A proposed scheme to cope with comorbidities in asthma.

The prevalence of non-communicable chronic diseases has been on the rise and the co-occurrence of morbidities is becoming more common. Multimorbidities are found more frequently among women, those with a history of mental disorders, lower level of schooling, and unfavorable socioeconomic condition. Physical inactivity, smoking and obesity are also associated with multimorbidities. Its occurrence is directly related to the age, affecting the majority of the individuals with more than 50 years old. It is important to consider the possibility of comorbid conditions that aggravate, complicate or simulate the symptoms of the disease in the face of a patient with asthma and poor response to treatment. Among subjects with asthma, some conditions stand out as the most frequent: chronic rhinitis or rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea syndrome, obesity, and cardiovascular disorders. Comorbidities reduce the chances of optimal asthma control. It is essential to assess and manage properly these complex situations, choosing wisely preventive strategies and treatment options to avoid adverse events and optimize outcomes. Medications for asthma have the potential to worsen cardiovascular conditions, while beta-adrenergic receptor blockers and angiotensin conversion enzyme inhibitors used for cardiovascular conditions, can worsen asthma. Handling properly these cases will save lives and resources. However, there are multiple gaps in knowledge requiring investigation in this field to inform integrated care pathways and policies. It is likely information may be obtained from real life studies and electronic medical databases. Communications between the providers and patients may be facilitated by electronic technology, opening a large window for guided self-management.

Evaluation of the Impact of Physical Exercise in Reducing Pain in Women Undergoing Mammography: A Randomized Clinical Trial.

Objective: To evaluate the efficacy of exercise prior to mammography in reducing perceived postexamination pain. Methods: An open, randomized, and controlled clinical trial was conducted. The interventions consisted of warm-up and stretching exercises of the upper or lower limbs of women who consulted at Barretos Cancer Hospital, São Paulo State, Brazil. The women were divided into three groups based on the intervention and its location: upper limbs (group 1), lower limbs (group 2), and no intervention (group 0). Quantitative variables were compared between and within groups using analysis of variance and Student's t test with a 5% significance level. Relative risk (RR) calculations and their derived measurements such as efficacy, number needed to treat (NNT), absolute risk reduction (ARR), and relative risk reduction (RRR) were taken. This study was approved by the Institutional Committee of Research Ethics. Results: A total of 198 (66 per group) women were evaluated. Sociodemographic data and level of physical activity were not found to be associated with perception of pain after mammogram. However, group 1 had the greatest reduction in postprocedure perception of pain compared with groups 2 (relative risk [RR] = 3.54, 95% confidence interval [CI] = 2.12-5.51, P < 0.05) and 0 (RR = 1.92 (95% CI = 1.08-3.42, P < 0.05). Conclusions: Pre-examination upper limb exercises were most effective in reducing the perception and sensation of pain. However, women who performed lower limb exercises also had a decreased perception of pain compared with the control group.