Evaluation of an educational programme for socially deprived asthma patients

The aim of this study was to evaluate the effectiveness of an asthma education programme in moderate and severe asthma patients in a longitudinal, prospective and randomized study with a control group. Fifty-three asthmatic patients were studied, 26 of whom were assigned to the educational group and 27 to the control group.The educational group attended the programme regularly for a period of 6 months. the programme included information about asthma, instruction on the appropriate use of medication and training in the metered dose inhaler (MDI) technique, and information about the identification and control of asthma attacks and the recognition of early signs of exacerbation. the control group was submitted to the routine tare provided at the Asthma Clinic, with no formal instruction regarding asthma control. the groups were identical with regard to severity parameters, skills, lung function and quality of Life at the beginning of the trial.At the end of the study, the education group showed significant differences when compared with the control group education/control (mean values) with respect to: visits to the asthma emergency room over the previous 6 months, 0.7/2 (p=0.03); nocturnal symptoms, 0.3/0.7 (p=0.04); score of symptoms, 1.3/2 (p=0.04). Improvements were also observed in skills and quality of life, knowledge of how to deal with attacks and how to control the environmental triggering factors, 73/35 (<0.05); correct use of the MDI, 8/4 (0.001); understanding of the difference between relief and antiinflammatory medication, 86/20 (<0.05); and in the global limitation quality of life score, 28/50 (0.02).It is concluded that the educational programme led to a significant improvement in asthma morbidity and that the implantation of educational programmes is possible for special populations when these programmes are adapted to the socioeconomic profile of the patients, with a significant gain in terms of the reduction of symptoms and improved pulmonary function and quality of life of asthmatics.Universidade Federal de São Paulo, Dept Med, Lund Div, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Lund Div, São Paulo, BrazilWeb of Scienc

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft

Background: Exacerbation of pulmonary dysfunction has been reported in patients receiving a pleural drain inserted through the intercostal space in comparison to patients with an intact pleura undergoing coronary artery bypass grafting (CABG). Evidence suggests that shifting the site of pleural drain insertion to the subxyphoid position minimizes chest wall trauma and preserves respiratory function in the early postoperative period. the aim of this study was to compare the pulmonary function parameters, clinical outcomes, and pain score between patients undergoing pleurotomy with pleural drain placed in the subxyphoid position and patients with intact pleural cavity after off-pump CABG (OPCAB) using left internal thoracic artery (LITA).Methods: Seventy-one patients were allocated into two groups: I (n = 38 open left pleural cavity and pleural drain inserted in the subxyphoid position); II (n = 33 intact pleural cavity). Pulmonary function tests and clinical parameters were recorded preoperatively and on postoperative days (POD) 1, 3 and 5. Arterial blood gas analysis and shunt fraction were evaluated preoperatively and in POD1. Pain score was assessed on POD1. To monitor pleural effusion and atelectasis chest radiography was performed routinely 1 day before operation and until POD5.Results: in both groups a significant impairment was found in lung function parameters until on POD5. However, no significant difference in forced vital capacity and forced expiratory volume in 1 second were seen between groups. A significant decrease in partial pressure of arterial oxygen and an increase in shunt fraction values were observed on POD1 in both groups, but no statistical difference was found when the groups were compared. Pleural effusion and atelectasis until on POD5 were similar in both groups. There were no statistical differences in pain score, duration of mechanical ventilation and postoperative hospital stay between groups.Conclusion: Subxyphoid insertion of pleural drain provides similar effects to preserved pleural integrity in pulmonary function, clinical outcomes, and thoracic pain after OPCAB. Therefore, our results support the hypothesis that once pleural cavities are incidentally or purposely opened during LITA dissection, subxyphoid placement of the pleural drain is recommended.Universidade Federal de São Paulo, Escola Paulista Med, Pirajussara Hosp, Dept Med,Cardiol Discipline, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Cardiol Discipline, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Physiotherapy Sch, Dept Human Movement Sci, BR-11060001 Santos, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Pneumol Discipline, BR-04039002 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pirajussara Hosp, Dept Med,Cardiovasc Surg Discipline, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Cardiovasc Surg Discipline, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pirajussara Hosp, Dept Med,Cardiol Discipline, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Cardiol Discipline, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Physiotherapy Sch, Dept Human Movement Sci, BR-11060001 Santos, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Pneumol Discipline, BR-04039002 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pirajussara Hosp, Dept Med,Cardiovasc Surg Discipline, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Cardiovasc Surg Discipline, BR-04024002 São Paulo, BrazilWeb of Scienc

Validation of a simplified socioeconomically quality-of-life questionnaire for deprived asthma patients

Introduction: Quality-of-life questionnaires have been recognized as an important tool to measure the impact of asthma in the patient's life and has become a main outcome in clinical research. To be effective, questionnaires should be adapted to reflect the needs of the target population. Objective: To assess the reliability, responsiveness, and cross-sectional validity of a simplified quality-of-life questionnaire (QQL-EPM) as a tool specially developed for a socioeconomically deprived target population of asthmatic patients. Method: Thirty-five asthma patients were followed in a prospective open study over a period of 9 weeks. Clinical visits were performed monthly with pulmonary function assessment and the patients filled out a diary card regarding symptom scores, use of rescue medication, and PEF. At each visit, FEV 1 and FVC were measured and two health-related quality-of-life questionnaires were applied: general quality of life (SF-36) and specific quality of life (QQL-EPM). the condition of patient regarding asthma control was assessed at each visit to the clinic, with treatment optimization and medication adjustment as needed. At the end of the study, each period was analyzed across the trial period and classified as stable or noncontrolled asthma. Results: QQL-EPM was able to correlate changes in quality of life in patients with alterations in their asthma control condition (global = 0.0001) and to differentiate these patients from those whose condition remained stable (global = 0.0001). the reliability of QQL-EPM was 0.68-0.90, and correlation with other clinical measurements and generic quality of life was moderate.Universidade Federal de São Paulo, Dept Med, Lung Div, EPM, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Lung Div, EPM, São Paulo, BrazilWeb of Scienc