Association of bone mineral density with chronic obstructive pulmonary disease in postmenopausal women

Abstract Background Osteoporosis (OP) is common in patients with chronic obstructive pulmonary disease (COPD). The relationship between OP and COPD has been primarily studied in male patients, and few reports are available in postmenopausal women. Objective The purpose of this study was to investigate the association between bone mineral density (BMD) and COPD in postmenopausal women. Methods This cross-sectional study included 133 clinically stable female ex-smokers with confirmed COPD, and 31 age-matched “ex-smoker” female controls. We analyzed groups according to their airway obstruction category. BMD was measured on dual-energy X-ray absorptiometry images of the left femoral neck. Results Patients with COPD had lower T-scores and higher prevalence of osteopenia/OP than the control group. In the COPD group, the airway obstruction category was significantly associated with the T-score after adjustment for confounders. Multivariate logistic regression analysis showed COPD was an independent marker for increased risk of osteopenia/OP in postmenopausal women. Conclusions COPD and airway obstruction category were strongly related to BMD. Postmenopausal women with COPD, especially those with severe airway obstruction, had a higher prevalence rate and a higher risk of osteopenia and OP than female controls without COPD.

Controversies and limitations in the diagnosis of chronic obstructive pulmonary disease

Abstract Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. While the cut-off point to define airflow obstruction has been controversial, it is widely accepted that the spirometry test is vital, as well as performing it after using a bronchodilator. The 6-second spirometry and the forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6) have demonstrated validity for defining obstruction, and it would be advisable to incorporate them in the definitions of obstruction. Another relevant issue is that spirometry with borderline obstruction can vary over time, changing to above or below the cut-off point. Thus, surveillance should be considered over time, repeating the spirometry to have a greater certainty in the diagnosis. The objective of this article was to conduct an in-depth review of the controversies in the diagnosis of COPD. During the past years, COPD definition has been updated in different times; however, it is now considered more as a complex syndrome with systemic participation, requiring a multidimensional assessment, and not only a spirometry.

Neurophysiological aspects and their relationship to clinical and functional impairment in patients with chronic obstructive pulmonary disease

OBJECTIVE: The purpose was to assess functional (balance L-L and A-P displacement, sit-to-stand test (SST) and Tinetti scale - balance and gait) and neurophysiological aspects (patellar and Achilles reflex and strength) relating these responses to the BODE Index. INTRODUCTION: The neurophysiological alterations found in patients with chronic obstructive pulmonary disease (COPD) are associated with the severity of the disease. There is also involvement of peripheral muscle which, in combination with neurophysiological impairment, may further compromise the functional activity of these patients. METHODS: A cross-sectional study design was used. Twenty-two patients with moderate to very severe COPD (>60 years) and 16 age-matched healthy volunteers served as the control group (CG). The subjects performed spirometry and several measures of static and dynamic balance, monosynaptic reflexes, peripheral muscle strength, SST and the 6-minute walk test. RESULTS: The individuals with COPD had a reduced reflex response, 36.77±3.23 (p<0.05) and 43.54±6.60 (p<0.05), achieved a lower number repetitions on the SST 19.27±3.88 (p<0.05), exhibited lesser peripheral muscle strength on the femoral quadriceps muscle, 24.98±6.88 (p<0.05) and exhibited deficits in functional balance and gait on the Tinetti scale, 26.86±1.69 (p<0.05), compared with the CG. The BODE Index demonstrated correlations with balance assessment (determined by the Tinetti scale), r = 0.59 (p<0.05) and the sit-to-stand test, r = 0.78 (p<0.05). CONCLUSIONS: The individuals with COPD had functional and neurophysiological alterations in comparison with the control group. The BODE Index was correlated with the Tinetti scale and the SST. Both are functional tests, easy to administer, low cost and feasible, especially the SST. These results suggest a worse prognosis; however, more studies are needed to identify the causes of these changes and the repercussions that could result in their activities ...

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.

Capacidade inspiratória, limitação ao exercício, e preditores de gravidade e prognóstico, em doença pulmonar obstrutiva crônica / Inspiratory capacity, exercise limitation, markers of severity, and prognostic factors in chronic obstructive pulmonary disease

OBJETIVO: Correlacionar a capacidade inspiratória (CI), por cento do previsto, pós-broncodilatador (pós-BD), com outras variáveis indicativas de gravidade e prognóstico, na doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: Oitenta pacientes estáveis com DPOC realizaram manobras de capacidade vital forçada, capacidade vital lenta, e teste de caminhada de 6 min, antes e após salbutamol spray (400 µg). Foram divididos em quatro grupos, segundo o volume expiratório forçado no primeiro segundo pós-BD. Diversas variáveis foram testadas, por análise univariada e multivariada, com a distância caminhada pós-BD, por cento do previsto. A CI pós-BD foi correlacionada com o estadiamento Global Initiative for Chronic Obstructive Lung Disease (GOLD) e o índice Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE). RESULTADOS: Por análise de regressão multivariada, a CI pós BD, por cento do previsto, (p = 0,001), o uso de oxigênio a longo prazo (p = 0,014), e o número de medicamentos usados (p = 0,044), mantiveram associação significativa com a distância caminhada, por cento do previsto. A CI < 70 por cento foi observada em 56 por cento dos pacientes em estágios GOLD 3 ou 4 comparado a 20 por cento em estágios GOLD 1 ou 2 ( p < 0,001). A CI < 70 por cento foi observada em 60 por cento dos pacientes com escore BODE 3 ou 4 vs. 33 por cento com BODE 1 ou 2 (p = 0,02). CONCLUSÃO: A CI, por cento do previsto, pós-BD é o melhor preditor funcional da distância caminhada, associando-se significativamente com o escore GOLD e o índice BODE. Por isso, propomos que a CI seja incluída na rotina de avaliação dos portadores de DPOC.

OBJECTIVE: To correlate the postbronchodilator (post-BD) inspiratory capacity (IC), percent of predicted, with other markers of severity and prognostic factors in chronic obstructive pulmonary disease (COPD). METHODS: Eighty stable patients with COPD performed forced vital capacity and slow vital capacity maneuvers, as well as the 6-min walk test, prior to and after receiving albuterol spray (400 µg). Patients were divided into four groups, based on post-BD forced expiratory volume in one second. Several variables were tested to establish correlations with the post-BD distance walked, using univariate and multivariate analysis. Post-BD IC was found to correlated with Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging and with the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. RESULTS: Multivariate regression analysis revealed that the distance walked, percent predicted, correlated significantly with the IC post-BD, percent predicted (p = 0.001), long-term oxygen use (p = 0.014), and number of medications used in the treatment (p = 0.044). IC < 70 percent was observed in 56 percent patients in GOLD stages 3 or 4 vs. 20 percent in GOLD 1 or 2 (p < 0.001). IC < 70 percent was observed in (60 percent) patients with BODE score 3 or 4 vs. (33 percent) BODE score 1 or 2 (p = 0.02). CONCLUSION: Post-BD IC percent predicted is the best functional predictor of distance walked and is significantly associated with GOLD staging and BODE index. Therefore, We propose that the inspiratory capacity should be added to the routine evaluation of the COPD patients.

Limitación crónica al flujo aéreo en pacientes con secuelas de tuberculosis pulmonar: Caracterización y comparación con EPOC / Chronic airways obstruction in patients with tuberculosis sequelae: a comparison with EPOC

Chronic airway obstruction (CAO) resulting from tuberculosis (TB) sequelae (CAO-TB) is a frequent condition in our population. However the information in the medical literature is scarce. The management of these patients usually follows guidelines for other illnesses such as chronic obstructive pulmonary disease (COPD) or asthma. To better characterize CAO-TB, 25 patients with this condition that never smoked nor were diagnosed having asthma, were studied by means of spirometry, arterial blood gases and 6-minute walk test. Furthermore, they were compared with 12 COPD patients with similar FEV1 values. CAO-TB patients had history of tuberculosis 35 ± 11 years earlier, and all of them presented with lung scarring in one or both upper lobes. They were younger than COPD (58 ± 11 vs 69 ± 6 y.o.; p = 0.001) and females predominated over males (20/5 vs 2/10; p = 0.001). The FEV1/FVC ratio pre- and post-bronchodilator were higher in CAO-TB than in COPD patients (67 percent ± 12 vs 54 percent ± 9 pre; p = 0.001; 65 percent ± 14 vs 51 percent ± 7; p = 0.003 post, respectively). There were no differences in the remaining spirometric indices nor in arterial blood gases. The 6-min distance walked was comparable in both groups: 343 m (69 percent) in CAO-TB and 361 m (76 percent) in COPD. There were no differences in the oxygen saturation nor in heart rate neither at the beginning nor at the end of the 6-min walk test. However, CAO-TB patients had a higher respiratory rate at the beginning (22.7 ± 4.7 vs 19.8 ± 3.1 breath/min; p = 0.05) and at the end of the walk test (27.3 ± 6.7 vs 21.9 ± 3.3; p = 0.01) than COPD patients; although the Borg dyspnoea score was not different (1 ± 0,7 vs 1 ± 0.5 initial, 3 ± 1.5 vs 2.5 ± 0.8 final). Furthermore, a significant linear correlation between respiratory rate and Borg score was found both at the beginning (r = 0.747; p < 0.001) and at the end (r = 0.507; p = 0.01) of the walk test. In conclusion, CAO-TB patients are functionally comparable to COPD patients, although they have higher respiratory rate and develop more dyspnoea because of their added restrictive impairment. In addition to spirometry, tests for assessment of dyspnoea such as 6-minute walk test must be considered, to evaluate the response to treatment in CAO-TB patients.

La limitación crónica al flujo aéreo (LCFA) secundaria a secuelas de tuberculosis (LCFA-TB) es relativamente frecuente en nuestro medio, pero la información sobre esta condición en la literatura es escasa. El manejo terapéutico de estos enfermos suele seguir las guías de otras entidades como la Enfermedad Pulmonar Obstructiva Crónica (EPOC) y el Asma Bronquial. Con el objetivo de caracterizar la LCFA-TB, 25 enfermos con esta condición, que nunca fumaron ni tuvieron asma, fueron estudiados mediante espirometría, gasometría arterial y prueba de caminata de 6 minutos. Los pacientes LCFA-TB fueron comparados con 12 pacientes EPOC que tenían un grado similar de obstrucción. Los enfermos con LCFA-TB habían presentado tuberculosis 35 ± 11 años antes y tenían lesiones fibrosas con retracción en uno o ambos lóbulos superiores. Eran más jóvenes que los pacientes con EPOC (58 ± 11 vs 69 ± 6 años; p = 0,001) y predominaban las mujeres sobre los hombres (20/5 vs 2/10; p = 0,001). La relación VEF1/CVF basal fue más elevada en los pacientes con LCFA-TB que en los con EPOC (67 por ciento ± 12 vs 54 por ciento ± 9; p = 0,001) al igual que la relación VEF1/CVF posterior a broncodilatador (65 por ciento ± 14 vs 51 por ciento ± 7; p = 0,003). No hubo diferencias en los demás índices espirométricos ni en los gases arteriales. La distancia recorrida en 6 minutos fue similar en ambos grupos de pacientes: 343 m (69 por ciento) en LCFA-TB y 361 m (76 por ciento) en EPOC. No hubo diferencias en la oximetría ni en la frecuencia cardíaca inicial ni final. En cambio, los pacientes con LCFA-TB presentaron una frecuencia respiratoria (FR) más elevada que los pacientes con EPOC, tanto al comienzo (22,7 ± 4,7 vs 19,8 ± 3,1; p = 0,05) como al final de la prueba (27,3 ± 6,7 vs 21,9 ± 3,3; p = 0,01). Aunque no hubo diferencias en el grado de disnea (escala de Borg: 1 ±0,7 vs 1 ± 0,5 inicial, 3 ± 1,5 vs 2,5 ± 0,8 final). Además, existió una correlación significativa entre la FR y los puntos de la escala de Borg al inicio de la prueba (r = 0,747; p < 0,001) y al final de ésta (r = 0,507; p = 0,01). En conclusión, los pacientes con LCFA-TB tienen un comportamiento funcional parecido a los pacientes con EPOC, aunque por el componente restrictivo de su limitación ventilatoria presentan más polipnea y tienden a desarrollar más disnea con el ejercicio. La valoración de la respuesta al tratamiento en estos enfermos debiera considerar, además de la espirometría, pruebas de evaluación de disnea como la distancia recorrida en seis minutos.

Doença pulmonar obstrutiva crônica / Chronic obstructive pulmonary disease

A doença pulmonar obstrutiva crônica (DPOC) vem tendo um grande destaque no meio médico nos últimos anos, em vista da tomada de consciência da sua importância como fator de morbidade e mortalidade. É caracterizada por um desenvolvimento progressivo de limitação ao fluxo aéreo e esta alteração não e totalmente reversível, estando associada a resposta inflamatória anormal dos pulmões a partículas ou gases nocivos. O tabagismo continua sendo a principal causa de seu desenvolvimento e o encorajamento do paciente por parte do médico a medidas antitabagísticas é uma importante estratégia no tratamento da patologia. O exame que quantifica a limitação ao fluxo é a expirometria, sendo obrigatória na suspeita clínica da doença. O tratamento se baseia em controlar os sintomas e evitar ambientes prejudicais. Não existem ainda terapias curativas disponíveis para a DPOC.

Entrenamiento por ejercicios en la limitación crónica al flujo áereo / Training by exercises in the chronic limitation to the airflow

El presente estudio consiste en una revisión bibliográfica de las modalidades de entrenamiento por ejercicios en la rahabilitación del enfermo con patología pulmonar. Se revisaron los aspectos más importantes en cuanto a criterios de selección, evaluaciones, métodos de entrenamiento y respuesta al entrenamiento en este tipo de pacientes