Artigo Original / Original Article
Tromboembolismo pulmonar e asma de difícil controlo
Pulmonary embolism and difficult-to-treat asthma
Catarina Teles Martins1, Carlos Lopes2, Alda Manique3, Dolores Moniz3, Renato Sotto-Mayor3, A Bugalho de Almeida4
1 Interna do Internato Complementar de Pneumologia, Serviço de Pneumologia do Hospital de Santa Maria, Lisboa / Pulmonology Resident, Pulmonology Unit, Hospital de Santa Maria, Lisbon
2 Assistente de Pneumologia, Serviço de Pneumologia do Hospital de Santa Maria, Lisboa / Pulmonology Consultant, Pulmonology Unit, Hospital de Santa Maria, Lisbon
3 Assistente Graduada de Pneumologia, Serviço de Pneumologia do Hospital de Santa Maria, Lisboa / Specialist Consultant in Pulmonology, Pulmonology Unit, Hospital de Santa Maria, Lisbon
4 Chefe de Serviço de Pneumologia, Serviço de Pneumologia do Hospital de Santa Maria, Lisboa / Head, Pulmonology Unit, Pulmonology Unit, Hospital de Santa Maria, Lisbon
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"etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Assistente Graduada de Pneumologia, Serviço de Pneumologia do Hospital de Santa Maria, Lisboa / <span class="elsevierStyleItalic">Specialist Consultant in Pulmonology, Pulmonology Unit, Hospital de Santa Maria, Lisbon</span>" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Chefe de Serviço de Pneumologia, Serviço de Pneumologia do Hospital de Santa Maria, Lisboa / <span class="elsevierStyleItalic">Head, Pulmonology Unit, Pulmonology Unit, Hospital de Santa Maria, Lisbon</span>" "etiqueta" => "4" "identificador" => "af0020" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pulmonary embolism and difficult-to-treat asthma" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-07-11" "fechaAceptado" => "2007-09-20" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570427" "palabras" => array:3 [ 0 => "Tromboembolismo pulmonar" 1 => "asma grave" 2 => "asma não controlada" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570428" "palabras" => array:3 [ 0 => "Pulmonary thromboembolism" 1 => "severe asthma" 2 => "difficult-to-treat asthma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">O presente trabalho teve por objectivo avaliar o papel do tromboembolismo pulmonar (TEP) na asma grave de difícil controlo.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18 anos; 86% sexo feminino); destes, 57% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) tinham doença “não controlada” – 35% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6) por má adesão à terapêutica; 29% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) por TEP (confirmado gamagra-ficamente); 12% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) por rinossinusite grave; 6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) por síndroma hipereosinofílica; 6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) por contacto mantido com alérgenos e 6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) em estudo.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Os doentes com TEP (idade média 56<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>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%).</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Os resultados do presente trabalho apoiam a inclusão do TEP no grupo de comorbilidades possivelmente responsáveis pelo mau controlo da asma.</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007; XIII (6): 776-787</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">In this group (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>254), 28 (11%) had severe persistent asthma and their mean age was 44<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD18 years old. 86% were females. Of these, 57% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) had uncontrolled disease: 35% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6) due to non-compliance with treatment; 29% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) pulmonary thrombombolism (scintigraphic confirmation); 12% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) severe rhinosinusitis; 6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) hypereosinophilic syndrome; 6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) persistent allergen exposure and 6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) are still being investigated.</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">Patients with TPE (mean age 56<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD9 years old; 80% females; 80% Caucasians) were diagnosed with asthma as adults (mean age 37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD14 years old). The mean time until the diagnosis of TPE was 18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD12 years. Predisposing factors for TPE were venous insufficiency (40%), hypertension (40%) and deficit of functional protein C and S (20%).</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">This study supports the inclusion of TPE in the group of comorbidities to consider while investigating uncontrolled asthma.</p><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007; XIII (6): 776-787</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia / Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "GINA Report WR 2006" ] ] ] 1 => array:3 [ "identificador" => "bb0010" "etiqueta" => "2." 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Difficult asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.E. Strek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/pats.200510-115JH" "Revista" => array:7 [ "tituloSerie" => "Proc Am Thorac Soc" "fecha" => "2006" "volumen" => "3" "numero" => "1" "paginaInicial" => "116" "paginaFinal" => "123" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16493159" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bb0030" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on diagnosis and management of acute pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "Torbicki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart Journal" "fecha" => "2000" "volumen" => "21" "paginaInicial" => "1301" "paginaFinal" => "1336" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bb0035" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical, laboratory, roentgenographic and electrocardiographic signs in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary diseas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "P.D. 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features of pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.W. Barritt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1961" "volumen" => "1" "paginaInicial" => "729" "paginaFinal" => "732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2564542" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bb0055" "etiqueta" => "11." 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Article information
ISSN: 08732159Original language: Portuguese
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