Ecological study of socio-economic indicators and prevalence of asthma in schoolchildren in urban Brazil

BACKGROUND: There is evidence of higher prevalence of asthma in populations of lower socio-economic status in affluent societies, and the prevalence of asthma is also very high in some Latin American countries, where societies are characterized by a marked inequality in wealth. This study aimed to examine the relationship between estimates of asthma prevalence based on surveys conducted in children in Brazilian cities and health and socioeconomic indicators measured at the population level in the same cities. METHODS: We searched the literature in the medical databases and in the annals of scientific meeting, retrieving population-based surveys of asthma that were conducted in Brazil using the methodology defined by the International Study of Asthma and Allergies in Childhood. We performed separate analyses for the age groups 6-7 years and 13-14 years. We examined the association between asthma prevalence rates and eleven health and socio-economic indicators by visual inspection and using linear regression models weighed by the inverse of the variance of each survey. RESULTS: Six health and socioeconomic variables showed a clear pattern of association with asthma. The prevalence of asthma increased with poorer sanitation and with higher infant mortality at birth and at survey year, GINI index and external mortality. In contrast, asthma prevalence decreased with higher illiteracy rates. CONCLUSION: The prevalence of asthma in urban areas of Brazil, a middle income country, appears to be higher in cities with more marked poverty or inequality

Fatores de risco para visitas à emergência por exacerbações de asma em pacientes de um programa de controle da asma e rinite alérgica em Feira de Santana, BA Risk factors for ER visits due to asthma exacerbations in patients enrolled in a program for the control of asthma and allergie rhinitis in Feira de Santana, Brazil

OBJETIVO: Determinar os fatores de risco para atendimentos de emergência por exacerbações da asma em pacientes acompanhados em um centro de referência. MÉTODOS: Estudo de coorte prospectiva de 253 crianças e adultos com asma e monitorados por 12 meses no Centro de Referência do Programa de Controle da Asma e Rinite Alérgica de Feira de Santana, BA. RESULTADOS: As exacerbações foram frequentes, e 36,5% dos pacientes buscaram assistência em serviços de emergência no período de 12 meses. Os fatores de risco associados às exacerbações foram idade > 20 anos (OR = 1,34; IC95%: 1,06-1,70); residência em zona urbana (OR = 1,19; IC95%: 1,06-1,33); baixa escolaridade (OR = 1,53; IC95%: 1,00-2,39); asma grave (OR = 1,65; IC95%: 1,24-2,18); e rinite crônica (OR = 2,20: IC95%: 1,00-4,80). CONCLUSÕES: Ter de rinite crônica, asma mais grave e baixa escolaridade foram os principais fatores de risco para atendimentos de emergência por exacerbações da asma nesta coorte. Esses resultados são semelhantes àqueles descritos para pacientes com asma sem tratamento regular.<br>OBJECTIVE: To determine the risk factors for ER visits due to asthma exacerbations in patients monitored at a referral center. METHODS: Prospective cohort study of 253 outpatients (children and adults) with asthma who were monitored for 12 months at the Referral Center of the Program for the Control of Asthma and Allergic Rhinitis in the city of Feira de Santana, Brazil. RESULTS: Exacerbations were common, and 36.5% of the patients sought ER treatment within the twelve-month period. The risk factors for asthma exacerbations were being over 20 years of age (OR = 1.34: (95% CI: 1.06-1.70), residing in an urban area (OR = 1.19; 95% CI: 1.06-1.33); having a low level of education (OR = 1.53: 95% CI: 1.00-2.39); having severe asthma (OR = 1.65; 95% CI: 1.24-2.18); and having chronic rhinitis (OR = 2.20; 95% CI: 1.00-4.80). CONCLUSIONS: In this cohort, having chronic rhinitis, having asthma that is more severe and having a low level of education were the main risk factors for ER visits due to asthma exacerbations. These results are similar to those reported for asthma patients who are receiving no regular treatment

Comparação entre dois métodos de avaliação do controle da asma baseados na percepção individual Comparison between two methods of asthma control evaluation based on individual perception

OBJETIVO: Comparar a percepção subjetiva do controle da asma informada pelo paciente com aquela obtida por meio do escore do Asthma Control Questionnaire com seis questões (ACQ-6) em pacientes com asma grave e verificar se o controle da asma está associado ao número de visitas a salas de emergência no mês anterior. MÉTODOS: Estudo transversal de 528 pacientes acompanhados na Central de Referência do Programa para Controle da Asma e Rinite Alérgica na Bahia, entre agosto de 2008 e março de 2010, em Salvador (BA). Os pacientes responderam ao ACQ-6 e a uma questão adicional específica para avaliar sua percepção do controle da doença na semana prévia. RESULTADOS: Foram avaliados 423 pacientes, que preencheram os critérios de inclusão. A maioria era do gênero feminino (81,3%) e possuía renda familiar menor que dois salários mínimos (64,3%). A média de idade foi de 49,85 ± 13,71 anos, e a duração dos sintomas de asma foi de 32,11 ± 16,35 anos. Os pacientes eram regularmente tratados no programa há 36,65 ± 18,10 meses. Baseados na percepção subjetiva do controle, 8% dos pacientes consideraram a sua asma não controlada, enquanto 38,8% obtiveram escore do ACQ > 1,5, indicando falta de controle. O coeficiente kappa revelou fraca concordância entre os dois métodos. Houve uma associação direta entre falta de controle e número de visitas a emergência no mês anterior (p < 0,001). CONCLUSÕES: Nesta amostra de pacientes, a percepção subjetiva do paciente sobre o controle da asma diferiu da medida por meio do ACQ-6, e os pacientes superestimaram seu controle, trazendo risco de subtratamento.<br>OBJECTIVE: To compare the subjective perception of asthma control reported by the patient with that measured by the score obtained on the Asthma Control Questionnaire 6-item version (ACQ-6) in patients with severe asthma and to determine whether asthma control is associated with the number of emergency room visits in the previous month. METHODS: This was a cross-sectional study involving 528 patients treated at the Bahia State Asthma and Allergic Rhinitis Control Program Central Referral Clinic between August of 2008 and March of 2010, in the city of Salvador, Brazil. The patients completed the ACQ-6 and answered a specific additional question in order to evaluate their own perception of asthma control in the previous week. RESULTS: We evaluated 423 patients who met the inclusion criteria. The sample was predominantly female (81.3%), and 64.3% had an income lower than two times the national minimum wage. The mean age was 49.85 ± 13.71 years, and the duration of asthma symptoms was 32.11 ± 16.35 years. The patients had been regularly treated via the program for 36.65 ± 18.10 months. Based on the subjective perception of asthma control, only 8% of the patients considered their asthma to be uncontrolled, whereas 38.8% had an ACQ-6 score > 1.5, which indicates poor control. The kappa statistic revealed poor concordance between the two methods. There was a direct association between uncontrolled asthma and the number of emergency room visits in the previous month (p < 0.001). CONCLUSIONS: In this sample of patients, the subjective perception of asthma control differed from that measured by the ACQ-6 score, and the patients overestimated their own level of asthma control, which puts them at risk of being undertreated