RESUMO

Dentre as neoplasias malignas, o câncer do pulmão é a segunda causa mais frequente de morte. Em metade dos pacientes, o diagnóstico é feito tardiamente (nos estágios III e IV), e, nessa fase, a terapêutica está voltada principalmente para o tratamento sintomático e a melhoria da qualidade de vida. A maior parte desses pacientes morre de complicações locais, sobretudo decorrentes de obstrução da via aérea. O presente artigo aborda o tratamento dessas obstruções — a causa principal de morbidade e mortalidade nesses pacientes. Fazemos uma revisão anatômica da via aérea para, em seguida, descrever as principais formas de obstrução das vias aéreas por doença maligna. Discutimos as diferentes técnicas utilizadas para esse fim: o desbridamento e a dilatação endobrônquica, a ressecção das lesões com laser, eletrocautério, pinças de biópsia ou a ponta do broncoscópio (core out), assim como a utilização de órteses de vias aéreas. Enfatizamos a importância da melhora da qualidade de vida desses pacientes com a utilização desses métodos, aliviando a dispneia e diminuindo a ocorrência de pneumonias associadas à obstrução brônquica. Ressaltamos que o manuseio dos pacientes com obstrução por invasão intraluminal ou por compressão extrínseca requer uma equipe multidisciplinar com experiência em broncoscopia flexível e rígida e que disponha de equipamentos apropriados e de suporte de terapia intensiva. Ressaltamos ainda a importância do envio precoce dos pacientes para tratamento especializado.

Lung cancer is the second leading cause of cancer death. Approximately half of all lung cancer patients are diagnosed at anadvanced stage (stage III or IV), and the treatment of such patients is aimed primarily at improving quality of life and alleviating symptoms. Most patients with advanced stage lung cancer will die from local complications, primarily from those related to airway obstruction. The objective of this review was to explore practical approaches to airway obstruction, which is the main cause of morbidity and mortality in such patients. We review airway anatomy and describe the various processes of airway obstruction in malignancy. We also discuss methods for alleviating airway obstruction: debridement; endobronchial dilation; laser resection; electrocauterization; core biopsy with forceps and a rigid bronchoscope; and airway stent placement. By alleviating dyspnea and reducing the incidence of pneumonia related to bronchial obstruction, the methods describedhere can improve quality of life in patients with advanced stage lung cancer. We stress the importance of a multidisciplinary approach in cases of intraluminal tumor invasion or extrinsic airway compression. The multidisciplinary team must includeprofessionals with experience in performing fiberoptic and rigid bronchoscopy, as well as having access to the equipment required in order to provide intensive care. In addition, patients should be referred to specialized facilities as early as possible.

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RESUMO

Discusses the national health information system in Brazil which, until very recently, consisted of two main structures of health services with a dichotomy between curative and preventive health care acting in a vertical manner. The autonomy of health authorities and specialized structures created numerous independent health information systems with different methods of data collection. Although the issues of decentralization and a unified health system had been agreed on in 1963, they had not been implemented until the new health policy reform was lunched in 1988. The reform was based on the strengthening of primary health care at national level and accelerating decentralization of health systems. However, in spite of strong political will the new health managers at local level are lacking essential information, data and instruments that only a decentralized health management information system can provide. Based on a study conducted in the Cearà State of the north east of Brazil, explores how the present health information system can support the process of decentralization.

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