RESUMEN

Consider flexible bronchoscopy as an option to retrieve aspirated foreign bodies in the airway.

RESUMEN

Pulmonary arterial hypertension used to be considered an ultimately fatal disease despite the formerly available therapy. It is a disease characterized by progressive elevation of pulmonary vascular resistance and pulmonary arterial pressure, eventually resulting in right ventricular failure and death. The purpose of this article is to review the basic pathophysiologic processes involved in pulmonary arterial hypertension, to discuss patient presentation, classification, and diagnostic workup. Regarding treatment, all patients with PAH should be considered for standard therapy with anticoagulation, oxygen, and diuretics for management of right heart failure. Calcium channel blockers are only indicated for patients with a positive acute vasoreactivity test. Patients with a negative vasoreactivity test and considered low risk can be treated with oral agents such as endothelin receptor antagonists or PDE-5 inhibitor. Patients at high risk should be treated with prostacyclin analogs. Finally, a brief mention of new and future potential therapeutic strategies is also included.

Asunto(s)

Hipertensión Pulmonar , Hipertensión Pulmonar Primaria Familiar , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/tratamiento farmacológico , Hipertensión Pulmonar/fisiopatología

RESUMEN

Bronchial asthma is one of the most common chronic conditions seen by any health care professional. Multiple stimuli may lead to acute airway hyperresponsiveness and an exacerbation of the disease, gastroesophageal reflux disease being one of them. We report the case of an elderly patient with chronic gastroesophageal reflux disease who secondarily developed a tracheoesophageal fistula, resulting in recurrent exacerbations of previously well-controlled asthma. After endoscopic correction of the fistula, the patient's respiratory disease improved dramatically, with essentially no exacerbations requiring urgent care or hospitalization.

Asunto(s)

Asma/etiología , Fístula Traqueoesofágica/complicaciones , Anciano , Humanos , Masculino , Fístula Traqueoesofágica/diagnóstico , Fístula Traqueoesofágica/cirugía

RESUMEN

Flow volume loops are an essential part of spirometry testing. Their appearance can give information that can be helpful in the differential diagnosis of a patient's clinical condition. We present two clinical scenarios in which careful evaluation of the flow-volume loop gives an insight into the cause of the disease process.

Asunto(s)

Laringoestenosis/fisiopatología , Espirometría , Tuberculosis Laríngea/fisiopatología , Anciano , Glotis , Humanos , Laringoestenosis/diagnóstico , Masculino , Tuberculosis Laríngea/diagnóstico

RESUMEN

RATIONALE: Independent replication of genetic associations in complex diseases, particularly in whole-genome association studies, is critical to confirm the association. OBJECTIVES: A whole-genome association study identified ORMDL3 as a promising candidate gene for asthma in white populations. Here, we attempted to confirm the role of ORMDL3 genetic variants in asthma in three ethnically diverse populations: Mexican, Puerto Rican, and African American. METHODS: We used family-based analyses to test for association between seven candidate single-nucleotide polymorphisms (SNPs) in and around the ORMDL3 gene and asthma and related phenotypes in 701 Puerto Rican and Mexican parent-child trios. We also evaluated these seven SNPs and an additional ORMDL3 SNP in 264 African American subjects with asthma and 176 healthy control subjects. MEASUREMENTS AND MAIN RESULTS: We found significant associations between two SNPs within ORMDL3 (rs4378650 and rs12603332) and asthma in Mexicans and African Americans (P = 0.028 and 0.001 for rs4378650 and P = 0.021 and 0.001 for rs12603332, respectively), and a trend toward association in Puerto Ricans (P = 0.076 and 0.080 for SNPs rs4378650 and rs12603332, respectively). These associations became stronger among Mexican and Puerto Rican subjects with asthma with IgE levels greater than 100 IU/ml. We did not find any association between ORMDL3 SNPs and baseline lung function or response to the bronchodilator albuterol. CONCLUSIONS: Our results confirm that the ORMDL3 locus is a risk factor for asthma in ethnically diverse populations. However, inconsistent SNP-level results suggest that further studies will be needed to determine the mechanism by which ORMDL3 predisposes to asthma.

Asunto(s)

Asma/etnología , Asma/genética , Negro o Afroamericano/genética , Proteínas de la Membrana/genética , Americanos Mexicanos/genética , Polimorfismo de Nucleótido Simple/genética , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Femenino , Volumen Espiratorio Forzado , Predisposición Genética a la Enfermedad/etnología , Predisposición Genética a la Enfermedad/genética , Humanos , Masculino , Puerto Rico/etnología , Espirometría , Estados Unidos/epidemiología

RESUMEN

Socioeconomic and environmental differences do not fully explain differences in asthma prevalence, morbidity, and mortality among Puerto Ricans, African Americans, and Mexican Americans. Differences in response to albuterol may be a factor. We compared bronchodilator responsiveness between these three populations. All groups demonstrated below expected responsiveness. Puerto Ricans of all ages and African American children with moderate-to-severe asthma demonstrated the lowest responsiveness overall. Among subjects with moderate-to-severe asthma, children were even less likely than adults to show the expected bronchodilator response. We conclude that ethnic-specific differences in bronchodilator drug responsiveness exist between Mexicans, Puerto Ricans, and African Americans with asthma. This may be of importance in asthma management.

Asunto(s)

Albuterol/uso terapéutico , Asma/tratamiento farmacológico , Asma/etnología , Negro o Afroamericano , Broncodilatadores/uso terapéutico , Hispánicos o Latinos , Americanos Mexicanos , Adolescente , Adulto , Asma/fisiopatología , Niño , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Masculino , México , Ciudad de Nueva York , Puerto Rico , San Francisco , Estadísticas no Paramétricas , Capacidad Vital/efectos de los fármacos

RESUMEN

BACKGROUND: High levels of IgE are associated with asthma. Whether higher levels of IgE are associated with more severe asthma is still unclear. OBJECTIVE: To determine whether IgE is associated with asthma severity among Latino and African American subjects with asthma. METHODS: We assessed lung function and asthma severity among African American, Mexican, and Puerto Rican patients with asthma with high IgE levels (> or =100 IU/mL; n = 492) and compared these values to those of patients with asthma with low IgE levels (<100 IU/mL; n = 247). We also examined IgE as a continuous variable among these groups. RESULTS: Patients with asthma with high IgE had a lower mean FEV(1) (87.6 +/- 17.1, percent of predicted) than patients with asthma with low IgE (91.5 +/- 17.0; P = .031). Regardless of race and ethnicity, baseline FEV(1), forced expiratory flow, and FEV(1)/forced vital capacity were lower among subjects with high IgE than among subjects with low IgE (P = .031, P < .0001, P = .0001, respectively). In addition, 54.7% of patients with asthma with high IgE had been previously hospitalized, compared with 44.1% of patients with asthma with low IgE (odds ratio, 1.33; 95% CI, 1.04-1.71). CONCLUSION: Higher IgE is associated with lower baseline lung function and more severe asthma among these populations. CLINICAL IMPLICATIONS: Among patients with asthma from 3 ethnically distinct groups, total IgE levels are inversely correlated with baseline lung function and asthma severity.

Asunto(s)

Asma/diagnóstico , Asma/etnología , Inmunoglobulina E/sangre , Adolescente , Adulto , Negro o Afroamericano , Niño , Humanos , México , Puerto Rico

RESUMEN

BACKGROUND: The prostanoid DP receptor (PTGDR) gene on chromosome 14q22.1 has been identified as an asthma susceptibility gene. A haplotype with decreased transcription factor binding and transcription efficiency was associated with decreased asthma susceptibility in African American and white subjects. The significance of PTGDR gene variants in asthma has yet to be determined in Latinos, the largest US minority population, nor has the association been replicated in other populations. OBJECTIVE: To determine the role of PTGDR gene variants in asthma susceptibility and asthma-related traits among the Mexican, Puerto Rican, and African American populations. METHODS: We determined whether single nucleotide polymorphisms (SNPs) and haplotypes in PTGDR were associated with asthma and asthma-related traits by family-based and cross-sectional cohort analyses in 336 Puerto Rican and 273 Mexican asthmatic trios and by case-control analysis among African American subjects with asthma and healthy controls (n = 352). RESULTS: We identified 13 SNPs in the PTGDR gene, and 6 were further analyzed. There was no significant association between PTGDR variants and asthma by family-based or case-control analyses. SNPs -441C and -197C and haplotype TTT showed marginal association with asthma-related traits in Mexican subjects. SNP -441 genotype TT (P = .05) and haplotype TTT (P = .02) were associated with increased IgE levels in African Americans. CONCLUSION: We conclude that the PTGDR gene is not a significant risk factor for asthma among Puerto Ricans, Mexicans, or African Americans. CLINICAL IMPLICATIONS: Asthma candidate genes provide insights to pathophysiology and potentially new therapeutic targets, although the PTGDR gene was not found to be a significant risk factor for asthma in 3 populations.

Asunto(s)

Asma/etnología , Asma/genética , Negro o Afroamericano , Predisposición Genética a la Enfermedad , Hispánicos o Latinos , Receptores Inmunológicos/genética , Receptores de Prostaglandina/genética , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Cromosomas Humanos Par 14/genética , Estudios de Cohortes , Estudios Transversales , Femenino , Haplotipos , Humanos , Masculino , Americanos Mexicanos , Polimorfismo de Nucleótido Simple , Puerto Rico/etnología

RESUMEN

BACKGROUND: Puerto Ricans, an admixed population of African, European, and Native American ancestries, have the highest asthma prevalence, morbidity, and mortality rates of any United States' population. Although socioeconomic status (SES) is negatively correlated with asthma incidence in most populations, no such relationship has been identified among Puerto Ricans. We hypothesized that, in this admixed population, the association between SES and asthma may interact with genetic ancestry. METHODS: We analyzed 135 Puerto Rican subjects with asthma and 156 control subjects recruited from six different recruitment centers in Puerto Rico. Individual ancestry for each subject was estimated using 44 ancestry informative markers. SES was assigned using the census tracts' median family income. Analyses of SES were based on the SES of the clinic site from which the subjects were recruited and on a subset of individuals on whom home address-based SES was available. RESULTS: In the two (independent) analyses, we found a significant interaction between SES, ancestry, and asthma disease status. At lower SES, European ancestry was associated with increased risk of asthma, whereas African ancestry was associated with decreased risk. The opposite was true for their higher SES counterparts. CONCLUSIONS: The observed interaction may help to explain the unique pattern of risk for asthma in Puerto Ricans and the lack of association with SES observed in previous studies when not accounting for varying proportions of ancestry.

Asunto(s)

Asma/etnología , Asma/genética , Hispánicos o Latinos , Clase Social , Adolescente , Adulto , Niño , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Puerto Rico/etnología

RESUMEN

In the United States, asthma prevalence and mortality are the highest among Puerto Ricans and the lowest among Mexicans. Case-control association studies are a powerful strategy for identifying genes of modest effect in complex diseases. However, studies of complex disorders in admixed populations such as Latinos may be confounded by population stratification. We used ancestry informative markers (AIMs) to identify and correct for population stratification among Mexican and Puerto Rican subjects participating in case-control studies of asthma. Three hundred and sixty-two subjects with asthma (Mexican: 181, Puerto Rican: 181) and 359 ethnically matched controls (Mexican: 181, Puerto Rican: 178) were genotyped for 44 AIMs. We observed a greater than expected degree of association between pairs of AIMs on different chromosomes in Mexicans (P < 0.00001) and Puerto Ricans (P < 0.00002) providing evidence for population substructure and/or recent admixture. To assess the effect of population stratification on association studies of asthma, we measured differences in genetic background of cases and controls by comparing allele frequencies of the 44 AIMs. Among Puerto Ricans but not in Mexicans, we observed a significant overall difference in allele frequencies between cases and controls (P = 0.0002); of 44 AIMs tested, 8 (18%) were significantly associated with asthma. However, after adjustment for individual ancestry, only two of these markers remained significantly associated with the disease. Our findings suggest that empirical assessment of the effects of stratification is critical to appropriately interpret the results of case-control studies in admixed populations.

Asunto(s)

Factores de Confusión Epidemiológicos , Genética de Población , Hispánicos o Latinos/genética , Alelos , Mapeo Cromosómico , Frecuencia de los Genes , Marcadores Genéticos , Genotipo , Humanos , México/etnología , Puerto Rico/etnología

RESUMEN

Genetic association studies in admixed populations may be biased if individual ancestry varies within the population and the phenotype of interest is associated with ancestry. However, recently admixed populations also offer potential benefits in association studies since markers informative for ancestry may be in linkage disequilibrium across large distances. In particular, the enhanced LD in admixed populations may be used to identify alleles that underlie a genetically determined difference in a phenotype between two ancestral populations. Asthma is known to have different prevalence and severity among ancestrally distinct populations. We investigated several asthma-related phenotypes in two ancestrally admixed populations: Mexican Americans and Puerto Ricans. We used ancestry informative markers to estimate the individual ancestry of 181 Mexican American asthmatics and 181 Puerto Rican asthmatics and tested whether individual ancestry is associated with any of these phenotypes independently of known environmental factors. We found an association between higher European ancestry and more severe asthma as measured by both forced expiratory volume at 1 second (r=-0.21, p=0.005) and by a clinical assessment of severity among Mexican Americans (OR: 1.55; 95% CI 1.25 to 1.93). We found no significant associations between ancestry and severity or drug responsiveness among Puerto Ricans. These results suggest that asthma severity may be influenced by genetic factors differentiating Europeans and Native Americans in Mexican Americans, although differing results for Puerto Ricans require further investigation.

Asunto(s)

Asma/etnología , Asma/genética , Hispánicos o Latinos/genética , Desequilibrio de Ligamiento/genética , Americanos Mexicanos/genética , Adolescente , Broncodilatadores/uso terapéutico , Niño , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Volumen Espiratorio Forzado/genética , Marcadores Genéticos , Genotipo , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina E/genética , Masculino , Fenotipo , Puerto Rico/etnología , Índice de Severidad de la Enfermedad

RESUMEN

BACKGROUND: In the United States, Puerto Ricans and Mexicans have the highest and lowest asthma prevalence, morbidity, and mortality, respectively. Ethnic-specific differences in the response to drug treatment may contribute to differences in disease outcomes. Genetic variants at the beta(2)-adrenergic receptor (beta(2)AR) may modify asthma severity and albuterol responsiveness. We tested the association of beta(2)AR genotypes with asthma severity and bronchodilator response to albuterol in Puerto Ricans and Mexicans with asthma. METHODS: We used both family-based and cross-sectional tests of association with 8 beta(2)AR single nucleotide polymorphisms in 684 Puerto Rican and Mexican families. Regression analyses were used to determine the interaction between genotype, asthma severity, and bronchodilator drug responsiveness. RESULTS: Among Puerto Ricans with asthma, the arginine (Arg) 16 allele was associated with greater bronchodilator response using both family-based and cross-sectional tests (p = 0.00001-0.01). We found a strong interaction of baseline FEV(1) with the Arg16Glycine (Gly) polymorphism in predicting bronchodilator response. Among Puerto Ricans with asthma with baseline FEV(1) < 80% of predicted, but not in those with FEV(1) > 80%, there was a very strong association between the Arg16 genotype and greater bronchodilator responsiveness. No association was observed between Arg16Gly genotypes and drug responsiveness among Mexicans with asthma. CONCLUSIONS: Ethnic-specific pharmacogenetic differences exist between Arg16Gly genotypes, asthma severity, and bronchodilator response in Puerto Ricans and Mexicans with asthma. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and drug responsiveness.

Asunto(s)

Albuterol/uso terapéutico , Asma/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Hispánicos o Latinos/genética , Americanos Mexicanos/genética , Adolescente , Albuterol/farmacocinética , Alelos , Asma/genética , Broncodilatadores/farmacocinética , Niño , Femenino , Frecuencia de los Genes , Genotipo , Haplotipos , Humanos , Masculino , México , Polimorfismo de Nucleótido Simple , Puerto Rico/etnología , Receptores Adrenérgicos beta 2/genética , Receptores Adrenérgicos beta 2/metabolismo , Análisis de Regresión , Pruebas de Función Respiratoria , Estados Unidos

RESUMEN

We conducted a survey to determine parent-reported asthma prevalence, morbidity, and healthcare utilization among 3527 children attending public schools (n = 2849) and private schools (n = 678) in San Juan, Puerto Rico. Schools were randomly selected from each of 12 geographic regions of the San Juan metropolitan area. Parents of children age 4-7 years old completed a 12-item questionnaire on asthma diagnosis, respiratory symptoms and morbidity, and healthcare utilization. Parents of children in public schools and private schools reported similar rates of a physician having previously diagnosed asthma in their children (43.2% vs. 39.4%); however, significantly more children in public schools were reported to still have asthma at the time of the survey (32.6% vs. 23.7%). Children attending public schools vs. private schools were reported to have missed significantly more school and to have had more hospitalizations and emergency department visits. Among children reported to still have asthma, significantly more children visited an emergency department, were hospitalized, and missed more school days due to respiratory symptoms in the past year. The high prevalence of parent-reported asthma, respiratory symptoms, and healthcare utilization among Puerto Rican children in San Juan calls for further studies using objective methods for ascertaining asthma and asthma-related morbidity. Differences in healthcare utilization between children attending public vs. private schools suggest that socioeconomic factors play a role in asthma management in Puerto Rico.

Asunto(s)

Asma/epidemiología , Absentismo , Asma/diagnóstico , Niño , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Padres , Pobreza , Prevalencia , Puerto Rico/epidemiología , Población Urbana/estadística & datos numéricos

RESUMEN

In the United States, Puerto Ricans and Mexicans have the highest and lowest asthma prevalence, morbidity, and mortality, respectively. To determine whether ethnicity-specific differences in therapeutic response, clinical response, and/or genetic factors contribute to differences in asthma outcomes, we compared asthma-related clinical characteristics among 684 Mexican and Puerto Rican individuals with asthma recruited from San Francisco, New York City, Puerto Rico, and Mexico City. Puerto Ricans with asthma had reduced lung function, greater morbidity, and longer asthma duration than did Mexicans with asthma. Bronchodilator responsiveness, measured as percentage change from baseline FEV1, was significantly lower among Puerto Ricans with asthma than among Mexicans with asthma. Puerto Ricans with asthma had on average 7.3% (95% confidence interval [CI], 4.6 to 9.9; p < 0.001) lower bronchodilator reversibility in FEV1, higher risk of an emergency department visit in the previous year (odds ratio, 2.63; 95% CI, 1.6 to 4.3; p < 0.001), and of previous hospitalization for asthma (odds ratio, 1.94; 95% CI, 1.2 to 3.2; p = 0.009) than Mexicans. Subgroup analysis corroborated that Puerto Ricans with asthma had more severe disease than did Mexicans on the basis of lung function measurements, responsiveness to beta2-adrenergic agonists, and health care use. We conclude that Puerto Ricans with asthma respond less to albuterol than do Mexicans with asthma. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and response to therapy.

Asunto(s)

Asma/tratamiento farmacológico , Asma/etnología , Broncodilatadores/uso terapéutico , Hispánicos o Latinos , Asma/diagnóstico , Pruebas de Provocación Bronquial , Estudios de Cohortes , Femenino , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Americanos Mexicanos , Probabilidad , Pronóstico , Pruebas de Función Respiratoria , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Resultado del Tratamiento , Estados Unidos/epidemiología

RESUMEN

A recent study identified the ADAM33 gene as a promising candidate contributing to asthma. In Puerto Rican and Mexican populations, we have genotyped six single nucleotide polymorphisms (SNPs) that were used in the Genetics of Asthma in Latino Americans Study. We chose to study these two populations because in the United States, Puerto Ricans have the highest asthma prevalence, morbidity, and mortality and Mexicans the lowest. We used the transmission disequilibrium test to analyze associations between the ADAM33 gene variants and asthma, asthma severity, bronchodilator responsiveness, and total IgE levels using single SNPs, two to six SNP combinations, and specific haplotypes in 583 trios (proband with asthma and both biological parents). We also genotyped matched control samples to allow case-control analyses. None of the transmission disequilibrium test or case-control results showed significant association in either population. We found no evidence for association of single SNPs with asthma severity, bronchodilator response, or IgE levels in Mexicans or in the combined population. Two SNPs showed a modest association in Puerto Ricans, insignificant when the number of comparisons was taken into account. We conclude that the ADAM33 gene is not an important risk factor for asthma or for asthma-associated phenotypes in Mexicans or in Puerto Ricans.

Asunto(s)

Asma/genética , Hispánicos o Latinos/genética , Metaloendopeptidasas/genética , Americanos Mexicanos/genética , Polimorfismo de Nucleótido Simple/genética , Proteínas ADAM , Adolescente , Asma/sangre , Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Estudios de Casos y Controles , Niño , Femenino , Genotipo , Humanos , Inmunoglobulina E/sangre , Masculino , Índice de Severidad de la Enfermedad

RESUMEN

PURPOSE: To evaluate Smoking Cessation Clinic success rate and attitudes toward smoking among current and quitters enrolled at the clinic. METHODS: Telephone survey among a random sample of 61 subjects enrolled at the Smoking Cessation Clinic in the San Juan Veterans Affairs Hospital. The questionnaire was validated and standardized for Hispanic subjects. RESULTS: Twenty eight percent of the subjects interviewed referred they had quit smoking. Quitters used to smoke more cigarettes than current smokers do. Quitters perceived their general health to be worse than current smoker's perception. Even though Quitters were concerned about weight gain after quitting, it was not a negative outcome for smoking cessation. No association was found between active smoking and use of ethanol, neither socializing with friends nor feeling anxious. CONCLUSION: The Smoking Cessation Clinic at the San Juan Veterans Affairs Hospital has a success rate similar to other clinics reported in the literature. Poor health perception and consumption of more than one pack per day predicted smoking cessation. There was no single strong factor associated to smoking cessation. The idiosyncrasy of targeted population should be taken in account when designing smoking cessation program.

Asunto(s)

Cese del Hábito de Fumar/estadística & datos numéricos , Tabaquismo/epidemiología , Adulto , Anciano , Recolección de Datos , Femenino , Predicción , Unidades Hospitalarias/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

A survey about tuberculosis infection status, surveillance and protection practices among pulmonologists and infectologists was performed.A fourteen-item questionnaire was mailed. The survey was addressed to 108 pulmonologists and 61 infectologists. Responses were collected from 35 pulmonologists (32 percent) and 18 infectologists (29 percent). Sixteen out 35 pulmonologists had a positive tuberculin test (TST) (46 percent). Nine of fourteen took at least 6 months of preventive therapy with isoniazid when converted. Three out of eighteen infectologists had a positive TST. 63 percent of the pulmonologists and 38 percent of the infectologists evaluate their TST every 12 months. 40 percent of the pulmonologists and 66 percent of the infectologists answered that they treat more than ten patients with tuberculosis annually. Interestingly, 50 percent of the responder bronchoscopists use surgical masks instead of recommended HEPA filter masks. 73 percent of the responders reported not having negative pressure rooms when performing procedures. Despite stamped-addressed envelopes and the relation of these professionals with the related issue, low participation was observed.Among the responders a low frequency of TST was observed, especially in those exposed to higher-risk procedures. Non-adequate facilities and lack of use of protective equipment was reported. Even though not representative of the entire medical community the results of this survey are concerning regarding educational and safety policies of our professionals and institutions

Asunto(s)

Humanos , Actitud del Personal de Salud , Enfermedades Profesionales/prevención & control , Medicina Interna , Neumología , Tuberculosis/prevención & control , Antituberculosos/uso terapéutico , Isoniazida/uso terapéutico , Puerto Rico , Encuestas y Cuestionarios , Factores de Riesgo , Factores de Tiempo , Prueba de Tuberculina , Tuberculosis/diagnóstico , Tuberculosis/transmisión

RESUMEN

OBJECTIVES: To assess the medical knowledge about asthma among residents from the Accreditation Council on Graduate Education (ACGME) accredited Internal Medicine programs. BACKGROUND: Asthma prevalence and morbidity has increased significantly in the last 20 years. Recent morbidity data suggests that approximately 14 to 15 million Americans suffer from asthma and 5,000 of them die annually due to this illness. Previous studies have suggested that Puerto Ricans are disproportionally affected by asthma. In order to impact both morbidity and mortality relates to asthma, primary care givers should be knowledgeable about the disease. METHODS: Based in the 1993 National Heart, Lung and Blood Institute (NHLBI) guidelines, a questionnaire was developed to evaluate the knowledge of asthma in physicians in the Internal Medicine Residency Programs. It consisted of 27 questions covering the areas of diagnosis and treatment of asthma. RESULTS: The questionnaire was answered by 90 per cent of the 138 residents active at the moment of the study. Fifty-one percent of the residents failed to obtain a score of 70 per cent or greater. Score on asthma diagnosis was less than 70 per cent and did not improve through year of training. Score obtained on asthma treatment improved through training year although no statistical difference was obtained. CONCLUSIONS: In view of these results it is imperative to reinforce the state of the art asthma education of physicians. Research initiatives must evaluate educational strategies to improve asthma education

Asunto(s)

Humanos , Asma , Atención Primaria de Salud , Medicina Interna/educación , Internado y Residencia , Puerto Rico , Encuestas y Cuestionarios , Asma/diagnóstico , Asma/terapia