The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

Abstract

Objective: Studies assessing the characteristics and management of patients hospitalized with asthma have been limited to a small number of facilities and have evaluated short time periods. The present study evaluated long-term changes among hospitalized asthma patients at a large number of facilities. Methods: This was a retrospective, hospital-based observational case series, designated the Study of Severe Asthma in Latin America and Spain, which was conducted in Spain and in eight Latin-American countries. We reviewed the hospital records of 3,038 patients (age range, 15-69 years) hospitalized with acute severe asthma at one of nineteen tertiary-care hospitals in 1994, 1999 and 2004. Results: Over time, the use of inhaled corticosteroids and long-acting β 2 agonists increased significantly, whereas the use of theophylline as a controller medication decreased. The utilization of pulmonary function tests also increased. There was a significant reduction in the mean hospital stay (8.5 days, 7.4 days and 7.1 days in 1994, 1999 and 2004, respectively, p = 0.0001) and a significant increase in the mean of the lowest arterial pH at hospital admission. In contrast, there was a significant decrease in the proportion of cases in which PEF was determined in the emergency room (48.6% in 1994 vs. 43.5% in 2004, p = 0.0001). We found the quality of asthma management and care to be generally better in Spain than in Latin America. Conclusions: Although there have been certain improvements in the management of asthma between severe exacerbations and during hospitalization, asthma management remains suboptimal in Spain and, especially, in Latin America.Keywords: Status asthmaticus; Asthma/therapy; Hospitalization. ResumoObjetivo: Estudos que avaliem as características e o gerenciamento de pacientes asmáticos hospitalizados têm sido limitados a um número pequeno de serviços e a curtos períodos de duração. O presente estudo avaliou alterações de longo prazo de pacientes asmáticos hospitalizados em um grande número de serviços. Métodos: Estudo retrospectivo, observacional, de base hospitalar, denominado Estudo sobre Asma Grave na América Latina e Espanha, realizado na Espanha e em oito países da América Latina. Foi realizada uma revisão dos registros hospitalares de 3.038 pacientes (variação de idade, 15-69 anos) hospitalizados com asma aguda grave em um dos 19 hospitais terciários em 1994, 1999 e 2004. Resultados: Ao longo do tempo, o uso de corticosteroides inalatórios e de β 2 -agonistas aumentou significativamente, ao passo que o uso de teofilina, como medicação de controle, decaiu. A utilização de testes de função pulmonar também aumentou. Houve uma redução significativa da média do tempo de internação (8,5 dias, 7,4 dias e 7,1 dias em 1994, 1999 e 2004, respectivamente; p = 0,0001) e um aumento significativo da média do menor pH arterial na admissão. Em contrapartida, houve uma diminuição significativa na proporção de casos submetidos ao PFE no pronto-socorro (48,6% em 1994 vs. 43,5% em 2004; p = 0,0001).O tratamen...

Hospitalization rate and 30-day mortality among patients with status asthmaticus in Denmark: a 16-year nationwide population-based cohort study

“…Although a definition of status asthmaticus is available,1–4 there are several different terms, including acute asthma, severe asthma, and hospital admission due to asthma 2,5,17,19–22,24,25,38. Furthermore, status asthmaticus is the only sub-code among the asthma diagnoses in the ICD-10 that denotes an acute asthmatic condition.…”

Medicamentos ao Norte, doentes ao Sul

“…Rodrigo et al showed us that the mean hospital stay was one week, which, obviously, results in an equal duration of work absenteeism. (1) In terms of the hospitalization of patients with severe asthma, the popular adage "Time is money" has been confirmed in studies conducted in Brazil. One year after asthma had been included in a program of control, including pharmacological treatment at no charge to the patient, there was a reduction in the number of asthma-related hospitalizations and emergency room visits, as well as an improvement in asthma "Medicaments au Nord, malades au Sud..."…”

“…That statement, which remains valid, can also be applied to asthma, for a variety of reasons, including the failure of many governments and government officials to recognize the extent and repercussions of this disease. This is illustrated in the study conducted by Rodrigo et al, published in this issue of the Brazilian Journal of Pulmonology, (1) in which the authors profiled patients with acute severe asthma, hospitalized in Spain or in one of a number of Latin-American countries. Mutatis mutandis, many of their findings reflect the fact that, south of the equator, budgets established for the health sector in general, as well as for increasing the availability of essential medications in particular, are insufficient.…”

“…This right is incompatible with the scenario described by Rodrigo et al in this issue. (1) patient quality of life, together with, notably, a savings of approximately US$1,500.00 to each family budget. (5) The overall cost of asthma to the average family has been shown to be 29% of the total household income.…”

“…In Brazil, such programs have been created at the municipal level in a small number of cities and have been initiated by a few health care professionals and officials who have recognized the relevance of the problem and have sought to implement measures that are known to be efficacious. (6)(7)(8) Although such initiatives could be considered timid in view of the dimensions of the challenge, they undoubtedly constitute a strategy to radically transform the panorama described by Rodrigo et al (1) The lack of attention given to asthma in public health policies is onerous not only to the patients and their families but also to society as a whole and to worker productivity. There are strategies that have been proven to be effective in the control of asthma, (6) and such strategies should be more widely implemented.…”