Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713


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

A baixa escolaridade é um fator limitante para o controle da asma em uma população com acesso a pneumologista e tratamento?

Cassia Caroline Emilio1,a, Cintia Fernanda Bertagni Mingotti1,b, Paula Regina Fiorin1,c, Leydiane Araujo Lima1,d, Raisa Lemos Muniz1,e, Luis Henrique Bigotto1,f, Evaldo Marchi2,g, Eduardo Vieira Ponte1,h

J Bras Pneumol.2019;45(1):e20180052-e20180052

Abstract PDF PT PDF EN Portuguese Text

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. Patients underwent spirometry, and patient inhaler technique was assessed. Results: 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). Conclusions: Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.


Keywords: Asthma; Educational status; Spirometry; Treatment adherence and compliance.


Perception of asthma control in asthma patients

A percepção do controle dos sintomas em pacientes asmáticos

Eduardo Vieira Ponte, Jaqueline Petroni, Daniela Campos Borges Ramos, Luciana Pimentel, Daise Naiane Freitas, Álvaro A Cruz

J Bras Pneumol.2007;33(6):635-640

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the proportion of asthma patients with poor perception of asthma control and to evaluate the characteristics of this subgroup. Methods: A cross-sectional study in which consecutive outpatients (over the age of 12) with mild, moderate, or severe asthma were selected. The patients underwent clinical examination, and pulmonary function tests, as well as being assessed for depression and perception of asthma control. The degree of concordance between patients and physicians regarding the perception of asthma control was determined. Patients with good perception of asthma control were compared, in terms of characteristics, with those presenting poor perception. Results: The degree of concordance between patients and physicians regarding the perception of asthma control was low (kappa index = 0.5). Of the 289 patients included, 66 (23%) presented poor perception of asthma control. The preliminary univariate analysis revealed that the patients with poor perception of asthma control were older, had a lower income, and presented a lower degree of asthma severity. Those factors did not change in the multivariate analysis. There were no differences between the groups in terms of gender, frequency of having literate patients, duration of asthma symptoms, having been diagnosed with rhinitis, frequency of depression, pulmonary function, or treatment compliance. Conclusions: The incidence of poor perception of asthma control in asthma patients is high, especially in elderly patients with lower income and a lower degree of asthma severity.


Keywords: Asthma; Signs and symptoms; Asthma/therapy.


Abnormalities on computed tomography scans of the paranasal sinus in adult patients with allergic rhinitis

Alterações tomográficas de seios paranasais em pacientes adultos com rinite alérgica

Eduardo Vieira Ponte, Fabiana Lima, Glauber Ferraz Aguiar, Fabíola Goyana, Marcelo Benício dos Santos, Álvaro Augusto Cruz

J Bras Pneumol.2005;31(5):421-426

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate, using computerized tomography, the frequency of paranasal sinus involvement in patients with allergic rhinitis. Methods: From among outpatients diagnosed with rhinitis and complaining of nasal obstruction, 60 were selected for evaluation. The patients were submitted to anterior rhinoscopy, skin prick test for reactivity to aeroallergens and computed tomography of the paranasal sinuses. In addition, questionnaires designed to evaluate symptom severity were administered. The Lund score was used to evaluate paranasal sinus involvement on computed tomography scans. Results: Computed tomography scans of the paranasal sinuses were abnormal in 31 patients (52%). The sum of the largest diameters of cutaneous reactions to the aeroallergens, symptom severity and anterior rhinoscopy findings did not differ between patients with paranasal sinus involvement and those without. All the patients with paranasal sinus abnormalities also presented osteomeatal complex abnormalities, whereas only 11 patients (38%) without paranasal sinus involvement presented such abnormalities (p < 0.01). Conclusion: In a sample of patients with allergic rhinitis, the frequency of paranasal sinus abnormalities on computed tomography scans was elevated and did not correlate with symptom severity or skin prick test reactivity but was correlated with osteomeatal complex obstruction.


Keywords: Rhinitis; Sinusitis; Tomography, X-ray computed; Paranasal sinuses/radiography


Evaluation of the Asthma Control Questionnaire validated for use in Brazil

Avaliação do Questionário de Controle da Asma validado para uso no Brasil

Mylene Leite, Eduardo Vieira Ponte, Jaqueline Petroni, Argemiro D`Oliveira Júnior, Emílio Pizzichini, Álvaro Augusto Cruz

J Bras Pneumol.2008;34(10):756-763

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate whether the Portuguese version of the Asthma Control Questionnaire (ACQ) is a valid instrument to measure asthma control in adult outpatients in Brazil. Methods: We selected 278 outpatients diagnosed with asthma. All of the patients completed the questionnaire, underwent spirometry and were clinically evaluated by a physician in order to characterize the control of the disease in the first visit. The questionnaire was evaluated in three versions, with 5, 6 and 7 questions, respectively, and scores of 0.75 and 1.50 were used as cut-off points. Results: Of the 278 patients, 77 (27.7%) had intermittent asthma, 39 (14.0%) had mild persistent asthma, 40 (14.4%) had moderate persistent asthma and 122 (43.9%) had severe persistent asthma. The sensitivity of ACQ to identify uncontrolled asthma ranged from 77% to 99%, and the specificity ranged from 36% to 84%. The positive predictive value ranged from 73% to 90%, and the negative predictive value ranged from 67% to 95%. The positive likelihood ratio ranged from 1.55 to 4.81, and the negative likelihood ratio ranged from 0.03 to 0.27. In the 5- and 6-question versions of the ACQ, the intraclass correlation coefficient was 0.92. These two versions were both responsive to clinical changes in the patients. Conclusions: All three versions of the ACQ satisfactorily discriminated between patients with uncontrolled asthma and those with controlled asthma. The 5- and 6-question versions also presented good reliability and responsiveness. Therefore, the ACQ is a valid tool for evaluating asthma control in adult outpatients in Brazil.


Keywords: Asthma; Therapeutics; Diagnosis; Questionnaires; Reproducibility of results.


Clinical characteristics and prognosis in near-fatal asthma patients in Salvador, Brazil

Características clínicas e prognóstico em pacientes com asma quase fatal em Salvador, Bahia

Eduardo Vieira Ponte, Adelmir Souza-Machado, Carolina Souza-Machado, Rosana Franco, Álvaro Augusto Cruz

J Bras Pneumol.2011;37(4):431-437

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the frequency of near-fatal asthma in a group of severe asthma patients, as well as the clinical characteristics and prognosis of these patients within a one-year follow-up period. Methods: A prospective study involving 731 low-income patients with severe asthma treated at a referral outpatient clinic located in the city of Salvador, Brazil. The patients were submitted to spirometry at admission, received medications for asthma, and were monitored regarding the frequency of asthma exacerbations during the follow-up period. A subsample of 511 patients also completed questionnaires regarding asthma symptoms and asthma-related quality of life. Results: Of the 731 patients studied, 563 (77%) were female. The median age was 47 years, and 12% were illiterate. Most of the patients had rhinitis, and 70 patients (10%) reported near-fatal asthma prior to admission. Of these 70 patients, 41 (59%) reported having been intubated previously. The patients reporting a history of near-fatal asthma at admission were more likely to have asthma exacerbations during the follow-up period and to respond poorly to therapy than were those not reporting such a history. At the end of the follow-up period, the scores on the two questionnaires were similar between the two groups of patients. Conclusions: The frequency of near-fatal asthma was high in this group of low-income patients with severe asthma. The patients with a history of near-fatal asthma had a worse prognosis than did those without such a history, although both groups had received the same kind of treatment. Curiously, the intensity of symptoms and the quality of life at the end of the study were similar between the two groups.


Keywords: Asthma/prevention and control; Asthma/complications; Quality of life; Prognosis.


Causes of death in asthma patients enrolled in the Bahia State Program for the Control of Asthma and Allergic Rhinitis

Causas de óbitos entre asmáticos graves admitidos no Programa de Controle da Asma e da Rinite Alérgica na Bahia

Adelmir Souza-Machado, Carolina Souza-Machado, Daisy Freitas Silva, Eduardo Vieira Ponte, Alvaro A. Cruz

J Bras Pneumol.2007;33(4):372-379

Abstract PDF PT PDF EN Portuguese Text

Objective: To report demographic and clinical characteristics of patients with asthma who evolved to death, as well as to describe the conditions related to this outcome in a subgroup of patients admitted to the Program for the Control of Asthma and Rhinitis in Bahia (ProAR). Methods: A descriptive, retrospective, observational study. Data from clinical charts and death certificates of 16 patients of 930 subjects with severe asthma monitored at the ProAR Central Reference Center from December 2003 to June 2006 were reviewed. Results: Of the 930 patients participating in the program, 16 (1.72%) died. Of these, there were 10 males and 6 females, ranging in age from 39 to 74 years (median, 55 years); 12 (75%) of the patients were black. Time since diagnosis ranged from 1 to 68 years (median, 30 years). In 43.8 and 53.8%, respectively, there was a personal or family history of atopy. Ex-smokers (<10 pack-years) accounted for 37.5% of the cases. Causes of death listed on the death certificates were as follows: asthma or asthma exacerbations in 8 (50%); respiratory failure in 3 (18.75%); acute heart infarction in 2 (12.5%); hepatitis in 1 (6.25%); hypovolemic shock in 1 (6.25%); and cardiorespiratory arrest in 1 (6.25%). Of the 16 deaths, 13 (81.25%) occurred inside hospitals. Conclusion: Asphyxia and cardiovascular diseases were the most common atributed causes of mortality in this subgroup of patients with severe asthma. Hospital-based mortality, male gender, advanced age, long-term disease and fixed airflow obstruction were the aspects most frequently observed in the cases studied.


Keywords: Mortality; Rhinitis/treatment; Asthma/treatment; Cardiovascular diseases.


Hospitalizations for asthma: impact of a program for the control of asthma and allergic rhinitis in Feira de Santana, Brazil

Hospitalizações por asma: impacto de um programa de controle de asma e rinite alérgica em Feira de Santana (BA)

Heli Vieira Brandão, Constança Margarida Sampaio Cruz, Ivan da Silva Santos Junior, Eduardo Vieira Ponte, Armênio Guimarães, Álvaro Augusto Cruz

J Bras Pneumol.2009;35(8):723-729

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the impact of the Programa de Controle da Asma e Rinite Alérgica em Feira de Santana (ProAR-FS, Program for the Control of Asthma and Allergic Rhinitis in Feira de Santana) on the frequency of hospitalizations for asthma in patients monitored at a referral center for one year. Methods: This was a historical control study involving 253 consecutive patients with asthma, ages ranging from 4 to 76 years. We compared the frequency of hospital admissions and visits to the emergency room (ER) in the 12 months prior to and after their admission to the ProAR-FS. During the program, patients received free treatment, including inhaled medications and education on asthma. Demographic and socioeconomic aspects were also assessed. Results: There was a significant reduction in the number of hospitalizations (465 vs. 21) and of visits to the ER (2,473 vs. 184) after their admission to ProAR-FS (p < 0.001 for both). Of the 253 patients who had been hospitalized and had had ER visits within the year prior to the admission to ProAR-FS, only 16 were hospitalized and 92 visited the ER during the follow-up year, representing a reduction of 94% and 64%, respectively. Conclusions: Implementing a referral center for the treatment of asthma and rhinitis in the Unified Health Care System, with the free distribution of inhaled corticosteroids and the support of an education program, is a highly effective strategy for the control of asthma.


Keywords: Hospitalization; Asthma; Rhinitis; Health services; Public health.


Interrelationship among asthma, atopy, and helminth infections

Inter-relação entre asma, atopia e infecções helmínticas

Eduardo Vieira Ponte, José Ângelo Rizzo, Álvaro Augusto Cruz

J Bras Pneumol.2007;33(3):335-342

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To describe the principal evidence in the literature regarding the interrelationship among helminth infections, atopy, and asthma, a nonsystematic review of the literature was conducted. Among the publications on the subject, we found a number in which there was controversy regarding the capacity of geohelminth infections to inhibit responsiveness to skin allergy tests and to minimize the symptoms of allergic diseases. However, although small in number, studies of patients infected with Schistosoma spp. suggest that these helminths can inhibit the responsiveness to skin allergy testing and minimize asthma symptoms. Evidence provided by in vitro studies suggests that helminthiases inhibit T helper 1- and T helper 2-type immune responses. This opens new therapeutic possibilities for the treatment of immune system diseases.


Keywords: Asthma; Helminths; Hypersensitivity; Epidemiology.


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

Obesidade e asma: caracterização clínica e laboratorial de uma associação frequente

Juliana Pires Viana de Jesus1,2,a, Aline Silva Lima-Matos2,3,b, Paula Cristina Andrade Almeida2,c, Valmar Bião Lima2,d, Luane Marques de Mello4,e, Adelmir Souza-Machado2,5,f, Eduardo Vieira Ponte5,6,g, Álvaro Augusto Cruz2,7,h

J Bras Pneumol.2018;44(3):207-212

Abstract PDF PT PDF EN Portuguese Text

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. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. Results: Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). Conclusions: Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.


Keywords: Asthma; Obesity; Overweight; Eosinophilia.


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

Programas e centros de atenção a asmáticos no Brasil; uma oficina de trabalho: revisitando e explicitando conceitos

Rafael Stelmach, Alcindo Cerci Neto, Ana Cristina de Carvalho Fernandez Fonseca, Eduardo Vieira Ponte, Gerardo Alves, Ildely Niedia Araujo-Costa, et al.

J Bras Pneumol.2015;41(1):3-15

Abstract PDF PT PDF EN Portuguese Text

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. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.


Keywords: Asthma; Academic medical centers; Area health education centers; Health planning organiza-tions; Regional medical programs; Managed care programs.


Portuguese-language version of the Asthma Control Test: validation for use in Brazil

Validação do Teste de Controle da Asma em português para uso no Brasil

Jaqueline Petroni Faria Roxo, Eduardo Vieira Ponte, Daniela Campos Borges Ramos, Luciana Pimentel, Argemiro D'Oliveira Júnior, Álvaro Augusto Cruz

J Bras Pneumol.2010;36(2):159-166

Abstract PDF PT PDF EN Portuguese Text

Objective: To develop and validate a Portuguese-language version of the Asthma Control Test (ACT) for use in Brazil. Methods: The study comprised 290 asthma outpatients over 12 years of age. The patients completed the ACT questionnaire and had an appointment with a pulmonologist in order to assess asthma control in two visits. In the first visit, the patients also underwent spirometry. The second visit took place at least four weeks later. Results: We found that a cut-off score of 18 points-to differentiate between subjects with controlled asthma and those with uncontrolled asthma-had a sensitivity of 93%, a specificity of 74%, a negative predictive value of 86% and a positive predictive value of 85%. The positive and negative likelihood ratios were 3.58 and 0.09, respectively. The questionnaire has an outstanding capacity to differentiate uncontrolled asthma from controlled asthma, with an area under the ROC curve of 0.904. The patients whose symptoms remained stable between the two visits had similar scores, demonstrating good test-retest reproducibility, with an intraclass correlation coefficient of 0.93. The patients whose symptoms improved in the second visit had significantly higher scores, demonstrating good responsiveness of the questionnaire in the identification of changes in disease control. Conclusions: The Portuguese-language version of the ACT showed good test-retest reproducibility and was capable of discriminating the levels of asthma control and detecting changes in asthma control in a population of patients with a low level of education and low family income at a public health facility in Brazil.


Keywords: Asthma; Questionnaires; Validation studies; Signs and symptoms.




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