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2023-09-15T20:17:03Z2023-09-15T20:17:03Z20177https://doi.org/10.1186/s13601-017-0183-62045-7022http://hdl.handle.net/1843/58738https://orcid.org/0000-0003-3183-0990https://orcid.org/0000-0002-5234-547Background: In severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day. Methods: This was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6–18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day. Results: At baseline, the forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity (FVC) ratio were both < 80% of the predicted values in 50.8% of the patients. The median age of the patients was 10.4 years (interquartile range 7.8–13.6 years). In the sample as a whole, there were signifcant increases in FEV1% and in the FEV1/FVC% ratio (p = 0.01 and p < 0.001, respectively) over the course of the study. In the > 800 µg/day group, there were no statistical increases or decreases in FEV1, the FEV1/FVC ratio, or forced expiratory fow between 25 and 75% of the FVC (FEF25–75%), when calculated as percentages of the predicted values. However, the z-score for FEF25–75% showed a statistically signifcant reduction, in the sample as a whole and in the > 800 µg/day group. Also in the > 800 µg/day group, there was a signifcant reduction in the post-bronchodilator FEV1% (p = 0.004). Conclusions: The fact that the spirometric parameters (as percentages of the predicted values) remained constant in the > 800 µg/day group, whereas there was a gain in lung function in the sample as a whole, suggests an early plateau phase in the > 800 µg/day group. However, there was some loss of lung function in the > 800 µg/day group, as evidenced by a decrease in the z-score for FEF25–75%, suggesting irreversible small airway impairment, and by a reduction in the post-bronchodilator FEV1%, suggesting reduced reversibility of airway obstruction. Among children and adolescents with severe asthma, the use of ICS doses higher than those recommended for age does not appear to improve lung function.Introdução: Na asma grave, altas doses de corticosteroides inalatórios (CI) são utilizadas para obter controle clínico e funcional. Este estudo teve como objetivo avaliar a função pulmonar em pacientes ambulatoriais (crianças e adolescentes) com asma grave no Brasil, todos tratados com altas doses de CI. Avaliamos todos os exames espirométricos em conjunto e pela dose de CI: 800 e > 800 µg/dia. Métodos: Este foi um estudo longitudinal de 3 anos no qual foram analisados 384 exames espirométricos em 65 pacientes com asma grave (6-18 anos de idade), divididos em dois grupos pela dose de CI (budesonida ou equivalente): 800 e > 800 µg/dia. Resultados: No início do estudo, o volume expiratório forçado no primeiro segundo (VEF1) e a relação VEF1/capacidade vital forçada (CVF) foram ambos < 80% dos valores previstos em 50,8% dos pacientes. A mediana de idade dos pacientes foi de 10,4 anos (intervalo interquartil 7,8–13,6 anos). Na amostra como um todo, houve aumentos significativos no VEF1% e na relação VEF1/CVF% (p = 0,01 e p < 0,001, respectivamente) ao longo do estudo. No grupo > 800 µg/dia, não houve aumentos ou reduções estatísticas no VEF1, na relação VEF1/CVF ou no fluxo expiratório forçado entre 25 e 75% da CVF (FEF25–75%), quando calculado como porcentagens do valores previstos. Entretanto, o escore z para FEF25–75% apresentou redução estatisticamente significativa, na amostra como um todo e no grupo > 800 µg/dia. Também no grupo > 800 µg/dia houve redução significativa do VEF1% pós-broncodilatador (p = 0,004). Conclusões: O fato dos parâmetros espirométricos (em porcentagens dos valores previstos) terem permanecido constantes no grupo > 800 µg/dia, enquanto houve ganho de função pulmonar na amostra como um todo, sugere uma fase de platô precoce no grupo > Grupo 800 µg/dia. No entanto, houve alguma perda de função pulmonar no grupo > 800 µg/dia, como evidenciado por uma diminuição no escore z para FEF25–75%, sugerindo comprometimento irreversível das pequenas vias aéreas, e por uma redução no VEF1 pós-broncodilatador. %, sugerindo reversibilidade reduzida da obstrução das vias aéreas. Entre crianças e adolescentes com asma grave, o uso de doses de CI superiores às recomendadas para a idade não parece melhorar a função pulmonar.engUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE PEDIATRIAClinical and Translational AllergyAsmaEspirometriaEstudos longitudinaisCooperação e adesão ao tratamentoAsthma in childhood and adolescenceSpirometryForced expiratory fowLongitudinal studyAdherence to treatmentLung function in severe pediatric asthma: a longitudinal study in children and adolescents in BrazilFunção pulmonar na asma pediátrica grave: estudo longitudinal em crianças e adolescentes no Brasilinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://ctajournal.biomedcentral.com/articles/10.1186/s13601-017-0183-6Mônica Versiani Nunes Pinheiro de QueirozCristina Gonçalves AlvimÁlvaro Augusto CruzLaura Maria de Lima Belizário Facury Lasmarapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/58738/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALLung function in severe pediatric asthma_ a longitudinal study in children and adolescents in Brazil.pdfLung function in severe pediatric asthma_ a longitudinal study in children and adolescents in Brazil.pdfapplication/pdf907439https://repositorio.ufmg.br/bitstream/1843/58738/2/Lung%20function%20in%20severe%20pediatric%20asthma_%20a%20longitudinal%20study%20in%20children%20and%20adolescents%20in%20Brazil.pdfd317f8cdc9740fb90cc8451076023796MD521843/587382023-09-15 17:17:03.741oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-09-15T20:17:03Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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