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Ana Amélia Corrêa de Araújo Veras,1 Suely Arruda Vidal,1 Vilma Costa de Macêdo,2 Marília de Carvalho Lima,3 Pedro Israel Cabral de Lira,3 Eduardo Jorge da Fonseca Lima,1 Malaquias Batista Filho1 1Programa de Pós-graduação em Medicina Integral, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil; 2Departamento de Enfermagem, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; 3Programa de Pós-graduação em Saúde da Criança e Adolescente, Universidade Federal de Pernambuco, Recife, PE, BrazilCorrespondence: Ana Amélia Corrêa de Araújo VerasPrograma de Pós-Graduação em Saúde Materno Infantil, Instituto de Medicina Integral Professor Fernando Figueira, Rua dos Coelhos, 300, Boa Vista, Recife, Pernambuco, CEP: 50.070-550, BrazilEmail anamelia.av@gmail.comBackground: The aim was to verify the prevalence of vaccination coverage, tendency and factors of the third dose of the vaccine against diphtheria, tetanus and pertussis-DTP3 in surveys over the period of 25 years in a state of the Northeast of Brazil.Methods: Cross-sectional and temporal series, utilizing ad hoc database, were extracted from the Health and Nutrition State Research 1991, 1997, 2006 and 2015/2016. Children from 12 to 23 months of age with proof in the vaccination card were included. The vaccination coverage (outcome) of each year was calculated, the tendency throughout the period was analyzed and the associations through Pearson chi-squared were tested. The results of the first and last survey were compared with a significance level of 5%. The reasons of the crude prevalence and confidence intervals of 95% were estimated.Results: The vaccination coverage in 1991, 1997, 2006 and 2015/2016 was 77.6%, 82.7%, 89.7% and 72.9%, respectively, with an increasing tendency from 1991 to 2006 (p< 0.001) and decreasing between 2006 and 2015/2016 (p< 0.001). Factors in 1991: low socioeconomic conditions; lack of access to health service and pre-natal care, nutritional deficit and diarrhea in children (p< 0.005). In 2015/2016, low socioeconomic conditions and diarrhea persisted and a larger family size, black, negative self-perception of happiness, both from the mother (p< 0.05), were identified.Conclusion: The factors of the recent decrease of vaccination coverage are complex, multifactorial, dependent of context and even on subjective aspects of the maternal perception. Its identification contributed to the understanding of inadequate vaccination at the state level.Keywords: vaccination coverage/DTP3, child health, epidemiologic surveys, family characteristics

Astrid Crespo-Lessmann,1 Eder Mateus,1,2 Montserrat Torrejón,1 Alicia Belda,1 Jordi Giner,1 Silvia Vidal,2 Oriol Sibila,1 Vicente Plaza,1 1Service of Pneumology, Hospital de la Santa Ceu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 2Department of Immunology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain Abstract: Asthma with bronchial hypersecretion is a type of asthma that is poorly studied. Its pathogenesis is not well understood, but is probably related to innate impaired immunity, particularly with toll-like receptors (TLRs) and secretory mucins (MUC). Objectives: 1) Define the clinical and inflammatory phenotype of asthma with bronchial hypersecretion of mucus. 2) Compare the type of mucin present in induced sputum (IS) of patients with and without bronchial hypersecretion. 3) Determine the expression of TLRs in IS and blood of asthmatics with and without bronchial hypersecretion. Materials and methods: Cross-sectional study which included 43 non-smoking asthmatic patients without bronchiectasis, 19 with bronchiectasis, and 24 without bronchial hypersecretion. All patients underwent the following: IS, spirometry, fractional exhaled nitric oxide, prick test, total immunoglobulin E (IgE), and blood albumin. Analysis of mucins was determined by ELISA and expression of TLR2 and TLR4 by flow cytometry. The level of asthma control was determined by the Asthma Control Test (ACT) questionnaire and quality of life was assessed by the reduced version of the Asthma Quality of Life Questionnaire (mini-AQLQ). Results: Asthmatics with bronchial hypersecretion were significantly older (62.6 years vs 48.5 years; p=0.02); had greater severity (persistent severe asthma 94.7% vs 29.2%; p=0.000); a higher proportion of nasal polyposis (36.8% vs 8.3%; p=0.022); less control of asthma (73.7% vs 8.3%; p=0,000); a higher proportion of asthma with negative prick test (68.4% vs 16.6%; p=0.001), and lower levels of IgE (113.4 IU/mL vs 448 IU/mL; p=0.007), compared with asthmatics without bronchial hypersecretion. Significant differences were observed neither in the expression of  TLRs 2 and 4 in inflammatory cells of IS or peripheral blood, nor in the expression of mucins between both groups. Conclusion: Asthma patients with bronchial hypersecretion have more severe and uncontrolled disease, with poor quality of life as well as a non-allergic inflammatory phenotype. Within the mechanisms involving these differences, it does not appear that mucins and TLRs play an important role. Keywords: asthma, mucins, inflammation, induced sputum, toll-like receptor