ESTUDO DE CUSTOS COMPARANDO DOIS MÉTODOS DE ADMINISTRAR O AEROSSOL BRONCODILATADOR NO TRATAMENTO DA ASMA AGUDA NA SALA DE EMERGÊNCIA: NEBULIZAÇÃO INTERMITENTE COM FLUXO DE AR COMPRIMIDO VERSUS SPRAY ACOPLADO A ESPAÇADOR VALVULADO

Objetive: Bronchodilator delivery by means of metered-dose inhaler or intermittent nebulization is equivalent in the acute treatment of asthma. Some studies suggest that metereddose inhaler is less costly. The choice of the delivery method will depend on the consideration of costs. The aim of the present study is to compare the costs of aerosol bronchodilator delivery by use of an intermittent nebulizater versus metered-dose inhaler with valved spacer in patients with acute asthma in the adult emergency department.Methods: We compared the costs of different beta-adrenergic agents with and without ipratropium bromide delivered by intermittent nebulizer versus metered-dose inhaler with valved spacer in the adult emergency department of Hospital de Clínicas de Porto Alegre. Comparisons were made for 1, 6 and 12-hour treatment. The costs of all material used were taken into consideration.Results: The metered-dose inhaler with spacer was a less costly method of bronchodilator delivery in comparison to intermittent nebulization for the different beta-agonist agents, with and without ipratropium bromide.Conclusions: Bronchodilator delivery by means of a metered-dose inhaler with valved spacer was cost-saving in comparison to delivery by means of an intermittent nebulization in the treatment of acute asthma in the emergency department. The metered-dose inhaler/spacer treatment is progressively less expensive as the length of stay in the emergency department increases.Objetivo: A administração de broncodilatadores através de dispositivo com aerossol dosimetrado (spray) ou através de nebulizador é equivalente em eficácia no tratamento da asma aguda. Alguns estudos sugerem que o spray tem um custo menor. A escolha do método de administração do aerossol depende de considerações sobre o custo. O objetivo deste estudo é comparar os custos entre nebulização intermitente com fluxo de ar comprimido versus spray acoplado a espaçador valvulado na administração do aerossol broncodilatador no tratamento da asma aguda no setor de adultos da sala de emergência.Méotdo:s Comparamos os custos de diferentes agentes beta-adrenérgicos, com e sem brometo de ipratrópio, administrados por nebulização intermitente versus spray acoplado a espaçador valvulado no setor de adultos da emergência do Hospital de Clínicas de Porto Alegre. As comparações foram feitas para 1, 6 e 12 horas de tratamento. Foram considerados os custos de todos os materiais utilizados.Resutlados: O spray com espaçador consistiu em um método mais barato de administrar o broncodilatador em comparação com a nebulização intermitente para diferentes agentes beta-agonistas, com e sem ipratrópio.Conculsões: A administração do broncodilatador por spray com espaçador valvulado foi mais econômica em comparação à administração por nebulização intermitente no tratamento da asma aguda na sala de emergência. O tratamento com spray/espaçador é progressivamente mais barato à medida que o tempo de permanência no setor de emergência aumenta

Effects of an outpatient education program in patients with uncontrolled asthma

OBJECTIVE: To evaluate the effects of an outpatient education program in patients with uncontrolled asthma. METHODS: This was an uncontrolled study evaluating an educational intervention and involving patients with uncontrolled asthma ≥ 14 years of age. The participants completed a questionnaire designed to assess the level of asthma control, the inhalation technique, and quality of life. All of the patients underwent pulmonary function testing, after which they participated in an education program consisting of one 45-min face-to-face session, followed by phone interviews at two, four, and eight weeks. The participants were reevaluated after three months. RESULTS: Sixty-three patients completed the study. There was a significant improvement in the level of asthma control (p < 0.001). Of the 63 patients, 28 (44.4%) and 6 (9.5%) were classified as having partially controlled asthma and controlled asthma, respectively. The mean FEV1 was 63.0 ± 20.0% and 68.5 ± 21.2% of the predicted value prior to and after the educational intervention, respectively (p = 0.002), and all of the quality of life scores improved (p < 0.05 for all). The same was true for the proportion of patients prior to and after the educational intervention using the proper inhalation technique when using metered dose inhalers (15.4% vs. 46.2%; p = 0.02) and dry powder inhalers (21.3% vs. 76.6%; p < 0.001). The logistic regression analysis revealed that an incorrect inhalation technique identified during the first evaluation was independently associated with a favorable response to the educational intervention. CONCLUSIONS: This study suggests that an outpatient education program for asthma patients improves the level of asthma control, lung function parameters, and quality of life. An incorrect inhalation technique identified during the first evaluation was predictive of a favorable response to the educational intervention

Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission

Objetivo: Comparar as características clínicas e os desfechos de pacientes hospitalizados por tuberculose que iniciaram tratamento nas primeiras 24 h de permanência hospitalar com as daqueles que iniciaram tratamento após 24 h. Métodos: Estudo de coorte retrospectivo de casos novos de tuberculose com idade ≥ 18 anos que necessitaram internação hospitalar após atendimento no setor de emergência. Resultados: Foram incluídos 305 pacientes hospitalizados, dos quais 67 (22,0%) iniciaram o tratamento nas primeiras 24 h (grupo ≤24h), e 238 (88,0%) o iniciaram após (grupo >24h). Ser do sexo feminino (OR = 1,99; IC95%: 1,06-3,74; p = 0,032) e ter pesquisa de BAAR positiva no escarro espontâneo (OR = 4,19; IC95%: 1,94-9,00; p < 0,001) se associaram com o tratamento nas primeiras 24 h. Na comparação dos grupos ≤24h e >24h, a taxa de internação em UTI foi de, respectivamente, 22,4% e 15,5% (p = 0,258), enquanto a ventilação mecânica foi utilizada em 22,4% e 13,9% (p = 0,133), a taxa de óbito hospitalar foi de 22,4% e 14,7% (p = 0,189), e a taxa de cura foi de 44,8% e 52,5% (p = 0,326). Conclusões: Embora o tratamento antituberculose tenha sido iniciado rapidamente em uma proporção considerável dos pacientes hospitalizados, as taxas de mortalidade hospitalar, internação em UTI e uso de ventilação mecânica permaneceram elevadas. Estratégias para o controle de tuberculose na atenção primária devem considerar que pacientes atendidos em hospitais chegam muito tardiamente e com doença avançada, sendo necessário implementar medidas de busca ativa na comunidade para o diagnóstico e o tratamento mais precoce.Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission (≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326). Conclusions: Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment

ESTUDO DE CUSTOS COMPARANDO DOIS MÉTODOS DE ADMINISTRAR O AEROSSOL BRONCODILATADOR NO TRATAMENTO DA ASMA AGUDA NA SALA DE EMERGÊNCIA: NEBULIZAÇÃO INTERMITENTE COM FLUXO DE AR COMPRIMIDO VERSUS SPRAY ACOPLADO A ESPAÇADOR VALVULADO

Objetive: Bronchodilator delivery by means of metered-dose inhaler or intermittent nebulization is equivalent in the acute treatment of asthma. Some studies suggest that metereddose inhaler is less costly. The choice of the delivery method will depend on the consideration of costs. The aim of the present study is to compare the costs of aerosol bronchodilator delivery by use of an intermittent nebulizater versus metered-dose inhaler with valved spacer in patients with acute asthma in the adult emergency department.Methods: We compared the costs of different beta-adrenergic agents with and without ipratropium bromide delivered by intermittent nebulizer versus metered-dose inhaler with valved spacer in the adult emergency department of Hospital de Clínicas de Porto Alegre. Comparisons were made for 1, 6 and 12-hour treatment. The costs of all material used were taken into consideration.Results: The metered-dose inhaler with spacer was a less costly method of bronchodilator delivery in comparison to intermittent nebulization for the different beta-agonist agents, with and without ipratropium bromide.Conclusions: Bronchodilator delivery by means of a metered-dose inhaler with valved spacer was cost-saving in comparison to delivery by means of an intermittent nebulization in the treatment of acute asthma in the emergency department. The metered-dose inhaler/spacer treatment is progressively less expensive as the length of stay in the emergency department increases.Objetivo: A administração de broncodilatadores através de dispositivo com aerossol dosimetrado (spray) ou através de nebulizador é equivalente em eficácia no tratamento da asma aguda. Alguns estudos sugerem que o spray tem um custo menor. A escolha do método de administração do aerossol depende de considerações sobre o custo. O objetivo deste estudo é comparar os custos entre nebulização intermitente com fluxo de ar comprimido versus spray acoplado a espaçador valvulado na administração do aerossol broncodilatador no tratamento da asma aguda no setor de adultos da sala de emergência.Méotdo:s Comparamos os custos de diferentes agentes beta-adrenérgicos, com e sem brometo de ipratrópio, administrados por nebulização intermitente versus spray acoplado a espaçador valvulado no setor de adultos da emergência do Hospital de Clínicas de Porto Alegre. As comparações foram feitas para 1, 6 e 12 horas de tratamento. Foram considerados os custos de todos os materiais utilizados.Resutlados: O spray com espaçador consistiu em um método mais barato de administrar o broncodilatador em comparação com a nebulização intermitente para diferentes agentes beta-agonistas, com e sem ipratrópio.Conculsões: A administração do broncodilatador por spray com espaçador valvulado foi mais econômica em comparação à administração por nebulização intermitente no tratamento da asma aguda na sala de emergência. O tratamento com spray/espaçador é progressivamente mais barato à medida que o tempo de permanência no setor de emergência aumenta

Active Case Finding of Tuberculosis (TB) in an Emergency Room in a Region with High Prevalence of TB in Brazil

Public hospital emergency room (ER) in Porto Alegre, Brazil, a setting with high prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV) infection.To determine the prevalence of PTB, using a symptom based active case finding (ACF) strategy in the ER of a public hospital in an area with high prevalence of TB and HIV, as well as variables associated with pulmonary TB diagnosis.Cross sectional study. All patients ≥ 18 years seeking care at the ER were screened for respiratory symptoms and those with cough ≥ 2 weeks were invited to provide a chest radiograph and two unsupervised samples of sputum for acid-fast bacilli smear and culture.Among 31,267 admissions, 6,273 (20.1%) reported respiratory symptoms; 197 reported cough ≥ 2 weeks, of which pulmonary TB was diagnosed in 30. In multivariate analysis, the variables associated with a pulmonary tuberculosis diagnosis were: age (OR 0.94, 95% CI: 0.92-0.97; p<0.0001), sputum production (OR 0.18, 95% CI 0.06-0.56; p = 0.003), and radiographic findings typical of TB (OR 12.11, 95% CI 4.45-32.93; p<0.0001).This study identified a high prevalence of pulmonary TB among patients who sought care at the emergency department of a tertiary hospital, emphasizing the importance of regular screening of all comers for active TB in this setting