Objective: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.

The Brazilian version of the Childhood Asthma Control Test proved to be valid and reliable in children aged 4-11 years.

The burden of asthma in Brazilian children seems to be substantial. New international guidelines with a special focus in developing countries settings, with more pragmatic approaches, should be a priority for discussion and implementation actions.

ResumoIntrodução: As mudanças na força e na capacidade funcional decorrentes do envelhecimento podem ser melhoradas mediante a prática de exercícios físicos como a musculação e a hidroginástica. Objetivo: Comparar a força e a capacidade funcional entre idosos praticantes de musculação, hidroginástica e não praticantes de exercícios físicos. Métodos: Estudo descritivo de corte transversal com amostragem não probabilística voluntária. Participaram do estudo 36 idosos (63,6±4,1 anos), sendo 12 praticantes de musculação, 12 praticantes de hidroginástica e 12 não praticantes de exercícios físicos. O nível de atividade física foi avaliado pelo Questionário Internacional de Atividade Física (IPAQ). A avaliação da força máxima foi realizada pelo teste de uma repetição máxima (1RM) em membros superiores e inferiores. A capacidade funcional foi avaliada pelos testes de levantar da cadeira em 30 segundos e velocidade de caminhada habitual e máxima. Foi utilizada Anova One Way com post-hoc de Bonferroni para comparação das variáveis dependentes entre os grupos com α=0,05. Resultados: Todos os grupos foram classificados como ativos. O grupo praticante de musculação apresentou os maiores valores de força máxima, quando comparado ao praticante de hidroginástica e não praticante de exercícios físicos (p≤0,01). Além disso, os grupos praticante de hidroginástica e não praticante de exercícios físicos não apresentaram diferenças na força máxima (p=1,0). Já para o teste de levantar da cadeira, não foram observadas diferenças entre os grupos (p=0,07), o mesmo sendo observado no teste de velocidade de caminhada habitual (p=0,06) e máxima (p=0,22). Conclusão: A musculação mostrouse mais eficaz para o aumento de força, mas o estilo de vida ativo é suficiente para a manutenção da capacidade funcional. In addition, hydrogymnastics practitioners and non-practitioners of physical exercises groups showed no differences in maximum strength (p=1.0). As for the chair lifting test, no differences were observed between groups (p=0.07) and the same was observed in habitual (p=0,06) and maximum (p=0,22) walking speed test. Conclusion:The strength training was more effective for increasing strength, but active lifestyle is sufficient to maintain functional capacity.

In this retrospective report, the use of omalizumab in Brazilian children with STRA significantly improved disease control, decreased hospitalizations, and allowed suspension of continuous oral corticosteroids.

Objective: To describe the clinical characteristics, lung function, radiological findings, and the inflammatory cell profile in induced sputum in children and adolescents with severe therapy-resistant asthma (STRA) treated at a referral center in southern Brazil. Methods: We retrospectively analyzed children and adolescents (3-18 years of age) with uncontrolled STRA treated with high-dose inhaled corticosteroids and long-acting ß2 agonists. We prospectively collected data on disease control, lung function, skin test reactivity to allergens, the inflammatory cell profile in induced sputum, chest CT findings, and esophageal pH monitoring results. Results: We analyzed 21 patients (mean age, 9.2 ± 2.98 years). Of those, 18 (86%) were atopic. Most had uncontrolled asthma and near-normal baseline lung function. In 4 and 7, induced sputum was found to be eosinophilic and neutrophilic, respectively; the inflammatory cell profile in induced sputum having changed in 67% of those in whom induced sputum analysis was repeated. Of the 8 patients receiving treatment with omalizumab (an anti-IgE antibody), 7 (87.5%) showed significant improvement in quality of life, as well as significant reductions in the numbers of exacerbations and hospitalizations. Conclusions: Children with STRA present with near-normal lung function and a variable airway inflammatory pattern during clinical follow-up, showing a significant clinical response to omalizumab. In children, STRA differs from that seen in adults, further studies being required in order to gain a better understanding of the disease mechanisms.

ObjectiveTo evaluate the levels of knowledge about asthma of parents of school children.MethodsA cross-sectional study was carried out with parents of children with medical diagnosis of asthma (mild, moderate and severe), followed up at an outpatient referral center for childhood asthma in the Southern region of Brazil (Asthma Group). Parents of children with asthma in remission and healthy children were also selected (Control Group). The Newcastle Asthma Knowledge Questionnaire (NAKQ) questionnaire was applied in both groups.ResultsA total of 154 parents of children participated in the study; in that, 62 (40.26%) in the Asthma Group, and 92 (59.74%) in the Control Group, with a mean age of 35.60±10.03 years. Of these, 132 (85.7%) were female, and 72 (46.8%) parents studied up to high school. The average score of level of knowledge was 18.06±4.11 points. Only 30.5% parents had acceptable levels of knowledge about asthma, which were more prevalent in the Asthma Group than in the Control Group (41.9% versus 22.8%, p=0.01). The mean score in Newcastle Asthma Knowledge Questionnaire (NAKQ) was higher in the Asthma Group (19.32±3.92 versus 17.21±4.03, p=0.001), respectively. The parents with mild and moderate asthmatic children scored more than those of severe asthma (19.5 and 19.9 versus 18.2 points, p=0.02).ConclusionMost parents had an unsatisfactory level of knowledge about asthma, which reinforces the need for changes in public asthma management programs.

Objective To investigate the effect of levels of physical activity on asthma control in children.Methods A cross-sectional study, including public school students aged 8 to 12 years, of both sexes, with asthma, from a capital and a medium-sized cities in Southern Brazil. At home, the students answered the questionnaire on levels of physical activity and disease control.Results A total of 482 schoolchildren with asthma participated in the study, with mean age of 10.9±2.2 years, and 253 (52%) were girls. Regarding disease control, 50% had controlled asthma, and 67% were considered sedentary. Schoolchildren with controlled asthma were more active than those with uncontrolled asthma (p=0.032). Active schoolchildren were more likely to have asthma controlled (OR=1.5; 95%CI: 1.04-2.25).Conclusion The results demonstrated an association between physical activity levels and asthma control. More active schoolchildren were more likely to have asthma controlled.