Severe asthma: what is the issue, treatment or diagnosis?

CARTAS AO EDITOR

Severe asthma: what is the issue, treatment or diagnosis ?

Dear Editor:

During the IV Brazilian Congress on Asthma, in Gramado – RS, we showed, at the round-table named “From Consensus to Clinical Practice”, the need for adequate investigation on patients with hard to control asthma before considering the possibility of using alternative drugs. At that occasion we presented a diagram with a proposal for a broad, summarized and flexible diagnostic investigation that might be adapted to the resources of several different pneumology services (Figure 1). Among the audience, some physicians asked for a copy of the diagnostic map, and therefore, I am now writing to make this suggestion for the approach of severe asthma patients available for other fellow pneumologists. This table is not intended to be a definitive truth, since nothing in Medicine is, but it might be the starting point for those who treat patients with more severe asthma.

Elcio Oliveira Vianna

Pneumology Division Professor

General Medicine Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

Reference

1. III Consenso Brasileiro no Manejo da Asma. J Pneumol 28(Supl 1): S13.

Dear Editor:

I am please to announce the recent naming of Professor José Roberto Lapa e Silva, Pneumology Head Professor, Universidade Federal do Rio de Janeiro-UFRJ, as Associate Professor of Medical Immunology at Weill Medical College of Cornell University. This is the result of ten years of active cooperation between the Academic Program on Tuberculosis at UFRJ, managed by myself, and the Division of International Medicine & Infectious Diseases at Cornell’s, in the setting of basic, pre-clinical and clinical and operational research on tuberculosis and AIDS. This cooperation is based on research projects and research training, and funded by the National Institute of Health-NIH and other organizations for national and international research and training support. Our Group has recently had the appraisal by NIH for another important project in cooperation with North-American universities at the research training area, which is now only waiting for a final decision concerning funding. If confirmed, this project will guarantee the mutual the cooperation until the end of 2008.

Our main objective is to prioritize partnership activities in Brazil between the Academic Program on Tuberculosis at UFRJ and other Universities, Research Institutes, Tuberculosis and AIDS Control Programs, at federal, state and county level, including also Civil Organizations.

Prof. Lapa e Silva’s naming is a reason for pride at UFRJ, at Jornal de Pneumologia, of which he is an active member at the Editorial Board, and at the Brazilian Pneumology Community, since it shows the enormous capacity of our colleagues in managing knowledge about relevant disorders for Public Health, like tuberculosis, in partnership with researchers from developed countries.

Afrânio Kritski

Tuberculosis Academic Program Coordinator

Instituto de Doenças do Tórax ('Chest Diseases Institute')/UFRJ

Dear Editor:

It was May, and I was preparing for the American Thoracic Society 2003 Congress, which would take place in Seattle, US. Passport, visa, air ticket, hotel reservation, the poster to be presented, everything was already set. Ready to leave, I remembered a chat I’d had with a colleague, Dr. João Jorge Leite, Assistant Physician at the Pneumology Discipline, FMUSP, and responsible for spirometry at that service. Months ago, while we were talking about trips, he told me that he had once used an oximeter during a flight.

Paraphrasing Glauber Rocha, I had an idea on my mind and an oximeter on my hand’, I had an idea. I went to Guarulhos airport, heading for Seattle with a one day stopover in New York. My chest x-ray and spirometry were normal and I had no respiratory symptoms.

I boarded an MD11, sat and did the first measurement of my oxygen saturation (O₂Sat), with the aircraft doors still open. I chose the indicator of my left hand, put the oximeter on it, and recorded the O₂Sat and heart rate values, (95% O₂Sat, 90 beats/min, respectively). Doors closed: new measurement, still on soil, and then every ten minutes, until one hour after take-off, when I asked the flight attendant to check with the commander at how many feet the cabin was pressurized (Table 1). After explanations and justifications about the apparatus on my finger, the answer came quickly. The cabin was pressurized at 6.000 feet (1.828 meters).

After that, I interrupted the measurements, dined, watched a film, slept, and then, one hour before landing in New York, I re-started the procedures the same way I had done at take-off (Table 2).

I believe that the values I obtained lead us, pneumologists, to an important consideration. It is a fact that our hypoxemic patients, including the ones with chronic obstructive pulmonary disease, are increasingly using air transportation, and yet, many of us are not informing them adequately about the risk of dessaturation during a flight.

Oxygen supplementation is a common practice for air companies, but it must be requested previously, and it is not available without previous preparation by the company. Is should always be remembered that the masks situated above the passengers’ heads are not appropriate for this use.

I think it is also important to point out that different aircrafts pressurize the cabin at different heights, but this information may be requested to the air company medical service, or obtained in special internet sites.

To all of those who would like to know more about the precautions to be taken by a hypoxemic patient, I recommend the article “Managing passengers with respiratory diseases planning air travel: British Thoracic Society recommendations. Thorax 2002;57:289-304”.

Observation: my oxygen saturation was higher in New York because this city is located at a lower altitude than São Paulo.

Mário Terra Filho

Pneumology Discipline, FMUSP

Publication Dates

• Publication in this collection
  02 Dec 2003
• Date of issue
  Aug 2003