Health-related quality of life is associated with COPD severity: a comparison between the GOLD staging and the BODE index.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease. Currently, severity Global initiative for chronic Obstructive Lung Disease (GOLD) criteria are used to diagnose the severity of COPD, but a new grading system, the body mass index, bronchial obstruction, dyspnea, exercise (BODE) index, was recently proposed to provide useful prognostic information. The objective of this study is to evaluate the association between health-related quality of life (HRQOL) and COPD severity assessed by two criteria: the GOLD classification and the BODE index. Sixty-four patients with COPD were examined with lung function tests and specific and generic HRQOL questionnaires (St. George's Respiratory Questionnaire [SGRQ], Nottingham Health Profile [NHP]). Participants were divided into four severity groups using the GOLD guidelines and the BODE index quartiles. The association between NHP and SGRQ subscales, and the BODE index was significant (P < 0.01). However, the GOLD classification shows a correlation only with SGRQ total score (P < 0.05) but not with NHP or SGRQ subscales. There was an association of the SGRQ total score between the severity groups of BODE (P = 0.0001), but there was no difference in the SGRQ total score between the severity groups of GOLD classification (P = 0.244). The present study suggests that COPD severity assessed by the BODE index can be more directly related with HRQOL.

Cuidados Paliativos en las enfermedades respiratorias crónicas en fase avanzada. Situación actual y propuesta de organización asistencial / Palliative Care in advanced chronic respiratory disease. State and assitential organization purpose

Actualmente no existen unos criterios objetivos válidos para predecirla mortalidad e incluir directamente a los pacientes con enfermedades respiratorias crónicas en fase avanzada (ERCA) en un programa de atención paliativa. Las ERCA tienen unas particularidades propias que hacen que los cuidados paliativos respiratorios tengan unas características diferentes a la atención paliativa convencional. Esta revisión constata que las ERCA no reciben una cobertura paliativa equiparable a la recibida por los pacientes neoplásicos a pesar de tener índices de mortalidad comparables al de la mayoría de cánceres comunes. La principal diferencia entre la atención apacientes en fases finales de ERCA respecto a pacientes neoplásicos, radica en la accesibilidad a un dispositivo sociosanitario. En esta revisión se propone un programa de atención continuada integrado en un dispositivo sociosanitario que incluya los cuidados paliativos respiratorios, cuando estos sean necesarios como una alternativa para el manejo de estos pacientes (AU)

Currently there are no valid and objective criteria to predict mortality and to directly include patients with advanced chronic respiratory disease(ACRD) in a palliative care programme. The particular aspects of ACRD make respiratory palliative care different from conventional palliative care. This review shows that patients with ACRD fail to receive the level of palliative care given to those affected by terminal cancer in spite of mortality rates in ACRD comparable to those of most common cancers. The main difference between the care given in the final stages of ACRD when compared with the equivalent one received by patients with terminal cancer is the different level of accessibility to a socio-sanitary network within the health system. This review proposes an on-going care programme integrated in the socio-sanitary network that includes respiratory palliative care whenever that option is deemed necessary as an alternative for these patients (AU)