Lilian Rech Pasin

Avaliação prognóstica precoce da asma aguda na sala de emergência

OBJETIVO: Estudar medidas clinicas e funcionais pulmonares utilizadas nos primeiros quinze minutos de manejo da asma aguda em um servico de emergencia, para predicao prognostica. METODOS: Estudo de coorte, prospectivo, que incluiu pacientes consecutivos com asma aguda, com idades entre doze e 55 anos e medida do pico de fluxo expiratorio menor ou igual a 50% do previsto. Realizaram-se avaliacoes na admissao, aos quinze minutos e em quatro horas apos o inicio do tratamento. O tratamento incluiu salbutamol e ipratropio, administrados por aerossol dosimetrado com espacador, e 100 mg de hidrocortisona intravenosa. O desfecho favoravel foi definido pelo pico de fluxo expiratorio maior ou igual a 50% do previsto apos a quarta hora de tratamento, e o desfecho desfavoravel pelo pico de fluxo expiratorio menor que 50% do previsto. RESULTADOS: Tiveram desfecho favoravel 27 pacientes e desfavoravel 24. A analise multivariada identificou o pico de fluxo expiratorio em porcentagem do previsto aos quinze minutos como variavel mais preditiva. O pico de fluxo expiratorio maior ou igual a 40% aos quinze minutos mostrou significativa contribuicao em predizer desfecho favoravel (sensibilidade = 0,74, especificidade = 1,00 e valor preditivo positivo = 1,00). O pico de fluxo expiratorio menor que 30% aos quinze minutos contribuiu para predizer desfecho desfavoravel (sensibilidade = 0,54, especificidade = 0,93 e valor preditivo positivo = 0,87). CONCLUSAO: O estudo sugeriu que a medida do pico de fluxo expiratorio aos quinze minutos do manejo da asma aguda em um servico de emergencia e um instrumento util para avaliacao prognostica.

Adesão ao tratamento em pacientes com fibrose cística

OBJECTIVES To evaluate the self-reported degree of adherence to treatment in patients with cystic fibrosis (CF), investigating associations with characteristics of the disease and with the degree of adherence perceived by health professionals. METHODS This was a prospective, cross-sectional study involving patients with CF monitored at a Program for Adults with CF. The degree of adherence was evaluated using a questionnaire. Patients were divided into two groups: greater degree of adherence and moderate/poor degree of adherence. Clinical data, Shwachman-Kulczycki clinical score, Brasfield radiographic score and spirometry data were obtained for all patients. RESULTS Out of 38 patients studied, 31 (81.6%) were classified as presenting a greater degree of adherence and 7 (18.4%) as presenting a moderate/poor degree of adherence. The self-reported patient adherence score correlated with the clinical score (r = -0.36, p = 0.028). The self-reported patient adherence score (median = 0.79) was higher than that perceived by health professionals (median = 0.71, p = 0.003). A greater degree of adherence was self-reported for respiratory therapy (by 84.2%), exercise (by 21.1%), prescribed diet (by 65.8%), pancreatic enzymes (by 96.3%), vitamins (by 79.4%), inhaled antibiotic therapy (by 76.7%) and inhaled DNase (by 79.4%). CONCLUSIONS Self-reported adherence of patients attending a Program for Adults with CF was good. The self-reported patient adherence score correlated inversely with the clinical score. Self-reported patient adherence was greater than the adherence perceived by health professionals.

Percepção da gravidade da doença em pacientes adultos com fibrose cística

OBJECTIVE: To evaluate the perception of disease severity in patients with cystic fibrosis (CF), investigating its relationship with clinical score, radiographic score, respiratory function tests, adherence to treatment and perception of self-care practices. METHODS: Prospective, cross-sectional study involving CF patients treated in a program for adults with CF. The perception of disease severity, adherence to treatment and reported self-care practices were evaluated by means of questionnaires. Clinical data, Shwachman-Kulczycki clinical score, Brasfield radiographic score and spirometry were obtained for all of the patients. RESULTS: Of the 38 patients studied, 3 (7.9%) patients rated their perception of health status as well below average; 5 (13.2%), as below average; 15 (39.5%), as average; 10 (26.3%), as above average; and 5 (13.2%), as well above average. The perception of disease severity correlated significantly with clinical score (r = 0.43, p = 0.007), FVC (r = 0.34, p = 0.034), FEV1 (r = 0.38, p = 0.019) and self-care practices (r = 0.33, p = 0.044), but not with degree of adherence (r = -0.03, p = 0.842) and radiographic score (r = 0.33, p = 0.51). CONCLUSIONS: The perception of disease severity correlated with objective measurements of disease severity (clinical score and respiratory function tests) and with reported self-care practices, but not with adherence to treatment.

Infecção bacteriana crônica e indicadores ecocardiográficos de hipertensão pulmonar em pacientes com fibrose cística

Objectives: To examine the relationship between chronic bacterial infection and pulmonary hypertension, using Doppler echocardiography, in patients with cystic fibrosis (CF). Methods: A prospective cross-sectional study involving CF patients (≥16 years of age) admitted to a program for adults with the disease. The study included 40 patients with a mean age of 23.7 ± 6.3 years. Patients were submitted to clinical evaluation, Doppler echocardiography, pulmonary function tests, chest X-rays and sputum cultures of Pseudomonas aeruginosa and Burkholderia cepacia. Results: In terms of the following variables, no significant differences were found between P. aeruginosa-positive patients and P. aeruginosa-negative patients: clinical score (p = 0.472); forced expiratory volume in one second (FEV 1 ; p = 0.693), radiological score (p = 0.760); tricuspid regurgitant jet velocity (TRV, p = 0.330); diameter of the right ventricle (DRV, p = 0.191); and right ventricular/ pulmonary artery (RV/PA) systolic acceleration time (SAT, p = 0.330). B. cepacia-positive patients presented significantly lower FEV 1 than did B. cepacia-negative patients (p = 0.011). No significant differences were found between B. cepacia-positive patients and B. cepacia-negative patients regarding the following variables: clinical score (p = 0.080); radiological score (p = 0.760); TRV (p = 0.613); DRV (p = 0.429); and RV/PA SAT (p = 0.149). Conclusions: Chronic infection with P. aeruginosa or B. cepacia presented no association with pulmonary hypertension in adult CF patients. Pulmonary function was worse in B. cepacia-positive patients than in P. aeruginosa-positive patients.

Incidência de infecção viral do trato respiratório em asma aguda atendida em sala de emergência

OBJETIVO: Avaliar a incidencia de infeccao viral em asma aguda em pacientes atendidos em setor de adultos de um servico de emergencia. METODOS: Conduzimos um estudo de coorte de pacientes que se apresentaram com asma aguda no setor de adultos do Servico de Emergencia do Hospital de Clinicas de Porto Alegre (idade > 12 anos). Um aspirado nasofaringeo foi obtido para deteccao de antigenos com a tecnica de coloracao de imunofluorescencia indireta para os virus sincicial respiratorio, adenovirus, influenza e parainfluenza tipos 1, 2, 3 e 4. Foram coletados dados referentes a caracteristicas demograficas, historia medica pregressa, crise que levou a atual visita ao servico de emergencia e desfechos da crise. RESULTADOS: No periodo de marco a julho de 2004, 49 pacientes foram examinados para infeccao viral do trato respiratorio. Foram identificados virus respiratorios em 6 pacientes (3 com adenovirus, 2 com influenza A e 1 com parainfluenza tipo 1). Os pacientes com infeccao viral do trato respiratorio apresentaram media de idade de 61,7 ± 11,5 anos, enquanto que os pacientes sem infeccao viral apresentaram media de idade de 41,7 ± 20,9 anos (p = 0,027). Nao houve outras diferencas significativas quanto as caracteristicas clinicas e desfechos. CONCLUSAO: Este estudo mostra uma incidencia de 12,24% de infeccao viral do trato respiratorio na asma aguda em pacientes com idade igual ou maior que doze anos atendidos em sala de emergencia, o que confirma a infeccao viral como um desencadeante nessa faixa etaria.