Comportamiento del asma bronquial en Cuba e importancia de la prevención de las enfermedades alérgicas en infantes  <span class="so-article-trans-title" dir="auto"> Translated title: Behavior of bronchial asthma in Cuba and importance of the prevention from allergic diseases in infants </span>

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Abstract

El asma es una enfermedad frecuente que continúa siendo difícil de diagnosticar, sobre todo en la primera infancia; y además, es de difícil tratamiento, a pesar de los avances medicamentosos de los últimos años. Por tales razones, las organizaciones de salud pública y los organismos que se ocupan de ella a nivel mundial, cada día enfocan su atención, fundamentalmente, al capítulo de la prevención, particularmente, en el niño propenso a ser asmático. Se analizan las estadísticas relacionadas con el asma bronquial de los años 2001-2004 en Cuba, específicamente en lo referente a: prevalencia en pacientes dispensarizados por asma según grupos de edad y sexo; número de pacientes dispensarizados por asma según grupos de edad; tasa de prevalencia de pacientes dispensarizados por asma según provincias; así como las principales causas de egresos hospitalarios con diagnóstico de asma según estado al egreso. Se presentan recomendaciones prácticas para la prevención de enfermedades alérgicas en infantes con riesgo.

Translated abstract

Asthma is a frequent disease that is still difficult to diagnose, mainly in early childhood. It is also difficult to treat, in spite of the medical advances attained in the last years. For these reasons, the health public organizations and the bodies having to do with it at the world level focus their attention mainly on prevention, particularly in the child that is prone to be asthmatic. The statistics related to bronchial asthma from 2001 to 2004 in Cuba, specially what refers to the prevalence in patients suffering from asthma categorized by age and sex, the number of asthmatic patients categorized by age groups, the rate of prevalence of asthmatic patients categorized by province, as well as the main causes of hospital discharges with asthma diagnosis according to their state at discharge, are analyzed. Practical recommendations are given for the prevention of allergic diseases in infants at risk.

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Most cited references 22

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The role of breast-feeding in the development of allergies and asthma.

N. Friedman, Robert Zeiger (2005)

Breast-feeding is the preferred method of infant nutrition for numerous reasons. However, its role in the prevention of allergic disease remains controversial. Reasons for this controversy include methodological differences and flaws in the studies performed to date, the immunologic complexity of breast milk itself and, possibly, genetic differences among patients that would affect whether breast-feeding is protective against the development of allergies or is in fact sensitizing. The preponderance of evidence does suggest, however, that there would be much to lose by not recommending breast-feeding. In general, studies reveal that infants fed formulas of intact cow's milk or soy protein compared with breast milk have a higher incidence of atopic dermatitis and wheezing illnesses in early childhood. Consistent with these findings, exclusive breast-feeding should be encouraged for at least 4 to 6 months in infants at both high and low risk of atopy and irrespective of a history of maternal asthma.

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Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness at 10 years of age.

R Kurukulaaratchy, S. Arshad, M Fenn … (2005)

We sought to identify early life factors (ie, first 4 years) associated with wheeze, asthma, and bronchial hyperresponsiveness (BHR) at age 10 years, comparing their relative influence for these conditions. Children were seen at birth, and at 1, 2, 4, and 10 years of age in a whole-population birth cohort study (1,456 subjects). Information was collected prospectively on genetic and environmental risk factors. Skin-prick testing was performed at 4 years of age. Current wheeze (in the last 12 months) and currently diagnosed asthma (CDA) [ie, current wheeze and ever-diagnosed asthmatic subject] were recorded at 10 years of age when BHR was measured at bronchial challenge. Independent significant risk factors for these outcomes were identified by logistic regression. Independent significance for current wheeze occurred with maternal asthma (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.27 to 3.41) and paternal asthma (OR, 2.12; 95% CI 1.29 to 3.51), recurrent chest infections at 2 years (OR, 3.98; 95% CI, 2.36 to 6.70), atopy at 4 years of age (OR, 3.69; 95% CI, 2.36 to 5.76), eczema at 4 years of age (OR, 2.15; 95% CI, 1.24 to 3.73), and parental smoking at 4 years of age (OR, 2.18; 95% CI, 1.25 to 3.81). For CDA, significant factors were maternal asthma (OR, 2.26; 95% CI, 1.24 to 3.73), paternal asthma (OR, 2.30; 95% CI, 1.17 to 4.52), and sibling asthma (OR, 2.00; 95% CI, 1.16 to 3.43), recurrent chest infections at 1 year of age (OR, 2.67; 95% CI, 1.12 to 6.40) and 2 years of age (OR, 4.11; 95% CI, 2.06 to 8.18), atopy at 4 years of age (OR, 7.22; 95% CI, 4.13 to 12.62), parental smoking at 1 year of age (OR, 1.99; 95% CI, 1.15 to 3.45), and male gender (OR, 1.72; 95% CI, 1.01 to 2.95). For BHR, atopy at 4 years of age (OR, 5.38; 95% CI, 3.06 to 9.47) and high social class at birth (OR, 2.03; 95% CI, 1.16 to 3.53) proved to be significant. Asthmatic heredity, predisposition to early life atopy, plus early passive smoke exposure and recurrent chest infections are important influences for the occurrence of wheeze and asthma at 10 years of age. BHR at 10 years of age has a narrower risk profile, suggesting that factors influencing wheezing symptom expression may differ from those predisposing the patient to BHR.

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Contemporaneous maturation of immunologic and respiratory functions during early childhood: implications for development of asthma prevention strategies.

John W. Upham, Peter Sly, Patrick Holt (2005)

The term asthma refers to a spectrum of wheezing syndromes resulting from airways inflammation triggered by a range of environmental stimuli, the most important of which are aeroallergens and viruses. We describe below a model for the cause of atopic asthma in which discrete sets of developmental factors governing the postnatal maturation of the immune and respiratory systems play central and complementary roles in disease causality. Within the immune system, the relevant developmental processes involve maturation of TH1 and associated innate immune functions that combat infection and concomitantly antagonize the early programming of TH2-polarized immunologic memory against inhalant allergens. Within the respiratory system, the relevant developmental processes involve intensive lung growth and airway remodeling during infancy. We hypothesize that delayed maturation of TH1-associated functions during early postnatal life increases the risk for sensitization to aeroallergens and for severe respiratory infection, resulting in airway inflammation at a crucial stage in lung development and precipitating changes in lung growth that are the harbingers of susceptibility to persistent asthma. We further hypothesize that protection of the growing lung against the effects of inflammation during infancy and early childhood has unique potential as a generic strategy for asthma prophylaxis.

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Author and article information

Journal

Journal ID (publisher-id): mgi

Title: Revista Cubana de Medicina General Integral

Abbreviated Title: Rev Cubana Med Gen Integr

Publisher: ECIMED (Ciudad de La Habana, , Cuba )

ISSN (Print): 0864-2125

ISSN (Electronic): 1561-3038

Publication date (Print and electronic): February 2006

Volume: 22

Issue: 1

Affiliations

[01] Ciudad de La Habana orgnameHospital Universitario Calixto García Cuba

[02] orgnameInfomed, CNICM

Article

Publisher ID: S0864-21252006000100013 Publisher ID: S0864-2125(06)02200113

SO-VID: 4804c9f8-e897-4dfc-94ca-9a967e3e97e6

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 23 May 2006

Date accepted : 30 May 2006

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Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 0

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SciELO Cuba

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Comportamiento del asma bronquial en Cuba e importancia de la prevención de las enfermedades alérgicas en infantes Translated title: Behavior of bronchial asthma in Cuba and importance of the prevention from allergic diseases in infants

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Most cited references 22

The role of breast-feeding in the development of allergies and asthma.

Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness at 10 years of age.

Contemporaneous maturation of immunologic and respiratory functions during early childhood: implications for development of asthma prevention strategies.

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