Prevalência de asma e sintomas asmáticos em escolares de 13 e 14 anos de idade

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Abstract

OBJETIVO: Antes do uso do questionário padronizado ISAAC (International Study of Asthma and Allergies in Childhood) em inquéritos epidemiológicos, pouco se conhecia sobre a ocorrência comparativa de asma no mundo, dados os diferentes métodos empregados. No Brasil, outros estudos utilizaram o questionário ISAAC em regiões urbanas. Realizou-se estudo utilizando esse questionário nas zonas urbana e rural com o objetivo de estimar a prevalência de asma em escolares. MÉTODOS: Estudo transversal com o questionário escrito ISAAC, acrescido de perguntas sobre exposições de interesse, auto-aplicado em 3.770 escolares de 13 e 14 anos de idade do município de Montes Claros (MG) selecionados por sorteio. RESULTADOS: A prevalência de "sibilos no último ano" foi 15,8%, e de "asma ou bronquite alguma vez na vida" 23,8%, sem diferença significativa entre sexos. Houve diferença estatística (p<0,05) entre sexos (feminino e masculino, respectivamente) em "sibilos alguma vez na vida" (37,8% e 33,6%), "sono alterado devido à crise de sibilos" (13,7% e 9,5%) e "tosse seca noturna sem infecção respiratória" (36,6% e 28,7%). Houve associação nociva entre "sibilos no último ano", "contato com animais domésticos" (OR=1,27; IC 95%: 1,03-1,56) e "história familiar de asma" (OR=1,79; IC 95%: 1,50-2,14), e associação protetora entre "sibilos no último ano" e "localização rural da escola" (OR=0,63; IC 95%: 0,44-0,91), mas não houve associação com sexo, idade, domínio escolar e tabagismo passivo. CONCLUSÕES: A prevalência de asma na amostra estudada foi elevada, com alguns sintomas predominantes no sexo feminino. A ocorrência de "sibilos no último ano" mostrou-se associada à história familiar, contato com animais domésticos e localização urbana das escolas.

Translated abstract

OBJECTIVE: Before the use of the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire in epidemiologic surveys, little could be told about the comparative occurrence of asthma in the world due to differences in employed methods. In Brazil, the ISAAC questionnaire has been used in some urban regions. In this study it was applied in both, urban and rural areas, in order to estimate the prevalence of asthma among schoolchildren living in Montes Claros, Brazil. METHODS: A cross-sectional study was carried out using the ISAAC written questionnaire with four questions added on exposures of interest. The questionnaire was self-applied in 3,770 randomly selected schoolchildren aged 13 and 14 years. RESULTS: The prevalence of "wheezing in the last year" was 15.8%, and "asthma or bronchitis ever" was 23.8% with no statistically significant difference between boys and girls. There were significant differences between girls and boys regarding "wheezing ever" (37.8% and 33.6%), "sleeping disturbed by wheezing" (13.7% and 9.5%), and "nocturnal dry coughing without respiratory infection" (36.6% and 28.7%), respectively. "Wheezing in the last year" was found to be positively associated with "pet contact" (OR=1.27; 95% CI: 1.03-1.56), and "family history of asthma" (OR=1.79; 95% CI: 1.50-2.14), and negatively associated with "rural school" (OR=0.63; 95% CI: 0.44-0.91). But no association was found with sex, age, private/public school, and passive smoking. CONCLUSIONS: The prevalence of asthma in Montes Claros was high and some symptoms were seen mainly among girls. The occurrence of "wheezing in the last year" showed to be associated with family history, contact with pets and urban schools.

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Prevalence and etiology of asthma.

R. Palmer Beasley, Meredith J. Crane, C K Lai … (2000)

An increased understanding of the causes of asthma is coming from the international comparisons of asthma prevalence, particularly those from the European Community Respiratory Health Survey of asthma prevalence in adults and the International Study of Asthma and Allergies in Childhood. From these and other studies of asthma prevalence, it is possible to draw some tentative conclusions as to the patterns of asthma prevalence worldwide. There are five striking patterns: first, asthma prevalence is increasing worldwide; second, asthma is generally more common in Western countries and less common in developing countries; third, asthma is more prevalent in English-speaking countries; fourth, asthma prevalence is increasing in developing countries as they become more Westernized or communities become urbanized; and fifth, the prevalence of other allergic disorders may also be increasing worldwide. These five key features of the international patterns of asthma prevalence raise major questions about the role of "established" risk factors for the development of asthma. As a result, recent research has expanded to include the study of novel factors that may "program" the initial susceptibility to sensitization or contribute to the development of asthma independent of atopic sensitization. These include various exposures in utero, which are reflected in various perinatal factors measured at birth, and exposures (or lack of exposures) in the early years of life that may make the infant more susceptible to the subsequent development of asthma. These issues are now the focus of an intensive research effort worldwide, and the next few years are likely to see exciting advances in our understanding of the causes of asthma.