Síndrome da resposta inflamatória sistêmica em pacientes com doença pulmonar obstrutiva crônica após vacina contra influenza
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2020-08-28
Autores
Bueno, Carina Grespi
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Universidade Estadual Paulista (Unesp)
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INTRODUÇÂO: A doença pulmonar obstrutiva crônica (DPOC) tornou-se uma das principais causas de morbidade e mortalidade em todo o mundo. A exacerbação aguda, que consiste na piora do estado estável anterior à doença, é vista cerca de 1-4 vezes por ano; e é frequentemente atribuída a infecções, causadas por vírus (25 a 30%), como o vírus da influenza, este é o patógeno viral mais frequentemente detectado. Por isso, a Iniciativa Global para a Doença Pulmonar Obstrutiva Crônica (GOLD) recomenda a vacinação contra influenza, a qual é capaz de reduzir as taxas de hospitalização e mortalidade. Apesar da ampla utilização da vacina, das altas porcentagens de cobertura vacinal, pouco se sabe sobre o efeito da vacinação na síndrome da resposta inflamatória nesses indivíduos. OBJETIVO: Analisar os efeitos da vacina contra influenza na síndrome da resposta inflamatória sistêmica e nos sintomas de pacientes com diagnostico de DPOC. METODOLOGIA: A coleta de dados foi realizada no período de maio de 2018 a junho de 2019. Foram avaliados 38 indivíduos com diagnóstico de DPOC atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu, com idade ≥ a 40 anos selecionados de forma consecutiva. As coletas de sangue foram realizadas no dia e 72 horas após a aplicação da vacina. O instrumento de coleta de dados foi aplicado no mesmo dia da aplicação da vacina, semanalmente até completar 30 dias e mensalmente até um ano. A dispneia, foi avaliada por meio do COPD Assessement Test (CAT) e da escala de dispneia modificada, do Medical Research Council (mMRC). Os dados coletados foram analisados através de estatística descritiva Sigma Stat 3.5. RESULTADOS: A idade média foi de 73,4 anos, 63,1% faziam uso de O2; 18,5% eram tabagistas. Na primeira semana relataram dor local (58%), mialgia (42%), febre (34%), edema (13%) prurido (11%), erupção (5%) e cefaleia (3%). Houve alteração nos resultados do hemograma e PCR, entretanto não houve alteração da interleucina-6. O serviço médico foi procurado por 71% deles, destes, sete foram a óbito. CONCLUSÃO: Apesar da comprovada eficácia da vacina em outros estudos, os participantes deste estudo mesmo apresentando síndrome da resposta inflamatória sistêmica após a vacinação, manifestaram quadros de exacerbações que evoluíram para morte.
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has become a major cause of morbidity and mortality worldwide. Acute exacerbation, considered to worsen the previous stable state of the disease, is seen about 1-4 times a year; and is often attributed to infections, 25 to 30% of infections are caused by viruses. Influenza is the most frequently detected viral pathogen. The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) recommends influenza vaccination because of its ability to reduce hospitalization and mortality rates. Despite the widespread use of the vaccine, the high percentages of vaccine coverage, little is known about the effect of vaccination on the inflammatory response syndrome in these individuals.OBJECTIVE: To analyze the effects of the influenza vaccine on the systemic inflammatory response syndrome and the symptoms of patients diagnosed with COPD. METHODOLOGY: Data collection was carried out from May 2018 to June 2019. 38 individuals diagnosed with COPD treated at the Hospital das Clínicas of the Botucatu Medical School, aged ≥ 40 years, were selected consecutively. Blood samples were taken on the day and 72 hours after vaccine application. The data collection instrument was applied on the same day as the vaccine was applied, weekly up to 30 days and monthly up to one year. Dyspnea was assessed using the COPD Assessement Test (CAT) and the modified dyspnea scale of the Medical Research Council (mMRC). The collected data were analyzed using descriptive statistics Sigma Stat 3.5. RESULTS: The average age was 73.4 years, 63.1% used O2; 18.5% were smokers. In the first week, they reported local pain (58%), myalgia (42%), fever (34%), edema (13%) itching (11%), rash (5%) and headache (3%). There was a change in the results of the CBC and PCR, however there was no change in the interleukin-6. 71% of them sought medical care, of whom 7 died. CONCLUSION: Despite the proven efficacy of the vaccine in other studies, the participants of this study, despite having a systemic inflammatory response syndrome after vaccination, manifested exacerbations that evolve to death.
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has become a major cause of morbidity and mortality worldwide. Acute exacerbation, considered to worsen the previous stable state of the disease, is seen about 1-4 times a year; and is often attributed to infections, 25 to 30% of infections are caused by viruses. Influenza is the most frequently detected viral pathogen. The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) recommends influenza vaccination because of its ability to reduce hospitalization and mortality rates. Despite the widespread use of the vaccine, the high percentages of vaccine coverage, little is known about the effect of vaccination on the inflammatory response syndrome in these individuals.OBJECTIVE: To analyze the effects of the influenza vaccine on the systemic inflammatory response syndrome and the symptoms of patients diagnosed with COPD. METHODOLOGY: Data collection was carried out from May 2018 to June 2019. 38 individuals diagnosed with COPD treated at the Hospital das Clínicas of the Botucatu Medical School, aged ≥ 40 years, were selected consecutively. Blood samples were taken on the day and 72 hours after vaccine application. The data collection instrument was applied on the same day as the vaccine was applied, weekly up to 30 days and monthly up to one year. Dyspnea was assessed using the COPD Assessement Test (CAT) and the modified dyspnea scale of the Medical Research Council (mMRC). The collected data were analyzed using descriptive statistics Sigma Stat 3.5. RESULTS: The average age was 73.4 years, 63.1% used O2; 18.5% were smokers. In the first week, they reported local pain (58%), myalgia (42%), fever (34%), edema (13%) itching (11%), rash (5%) and headache (3%). There was a change in the results of the CBC and PCR, however there was no change in the interleukin-6. 71% of them sought medical care, of whom 7 died. CONCLUSION: Despite the proven efficacy of the vaccine in other studies, the participants of this study, despite having a systemic inflammatory response syndrome after vaccination, manifested exacerbations that evolve to death.
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Síndrome da resposta inflamatória sistêmica, Vacina contra influenza, Doença pulmonar obstrutiva crônica, Systemic inflammatory response syndrome, Influenza vaccine, Chronic obstructive pulmonary disease