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Vol. 33. Issue 8.
Pages 389-394 (September 1997)
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Vol. 33. Issue 8.
Pages 389-394 (September 1997)
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Estudio de factores relacionados con la morbilidad del asma
Factors related to asthma morbidity
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J.E. Cimasa,*, M.C. Arceb, M.E. Gonzálezc, A. López Viñad
a Centro de Salud de Contrueces. Hospital de Cabueñes. Gijón
b Unidad de Hospitalización a Domicilio, Hospital de Cabueñes. Gijón
c Centro de Salud de El Coto, Hospital de Cabueñes. Gijón
d Sección de Neumología. Hospital de Cabueñes. Gijón
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El objetivo de este estudio ha sido averiguar la situación clínica, el tratamiento prescrito y el cumplimiento del mismo en los pacientes con asma, así como conocer cuáles son los parámetros que más influyen en el control de la enfermedad.

Se estudiaron 335 pacientes asmáticos adscritos a centros de salud. Se realizaron a todos una espirometría y una entrevista, recogiéndose parámetros de morbilidad, tratamiento prescrito y método de inhalación utilizado. Se valoró mediante escalas el cumplimiento del tratamiento y el uso de los inhaladores. La adecuación del tratamiento se estimó según los criterios del consenso internacional del asma.

Mediante análisis multivariante se estudió qué variables influyen en el control del asma, incluyéndose edad, sexo, hábito tabáquico, corrección del tratamiento, técnica de inhalación, cumplimiento del tratamiento y tiempo de evolución de la enfermedad.

Noventa y seis pacientes (28,7%) tenían morbilidad baja, 111 (33,1%) media y 128 (38,2%) alta. El tratamiento era correcto en 118 (35,2%), en 72 (21,5%) se utilizaban más fármacos o más dosis de los recomendados y en 145 (43,3%) el tratamiento era incorrecto. La técnica de inhalación era adecuada en 87 personas (27,5%) e inadecuada en 229 (72,5%). Cumplían bien el tratamiento 94 pacientes (28,1%), y mal 241 (71,.9%).

Las variables que mostraron influencia significativa sobre el asma fueron el tratamiento correcto y el cumplimiento.

Existe una elevada morbilidad por asma en la población estudiada. Se observa un alto porcentaje de tratamiento incorrecto y bajo cumplimiento, siendo estas las situaciones que más influyen en el control de la enfermedad.

Palabras clave:
Asma
Tratamiento
Cumplimiento

To determine the clinical situation, prescribed treatment and compliance in patients with asthma, and to identify the parameters that most influence control of the disease.

We studied 335 asthma patients assigned to health centers. All were interviewed and respiratory gases were measured. Disease symptoms were recorded, along with treatment prescribed and inhalation method used. Compliance and inhaler use were assessed on a scale. Treatment appropriateness was evaluated against criteria of international consensus.

Multiple regression analysis was used to identify the variables that most influenced control of asthma. Variables considered were age, sex, smoking, treatment appropriateness, inhaler technique, compliance with prescribed treatment and time since diagnosis.

Disease was mild in 96 patients (28.7%), moderate in 111 (33.1%) and severe in 128 (38.2%). Treatment was appropriate in 118 (35.2%). Seventy-two (21.5%) used more drugs or higher doses than recommended. Prescribed treatment was inappropriate in 145 (43.3%). The inhalation technique was appropriate in 87 (27.5%) and inappropriate in 229 (72.5%). Ninety-four patients (28.1%) complied well with treatment and 241 (71.9%) were poor compliers.

The variables that were significantly realted to control of asthma were appropriate treatment and compliance.

There is a high rate of morbidity due to asthma in the population studied. The percentage of inappropriate treatment is high, and compliance is low, these factors being the ones that most influence control of the disease.

Key words:
Asthma
Treatment
Compliance
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Bibliografía
[1.]
F.E. Hargreave, J. Dolovich, M.T. Newhouse.
The assessment and treatment of asthma: a conference report.
J Allergy Clin Immunol, 85 (1990), pp. 1.098-1.111
[2.]
M. Tumer-Warwick.
Nocturnal asthma: a study in general pratice.
J R Coll Gen Pract, 39 (1989), pp. 239-243
[3.]
K.P. Jones, D.G.J. Bain, M. Middelton, M.A. Mullee.
Correlatos of asthma morbidity in primary care.
Br Med J, 304 (1992), pp. 361-364
[4.]
A.N.P. Speight, D.A. Lee, E.N. Hey.
Underdiagnosis and undertreatment of asthma in childhood.
Br Med J, 286 (1983), pp. 1.253-1.256
[5.]
M. Levy, L. Bell.
General practice audit of asthma in childhood.
Br MedJ, 289 (1984), pp. 1.115-1.116
[6.]
A.R. Gellert, S.L. Gellert, S.R. Iliffe.
Prevalence and management of asthma in a London inner city general practice.
Br J Gen Pract, 40 (1990), pp. 197-201
[7.]
C.R. Hom, G.M. Cochrane.
Management of asthma in general practice.
Respir Med, 83 (1989), pp. 67-70
[8.]
C.R. Horn, T.J.H. Clark, G.M. Cochrane.
Compliance with inhaled therapy and morbidity from asthma.
Respir Med, 84 (1990), pp. 67-70
[9.]
Grupo Español del Estudio Europeo del Asma.
Estudio Europeo del Asma Prevalencia de síntomas relacionados con el asma en cinco áreas españolas.
Med Clin (Barc), 104 (1995), pp. 487-492
[10.]
National Hearth, Lung, Blood Institute.
International Consensus Report on Diagnosis and Treatment of Asthma.
Eur Respir J, 5 (1992), pp. 601-641
[11.]
A. López Viña, J.L. Pérez Santos.
Educación del paciente con asma.
Arch Bronconeumol, 29 (1993), pp. 309-311
[12.]
P.G.J. Bumey, L.A. Laitinen, S. Perdritzet, H. Huckauf, A.E. Tattersfield, S. Chinn, et al.
Validity and repeteability of the IUATLD (1984) bronchial symptoms questionnaire: an intemational comparison.
Eur Respir J, 2 (1989), pp. 940-945
[13.]
D.E. Morisky, L.W. Green, D.M. Levine.
Concurrent and predictive validity of self-reported measure of medication adherence.
Med Care, 1 (1986), pp. 67-73
[14.]
C. Naberán.
Tratamiento del asma bronquial.
Aten Primaria, 10 (1992), pp. 743-747
[15.]
C.R. Hom, G.M. Cochrane.
An audit of morbidity associated with chronic asthma in general practice.
Respir Med, 83 (1989), pp. 71-75
[16.]
R. Evans, D.I. Mullally, R.W. Wiison, P.J. Gergen, H.M. Rosemberg, J.S. Grauman, et al.
National trends in the morbidity and mortality of asthma in the US Prevalence, hospitalization and death from asthma over two decades: 1965-1984.
Chest, 91 (1987), pp. 65-74
[17.]
M. Modell, J.M. Harding, E.J. Horder, P.R. Williams.
Improving the care of asthmatic patients in general practice.
Br Med J, 286 (1983), pp. 2.027-2.030
[18.]
British Thoracic Association.
Death from asthma in two regions of England.
Br Med J, 285 (1982), pp. 1.251-1.255
[19.]
R.E. Dales, P.E. Kerr, I. Schweitzer, K. Reesor, L. Gougeon, G. Dickinson.
Asthma management preceding an emergency department visit.
Arch Intem Med, 152 (1992), pp. 2.041-2.044
[20.]
D.L. Sackett, J.C. Snow.
Magnitude of compliance and noncompliance.
Compliance in health care, pp. 11-22
[21.]
C.S. Rand, R.A. Wise, M. Nides, M.S. Simmons, E.R. Bleecker, J.W. Kusek, et al.
Metered-Dose inhaler adherence in a clinical trial.
Am Rev Respir Dis, 146 (1992), pp. 1.559-1.564
[22.]
E. Márquez, C. Gutiérrez, C. Jiménez, C. Franco, C. Baquero, R. Ruiz.
Observancia terapéutica en la hipertensión arterial Validación de métodos indirectos que valoran el cumplimiento terapéutico.
Aten Primaria, 16 (1995), pp. 496-500
[23.]
A.G.N. Agustí, P. Ussetti, J. Roca, J.M. Montserrat, R. Rodríguez-Roisin, A. Agustí-Vidal.
Asma bronquial y broncodilatadores en aerosol: empleo incorrecto en nuestro medio.
Med Clin (Barc), 81 (1980), pp. 893-894
[24.]
S. Hilton, B. Sibbaid, H.R. Anderson, P. Freeling.
Controlled evaluation of the effects of patient education on asthma morbidity in general practice.
Lancet, 1 (1986), pp. 26-29
[25.]
E. Dompeling, P.M. Van Grunsven, C.P. Van Schayck, H. Folgering, J. Molema, C. Van Weel.
Treatment with Inhaled Steroids in Asthma and Chronic Bronchitis: Long-term Compliance and Inhaler Technique.
Fam Practice, 9 (1992), pp. 161-166
[26.]
L. Agertoft, S. Pedersen.
The importance of delivery system for the effect of budesonide.
Arch Dis Child, 69 (1993), pp. 130-133
[27.]
I. Chartion, G. Chartion, J. Broomfield, M. Mulee.
Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice.
Br Med J, 301 (1990), pp. 1.355-1.359
[28.]
R. Beasley, M. Cushley, S.T. Holgate.
A self management plan in the treatment of adult asthma.
Thorax, 44 (1989), pp. 200-204
Copyright © 1997. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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