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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2018.tde-15032018-111201
Document
Author
Full name
Karina Pierantozzi Vergani
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2017
Supervisor
Committee
Rodrigues, Joaquim Carlos (President)
Almeida, Marina Buarque de
Pastorino, Antonio Carlos
Pinto, Regina Maria de Carvalho
Title in Portuguese
Asma grave em crianças e adolescentes: análise da variação fenótica e fatores relacionados ao não controle clínico
Keywords in Portuguese
Asma
Criança
Escarro
Espirometria
Fenótipo
Qualidade de vida
Abstract in Portuguese
Introdução: Há um grande desafio na identificação de crianças e adolescentes com asma grave resistente ao tratamento (AGRT). O objetivo do estudo foi detectar crianças e adolescentes com AGRT pela análise dos parâmetros clínicos, laboratoriais, funcionais e comorbidades. Métodos: Este estudo de coorte prospectivo incluiu 40 pacientes (6-18 anos) com asma grave. Os pacientes foram avaliados durante 3 visitas consecutivas. Na primeira e na última visita (intervalo de 3 meses) foram determinados testes funcionais, FeNO e análise de escarro induzido. Foi aplicado o Teste de Controle de Asma (ACT) e o Questionário de Qualidade de Vida (pAQLQ). Foram avaliadas as anormalidades estruturais nasais e torácicas e a doença do refluxo gastroesofágico. Após a correção da técnica inalatória, adesão e tratamento das comorbidades, as crianças e adolescentes foram classificados em dois subgrupos: asma grave controlada e AGRT, de acordo com as recomendações da ATS/ERS. Resultados: foram identificados 27/40 (67,5%) pacientes com asma grave controlada, 13/40 (32,5%) com AGRT. Não houve diferenças estatisticamente significativas nos parâmetros demográficos, atopia, medição de FeNO, parâmetros espirométricos e pletismográficos entre esses subgrupos. Os achados da TC de tórax e seios da face foram semelhantes. Os pacientes com AGRT apresentaram maior probabilidade do sintoma de tosse estar relacionado ao refluxo ácido (p = 0,0024). Pacientes controlados apresentaram maior porcentagem do padrão inflamatório eosinofílico na primeira visita do que os pacientes AGRT (p = 0,038). O pAQLQ foi significativamente menor no subgrupo AGRT. Conclusões: Os parâmetros clínicos, funcionais, laboratoriais e estruturais são semelhantes em AGRT e crianças e adolescentes asmáticos graves controlados. As comorbidades não são mais prevalentes em pacientes AGRT. O padrão inflamatório eosinofílico é muito comum na asma grave pediátrica, mas as crianças e adolescentes que atingem o controle possuem maior taxa de eosinófilos do que AGRT. O pAQLQ e o ACT podem ser uma ferramenta útil para identificar os pacientes com AGRT
Title in English
Severe asthma in children and adolescents: analysis of phenotypic variation and factors related to non-clinical control
Keywords in English
Asthma
Child
Phenotype
Quality of life
Spirometry
Sputum
Abstract in English
Background: It's challenger to identify children and adolescents with severe therapy-resistant asthma (STRA). The aim of this study was to detected STRA children through clinical, laboratory, functional parameters and comorbidities. Methods: This prospective cohort study included 40 patients (6-18 years old) with severe asthma. Patients were evaluated during 3 consecutive visits. At the first and final visit (interval of 3 months): functional tests, FeNO, induced sputum analysis was determined. Asthma Control Test (ACT) and Quality of Life Questionnaire (pAQLQ) were applied. Nasal and chest structural abnormalities and gastroesophageal reflux disease were evaluated. After correction of inhalation technique, adherence, and treatment of comorbidities children and adolescents were classified in two subgroups: severe controlled asthma and STRA according ATS/ERS recommendation. Results: Were identified 27/40 (67.5%) patients with controlled asthma, 13/40 (32.5%) with STRA. Didn't have statistically significant differences in demographic parameters, atopy, FeNO measurement, spirometric and plethysmograph parameters between these subgroups. The findings in chest and sinus CT are similar. STRA patients had higher probability of cough symptom being related to acid reflux (p = 0.0024). Controlled patients had higher percentage of eosinophilic inflammatory pattern at the first visit than STRA (p = 0.038). The pAQLQ was significantly lower in STRA subgroup. Conclusions: Clinical, functional, laboratory and structural parameters are similar in STRA and severe controlled asmathic children. Comorbidities aren't more prevalent in STRA. Predominant eosinophilic inflammatory pattern is very common in pediatric severe asthma, but children and adolescents that achieve the control have higher rate of eosinophils than STRA. The pAQLQ and ACT can be useful tool to identify STRA patients
 
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Publishing Date
2018-03-16
 
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