RESUMO
BACKGROUND: Mycoplasma pneumoniae and Chlamydia pneumoniae are frequent agents of acute respiratory diseases and they have been recognized as infectious triggers of asthma. OBJECTIVE: To determine the frequency of these triggers and their relationship to severe asthma. METHODS: 82 patients were enrolled in a prospective cross-sectional study from January 2007 to March 2013 and they were divided into three study groups: Group 1: 27 children with severe asthma, Group 2: 29 children with stable asthma and Group 3: 26 children which was the control group. Serological tests included IgG and IgM for both C. pneumoniae and M. pneumoniae. RESULTS: Average age ± SD was 10.9 ± 2.5 for Group 1; 10.1 ± 2.9 for Group 2 and 9.9± 1.9 for Group 3 (p = 0.4). M. pneumoniae IgM was observed in 6/27 (22.2%) in Group 1, 2/29 (6.9%) in Group 2 and 0/26 in the Control Group (p = 0,01). C.pneumoniae IgM was present in 7/26 (26.9%) in Group 1, 2/29 (6.9%) in Group 2 and 0/26 in Group 3 (p = 0.005). No significant difference was observed between Group 2 and Group 3. M. pneumoniae IgG was observed in 7/27 (25.9%) in Group 1, 4/29 (13.7%) in Group 2 and 0/26 in the Control Group (p < 0,05). C.pneumoniae IgG was present in 8/26 (30.7%) in Group 1, 5/29 (17.2%) in Group 2 and 0/26 in Group 3 (p < 0,05). CONCLUSIONS: M. pneumoniae and C. pneumoniae may play a role in the development of severe asthma.
Assuntos
Asma/epidemiologia , Asma/fisiopatologia , Pneumonia por Clamídia/epidemiologia , Pneumonia por Mycoplasma/epidemiologia , Adolescente , Criança , Pré-Escolar , Pneumonia por Clamídia/imunologia , Chlamydophila pneumoniae , Estudos Transversais , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Masculino , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/imunologia , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: The combination of inhaled ß(2) agonists and anticholinergics is recommended for children with acute asthma, although there are few randomized controlled trials. The aim of the study was to determine whether salbutamol plus ipratropium bromide improves oxygenation and lung function and reduces the frequency of hospitalization in children with asthma crises. METHODS: A prospective, randomized, double-blind study of children aged 2-18 years with moderate to severe asthma crises. Patients were evaluated using the asthma score and spirometry. They received six nebulizations of salbutamol plus placebo or salbutamol plus ipratropium and were reevaluated at 30, 60, 90, 120, and 240 minutes, at which time it was decided whether they were to be admitted. RESULTS: A total of 97 patients completed the study, 49 in the salbutamol plus ipratropium group and 48 in the salbutamol-only group. There were no differences in the status at baseline between the two groups. Children treated with salbutamol plus ipratropium presented a greater improvement in clinical state and lung function and required hospitalization less frequently (18.4%) than children in the salbutamol group (43.8%) (p = .007). Improvement was more marked in children with severe asthma crises than in those with moderate crises. The effect of salbutamol plus ipratropium was similar in children over 8 years of age and in younger children. CONCLUSIONS: Salbutamol plus ipratropium bromide improves lung function in asthmatic children with moderate to severe asthma crises, independently of age. The effect is greater in children with severe crises, with a substantial reduction in the need for hospitalization.