2005, Number 4
<< Back Next >>
Rev Invest Clin 2005; 57 (4)
Characteristics of Mexican asthmatic subjects attending an outpatient service
Fernández-Vega M, Vargas MH, Regalado-Pineda J, Chapela-Mendoza R, Salas-Hernández J
Language: Spanish
References: 34
Page: 513-521
PDF size: 119.77 Kb.
ABSTRACT
Background. Despite the high prevalence of asthma in Mexico, studies describing general characteristics of these patients are scarce.
Objective. To analyze the sociodemographic, clinical and respiratory functional profile of asthmatic patients attending for the first time the outpatient service of a tertiary-level hospital, as well as to investigate treatments already received and the abandonment rate.
Methods. Adolescent and adult asthmatic subjects seen from February 2000 to November 2002 in the outpatient service of the National Institute of Respiratory Diseases, in Mexico City, were prospectively studied. Sociodemographic information was gathered and clinical and spirometric evaluations were carried out. The severity of the disease was classified according to international criteria.
Results. A total of 1403 patients between 12 and 82 years of age, with predominance of the female gender, were included in the analysis. An 88.7% of patients had the mildest forms of the disease, 10% had moderate asthma, and 1.3% had severe asthma. While 21.4% had never received anti-asthma treatment, about one third of the remaining patients had received corticosteroids, independently of the asthma severity, indicating an over-treatment of the intermittent form of the disease and an under-treatment of persistent forms. A high abandonment rate (65.7%) was observed. A positive bronchodilator test was observed in 30.3% of patients with intermittent asthma, though this proportion increased to about 67% in those with moderate and severe asthma.
Conclusion. Mildest forms of the disease predominate among asthmatic patients attending for the first time an outpatient service, with a still very high frequency of inadequate use of corticosteroids.
REFERENCES
Vargas MH, Sienra-Monge JJ, Salas J. Diagnóstico y tratamiento del asma. Rev Inst Nac Enf Resp (Méx) 1994; 7: 53-66.
Bender BG, Ellison MC, Gleasson M, Murphy JR, Sundstrom DA, Szefler SJ. Minimizing attrition in a long-term clinical trial of pediatric asthma. Ann Allergy Asthma Immunol 2003; 91: 168-76.
Instituto Nacional de Enfermedades Respiratorias. Informe de labores (1994-2003). México: El Instituto.
Aït-Khaled N, Enarson DA. El manejo del asma en los adultos. Guía para países con escasos recursos económicos. París: Unión Internacional Contra la Tuberculosis y las Enfermedades Respiratorias; 1996.
American Thoracic Society. Standardization of spirometry. 1994 update. Am J Respir Crit Care Med 1995; 152: 1107-36.
American Thoracic Society. Lung function testing: Selection of reference values and interpretative strategies. Am Rev Respir Dis 1991; 144: 1202-18.
Zar JH. Biostatistical analysis. 4th. Ed. Upper Saddle River: Prentice Hall; 1999, p. 223-5.
Ronchetti R, Villa MP, Barreto M, et al. Is the increase in childhood asthma coming to an end? Findings from three surveys of schoolchildren in Rome, Italy. Eur Respir J 2001; 17: 881-6.
Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics 2002; 110: 315-22.
Mannino DM, Homa DM, Akinbami LJ, et al. Surveillance for asthma in United States, 1980-1999. MMWR Surveill Summ 2002; 51: 1-13.
Senthilselvan A, Lawson J, Rennie DC, Dosman JA. Stabilization of an increasing trend in physician-diagnosed asthma prevalence in Saskatchewan, from 1991 to 1998. Chest 2003; 124: 438-48.
Braun-Fahrländer C, Gassner M, Grize L, Takken-Sahli K, Neu U, Stricker T, et al. No further increase in asthma, hay fever and atopic sensitization in adolescents living in Switzerland. Eur Respir J 2004; 23: 407-13.
Vargas MH, Díaz-Mejía G, Furuya MEY, Salas J, Lugo A. Trends of asthma in Mexico. An 11-year analysis in a nationwide institution. Chest 2004; 125: 1993-7.
Vargas MH, Sienra-Monge JJ, Díaz-Mejía SS, Olvera-Castillo R, De León-González M. Grupo de estudio del asma en el niño. Aspectos epidemiológicos del asma infantil en México. Gac Méd Méx 1996; 132: 255-65.
Kanner RE, Connett JE, Altose MD, Buist S, Lee WW, Tashkin DP, Wise RA. Gender difference in airway hyperresponsiveness in smokers with mild COPD. Am J Respir Crit Care Med 1994; 150: 956-61.
Peat JK, Salome CM, Woolcock AJ. Factors associated with bronchial hyperresponsiveness in Australian adults and children. Eur Respir J 1992; 5: 921-9.
Redline S, Gold D. Challenges in interpreting gender differences in asthma. Am J Respir Crit Care Med 1994; 150: 1219-21.
Paterson NAM, Peat JK, Mellis CM, Xuan W, Woolcock AJ. Accuracy of asthma treatment in schoolchildren in NSW, Australia. Eur Respir J 1997; 10: 658-64.
Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J 2000; 16: 802-7.
National Asthma Education and Prevention Program. National Asthma Education and Prevention Program. Expert panel report: guidelines for the diagnosis and management of asthma update on selected topics -2002. J Allergy Clin Immunol 2002; 110(Supl 5): S141-S219.
Global initiative for asthma. Global strategy for asthma management and prevention. Update 2003. NIH Publication No. 02-3659 (update 2003). Bethesda: NIH; 2003.
British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Thorax 2003; 58(Suppl. 1): 1-94.
Boulet LP, Becker A, Bérubé D, Beveridge R, Ernst P, on behalf of the Canadian Asthma Consensus Group. Canadian asthma consensus report, 1999. Can Med Assoc J 1999 (Supl 11 ): S1-S62.
Salas-Hernández J, Ramírez-Venegas A, Carrillo-Rodríguez G, Pérez-Chavira R, Sansores-Martínez RH, Mejía-Avila M, Chapela-Mendoza R. La conducta de un grupo de médicos mexicanos ante el diagnóstico y tratamiento del asma. Rev Inst Nal Enf Respir (Mex) 1994; 7: 116-21.
Bush RK. The role of allergy in asthma. Chest 1992; 101 (Suppl 6): S378-S380.
Eisner MD, Yelin EH, Katz PP, Earnest G, Blanc PD. Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves, and wood smoke. Thorax 2002; 57: 973-8.
Wakefield M, Ruffin R, Campbell D, Roberts L, Wilson D. Smoking-related beliefs and behavior among adults with asthma in a representative population sample. Aust N Z J Med 1995; 25: 12-7.
Mishra V. Effect of indoor air pollution from biomass combustion on prevalence of asthma in the elderly. Environ Health Perspect 2003; 111: 71-8.
Golshan M, Faghihi M, Marandi MM. Indoor women jobs and pulmonary risks in rural areas of Isfahan, Iran, 2000. Respir Med 2002; 96: 382-8.
Johansson G, Carlson KH, Mowinckel P. Asthma drug adherence in a long-term clinical trial. Arch Dis Child 2000; 83: 330-3.
Tinkelman DG, Reed CE, Nelson HS, Offord KP. Aerosol beclomethasone diproprionate compared with theophylline as primary treatment of chronic, mild to moderately severe asthma in children. Pediatrics 1993; 92: 64-77.
Van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, Duiverman EJ, Pocock SJ, Kerrebijn KF. Effects of 22 months of treatment with inhaled corticosteroids and/or b2-agonists on lung function, airway responsiveness, and symptoms in children with asthma. The Dutch Chronic Non-Specific Lung Disease Study Group. Am Rev Respir Dis 1992; 146: 547-54.
Waalkens HJ, van Essen-Zandvliet EE, Hughes MD, et al. Cessation of long-term treatment with inhaled corticosteroid (budesonide) in children with asthma results in deterioration. The Dutch CNSLD Study Group. Am Rev Respir Dis 1993; 148: 1252-7.
Parker AL. Airway reactivity is a determinant of bronchodilator responsiveness after methacholine-induced bronchoconstriction. J Asthma 2004; 41: 671-7.