Investigation of factors associated with difficult-to-control asthma.

OBJECTIVE: To determine the prevalence of factors associated with difficult-to-control asthma. METHODS: Patients with severe asthma were selected from the outpatient asthma clinic of the Ribeirão Preto School of Medicine Hospital das Clínicas. The patients were divided into two groups: controlled severe asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, congestive heart failure (CHF), pulmonary embolism, cystic fibrosis, vocal cord dysfunction, alpha-1 antitrypsin deficiency, and Churg-Strauss syndrome, were performed. RESULTS: 77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma, being 68.1% female, with mean age of 44.4 years (+/-14.4), and forced expiratory volume in one second of 54.7% (+/-18.3). The most factors most often associated with difficult-to-control asthma were noncompliance with treatment (68%), rhinitis/sinusitis (57%), GERD (49%), environmental exposure (34%), occupational exposure (17%), smoking history (10%), obstructive sleep apnea (2%), and CHF (2%). At least one of these factors was identified in every case. CONCLUSIONS: Noncompliance with treatment was the factor most often associated with difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.

Atelectasis due to bronchial compression by the vertebral column.

The authors report the case of an 18-year-old woman with a multicore-minicore syndrome in acute respiratory distress. Initially, she was treated as having pneumonia, without a complete clinical response. Further investigation showed right lower lobe atelectasis associated with an extrinsic compression of the right mainstem bronchus secondary to thoracic lordoscoliosis. Therapeutic interventions involved respiratory therapy, noninvasive ventilation, cephalic traction, and orthopedic surgery, leading to clinical and functional improvement.

Impaired quality of life of healthy young smokers.

STUDY OBJECTIVE: To investigate the health-related quality of life (HRQL) profile of healthy young subjects with a short smoking history. DESIGN: Observational data at a single point in time. SETTING: Survey in two public universities. PARTICIPANTS: Seventy-seven smoker students without any comorbidities (39 men; mean +/- SD age, 20.5 +/- 2.0 years). A control group for HRQL measurements was composed of 97 healthy, never-smoker students from the same universities (55 men; mean +/- SD age, 20.6 +/- 2.0 years). INTERVENTIONS: All subjects were blinded to the study proposal, and answered autoapplicable forms dealing with healthy habits, smoking, and the 36-item short form questionnaire. RESULTS: Never-smokers showed higher mean quality-of-life scores than smokers in all domains. Statistically significant differences were observed for the domains physical functioning (86.5 +/- 12.9 vs 93.4 +/- 9.6), general health perceptions (64.3 +/- 19.8 vs 79.2 +/- 13.4), vitality (58.4 +/- 20.0 vs 64.6 +/- 16.5), social functioning (59.3 +/- 19.7 vs 76.3 +/- 19.6), and mental health index (66.4 +/- 21.1 vs 71.9 +/- 15.5). CONCLUSIONS: Healthy, light-to-moderate smokers with a short smoking history show significant impairment in physical and mental domains of HRQL in comparison to never-smokers. A better elucidation of these aspects may provide useful information for planning smoking-cessation interventions.

Funcao autonomica dos sistemas cardiovascular e respiratorio no diabetes mellitus

Sabe-se que muitos pacientes diabeticos apresentam comprometimento do sistema nervoso autonomo. A maior parte do nosso conhecimento acerca do controle autonomico cardiovascular em pacientes diabeticos resulta de investigacoes sobre os reflexos cardiovasculares e cardiorrespiratorios. Neste estudo, nos comparamos as respostas cardiovasculares a tres testes da funcao autonomica em pacientes diabeticos e em individuos normais: 1) respostas da frequencia cardiaca e da pressao arterial ao teste postural passivo com inclinacao de 70 graus. 2) respostas da frequencia cardiaca e da pressao arterial a manobra de Valsalva. 3) variacao da frequencia cardiaca durante respiracao em seis ciclos/minuto (arritmia sinusal respiratoria). Alem disso, nos medimos a resistencia das vias aereas antes e apos a inalacao de sulfato de atropina nos pacientes diabeticos e nos individuos do grupo controle. Comparados aos normais, nos pacientes diabeticos nos observamos respostas cardiovasculares alteradas sugerindo comprometimento da atividade parassimpatica e simpatica. Varios pacientes com neuropatia autonomica tiveram resposta broncodilatadora diminuida a atropina, sugerindo que a inervacao vagal das vias aereas pode estar lesada no diabetes mellitus.