Tratamento de asma em pacientes enuréticos: repercussão nos sintomas urinários

Abstract

The association between enuresis and Sleep Respiratory Disorders has already been demonstrated, with a resolution of two –thirds or more cases of enuresis after surgical procedures for sleep respiratory disorder (adenoidectomy and/or tonsillectomy). Enuretics are also more likely to be asthmatic. The question is whether this association between enuresis and asthma is related to the concomitant presence of blockage of the upper airways, since the abnormalities of the upper and lower airways may coexist according to the “unified airway theory”. However, this theory does not explain the association already found between enuresis and allergic diseases such as rhinitis, food allergies and positive allergic skin tests. To evaluate whether the treatment of asthma changes the evolution of enuresis in children older than 5 years with both diseases, and if there is a predictive factor associated with this improvement. Twenty patients between 5 and 12 years old, enuretic and uncontrolled asthmatics received asthma treatment after a consultation where parents/guardians answered about their child’s allergies (allergic rhinitis and others). Obesity was defined on physical examination; the primary enuresis was evaluated through dry nights and voiding diaries and the upper airways blockage through nasal videoendoscopy. Children under five years of age; with diseases and/or in use of medications that interfere with the functioning of the bladder or urethral sphincter; diabetes; sickle cell disease; secondary enuresis, controlled asthma or those who refused to participate in the study were not included. After 6 months of asthma treatment, the improvement in urinary symptoms was evaluated considering a total improvement of 99% or more, and a partial improvement between 50% to 99%. At least a partial improvement in enuresis was observed in 55% patients. The increase in the amount of dry nights in 30 days at the beginning and end of the research was significant: 64,4% (p = 0.010). All patients presented symptoms of allergic rhinitis making it impossible to use this variable. We observed that the variable “obesity” did not influence in the improvement of enuresis (OR = 0,361; IC -3,770-1,730), but the “presence of other allergies” and “changes in nasal videoendoscopy” influenced positively the improvement in urinary symptoms (OR = 3,350; IC -0,170-2,588) and (OR= 1,272; IC-0,734-1,2151). The treatment and control of asthma in children with primary enuresis resulted in a significant increase in dry nights in 30 days.