Sex-related differences in COPD in five Latin American cities: the PLATINO study.

There is evidence to suggest sex differences exists in chronic obstructive pulmonary disease (COPD) clinical expression. We investigated sex differences in health status perception, dyspnoea and physical activity, and factors that explain these differences using an epidemiological sample of subjects with and without COPD. PLATINO is a cross-sectional, population-based study. We defined COPD as post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio <0.70, and evaluated health status perception (Short Form (SF)-12 questionnaire) and dyspnoea (Medical Research Council scale). Among 5,314 subjects, 759 (362 females) had COPD and 4,555 (2,850 females) did not. In general, females reported more dyspnoea and physical limitation than males. 54% of females without COPD reported a dyspnoea score ≥ 2 versus 35% of males. A similar trend was observed in females with COPD (63% versus 44%). In the entire study population, female sex was a factor explaining dyspnoea (OR 1.60, 95%CI 1.40-1.84) and SF-12 physical score (OR -1.13, 95%CI -1.56- -0.71). 40% of females versus 28% of males without COPD reported their general health status as fair-to-poor. Females with COPD showed a similar trend (41% versus 34%). Distribution of COPD severity was similar between sexes, but currently smoking females had more severe COPD than currently smoking males. There are important sex differences in the impact that COPD has on the perception of dyspnoea, health status and physical activity limitation.

Paid employment in subjects with and without chronic obstructive pulmonary disease in five Latin American cities: the PLATINO study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a costly condition that frequently causes permanent work disabilities. Little information exists regarding the impact of COPD on work force participation and the indirect costs of the disease in developing countries. OBJECTIVE: To examine the frequency of paid employment and factors influencing it in a Latin-American population-based study. METHODS: Post-bronchodilator FEV(1)/FVC < 0.70 (forced expiratory volume in 1 s/forced vital capacity) was used to define COPD. Information regarding paid work was assessed by the question 'At any time in the past year, have you worked for payment?' RESULTS: Interviews were conducted with 5571 subjects; 5314 (759 COPD and 4554 non-COPD) subjects underwent spirometry. Among the COPD subjects, 41.8% reported having paid work vs. 57.1% of non-COPD (P < 0.0001). The number of months with paid work was reduced in COPD patients (10.5 ± 0.17 vs. 10.9 ± 0.06, P < 0.05). The main factors associated with having paid work in COPD patients were male sex (OR 0.33, 95%CI 0.23-0.47), higher education level (OR 1.05, 95%CI 1.01-1.09) and younger age (OR 0.90, 95%CI 0.88-0.92). COPD was not a significant contributor to employment (OR 0.83, 95%CI 0.69-1.00, P = 0.054) in the entire population. CONCLUSIONS: Although the proportion of persons with paid work is lower in COPD, having COPD appears not to have a significant impact on obtaining paid employment in the overall population of developing countries.

Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America.

The aim of the present study was to evaluate the association between history of tuberculosis and airflow obstruction. A population-based, multicentre study was carried out and included 5,571 subjects aged > or =40 yrs living in one of five Latin American metropolitan areas: Sao Paulo (Brazil); Montevideo (Uruguay); Mexico City (Mexico); Santiago (Chile); and Caracas (Venezuela). Subjects performed pre- and post-bronchodilator spirometry and were asked whether they had ever been diagnosed with tuberculosis by a physician. The overall prevalence of airflow obstruction (forced expiratory volume in one second/forced vital capacity post-bronchodilator <0.7) was 30.7% among those with a history of tuberculosis, compared with 13.9% among those without a history. Males with a medical history of tuberculosis were 4.1 times more likely to present airflow obstruction than those without such a diagnosis. This remained unchanged after adjustment for confounding by age, sex, schooling, ethnicity, smoking, exposure to dust and smoke, respiratory morbidity in childhood and current morbidity. Among females, the unadjusted and adjusted odds ratios were 2.3 and 1.7, respectively. In conclusion, history of tuberculosis is associated with airflow obstruction in Latin American middle-aged and older adults.

Effects of almitrine on the ventilatory control, breathing pattern and maximal exercise tolerance in hypoxemic patients with chronic obstructive pulmonary disease

Almitrine bismesylate improves arterial blood gases in patients with chronic obstructive pulmonary disease (COPD), but side effects such as increase of ventilatory drive and dyspnea have been reported in some studies. We studied 18 COPD patients (mean age=59.1 years; mean FEV1=0.921; mean PaO2=58.6mmHg) in a double-blind randomized study using placebo or almitrine 50 mh twice a day by mouth, for 60 days. In contrast to the placebo group, 40 per cent of the patients in the almitrine group presented a significant increase in PaO2 and a decrease in P(A-a))2>=5mmHg during submaximal exercise after 60 days of treatment. Ventilatory drive and the breathing pattern were measured at rest and during submaximal exercise. Both goups showed high levels of ventilatory drive and atachypneic breathing pattern before drug tratment and no modification was found 30 and 60 days after treatment. Metabolis, cardiovascular and ventilatory variables were studied during an incremental to maximum exercise symptom-limited test (cycloergometry). Maximal VO2 ranged from 46 to 52 per cent and heart rate from 76 to 78 per cent in relation to the predicted values. The percent ratio of ventilation at maximal exercise to maximal voluntary ventilation at rest ranged from 86 to 94 per cent. These results show that the reduction of ventilatory capacity was the main factor decreasing the aerobic performance of our COPD patients. Maximal exercise tolerance (VO2 max) did not change after almitrine treatment. Negative factors like an increase in neuromuscular drive did not occur, and positive factors like an increase in PaO2 and oxygen transport had no critical influence on exercise performance in our ventilatory-limited COPD patients.

Drenagem postural x tapotagem x tecnica de expiracao forcada: analise da transportabilidade do muco bronquico / Drainage postural x tapotagem x forced expiratory technique

E comum na fisioterapia respiratoria a utilizacao das manobras de higiene bronquica, no entanto, ainda nao esta bem claro o melhor protocolo de atendimento, visto que os efeitos isolados de cada manobra necessitam ser mais explorados, inclusive com metodos de analise de transportabilidade do muco bronquico. Este estudo analisou amostras de muco bronquico expectorado por 12 bronquiectasicos submetidos a drenagem postural isolada e associada a tapotagem e a tecnica de expiracao forcada. Para analisar a transportabilidade foi realizada a mensuracao do angulo de adesao, do deslocamento do muco na maquina da tosse e da velocidade relativa de transporte no palato de ra, alem do peso umido e da relacao peso seco/peso umido do muco. Houve forte tendencia de remocao de maior quantidade de secrecao apos drenagem postural isolada e associada a tapotagem, alem da tendencia de remocao de secrecao com menor teor liquido apos duas sessoes (50 minutos) de drenagem postural associada a tapotagem. O angulo de adesao do muco removido apos 80 minutos da conduta CONT foi menor (p<0,05) e, proximo da normalidade, de facil remocao. Neste caso, considerando que as demais manobras nao contribuem para a piora das qualidades fisico-quimicas do muco, e que os tempos iniciais das condutas anao apresentaram diferncas estatisticas, o muco expectorado por essas manobras apresentou angulo distante da normalidade, sugerindo que em todos os tempos das condutas estudads o muco expectorado apresentou pior perfil reologico, isto e, de dificil remocao, e somente pela aplicacao das mesmas edsse muco pode ser removido

Mechanisms of hypercapnia in patients with chronic obstructive pulmonary disease (COPD)

A higher ventilatory drive evaluated by the inspiratory occlusion pressure (Poc) and a respiratory pattern characterized by smaller tidal volume (VT) and higher breathing frequency (f) was detected in patients with chronic obstructive pulmonary disease (COPD), in relation to normals. The purpose of this study was to identify the possible mechanisms involved in the development of hypercapnia in those patients, at rest and during exercise. We have studied 11 normocapnic (PaCO2 ( 45 mmHg) and 9 hypercapnic (PaCO2 > 45 mmHg) COPD patients. As expected, no difference in the ventilatory response and neural drive was detected between the two groups. However, the hypercapnic patients have higher values of serum HCO-3 and lower values of PaO2 at rest and values of the ratio dead volume to tidal volume (VD/VT) significantly higher at rest (0.67 vs. 0.55) and during exercise (0.54 vs. 0.38) in relation to normocapnic individuals. There was also a significant positive correlation at rest (r = 0.66*) and during exercise (r = 0.65*; *p < 0.05), between PaCO2 and VD/VT, identifying a decreased alveolar ventilatory efficiency, important in the development of hypercapnia in those patients. when the COPD patients were divided into two distinct groups (PaCO2 ( 40 and ( 50 mmHg), a respiratory pattern characterized by higher f and smaller VT was detected in the hypercapnic group during exercise. In conclusion, a higher VD/VT linked to alterations of the respiratory pattern (lower VT) and to inequalities of ventilation/perfusion (high V/Q areas), seems to explain the hypercapnia of our COPD patients, since the ventilatory response and neural drive were similar in normo and hypercapnic patients.