Background: Asthma education programs induce better asthma control and are one of main recommendations in guidelines. The programs recommendations should include a nurse in the educational team applying the structured program. The purpose of the intervention is to bring a change in the daily life of the patient and the family in order to improve disease control and quality of life. Aim: To standardize and apply a structured post-consultation model as part of multidisciplinary care in an educational program for asthmatic patients seen at the outpatient clinic of a public hospital, and to monitor the changes in asthma knowledge and quality of life. Methods: A longitudinal prospective study over six months with regular visits at four week intervals (total = 6 visits), conducted at the outpatient department of Unifesp/EPM/HSP, and the patients were included after signing a consent form. The asthma structured educational plan was conducted by a multidisciplinary team and addressed the following issues: what is asthma, relief and prevention medicines, daily report of symptoms and dyspnea score, training of the correct use of inhaled medication, discussion and actions regarding triggering factors and how to avoid them, and tips to recognize the signals of uncontrolled asthma. A standard questionnaire about general knowledge on asthma and a quality of life questionnaire were applied at the beginning, during the course, and at the end of the program. Results: 26 asthmatics were followed over six months and showed a statistically significant improvement in their identification and management of asthma skills as well as better quality of life indices. Conclusion: The model of care and the approach and training techniques were adequate and useful in the development of a structured educational program for socially deprived patients.

Objective: To compare the incidences of pulmonary and cardiopulmonary postoperative complications estimated using, respectively, the scoring systems devised by Torrington and Henderson and by Epstein in a populational sample undergoing lung resection for the treatment of lung cancer. Methods: Prospective data from patients submitted to resection of one or more pulmonary lobes were selected from the databases of two tertiary-care hospitals. The outcome measures were pulmonary complications, cardiac complications and mortality rates. Fisher's exact test was used to evaluate the concordance between the predicted and observed complications. Results: The Torrington and Henderson scoring system was applied to 50 patients, in which the risk was found to be mild in 12, moderate in 32, and high in 6. Although accurately identifying patients at high risk, the Torrington and Henderson scale underestimated the rate of postoperative cardiopulmonary complications in the mild and moderate risk categories (p = 0.0003 and p = 0.0006, respectively). The Epstein scoring system was applied to 38 patients, 4 of which were found to be at high risk, and 34 of which were found to be at mild risk. The Epstein scale also underestimated the risk in the patients (the majority) that were classified as being at mild risk (p < 0.0001) and yet, like the Torrington and Henderson scale, accurately identified those at high risk. Conclusion: Neither of the two scoring systems analyzed were found to be appropriate for predicting the risk of pulmonary and cardiopulmonary complications in most cases.

Keywords: Postoperative complications; Preoperative care; Thoracic surgical procedures/mortality; Lung neoplasms/surgery; Pneumonectomy; Respiratory function tests; Risk factors; Risk assessment

The direct costs incurred in managing patients with poorly controlled asthma are high and educational programs could decrease these costs. Aim: The objectives of this study were to compare the direct cost of the implementation of an educational program for adult asthmatic patients with the cost of the usual care delivered to asthmatics by specialists. Methods: Five years ago, a six-month study demonstrated that an educational program improved clinical outcomes (22 in educational program-E and 20 patients in control group-C). Throughout the educational intervention period all cases of hospitalization, emergency and regular calls involving patients from both groups were recorded. The basis for the values utilized in the calculation of costs was the healthcare database of the Brazilian government (DATASUS). The overall medication cost/patient in both groups was based on the amount of medication taken during the month preceding the last call. The final values were converted into US dollars. Results: The mean direct cost/patient in the educational (E) and control (C) groups and the difference (Δ) between groups were: hospitalizations (C = US$ 183, E = 0, Δ = US$ 183); emergency calls (C = US$ 14, E = US$ 5, Δ = US$ 9); regular calls (C = US$ 10, E = US$ 24, Δ = -US$ 14); medication (C = US$ 124,3, E = US$ 195,6, Δ = -US$ 71,3). The total cost was US$ 33/patient in group C and US$ 224/patient in group E with an average cost saving of US$ 107/patient. Conclusion: The expenses with medication is higher in E group because the regular use of maintenance drugs, however the study suggested that the application of the asthma education program reduced the total direct costs of asthma.

Keywords: Asthma. Cost-benefit. Patient education.