CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / A pesquisa farmacolÃgica, quÃmica e agronÃmica de inÃmeras plantas recebeu um forte estÃmulo em 2008 quando o Governo Federal aprovou o Programa Nacional de Plantas Medicinais e FitoterÃpicos, publicado em uma portaria interministerial assinada pelo MinistÃrio da SaÃde. Plantas de uso popular (com aÃÃo broncodilatadora, antinflamatÃria, laxante, parasiticida, anti-hipertensiva, anti-ulcerogÃnica,...) passaram a receber maior atenÃÃo. O objetivo deste estudo foi avaliar a eficÃcia terapÃutica do Xarope de Justicia Pectoralis, Plectranthus Amboinicus e Mentha Arvensis (ChambÃ) em portadores de asma, avaliar a eficÃcia do Xarope na qualidade de vida e nas provas de funÃÃo pulmonar nos pacientes portadores de asma, em terapia broncodilatadora e ampliar as opÃÃes terapÃuticas aos usuÃrios do SUS, com acesso ao fitoterÃpico com seguranÃa, eficÃcia e qualidade. Neste contexto, o estudo propÃe a utilizaÃÃo de xarope composto por Justicia Pectoralis, Plectranthus Amboinicus e Mentha Arvensis, plantas da RelaÃÃo Nacional de Plantas Medicinais de Interesse ao SUS (RENISUS), atravÃs de ensaio clÃnico prospectivo do tipo duplo-cego, controlado por placebo, randomizado e paralelo. A realizaÃÃo do ensaio clÃnico utilizando este fitoterÃpico em pacientes com diagnÃstico de asma resultou em tentativa de conseguir outra opÃÃo terapÃutica para ser utilizada em associaÃÃo com a medicaÃÃo, para minimizar os sintomas e melhorar a qualidade de vida dos pacientes. O uso terapÃutico do xarope de ChambÃ, utilizado em 35 pacientes com asma leve, como terapia complementar, embora nÃo tenha apresentado modificaÃÃes nos parÃmetros de provas de funÃÃo pulmonar, apresentou uma melhora na qualidade de vida, atravÃs dos resultados do questionÃrio de Qualidade de Vida em Asma com Atividades Padronizadas â AQLQ(S), sem causar toxicidade ou efeitos adversos. Pode-se concluir que ao analisar a qualidade de vida AQLQ(S) dos pacientes dos grupos Placebo e ChambÃ, durante os 28 dias de ensaio clÃnico verificou-se que, em ambos os grupos, os escores do domÃnio sintomas verificados nos D7 (P < 0,01), D14 (P < 0,001) e D28 (P < 0,001) foram significantemente maiores que o observado no prÃ-tratamento (D0). / The pharmacological research, numerous chemical and agronomic plants received a strong boost in 2008 when the Federal Government approved the National Program for Medicinal Plants and Herbal Medicines, published in a ministerial decree signed by the Ministry of Health Plans in popular use (with bronchodilator, anti-inflammatory, laxative, parasiticide, anti-hypertensive, anti-ulcerogenic, ...) have received increased attention. The objective of this study was to evaluate the therapeutic efficacy of syrup Justicia pectoralis, Plectranthus amboinicus and Mentha arvensis (Chamba) in patients with asthma, to evaluate the effectiveness of the syrup in the quality of life and pulmonary function tests in patients with asthma, bronchodilator therapy and expand the therapeutic options to SUS users with access to herbal safety, efficacy and quality. In this context, the study proposes the use of syrup composed of Justicia pectoralis, Plectranthus amboinicus and Mentha arvensis, plants of the National Medicinal Plant Interest rates (RENISUS) through prospective clinical trial of the double-blind, placebo-controlled randomized parallel. The conducting a clinical trial using this herbal in patients with asthma resulted in an attempt to achieve other therapeutic option to be used in combination with the medication to minimize the symptoms and improve the quality of life of patients. The therapeutic use of Chamba syrup, used in 35 patients with mild asthma, as a complementary therapy, although not presenting changes in parameters of pulmonary function tests, showed an improvement in quality of life through the results of the questionnaire Quality of Life Standardized Asthma Activities - AQLQ (S), without causing toxicity or adverse effects. It can be concluded that to analyze the quality of life AQLQ (S) of the patients and placebo groups Chamba during 28 days of the trial it was found that in both groups, the scores of the symptoms observed in the field D7 (P <0,01), D14 (P <0,001) and D28 (P <0,001) were significantly higher than that observed before treatment (D0).

There are approximately 22.2 million Americans’ who are living with asthma and of those 18.4 million are adults. African Americans’ are more likely to be diagnosed with asthma compared to Caucasians, and experience more asthma attacks. In this study, the Social Cognitive Theory was used to examine the relationships among personal characteristics, environmental factors, asthma self-efficacy, self-management behaviors, and quality of life (QOL) in African American adults with asthma. A correlational design was used. Data were collected from a non-random sample of adult African Americans’ with asthma (N = 39) using the following self-report questionnaires: the Knowledge, Attitude, and Self-Efficacy of Asthma Questionnaire (KASE), the short form of the Rapid Estimate of Adult Literacy in Medicine (REALM-SF), the Medical Outcomes Study (MOS) for social support, the Asthma Trigger Inventory (ATI), the Morisky Medication Adherence Questionnaire, Asthma Self-Management Questionnaire (ASMQ), the Modified Pittsburgh Sleep Quality Index (PSQI), the Asthma Control Test (ACT), and the Asthma Quality of Life Standardized (AQLQ-S). Data analyses included descriptive statistics, Pearson Product correlations, and hierarchical multiple regression. On average, participants (N = 39) were middle aged (M = 55.9 ± 7.9) years, female (65%), did not smoke (87%), did not use a peak flow meter (PEFR) to self-manage their asthma (72%), and were obese (M = 34.06, SD = 10.78). Participants reported high confidence in asthma self-management; however, had low medication adherence and scores indicating uncontrolled asthma (M = 16.10, SD = 4.29). More than half (67%) of the participants reported poor sleep quality (PSQI). BMI and sleep quality accounted for significant variance (38%) in asthma QOL (F (2, 38) = 7.08, p = .001). Social support was an independent predictor of asthma self-efficacy (F (2, 38) = 5.65, p = .02). Better control of weight and asthma symptoms may improve sleep quality. Health care providers need to address the ongoing challenges of asthma self-management and monitor sleep quality. Encouraging the use of peak flow meters, which have been shown to improve self-management and asthma control, may result in better quality of life for African Americans’ with asthma.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Nesta tese vamos investigar as associações entre: Artigo 1 - Avaliar a qualidade de vida (QV) e sua associação com a gravidade da asma, presença de outras doenças crônicas e estilo de vida; Artigo 2 - O objetivo dessa pesquisa foi avaliar a associação entre TMC e qualidade de vida em adolescentes asmáticos. Artigo 1 - Trata-se de um estudo seccional de base ambulatorial em 210 adolescentes asmáticos entre 12 e 21 anos, de ambos os sexos atendidos em um serviço especializado em atenção ao adolescente em uma universidade pública no estado do Rio de Janeiro. Para avaliação da QV utilizou-se um questionário autopreenchível, o Paediatric Asthma Quality of Life Questionnaire PAQLQ. As variáveis explicativas foram: as outras doenças alérgicas, uso de medicamentos, fumo passivo, trabalho, gravidade da asma e o estilo de vida. As análises foram conduzidas considerando o desfecho em estudo (QV) dicotômico (boa-ruim) a partir da média dos escores. Modelos lineares generalizados (log-binomial) foram utilizados para o cálculo de razões de prevalência brutas e ajustadas; Artigo 2 - Estudo seccional de base ambulatorial, entre 210 adolescentes asmáticos de 12 a 21 anos atendidos em um ambulatório especializado de um serviço universitário voltado à atenção ao adolescente, no Rio de Janeiro, Brasil. A qualidade de vida (QV) foi avaliada através do Paediatric Asthma Quality of Life Questionnaire PAQLQ e os TMC, pelo General Health Questionnaire (GHQ-12). A qualidade de vida total e suas diferentes dimensões foram tratadas como variável dicotômica e utilizou-se o modelo log-binomial para o cálculo das razões de prevalência brutas e ajustadas. Artigo 1 - Quarenta e seis por cento das adolescentes apresentavam uma qualidade de vida ruim, assim como 57% dos meninos. Não houve correlação entre outras doenças crônicas e QV ruim. Escolaridade baixa, uso de medicamentos, fumo passivo e trabalho tiveram relação estatisticamente significativa (p<0,05) com QV ruim. A análise ajustada mostrou que asma grave (RP=1,53; IC 95% 1,12-2,11), uso de medicação (RP=1,58; IC 95% 1,09-2,28), ter menos de 5 anos de diagnóstico de asma (RP= 1,30.; IC 95% 0,97-1,86), fumo passivo (RP= 1,38; IC 95%; 1,35-2,00) e estar trabalhando (RP=1,30 IC 95% 0,96 1,74) associavam-se à qualidade de vida ruim; Artigo 2 - A prevalência total de asmáticos com TMC foi de 32,4%. A prevalência de QV ruim entre adolescentes com TMC foi de 36,6%. O modelo final ajustado mostrou uma associação entre TMC e QV total ruim (RP= 1,84 IC 95% 1,19-2,86), assim como para os domínios referentes à emoção (RP=1,77 IC 95% 1,16-2,62) e sintomas (RP=1,75 IC 95% 1,14-2,70). Para o domínio atividade física, a associação com TMC foi de apenas borderline (RP=1,43 IC 95% 0,97-2,72). Artigo 1 - O impacto negativo na qualidade de vida está diretamente relacionado a ter asma grave, ser fumante passivo e um diagnóstico mais recente de asma. A equipe multidisciplinar necessita enfrentar esse desafio que é a busca e manutenção de uma boa qualidade de vida, visando uma melhor adequação desse paciente com a sociedade e com ele próprio; Artigo 2 - Os resultados desse estudo tornam visíveis as necessidades de atenção aos aspectos emocionais dos adolescentes portadores de doenças crônicas, de forma a subsidiar ações mais efetivas na área de saúde mental, visando à melhor qualidade de vida e ao tratamento global do paciente asmático. / Objectives: The association between quality of life and adolescents with asthma: Paper 1 - Evaluate the association between the severity of asthma, the presence of comorbid chronic diseases, lifestyle and quality of life (QoL); Paper 2 - Evaluate the association between CMD and quality of life in adolescents with asthma. Method: Paper 1 - We undertook a sectional study 210 adolescents between ages 12 and 21, of both sexes with asthma, seen in the adolescent medicine service of public university hospital in the state of Rio de Janeiro. The self-administered Paediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to evaluate QoL. The explanatory variables used included other allergic disease, medication use, passive smoke exposure, employment, asthma severity and lifestyle. The analyses were conducted considering dichotomous outcome definitions of QoL (good-poor) using the mean of the scores. Generalized linear models (log-binomial) were used to calculate the gross and adjusted prevalence ratios; Paper 2 - This transverse study investigated 210 adolescents with asthma between ages 12 and 21, seen at a university outpatient adolescent medicine service in Rio de Janeiro, Brazil. The Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and General Health Questionnaire (GHQ-12) were used to assess QoL and common mental disorders (CMD) respectively. Total quality of life and its various dimensions were treated as dichotomous variables. A binomial log-rithmic model was used to calculate raw and adjusted prevalence ratios. Results: Paper 1 - Forty-six percent of woman, and 57% of men reported poor quality of life. There was no correlation between other chronic disease and poor QoL. Poor QoL was associated with low levels of education, medication use, passive smoke exposure, and employment; the relationship was - The prevalence of asthmatics with CMD was 32.4%. Examining CMDs relation to QoL, the prevalence of poor QoL was associated with low levels of education, medication use, passive smoke exposure, and employment; the relationship was statistically significant (p< 0.05). The adjusted analysis showed that severe asthma (RP=1.53; CI 95%: 1.12-2.11), medication use (RP=1.58; CI 95% 1.09-2.28), asthma diagnosis within the prior five years (RP= 1.30; CI 95%: 0.97-1.86), passive smoke exposure (RP= 1.38; CI 95%: 1.35-2.00) and being employed (RP=1.30; CI 95% 0.97-1.74) are associated with poor quality of life; Paper 2 - The prevalence of asthmatics with CMD was 32.4%. Examining CMDs relation to QoL, the prevalence of poor QoL was 36.6%. The adjusted final models showed an association between CMD and poor total quality of life (PR= 1, 84 IC 95% 1,19-2,86) as for the domains related to emotions (PR =1,77 IC 95% 1,16-2,62) and symptoms (RP=1,75 IC 95% 1,14-2,70). For the domain related to physical activity, the association to CMD was only borderline (RP=1,43 IC 95% 0,97-2,72). We conclude that: Paper 1 -The negative impact on quality of life is directly related to having severe asthma, being exposed to passive smoke, or being recently diagnosed with asthma. The multidisciplinary team faced with the challenge of establishing and maintaining a good quality of life needs a comprehensive approach to the adolescent capable of helping these patients cope with society and their own issues; Paper 2- The results of this study suggest that greater attention be paid to the emotional needs of adolescents with chronic diseases, including more effective initiatives in the area of mental health in order to promote better quality of life and more comprehensive treatment for young patients with asthma.

Nesta tese vamos investigar as associações entre: Artigo 1 - Avaliar a qualidade de vida (QV) e sua associação com a gravidade da asma, presença de outras doenças crônicas e estilo de vida; Artigo 2 - O objetivo dessa pesquisa foi avaliar a associação entre TMC e qualidade de vida em adolescentes asmáticos. Artigo 1 - Trata-se de um estudo seccional de base ambulatorial em 210 adolescentes asmáticos entre 12 e 21 anos, de ambos os sexos atendidos em um serviço especializado em atenção ao adolescente em uma universidade pública no estado do Rio de Janeiro. Para avaliação da QV utilizou-se um questionário autopreenchível, o Paediatric Asthma Quality of Life Questionnaire PAQLQ. As variáveis explicativas foram: as outras doenças alérgicas, uso de medicamentos, fumo passivo, trabalho, gravidade da asma e o estilo de vida. As análises foram conduzidas considerando o desfecho em estudo (QV) dicotômico (boa-ruim) a partir da média dos escores. Modelos lineares generalizados (log-binomial) foram utilizados para o cálculo de razões de prevalência brutas e ajustadas; Artigo 2 - Estudo seccional de base ambulatorial, entre 210 adolescentes asmáticos de 12 a 21 anos atendidos em um ambulatório especializado de um serviço universitário voltado à atenção ao adolescente, no Rio de Janeiro, Brasil. A qualidade de vida (QV) foi avaliada através do Paediatric Asthma Quality of Life Questionnaire PAQLQ e os TMC, pelo General Health Questionnaire (GHQ-12). A qualidade de vida total e suas diferentes dimensões foram tratadas como variável dicotômica e utilizou-se o modelo log-binomial para o cálculo das razões de prevalência brutas e ajustadas. Artigo 1 - Quarenta e seis por cento das adolescentes apresentavam uma qualidade de vida ruim, assim como 57% dos meninos. Não houve correlação entre outras doenças crônicas e QV ruim. Escolaridade baixa, uso de medicamentos, fumo passivo e trabalho tiveram relação estatisticamente significativa (p<0,05) com QV ruim. A análise ajustada mostrou que asma grave (RP=1,53; IC 95% 1,12-2,11), uso de medicação (RP=1,58; IC 95% 1,09-2,28), ter menos de 5 anos de diagnóstico de asma (RP= 1,30.; IC 95% 0,97-1,86), fumo passivo (RP= 1,38; IC 95%; 1,35-2,00) e estar trabalhando (RP=1,30 IC 95% 0,96 1,74) associavam-se à qualidade de vida ruim; Artigo 2 - A prevalência total de asmáticos com TMC foi de 32,4%. A prevalência de QV ruim entre adolescentes com TMC foi de 36,6%. O modelo final ajustado mostrou uma associação entre TMC e QV total ruim (RP= 1,84 IC 95% 1,19-2,86), assim como para os domínios referentes à emoção (RP=1,77 IC 95% 1,16-2,62) e sintomas (RP=1,75 IC 95% 1,14-2,70). Para o domínio atividade física, a associação com TMC foi de apenas borderline (RP=1,43 IC 95% 0,97-2,72). Artigo 1 - O impacto negativo na qualidade de vida está diretamente relacionado a ter asma grave, ser fumante passivo e um diagnóstico mais recente de asma. A equipe multidisciplinar necessita enfrentar esse desafio que é a busca e manutenção de uma boa qualidade de vida, visando uma melhor adequação desse paciente com a sociedade e com ele próprio; Artigo 2 - Os resultados desse estudo tornam visíveis as necessidades de atenção aos aspectos emocionais dos adolescentes portadores de doenças crônicas, de forma a subsidiar ações mais efetivas na área de saúde mental, visando à melhor qualidade de vida e ao tratamento global do paciente asmático. / Objectives: The association between quality of life and adolescents with asthma: Paper 1 - Evaluate the association between the severity of asthma, the presence of comorbid chronic diseases, lifestyle and quality of life (QoL); Paper 2 - Evaluate the association between CMD and quality of life in adolescents with asthma. Method: Paper 1 - We undertook a sectional study 210 adolescents between ages 12 and 21, of both sexes with asthma, seen in the adolescent medicine service of public university hospital in the state of Rio de Janeiro. The self-administered Paediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to evaluate QoL. The explanatory variables used included other allergic disease, medication use, passive smoke exposure, employment, asthma severity and lifestyle. The analyses were conducted considering dichotomous outcome definitions of QoL (good-poor) using the mean of the scores. Generalized linear models (log-binomial) were used to calculate the gross and adjusted prevalence ratios; Paper 2 - This transverse study investigated 210 adolescents with asthma between ages 12 and 21, seen at a university outpatient adolescent medicine service in Rio de Janeiro, Brazil. The Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and General Health Questionnaire (GHQ-12) were used to assess QoL and common mental disorders (CMD) respectively. Total quality of life and its various dimensions were treated as dichotomous variables. A binomial log-rithmic model was used to calculate raw and adjusted prevalence ratios. Results: Paper 1 - Forty-six percent of woman, and 57% of men reported poor quality of life. There was no correlation between other chronic disease and poor QoL. Poor QoL was associated with low levels of education, medication use, passive smoke exposure, and employment; the relationship was - The prevalence of asthmatics with CMD was 32.4%. Examining CMDs relation to QoL, the prevalence of poor QoL was associated with low levels of education, medication use, passive smoke exposure, and employment; the relationship was statistically significant (p< 0.05). The adjusted analysis showed that severe asthma (RP=1.53; CI 95%: 1.12-2.11), medication use (RP=1.58; CI 95% 1.09-2.28), asthma diagnosis within the prior five years (RP= 1.30; CI 95%: 0.97-1.86), passive smoke exposure (RP= 1.38; CI 95%: 1.35-2.00) and being employed (RP=1.30; CI 95% 0.97-1.74) are associated with poor quality of life; Paper 2 - The prevalence of asthmatics with CMD was 32.4%. Examining CMDs relation to QoL, the prevalence of poor QoL was 36.6%. The adjusted final models showed an association between CMD and poor total quality of life (PR= 1, 84 IC 95% 1,19-2,86) as for the domains related to emotions (PR =1,77 IC 95% 1,16-2,62) and symptoms (RP=1,75 IC 95% 1,14-2,70). For the domain related to physical activity, the association to CMD was only borderline (RP=1,43 IC 95% 0,97-2,72). We conclude that: Paper 1 -The negative impact on quality of life is directly related to having severe asthma, being exposed to passive smoke, or being recently diagnosed with asthma. The multidisciplinary team faced with the challenge of establishing and maintaining a good quality of life needs a comprehensive approach to the adolescent capable of helping these patients cope with society and their own issues; Paper 2- The results of this study suggest that greater attention be paid to the emotional needs of adolescents with chronic diseases, including more effective initiatives in the area of mental health in order to promote better quality of life and more comprehensive treatment for young patients with asthma.

Diss. (sammanfattning) Umeå : Umeå universitet, 2005. / Härtill 4 uppsatser. S. 77-87: Bibliografi.

Asthma is not a disease with a single etiology but a very complex syndrome. Irrespective of a better understanding of the pathophysiology of asthma and its related therapeutic regimens the disease still escalates in prevalence and severity. Characteristic features of chronicity and remission ensures a fertile ground for non-compliance by patients. This quantitative, descriptive study set out to determine the asthma knowledge, asthma control and quality of life of adult asthmatics who attended the respiratory outpatient clinic at Tygerberg Hospital. The purpose was to determine an association between asthma knowledge, asthma control and asthma quality of life. A statistically significant association was found between asthma control and asthma quality of life, not with knowledge of asthma for either of the concepts. Important gaps in knowledge were identified namely an inability to recognise nocturnal coughing as a risk factor. The increased role of nurse practitioners in asthma care is highly recommended. / Health Studies / M.A. (Health Studies)

Asthma is not a disease with a single etiology but a very complex syndrome. Irrespective of a better understanding of the pathophysiology of asthma and its related therapeutic regimens the disease still escalates in prevalence and severity. Characteristic features of chronicity and remission ensures a fertile ground for non-compliance by patients. This quantitative, descriptive study set out to determine the asthma knowledge, asthma control and quality of life of adult asthmatics who attended the respiratory outpatient clinic at Tygerberg Hospital. The purpose was to determine an association between asthma knowledge, asthma control and asthma quality of life. A statistically significant association was found between asthma control and asthma quality of life, not with knowledge of asthma for either of the concepts. Important gaps in knowledge were identified namely an inability to recognise nocturnal coughing as a risk factor. The increased role of nurse practitioners in asthma care is highly recommended. / Health Studies / M.A. (Health Studies)