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Antibióticos inalados em doentes com Fibrose quística com infeção crónica por Pseudomonas aeruginosa
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Introdução: A Fibrose Quística é uma doença genética que afeta vários sistemas, sendo a doença respiratória a principal causa de morte destes indivíduos. Os doentes com FQ são mais suscetíveis a infeção das vias aéreas por Pseudomonas aeruginosa, principal preditor de deterioração respiratória, morbilidade e mortalidade. Os antibióticos antipseudomonas têm sido um tratamento de base na FQ dado estarem associados à diminuição do declínio da função respiratória e melhoria da sobrevida.
Objetivos: Caraterizar os doentes adultos com Fibrose Quística com infeção crónica por Pseudomonas aeruginosa, seguidos no Centro especializado de Fibrose Quística do HSM. Investigar a existência de relações entre variáveis associadas à doença nomeadamente FEV1 e a terapêutica antibiótica inalada.
Materiais e métodos: Foi realizado um estudo retrospetivo descritivo onde foram incluídos 18 doentes com Fibrose Quística com infeção crónica por Pseudomonas Aeruginosa seguidos no Centro Especializado de Fibrose Quística do HSM. Aplicaram-se testes estatísticos utilizando o software SPSS versão 21 para identificar relações entre os potenciais condicionantes do declínio da função respiratória (idade, idade de diagnóstico, sexo, genótipo, status pancreático, diabetes relacionada com a Fibrose Quística, prova de suor, IMC, FEF25-75, VR, pO2, pCO2, hemoptises e número de internamentos por ano) e consequente deterioração clínica.
Resultados: Observou-se que os doentes com pior evolução são os diagnosticados na infância, estando associados a genótipos de maior gravidade, insuficiência pancreática exócrina, pior status nutricional, doença respiratória grave e maior número de internamentos. Observou-se que o sexo feminino apresentou valores inferiores de FEV1 relativamente ao sexo masculino. Houve correlação significativa de FEV1 com o FEF25-75 e o VR, de IMC com idade de diagnóstico e valores da prova de suor e de número de internamentos com idade de diagnóstico. Em 2011, todos os doentes se encontravam a realizar Tis. A maioria dos doentes alterou a terapêutica para TIP por comodidade e tempo de administração do fármaco relativamente ao Tis. O Promixin® foi sempre utilizado em terapêutica dupla. O Aztreonam foi introduzido na terapêutica inalada quando ocorria agravamento da doença. A tosse foi o efeito adverso mais frequente. Os efeitos adversos foram mais frequentes com TIP, que se revelou o único antibiótico inalado que promoveu o aparecimento de efeitos adversos graves.
Conclusões: A deterioração clínica pode ser aferida por diversos parâmetros, sendo essencial reconhecer quais os que se alteram precocemente, já que a maioria pode ser prevenida ou é potencialmente tratável. Todos os doentes da amostra estavam medicados com antibióticos inalados. O TIP é mais cómodo e, por isso, mais frequentemente usado. O Aztreonam parece ser o antibiótico de reserva, usado nos casos de deterioração clínica. Não foram encontradas relações entre o uso de esquemas de antibióticos inalados e a função respiratória. A aplicação de registos frequentes das provas de função respiratória permitiria dirigir melhor a terapêutica consoante as características individuais e o estadio da doença.
Introduction: Cystic fibrosis is a genetic disease that affects multiple systems being the lung disease the leading cause of death of these individuals. Patients with CF are more susceptible to infection of the airways by Pseudomonas aeruginosa, the main predictor of respiratory impairment, morbidity and mortality. The antipseudomonal antibiotics have been a base treatment in Cystic Fibrosis because they are associated with decreased lung function decline and improving survival. Objectives: Characterize adult patients with Cystic Fibrosis with chronic Pseudomonas aeruginosa infection followed in specialized HSM Cystic Fibrosis Center. To investigate relationships between variables associated with the disease between FEV1 and inhaled antibiotic therapy. Methods: We conducted a descriptive retrospective study that included 18 patients with Cystic Fibrosis with chronic Pseudomonas aeruginosa infection followed in specialized HSM Cystic Fibrosis Center. Applied different statistical tests using SPSS software version 21 to identify relationships between the potential limitations of worsening lung function (age, age at diagnosis, sex, genotype, pancreatic status, diabetes related to Cystic Fibrosis, sweat proof, BMI , FEF 25-75, VR, pO2, pCO2, hemoptysis and number of admissions per year) and subsequent clinical deterioration. Results: It was observed that women had lower values for FEV1 relative to males. There was a significant correlation of FEV1 with FEF25-75 and the VR, BMI with age at diagnosis and values of sweat-proof and number of admissions with age at diagnosis. In 2011, all patients were doing therapy with Tis. Most patients had modified therapy for TIP due less time to drug administration. The Promixin® was always used in double therapy. Aztreonam was introduced in the inhalation therapy when there was worsening of the disease. Cough was the most common adverse effect. Adverse effects were more common with TIP, which proved the only inhaled antibiotic that promoted the emergence of severe adverse effects. Conclusions: The clinical deterioration can be measured by several parameters which it is essential to recognize those that change prematurely since most of them can be prevented or are potentially treatable. All patients in the sample were treated with inhaled antibiotics. The TIP is more convenient and therefore most often used. The Aztreonam antibiotic appears to be the reserve, used in cases of clinical deterioration.The application of serial records of respiratory function tests would better direct the therapy according to the individual characteristics and disease status.
Introduction: Cystic fibrosis is a genetic disease that affects multiple systems being the lung disease the leading cause of death of these individuals. Patients with CF are more susceptible to infection of the airways by Pseudomonas aeruginosa, the main predictor of respiratory impairment, morbidity and mortality. The antipseudomonal antibiotics have been a base treatment in Cystic Fibrosis because they are associated with decreased lung function decline and improving survival. Objectives: Characterize adult patients with Cystic Fibrosis with chronic Pseudomonas aeruginosa infection followed in specialized HSM Cystic Fibrosis Center. To investigate relationships between variables associated with the disease between FEV1 and inhaled antibiotic therapy. Methods: We conducted a descriptive retrospective study that included 18 patients with Cystic Fibrosis with chronic Pseudomonas aeruginosa infection followed in specialized HSM Cystic Fibrosis Center. Applied different statistical tests using SPSS software version 21 to identify relationships between the potential limitations of worsening lung function (age, age at diagnosis, sex, genotype, pancreatic status, diabetes related to Cystic Fibrosis, sweat proof, BMI , FEF 25-75, VR, pO2, pCO2, hemoptysis and number of admissions per year) and subsequent clinical deterioration. Results: It was observed that women had lower values for FEV1 relative to males. There was a significant correlation of FEV1 with FEF25-75 and the VR, BMI with age at diagnosis and values of sweat-proof and number of admissions with age at diagnosis. In 2011, all patients were doing therapy with Tis. Most patients had modified therapy for TIP due less time to drug administration. The Promixin® was always used in double therapy. Aztreonam was introduced in the inhalation therapy when there was worsening of the disease. Cough was the most common adverse effect. Adverse effects were more common with TIP, which proved the only inhaled antibiotic that promoted the emergence of severe adverse effects. Conclusions: The clinical deterioration can be measured by several parameters which it is essential to recognize those that change prematurely since most of them can be prevented or are potentially treatable. All patients in the sample were treated with inhaled antibiotics. The TIP is more convenient and therefore most often used. The Aztreonam antibiotic appears to be the reserve, used in cases of clinical deterioration.The application of serial records of respiratory function tests would better direct the therapy according to the individual characteristics and disease status.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Fibrose quística Pseudomonas aeruginosa Antibióticos Pneumologia