BackgroundPatients with severe refractory asthma (SRA), even when using high doses of multiple controller medications in a regular and appropriate way, can have persistent complaints of exercise limitation.MethodsThis was a cross-sectional study involving patients with SRA (treated with ≥ 800 μg of budesonide or equivalent, with ≥ 80% adherence, appropriate inhaler technique, and comorbidities treated), who presented no signs of a lack of asthma control other than exercise limitation. We also evaluated healthy controls, matched to the patients for sex, age, and body mass index. All participants underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer, maximum exertion being defined as ≥ 85% of the predicted heart rate, with a respiratory exchange ratio ≥ 1.0 for children and ≥ 1.1 for adolescents. Physical deconditioning was defined as oxygen uptake (VO2) < 80% of predicted at peak exercise, without cardiac impairment or ventilatory limitation. Exercise-induced bronchoconstriction (EIB) was defined as a forced expiratory volume in one second ≥ 10% lower than the baseline value at 5, 10, 20, and 30 minutes after CPET.ResultsWe evaluated 20 patients with SRA and 19 controls. In the sample as a whole, the mean age was 12.9 ± 0.4 years. The CPET was considered maximal in all participants. In terms of the peak VO2 (VO2peak), there was no significant difference between the patients and controls, (P = 0.10). Among the patients, we observed isolated EIB in 30%, isolated physical deconditioning in 25%, physical deconditioning accompanied by EIB in 25%, and exercise-induced symptoms not supported by the CPET data in 15%.Conclusion and Clinical RelevancePhysical deconditioning, alone or accompanied by EIB, was the determining factor in reducing exercise tolerance in patients with SRA and was not therefore found to be associated with a lack of asthma control.

Objective: To evaluate the effectiveness of home visits in a group of children and adolescents with severe asthma by using the inhalation technique score and adherence rates to drug treatment. Method: A 12-month randomized controlled trial involving patients aged between three and 17 years under regular follow-up treatment at a pediatric pulmonology outpatient clinic of a university hospital in southeastern Brazil. A group of patients received only outpatient consultations and the other group received home visits from nurses in addition to outpatient consultations. The differences between groups were analyzed through the outcomes of inhalation technique scores and treatment adherence rate. Results: Participation of 29 patients. In the intervention group, there was a statistically significant increase in inhalation technique scores (p<0.05) and elimination of critical errors between the first and the second evaluation, and results were maintained in the third evaluation. In the control group, there were no significant changes in inhalation technique scores. Rates of adherence to drug treatment in both groups did not rise. Conclusion: Home visits were effective for improving inhalation technique scores in patients with severe asthma. Brazilian Registry of Clinical Trials: RBR-8GZWZP.

BackgroundIn severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day.MethodsThis was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6–18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day.ResultsAt baseline, the forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity (FVC) ratio were both < 80% of the predicted values in 50.8% of the patients. The median age of the patients was 10.4 years (interquartile range 7.8–13.6 years). In the sample as a whole, there were significant increases in FEV1% and in the FEV1/FVC% ratio (p = 0.01 and p < 0.001, respectively) over the course of the study. In the > 800 µg/day group, there were no statistical increases or decreases in FEV1, the FEV1/FVC ratio, or forced expiratory flow between 25 and 75% of the FVC (FEF25–75%), when calculated as percentages of the predicted values. However, the z-score for FEF25–75% showed a statistically significant reduction, in the sample as a whole and in the > 800 µg/day group. Also in the > 800 µg/day group, there was a significant reduction in the post-bronchodilator FEV1% (p = 0.004).ConclusionsThe fact that the spirometric parameters (as percentages of the predicted values) remained constant in the > 800 µg/day group, whereas there was a gain in lung function in the sample as a whole, suggests an early plateau phase in the > 800 µg/day group. However, there was some loss of lung function in the > 800 µg/day group, as evidenced by a decrease in the z-score for FEF25–75%, suggesting irreversible small airway impairment, and by a reduction in the post-bronchodilator FEV1%, suggesting reduced reversibility of airway obstruction. Among children and adolescents with severe asthma, the use of ICS doses higher than those recommended for age does not appear to improve lung function.

Objective: to verify the role of peak expiratory flow, measured through portable meters, as an alternative test to assess pulmonary disease in cystic fibrosis.Methods: forty-nine patients aged five to 19 years old in stable health condition and able to perform the peak expiratory flow maneuver were included. In the same visit, Shwachman-Kulczycki score was recorded. Linear regression was used to assess the correlation between the Shwachman-Kulczycki score and the peak expiratory flow rate. A P value of 0.05 was considered to be significant.Results: a slight, but statistically significant correlation between absolute and percent values for this functional parameter and the Shwachman-Kulczycki score (r = 0.31, P = 0.02 and r = 0.30, P = 0.03, respectively) was found.Conclusions: although this correlation was statistically significant, these findings are not clinically relevant, i.e., the lung involvement in this disease should be assessed by classic pulmonary function tests, such as spirometry.J Pediatr (Rio J) 2002; 78 (1): 45-49: peak expiratory flow rate, cystic fibrosis. ResumoObjetivo: avaliar o valor do pico de fluxo expiratório, obtido através de medidores portáteis, como método alternativo de acompanhamento da função pulmonar na fibrose cística.Métodos: quarenta e nove pacientes, de 5 a 19 anos, clinicamente estáveis e aptos a realizar a manobra para obtenção do pico do fluxo foram incluídos no estudo. Na mesma visita, pontuou-se o escore de Shwachman-Kulczycki e registrou-se o valor do pico do fluxo expiratório. Analisou-se a correlação entre esses dois parâme-tros pela regressão linear, com nível de significância de p = 0,05.Resultados: obteve-se uma correlação discreta, mas estatisticamente significante, entre os valores absolutos e percentuais desse parâmetro funcional com o escore clínico-radiológico (r = 0,31, p = 0,02 e r = 0,30, p = 0,03, respectivamente).Conclusões: conclui-se que a significância estatística observada não corresponde necessariamente a uma relevância clínica e, portanto, a função pulmonar na fibrose cística deve ser avaliada pela espirometria convencional.J Pediatr (Rio J) 2002; 78 (1): 45-49 IntroduçãoA despeito do caráter sistêmico da fibrose cística, o acometimento pulmonar é a principal causa de morbidade e mortalidade nessa afecção. Alterações anátomo-patológi-cas se instalam já nos primeiros meses de vida, com dilatação e hipertrofia de glândulas produtoras de muco, levando ao acometimento das pequenas vias aéreas, com posterior obstrução bronquiolar, desenvolvimento gradual de bronquiectasias e destruição progressiva do parênquima, com conseqüente redução da capacidade funcional respirató-ria 1 .A avaliação seqüencial da função pulmonar é, pois, obrigatória nesta doença e, com a finalidade de avaliar a intensidade do envolvimento pulmonar, provas funcionais devem ser realizadas pelo menos uma vez ao ano, e a disponibilidade e acesso irrestritos a espirômetros torna-se então indispensável no seguimento dos pacientes para a devida quantificação dos diversos parâmetros...

Objective: to verify the role of peak expiratory flow, measured through portable meters, as an alternative test to assess pulmonary disease in cystic fibrosis.Methods: forty-nine patients aged five to 19 years old in stable health condition and able to perform the peak expiratory flow maneuver were included. In the same visit, Shwachman-Kulczycki score was recorded. Linear regression was used to assess the correlation between the Shwachman-Kulczycki score and the peak expiratory flow rate. A P value of 0.05 was considered to be significant.Results: a slight, but statistically significant correlation between absolute and percent values for this functional parameter and the Shwachman-Kulczycki score (r = 0.31, P = 0.02 and r = 0.30, P = 0.03, respectively) was found.Conclusions: although this correlation was statistically significant, these findings are not clinically relevant, i.e., the lung involvement in this disease should be assessed by classic pulmonary function tests, such as spirometry.J Pediatr (Rio J) 2002; 78 (1): 45-49: peak expiratory flow rate, cystic fibrosis. ResumoObjetivo: avaliar o valor do pico de fluxo expiratório, obtido através de medidores portáteis, como método alternativo de acompanhamento da função pulmonar na fibrose cística.Métodos: quarenta e nove pacientes, de 5 a 19 anos, clinicamente estáveis e aptos a realizar a manobra para obtenção do pico do fluxo foram incluídos no estudo. Na mesma visita, pontuou-se o escore de Shwachman-Kulczycki e registrou-se o valor do pico do fluxo expiratório. Analisou-se a correlação entre esses dois parâme-tros pela regressão linear, com nível de significância de p = 0,05.Resultados: obteve-se uma correlação discreta, mas estatisticamente significante, entre os valores absolutos e percentuais desse parâmetro funcional com o escore clínico-radiológico (r = 0,31, p = 0,02 e r = 0,30, p = 0,03, respectivamente).Conclusões: conclui-se que a significância estatística observada não corresponde necessariamente a uma relevância clínica e, portanto, a função pulmonar na fibrose cística deve ser avaliada pela espirometria convencional.J Pediatr (Rio J) 2002; 78 (1): 45-49 IntroduçãoA despeito do caráter sistêmico da fibrose cística, o acometimento pulmonar é a principal causa de morbidade e mortalidade nessa afecção. Alterações anátomo-patológi-cas se instalam já nos primeiros meses de vida, com dilatação e hipertrofia de glândulas produtoras de muco, levando ao acometimento das pequenas vias aéreas, com posterior obstrução bronquiolar, desenvolvimento gradual de bronquiectasias e destruição progressiva do parênquima, com conseqüente redução da capacidade funcional respirató-ria 1 .A avaliação seqüencial da função pulmonar é, pois, obrigatória nesta doença e, com a finalidade de avaliar a intensidade do envolvimento pulmonar, provas funcionais devem ser realizadas pelo menos uma vez ao ano, e a disponibilidade e acesso irrestritos a espirômetros torna-se então indispensável no seguimento dos pacientes para a devida quantificação dos diversos parâmetros...

No abstract