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Previous issue date: 2014-10-27 / Introduction: Studies of children with severe therapy-resistant asthma are scarce in developed countries and there is no published data about clinical presentations and characteristics of these patients in developing countries.
Objective: To describe the main clinical characteristics, lung function, radiological findings, and inflammation of induced sputum of children with severe therapy-resistant asthma from a reference center in southern Brazil.
Methods: Children between 6-14 years of age, followed by at least 6 months in a reference center, with severe therapy-resistant asthma (uncontrolled asthma using elevated doses of inhaled corticoid associated with long-acting beta-2 agonist) were retrospectively selected. All subjects from the reference center had clinical data, disease control, lung function, skin test reactivity to aeroallergens, inflammation of induced sputum, chest computerized tomography, and pH esophageal monitoring results prospectively collected.
Results: 21 patients were selected (mean age: 9.2 yo). Eighteen patients (86%) were atopic. Most patients presented uncontrolled disease during most visits, with nearly normal baseline lung function parameters. The sputum of two patients were paucigranulocytic, 4 were eosinophilic and 7 neutrophilic, where 67% of the children who repeated sputum exam changed the inflammatory patterns. 6/7 (86%) of the children who were treated with omalizumab (anti-IgE) showed improvement in quality of life, with an important reduction in exacerbations and hospitalizations.
Conclusions: Most children with severe therapy-resistant asthma from a non-affluent population were patients with difficult-to-control disease, with nearly normal lung function and prone to change airway inflammatory pattern during follow-up, most of them atopics. This profile, unlike adults, need to be better understood in relation to the mechanisms that result in symptoms unresponsive to optimized drug therapies. / Introdu??o: estudos de crian?as com asma grave resistente ? terapia (AGRT) s?o escassos em pa?ses desenvolvidos e n?o h? dados publicados sobre apresenta??o cl?nica e caracter?sticas desses pacientes em pa?ses em desenvolvimento.
Objetivo: descrever as principais caracter?sticas cl?nicas, funcionais, radiol?gicas e de inflama??o no escarro induzido de crian?as com AGRT, provenientes de um centro de refer?ncia do sul do Brasil.
M?todos: foram selecionadas retrospectivamente crian?as entre 6-14 anos, acompanhadas por pelo menos 6 meses em um centro de refer?ncia do sul do Brasil, com diagn?stico AGRT (asma n?o controlada, usando doses elevadas de corticoide inalat?rio associado a beta-2 agonista de a??o longa). A partir de dados coletados prospectivamente no seguimento cl?nico, foram analisados controle da doen?a, fun??o pulmonar, teste cut?neo para aeroal?rgenos, avalia??o da inflama??o no escarro induzido, tomografia de t?rax, e phmetria.
Resultados: 21 pacientes foram selecionados (m?dia de 9,2 anos). Dezoito (86%) pacientes s?o at?picos. A maioria dos pacientes apresenta pouco controle da doen?a, com fun??o pulmonar basal sempre pr?xima do normal. Dois pacientes apresentaram escarro paucigranuloc?tico, 4 eosinof?lico e 7 neutrof?lico, onde 67% que repetiram o exame apresentaram mudan?a no padr?o inflamat?rio. 6/7 (86%) pacientes que utilizaram omalizumabe (anti-IgE) apresentaram melhora importante da qualidade de vida, com redu??o importante das exacerba??es.
Conclus?es: crian?as com AGRT apresentam doen?a dif?cil de controlar, fun??o pulmonar pr?xima do normal e padr?o inflamat?rio das vias a?reas vari?vel durante seguimento cl?nico, sendo em sua maioria at?picas. Esse perfil, diferente dos adultos, precisa ser melhor entendido em rela??o aos mecanismos que resultam em sintomas n?o responsivos a terapias medicamentosas otimizadas.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/1446 |
| Date | 27 October 2014 |
| Creators | Rodrigues, Andr?a Mendon?a |
| Contributors | Pitrez, Paulo M?rcio Condessa |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a, PUCRS, BR, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 3098206005268432148, 500, 600, -8624664729441623247 |
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