[Asthma follow-up after treatment of status asthmaticus in ICU Pneumonology Department in Warsaw Medical University]. / Przebieg leczenia astmy oskrzelowej u chorych po stanie astmatycznym leczonych w Osrodku Leczenia Stanów Astmatycznych.

Asthmatic patients who were treated in ICU because of exacerbation of asthma must be in close contact with doctors. They need steroid therapy, regular PEF measurements and should take part in educational programs for asthmatic. The 87 (60f, 27m) patients after treatment of status asthmaticus in our ICU were answered to the questionnaire about next hospitalisation, factors causing exacerbation, treatment, spacers, electrical nebulizators, PEF-meters and asthma educational program. Eight men (29.6%) and 13 woman (21.6%) needed next hospitalisation. Airway infection, exercise and cool air are the common cause of asthma exacerbation. Oral steroid was used continuously by 44.8% of patients and 68.9% inhaled steroid. Inhaled beta-agonists were taken by 71.2% of patients, oral theophylline by 70.1%, inhaled ipratropium bromide by 26.9%, 11.1% cromolyn and leucotriene receptor antagonists by 16.1%. At home 27.5% of patients have electrical nebulizator and 75.8% spacer. PEF-meters are utilized by 42.5% of patients but they did not use it correctly. A large number of patients (47%) did not take part in educational program for asthmatic patients. Our data show that patients after status asthmaticus in our ICU mainly treat exacerbations but they not prevent asthma attacks.

Modulación de la hiperreactividad bronquial en el asma en relación con los recursos y tiempos terapéuticos / Modulation of the bronchial hyperreactivity in the asthma in relation with the therapeutic resort and time

Se publican ciertos lineamientos que deben seguirse para la regulación y modulación de la reactividad bronquial. Se hace hincapié en la fase inflamatoria del asma que está relacionada con la mayor morbimortalidad. Los estímulos que inducen asma bronquial se dividen en dos clases: 1) inespecíficos no alérgicos, que generan respuestas con poco o ningún incemento de la hiperreactividad bronquial, y 2) estímulos específicos, capaces de activar la fase celular de la inflamación de las vías aéreas. La fase inflamatoria del asma bronquial provoca edema e hipersecreción mucosa que, sumadas a la contracción del músculo liso bronquial, se traducen clínicamente por insuficiencia ventilatoria obstructiva y por incremento de la hiperreactividad bronquial. Este aumento de la reactividad puede perdurar un tiempo prolongado si no se actúa en forma adecuada y oportuna. La medicación con corticosteroides es indicación absoluta para la resolución de esta fase. Un oportuno tratamiento con corticosteroides, en una crisis de asma bronquial con componente inflamatorio, es una medida estratégica clave en esta afección. Fueron estudiados 12 pacientes de ambos sexos entre 10 y 60 años, con estados de asma latente y prolongada. Estos pacientes llegaron a la consulta con enfoques terapéuticos erróneos. Se evaluó la función pulmonar, en el momento de la consulta, con prueba de provocación bronquial con ejercicio y sin ella. Luego de lograrse la estabilización clínica y de la realización de un tratamiento adecuado, volvió a evaluarse a los 30 días la función pulmonar con prueba de provocación bronquial y sin ella. Los resultados indicaron que la reactividad bronquial es modulable cuando los recursos terapéuticos son aplicados en forma adecuada y acorde con los tiempos terapéuticos

Effects of chest physical therapy on lung function in children recovering from acute severe asthma.

The effects of chest physical therapy in acute severe asthma in children have been studied in 38 children aged 6 to 13 years in a randomized placebo controlled trial. The study began between 6 and 24 hours after admission to hospital; 19 children received chest physical therapy (PT) and 19 children received placebo visits. Each child had 4 treatments over 2 days which were preceded by nebulized salbutamol. Lung volumes and flow rates were measured in a body plethysmograph before salbutamol and before and after either PT or placebo on the first and fourth treatments. Throughout the study standard asthma drug therapy was given. In both groups characteristics such as sex, race, age, height, weight, severity, and baseline lung function were similar. Taking into account the baseline, lung function at the end of the study was similar in both groups. Three 12 year old children in the PT group showed improvements in flows above those seen in any children in the placebo group. We conclude that chest PT, when combined with asthma drug therapy, does not improve lung function in most children in this age group with acute severe asthma.