Protocolo de atendimento e seguimento fisioterapêutico na fibrose cística
DOI:
https://doi.org/10.33233/fb.v19i4.2245Abstract
A Fibrose Cística (FC) requer uma abordagem multidisciplinar culminando em um complexo regime terapêutico. A fisioterapia tem papel fundamental na depuração das vias aéreas, melhora da ventilação pulmonar e da tolerância ao exercício. No entanto, aspectos como acompanhamento da evolução clínica do paciente, identificação de períodos de exacerbação pulmonar e avaliação da adesão ao tratamento também fazem parte da rotina fisioterapêutica. Com o objetivo de contemplar os principais instrumentos disponíveis que auxiliam em um melhor controle, acompanhamento e avaliação de pacientes com FC, elaborou-se o PASFIC - Protocolo de Atendimento e Seguimento Fisioterapêutico na Fibrose Cística. Este protocolo inclui 10 critérios: 1) fisioterapia respiratória, 2) escore de gravidade, 3) escores de exacerbação pulmonar, 4) avaliação do peso e da estatura, 5) avaliação respiratória, 6) espirometria, 7) coleta de secreção das vias respiratórias, 8) aderência, 9) habilidades funcionais, 10) anormalidades posturais. A finalidade do PASFIC é caracterizar a população, identificar as alterações clínicas e acompanhar a evolução clínica e o atendimento fisioterapêutico de pacientes com FC, viabilizando suporte assistencial individualizado, uma melhor adesão ao tratamento e intervenção precoce durante as agudizações pulmonares, facilitando a monitorização pela equipe multiprofissional, otimizando o atendimento de pacientes com FC.
Palavras-chave: fibrose cística, fisioterapia, protocolos, continuidade da assistência ao paciente.
References
Prasad SA, Main E, Dodd ME. Finding consensus on the physiotherapy management of assymptomatic infants with Cystic Fibrosis. Pediatr Pulmonol 2008;43:236-44.
Kerem E, Conway S, Elborn S, Heijerman H. Standards of care for patients with cystic fibrosis: a European Consensus. J Cyst Fibros 2005;4:7-26.
Smyth AR, Bell SC, Bojcin S, Bryon M, Duff A, Flume P et al. European cystic fibrosis society standards of care: best practice guidelines. J Cyst Fibros 2014; 13:23-42.
Daniels T, Morrison L, Harnett N, Lewis S. Standards of care and good clinical practice for the physiotherapy management of cystic fibrosis. Cystic Fibrosis Trust 2017.
Melotti RCNC, Ferrão DMT, Marchette AC, Silva EPS, Malini FB et al. Protocolo Assistencial de Fibrose CÃstica Serviço de Referência Pediátrico e Adulto do Estado do EspÃrito Santo. Governo do EspÃrito Santo; 2016.
Gomez de Aguero MIB, Hernandez GG, Gartner S y Grupo de Trabajo de Fibrosis QuÃstica. Protocolo de diagnóstico y seguimiento de los pacientes con ï¬brosis quÃstica. An Pediatr (Barc) 2009;71:250-64.
Association of Chartered Physiotherapists in Cystic Fibrosis. Standards of care and good clinical practice for the physiotherapy management of cystic fibrosis. 2nd ed. London: Cystic Fibrosis Trust; 2011. Available from: https://www.cysticfibrosis.org.uk/about-cf/publications/consensus-documents.aspx
Doershuk CF, Matthews LW, Tucker AS, Nudleman H, Eddy G, Wise M et al. A 5 year clinical evaluation of a therapeutic program for patients with cystic fibrosis. J Pediatr 1964;65:677-93.
Bhalla M, Turcios N, Aponte V, Jenkins M, Leitman BS, McCauley D et al. Cystic Fibrosis: scoring system with thin-section CT. Radiol 1991;179:783-8.
Kanga J, Kuhn R, Craigmyle L, Haverstock D, Church D. Cystic Fibrosis Clinical Score: A new scoring system to evaluate acute pulmonary exacerbation. Clin Ther 1999;21:1343-56.
Ramsey BW, Boat TF. Outcome measures for clinical trials in cystic fibrosis. J Pediatr 1994;124:177-92.
Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z et al. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 2002;246:1-190.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A et al. Standardization of spirometry. American Thoracic Society. Eur Respir J 2005;26:319-38.
Hurley MN, Cámara M, Smyth AR. Novel approaches to the treatment of Pseudomonas aeruginosa infections in cystic fibrosis. Eur Respir J 2012;40:1014-23.
Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428-46
Santos JB, Moro ARP, Cesar MR, Reis PF, Luz JD, Reis DC. Descrição do método de avaliação postural de Portland State University. Fisio Brasil 2005;6:392-5.
Elborn JS, Shale DJ, Britton JR. Cystic fibrosis: current survival and population estimates to the year 2000. Thorax 1991;46:881–5.
Mahadeva R, Webb K, Westerbeek RC, Carroll NR, Dodd ME, Bilton D et al. Clinical outcome in relation to care in centres specialising in cystic fibrosis: cross sectional study. BMJ 1998;316:1771-5.
Ratjen F, Doring G. Cystic fibrosis. Lancet 2003;361:681-9.
Dodge JA, Lewis PA, Stanton M, Wilsher J. Cystic ï¬brosis mortality and survival in the UK: 1947–2003. Eur Respir J 2007;29:522-6.
Cystic Fibrosis Foundation Patient Registry. 2016 Annual Data Report. Maryland: Cystic Fibrosis Foundation; 2017.
Kennedy MJ. Current status of gene therapy for Cystic Fibrosis Pulmonary Disease. Am J Respir Med 2002;1:349-60.
Downey DG, Brockbank S, Marptin SL, Ennis M, Elborn JS. The effect of treatment of cystic fibrosis pulmonary exacerbations on airway and systemic inflammation. Pediatr Pulmonol 2007;42:729-35.
Smyth A, Elborn JS. Exacerbations in cystic fibrosis: management. Thorax 2008;63:180-4.
Santos CIS, Ribeiro JD, Ribeiro AF, Hessel G. Análise crÃtica dos escores de avaliação de gravidade da fibrose cÃstica: Estado da arte. J Bras Pneumol 2004;30:286-98.
Morton S, Gilbert J, Littlewood JM. The current physical therapy regimens of 108 consecutive patients attending a regional cystic fibrosis unit. Scand J Gastroenterol 1988;23:110-3.
Robinson P. Cystic fibrosis. Thorax 2001;56:237-41.
Buttom BM, Lannefors L, Mcllwaine M. Physiotherapy in infants and young children with cystic fibrosis: current and practice and future developments. J R Soc Med 2004;97:8-25.
Ievers CE, Brown RT, Drotar D, Caplan D, Pishevar BS, Ambert RG. Knowledge of physician prescriptions and adherence to treatment among children with cystic fibrosis and their mothers. J Dev Behav Pediatr 1999;20:335-43.
Kettler JL, Sawyer SM, Winefield HR, Greville HW. Determinants of adherence in adults with cystic fibrosis. Thorax 2002;57:459-64.
Tipping CJ, Scholes RL, Cox NS. A qualitative study of physiotherapy education for parents of toddlers with cystic fibrosis. J Cyst Fibros 2010;9:205-11.
Prasad A, Tannenbaum EL, Mikelsons C. Pysiotherapy in cystic fibrosis. J R Soc Medic 2000;38:27-36.
Feiten TS, Flores JS, Farias BL, Rovedder PM, Camargo EG, Dalcin PT et al. Respiratory therapy: a problem among children and adolescents with cystic fibrosis. Braz J Pneumol 2016;42:29-34.
Prasad A, Main E. Finding evidence to support airway clearance techniques in cystic fibrosis. Disabil Rehabil 1998;20:235-46.
Main E, Prasad A, Van der Schans C. Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis. Cochrane Database Syst Rev 2005; 25:CD002011.
Flume PA, Robinson KA, O’Sullivan BP, Finder JD, Vender RL, Wiley-Courand DB et al. Clinical Practice Guidelines for Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: airway clearance therapies. Respir Care 2009;54:522-37.
McIlwaine M. Chest physical therapy, breathing techniques and exercise in children with CF. Paediatr Respir Rev 2007;8:8-16.
Van der Schans C, Postma DS, Koeter GH, Rubin BK. Physiotherapy and bronchial mucus transport. Eur Respir J 1999;13:1477-86.
Rand S, Hill L, Prasad SA. Physiotherapy in cystic fibrosis: optimizing techniques to improve outcomes. Paediatr Respir Rev 2013;14:263-9.
Robertson CF. How do we choose a therapeutic regimen in cystic ï¬brosis? Thorax 2002;57:839-40.
Habib AR, Manji J, Wilcox PG, Javer AR, Buxton JA, Quon BS. A systematic review of factors associated with health-related quality of life in adolescents and adults with cystic fibrosis. An Am Thorac Soc 2015;12:420-8.
Aris RM, Stephens AR, Ontjes DA, Denene Blackwood A, Lark RK, Hensler MB et al. Adverse alterations in bone metabolism are associated with lung infection in adults with Cystic Fibrosis. Am J Respir Crit Med 2000;162:1674-8.
Denton JR, Tietjen R, Garerlan PF. Thoracic kyphosis in Cystic Fibrosis. Clin Orthopaed Related Res 1981;155:71-4.
Tattersall R, Walshaw MJ. Posture in cystic fibrosis. J R Soc Med 2003;96:18-22.
Okuro RT, Côrrea EP, Conti PB, Ribeiro JD, Ribeiro MA, Schivinski CI. Influence of thoracic spine postural disorders on cardiorespiratory parameters in children and adolescents with cystic fibrosis. J Pediatr (Rio J) 2012;88:310-6.
Published
Issue
Section
License
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.