Samuel Millán Menegotto

Impacto de uma intervenção educacional de curta duração sobre a adesão ao tratamento e controle da asma

OBJECTIVE To evaluate the effect of a short-term individualized education program on adherence to asthma treatment, inhalation techniques, and asthma control. METHODS A prospective study involving patients aged 14 years or older, with a confirmed diagnosis of asthma and recruited from the asthma outpatient clinic of a university hospital in the city of Porto Alegre, Brazil. The study was conducted in two phases (before and after the educational intervention). At a routine medical visit, the participants completed a general questionnaire in order to assess the level of asthma control and inhalation techniques. The participants also underwent pulmonary function testing. Subsequently, they participated in an asthma education program, which consisted of one individualized session. The participants were reevaluated after three months. RESULTS Of the 174 patients recruited, 115 completed the study. Between the first and second evaluations, there was a significant improvement in the effective use of inhaled corticosteroids (90.4% vs. 93.3%; p = 0.003), the effective use of long-acting β2 agonists (57.4% vs. 63.5%; p < 0.0001), the effective use of a combined regimen with these two medications (57.4% vs. 62.6%; p < 0.0001), and the self-reported adherence to corticosteroid therapy (p = 0.001). There was a significant decrease in the proportion of patients visiting ERs (30.4% vs. 23.5%; p = 0.012). However, the level of asthma control and the inhalation technique did not improve significantly (p = 0.095 and p = 0.512, respectively). CONCLUSIONS This short-term asthma education program resulted in an improvement in the use of medications for asthma control and a decrease in the number of ER visits, although it had no significant effect on the inhalation technique.

Factors related to the incorrect use of inhalers by asthma patients

OBJECTIVE: To evaluate inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control. METHODS: This was a cross-sectional study involving patients > 14 years of age with physician-diagnosed asthma. The patients were recruited from the Asthma Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, in the city of Porto Alegre, Brazil. The patients completed two questionnaires (a general questionnaire and an asthma control questionnaire based on the 2011 Global Initiative for Asthma guidelines), demonstrated their inhaler technique, and performed pulmonary function tests. Incorrect inhaler technique was defined as the incorrect execution of at least two of the predefined steps. RESULTS: We included 268 patients. Of those, 81 (30.2%) showed incorrect inhaler technique, which was associated with poor asthma control (p = 0.002). Logistic regression analysis identified the following factors associated with incorrect inhaler technique: being widowed (OR = 5.01; 95% CI, 1.74-14.41; p = 0.003); using metered dose inhalers (OR = 1.58; 95% CI, 1.35-1.85; p < 0.001); having a monthly family income < 3 times the minimum wage (OR = 2.67; 95% CI, 1.35-1.85; p = 0.008), and having > 2 comorbidities (OR = 3.80; 95% CI, 1.03-14.02; p = 0.045). CONCLUSIONS: In the sample studied, incorrect inhaler technique was associated with poor asthma control. Widowhood, use of metered dose inhalers, low socioeconomic level, and the presence of > 2 comorbidities were associated with incorrect inhaler technique.

Prevalência de obesidade na asma e suas relações com gravidade e controle da asma

OBJECTIVE To determine the prevalence of obesity in asthmatic patients attending at an outpatient clinic, and to investigate its relationships with asthma severity and level of asthma control. METHODS In a cross-sectional study we recruited patients aged 11 years and older with confirmed asthma diagnosis from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. They underwent an evaluation by a general questionnaire, an asthma control questionnaire and by pulmonary function tests. Nutritional status was classified by body mass index (BMI). RESULTS 272 patients were included in the study. Mean age was 51.1 ± 16.5 years and there were 206 (74.9%) female patients. Mean BMI was 27.5 ± 5.3kg/m(2), and 96 (35.3%) patients were classified as normal weight, 97 (35.7%) as overweight and 79 (29%) as obesity. There was a significant higher proportion of female than male patients (34.3% vs. 13.2%, p = 0.002) in the obesity group. There were no significant differences with respect to asthma control (p = 0.741) and severity classification (p = 0.506). The FEV1% predicted was significantly higher in the obese than in the non-obese group (73.7% vs. 67.2%, p = 0.037). Logistic regression analysis identified sex (OR = 3.84, p = 0.002) as an independent factor associated with obesity. CONCLUSIONS This study showed a high prevalence of obesity in asthmatic patients. Obese and non-obese subjects were similar in regard to asthma severity and level of asthma control. Female sex was associated with obesity in this asthma population.OBJETIVO: Determinar a prevalencia de obesidade em pacientes asmaticos atendidos no ambulatorio clinico, e investigar sua relacao com a gravidade e controle da asma. METODOS: Estudo transversal, envolvendo pacientes, com idade igual ou superior a 11 anos e diagnostico de asma confirmado, do ambulatorio clinico do Hospital de Clinicas de Porto Alegre, Brasil. Os pacientes foram submetidos a avaliacao atraves de um questionario geral, questionario de controle da asma e teste de funcao pulmonar. O estado nutricional foi classificado conforme o indice de massa corporal (IMC). RESULTADOS: Foram incluidos no estudo 272 pacientes, sendo 206 (74,9%) pacientes do sexo feminino. A media de idade foi 51.1 ± 16.5 anos. O IMC medio foi 27.5 ± 5.3 kg/m2, sendo 96 (35.3%) pacientes classificados como eutroficos, 97 (35,7%) como sobrepeso e 79 (29%) como obesidade. Observou-se significativamente maior proporcao de pacientes do sexo feminino no grupo de obesidade quando comparados aos pacientes do sexo masculino (34.3% vs. 13.2%, p = 0.002). Nao houve diferenca significativaemrelacao ao controle da asma (p = 0.741) e classificacao de gravidade (p = 0.506). O FEV1% predito foi significativamente maior nos pacientes obesos quando comparados aos nao obesos (73.7% vs. 67.2%, p = 0.037). A analise de regressao logistica identificou genero como fator independente associado com a obesidade. (OR = 3.84, p = 0.002). CONCLUSAO: O presente estudo observou alta prevalencia de obesidade em pacientes asmaticos. Individuos obesos e nao obesos tiveramsimilaridade para gravidade e controle da asma. O genero feminino foi associado com obesidade nesta populacao asmatica.