Epidemiological aspects of and risk factors for wheezing in the first year of life

Objective: To determine, in a sample of infants, the prevalence of and risk factors for occasional wheezing (OW) and recurrent wheezing wheezy baby syndrome (WBS). Methods: Parents of infants (12-15 months of age) completed the International Study of Wheezing in Infants questionnaire. Results: We included 1,269 infants residing in the city of Blumenau, Brazil. of those, 715 (56.34%) had a history of wheezing, which was more common among boys. the prevalences of OW and WBS were 27.03% (n = 343) and 29.31% (n = 372), respectively. On average, the first wheezing episode occurred at 5.55 +/- 2.87 months of age. Among the 715 infants with a history of wheezing, the first episode occurred within the first six months of life in 479 (66.99%), and 372 (52.03%) had had three or more episodes. Factors associated with wheezing in general were pneumonia; oral corticosteroid use; a cold; attending daycare; having a parent with asthma or allergies; mother working outside the home; male gender; no breastfeeding; and mold. Factors associated with WBS were a cold; physician-diagnosed asthma; ER visits; corticosteroid use; pneumonia; bronchitis; dyspnea; attending daycare; bronchodilator use; having a parent with asthma; no breastfeeding; mother working outside the home; and a dog in the household. Conclusions: the prevalence of wheezing in the studied population was high (56.34%). the etiology was multifactorial, and the risk factors were intrinsic and extrinsic (respiratory tract infections, allergies, attending daycare, and early wheezing). the high prevalence and the intrinsic risk factors indicate the need and the opportunity for epidemiological and genetic studies in this population. in addition, mothers should be encouraged to prolong breastfeeding and to keep infants under six months of age out of daycare.Univ Estadual Campinas, Fac Ciencias Med, Dept Pediat, Campinas, SP, BrazilWeb of Scienc

Effects of swimming on spirometric parameters and bronchial hyperresponsiveness in children and adolescents with moderate persistent atopic asthma

OBJECTIVE: To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma (MPAA). METHODS: A randomized, prospective study of children and adolescents (age 7-18 years) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil. After a 1-month run-in period, 61 patients (34 female) were randomized into two groups, a swimming group (n = 30) and a control group (n = 31), and followed for 3 months. Both patient groups received inhaled fluticasone (dry powder, 250 mcg twice a day) and salbutamol as needed. The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions. Both groups underwent spirometric assessment and methacholine challenge test - provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) - before and after the study period. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured only in the swimming group. RESULTS: Significant increases in PC20 (pre-training, 0.31±0.25; post-training, 0.63±0.78; p = 0.008), MIP (pre-training, 67.08±17.13 cm H2O; post-training 79.46±18.66; p < 0.001), and MEP (pre-training, 71.69±20.01 cm H2O; post-training, 78.92±21.45 cm H2O; p < 0.001) were found in the swimming group. CONCLUSION: Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness, as determined by increased PC20 values, when compared with asthmatic controls who did not undergo swim training. Participants in the swimming group also showed improvement in elastic recoil of the chest wall.OBJETIVO: Investigar os benefícios a médio prazo de um programa de natação em escolares e adolescentes com asma atópica persistente moderada (AAPM). MÉTODOS: Realizou-se um estudo randomizado e prospectivo com crianças e adolescentes (7-18 anos de idade) com AAPM no Hospital de Clínicas da Universidade Estadual de Campinas (UNICAMP), Campinas (SP). Após um período de run in de um mês, 61 pacientes (34 femininos) foram randomizados em dois grupos: grupo natação (GN) (n = 30) e grupo controle (GC) (n = 31) e foram acompanhados durante 3 meses. Os dois grupos receberam fluticasona (pó) inalada (250 mcg, 2 vezes ao dia) diariamente e salbutamol inalado, quando necessário. O programa de natação consistiu em um total de 24 aulas, duas vezes por semana, por 3 meses. O GN e o GC realizaram espirometria, teste de broncoprovocação com metacolina (provocative concentration of methacholine causing a 20% fall in FEV1, PC20 de metacolina), antes e após os 3 meses de estudo. Pressão inspiratória máxima (PImax) e pressão expiratória máxima (PEmax) foram realizadas somente no GN. RESULTADOS: Observou-se que o GN apresentou aumento significativo da PC20 de metacolina (inicial 0,31±0,25 e final 0,63±0,78; p = 0,008), pressão inspiratória máxima (inicial 67,08±17,13 cm H2O e final 79,46±18,66; p < 0,001), pressão expiratória máxima (inicial 71,69±20,01 cm H2O e final 78,92±21,45 cm H2O; p < 0,001). CONCLUSÃO: Crianças e adolescentes com AAPM que se submeteram a um programa de natação apresentaram diminuição estatisticamente significativa da hiper-responsividade brônquica, com aumento dos valores da PC20 de metacolina, quando comparados aos com AAPM que não realizaram natação. O GN também apresentou melhora no componente da força elástica do tórax.38439

Are there differences in the level of physical activity and functional capacity between healthy and asthmatic children and adolescents?

Sem informação5463European Respiratory Society (ERS) International Congres

Analysis of motor and respiratory function in Duchenne muscular dystrophy patients

Duchenne muscular dystrophy(DMD) shows motor and respiratory impairment. Methods: 19 DMD patients (DMDG) (nine ambulatory and 10 non-ambulatory) were evaluated through motor function measure (MFM), 6-minute walk test (6MWT), respiratory muscle strength, cough peak flow, spirometry and volumetric capnography (VCap) tools. Control group that performed spirometry and VCap (CG1-n = 17) were different from those that performed the 6MWT (CG2-n = 8). Results: The follow tools were assessed (p 11 years-old): higher HR and lower slope 2. There was correlation between spirometry, mainly for zFEV(1)/FVC, and MFM. Conclusion DMDG showed motor (MFM/6MWT) and respiratory (spirometry/VCap) deterioration when compared with CG. Non-ambulatory condition was associated with worse MFM and spirometry.262111FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2011/12939-4; 2015/12183-8; 2015/12858-5; 0648/2015; 2011/18845-

Clinical characteristics, lung function, quality of life, exercise capacity and inflammatory biomarkers in induced sputum and serum in children and adolescents with uncontrolled severe asthma

Sem informação5463European Respiratory Society (ERS) International Congres

Differences between patients who achieved asthma control and those who remain uncontrolled after standardized severe asthma care strategy

Objective: To assess clinical, functional, and inflammatory patterns of children and adolescents with severe uncontrolled asthma, and investigate the differences between patients who achieved asthma control and those who remain uncontrolled after standardized asthma care strategy. Methods: Screening all children and adolescents with asthma from the Pediatric Pulmonology Outpatient Clinic of Unicamp, Brazil, and included those with severe uncontrolled asthma according to GINA guidelines criteria. Patients were assessed at baseline and after by demographic and medication data, questionnaires (Asthma Control Test and Pediatric Asthma Quality of Life Questionnaire), Six-Minute Walk Test, skin prick test, spirometry, induced sputum, and blood collection (total immunoglobulin E and eosinophil count). Cytokine dosage was analyzed in sputum supernatant and serum by Cytometric Bead Array. Results: Thirty-three patients with severe uncontrolled asthma were included (median age 10.9 [7.00–17.60] years). All patients presented satisfactory adherence to treatment and 50% of them achieved good asthma control after six-month follow-up (p < 0.001). Patients who achieved asthma control reported higher intervals since their last exacerbation episode (p = 0.008) and higher quality of life scores (p < 0.001) as compared to patients who remained uncontrolled. We found no changes in lung function markers, inflammatory biomarkers, or cytokine levels between patients with uncontrolled and controlled asthma. Conclusion: Participation of six months in a structured outpatient clinic for children with severe asthma had a notable improvement in control and quality of life of patients. This demonstrates the importance of a global assessment, focused on peculiarities presented by patients with severe uncontrolled asthma