Most of the asthma patients treated at the public referral center in Porto Alegre did not receive treatment that was consistent with the Consensus guidelines. Undertreatment with inhaled corticosteroids was the principal source of that inconsistency.
Objective: To determine whether the guidelines put forth in the ΙΙΙ Brazilian Consensus on Asthma Management are being applied in a population of asthma patients treated at a public hospital that is a referral center for asthma in the city of Porto Alegre, Brazil. Methods: All adult asthma patients who began their treatment between 1999 and 2002 were evaluated. The treatment given was classified as consistent or inconsistent with the Consensus guidelines. The clinical features of asthma and the frequency of treatment provided by a specialist were compared between the two groups (those receiving guideline-consistent treatment and those receiving guideline-inconsistent treatment). Results:The charts of 357 patients were evaluated. The study sample consisted of 106 males (29.9%) and 251 females (70.3%). The mean age was 41 years, and 33 (9.2%) of the patients were smokers. The treatment was considered inconsistent with the Consensus guidelines in 246 cases (70%). Of those 246, 174 (71%) had presented persistent asthma and were not treated with an inhaled corticosteroid. Normal forced expiratory volume in one second, being from 12 to 18 years of age, and having intermittent asthma were more frequently observed among the patients receiving guideline-consistent treatment (p < 0.01). No correlations were found between guideline-inconsistent treatment and being treated by a pulmonologist, severity of persistent asthma or number of emergency room visits. Conclusion: Most of the asthma patients treated at the public referral center in Porto Alegre did not receive treatment that was consistent with the Consensus guidelines. Undertreatment with inhaled corticosteroids was the principal source of that inconsistency.
RESUMO:O objetivo deste estudo é apontar quais os novos potenciais marcadores biológicos na rinite alérgica (RA). Buscou-se nas bases de dados Scielo e PUBMED artigos com os descritores "Rinite Alérgica" e "Biomarcadores" ou "Citocinas" ou "Interleucinas" ou "Eicosanoides", bem como na língua inglesa. A perspectiva do uso de novos biomarcadores na rinite alérgica vem sendo pesquisada, visto que marcadores sensíveis e específicos da doença poderiam permitir rápido diagnóstico, avaliação do estágio da doença e estimação da resposta ao tratamento. Vários métodos para coleta de amostras não invasivos ou semi-invasivos nas vias aéreas oferecem a possibilidade de mensuração de uma grande quantidade de novos biomarcadores na RA. Como potenciais biomarcadores, a análise do perfil de citocinas nasais apresenta uma boa caracterização diagnóstica (IL-5 e IL-13), além da relação de severidade da doença (IL-9 e IL-17B). Como avaliação isolada, a dosagem sérica de Proteína da Célula de Clara (CC16) parece ter grande potencial, pois permite o diagnóstico e seus níveis estão inversamente relacionados com a severidade da doença. Além disso, a dosagem de FeNO vem como uma arma importante para predizer asma nos pacientes com RA.
PALAVRAS-CHAVE:Biomarcadores; Rinite alérgica; Citocinas; Interleucinas; Eicosanoides.
BIOMARKERS IN ALLERGIC RHINITIS: ITS IMPORTANCE AND DIAGNOSTIC POTENTIALABSTRACT: Current analysis deals with the new potential biological markers in allergic rhinitis. Scielo and PUBMED databases were researched for articles through descriptors "Allergic rhinitis" and "Biomarkers" or "Cytokines" or "Interleukins" or "Eicosanoids", in English and Portuguese. The use of new biomarkers for allergic rhinitis is researched since sensitive and specific markers provide a quick diagnosis, assessment of the disease´s stage and estimates of treatment responses. Several invasive and semi-invasive methods for sample collection from the aerial pathways make possible the measurement of a great number of new biomarkers in allergic rhinitis. As potential biomarkers, the analysis of nasal cytokines offers a good diagnose (IL-5 and IL-13), coupled to the disease´s severity (IL-9 and IL-17B). As an isolated evaluation, serum dosage of Clara Cell Protein (CC16) seems to be highly promising since it favors diagnosis with inversely related levels for the disease´s severity. Further, FeNO dosage is an important tool to predict asthma in AR patients.
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