World Asthma Day 2012

World Asthma Day 2012, organized and sponsored by the Global Initiative for Asthma (GINA), will be held on May 1, 2012 as a partnership between health care groups and asthma educators to raise awareness about asthma and improve asthma care throughout the world.

The theme of World Asthma Day 2012 will be “You Can Control Your Asthma.” This year’s event continues the focus on this positive theme established over the past several years, and is consistent with the emphasis on asthma control set out in the latest versions of the GINA documents.

The event will also bring continued efforts around the Asthma Control Challenge, a global campaign GINA launched on World Asthma Day 2010 to encourage governments, health departments, and health care professionals to improve asthma control and reduce asthma hospitalization 50% in 5 years. Researchers and public health workers around the world are encouraged to enter their information in the online data collection system to help track their
progress towards this goal: http://www.core.ubc.ca/Asthma/GINA.


Asthma control is the goal of treatment and can be achieved in the vast majority of asthma patients with proper management. A person’s asthma is under control when he or she has:
• No (or minimal) asthma symptoms.
• No waking at night due to asthma.
• No (or minimal) need to use “reliever” medication.
• The ability to do normal physical activity and exercise.
• Normal (or near-normal) lung function test results (PEF and FEV1).
• No (or very infrequent) asthma attacks.


A strategy for achieving and maintaining asthma control is set out in the GINA Global Strategy for Asthma Management and Prevention. The strategy requires four interrelated components of
therapy:

• Develop patient/doctor partnership.
• Identify and reduce exposure to risk factors.
• Assess, treat, and monitor asthma.
• Manage asthma exacerbations.


Under this strategy, asthma is treated in a stepwise manner to achieve and maintain control of the disease. Medication is increased—“stepped up”—when asthma is not controlled, and gradually stepped down once good control is achieved and maintained for a period of time. 

Respiratory Decade joins World Allergy Week 2012!

Dear Respiratory friends we have great news: next week is World Allergy Week 2012! This is Global event which is organized by World Allergy Organization! Join this important event! Be a part of this Respiratory event in your country at the local level and you will become visible globally!

The prevalence of allergic diseases worldwide is rising  dramatically in both developed and developing countries.

These diseases include:  

  asthma; 

  rhinitis; 

  anaphylaxis; 
  drug, food, and insect allergy; 
  eczema; 
  urticaria (hives) 
  angioedema.
This increase is especially problematic in children, who are bearing the greatest burden of the rising trend which has occurred over the last two decades. In spite of this increase, even in the developed world, services for patients with allergic diseases are fragmented and far from ideal. Very few countries have comprehensive services in this field of medicine.

Phenotypes of Alpha 1 Antitrypsin Deficiency in Brazil

Today we are publishing abstract which was presented by doctor Maria Vera Cruz de Oliveira from Hospital do Servidor Público Estadual and ABRADAT (Associação Brasileira de Deficiência de Alfa 1 Antitripsina/Brazilian Association of Alpha 1 Antitrypsin Deficiency) on last American Thoracic Society (ATS) meeting.

We are grateful for this post to our most active member from Brazil: Marilia Varella!

Introduction

Alpha 1 Antitrypsin Deficiency (A1ATD) is a hereditary disease often under-diagnosed. The estimated prevalence of A1ATD is known in many countries, but in Brazil until 2005 only isolated cases were published or reported.

Brazilian Association of Alpha 1 Antitrypsin Deficiency (ABRADAT) was founded in 2005. ABRADAT has an education program for physicians and for general population and offer free phenotype tests for COPD patients with possible A1ATD.

The aim of the present study is to describe phenotypes in Brazilian COPD patients with A1ATD.

Methods

This is a descriptive transverse study of the phenotypes of COPD patients with A1ATD, characterized by serum concentration < 80 mg/dL. A paper filter for the blood sample collection was delivered by mail upon request of physicians from several parts of the country. All patients agreed with the test and signed an informed consent.

 

Results

Between February, 2005 and May, 2010, 106 phenotypes tests were performed in patients with COPD and alpha 1 antitrypsin concentration < 80 mg/dL. The tested samples came from 16 different States (Brazil has 27 States). Eighty eight cases with phenotypes not PiMM were found: 47 PiZZ (53, 4%), 27 PiMZ (30,7%), 10 PiSZ (11, 4%) and 4 PiMS (4, 5%) 

Discussion

In this survey phenotypes PI were identified in selected patients with COPD and A1AT serum levels below normal values. Brazil was discovered by Portugal, and was a Portuguese colony for 300 years. Genetic epidemiological studies show that Portugal has the predominant allele PiS, and de Serres estimated the prevalence of PI*S around 46.3 and PI*Z around 5.7 in Brazil (Figure 2). In Brazilian ethnic composition there is 53,4% of Caucasians, and although most of the immigrants are from Portugal, there are also from Germany, Italy and others European countries, so maybe the prevalence of PI phenotypes is different from de Serres study.

We didn’t have data about the real prevalence of A1ATD in Brazil until now, but this program to identify individuals with A1ATD is important for the appropriate management of these patients.

Conclusion

The most common phenotype associated with A1ATD in Brazil is PiZZ, followed by PiMZ.

Easter Greetings 2012 from Respiratory Decade

Dear Respiratory Decade friends,

We want to wish Happy Easter to you and your families!
We are grateful for your outstanding contribution to Respiratory Decade in the world and your continuing support of Respiratory Decade campaign!

Alpha-1 antitrypsin deficiency: a clinically under-recognized inherited disorder

Dear Respiratory Friends, we are happy to present new post from Doctor Marilia Varella (Brazil) abot Alpha-1 antitrypsin deficiency!

What is Alpha-1 antitrypsin deficiency?

It is a clinically under-recognized inherited disorder affecting the lung (emphysema), liver (neonatal hepatitis, chronic liver disease), and rarely, skin (panniculitis). Emphysema is thought to result from an imbalance between neutrophil elastase in the lung and the elastase inhibitor AAT, which protects against proteolytic degradation of elastin.

The prevalence of AAT varies considerably from one country to another; however, it is estimated that more than 3 million people worldwide have allele combinations associated with severe AAT deficiency.

Recent surveys demonstrated that there is an average delay of 7.2 years between the first onset of symptoms and the diagnosis even in individuals with severe deficiency; those individuals also reported seeing at least three (up to ten) clinicians before the diagnosis of AAT deficiency was first made.

It`s also important to notice that under-recognition persists despite extensive educational efforts and the publication of evidence-based guidelines for diagnosis and management of AAT deficiency.

Risk factors:

AAT (encoded by the gene PI, MIM +107400) is a member of the serpin family of protease inhibitors. The normal alpha-1 antitrypsin allele is the M allele. Over 100 allelic variants have been described, of which the most common severely deficient variant is the Z allele.

The normal plasma concentration of AAT ranges from 20 to 48 µmol /L. Population studies suggest a protective threshold of 11 µmol per L, below which there is insufficient AAT to protect the lung.

Severe deficiency of AAT poses a strong risk factor for early-onset emphysema, but not every severely deficient individual is destined to develop emphysema. Smoking is the major factor influencing the course of COPD.

Symptoms:

The clinical manifestations of AAT deficiency during the first two to three decades of life is that of liver disease, specifically chronic elevation of liver enzymes or cirrhosis.

Beyond the first two to three decades of life, patients with severe deficiency of AAT have an accelerated rate of lung function decline.

The clinical presentation of emphysema due to AAT deficiency has many features in common with usual COPD. However, the onset of emphysema in AAT-deficient individuals may be earlier than that in non-AAT-deficient individuals, who usually present in the sixth and seventh decades of life.

Emphysema associated with AAT deficiency often shows a characteristic chest radiographic pattern, in which bullous changes are more prominent at the lung bases than at the apices.

Diagnosis:

Patients with persistent airflow obstruction on spirometry should be tested. Additional features that should lead clinicians to test for severe AAT deficiency include:

·        Emphysema in a young individual (≤45 years)

·        Emphysema in a nonsmoker or minimal smoker

·        Emphysema characterized by predominant basilar changes on the X-Ray

·        A family history of emphysema and/or liver disease

·        Clinical findings or history of panniculitis

·        Clinical findings or history of unexplained chronic liver disease

The diagnosis of severe AAT deficiency is confirmed by demonstrating a serum level below 11 micromol/L in combination with confirmation of a severe deficient genotype (generally determined by isoelectric focusing or polymerase chain reaction testing).

Browse through the links listed below to learn more about AAT deficiency:

http://patients.thoracic.org/information-series/en/resources/what-is-alpha-1-antitrypsin-deficiency.pdf

http://www.ers-education.org/media/2007/pdf/40253.pdf

http://alpha-1foundation.org/

http://www.lunguk.org/you-and-your-lungs/conditions-and-diseases/alpha-1-antitrypsin-deficiency

http://www.nationaljewish.org/healthinfo/conditions/alpha-1/