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Introduction: Patients with severe allergic asthma (SAA) are at risk of severe exacerbations. Omalizumab is recommended as an add-on treatment for patients with uncontrolled SAA, despite high-dose inhaled corticosteroids and long acting β2-agonist combination therapy (standard therapy). RELIEF was a prospective, open label, multicenter study conducted to assess the real-life effectiveness of omalizumab co-administered with standard therapy in patients with SAA for 24 months. Methods: A total of 347 patients aged ≥ 6 years with SAA were enrolled, 285 of whom (8 pediatrics and 277 adolescents and adults) completed this 24-month study. Compared with the 12 months prior to baseline, the mean number of exacerbations was reduced in the overall population at any time interval during the study. Proportion of patients with no exacerbations increased to 77.7% at 24 months from 32.6% at 12 months prior to baseline. A reduction in healthcare resource utilization was also observed. The mean number of specialist visits reduced from baseline (5.8 visits) to 2.4 visits at Month 24. Results: The mean asthma control test score was >19 at every time-point during the study. The rate of Global Evaluation of Treatment Effectiveness (GETE) for asthma response significantly increased at Months 18 and 24 (P Conclusion: RELIEF study showed that add-on therapy with omalizumab is effective in reducing exacerbations, healthcare utilization, and improving GETE score in patients with SAA uncontrolled by standard therapy.

Introdução: a asma é uma doença heterogênea, caracterizada por inflamação crônica das vias aéreas inferiores, associada a diferentes fenótipos. O omalizumabe é utilizado em adição ao tratamento quando não se obtém o controle adequado da asma. Este estudo mostra o perfil epidemiológico e a adesão ao tratamento dos pacientes acompanhados no Ambulatório de Especialidades do Hospital Universitário da Universidade Estadual de Londrina (AEHU-UEL) em uso de omalizumabe em um período de 12 meses. Método: realizado um estudo transversal retrospectivo através de dados secundários de prontuário avaliando pacientes com diagnóstico de asma alérgica grave em uso de omalizumabe nos 12 meses prévios ao recrutamento. Resultados: foram selecionados 40 pacientes que preencheram os critérios de inclusão. A média de idade foi de 51,4 anos, com predomínio de mulheres (70%), brancos (48%), não tabagistas (90%), com sobrepeso ou obesidade (75%) e diagnóstico de asma na infância (45%). O tempo médio de tratamento foi de 8,1 anos (DP 0,8). Havia comorbidades em 85% dos pacientes, com predomínio de rinite (62,5%) e DRGE (40%). Houve exacerbação em 29 pacientes levando a 8 internações (27,5%); 93% dos exacerbadores apresentaram faltas. Conclusão: a amostra é comparável a outros estudos de vida real nos achados epidemiológicos (idade, sexo, fenótipo, tempo de diagnóstico, controle da doença e tabagismo). O elevado número de faltas, assim como frequência de DRGE e outras comorbidades e a baixa adesão à terapêutica, podem justificar o elevado número de exacerbações e maior dificuldade de controle.

COVID-19 has quickly become a public health problem worldwide, and treatment for this new disease is needed. Hydroxychloroquine is an antimalarial that in vitro studies have shown action against SARS-CoV-2, which is why it has been the target of clinical studies with conflicting results. Therefore, the aim of this systematic review was to assess the association of hydroxychloroquine use with the virological cure, clinical recovery, mortality, and development of adverse effects in patients with COVID-19. PubMed, Cochrane Library, and Lilacs were searched until 7 January 2021, for randomized clinical trials with COVID-19 patients treated with hydroxychloroquine or chloroquine. Of the 130 studies found, 12 met the inclusion criteria. Compared to the patient’s control group, the risk ratio (RR) for the virological cure and clinical recovery with hydroxychloroquine or chloroquine use was 1.04 (95%CI 0.91–1.17) and 1.03 (95%CI 0.92–1.13), respectively. Hydroxychloroquine (with or without azithromycin) was also not associated with mortality (RR = 1.09, 95%CI 0.98–1.20). Treatment with hydroxychloroquine was associated with any adverse effects (RR = 1.50, 95%CI 1.18–1.81). Hydroxychloroquine or chloroquine use did not have a significant effect on virological cure, the time of clinical recovery, and improvement in survival in COVID-19 patients. However, patients who used hydroxychloroquine showed an increase in adverse effects.

To verify the validity, reliability, learning effect, Minimal Detectable Change (MDC), and feasibility of four functional tests (4-Meter Gait Speed [4MGS], Timed Up-and-Go [TUG], Sit-To-Stand [STS], and Short Physical Performance Battery [SPPB]) for adults with asthma. In this cross-sectional study, fifty-two subjects with stable asthma underwent three sets of different functional tests protocols (4MGS, TUG, STS, SPPB) in a random order by two raters. For validation analysis, tests were compared with a sex-age matched control group without asthma and correlated with the Six Minute Walking Test (6MWT), and peripheral muscle strength, as well as with quality of life and asthma control questionnaires. Intra-rater and inter-rater reliability, MDC, and feasibility were verified. Adults with asthma presented worse results than controls in the functional tests, except for SPPB. All functional tests were significantly correlated with 6MWT (0.45 r r r Different protocols of 4MGS, TUG, STS, and SPPB are valid, reliable, and feasible to assess the functional capacity of adults with asthma. These tests are quick and practical new alternatives for assessing functional capacity in this population.

Introduction: Patients with severe asthma may present with different phenotypes. Severe eosinophilic asthma patients require frequent use of health care resources and have impaired health-related quality of life. Objective: We sought to determine the prevalence of an eosinophilic phenotype, defined as blood eosinophil counts >300 cells/mm3, for patients with severe asthma in Brazil. Methods: This was a cross-sectional, observational study of adult patients with severe asthma (high dose inhaled corticosteroid [GINA 2018] plus second controller) in routine clinical practice in Brazil. Allergic phenotype was defined as serum IgE>100 IU/mL plus clinical features of allergy. Results: A total of 385 patients were enrolled from 10 Brazilian centers. Most were female (78.4%) and white (57.4%), with a mean age of 53±13 years old. Prevalence of patients with eosinophilic phenotype was 40.0% [95% CI: 35.1–44.9%]. Those were mainly female (76.0%), white (62.3%), with mean age 50±14 years old. Eosinophilic patients presented lower BMI, with no other relevant clinical or demographics differences compared with non-eosinophilic phenotype patients. A high prevalence of allergic phenotype of 62.6% [95% CI: 57.8%-67.4%] was also identified. There was a high overlap between phenotypes as 79.9% [95% CI: 73.5–86.2%] of eosinophilic patients were also allergic. Conclusions: The prevalence of an eosinophilic phenotype for patients with severe asthma in Brazil is high, and these patients present with clinical and demographic characteristics similar to other worldwide populations. The overlap between allergic and eosinophilic phenotypes was common.

Introduction: Measurement properties of functional tests have not been assessed yet in adults with asthma. Aims: To verify the validity, reliability, learning effect, Minimal Detectable Change (MDC) and feasibility of different protocols of three functional tests (4-Meter Gait Speed [4MGS], Timed Up-and-Go [TUG] and Sit-To-Stand [STS]) in adults with asthma. Methods: Fifty-two patients with stable asthma (49±15 years) underwent 3 sets of seven functional test protocols (4MGS and TUG at usual and maximum speeds; STS in 5-repetition, 30 seconds and 1 minute protocols) in random order by two raters. For validation analysis, results were compared with those from a sex-age matched control group and correlated with the Six Minute Walking Test (6MWT), and peripheral muscle strength, as well as with quality of life (QoL) and asthma control questionnaires. Intra and inter-rater reliability, MDC, learning effect and feasibility were verified. Results: Asthmatic subjects performed worse than controls in all functional tests (p Conclusions: Different protocols of 4MGS, TUG and STS are valid, reliable and feasible to assess functional capacity of adults with asthma.

The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages. RESUMO O manejo farmacológico da asma mudou consideravelmente nas últimas décadas, com base no entendimento de que a asma é uma doença heterogênea e complexa, com diferentes fenótipos e endótipos. Agora está claro que o objetivo do tratamento da asma deve ser alcançar e manter o controle da doença e evitar riscos futuros (exacerbações, instabilidade da doença, perda acelerada da função pulmonar e efeitos adversos do tratamento). Isso implica em uma abordagem personalizada, incluindo tratamento farmacológico, educação do paciente, plano de ação por escrito, treinamento para uso do dispositivo inalatório e revisão da técnica inalatória a cada visita ao consultório. Um painel de 22 pneumologistas brasileiros foi convidado a revisar criticamente evidências recentes de tratamento farmacológico da asma e a preparar esta recomendação, um guia de tratamento adaptado à nossa realidade. A escolha dos tópicos ou questões relacionadas às mudanças mais significativas nos conceitos e, consequentemente, no manejo da asma na prática clínica foi realizada por um painel de especialistas. Foi solicitado a cada especialista que revisasse criticamente um tópico ou respondesse a uma pergunta, com base em evidências, para estas recomendações. Numa segunda fase, três especialistas discutiram e estruturaram todos os textos submetidos pelos demais e, na última fase, todos revisaram e discutiram cada recomendação. As presentes recomendações se aplicam a adultos e crianças com asma e destinam-se a médicos envolvidos no tratamento da doença.

This study aimed to investigate the dental caries status and salivary properties in 3- to 15-year-old children/adolescents.The sample was split in two groups: asthma group (AG), composed of 65 patients who attended Public Health Service; asthma-free group (AFG), composed of 65 nonasthmatic children/adolescents recruited in two public schools. Stimulated salivary samples were collected for 3 min. Buffering capacity and pH were ascertained in each salivary sample. A single trained and calibrated examiner (kappa = 0.98) performed the dental caries examination according to WHO criteria.The AFG showed salivary flow rate (1.10 ± 0.63 mL/min) higher (P = 0.002) than AG (0.80 ± 0.50 mL/min). An inverse relationship was observed between asthma severity and salivary flow rate (Phi coefficient, rφ: 0.79, P = 0.0001). Children with moderate or severe asthma showed an increased risk for reduced salivary flow rate (OR: 17.15, P 0.001). No association was observed between drug use frequency (P 0.05) and drug type (P 0.05) with salivary flow rate. Buffering capacity was similar in both groups. No significant differences were encountered in dental caries experience between AFG and AG groups.Although asthma can cause reduction in flow rate, the illness did not seem to influence dental caries experience in children with access to proper dental care.

O objetivo deste estudo foi avaliar o programa de controle da asma (programa "Respira Londrina") do Município de Londrina, Paraná, Brasil. Trata-se de estudo transversal, comparando unidade de saúde da família (USF) com o programa consolidado e duas USF sem o programa consolidado. Foram entrevistados 313 asmáticos, 168 da USF com programa consolidado e 145 das USF com programa não consolidado. Na amostra estudada, houve diferenças significativas (p < 0,001) na utilização de broncodilatadores e no número de atendimentos de urgência nas USF com programa consolidado e não consolidado. Dos asmáticos inscritos na USF com programa consolidado, 55,4% referiram uso de broncodilatador em comparação a 74,5% dos inscritos nas USF com programa não consolidado. Respectivamente, 29,2% e 55,9% dos pacientes das USF com programa consolidado e não consolidado necessitaram de atendimento de urgência. Um programa de controle da asma bem estruturado pode resultar na redução dos atendimentos de urgência decorrentes de crises asmáticas, contribuindo na melhoria dos indicadores de saúde, bem como para a elevação da qualidade de vida.

The objective of this study was to evaluate the asthma control program in Londrina, Paraná State, Brazil. This is a cross-sectional study, comparing a family health unit (USF) with a consolidated program with two USFs without one. Interviews were performed with 313 asthma patients, 168 from the USF with a consolidated program and 145 from the USFs without one. In the studied sample, there were significant differences (p0.001) in the use of bronchodilators and in the number of emergency department visits between the USF with and without a consolidated program. Among the patients enrolled in the USF with a consolidated program, 55.4% reported the use of bronchodilator, in comparison with 74.5% of those enrolled in the two USF without a consolidated program. Respectively 29.2% and 55.9% of the patients from the USFs with and without a consolidated program needed emergency department care. A well-organized asthma control program may result in reduction of emergency department visits due to asthma exacerbation, thus contributing to improving health indicators and quality of life.

Objective: To determine the prevalence of symptoms of asthma, rhinitis and atopic eczema among students between 6 and 7 years of age in the city of Londrina, Brazil. Methods: A population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaire (asthma, rhinitis and atopic eczema modules), validated for use in Brazil, in public school students between 6 and 7 years of age. Results: Of the 3,963 questionnaires retrieved, 3,600 (90.8%) were appropriately completed and were used in the analysis. The prevalence of symptoms of asthma, rhinitis and atopic eczema in the last 12 months was 22.0%, 27.3% and 9.6%, respectively. The prevalence of physician-diagnosed asthma, rhinitis and atopic eczema was 10.4%, 23.4% and 11.4%, respectively. The prevalence of rhinoconjunctivitis and flexural eczema was 13.6% and 6.6%, respectively. Although symptoms of asthma and rhinitis were more common in males than in females, no gender difference was found regarding atopic eczema symptoms. Conclusions: The prevalence of symptoms of asthma, rhinitis and atopic eczema in our sample was within the range found at the facilities that participated in phases I and III of the ISAAC in Brazil. The low prevalence of physician-diagnosed asthma suggests that asthma continues to be underdiagnosed.

To determine the prevalence of symptoms of asthma, rhinitis and atopic eczema among students between 6 and 7 years of age in the city of Londrina, Brazil.A population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaire (asthma, rhinitis and atopic eczema modules), validated for use in Brazil, in public school students between 6 and 7 years of age.Of the 3,963 questionnaires retrieved, 3,600 (90.8%) were appropriately completed and were used in the analysis. The prevalence of symptoms of asthma, rhinitis and atopic eczema in the last 12 months was 22.0%, 27.3% and 9.6%, respectively. The prevalence of physician-diagnosed asthma, rhinitis and atopic eczema was 10.4%, 23.4% and 11.4%, respectively. The prevalence of rhinoconjunctivitis and flexural eczema was 13.6% and 6.6%, respectively. Although symptoms of asthma and rhinitis were more common in males than in females, no gender difference was found regarding atopic eczema symptoms.The prevalence of symptoms of asthma, rhinitis and atopic eczema in our sample was within the range found at the facilities that participated in phases I and III of the ISAAC in Brazil. The low prevalence of physician-diagnosed asthma suggests that asthma continues to be underdiagnosed.

O objetivo do trabalho foi o de determinar quais são os programas brasileiros que apresentam experiência no manejo da asma. As informações sobre os programas e suas características foram obtidas via correio eletrônico. As variáveis analisadas eram relacionadas aos asmáticos, ao próprio programa e aos profissionais envolvidos. Utilizou-se a estatística descritiva. Foram analisados 17 programas. Todos os programas possuíam financiamento público, produção de materiais informativos e de treinamento e presença de médico especialista. Concluiu-se que a experiência acumulada em todos os programas pode ser utilizada como um dos pilares para a consolidação de um programa nacional de controle da asma. The aim of this study was to determine which Brazilian programs demonstrate experience in asthma management. Data on and characteristics of those programs were obtained by electronic mail. The variables studied were related to the program itself, its patients and staff. Descriptive statistics were used in the study, which evaluated 17 programs. All programs received public funding, produced educational/training materials and had specialized physicians on staff. We concluded that the experience accumulated by all the programs can be used as one of the pillars of a national program for the control of asthma in Brazil.

To evaluate the relationship between the reduction in the number of asthma-related hospital admissions and the changes occurring after the intervention performed in the health care system of the city of Londrina, Brazil.In 2003, an intervention was performed in the local health care system (Family Health Clinics). The steps adopted were as follows: development of a protocol based on the III Brazilian Consensus on Asthma Management; access to free inhaled corticosteroids for patients; training of health professionals; and implementation of educational measures, especially for the community. The authorizations for hospital admissions of patients diagnosed with asthma alone between 2002 and 2005 in the city of Londrina were analyzed.The mean age was 14.3 +/- 0.5 years, without gender predominance. The number of hospital admissions fell more markedly in 2005 than in the previous years studied. This decline was more pronounced at the Family Health Clinics where professional training occurred earlier. The post-intervention (2004-2005) rate of asthma-related hospital admissions (120/100,000 inhabitants) was significantly lower than the pre-intervention (2002-2003) rate (178/100,000 inhabitants; p0.01).The admission curve showed a tendency toward a reduction after 2003, and, aside from the intervention performed, no other factors that would explain the results obtained were identified. The rate at which the number of hospital admissions decreased was in direct proportion to the length of time elapsed since the intervention (greater decreases over time). We conclude that the intervention performed in the local health care system was responsible for the data presented.

The aim of this study was to determine which Brazilian programs demonstrate experience in asthma management. Data on and characteristics of those programs were obtained by electronic mail. The variables studied were related to the program itself, its patients and staff. Descriptive statistics were used in the study, which evaluated 17 programs. All programs received public funding, produced educational/training materials and had specialized physicians on staff. We concluded that the experience accumulated by all the programs can be used as one of the pillars of a national program for the control of asthma in Brazil.

OBJECTIVE: To determine the relative frequency of hypomagnesemia among patients with chronic airflow limitation treated as outpatients at a referral center in the northern part of the state of Parana between 2000 and 2001, as well as to determine whether hypomagnesemia correlates with hypoxia, with other electrolyte disturbances and with the severity of airflow limitation. METHODS: This was a descriptive study of the relative frequency of hypomagnesemia in 72 patients with chronic airflow limitation. All of the patients were submitted to blood tests to determine serum levels of magnesium and other electrolytes, as well as to staging of the underlying disease. RESULTS: The prevalence of hypomagnesemia was 27.8%. The mean age was 65 ± 9.9 years, and there was a predominance of males. The mean forced expiratory volume in one second was 1.31 ± 0.52 L. Most of the patients (68.1%) were found to be in the advanced stages of the disease. Hypomagnesemia was not found to correlate with other electrolyte disturbances, hypoxemia or disease stage. CONCLUSION: The high frequency of patients in the advanced stages is likely attributable to the fact that the outpatient facility is a referral center for the region. Further studies should be conducted in order to determine the probable causes of this high prevalence of hypomagnesemia.

To determine the relative frequency of hypomagnesemia among patients with chronic airflow limitation treated as outpatients at a referral center in the northern part of the state of Paraná between 2000 and 2001, as well as to determine whether hypomagnesemia correlates with hypoxia, with other electrolyte disturbances and with the severity of airflow limitation.This was a descriptive study of the relative frequency of hypomagnesemia in 72 patients with chronic airflow limitation. All of the patients were submitted to blood tests to determine serum levels of magnesium and other electrolytes, as well as to staging of the underlying disease.The prevalence of hypomagnesemia was 27.8%. The mean age was 65 +/- 9.9 years, and there was a predominance of males. The mean forced expiratory volume in one second was 1.31 +/- 0.52 L. Most of the patients (68.1%) were found to be in the advanced stages of the disease. Hypomagnesemia was not found to correlate with other electrolyte disturbances, hypoxemia or disease stage.The high frequency of patients in the advanced stages is likely attributable to the fact that the outpatient facility is a referral center for the region. Further studies should be conducted in order to determine the probable causes of this high prevalence of hypomagnesemia.

Introdução: A elevada prevalência de doenças alérgicas na infância e tendências de aumento detectadas em diversos estudos no mundo tem motivado pesquisadores a buscar melhor conhecimento da real prevalência dessas doenças e os fatores que estejam envolvidos em sua manifestação. No Brasil há poucos dados publicados. Objetivo: Verificar a prevalência de sintomas de asma, rinite e eczema atópico e do diagnóstico médico, em escolares de 6 e 7 anos na cidade de Londrina-PR. Método: Estudo de prevalência de base populacional, utilizando o questionário do International Study of Asthma and Allergies in Childhood (ISAAC) padronizado e validado para o Brasil, nos módulos de asma, rinite e eczema atópico, em escolares de 6 e 7 anos de 38 escolas públicas de Londrina-PR. Resultados: Foram entregues 3.963 questionários, sendo que 3.600 (90,8%) estavam completamente respondidos pelos pais ou responsáveis. Sintomas de asma, rinite e eczema nos últimos 12 meses foram de 22%, 27,3% e 9,6%, respectivamente. O diagnóstico médico foi de 10,4% para asma, 23,4% para rinite e 11,4% para eczema atópico. Rinoconjuntivite ocorreu em 13,6% e eczema em local específico em 6,6% dos escolares. Para sintomas de asma e rinite houve predomínio para o sexo masculino, mas não para eczema atópico. Conclusão: A prevalência de sintomas de asma, rinite e eczema em Londrina-PR está dentro da variação encontrada em centros brasileiros que participaram da Fase I e Fase III do ISAAC. A baixa taxa de diagnóstico médico de asma sugere que esta morbidade ainda é subdiagnosticada. Introduction: The high prevalence of allergic diseases in childhood and trends of its increase in several studies, have attracted researchers to determine the prevalence of theses conditions and the associated risk factors. There are few studies in Brazil reporting to this data. Objective: To determine the prevalence of symptoms of asthma, rhinitis and atopic eczema and physician-diagnosed among schoolchildren aged 6 and 7 years in Londrina-PR city. Methods: Prevalence population based study was held using the International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaires, validate to Brazilian population, on Modules of asthma, rhinitis and atopic eczema in schoolchildren aged 6 and 7 years for 38 public schools in Londrina-PR city. Results: Among 3963 questionnaires, 3600 (90,8%) write questionnaires were analyzed. Symptoms of asthma, rhinitis and atopic eczema in the last 12 months were 22%, 27,3% and 9,6%. Physician-diagnosed was 10,4% for asthma, 23,4% for rhinitis and 11,4% for atopic eczema. Rhinoconjunctivitis was 13,6% and flexural eczema was 6,6%. There was predominance of symptoms in males to asthma and rhinitis, but not to atopic eczema. Conclusion: The prevalence of symptoms of asthma, rhinitis and atopic eczema in Londrina-PR has the same variation of others Brazilian centers who participated from ISAAC Fase I and III. The low prevalence of physician-diagnosed for asthma suggested sub diagnosis.