Fatores associados à gravidade da asma entre adultos de um centro de referência para asma
Factors associated severity of asthma among adults in a reference center for asthma
Heli V. Brandão; Armênio Guimarães; Álvaro A. Cruz; Constança S. Cruz
Resumo
Objetivo: A asma é uma doença de elevada morbidade cujos fatores associados às suas formas graves têm importância no controle da doença. O objetivo deste estudo foi de investigar os fatores associados à gravidade da asma entre adultos portadores de asma matriculados no Programa de Controle da Asma de Feira de Santana (ProAR-FS).
Métodos: Estudo retrospectivo de pacientes registrados em um ambulatório de referência em asma. Foram analisados características clínicos e demográficas de uma amostra de 102 asmáticos consecutivos com idade entre 20 e 79 anos na sua primeira avaliação no ProAR-FS. As variáveis qualitativas foram expressas por frequência e comparadas através do teste do Qui quadrado. Análise de regressão logística foi realizada com as variáveis com p < 0,10.
Resultados: 66,7% (68) eram portadores de asma grave. A frequência de hipertensão arterial sistêmica (HAS) nos portadores de asma leve a moderada foi de 11,8% (4) enquanto naqueles com asma grave foi 30,9% (21). A frequencia de sobrepeso e obesidade foi elevada em todos os portadores de asma 61,7% (63) e naqueles com HAS e asma grave foi de 62,4% (15). A asma grave associou-se positivamente com HAS (OR = 4,28; IC 95%: 1,19-15,30). A idade na primeira crise de asma menor que cinco anos associou-se a asma não grave (OR = 0,33; IC 95%: 0,12-0,90).
Conclusão: A asma grave esteve associada à HAS em um centro de referência para asma.
Palavras-chave
Abstract
Objective: Asthma is an illness of high morbidity and whose factors associated with severity important for control of the disease. Our objective was to investigate factors associated the severity of asthma among adults in reference center of Program of asthma and rhinitis in Feira de Santana (ProAR-FS).
Methods: Retrospective study of patients registered in a center of reference for asthma. Analysis of clinical and demographic characteristics of 102 consecutive patients aged between 20 and 79 years registered in their first evaluation in ProAR-FS. The qualitative variable were expressed according to their frequency and compared by the Chi-square test. Analysis of logistic regression was performed in variable with p < 0.10.
Results: 66.7% (68) of the subjects had severe asthma. The frequency of systemic arterial hypertension (SAH) in the mild to moderate cases of asthma was of 11.8% (4) while in those with severe forms of the disease it was 30.9% (21). The frequency of overweight and obesity was high in all patients with asthma 61.7% (63) and those with hypertension and severe asthma was 62.4% (15). Severe asthma was positively associated with SAH (OR = 4.28; 95% CI: 1.19-15.30). The age in the first attack of asthma being less than five years was associated with not severe asthma (OR = 0.33; 95% CI: 0.12-0.90).
Conclusion: Severe asthma is associated with SAH in a reference center for asthma.
Keywords
References
1. Brasil. Ministério da Saúde do Brasil. Informações de Saúde. Disponível em: www.datasus.gov.br/tabnet/tabnet.htm.
2. Downs SH, Mitakakis TZ, Marks GB, Car NG, Belousova EG, Leüppi CG, et al. Clinical importance of Alternaria exposure in children. Am J Respir Crit Care Med 2001;164(3):455-9.
3. Macedo EC, Menezes AM, Knorst M, Dias-da-Costa JS, Gigante DP, Olinto A, et al. Fatores de risco para a asma em adultos, Pelotas, Rio grande do Sul. Cad Saude Publica 2007;23(4):863-74.
4. Kocevar VS, Thomas J, Jonsson L, Yin DD, Bisgard H. Association between allergic rhinitis and hospital resource use among asthmatic children in Norway. Allergy 2005;60 (3):338-42.
5. Ponte EV, Franco R, Nascimento HF, Souza-Machado A, Cunha S, Barreto ML, et al. Lack of control of severe asthma is associated with co-existence of moderate-to-severe rhinitis. Allergy 2008;63(5):564-9.
6. Navarro B, Castro-Rodrigues J, Nieto NG, Berber A, Toussaint G, Sienro-Monge JJ, et al. Higher Metabolic syndrome in obese asthma compared to obese nonasthmatic adolescent males. J Asthma 2010;47:501-6.
7. Saruta T. Mechanism of glucocorticoid-induced hypertension. Hypertens Res 1996;19(1):1-8.
8. Salako BL, Ajay SO. Bronchial asthma: a risk factor for hypertension. Afr J Med Med Sci 2000;29(1):47-50.
9. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention 2010. Disponível em: www.ginabrasil. org.
10. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA). Allergy 2008;63(Suppl 86):8-160.
11. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52.
12. WHO. Physical Status. The use and interpretation of anthropometric. Geneva: World Health Organization, 1995.
13. Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertension participants in the Framingham Heart Study (BHAS): a cohort study. Lancet 2001;358:1682-6.
14. Burrows B, Barbee RA, Cline MG, Knudson RJ, Lebowitz MD. Characteristics of asthma among elderly adults in a sample of the general population. Chest 1991;100(4):935-42.
15. Brem AS. Insights into glucocorticoid associated hypertension. Am Kidney Dis 2001;37(1):1-101.
16. Brandão HV, Cruz CS, Guimarães A, Camargos PA, Cruz AA. Fatores preditores de hospitalização por asma em crianças e adolescentes participantes de um programa de controle da asma. J Bras Pneumol 2010;36(6):700-6.
17. Lacourciere Y, Lefebvre J, Nakhle G. Association between cough and angiotensin converting enzyme inhibitors versus angiotensin II antagonists: the design of a prospective controlled study. J Hypertens 1994;12(Suppl l):49-53.
18. Lopes HF. Hipertensão e inflamação: papel da obesidade. Rev Bras Hipertensão 2007;14(4);239-44.
19. Hall JE, Brands MW, Hildebrandt DA, Kuo J, Fitzgerald S. Role of sympathetic nervous system and neuropeptides in obesity hypertension. Braz J Med Biol Res 2000;33:605-18.
20. Silveira AS, Xisto DG, Dias CM, Lapa e Silva JR, Rocco PR. Entendendo os mecanismos relacionados a obesidade e asma. Pulmão RJ 2007;16(1);39-43.
21. Barros LL, Souza-Machado A, Corrêa LB, Santos JS, Cruz C, Leite M, et al. Obesity and poor asthma control in patients with severe asthma. J Asthma 2011;48(2):171-6.
22. Camargo CA, Weiss ST, Zhang S, Wilett WC, Speizer FE. Prospective study of body mass index, weight change and risk of adult onset asthma in women. Arch Intern Med 1999;159 (22):2582-8.
23. Schacter LM, Salome CM, Peat JK, Woolock AJ. Obesity is a risk for asthma and wheeze but not airway hiperresponsiveness. Thorax 2001;56(9):740-1.
24. Lee EJ, In KH, Ha ES, Lee KJ, Hur GY, Kang EH, et al. Asthmalike symptoms are increased in the metabolic syndrome. Asthma 2009;46(4):339-42.
25. Luder E, Melnik T, Di Maio M. Association of being overweight with greater asthma symptoms in inner city black and Hispanic children. J Pediatr 1998;132(4):699-703.
26. Cunha SS, Pujades-Rodriguez M, Barreto ML, Genser B, Rodrigues LC. Ecological study of socio-economic indicators and prevalence of asthma in schoolchildren in urban Brazil. BMC Public Health 2007;7:205.
27. Sembajwe G, Cifuentes M, Tak SW, Kriebel D, Gore R, Punnett L. National income, self-reported wheezing and asthma diagnosis from the World Health Survey. Eur Respir J 2010;35:279-86.
Submitted date:
01/31/2012
Accepted date:
07/10/2012
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