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Gebremariam TH, Sherman CB, Schluger NW. Perception of asthma control among asthmatics seen inChest Clinic at Tertiary Hospital, Addis Ababa, Ethiopia. BMC Pulm Med 2019; 19:187. [PMID: 31660922 PMCID: PMC6819349 DOI: 10.1186/s12890-019-0959-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/15/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patient awareness of asthma severity is important for optimal asthma management. However, there is often a discrepancy between physician assessment of asthma control based on guidelines and patient discernment of control. We compared physician and patient perception of asthma control in a clinic population seen at a tertiary hospital in Addis Ababa, Ethiopia. METHODS In this cross-sectional study, 182 consecutive patients with a physician diagnosis of asthma seen in Chest Clinic at Tikur Anbessa Specialized Hospital (TASH) between July and December 2015 were studied. Demographics, asthma symptoms, medication use in the past month, and self-perception of asthma control in the past 7 days were obtained from the clinic records. Physician assessed asthma control was based on the GINA asthma symptom control assessment tool. Lung function was measured using a Diagnostic EasyOne Plus model 2001 SN spirometer. The institutional review board approved the study protocol. RESULTS Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years, and the mean (SD) duration of asthma was 19.4 ± 12.7 years. Forty-four (24.2%) patients had physician determined well-controlled asthma and 138 (75.8%) patients had physician determined partly controlled/uncontrolled asthma. One hundred and fifty-one (83%) patients thought their asthma control was good. However, the degree of concordance between physician evaluation and patient perception of asthma control was low (kappa index = 0.09). On multivariate analysis, self-perceived poor asthma control was associated with any activity limitation due to asthma and inconsistent inhaled corticosteroid use. CONCLUSION In our study, the first of its kind in Ethiopia, a high percent of patients with physician determined well-controlled asthma has appropriate perception of their disease state. However, those patients with partly controlled/uncontrolled asthma had poor self-perception of their disease, emphasizing the need for further patient education. These conclusions may be especially useful in the care of asthmatics from other low-income countries.
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Affiliation(s)
- Tewodros H. Gebremariam
- Addis Ababa University, College of Heath Sciences, Lideta Sub-city Gambia St., P O Box 22787 code, 1000 Addis Ababa, Ethiopia
| | | | - Neil W. Schluger
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia, USA
- University College of Physicians and Surgeons, New York, NY USA
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Castelluccio JF, Stirbulov R, Perez EA, Oliveira JCM, Donner CF, Oliveira LVF, Rasslan Z. Study of correlation between forced vital capacity and demand for healthcare services in severe asthmatics. Multidiscip Respir Med 2015. [PMID: 26199726 PMCID: PMC4508817 DOI: 10.1186/s40248-015-0020-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Involvement of the small airways may be related to increased severity and increased demand for health care services and incurring in high costs, private or for the healthcare system. The hyperinflation consequent to this involvement reduces lung volumes, such as FVC, FEV1 and SVC. The aim of this study was to evaluate the correlation between the predicted values of FVC, FEV1 and SVC with the demand for healthcare services by severe asthmatics. METHODS We retrospectively evaluated in order of arrival, the medical records of 98 patients with severe asthma, in step 4 treatment in the intercritical period of the disease, correlating the number of times each patient sought health care services represented by admissions to the ER, ICU and hospital wards due to asthma, in the year before the last spirometry and the predicted values of FVC, FEV1 and SVC. RESULTS Our sample showed a clear and significant negative correlation between the predicted values of FVC, FEV1 and SVC and demand for healthcare services. CONCLUSION For this sample we conclude, that reduced forced vital capacity correlated with asthma severity, defined by greater demand for care in the ER, ICU and hospital ward and was more evident in women.
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Affiliation(s)
- J F Castelluccio
- Assistant Professor Internal Medicine Department, Santa Casa School of Medicine and Hospitals of São Paulo, São Paulo (SP), Brazil
| | - R Stirbulov
- Associate Professor Internal Medicine Department - Pneumology, Santa Casa School of Medicine and Hospitals of São Paulo, São Paulo (SP), Brazil
| | - E A Perez
- Master Degree Program in Research in Surgery of Santa Casa School of Medicine of Sao Paulo (FCMSCSP), Sao Paulo (SP), Brazil
| | - J C M Oliveira
- Rehabilitation Sciences PhD Program, Nove de Julho University, Sao Paulo, Brazil
| | - C F Donner
- Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero, NO Italy
| | - L V F Oliveira
- Rehabilitation Sciences Master and PhD Program, Nove de Julho University, Sao Paulo, Brazil ; Rua Itapicuru, 380 apto 111 Perdizes, CEP 05006-000 Sao Paulo, SP Brazil
| | - Z Rasslan
- Assistant Professor Internal Medicine Department, Santa Casa School of Medicine and Hospitals of São Paulo, São Paulo (SP), Brazil
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Fernandes AGO, Souza-Machado C, Coelho RCP, Franco PA, Esquivel RM, Souza-Machado A, Cruz AA. Risk factors for death in patients with severe asthma. J Bras Pneumol 2015; 40:364-72. [PMID: 25210958 PMCID: PMC4201166 DOI: 10.1590/s1806-37132014000400003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/02/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma
treated between December of 2002 and December of 2010 at the Central Referral
Outpatient Clinic of the Bahia State Asthma Control Program, in the city of
Salvador, Brazil, we selected all those who died, as well as selecting other
patients with severe asthma to be used as controls (at a ratio of 1:4). Data were
collected from the medical charts of the patients, home visit reports, and death
certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were
attributed to respiratory causes and occurred within a health care facility.
Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease,
long-standing asthma, and persistent airflow obstruction were common features in
both groups. Multivariate analysis showed that male gender, FEV1
pre-bronchodilator < 60% of predicted, and the lack of control of asthma
symptoms were significantly and independently associated with mortality in this
sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred
predominantly due to respiratory causes and within a health care facility. Lack of
asthma control and male gender were risk factors for mortality.
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Cukier A. Perception of asthma symptoms. J Bras Pneumol 2011; 36:523-4. [PMID: 21085815 DOI: 10.1590/s1806-37132010000500001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Reck CL, Fiterman-Molinari D, Barreto SSM, Fiterman J. Poor perception of dyspnea following methacholine challenge test in patients with asthma. J Bras Pneumol 2011; 36:539-44. [PMID: 21085818 DOI: 10.1590/s1806-37132010000500004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 05/27/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the proportion of asthma patients with a poor perception of dyspnea, correlating the level of that perception with the severity of acute bronchoconstriction, bronchial hyperresponsiveness, use of maintenance medication, and asthma control. METHODS Uncontrolled clinical trial involving asthma patients treated at the Pulmonology Outpatient Clinic of the São Lucas Hospital, in Porto Alegre , Brazil. Methacholine challenge testing was performed using a five-breath dosimeter protocol. The perception of dyspnea after each breath was determined using the Borg scale. Data concerning asthma control, medication in use, and use of rescue short-acting bronchodilators were recorded. RESULTS Of the 65 patients included in the study, 53 completed the evaluation. Of those, 32 (60.5%) showed adequate perception of dyspnea after the methacholine challenge test, whereas 21 (39.5%) did not perceive any changes in the degree of dyspnea even after a 20% fall in FEV1. There were no significant differences between the two groups regarding baseline FEV1, percentage fall in FEV1, and the dose of methacholine causing a 20% fall in FEV1. The perception of dyspnea was not significantly associated with age (p = 0.247); gender (p = 0.329); use of maintenance medication (p = 0.152); asthma control (p = 0.562), bronchial hyperresponsiveness (p = 0.082); or severity of acute bronchoconstriction (p = 0.749). CONCLUSIONS A significant proportion of asthma patients have a poor perception of dyspnea. The factors related to the inability of these patients to identify changes in pulmonary function have not yet been well defined. In order to reduce asthma-related morbidity and mortality, it is essential that this group of patients be identified and counseled.
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Affiliation(s)
- Cláudia Loss Reck
- Pontifical Catholic University of Rio Grande do Sul – São Lucas Hospital, Porto Alegre, Brazil
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Leite M, Ponte EV, Petroni J, D'Oliveira Júnior A, Pizzichini E, Cruz AA. Evaluation of the asthma control questionnaire validated for use in Brazil. J Bras Pneumol 2009; 34:756-63. [PMID: 19009207 DOI: 10.1590/s1806-37132008001000002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 02/01/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate whether the Portuguese version of the Asthma Control Questionnaire (ACQ) is a valid instrument to measure asthma control in adult outpatients in Brazil. METHODS We selected 278 outpatients diagnosed with asthma. All of the patients completed the questionnaire, underwent spirometry and were clinically evaluated by a physician in order to characterize the control of the disease in the first visit. The questionnaire was evaluated in three versions, with 5, 6 and 7 questions, respectively, and scores of 0.75 and 1.50 were used as cut-off points. RESULTS Of the 278 patients, 77 (27.7%) had intermittent asthma, 39 (14.0%) had mild persistent asthma, 40 (14.4%) had moderate persistent asthma and 122 (43.9%) had severe persistent asthma. The sensitivity of ACQ to identify uncontrolled asthma ranged from 77% to 99%, and the specificity ranged from 36% to 84%. The positive predictive value ranged from 73% to 90%, and the negative predictive value ranged from 67% to 95%. The positive likelihood ratio ranged from 1.55 to 4.81, and the negative likelihood ratio ranged from 0.03 to 0.27. In the 5- and 6-question versions of the ACQ, the intraclass correlation coefficient was 0.92. These two versions were both responsive to clinical changes in the patients. CONCLUSIONS All three versions of the ACQ satisfactorily discriminated between patients with uncontrolled asthma and those with controlled asthma. The 5- and 6-question versions also presented good reliability and responsiveness. Therefore, the ACQ is a valid tool for evaluating asthma control in adult outpatients in Brazil.
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Affiliation(s)
- Mylene Leite
- Programa de Controle da Asma e Rinite Alérgica na Bahia, Salvador, BA, Brasil.
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Souza-Machado A, Souza-Machado C, Silva DF, Ponte EV, Cruz AA. Causes of death in asthma patients enrolled in the Bahia State Program for the Control of Asthma and Allergic Rhinitis. J Bras Pneumol 2008; 33:372-9. [PMID: 17982528 DOI: 10.1590/s1806-37132007000400005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 01/04/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report demographic and clinical characteristics of patients with asthma who evolved to death, as well as to describe the conditions related to this outcome in a subgroup of patients admitted to the Program for the Control of Asthma and Rhinitis in Bahia (ProAR). METHODS A descriptive, retrospective, observational study. Data from clinical charts and death certificates of 16 patients of 930 subjects with severe asthma monitored at the ProAR Central Reference Center from December 2003 to June 2006 were reviewed. RESULTS Of the 930 patients participating in the program, 16 (1.72%) died. Of these, there were 10 males and 6 females, ranging in age from 39 to 74 years (median, 55 years); 12 (75%) of the patients were black. Time since diagnosis ranged from 1 to 68 years (median, 30 years). In 43.8 and 53.8%, respectively, there was a personal or family history of atopy. Ex-smokers (<10 pack-years) accounted for 37.5% of the cases. Causes of death listed on the death certificates were as follows: asthma or asthma exacerbations in 8 (50%); respiratory failure in 3 (18.75%); acute heart infarction in 2 (12.5%); hepatitis in 1 (6.25%); hypovolemic shock in 1 (6.25%); and cardiorespiratory arrest in 1 (6.25%). Of the 16 deaths, 13 (81.25%) occurred inside hospitals. CONCLUSION Asphyxia and cardiovascular diseases were the most common attributed causes of mortality in this subgroup of patients with severe asthma. Hospital-based mortality, male gender, advanced age, long-term disease and fixed airflow obstruction were the aspects most frequently observed in the cases studied.
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Cavalcante TDMC, Diccini S, Barbosa DA, Bittencourt ARDC. The use of Borg's modified scale in asthma crises. ACTA PAUL ENFERM 2008. [DOI: 10.1590/s0103-21002008000300014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: Verify the correlation of the improvement of the degree of dyspnea by BME with improved pulmonary performance verified by Expiratory Flow Peak (EFP) and Peripheral Oxygen Saturation (PO2S). METHODS: Analytical, cross-sectional study with 124 patients during an asthma crisis, who received care at a Pneumology emergency service. Heart rate, respiratory frequency EFP, PO2S were evaluated before and after treatment of asthma crisis, and they were questioned about their perception of dyspnea by BME. RESULTS: In the pre-treatment stage, high scale values were related to low EFP values, inverting this relation after treatment. There was also a slight correlation between EFP, PO2S and the perception of dyspnea measured by the patient through BME. CONCLUSION: The scale does not replace other clinical parameters, and can be used as an additional tool, provided that the patient is correctly informed about the scale values.
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Cavallazzi TGDL, Cavallazzi RS, Cavalcante TDMC, Bettencourt ARDC, Diccini S. Avaliação do uso da Escala Modificada de Borg na crise asmática. ACTA PAUL ENFERM 2005. [DOI: 10.1590/s0103-21002005000100006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A dispnéia é a maior causa de incapacidade e redução da qualidade de vida para pacientes com doenças respiratórias como é o caso da asma. Os objetivos deste estudo foram verificar o grau de dispnéia dos pacientes em crise asmática pela Escala Modificada de Borg e a correlação da melhora do grau de dispnéia com a melhora da função pulmonar verificada pelo Pico de Fluxo Expiratório (PFE). Foram incluídos 40 pacientes asmáticos em crise aguda, atendidos no serviço de Pronto Atendimento em Pneumologia do Hospital São Paulo, no período de setembro à dezembro de 2003. Antes e após o tratamento, os seguintes dados foram coletados: freqüência cardíaca (FC), freqüência respiratória (FR), PFE e saturação periférica de oxigênio (SpO2). O paciente era questionado sobre sua percepção da dispnéia pela Escala Modificada de Borg. No pré-tratamento ocorreu uma tendência dos valores altos da escala de Borg estarem relacionados aos valores baixos do PFE, invertendo esta relação no pós-tratamento. Esta escala é rápida, barata e de fácil aplicabilidade na avaliação de pacientes asmáticos. Pode ser utilizada por profissionais de saúde para a avaliação inicial dos pacientes em crise, bem como sua resposta ao tratamento.
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