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

Abstract

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.

Respira project: Humanistic and economic burden of asthma in Brazil

“…Nocturnal symptoms and sleep pattern disruptions (awakenings) have been reported in 51% and daily symptoms in 56% of patients with asthma in Latin America (7). Asthma negatively influences the quality of life (QoL) of patients; increased psychological disorders such as depression and anxiety have been associated with both mild and severe asthma.…”

“…These individuals also place a heavy burden on the healthcare system, making particularly frequent healthcare provider visits, emergency room (ER) visits, and hospitalizations (7,10). The disease is, therefore, associated with high expenditure that include both direct (e.g., hospital admissions and pharmaceuticals) and indirect costs (e.g., time lost from work and premature death), making asthma one of the most expensive diseases due to the significant healthcare utilization associated with this condition (2,3).…”

Asma, rinite e atopia em escolares de duas cidades ambientalmente distintas: metrópole industrializada e região agrícola

“…O Brasil é um dos países da América Latina com maior número de centros de pesquisa vinculados ao ISAAC, com 58.418 adolescentes avaliados e média nacional de asma atual de 18,7% [4]. Além disso, uma revisão sistemática, que reuniu dados referente a prevalência da asma nos centros brasileiros oficiais do ISAAC e outras de pesquisas que usaram a mesma metodologia, demonstrou prevalência asma de 18,2% em Porto Alegre [5].…”

“…Na América Latina a prevalência média atual de sintomas de asma em adolescentes, verificada pela Fase III do International Study of Asthma and Allergies in Childhood (ISAAC) é de 17%, com alta variação entre os países (6,9%-37,6%) [4]. No Brasil, as taxas de prevalência de asma ativa em adolescentes entre 11,8% e 30,5% [5,6].…”

Flujometría versus espirometría para el diagnóstico de asma en adultos

“…El Instituto Mexicano del Seguro Social tiene una incidencia de 3.5 por cada 1000 derechohabientes. 4,5,6,7 La inflamación característica está mediada principalmente por el perfil Th2, en el que IL4, IL5 e IL13 promueven la activación, migración y proliferación de eosinófilos y células cebadas para la síntesis de IgE. 8 Por otra parte, el perfil Th1 (IFN-γ, interferón gamma) activa fagocitos, producción de opsoninas y estimula la respuesta inmune celular.…”