Prevalência de asma e sua relação com a poluição atmosférica avaliada pela presença de carbono em macrófagos alveolares e a função pulmonar em adolescentes do município de Taubaté/SP
Data
2015-11-27
Autores
Toledo, Maristella Froio 
Orientadores
Solé, Dirceu
Tipo
Tese de doutorado
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ISSN da Revista
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Objetivo: Determinar a prevalência da asma e sua relação com a poluição atmosférica pela presença de carbono em macrófagos alveolares e a função pulmonar em adolescentes de Taubaté, SP. Materiais e método: Estudo epidemiológico transversal realizado em adolescentes (13-14 anos; n=1039)provenientes de escolas públicas e privadas de Taubaté, SP. O estudo foi realizado em duas etapas consecutivas. Na primeira obteve-se os dados de prevalência da asma empregando-se o protocolo ISAAC (International Study of Asthma and Allergies in Childhood) a 1039 adolescentes. Os com resposta afirmativa à questão "você teve chiado nos últimos 12 meses?" foram caracterizados como asmáticos (A), e os com resposta negativa não asmáticos (NA). De acordo com a distância da residência em relação à rodovia Presidente Dutra (RPD) esses adolescentes foram categorizados como: muito próximo (até 200m), próximo (200 a 1000m) e longe (acima de 1000m). A segunda etapa foi realizada com 50 A e 200 NA, selecionados aleatoriamente, que responderam o questionário ISAAC complementar (fatores de risco). Os "A" realizaram espirometria antes e após broncodilatador e em seguida quatro nebulizações com solução salina hipertônica a 3% (SSH) a cada 5 minutos para indução e coleta de escarro, e após cada nebulização a aferição do VEF1. Em tempo máximo de duas horas após a coleta, as amostras de escarro foram processadas e as lâminas foram escaneadas e analisadas. Na dependência das variáveis estudadas foram utilizados métodos paramétricos ou não paramétricos fixando-se em 5% o nível para rejeição da hipótese de nulidade. Resultados: A prevalência de asma ativa foi 20,4%, significantemente mais elevada do que a observada em 2005, fato similar ocorreu com relação a: asma induzida por exercício (13,5% vs 19,2%). Entretanto, houve redução significante de rinite ativa (36,6% vs 18,5%) e de eczema na vida (16,2% vs 3,4%). Observou-se maior frequência de asma isolada ou associada à rinite entre os adolescentes que moravam muito próximos/próximos à RPD em relação aos que moravam afastados (5,8% vs 0,9%) e (23,2% vs 19,4%). Foram identificados como associados à expressão da asma: tempo de aleitamento materno (OR=23,9, IC95%:7,4-77,7); pai com rinite (OR=7,4,IC95%:2,2-24,7); mãe com rinite (OR=5,0, IC95%:2,0-12,34); roupa de cama (OR=6,1, IC95%:1,9-19,1) e morar próximo à RPD (OR=2,5, IC95%:1,05-5,98). A entrada no jardim da infância antes dos 4 anos mostrou ser um fator protetor. Ao analisarmos a presença de carbono em macrófagos, obtidos após escarro induzido, não verificamos maior frequência deles entre os moradores muito próximos/próximos da RPD, assim como às alterações da função pulmonar. Conclusão: Houve aumento na prevalência da asma e de sua gravidade entre adolescentes de Taubaté nos últimos sete anos. Morar próximo à RPD mostrou-se um fator de risco importante para asma e alergias, no entanto a presença de carbono no interior dos macrófagos alveolares não mostrou correlação positiva com o local de residência muito próximo/próximo à RPD ou sobre a função pulmonar.
Objective: Determine the prevalence of asthma and its relation to atmospheric pollution by verifying the presence of carbon in alveolar macrophages and the lung function in adolescents of Taubaté-SP. Materials and methods: Cross-sectional epidemiological study carried out in adolescents (13-14 years; n = 1039) from public and private schools in Taubaté, SP. The study was conducted in two consecutive stages. The first was obtaining data on the prevalence of asthma employing the ISAAC's (International Study of Asthma and Allergies in Childh ood) protocol to 1039 adolescents. Those with affirmative answer to the question "have you had wheezing in the last 12 months?" were characterized as asthmatics (A), and non-asthmatics those with negative response (NA). According to the distance of the residence in relation to the Presidente Dutra highway (PDH) these adolescents were categorized as very close (up to 200m), close (200 to 1000m) and distant (above 1000m). The second stage was carried out with 50 A and 200 NA randomly selected, who answered a complementary ISAAC questionnaire (risk factors). Those (A) carried out spirometry before and after bronchodilator and then 4 nebulizations with 3% hypertonic saline solution (SSH) every 5 minutes for induction and collect of sputum,and after each nebulization the measurement of VEF1. In maximum time of 2 hours after sputum collection, the samples were processed and the slides were scanned and analyzed. Depending on the variables studied, methods parametric or nonparametric were used to stand at 5% the level to reject the null hypothesis. Results: The prevalence of active asthma was 20.4%, significantly higher than that observed in 2005, a similar fact occurred with exercise-induced asthma (13.5% vs 19.2%). However, there was a significant reduction of active rhinitis (36.6% vs 18.5%) and eczema in life (16.2% vs 3.4%). There was a higher frequency of asthma, isolated or associated to rhinitis among adolescents who lived very close / near PDH in relation to those who lived away (5.8% vs 0.9%) and (23.2% vs 19.4 %) respectively. Have been identified as associated to the expression of asthma: duration of breastfeeding < 6 months (OR=23.9, 95%CI: 7.4-77.7); father with rhinitis (OR=7.4, 95%CI:2.2-24.7); mother with rhinitis (OR:5,0, 95%CI:2-12,34), bedding (OR=6.1, 95%CI: 1.9-19.1) and live near the PDH (OR=2.5, 95% CI:1.05-5.98). Entry to the kindergarten with less than four years old proved to be a protective factor. When we analyzed the presence of carbon in macrophages, obtained after induced sputum, higher frequency of them wasn?t checked among the residents who lived very close/ close to the PDH as the changes in lung function. Conclusions: There was an increase in the prevalence of asthma and its severity among adolescents of Taubaté in the last 7 years. Living close to the PDH proved to be an important risk factor for asthma and allergies, however the presence of carbon in alveolar macrophages showed no positive correlation with the place of residence very close /near the PDH or with lung function.
Objective: Determine the prevalence of asthma and its relation to atmospheric pollution by verifying the presence of carbon in alveolar macrophages and the lung function in adolescents of Taubaté-SP. Materials and methods: Cross-sectional epidemiological study carried out in adolescents (13-14 years; n = 1039) from public and private schools in Taubaté, SP. The study was conducted in two consecutive stages. The first was obtaining data on the prevalence of asthma employing the ISAAC's (International Study of Asthma and Allergies in Childh ood) protocol to 1039 adolescents. Those with affirmative answer to the question "have you had wheezing in the last 12 months?" were characterized as asthmatics (A), and non-asthmatics those with negative response (NA). According to the distance of the residence in relation to the Presidente Dutra highway (PDH) these adolescents were categorized as very close (up to 200m), close (200 to 1000m) and distant (above 1000m). The second stage was carried out with 50 A and 200 NA randomly selected, who answered a complementary ISAAC questionnaire (risk factors). Those (A) carried out spirometry before and after bronchodilator and then 4 nebulizations with 3% hypertonic saline solution (SSH) every 5 minutes for induction and collect of sputum,and after each nebulization the measurement of VEF1. In maximum time of 2 hours after sputum collection, the samples were processed and the slides were scanned and analyzed. Depending on the variables studied, methods parametric or nonparametric were used to stand at 5% the level to reject the null hypothesis. Results: The prevalence of active asthma was 20.4%, significantly higher than that observed in 2005, a similar fact occurred with exercise-induced asthma (13.5% vs 19.2%). However, there was a significant reduction of active rhinitis (36.6% vs 18.5%) and eczema in life (16.2% vs 3.4%). There was a higher frequency of asthma, isolated or associated to rhinitis among adolescents who lived very close / near PDH in relation to those who lived away (5.8% vs 0.9%) and (23.2% vs 19.4 %) respectively. Have been identified as associated to the expression of asthma: duration of breastfeeding < 6 months (OR=23.9, 95%CI: 7.4-77.7); father with rhinitis (OR=7.4, 95%CI:2.2-24.7); mother with rhinitis (OR:5,0, 95%CI:2-12,34), bedding (OR=6.1, 95%CI: 1.9-19.1) and live near the PDH (OR=2.5, 95% CI:1.05-5.98). Entry to the kindergarten with less than four years old proved to be a protective factor. When we analyzed the presence of carbon in macrophages, obtained after induced sputum, higher frequency of them wasn?t checked among the residents who lived very close/ close to the PDH as the changes in lung function. Conclusions: There was an increase in the prevalence of asthma and its severity among adolescents of Taubaté in the last 7 years. Living close to the PDH proved to be an important risk factor for asthma and allergies, however the presence of carbon in alveolar macrophages showed no positive correlation with the place of residence very close /near the PDH or with lung function.
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Citação
TOLEDO, Maristella Froio. Prevalência de asma e sua relação com a poluição atmosférica avaliada pela presença de carbono em macrófagos alveolares e a função pulmonar em adolescentes do município de Taubaté/SP. 2015. 121 f. Tese (Doutorado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.