Sibilância recorrente em lactentes no primeiro ano de vida em Belém (Pará, Brasil): prevalência e fatores de risco associados
Recurrent wheezing in infants in the first year of life in Belém (Pará, Brazil): prevalence and associated risk factors
Elaine Xavier Prestes, Javier Mallol, Dirceu Solé
Resumo
Objetivo: determinar a prevalência e os fatores de risco para sibilância recorrente em lactentes no primeiro ano de vida em Belém, Pará, Brasil. Método: Estudo transversal que utilizou o questionário escrito do Estudio Internacional de Sibilancias en Lactentes (EISL) para pais de lactentes de 12 a 15 meses, nas Unidades de Saúde de Belém, por ocasião de vacinação, entremaioeagosto de 2006. Utilizou-se o Teste t de Student na comparação de médias numéricas e estimação da razão de chances (RC), com intervalo de confiança 95%, e ajuste de modelo de regressão logística para avaliar fatores de risco ou proteção com nível de significância de 5%. Resultados: 3.024 crianças participaram do estudo. A prevalência de sibilância recorrente nesses lactentes foi de 21,9%. Os fatores de risco para sibilância recorrente no primeiro ano de vida foram: gênero masculino, infecção de vias aéreas, infecção de vias aéreas antes de cinco meses de idade, raça negra, exposição à poluição atmosférica, história familiar de asma e rinite, dermatite atópica pessoal. Ter o calendário vacinal atualizado e ter seis meses de idade ou mais na primeira infecção foram fatores de proteção. Conclusão: a prevalência de sibilância recorrente é elevada em Belém e seus fatores de risco estão ligados a genética e fatores ambientais. Prevenir infecção de vias aéreas em lactente jovem e controlara poluição ambiental pode minimizar a doença sibilante.
Palavras-chave
Abstract
Purpose: To identify the prevalence and risk factors for recurrent wheezing in infants fromBelém, Pará, Brazil. Methods: A cross-sectional study that used the written questionnaire EstudioInternational de Sibilancias en Lactentes (EISL) for parents of infants 12 to15 month-old, in the Health Units of Belém at the time of vaccination between May and August 2006. The Student t test for continuous variables and Chi-square test for categorical variables, estimation of Odds ratio (OR) with 95% confidence interval and adjustmentof logistic regression model to evaluate risk factors with a significance level of 5% were done. Results: 3,024 children participated in the study. The prevalence of recurrent wheezing in these infants was 21.9%. Risk factors associated with recurrent wheezing were male sex, respiratory infections, especially under five months-old, rhinitis and asthma in the family, atopic dermatitis, living in a polluted area, and blackrace. Immunization schedule completeand respiratory infections after six months-old were protective factor. Conclusion: The prevalence of recurrent wheezing is higher in Belém and some of its known risk factors may help to promote preventive measures applicable to wheezing.
Keywords
Referências
1. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ, et al. Asthma and wheezing in the first six years of life. N Engl J Med. 1995;332(3):133-8. http://dx.doi.org/10.1056/NEJM199501193320301. PMid:7800004.
2. Stern DA, Morgan WJ, Wright AL, Guerra S, Martinez FD. Poor airway function in early infancy and lung function by age 22 years: a non selective longitudinal cohort study. Lancet. 2007;370(9589):758-64. http://dx.doi.org/10.1016/S0140-6736(07)61379-8. PMid:17765525.
3. Stein RT. Long-term airway morbidity following viral LRTI in early infancy: recurrent wheezing or asthma? Paediatr Respir Rev. 2009;10(Suppl 1):29-31. http://dx.doi.org/10.1016/S1526-0542(09)70013-2. PMid:19651399.
4. Wright AL, Sherrill D, Holberg CJ, Halonen M, Martinez FD. Breast-feeding, maternal IgE, and total serum IgE in childhood. J Allergy Clin Immunol. 1999;104(Pt 1):589-94. http://dx.doi.org/10.1016/S0091-6749(99)70328-3. PMid:10482832.
5. Noakes PS, Hale J, Thomas R, Lane C, Devadason SG, Prescott SL. Maternal smoking is associated with impaired neonatal toll-like-receptormediated immune responses. Eur Respir J. 2006;28(4):721-9. http://dx.doi.org/10.1183/09031936.06.00050206. PMid:16870663.
6. Luijk MP, Sonnenschein-van der Voort AM, Mileva-Seitz VR, Jansen PW, Verhulst FC, Hofman A, et al. Is parent-child bed-sharing a risk for wheezing and asthma in early childhood? Eur Respir J. 2015;45(3):661-9. http://dx.doi.org/10.1183/09031936.00041714. PMid:25504998.
7. Cardoso MRA, Cousens SN, Siqueira LFG, Alves FM, D’Angelo LAV. Crowding: risk factor or protective factor for lower respiratory disease in Young children? BMC Public Health. 2004;4(1):19. http://dx.doi.org/10.1186/1471-2458-4-19. PMid:15176983.
8. Mommers M, Weishoff-Houben M, Swaen GM, Creemers H, Freund H, Dott W, et al. Infant immunization and the occurrence of atopic disease in Dutch and German children: a nested case-control study. Pediatr Pulmonol. 2004;38(4):329-34. http://dx.doi.org/10.1002/ppul.20089. PMid:15334511.
9. Bianca AC, Wandalsen GF, Miyagi K, Camargo L, Cezarin D, Mallol J, et al. International Study of Wheezing in Infants (EISL). Validation of written questionnaire for children aged bellow 3 years. J Investig Allergol Clin Immunol. 2009;19(1):35-42. PMid:19274927.
10. Chong No HJ, Rosário NA, Solé D, Mallol J. Prevalence of recurrent wheezing in infants. J Pediatr (Rio J). 2007b;83(4):357-62. PMid:17676238.
11. Dela Bianca AC, Wandalsen G, Mallol J, Solé D. Prevalência e gravidade da sibilância no primeiro ano de vida. J Bras Pneumol. 2010;36(4):402-9. http://dx.doi.org/10.1590/S1806-37132010000400003. PMid:20835585.
12. Mallol J, García-Marcos L, Solé D, Brand P, EISL Study Group. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010 nov;65(11):1004-9. http://dx.doi.org/10.1136/thx.2009.115188. PMid:20855440.
13. Mallol J, Solé D, Garcia-Marcos L, Rosario N, Aguirre V, Chong H, et al. Prevalence, severity, and treatment of recurrent wheezing during the first year of life: a cross-sectional study of 12,405 latin american infants. Allergy Asthma Immunol Res. 2016;8(1):22-31. http://dx.doi.org/10.4168/aair.2016.8.1.22. PMid:26540498.
14. Mallol J, Solé D, Aguirre V, Chong H, Rosario N, García-Marcos L. Changes in the prevalence and severity of recurrent wheezing in infants: the results of two surveys administered 7 years apart. J Asthma. 2018 nov;55(11):1214-22. PMid:29231772.
15. Garcia-Marcos L, Mallol J, Solé D, Brand PL, EISL Study Group. International study of wheezing in infants:risk factors in affluent and nonaffluentcountries during the first year of life. Pediatr Allergy Immunol. 2010;21(5):878-88. http://dx.doi.org/10.1111/j.1399-3038.2010.01035.x. PMid:20444158.
16. Seneviratne R, Gunawardena NS. Prevalence and associated factors of wheezing illnesses of children aged three to five years living in underserved settlements of the Colombo Municipal Council in Sri Lanka: a cross-sectional study. BMC Public Health. 2018;18(1):127. http:// dx.doi.org/10.1186/s12889-018-5043-3. PMid:29325544.