Características de pacientes asmáticos com bronquiectasias
Characteristics of asthmatic patients with bronchiectasis
João Paulo de Assis; Gabriella Melo Fontes Silva Dias; Giane Cristina de Moraes Garcia; Jorge Kalil; Pedro Giavina-Bianchi; Rosana Câmara Agondi
Resumo
Introdução: A bronquiectasia é uma enfermidade caracterizada por dilatações anormais e irreversíveis de um ou mais brônquios. Pode estar associada a diversas outras comorbidades respiratórias, entre elas, a asma. Objetivo: Caracterizar os pacientes asmáticos com bronquiectasias acompanhados em um serviço terciário de alergia. Métodos: Análise retrospectiva de prontuários de pacientes asmáticos que apresentavam bronquiectasias nos exames de tomografia computadorizada de tórax. Os portadores de aspergilose broncopulmonar alérgica (ABPA) foram excluídos. Foram analisados os dados demográficos e exames complementares (espirometria, eosinófilos periféricos, IgE total e IgE específica). A caracterização das bronquiectasias foi avaliada conforme sua localização nos campos pulmonares. Resultados: Quarenta e nove pacientes foram selecionados, sendo 88% do sexo feminino. A média de idade do grupo era de 63 anos, e de tempo de doença de 43 anos. O tratamento prévio de tuberculose (TB), em algum momento da vida, foi relatado por 31% dos pacientes. Doença do refluxo gastroesofágico (DRGE) estava presente em 76% dos pacientes, e a história de tabagismo ativo ou passivo, em 65% dos pacientes. Mais de 80% dos pacientes estavam no step 4 de tratamento da asma, e apresentavam VEF1 reduzido. A média de eosinófilos periféricos foi de 253,4 cel/mm3, de IgE total foi de 458,8 UI/mL, e 69% dos pacientes eram sensibilizados para algum aeroalérgeno. Em relação à localização das bronquiectasias, o lobo superior direito foi o mais acometido, seguido pelo lobo superior esquerdo e lobo inferior direito, respectivamente. Conclusão: Neste estudo, 88% dos pacientes asmáticos com bronquiectasias apresentavam asma grave e função pulmonar alterada, apesar do tratamento otimizado. A bronquiectasia pode estar associada à dificuldade no controle da asma e, embora a história de TB prévia estivesse presente em 31% dos pacientes, a frequência elevada de comprometimento dos lobos superiores (49%) sugere uma frequência maior de doença pulmonar associada à TB.
Palavras-chave
Abstract
Introduction: Bronchiectasis is a disease characterized by abnormal and irreversible dilatation of one or more bronchi. It may be associated with several other respiratory comorbidities including asthma. Objective: To characterize asthmatic patients with bronchiectasis seen at a tertiary allergy service. Methods: Retrospective analysis of medical records of asthmatic patients showing bronchiectasis on chest computed tomography scans was conducted. Patients with allergic bronchopulmonary aspergillosis (ABPA) were excluded. Demographic data and complementary tests (spirometry, peripheral eosinophils, total IgE and specific IgE) were analyzed. Bronchiectasis characterization was evaluated according to its location in the lung fields. Results: Forty-nine patients were selected, and 88% were female. Mean age in the group was 63 years, and disease time was 43 years. Previous treatment of tuberculosis (TB) at some point in life was reported by 31% of the patients. Gastroesophageal reflux disease (GERD) was present in 76% of the patients, and history of active or passive smoking in 65%. More than 80% of the patients were on step 4 of asthma treatment and showed reduced FEV1. Mean peripheral eosinophils was 253.4 cell/mm3, total IgE was 458.8 IU/mL, and 69% of the patients were sensitized to some aeroallergen. Regarding the location of bronchiectasis, the right upper lobe was most commonly affected, followed by the left upper lobe and the right lower lobe, respectively. Conclusion: In this study, 88% of asthmatic patients with bronchiectasis had severe asthma and altered pulmonary function despite optimized treatment. Bronchiectasis may be associated with difficulty in controlling asthma. Although previous history of TB was present in 31% of the patients, the high frequency of involvement of the upper lobes (49%) suggests a higher frequency of TB-associated lung disease.
Keywords
Referências
1. Lang WR, Howden CW, Laws J, Burton JF. Bronchopneumonia with serious sequelae in children with evidence of adenovirus type 21 infection. Brit Med J. 1979;1:73-9.
2. Polverino E, Goeminne PC, McDonnell ML, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50:1700629.
3. Whitters D, Stockley R. Immunity and bacterial colonisation in bronchiectasis. Thorax. 2012;67:1006-13.
4. Al Subie H, Fitzgerald DA. Non-cystic fibrosis bronchiectasis. J Paediatr Child Health. 2012;48:382-8.
5. Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65:577.
6. Tsang KW, Bilton D. Clinical challenges in managing bronchiectasis. Respirology. 2009;14:637-50.
7. Boyton RJ, Altman DM. Bronchiectasis: current concepts in pathogenesis, immunology, and microbiology. Annu Rev Pathol Mech Dis. 2016;11:523-54.
8. Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respiratory Medicine. 2007;101:1163-70.
9. Kang HR, Choi GS, Park SJ, et al. The effects of bronchiectasis on asthma exacerbation. Tuberc Respir Dis. 2014;77:209-14.
10. Reddel HK, Bateman ED, Becker A, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015;46:622-39.
11. Wenzel S. Severe asthma in adults. Am J Respir Crit Care Med. 2005;172:149-60.
12. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Am J Respir Crit Care Med. 2014;43:343-73.
13. Grenier P, Mourey-Gerosa I, Benali K, et al. Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intraobserver variability. Eur Radiol. 1996;6:199-206.
14. Paganin F, Seneterre E, Chanez P, et al. Computed tomography of the lungs in asthma: influence of disease severity and etiology. Am J Respir Crit Care Med. 1996;153:110-14.
15. Mao B, Yang JW, Lu HW, Xu JF. Asthma and bronchiectasis exacerbation. Eur Respir J. 2016;47:1680-8.
16. Säynäjäkangas O, Keistinen T, Tuuponen T, et al. Links between hospital diagnoses of bronchiectasis and asthma. Allergy. 1997;52:1120-2.
17. Costa E, Melo JML, Aun MV, et al. Guia para o manejo da asma grave. Braz J Allergy Immunol. 2015;3:205-25.
18. Lee AL, Button BM, Denehy L, et al. Proximal and distal gastrooesophageal reflux in chronic obstructive pulmonary disease and bronchiectasis. Respirology. 2014;19:211-7.
19. Thakkar K, Boatright RO, Gilger MA, El-Serag HB. Gastroesophageal reflux and asthma in children: a systematic review. Pediatrics. 2010;125:e925-30.
20. Balson BM, Kravitz EKS, McGeady SJ. Diagnosis and treatment of gastroesophageal reflux in children and adolescents with severe asthma. Ann Allergy Asthma Immunol. 1998;81:159-64.
21. Andze GO, Brandt ML, Vil DS, Bensoussan AL, Blanchard H. Diagnosis and treatment of gastroesophageal reflux in 500 children with respiratory symptoms: the value of pH monitoring. J Pediatr Surg. 1991;26:295-300.
22. Tucci F, Resti M, Fontana R, Novembre E, Lami CA, Vierucci A. Gastroesophageal reflux and bronchial asthma: prevalence and effect of cisapride therapy. J Pediatr Gastroenterol Nutr. 1993;17:265‑70.
23. Harding SM, Guzzo MR, Richter JE. 24-h esophageal pH testing in asthmatics: respiratory symptom correlation with esophageal acid events. Chest. 1999;115:654-9.
24. Pasteur MC, Helliwell SM, et cols. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med. 2000;162:1277-84.
25. Barker AF, Bardana EJ. Bronchiectasis: update of an orphan disease. Am Rev Respir Dis. 1988;137:969-78.
26. Chan CHS, Ho AKC, Chan RCY, Cheung H, Cheng AFB. Mycobacteria as a cause of infective exacerbation in bronchiectasis. Postgrad Med J. 1992;68:896-9.
27. Capone D, Jansen JM, Lopes AJ et al. Diagnóstico por imagem da tuberculose. Pulmão RJ. 2006;15:166-74.
28. Gomes Neto A, Medeiros ML, Gifoni JMM. Bronquiectasia localizada e multissegmentar: perfil clínico-epidemiológico e resultado do tratamento cirúrgico em 67 casos. J Pneumologia. 2000;27:1-6.
29. Bogossian M, Santoro IL, Jamnik S, Romaldini H. Bronquiectasias: estudo de 314 casos tuberculose x não-tuberculose. J Pneumol. 1998;24:11-16.
30. Goeminne PC, Nawrot TS, Ruttens D, et al. Mortality in non-cystic fibrosis bronchiectasis: a prospective cohort analysis. Respir Med. 2014;108:287-96.
31. Diaz AA, Young TP, Maselli DJ, et al. Quantitative CT measures of bronchiectasis in smokers. Chest. 2017;151:1255-62.
32. Huss K, Naumann PL, Mason PJ, et al. Asthma severity, atopic status, allergen exposure and quality of life in elderly persons. Ann Allergy Asthma Immunol. 2001;86:524-30.
33. Kim RD, Greenberg DE, Ehrmantraut ME, et al. Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome. Am J Respir Crit Care Med. 2008;178:1066-74.
34. Kennedy MP, Noone PG, Leigh MW, et al. High-resolution CT of patients with primary ciliary dyskinesia. AJR Am J Roentgenol. 2007;188:1232-8.
35. Santamaria F, Montella S, Tiddens HAWM, et al. Structural and functional lung disease in primary ciliary dyskinesia. Chest. 2008;134:351-7.
Submetido em:
06/11/2017
Aceito em:
23/11/2017
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