“Diagnosis of asthma requires a high degree of clinical suspicion.”

“Bronchial Asthma and Allergies” was the theme of World Allergy Week 2022, which was held from June 11th to 15th this month. As explained by Pedro Morais Silva, an immunoallergist and coordinator of the Portuguese Society of Allergology and the CSP Interest Group (GI) of the Clinical Immunology (SPAIC), these are two different clinical entities and often intersect. increase.

“It is essential to be aware of both in order to choose the most appropriate treatment. About 90% of children and adults with asthma are allergic.

Pedro Morais Silva has permanent contact with primary health care and emphasizes the “basic” role of family doctors in the diagnosis, treatment and prevention of asthma. He also warns that certain important symptoms need to be paid attention to in different age groups.

“Some patients consider asthma to be a limited illness, and because it appears only occasionally, they do not need daily medication. They are more likely to have wheezing before bedtime or coughing with exercise. Devalues ​​frequent mild symptoms, “he commented.

In other words, they usually do not complain, which means a bet on “aggressive diagnosis”. That is, “as with any other medical condition: high blood pressure or diabetes, it must be the clinician who asks the question. Asthma requires a high degree of clinical suspicion.”


Pedro Morais Silva

Special attention should be paid to high-risk groups: smokers, overweight and obese patients, and patients suffering from allergic rhinitis. “In the spring, it is common for the person to have a persistent dryness, even if sporadic, to increase the condition of rhinitis that is essentially manifested by stuffy nose, runny nose, sneezing, and itching in the nasal pharynx. You need to ask if you have a cough, a tight chest, difficulty breathing, a runny nose, or a limited effort, “says Pedro Morais Silva.

In this way, he says, it is possible to combat the “underdiagnosis and undertreatment” of entities that have very negative consequences for a person’s quality of life.

CARAT: “Easy and fast” tool

Therefore, in order to properly manage the disease, Pedro Morais Silva advocates the application of validated questionnaires such as CARAT, which are also available online and enable early detection of possible cases of asthma. .. “It’s an important help because there is no easily accessible complementary diagnostic test, as opposed to what happens with other medical conditions,” he emphasizes.

In addition, it is a “practical, fast and validated tool for Portuguese for both children and adults”. For example, it should be “a bet for patients with rhinitis who initiate bronchial symptoms, not only for diagnosis, but also to measure the progression of the situation.”

Asthma, as he says, appears in the mid-term in principle, so this “pursuit of diagnosis” is also important. Because, as he says, “testing is not always exhaustive.” “Even bronchial obstruction is dynamic and is exacerbated by environmental, timing, or contact with allergens,” recalls Pedro Morais Silva.

Immunoallergic specialists also warn of the need for continuous follow-up and monitoring of the disease, and the importance of demonstrating drug use.

“Correct use of the inhaler is essential because incorrect use of the inhaler is enough to make it worse. Moreover, not all of these devices are the same, which can be very confusing. There is sex. “

Also, keep in mind that SPAIC organizes training actions on this topic for both medical professionals and the general public. It also emphasizes the need to sensitize patients to the fact that it is a chronic condition that implies the presence of inflammation even in the absence of symptoms. “We must be vigilant! Its natural history is characterized by gradual deterioration over time,” he justifies.

Also, it is the combination treatment of allergic diseases that makes all the difference in asthma control. “For example, allergic rhinitis affects about one in four Portuguese people, and simple activities such as walking or playing with children can exacerbate the asthma situation. Spring Garden. “

However, Pedro Morais Silva warns that “family doctors need to be aware of spring pollen as well as allergic reactions caused by mites, food, medicine and hymenoptera.”

Regarding referrals to immunoallergology, physicians should refer to cases that are resistant to the first stages of treatment and the most serious cases that may require treatment given in a hospital environment. I am.

“Asthma should always be monitored together with a PHC, regardless of specialist consultation, so SPAIC is investing heavily in training in this area,” the interviewee emphasized, “my doctor. We guarantee that you will be able to deal with asthma and allergic diseases. “

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