Estudo sobre fatores de risco para a recorrência de ataques de asma e educação em asma

Abstract

Introduction: Asthma is a chronic inflammatory disease in which the interaction between intrinsic and extrinsic factors determines the lack of control and the occurrence of severe exacerbations. Many of these events are preventable; therefore, recognizing individual and environmental risk factors allows the development of preventive strategies and consequent reduction of morbidity and risk of death. This study aimed to assess risk factors for recurrent asthma exacerbations. Methods: Prospective cohort study between July/2019 and March/2021, involving adults treated at an emergency unit due to a severe asthma attack. The following were performed: pulmonary function test, skin allergy test, blood eosinophil count, a prescription medication for asthma, questionnaires for clinical assessment, risk factors for asthma attacks, and asthma knowledge; monitoring by telemonitoring for 12 months. Results: We performed an integrative literature review to identify potential risk factors for the recurrence of asthma attacks. Nineteen studies were selected, which identified predictors related to treatment, comorbidities, and environmental exposure. The results of the cohort study involved 195 participants. The recurrence rate of exacerbations was 28.7 %/year, and the independent predictors were asthma-related hospitalization in the last year, previous admission to the intensive care unit for asthma, diagnosis of depression, and gastroesophageal reflux disease (GERD). In this study, a multifaceted and multidisciplinary intervention program for asthma control developed for primary health care (PHC) in a poor region of Brazil was implemented, including the production of an educational booklet on asthma and health education technologies for the follow-up of patients. One hundred sixty-five participants were assessed regarding knowledge about asthma. 15.8% of them had satisfactory knowledge before the interventions were performed, and in the end, this proportion increased to 46.7%. Conclusions: Previous asthma-related hospital admissions and associated comorbidities (GERD and depression) independently predicted a higher rate of recurrence of severe asthma attacks. Identifying risk factors after an exacerbation can be useful for the clinical management and prevention of future asthma exacerbations. Joint actions strengthened the patient-professional relationship, increased knowledge, and facilitated asthma management in a setting of few resources. Despite being promising, the implementation of these technologies must consider the social and economic characteristics of the region.