Abstract
ObjectiveTo evaluate the clinical evolution and the association between nutritional status and severity of asthma in children and adolescents enrolled in Primary Health Care. MethodsA retrospective cohort study of 219 asthmatic patients (3 to 17 years old) enrolled in primary care services (PCSs) in Embu das Artes (SP), from 2007 to 2011. Secondary data: gender, age, diagnosis of asthma severity, other atopic diseases, family history of atopy, and body mass index. To evaluate the clinical outcome of asthma, data were collected on number of asthma exacerbations, number of emergency room consultations and doses of inhaled corticosteroids at follow‐up visits in the 6th and 12th months. The statistical analysis included chi‐square and Kappa agreement index, with 5% set as the significance level. Results50.5% of patients started wheezing before the age of two years, 99.5% had allergic rhinitis and 65.2% had a positive family history of atopy. Regarding severity, intermittent asthma was more frequent (51.6%) and, in relation to nutritional status, 65.8% of patients had normal weight. There was no association between nutritional status and asthma severity (p=0,409). After one year of follow‐up, 25.2% of patients showed reduction in exacerbations and emergency room consultations, and 16.2% reduced the amount of inhaled corticosteroids. ConclusionsThe monitoring of asthmatic patients in PCSs showed improvement in clinical outcome, with a decreased number of exacerbations, emergency room consultations and doses of inhaled corticosteroids. No association between nutritional status and asthma severity was observed in this study.
Highlights
Asthma is a complex inflammatory disease, recognized as one of the most common chronic diseases of childhood
Considering the nutritional transition in Brazil, with the reduction in the prevalence of malnutrition and increase in the prevalence of obesity,[7] a phenomenon which was observed in the municipality of Embu das Artes,[24] and considering a possible association between obesity and worsening of asthma, with more exacerbation crises and visits to the emergency room in pediatric patients,15---21 the present study aimed to evaluate the clinical evolution and the association between nutritional status and disease severity in children and adolescents with asthma enrolled at and followed in a Primary Care Service (PCS) of the Brazilian Public Health System (SUS)
When analyzing the nutritional status of asthmatic patients in this study, it is observed that the results contrast with the findings of Ventura et al.[28] in the same program of the municipality, the nutritional status classification criteria are different in the two assessed moments, including regarding the use of the term ‘‘malnutrition’’ and not thinness, as currently recommended by the WHO26,27; the authors did not report any patients with excess weight, and 38% were malnourished according to that assessment, which reinforces the observation of the nutritional transition among the patients in this program, as reported in the national Household Budget Survey of 2008---2009.7
Summary
Asthma is a complex inflammatory disease, recognized as one of the most common chronic diseases of childhood. It is characterized by recurrent respiratory symptoms and it significantly impairs the quality of life. In Brazil, epidemiological studies carried out in recent decades indicate a trend of increasing prevalence of asthma in children and adolescents.1---5 In this same period, an increase in the prevalence of overweight and obesity in children and adolescents has been observed in several countries and in Brazil, which constitutes a major public health problem.[6] This analysis is supported by three national surveys that assessed nutritional status from 1974 to 2009, showing an increase in overweight and obesity in children and adolescents in all income groups and in all regions of Brazil.[7] Obesity is a complex and multifactorial disease and it actively contributes to the development of cardiovascular diseases, arterial hypertension, diabetes mellitus and metabolic syndrome, in addition to exacerbating asthma.8---12
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