Return to Contents in this Issue

Original Article


Children's asthma and the third world: an approach


E. Capriles1, A. Do Campo2, O. Verde3, S. Pluchino4, A. Capriles Hulett5

1 Faculty of Medicine, JM Vargas, UCV, Caracas, Venezuela;
2 Allergology Unit, Hospital Pediátrico San Juan de Dios, Caracas, Venezuela;
3 Fundación CIEPE, San Felipe, Edo Yaracuy, Venezuela;
4 Pharmacology Service, Instituto de Medicina Experimental, L. Razzeti School of Medicine, Faculty of Medicine, UCV, Caracas, Venezuela;
5 Allergology Unit, Hospital Pediátrico San Juan de Dios, Caracas, Venezuela

J Investig Allergol Clin Immunol 2006; Vol. 16(1): 11-18



Background: More than a million visits/year characterize acute asthma morbidity at Venezuela’s (24 million inhabitants) Ministry of Health ambulatory services, caring for 80% or more of the population; acute morbidity from asthma is second to “viral syndrome” but ahead of diarrhea and other diseases. These acute episodes are the
only contact of a poor asthmatic child with this health care system and portray the prevailing approach focused around acute care; to be reversed, a simple cost/effective program ought to be implemented during these acute asthma visits. Since convenience of administration is a key factor in compliance, a pilot study to explore the efficacy
of budesonide CFC 400 µg administered on a once-a-day basis for adherence was carried out within a naturalistic realworld design.

Methods: Thirty persistent asthmatic patients attending the Allergology Unit of the Hospital Pediátrico San Juan de Dios in Caracas were enrolled, and their asthma signs/symptoms quantified and registered on diary cards (0-3 scale) as well as peak flow measurements in am/pm for a period of 2 weeks prior to budesonide administration
(control data) and until completion of study. Only 12 (mean age: 9 years) of the initial patients were able to properly keep a diary and scheduled visits for a period of 15 weeks.

Results: Data allowed comparison between pre- and posttreatment
symptoms/signs scores and PF values. After 3 weeks treatment with budesonide, statistically significant improvements were shown for all parameters, except for PF, whose minor improvements did not reach statistical significance.

Conclusions: Budesonide CFC 400 µg administered once a day seems effective in control of asthma signs/symptoms within study design. Confirmation of the above findings in larger groups of patients, treated similarly and for longer periods of time, seems justified. A simple cost-effective intervention, analogous conceptually to the proven successful oral rehydration therapies for diarrhea in public health, should be considered in third world countries with high urban asthma prevalence.

Key words: children, asthma, third world, approach, cost-effectiveness.