Asthma In Brazil Research Articles

Gut microbiome signature and nasal lavage inflammatory markers in young people with asthma

BackgroundAsthma is a complex disease and a severe global public health problem resulting from interactions between genetic background and environmental exposures. It has been suggested that the gut microbiota may be related to asthma development, however, such relationships needs further investigation. ObjectiveThis study aimed to characterize the gut microbiota as well as the nasal lavage cytokine profile of asthmatic and non-asthmatic individuals. MethodsStool and nasal lavage samples were collected from 29 children and adolescents with Type 2-asthma (defined as asthma with >2.5% eosinophils in sputum, and a positive skin prick test) and 28 children without asthma in Brazil. Amplicon sequencing of the stool bacterial V4 region of the 16S rRNA gene was performed using Illumina MiSeq. Microbiota analysis was performed using QIIME2 and PICRUST. Type 2-asthma phenotype was characterized by high sputum eosinophil counts and positive skin prick tests for house dust mites, cockroaches, cat or dog dander. The nasal immune marker profile was assessed using a customized multiplex panel. ResultsThe stool microbiota differed significantly between asthmatic and non-asthmatic participants (p=0.001). Bacteroides was more abundant in participants with asthma (p<0.05), while Prevotella was more abundant in non-asthmatics (p<0.05). In asthmatics, the relative abundance of Bacteroides correlated with IL-4 concentration in nasal lavage. Inference of microbiota functional capacity identified differential fatty acid biosynthesis in asthmatics compared to non-asthmatics. ConclusionThe stool microbiota differed between asthmatics and non-asthmatics in young people in Brazil. Asthma was associated with higher Bacteroides which correlated with nasal IL-4 concentration.

The economic impact of asthma on private healthcare system in Brazil: Economic impact of asthma in Brazil.

To assess healthcare resource utilization and costs of patients with asthma in Brazilian Supplementary Healthcare System, focusing on hospitalization data. Retrospective cohort study, using data from an administrative database of a private company (Orizon). Patients aged ≥ 12 years with at least one record of emergency visit/hospitalization in the database with the ICD-10 J45 between January/2010 and June/2015 were included and followed until June/2016, death or inactivation of health plan. Sociodemographic characteristics, emergency visit and hospital admission per patient per year (exacerbation rate), physician visit with a procedure, exams, length of hospitalization (with/without intensive care unit (ICU)), and in-hospital treatments were assessed. A total of 54,568 patients were included in this analysis. Regarding resource utilization, emergency visit and hospital admission rates of 0.34 and 0.04 per person-year were observed, respectively. Mean length of hospital stay were 8.82 (SD = 36.48), 5.24 (SD = 19.06) and 19.53 (63.89) days for hospitalizations in general, without and with ICU, respectively. An exacerbation rate of 0.36 per person year was observed with a mean cost per episode of 3178 Brazilian Real (BRL) (SD = 31,667). Mean cost related to emergency department visits was estimated at 293 BRL (SD = 328). Hospitalization costs were stratified by the need of ICU and values observed were of 9307 BRL (SD = 18,979) without ICU, and 75,252 BRL (SD = 174,248) with ICU need. Asthma exacerbations may cost ~75,000 BRL for an ICU-dependent event in the Supplementary Healthcare System. To improve disease control may reduce disease burden for both healthcare system and patients.

Strengthening the global role of environmental epidemiology in the Respiratory Diseases Exploratory: Analysis of Age in the Diagnosis of Asthma in Brazil, 2019

Strengthening the global role of environmental epidemiology in the Respiratory Diseases Exploratory: Analysis of Age in the Diagnosis of Asthma in Brazil, 2019

Prevalence of the eosinophilic phenotype among severe asthma patients in Brazil: the BRAEOS study.

ABSTRACTObjective:To assess the prevalence of the eosinophilic and allergic phenotypes of severe asthma in Brazil, as well as to investigate the clinical characteristics of severe asthma patients in the country. Methods:This was a cross-sectional study of adult patients diagnosed with severe asthma and managed at specialized centers in Brazil. The study was conducted in 2019. Results:A total of 385 patients were included in the study. Of those, 154 had a blood eosinophil count > 300 cells/mm3 and 231 had a blood eosinophil count of ≤ 300 cells/mm3. The median age was 54.0 years, and most of the patients were female, with a BMI of 29.0 kg/m2 and a history of allergy (81.6%). The prevalence of patients with a blood eosinophil count > 300 cells/mm3 was 40.0% (95% CI: 35.1-44.9), and that of those with a blood eosinophil count > 300 cells/mm3 and a history of allergy was 31.9% (95% CI: 27.3-36.6). Age and BMI showed positive associations with a blood eosinophil count > 300 cells/mm3 (OR = 0.97, p < 0.0001; and OR = 0.96, p = 0.0233, respectively), whereas the time elapsed since the onset of asthma symptoms showed an increased association with a blood eosinophil count > 300 cells/mm3 (OR = 1.02, p = 0.0011). Conclusions:This study allowed us to characterize the population of severe asthma patients in Brazil, showing the prevalence of the eosinophilic phenotype (in 40% of the sample). Our results reveal the relevance of the eosinophilic phenotype of severe asthma at a national level, contributing to increased effectiveness in managing the disease and implementing public health strategies.

Equine asthma in Brazil – a scoping review

Asthma is a chronic respiratory disease that can occur in horses of different breeds and ages. While its occurrence has been reported in many countries, its occurrence across Brazil is unclear. This review aimed to gather information about equine asthma from studies performed in Brazil by different groups and investigate a variety of horse populations. Articles published in peer-reviewed scientific journals, as well as information contained in dissertations and theses, were searched on PubMed, SciELO, Google Scholar, and the Brazilian government catalog of dissertations and theses. Fifteen studies were included in this review, and according to the published information, the authors identified equine asthma using clinical signs, endoscopic findings, and/or cytological examination of tracheal wash and/or bronchoalveolar lavage fluid. Studies have investigated horses of different breeds and activities (racehorses, police horses, riding horses, Crioulos horses, and others) and were performed in different regions with diverse climatic conditions. On the previous observed studies, the occurrence varied from 14.0% to 60.0%, with a mean occurrence of 24% for severe asthma. Other studies must be performed to further understand the occurrence of equine asthma in Brazil, according to different climatic regions.

POSA175 What Do Public Data Sources Tell Us about Asthma in Brazil?

POSA175 What Do Public Data Sources Tell Us about Asthma in Brazil?

An expert review on breaking barriers in severe asthma in Brazil: Time to act.

Currently, Brazil lacks a national asthma management program and is burdened with nearly 200,000 hospitalizations due to the disease per year and approximately 5 deaths per day. The purpose of this article was to analyze the current issues surrounding severe asthma in Brazil, as the status of diagnosis and treatment is largely unknown, and to provide feasible recommendations to elicit imminent action. A panel of Brazilian medical experts in the field of severe asthma was provided with a series of relevant questions to address prior to a multi-day conference. Within this conference, each narrative was discussed and edited by the entire group. Through numerous rounds of discussion consensus was achieved. In order to overcome barriers to adequate asthma treatment, this panel recommends specific initiatives that can be implemented in the short-term to decrease the burden of severe asthma in Brazil. With increasing healthcare costs and limited resources globally, there is an opportunity to implement these recommendations in other countries in order to achieve adequate asthma care. Severe asthma is a heterogeneous and complex disease with various phenotypes that requires strict attention for diagnosis and management. Although this disease affects only a small proportion of the population with asthma, it poses a great burden to healthcare systems. Thus, barriers to diagnosis, treatment, and management should be overcome as quickly and efficiently as possible.

Vitamin D: association with eosinophil counts and IgE levels in children with asthma.

ABSTRACTIn this cross-sectional study, we investigated the relationship that levels of vitamin D had with eosinophil counts and IgE levels in 26 children with asthma (6-12 years of age) in the city of Londrina, Brazil. Vitamin D levels were found to correlate significantly, albeit moderately, with age (r = −0.51) and eosinophilia (r = −0.49), although not with IgE levels (r = −0.12). When we stratified the sample into two groups by the median vitamin D level (< or ≥ 24 ng/mL), we found that those in the < 24 ng/mL group were older, had higher eosinophil counts, and had higher IgE levels. To our knowledge, this is the first study to show an association between low levels of vitamin D and more pronounced eosinophilia in children with asthma in Brazil.

Equine Pasture Asthma in Brazil

Background: Summer Pasture Associated Obstructive Pulmonary Disease (SPAOPD), or Equine Pasture Asthma (EPA), as termed by Ferrari et al. [17], has been described as an environmentally-induced respiratory disease that occurs during the warmer and more humid months, leading to reversible airway obstruction, persistent and non-specific airway hyper-responsiveness, and chronic neutrophilic airway inflammation. Exacerbation of clinical signs vary according to warm seasons, and range from mild to severe episodes of wheezing, coughing, and laboured breathing in a chronic state that is debilitating for the equine [4]. This report describes two cases of Equine Pasture Asthma that show clinical and environmental similarities with Summer Pasture Associated Obstructive Pulmonary Disease.Case: The patients were crossbreed geldings that have never been stabled and were used for cattle management in a farm in southeastern Brazil. They presented poor performance and a persistent cough for over 3 years. Initially, the respiratory signs were only observed after exercise but, over the years, it gradually progressed to being observed when the horses were at rest. Both animals had a history of regular deworming and were previously treated by other veterinarians with antibiotics, clenbuterol, and mucokinetics. Little improvement was noticed by the owner and the signs returned over time as treatment was often discontinued. Clinical findings were compatible with the grade 3 mucus classification of Gerber et al. [18] as well as with score 2 for Severe Asthma of Davis and Sheats [13]. BALF cytology was done following the technique described by Couetil et al. [10]. Animal 1 presented slides with free yeast; macrophages and mucus with Curschmann’s spiral and counting of 29,7% of neutrophils (NE), 43,7% of lymphocytes (LP), 25,3% of macrophages (MC) and 1,3% of eosinophils (EO). Animal 2 presented slides with phagocytized yeast, mucus and counting of 27% of NE, 38,5% of LP, 33% of MC and 1,5% of EO.Discussion: Diagnostic findings fit the clinical score 2 (from 0 to 3) for Severe Asthma [13], where the animal presented frequent cough with periods of no coughing, nostrils flares in inspiration and exhalation, obvious abdominal flattening and “heave line”, pulmonary auscultation with crackles, and scarce mucous nasal discharge. The cytological findings of our reported cases also falls within the Severe Asthma classification [13], when the specific counting of 300 cells is equivalent to ≥20% of neutrophils on BALF analysis and the animal present increase in respiratory rate/effort at rest. Similar counts were found by Costa et al. [9] counting 200 cells, Rossi et al. [28] also counting 300 cells, and Couetil and Thompson [11] counting 5 fields (of at least 100 cells) on a cytocentrifuge smear. The present report took place in a region of the Rio de Janeiro State, southeastern Brazil, which shows predisposing climatic characteristics similar to those described in previous SPAOPD reports. Yet, this very climate remains somewhat constant throughout the year, as seasonality in the Rio de Janeiro State is not as marked as in the Northern Hemisphere. Given this contrasting aspect, we believe that the term Equine Pasture Asthma, instead of SPAOPD, is more appropriate to describe the cases presented here. Also, to the best of the authors’ knowledge, this is the first documented description in Brazil of Equine Pasture Asthma in animals that were never stabled or fed with hay. This documented evidence of a chronic respiratory condition consistent with Equine Pasture Asthma but little related to seasonal changes presents as a warning to other possible cases that might be unnoticed in equine herds in Brazil and in similar climates.

Analysis of the trend of hospitalizations for asthma in children and adolescents in Brazil

ObjectiveTo analyze the trend of hospitalizations for asthma in children and adolescents by region and age group in Brazil, from 2008 to 2017. MethodThis is a time-series study with secondary data regarding hospitalizations for asthma in children and adolescents, according to age, region, and gender. Descriptive statistics procedures were used with measures of central tendency to calculate the variation between the periods of 2008 and 2017. Rates of hospitalizations were calculated specifically by age group and region. Time trend analysis was performed by simple linear regression, considered as stationary (p>0.05), declining (p<0.05 and negative regression coefficient), or ascending (p<0.05) and positive regression coefficient). ResultsThe present study identified a higher proportion of hospitalizations for asthma in Brazil in children aged 5–9 years. Regarding gender, there were more hospitalizations in boys. The region that presented the highest proportion of hospitalizations, in all age groups investigated, was the Northeast. As for the trend analysis, this article showed that, in Brazil, there was a trend toward a reduction in hospitalization rates for asthma. ConclusionIn Brazil, there was a tendency to reduce hospitalizations for all investigated age groups. The Northeast was the only region that showed a decline in all age groups.

PRS8 IMPLEMENTING AN ASTHMA DATATHON TO LEVERAGE PUBLIC DATA TO INFORM DECISION AND POLICY-MAKERS IN BRAZIL

to integrate and analyze public datasets to create interactive vizualizations of asthma-related outcomes, through an online open data analytics competition-datathon. A 2-day design-thinking workshop was organized by GSK in partnership with Eretz.bio (startup incubator) from Hospital Israelita Albert Einstein, to define the datathon challenge, rules, timelines and prizes. The theme was to understand the impact of diagnosis, hospitalizations, costs, mortality, structural, social and environmental factors related to asthma in Brazil. An open online call was made to invite teams to develop their projects in 2 weeks. Each team with 3 members had to use at least one database from the Public Health system (DATASUS). The evaluation criteria included: creativity and innovation in epidemiological analysis; technical capability and methodology; quality of dashboards and its visualization. Each criteria was graded from 0 to 5 by an independent judging panel, and the top 3 scores were the winners. There were 240 participants (80 teams) from 15 Brazilian States. Among them, 85% were male and regarding the background, 45% were data scientist, 24% undergraduate students, 18% healthcare professionals, 11% investigators and 2% designers. Novel analytical dashboards included interactive maps and tables describing trends of asthma hospitalizations per day/month in different regions, days of school missed last year due to asthma in school; comparison of asthma to other chronic diseases like diabetes, demonstrating similar impact on costs and resource use. These dashboards were deemed useful for public health administrators at different levels. There was consistency in the analyses of the top teams which provided insights and deeper understanding of the impact of asthma and its multiple effects. Public healthcare databases are increasing, offering the opportunity to generate evidence for decision makers. Countries with open datasets should consider implementing similar activities to increase understanding of healthcare conditions and support decision making.

A Pragmatic Study to Investigate the Efficacy and Safety of Mepolizumab in Severe Uncontrolled Asthma in Brazil

A Pragmatic Study to Investigate the Efficacy and Safety of Mepolizumab in Severe Uncontrolled Asthma in Brazil

Genetic variants in 17q12-21 locus and childhood asthma in Brazil: Interaction with Varicella zoster virus seropositivity

BackgroundAsthma is a complex disease with worldwide public health relevance, is related to environmental causes and a genetic predisposition. The chromosomal 17q12-21 locus has been consistently demonstrated to be associated with asthma risk. The effects of variants in the 17q12-21 locus on childhood asthma were first identified in a genome wide- association study. Since that time, those findings have been replicated in different populations but not in South American populations. ObjectiveThis study aimed to investigate the role of variants in the 17q12-21 locus on asthma in a sample of Brazilian children. MethodsThis was a cross-sectional study conducted on a cohort of 1247 children. These analyses used 50 Single Nucleotide Variants (SNVs) in the 17q12-21 locus were genotyped as part of a genome wide association study (GWAS). ResultsFour SNVs (rs4065275, rs12603332, rs73985228 and rs77777702) were associated with childhood asthma. The rs73985228 exhibited the strongest association across the different genetic models (OR, 95%CI 2.8, 1.44–3.21, p < 0.01). In an analysis that was stratified by atopy, two SNVs (rs73985228 and rs2715555) were found to be associated with atopic and non-atopic asthma. For the first time, we observed a significant interaction with seropositivity for the Varicella zoster virus (for rs4065275, p = 0.02, and for rs12603332, p = 0.04); i.e., the association was found in those who were seropositive but not in those who were seronegative for this virus. ConclusionsWe confirmed the associations of variants in the 17q12-21 locus with atopic and non-atopic asthma and identified an interaction with seropositivity for the Varicella zoster virus.

Respira project: Humanistic and economic burden of asthma in Brazil

ABSTRACTObjective: To determine the association of asthma on health-related quality of life (QoL), productivity, and use of healthcare resources among adults in Brazil. Methods: Data were analyzed from the 2015 Brazil National Health and Wellness Survey, a cross-sectional survey with 12,000 adult respondents. Asthma and control groups were compared with respect to health-related QoL, asthma control, work productivity, and adherence. Generalized linear models were developed to compare asthma-related associations controlling for potential confounding factors. Results: Among respondents, 4.1% (n = 494) reported an asthma diagnosis; those without asthma symptoms were used as the control group (n = 11,487). Regarding asthma control, 51.2% of patients had uncontrolled asthma, 36.4% partially controlled asthma, and 12.3% were fully controlled. Short-acting β2 agonists were the most commonly used class of drugs (38.5%). Approximately 32.4% of asthma patients were considered fully adherent to their treatment. In multivariable analyses, asthma patients presented lower health-related QoL and had more frequent visits with medical healthcare providers (6.1 versus 4.2) emergency room visits (1.0 versus 0.5), and more hospitalizations (0.4 versus 0.2), than control respondents six months prior to the study (p < 0.05). Rates of absenteeism and presenteeism varied between 11.5% and 7.4% (p < 0.05) and 30.4% and 20.9% (p < 0.001) between asthma patients and controls, respectively. Conclusions: Asthma had a negative association on health-related QoL, work productivity, and use of healthcare resources. Excessive use of short-acting β2 agonists and poor treatment adherence reflect poor asthma control and suggest the need to implement new strategies for asthma treatment in Brazil.

On-demand intermittent beclomethasone is effective for mild asthma in Brazil

BackgroundDaily inhaled corticosteroids are widely recommended for mild persistent asthma. This study aimed to assess the efficacy of the intermittent use of beclomethasone as an alternative treatment for mild persistent asthma.MethodsIn this 16-week trial, children aged 6–18 years were evaluated. Subjects in the continuous treatment arm of the study received 500 μg/day of beclomethasone, whereas the intermittent ones were given 1000 μg/day (250 μg every 6 h) in combination with albuterol for 7 days upon exacerbations or worsening of symptoms. Primary outcome (i.e., treatment failure) was the occurrence of any asthma exacerbation requiring prednisone, and co-secondary outcomes were the mean/median differences for both, (1) the pre-bronchodilator FEV1 (% predicted) and (2) asthma control test (ACT/cACT) scores, from randomization to the last follow-up visit, and beclomethasone and albuterol consumption.ResultsNinety-four subjects from each treatment arm were included. They were comparable regarding all baseline characteristics; prednisone was used by 10 (10.6%) and 7 (7.4%) patients, respectively (95% CI − 6.1 to 12.6%, for the difference; p = 0.47). Statistical analysis showed no statistically significant differences with respect to both FEV1 (p = 0.39) and ACT/cACT scores (p = 0.38). As assessed through canister weighting, children used from 0.5 to 0.7 and from 1.6 to 1.8 puffs per day of beclomethasone in the intermittent and continuous regimens, respectively. Regarding albuterol, received 0.3–0.4 (intermittent) and 0.1–0.2 (continuous) inhalations per day. There were no relevant clinical or functional differences between the two treatment regimens.ConclusionClinicians might consider intermittent inhaled steroid therapy as a therapeutic regimen for mild persistent asthma.Trial registration The Portuguese and English versions of the study protocol were submitted, approved, and registered in the Brazilian Network Platform for Clinical Trials (http://www.ensaiosclinicos.gov.br) under the primary identifier number “RBR-3gbyhk”. This platform is part of the Primary Registries in the World Health Organization Registry Network, where the trial is registered under the following Universal Trial Number: 1111-1149-4774

Trend of self-reported asthma prevalence in Brazil from 2003 to 2013 in adults and factors associated with prevalence.

ABSTRACTObjectives:To determine the trend of self-reported asthma diagnosed prevalence and to describe the factors associated with asthma in Brazilian adults. Method:Epidemiological cross-sectional study based on databases analysis from three national household surveys: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 and Pesquisa Nacional de Saúde (PNS) 2013. Participants between 18-45 years old were included. Trend analysis of asthma diagnosed prevalence was conducted using a logistic general linear model. A hierarchical logistic regression model was used to select factors significantly associated with asthma prevalence. Results:Asthma diagnosed prevalence was 3.6% (2003), 3.7% (2008) and 4.5% (2013), showing a statistically significant increased trend. Asthma diagnosed prevalence also increased when analysed by gender (annual change for men: 2.47%, p < 0.003; women: 2.16%, p < 0.001), urban area (annual change for urban: 2.15%, p < 0.001; rural: 2.69%, p = 0.072), healthcare insurance status (annual change without healthcare insurance: 2.18%, p < 0.001; with healthcare insurance: 1.84%, p = 0.014), and geographic regions (annual change North: 4.68%, p < 0.001; Northeast: 4.14%, p < 0.001; and Southeast: 1.84%, p = 0.025). Female gender, obesity, living in urban areas and depression were associated with asthma diagnosed prevalence. Discussion:PNAD and PNS surveys allow for a very large, representative community-based sample of the Brazilian adults to investigate the asthma prevalence. From 2003 to 2013, the prevalence of self-reported physician diagnosis of asthma increased, especially in the North and Northeast regions. Gender, region of residence, household location (urban/rural), obesity, and depression diagnosis seem to play significant roles in the epidemiology of asthma in Brazil.

Lung function in severe pediatric asthma: a longitudinal study in children and adolescents in Brazil

BackgroundIn severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day.MethodsThis was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6–18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day.ResultsAt baseline, the forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity (FVC) ratio were both < 80% of the predicted values in 50.8% of the patients. The median age of the patients was 10.4 years (interquartile range 7.8–13.6 years). In the sample as a whole, there were significant increases in FEV1% and in the FEV1/FVC% ratio (p = 0.01 and p < 0.001, respectively) over the course of the study. In the > 800 µg/day group, there were no statistical increases or decreases in FEV1, the FEV1/FVC ratio, or forced expiratory flow between 25 and 75% of the FVC (FEF25–75%), when calculated as percentages of the predicted values. However, the z-score for FEF25–75% showed a statistically significant reduction, in the sample as a whole and in the > 800 µg/day group. Also in the > 800 µg/day group, there was a significant reduction in the post-bronchodilator FEV1% (p = 0.004).ConclusionsThe fact that the spirometric parameters (as percentages of the predicted values) remained constant in the > 800 µg/day group, whereas there was a gain in lung function in the sample as a whole, suggests an early plateau phase in the > 800 µg/day group. However, there was some loss of lung function in the > 800 µg/day group, as evidenced by a decrease in the z-score for FEF25–75%, suggesting irreversible small airway impairment, and by a reduction in the post-bronchodilator FEV1%, suggesting reduced reversibility of airway obstruction. Among children and adolescents with severe asthma, the use of ICS doses higher than those recommended for age does not appear to improve lung function.

The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system.

ABSTRACTObjective:To present official longitudinal data on the impact of asthma in Brazil between 2008 and 2013. Methods:This was a descriptive study of data collected between 2008 and 2013 from an official Brazilian national database, including data on asthma-related number of hospitalizations, mortality, and hospitalization costs. A geographical subanalysis was also performed. Results:In 2013, 2,047 people died from asthma in Brazil (5 deaths/day), with more than 120,000 asthma-related hospitalizations. During the whole study period, the absolute number of asthma-related deaths and of hospitalizations decreased by 10% and 36%, respectively. However, the in-hospital mortality rate increased by approximately 25% in that period. The geographic subanalysis showed that the northern/northeastern and southeastern regions had the highest asthma-related hospitalization and in-hospital mortality rates, respectively. An analysis of the states representative of the regions of Brazil revealed discrepancies between the numbers of asthma-related hospitalizations and asthma-related in-hospital mortality rates. During the study period, the cost of asthma-related hospitalizations to the public health care system was US$ 170 million. Conclusions:Although the numbers of asthma-related deaths and hospital admissions in Brazil have been decreasing since 2009, the absolute numbers are still high, resulting in elevated direct and indirect costs for the society. This shows the relevance of the burden of asthma in middle-income countries.

Phenotypes of asthma in low-income children and adolescents: cluster analysis.

ABSTRACTObjective: Studies characterizing asthma phenotypes have predominantly included adults or have involved children and adolescents in developed countries. Therefore, their applicability in other populations, such as those of developing countries, remains indeterminate. Our objective was to determine how low-income children and adolescents with asthma in Brazil are distributed across a cluster analysis. Methods: We included 306 children and adolescents (6-18 years of age) with a clinical diagnosis of asthma and under medical treatment for at least one year of follow-up. At enrollment, all the patients were clinically stable. For the cluster analysis, we selected 20 variables commonly measured in clinical practice and considered important in defining asthma phenotypes. Variables with high multicollinearity were excluded. A cluster analysis was applied using a twostep agglomerative test and log-likelihood distance measure. Results: Three clusters were defined for our population. Cluster 1 (n = 94) included subjects with normal pulmonary function, mild eosinophil inflammation, few exacerbations, later age at asthma onset, and mild atopy. Cluster 2 (n = 87) included those with normal pulmonary function, a moderate number of exacerbations, early age at asthma onset, more severe eosinophil inflammation, and moderate atopy. Cluster 3 (n = 108) included those with poor pulmonary function, frequent exacerbations, severe eosinophil inflammation, and severe atopy. Conclusions: Asthma was characterized by the presence of atopy, number of exacerbations, and lung function in low-income children and adolescents in Brazil. The many similarities with previous cluster analyses of phenotypes indicate that this approach shows good generalizability.

Free asthma medications reduces hospital admissions in Brazil (Free asthma drugs reduces hospitalizations in Brazil)

BackgroundSince June 2011, the Brazilian health system started providing asthma medications (beclomethasone and salbutamol), totally free of charge to patients with asthma. The aim of this study was to evaluate the impact of the provision of free asthma medications on hospital admissions for asthma in Brazil, using a national hospitalization database (DATASUS), comparing the incidence of hospital admissions before and after the free supply of these drugs. MethodsAdmissions of patients with 1–49 years of age by the Brazilian public health system with the diagnosis of asthma were compared pre (2008–2010) and post (2012–2014) provision of free medicines (beclomethasone and salbutamol). The number of hospital admissions due to asthma and non-respiratory diseases, as well as the amount spent with asthma hospitalization, were obtained from DATASUS, the Brazilian government open-access public health database system. ResultsAdmission rates for asthma significantly decreased from 90.09/100.000 (2008–2010) to 59.85/100.000 (2012–2014), when the period pre and post provision of free medicines were compared [OR 0.67 (CI 0.48–0.92)]. Non-respiratory admission rates remained stable, when both periods were also compared. ConclusionAsthma hospitalization rates significantly decreased in the three-year period after the provision of free medicines to treat asthma. Our findings suggest that the provision of free medications for asthma may have a particular public health impact by its own in developing countries.