Underestimated asthma prevalence in Guarda's district leads to overestimated hospitalizations

Silva, J.M.; Ferreira, L.

doi:10.1016/j.pulmoe.2023.06.002

array:23 ["pii" => "S2531043723001204" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.06.002" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "1884" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Pulmonol. 2023;29:573" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2531043723000132" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.01.006" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "1839" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Pulmonol. 2023;29:574-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Photo" "titulo" => "A rare case of pulmonary malignant peripheral nerve sheath tumor" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "574" "paginaFinal" => "575" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 720 "Ancho" => 2918 "Tamanyo" => 426806 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) PET scan image showing high accumulation of FDG in the pulmonary mass. (B) Spindle cell tumor with infiltration of bronchial structures (HE 200X). Magnification bar = 200 µm.(C) Atypical neoplastic cells with frequent mitotic figures (HE 400x). Magnification bar = 100 µm." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rita Costa, José Maximo, Pedro Fernandes, Susana Guimarães, Roberto Silva, Adriana Magalhães" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Rita" "apellidos" => "Costa" ] 1 => array:2 [ "nombre" => "José" "apellidos" => "Maximo" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Fernandes" ] 3 => array:2 [ "nombre" => "Susana" "apellidos" => "Guimarães" ] 4 => array:2 [ "nombre" => "Roberto" "apellidos" => "Silva" ] 5 => array:2 [ "nombre" => "Adriana" "apellidos" => "Magalhães" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043723000132?idApp=UINPBA00004E" "url" => "/25310437/0000002900000006/v3_202311162326/S2531043723000132/v3_202311162326/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2531043723000946" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.05.004" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "1877" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Pulmonol. 2023;29:570-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "An investigation of TB infection and reinfection among stone quarry workers" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "570" "paginaFinal" => "572" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1574 "Ancho" => 3333 "Tamanyo" => 235424 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Detailed analysis of the 12 cases of Cluster 1 by trimester (T) regarding risk factors and time of diagnosis. Infectious period was considered for three months before symptoms onset if positive sputum smear or for one month before symptoms onset if negative sputum smear." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Sousa, C.M. Alves, R. Macedo, C. Carvalho, G. Gonçalves, R. Duarte" "autores" => array:6 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Sousa" ] 1 => array:2 [ "nombre" => "C.M." "apellidos" => "Alves" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Macedo" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Carvalho" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Gonçalves" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Duarte" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043723000946?idApp=UINPBA00004E" "url" => "/25310437/0000002900000006/v3_202311162326/S2531043723000946/v3_202311162326/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Correspondence" "titulo" => "Underestimated asthma prevalence in Guarda's district leads to overestimated hospitalizations" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "573" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Silva, L. Ferreira" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Silva" "email" => array:1 [ 0 => "paulo.silva@ulsguarda.min-saude.pt" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0001" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Ferreira" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal" "etiqueta" => "b" "identificador" => "aff0002" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Bairro do Torrão n° 83, 6300-767, Guarda, Portugal." ] ] ] ] "textoCompleto" => "As pulmonologists in Guarda's Local Health Unit, we cannot avoid commenting on the editorial published in March 2023 in Pulmonology Journal<a class="elsevierStyleCrossRef" href="#bib0001">1</a> as it greatly concerns us.The article states that, in mainland Portugal, the Guarda district has the most prevalence-adjusted asthma hospital admissions. These results are based on an asthma prevalence in the Guarda district of 1.7%. That estimated prevalence is, by far, the lowest in mainland Portugal. The lowest after Guarda is the Braga district, with 4.2% (2.5 times higher than in our district).The reference for this data is the Portuguese National Asthma Survey,<a class="elsevierStyleCrossRef" href="#bib0002">2</a> published in 2010. However, there is no detailed data on asthma prevalence by district in that study. The results are presented by region, with a prevalence of asthma of 6.2% in the centre of Portugal (location of Guarda). This prevalence includes our neighbouring districts, where patients have similar characteristics:<ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001">•5.2% in Viseu (more than three times higher than the estimated prevalence in Guarda)</li><li class="elsevierStyleListItem" id="celistitem0002">•4.95% in Castelo Branco (2.9 times higher than the estimated prevalence in Guarda).</li></ul>It is therefore impossible to know where the data for the Guarda district was found.According to the Portuguese census of 2021, the population in Guarda's Local Health Unit area is 137,788 inhabitants.In our hospital, we conduct severe asthma consultations. In 2022, we observed a total of 238 patients. GINA estimates that 3.7% of asthma patients worldwide have severe asthma. This statistic allows us to infer that, given our consultation data compared to the Guarda district population, we obtained circa 6432 patients with asthma in the Guarda district. This number gives us an estimated asthma prevalence in the Guarda district of 4.67% - a significantly higher percentage than the one mentioned in the editorial abovementioned. Moreover, that is a low estimate since not all patients with severe asthma in the Guarda district have medical records in our hospital.Therefore, the prevalence of asthma in the Guarda district is underestimated and distorts the prevalence-adjusted asthma hospital admissions, skewing the study's conclusions." "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-08" "fechaAceptado" => "2023-06-08" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asthma hospitalizations: a call for a national strategy to fight health inequities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Vieira" 1 => "B. Sousa-Pinto" 2 => "A.M. Pereira" 3 => "C.R. Cordeiro" 4 => "C.C. Loureiro" 5 => "F. Regateiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pulmoe.2022.12.001" "Revista" => array:7 [ "tituloSerie" => "Pulmonology" "fecha" => "2023" "volumen" => "29" "numero" => "3" "paginaInicial" => "179" "paginaFinal" => "183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36907817" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of asthma in Portugal – the Portuguese National Asthma Survey" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sa-Sousa" 1 => "M. Morais-Almeida" 2 => "L.F. Azevedo" 3 => "R. Carvalho" 4 => "T. Jacinto" 5 => "A. Todo-Bom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/2045-7022-2-15" "Revista" => array:6 [ "tituloSerie" => "Clin Transl Allergy" "fecha" => "2012" "volumen" => "2" "paginaInicial" => "1" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22409857" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002900000006/v3_202311162326/S2531043723001204/v3_202311162326/en/main.assets" "Apartado" => array:4 [ "identificador" => "86736" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002900000006/v3_202311162326/S2531043723001204/v3_202311162326/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043723001204?idApp=UINPBA00004E"]

Pulmonology

ISSN: 2531-0437

Pulmonology (previously Revista Portuguesa de Pneumologia) is the official journal of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia/SPP). The journal publishes 6 issues per year, mainly about respiratory system diseases in adults and clinical research. This work can range from peer-reviewed original articles to review articles, editorials, and opinion articles. The journal is printed in English, and is freely available in its web page as well as in Medline and other databases.

Special Issue 2023. Volume 29, Issue S4.

Indexed in:

Science Citation Index Expanded, Journal of Citation Reports; Index Medicus/MEDLINE; Scopus; EMBASE/Excerpta Medica

The article states that, in mainland Portugal, the Guarda district has the most prevalence-adjusted asthma hospital admissions. These results are based on an asthma prevalence in the Guarda district of 1.7%. That estimated prevalence is, by far, the lowest in mainland Portugal. The lowest after Guarda is the Braga district, with 4.2% (2.5 times higher than in our district).

The reference for this data is the Portuguese National Asthma Survey,2 published in 2010. However, there is no detailed data on asthma prevalence by district in that study. The results are presented by region, with a prevalence of asthma of 6.2% in the centre of Portugal (location of Guarda). This prevalence includes our neighbouring districts, where patients have similar characteristics:

•
5.2% in Viseu (more than three times higher than the estimated prevalence in Guarda)
•
4.95% in Castelo Branco (2.9 times higher than the estimated prevalence in Guarda).

It is therefore impossible to know where the data for the Guarda district was found.

According to the Portuguese census of 2021, the population in Guarda's Local Health Unit area is 137,788 inhabitants.

In our hospital, we conduct severe asthma consultations. In 2022, we observed a total of 238 patients. GINA estimates that 3.7% of asthma patients worldwide have severe asthma. This statistic allows us to infer that, given our consultation data compared to the Guarda district population, we obtained circa 6432 patients with asthma in the Guarda district. This number gives us an estimated asthma prevalence in the Guarda district of 4.67% - a significantly higher percentage than the one mentioned in the editorial abovementioned. Moreover, that is a low estimate since not all patients with severe asthma in the Guarda district have medical records in our hospital.

Therefore, the prevalence of asthma in the Guarda district is underestimated and distorts the prevalence-adjusted asthma hospital admissions, skewing the study's conclusions.

References

[1]

R.J. Vieira, B. Sousa-Pinto, A.M. Pereira, C.R. Cordeiro, C.C. Loureiro, F. Regateiro, et al.

Asthma hospitalizations: a call for a national strategy to fight health inequities.

Pulmonology, 29 (2023), pp. 179-183

http://dx.doi.org/10.1016/j.pulmoe.2022.12.001 | Medline

[2]

A. Sa-Sousa, M. Morais-Almeida, L.F. Azevedo, R. Carvalho, T. Jacinto, A. Todo-Bom, et al.

Prevalence of asthma in Portugal – the Portuguese National Asthma Survey.

Clin Transl Allergy, 2 (2012), pp. 1-12

http://dx.doi.org/10.1186/2045-7022-2-15 | Medline