Acute bronchial asthma in emergency care in a city of Pernambuco during the COVID-19 pandemic: Case report
Keywords:Asthma; Symptom flare up; Therapeutics; Ambulatory care; Coronavirus infections.
Bronchial asthma is a chronic disease of the airways, heterogeneous and of unknown etiology. In Brazil, decompensated bronchial asthma is the fourth leading cause of hospitalizations, with a higher incidence in the Northeast and Southeast regions, with descending mortality rates. The most common symptoms and signs are dyspnea, wheezing, retrosternal chest tightness and cough, resulting from the inflammatory process, with bronchial hyperreactivity and bronchoconstriction. This article aims to alert health professionals about the early diagnosis and treatment of exacerbated asthma in an emergency in the pandemic context of COVID-19, through this case report. Also dealing with the differential diagnosis in respiratory symptoms for COVID-19 with assessment of epidemiological risks and radiography, not very sensitive and specific for COVID-19, but widely available. This case report is about a 19-year-old Caucasian woman, single, born in Caruaru-PE, with complaints of low intensity chest discomfort, dyspnea and fatigue for three days, presenting exacerbation of symptoms in the last four hours, with previous diagnosis of asthma since childhood, currently with treatment interrupted due to fear of worsening for COVID-19 and waking up at night every day during the last month. After therapeutic conduct and clinical improvement, the patient was discharged with instructions on continuity of oral corticosteroids, return to bronchial asthma control therapy, need for follow-up in Primary Health Care (PHC) and symptoms of severity for bronchial asthma and COVID- 19 that indicate the need for emergency care.
Boulet, L. P. et al. (2019). The global initiative for asthma (GINA): 25 years later. European Respiratory Journal, 54(2).
Brasil. Ministério da Saúde. (2021). Sistema de Informações Hospitalares do SUS (SIH/SUS). http://www2.datasus.gov.br/DATASUS/in dex.php?area=060502.
Brasil. Ministério da Saúde. (2020). Orientações para manejo de pacientes com COVID-19. https://portalarquivos.saude.gov.br/images/pdf/2020/J une/18/Covid19-Orientac--o--esManejoPacientes.pdf.
Cardoso, T. D. A., Roncada, C., Silva, E. R. D., Pinto, L. A., Jones, M. H., Stein, R. T., & Pitrez, P. M. (2017). The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system. Jornal brasileiro de pneumologia, 43(3), 163-168.
Chesné, J. et al. (2014). IL-17 in severe asthma. Where do we stand? Am. J. Respir. Crit. Care Med. 190, 1094–1101.
Custovic, A. (2015) To what extent is allergen exposure a risk factor for the development of allergic disease? Clin. Exp. Allergy 45, 54–62
Gupta, S., Price, C., Agarwal, G., Chan, D., Goel, S., Boulet, L. P., & Straus, S. E. (2019). The Electronic Asthma Management System (eAMS) improves primary care asthma management. European Respiratory Journal, 53(4).
Harkness, L. M., Ashton, A. W. & Burgess, J. K. (2015). Asthma is not only an airway disease, but also a vascular disease. Pharmacol. Ther. 148, 17–33 (2015).
Hartmann-Boyce, J., Gunnell, J., Drake, J., Otunla, A., Suklan, J., Schofield, E., & Dennison, P. (2020). Asthma and COVID-19: review of evidence on risks and management considerations. BMJ Evidence-Based Medicine.
Holgate, S., Wenzel, S., Postma, D. et al. (2015). Asthma. Nat Rev Dis Primers 1, 15025. https://doi.org/10.1038/nrdp.2015.25
Li, X., Xu, S., Yu, M., Wang, K., Tao, Y., Zhou, Y., & Zhao, J. (2020). Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology, 146(1), 110-118.
Liu, S., Zhi, Y., & Ying, S. (2020). COVID-19 and asthma: reflection during the pandemic. Clinical reviews in allergy & immunology, 59, 78-88.
Longo, D. L., Kasper, D. L., Jameson, J. L., Fauci, A. S., Hauser, S. L., & Loscalzo, J. (2020). Medicina interna de Harrison. In Medicina interna de Harrison. 20. ed. Porto Alegre. Artmed.
Lundbäck, B., Backman, H., Lötvall, J., & Rönmark, E. (2016). Is asthma prevalence still increasing?. Expert review of respiratory medicine, 10(1), 39-51.
Martinez-Gonzalez, I., Steer, C. A. & Takei, F. (2015). Lung ILC2s link innate and adaptive responses in allergic inflammation. Trends Immunol. 36, 189–195 (2015).
Mendes, N. F., Jara, C. P., Mansour, E., Araújo, E. P., & Velloso, L. A. (2021). Asthma and COVID-19: a systematic review. Allergy, Asthma & Clinical Immunology, 17(1), 1-12.
Pizzichini, M. M. M., Carvalho-Pinto, R. M. D., Cançado, J. E. D., Rubin, A. S., Cerci Neto, A., Cardoso, A. P., & Cukier, A. (2020). Recomendações para o manejo da asma da Sociedade Brasileira de Pneumologia e Tisiologia-2020. Jornal Brasileiro de Pneumologia, 46(1).
Papi, A. et al. (2018). Asthma, Asthma–Science Direct, 391(24), 783-800.
WHO. World Health Organization. (2020). Clinical management of severe acute respiratory infection when novel coronavirus ( nCoV) infection is suspected: interim guidance, 25 January 2020 (No. WHO/nCoV/Clinical/2020.2). World Health Organization.
Wu, T. D., Brigham, E. P., & McCormack, M. C. (2019). Asthma in the primary care setting. Medical Clinics, 103(3), 435-452.
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet, 395(10229), 1054-1062.
How to Cite
Copyright (c) 2021 Thyago de Oliveira Afonso; Samuel Lopes dos Santos; Gustavo Baroni Araújo; Igor de Oliveira Carvalho; Guilherme Dantas Borges; Caio Victor Muniz de Lima Barros; Simone Barroso de Carvalho; Elvira Marques da Luz Dias; Marília Girão de Oliveira Machado; Rosanna Rafena Ribeiro Barbosa; Ana Izabel Aparecida Vieira; Luziane Cardoso Costa; Leandro Luiz da Silva Loures; Bernardo da Luz Barbosa; Gustavo Martins de Araújo Porto; Isadora Nunes Delaia; Erica Patrícia Dias de Souza; Mariana Teixeira da Silva; Camila Leanne Teixeira Coelho de Sousa; Ana de Cássia Ivo dos Santos; Francisca Agda Oliveira Dias
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.