There are only a few studies assessing the relationship between adherence rate to ICS, as assessed by electronic monitoring, and the level of asthma control in childhood. The present study was carried out to examine the relationship between adherence to beclomethasone diproprionate (BDP) as well as other factors related to poor asthma control. In this prospective cohort study, 102 steroid naïve randomly selected subjects with persistent asthma, aged 5-14 years were prescribed 500-750 μg daily of BDP-CFC and followed during one year. Adherence to BDP was measured electronically in the 4th, 8th and 12th months of study. The level of asthma control was classified as either controlled or uncontrolled instead of the current three categories recommended by the Global Initiative for Asthma (GINA). Mean adherence rate was higher in patients with controlled asthma during follow-up, but went down from 60.4% in the 4th month to 49.8% in the 12th month (p = 0.038). Conversely, among patients with uncontrolled asthma, the mean adherence rate decreased from 43.8% to 31.2% (p = 0.001). Multivariate analysis showed that the level of asthma control was independently associated to the adherence rate in all follow-up visits (p-values equal or lower than 0.005). The level of asthma control was directly proportional to adherence rate. Our results suggest that a BDP daily dose by 300 μg seems to be enough to attain control over mild and moderate persistent asthma, including exercise induced asthma.
The results suggest an association between the use of inhaled corticosteroids and an increased risk of dental caries and bacterial plaque, which calls for special attention of these patients by doctors and dental health professionals.
The objective of this study was to review the literature and to discuss epidemiological and physiopathological aspects and therapeutical implications of an unified approach to allergic rhinosinusitis and asthma. The bibliographic survey was based on the information provided by the following databases: Medline, MD Consult, Highwire, Medscape, LILACS and through direct search over thirty years, using the terms allergic rhinitis and asthma. Fifty-five original articles were selected in the no systematically review addressing the issue of clinical association between allergic rhinusinusitis and asthma. It is noteworthy that in the late years, with the use of specific topical medications for the lower airways or else, to the upper airways, the therapeutical approach has been distinct. However, numerous epidemiological surveys, immunopatological and clinical studies demonstrate the inter-relationship between asthma and allergic rhinossinusitis, characterized by: i) allergic rhinitis is associated to asthma and constitute an independent risk factor for its occurrence; ii) the immunopathological characteristics of allergic rhinitis and asthma are similar; iii) allergic rhinitis and asthma are manifestations of a systemic disease; iv) control of rhinitis favors asthma control. taking into consideration the close inter-relationship between allergic rhinitis and asthma, the approach to diagnosis, treatment and prophylaxis of these illnesses should be integrated. Therapeutical options that allow for the simultaneous control of asthma and allergic rhinitis offer advantages related both to costs and tolerability.
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