However, this study protocol should be reproduced in a sample that includes both adults and children, and hospitalization should be evaluated as a primary outcome measure before its generalized implementation can be recommended.ĭespite all of the pharmacological advances that offer highly efficacious options for the treatment of asthma, this disease continues to be one of the leading causes of emergency treatment and hospitalization in Brazil.Ĭonsidering the high rates of asthma morbidity and the typically overloaded state of Brazilian emergency rooms and hospitals, it is necessary to work on two fronts. Although the study carried out in Rio Grande do Sul does not allow the 'dissection' of the relevant components of the prognostic marker identified (since only PEF measured at fifteen minutes after the initiation of treatment was taken into consideration), it offers a simple and easily executed option for objective measurement of the degree of airway obstruction for routine use in the emergency treatment of asthma. This immediate response may be a more significant prognostic factor than is baseline PEF. The authors included the immediate response to the first doses of bronchodilator in their results. The decision made by Piovesan et al.(5) to evaluate PEF at fifteen minutes after the initiation of treatment probably facilitated the performance of the maneuver, obtaining greater co-operation by the patients. Performing the PEF maneuver is unpleasant in this situation and can occasionally aggravate the bronchospasm, in addition to delaying the initiation of treatment. In the emergency treatment of an asthma patient, it is necessary, first of all, to provide relief. Second, the outcome measure evaluated in the study carried out in Rio Grande do Sul was PEF at four hours after the first dose of bronchodilator, whereas that evaluated in the study carried out in São Paulo was hospital admission due to asthma. First of all, the age brackets were quite different. There are some differences between the methodologies of these studies that may explain the diversity of the results. Studying predictive factors of hospital admissions due to asthma, these authors reported that arterial oxygen saturation and clinical scores obtained at the beginning of the emergency treatment were useful but found that PEF measurement did not contribute to predicting hospitalization. The study was carried out in the state of Rio Grande do Sul.Ĭontradicting this conclusion, we found the recent report by Paro and Rodrigues,(6) who evaluated 130 children from one to thirteen years of age with acute asthma in São Paulo. In this issue of the Jornal Brasileiro de Pneumologia (Brazilian Journal of Pulmonology), Piovesan et al.(5) present the results of a study that reaffirms the usefulness of serial measurement of peak expiratory flow (PEF) in the emergency treatment of adults and teenagers with asthma, demonstrating that the PEF measured at fifteen minutes after the initiation of treatment is a good prognostic marker of the outcome of the attack, which was evaluated by a second PEF measurement at four hours after the first bronchodilator inhalation. In asthma, poor perception of the severity of the obstructive phenomena may deceive some patients,(1-2) creating a risk of asphyxia due to lack of appropriate treatment.(3) Inaccurate perception of the severity also deceives physicians, as we have demonstrated in a study of outpatients with moderate to severe asthma.(4)
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |