Análise da prevalência e fatores associados à sibilância e ao uso de corticoide inalatório em crianças menores de cinco anos de idade, Cuiabá/MT, Brasil

Abstract

Wheezing is highly prevalent in Brazil, with variations in rates and risk factors between the regions of the country. Among diseases that currently include wheezing, asthma is the most common chronic respiratory disease in childhood, with greater impact on health services. Aims: this study aimed to analyze the prevalence of and factors associated with wheezing in children under five years old; to describe the frequency of use of the inhaled corticosteroids in children with medical diagnosis of asthma and probable asthma; and to analyze associated factors with inhaled corticosteroids use in children. Methods: crosssectional study carried out in Cuiabá, State of Mato Grosso, Brazil, with a sample of 733 children under five years old. This sample was expanded by considering the weights and sampling, based on the population under five years of age according to the Brazilian Institute of Geography and Statistics Census – (IBGE, 2010) from 2000, the last available census was in 2010. We applied a brief version of the standardized instrument from the "International Study of Wheezing in Infants (EISL)". In Chapter 1, for the analysis of factors associated with wheezing was applied logistic regression with a hierarchical approach on 3 levels considering the modifiable and non-modifiable risk factors. In Chapter 2, we analyzed the frequency of use of inhaled corticosteroids in children with probable asthma and those with medical diagnosis. In Chapter 3, associated with the use of inhaled corticosteroids among wheezing children through models of simple and multiple logistic regression factors were performed. Results: The expanded sample estimated resulted on 37,172 children living in the urban area of the Cuiabá. The prevalence of wheezing in the past 12 months was 43.2% and recurrent wheezing corresponded to 35.5%. They were associated with wheezing no breastfeeding for six months or more, diagnosis of familial asthma, previous disease and male sex. The frequency of use of inhaled corticosteroids in the last 12 months was 13.2% among wheezing children. Among the 2,122 children with probable asthma, 1,635 (77.1%) did not use this medicine on the other hand, 1,497 children who did not meet the criteria for probable asthma used inhaled corticosteroids, which corresponds to 75.5 % of children who did use of this medicine. This was associated with inhaled corticosteroids: characteristic of health services, with greater chances for children seeking private service, physician-diagnosed asthma, and hospitalization for bronchitis and wheezing ≥ 3 times in the last 12 months. Conclusions: the prevalence of wheezing in children under five years living in Cuiabá is high, with risk factors related both to the likely atopy or infections. Undertreatment with inhaled corticosteroids as overtreatment in those children who do not have probable asthma or medical diagnosis were verified. Finally, the use of inhaled corticosteroids was associated with private health care, medical diagnosis of asthma and indicators of severity of the disease.