Treatment of wheezing in <scp>B</scp>razilian infants in the first year of life

Bianca, Ana Caroline Cavalcanti Dela; Wandalsen, Gustavo F.; Prestes, Elaine; Lamenha, Mércia; Bessa, Olívia Andréa Alencar Costa; Chong-Neto, Herberto José; Medeiros, Décio; Sarinho, Emanuel; Filho, Nelson Augusto Rosário; Mallol, Javier; Solé, Dírceu

doi:10.1111/pai.12144

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…This notoriously troublesome progression of RW, with exacerbations mainly associated with colds, would explain in part ICS, OCS, ALTR, ATB, and PCM plus several others of doubtful efficacy clinicians prescribe to the large proportion of these infants. 1 2 3 …”

Section: Discussionmentioning

confidence: 99%

“…It is a major health problem (causing a considerable use of health services and medications expenses. 1 2 3 Furthermore, during the first year of life a high proportion of infants with RW have severe episodes resulting in an elevated frequency of visits to the Emergency Department (ED) and hospital admissions for wheezing, 3 evidencing that RW in infants is not a benign condition as usually considered independently of how it will progress later in childhood or adolescence. Despite the magnitude of this health problem, studies regarding prevalence, severity, and treatments of RW in infants are scarce.…”

Section: Introductionmentioning

confidence: 99%

“…Several of these wheezy infants, particularly those with troublesome coughing and wheezing, will receive inhaled bronchodilators (IBD), inhaled corticosteroids (ICS), oral corticosteroids (OCS), leukotriene receptor antagonists (LTRA), antibiotics (ATB), and paracetamol (PCM), and others. 1 2 3 Although there is no information on the frequency of and indications for the prescription of ATB and PCM to infants with RW, it is likely that as with older children, 4 5 6 ATB are commonly prescribed to infants with viral respiratory conditions and asthma symptoms. This knowledge would be important because both medications have been related to the development of asthma later in childhood.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, Severity, and Treatment of Recurrent Wheezing During the First Year of Life: A Cross-Sectional Study of 12,405 Latin American Infants

Mallol

Solé

García‐Marcos

et al. 2016

Allergy Asthma Immunol Res

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PurposeThis study aimed to determine the prevalence and severity of recurrent wheezing (RW) defined as ≥3 episodes of wheezing, risk factors, and treatments prescribed during the first year of life in Latin American infants.MethodsIn this international, cross-sectional, and community-based study, parents of 12,405 infants from 11 centers in 6 South American countries (Argentina, Brazil, Chile, Colombia, Peru, and Uruguay) completed a questionnaire about wheezing and associated risk/protective factors, asthma medications, and the frequency of and indications for the prescription of antibiotics and paracetamol during the first year of life.ResultsThe prevalence of RW was 16.6% (95% CI 16.0-17.3); of the 12,405 infants, 72.7% (95% CI 70.7-74.6) visited the Emergency Department for wheezing, and 29.7% (27.7-31.7) was admitted. Regarding treatment, 49.1% of RW infants received inhaled corticosteroids, 55.7% oral corticosteroids, 26.3% antileukotrienes, 22.9% antibiotics ≥4 times mainly for common colds, wheezing, and pharyngitis, and 57.5% paracetamol ≥4 times. Tobacco smoking during pregnancy, household income per month <1,000 USD, history of parental asthma, male gender, and nursery school attendance were significant risk factors for higher prevalence and severity of RW, whereas breast-feeding for at least 3 months was a significant protective factor. Pneumonia and admissions for pneumonia were significantly higher in infants with RW as compared to the whole sample (3.5-fold and 3.7-fold, respectively).ConclusionsRW affects 1.6 out of 10 infants during the first year of life, with a high prevalence of severe episodes, frequent visits to the Emergency Department, and frequent admissions for wheezing. Besides the elevated prescription of asthma medications, there is an excessive use of antibiotics and paracetamol in infants with RW and also in the whole sample, which is mainly related to common colds.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence, Severity, and Treatment of Recurrent Wheezing During the First Year of Life: A Cross-Sectional Study of 12,405 Latin American Infants

Mallol

Solé

García‐Marcos

et al. 2016

Allergy Asthma Immunol Res

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“…The average prevalence of medical diagnosis of asthma in EISL-3 was 4.5% (with prevalence ranging from 2.6% in Cuiabá, Brazil to 9.7% in São Paulo, Brazil) [24], and children with a medical diagnosis were those with most severe wheezing. Nonetheless, the individual analysis for each center revealed that all patients with a medical diagnosis of asthma in São Paulo had been treated with short-acting beta 2 agonists and oral corticosteroids, while 22.0% of these patients received inhaled corticosteroids as a form of anti-inflammatory treatment, revealing the inadequate treatment that these patients were receiving [25]. Moreover, the inadequate control of these patients may explain the higher of complications found among them, such as high rate of hospital admissions due to wheezing, medical diagnosis of pneumonia and even hospitalizations due to pneumonia [24, 26].…”

Section: Introductionmentioning

confidence: 99%

Asthma: epidemiology of disease control in Latin America – short review

Solé

Aranda²,

Wandalsen³

2017

asthma res and pract

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Asthma is reported as one of the most common chronic diseases in childhood, impairing the quality of life of patients and their families and incurring high costs to the healthcare system and society. Despite the development of new drugs and the availability of international treatment guidelines, asthma is still poorly controlled, especially in Latin America. Original and review articles on asthma control or epidemiology with high levels of evidence have been selected for analysis among those published in PubMed referenced journals during the last 20 years, using the following keywords: “asthma control” combined with “Latin America”, ” epidemiology”, “prevalence”, “burden”, “mortality”, “treatment and unmet needs”, “children”, “adolescents”, and “infants”. There was a high prevalence and severity of asthma during the period analyzed, especially in children and adolescents. Wheezing in infants was a significant reason for seeking medical care in Latin American health centers. Moreover, the frequent use of quick-relief bronchodilators and oral corticosteroids by these patients indicates the lack of a policy for providing better care for asthmatic patients, as well as poor asthma control. Among adults, studies document poor treatment and control of the disease, as revealed by low adherence to routine anti-inflammatory medications and high rates of emergency care visits and hospitalization. In conclusion, although rare, studies on asthma control in Latin America repeatedly show that patients are inadequately controlled and frequently overestimate their degree of asthma control according to the criteria used by international asthma treatment guidelines. Additional education for doctors and patients is essential for adequate control of this illness, and therefore also for reduction of the individual and social burden of asthma.

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