RESUMO
BACKGROUND: Fractional exhaled nitric oxide (FeNO) is a marker of airway inflammation. Elevated FeNO has been associated with environmental exposures, however, studies from tropical countries are limited. Using data from the Infants' Environmental Health Study (ISA) birth cohort, we evaluated medical conditions and environmental exposures' association with elevated FeNO. METHODS: We performed a cross-sectional analysis of 277 women and 293 8-year old children who participated in the 8-year post-partum visit in 2019. We measured FeNO and collected information on medical conditions and environmental exposures including smoke from waste burning, work in banana plantations, and home pesticide use. We defined elevated FeNO as >25 ppb for women and >20 ppb for children. To evaluate factors associated with elevated FeNO, we used logistic regression models adjusted for obesity in women and unadjusted in children. RESULTS: Overall elevated FeNO was common (20% of women, 13% of children). Rhinitis diagnosis was significantly associated with elevated FeNO in both women (odds ratio (OR): 3.67 95% Confidence Interval (CI): 1.81,7.35) and children (OR: 8.18 95%CI: 3.15, 21.22); wheeze was associated with elevated FeNO in women (OR: 4.50 95% CI: 2.25, 8.99). Environmental exposures were associated with elevated FeNO, but not significantly. Waste burning was associated with elevated FeNO in both women (OR: 1.58 95%CI 0.68, 4.15) and children (OR: 2.49 95%CI:0.82, 10.79). Para-occupational pesticide exposures were associated with elevated FeNO in women and children. For women, having a partner working in agriculture was associated with elevated FeNO (OR: 1.61 95%CI:0.77, 3.58) and for children, maternal work in agriculture was associated with elevated FeNO. (OR 2.08 95%CI 0.86, 4.67) CONCLUSION: Rhinitis and wheeze were associated with elevated FeNO in this rural, agricultural population. Smoke from waste burning as well as para-occupational pesticide exposure may contribute to elevated FeNO in rural communities.
Assuntos
Asma , Praguicidas , Rinite , Lactente , Humanos , Criança , Feminino , Estudos Transversais , Teste da Fração de Óxido Nítrico Exalado , Asma/epidemiologia , Coorte de Nascimento , Costa Rica , Óxido Nítrico/análise , Testes Respiratórios , Fumaça/efeitos adversos , ExpiraçãoRESUMO
Our aim is to review current asthma epidemiology, achievements from the last 10 years, and persistent challenges of asthma management and control in low-middle income countries (LMICs). Despite global efforts, asthma continues to be an important public health problem worldwide, particularly in poorly resourced settings. Several epidemiological studies in the last decades have shown significant variability in the prevalence of asthma globally, but generally a marked increase in LMICs resulting in significant morbidity and mortality. Poverty, air pollution, climate change, exposure to indoor allergens, urbanization and diet are some of the factors that contribute to inadequate control and poor outcomes in developing countries. Although asthma guidelines have been developed to raise awareness and improve asthma diagnosis and treatment, problems with underdiagnosis and undertreatment are still common. In addition, important social, financial, cultural and healthcare barriers are common obstacles in LMICs in achieving control. Given the high burden of asthma in these countries, adaptation and implementation of national asthma guidelines tailored to local needs should be a public health priority. Governmental commitment, education, better health system infrastructure, access to care and effective asthma medications are the cornerstone of achieving success. CONCLUSION: Asthma poses significant challenges to LMICs. Whilst there are ongoing efforts in improving asthma diagnosis and decreasing asthma burden in LMICs; reasons for inadequate asthma control are also common and difficult to tackle. Improving asthma diagnosis, access to appropriate treatment and decreasing risk factors should be key goals to reduce asthma morbidity and mortality worldwide.
Assuntos
Asma/epidemiologia , Países em Desenvolvimento , Poluição do Ar/estatística & dados numéricos , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Alérgenos , Asma/diagnóstico , Asma/terapia , Criança , Mudança Climática/estatística & dados numéricos , Erros de Diagnóstico , Dieta/estatística & dados numéricos , Humanos , Pobreza/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Saúde Pública , Política Pública , Fatores de Risco , Urbanização/tendênciasRESUMO
Hydropneumothorax is an uncommon presentation of a complicated pneumonia, and very few cases in the pediatric population have been reported. This is a case of a 5-month-old patient who presented to the emergency department (ED) with a three-day history of fever, diarrhea, and respiratory distress. His initial assessment suggested a lower respiratory tract infection and because of his respiratory distress and hypoxia a chest X-ray was performed. Other clinical information and radiologic studies will be discussed further, but his chest X-ray suggested a right-sided hydropneumothorax secondary to a complicated pneumonia. He completed 12 days of IV antibiotic treatment and required a chest tube for drainage. Patient was discharged home with a full recovery.
RESUMO
OBJECTIVES: To examine the prevalence of asthma and the relation between tobacco use and asthma among university students in Costa Rica. METHODS: Cross-sectional study of 1279 adolescents and young adults enrolled in careers in the health sciences in public and private universities in Costa Rica. RESULTS: Of the 1279 study participants, 105 (8.2%) had current asthma, and 136 (10.6%) reported wheezing in the previous 12 months (current wheezing). Among individuals with either current wheezing or current asthma, none was using anti-inflammatory medications for asthma (e.g., inhaled corticosteroids). Approximately one third of the study participants reported any cigarette smoking. Young adults who had current wheezing were 5.8 times more likely to smoke at least 10 cigarettes per day than those who had no current wheezing [95% confidence interval (CI) for odds ratio (OR) = 3.3-10.2, p < 0.001]. Similar results were observed when an alternative definition of asthma (current asthma) was used in the analysis (OR for smoking at least 10 cigarettes per day = 4.4, 95% CI = 2.3-8.5, p < 0.001). CONCLUSIONS: Adequate public health measures are needed to prevent tobacco use in Costa Rican adolescents and to promote smoking cessation among young adults. Young adults with asthma living in Latin American countries with high asthma prevalence, such as Costa Rica, should be better educated with regard to asthma and the risks of tobacco use.