RESUMO
OBJETIVO: Estimar el efecto de una intervención educativa breve dirigida a mejorar la técnica de uso de dispositivos de inhalación sobre la reducción del número de agudizaciones en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) durante un año. MATERIAL Y MÉTODOS: Ensayo clínico aleatorizado con diseño en paralelo y triple ciego. CRITERIOS DE INCLUSIÓN: edad entre 40-75 años, diagnóstico de EPOC y tratamiento con inhaladores. Se seleccionó aleatoriamente a 97 pacientes. Asignación aleatoria estratificada por gravedad espirométrica a 2 grupos: grupo intervención (GI): evaluación de técnica inhalatoria, corrección de errores y visita refuerzo a los 2 y 7 meses, y grupo control (GC): evaluación de técnica inhalatoria y citación anual. Se realizó medición de las agudizaciones a los 12 meses. Variables estudiadas: sociodemográficas, nivel de estudios, IMC, tabaquismo, grado de disnea, FEV1, FEV1/FVC, estadio de EPOC, índice BODEX, técnica inhalatoria, agudizaciones previas. Se realizó análisis mediante inferencia bayesiana utilizando modelos de regresión logística. RESULTADOS: Cincuenta y seis pacientes fueron asignados al GI y 41 al GC. Hubo 16 y 14 pérdidas, respectivamente. En el GI agudizaron el 44,6% de los pacientes frente al 56,1% en el GC, OR ajustada = 0,57 (ICred 95%: 0,22-1,22). Probabilidad posterior OR < 1 = 93%. Las agudizaciones que requirieron ingreso hospitalario presentan un OR = 0,21 (ICred 95%: 0,02-0,76) con probabilidad posterior OR < 1 = 99%. CONCLUSIONES: La intervención educativa muestra eficacia en la reducción del número de agudizaciones
OBJECTIVE: To predict the effect of a brief educational intervention aimed at improving the inhaler technique on the reduction of exacerbations in patients with COPD over a year. MATHERIAL AND METHODS: A triple blind, randomised controlled clinical trial with parallel design. Inclusion criteria: to be between 40-75 years, having been diagnosed with COPD, and being on treatment with inhalers. A total of 97 patients were randomly selected. They were randomly assigned into 2 groups according to their functional severity measured with spirometry. Intervention group: evaluation of the inhalation technique. Their mistakes were corrected using a brief educational intervention. Reinforcement visits were made in the second and seventh month. CONTROL GROUP: evaluation of the inhalation technique. No educational intervention was made. After 1 year of follow-up, the number of exacerbations in each group was checked. Variables measured: social and demographic, study, dyspnoea level, body-mass index, tobacco use, FEV1, FEV1/FVC, COPD stage, BODEX index, number, type, and inhaler technique, number of previous exacerbations. Bayesian inference analysis was performed using logistic regression models. RESULTS: A total of 56 patients were assigned to de intervention group and 41 to the control one. There were 16 and 14 lost to follow-up, respectively. In the intervention group, 44.6% of the patients had an exacerbation, compared to the control group, with 56.1%. OR adjusted = 0.57 (95% CI: 0.22-1.22). Posterior probability OR < 1 = 93%. Exacerbations which required hospital admission had an OR = 0.21 (95% CI: 0.02-0.75) with posterior probability OR < 1= 99%. CONCLUSIONS: A brief educational technique is an effective method for reducing the number of exacerbations in patients with COPD
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Hospitalização/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Nebulizadores e Vaporizadores , Teorema de Bayes , Método Duplo-Cego , Seguimentos , Volume Expiratório Forçado , Modelos Logísticos , Índice de Gravidade de Doença , EspirometriaRESUMO
OBJECTIVE: To predict the effect of a brief educational intervention aimed at improving the inhaler technique on the reduction of exacerbations in patients with COPD over a year. MATHERIAL AND METHODS: A triple blind, randomised controlled clinical trial with parallel design. INCLUSION CRITERIA: to be between 40-75 years, having been diagnosed with COPD, and being on treatment with inhalers. A total of 97 patients were randomly selected. They were randomly assigned into 2groups according to their functional severity measured with spirometry. Intervention group: evaluation of the inhalation technique. Their mistakes were corrected using a brief educational intervention. Reinforcement visits were made in the second and seventh month. CONTROL GROUP: evaluation of the inhalation technique. No educational intervention was made. After 1 year of follow-up, the number of exacerbations in each group was checked. VARIABLES MEASURED: social and demographic, study, dyspnoea level, body-mass index, tobacco use, FEV1, FEV1/FVC, COPD stage, BODEX index, number, type, and inhaler technique, number of previous exacerbations. Bayesian inference analysis was performed using logistic regression models. RESULTS: A total of 56 patients were assigned to de intervention group and 41 to the control one. There were 16 and 14 lost to follow-up, respectively. In the intervention group, 44.6% of the patients had an exacerbation, compared to the control group, with 56.1%. OR adjusted = 0.57 (95% CI: 0.22-1.22). Posterior probability OR < 1 = 93%. Exacerbations which required hospital admission had an OR = 0.21 (95% CI: 0.02-0.75) with posterior probability OR < 1= 99%. CONCLUSIONS: A brief educational technique is an effective method for reducing the number of exacerbations in patients with COPD.
