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1.
Respirar (Ciudad Autón. B. Aires) ; 16(3): 245-254, Septiembre 2024.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1570574

ABSTRACT

Introducción: Los objetivos del control del asma son prevenir la aparición de síntomas y reducir el riesgo de exacerbaciones y mortalidad mediante educación médica, técnica inhalatoria, adherencia a medicación controladora e indicación de planes de acción (PA); pero los pacientes enfrentan exacerbaciones de diversa gravedad. Objetivos: El objetivo principal del estudio SABINA EMERGENCIAS fue describir la forma en que los pacientes concurren al servicio de emergencias (SE), considerando la frecuencia y uso de medicación de rescate. Objetivos secundarios: consultas al SE; uso de corticoides sistémicos (CS), agonistas beta-2 de acción corta (SABA) y tratamiento controlador; disponibilidad de PA. Material y Métodos: Estudio transversal, observacional, descriptivo, en cuatro hospitales del área metropolitana de Buenos Aires en adultos con asma. Resultados: n=323 (edad: 43,7±16,8 años; mujeres: 66,6%): 61,3% no eran seguidos por especialistas; 90,1% utilizaron SABA como rescate (mediana:10 inhalaciones; rango 0-100) la semana previa; 75,9% tuvieron ≥1 consulta al SE el año previo (mediana:2 [0-100]); 29,4% habían sido hospitalizados; 59,1% recibieron ≥1 ciclo de CS; mediana de consumo de SABA: 3 envases/año (0-23); 51,7% habían utilizado ≥3 envases; 30% no empleaban tratamiento de mantenimiento (23% usaba SABA); 75,9% no efectuaban terapia regular de mantenimiento; 77,1% no contaban con PA. Conclusión: Una reducida proporción de pacientes asmáticos que concurren al SE son seguidos por médicos especialistas, con alto consumo y elevada frecuencia de aplicación de SABA como rescate y baja adherencia al tratamiento de mantenimiento. Se remarca la necesidad de optimizar el manejo, con énfasis en la derivación al especialista, adherencia al tratamiento y prescripción de PA.


Introduction: The objectives of asthma control are to prevent the onset of symptoms and reduce the risk of exacerbations and mortality through medical education, inhaler technique, adherence to controller medication and indication of action plans (AP); but patients experience exacerbations of varying severity. Objective: The main objective of the SABINA EMERGENCIAS study was to describe how patients attend the emergency department (ED), considering the frequency and use of rescue medication. Secondary objectives: ED visits; use of systemic corticosteroids (SC), short-acting beta-2 agonists (SABA) and controller therapy; availability of AP. Methods: Cross-sectional, observational, descriptive study in 4 hospitals in the metropolitan area of Buenos Aires in adults with asthma. Results: n=323 (age:43.7±16.8 years; women:66.6%): 61.3% were not followed by specialists; 90.1% used SABA as rescue medication (median:10 puffs; range 0-100) the previous week; 75.9% had ≥1 visit to the ES the previous year (median: 2 [0-100]); 29.4% had been hospitalized; 59.1% received ≥1 cycle of CS; median SABA consumption: 3 cannisters/year (0-23); 51.7% had used ≥3 cannisters; 30% did not use maintenance therapy (23% used SABA); 75.9% did not perform regular maintenance therapy; 77.1% did not have an AP. Conclusion: A small proportion of asthmatic patients attending the ES are followed by specialist physicians, with high consumption and high frequency of SABA application as rescue medication and low adherence to maintenance treatment. The need to optimize management is highlighted, with emphasis on referral to specialists, adherence to treatment and prescription of APs.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Asthma/diagnosis , Emergency Service, Hospital , Symptom Flare Up , Argentina , Quality of Life , Bronchodilator Agents , Surveys and Questionnaires , Adrenal Cortex Hormones , Dyspnea , Education, Medical , Treatment Adherence and Compliance
2.
Vet. zootec ; 31: 1-20, 2024. ilus, tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1552920

ABSTRACT

As doenças respiratórias são consideradas doenças graves e potencialmente deletérias. Dentre elas, a asma e a bronquite crônica caracterizam-se como disfunções respiratórias que ameaçam constantemente o bem-estar dos gatos. Os pacientes apresentam mudanças na estrutura respiratória, reversíveis ou não, devido ao extenso quadro inflamatório, que obstrui o fluxo de ar, permite o acúmulo de muco e reduz o lúmen das vias aéreas. Os gatos acometidos apresentam tosses, respiração ruidosa, dispneia, e, em muitos casos, assumem posição ortopneica. O diagnóstico pode ser obtido através de exames de rotina, uso de radiografias torácicas, coleta e análise de fluidos broncoalveolares, e testes alergênicos. O manejo terapêutico baseia-se, combinado ou não, no uso de drogas como broncodilatadores, antiinflamatórios esteroidais, mucolíticos, antibióticos, agentes inalatórios e mudanças ambientais com objetivo de redução da exposição aos possíveis agentes alergênicos responsáveis pela incitação do quadro respiratório.


Respiratory diseases are considered serious and potentially harmful diseases. Among them, asthma and chronic bronchitis are characterized as respiratory disorders that constantly threaten the well-being of cats. The patients present changes in the respiratory structure, reversible or not, due to the extensive inflammatory condition, which obstructs the air flow, allows the accumulation of mucus and reduces the lumen of the airways. Affected cats have coughs, wheezing, dyspnoea, and in many cases assume an orthopneic position. The diagnosis can be obtained through routine exams, use of chest x-rays, collection and analysis of bronchoalveolar fluids, and allergen testing. Therapeutic management is based, combined or not, on the use of drugs such as bronchodilators, steroidal anti-inflammatory, mucolytics, antibiotics, inhalational agents and environmental changes in order to reduce exposure to possible allergenic agents responsible for the incitation of the respiratory condition.


Las enfermedades respiratorias son consideradas enfermedades graves y potencialmente dañinas. Entre ellos, el asma y la bronquitis crónica se caracterizan por ser trastornos respiratorios que amenazan constantemente el bienestar de los gatos. Los pacientes presentan cambios en la estructura respiratoria, reversibles o no debido al cuadro inflamatorio extenso, que obstruye el flujo de aire, permite la acumulación de moco y reduce la luz de las vías respiratorias. Los gatos afectados presentan tos, respiración ruidosa, disnea y, en muchos casos, adoptan una posición ortopneica. El diagnóstico se puede obtener mediante exámenes de rutina, uso de radiografías de tórax, recolección y análisis de líquidos broncoalveolares, y pruebas de alérgenos. El manejo terapéutico se basa, combinado o no, en el uso de fármacos como broncodilatadores, antiinflamatorios esteroides, mucolíticos, antibióticos, agentes inhalatorios y cambios ambientales con el objetivo de reducir la exposición a posibles agentes alergénicos responsables de incitar la afección respiratoria.


Subject(s)
Animals , Cats , Asthma/pathology , Bronchitis/pathology , Bronchodilator Agents/therapeutic use , Airway Obstruction/veterinary , Anti-Inflammatory Agents/therapeutic use
3.
Rev. cuba. med ; 62(1)mar. 2023.
Article in Spanish | LILACS, CUMED | ID: biblio-1450001

ABSTRACT

Introducción: Los pacientes mayores de 60 años suelen tener un asma más grave, menos controlada y peor función pulmonar que los jóvenes. Objetivo: Caracterizar a los pacientes mayores de 60 años con asma grave no controlada. Métodos: Se realizó un estudio observacional descriptivo, prospectivo y transversal en el Hospital Neumológico Benéfico Jurídico en el período comprendido entre enero del 2020 y enero del 2021. Resultados: Edad predominante 60-69 años (76,5 por ciento). Mujeres (61,8 por ciento). Antecedentes familiares de asma o alergia (64,7 por ciento). Asma de larga evolución (85,3 por ciento). Asma asociada a obesidad y mal control (55,9 por ciento). Reversibilidad del VEF1 (volumen espiratorio forzado en el primer segundo) después de la aplicación del broncodilatador (26,5 por ciento). Adherencia al tratamiento (61,8 por ciento). El riesgo futuro de resultados adversos fue bajo en el 58,8 por ciento, es el principal factor, el mal control actual en el 100 por ciento. Conclusiones: El asma grave no controlada en mayores de 60 años es más frecuente en el sexo femenino, los pacientes suelen tener antecedentes familiares de asma o alergia, presentar asma de larga evolución, obesidad asociada al mal control, disminución de la reversibilidad del VEF1 con la aplicación del broncodilatador, mala adherencia al tratamiento y el mal control actual como riesgo futuro de la enfermedad(AU)


Introduction: Patients older than 60 years tend to have more severe, less controlled asthma and worse lung function than younger people. Objective: To characterize patients older than 60 years with severe uncontrolled asthma. Methods: A descriptive, prospective and cross-sectional observational study was carried out at Benéfico Jurídico Pneumological Hospital from January 2020 to January 2021. Results: The age group 60-69 years (76.5percent) predominated. Women also predominated (61.8percent), as well as family history of asthma or allergy (64.7percent), and long-standing asthma (85.3percent). Asthma associated with obesity and poor control was 55.9percent. The reversibility of the forced expiratory volume in the first second (FEV1) after the application of the bronchodilator was 26.5percent. The adherence to treatment was 61.8percent. The future risk of adverse results was low (58.8percent), which is the main factor, the current poor control in 100percent. Conclusions: Severe uncontrolled asthma in people over 60 years of age is more frequent in women, patients usually have family history of asthma or allergy, there is long-term asthma. It was observed that obesity is associated with poor control, the decreased FEV1 reversibility with the application of the bronchodilator, poor adherence to treatment and poor current control as a future risk of the disease(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Asthma/epidemiology , Bronchodilator Agents/adverse effects , Medical Assistance , Obesity/epidemiology , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective Studies , Observational Study
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; (12): 427-432, 2023.
Article in Chinese | WPRIM | ID: wpr-969906

ABSTRACT

To observe the symptom control, pulmonary function changes and safety of use of omalizumab in patients with moderate to severe allergic asthma for 1 year. A small sample self-controlled study before and after treatment was conducted to retrospective analysis involved 17 patients with moderate to severe asthma who received omalizumab therapy for 12 months in Peking University People's Hospital and Beijing Jishuitan Hospital from January 2020 to December 2021. The clinical symptoms and pulmonary function changes were compared before treatment, after 6 months and 12 months of treatment, and the clinical data such as the use of other drugs and adverse reactions were observed. Statistical data are collected using the median method, and non-parametric paired Wilcoxon analysis was used for pairwise comparison. Before treatment with omalizumab, the patients' FeNO value was 79(58, 121) ppb, and the total serum IgE was 228(150.5, 345.5) IU/ml. After 6 months of omalizumab therapy, the percent predicted value of the forced expiratory volume in 1 second (FEV1%) before inhaled bronchodilator increased from 86.70(82.65, 91.35)% to 90.90(87.70, 95.85)% (Z=-3.626, P<0.001). The FEV1%pred after inhaled bronchodilator increased from 92.60(85.75, 96.90)% to 94.30(89.95, 98.15)% (Z=-2.178, P=0.029). The absolute value of improvement in FEV1 decreased from 150(95, 210)ml to 50(20, 125) ml (Z=-2.796, P=0.005), and the improvement rate decreased from 6.60(3.80, 7.85)% to 1.90(0.75, 4.85)% (Z=-2.922, P=0.003). After 12 months of treatment, the FEV1%pred before inhaled bronchodilator further increased to 92.90 (91.60, 98.15)% (Z=-3.575, -2.818, and P<0.001, 0.005 compared with before treatment and 6 months after treatment, respectively). The FEV1%pred after inhaled bronchodilator increased to 96.80 (91.90, 101.25)% (Z=-3.622, -1.638, and P<0.001, 0.008 compared with before treatment and after 6 months of treatment, respectively). The absolute value of improvement in FEV1 was 70 (35, 120) ml (P=0.004, 0.842 before treatment and 6 months after treatment, respectively), and the improvement rate was 3.0(1.0, 5.0)% (Z=-2.960, -0.166, and P=0.003, 0.868, compared with before treatment and after 6 months of treatment, respectively). After 12 months of treatment, ACT increased from 13 (10.5, 18) before treatment to 24 (23, 25) (Z=-3.626,P<0.001). Only 1 patient experienced an injection site skin reaction during treatment. Therefore, after 6 months and 12 months of treatment with omalizumab, the patient's lung function improved and symptoms were relieved, which could effectively prevent the acute exacerbation of asthma. Omalizumab treatment is safe and well tolerated, and no effect on blood pressure and blood glucose was observed.


Subject(s)
Humans , Omalizumab/therapeutic use , Anti-Asthmatic Agents/therapeutic use , Retrospective Studies , Bronchodilator Agents/therapeutic use , Asthma/diagnosis , Treatment Outcome
5.
Neumol. pediátr. (En línea) ; 18(1): 12-13, 2023. ilus
Article in Spanish | LILACS | ID: biblio-1442719

ABSTRACT

Tradicionalmente se ha definido la respuesta broncodilatadora (RB) positiva como una mejoría ≥ de 12 % del VEF1. En el año 2022 se publica una Guía sobre la interpretación de función la pulmonar de la Sociedad Americana de Tórax y la Sociedad Europea de Enfermedades Respiratorias, donde se propone que la RB debe expresarse como el cambio porcentual del VEF1 en relación con el VEF1 predicho y que un cambio ≥ 10 % indica una RB positiva. Las sociedades científicas en Chile están evaluando estas recomendaciones para decidir su adecuada implementación en pediatría.


Traditionally, a positive bronchodilator (BR) response has been defined as a ≥ 12% improvement in FEV1. In the year 2022, a Guide on the interpretation of pulmonary function of the American Thoracic Society and the European Society of Respiratory Diseases was published, where it was proposed that BR should be expressed as the percent change in FEV1 relative to predicted FEV1 and that a change ≥ 10% indicates a positive BR. Scientific societies in Chile are evaluating these recommendations to decide their proper implementation in pediatrics.


Subject(s)
Humans , Child , Respiratory Tract Diseases/physiopathology , Spirometry , Bronchodilator Agents/pharmacology , Forced Expiratory Volume
6.
Acta Medica Philippina ; : 12-24, 2023.
Article in English | WPRIM | ID: wpr-998835

ABSTRACT

Objectives@#As asthma is a chronic inflammatory disease of the airways, anti-inflammatory treatment should be positioned at the forefront of guideline-directed asthma care. However, patients tend to rely on short-acting β2-agonists (SABAs) for rapid-onset symptom relief. The impact of SABA overuse and associated clinical outcomes have been investigated extensively in Europe and North America. Limited data are available from countries in Asia, Africa, Latin America, and the Middle East. The SABA use IN Asthma (SABINA) III program, a large multicountry, observational study, was undertaken to describe the global extent of SABA use and its potential contribution to suboptimal disease control. As part of the SABINA III study, we aimed to characterize SABA prescription collection and asthma-related clinical outcomes among patients in the Philippines.@*Methods@#This nationwide, observational, cross-sectional, SABINA III study included patients (aged ≥12 years) with a documented asthma diagnosis recruited between May 2019 and January 2020 from 10 sites in the Philippines. Demographics, disease characteristics and prescribed asthma treatments, including SABA and inhaled corticosteroids (ICS) in the 12 months preceding study start, were recorded during a single visit, and transcribed onto an electronic case report form (eCRF). Patients were classified by investigator-defined asthma severity, guided by the 2017 Global Initiative for Asthma (GINA) report and practice type, either primary or pulmonary medicine specialist care.@*Results@#Of 245 patients analyzed, 63.3% were classified as having moderate-to-severe asthma (GINA steps 3−5), and most patients (63.3%) were enrolled by pulmonary medicine specialists. Overall, 33.1% (n=81) of patients had experienced ≥1 severe exacerbation in the previous 12 months and 18.4% (n=45) of patients had uncontrolled asthma. With respect to asthma treatments, a total of 6.5% (n=16), 40.4% (n=99), and 2.4% (n=6) of patients were prescribed SABA monotherapy, SABA in addition to maintenance therapy, and ICS, respectively, in the 12 months prior to their study visit. Most patients (n=156 [63.7%]) received prescriptions of fixed-dose combina-tions of ICS and long-acting β2-agonists. SABA over-prescription, defined as ≥3 SABA canister prescriptions per year, was observed in 10.6% (n=21) of patients. Additionally, 25.6% (n=23) of patients classified as having mild asthma were prescribed either nebulized SABA (n=17) or oral SABA (n=6). Nearly one-third of patients (n=75 [30.6%]) had purchased over-the-counter (OTC) SABA, and 46.9% (n=115) were prescribed antibiotics.@*Conclusions@#In this SABINA III Philippines study cohort, more than 10% of patients were over-prescribed SABA canisters. Additionally, prescriptions for oral or nebulized SABA, the purchase of non-prescription (OTC) SABA, and the high percentage of prescriptions for antibiotics warrant country-wide improvements in asthma care and management.


Subject(s)
Asthma , Bronchodilator Agents , Philippines , Prescriptions
7.
Rev. chil. enferm. respir ; Rev. chil. enferm. respir;39(3): 226-232, 2023. tab, graf
Article in Spanish | LILACS | ID: biblio-1521831

ABSTRACT

El asma se caracteriza por su impacto deletéreo que incluye gran coste económico para el sistema de salud. En pacientes con asma mal controlada a pesar del tratamiento, se propone un régimen de mantenimiento con corticoides inhalados y formoterol. El objetivo del presente estudio observacional retrospectivo fue evaluar las modificaciones espirométricas tras el cambio del medicamento controlador en pacientes con asma moderada a severa asistidos en el Hospital Clínico de Magallanes de Punta Arenas, así como también cuantificar la modificación en el número de exacerbaciones graves (consulta a un servicio de urgencia y/u hospitalización por asma). Participaron 61 adultos con asma moderada a severa (mediana de edad: 60 años [rango: 21-87], mujeres: 69,4%; comorbilidad atópica/alérgica: 79%; otras comorbilidades: 46,8%) en los que se cambió el tratamiento con fluticasona/salmeterol 250/25 μg por budesónida/formoterol 160/4,5 μg. No se observaron cambios significativos en los índices espirométricos tras el cambio. Con el tratamiento inicial, el 46,9% presentó ≥ 1 visita a urgencias (total: 50 consultas). Tras el cambio por budesonida/formoterol, el 21% requirió al menos una visita a urgencias (total: 14 consultas; p < 0,01). La proporción de pacientes con ≥ 2 consultas a urgencias fue de 19,7% con el tratamiento basal y de 1,6% tras el cambio a budesonida/formoterol (p < 0,01). No se observaron diferencias significativas en la cantidad de hospitalizaciones. En este estudio del mundo real de pacientes con asma moderada a grave, el cambio del tratamiento a budesonida/formoterol se asoció con reducción significativa de las consultas a urgencias, a pesar de no detectarse cambios de significación estadística en los índices espirométricos habituales.


Asthma is characterized by its deleterious impact, including a high cost to the healthcare system. In patients with poorly controlled asthma despite treatment, a maintenance regimen of inhaled corticosteroids and formoterol is proposed. The aim of this retrospective, observational study was to evaluate the spirometric changes after switching the controller medication in patients with moderate to severe asthma attended in our institution ("Hospital Clínico de Magallanes"), as well as the variation in the number of severe exacerbations (consultation to an emergency department and/or hospitalization for asthma). Sixty-one adults with moderate to severe asthma (median age: 60 years-old [range: 21-87], women: 69.4%; atopic/allergic comorbidity: 79%; other comorbidities: 46.8%) in whom treatment with fluticasone/salmeterol 250/25 μg was switched to budesonide/formoterol 160/4.5 μg participated in our study. No significant changes in spirometric parameters were observed after the replacement treatment. With the initial treatment, 46.9% patients presented ≥ 1 visit to the emergency department (total: 50 visits). After the switch to budesonide/formoterol, 21% required at least one emergency department visit (total: 14 consultations; p < 0.01). The proportion of patients with ≥ 2 emergency department visits was 19.7% with baseline treatment and 1.6% after switching to budesonide/formoterol (p < 0.01). No significant differences were observed in the number of hospitalizations. In this real-world study of moderate to severe asthma patients, switching to budesonide/formoterol was associated with a significant reduction in emergency department visits, despite no statistically significant changes in the usual spirometric parameters.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Asthma/drug therapy , Spirometry , Budesonide/administration & dosage , Formoterol Fumarate/administration & dosage , Bronchodilator Agents/administration & dosage , Drug Administration Schedule , Forced Expiratory Volume , Retrospective Studies , Drug Therapy, Combination , Fluticasone-Salmeterol Drug Combination/administration & dosage
8.
Braz. j. otorhinolaryngol. (Impr.) ; Braz. j. otorhinolaryngol. (Impr.);88(2): 204-211, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1374713

ABSTRACT

Abstract Introduction: General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries. Objective: The purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma. Methods: Twenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO2/FiO2 ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied. Results: Among twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56±33.5min vs. 66.7±15.7min; p = 0.005). The change in lung ultrasound score significantly correlated with change in PaO2/FiO2 ratio (r = −0.56, p = 0.03). Elevated total leukocyte count >8200 ΜL and serum lactate >2.1 mmoL/L also predicted prolonged postoperative mechanical ventilation. Conclusion: This preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.


Resumo Introdução: A anestesia geral causa atelectasia pulmonar poucos minutos após sua indução. Isso pode ter um impacto significativo no resultado pós-operatório de pacientes com câncer submetidos a cirurgias reconstrutivas prolongadas. Objetivo: Avaliar o impacto das atelectasias perioperatórias detectadas por ultrassonografia na necessidade de suplementação pós-operatória de oxigênio, terapia broncodilatadora e fisioterapia respiratória assistida em pacientes com carcinoma de cabeça e pescoço submetidos a cirurgias com uso de retalho livre. Método: Foram submetidos a avaliações ultrassonográficas pulmonares bilaterais antes e após a cirurgia 28 pacientes com câncer de cabeça e pescoço. Os escores de ultrassonografia pulmonar, lactato sérico, razão PaO2/FiO2 foram medidos no início e no fim da cirurgia. Os pacientes foram avaliados na posição supina e o número de linhas B confluentes e únicas foi observado. Esses valores foram correlacionados com a necessidade de oxigenoterapia, necessidade de broncodilatadores e tempo total de desmame para predizer o resultado pós-operatório. Outros fatores que afetam o desmame também foram estudados. Resultados: Entre os 28 pacientes, sete apresentaram escore médio de ultrassonografia pulmonar ≥ 10,5, que se correlacionou com o tempo de desmame prolongado (144,56 ± 33,5 minutos vs. 66,7 ± 15,7 minutos; p = 0,005). A mudança no escore de ultrassonografia pulmonar correlacionou-se significantemente com a mudança na razão PaO2/FiO2 (r = −0,56, p = 0,03). A contagem total elevada de leucócitos > 8200 uLe o nível de lactato sérico >2,1 mmoL/L também previram ventilação mecânica pós-operatória prolongada. Conclusão: Este estudo preliminar detectou um nível significante de atelectasia perioperatória com ultrassonografia pulmonar no local de atendimento em pacientes com câncer de cabeça e pescoço submetidos a reconstruções cirúrgicas de longa duração. Escores mais altos de ultrassonografia pulmonar enfatizaram a necessidade de nebulizações broncodilatadoras frequentes e fisioterapia respiratória assistida e foram associados a desmame tardio. Propomos avaliações ultrassonográficas pulmonares mais frequentes no local de atendimento e o uso de manobras de recrutamento para reduzir o impacto das atelectasias pulmonares perioperatórias.


Subject(s)
Humans , Pulmonary Atelectasis/etiology , Pulmonary Atelectasis/therapy , Pulmonary Atelectasis/diagnostic imaging , Plastic Surgery Procedures/adverse effects , Free Tissue Flaps , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/diagnostic imaging , Postoperative Complications , Bronchodilator Agents , Ultrasonography/adverse effects , Lactates , Lung
9.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1359159

ABSTRACT

Tecnologia: Tripla terapia broncodilatadora (vilanterol/ umeclidínio/ fluticasona, formoterol/ glicopirrônio/ beclometasona) e dupla terapia. Indicação: Tratamento de doença pulmonar obstrutiva crônica (DPOC), formas grave e muito grave. Pergunta: Há diferenças de efeito nos principais desfechos de eficácia e segurança entre a tripla terapia broncodilatadora e as duplas terapias no tratamento de pacientes com DPOC, formas grave e muito grave? Métodos: Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foram selecionadas e incluídas 2 revisões sistemáticas. Conclusão: A tripla terapia broncodilatadora era mais eficaz que a dupla terapia para reduzir a taxa anual de exacerbações moderadas a severas, mas não tinha superioridade para obter ganhos clínicos em outros desfechos (volume expiratório forçado no primeiro segundo, qualidade de vida, índice de dispneia, mortalidade geral, mortalidade respiratória), exceto que a tripla terapia era superior à dupla terapia com agonistas beta-2/ antagonistas antimuscarínicos e similar à dupla terapia com agonistas beta-2/ corticoesteróides inalatórios para reduzir mortalidade. A tripla terapia tinha perfil de segurança similar à dupla terapia, com mesmo risco para eventos adversos e eventos adversos graves. A tripla terapia tinha maior risco para pneumonias que a dupla terapia com agonistas beta-2/ antagonistas antimuscarínicos


Technology: Triple bronchodilator therapy (vilanterol/ umeclidinium/ fluticasone, formoterol/ glycopyrronium/ beclomethasone) and dual therapy. Indication: Treatment of chronic obstructive pulmonary disease (COPD), severe and very severe forms. Question: Are there differences in effects of efficacy and safety outcomes between triple bronchodilator therapy and dual therapies in treating patients with severe and very severe forms of COPD? Methods: Rapid review of evidence (overview) from systematic reviews, with a bibliographic search in the PUBMED database, using a structured strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (Methodological Quality Assessment of Systematic Reviews). Results: Two systematic reviews were selected and included. Conclusion: Triple bronchodilator therapy was more effective than dual therapy in reducing the annual rate of moderate to severe exacerbations, but had no superiority for clinical gains in other outcomes (forced expiratory volume in first second, quality of life, dyspnea index, general mortality, respiratory mortality), except that, for reducing mortality, triple therapy was superior to dual therapy with beta-2 agonists/ antimuscarinic antimuscarinics and similar to dual therapy with beta 2 agonists/ inhaled corticosteroids. The triple therapy had a similar safety profile to dual therapy, with the same risk for adverse events and serious adverse events. The triple therapy had a higher risk for pneumonia than a dual therapy with beta-2 agonists/ antimuscarinic antagonists


Subject(s)
Humans , Bronchodilator Agents/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Beclomethasone/therapeutic use , Evidence-Based Medicine , Formoterol Fumarate/therapeutic use , Fluticasone/therapeutic use , Glycopyrrolate/therapeutic use
10.
Arch. pediatr. Urug ; 92(2): e305, dic. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278305

ABSTRACT

Las afecciones respiratorias agudas son la primera causa de consulta e ingreso hospitalario en los meses de invierno, y entre ellas el asma ocupa un lugar preponderante. El salbutamol es un broncodilatador con eficacia demostrada en las exacerbaciones y se utiliza de primera línea en el tratamiento. El objetivo de la presente comunicación es analizar dos casos clínicos de niños asmáticos que presentaron efectos adversos al salbutamol y requirieron el ingreso en la Unidad de Terapia Intensiva. Se propone revisar los efectos adversos del salbutamol empleado en crisis asmáticas y analizar las alternativas terapéuticas en esta enfermedad. Los síntomas de los efectos secundarios pueden confundirse con los causados por la propia enfermedad, por lo que puede usarse el fármaco de modo excesivo y es importante conocer el perfil posológico y caracterizar los posibles efectos secundarios en los pacientes para usar de manera racional y segura este medicamento.


Acute respiratory conditions are the first cause of consultation and hospital admission in the Winter months, being asthma the most important. Salbutamol is a bronchodilator with proven efficacy in exacerbations used first-line in treatment. The objective of this paper is to analyze two clinical cases of asthmatic children who presented adverse effects to salbutamol and required admission to the Intensive Care Unit. It is proposed to review the adverse effects of salbutamol used in asthmatic crises and to analyze therapeutic alternatives in this disease. Symptoms of side effects can be confused with those caused by the disease itself, determining the excessive use of this drug, thus, it is important to know the dosage profile and characterize the possible side effects to make rational and safe use of this drug.


As doenças respiratórias agudas são a primeira causa de consultas e internações nos meses de inverno e a asma ocupa é a mais importante. O salbutamol é um broncodilatador com eficácia comprovada nas exacerbações e é usado como tratamento de primeira linha. O objetivo desta comunicação é analisar dois casos clínicos de crianças asmáticas que apresentaram efeitos adversos ao salbutamol e necessitaram de internação em Unidade de Terapia Intensiva. Propõe-se revisar os efeitos adversos do salbutamol utilizado na crise asmática e analisar as alternativas terapêuticas nessa doença. Os sintomas de efeitos colaterais podem ser confundidos com os causados pela própria doença, determinando o uso excessivo desse medicamento, sendo importante conhecer o perfil posológico e caracterizar os possíveis efeitos colaterais nos pacientes para fazer um uso racional e seguro desse medicamento.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Acidosis, Lactic , Bronchodilator Agents/adverse effects , Albuterol/adverse effects , Hyperglycemia/chemically induced , Hypokalemia/chemically induced , Psychomotor Agitation/etiology , Recurrence , Asthma/drug therapy , Tachycardia/chemically induced , Tremor/chemically induced , Hallucinations/chemically induced
11.
Acta pediátr. hondu ; 12(1): 1237-1240, abr.-sep. 2021. ilus
Article in Spanish | LILACS, BIMENA | ID: biblio-1381266

ABSTRACT

En los ámbitos científico e institucional existe controversia sobre el manejo idóneo de la bron- quiolitis en pacientes pediátricos. El objetivo de este trabajo es valorar el nivel de evidencia cientí- fica que existe sobre el manejo de la bronquiolitis para determinar si las recomendaciones actuales son o no adecuadas. Se realizó una revisión sis- temática de artículos científicos consultando di- versas bases de datos, sin restricción de fecha, en los idiomas español e inglés. Se incluyó literatura gris mediante búsqueda manual. No se hicieron restricciones respecto al tipo de estudio. Se re- visaron los resúmenes y en los casos necesarios los artículos completos, teniéndose en cuenta fi- nalmente todos los artículos que incluían apor- tes sobre el manejo adecuado de la bronquiolitis. Como resultado la mayoría de las recomenda- ciones realizadas por las sociedades fueron a tra- vés de guías de práctica clínica o artículos de opinión, concluyendo que no se cuenta con un esquema de tratamiento adecuado para tratar la bronquiolitis aguda, existiendo un manejo erróneo con el uso de esteroides y antibióticos, mientras que uno de los tratamiento más viables y costo efectivos queda en el olvido como es la solución hipertónica al 3%, la cual ha demostra- do reducción de la estancia hospitalaria...(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Bronchitis/diagnosis , Bronchodilator Agents , Steroids , Nebulizers and Vaporizers , Hypertonic Solutions
12.
Arch. argent. pediatr ; 119(4): S123-S158, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281031

ABSTRACT

En 1995 se publicó en Archivos Argentinos de Pediatría la primera "Guía de diagnóstico y tratamiento: asma bronquial en niños". En 2007 y 2016 se realizaron actualizaciones. Luego de 5 años se presentan los nuevos contenidos. Las modificaciones más relevantes, aunque no las únicas, se observan en las estrategias terapéuticas. En esta versión se estratifica el tratamiento en "niveles" (1 a 5). El paradigma de cambio en el tratamiento crónico del asma consiste en erradicar la prescripción de broncodilatadores (salbutamol) a demanda, por un lado, y por otro, aparece la opción de tratamiento combinado intermitente con corticoides inhalados y broncodilatadores acción prolongada (LABA) para las formas más leves (niveles 1 y 2), en niños de 12 años o mayores. Aún no se dispone de suficiente evidencia que avale estas opciones en menores de 12 años, por lo que se mantienen las normativas previas vigentes en este grupo. Para más detalles, sugerimos la lectura del documento completo


In 1995, the first Guideline on Diagnosis and Treatment for Childhood Asthma was published in Archivos Argentinos de Pediatría. Updates were made in 2007 and 2016. After 5 years, the new contents are presented. The most relevant modifications, although not the only ones, are observed in therapeutic strategies. In this version, treatment is stratified into "levels" (1 to 5). The current paradigm of change in chronic asthma treatment consists in eradicating the prescription of bronchodilators (salbutamol) on demand. Besides that, the option of intermittent treatment with inhaled corticosteroids plus long-acting bronchodilators (LABA) appears for milder forms (levels 1 and 2) in children > 12 years old. There is still not enough evidence to support these options in < 12 years old maintaining the previous recommendations in this group. For more details we suggest reading the full document.


Subject(s)
Humans , Child , Asthma/diagnosis , Asthma/therapy , Bronchodilator Agents/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Anti-Inflammatory Agents/therapeutic use
13.
Cambios rev. méd ; 20(1): 74-79, 30 junio 2021.
Article in Spanish | LILACS | ID: biblio-1292925

ABSTRACT

INTRODUCCIÓN. Para el tratamiento farmacoterapéutico de enfermedades respi-ratorias, el uso de herramientas para abordar la vía inhalatoria es de elección por su mayor eficacia y menos efectos secundarios; registrar su adhesión y prevalencia es importante. OBJETIVO. Determinar el nivel y la prevalencia de adhesión al uso de inhaladores en pacientes con Asma y Enfermedad Pulmonar Obstructiva Cróni-ca. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 215 y muestra de 121 Historias Clínicas. Se aplicó el Test de Adhesión a Inhaladores, que consistió en dos cuestionarios complementarios: el de 10 ítems, que valoró el nivel de adhesión, y el de 12 que identificó el tipo de incumplimiento en pacientes de Consulta Externa de la Unidad Técnica de Neumología del Hospital de Especialidades Carlos Andrade Marín, periodo julio 2018 - enero 2019. La tabulación y análisis de datos se realizó con el programa Excel. RESULTADOS. La prevalencia de mala adhesión en asmáticos fue de 83,33% y en Enfermedad Pulmonar Obstructiva Crónica 13,33%. En cuanto al sexo, la prevalencia de mala adhesión fue de 15,28% en hombres y de 40,82% en mujeres, con una p<0,05. No se encontró diferencia significativa respecto a los niveles de instrucción. CONCLUSIÓN. La prevalencia de mala adhesión al uso de inhaladores en pacientes con Asma y Enfermedad Pulmonar Obstructiva Crónica fue alta sobre todo en los asmáticos.


INTRODUCTION. For respiratory diseases and their pharmacotherapeutic treatment, the use of tools to address the inhalation route is chosen due to its greater efficacy and fewer secondary effects; then record the adherence and prevalence is important. OBJECTIVE. To determine both level and prevalence of adherence to the use of inhalers in patients with Asthma and Chronic Obstructive Pulmonary Disease. MATE-RIALS AND METHODS. Cross-sectional analytical study. Population of 215 and sam-ple of 121 patients. The Inhaler Adherence Test was applied, which consisted of two complementary questionnaires: a 10-item questionnaire, which assessed the level of adherence, and a 12-item questionnaire that identified the type of non-compliance in patients of the Pneumology Technical Unit of the Hospital de Especialidades Carlos Andrade Marín, period July 2018 - January 2019. The tabulation and data analysis was performed with Microsoft Excel program. RESULTS. The prevalence of poor ad-herence in asthmatics was 83.33% and in Chronic Obstructive Pulmonary Disease was 13.3%. Regarding gender, the prevalence of poor adherence was 15.28% in men and 40.82% in women, with a p <0.05. No significant differences were found regarding the levels of instruction. CONCLUSION. The prevalence of poor adherence to the use of inhalers in patients with Asthma and Chronic Obstructive Pulmonary Disease was high, especially in asthmatics


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Respiratory Tract Diseases , Asthma , Nebulizers and Vaporizers , Pulmonary Medicine , Pulmonary Disease, Chronic Obstructive , Treatment Adherence and Compliance , Respiratory Therapy , Bronchodilator Agents , Medication Therapy Management , Medication Adherence , Dry Powder Inhalers
14.
Rev. cuba. med. mil ; 50(2): e1108, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1341420

ABSTRACT

Introducción: Existen pocas publicaciones relacionadas con las pruebas de esfuerzo cardiopulmonar de soldados heridos en combate, y las diversas complicaciones que puede ocasionar el trauma de guerra. Objetivo: Describir las variables cardiopulmonares en soldados con trauma torácico de guerra, sometidos a pruebas de esfuerzo. Método: Se realizó un estudio descriptivo, entre los años 2010 - 2016, en el Hospital Militar Central de Bogotá, D.C., Colombia. La población de estudio estuvo constituida por 27 pacientes con antecedente de trauma torácico derivado de la guerra, quienes fueron sometidos a pruebas de esfuerzo cardiopulmonar. Se exploran las variables edad, sexo, síntomas, consumo de oxígeno, variables cardiopulmonares medidas por espirometría, tipo de cirugía, trauma y arma. Resultados: El consumo de oxígeno pico medio ml/min fue 2 891,8 (DE: 621,86), consumo de oxígeno pico mL/kg/min 43,25 (DS: 9,72), capacidad vital forzada prebroncodilatador (L) 4,5 (DS: 1, 3) y posbroncodilatador (L) 4,3 (DS: 1,01). El análisis exploratorio encontró diferencias significativas entre quienes tenían heridas por arma de fuego de alta velocidad, y heridas por otros tipos de armas. Conclusión: En pacientes con antecedentes de trauma de guerra, el consumo de oxígeno pico ml/min, oxígeno pico mL/kg/min y capacidad vital forzada, es menor que en población sana; aparentemente, el tipo de herida por arma de fuego de alta velocidad afecta en mayor medida a estas variables evaluadas por las pruebas de esfuerzo cardiopulmonar(AU)


Introduction: There are few publications related to cardiopulmonary stress tests in soldiers wounded in combat, and the various complications cause war trauma. Objective: To describe the cardiopulmonary variables in patients with war thoracic trauma submitted to stress tests. Methods: A descriptive study was carried out between 2010 and 2016, at the Hospital Militar Central de Bogotá, D.C., Colombia. The study population consisted of 27 patients with a history of war-derived thoracic trauma, who were submitted to cardiopulmonary stress tests. The variables of age, sex, symptoms, oxygen consumption, cardiopulmonary variables measured by spirometry, type of surgery, trauma and weapon were explored. Results: A total of 27 participants were included. Mean oxygen consumption peak ml / min was 2 891,8 (SD: 621,86), oxygen consumption peak mL/kg/min 43,25 (DS: 9,72), forced vital capacity pre-bronchodilator (L) 4,5 (DS: 1, 3) and post-bronchodilator (L) 4,3 (DS: 1,01). Exploratory analysis found significant differences among those who had a high velocity firearm wounds against other types of weapons. Conclusions: In patients with a history of trauma, peak oxygen consumption ml / min, peak oxygen mL/kg/min and forced vital capacity is lower than in the healthy population; Apparently, the type of high-velocity firearm wound has a greater effect on these variables evaluated by cardiopulmonary stress tests(AU)


Subject(s)
Humans , Wounds, Gunshot , Bronchodilator Agents , Vital Capacity , Exercise Test , Military Personnel
15.
Rev. cuba. med ; 59(4): e1388, oct.-dic. 2020. tab
Article in Spanish | CUMED, LILACS | ID: biblio-1144502

ABSTRACT

Introducción: La obesidad está asociada al uso frecuente de medicación de rescate y padecer asma de mayor gravedad. Los obesos asmáticos tienen menor reactividad bronquial, sin embargo, existe información limitada sobre la magnitud de la reversibilidad aguda al broncodilatador (RAB). Objetivo: Evaluar la magnitud de respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos. Métodos: Se realizó un estudio descriptivo transversal con 49 pacientes asmáticos sobrepesos y obesos atendidos en consulta externa del Hospital Neumológico Benéfico Jurídico (enero 2017˗ enero 2018) y se constató mediante espirometría la respuesta aguda al broncodilatador. Resultados: Predominó la edad (40-59 años), mayor asociación de padecer asma, poca mejoría con la aplicación del broncodilatador. El sexo femenino (20-59 años) presentó mayor número que el masculino y menor reversibilidad al broncodilatador. Los pacientes con antecedentes patológicos familiares de asma o atopia representaron 73,5 por ciento del total. El 76,5 por ciento de los obesos no presentó mejoría con la aplicación del broncodilatador. Predominó la categoría de gravedad persistente moderada. Conclusiones: El sexo femenino tiene más riesgo de padecer asma y no tener mejoría al aplicar el broncodilatador. Los obesos mayores de 40 años tienen mayor riesgo de no presentar reversibilidad aguda al broncodilatador. Los antecedentes patológicos familiares de asma o atopia y personales de otras enfermedades no predisponen a menor reversibilidad aguda al broncodilatador. La gravedad del asma no influye en la reversibilidad aguda al broncodilatador(AU)


Introduction: Obesity is associated with the frequent use of rescue medication and suffering from more severe asthma. Obese asthmatics have less bronchial reactivity, however, there is limited information on the magnitude of acute bronchodilator reversibility. Objective: To assess the magnitude of the acute response to the bronchodilator in overweight and obese asthmatic patients. Methods: A cross-sectional descriptive study was carried out in 49 overweight and obese asthmatic patients seen in the outpatient clinic at Benéfico Jurídico Pneumologic Hospital from January 2017 to January 2018, and the acute response to bronchodilator was verified by spirometry. Results: Age predominated (40-59 years), greater association of suffering from asthma, and little improvement with the use of bronchodilator. The female sex (20-59 years) showed greater number than the male and less reversibility to bronchodilator. Patients with family pathological history of asthma or atopy represented 73.5 percent of the total. 76.5 percent of the obese did not show improvement with the use of bronchodilator. The category of moderate persistent severity predominated. Conclusions: The female sex has greater risk of suffering from asthma and has no improvement when applying bronchodilator. Obese individuals over 40 years of age have higher risk of not having acute reversibility to the bronchodilator. Family pathological history of asthma or atopy and personal history of other diseases do not predispose to less acute reversibility of bronchodilator. The severity of asthma does not influence acute reversibility to bronchodilator(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Bronchodilator Agents/therapeutic use , Dose-Response Relationship, Drug , Obesity/complications , Epidemiology, Descriptive , Cross-Sectional Studies
16.
Arq. Asma, Alerg. Imunol ; 4(2): 205-212, abr.jun.2020. ilus
Article in Portuguese | LILACS | ID: biblio-1381920

ABSTRACT

Introdução: A resposta ao broncodilatador (RBD) é frequentemente utilizada no apoio diagnóstico e na tomada de decisões terapêuticas em crianças com sintomas respiratórios. Entretanto, não há um consenso do ponto de corte da RBD em crianças pré-escolares. Objetivo: Avaliar RBD através da porcentagem e do deslocamento do escore Z do volume expiratório forçado em relação ao tempo (VEFt) de crianças asmáticas pré-escolares e propor novos pontos de corte. Métodos: Estudo transversal com 174 espirometrias de crianças asmáticas do ambulatório de alergia/imunologia de hospital de referência nacional no Rio de Janeiro (RJ), realizadas antes e após 15 minutos do uso do broncodilatador, expressas em escore Z e classificadas com padrão obstrutivo quando VEF1/capacidade vital (CV) < -1,645. O poder discriminatório para a RBD dos parâmetros espirométricos foi analisado por curvas ROC, e novos pontos de corte de RBD positiva foram calculados. Resultados: 23,4% apresentou padrão obstrutivo. O índice de Tiffeneau em crianças asmáticas com 3 anos é significativamente menor do que em crianças de 4-6 anos (p = 0,040). VEF0,75 apresentou maior poder discriminatório para RBD (variação > 11% e acurácia > 90%). Os pontos de corte encontrados para as variações percentuais na resposta positiva ao RBD foram 9,5 (VEF1); 13,8 (VEF0,75); 0,6 (escore Z VEF1) e 0,8 (escore Z VEF0,75). Tais pontos de corte refletem altos valores de sensibilidade e especificidade, com valores preditivos positivo e negativo variando em 90%. A conclusão pode ser estendida às variações nos escores Z de VEFt. Conclusões: O VEF0,75 > 11% apresentou melhor discriminação para RBD, demonstrando ser bom parâmetro para a clínica. Os valores encontrados no deslocamento do escore Z após o broncodilatador corroboram com a percepção de que seja um novo recurso para a interpretação da RBD.


Introduction: Bronchodilator response (BDR) is often used to support diagnostic and therapeutic decision-making in children with respiratory symptoms. However, there is no consensus on the BDR cutoff in preschool children. Objective: To evaluate BDR through the percentage and displacement of Z-scores for forced expiratory volume over time (FEVt) of preschool asthmatic children and to propose new cutoff points. Methods: Crosssectional study with 174 spirometry tests of asthmatic children from the allergy/immunology outpatient clinic of a national reference hospital in Rio de Janeiro, Brazil, performed before and after 15 min of bronchodilator use, expressed as Z-score and classified as obstructive pattern when forced expiratory volume in 1 minute (FEV1)/vital capacity (VC) < -1,645. The discriminatory power of spirometric parameters to assess BDR was analyzed by receiver operating characteristics (ROC) curves and new positive BDR cutoff points were calculated. Results: 23.4% presented obstructive pattern. The Tiffeneau index in asthmatic children aged 3 years is significantly lower than that found in children aged 4-6 years (p = 0.040). FEV0.75 presented higher discriminatory power for BDR (variation > 11% and accuracy > 90%). The cutoff points found for percentage changes in positive BDR were 9.5 (FEV1); 13.8 (FEV0.75); 0.6 (FEV1 Z-score) and 0.8 (FEV0.75 Z-score). Such cutoff points reflect high sensitivity and specificity values, with positive and negative predictive values ranging by 90%. The conclusion can be expanded to variations in FEVt Z-scores. Conclusions: FEV0.75 > 11% presented better discrimination for BDR, proving to be a good parameter for clinic practice. The values found in the Z-score displacement after use of bronchodilator corroborate the perception that it is a new resource for the interpretation of BDR.


Subject(s)
Humans , Child, Preschool , Child , Asthma , Bronchodilator Agents , Signs and Symptoms , Spirometry , Therapeutics , Vital Capacity , Forced Expiratory Volume , Cross-Cultural Comparison , Predictive Value of Tests , Diagnosis , Allergy and Immunology , Hypersensitivity , Methods
17.
Arq. Asma, Alerg. Imunol ; 4(1): 3-34, jan.mar.2020. ilus
Article in Portuguese | LILACS | ID: biblio-1381780

ABSTRACT

Asma grave é a asma que requer tratamento com altas doses de corticosteroide inalado associado a um segundo medicamento de controle (e/ou corticosteroide sistêmico) para impedir que se torne "descontrolada" ou permaneça "descontrolada" apesar do tratamento. Asma grave é considerada um subtipo de asma de difícil tratamento. A prevalência em crianças evidenciada pelo International Study of Asthma and Allergies in Childhood variou entre 3,8% e 6,9%. Existem diversos instrumentos para avaliação subjetiva, como diários de sintomas e questionários, bem como para avaliação objetiva com função pulmonar e avaliação da inflamação por escarro induzido, ou óxido nítrico exalado. A abordagem terapêutica varia desde doses altas de corticosteroide inalado e/ou oral, broncodilatadores de longa duração, antaganonistas de receptores muscarínicos, até os mais recentes imunobiológicos que bloqueiam a IgE ou IL-5.


Severe asthma is asthma that requires treatment with high doses of inhaled corticosteroids in combination with a second control drug (and/or a systemic corticosteroid) to prevent it from becoming "uncontrolled" or remaining "uncontrolled" despite treatment. Severe asthma is considered a difficult-to-treat asthma subtype. The prevalence in children found by the International Study of Asthma and Allergies in Childhood ranged from 3.8% to 6.9%. There are several instruments for subjective assessment, such as symptom diaries and questionnaires, as well as for objective assessment, including pulmonary function testing and evaluation of inflammation by induced sputum or exhaled nitric oxide. The therapeutic approach includes high doses of inhaled and/or oral corticosteroids, long-acting bronchodilators, muscarinic receptor antagonists, and the latest biologics that block IgE or IL-5.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Asthma , Societies, Medical , Bronchodilator Agents , Immunoglobulin E , Interleukin-5 , Adrenal Cortex Hormones , Respiratory Therapy , Signs and Symptoms , Sinusitis , Sputum , Therapeutics , Vocal Cords , Nebulizers and Vaporizers , Influenza Vaccines , Prevalence , Sleep Apnea, Obstructive , Pneumococcal Vaccines , Diagnosis, Differential , Allergy and Immunology , Rhinitis, Allergic , Omalizumab , Nitric Oxide , Obesity
18.
s.l; IETSI; 24 mar. 2020.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-1095866

ABSTRACT

CONTEXTO: El paciente con diagnóstico de COVID19 puede desarrollar dentro de sus complicaciones, compromiso pulmonar y neumonía, esto se traduce en síntomas como dificultad para respirar (distress respiratorio); de confirmarse el diagnóstico se debe realizar el manejo del cuadro causado por el virus SARS-CoV-2. En ese contexto se aplican medicamentos como los broncodilatadores. Gracias a su acción beta-2- agonista, llegan por vía inhalada a los pulmones y al músculo liso bronquial donde incrementa el diámetro del bronquio, lo que mejora la ventilación pulmonar. La vía de administración del medicamento puede realizarse mediante: (a) nebulización, utilizando una mascarilla que cubra la región de nariz y boca conectada a una solución que contenga el broncodilatador, donde la solución se convierte en aerosol lo que es impulsado hacia los pulmones con ayuda de un pequeño motor eléctrico o a baterías; (b) aerocámara, es un dispositivo que por un extremo cubre la región de nariz y boca, que tiene en el otro extremo una desembocadura que encaja en la boquilla de un inhalador (producto que contiene el medicamento precargado y dosificado en puffs). Ante el escenario de administrar un broncodilatador por vía inhalada mediante nebulización versus aerocámara en pacientes con COVID19, es que nos planteamos los siguientes escenarios: (a) determinar si existen diferencias en la eficacia de la administración de medicamento (como el broncodilatador) mediante nebulización versus aerocámara, en pacientes con diagnostico de COVID19 que se encuentren estables y (b) determinar si la nebulización del paciente con diagnóstico de COVID19 con medicamentos tipo broncodilatadores, incrementan el riesgo de contagio al personal de salud. EFICACIA DE LA ADMINISTRACIÓN DE MEDICAMENTO (COMO EL BRONCODILATADOR) MEDIANTE NEBULIZACIÓN VERSUS AEROCÁMARA, EN PACIENTES CON DIAGNÓSTICO DE COVID19 QUE SE ENCUENTREN ESTABLES: Encontramos que a la fecha (21 marzo 2020), no existen estudios comparativos que evalúen la eficacia de la administración de medicamento (como el broncodilatador) mediante nebulización versus aerocámara, en pacientes con diagnóstico de COVID19 que se encuentren estables. Sin embargo, como antecedente tomamos información de una revisión sistemática (RS) donde se hace la misma comparación en pacientes con diagnóstico de asma (Cates, Welsh, and Rowe 2013). En dicha RS, se tuvo como objetivo evaluar la efectividad comparada de las aerocámaras vs nebulizadores para administración de broncodilatadores (beta-2-agonistas) en pacientes con asma aguda. No se encontraron diferencias significativas entre la cantidad de hospitalizaciones en los pacientes atendidos con broncodilatador mediante aerocámara comparada con nebulización en niños (RR=0.71 IC95% 0.47 a 1.08) ni en adultos (RR=0.94 IC95% 0.61 a 1.43) con asma (que no llegaba a comprometer la vida del paciente). En el grupo de pacientes pediátricos, los que recibieron broncodilatador mediante aerocámara permanecieron en la emergencia durante menos tiempo (media tiempo de permanencia=33 minutos), comparado con los niños que recibieron el broncodilatador mediante nebulizador (media de tiempo= 103 minutos), (IC95% -43 a -24 minutos). Por ello, los autores concluyeron de manera indirecta, que la recuperación de la crisis asmática en el paciente pediátrico con el uso de aerocámara fue más rápida que cuando se utilizó el nebulizador. LA NEBULIZACIÓN DEL PACIENTE CON DIAGNÓSTICO DE COVID19 CON MEDICAMENTOS TIPO BRONCODILATADORES, INCREMENTAN EL RIESGO DE CONTAGIO AL PERSONAL DE SALUD: Guías de Práctica Clínica: La ANZICS, publicó el 16 de marzo 2020, recomendaciones sobre el manejo de aerosoles por parte del personal de salud y del uso de equipo de protección personal (EPP). La guía recomienda el uso de equipo de protección personal (EPP) contra infecciones trasmitidas por aerosoles como precaución en la atención de pacientes hospitalizados en la UCI, con diagnóstico de COVID19. Recomienda aplicar la mínima cantidad de procedimientos que generen aerosoles en el paciente con COVID19 en la UCI, como la intubación, extubación, broncoscopía, uso de oxígeno de alto flujo, ventilación no invasiva (con pobre sello hermético), realizar procedimientos en niños en llanto, traqueostomía, resucitación cardiopulmonar antes de la intubación; en habitaciones a presión negativa (de preferencia) o en habitaciones con aire ambiental. Manifiestan una recomendación en contra de la nebulización de medicamentos como broncodilatadores o solución salina. Además, se manifiestan en contra de utilizar el EPP que no cumpla con las recomendaciones señaladas. REPORTE DE CASO: Este es el reporte de un paciente en China que ejemplifica que, si se utiliza adecuadamente la EPP, los contagios a personal de salud se pueden minimizar. En este reporte se presenta un paciente con neumonía severa inicialmente con sospecha de COVID19, en quien se realizó los siguientes procedimientos: administración de oxígeno. por presentar dificultad respiratoria, intubación endotraqueal, laringoscopía y ventilación mecánica (VM) en la UCI. El paciente mejoró y a los 3 días salió de VM. La confirmación de que el paciente tenía COVID19 se obtuvo cuando se extubó al paciente. El punto de interés es que 41 profesionales de la salud estuvieron en contacto con el paciente durante procedimientos que generaron aerosoles, por lo menos durante 10 minutos y a una distancia de menos de 2 metros del paciente. Todos los trabajadores fueron aislados por dos semanas, tuvieron monitorización cercana de los síntomas, con realización de PCR para determinar infección. Sin embargo, ninguno de los 41 trabajadores de salud desarrolló síntomas y todos los PCR fueron negativos. Este reporte no pretende determinar que no existen contagios de pacientes con COVID19 a profesionales de la salud, sino ser un ejemplo, de que cuando se tienen las medidas de protección adecuada (EPP), el riesgo de contagio puede llegar a ser muy bajo. CONCLUSIONES: No se han encontrado estudios que evalúen si hay diferencias respecto a usar nebulizadores o aerocámaras en aliviar la dificultad respiratoria en pacientes con COVID-19. No obstante, se tiene evidencia científica proveniente de estudios en asma que muestra que, para el desenlace clínico de cantidad de hospitalizaciones en el contexto de pacientes con asma aguda, no existen diferencias entre usar nebulizadores o aerocámaras. Lo que sugiere que, desde la perspectiva del paciente, podría ser igual de beneficioso usar uno u otro método para mejorar los síntomas de dificultad respiratoria. Sin embargo, al ser el SARS-CoV-2 un agente infeccioso con alto índice de transmisión existiría un riesgo de infección para los trabajadores de salud si se nebuliza a estos pacientes debido a la alta dispersión de aerosol exhalado, por lo que sería recomendable preferir administrar el broncodilatador por aerocámara.


Subject(s)
Humans , Nebulizers and Vaporizers , Bronchodilator Agents/administration & dosage , Coronavirus Infections/therapy , Peru , Technology Assessment, Biomedical
19.
Arch. argent. pediatr ; 118(1): 38-43, 2020-02-00. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1095346

ABSTRACT

Introducción. El asma es una enfermedad inflamatoria crónica con alta prevalencia en pacientes pediátricos. Existen resultados contradictorios respecto al efecto de esta enfermedad en los índices de caries dental. El objetivo del estudio fue determinar la prevalencia de caries dental en pacientes pediátricos asmáticos con medicación inhalatoria. Población y métodos. Estudio de casos y controles cuya muestra estuvo conformada por pacientes pediátricos que acudieron al Centro Médico Naval "Cirujano Mayor Santiago Távara" de diciembre de 2014 a marzo de 2015. Se dividieron en dos grupos: el primero (casos), integrado por pacientes asmáticos que utilizaban inhaladores en su tratamiento; el segundo (controles), por pacientes sanos del mismo nosocomio. Se realizó una evaluación médica para determinar tipo, tiempo y frecuencia del tratamiento y un examen oral para determinar la prevalencia de caries dental y el índice de dientes cariados, perdidos y obturados (CPOD). Resultados. Se encontró que la prevalencia de caries dental en el grupo control fue del 34,2 %, mientras, en el grupo casos, fue del 28,3 % (p = 0,094). Con respecto al índice de caries dental, el grupo control presentó CPOD de 4,73 ± 0,32, y el grupo casos, de 3,98 ± 0,31 (p = 0,08). Sin embargo, se evidenció que, a mayor tiempo de tratamiento con los inhaladores, el índice CPOD aumentaba significativamente (p = 0,04).Conclusiones. La medicación inhalatoria no incrementa la prevalencia de caries dental en pacientes pediátricos asmáticos. Sin embargo, existe una relación directa entre la duración del tratamiento y la prevalencia de caries dental


Introduction. Asthma is a chronic inflammatory disease that is highly prevalent among pediatric patients. The results about the effect of asthma on the rate of dental caries are contradictory. The objective of this study was to determine the prevalence of dental caries in asthma pediatric patients using inhaled drugs. Population and methods. Case-control study in a sample made up of pediatric patients who attended Centro Médico Naval "Cirujano Mayor Santiago Távara" between December 2014 and March 2015. Patients were divided into two groups: group A (cases) included asthma patients using inhalers as part of their treatment; group B (controls), healthy subjects who attended the same facility. A medical examination was done to determine the type, time, and frequency of treatment and an oral exam, to establish the prevalence of dental caries and the decayed, missing, and filled teeth (DMFT) index. Results. The prevalence of dental caries was 34.2 % in the control group and 28.3 % in the case group (p = 0.094). In relation to the rate of dental caries, the DMFT index in the control group was 4.73 ± 0.32, and 3.98 ± 0.31 in the case group (p = 0.08). However, it was evidenced that a longer duration of inhaler use led to a significantly higher DMFT index (p = 0.04).Conclusions. Inhaled drugs do not increase the prevalence of dental caries in asthma pediatric patients. However, there is a direct relationship between treatment duration and the prevalence of dental caries.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Asthma/drug therapy , Dental Caries Susceptibility , Metered Dose Inhalers , Dry Powder Inhalers , Bronchodilator Agents/administration & dosage , Case-Control Studies , Epidemiology, Descriptive , Prevalence , Tooth Loss , Adrenal Cortex Hormones/administration & dosage , Dental Care for Children
20.
Rev. Assoc. Med. Bras. (1992, Impr.) ; Rev. Assoc. Med. Bras. (1992, Impr.);66(2): 187-193, Feb. 2020. tab
Article in English | SES-SP, LILACS | ID: biblio-1136182

ABSTRACT

SUMMARY OBJECTIVE To analyze clinical and demographic variables possibly associated with the prescriptions of non-recommended but routinely used therapies for infants with acute viral bronchiolitis. METHODS A cross-sectional study included hospitalized infants with bronchiolitis caused by the respiratory syncytial virus. Those with other associated infections and/or morbidities were excluded. The data were collected from medical records. RESULTS Among 120 cases, 90% used inhaled beta-agonists, 72.5% corticosteroids, 40% antibiotics, and 66.7% inhaled hypertonic saline solution. The use of bronchodilators did not present an independent association with another variable. More frequent use of corticosteroids was associated with low oximetry, longer hospitalization time, and age>3 months. Antibiotic therapy was associated with the presence of fever, longer hospitalization, and age>3 months. Inhaled hypertonic saline solution was associated with longer hospitalization time. CONCLUSIONS Non-recommended prescriptions were frequent. Corticosteroid and antibiotic therapy were associated with signs of severity, as expected, but interestingly, they were more frequently used in infants above 3m, which suggested less safety in the diagnosis of viral bronchiolitis in these patients. The use of bronchodilators was even more worrying since they were indiscriminately used, without association with another variable related to the severity or characteristics of the host. The use of the inhaled hypertonic solution, although not associated with severity, seems to have implied a longer hospitalization time. The identification of these conditions of greater vulnerability to the prescription of inappropriate therapies contributes to the implantation of protocols for the bronchiolitis treatment, for continuing education and for analysis of the effectiveness of the strategies employed.


RESUMO OBJETIVOS Analisar variáveis clínicas e demográficas possivelmente associadas às prescrições de terapêuticas não recomendadas, porém rotineiramente utilizadas, para lactentes com bronquiolite viral aguda. MÉTODOS Estudo transversal incluiu lactentes hospitalizados com bronquiolite por vírus sincicial respiratório. Excluídos aqueles com outras infecções e/ou morbidades. Dados coletados de prontuários. RESULTADOS Analisados 120 casos, para os quais foram prescritos: beta-agonistas inalatórios a 90%; corticosteroides a 72,5%, antibióticos a 40% e solução salina hipertônica inalatória a 66,7%. O uso de broncodilatadores não apresentou associação independente com outra variável. Maior uso de corticosteroide associou-se à baixa oximetria, maior tempo de internação e idade >3 meses. Antibioticoterapia associou-se à presença de febre, maior tempo de internação e idade >3 meses. Solução salina hipertônica inalatória associou-se a maior tempo de internação. CONCLUSÕES A frequência das prescrições não recomendadas foi elevada. Corticosteroide e antibioticoterapia foram associados a sinais de gravidade, como esperado, porém, interessantemente, foram mais utilizados nos lactentes com idade acima de 3 meses, o que sugeriu menor segurança no diagnóstico de bronquiolite viral nesses pacientes. O uso de broncodilatadores foi ainda mais preocupante, uma vez que foram indiscriminadamente utilizados, sem associação com outra variável, seja relacionada à gravidade, seja a características do hospedeiro. O uso de solução hipertônica inalatória, apesar de não associado à gravidade, parece ter implicado maior tempo de internação. A identificação dessas condições de maior vulnerabilidade à prescrição de terapêuticas inadequadas contribui para a implantação de protocolos para o tratamento da BVA, para educação continuada e para posteriores comparações e análises de eficácia das estratégias empregadas.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Bronchiolitis, Viral/drug therapy , Respiratory Syncytial Virus Infections/drug therapy , Inappropriate Prescribing/statistics & numerical data , Saline Solution, Hypertonic/administration & dosage , Bronchodilator Agents/administration & dosage , Logistic Models , Acute Disease , Cross-Sectional Studies , Multivariate Analysis , Adrenal Cortex Hormones/administration & dosage , Statistics, Nonparametric , Hospitalization , Anti-Bacterial Agents/administration & dosage
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