tromboembolismo pulmonar e asma de difícil controlo

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ID: 189386
2007
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Abstract
Resumo: O controlo da asma é um factor crucial na abordagem do doente: a mais recente actualização do GINA considera que uma “asma difícil de tratar” é uma asma para investigar. O não cumprimento da terapêutica, a DPOC concomitante, o tabagismo, a rinossinusite, o refluxo gastroesofágico e a obesidade são considerados os principais motivadores da asma difícil de controlar.O presente trabalho teve por objectivo avaliar o papel do tromboembolismo pulmonar (TEP) na asma grave de difícil controlo.Foram revistos os processos clínicos de doentes asmáticos da consulta de Alergologia Respiratória do nosso Serviço, entre 2004 e 2006, com asma “persistente grave” de acordo com o GINA 2005. Foram seleccionados os que, apesar de terapêutica optimizada, apresentavam asma “não controlada” (GINA 2006) e analisadas as suas causas. Dos 254 doentes estudados, 28 (11%) preenchiam os critérios de “asma persistente grave” (idade média 44±18 anos; 86% sexo feminino); destes, 57% (n=16) tinham doença “não controlada” – 35% (n=6) por má adesão à terapêutica; 29% (n=5) por TEP (confirmado gamagra-ficamente); 12% (n=2) por rinossinusite grave; 6% (n=1) por síndroma hipereosinofílica; 6% (n=1) por contacto mantido com alérgenos e 6% (n=1) em estudo.Os doentes com TEP (idade média 56±9 anos; 80% sexo feminino; 80% raça branca) tiveram o diagnóstico de asma na idade adulta (média 37 anos), tendo decorrido cerca de 18 anos até ao diagnóstico de TEP. A análise dos factores predisponentes para TEP revelou: insuficiência venosa periférica (40%), HTA (40%) e deficiência de proteína C e S funcionais (20%).Todos os doentes efectuaram terapêutica anticoagulante (80% ainda mantém), referindo-se que, após o início da anticoagulação, 40% dos doentes alcançaram o controlo da doença e 40% têm, actualmente, asma “parcialmente controlada”, não se tendo verificado novos internamentos por agudização da doença.Os resultados do presente trabalho apoiam a inclusão do TEP no grupo de comorbilidades possivelmente responsáveis pelo mau controlo da asma.Rev Port Pneumol 2007; XIII (6): 776-787 Abstract: Asthma control is a key point in patient management. GINA’s most recent report emphasises the need to investigate uncontrolled asthma, of which non-com-pliance with treatment, COPD, smoking, chronic sinusitis, gastroesophageal reflux disease and obesity are the usual causes.The aim of this work is to evaluate the role of pulmonary thromboembolism (PTE) in cases of difficult-to-treat asthma. We reviewed the case reports of patients with severe persistent asthma followed in our Asthma Outpatients Clinic between 2004 and 2006. We selected the ones that maintained uncontrolled disease despite an optimal therapeutical approach and investigated the causes.In this group (n=254), 28 (11%) had severe persistent asthma and their mean age was 44±SD18 years old. 86% were females. Of these, 57% (n=16) had uncontrolled disease: 35% (n=6) due to non-compliance with treatment; 29% (n=5) pulmonary thrombombolism (scintigraphic confirmation); 12% (n=2) severe rhinosinusitis; 6% (n=1) hypereosinophilic syndrome; 6% (n=1) persistent allergen exposure and 6% (n=1) are still being investigated.Patients with TPE (mean age 56±SD9 years old; 80% females; 80% Caucasians) were diagnosed with asthma as adults (mean age 37±SD14 years old). The mean time until the diagnosis of TPE was 18±SD12 years. Predisposing factors for TPE were venous insufficiency (40%), hypertension (40%) and deficit of functional protein C and S (20%).All these patients received anticoagulant therapy (80% are still medicated). It should be noted that after the beginning of anticoagulants, 40% of the patients achieved control of their asthma and 40% have partially controlled disease. There were no hospital admissions for asthma exacerbations after the beginning of anticoagulation in this group.This study supports the inclusion of TPE in the group of comorbidities to consider while investigating uncontrolled asthma.Rev Port Pneumol 2007; XIII (6): 776-787 Palavras-chave: Tromboembolismo pulmonar, asma grave, asma não controlada, Key-words: Pulmonary thromboembolism, severe asthma, difficult-to-treat asthma
Reference Key
martins2007revistatromboembolismo Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Catarina Teles Martins;Carlos Lopes;Alda Manique;Dolores Moniz;Renato Sotto-Mayor;A Bugalho de Almeida
Journal the journal of applied psychology
Year 2007
DOI
DOI not found
URL
http://www.sciencedirect.com/science/article/pii/S0873215915303755
Keywords
diseases of the respiratory system

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