Hospitalization due to exacerbation of COPD: "Real-life" outcomes.

INTRODUCTION:: Hospitalization due to chronic obstructive pulmonary disease exacerbation (eCOPD) may indicate worse prognosis. It is important to know the profile of hospitalized patients and their outcome of hospitalization to customize and optimize treatment. METHOD:: Evaluation of patients hospitalized for eCOPD, with ≥ 10 pack/years and ≥ 1 previous spirometry with airway obstruction over the course of one year at the pulmonology service of a general hospital, applying: COPD assessment test (CAT); mMRc and Visual Analogue Scale (VAS) for dyspnea; hospitalized anxiety and depression questionnaire (HAD); Divo's comorbidities and Cote index; spirometry; and laboratory tests including number of eosinophils, C-reactive protein (CRP), brain natriuretic protein (BNP). Patient progression, number of days of hospitalization and hospitalization outcomes were observed. RESULTS:: There were 75 (12%) hospitalizations for eCOPD, with 27 readmissions, nine of which during a period ≤ 30 days after hospital discharge. The main outcomes were: number of days of hospitalization (17±16.5 [2-75]); hospital discharge (30 [62.5%] patients); discharge/rehospitalization (18 [37.5%] patients), eight of them more than once; death (7 [14.5%] patients), five during rehospitalization. We analyzed 48 patients in their first hospitalization. The sample comprised a heterogeneous group separated in three clusters according to age, FEV1, body mass index (BMI) and CAT. The clusters did not correlate with the main outcomes. CONCLUSION:: Hospitalization for eCOPD is frequent. The number of readmissions was high and associated with death as an outcome. Patients hospitalized for eCOPD were a heterogeneous group separated in three clusters with different degrees of disease severity and no correlation with hospitalization outcomes.

Hospitalization due to exacerbation of COPD: "Real-life" outcomes / Hospitalização por exacerbação da DPOC: desfechos da "vida real"

Summary Introduction: Hospitalization due to chronic obstructive pulmonary disease exacerbation (eCOPD) may indicate worse prognosis. It is important to know the profile of hospitalized patients and their outcome of hospitalization to customize and optimize treatment. Method: Evaluation of patients hospitalized for eCOPD, with ≥ 10 pack/years and ≥ 1 previous spirometry with airway obstruction over the course of one year at the pulmonology service of a general hospital, applying: COPD assessment test (CAT); mMRc and Visual Analogue Scale (VAS) for dyspnea; hospitalized anxiety and depression questionnaire (HAD); Divo's comorbidities and Cote index; spirometry; and laboratory tests including number of eosinophils, C-reactive protein (CRP), brain natriuretic protein (BNP). Patient progression, number of days of hospitalization and hospitalization outcomes were observed. Results: There were 75 (12%) hospitalizations for eCOPD, with 27 readmissions, nine of which during a period ≤ 30 days after hospital discharge. The main outcomes were: number of days of hospitalization (17±16.5 [2-75]); hospital discharge (30 [62.5%] patients); discharge/rehospitalization (18 [37.5%] patients), eight of them more than once; death (7 [14.5%] patients), five during rehospitalization. We analyzed 48 patients in their first hospitalization. The sample comprised a heterogeneous group separated in three clusters according to age, FEV1, body mass index (BMI) and CAT. The clusters did not correlate with the main outcomes. Conclusion: Hospitalization for eCOPD is frequent. The number of readmissions was high and associated with death as an outcome. Patients hospitalized for eCOPD were a heterogeneous group separated in three clusters with different degrees of disease severity and no correlation with hospitalization outcomes.

Resumo Introdução: As hospitalizações por exacerbação da doença pulmonar obstrutiva crônica (eDPOC) podem indicar um pior prognóstico. É importante conhecer o perfil dos pacientes internados e os desfechos das internações para personalizar e otimizar seu tratamento. Método: Avaliação dos pacientes hospitalizados por eDPOC, com ≥ 10 anos/maços e ≥ 1 espirometria prévia com obstrução ao fluxo aéreo no período de um ano em um serviço de pneumologia de um hospital geral. Foram utilizados: teste de avaliação da DPOC (CAT); mMRC e Escala Analógica Visual (EAV) para aferição da dispneia; escala hospitalar de ansiedade e depressão (HAD); comorbidades pelos critérios de Divo e índice de Cote; espirometria; e exames laboratoriais, eosinófilos no sangue, proteína C reativa (PCR), brain natriuretic peptide (BNP). Observamos evolução dos pacientes, duração da internação e desfechos da hospitalização. Resultados: Ocorreram 75 (12%) internações por eDPOC, sendo 27 reinternações, nove das quais com menos de 30 dias após a alta. Os principais desfechos foram: duração da internação de 17±16,5 (2-75) dias; 30 (62,5%) altas hospitalares; 18 (37,5%) altas/reinternações, oito pacientes reinternaram mais de uma vez; e sete (14,5%) óbitos, cinco durante as reinternações. Analisamos 48 pacientes em sua primeira internação. A amostra era um grupo heterogêneo que ordenamos em três clusters de acordo com idade, VEF1, índice de massa corporal (IMC) e CAT. Os clusters não se correlacionaram com os principais desfechos. Conclusão: A eDPOC é causa frequente de internações. Foram frequentes as reinternações e estas se correlacionaram com o desfecho óbito. Os pacientes internados por eDPOC formaram um grupo heterogêneo, que pôde ser agrupado em três clusters com diferentes graus de gravidade e sem correlação com os desfechos das hospitalizações.

Dyspnea in COPD: beyond the modified Medical Research Council scale.

OBJECTIVE: To determine the correlations among various dyspnea scales, spirometric data, exercise tolerance data, and the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index in patients with COPD. METHODS: Between March of 2008 and July of 2009, 79 patients with COPD were recruited, and 50 of those patients were included in the study. After being regularly treated with formoterol for one month, the patients completed the modified Medical Research Council (mMRC, dyspnea scale), Baseline Dyspnea Index (BDI), Oxygen Cost Diagram (OCD), and Shortness Of Breath Questionnaire (SOBQ). Subsequently, the patients underwent spirometry and six-minute walk tests (6MWTs), with determination of the six-minute walk distance (6MWD), as well as initial and final SpO2. All patients also completed the Visual Analogue Scale (VAS) and the Borg scale. RESULTS: The best correlations were between the Borg scale and the VAS (r s = 0.79) and between the BDI and the SOBQ (r s = -0.73). Among the one-dimensional scales (the VAS, mMRC, OCD, and Borg scale), only the VAS correlated with the spirometric parameters, whereas the multidimensional scales BDI and SOBQ did correlate, but poorly. The MRC, BDI, and SOBQ correlated well with 6MWD. Among the spirometric data, inspiratory capacity (IC) and FVC had the strongest correlations with 6MWD. In the multivariate analysis, BDI and IC were selected as the best predictors of 6MWD. CONCLUSIONS: Multidimensional dyspnea scales should be applied in the evaluation of COPD patients.

Dispneia em DPOC: além da escala modified Medical Research Council / Dyspnea in COPD: beyond the modified Medical Research Council scale

OBJETIVO: Avaliar as correlações entre diversos instrumentos de avaliação de dispneia, dados espirométricos e de tolerância ao exercício e índice Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) em pacientes com DPOC. MÉTODOS: Entre março de 2008 e julho de 2009, de 79 pacientes com DPOC recrutados, 50 foram selecionados. Esses pacientes retornaram após um mês de tratamento regular com formoterol e responderam aos seguintes instrumentos: escala modified Medical Research Council (mMRC), Baseline Dyspnea Index (BDI), Oxygen Cost Diagram (OCD) e Shortness Of Breath Questionnaire (SOBQ). Em seguida, realizaram espirometria e teste de caminhada de seis minutos (TC6), com a medição da distância percorrida no TC6 (DTC6), medida de SpO2 inicial e final, e graduação da dispneia pela escala analógica visual (EAV) e escala de Borg. RESULTADOS: As melhores correlações entre os instrumentos foram entre Borg e EAV (r s = 0,79) e BDI e SOBQ (r s = -0,73). Entre as escalas unidimensionais (VAS, mMRC, OCD e de Borg), apenas VAS se correlacionou com os parâmetros de espirometria, ao passo que as escalas multidimensionais BDI e SOBQ apresentaram fraca correlação. Houve boas correlações entre mMRC, BDI e SOBQ com DTC6. Entre os parâmetros espirométricos, a capacidade inspiratória (CI) e CVF tiveram as melhores correlações com DTC6. Na análise multivariada, BDI e CI foram selecionados como os melhores preditores para DTC6. CONCLUSÕES: Escalas multidimensionais de dispneia devem ser aplicadas para avaliar pacientes com DPOC.

OBJECTIVE: To determine the correlations among various dyspnea scales, spirometric data, exercise tolerance data, and the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index in patients with COPD. METHODS: Between March of 2008 and July of 2009, 79 patients with COPD were recruited, and 50 of those patients were included in the study. After being regularly treated with formoterol for one month, the patients completed the modified Medical Research Council (mMRC, dyspnea scale), Baseline Dyspnea Index (BDI), Oxygen Cost Diagram (OCD), and Shortness Of Breath Questionnaire (SOBQ). Subsequently, the patients underwent spirometry and six-minute walk tests (6MWTs), with determination of the six-minute walk distance (6MWD), as well as initial and final SpO2. All patients also completed the Visual Analogue Scale (VAS) and the Borg scale. RESULTS: The best correlations were between the Borg scale and the VAS (r s = 0.79) and between the BDI and the SOBQ (r s = -0.73). Among the one-dimensional scales (the VAS, mMRC, OCD, and Borg scale), only the VAS correlated with the spirometric parameters, whereas the multidimensional scales BDI and SOBQ did correlate, but poorly. The MRC, BDI, and SOBQ correlated well with 6MWD. Among the spirometric data, inspiratory capacity (IC) and FVC had the strongest correlations with 6MWD. In the multivariate analysis, BDI and IC were selected as the best predictors of 6MWD. CONCLUSIONS: Multidimensional dyspnea scales should be applied in the evaluation of COPD patients.