto de Metacolina/farmacologiaRESUMO
Hiperreactividad bronquial (HRB) y atopia se asocian a menudo en el asma bronquial de la infancia y es cada vez mayor el número de estudios que así lo sugieren. Con la finalidad de cuantificar esa asociación, se estudiaron 35 niños asmáticos atópicos, entre 7 y 16 años, divididos en tres grupos de acuerdo con la severidad clínica-leve, moderada y severa. Material y métodos: Se determinó el grado de reactividad bronquial por inhalación de metacolina (PC20 VEF1 en mg/ml), pruebas cutáneas con aeroalergenos por método escarificación e IgE sérica total (en Ul/ml) por radioinmunoanálisis (RIA). Como parámetro principal de atopia se establecieron dos puntajes de pruebas cutáneas (PPC): PPc1: número de antígenos positivos (pápula igual o mayor de 3mm) y PPC2: suma de los diámetros (mm) de las pápulas generadas por los antígenos positivos. Resultados: Se observaron diferencias significativas para cada una de las variables estudiadas según el grado de severidad clínica del asma (para PC20 VEF1 p < 0,001; PPC1 p < 0,001; PPC2 p < 0,001 e IgE sérica total p < 0,001). Existió una correlación significativa entre PPC1 y PPC2 y el grado de reactividad bronquial medida por el log (PC20 VEF1) (r=0,61, p < 0,001 y r=0,65, p < 0,001 respectivamente). Lo mismo surgió de correlacionar IgE sérica y log (PC20 VEF1) (r=0,78, p < 0,001). Conclusiones: Creemos que la sensibilización con aeroalergenos es un factor relevante en la génesis del asma de la infancia; este estudio mostró que los parámetros de atopia considerados se asociaron en forma cuantitativa con el grado de severidad clínica del asma y de reactividad bronquial a la metacolina
Assuntos
Humanos , Masculino , Feminino , Adolescente , Asma/complicações , Hiper-Reatividade Brônquica/imunologia , Hipersensibilidade Imediata/diagnóstico , Asma/imunologia , Fenoterol/uso terapêutico , Imunoglobulina E/sangue , Cloreto de Metacolina/efeitos adversos , Testes Cutâneos/estatística & dados numéricos , Testes CutâneosRESUMO
Hiperreactividad bronquial (HRB) y atopia se asocian a menudo en el asma bronquial de la infancia y es cada vez mayor el número de estudios que así lo sugieren. Con la finalidad de cuantificar esa asociación, se estudiaron 35 niños asmáticos atópicos, entre 7 y 16 años, divididos en tres grupos de acuerdo con la severidad clínica-leve, moderada y severa. Material y métodos: Se determinó el grado de reactividad bronquial por inhalación de metacolina (PC20 VEF1 en mg/ml), pruebas cutáneas con aeroalergenos por método escarificación e IgE sérica total (en Ul/ml) por radioinmunoanálisis (RIA). Como parámetro principal de atopia se establecieron dos puntajes de pruebas cutáneas (PPC): PPc1: número de antígenos positivos (pápula igual o mayor de 3mm) y PPC2: suma de los diámetros (mm) de las pápulas generadas por los antígenos positivos. Resultados: Se observaron diferencias significativas para cada una de las variables estudiadas según el grado de severidad clínica del asma (para PC20 VEF1 p < 0,001; PPC1 p < 0,001; PPC2 p < 0,001 e IgE sérica total p < 0,001). Existió una correlación significativa entre PPC1 y PPC2 y el grado de reactividad bronquial medida por el log (PC20 VEF1) (r=0,61, p < 0,001 y r=0,65, p < 0,001 respectivamente). Lo mismo surgió de correlacionar IgE sérica y log (PC20 VEF1) (r=0,78, p < 0,001). Conclusiones: Creemos que la sensibilización con aeroalergenos es un factor relevante en la génesis del asma de la infancia; este estudio mostró que los parámetros de atopia considerados se asociaron en forma cuantitativa con el grado de severidad clínica del asma y de reactividad bronquial a la metacolina (AU)