RESUMO
Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled). Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70) and hospitalization (US$86.30 vs US$12.88)], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2%) and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.
Assuntos
Asma/economia , Efeitos Psicossociais da Doença , Custos Diretos de Serviços/estatística & dados numéricos , Adulto , Asma/tratamento farmacológico , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled). Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70) and hospitalization (US$86.30 vs US$12.88)], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2 percent) and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Asma/economia , Efeitos Psicossociais da Doença , Custos Diretos de Serviços/estatística & dados numéricos , Asma/tratamento farmacológico , Brasil , Estudos Transversais , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
A aerossolterapia e utilizada com frequencia no tratamento das alteracoes do aparelho mucociliar, entretanto, ate hoje nao ha provas significativas de seus efeitos. Este estudo analisou amostras de muco bronquicoexpectorado por 12 bronquiectasicos submetidos a inaloterapia com N-acetilcisteina (NAC 10 por cento), salina hipertonica (SH 1,5 por cento), salina isotonica (SI 0,9 por cento) e agua destilada (AD). Para analisar as propriedades do muco bronquico foram realizadasa mensuracao do angulo de adesao do deslocamento do muco na maquina simuladora da tosse e a celocidade de transporte em palato isolado de ra, alem da quantidade de muco expectorado, pela analise do peso umido e pela relacao peso seco/peso umido. Nao foram verificadas diferencas significativas (p<0,05) quando comparadas as substancias estudadas para as variaveis espirometria, relacao peso seco/peso umido, angulo e adesao e medida de deslocamento do mucona maquina simuladora da tosse. Porem, ao serem analisadas cada uma separadamente em relacao aos periodos antes, apos e 60 minutos do termino da sessao foram encontradas diferencas para as variaveis peso umido, na maquina simuladora da tosse e transporte palato ra. A solucao salina hipertonica (1,5 por cento), determinou reducao significativa (p<0,05) na quantidade de muco expectorado apos 60 minutos de inalacao (80), porem de melhor transportabilidade. A N-acetilcisteina (NAC 10 por cento) promoveu aumento significativo (p<0,05) na quantidade de muco expectorado, associado a tendencia de pior transportabilidade"""''as
Assuntos
Acetilcisteína , MucoRESUMO
E comum na fisioterapia respiratoria a utilizacao das manobras de higiene bronquica, no entanto, ainda nao esta bem claro o melhor protocolo de atendimento, visto que os efeitos isolados de cada manobra necessitam ser mais explorados, inclusive com metodos de analise de transportabilidade do muco bronquico. Este estudo analisou amostras de muco bronquico expectorado por 12 bronquiectasicos submetidos a drenagem postural isolada e associada a tapotagem e a tecnica de expiracao forcada. Para analisar a transportabilidade foi realizada a mensuracao do angulo de adesao, do deslocamento do muco na maquina da tosse e da velocidade relativa de transporte no palato de ra, alem do peso umido e da relacao peso seco/peso umido do muco. Houve forte tendencia de remocao de maior quantidade de secrecao apos drenagem postural isolada e associada a tapotagem, alem da tendencia de remocao de secrecao com menor teor liquido apos duas sessoes (50 minutos) de drenagem postural associada a tapotagem. O angulo de adesao do muco removido apos 80 minutos da conduta CONT foi menor (p<0,05) e, proximo da normalidade, de facil remocao. Neste caso, considerando que as demais manobras nao contribuem para a piora das qualidades fisico-quimicas do muco, e que os tempos iniciais das condutas anao apresentaram diferncas estatisticas, o muco expectorado por essas manobras apresentou angulo distante da normalidade, sugerindo que em todos os tempos das condutas estudads o muco expectorado apresentou pior perfil reologico, isto e, de dificil remocao, e somente pela aplicacao das mesmas edsse muco pode ser removido
Assuntos
Tosse , Drenagem Postural , MucoRESUMO
CONTEXT: Budesonide is an inhaled corticosteroid with high topical potency and low systemic activity recommended in the treatment of chronic asthma. OBJECTIVE: This study was conducted to determine the efficacy and safety of inhaled budesonide via a breath-activated, multi-dose, dry-powder inhaler. TYPE OF STUDY: Multicenter randomized parallel-group, placebo-controlled, double-blind, clinical trial. SETTING: Multicenter study in the university units. PARTICIPANTS: Adult patients with mild-to-moderate asthma that was not controlled using bronchodilator therapy alone. PROCEDURES: Comparison of budesonide 400 microg administered twice daily via a breath-activated, multi-dose, dry-powder inhaler with placebo, in 43 adult patients (aged 15 to 78 years) with mild-to-moderate asthma (FEV1 71% of predicted normal) that was not controlled using bronchodilator therapy alone. MAIN MEASUREMENTS: Efficacy was assessed by pulmonary function tests and asthma symptom control (as perceived by the patients) and the use of rescue medication. RESULTS: Budesonide 400 microg (bid) was significantly more effective than placebo in improving morning peak expiratory flow (mean difference: 67.9 l/min; P < 0.005) and FEV1 (mean difference: 0.60 l; P < 0.005) over the 8-week treatment period. Onset of action, assessed by morning peak expiratory flow, occurred within the first two weeks of treatment. CONCLUSIONS: Budesonide via a breath-activated, multi-dose, dry-powder inhaler results in a rapid onset of asthma control, which is maintained over time and is well tolerated in adults with mild-to-moderate asthma.
Assuntos
Anti-Inflamatórios/uso terapêutico , Asma/tratamento farmacológico , Budesonida/uso terapêutico , Administração por Inalação , Administração Tópica , Adolescente , Adulto , Idoso , Anti-Inflamatórios/efeitos adversos , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Budesonida/efeitos adversos , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , Glucocorticoides , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Resultado do TratamentoRESUMO
PURPOSE: To validate the Torrington & Henderson preoperative risk assessment program in the population of surgical patients in an university hospital (Hospital São Paulo, UNIFESP, São Paulo, Brasil). MATERIAL AND METHODS: We evaluated 1162 patients who underwent to major thoracic, upper and under abdominal surgery using the Torrington & Henderson program. The patients were classified in low (785), moderate (317) and high risk (60). All patients were accompanied daily during the postoperative period by the same medical team which assessed the preoperative period, until discharged or died. RESULTS: The postoperative pulmonary complications were present in 6.1%, 23.3% and 35.0% in the low, moderate and high risk respectively. The relative risk to develop postoperative pulmonary complications was 3.8 higher in the patients with moderate risk and 5.7 higher in the patients with high risk. The mortality rate due to pulmonary complications was 1.7%, 6.3% and 11.7% respectively in the patients with low, moderate and high risk. The relative risk to the death was 3.7 higher in the patients with moderate risk and 6.9 in the high risk. CONCLUSION: We concluded that the Torrington & Henderson preoperative risk assessment program can identify in our population patients who will develop postoperative pulmonary complications.
Assuntos
Procedimentos Cirúrgicos Eletivos , Pneumopatias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Estudos Longitudinais , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Testes de Função Respiratória , Medição de Risco , Fatores de RiscoRESUMO
OBJETIVO: Validar a escala de Torrington e Henderson na estratificação do risco cirúrgico da nossa população, fornecendo a quantificação do mesmo. Tipo de estudo: coorte prospectivo longitudinal. Duração do estudo: 30 meses. MÉTODOS: Foram avaliados 1162 pacientes no pré-operatório de cirurgia geral eletiva no Ambulatório de Risco Cirúrgico da Disciplina de Pneumologia da EPM/Unifesp. De acordo com a escala de Torrington e Henderson os pacientes foram classificados no período pré-operatório em portadores de baixo (n=785), moderado (n=317) e alto risco (n=60) para a ocorrência de complicações pulmonares e óbito, no período pós-operatório. No pós-operatório realizou-se avaliação clínica diária dos mesmos até alta hospitalar ou óbito verificando-se a ocorrência das seguintes complicações pulmonares neste período: infecção respiratória aguda (pneumonia ou traqueobronquite),atelectasia, insuficiência respiratória aguda, entubação orotraqueal ou ventilação mecânica por mais de 48 horas e broncoespasmo. RESULTADOS: Complicações pulmonares no pós-operatório ocorreram em 6,1 por cento dos pacientes de baixo risco, 23,3 por cento nos de moderado e 35 por cento nos de alto risco (p < 0,05). O risco relativo de ocorrer complicações pulmonares foi de 3,8 vezes para os pacientes de moderado risco e de 5,7 vezes para os de alto risco em relação aos de baixo risco. A incidência de óbito de causa pulmonar no pós-operatório foi, respectivamente, de 1,7 por cento , 6,3 e 11,7 por cento entre os pacientes de baixo, moderado e de alto risco (p < 0,001). O risco relativo de óbito pulmonar foi de 3,7 vezes para os pacientes de moderado risco e de 6,9 vezes para aqueles de alto risco em relação aos de baixo risco. CONCLUSÃO: A escala de Torrington e Henderson é útil na estratificação do risco cirúrgico nesta população estudada.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Eletivos , Pneumopatias/prevenção & controle , Complicações Pós-Operatórias/mortalidade , Testes de Função Respiratória , Idoso de 80 Anos ou mais , Estudos Prospectivos , Fatores de Risco , Estudos Longitudinais , Pneumopatias/mortalidadeRESUMO
The aim of this study was to evaluate the effectiveness of an asthma education programme in moderate and severe asthma patients in a longitudinal, prospective and randomized study with a control group. Fifty-three asthmatic patients were studied, 26 of whom were assigned to the educational group and 27 to the control group. The educational group attended the programme regularly for a period of 6 months. The programme included information about asthma, instruction on the appropriate use of medication and training in the metered dose inhaler (MDI) technique, and information about the identification and control of asthma attacks and the recognition of early signs of exacerbation. The control group was submitted to the routine care provided at the Asthma Clinic, with no formal instruction regarding asthma control. The groups were identical with regard to severity parameters, skills, lung function and quality of life at the beginning of the trial. At the end of the study, the education group showed significant differences when compared with the control group (education/control (mean values)) with respect to: visits to the asthma emergency room over the previous 6 months, 0.7/2 (p=0.03); nocturnal symptoms, 0.3/0.7 (p=0.04); score of symptoms, 1.3/2 (p=0.04). Improvements were also observed in skills and quality of life, knowledge of how to deal with attacks and how to control the environmental triggering factors, 73/35 (<0.05); correct use of the MDI, 8/4 (0.001); understanding of the difference between relief and anti-inflammatory medication, 86/20 (<0.05); and in the global limitation quality of life score, 28/50 (0.02). It is concluded that the educational programme led to a significant improvement in asthma morbidity and that the implantation of educational programmes is possible for special populations when these programmes are adapted to the socioeconomic profile of the patients, with a significant gain in terms of the reduction of symptoms and improved pulmonary function and quality of life of asthmatics.
Assuntos
Asma/reabilitação , Educação de Pacientes como Assunto/organização & administração , Carência Psicossocial , Adulto , Asma/fisiopatologia , Asma/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pacientes Ambulatoriais , Estudos Prospectivos , Qualidade de Vida , Testes de Função Respiratória , Índice de Gravidade de Doença , Classe Social , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. DESIGN: Prospective clinical trial. SETTING: A tertiary university hospital. PATIENTS: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. MEASUREMENTS: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. RESULTS: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). CONCLUSIONS: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient's pulmonary status.
Assuntos
Abdome/cirurgia , Pneumopatias/etiologia , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Doença Crônica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , EspirometriaRESUMO
OBJECTIVE: We have investigated the effects of the inhaled corticosteroid flunisolide on bone metabolism and adrenal function in patients with moderate asthma. SUBJECTS AND DESIGN: Twenty ambulatory patients (13 females, 7 males, mean age +/- SD of 36.4 +/- 12.4 years) with moderate asthma were recruited. None had taken corticosteroids for at least 1 month. Flunisolide 500 microg was given twice a day for 10 weeks, without any other medication. Blood and urine were collected before and at the end of treatment course. Cortisol (basal and 1 h after ACTH 250 microg i.v.) was measured to evaluate adrenal function. A peak cortisol response of 496 nmol/l was considered an adequate response. Serum ionized calcium, intact PTH, plasma osteocalcin (OC) and urinary pyridinoline (Pyr) and deoxy-pyridinoline (D-Pyr) were measured to evaluate bone metabolism. Wilcoxon paired test was performed for statistical analysis. Results are expressed as mean +/- SD. RESULTS: In most patients (85%), there was no difference after treatment with flunisolide on basal and stimulated cortisol levels. We found a significant decrease of OC (3.55 +/- 1.42 to 2.97 +/- 1.05 nmol/l) and Pyr (66.4 +/- 20.0 to 59.5 +/- 24.9 pmol/micromol creatinine) levels after treatment (P < 0.05). We also observed a positive correlation between the variations seen in pre and post treatment values of OC and Pyr/D-Pyr. CONCLUSIONS: The use of inhaled flunisolide 1000 microg/day for 10 weeks had no suppressive effect on adrenal function in the majority of asthmatic patients studied. However, the effects seen on bone and mineral metabolism, evidenced by the significant fall in osteocalcin and pyridinoline levels, may indicate a possible systemic effect of this drug. Clinical consequences of long-term treatment with flunisolide need to be further evaluated.