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https://www.arca.fiocruz.br/handle/icict/57144
ASTHMA INFLAMMATORY PHENOTYPES ON FOUR CONTINENTS: MOST ASTHMA IS NON-EOSINOPHILIC
Fenótipos inflamatórios
Crianças
Adolescentes
Indução de escarro
LMIC
HIC
Author
Pembrey, Lucy
Brooks, Collin
Mpairwe, Harriet
Figueiredo, Camila A.
Oviedo, Aida Y.
Chico, Martha
Ali, Hajar
Nambuya, Irene
Tumwesige, Pius
Robertson, Steven
Rutter, Charlotte E.
Veldhoven, Karin van
Ring, Susan
Barreto, Mauricio L.
Cooper, Philip J.
Henderson, John
Cruz, Alvaro A.
Douwes, Jeroen
Pearce, Neil
Brooks, Collin
Mpairwe, Harriet
Figueiredo, Camila A.
Oviedo, Aida Y.
Chico, Martha
Ali, Hajar
Nambuya, Irene
Tumwesige, Pius
Robertson, Steven
Rutter, Charlotte E.
Veldhoven, Karin van
Ring, Susan
Barreto, Mauricio L.
Cooper, Philip J.
Henderson, John
Cruz, Alvaro A.
Douwes, Jeroen
Pearce, Neil
Affilliation
Department of Medical Statistics. London School of Hygiene & Tropical Medicine. London, UK.
Centre for Public Health Research. Massey University. Wellington, New Zealand.
MRC/UVRI and LSHTM Uganda Research Unit. Entebbe, Uganda.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, Brasil.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Ecuador.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Ecuador.
Centre for Public Health Research. Massey University. Wellington, New Zealand.
MRC/UVRI and LSHTM Uganda Research Unit. Entebbe, Uganda.
MRC/UVRI and LSHTM Uganda Research Unit. Entebbe, Uganda.
Department of Medical Statistics. London School of Hygiene & Tropical Medicine. London, UK.
Department of Medical Statistics. London School of Hygiene & Tropical Medicine. London, UK.
Department of Non-communicable Disease Epidemiology. London School of Hygiene & Tropical Medicine. London, UK.
Population Health Sciences. Bristol Medical School. University of Bristol. Bristol, UK /MRC Integrative Epidemiology Unit at University of Bristol. Bristol, UK.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Muniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Ecuador / School of Medicine. Universidad Internacional del Ecuador. Quito, Ecuador / Institute of Infection and Immunity. St George’s University of London. London, UK.
Population Health Sciences. Bristol Medical School. University of Bristol. Bristol, UK.
Universidade Federal da Bahia. ProAR. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Ciências da Saúde. Salvador, BA, Brasil.
Centre for Public Health Research. Massey University. Wellington, New Zealand.
Department of Medical Statistics. London School of Hygiene & Tropical Medicine. London, UK / Centre for Public Health Research. Massey University. Wellington, New Zealand.
Centre for Public Health Research. Massey University. Wellington, New Zealand.
MRC/UVRI and LSHTM Uganda Research Unit. Entebbe, Uganda.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, Brasil.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Ecuador.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Ecuador.
Centre for Public Health Research. Massey University. Wellington, New Zealand.
MRC/UVRI and LSHTM Uganda Research Unit. Entebbe, Uganda.
MRC/UVRI and LSHTM Uganda Research Unit. Entebbe, Uganda.
Department of Medical Statistics. London School of Hygiene & Tropical Medicine. London, UK.
Department of Medical Statistics. London School of Hygiene & Tropical Medicine. London, UK.
Department of Non-communicable Disease Epidemiology. London School of Hygiene & Tropical Medicine. London, UK.
Population Health Sciences. Bristol Medical School. University of Bristol. Bristol, UK /MRC Integrative Epidemiology Unit at University of Bristol. Bristol, UK.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Muniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Ecuador / School of Medicine. Universidad Internacional del Ecuador. Quito, Ecuador / Institute of Infection and Immunity. St George’s University of London. London, UK.
Population Health Sciences. Bristol Medical School. University of Bristol. Bristol, UK.
Universidade Federal da Bahia. ProAR. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Ciências da Saúde. Salvador, BA, Brasil.
Centre for Public Health Research. Massey University. Wellington, New Zealand.
Department of Medical Statistics. London School of Hygiene & Tropical Medicine. London, UK / Centre for Public Health Research. Massey University. Wellington, New Zealand.
Abstract
Background: Most studies assessing pathophysiological heterogeneity in asthma have been conducted in high-income countries (HICs), with little known about the prevalence and characteristics of different asthma inflammatory phenotypes in low-and middle-income countries (LMICs). This study assessed sputum inflammatory phenotypes in five centres, in Brazil, Ecuador, Uganda, New Zealand (NZ) and the United Kingdom (UK). Methods: We conducted a cross-sectional study of 998 asthmatics and 356 non-asthmatics in 2016–20. All centres studied children and adolescents (age range 8–20 years), except the UK centre which involved 26–27 year-olds. Information was collected using questionnaires, clinical characterization, blood and induced sputum. Results: Of 623 asthmatics with sputum results, 39% (243) were classified as eosinophilic or mixed granulocytic, i.e. eosinophilic asthma (EA). Adjusted for age and sex, with NZ as baseline, the UK showed similar odds of EA (odds ratio 1.04, 95% confidence interval 0.37–2.94) with lower odds in the LMICs: Brazil (0.73, 0.42–1.27), Ecuador (0.40, 0.24–0.66) and Uganda (0.62, 0.37–1.04). Despite the low prevalence of neutrophilic asthma in most centres, sputum neutrophilia was increased in asthmatics and non-asthmatics in Uganda. Conclusions: This is the first time that sputum induction has been used to compare asthma
inflammatory phenotypes in HICs and LMICs. Most cases were non-eosinophilic, including in settings where corticosteroid use was low. A lower prevalence of EA was observed in the LMICs than in the HICs. This has major implications for asthma prevention and manage ment, and suggests that novel prevention strategies and therapies specifically targeting non-eosinophilic asthma are required globally
Keywords in Portuguese
AsmaFenótipos inflamatórios
Crianças
Adolescentes
Indução de escarro
LMIC
HIC
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