Preferred Name. escala de disnea de Borg: 2 – leve. Synonyms. escala de disnea de Borg: 2 – leve (hallazgo). ID. También se evaluó la disnea mediante la escala visual analógica (VAS) y mediante la escala de Borg. Se realizó una prueba progresiva de esfuerzo en tapiz. (1)Departamento de Oncología, Hospital Universitario de Torrejón, índice de disnea de Mahler, escala de Borg, escala Edmonton Symptoms.
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Analytical, cross-sectional study with patients during an asthma crisis, who received care at a Pneumology emergency service. Heart rate, respiratory frequency EFP, PO 2 S were evaluated before and after treatment of asthma crisis, and they were questioned about their perception of dyspnea by BME.
In the pre-treatment stage, high scale djsnea were related to low EFP values, inverting this relation after treatment. The scale does not replace other clinical parameters, and can be used as an additional tool, provided that the patient is correctly informed about the scale values. Asthma is a potentially deadly chronic inflammatory disease characterized by bronchial hyper-reactivity to several stimuli. Despite the stabilization in the prevalence of asthma in some countries, mortality due to this disease is still high.
In Brazil, inthe mortality rate by asthma as the basic or associated cause was 2. Asthma crises may be associated to a sudden or gradual onset 3. The asthmatic crisis is a very common medical emergency.
It is responsible for the use of a significant share of emergency room resources, with a high hospitalization rate In patients with respiratory problems, dyspnea is one of the most common symptoms, sscala it can show significant complications, implying the risk of asphyxia by lack of adequate treatment 6. The perception of the symptom is defined as the dee conscious sensation of a physiological problem, the result of a series of events: Failure in perceiving the severity of bronchoconstriction logically results in a delay to seek help, inadequate use of effective medication, and can even lead to avoidable deaths.
On the other hand, the excessive perception of modest bronchoconstriction logically results in the early search for help, overuse dd healthcare services and potential iatrogenesies as side borrg 8. As such, the perception of the asthma patient about the severity visnea bronchoconstriction has been reported as very important in the effective handling of asthma. The relation between the intensity of perception and the intensity of the stimulus cam be quantified by using the detection of the stimulus or by employing technical scales.
In this study, we decided to use Borg’s Modified Scale to quantify dyspnea, since this is the most commonly bodg method, and its measurement is performed disnex, whenever the patient is having the sensation. In the face of this reality, it is known that delays in the application of therapy can often deteriorate the patient’s clinical situation, even disbea the extent of leading to death.
Since the nurse is the professional who has the first contact with the patient, upon arrival, we believe that, if this professional is well supported by tools that aid in the evaluation of the gravity of dyspnea, such as BME, therapy can be started early and several deaths can be avoided.
The sample was constituted by patients with an asthma crisis diagnosis 1of both genders and over 12 years old. Smoking patients over 50 years old were excluded, as well as patients smoking for more than 30 years; patients with chronic respiratory diseases, bog as Chronic Obstructive Pulmonary Disease and bronchitis, and with previous or associate pulmonary diseases resulting in sequels, such as tuberculosis, thoracic surgery, etc; patients with acute respiratory infection of the lower airways, characterized by at least two out of three findings: In total, patients with diagnosed asthma and during an asthma crisis were assessed.
Nine patients were excluded due to associated chronic pneumopathies; five disneq been smoking for more than 30 years; two had a heart disease; seven presented signs and symptoms of acute respiratory infection of the lower airways; 11 had participated in this study before and three did not agree to sign the term of consent. Therefore, patients were included in the study. After the arrival of the patient, during a bronchospasm crisis, he underwent a medical appointment, when the evaluation, diagnosis and medication prescription were performed.
Esvala this evaluation, the patient was referred to the Nursing Station, where he was treated.
Immediately after his arrival, he was informed about the study and, after consenting, some data were collected before treatment was started: Patients were asked about their sensation of dyspnea through BME, which is a vertical scale quantified from 0 to 10, where 0 stands for no symptoms and 10 stands for maximum symptoms Chart 1. The patients were free to choose any of the ratings, and were carefully instructed not to pay attention to other types of sensation, such as nasal and throat irritation.
The use of accessory musculature was defined as a visible retraction of this same musculature, and was classified according to data from literature 11 in: Hissing was defined as musical sounds, audible with the aid of a stethoscope during breathing.
They were graded on a 0-to-3 scale, where 0 meant absent, 1 – light audible in one pulmonary field2 – moderate audible in two pulmonary fields and 3 – grave spread through all pulmonary fields Successive expiratory maneuvers were performed, and the maneuver with the highest value was registered. The result was expressed in percentages according to gender, age and height, in line with worldwide consensual guidelines 1,10, These measurements were performed at intervals: After the described measurements were taken, the patients were classified in three groups: After the groups were separated, all patients received four streams, totaling mcg salbutamol and 80 mcg ipratropium bromide combivent spray – Boehringer Ingelheimusing a metered-dose inhaler connected to a ml suspension chamber Fisionair.
Each stream was administered at second intervals. This setup could be provided up to three times, with a minute interval between each treatment.
Data were collected prior to the first treatment and 15 minutes after each medication application. Patients were followed until they were discharged or broke the protocol.
SNOMED Terminos Clinicos – escala de disnea de Borg: 2 – leve – Classes | NCBO BioPortal
The evaluation of the pulmonary function by EFP determined the end or the continuation of the treatment. In these cases, the patients received the predicted medications in sequence, according to the III Consenso Brasileiro no Manejo da Asma Parametric and non-parametric tests were used to analyze the data, considering the nature of the studied variables or the variability of the performed measurements.
The following tests were applied: Student’s t, paired with the purpose of comparing pre- and post-treatment in relation bprg HR, RF, PO 2 S and EFP; signaled Wilcoxon’s test for the evaluation of BME due to high data variability; grouped distribution analysis of two qualitative variables for the evaluation of pre- and post- Borg treatment and Spearman’s rank correlation coefficient to evaluate the association between the variations in EFP cisnea BME parameters.
The data referring to the general characteristics of the patients with asthma crisis who received care at a Pneumology emergency service are presented in Table 1. According to Table 1most patients were female The time of asthma for these patients varied from 3 months to 73 years, with a median time of 19 years.
Table 3 shows the result of the objective evaluation of the gravity of the asthma crisis, before and after the treatment, according to the crisis groups. Comparing the period before the beginning and that after the last treatment, a statistically significant difference was observed for the variables HR, RF, EFP in liters and BME in all groups.
Escaal the grouped Eecala distribution was performed before the beginning and after the last treatment in the patients, a significant improvement was observed in relation to the value attributed to dyspnea by this scale upon admission and after treatment, except in one patient.
No significant correlations were observed among the groups when correlation tests were performed between the BME and PO 2 S values, before and after the treatment.
In our study, all patients included had a previous asthma diagnosis from a physician, based on the symptoms and complementary exams, in accordance with the guidelines 1,10, The asthma crisis was more frequent in women, which can be explained by the results of other studies, which identify that women have a higher bronchial response than men, almost exclusively because of the caliber of their airways The educational level is the most usual indicator of socioeconomic level for adults, because it is generally not altered.
Other indicators are income and occupation; however, disne former was not evaluated in this research. Low educational level, marital status, profession and levels of anxiety usually relate with a higher frequency of asthma exacerbation For some authors, educational level and profession are the best indicators to probably describe occupational exposure In the present study, most patients with an asthma crisis were female, with an average age of This is in accordance with most studies A quarter of the patients were smokers.
Although some studies have shown that smoking is not a risk factor for asthma in adults, it is known that smoking increases the gravity of asthma and can be an obstacle to control this disease. The association between smoking and asthma is a complex one. In one study, an association between the risk of asthma and the amount of cigarettes smoked was found only in women During the research, patients between 12 and 79 years of age were admitted. Elderly patients and children over 8 years old were not excluded, since the bronchodillating response to salbutamol, as well as ipratropium bromide, in asthma, does not vary with age In this study, due to technical reasons, the EFP was the only one eecala as a pulmonary functional variable.
Even though spirometry is considered the best method to evaluate the limitation of air flow in asthma, EFP measurement is easier to perform in emergency services.
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Besides, the devices used for EFP are less expensive and more readily available at this sector The data about the history of the current crisis, which denote gravity for some authors, include a prolonged duration of the symptoms, delays in seeking medical help, exacerbation during corticotherapy and adequate bronchodillating treatment, receding symptoms within hours or few days of emergency care. Other factors related to higher mortality are age over 55 years old and the presence of comorbidities When compared at the early clinical presentation and evolution after therapy, in patients with light or moderate cisnea or very grave asthma crisis, HR, RF, EFP in liters and the BME evaluation were bory significant.
PO 2 S was only statistically significant in patients with grave and very grave crisis. BME seemed to be a quick, inexpensive and easily applicable instrument in the evaluation of patients with asthma. It can be used by healthcare professionals during the initial evaluation of patients with asthma crisis, as well as to evaluate their response to treatment. Since this scale is easily applicable, we chose to use it at the emergency service.
Indeed, in our study, there were no difficulties in applying BME, and the patients did not consider its rating scale difficult to understand. When the BME values are evaluated before and after the last treatment, we observed a significant improvement in all patients regarding the values attributed by this scale, regardless of the type of crisis.
A correlation test between the BME values and the EFP values in liters before the treatment and 15 minutes after the last treatment showed a significant correlation in patients with light or moderate asthma, and those with very grave asthma before treatment, which did not occur in grave asthma, either before or after treatment. In all figures, there is borb that higher BME values upon admission are associated to lower EFP values in liters before treatment, while higher EFP values are associated to lower BME values after the last treatment.
Studies show that asthmatic patients present varied degrees of anxiety and depression when compared to the general population, which may interfere in their sensation of dyspnea When the EMB values are correlated with the PO 2 S values before treatment and 15 minutes after the last treatment, none of the groups showed statistical significance, although the saturation values, as expected, had increased after treatment and the Sisnea values had decreased.
Another point that can be considered is that, although the use of metered-dose inhalers is effective and less expensive than the usual inhalations, patients and healthcare professionals find it difficult to abandon the use of such inhalations.
They believe that these are more effective because, as the patient inhales for approximately 20 minutes, the benefits are more perceptible at obrg end of the inhalation. It may take longer to achieve the benefits of using metered-dose inhalers, however, which may cause the false impression that they are less effective The results obtained in this study demonstrate a weak correlation between the degree of bronchoconstriction, evaluated by EFP and PO 2 S, and the perception of dyspnea measured by the patient and evaluated by BME.
The statistical correlation between EFP, PO 2 S and BME showed that the latter can be useful to evaluate the escxla of dyspnea, but it was not shown to be specific enough to evaluate the degree of asthma severity due to a weak correlation.
This weak correlation can be a consequence, among other factors, of phenomena of adaptation to hypoxia or even emotional phenomena involved, according to literature. Our study contributes to the theme by disneq that BME, although widely used in the evaluation of induced bronchoconstriction by exercise, does not substitute any other clinical parameter in the individual with asthmatic crisis. It can dienea useful only as an additional tool, provided that the patient is correctly informed about the values of the scale by a capable healthcare professional, dishea in the case of nurses.
Acute asthma in dr Risck factors for near-fatal asthma.
A case-control study in hospitalized patients with asthma. Symptom perception and respiratory sensation in borv. Psychophysical methods in the study of respiratory sensation.
Adams L, Guz A, editors. Sociedade Brasileira de Pneumologia e Tisiologia. Rodrigo GJ, Rodrigo C.