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El cambio climático es uno de los principales fenómenos que están ocurriendo y son responsables por emergencias sanitarias en todo el mundo. El cambio climático ha determinado un aumento en el número de incendios forestales, debido a la combinación de condiciones cálidas y secas, con vientos, deforestación e intervención humana. Los incendios forestales, provocados por causas naturales o antropogénicas, son considerados una de las perturbaciones naturales más extendidas en los ecosistemas forestales del mundo. Se estima que la exposición al material particulado PM2,5 liberadas durante los incendios forestales se encuentran asociado a 0,68 millones de muertes/año, la mayoría de ellas en niños menores de cinco años. El transporte de PM2.5 relacionado con los incendios forestales es de gran alcance y contribuye a la mala calidad del aire incluso después de las temporadas de incendios. La actividad de incendios forestales en 2021-2022 en algunas regiones del mundo fue en una escala mucho mayor que la vista anteriormente en el conjunto de datos del Servicio de Monitoreo de la Atmósfera de Copernicus (CAMS). Así, este documento presenta diferentes informes sobre incendios forestales ocurridos en diversas partes del mundo, especialmente en América Latina, durante los años 2019-2022.

Background: Contrary to what happens in children and adults, the prevalence and the factors related to hospitalisation for asthma/wheezing in infants with recurrent asthma-like symptoms are poorly known.Methods: This study is part of the International Study of Wheezing in infants Phase 3; 2,079 infants (aged 12–18 months) with recurrent asthma-like symptoms, from 11 South American centres, were studied to determine the prevalence and the associated factors for wheezing exacerbation admission. Descriptive statistics and multivariate logistic regression were employed for analysis.Results: The prevalence of admission for wheezing was 29.7% (95% CI 27.7–31.6) and was significantly associated to severe wheezing episodes (OR: 3.89; 95% CI: 2.93–5.18, p < 0.001), physician-diagnosed asthma (OR: 1.79; 95% CI: 1.33–2.41, p < 0.0001), use of inhaled corticosteroids (OR: 1.78; 95%CI: 1.38–2.29, p < 0.0001), maternal tobacco smoking during pregnancy (OR:1.69; 95% CI: 1.19–2.39, p = 0.003) and onset of wheezing in the first trimester of life (OR: 1.30; 95% CI: 1.02–1.66, p = 0.038). Breast feeding ≥4 months (OR: 0.72; 95% CI: 0.54–0.96, p = 0.004), maternal high educational level (>12 years) (OR: 0.66; 95% CI: 0.51–0.85, p = 0.001) and total monthly household income ≥US$ 3,000 (OR: 0.34; 95% CI: 0.18–0.67, p = 0.002), were protective factors.Conclusions: Infants with recurrent asthma-like symptoms have a high rate of admissions. Tobacco smoking in pregnancy, viral respiratory illness in the first trimester of life and severe progression were risks for admissions. Improving medical management to prevent severe exacerbations, prolonging the postnatal period at home longer than 3 months, favouring breastfeeding and avoiding smoking during pregnancy may have a preventive role for admissions in infants with recurrent asthma-like symptoms.

Background: Tobacco-smoking in children is one of the most crucial public health concerns, which could be highly prevalent in underprivileged populations. Methods: A cross sectional, random sampling survey was conducted to determine the prevalence of current tobacco-smoking and related risk factors among adolescents living in a low-income area of Santiago de Chile. Results: Of the 2,747 adolescents participating in the study, 24.0% [95% confidence interval (CI) 22.3–25.5] were current smokers, with no significant difference between girls and boys. Factors associated with current smoking were as follows: positive attitude to smoking cigarettes offered by peers [odds ratio (OR) 8.0; 95% CI 5.7–11.3, P

Aunque los estudios globales han proporcionado información valiosa sobre la prevalencia del asma en niños de América Latina, hay muy poca información en la región acerca de si el asma actual reportada por los niños se asocia con características funcionales de esta como disminución de la función pulmonar e hiperreactividad bronquial (BHR). Este estudio examinó la relación entre las sibilancias auto informadas en los últimos 12 meses, la espirometría, la pletismografía, la capacidad de respuesta de las vías respiratorias y la atopia en dos muestras aleatorias (60 cada una) de niños de 13 a 14 años que habían tenido o no sibilancias en los últimos 12 meses. En comparación con los niños sin sibilancias, aquellos que informaron sibilancias actuales tuvieron una hiperreactividad bronquial (HRB) significativamente mayor a la metacolina (55% frente a 18,2%, p=0.007), función pulmonar significativamente más baja en la espirometría (p=0.001) y una resistencia significativamente mayor en pletismografía (p=0.001). La atopia fue significativamente mayor en los que informaron síntomas de asma actuales (p=0.007). Nuestros resultados muestran que los adolescentes que reportan síntomas actuales del asma mediante un cuestionario tienen una HRB significativamente más alta y una función pulmonar más baja que los niños sin antecedentes de asma.

Functional and inflammatory measures have been recommended to corroborate asthma diagnosis in schoolchildren, but the evidence in this regard is conflicting. We aimed to determine, in real-life clinical situation, the value of spirometry, spirometric bronchial reversibility to salbutamol (BDR), bronchial responsiveness to methacholine (MCT) and fractional exhaled nitric oxide (FENO), to corroborate the diagnosis of asthma in children on regular inhaled corticosteroids (ICS) referred from primary care.One hundred and seventy-seven schoolchildren with mild-moderate persistent asthma, on treatment with regular ICS, participated in the study. Abnormal tests were defined as FENO ≥ 27 ppb, BDR (FEV1 ≥ 12%) and methacholine PC20 ≤ 4 mg/mL.The proportions of positive BDR, FENO and MCT, were 16.4%, 33.3%, and 87.0%, respectively. MCT was associated with FENO (p 0.03) and BDR (p = 0.001); FENO was associated with BDR (p = 0.045), family history of asthma (p = 0.003) and use of asthma medication in the first two years of life (p = 0.004). BDR was significantly related with passive tobacco exposure (p = 0.003).Spirometry, BDR and BDR had a poor performance for corroborating diagnosis in our asthmatic children on ICS treatment; on the contrary, MCT was positive in most of them, which agrees with previous reports. Although asthma tests are useful to corroborate asthma when positive, clinical diagnosis remains the best current approach for asthma diagnosis, at least while better objective and feasible measurements at the daily practice are available. At present, these tests may have a better role for assessing the management and progression of the condition.

This study assesses the temporal trend of current asthma symptoms prevalence and associated factors in Chilean adolescents from South-Santiago, considering surveys performed in 1994, 2002 and 2015.The prevalence of current asthma symptoms showed a trend to increase from 11.1% in 1994 to 13.4% in 2015 (p0.001); physician-diagnosed asthma increased from 11.5% to 13.8%, (p0.001) whereas severe asthma and asthma with exercise decreased (p0.001). Female adolescents had a higher prevalence of current asthma in the three surveys (p0.001), and was a risk factor for asthma in the three surveys. In 2002, frequent consumption of meat and potatoes were associated with current asthma while frequent vigorous exercise was protective. Frequent exercise and parental tobacco smoking were risk for asthma in 2015 (p0.001). Current active tobacco smoking showed a trend to increase reaching a prevalence of 28.9% in 2015 (p0.001). There was a consistently low proportion of adolescents with current wheezing and asthma diagnosis (32.1% in 2015) and 37.6% of them had no asthma treatment.The prevalence of current asthma in adolescents from the studied area would be still increasing. As in other studies, female adolescents had a higher prevalence of current asthma. Current active tobacco smoking has strikingly increased in the studied children while indoor passive tobacco exposure remains inadmissibly high. Our findings suggest that asthma in children is underdiagnosed and undertreated. More attention should be given to female gender, tobacco exposure, air pollution and local diagnostic preferences when studying and interpreting trends of asthma prevalence in adolescents from developing localities.

Background Recurrent wheezing during the first year of life is a major cause of respiratory morbidity worldwide, yet there are no studies on its prevalence in Portugal. Objective Determine the prevalence and severity of recurrent wheezing, treatments employed and other related aspects, in infants during their first year of life in Setubal, Portugal. Methods This is a cross-sectional study of a random sample of infants aged 12–15 months living in Setubal district. It uses a validated questionnaire answered by parents/caregivers at local healthcare facilities where infants attend for growth/development monitoring and/or vaccine administration. Results Among the 202 infants surveyed, 44.6% (95% CI 37.7–51.4) had at least one episode of wheezing; and 18.3% (95% CI 12.9–23.6) had recurrent wheezing. There was significant morbidity associated to recurrent wheezing in terms of severe episodes (17.3%–95% CI 12–22.5), visits to the emergency department (26.2%–95% CI 20.1–32.2) and hospital admissions (5.4%–95% CI 2.2–8.5); 10.4% (95% CI 6.1–14.6) used inhaled corticosteroids and 7.9% (95% CI 4.1–11.6) used a leukotriene receptor antagonist. Conclusions The prevalence of recurrent wheezing in infants during the first year of life is high and is associated with significant morbidity, presenting as a relevant public health problem. An important proportion of infants’ progress with a more severe condition, resulting in high use of health resources (visits to emergency department and hospitalisations). The prevalence of recurrent wheezing in this district of Portugal stays between those related in other European and Latin American Centres, suggesting that maybe some of the well-known risk factors are shared with affluent countries.

Background\ud Asthma is the most common chronic disease in children globally. The Global Asthma Network (GAN) Phase I study aimed to determine if the worldwide burden of asthma symptoms is changing.\ud Methods\ud This updated cross-sectional study used the same methods as the International study of Asthma and Allergies in Childhood (ISAAC) Phase III. Asthma symptoms were assessed from centres that completed GAN Phase I and ISAAC Phase I (1993–95), ISAAC Phase III (2001–03), or both. We included individuals from two age groups (children aged 6–7 years and adolescents aged 13–14 years) who self-completed written questionnaires at school. We estimated the 10-year rate of change in prevalence of current wheeze, severe asthma symptoms, ever having asthma, exercise wheeze, and night cough (defined by core questions in the questionnaire) for each centre, and we estimated trends across world regions and income levels using mixed-effects linear regression models with region and country income level as confounders.\ud Findings\ud Overall, 119 795 participants from 27 centres in 14 countries were included: 74 361 adolescents (response rate 90%) and 45 434 children (response rate 79%). About one in ten individuals of both age groups had wheeze in the preceding year, of whom almost half had severe symptoms. Most centres showed a change in prevalence of 2 SE or more between ISAAC Phase III to GAN Phase I. Over the 27-year period (1993–2020), adolescents showed a significant decrease in percentage point prevalence per decade in severe asthma symptoms (–0·37, 95% CI –0·69 to –0·04) and an increase in ever having asthma (1·25, 0·67 to 1·83) and night cough (4·25, 3·06 to 5·44), which was also found in children (3·21, 1·80 to 4·62). The prevalence of current wheeze decreased in low-income countries (–1·37, –2·47 to –0·27], in children and –1·67, –2·70 to –0·64, in adolescents) and increased in lower-middle-income countries (1·99, 0·33 to 3·66, in children and 1·69, 0·13 to 3·25, in adolescents), but it was stable in upper-middle-income and high-income countries.\ud Interpretation\ud Trends in prevalence and severity of asthma symptoms over the past three decades varied by age group, country income, region, and centre. The high worldwide burden of severe asthma symptoms would be mitigated by enabling access to effective therapies for asthma.\ud Funding\ud International Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca Educational Grant, National Institute for Health Research, UK Medical Research Council, European Research Council, and Instituto de Salud Carlos III.

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Introducción: Los episodios de obstrucción bronquial a temprana edad constituyen un problema frecuente en pediatría. El objetivo de este estudio, además de conocer la prevalencia de sibilancias recurrentes en lactantes de Buenos Aires, fue identificar los factores asociados. Métodos: Estudio de tipo transversal realizado durante 2011 y 2012, en el Hospital de Niños Ricardo Gutiérrez, Buenos Aires, como parte del Estudio Internacional de Sibilancias en Lactantes, mediante una encuesta validada para padres de lactantes de 12 a 15 meses. Se evaluó la prevalencia de sibilancias, fundamentalmente de tipo recurrentes (tres o más episodios) y los posibles factores asociados. El análisis estadístico se realizó por prueba de χ2, prueba de Fisher y análisis de regresión logística univariada y multivariada. El nivel de significación fue de 0.05. Resultados: De 1063 lactantes, el 58.9% (intervalo de confianza (IC) 95% 55.9-61.9) presentaron al menos un episodio de sibilancia y el 26.3% (IC 95% 23.8-29.9), tres o más episodios (sibilancias recurrentes). Los factores vinculados a padecer al menos un episodio de sibilancia fueron el sexo masculino (p = 0.001), seis o más resfríos en el primer año (p

Aim To examine the relationship between reported vigorous physical activity (VPA) and body mass index (BMI) in children (6-7 years) and adolescents (13-14 years). Methods In the International Study of Asthma and Allergies in Childhood Phase Three, 75,895 children's parents and 199,502 adolescents answered questions relating to VPA, height and weight. The association between VPA and BMI was analysed using general linear models, adjusting for country gross national index. Results Compared to children who undertook no VPA, those in the infrequent group (once or twice per week) and those in the frequent group (three or more times per week) had mean (95%CI) BMI values 0.07 kg/m2 (0.03 to 0.11) and 0.09 kg/m2 (0.03 to 0.15) greater respectively (P=0.001). Compared to adolescents reporting no VPA, those in the infrequent group had a BMI 0.19 kg/m2 (0.15 to 0.23) greater while those in the frequent group had a BMI 0.01 kg/m2 (-0.03 to 0.05) greater (P

RESUMEN El asma del lactante en los dos primeros anos de vida, es la forma de presentacion mas frecuente, ademas de episodios recurrentes de sibilancias y tos, es una condicion de alta prevalencia; sin embargo, es frecuentemente sub-diagnosticada y sub-tratada. Una elevada proporcion de estos lactantes sufren episodios severos, visitas a servicios de urgencia y hospitalizaciones, lo cual altera profundamente su calidad de vida y la de sus padres. El diagnostico de asma en el lactante es clinico y se basa en la presencia de tos y sibilancias recurrentes, presencia de factores de riesgo para asma, y la respuesta al tratamiento. Los corticoides inhalados son el tratamiento de primera linea y tanto su efecto como la adherencia, deben ser monitoreados. Actualmente, no hay razones cientificas ni clinicas para posponer el diagnostico y tratamiento en lactantes con sintomas de asma, especialmente si la frecuencia y severidad de los episodios alteran la calidad de vida del nino y de su familia.

Background The International Study of Wheezing in Infants (EISL) is a cross-sectional, population-based study, based on ISAAC ( http://www.isaac.auckland.ac.nz ). It uses a validated questionnaire on early wheezing and risk/protective factors. Objective To apply the EISL questionnaire regarding wheezing events in 0- to 12-month-old infants with or without atopic background searching for risk factors in the tropics. Methods The population was toddlers coming in for a checkup or 12-months’ vaccination in primary health care clinics of a tropical city. Apart from child factors (eg, daycare attendance), we evaluated home factors (eg, air conditioning, bathroom, carpet, >6 persons, pollution) and mothers' factors (eg, education level, employment, cellphone). Data analysis was descriptive and case-control, with as cases atopic (AW) or non-atopic (NAW) wheezing children vs healthy controls. Wheezing-associated factors were evaluated using multivariate analysis, adjusted for the relation of AW/NAW with factors that were significant in prior univariate analysis. Results The study included 999 toddlers. Any wheeze: 31.3%, recurrent wheeze (≥3 episodes): 12.1%. Major risk factors for AW (OR; 95%CI) included smoking (11.39; 2.36-54.99), common cold before 3 months of life (3.72; 2.59-5.36), mold (3.48; 2.28-5.30), kitchen indoors (2.40; 1.27-4.54), and pets (1.69; 1.09-2.62); breastfeeding was almost protective. For NAW, common cold and pets were risk factors, but cesarean section (0.44; 0.23-0.82), more than 1 sibling (0.33; 0.18-0.61), and breastfeeding for longer than 3 months (0.50; 0.28-0.91) were protective. Conclusion Wheezing is a health care burden. We found potential new risk factors for AW, some possibly unique for tropical climates. We suggest testing several hypotheses: could early AW be reduced in the tropics by attacking mold growth? Enhancing cooking place ventilation? Keeping pets outside? Or by postponing daycare attendance until after 4 months of age and avoiding (passive) smoking during pregnancy?

RESUMO Objetivo: Avaliar a prevalência e a gravidade da sibilância em lactentes no primeiro ano de vida, utilizando o protocolo padronizado do Estudio Internacional de Sibilancias en Lactantes- fase 3, e comparar os valores obtidos com os observados no Estudio Internacional de Sibilancias en Lactantes- fase 1, realizado no mesmo centro. Métodos: Entre 2009 e 2010, pais e responsáveis de lactentes responderam ao questionário escrito do Estudio Internacional de Sibilancias en Lactantes- fase 3, e os resultados obtidos foram comparados aos do Estudio Internacional de Sibilancias en Lactantes- fase 1, realizado entre 2005 e 2006. Oslactentes foram separados em sibilantes e “não sibilantes”. Osprimeiros foram divididos de acordo com a frequência dos episódios: sibilância ocasional, quando apresentaram menos de três, e sibilância recorrente, quando manifestaram três ou mais. Resultados: A prevalência de sibilantes foi similar nas duas fases (44,6 versus46%). Segundo a frequência, houve aumento na prevalência de sibilância ocasional (19,4 versus 23%; p=0,03) e redução na de sibilância recorrente (26,7 versus 21,6%; p=0,005). Observou-se, ainda, aumento expressivo no diagnóstico de asma (7,5 versus 21,8%) e no uso de corticosteroides inalatórios (11,7 versus 35%), como também na hospitalização por sibilância na fase 3 (19,7 versus 32,6%), período da pandemia Influenza A (H1N1), o que pode ter contribuído para este desfecho. Conclusões: A prevalência da sibilância no primeiro ano de vida permanece elevada. Apesar de a avaliação temporal mostrar queda na prevalência da sibilância recorrente, aumento significante de sua morbidade foi identificado pelo maior número de hospitalizações. Além disso, houve indícios de melhora no manejo da sibilância dos lactentes, refletido pelo aumento do diagnóstico de asma e maior indicação de tratamentos preventivos.

Background: The relationship between pneumonia and recurrent wheezing (RW) and the factors associated to pneumonia in wheezing and non-wheezing infants have not been compared between affluent and non-affluent populations. Methods: The International Study of Wheezing in Infants (EISL) is a large population-based cross-sectional study carried out in Latin America (LA) and Europe (EU). We used a validated questionnaire for identifying wheeze in the first year of life. The questionnaire also inquired about pneumonia diagnosis, together with other potentially related factors. Associations between both conditions and between potential risk/protective factors for pneumonia were tested by random-effects logit model and adjusting for all factors found previously associated to RW in this cohort. Results: Pneumonia and RW were strongly associated to each other in LA and EU (aOR 5.42; 95% CI: 4.87-6.04 and aOR 13.99; 95% CI: 9.61-20.36, respectively). Infant eczema was the most consistent risk factor of pneumonia in both continents, in the whole population and also among wheezers and non-wheezers (aOR ranging from 1.30; 95% CI: 1.11-1.52 to 2.65; 95% CI: 1.68-4.18); while breast feeding for at least 3 months was the most consistent protective factor (aOR ranging from 0.60; 95% CI: 0.51-0.71 to 0.76; 95% CI: 0.69-0.84). Factors associated to pneumonia were similar between continents among wheezers, but differed considerably among non-wheezers. Conclusion: Pneumonia and RW are associated conditions sharing many risk/protective factors in EU and LA among wheezing infants, but not among non-wheezing infants. The association between pneumonia and RW could be due to shared pathophysiology or by diagnostic confusion between the two conditions. (C) 2015 Wiley Periodicals, Inc.

To identify changes in the prevalence and severity of recurrent wheezing (RW) in infants using data obtained from two surveys administered seven years apart.A cross-sectional, international, population-based study in infants aged 12-15 months was conducted. Data were obtained from two surveys (S1 and S2, in 2005 and 2012, respectively) using the same methodology in three large Latin American cities: Curitiba (Brazil), São Paulo (Brazil), and Santiago (Chile).A decrease in the overall prevalence of RW was identified between S1 (23.3%) and S2 (20.4%), p = 0.004, but it was mainly driven by the reduction observed in São Paulo; in Curitiba and Santiago, this change was not significant. The mean prevalence of the following RW severity indicators remained high and stable: severe wheezing episodes (56.9% in S1 and 54.2% in S2, p = 0.32) and emergency department (ED) visits for wheezing (S1 = 68.1%, S2 70.9%, p = 0.21). A significant increase in admissions for wheezing (21.1% to 26.7%, p = 0.004) was observed. In Curitiba and São Paulo, there were significant increases in the prevalence of physician-diagnosed asthma and in the use of inhaled corticosteroids and oral antileukotrienes.The prevalence and severity of RW during the first year of life remained high over time, with remarkably high rates of ED visits, admissions for wheezing and use of asthma medications. This study suggests the need for considering early asthma diagnosis and to establish an appropriate treatment in infants with recurrent and severe asthma-like symptoms.

The episodes of bronchial obstruction at early age constitute a frequent problem in Pediatrics. The aim of this study was to evaluate the prevalence of recurrent wheezing in infants in Buenos Aires City, as well as to identify any associated factors.Cross-sectional study performed from 2011 to 2012 in the Children Hospital Ricardo Gutiérrez, Buenos Aires City, as part of the International Study of Wheezing in Infants. A validated questionnaire was applied to parents of infants aged between 12 and 15 months. The prevalence of wheezing, mostly the recurrent episodes (three or more), and their probable associated factors were evaluated. Data were statistically analyzed with χOver 1063 infants, 58.9% (confidence interval (CI) 95% 55.9-61.9) presented at least one episode of wheezing and 26.3% (CI95% 23.8-29.9) three or more episodes (recurrent wheezing). Risk factors associated to wheezing were male gender (p=0.001), six or more episodes of cold during the first year of life (p0.0001), age at first cold4 months (p0.0001); pneumonia (p0.0001) and smoking during pregnancy (tobacco) (p=0.01). For recurrent wheezing, risk factors we considered as six or more episodes of cold during the first year of life (p0.0001), early (4 month of age) onset wheezing (p0.0001) and nocturnal wheezing (p0.0001).The prevalence of recurrent wheezing among infants in Buenos Aires Ciy was high (26.3%). Some identified associated factors can be preventable.

BACKGROUND: Associations of larger families with lower prevalences of hay fever, eczema and objective markers of allergic sensitization have been found fairly consistently in affluent countries, but little is known about these relationships in less affluent countries. METHODS: Questionnaire data for 210,200 children aged 6-7 years from 31 countries, and 337,226 children aged 13-14 years from 52 countries, were collected by Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC). Associations of disease symptoms and labels of asthma, rhinoconjunctivitis and eczema were analysed by numbers of total, older and younger siblings, using mixed (multi-level) logistic regression models to adjust for individual covariates and at the centre level for region, language and national affluence. RESULTS: In both age groups, inverse trends (P < 0.0001) were observed for reported 'hay fever ever' and 'eczema ever' with increasing numbers of total siblings, and more specifically older siblings. These inverse associations were significantly (P < 0.005) stronger in more affluent countries. In contrast, symptoms of severe asthma and severe eczema were positively associated (P < 0.0001) with total sibship size in both age groups. These associations with disease severity were largely independent of position within the sibship and national GNI per capita. CONCLUSIONS: These global findings on sibship size and childhood asthma, rhinoconjunctivitis and eczema suggest at least two distinct trends. Inverse associations with older siblings (observations which prompted the 'hygiene hypothesis' for allergic disease) are mainly a phenomenon of more affluent countries, whereas greater severity of symptoms in larger families is globally more widespread.

ObjectiveTo evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil.MethodsParents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactantes (EISL) – phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010.Results1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (

Background: The prevalence of atopy in asthmatic children is widely variable around the world as demonstrated by large multicentric international studies. Aim: To determine the prevalence of atopy, defined as a positive reaction to one or more allergens in the skin prick test (SPT), in children with persistent asthma. Material and methods: We studied 1,199 children (54% male), aged between 4 and 16 years of age with confirmed diagnosis of asthma and followed at a Department of Pediatric Respiratory Medicine, between 2006 and 2011. SPT was performed according to international recommendations using standardized aeroallergens, in the forearm. A positive reaction was defined as a wheal ?3 mm to one or more allergens. Results: The overall prevalence of atopy (positive SPT) was 49.4% (95% confidence interval (CI) 46.5-52.2) and there was a significant trend towards a higher prevalence with increasing age (p

Background The association between birthweight and asthma, eczema and rhinoconjunctivitis is conflicting. Aims To examine the association between birthweight and symptoms of asthma, eczema and rhinoconjunctivitis. Methods Parents or guardians of children aged 6–7 yr completed written questionnaires about symptoms of asthma, rhinoconjunctivitis and eczema, and several risk factors, including birthweight. Results There were 162,324 children from 60 centres in 26 countries. Low birthweight (

Objective: to identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil. Methods: this was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI). Results: the written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46). Conclusions: the study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood. Resumo: Objetivo: identificar possíveis fatores de risco associados à sibilância em lactentes (12 a 15 meses) no estado de Mato Grosso, Brasil. Métodos: estudo transversal, utilizando o questionário escrito padronizado do Estudio Internacional de Sibilancia en Lactantes (EISL) – fase 3. Pais e/ou responsáveis pela criança foram entrevistados em Unidades Básicas de Saúde quando as procuravam para imunização de rotina ou durante visitas nos domicílios de crianças matriculadas nos programas de saúde da família, no período de agosto de 2009 a novembro de 2010. Fatores associados à sibilância foram avaliados utilizando análise bivariada e multivariada e expressos como odds ratio (OR) e intervalo de confiança 95% (IC95%). Resultados: ao todo, um mil e sessenta (n = 1.060) pais e/ou responsáveis responderam o questionário escrito. Os fatores de risco para sibilância foram: história familiar de asma [mãe (OR = 1,62; IC95%= 1,07-2,43); pai (OR = 1,98; IC95% = 1,22-3,23); irmãos (OR = 2,13; IC95% = 1,18-3,87)]; história prévia de pneumonia (OR = 10,8; IC 95% = 4,52-25,77); ter mais de seis infecções de vias aéreas superiores (IVAS) (OR = 2,95; IC95% = 2,11-4,14) e a primeira IVAS antes dos três meses de idade (OR = 1,50; IC95% = 1,04-2,17); residir em local com moderada poluição (OR = 1,59; IC95% = 1,08-2,33); uso de paracetamol por IVAS (OR = 2,13; IC95% = 1,54-2,95); e uso de antibiótico por infecção na pele (OR = 2,29; IC 95% = 1,18-4,46). Conclusões: O estudo dos fatores de risco para sibilância no primeiro ano de vida é importante para auxiliar na identificação, entre os lactentes sibilantes, aqueles de alto risco para desenvolver asma, e para o desenvolvimento de estratégias de prevenção por políticas pública de saúde visando minimizar a morbidade da sibilância na infância. Keywords: Infant, Wheezing, Asthma, Risk factors, Palavras-chave: Lactente, Sibilos, Asma, Fatores de risco

Background: Although the association between latitude and asthma prevalence has been studied to a certain extent, its influence on the magnitude of the association of risk/protective factors with recurrent wheeze in infants has never been reported.Methods: The adjusted odd ratios (aOR) of various risk/protective factors for recurrent wheeze from 31 920 infants from 19 centres of the "Estudio Internacional de Sibilacias en Lactantes" (EISL) in very different parts of the world were used to build a meta-regression using the strength of the aOR of each factor as dependent variable and centre latitude as explanatory variable. The meta-regression was further adjusted for continent.Results: There was a positive significant correlation between latitude and the magnitude of the aOR between recurrent wheeze and having cold(s) during the first three months of life (p = 0.004); attending a nursery school (p = 0.011); and having additional siblings (p = 0.003). Furthermore, there was a negative correlation for having been breastfed for at Least three months (p = 0.044). Heterogeneity (as measured by I-2) of the magnitude of aORs between centres was quite high except for breast feeding: 73.1% for colds; 66.9% for nursery school; 52.6% for additional siblings; and 18.1% for breast feeding. Latitude explained a considerable amount of that heterogeneity: 63.8% for colds; 52.8% for nursery school; 86.6% for additional siblings; and 100% for breast feeding, probably as a consequence of its low heterogeneity.Conclusion: The magnitude in which some risk/protective factors are associated to recurrent wheeze during the first year of life varies significantly with latitude. (C) 2013 Elsevier Ltd. All rights reserved.

The objective of this study was to identify risk factors for wheezing disorders in the first year of life in infants living in São Paulo (SP), Brazil, applying the standardized protocol of the Estudio Internacional de sibilancia en lactentes-Phase 1. A total of 1014 parents or caregivers of infants, who attended for routine evaluation and immunization in public health centers were interviewed in Southern SP city. Risk factors significantly associated with recurrent wheezing were: history of previous pneumonia, daycare attendance, consumption of processed food, presence of a cat at home, more than five upper respiratory infection (URI) episodes and the first URI before the age of sixth month. Most of these risk factors for wheezing can be avoided or controlled. Prospective studies on wheezing, especially in children with a severe presentation, are needed to analyze the impact of these risk factors and the effect of preventive actions.

Some have suggested a protective effect of tuberculosis (TB) infection on allergic disease risk, but few studies have examined the association between the two. We therefore investigated whether TB disease and bacillus Calmette-Guerin (BCG) vaccination in early life protect against allergic disease. Information on allergic disease symptoms, past TB disease, and BCG vaccination as well as potential confounding factors was gathered by parental questionnaire from a randomly selected subset of 23,901 8- to 12-yr-old schoolchildren in 20 centers in both developed and developing countries. Children were also physically examined for flexural eczema and underwent skin prick testing. Pooled odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) across study centers were calculated, using random effects meta-analysis models. There were 245 (1.0%) reported cases of TB disease, and 66.3% (15,857) of all children received the BCG vaccine. Asthma, hay fever, and flexural eczema symptoms in the past year as well as flexural eczema on skin examination were all positively linked to a history of TB (adjusted pooled OR 'wheeze in the past year' = 2.27, 95% CI 1.52-3.41; adjusted pooled OR 'hay fever symptoms in the past year' = 2.23, 1.22-4.09; adjusted pooled OR 'flexural eczema symptoms in the past year' = 3.21, 2.01-5.12; adjusted pooled OR 'flexural eczema on skin examination' = 4.04, 1.71-9.56). Even higher risk estimates were seen for severe asthma and eczema symptoms [adjusted OR = 4.02 (2.17-7.47) and adjusted OR = 6.31 (2.19-18.17), respectively]. There was no significant association between past TB and skin prick test positivity (adjusted pooled OR = 1.32, 0.87-2.02). BCG vaccination during the first year of life was also not associated with any of the allergy outcomes. We found a uniform positive association between TB and all allergic disease outcomes, including eczema on skin examination. As this was a cross-sectional study, it is unclear whether this positive association is attributable to a causal relationship, and further longitudinal studies are required.

Summary Background In Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC), we investigated the relationship between breast feeding in infancy and symptoms of asthma, rhinoconjunctivitis and eczema in 6–7 year old children. Methods Parents or guardians of 6–7 year old children completed written questionnaires on current symptoms of asthma, rhinoconjunctivitis and eczema, and on a range of possible asthma risk factors including a history of breast feeding ever. Prevalence odds ratios were estimated using logistic regression, adjusted for gender, region of the world, language, per capita gross national income, and other risk factors. Results In all 206,453 children from 72 centres in 31 countries participated in the study. Reported breast feeding ever was not associated with current wheeze, with an odds ratio (adjusted for gender, region of the world, language, per capita gross national income, and factors encountered in infancy) of 0.99 (95% CI 0.92–1.05), current rhinoconjunctivitis (OR 1.00, 95% CI 0.93–1.08), current eczema (OR 1.05, 95% CI 0.97–1.12), or symptoms of severe asthma (OR 0.95, 95% CI 0.87–1.05). Breast feeding was however associated with a reduced risk of severe rhinoconjunctivitis (OR 0.74, 95% CI 0.59–0.94) and severe eczema (OR 0.79, 95% CI 0.66–0.95). Conclusions There was no consistent association between breast feeding use in the first year of life and either a history or current symptoms of wheezing, rhinoconjunctivitis or eczema in 6–7 year old children, but possibly an effect on severe symptoms of the latter two conditions.

Background Recurrent wheezing (RW) during the first year of life is a major cause of respiratory morbidity worldwide, yet there are no studies on its prevalence at an international level. A study was undertaken to determine the prevalence of RW in infants during their first year of life in affluent and non-affluent localities. Methods This international population-based study was performed in random samples of infants aged 12–15 months from 17 centres in Latin America and Europe. It uses a validated questionnaire answered by parents at the primary care health clinics where infants attend for growth/development monitoring and/or vaccine administration. Results Among the 30 093 infants surveyed, 45.2% (95% CI 44.7% to 45.8%) had at least one episode of wheezing and 20.3% (95% CI 19.8% to 20.7%) had RW. The mean prevalence of RW in Latin American and European centres was 21.4% (95% CI 20.9% to 21.9%) and 15.0% (95% CI 14.0% to 15.9%), respectively (p

Objetivo: Avaliar a prevalencia e a gravidade da sibilância, bem como sua relacao com o diagnostico medico de asma, em lactentes no primeiro ano de vida, utilizando o protocolo padronizado do “Estudio Internacional de Sibilancias en Lactantes” (EISL, Estudo Internacional de Sibilâncias em Lactentes). Metodos: Entre marco de 2005 e agosto de 2006, os pais ou responsaveis de lactentes que procuraram unidades basicas de saude na regiao centro-sul de Sao Paulo (SP) para procedimentos de rotina e imunizacao responderam ao questionario escrito do EISL. Resultados: A amostra foi constituida por 1.014 lactentes (media de idade = 5,0 ± 3,0 meses), 467 (46,0%) dos quais apresentaram sibilância no primeiro ano de vida, sendo que 270 (26,6%) tiveram tres ou mais episodios. Entre esses ultimos, o uso de β 2 -agonista inalatorio, corticosteroide inalatorio e antileucotrieno, assim como a presenca de sintomas noturnos, dificuldade para respirar, pneumonia, idas ao pronto socorro e internacao por sibilância grave, foram significantemente mais frequentes (p < 0,05). Os pais de 35 (7,5%) dos 467 lactentes relataram o diagnostico medico de asma, o qual foi associado ao uso de corticosteroide inalatorio, percepcao de falta de ar durante as crises e seis ou mais episodios de sibilância no primeiro ano de vida. Entretanto, menos de 40% desses lactentes recebiam corticosteroide inalatorio ou antileucotrieno como tratamento. Conclusoes: A prevalencia da sibilância no primeiro ano de vida de lactentes no estudo foi alta e teve inicio precoce. A proporcao de lactentes diagnosticados e tratados como asmaticos foi baixa. Descritores: Asma/diagnostico; Asma/epidemiologia; Sons respiratorios.