Raissa Martins Guinossi’s research while affiliated with Faculdade de Medicina de Jundiaí and other places

We hypothesize that green areas within cities affect the respiratory symptoms of individuals with asthma, but this effect may not be the same for all age groups, because the immunopathology of asthma in children-adolescents is different from the immunopathology of asthma in adults. The objective of this study is to evaluate whether there is an association between the percentage of green area close to the residence and asthma outcomes, stratified by age group. We included individuals with asthma over the age of ten years. Two independent trained researchers measured, in satellite images, the extent of green area around the residence. The primary outcome of the study was the severity of respiratory symptoms measured by the Asthma Control Test. The secondary outcome was the presence of airway obstruction in the spirometry test carried out on the day of the study visit. Binary logistic regression analyzes evaluated whether the percentage of green area close to the residence was associated with asthma outcomes. In children-adolescents, greater density of green area was associated with a greater frequency of uncontrolled asthma symptoms. In adults, greater density of green area was associated with a lower frequency of uncontrolled asthma symptoms and a lower frequency of airway obstruction. We conclude that the extent of green areas close to the residence is associated with asthma morbidity. The expansion of green areas within cities should favor species that do not disseminate pollen with allergenic potential, especially in regions close to schools and daycare centers.

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.