Eduardo Vieira Ponte’s research while affiliated with Faculdade de Medicina de Jundiaí and other places

In the real world, health professionals need to care for individuals with asthma-like symptoms who have a persistently negative bronchodilator response (BDR). Little is known about the evolution of symptoms and lung function of these individuals because they are usually excluded from studies on asthma. The aim of this study was to evaluate whether individuals with asthma-like symptoms but with a persistently negative BDR have a different evolution of symptoms and lung function compared to individuals with asthma proven by positive BDR. This prospective cohort study included adults with asthma-like symptoms. Individuals participated in two visits 12 months apart. They responded to questionnaires and underwent a spirometry test. In individuals without airway obstruction in the first visit, those with asthma-like symptoms and persistently negative BDR were less likely to lose forced expiratory volume in the first second during follow-up or progress to airway obstruction at the final visit compared to individuals with asthma proven by positive BDR. Among individuals with airway obstruction at baseline, those with asthma-like symptoms and persistently negative BDR were less likely to resolve the airway obstruction during follow-up compared to individuals with asthma proven by positive BDR. In individuals with proven asthma, the emergence or persistence of positive BDR during follow-up was accompanied by a worsening of asthma outcomes compared to the remission of positive BDR. Thus, BRD is an accessible marker of disease progression in individuals with asthma-like symptoms. In individuals with asthma proven by positive BDR, the trend in BDR was associated with the evolution of symptoms and lung function.

OBJECTIVES Primary hyperhidrosis is a functionally and socially limiting condition. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis. However, post-sympathectomy compensatory sweating remains a challenge in clinical practice. METHODS Record analysis of patients who underwent thoracoscopic sympathectomy between 2002 and 2020. Emphasis was given to demographic data, site of complaint, functional and social impairment, procedure performed, postoperative results, and compensatory sweating. RESULTS A total of 820 patients were included (age 23.8 [7.3] years, body mass index—BMI 22.3 [3.0] kg/m2, 66.3% female). The palmoplantar (44.3%) and palmoplantar-axillary (41.6%) sites were the most affected, followed by the axillary (12.3%) and craniofacial sites (1.8%). On a 0 to 4 scale, functional impairment was significantly greater in the palmoplantar group (p < 0.001) and social impairment in the axillary, palmoplantar-axillary, and craniofacial groups (p < 0.001). The degree of compensatory sweating after surgery was minimal in groups palmoplantar (74.9%), palmoplantar-axillary (70.4%), axillary (63.4%), and mild in the craniofacial group (66.7%). The bivariate analyses showed significant differences in the compensatory sweating variable for age, sex, BMI, and site. The multiple analysis by logistic regression showed BMI, sex, and the palmoplantar-axillary, axillary, and craniofacial variables to be significant for compensatory sweating. CONCLUSIONS Thoracoscopic sympathectomy was an effective procedure for controlling primary focal hyperhidrosis, with tolerable compensatory sweating in the patients analyzed in this study.

Introduction: Studies have identified a greater risk of sensory neural hearing loss in individuals with COPD compared to healthy individuals, but it is unclear whether they are at increased risk of hearing loss with impaired speech recognition. The aim of this study was to assess whether COPD is associated with hearing loss that affects speech recognition. Methods: This is a case-control study. We screened individuals from health facilities in the municipality of Jundiai. We enrolled a test group of individuals with COPD and an age-matched control group composed of individuals with asthma. The selected individuals attended an appointment with a chest physician, responded questionnaires and underwent tonal and speech audiometry. Adjusted binary logistic regression analysis evaluated whether COPD was associated with reduced speech recognition. Results: We enrolled 36 individuals with COPD and 72 with asthma. Individuals with COPD were more likely to have a reduced speech recognition compared to asthmatic individuals [Reduced recognition of three-syllable words: adjusted OR 3.72, 95 CI (1.38 - 10.02)] [Reduced recognition of monosyllable words: adjusted OR 4.74, 95 CI (1.52 - 14.76)]. Conclusion: We conclude that individuals with COPD from primary and secondary healthcare facilities have at least 38% greater risk of hearing loss with reduced speech recognition compared to an age-matched control group of individuals with asthma recruited from the same facilities. We recommend that longitudinal studies evaluate whether regular screening could contribute to the prevention or early treatment of hearing loss in individuals with moderate-severe COPD.

Introduction: Current guidelines incorporate the option of a rapid onset bronchodilator (ROB) plus an inhaled corticosteroid (ICS) for the relief of asthma symptoms, but there is doubt whether the combined therapy for relief could lead to suboptimal maintenance therapy since individuals might prefer it to the maintenance therapy. The objective of this study was to assess whether the type of rescue medication that the individual with asthma has available is associated with suboptimal maintenance therapy. Methods: This cross-sectional study included non-smokers with asthma, ≥12 years old. The individuals attended an appointment with a physician, responded questionnaires and performed a spirometry. Adjusted regression analysis evaluated whether the type of rescue medication was associated with suboptimal maintenance therapy. Results: We enrolled 953 individuals, of which 221 reported having no rescue medication, 171 carried any ROB + ICS for symptoms relief and 561 carried SABA alone to rescue. The frequency of suboptimal maintenance therapy was not different between individuals carrying the combination and those carrying SABA alone for symptoms relief, but individuals who reported having no rescue medication had less suboptimal maintenance therapy (P < 0.01). Conclusions: The frequency of suboptimal maintenance therapy for asthma was similar between individuals carrying any ROB + ICS for symptoms relief and those carrying SABA alone to rescue, whilst it was less frequent in the group that reported not having any reliever medication. Data from this study indicate that recent changes in asthma guidelines regarding the use of rescue medication have little risk of impairing maintenance therapy.

Background: It is unclear if depression is associated with impaired lung function in subjects with asthma, while few studies evaluated the effect of antidepressants on the relationship between depression and asthma. We designed this study to investigate if subjects with concomitant asthma and depression not taking antidepressants have worse asthma outcomes compared to asthmatic subjects without depression, and to evaluate whether antidepressants modify this association. Methods: This is a cross-sectional study. We included non-smokers with asthma, 18 years old or above. Study subjects attended an appointment with a chest physician, answered study questionnaires and underwent a spirometry test. We performed crude and adjusted binary logistic regression analyses. Results: We enrolled 309 subjects with asthma, of whom 48 with depression taking antidepressants, 52 with depression not taking antidepressants, and 209 without depression (control group). Asthmatic subjects with depression who had not used antidepressants before enrollment were more likely to have uncontrolled symptoms of asthma [adjusted OR 3.10, 95CI (1.56-6.15)] and airway obstruction [adjusted OR 2.41, 95CI (1.24-4.69)] compared to the control group. Subjects who had used antidepressants had higher odds of uncontrolled symptoms of asthma [adjusted OR 3.02, 95CI (1,50-6.07)], but similar odds of airway obstruction [adjusted OR 1.24, 95CI (0.87-1.77)] compared to the control group. Conclusions: Non-treated depression is associated with airway obstruction in subjects with asthma, but antidepressants modify this association. Thus, we recommend regular screening of depression in subjects with asthma, and prescription of antidepressants whenever depression symptoms justify pharmacological therapy.

Objetivo: avaliar a relação entre a exposição à poluição atmosférica e fenótipos da asma, controle dos sintomas e função pulmonar. Métodos: residentes num raio de dois quilômetros das oito estações fixas de monitoramento do ar, com asma grave ou asma leve a moderada, subdivididos em: atópico e eosinofílico e avaliados com o Questionário de Controle da Asma e espirometria. Resultados: nos indivíduos com asma leve/moderada, o fenótipo não eosinofílico esteve associado a maior exposição ao material particulado e ao dióxido de nitrogênio; a amostra com asma grave não demonstrou associação a qualquer desfecho de controle da asma. Conclusão: A exposição de indivíduos com asma leve a moderada aos poluentes MP10 e NO2 esteve associada ao fenótipo não eosinofílico da asma em Salvador, Brasil.

Objective To evaluate the relationship between asthma control, family income and family costs of asthma in a population of children-adolescents; to detail the family costs of asthma in this age range; and to compare asthma costs for the families of children-adolescents and adults. Methods The authors invited asthmatic subjects who attended a scheduled spirometry test at the Jundiaí School of Medicine (FMJ). The FMJ performs all spirometry tests requested by staff physicians who serve at the public healthcare system in the municipality. Volunteers responded to the ACQ, the Asthma Family Costs Questionnaire and underwent a spirometry test. Results The authors included 342 children-adolescents. Families of children-adolescents taking maintenance therapy and families of those reporting uncontrolled asthma symptoms were more likely to report any expenditure with asthma during the preceding month. In this age range, the smallest expenditures were on diagnostic tests and medical consultations, while home expenditures to avoid asthma triggers were the highest ones. As compared to adults’ families, the children and adolescents families reported a greater proportion of income committed with asthma. Expenditures with transportation to healthcare facilities for asthma care were greater in the families of children-adolescents as compared to the values reported by the adults’ families; in contrast, loss of income due to asthma was smaller in the families of children-adolescents. Conclusions Children-adolescents’ asthma affects the household economy. The authors believe researchers should assess this outcome when designing studies about asthma. Finally, the study's data support the necessity of public policies in low-resource communities to minimize the economic impact of children and adolescents’ asthma.