Subject(s)
Anti-Asthmatic Agents , Asthma , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , HumansABSTRACT
La creciente prevalencia de enfermedades respiratorias crónicas y su más larga supervivencia han motivado que aumente el número de pacientes en situación avanzada de la enfermedad y en techo terapéutico. Sin embargo, este hecho epidemiológico no se ha acompañado de un desarrollo paralelo de programas de cuidados paliativos, lo que motiva que los enfermos que se encuentran en esta situación no reciban los cuidados médicos óptimos para asegurar su confort y evitar ingresos sucesivos que poco aportan a su pronóstico y calidad de vida. La experiencia del Hospital Lucus Agusti revela que el 7% del total de ingresos de neumología corresponden a pacientes con enfermedad crónica respiratoria avanzada no neoplásica, que solo el 65% de ellos reciben tratamiento paliativo de sus síntomas y que la práctica totalidad fallece en el hospital. Es necesario poner en práctica proyectos que no solo involucren a neumólogos, sino también a personal de enfermería, médicos de atención primaria, de hospitalización a domicilio y personal del hospital de día
The increasing prevalence of chronic respiratory diseases and the longer survival of patients with these disorders have lead to a rise in the number of individuals in a terminal condition with no chances of responding to additional medication. Nevertheless, this epidemiological fact has not been accompanied by a parallel development of palliative care programmes, and this prevents the patients from receiving optimal medical care to ensure their well-being and to avoid further unnecessary admissions to hospital. Our local experience in the Lucus Augusti University Hospital reveals that 7% of the admissions to the respiratory ward correspond to patients with advanced and non-neoplastic chronic respiratory disorders. Only 65% of these patients benefit from a well-structured palliative care plan and practically all of them die in the hospital. Altogether, these data highlight the need for a strategy that involves not only pneumologists but also general practitioners, nurses and palliative care physicians
Subject(s)
Humans , Hospice Care/methods , Respiratory Insufficiency/therapy , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Fibrosis/therapy , Hospice and Palliative Care Nursing/trends , Day Care, Medical/trends , Home Care Services, Hospital-Based/trends , Bronchodilator Agents/administration & dosage , Morphine/administration & dosage , Oxygen Inhalation TherapyABSTRACT
The increasing prevalence of chronic respiratory diseases and the longer survival of patients with these disorders have lead to a rise in the number of individuals in a terminal condition with no chances of responding to additional medication. Nevertheless, this epidemiological fact has not been accompanied by a parallel development of palliative care programmes, and this prevents the patients from receiving optimal medical care to ensure their well-being and to avoid further unnecessary admissions to hospital. Our local experience in the Lucus Augusti University Hospital reveals that 7% of the admissions to the respiratory ward correspond to patients with advanced and non-neoplastic chronic respiratory disorders. Only 65% of these patients benefit from a well-structured palliative care plan and practically all of them die in the hospital. Altogether, these data highlight the need for a strategy that involves not only pneumologists but also general practitioners, nurses and palliative care physicians.
ABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Hypoventilation/complications , Hypoventilation/diagnosis , Obesity/complications , Prognosis , Sleep Apnea, Obstructive/complications , Body Mass Index , Comorbidity , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Palliative Care , Pulmonary Disease, Chronic Obstructive/epidemiology , Lung Diseases, Interstitial/epidemiology , Delivery of Health Care/statistics & numerical dataSubject(s)
Lung Diseases, Interstitial/therapy , Palliative Care/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/therapy , Aged , Chronic Disease , Disease Progression , Female , Humans , Lung Diseases, Interstitial/mortality , Male , Palliative Care/methods , Pulmonary Disease, Chronic Obstructive/mortality , Spain , Terminal Care/statistics & numerical dataSubject(s)
Obesity Hypoventilation Syndrome/complications , Sleep Apnea, Obstructive/complications , Aged , Body Mass Index , Cardiovascular Diseases/epidemiology , Comorbidity , Diabetes Mellitus/epidemiology , Dyslipidemias/epidemiology , Female , Follow-Up Studies , Humans , Male , Matched-Pair Analysis , Middle Aged , Obesity Hypoventilation Syndrome/blood , Obesity Hypoventilation Syndrome/epidemiology , Oxygen/blood , Prognosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortality , Retrospective Studies , Sleep Apnea, Obstructive/blood , Sleep Apnea, Obstructive/epidemiology , Smoking/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Bronchial Provocation Tests/methods , Asthma/diagnosis , Withholding Treatment , Patient Safety , Methacholine Chloride , Forced Expiratory Volume , Asthma/drug therapyABSTRACT
No disponible
Subject(s)
Humans , Asthma/physiopathology , Airway Obstruction/epidemiology , Steroids/therapeutic use , Adrenal Cortex Hormones , Respiratory Function Tests/methods , Bronchodilator AgentsSubject(s)
Adrenal Cortex Hormones/pharmacology , Airway Obstruction/etiology , Asthma/diagnosis , Bronchodilator Agents/pharmacology , Adult , Airway Obstruction/drug therapy , Anti-Asthmatic Agents/therapeutic use , Asthma/complications , Asthma/drug therapy , Asthma/physiopathology , Female , Forced Expiratory Volume , Humans , Male , Middle Aged , Practice Guidelines as Topic , Pregnenediones/therapeutic use , SpainABSTRACT
No disponible
Subject(s)
Humans , Asthma/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Comorbidity , Risk Factors , Inflammation/therapy , Renal Insufficiency/epidemiology , Myocardial Ischemia/epidemiology , Longitudinal Studies , Myocardial Ischemia/epidemiologySubject(s)
Asthma/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Asthma/pathology , Asthma/therapy , Comorbidity , Disease Management , Humans , Inflammation/therapy , Longitudinal Studies , Models, Biological , Myocardial Ischemia/epidemiology , Pulmonary Disease, Chronic Obstructive/pathology , Pulmonary Disease, Chronic Obstructive/therapy , Renal Insufficiency/epidemiology , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Asthma/drug therapy , Steroids/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Cholinergic Antagonists/therapeutic use , Pulmonary Eosinophilia/complications , Pulmonary Eosinophilia/diagnosis , Obesity/complications , Sinusitis/complications , Peak Expiratory Flow Rate , Peak Expiratory Flow Rate/physiology , Forced Expiratory Flow RatesSubject(s)
Adrenal Cortex Hormones/administration & dosage , Asthma/drug therapy , Administration, Oral , Aged , Female , Humans , Middle AgedABSTRACT
Introducción. La coexistencia de procesos potencialmente agravantes es frecuente en asmáticos, especialmente en individuos con control difícil. Es objetivo primario conocer si la comorbilidad es más frecuente en los pacientes no controlados. Como objetivo secundario nos propusimos evaluar el grado de correlación entre test de control del asma (ACT) y la fracción exhalada de óxido nítrico (FENO). Pacientes y métodos. Estudio prospectivo, observacional, que comparó funcional y clínicamente dos grupos de asmáticos: controlados (ACT≥20) y no controlados (ACT<20). En todos se investigó la presencia de tabaquismo, rinosinusitis, obesidad, ansiedad, depresión, disfunción de cuerdas vocales, reflujo gastroesofágico (RGE), aspergilosis broncopulmonar alérgica (ABPA), EPOC y poliposis nasal. Resultados. Se incluyeron 56 pacientes con asma controlada y 102 con un control subóptimo. Los pacientes con un ACT≥20 tenían mejor función pulmonar, menor variabilidad del PEF, menos hiperreactividad bronquial y menores valores de FENO. Se hallaron comorbilidades en el 95% de los asmáticos controlados y en el 97% de los no controlados. Sólo la presencia de poliposis nasal, RGE y ABPA fue más frecuente en el grupo no controlado. Sin embargo, la presencia simultánea de 3 o más factores de comorbilidad fue significativamente más frecuente en los pacientes con un control subóptimo (p=0,01). No hubo correlación significativa entre los valores del FENO y los del ACT (rho=−0,08; p=0,32). Conclusiones. La suma de comorbilidades agravantes es más frecuente en pacientes con control subóptimo. No existe correlación entre los valores de ACT y de FENO (AU)
Introduction. The coexistence of potentially aggravating processes is common in asthmatics, particularly in patients with difficult control. The primary aim of this study is to ascertain whether comorbidity id more common in uncontrolled patients. As a secondary aim, we propose to evaluate the correlation between the asthma control test (ACT) and the fraction of exhaled nitric oxide (FENO). Patient and methods. A prospective, observational study comparing the function and clinical picture of two groups of asthmatics: controlled (ACT≥20) and uncontrolled (ACT<20). They were all assessed for, smoking, rhinosinusitis, obesity, anxiety, depression, vocal cord dysfunction, gastro-oesophageal reflux (GORD), allergic bronchopulmonary aspergillosis (ABPA), COPD and nasal polyps. Results. A total of 50 patients with controlled asthma and 102 with suboptimal control were included. The patients with an ACT≥20 had better lung function, less variation in PEF, less bronchial hyper-reactivity and lower FENO values. Comorbidities were found in 95% of the controlled asthmatics and in 97% of the uncontrolled. Only the presence of nasal polyps, GORD and ABPA was more frequent in the uncontrolled group. However, the simultaneous presence of 3 or more comorbidity factors was significantly more frequent in patients with sub-optimal control (P=0.01). There was no significant correlation between the FENO and the ACT values (rho=−0.08; P=0.32). Conclusions. Aggravating comorbidities are more common in patients with sub-optimal control. There was no correlation between the FENO and the ACT values (AU)
Subject(s)
Humans , Asthma/epidemiology , Status Asthmaticus/prevention & control , Respiratory Function Tests/trends , Nitric Oxide , Comorbidity , Asthma/complications , Depression/epidemiology , Anxiety/epidemiologyABSTRACT
INTRODUCTION: The coexistence of potentially aggravating processes is common in asthmatics, particularly in patients with difficult control. The primary aim of this study is to ascertain whether comorbidity id more common in uncontrolled patients. As a secondary aim, we propose to evaluate the correlation between the asthma control test (ACT) and the fraction of exhaled nitric oxide (FENO). PATIENT AND METHODS: A prospective, observational study comparing the function and clinical picture of two groups of asthmatics: controlled (ACT≥20) and uncontrolled (ACT<20). They were all assessed for, smoking, rhinosinusitis, obesity, anxiety, depression, vocal cord dysfunction, gastro-oesophageal reflux (GORD), allergic bronchopulmonary aspergillosis (ABPA), COPD and nasal polyps. RESULTS: A total of 50 patients with controlled asthma and 102 with suboptimal control were included. The patients with an ACT≥20 had better lung function, less variation in PEF, less bronchial hyper-reactivity and lower FENO values. Comorbidities were found in 95% of the controlled asthmatics and in 97% of the uncontrolled. Only the presence of nasal polyps, GORD and ABPA was more frequent in the uncontrolled group. However, the simultaneous presence of 3 or more comorbidity factors was significantly more frequent in patients with sub-optimal control (P=0.01). There was no significant correlation between the FENO and the ACT values (rho=-0.08; P=0.32). CONCLUSIONS: Aggravating comorbidities are more common in patients with sub-optimal control. There was no correlation between the FENO and the ACT values.
