Journal Information
Vol. 35. Issue 8.
Pages 372-378 (September 1999)
Share
Share
Download PDF
More article options
Vol. 35. Issue 8.
Pages 372-378 (September 1999)
Full text access
Ingreso en el hospital por asma. Análisis descriptivo y factores pronósticos tras el alta
Hospital admission for asthma. A descriptive study and analysis of factors related to prognosis after relase
Visits
4882
J. Serrano, V. Plaza*, J. Sanchis
Departamento de Neumología. Hospital de la Santa Creu i Sant Pau. Barcelona
This item has received
Article information
Fundamento

En España, los estudios observacionales sobre los asmáticos que ingresan por una agudización de su enfermedad son escasos. El objetivo del presente estudio fue determinar las características clínicas de estos pacientes y analizar qué factores influyen en su evolución tras el alta.

Métodos

Se incluyeron prospectivamente los asmáticos que ingresaron en nuestro hospital durante 12 meses consecutivos. Tras el alta, se efectuaron dos controles telefónicos al primer y cuarto mes. Se recogieron las características demográficas y clínicas de los pacientes, las exacerbaciones, los reingresos, el tratamiento y el control médico recibidos.

Resultados

Se incluyeron 65 pacientes (44 mujeres y 21 varones; media de edad 45 años; DE: 19). La mayoría (54%) ingresó en otoño y las causas más frecuentes de exacerbación fueron las infecciones del tracto respiratorio (68%). El 54% de los pacientes presentaba asma grave, el 32% moderada y el 14% leve antes del ingreso. Durante el seguimiento, el 51% de los mismos presentó, al menos, una exacerbación del asma, el 38% precisó asistencia en urgencias y el 19% reingresó. Dos pacientes (3%) fallecieron por asma. El análisis de regresión logística múltiple relacionó la aparición de exacerbaciones tras el alta con la mayor gravedad del asma y la ausencia de betaadrenérgicos de acción prolongada; los reingresos se relacionaron con la menor duración del tratamiento con glucocorticoides orales al alta y un mayor número de ingresos hospitalarios previos.

Conclusiones

a) Los ingresos por asma se producen mayoritariamente en otoño, probablemente en relación con las infecciones de vías respiratorias, y no son exclusivos del asma grave; b) tras el alta, la morbilidad y la mortalidad de la enfermedad, a corto plazo, son elevadas, y c) la propia gravedad de la enfermedad y un tratamiento insuficiente son factores relacionados con una mala evolución clínica del asma tras la hospitalización.

Palabras clave:
Asma
Estudio descriptivo
Ingreso hospitalario
Factores pronósticos
Background

Few authors have looked at admissions in Spain of patients with acute asthma attacks. The aim of this study was to determine the clinical profile of such patients and analyze factors influencing disease course after release.

Methods

Asthmatics admitted to our hospital were enrolled prospectively over 12 consecutive months. The patients were telephoned one and four months after release. Demographic and clinical data were collected in addition to data on exacerbations, readmissions, treatment and medical follow-up.

Results

Sixty-five patients (44 women and 21 men, mean age 45, SD 19). Most (54%) were admitted in autumn and the most common cause of exacerbation was respiratory tract infection (68%). Before admission, 54% had severe asthma, 32% had moderate asthma and 14% had mild asthma. At least one exacerbation occurred for 54% of patients, while 38% required emergency assistance and 19% were readmitted. Two patients (3%) died of asthma. Multiple factor logistic regression analysis showed a relation between the appearance of exacerbation after release and greater severity of asthma and the absence of long-lasting (β-adrenergic drugs. Readmission was related to shorter duration of treatment with oral glucocorticoids after release and a higher number of prior hospital admissions.

Conclusions

1) Admission due to asthma occurs mainly in autumn and is probably related to respiratory infections, rather than exclusively to severe asthma. 2) After release, short-term morbidity and mortality due to the disease are high. 3) Disease severity itself and inadequate treatment are both related to poor clinical course after release.

Key words:
Asthma
Descriptive study
Prognostic factors
Full text is only aviable in PDF
Bibliografía
[1.]
R. Evans, D.I. Mullally, R.W. Wilson, P.J. Gergen, H.M. Rosenberg, J.S. Grauman, et al.
National trends in the morbidity and mortality of asthma in the US. Prevalence, hospitalization and dead form asthma over two decades: 1965-1984.
Chest, 91 (1987), pp. 65-74
[2.]
Asthma-United States. 1982-1992.
MMWR, 43 (1995), pp. 952-955
[3.]
E.K. Wobig, P. Rosen.
Death from asthma: rare but real.
J Emerg Med, 14 (1996), pp. 233-240
[4.]
D. Li, D. German, S. Lulla, R.G. Thomas, S.R. Wilson.
Prospective study of hospitalization for asthma. A preliminary risk factor model.
Am J Respir Crit Care Med, 151 (1995), pp. 647-655
[5.]
C. Picado, E. Benlloch, P. Casan, F. Duce, F. Manresa, M. Perpinyá, et al.
Recomendaciones para el tratamiento del asma en los adultos.
Arch Bronconeumol, 29 (1993), pp. 8-13
[6.]
Grupo de trabajo de la SEPAR.
Normativa sobre diagnóstico y tratamiento del asma aguda y crónica.
Ediciones Doyma S.A, (1996),
[7.]
Sociedad Española de Neumología, Cirugía Torácica (SEPAR), Sociedad Española de Medicina Familiar, Comunitaria (semFYC).
Recomendaciones para la atención del paciente con asma.
Arch Bronconeumol, 34 (1998), pp. 394-399
[8.]
International Consensus Report on Diagnosis, Treatment of Asthma.
National Hearth, Lung and Blood Institute, National Institutes of Health. Bethesda, Maryland 20892. Publication n.° 92-3091.
Eur Respir J, 5 (1992), pp. 601-641
[9.]
British Thoracic Society.
The british guidelines on asthma management.
1995 review and position statement. Thorax, 52 (1997), pp. 1-21
[10.]
Global initiative for asthma., Global strategy for asthma management, prevention.
NHLBI/WHO workshop report.
National Institute of Health, (1995),
[11.]
R.E. Dales, I. Schweitzer, P. Kerr, L. Gougeon, R. Rivington, J. Draper.
Risk factors for recurrent emergency department visits for asthma.
Thorax, (1995), pp. 520-524
[12.]
I. Coll, B. Barreiro, J.J. Canet, L.I. Esteban, J.L. Heredia.
Respuesta clínica al tratamiento de la crisis asmática en el Servicio de Urgencias.
Arch Bronconeumol, 32 (1996), pp. 43
[13.]
I. Pascal, J.B. Galdiz, P. Gil, A. Campo, F. Uresandi, V. Sobradillo.
Crisis asmática: características clínicas y funcionales durante la crisis y posterior seguimiento.
Arch Bronconeumol, 32 (1996), pp. 43
[14.]
J. Sanchis, P. Casan, J. Castillo, N. González, L. Palenciano, J. Roca.
Normativa para la práctica de la espirometría forzada.
Arch Bronconeumol, 256 (1989), pp. 132-142
[15.]
A. Valencia, P. Casan, M. Díaz, M. Perpiñá, M.D. Sebastián.
Normativa de los tests de provocación bronquial inespecífica forzada.
Arch Bronconeumol, 25 (1989), pp. 132-142
[16.]
J.G. Donahue, S.T. Weiss, J.M. Livingston, M.A. Goetsch, D.K. Greineder, R. Platt.
Inhaled steroids and the risk of hospitalization for asthma.
JAMA, 277 (1997), pp. 887-891
[17.]
B.H. Rowe, J.L. Keller, A.D. Oxman.
Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis.
Am J Emerg Med, 10 (1992), pp. 301-310
[18.]
R.A. Pauwels, C.G. Lófdahl, D.S. Postma, A.E. Tattersfield, P. O’Byme, P.J. Bames, et al.
Effect of inhaled formoterol and budesonide on exacerbations of asthma.
N Engl J Med, 337 (1997), pp. 1.405-1.411
[19.]
E. Prescott, P. Lange, J. Vestbo, The Copenhagen City Heart Study Group.
Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma: a prospective study based on a sample of the general population.
Thorax, 52 (1997), pp. 287-289
[20.]
E.M. Skobeloff, W.H. Spivey St., S.S. Clair, J.M. Schoffstall.
The influence of age and sex on asthma admissions.
JAMA, 268 (1992), pp. 3.437-3.440
[21.]
R.E. Dales, I. Schweitzer, J.H. Toogood, M. Drouin, W. Yang, J. Dolovich, et al.
Respiratory infections and the autoumn increase in asthma morbidity.
Eur Respir J, 9 (1996), pp. 72-77
[22.]
S.L. Johnston, P.K. Pattemore, G. Sanderson, S. Smith, M.J. Campbell, L.K. Josephs, et al.
The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis.
Am J Respir Crit Care Med, 154 (1996), pp. 654-660
[23.]
K. Priftis, J. Anagnostakis, E. Harokopos, I. Orfanou, M. Petraki, P. Saxoni-Papageorgiou.
Time trends and seasonal variation in hospital admisions for childhood asthma in the Athens region of Greece: 1978-1988.
Thorax, 48 (1993), pp. 1.168-1.169
[24.]
M.L. Osborne, W.M. Vollmer, A.S. Buist.
Periodicity of asthma, emphysema, and chronic bronchitis in a northwest helath maintenance organization.
Chest, 110 (1996), pp. 1.458-1.462
[25.]
G.E. D’Alonzo, R.A. Nathan, S. Henochowicz, R.J. Morris, P. Ratner, S.I. Rennard.
Salmeterol xinafoate as maintenance therapy compared with albuterol in patients with asthma.
JAMA, 271 (1994), pp. 1.412-1.416
[26.]
A.P. Greening, P.W. Ind, M. Northfield, G. Shae.
Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing corticosteroid.
Lancet, 344 (1994), pp. 219-224
[27.]
A. Woolcock, B. Lundback, N. Ringdal, L.A. Jacques.
Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids.
Am J Respir Crit Care Med, 153 (1996), pp. 1.481-1.488
[28.]
D.S. Pearlman, P. Chervinsky, C. LaForce, J.M. Seltzer, D.L. Souhtern, J.P. Kemp, et al.
A comparison of salmeterol with albuterol in the treatment of mild-to-modrate asthma.
N Engl J Med, 327 (1992), pp. 1.420-1.425
[29.]
S. Kesten, K.R. Chapman, I. Broder, A. Cartier, R.H. Hyland, A. Knight, et al.
A three-month comparison of twice daily inhaled formoterol versus four times daily inhaled albuterol in the management of stable asthma.
Am Rev Respir Dis, 144 (1991), pp. 622-625
[30.]
M.C. Rogado, A. De Diego, P. De la Cuadra, M. Perpiñá, L. Compte, M. León.
Crisis asmática en los Servicios de Urgencias.
¿Se cumplen las normativas?. Arch Bronconeumol, 32 (1996), pp. 37
[31.]
R.J. Schilling, S.B. Hurding, J.L. Maddocks.
Care of asthmatics on discharge from hospital: a hospital audit.
J Asthma, 32 (1995), pp. 161-163
[32.]
T.V. Hartert, H.H. Windom, R.S. Peebles, L.R. Freidhoff, A. Togias.
Inadequate outpatient medical therapy for patients with asthma admitted to two urban hospitals.
Am J Med, 100 (1996), pp. 386-394
[33.]
S.J. McLeod, M.J. Pearce, S.A. Rigby, E.J. Beeg, M.E.J. Beard, I.R. Martin, et al.
ASthma management at Christchurch Hospital: compliance with guidelines.
N Z Med J, 109 (1996), pp. 115-118
[34.]
E.A. Mitchell, J.M. Bland, J.M.D. Thompson.
Risk factors for readmission to hospital for asthma in childhood.
Thorax, 49 (1994), pp. 33-36
Copyright © 1999. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?