Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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2020 Brazilian Thoracic Association recommendations for the management of asthma

Recomendações para o manejo da asma da Sociedade Brasileira de Pneumologia e Tisiologia - 2020

Marcia Margaret Menezes Pizzichini1, Regina Maria de Carvalho-Pinto2, José Eduardo Delfini Cançado3, Adalberto Sperb Rubin,4,5, Alcindo Cerci Neto6,7, Alexandre Pinto Cardoso8, Alvaro Augusto Cruz9,10, Ana Luisa Godoy Fernandes11, Daniella Cavalet Blanco12, Elcio Oliveira Vianna13, Gediel Cordeiro Junior14,15, José Angelo Rizzo16, Leandro Genehr Fritscher12, Lilian Serrasqueiro Ballini Caetano11, Luiz Fernando Ferreira Pereira17, Marcelo Fouad Rabahi18, Maria Alenita de Oliveira19, Marina Andrade Lima20, Marina Buarque de Almeida21, Rafael Stelmach2, Paulo Márcio Pitrez22, Alberto Cukier2

J Bras Pneumol.2020;46(1):e20190307-e20190307

Abstract PDF PT PDF EN Portuguese Text

The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.

 


Keywords: Asthma/therapy; Asthma/drug therapy; Asthma/prevention & control; Practice guideline.

 


Six-minute walk test and respiratory muscle strength in patients with uncontrolled severe asth-ma: a pilot study

Teste de caminhada de seis minutos e força muscular respiratória em pacientes com asma grave não controlada: um estudo piloto

Luiz Fernando Ferreira Pereira1, Eliane Viana Mancuzo2, Camila Farnese Rezende3, Ricardo de Amorim Côrrea4

J Bras Pneumol.2015;41(3):211-218

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate respiratory muscle strength and six-minute walk test (6MWT) variables in patients with uncontrolled severe asthma (UCSA). Methods: This was a cross-sectional study involving UCSA patients followed at a university hospital. The patients underwent 6MWT, spirometry, and measurements of respiratory muscle strength, as well as completing the Asthma Control Test (ACT). The Mann-Whitney test was used in order to analyze 6MWT variables, whereas the Kruskal-Wallis test was used to determine whether there was an association between the use of oral corticosteroids and respiratory muscle strength. Results: We included 25 patients. Mean FEV1 was 58.8  21.8% of predicted, and mean ACT score was 14.0  3.9 points. No significant difference was found between the median six-minute walk distance recorded for the UCSA patients and that predicted for healthy Brazilians (512 m and 534 m, respectively; p = 0.14). During the 6MWT, there was no significant drop in SpO2. Mean MIP and MEP were normal (72.9  15.2% and 67.6  22.2%, respectively). Comparing the patients treated with at least four courses of oral corticosteroids per year and those treated with three or fewer, we found no significant differences in MIP (p = 0.15) or MEP (p = 0.45). Conclusions: Our findings suggest that UCSA patients are similar to normal subjects in terms of 6MWT variables and respiratory muscle strength. The use of oral corticosteroids has no apparent impact on respiratory muscle strength.

 



 

 


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CNPq, Capes, Ministério da Educação, Ministério da Ciência e Tecnologia, Governo Federal, Brasil, País Rico é País sem Pobreza
Secretariat of the Brazilian Journal of Pulmonology
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E-mails: jbp@jbp.org.br
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