Subject(s)
Anaphylaxis , Asthma , Humans , Asthma/drug therapy , Anaphylaxis/chemically induced , Anaphylaxis/complications , Anaphylaxis/therapyABSTRACT
Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.
Subject(s)
Asthma , Asthma/diagnosis , Asthma/drug therapy , Biomarkers , Brazil , Humans , PhenotypeABSTRACT
The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Anti-Asthmatic Agents/administration & dosage , Asthma/drug therapy , Disease Management , Administration, Inhalation , Age Factors , Brazil , Humans , Risk Factors , Severity of Illness Index , Symptom Flare UpABSTRACT
ABSTRACT The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
RESUMO O manejo farmacológico da asma mudou consideravelmente nas últimas décadas, com base no entendimento de que a asma é uma doença heterogênea e complexa, com diferentes fenótipos e endótipos. Agora está claro que o objetivo do tratamento da asma deve ser alcançar e manter o controle da doença e evitar riscos futuros (exacerbações, instabilidade da doença, perda acelerada da função pulmonar e efeitos adversos do tratamento). Isso implica em uma abordagem personalizada, incluindo tratamento farmacológico, educação do paciente, plano de ação por escrito, treinamento para uso do dispositivo inalatório e revisão da técnica inalatória a cada visita ao consultório. Um painel de 22 pneumologistas brasileiros foi convidado a revisar criticamente evidências recentes de tratamento farmacológico da asma e a preparar esta recomendação, um guia de tratamento adaptado à nossa realidade. A escolha dos tópicos ou questões relacionadas às mudanças mais significativas nos conceitos e, consequentemente, no manejo da asma na prática clínica foi realizada por um painel de especialistas. Foi solicitado a cada especialista que revisasse criticamente um tópico ou respondesse a uma pergunta, com base em evidências, para estas recomendações. Numa segunda fase, três especialistas discutiram e estruturaram todos os textos submetidos pelos demais e, na última fase, todos revisaram e discutiram cada recomendação. As presentes recomendações se aplicam a adultos e crianças com asma e destinam-se a médicos envolvidos no tratamento da doença.
Subject(s)
Humans , Asthma/drug therapy , Adrenal Cortex Hormones/administration & dosage , Anti-Asthmatic Agents/administration & dosage , Disease Management , Severity of Illness Index , Administration, Inhalation , Brazil , Risk Factors , Age Factors , Symptom Flare UpABSTRACT
OBJETIVO: Medir a prevalência de asmáticos adultos, nao tabagistas, com perda de funçao pulmonar e identificar marcadores clínicos e espirométricos desta populaçao. TIPO DE ESTUDO: Analítico observacional transversal. MÉTODOS: Foram incluídos oitenta e três asmáticos com acompanhamento regular no Ambulatório de Asma da Disciplina de Pneumologia-UNIFESP e portadores de uma espirometria anterior, há pelo menos 5 anos. Após serem submetidos a questionário padronizado e nova espirometria antes e após inalaçao com 400mcg de salbutamol, foram classificados em: Respondedores (R) quando atingiram o limite inferior da normalidade do previsto para o VEF, após a inalaçao de Bd, e como Nao Respondedores (NR) quando nao atingiram este limite. Foram estudadas a associaçao e as diferenças das diversas variáveis clínicas e espirométricas nos Grupos R e NR. A seguir foi efetuada a análise de regressao logística multivariada para identificar os fatores de risco capazes de prognosticar a maior probabilidade de perda de funçao pulmonar. RESULTADOS. A prevalência de NR nesta amostra foi de 43 por cento (n=36). Houve associaçao significante entre início dos sintomas de asma < 20 anos (0,009), maior duraçao da asma (0,021), e resposta positiva a inalaçao de Bd na espirometria basal, para os níveis de corte 12 por cento (0,016), 15 por cento (0,019) e 40 por cento (0,002) entre os grupos R e NR. Na espirometria basal, observamos menor VEF, (0,003), menor VEF,/CVF (<0,001) e houve maior média de perda de VEF, em ml/ano (0,033) nos pacientes do grupo NR. A análise da classificaçao da gravidade de obstruçao na espirometria atual revelou que houve aumento do número de pacientes normais no grupo R, em relaçao a espirometria basal e houve aumento de freqüência dos pacientes moderados e graves no grupo NR, caracterizado melhor a associaçao entre a gravidade da obstruçao e os grupos R e NR (p<0,001). Em relaçao a resposta broncodilatadora, o nível de corte de 40 por cento de reversibilidade, identificou mais populaçao do grupo NR...(au)
