Clinical assessment of asthma progression in children and adults

Spahn, Joseph D.; Covar, Ronina

doi:10.1016/j.jaci.2008.01.012

“…Nosso estudo utilizou como critério de gravidade "epidemiológica" da asma, as respostas de maior gravidade referentes aos sintomas de asma disponíveis no questionário ISAAC, ou seja, o número máximo de exacerbações no ano (mais de 12) e de despertares noturnos por semana (mais de 1), bem como a dificuldade de pronunciar palavras completas nas crises. 17 , como mostrado em alguns estudos longitudinais 18,19 . Outra explicação possível para esse achado é ter ocorrido uma variação na percepção do sibilo, o que pode ocorrer em casos de doença mais leve 20 ou tratar-se de formas atípicas de asma como a variante tosse, que constitui um subgrupo de asmáticos que não manifestam a sibilância 21,22 .…”

Section: Discussionunclassified

Distribution of severity of asthma in childhood

Simões¹,

Cunha²,

Barreto³

et al. 2010

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Objective: To estimate the distribution of asthma severity in a population-based sample of children from Salvador, Brazil.Methods: An epidemiologically oriented questionnaire (International Study of Asthma and Allergies in Childhood, ISAAC) and a questionnaire based on criteria used in clinical practice (The Global Initiative for Asthma, GINA) were administered simultaneously to 417 children aged 5 to 12 years who reported symptoms of asthma in the past 12 months. According to the ISAAC instrument, children were classified into severe and non-severe asthma, whereas GINA clinical criteria produced four categories of severity: intermittent, mild persistent, moderate persistent and severe asthma.Results: Ninety children reported symptoms indicative of severity according to the ISAAC questionnaire. According to GINA criteria, 143 children had intermittent asthma, 160 mild persistent, 51 moderate and 43 severe asthma. Agreement between the two instruments was 81.3% (kappa = 0.5). Conclusions:Most asthmatic children in the Salvador urban area have persistent asthma. Agreement between epidemiological and clinical classifications of asthma severity was satisfactory.J Pediatr (Rio J). 2010;86(5):417-423: Asthma, severity, questionnaire, child.

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“…These findings may be due to an improvement in asthma symptoms experienced by some children as they grow, the so-called remission period of asthma, 17 as reported in some longitudinal studies. 18,19 Another possible explanation is a change in wheezing perception, which may occur in milder asthma, 20 or cases of atypical asthma, such as the cough variant, which constitutes a subgroup of asthmatic patients who do not present with wheezing.…”

Section: Discussionmentioning

confidence: 67%

Distribuição da gravidade da asma na infância

Simões¹,

Cunha²,

Barreto³

et al. 2010

J. Pediatr. (Rio J.)

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Objective: To estimate the distribution of asthma severity in a population-based sample of children from Salvador, Brazil.Methods: An epidemiologically oriented questionnaire (International Study of Asthma and Allergies in Childhood, ISAAC) and a questionnaire based on criteria used in clinical practice (The Global Initiative for Asthma, GINA) were administered simultaneously to 417 children aged 5 to 12 years who reported symptoms of asthma in the past 12 months. According to the ISAAC instrument, children were classified into severe and non-severe asthma, whereas GINA clinical criteria produced four categories of severity: intermittent, mild persistent, moderate persistent and severe asthma.Results: Ninety children reported symptoms indicative of severity according to the ISAAC questionnaire. According to GINA criteria, 143 children had intermittent asthma, 160 mild persistent, 51 moderate and 43 severe asthma. Agreement between the two instruments was 81.3% (kappa = 0.5). Conclusions:Most asthmatic children in the Salvador urban area have persistent asthma. Agreement between epidemiological and clinical classifications of asthma severity was satisfactory.

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“…Risk factors in relationship to asthma have been evaluated in the context of disease inception [e.g., viral infections(1,2,39); environmental exposures (e.g., aeroallergens (40), pollution (41)(42)(43), tobacco smoke (44)(45)(46)(47)) and lifestyle (e.g., living on a farm (48), diet (49), antibiotic use(50)); comorbid conditions (e.g., atopic dermatitis(51), obesity(52)); occupational exposures(3); among others], as well as disease severity (as defined by the risk domaindiscussed subsequently) [hospitalizations (53,54); frequency and severity of exacerbations (55); and loss of lung function (8,56)]. Genetic factors also contribute significantly to disease expression and severity.…”

Section: Risk Factorsmentioning

confidence: 99%

“…(8,11,12) Some have reported that the peak in lung function that is achieved at about twenty years of age in asthma may be decreased (13), and that the rate of further loss during adulthood may be increased in asthmatic subjects. (14) About one fourth of children with asthma may experience greater rates of loss of lung function, and these children have certain phenotypic characteristics: younger age, male gender, higher postbronchodilator FEV 1 % predicted, and greater airway eosinophilic inflammation.…”

mentioning

confidence: 99%

Asthma: Clinical expression and molecular mechanisms

2010

Journal of Allergy and Clinical Immunology

1

0

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Asthma is a heterogenous disorder that is characterized by variable airflow obstruction, airway inflammation and hyperresponsiveness, and reversibility either spontaneously or as a result of treatment. Multiple etiologies no doubt exist for both its inception and symptom exacerbation once the disease is established. Factors underlying inception can range from viral respiratory tract infections in infancy(1,2) to occupational exposures in adults.(3) Factors underlying asthma exacerbations include allergen exposure in sensitized individuals, viral infections, exercise, irritants, ingestion of nonsteroidal anti-inflammatory agents, among others. Exacerbating factors may include one or all of these exposures, and vary both among and within patients. Asthma treatment is determined to a large extent following an initial assessment of severity and subsequent establishment of control, both of which can be variable over time and assessed in two domains: impairment (current) and risk (long term consequences).(4) Unfortunately, despite the availability of effective therapies, suboptimal asthma control exists in many patients on a world-wide basis.(5) The future development of novel therapies and treatment paradigms should address these disparities.

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Clinical assessment of asthma progression in children and adults

Cited by 49 publications

References 76 publications

Distribution of severity of asthma in childhood

Distribution of severity of asthma in childhood

Distribuição da gravidade da asma na infância

Asthma: Clinical expression and molecular mechanisms

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