Physical Activity Levels and Associated Factors in a Latin American COPD Population of Patients. The LASSYC Study.

Reduced physical activity (PA) is an independent risk factor for lung function decline, hospitalization and mortality in chronic obstructive pulmonary disease (COPD) and affects a large proportion of patients from Europe and the United States. However, little is known of the level of PA of COPD patients in Latin America. The aim of this study was to provide information of the level of PA and its determinants in COPD patients in Latin America. This is an observational, cross-sectional study on patients with COPD in seven Latin American countries. PA level was evaluated with the short version of the International Physical Activity Questionnaire (IPAQ) and the association between PA and other variables was investigated. Complete information of PA level was obtained in 734 COPD patients consecutively recruited from specialized outpatient clinics; 448 (61%) were men, with a mean age of 69.6 years (standard deviation [SD] = 8.7) and a mean FEV1 (% predicted) = 49.1% (17.5%). In 37.9% the level of PA was low, and the average sitting time was 36.1 h per week. Patients with low levels of PA were older, with higher levels of dyspnea and higher CAT scores. Additionally, we found that patients with low level of PA presented more symptoms during the day. Low levels of PA have been observed in a large proportion of COPD patients of Latin America, which is higher in women and older patients and it is related with worse functional and clinical characteristics.

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study.

BACKGROUND: To analyse the relationship between symptoms at different times during the 24-hour day and outcomes in COPD. METHODS: Observational cross-sectional study in a patients from 7 Latin American countries. The frequency of symptoms in the morning, at night and during the day was explored by means of standardised and validated questionnaires, and the relationship between symptoms and exacerbations and quality of life were investigated. RESULTS: 734 patients (59.6% male, mean age 69.5 years, mean FEV1 50% predicted normal) were recruited. The most frequent symptoms during the day were dyspnea (75% of patients, of which 94% mild-moderate) and cough (72.2%, of which 93.4% mild-moderate). Highly symptomatic patients had a greater impairment in FEV1, more exacerbations and worse scores in COPD assessment test (CAT) and Body Mass Index, Obstruction, Dyspnoea and Exacerbations (BODEx) index (all p < 0.001). Morning symptoms were more frequent than night-time symptoms, particularly cough and dyspnoea (morning: 50.1% and 45.7%; night-time: 33.2% and 24.4%, respectively), and mostly rated as mild or moderate. Patients with morning or night-time symptoms presented with worse severity of daytime symptoms. There was a strong correlation between intensity of daytime with morning or night-time symptoms, as well as with CAT score (r = 0.715; p < 0.001), but a weak correlation with FEV1 (r = -0.205; p < 0.001). CONCLUSION: Morning symptoms were more frequent than night-time symptoms, and having either morning and/or night-time symptoms was associated with worse severity of daytime symptoms. Increased symptoms were strongly associated with worse quality of life and more frequent exacerbations, but weakly associated with airflow limitation. CLINICAL TRIAL REGISTRATION: NCT02789540.

Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study.

BACKGROUND: This study assessed the adherence profiles to inhaled therapies and the agreement between two patient self-report adherence methods in stable COPD lpatients from seven Latin American countries. METHODS: This observational, cross-sectional, multinational, multicenter study involved 795 COPD patients (post-bronchodilator forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] <0.70). Adherence to inhaled therapy was assessed using the specific Test of Adherence to Inhalers (10-item TAI) and the generic 8-item Morisky Medication Adherence Scale (MMAS-8) questionnaires. The percentage agreement and the kappa index were used to compare findings. RESULTS: 59.6% of patients were male (69.5±8.7 years); post-bronchodilator FEV1 percent predicted was 50.0±18.6%. Mean values for 10-item TAI and MMAS-8 questionnaires were 47.4±4.9 and 6.8±1.6, respectively. Based on the TAI questionnaire, 54.1% of patients had good, 26.5% intermediate, and 19.4% poor adherence. Using the MMAS-8 questionnaire, 51% had high, 29.1% medium, and 19.9% low adherence. According to both questionnaires, patients with poor adherence had lower smoking history, schooling but higher COPD Assessment Test score, exacerbations in the past-year and post-bronchodilator FEV1. The agreement between 10-item TAI and MMAS-8 questionnaires was moderate (Kappa index: 0.42; agreement: 64.7%). CONCLUSION: Suboptimal adherence to medication was frequent in COPD patients from Latin America. Low adherence was associated with worse health status impairment and more exacerbations. There was inadequate agreement between the two questionnaires. Greater effort should be made to improve COPD patients' adherence to treatment, and assessment of adherence with more specific instruments, such as the TAI questionnaire, would be more convenient in these patients. CLINICAL TRIAL REGISTRATION: NCT02789540.

A Epidemia da Gripe Espanhola e do COVID-19 no Brasil: um paralelo / The epidemic of Spanish Flu and COVID-19 in Brazil: a parallel

O artigo traça um paralelo entre a pandemia da Gripe Espanhola e da COVID-19 perante suas repercussões em âmbito social, governamental e de saúde no Brasil. Através da análise de textos e registros que retratam os impactos dessas doenças infectocontagiosas separadas por um período secular, nota-se que as evoluções e mudanças na ciência e na sociedade durante esse distanciamento cronológico não foram o suficiente para impedir a máxima: a história é cíclica. Falsas notícias, remédios caseiros milagrosos, polêmicas na condução dos responsáveis pela saúde pública, contradição no discurso da saúde e até a vitimização desproporcional da população devido à raiz histórica marcada pela desigualdade social do país são alguns dos denominadores comuns desses eventos. Por outro lado, os pontos divergentes demonstram como um século possibilitou a aquisição de conhecimentos que propiciaram o surgimento de novas alternativas para enfrentar desafios semelhantes. Dessa forma, o paralelo permite incitar reflexões acerca da sociedade e do estado brasileiro e a suas formas de enfrentamento frente a esses eventos sombrios que as epidemias representam, cujos desfechos são razão de registro e fascínio desde a Antiguidade.

The article draws a parallel between the Pandemic of the Spanish Influenza and COVID-19 in view of its social, governmental and health repercussions in Brazil. Through the analysis of texts and records that portray the impacts of these infectious diseases separated by a secular period, it is noted that the evolutions and changes in science and society during this chronological distancing were not enough to prevent the maxim: history is cyclical. False news, miraculous home remedies, controversies in the conduct of those responsible for the public health, contradiction in health discourse and even the disproportionate victimization of the population due to the historical root marked by social inequality in Brazil are some of the common denominators of these events. On the other hand, the divergent points demonstrate how a century has made it possible to acquire knowledge that has enabled the emergence of new alternatives to face similar challenges. In this way, the parallel allows us to stimulate reflections about society and the Brazilian state and their ways of confronting these dark events that the epidemics represent, whose outcomes have been a reason for registration and fascination since antiquity.