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Biomedical subjects

D Solé

Publications and source records attributed to D Solé.

At least 37 records · Page 2Linked to original sources
PubMed1999

Prevalence of asthma and related symptoms in school-age children in São Paulo, Brazil--International Study of Asthma and Allergies in Children (ISAAC).

We studied the prevalence of asthma and related symptoms using a standard written questionnaire designed for the International Study of Asthma and Allergies in Children (ISAAC). The written questionnaire (questions 1-8 related to asthma) was applied to 3005 children aged 6-7 years and to 3008 children aged 13-14 years. The parents of the 6-7-year-old children answered the questionnaire, whereas the 13-14-year-old children answered the questionnaire themselves. Response rates were 72% in the 6-7-year-old group and 94% in the 13-14-year-old group. There was a slight predominance of females in the population studied (male:female ratio 0.94). In the group of the 6-7-year-old children, the prevalence of diagnosed asthma was 7.3% for boys and 4.9% for girls, and in the group of the 13-14-year-old children, the prevalence was 9.8% and 10.2% for boys and girls, respectively. Asthma severity was similar for both age groups, and wheezing following exercise was more frequent among the adolescents. In keeping with studies in other parts of the world, comparison between reported symptoms and diagnosed asthma revealed significantly lower frequency of diagnosed asthma, suggesting that in the population we have studied, asthma is underdiagnosed. Using a global cut-off score to define asthma, we found a significantly higher prevalence of asthma among 6-7-year-old boys, as compared to girls (23.8% vs. 20.4%), and no significant differences among adolescent boys and girls (22.5% and 21.9%, respectively).

Adolescent↗
PubMed1999

Pulse oximetry in the evaluation of the severity of acute asthma and/or wheezing in children.

We evaluated 174 children with acute asthma and/or wheezing attending two different settings, the allergy clinic (AC) and the emergency room (ER), and compared clinical symptoms and spirometric findings with arterial oxygen saturation as measured by pulse oximetry (SpO2). Seventy-four children (4 months to 15 years old) seen at the AC and 100 children (2 months to 14 years old) seen at the ER for the treatment of acute asthma and/or wheezing were evaluated and a clinical score was attributed on the basis of their symptoms. In addition, the heart rate (HR) was recorded and SpO2 was measured. Among the children seen at the AC, 58 were able to perform pulmonary function tests, and the forced respiratory volume in 1 sec (FEV1) and forced expiratory flow between 25% and 75% of the forced vital capacity (FEF(25-75)) were determined. Children from both groups underwent treatment with a nebulized beta2-agonist (Fenoterol 0.5% solution, 0.08 mg/kg/dose, maximum 2.5 mg) and were re-evaluated after 30 min. Our results showed a significant correlation between decrease in clinical scores and increase of SpO2 following treatment with bronchodilator in both groups of children. SpO2 levels correlated positively with FEV1 and FEF(25-75) values, and negatively with clinical scores and heart rate. The data revealed that a clinical score greater than 3 and an SpO2 < 94% were associated with increased severity of the asthma attack. In addition, SpO2 levels < or = 92% were associated with a 6.3-fold greater relative risk for requiring additional treatment. We concluded that determination of oxygen saturation by pulse oximetry is helpful in monitoring the severity of an acute exacerbation of asthma and/or wheezing, and has a prognostic value.

Acute Disease↗
PubMed1998

Evaluation of the potential cardiotoxicity of the antihistamines terfenadine, astemizole, loratadine, and cetirizine in atopic children.

BACKGROUND: Adverse cardiac effects have been related to the use of H1-receptor antagonists terfenadine and astemizole. OBJECTIVE: We have investigated the cardiac effects of the H1-receptor antagonists terfenadine, astemizole, loratadine and cetirizine, used in recommended doses, concomitantly or not with the antibiotic erythromycin. METHODS: A group of 80 children aged 5 to 12 years was studied. All children had been diagnosed with perennial allergic rhinitis based on symptoms, clinical signs and a positive immediate skin test to Dermatophagoides pteronyssinus. The children had no personal history of cardiac disease or hepatic dysfunction, and they had a normal electrocardiogram (ECG) at the beginning of the study. Forty children had allergic rhinitis and sinusitis, and were assigned to subgroups of ten children who received terfenadine, astemizole, loratadine, or cetirizine, concomitantly with erythromycin, for 14 days. Erythromycin was started to treat presumed bacterial infection in children with complete radiologic opacification of the maxillary sinus(es). The remaining 40 children had no sinusitis, and were assigned to subgroups of 10 children who received terfenadine, astemizole, loratadine, or cetirizine for 14 days. RESULTS: No significant changes in the QT interval and QTc (QT corrected by Bazzett's equation) were observed among children who received astemizole, loratadine or cetirizine, with or without erythromycin. Children who have received terfenadine and erythromycin showed significantly prolonged QT interval (mean pretreatment and posttreatment values 0.32s and 0.34s, respectively). Analysis of the QTc interval, however, showed no significant differences in the group treated with terfenadine and erythromycin (mean values 0.39s and 0.39s, respectively). CONCLUSIONS: Our results show that H1-receptor antagonists terfenadine, astemizole, loratadine and cetirizine, administered with or without erythromycin, to atopic children in recommended doses, do not induce adverse cardiac effects. Although the association between terfenadine and erythromycin has caused a statistically significant increase in QT interval measurements, the magnitude of these changes was below levels considered cardiotoxic or clinically relevant.

Anti-Allergic Agents↗
PubMed1998

Prevalence and characteristics of exercise-induced asthma in children.

We have evaluated the prevalence and the characteristics of exercise-induced asthma (EIA) in a group of 71 patients with a prior history of mild, moderate or severe asthma (42 males and 29 females), aged 6-16 years-old. Measurements of the forced expiratory volume in 1 second (FEV1) were obtained before and at regular intervals up to 8 hours following exercise. As a control, the same patients were evaluated at similar time intervals on another day when they had not been submitted to an exercise challenge. Using pre-exercise FEV1 values as the reference, 32 patients (45.1%) had a positive exercise challenge, defined as a fall in FEV1 value equal to or greater than 15% from baseline following exercise. Among the patients with a positive exercise challenge, the majority (23/32, 71.8%) had an immediate response alone, with no significant changes in FEV1 within the 8-hour follow-up. However, a subgroup of patients (9/32, 28.1%) had both an immediate and a late-phase response to exercise. During the control day, no significant fall in FEV1 were observed. In keeping with previous investigations, no correlation was found between a history of EIA and a positive exercise challenge in the present study. Positive exercise challenges were found more frequently among patients with moderate and severe asthma than patients with mild asthma.

Adolescent↗
PubMed1998

[Rhinosinusitis in children]

OBJECTIVES: To review the pathogenic mechanisms and treatment of sinusitis in children.METHODS: Mucopurulent secretion and halitosis are important signs and symptoms for the diagnose of sinusitis. The radiographic and computorized tomography investigations confirm the sinusal disease.RESULT: The identification of the main pathogens involved in the acute and chronic sinusitis is fundamental to give a better therapeutic control to these patients. CONCLUSIONS: Rhinosinusitis is one of the most reported diseases among the general population, and its prevalence has been rising in the last years. Many questions remain unanswered about its cause, pathophysiology and optimal treatment, especially in the pediatric population, generating health care costs and a high rate of morbidity.

Journal Article↗
PubMed1998

[Asthma in children: classification and treatment]

OBJECTIVES: To review concepts, classification based on severity, and long term treatment for children with asthma. METHODS: To identify precipitating factors of acute asthma attacks and classify the disease in order to establish long term treatment. RESULTS: Different plans of management according to its classification: mild, moderate and severe asthma. Antiinflammatory therapy is reserved to moderate and severe asthma. CONCLUSIONS: The identification and control of the etiologic and precipitating factors are important tasks in the management of asthma. The inhalatory route is the most appropriate to treat patients suffering from asthma. The usual drugs indicated in asthma treatment are reviewed. Precocious treatment with inhaled glucocorticosteroids is recommended by several authors.

Journal Article↗
PubMed1997

Comparative efficacy of inhaled furosemide and disodium cromoglycate in the treatment of exercise-induced asthma in children.

BACKGROUND: Inhaled furosemide has been shown, in patients with asthma, to have prophylactic properties similar to those of disodium cromoglycate. OBJECTIVE: The aim of this study was to evaluate the protective effect of these drugs in the treatment of exercise-induced asthma. METHODS: Fifteen children with exercise-induced asthma (mean age, 10.8 years) underwent exercise challenge after a single dose of nebulized placebo, furosemide (20 mg/m7 body area), or disodium cromoglycate (20 mg), 2 days apart, in a single-blind crossover trial. RESULTS: Both furosemide and disodium cromoglycate exerted significant protection against the bronchial response to exercise challenge, with a mean maximum percentage falls in FEV1 of 4.66% and 7.22%, respectively (p < 0.05). On the placebo day, the mean maximum percentage fall in FEV1 was 34.50% (p < 0.05). CONCLUSION: The results of this study suggest that furosemide and disodium cromoglycate provide comparable efficacy in preventing exercise-induced asthma in children, with no side effects.

Administration, Inhalation↗
PubMed1997

Improvement of bronchial hyperresponsiveness in asthmatic children treated for concomitant sinusitis.

BACKGROUND: There appears to be an association between sinusitis and asthma. The effect on bronchial hyperresponsiveness of clinical therapy for sinusitis in children may help to decipher whether sinusitis and asthma are independent manifestations of the same disease. OBJECTIVE: To evaluate the effect of clinical treatment for sinusitis in patients with rhinitis and/or asthma on symptoms and on bronchial hyperresponsiveness to methacholine. METHODS: Open label, randomized, non-treatment control in a teaching hospital in São Paulo, Brazil. Forty-six atopic and 20 normal children were studied. The atopic children consisted of 18 with allergic rhinitis (12 without sinusitis and 6 with sinusitis), and 28 children with rhinitis with asthma (13 with normal sinus radiographs and 15 with complete opacification of the maxillary sinuses). Methacholine PC20 was determined before and 30 days after treatment with nasal saline, sulfamethoxazole-trimethoprim, antihistamine/decongestant, and five days of prednisone. Sinus radiographs were also repeated. RESULTS: The only patients with increase in methacholine PC20 were patients with rhinitis and asthma with opacified maxillary sinuses at entry and who at 30 days had normal sinus radiographs (P < .05). CONCLUSION: In this study, children with allergic rhinitis and sinusitis with asthma improved their bronchial hyperresponsiveness to methacholine and decreased their symptoms with appropriate response of their sinuses to clinical therapy.

Administration, Intranasal↗
PubMed1997

Endotoxin exposure and symptoms in asthmatic children.

Endotoxins (ET) are pro-inflammatory substances present in house dust which may increase non-specific bronchial reactivity in asthmatic patients. Endotoxins (EU/g) and Der p 1 levels were compared in the homes of ten asthmatic and ten control children, aged 6-16 years, living in São Paulo, Brazil. The houses were visited once a month from February 1993 to February 1994 and dust samples were collected from the bedding and floor of each subject's house. No significant differences were observed in ET and Der p 1 levels in the homes of asthmatics and controls. The highest ET levels were detected in January and November, whereas the lowest levels were detected in April and August (p < 0.05), demonstrating a distinct seasonal distribution. The highest Der p 1 levels in bedding were observed in July and the lowest in February (p < 0.05), while Der p 1 levels in floor did not show significant differences throughout the year. Symptom and medication scores were evaluated monthly in the group of asthmatic children. There was a significant correlation (p < 0.05, r = 0.63) between clinical symptom scores and ET exposure, however no significant correlation was found for mite exposure (p > 0.05, r = 0.19). The results suggest that ET exposure exacerbates asthmatic symptoms in mite allergic, asthmatic children.

Adolescent↗
PubMed1997

HLA antigens in asthmatic children.

The purpose of the present study was to analyze the frequency of HLA-DR and DQ antigens in Brazilian asthmatic children with skin-test and RAST positivity to Dermatophagoides pteronyssinus. The comparison of HLA-DR and DQ antigenic frequencies between patients (n = 30) and controls disclosed a significantly higher HLA-DQ2 frequency in the patients (60% versus 34%, p = 0.013; R. R. = 2.8).

Adolescent↗
PubMed1996

Short stature in children with respiratory allergy.

We evaluated the prevalence of short stature (SS) among children with respiratory allergic disease followed up in a specialised centre. These patients (N = 617; 8 months to 16 years) with respiratory allergy (asthma and/or rhinitis) were evaluated for SS (stature shorter than the 3rd percentile, NCHS pattern). The possible links between SS and gender; current age; type, severity, and duration of the allergic disease, treatment with corticosteroid and birth weight were also studied. To assess the influence of the socioeconomic level on SS frequency among atopics, 120 of these patients were compared to their non-atopics siblings. The overall prevalence of SS was 7.9%. Relationship between SS and gender type and severity of the allergic disease and treatment with corticosteroids were not observed. A significant higher frequency of SS occurred among patients with longer period of disease and birth weight less than 2,500 gr. Analysis of the pairs of brothers showed significant higher frequency of SS between allergics (12.5% x 4.2%) showing influence of allergic disease per se. Longitudinal studies for long periods of time are required to properly establish the relation between atopic disease and SS.

Adolescent↗
PubMed1996

Efficacy and side effects of beta 2-agonists by inhaled route in acute asthma in children: comparison of salbutamol, terbutaline, and fenoterol.

Thirty-seven separate episodes of acute bronchial asthma were studied in 21 asthmatic children. The bronchodilator, cardiovascular, and tremorigenic responses following administration of salbutamol (SAL), terbutaline (TER) and fenoterol (FEN) by closed-port intermittent nebulization were compared for a period of 8 hr. SAL was used at the maximum dose recommended by the manufacturer and TER and FEN at the average doses commonly used in children. Eleven acute attacks were treated with SAL, 12 with TER, and 14 with FEN. Pulmonary function was evaluated by clinical assessment and by the spirometric indices FEV1 and FEF25-75. Tremor was objectively measured, as well as heart rate (HR), respiratory rate, and blood pressure. The onset of bronchodilating effect occurred at 5 min for all three drugs and there were no differences in intensity and duration of bronchodilation between drugs. All three drugs caused rapid onset of tremor (5 min) and this tended to be more intense with SAL. There was a slight decrease in HR in the TER group, whereas SAL and FEN caused increase in HR, with mean values significantly greater than in the TER group from 5 to 30 min after drug administration. Our results indicate that the three short-acting beta 2-agonists studied are equally effective in treatment of acute bronchospasm by the inhaled route in children, in the doses used. Our findings imply that a dose of SAL twice as great as that commonly used by nebulization in children is equipotent to those usually employed for TER and FEN, as far as therapeutic effect is concerned, but it could generate more intense tremorigenic and tachycardic side effects.

Administration, Inhalation↗
PubMed1996

Transfer of IgG subclasses across placenta in term and preterm newborns.

In order to study placental transfer of IgG subclasses, paired blood samples were collected from mothers and umbilical cord of preterm (N = 69) and full-term (N = 68) newborns. The full-term group was further divided into 3 subgroups: appropriate for gestational age (AGA, N = 43), large for gestational age (LGA, N = 13) and small for gestational age (SGA, N = 12), according to birth weight. IgG subclasses (IgG1, IgG2, IgG3 and IgG4) were measured by the single radial immunodiffusion technique using monoclonal antibodies. IgG1 and IgG3 newborn subclass concentrations (10.17 and 0.57 g/l, respectively) increased with increasing gestational age and reached maternal levels (IgG1 = 8.86; IgG3 = 0.67 g/l) during the 37th week of pregnancy. Low levels of these subclasses were found in premature newborns. IgG2 from newborns were always lower than maternal levels (P < 0.05). LGA and SGA newborns had equivalent levels of IgG1 and IgG2 compared with AGA. SGA newborns had higher levels of IgG3 and lower levels of IgG4 than LGA and AGA newborns.

Female↗