Impact of COPD severity on physical disability and daily living activities: EDIP-EPOC I and EDIP-EPOC II studies.

AIMS: The severity of chronic obstructive pulmonary disease (COPD) is associated to patients' health-related quality of life (HRQL). Physical impairment increasingly affects daily activities creating economic, social and personal burden for patients and their families. This burden should be considered in the management of COPD patients; therefore, we intended to assess the impact of the disease severity on physical disability and daily activities. METHODS: Two epidemiological observational cross-sectional descriptive studies were carried out in 1596 patients with moderate COPD and 2012 patients with severe or very severe COPD in the routine clinical practice. Demographic and basic clinical-epidemiological data were collected and patients completed questionnaires to assess their physical disability because of COPD [Medical Research Council (MRC)], COPD repercussion on daily activities [London Chest Activity of Daily Living (LCADL)], job, economy and family habits and their health status [EQ-5D visual analogue scale (VAS)]. RESULTS: In all, 37% of severe/very severe COPD patients and 10% of moderate (p < 0.0001) had MRC grades 4 and 5. Mean global LCADL was significantly higher in severe/very severe than in moderate patients [29.6 (CI 95%: 28.91-30.25) vs. 21.4 (CI 95%: 20.8-21.9); p < 0.0001]. COPD job impact and economic and family habits repercussions were significantly higher and health status significantly worse in severe/very severe cases than in patients with moderate COPD. CONCLUSIONS: COPD severity is highly associated with physical disability by MRC grading, with functionality on daily activities and with impairment of other social and clinical activities. Moderate COPD patients show already a significant degree of impairment in all these parameters.

Patología pulmonar intersticial / Interstitial lung disease

No disponible

Factores de riesgo de rehospitalización en pacientes ingresados por exacerbación de EPOC / No disponible

Objetivo: Identificar los factores predisponentes de futuros reingresas hospitalarios en los pacientes con EPOC, tras el alta hospitalaria por una agudización de su enfermedad. Material y métodos: Se trata de un estudio descriptivo y observacional. Se incluyeron pacientes que ingresaron con el diagnóstico de EPOC reagudizada. Se recogieron los antecedentes personales, las características clínicas, los resultados de las pruebas complementarias y el tratamiento pautado. Al alta se les siguió durante un periodo de 6 meses, evaluando el número de reingresos hospitalarios durante dicho periodo. Resultados: Se evaluaron 41 pacientes, 39 varones (95,1 %) y 2 mujeres (4,9%), con una edad media de 65,8+- 14,6 años y un valor medio de FEVI de 38,2+- 15,6%. De ellos, 12 eran fumadores activos (29,3%) y 29 exfumadores (70,7%). El número medio de hospitalizaciones en el año previo fue de 2,3 +- 2.3. Las patologías acompañantes más frecuentes fueron la cardiopatía isquémica (24,4%) y la diabetes mellitus (22%). Los tratamientos más comúnmente usados antes del ingreso fueron los agonistas beta~2 adrenérgicos de larga duración (87,8%) y los anticolinérgicos de acción prolongada (65,9%). Además, 18 enfermos (43,9%) seguían tratamiento con oxigenoterapia domiciliaria antes de ingresar. Respecto al tratamiento farmacológico pautado al alta, cabe destacar que al 85,4% de los enfermos se les pautó corticoides inhalados y al 56,1% corticoides orales. En relación con los reingresas hospitalarios, 14 enfermos (34,1 %) fueron nuevamente ingresados en los 6 meses posteriores al alta. En el análisis univariante se comprobó que los factores relacionados con el reingreso hospitalario fueron el número de hospitalizaciones en el año previo, la existencia de al menos una patología asociada, el tratamiento previo con oxigenoterapia, el grado de disnea al finalizar el ingreso y el tratamiento con corticoides orales al alta (p>0,05). Sin embargo en el análisis multivariante se observó que, de todos ellos, sólo la prescripción de corticoides orales al alta constituía un factor determinante independiente de rehospitalización en estos pacientes (p<0,05). Conclusiones: La prescripción de corticoides orales al alta es un factor predictivo independiente de la probabilidad de ingreso en los 6 meses siguientes al alta. Se necesitan nuevos estudios, con mayor número de pacientes y un tiempo de seguimiento más largo, para establecer la verdadera influencia de otros factores (AU)

Objective: Identify the predisposing factors of future hospital re-admissions in patients with COPD after hospital discharge due lo worsening of their disease. Material and methods: This is a descriptive and observational study. Patients admitted with the diagnosis of worsened COPD were included. Personal backgrounds, clinical characteristics, results of the complementary tests and treatment prescribed were collected. They were followed-up after discharge for a 6-month period, evaluating the number of re-admissions during that period. Results: A total of 41 patients, 39 men (95.1%) and 2 women (4.9%), with a mean age of65.8+- 14.6 years and mean value of FEVI of 38.2+- 15.6% were evaluated. Twelve of them were active smokers (29.3%) and 29 ex-smoker (70.7%). Mean number of hospitalizations during the previous year was 2.3 +- 2.3. The most frequent accompanying diseases were ischemic heart disease (24.4%) and diabetes mellitus (22%). The most commonly used treatments prior to admission were long-acting beta-2 adrenergic agonists (87.8%) and long-acting anticholinergics (65.9%). In addition, 18 patients (43.9%) were treated with home oxygen therapy before admission. Regarding drug treatment prescribed on discharge, it stands out that 85.4% of the patients were prescribed inhaled corticosteroids and 56.1% oral corticosteroids. Regarding hospital readmissions, 14 patients (34.1%) were readmitted during the six months following discharge. In the univariate analysis, it was verified that the factors related with hospital readmission were the number of hospitalizations in the previous year, existence of at least one associated disease, previous treatment with oxygen therapy, degree of dyspnea at the end of the hospitalization and treatment with oral corticosteroids on discharge (p>0.05). However, the multivariate analysis showed that out of all of these, only the prescription of oral corticosteroids on discharge was a determining independent factor in rehospitalization in these patients (p<0.05). Conclusions: Prescription of oral corticosteroids on discharge is an independent predictive factor of the like-lihood of admission during the six months following discharge. New studies are needed with a larger number of patients and longer follow-up time to establish the true influence of other factors (AU)

Nódulos traqueales / Tracheal nodes

No disponible

Fístula traqueoesofágica / Tracheoesophageal fistula

No disponible

Aspergilosis pulmonar invasiva en un paciente con EPOC grave / Invasive pulmonary aspergillosis in a patient with serious

No disponible