A relação de fatores de risco ambientais e familiares com sibilância em escolares da cidade de Uruguaiana, RS

• Ano de defesa: 2005
• Autor(a) principal: Pereira, Marilyn Urrutia
• Orientador(a): Stein, Renato Tetelbom
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: MEDICINA; PEDIATRIA; ASMA; FATORES DE RISCO; PULMÕES - DOENÇAS
• Link de acesso: http://hdl.handle.net/10923/4741

Objective: To determine risk factors associated with wheezing in children studying in the school of the city of Uruguaiana, RS. Methods: This is a cross-sectional study with children from the third and fourth school years from public schools, living in the urban area of a small city of poor income of Rio Grande do Sul, Brazil. A representative sample of this population of children was randomly sampled and parents or family representatives answered to a questionnaire applied by interviewers, with questions on asthma, wheezing, personal, or environmental family risk factors (based on the ISAAC questionnaire – International Study of Asthma and Allergies in Childhood). A random sub sample of children had stool samples collected for parasitological diagnosis (3 samples of stools per child with the methods of Ritchie, Kato-Katz and Baermann) and was also tested with skin prick tests for common environmental allergens (6 allergens, with tests from ALK, Spain).Results: The sampled children (n=1982) with a mean age of 10. 1 years had a prevalence of active wheeze (in the past 12 months) of 25,7% and of 12,6% for asthma ever in life. Almost 90% of the population lived in a poor area of the city, with low maternal level of education (75,7% had less than 8 years of formal education) and a third of the subjects exposed to maternal smoking. Contact with animals was frequent in the first year of life or at the time of the interviews. Factors that were significantly associated with active wheeze in the bivariate analysis were: maternal history of asthma (OR=3. 3 95%CI 2. 4 - 4. 7), eczema diagnosed before age 2 years (OR= 2. 5 95%CI 1. 4 - 4. 7), prematurity (OR=1. 7 95%CI 1. 2 - 2. 3), maternal smoking during pregnancy (OR=1. 5 95%CI 1. 2 - 1. 9), maternal smoking at age 10. 1 (OR= 1. 4 95% CI1. 1 - 1. 7), humid housing (OR=2. 0 95% CI 1. 6 - 2. 4), history of parasites (OR= 1. 7 95%CI 1. 4- 2. 0), contact with cats (OR=1. 2 95%CI 1. 0 - 1. 5). To live in a poor are of town (OR=0. 7 95%CI 0. 5 - 0. 9) was inversely associated with active wheeze, as well as having had contact with dog in the first year of life (OR=0. 8 95%CI 0. 7 - 1. 0). In the multivariate analysis family history of asthma, eczema before age 2 years, being born premature, history of parasite infections, house with molds or humidity, maternal smoking and contact with cats at the age of the survey were independent and significantly associate with active wheeze. Living in a poor are of town was also independently and inversely associated with active wheezing (OR=0. 6 95%CI 0. 5 - 0. 9). In the sub sample tested (n=411) 11. 7% of the children had at least one positive skin tests, and 49. 6% had at least one diagnostic test for intestinal parasites. A total of 33. 3% of the children had positive tests for helminths or giardia. Conclusions: Family history of asthma, eczema in the first years of life, prematurity, history of parasitic disease, maternal smoking, house with molds or humidity, or contact with cats at the time of the survey were all risk factors found associated with wheezing at mean age 10. 1 in students in Uruguaiana, RS. Living in a poor area of town was found protective to the development of wheezing at age 10 years. This findings and the fact that a very low percent of children has positive skin tests suggest that wheezing in this population is related to a variety of risk factors. Prevalence of atopic disease is very low in this population, and even though it was not possible to confirm the hypothesis that atopy was not significantly associated with wheezing we can suggest that asthma in this population of low socio-economic level is related to a variety of environmental stimuli (some different than what is found in more developed countries) in conjunction with a family predisposition for asthma. Factors that might protect the development of wheezing or asthma, or even atopy will be studied in more detail in the future. Living in a poor area of town conferred protection to wheezing at age 10, thus suggesting that in the next studies we should collect more detailed information related to these factors.