The Global Asthma Report 2018

Brazil

No national asthma plan despite continued high prevalence of asthma.

The prevalence of asthma in Brazilian children and adolescents is among the highest in the world and remains unchanged. More than a decade ago the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three found the average prevalence of current asthma symptoms in adolescents was around 20%. The World Health Organization’s World Health Survey database found that 23% of Brazilians aged 18-54 years old had wheezing in the last year. Nevertheless, only 12% had a doctor diagnosis of asthma.

Prevalence remains high

The Ministry of Health’s (MoH) National Adolescent School-based Health Survey (PeNSE), included ISAAC questions on asthma for the first time in 2012. PeNSE is a national cross sectional study of 9th grade students, with 109,104 adolescents at public and private schools self-completing a questionnaire. The prevalence of asthma symptoms was again 23% and the prevalence of a medical diagnosis of asthma 12%, similar to previous findings in Brazilian adults and adolescents.

Admissions and mortality

In 2011, asthma was the fourth leading cause of hospital admissions in the country, with the MoH registering 175,000 asthma admissions at all ages. Asthma mortality is still over 2,000 deaths a year. However, the hospital admission and mortality rates are declining in most regions, except for underserved areas of the Northeast. Inhaled corticosteroids, shortacting inhaled bronchodilators and a combination of inhaled corticosteroids and long-acting β2-agonists are free of charge for the users of the public health system. Although there is neither a national action plan for asthma control in Brazil, nor a priority to build the capacity of primary care teams for asthma, several municipal interventions at the outpatient primary and secondary care levels, have proven effective on symptom control, reducing exacerbations and hospital admissions. These activities could be expanded to further reduce the burden of asthma in Brazil.

Dirceu Solé, Álvaro Cruz

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Patient Story

A 6 year old boy presented to the emergency department with his third severe asthma attack in one year. He improved with salbutamol by nebuliser, oxygen and intravenous hydrocortisone. Upon discharge, 24h later, he was prescribed oral prednisolone for five days and inhaled salbutamol as needed, but no inhaled corticosteroid was recommended nor was he referred for follow-up.