Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da PUC_RS |
Texto Completo: | http://tede2.pucrs.br/tede2/handle/tede/8774 |
Resumo: | INTRODUCTION: Exercise-induced asthma (EIA) is defined as transient airway obstruction during and after exercise and may be evidenced by a decrease in forced expiratory volume in the first second (FEV1). Although several instruments have been designed and tested to detect EIA, most have low diagnostic power. Thus, considering the wide use of the Global Initiative for Asthma (GINA) in clinical practice and that it has a specific question for physical activity, it is relevant to evaluate its performance in the detection of EIA. OBJECTIVES: To evaluate the diagnostic performance of the physical activity related question of GINA in the detection of EIA in children and adolescents with asthma. METHODS: This is a cross-sectional, observational, study performed in the Laboratory of Pediatric Physical Activity. Children and adolescents (6 to 18 years old) with clinical diagnosis of asthma were included. Patients with signs of pulmonary exacerbation and those with motor limitations were excluded. Patients were divided into 2 groups according to severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). Both the assessment of severity and disease control followed GINA criteria. Anthropometric and clinical data were collected. In addition, pulmonary function was evaluated and the exercise-induced bronchoprovocation test (EIB) was performed. The EIB test was performed on a treadmill, with increases in speed and inclination, in accordance with international recommendations. We have used the fourth question of GINA (Any activity limitation due to asthma?) to evaluate the diagnostic power of the instrument. For statistical purposes, the comparisons were performed using the Student t test and the Pearson's chi-square test. The analysis of the diagnostic performance of the GINA questionnaire specific question for the detection of EIB was evaluated using the ROC curve. The study was approved by the Research Ethics Committee and all parents and/or guardians signed a free and informed consent form and the participants the study assent term. RESULTS: We have evaluated 40 patients, 17 of the MMA group and 23 of the STRA group. The mean age was 11.25 years, with a FEV1 (z-score) of 0.33 and 32.5% classified as uncontrolled disease. Of these, 19 (47.5%) presented a decrease in FEV1 in the EIB test, 13 (56.5%) in the STRA group and 6 (35.2%) in the MMA group. There was a significantly higher EIA frequency (p=0.05) in subjects with lower FEV1 (z-score <-1.0) compared to those with z-score >-1.0. However, there were no significant differences in the frequency of EIB when evaluating the influence of disease severity and control. Likewise, no association of question 4 of GINA was found with the EIA results (p>0.05). The sensitivity found was 57.9% and the specificity was 57.1% (n=40). The area under the ROC curve did not demonstrate a discriminative power of the fourth GINA question for the detection of EIA in children and adolescents with asthma (p=0.35). CONCLUSION: The results of the present study demonstrated that the fourth question of the GINA questionnaire (physical activity) has a clinically insufficient diagnostic power for the detection of EIA in children and adolescents with asthma (MMA and STRA). Thus, it is recommended that the evaluation of EIA to be performed by the EIB test, avoiding underestimation and/or overestimation resulting from this evaluation. |
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Donadio, Márcio Vinícius Fagundeshttp://lattes.cnpq.br/8321335627100144http://lattes.cnpq.br/4011402003830297Wehrmann, Daniele Schiwe2019-06-28T17:09:24Z2019-03-01http://tede2.pucrs.br/tede2/handle/tede/8774INTRODUCTION: Exercise-induced asthma (EIA) is defined as transient airway obstruction during and after exercise and may be evidenced by a decrease in forced expiratory volume in the first second (FEV1). Although several instruments have been designed and tested to detect EIA, most have low diagnostic power. Thus, considering the wide use of the Global Initiative for Asthma (GINA) in clinical practice and that it has a specific question for physical activity, it is relevant to evaluate its performance in the detection of EIA. OBJECTIVES: To evaluate the diagnostic performance of the physical activity related question of GINA in the detection of EIA in children and adolescents with asthma. METHODS: This is a cross-sectional, observational, study performed in the Laboratory of Pediatric Physical Activity. Children and adolescents (6 to 18 years old) with clinical diagnosis of asthma were included. Patients with signs of pulmonary exacerbation and those with motor limitations were excluded. Patients were divided into 2 groups according to severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). Both the assessment of severity and disease control followed GINA criteria. Anthropometric and clinical data were collected. In addition, pulmonary function was evaluated and the exercise-induced bronchoprovocation test (EIB) was performed. The EIB test was performed on a treadmill, with increases in speed and inclination, in accordance with international recommendations. We have used the fourth question of GINA (Any activity limitation due to asthma?) to evaluate the diagnostic power of the instrument. For statistical purposes, the comparisons were performed using the Student t test and the Pearson's chi-square test. The analysis of the diagnostic performance of the GINA questionnaire specific question for the detection of EIB was evaluated using the ROC curve. The study was approved by the Research Ethics Committee and all parents and/or guardians signed a free and informed consent form and the participants the study assent term. RESULTS: We have evaluated 40 patients, 17 of the MMA group and 23 of the STRA group. The mean age was 11.25 years, with a FEV1 (z-score) of 0.33 and 32.5% classified as uncontrolled disease. Of these, 19 (47.5%) presented a decrease in FEV1 in the EIB test, 13 (56.5%) in the STRA group and 6 (35.2%) in the MMA group. There was a significantly higher EIA frequency (p=0.05) in subjects with lower FEV1 (z-score <-1.0) compared to those with z-score >-1.0. However, there were no significant differences in the frequency of EIB when evaluating the influence of disease severity and control. Likewise, no association of question 4 of GINA was found with the EIA results (p>0.05). The sensitivity found was 57.9% and the specificity was 57.1% (n=40). The area under the ROC curve did not demonstrate a discriminative power of the fourth GINA question for the detection of EIA in children and adolescents with asthma (p=0.35). CONCLUSION: The results of the present study demonstrated that the fourth question of the GINA questionnaire (physical activity) has a clinically insufficient diagnostic power for the detection of EIA in children and adolescents with asthma (MMA and STRA). Thus, it is recommended that the evaluation of EIA to be performed by the EIB test, avoiding underestimation and/or overestimation resulting from this evaluation.INTRODUÇÃO: A asma induzida pelo exercício (AIE) é definida como uma obstrução transitória das vias aéreas durante e após o exercício, podendo ser evidenciada pela queda no volume expiratório forçado no primeiro segundo (VEF1). Embora vários instrumentos tenham sido criados e testados para detectar a AIE, a maioria possui baixo poder diagnóstico. Nesse sentido, considerando a ampla utilização da Global Initiative for Asthma (GINA) na prática clínica e que o mesmo possui uma questão específica de atividade física, torna-se relevante a avaliação do seu desempenho na detecção de AIE. OBJETIVO: Avaliar o desempenho diagnóstico da questão relacionada à atividade física do GINA na detecção de AIE em crianças e adolescentes com asma. MÉTODOS: Trata-se de um estudo observacional, do tipo transversal, realizado no Laboratório de Atividade Física em Pediatria. Foram incluídas crianças e adolescentes (6 e 18 anos) com diagnóstico clínico de asma. Excluiu-se pacientes com sinais de exacerbação pulmonar e aqueles que apresentassem limitações motoras. Os pacientes foram divididos em 2 grupos de acordo com a classificação da gravidade: asma leve/moderada (ALM) e asma grave resistente à terapia (AGRT). Tanto a avaliação da gravidade como do controle da doença seguiram os critérios da GINA. Dados antropométricos e clínicos foram coletados. Além disso, foi avaliada a função pulmonar e realizado o teste de broncoprovocação induzida por exercício (BIE). O teste de BIE foi realizado em uma esteira, com aumentos de velocidade e inclinação, de acordo com recomendações internacionais. Utilizou-se a quarta questão do GINA (Alguma limitação de atividade física por asma?) para avaliar o poder diagnóstico do instrumento. Para fins estatísticos, as comparações foram realizadas pelo teste t de Student e pelo teste de qui-quadrado de Pearson. A análise do desempenho diagnóstico da questão específica do questionário da GINA para a detecção da BIE foi avaliada pela curva ROC. O estudo foi aprovado pelo Comitê de Ética em Pesquisa e todos os pais e/ou responsáveis assinaram um termo de consentimento livre e esclarecido e os participantes o termo de assentimento do estudo. RESULTADOS: Foram avaliados 40 pacientes, sendo 17 do grupo ALM e 23 do grupo AGRT. A média de idade foi de 11,25 anos, com o VEF1 (escore-z) de 0,33 e 32,5% classificados como doença não controlada. Destes, 19 (47,5%) apresentaram queda do VEF1 no teste de BIE, sendo 13 (56,5%) do grupo AGRT e 6 (35,2%) no grupo ALM. Houve uma frequência de AIE significativamente maior (p=0,05) nos sujeitos com VEF1 mais baixo (escore-z <-1,0) em comparação aos que apresentaram escore-z >-1,0. No entanto, não houve diferenças significativas na frequência de BIE quando avaliada a influência da gravidade e do controle da doença. Da mesma forma, não foi encontrada associação da questão 4 da GINA com os resultados da AIE (p>0,05). A sensibilidade encontrada foi de 57,9% e a especificidade de 57,1% (n=40). A área sob a curva ROC não demonstrou um poder discriminativo da quarta questão do GINA para a detecção de AIE em crianças e adolescentes com asma (p=0,35). CONCLUSÃO: Os resultados do presente estudo demonstraram que a quarta questão do questionário da GINA (atividade física) possui um poder diagnóstico insuficiente do ponto de vista clínico para a detecção de AIE em crianças e adolescentes com asma (ALM e AGRT). Desta forma, recomenda-se que a avaliação da AIE seja ainda realizada pelo teste de broncoprovocação induzida por exercício, evitando assim, subestimativas e/ou superestimativas nos resultados da avaliação.Submitted by PPG Pediatria e Saúde da Criança (pediatria-pg@pucrs.br) on 2019-06-28T14:12:02Z No. of bitstreams: 1 Dissertação Dani05062019.pdf: 1556969 bytes, checksum: dd575101a3028e3ef0bbc17f601fd42b (MD5)Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2019-06-28T17:06:11Z (GMT) No. of bitstreams: 1 Dissertação Dani05062019.pdf: 1556969 bytes, checksum: dd575101a3028e3ef0bbc17f601fd42b (MD5)Made available in DSpace on 2019-06-28T17:09:24Z (GMT). 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dc.title.por.fl_str_mv |
Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma |
title |
Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma |
spellingShingle |
Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma Wehrmann, Daniele Schiwe Asma Testes de Função Respiratória Asma Induzida pelo Exercício Atividade Física Pediatria Asthma Respiratory Function Tests Exercise-Induced Asthma Physical Activity Pediatrics CIENCIAS DA SAUDE::MEDICINA |
title_short |
Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma |
title_full |
Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma |
title_fullStr |
Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma |
title_full_unstemmed |
Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma |
title_sort |
Avaliação do desempenho diagnóstico do questionário Global Initiative for Asthma (GINA) para detecção de asma induzida pelo exercício em pacientes com asma |
author |
Wehrmann, Daniele Schiwe |
author_facet |
Wehrmann, Daniele Schiwe |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Donadio, Márcio Vinícius Fagundes |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/8321335627100144 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4011402003830297 |
dc.contributor.author.fl_str_mv |
Wehrmann, Daniele Schiwe |
contributor_str_mv |
Donadio, Márcio Vinícius Fagundes |
dc.subject.por.fl_str_mv |
Asma Testes de Função Respiratória Asma Induzida pelo Exercício Atividade Física Pediatria |
topic |
Asma Testes de Função Respiratória Asma Induzida pelo Exercício Atividade Física Pediatria Asthma Respiratory Function Tests Exercise-Induced Asthma Physical Activity Pediatrics CIENCIAS DA SAUDE::MEDICINA |
dc.subject.eng.fl_str_mv |
Asthma Respiratory Function Tests Exercise-Induced Asthma Physical Activity Pediatrics |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA |
description |
INTRODUCTION: Exercise-induced asthma (EIA) is defined as transient airway obstruction during and after exercise and may be evidenced by a decrease in forced expiratory volume in the first second (FEV1). Although several instruments have been designed and tested to detect EIA, most have low diagnostic power. Thus, considering the wide use of the Global Initiative for Asthma (GINA) in clinical practice and that it has a specific question for physical activity, it is relevant to evaluate its performance in the detection of EIA. OBJECTIVES: To evaluate the diagnostic performance of the physical activity related question of GINA in the detection of EIA in children and adolescents with asthma. METHODS: This is a cross-sectional, observational, study performed in the Laboratory of Pediatric Physical Activity. Children and adolescents (6 to 18 years old) with clinical diagnosis of asthma were included. Patients with signs of pulmonary exacerbation and those with motor limitations were excluded. Patients were divided into 2 groups according to severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). Both the assessment of severity and disease control followed GINA criteria. Anthropometric and clinical data were collected. In addition, pulmonary function was evaluated and the exercise-induced bronchoprovocation test (EIB) was performed. The EIB test was performed on a treadmill, with increases in speed and inclination, in accordance with international recommendations. We have used the fourth question of GINA (Any activity limitation due to asthma?) to evaluate the diagnostic power of the instrument. For statistical purposes, the comparisons were performed using the Student t test and the Pearson's chi-square test. The analysis of the diagnostic performance of the GINA questionnaire specific question for the detection of EIB was evaluated using the ROC curve. The study was approved by the Research Ethics Committee and all parents and/or guardians signed a free and informed consent form and the participants the study assent term. RESULTS: We have evaluated 40 patients, 17 of the MMA group and 23 of the STRA group. The mean age was 11.25 years, with a FEV1 (z-score) of 0.33 and 32.5% classified as uncontrolled disease. Of these, 19 (47.5%) presented a decrease in FEV1 in the EIB test, 13 (56.5%) in the STRA group and 6 (35.2%) in the MMA group. There was a significantly higher EIA frequency (p=0.05) in subjects with lower FEV1 (z-score <-1.0) compared to those with z-score >-1.0. However, there were no significant differences in the frequency of EIB when evaluating the influence of disease severity and control. Likewise, no association of question 4 of GINA was found with the EIA results (p>0.05). The sensitivity found was 57.9% and the specificity was 57.1% (n=40). The area under the ROC curve did not demonstrate a discriminative power of the fourth GINA question for the detection of EIA in children and adolescents with asthma (p=0.35). CONCLUSION: The results of the present study demonstrated that the fourth question of the GINA questionnaire (physical activity) has a clinically insufficient diagnostic power for the detection of EIA in children and adolescents with asthma (MMA and STRA). Thus, it is recommended that the evaluation of EIA to be performed by the EIB test, avoiding underestimation and/or overestimation resulting from this evaluation. |
publishDate |
2019 |
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