Asthma in the elderly: what we know and what we have yet to know

In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients

The effects of a respiratory exercise program tailored for elderly people with asthma

INTRODUÇÃO: A asma pode ter início em qualquer idade sendo que sua prevalência em idosos pouco difere dos grupos de menor idade. O subdiagnóstico da asma no idoso é refletido na observação de que aproximadamente 60% do total de mortes relacionadas à asma ocorrem em pessoas com 65 anos ou mais, sendo de igual importância a observação de que a função pulmonar diminuída, associada à obstrução das vias aéreas reduz a qualidade de vida dessa população. Sabe-se que devido à broncoconstrição das vias aéreas e conseqüente hiperinsuflação pulmonar, os asmáticos apresentam os músculos inspiratórios em posição de desvantagem mecânica, o que contribui para agravamento do quadro clínico do paciente. No intuito de auxiliar no tratamento da asma e melhorar a qualidade de vida desses pacientes, estudos sobre fisioterapia respiratória, e diferentes técnicas respiratórias têm sido feitos. Porém, até o momento não havia estudos sobre exercícios respiratórios sem o uso de aparelhos realizados com idosos asmáticos. OBJETIVO: Avaliar os efeitos de um programa de exercícios respiratórios (sem aparelho) para idosos asmáticos. MÉTODOS: foram selecionados 24 de 132 pacientes do PRONTMED (Prontuário Eletrônico do Serviço de Imunologia Clínica e Alergia do HCFMUSP), com idade igual ou superior a 60 anos, com diagnóstico de asma moderada ou grave. Dos pacientes selecionados, 21 iniciaram o programa e 14 freqüentaram regularmente e concluíram o programa de exercícios respiratórios. Antes do início do programa todos os pacientes foram avaliados com relação à função pulmonar, força da musculatura respiratória, capacidade aeróbia, qualidade de vida, e quadro clínico. Devido à pequena amostra, os pacientes foram controles deles mesmos. Após oito semanas de exercícios, e ao término do programa, todas as avaliações foram refeitas, e após um mês do término do programa, as avaliações mais uma vez foram refeitas. Durante o estudo os pacientes preenchiam diariamente um diário de sintomas da asma. RESULTADOS: após as 16 semanas de intervenção não observamos alterações significativas nas variáveis pulmonares, porém observamos aumentos significativos nas pressões inspiratórias (Pimáx) e expiratórias máximas (Pemáx), 27,6% e 20,54% respectivamente, que refletem a força da musculatura respiratória. Com relação à qualidade de vida verificamos melhoras significativas. As avaliações clínicas, juntamente com os diários de sintomas, indicaram melhoras significativas devido à redução da sintomatologia respiratória. Porém, após um mês sem os exercícios respiratórios, observamos que ocorreu o que é definido pela literatura como destreinamento: observamos diminuição de 21,4% na Pimáx e de 37,33% na Pemáx, que parecem ter refletido no quadro clínico, nos diários de sintomas e na qualidade de vida dos pacientes. Pois, observamos regressão nas melhoras anteriormente verificadas nessas variáveis. Logo, apesar de ter ocorrido o destreinamento, que é algo comum ao treinamento físico, quando este é reduzido ou interrompido, podemos inferir que o presente estudo de exercícios respiratórios contribuiu para aumento da força da musculatura respiratória e que esse aumento refletiu positivamente tanto no quadro clínico quanto na qualidade de vida dos pacientes, de modo que o mesmo poderia ser utilizado como um coadjuvante ao tratamento clínico-medicamentoso de pacientes idosos asmáticos.INTRODUCTION: People can develop asthma at any given age, and asthma prevalence in older adults is no different than that observed in younger people. Asthma in older adults is frequently underdiagnosed, and this is reflected in the fact that approximately 60% of people who die from asthma have surpassed the age of 65. Equally important is the fact that reduced lung function and airway obstruction have a negative impact on the quality of life for this population. In asthmatic patients, bronchoconstriction and consequent lung hyperinflation, leave the inspiratory muscles in a position of mechanical disadvantage, and thus, contribute to the exacerbation of the clinical presentation. A number of studies on respiratory physiotherapy and different breathing techniques have been performed in order to help asthma treatment and to improve the patients quality of life. Nevertheless, so far, we are not aware of any reports regarding breathing exercises without breathing equipment in older adults with asthma. OBJECTIVE: Evaluate the effects of a respiratory exercise program (without breathing equipment) tailored for elderly people. METHODS: Out of 132 patients listed in the PRONTMED (electronic filing system of the Clinical Immunology and Allergy Division of HCFMUSP), we selected 24 patients, aged 60 or greater, with a diagnosis of moderate or severe asthma. Out of the 24 patients, 21 started the program and 14 participated regularly and concluded the respiratory exercise program. Prior to the start of the program all patients were evaluated with regard to lung function, respiratory muscle strength, aerobic capacity, quality of life and clinical presentation. Due to the small sample size, patients were their own controls. At the end of a 16-week-exercise program all evaluations were repeated. During the study period, patients were requested to keep a diary and record symptoms every day. RESULTS: After 16 weeks of interventions, we did not observe significant changes in pulmonary lung function tests. However, we observed significant increases in maximum inspiratory pressure (Pimax) and maximum expiratory pressure (Pemax) (27.6 % and 20.54 % respectively), which are associated with respiratory muscle strength. In regards to quality of life, we observed considerable improvements. Clinical evaluations and the daily-recorded symptoms diary indicate significant improvements and fewer respiratory symptoms. Yet, a month after exercise interruption, we observed detraining, with reduction of Pimax (21.4 %) and Pemax (37.33 %). Detraining had a negative impact on clinical presentation, recording of symptoms, and patient quality of life, parameters that had previously improved with training. Despite the occurrence of detraining, which is common after reduction or interruption of exercise, we conclude that a respiratory exercise program increased muscle strength, which in turn had a positive effect on patient clinical presentation and quality of life. Therefore, a respiratory training program could be associated with the medical and clinical therapeutic approach of older adults with asthma

Respiratory exercise program for elderly individuals with asthma

INTRODUCTION: Asthma in older adults is frequently underdiagnosed, as reflected by approximately 60% of asthma deaths occurring in people older than age 65. OBJECTIVE: The present study evaluates the effects of a respiratory exercise program tailored for elderly individuals with asthma. We are not aware of any other reports examining breathing exercises in this population. METHODS: Fourteen patients concluded the 16-week respiratory exercise program. All the patients were evaluated with regard to lung function, respiratory muscle strength, aerobic capacity, quality of life and clinical presentation. RESULTS: After 16 weeks of this open-trial intervention, significant increases in maximum inspiratory pressure and maximum expiratory pressure (27.6% and 20.54%, respectively) were demonstrated. Considerable improvement in quality of life was also observed. The clinical evaluations and daily recorded-symptoms diary also indicated significant improvements and fewer respiratory symptoms. A month after the exercises were discontinued, however, detraining was observed. DISCUSSION: In conclusion, a respiratory exercise program increased muscle strength and was associated with a positive effect on patient health and quality of life. Therefore, a respiratory training program could be included in the therapeutic approach in older adults with asthma

Qualidade da informação da internet disponível para pacientes em páginas em português Quality of internet information available to patients on websites in Portuguese

OBJETIVO: Pacientes e seus familiares frequentemente procuram na internet informações a respeito de suas doenças. Diabetes mellitus (DM), hipertensão arterial sistêmica (HAS) e infarto agudo do miocárdio (IAM) são muito prevalentes no Brasil, e informações sobre estas patologias são bastante procuradas na internet. Por isso, buscamos avaliar a qualidade da informação relacionada com estas doenças disponível em português na internet. MÉTODOS: Foram selecionadas as primeiras 20 páginas em português de cada uma das doenças escolhidas, através do algoritmo de busca do Google®. Como ferramentas para avaliar a qualidade da informação foram utilizados o Discern Questionnarie (DQ) e o Health on Net (HON). Para saber se as informações eram adequadas, foram utilizadas as diretrizes (guidelines) brasileiras e internacionais para as diferentes comorbidades. RESULTADOS: Ao avaliar o conteúdo das informações disponíveis, 45%, 95%, 85% das páginas continham, respectivamente, a definição de DM, HAS e IAM. Com relação ao diagnóstico e ao tratamento, somente 25% das páginas das três comorbidades apresentavam especificamente esta informação. Somente 15%, 20% e 10% das páginas tinham a certificação pelo HON, respectivamente. Em função do DQ, as páginas obtiveram notas maiores que 50% em 70% das páginas de DM, 65% nas de HAS e 55% nas de IAM. CONCLUSÃO: A informação disponível em português na internet sobre as três patologias escolhidas (DM, HAS e IAM) é frequentemente inadequada e insuficiente.<br>OBJECTIVE: Patients and their relatives often look for information about their diseases on the internet. Diabetes mellitus (DM), systemic arterial hypertension (SAH), and acute myocardial infarction (AMI) are the most prevalent in Brazil, thus, information on these pathologies is extremely searched for on the internet. For this reason, this study attempted to evaluate the quality of information available in Portuguese on the web regarding these disorders. METHODS: The first 20 websites in Portuguese for each disease through the Google® search algorithm were selected. The Discern Questionnaire (DQ) and Health on the Net (HON) were used as tools in order to evaluate the quality of information. To assess adequacy, international and Brazilian guidelines for different co-morbidities were used. RESULTS: When evaluating the information content available, 45%, 95%, and 85% of pages had the definition of DM, SAH, and AMI, respectively. Only 25% of the websites regarding the three co-morbidities had specific information on diagnosis and treatment. Only 15%, 20%, and 10% of the websites had HON certification, respectively. Using the DQ approach, scores higher than 50% were obtained in 70% of the DM websites, in 65% of SAH websites, and in 55% of the AMI websites. CONCLUSION: The available information in Portuguese on the internet regarding the three pathologies selected (DM, SAH, and AMI) is quite often inadequate and insufficient