RESUMO
The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.
Assuntos
Doença Pulmonar Obstrutiva Crônica , Telemedicina , Seguimentos , Hospitalização , Humanos , Alta do Paciente , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de VidaRESUMO
El asma es una enfermedad crónica muy prevalente que genera un consumo importante de recursos sanitarios. El mal manejo de estos enfermos conlleva a un inadecuado control de la enfermedad, a un mayor coste sanitario y a un aumento de la morbimortalidad. La creación de unidades multidisciplinares es muy recomendable, principalmente en las formas más graves y ha demostrado una mejoría asistencial (efectividad), reduciendo notablemente los costes económicos de la enfermedad (eficiencia). Dichas unidades precisan un coordinador (neumólogo) que sea conocedor de todos los aspectos del asma y que organice todo el cuidado, incluyendo al resto de las especialidades implicadas (alergólogos, otorrinolaringólogos, gastroenterólogos, endocrinos, psicólogos y psiquiatras)
Asthma is a very prevalent chronic disease that generates a significant consumption of health resources. The mismanagement of these patients leads to poor control of the disease, a higher health cost and an increase in morbidity and mortality. The creation of multidisciplinary units is highly recommended, mainly in the most severe forms. It requires a coordinator (pneumologist) who is knowledgeable about all aspects of asthma and who organizes all the care, including the rest of the specialties involved (allergists, otolaryngologists, gastroenterologists, endocrines, psychologists and psychiatrists). The creation of these units has shown a welfare improvement (effectiveness), significantly reducing the economic costs of the disease (efficiency)
Assuntos
Humanos , Unidades de Internação , Comunicação Interdisciplinar , Asma/tratamento farmacológico , Asma/economia , Farmacoeconomia , Análise Custo-Benefício , Cooperação do Paciente , Relações InterprofissionaisRESUMO
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Assuntos
Humanos , Asma/epidemiologia , Broncoconstrição/imunologia , Cooperação do Paciente , Asma/terapia , Biomarcadores , Corticosteroides/administração & dosagemAssuntos
Asma/terapia , Avaliação de Processos em Cuidados de Saúde/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Asma/diagnóstico , Asma/fisiopatologia , Consenso , Prioridades em Saúde/normas , Humanos , Padrões de Prática Médica/normas , Valor Preditivo dos Testes , Espanha , Resultado do TratamentoRESUMO
BACKGROUND: Continuous positive airway pressure (CPAP) in asthma patients with concomitant obstructive sleep apnea syndrome (OSAS) seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. METHODS: Prospective, multicenter study. We examined asthma outcomes after 6 months of CPAP in 99 adult asthma patients (mean age 57 years) with OSAS (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire (ACQ) and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), respectively. Data were analyzed by intention-to-treat basis. RESULTS: The mean ± SD score of the ACQ decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the mAQLQ increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. CONCLUSIONS: Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome.
Assuntos
Asma/epidemiologia , Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Asma/diagnóstico , Asma/tratamento farmacológico , Pressão Positiva Contínua nas Vias Aéreas/métodos , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Qualidade de Vida , Testes de Função Respiratória , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Resultado do TratamentoRESUMO
No dispoinble
No disponible
Assuntos
Humanos , Masculino , Feminino , Asma/epidemiologia , Asma/imunologia , Asma/prevenção & controle , Monitorização Imunológica/métodos , Regulação e Fiscalização em Saúde , Indicadores de Serviços/organização & administração , Indicadores de Serviços/estatística & dados numéricos , Indicadores de Qualidade de Vida , Indicadores Básicos de Saúde , Indicadores de Qualidade em Assistência à Saúde/tendênciasRESUMO
BACKGROUND: Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement. METHODS: The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II). RESULTS: In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups. CONCLUSIONS: The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma.
Assuntos
Asma/terapia , Fidelidade a Diretrizes , Assistência ao Paciente , Adulto , Criança , Pesquisas sobre Atenção à Saúde , Humanos , EspanhaRESUMO
Fundamento: En línea con el lanzamiento de la guía GEMA2009, el objetivo del estudio fue identificar y evaluar las carencias en la implementación de las recomendaciones de la misma y proponer iniciativas de mejora. Material y métodos: Estudio descriptivo-comparativo, transversal, cualitativo. Inicialmente se identificaron los aspectos mejorables refrendándolos con la GEMA2009 (Fase I), para posteriormente priorizar su necesidad de abordaje puntuando los aspectos mejorables utilizando una escala Likert de 9 puntos (Fase II). Resultados: Participaron 134 médicos en la Fase I, y de estos, 107 en la Fase II. El estudio recogió y evaluó las opiniones de un grupo multidisciplinar de expertos en asma (neumólogos, alergólogos, pediatras y médicos de atención primaria). El 81% de las limitaciones identificadas en la atención a adultos y el 49,2% en los niños se consideraron de prioridad alta. Las más importantes fueron: en adultos, mejorar el tratamiento de las embarazadas; en niños, el empleo de los b2-adrenérgicos a dosis elevadas en la exacerbación de asma. Otras carencias relevantes fueron: la escasa utilización de la espirometría, de cuestionarios de síntomas y de planes de acción por escrito para los pacientes, la falta de implicación del personal de enfermería y no ajustar el tratamiento según el grado de control en revisiones. Conclusiones: Las áreas de mejora prioritaria son las relacionadas con el tratamiento. Los futuros programas de implementación de las guías deberían priorizar el uso de los cuestionarios de síntomas, la implicación de enfermería y la atención de la asmática embarazada (AU)
Background: Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement. Methods: The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II). Results: In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups. Conclusions: The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma (AU)
Assuntos
Humanos , Asma/diagnóstico , Asma/tratamento farmacológico , Melhoramento Biomédico/métodos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Padrões de Prática Médica , Pesquisas sobre Atenção à Saúde/estatística & dados numéricosRESUMO
El concepto de asma de control difícil engloba a todos aquellos pacientes con asma insuficientemente o mal controlada, a pesar de seguir una estrategia terap¨¦utica apropiada, una vez se ha comprobado el cumplimiento de esta, se han descartado otras enfermedades y controlados los factores agravantes de la enfermedad. Los factores que contribuyen a que el asma sea refractaria al tratamiento no son bien conocidos. Algunos estudios establecen asociaciones d¨¦biles entre determinadas alteraciones gen¨¦ticas y varios factores ambientales. Se ha descrito que mutaciones del gen IL-4 y su receptor parecen tener relaci¨®n con la p¨¦rdida de funci¨®n pulmonar y con episodios de asma de riesgo vital. Tambi¨¦n se han relacionado con la gravedad del asma factores implicados en el remodelado de la v¨ªa a¨¦rea as¨ª como mutaciones de los receptores para los glucocorticoides y los ¦Â2-adren¨¦rgicos. Por otra parte se han asociado con la gravedad del asma diversos factores ambientales como la exposici¨®n continua a al¨¦rgenos, tabaquismo, intolerancia a antiinflamatorios no esteroideos (AINE) e infecciones. Estudios multic¨¦ntricos como el estudio ENFUMOSA y el estudio TENOR nos han ayudado a comprender en parte esta enfermedad (AU)
The concept of difficult-to-control asthma covers all those patients with insufficiently or poorly controlled asthma who, in spite of having followed an appropriate therapeutic strategy, and after having verified its compliance, other diseases have been ruled out and aggravating factors of the disease controlled. The factors that contribute to making asthma refractory to treatment are not well known. Some studies establish weak associations between certain genetic alterations and several environmental factors. It has been described that mutations of the IL-4 gene and its receptor seem to have a relationship with loss of pulmonary function and with life-threatening asthma episodes. They have also been related with the severity of the asthma factors involved in airway remodeling and mutations of glucocorticoids and beta 2-adrenergic receptors. On the other hand, different environmental factors such as continuing exposure to allergens, tobacco smoke, intolerance to NSAIDs and infections have been associated with the severity of asthma. Multicenter study such as the ENFUMOSA study and the TENOR study have partially helped us to understand this disease (AU)
Assuntos
Humanos , Asma/complicações , Resistência a Medicamentos , Fatores de Risco , Índice de Gravidade de Doença , Corticosteroides/uso terapêutico , Receptores de Glucocorticoides/genética , Remodelação das Vias Aéreas/fisiologiaRESUMO
BACKGROUND: Data on the association between obesity and asthma control are conflicting. We performed an analysis to elucidate the association between body mass index (BMI) and asthma control in a large sample of asthmatics. MATERIALS AND METHODS: Data were obtained from a previous study in which the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT) were validated for a Spanish population. The study sample comprised 607 adult (> or = 18 years) asthmatic patients (61% female), of whom 235 (39%) had mild-persistent asthma, 246 (41%) had moderate-persistent asthma, and 126 (21%) had severe-persistent asthma. RESULTS: The analysis showed a significant but very low correlation between BMI and ACQ-forced expiratory volume in the first second of expiration (FEV1) (r=0.1, P=.007) and ACQ-peak expiratory flow (PEF) (r=0.1, P=.010), but not ACQ-without lung function (wLF) (r=0.06, P=.116) or ACT. No significant association was found between BMI and asthma control as defined by physicians or according to ACT or ACQ (ACQ-FEV1, ACQ-PEF and ACQ-wLF) scores. We found no significant associations between ACT, ACQs (ACQ-FEV1, ACQ-PEF and ACQ-wLF), and BMI when BMI was classified as low (BMI, <18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity (BMI, > or = 30 kg/m2), or morbid obesity (BMI, >34.9 kg/m2). However, the percentage of patients with poor control was slightly greater in patients with low BMI and obesity. CONCLUSIONS: Using specific and validated tools, and in the context of clinical practice, this study did not find a relevant association between BMI and asthma control.
Assuntos
Asma/fisiopatologia , Índice de Massa Corporal , Obesidade/fisiopatologia , Adolescente , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Testes de Função RespiratóriaRESUMO
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Assuntos
Humanos , Asma/diagnóstico , Asma/tratamento farmacológico , Recidiva/prevenção & controle , Padrões de Prática Médica , Espirometria , Broncodilatadores , Índice de Gravidade de Doença , Agonistas Adrenérgicos beta/administração & dosagem , Rinite Alérgica Perene/diagnósticoRESUMO
No disponible
No disponible
Assuntos
Humanos , Asma/fisiopatologia , Asma/diagnóstico , Asma/tratamento farmacológicoRESUMO
OBJECTIVE: Validation of the Spanish version of the Asthma Control Test (ACT). METHODS: A total of 607 asthmatic patients were assessed. The psychometric properties of ACT were evaluated. The ACT capacity to predict the physician's assessment of asthma control was assessed using the area under the receiving operating characteristics (ROC) curve (AUC), sensitivity, specificity, and positive-negative predictive values. RESULTS: ACT's Cronbach alpha was 0.84. The intraclass correlation coefficient was 0.85. The AUC was 0.86, with a sensitivity of 71% and a specificity of 85% for a score of < or =19. CONCLUSIONS: The Spanish version of ACT is shown to be a reliable and valid tool for evaluating and discriminating asthma control.
Assuntos
Asma/diagnóstico , Inquéritos e Questionários , Idoso , Asma/prevenção & controle , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , EspanhaRESUMO
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Assuntos
Humanos , Asma/tratamento farmacológico , Antiasmáticos/farmacocinética , Inflamação/tratamento farmacológico , Esteroides/uso terapêutico , Agonistas Adrenérgicos beta/uso terapêutico , Interleucinas/antagonistas & inibidoresRESUMO
La neumonía lipoidea aguda es una enfermedad poco frecuente producida por la aspiración masiva de material graso. Presenta unas características clínicas, radiológicas y histopatológicas muy llamativas y una evolución generalmente favorable.Se presenta un caso de neumonía lipoidea aguda en un varón de 26 años comedor de fuego
Acute lipoid pneumonia is an uncommon disease produced by massive aspiration of fatty substances. It has very striking clinical, radiological and histopathological characteristics and a generally favorable evolution.A case of acute lipoid pneumonia in a 26-year old male, "fire-eater" is presented
Assuntos
Humanos , Masculino , Adulto , Pneumonia Lipoide/diagnóstico , Pneumonia Aspirativa/diagnóstico , Óleo Mineral/efeitos adversos , Pneumonia Lipoide/etiologia , Pneumonia Aspirativa/etiologia , IncêndiosAssuntos
Asma/psicologia , Atitude Frente a Saúde , Cooperação do Paciente , Asma/terapia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevista Psicológica , Motivação , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Personalidade , Relações Médico-PacienteRESUMO
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