Browsing by Author "Mocelin, Helena Teresinha"

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    Post Infectious Bronchiolitis Obliterans in Children
    (2010) Fischer, Gilberto Bueno; Sarria, Edgar Enrique; Mattiello, Rita; Mocelin, Helena Teresinha; Castro Rodríguez, José Antonio
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    Severe childhood asthma in low and middle-income countries
    (2025) Castro Rodríguez, José Antonio; Soto-Martínez, Manuel E.; Rodriguez-Martinez, Carlos E.; Mocelin, Helena Teresinha; Bueno Fischer, Gilberto; Mallol, Javier
    Severe asthma is relatively uncommon among children and adolescents in low- and middle-income countries (LMICs), affecting 2.1 % and 4.3 %, respectively. However, it results in significant morbidity and occasional mortality, as well as considerable management challenges compared to high-income countries. Furthermore, nearly 6 % of infants in LMICs experience nighttime symptoms weekly. Socioeconomic inequities and exposure to environmental risk factors contribute to marked variability in prevalence, with children from disadvantaged backgrounds being at a higher risk. In these settings, numerous preventable risk factors have been identified, including exposure to tobacco smoke, indoor and outdoor air pollution (e.g., biomass fuel use), allergens, unhealthy diet, and lifestyle changes associated with urbanization.Nearly half of children with severe asthma in LMICs receive suboptimal treatment. For instance, only 55 % use inhaled corticosteroids (ICS), and while most physicians prefer pressurized metered-dose inhalers, only one-third recommend using spacers. In some countries, oral short-acting beta agonists and theophylline are still used. Compared to fixed-dose ICS/long-acting beta-agonists (LABA) therapy, maintenance and reliever therapy (MART), add-on tiotropium therapy, and triple therapy (ICS + LABA + LAMA) are cost-effective in LMICs. However, biologic therapies are prohibitively expensive and inaccessible in most of these regions, and cost-effectiveness studies have shown that omalizumab and dupilumab are not viable treatment options in LMICs.Key barriers to optimal care include fragmented health systems, limited access to spirometry, and poor treatment adherence. Public health strategies should prioritize improving access to affordable and effective asthma medications, strengthening diagnostic infrastructure in underserved areas, and mitigating modifiable environmental risk factors that contribute to asthma.
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    The wheezy infant: A viewpoint from low-middle income countries
    (W.B. Saunders Ltd, 2022) Mocelin, Helena Teresinha; Fischer Bueno, Gilberto; da Silva Filho, Luiz Vicente Ribeiro Ferreira; Castro Rodríguez, José Antonio; Sarria, Edgar E.
    To review the recent evidence in the literature of various aspects of recurrent/severe wheezing in children under 3 in low-middle income countries [LMICS]. Sources: A non-systematic review including articles in English. We mainly selected publications from the last 5 years. Studies on epidemiology, aetiology, diagnosis, treatment, and prevention were included in the search. We reviewed differential diagnoses of wheezing that focused on LMICS. We also reviewed aspects of prevention. Summary of the findings: Many epidemiological studies have shown a variable but significant number of wheezy infants [WI] cases in LMICS when compared to other countries. The differential diagnosis of causes of wheezing in this age group is mandatory, taking into account local facilities. Few treatment options have been well studied for this age group. In LMICS, a pragmatic approach could be considered, as described in the article. It is difficult to study primary prevention for WI and secondary prevention (mainly environmental) may have some impact. A schematic approach for recurrent wheezers is presented, which takes into account settings with limited resources. Conclusion: Severely or recurrently wheezy children under 3 is a common clinical issue in LMICS. Studies on this age group are needed to reduce the significant morbidity. It may be possible to lower the high burden of wheezing in this age group by selecting the phenotype which may respond to inhaled steroids.