Objective: To evaluate the effect of a short-term individualized education program on adherence to asthma treatment, inhalation techniques, and asthma control. Methods: A prospective study involving patients aged 14 years or older, with a confirmed diagnosis of asthma and recruited from the asthma outpatient clinic of a university hospital in the city of Porto Alegre, Brazil. The study was conducted in two phases (before and after the educational intervention). At a routine medical visit, the participants completed a general questionnaire in order to assess the level of asthma control and inhalation techniques. The participants also underwent pulmonary function testing. Subsequently, they participated in an asthma education program, which consisted of one individualized session. The participants were reevaluated after three months. Results: Of the 174 patients recruited, 115 completed the study. Between the first and second evaluations, there was a significant improvement in the effective use of inhaled corticosteroids (90.4% vs. 93.3%; p = 0.003), the effective use of long-acting β 2 agonists (57.4% vs. 63.5%; p < 0.0001), the effective use of a combined regimen with these two medications (57.4% vs. 62.6%; p < 0.0001), and the self-reported adherence to corticosteroid therapy (p = 0.001). There was a significant decrease in the proportion of patients visiting ERs (30.4% vs. 23.5%; p = 0.012). However, the level of asthma control and the inhalation technique did not improve significantly (p = 0.095 and p = 0.512, respectively). Conclusions: This short-term asthma education program resulted in an improvement in the use of medications for asthma control and a decrease in the number of ER visits, although it had no significant effect on the inhalation technique. ResumoObjetivo: Avaliar o efeito de um programa educativo individualizado de curta duração para asma sobre a adesão ao tratamento, técnicas inalatórias e controle da doença. Métodos: Estudo prospectivo em duas fases (antes e depois da intervenção) em pacientes com idade ≥ 14 anos e com diagnóstico confirmado de asma, recrutados no ambulatório especializado de um hospital universitário em Porto Alegre (RS). Durante a visita médica de rotina, os participantes responderam um questionário geral para avaliar o nível de controle da asma e a técnica inalatória e foram submetidos a testes de função pulmonar. Participaram, então, de um programa educativo em asma que consistiu de uma sessão individualizada. A reavaliação ocorreu em três meses. Resultados: Dos 174 pacientes recrutados, 115 completaram o estudo. Entre as avaliações, houve uma melhora significativa no uso efetivo de corticosteroides inalatórios (90,4% vs. 93,3%; p = 0,003), no uso efetivo de β 2 -agonistas de longa ação (57,4% vs. 63,5%; p < 0,0001), no uso efetivo do regime combinado dessas duas medicações (57,4% vs. 62,6%; p < 0,0001) e na adesão relatada ao tratamento com corticosteroides (p = 0,001). Houve uma redução significativa na proporção de pacientes com visitas a emergência (30,4% v...

Objective: Few studies have evaluated the variability of the perception of dyspnea in healthy subjects. The objective of this study was to evaluate the variability of the perception of dyspnea in healthy subjects during breathing against increasing inspiratory resistive loads, as well as to assess the association between the level of perception of dyspnea and the level of physical activity. Methods: This was a cross-sectional study involving healthy individuals 16 years of age or older. Subjects underwent inspiratory resistive loading testing, in which the level of perception of dyspnea was quantified with the modified Borg scale. We also determined body mass indices (BMIs), assessed maximal respiratory pressures, performed pulmonary function tests, applied the international physical activity questionnaire (IPAQ)-long form, and conducted six-minute walk tests (6MWTs). The level of perception of dyspnea was classified as low (Borg score < 2), intermediate (Borg score, 2-5), or high (Borg score > 5). Results: We included 48 healthy subjects in the study. Forty-two subjects completed the test up to a load of 46.7 cmH2O/L/s. The level of perception of dyspnea was classified as low, intermediate, and high in 13, 19, and 10 subjects, respectively. The level of perception of dyspnea was not significantly associated with age, gender, BMI, IPAQ-long form score, maximal respiratory pressures, or pulmonary function test results. Conclusions: The scores for perceived dyspnea induced by inspiratory resistive loading in healthy subjects presented wide variability. The perception of dyspnea was classified as low in 31% of the subjects, intermediate in 45%, and high in 24%. There was no association between the level of perception of dyspnea and the level of physical activity (IPAQ or six-minute walk distance).

Purpose: Study the repeatability of the evaluation of the perception of dyspnea using an inspiratory resistive loading system in healthy subjects. Methods: We designed a cross sectional study conducted in individuals aged 18 years and older. Perception of dyspnea was assessed using an inspiratory resistive load system. Dyspnea was assessed during ventilation at rest and at increasing resistive loads (0.6, 6.7, 15, 25, 46.7, 67, 78 and returning to 0.6 cm H2O/L/s). After breathing in at each level of resistive load for two minutes, the subject rated the dyspnea using the Borg scale. Subjects were tested twice (intervals from 2 to 7 days). Results: Testing included 16 Caucasian individuals (8 male and 8 female, mean age: 36 years). The median scores for dyspnea rating in the first test were 0 at resting ventilation and 0, 2, 3, 4, 5, 7, 7 and 1 point, respectively, with increasing loads. The median scores in the second test were 0 at resting and 0, 0, 2, 2, 3, 4, 4 and 0.5 points, respectively. The intra-class correlation coefficient was 0.57, 0.80, 0.74, 0.80, 0.83, 0.86, 0.91, and 0.92 for each resistive load, respectively. In a generalized linear model analysis, there was a statistically significant difference between the levels of resistive loads (p<0.001) and between tests (p=0.003). Dyspnea scores were significantly lower in the second test. Conclusion: The agreement between the two tests of the perception of dyspnea was only moderate and dyspnea scores were lower in the second test. These findings suggest a learning effect or an effect that could be at least partly attributed to desensitization of dyspnea sensation in the brain.

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