Exacerbations in severe persistent asthma – Impact of risk factors control

Diva Ferreira¹

Raquel Duarte²

Aurora Carvalho³

Resumo

Nos países desenvolvidos, 1 a 2% do total dos custos em cuidados de saúde são gastos no controlo da asma. Ahistória natural e as causas da asma grave não estão ainda bem definidas. A asma persistente grave é uma situação menos comum, representando 5% do total de doentes asmáticos. Apesar de constituir um pequeno número de doentes, este grupo é responsável por elevados custos na asma. Como consequência, o controlo dos factores de risco pode levar a ganhos socioeconómicos e também na saúde. O objectivo deste trabalho foi analisar os factores de risco de exacerbações na asma persistente rave num grupo de doentes asmáticos. Consistiu num estudo retrospectivo de doentes com asma persistente grave em vigilância em consulta hospitalar de asma entre 1984 e 2005, baseando-se na revisão de processos clínicos. Foram incluídos 27 doentes, idade média=50,64±12,7 anos, 81,5% do sexo feminino. Analisaram-se os principais factores de risco de exacerbações: atopia, infecções respiratórias, asma pré-menstrual, sintomas nasais, refluxo gastroesofágico, psicológicos e obesidade. A correcção destes factores permitiu um melhor controlo da doença. O impacto mais significativo foi conseguido através da polipectomia e contracepção oral numa adolescente Em conclusão, a correcta identificação de todos os factores de risco de exacerbação da asma, a selecção dos factores que podem ser controlados e a sua correcção podem melhorar o controlo da doença.

Abstract

It is estimated that in developed countries between 1% and 2% of total healthcare expenditure goes on asthma treatment. The natural progression and causes of severe asthma are still not well defined. Severe persistent asthma is a less common situation, accounting for 5% of total asthma patients. Despite representing a small percentage of total patients, this group is largely responsible for the high health costs of asthma. Consequently, the improvement of risk factors can lead to both socioeconomic and health gains. The aim of this study was to examine risk factors for exacerbations in a group of patients with severe persistent asthma. It was a retrospective study, based on patient case histories that included subjects with severe persistent asthma with follow-up in an allergy unit between 1984 and 2005. A total 27 patients were included (mean age=50.64±12.7 years), 81.5% female. Main risk factors for exacerbations analysed were atopy, respiratory infections, premenstrual asthma, nasal symptoms, gastroesophageal reflux disease (GERD), psychological factors and obesity. Correction of these risk factors improved asthma control. The most significant impact was achieved with polypectomy and oral contraceptives in a teenager. In conclusion, correct identification of all risk factors for exacerbation in asthma, selection of those that can be controlled and their correction can improve asthma control.

Key-words: Severe persistent asthma, risk factors, control.

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Bibliografia / Bibliography

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¹Interna Complementar de Pneumologia / Pulmonology Resident

²Assistente Hospitalar de Pneumologia / Pulmonology Consultant

³Assistente Graduada de Pneumologia / Specialist Consultant in Pulmonology

Correspondência / Correspondence to:

Diva de Fátima Gonçalves Ferreira

Serviço de Pneumologia

Centro Hospitalar de Vila Nova de Gaia

Rua Conceição Fernandes

4434-502 Vila Nova de Gaia

email: divafferreira@sapo.pt

Aceite para publicação/accepted for publication: 07.04.27