RESUMO
Early palliative care is now recommended in international guidelines. A meta-analyze combining seven randomized studies has been published in 2007. It confirms that early palliative care improves patient's quality of life and reduces symptom burden. There is also a trend for the reduction of depressive disorder and the increase of overall survival. Other studies show that early palliative care improves quality of life of patient's relatives and reduces end of life care aggressiveness. Most of the time, early palliative care is introduced as soon as the diagnosis of advanced cancer is made, and the precise referral criteria need to be addressed. Other studies have assessed the palliative care consultation; patient-centered care, focusing on symptom management, filling information and education needs about illness and prognosis, helping psychologic adaptation and coping.
Assuntos
Neoplasias/terapia , Cuidados Paliativos/métodos , Qualidade de Vida , Assistência Terminal/métodos , Sobreviventes de Câncer/estatística & dados numéricos , Depressão/terapia , Humanos , Oncologia , Metanálise como Assunto , Neoplasias/mortalidade , Neoplasias/psicologia , Cuidados Paliativos/economia , Educação de Pacientes como Assunto , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
A severe acute asthma attack is defined by the presence of clinical signs of severity and/or a value of peak expiratory flow (PEF) < 30% predicted. The treatment is based mainly on inhaled beta 2 agonists and systemic corticosteroids. Nebulization is the route of administration of choice, because of its simplicity, its efficacy and its tolerability. Anticholinergics are indicated in association with nebulised beta 2 agonists. Response to treatment must be evaluated within an hour, permitting the early detection of "responders" or "non-responders" to the initial treatment. The great majority of deaths from acute asthma are avoidable, underlining the importance of preventive measures. Prevention is based on the control of the asthma by personalized ongoing treatment based on long-term inhaled corticosteroids and the use of oral corticosteroids in the treatment of exacerbations. However, a severe acute asthma attack can appear at any stage of severity of asthma, including controlled asthma, justifying the utilisation of action plans to treat exacerbations.