Relationship between symptoms and results on spirometry in adults seen in non-tertiary public health facilities presenting with preserved ratio impaired spirometry.

Preserved ratio impaired spirometry (PRISm), defined by reduced forced expiratory volume in 1 second (FEV1) without meeting criteria for airway obstruction, is often encountered in clinical practice. The management of this heterogeneous condition in individuals with chronic respiratory symptoms is challenging, especially under limited diagnostic resources. Since 2020, all consecutive patients referred for spirometry at our institution have been invited to participate in our registry.

Association between Chronic Obstructive Pulmonary Disease and Hearing Loss with Impaired Speech Recognition: A Cross-Sectional Study.

Introduction: Studies have identified a greater risk of sensory neural hearing loss in individuals with chronic obstructive pulmonary disease (COPD) compared to healthy individuals, but it is unclear whether they are at increased risk of hearing loss with impaired speech recognition. The aim of this study was to assess whether COPD is associated with hearing loss that affects speech recognition.

Methods: This is a case-control study.

Evaluating the relationship between the type of rescue medication and the adequacy of asthma maintenance therapy.

Introduction: Current guidelines incorporate the option of a rapid onset bronchodilator (ROB) plus an inhaled corticosteroid (ICS) for the relief of asthma symptoms, but there is doubt whether the combined therapy for relief could lead to suboptimal maintenance therapy since individuals might prefer it to the maintenance therapy. The objective of this study was to assess whether the type of rescue medication that the individual with asthma has available is associated with suboptimal maintenance therapy.

Methods: This cross-sectional study included non-smokers with asthma, ≥12 years old.

Evaluating the effect of antidepressants on the relationship between depression and asthma.

Background: It is unclear if depression is associated with impaired lung function in subjects with asthma, while few studies evaluated the effect of antidepressants on the relationship between depression and asthma. We designed this study to investigate if subjects with concomitant asthma and depression not taking antidepressants have worse asthma outcomes compared to asthmatic subjects without depression, and to evaluate whether antidepressants modify this association.

Methods: This is a cross-sectional study.

Evaluating the effect of childhood and adolescence asthma on the household economy.

Objective: To evaluate the relationship between asthma control, family income and family costs of asthma in a population of children-adolescents; to detail the family costs of asthma in this age range; and to compare asthma costs for the families of children-adolescents and adults.

Methods: The authors invited asthmatic subjects who attended a scheduled spirometry test at the Jundiaí School of Medicine (FMJ). The FMJ performs all spirometry tests requested by staff physicians who serve at the public healthcare system in the municipality.

Comparing hospital admissions, comorbidities, and biomarkers between severe asthma and Gold III-IV chronic obstructive pulmonary disease.

Introduction: In spite of difficulties in differentiating asthma from chronic obstructive pulmonary disease (COPD), physicians should strive for accurate diagnosis because outcomes may be different.

Objectives: Our aims were to compare the frequency of hospital admissions (HA) between severe asthmatic (SA) and Gold III-IV COPD subjects receiving disease-specific guideline recommended therapy and to depict the frequency of prevalent chronic disorders and the laboratorial profile suggesting allergic and eosinophilic phenotypes.

Methods: This cross-sectional study comprises one group of SA subjects and another group of Gold III-IV COPD subjects.

Hospital admission rate in children and adolescents with mild persistent asthma.

Introduction: The health and financial burden of mild-persistent asthma has been poorly investigated.

Objective: Our aim was to compare the rate of hospital admissions that have occurred during the preceding year between children and adolescents with current mild-persistent (MP) and moderate-severe (MS) asthma.

Methods: We screened children and adolescents with asthma at eight outpatient clinics.

Lung Cancer Mortality and the Availability of Chest Computerized Tomography: A Longitudinal Nationwide Study.

Lung-cancer screening with chest computerized tomography (CT) is not easy to introduce in low-medium resource countries due to cost issues. We investigated whether the increasing availability of chest CT exams in Brazil, in spite of no lung-cancer screening protocol, was associated with lung-cancer death rate along 10-year follow-up. We performed regressions to estimate the rate ratio between chest CT exams and lung-cancer deaths per 10 inhabitants.

Severe asthma and eligibility for biologics in a Brazilian cohort.

Objective: This study aims to describe the eligibility for biologic therapies for severe asthma (SA) in a cohort of patients attending the Program for Control of Asthma (ProAR) in Bahia, Brazil.

Methods: Data from SA patients (≥18 years old) attending the ProAR, that were included in a case-control study conducted from 2013 to 2015, were used to reassess patients according to a modified ERS/ATS 2014 SA criteria. Patients were then classified according to the eligibility for SA biological therapy based on current prescription labels.

Provision of inhaled corticosteroids is associated with decrease in hospital admissions in Brazil: A longitudinal nationwide study.

Objective: To describe trends of hospital admissions due to asthma from 2008 to 2015 and to evaluate their relationship with trends of inhaled corticosteroids (ICS) provision by the government in Brazil.

Methods: We used Brazilian Government data to calculate hospital admission rates due to asthma, number of physicians, number of hospital beds, number of subjects that received ICS per 100,000 inhabitants in Brazil and in each of its municipalities for each year of the study. We performed Poisson Multilevel Regression Analyses to evaluate the relationship between the trends of hospital admission rates due to asthma with the trends of the number of subjects that had been receiving ICS during the study period.

Evaluating the FEV/FVC ratio in the lower range of normality as a marker of worse clinical outcomes in asthmatic subjects without airway obstruction.

Background: We should continually improve tools for evaluating asthma. The aim of this study was to evaluate whether the FEV/FVC ratio in the lower range of normality is associated with worse outcomes in asthmatics without airway obstruction.

Methods: We screened asthmatics at eight clinics.

Asthma similarities across ProAR (Brazil) and U-BIOPRED (Europe) adult cohorts of contrasting locations, ethnicity and socioeconomic status.

Background: Asthma prevalence is 339 million globally. 'Severe asthma' (SA) comprises subjects with uncontrolled asthma despite proper management.

Objectives: To compare asthma from diverse ethnicities and environments.

Rural to urban migration contributes to the high burden of asthma in the urban area.

Introduction: It is unknown whether rural-urban migration contributes to worse the burden of asthma in the cities.

Objectives: The aim of this study was to evaluate whether subjects with asthma that migrated from rural areas to a large urban center in Brazil have more severe disease than asthmatic subjects that was born and always lived in the urban area.

Methods: This is a case-control study.

Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment?

Objective: To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment.

Methods: This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence.

Eosinophilic asthma, according to a blood eosinophil criterion, is associated with disease severity and lack of control among underprivileged urban Brazilians.

Background: Asthma is a syndrome with multiple phenotypes. Peripheral blood eosinophil counts might be the ideal biomarker to identify subjects with eosinophilic asthma. It is available, inexpensive, and it is associated with eosinophilia in sputum.

Greater Access to Long Acting Beta Agonists Is Associated with Less Hospital Admissions Due to COPD: A Longitudinal Nation-Wide Study.

Purpose: Long Acting Beta Agonists (LABA) prevent COPD exacerbations in strictly standardized clinical trials. Our aim was to evaluate the relationship between the amount of LABA provided by the government and the trend in COPD hospital admission (HA) rate in Brazil.

Methods: This is a longitudinal large-scale real-life study.

Obesity and asthma: clinical and laboratory characterization of a common combination.

Objective: To evaluate the relationship between obesity and asthma.

Methods: This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference.

Age is associated with asthma phenotypes.

Background And Objective: The relationship between age and asthma phenotypes is important as population is ageing, asthma is becoming common in older ages and recently developed treatments for asthma are guided by phenotypes. The aim of this study is to evaluate whether age is associated with specific asthma phenotypes.

Methods: This is a cross-sectional study.

Asthma prevalence and severity in low-resource communities.

Purpose Of Review: The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries.

Recent Findings: Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing.

Urbanization is associated with increased asthma morbidity and mortality in Brazil.

Introduction: Previous cross-sectional studies could establish an association between prevalence of self-reported wheeze and urban-rural environment, but the impact of urbanization on meaningful outcomes of asthma for public health is not established yet.

Objectives: Evaluate the effect of urbanization on asthma burden.

Methods: A time series study of 5,505 Brazilian municipalities.

Irreversible airway obstruction in asthma: A risk factor for severe exacerbations in spite of proper treatment.

Objectives: To evaluate whether irreversible airway obstruction (IAO) related to asthma is a risk factor for lack of symptoms control, poor quality of life and exacerbations.

Methods: We evaluated consecutive outpatients with asthma in a one-year cohort study. We excluded subjects with smoke history > 9 pack-years.

A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts.

Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs.

Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs.

Age is not associated with hospital admission or uncontrolled symptoms of asthma if proper treatment is offered.

Background: Aging modifies immune response and respiratory physiology. Few studies evaluate the effect of age on asthma. The aim of our study was to evaluate whether age is associated with uncontrolled symptoms and hospital admissions due to asthma in a setting where patients were receiving proper treatment.