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OBJECTIVES: To determine the differences between sexes in perceptions of asthma symptoms, asthma control, daily activities, and symptom exacerbation in Latin American countries. METHODS: This cross-sectional study was performed using data from the Latin America Asthma Insight and Management (LA-AIM) study (n = 2167) carried out in Argentina, Brazil, Mexico, Venezuela, and Puerto Rico. Face-to-face interviews were conducted, and patients orally completed a 53-question survey assessing five main domains of asthma: symptoms, impact on daily activities, disease control, exacerbation, and treatment/medication. RESULTS: Of the 2167 participants, 762 (35.2%) were males and 1405 (64.8%) were females. Male participants smoked more than females, but history of rhinitis and allergies was more common in females (p < 0.05). Women aged 18-40 years had a higher proportion of uncontrolled asthma compared to men of the same age (37.8% and 30.0%, respectively). A higher proportion of symptomatic females reported more frequent symptoms (daytime cough, shortness of breath, breathlessness/wheezing, sputum, tightness in the chest, etc.) than males (p < 0.05). Females also experienced more limitations in sports/recreational activities, normal physical exertion, social activities, sleep, and daily activities. Females consulted with health professionals more often than males (67.8% and 59.6%, respectively; p < 0.05). Asthma caused a feeling of lack of control over life in 42.6% of females and 31.4% of males. CONCLUSION: In Latin America, females report more asthma symptoms, poorer asthma control, more impact on their daily activities, and more visits with health professionals than males.
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Asma , Asma/tratamento farmacológico , Asma/epidemiologia , Estudos Transversais , Dispneia , Feminino , Humanos , América Latina/epidemiologia , Masculino , Percepção , Fatores SexuaisRESUMO
Limited information is available regarding the role of anaerobic metabolism capacity on GOLD 1 and 2 COPD patients during upper limb exercise. We aimed to compare the upper limb anaerobic power capacity, blood lactate concentration, cardiovascular and respiratory responses, in male COPD patients versus healthy subjects during the 30-s Wingate anaerobic test (WAnT). The rate of fatigue and time constant of the power output decay (τ, tau) were also calculated and a regression analysis model was built to assess the predictors of τ in these patients. Twenty-four male COPD patients (post-bronchodilator FEV1 73.2 ± 15.3% of predicted) and 17 healthy subjects (FEV1 103.5 ± 10.1% of predicted) underwent the WAnT. Measurements were performed at rest, at the end of the WAnT, and during 3' and 5' of recovery time. Peak power (p = 0.04), low power (p = 0.002), and mean power output (p = 0.008) were significantly lower in COPD patients than in healthy subjects. Power output decreased exponentially in both groups, but at a significantly faster rate (p = 0.007) in COPD patients. The time constant of power decay was associated with resistance (in ohms) and fat-free mass (r2 = 0.604, adjusted r2 = 0.555, and p = 0.002). Blood lactate concentration was significantly higher in healthy subjects at the end of the test, as well as during 3' and 5' of recovery time (p < 0.01). Compared with healthy subjects, COPD patients with GOLD 1 and 2 presented lower upper limb anaerobic capacity and a faster rate of power output decrease during a maximal intensity exercise. Also, the WAnT proved to be a valid tool to measure the upper limb anaerobic capacity in these patients.
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Teste de Esforço , Doença Pulmonar Obstrutiva Crônica , Anaerobiose , Humanos , Ácido Láctico , Masculino , Extremidade SuperiorRESUMO
Pulmonary rehabilitation (PR) is a mandatory component of a comprehensive treatment of patients with chronic respiratory disease. However, there is no officially published data about PR Centers in Latin America.The objetive is to identify Latin American Pulmonary Rehabilitation Centers and evaluate their characteristics and organizational aspects.A cross-sectional study with the Pulmonary Rehabilitation Centers indicated by the Latin American Respiratory and Physiotherapy Societies and by our own personal survey among physicians and physiotherapists. An eletronic transmission questionnaire with 20 questions was sent to the Coordinator of each one of the Centers.217 Pulmonary Rehabilitation Centers were found throughout Latin America and a total of 160 (73.7%) Centers answered the questionnaire. Of these, 65.8% had private administration; 68.8% had an associated program for patients with heart disease; programs lasted an average of 24 sessions; the rehabilitation team consisted mainly of physiotherapists, physicians and dietitians; 90.6% of the centers evaluated the patients with different questionnaires; 91.9% used treadmill and 90.6% bicycle for exercises of lower limbs and 80.1% proprioceptive neuromuscular facilitation technique with weights to train the upper limbs of their patients; 55.6% had an educational program and 36.9% presented a home-based program.There has been a great increase in the number of Latin American Pulmonary Rehabilitation Centers, presenting diversity in organizational aspects.
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Doença Pulmonar Obstrutiva Crônica , Centros de Reabilitação , Estudos Transversais , Humanos , América Latina/epidemiologia , Pneumopatias/reabilitação , Doença Pulmonar Obstrutiva Crônica/reabilitação , Centros de Reabilitação/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
The Glittre ADL-test is based on important and common activities of daily living (ADLs), and it is an useful test to objectively distinguish patients with and without self-reported functional limitations. This study aims to analyze if difficulty to perform ADLs, as self-reported by patients with COPD, would reflect a worse Glittre ADL-test performance. In the first visit, patients were evaluated for clinical and nutritional status, spirometry, maximal cardiopulmonary exercise test on a treadmill. One week later, the patients performed two Glittre ADL-tests. Maximal voluntary ventilation (MVV) and the VEGlittre/MVV, VO2Glittre/VO2peak, and HRGlittre/HRpeak ratios were calculated to analyze the ventilatory, metabolic, and cardiac reserves. The London Chest Activity of Daily Living (LCADL) scale was only answered after the two Glittre ADL-test were performed. Patients were splited into two subgroups based on the anchor question of the LCADL: those with and those without self-reported ADL limitation. Sixty-two COPD patients were included (65.3 ± 8.6 years, FEV1 62 ± 22%pred). Those with ADL limitation (39 patients) completed the Glittre ADL-test with a significantly longer time (p = 0.002), as well as higher VEGlittre/MVV (p = 0.005) and lower oxygen pulse (p = 0.021) than those without ADL limitation. The time spent to perform the Glittre ADL-test was significantly associated with total LCADL score (ρ = 0.327, p < 0.05). A cutoff of 253 s was able to distinguish those patients without and with ADL limitation. COPD patients who self-reported ADL limitation according to the LCADL scale took a longer time to perform the Glittre ADL-test with higher VEGlittre/MVV and lower oxygen pulse than those without ADL limitation.
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Atividades Cotidianas , Teste de Esforço , Desempenho Físico Funcional , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Feminino , Volume Expiratório Forçado , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Ventilação Pulmonar , AutorrelatoRESUMO
The objective of this study was to investigate whether some activities of daily living (ADLs) usually related to dyspnea sensation in patients with chronic obstructive pulmonary disease (COPD) are associated with dynamic lung hyperinflation (DH) and whether the use of simple energy conservation techniques (ECTs) might reduce this possible hyperinflation. Eighteen patients (mean age: 65.8 ± 9.8 years) with moderate-to-severe COPD performed six ADLs (walking on a treadmill, storing pots, walking 56 meters carrying a 5-kilogram weight, climbing stairs, simulating taking a shower, and putting on shoes) and had their inspiratory capacity (IC) measured before and after each task. The patients were moderately obstructed with forced expiratory volume in 1 second (FEV1): 1.4 ± 0.4 L (50% ± 12.4); FEV1/forced vital capacity: 0.4 ± 8.1; residual volume/total lung capacity: 52.7 ± 10.2, and a reduction in IC was seen after all six activities (p < 0.05): (1) going upstairs, 170 mL; (2) walking 56 meters carrying 5 kilogram weight, 150 mL; (3) walking on a treadmill without and with ECT, respectively, 230 mL and 235 mL; (4) storing pots without and with ECT, respectively, 170 mL and 128 mL; (5) taking a shower without and with ECT, respectively, 172 mL and 118 mL; and (6) putting on shoes without and with ECT, respectively, 210 mL and 78 mL). Patients with moderate to severe COPD develop DH after performing common ADLs involving the upper and lower limbs. Simple ECTs may avoid DH in some of these ADLs.
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Atividades Cotidianas , Dispneia/prevenção & controle , Esforço Físico/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Dispneia/etiologia , Dispneia/fisiopatologia , Teste de Esforço , Volume Expiratório Forçado , Humanos , Capacidade Inspiratória , Remoção , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Índice de Gravidade de Doença , Caminhada/fisiologiaRESUMO
Patients with chronic obstructive pulmonary disease (COPD) usually complain of symptoms such as cough, sputum, wheezing, and dyspnea. Little is known about clinical symptoms in individuals with restrictive ventilatory impairment. The aim of this study was to compare the prevalence and type of respiratory symptoms in patients with COPD to those reported by individuals with restrictive ventilatory impairment in the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar study. Between 2002 and 2004, individuals ≥40 years of age from five cities in Latin America performed pre and post-bronchodilator spirometry and had their respiratory symptoms recorded in a standardized questionnaire. Among the 5315 individuals evaluated, 260 (5.1%) had a restrictive spirometric diagnosis (forced vital capacity (FVC) < lower limit of normal (LLN) with forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) ≥ LLN; American Thoracic Society (ATS)/European Respiratory Society (ERS) 2005) and 610 (11.9%) were diagnosed with an obstructive pattern (FEV1/FVC < LLN; ATS/ERS 2005). Patients with mild restriction wheezed more ((30.8%) vs. (17.8%); p < 0.028). No difference was seen in dyspnea, cough, and sputum between the two groups after adjusting for severity stage. The health status scores for the short form 12 questionnaire were similar in restricted and obstructed patients for both physical (48.4 ± 9.4 vs. 48.3 ± 9.8) and mental (50.8 ± 10.6 vs. 50.0 ± 11.5) domains. Overall, respiratory symptoms are not frequently reported by patients with restricted and obstructed patterns as defined by spirometry. Wheezing was more frequent in patients with restricted pattern compared with those with obstructive ventilatory defect. However, the prevalence of cough, sputum production, and dyspnea are not different between the two groups when adjusted by the same severity stage.
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Tosse/epidemiologia , Dispneia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Escarro/metabolismo , Adulto , Idoso , Tosse/etiologia , Dispneia/etiologia , Feminino , Volume Expiratório Forçado , Nível de Saúde , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Sons Respiratórios/etiologia , Espirometria , Inquéritos e Questionários , Capacidade VitalRESUMO
Functional status and quality of life are measures of the chronic obstructive pulmonary disease (COPD) patient's health status and can demonstrate the impact of the disease on the patient's ability to perform activities of daily living (ADLs). The Glittre-ADL test was developed to evaluate the functional status of COPD patients and their ability to perform activities of daily life. The objective of this study was to evaluate the cardiac, respiratory, and metabolic adjustments and reproducibility of the Glittre ADL test performed by COPD patients. Twenty-two mild to severe COPD patients (forced expiratory volume in 1 second (FEV1): 56.6 ± 19.9% predicted; mean age: 66.3 ± 9.18 years old) were enrolled in this study. Metabolic (oxygen uptake (VO2), carbon dioxide production (VCO2), pulmonary ventilation (VE)/VCO2, and VE/VO2), ventilatory (tidal volume, respiratory rate, and VE), and cardiovascular (pulse oxygen saturation, VO2/heart rate (HR), and HR) variables, lower limbs fatigue, and dyspnea (Borg score) after each lap of two Glittre ADL test were analyzed. All metabolic, ventilatory, and cardiac variables increased their values up to the third lap and remained stable (plateau) until the end of the test (five laps; multivariate analysis); there was no difference among the time spent to complete each of the five laps in each test and between tests (total time of second test: 4 minutes and 3 seconds); the second test was 17.8 seconds (6.6%) shorter than the first one (NS). All variables were highly reproducible in the two tests (NS). At the end of the test, patients reached 87.7% of the VO2 max, 81% of VE peak, and 88.5% of the HR peak obtained from an incremental maximal test on a treadmill. The Glittre ADL test is easy for COPD patients to perform and is a highly reproducible test in COPD patients with mild to severe stages of the disease. In addition, our results suggest that it is possible to demonstrate the patient's functional capacity with a single test of only three laps, making it faster and easier to apply and less stressful for some patients.
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Atividades Cotidianas , Teste de Esforço , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Caminhada/fisiologia , Idoso , Dispneia/etiologia , Feminino , Frequência Cardíaca , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fadiga Muscular , Oxigênio/sangue , Consumo de Oxigênio , Ventilação Pulmonar , Qualidade de Vida , Reprodutibilidade dos Testes , Taxa Respiratória , Volume de Ventilação PulmonarRESUMO
To assess healthcare resource utilization and costs of patients with asthma in Brazilian Supplementary Healthcare System, focusing on hospitalization data. Retrospective cohort study, using data from an administrative database of a private company (Orizon). Patients agedâ ≥â 12 years with at least one record of emergency visit/hospitalization in the database with the ICD-10 J45 between January/2010 and June/2015 were included and followed until June/2016, death or inactivation of health plan. Sociodemographic characteristics, emergency visit and hospital admission per patient per year (exacerbation rate), physician visit with a procedure, exams, length of hospitalization (with/without intensive care unit (ICU)), and in-hospital treatments were assessed. A total of 54,568 patients were included in this analysis. Regarding resource utilization, emergency visit and hospital admission rates of 0.34 and 0.04 per person-year were observed, respectively. Mean length of hospital stay were 8.82 (SDâ =â 36.48), 5.24 (SDâ =â 19.06) and 19.53 (63.89) days for hospitalizations in general, without and with ICU, respectively. An exacerbation rate of 0.36 per person year was observed with a mean cost per episode of 3178 Brazilian Real (BRL) (SDâ =â 31,667). Mean cost related to emergency department visits was estimated at 293 BRL (SDâ =â 328). Hospitalization costs were stratified by the need of ICU and values observed were of 9307 BRL (SDâ =â 18,979) without ICU, and 75,252 BRL (SDâ =â 174,248) with ICU need. Asthma exacerbations may cost ~75,000 BRL for an ICU-dependent event in the Supplementary Healthcare System. To improve disease control may reduce disease burden for both healthcare system and patients.
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Asma , Humanos , Brasil/epidemiologia , Estudos Retrospectivos , Asma/epidemiologia , Asma/terapia , Atenção à Saúde , HospitalizaçãoRESUMO
BACKGROUND: Oxygen therapy is an important therapeutic resource for patients with hypoxemia. When changing oxygen flow meters, we have observed that sometimes, even with the same oxygen flow setting as before, a different S(pO(2)) is obtained. OBJECTIVE: To analyze the precision and accuracy of flow meters used in hospital settings. METHODS: An experimental study was performed to test oxygen flow meters from a tertiary hospital, by using a calibrated flow analyzer. Used and new flow meter accuracy was tested by reading in the gas analyzer a single measurement at flow rates of 1, 3, 5, and 10 L/min in 91 flow meters, and they were compared using the Student t test or Mann-Whitney U test. Flow meter precision was tested by reading in the flow analyzer 3 repetitive measurements set at flow rates of 1, 3, 5, and 10 L/min in 11 flow meters, and the reproducibility of these measurements was conducted by using the intraclass correlation coefficient and the Friedman test. RESULTS: The mean measured flow rates were slightly lower than the stipulated flow rate at 1 L/min, very close for 3 L/min, and higher for the 5 and 10 L/min flow rates. There was a large variability among the measurements from different flow meters, mainly at low flow rates (1 and 3 L/min). There was no difference between new and used flow meters at the flow rates measured, except at 10 L/min. Flow meters precision analysis showed a good reproducibility in 3 repetitive measurements for each flow rate (minimum 0.95, maximum 0.99 intraclass correlations). CONCLUSIONS: The flow meters tested showed good precision and poor accuracy.
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Fluxômetros/normas , Oxigenoterapia/instrumentação , Calibragem , Hospitais , Humanos , Teste de Materiais , Consumo de Oxigênio , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Unstimulated whole salivary parameters have been identified as potential markers of hydration status. Reduced salivary flow rate and increased salivary osmolality have been shown to be useful to identify dehydration, even when minimal loss of body water occurs. This study aimed to evaluate whether unstimulated salivary flow rate and salivary osmolality from individuals with cerebral palsy correlate with plasma and urine osmolality. METHODS: Thirty-five male and female children, aged 9-13 years old, diagnosed with cerebral palsy were compared to 27 nondisabled children (10-12 years old). Unstimulated whole saliva was collected under slight suction and salivary flow rate (ml/min) was calculated. Plasma without venostasis and urine were also collected. Salivary, plasma and urine osmolality were measured using a freezing point depression osmometer. RESULTS: Cerebral palsy children presented a reduction in salivary flow rate (50%) compared to the control group (P < 0.01). Moreover, an increase in salivary (50%), plasma (3%), and urine osmolality (20%) was also observed in the cerebral palsy children compared to the control group (P < 0.01). Salivary flow rate was negatively correlated with the salivary, plasma and urine osmolality (P < 0.01). Salivary osmolality correlated positively with plasma and urine osmolality (P < 0.01). CONCLUSION: Cerebral palsy children seem to present impaired adequate hydration status. Since the possible hypohydration condition may be reflected in saliva fluid, which could compromise the protective function exerted by saliva, the earlier this condition is identified the greater the chances of administering preventive measures. Moreover, salivary osmolality is a reliable parameter that reflects changes in plasma and urine.
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Paralisia Cerebral/fisiopatologia , Saliva/química , Equilíbrio Hidroeletrolítico/fisiologia , Adolescente , Paralisia Cerebral/sangue , Paralisia Cerebral/urina , Criança , Feminino , Humanos , Masculino , Concentração Osmolar , Saliva/fisiologia , Taxa Secretória/fisiologia , Desequilíbrio Hidroeletrolítico/diagnósticoRESUMO
SARS coronavirus-2 (SARS-CoV-2) detection in different clinical specimens has raised important insights about its pathogenesis, but some details remain to be understood. In that respect, disrupt viral control seen in solid organ transplant patients on chronic immunosuppression can help unveil pathogenic mechanisms and characterize new coronavirus disease-19 (COVID-19) immunological and clinical aspects, as well as secondary complications. We herein report a case of SARS-CoV-2 detection in ascitic fluid from a kidney transplant patient with decompensated cirrhosis and COVID-19 and then discuss about immune, cellular, and virological aspects of such clinical presentation of the disease, which also included a disseminated infection, demonstrated by viral detection in his blood sample. We subsequently discuss about the fatal outcome caused by a secondary bloodstream infection by Cryptococcus neoformans. This unprecedented case report presents ascitic fluid as a novel specimen in which SARS-CoV-2 can be detected. Immune dysregulation and cumulative risk factors may lead to secondary infections by opportunistic agents, including Cryptococcus neoformans.
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It has been shown that the better outcomes of chronic obstructive pulmonary disease (COPD) are closely associated with adherence to drug therapy, independent of the treatment administered. The clinical trial Towards a Revolution in COPD Health (TORCH) study clearly showed in a three year follow up that patients with good adherence to their inhaler treatment presented a longer time before the first exacerbation, a lower susceptibility to exacerbation and lower all-cause mortality. The Latin American Study of 24-hour Symptoms in Chronic Obstructive Pulmonary Disease (LASSYC), a real-life study, evaluated the self-reported inhaler adherence in COPD patients in seven countries in a cross-sectional non-interventional study and found that approximately 50% of the patients had good adherence, 30% moderate adherence and 20% poor adherence. Adherence to inhaler may be evaluated by the specific inhaler adherence questionnaire, the Test of Adherence to Inhalers (TAI). Several factors may predict the incorrect use of inhalers or adherence in COPD outpatient, including the number of devices and the daily dosing frequency. Ideally, patient education, simplicity of the device operation, the use of just one device for multiple medications and the best adaptation of the patient to the inhaler should guide the physician in prescribing the device.
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BACKGROUND: Osteoporosis is a systemic skeletal disease characterized by low bone mass and/or microarchitectural deterioration of bone. Osteoporosis is a risk factor for fractures specially in patients with advanced COPD. The aim of this cross-sectional study was to determine the frequency of osteoporosis and vertebral fracture in COPD patients. METHODS: We evaluated 91 COPD patients and compared to 82 healthy subjects (control group) matched for gender and age. We measured the bone mineral density by means of dual energy X-ray absorptiometry (DXA), evaluating the lumbar vertebra (L1-L4), proximal femur and total femur and evaluated vertebral fractures in thoracic and lumbar spine using X-ray. We questioned patients whether they had had any fall that resulted in any fracture in the past five years. RESULTS: Males comprised 60.4% of COPD group and 57.3% of the control group. Mean age was 66.2±9.2 years for COPD group and 64.2±8.8 for the control group. The frequency of osteoporosis in the COPD group was 29.7% and 18.3% in control group (p=0.007). The frequency of vertebral fractures was 18.6% in the COPD group and 9.0% in control group (p=0.06). The frequency of reported falls at resulting in any fracture was 36.3% in the COPD group and 7.3% in control group (p=0.001). CONCLUSIONS: Our data indicate that COPD patients present a high frequency of osteoporosis and falls seem to be an important factor for vertebral fracture.
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Osteoporose/epidemiologia , Osteoporose/etiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Gastroesophageal reflux disease (GERD) is associated with different pulmonary diseases, including chronic obstructive pulmonary disease (COPD). Whether GERD is contributory to COPD severity remains unclear. This study aims to evaluate the contribution of GERD to the clinical manifestation of COPD based on ventilatory parameters and yearly clinical exacerbations. We studied 48 patients (56% females, age 66 years) with COPD. All patients underwent high-resolution manometry and esophageal pH monitoring. The patients were separated into two groups according to the presence of GERD. GERD was present in 21 (44%) patients. GERD + and GERD - groups did not differ in regard to gender, age, and body mass index. Pulmonary parameters were not different in the absence or presence of GERD. The number of yearly exacerbations was higher in patients GERD+. The severity of GERD (as measured by DeMeester score) correlated with the number of exacerbations. Our results show the following: 1) GERD does not influence pulmonary parameters and 2) GERD is associated with a higher number of annual clinical exacerbations. We believe GERD must be objectively tested in patients with COPD because the prevalence of GERD in these patients is underestimated when only symptoms are considered. GERD treatment might decrease the frequency of episodes of exacerbation.
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Monitoramento do pH Esofágico , Refluxo Gastroesofágico/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Índice de Massa Corporal , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversosRESUMO
OBJECTIVE: To evaluate the discriminative properties and validity of the Airways Questionnaire 20 (AQ20) in a sample of patients with airway obstruction and to compare its properties with those of the St George's Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36). PATIENTS AND METHODS: A convenience sample of 47 subjects was recruited from among 61 consecutive patients referred to an outpatient clinic specialized in obstructive airway diseases. All subjects completed the AQ20, SGRQ, and SF-36. Other measures were the baseline dyspnea index (BDI), 6-minute walk test (6MWT) distance, spirometry, results of arterial blood gas analysis, and body mass index. RESULTS: The AQ20 showed very good correlation with the SGRQ total score (rho=0.84, P< .001) and moderate correlation with all SF-36 domains (physical capacity, rho=-0.53; physical functioning, rho=-0.61; bodily pain, rho=-0.55; general health, rho=-0.59; vitality, rho=-0.55; social functioning, rho=-0.57; emotional role functioning, rho=-0.51; mental health, rho=-0.61; all P< .001). The BDI and the 6MWT distance were the best predictors of AQ20 score (r2=0.31) in the regression model. An area under the receiver operating characteristic curve of 0.91 (P< .001) indicated a high level of accuracy for the AQ20, using the SGRQ as the gold standard. CONCLUSION: This study shows that the AQ20 is an accurate health status questionnaire in patients with moderate-to-severe airway obstruction. It could be an alternative to longer, traditional questionnaires such as the SGRQ.
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Nível de Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) have body balance deficits, with consequent fall risk. It is possible that body sway in patients with COPD affects their ability to perform daily activities. The purpose of this study was to determine whether body balance is similar in patients with COPD and healthy persons when performing static and dynamic activities. In addition, we wanted to assess whether impairment of balance is related to the presence of falls in patients with COPD. METHODS: This is a cross-sectional study, in which every spirometric classification in patients with COPD (mild, moderate, severe, and very severe degrees) and age-matched healthy subjects was assessed. Subjects who were current smokers and patients who underwent physical training in the last 6 months prior to the start of the study were excluded. Static balance was assessed by computerized posturography and dynamic body balance using the Berg Balance Scale. RESULTS: Ninety-three patients with COPD and 39 healthy persons were evaluated. Mean age was 67.3 (10.8) and 65.1 (9.7) years and mean forced expiratory volume in 1 second (FEV1) was 50.4 (19.0) and 89.2 (23.6) for patients with COPD and healthy individuals, respectively. The impairment of body balance was higher for the group of patients with COPD (P = .0005). Patients with greater impairment in body balance had greater incidence of falls, and body balance was more affected with age in patients with COPD than in healthy persons. CONCLUSION: Impairment of body balance is more frequent in patients with COPD than in healthy persons while performing dynamic activities, and a greater incidence of falls activities was also found for this group.
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Acidentes por Quedas/prevenção & controle , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de RiscoRESUMO
BACKGROUND: The Glittre activities of daily living (ADL) test is supposed to evaluate the functional capacity of COPD patients. The physiological requirements of the test and the time taken to perform it by COPD patients in different disease stages are not well known. The objective of this work was to compare the metabolic, ventilatory, and cardiac requirements and the time taken to carry out the Glittre ADL test by COPD subjects with mild, moderate, and severe disease. METHODS: Spirometry, Medical Research Council questionnaire, cardiopulmonary exercise test, and 2 Glittre ADL tests were evaluated in 62 COPD subjects. Oxygen uptake (VÌO2 ), carbon dioxide production, pulmonary ventilation, breathing frequency, heart rate, SpO2 , and dyspnea were analyzed before and at the end of the tests. Maximum voluntary ventilation, Glittre peak VÌO2 /cardiopulmonary exercise test (CPET) peak VÌO2 , Glittre VÌE/maximum voluntary ventilation, and Glittre peak heart rate/CPET peak heart rate ratios were calculated to analyze their reserves. RESULTS: Subjects carried out the Glittre ADL test with similar absolute metabolic, ventilatory, and cardiac requirements. Ventilatory reserve decreased progressively from mild to severe COPD subjects (P < .001 for Global Initiative for Chronic Obstructive Lung Disease [GOLD] 1 vs GOLD 2, P < .001 for GOLD 1 vs GOLD 3, and P < .001 for GOLD 2 vs GOLD 3). Severe subjects with COPD presented a significantly lower metabolic reserve than the mild and moderate subjects (P = .006 and P = .043, respectively) and significantly lower Glittre peak heart rate/CPET peak heart rate than mild subjects (P = .01). Time taken to carry out the Glittre ADL test was similar among the groups (P = .82 for GOLD 1 vs GOLD 2, P = .19 for GOLD 1 vs GOLD 3, and P = .45 for GOLD 2 vs GOLD 3). CONCLUSIONS: As the degree of air-flow obstruction progresses, the COPD subjects present significant lower ventilatory reserve to perform the Glittre ADL test. In addition, metabolic and cardiac reserves may differentiate the severe subjects. These variables may be better measures to differentiate functional performance than Glittre ADL time.
Assuntos
Atividades Cotidianas , Avaliação da Deficiência , Dispneia/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Dispneia/etiologia , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Testes de Função Respiratória , EspirometriaRESUMO
INTRODUCTION: To evaluate if the association between the BODE index and deterioration in health-related quality of life is linear. To determine possible associations between the BODE index and health status evaluated by the Saint George's Respiratory Questionnaire (SGRQ) at all levels of disease severity in COPD. METHODS: A cross-sectional study was carried out on 253 patients from two Latin American respiratory centers (Brazil and Chile) with a clinical diagnosis of COPD, based on GOLD criteria. Assessment included the BODE index and the SGRQ questionnaire. RESULTS: Patients had a BODE index of 3.1±2.0; FEV1 (%) of 49±19.2; BMI (kg/m(2)) of 24.7±5.1; 6MWT distance (meters) of 444±96. Significant correlations were found between the BODE index and SGRQ total scores (r=0.5; <0.001), impact (r=0.45; <0.001) and activity (r=0.5; <0.001). From BODE score zero, HRQOL was already compromised in all SGRQ domains. SGRQ scores (total and domain) increased progressively for individual components of the BODE index, with the decrease in airflow limitation (<0.05), BMI (<0.002) and 6MWT (<0.05), and with the increase in the Modified Medical Research Council (MMRC) score (<0.05). CONCLUSION: There is an association between health-related quality of life, as assessed by the SGRQ and the BODE index within the entire spectrum of COPD severity. Even in early disease stages and BODE index zero, health-related quality of life is already impaired.
Assuntos
Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Índice de Gravidade de Doença , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Chile/epidemiologia , Estudos Transversais , Progressão da Doença , Dispneia/epidemiologia , Dispneia/etiologia , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Espirometria , Inquéritos e Questionários , Avaliação de SintomasRESUMO
BACKGROUND: Although the internet is an important tool for entertainment, work, learning, shopping, and communication, it is also a possible source for information on health and disease. The aim of this study was to evaluate the proportion of subjects with COPD in São Paulo, Brazil, who use the internet to obtain information about their disease. METHODS: Subjects (N = 382) with COPD answered a 17-question survey, including information regarding computer use, internet access, and searching for sites on COPD. Our sample was distributed according to the socioeconomic levels of the Brazilian population (low, 17.8%; medium, 66.5%; and high, 15.7%). RESULTS: Most of the subjects in the sample were male (62.6%), with a mean age of 67.0 ± 9.9 y. According to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, 74.3% of the subjects were in stage II or III. In addition, 51.6% of the subjects had a computer, 49.7% accessed the internet, and 13.9% used it to search for information about COPD. The internet was predominantly accessed by male (70.3%) and younger (64.6 ± 9.5 y of age) subjects compared with female (29.7%, P = .04) and older (67.5 ± 9.6 y of age, P < .007) subjects. Searching for information about COPD on the internet was associated with having a computer (5.9-fold), Medical Research Council dyspnea level 1 (5.3-fold), and high social class (8.4-fold). The search for information on COPD was not influenced by GOLD staging. CONCLUSIONS: A low percentage of subjects with COPD in São Paulo use the internet as a tool to obtain information about their disease. This search is associated with having a computer, low dyspnea score, and high socioeconomic level.
Assuntos
Informação de Saúde ao Consumidor/estatística & dados numéricos , Comportamento de Busca de Informação , Internet/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/psicologia , Fatores Etários , Idoso , Brasil , Computadores/estatística & dados numéricos , Informação de Saúde ao Consumidor/métodos , Dispneia/etiologia , Dispneia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The aim of this study was to develop an efficient, low-cost, home-based pulmonary rehabilitation program and to evaluate the impact of the program on exercise as measured by the 6-min walk test (6MWT) and treadmill endurance test. METHODS: Twenty-nine subjects with COPD (FEV1 = 62.4 ± 10.7% of predicted, 62.4 ± 10.7 y old) were included in a randomized and prospective pulmonary rehabilitation program, and they performed 24 sessions, 5 d/week. The control group included 15 subjects (FEV1 = 54 ± 26.2% of predicted, 65.3 ± 8 y old). They were evaluated pre-intervention and post-intervention by the 6MWT, St George Respiratory Questionnaire (SGRQ), treadmill endurance test, and spirometry. The home-based pulmonary rehabilitation program consisted of walking for 40 min along a corridor or a street, climbing stairs for 15 min, and exercising the arms with an oil can (1 kg) using diagonal movements for 15 min. Subjects were called once each week for encouragement and verification of adherence. Both groups received the usual pharmacologic treatment; in addition, the control group received a telephone call without guidance on exercise. RESULTS: The 2 groups were similar regarding age, FEV1, and FVC. The home-based pulmonary rehabilitation group increased by 65 m in the 6MWT (P < .05) and 316.6 ± 81.8 m in the endurance test (P < .05) and decreased by > 4 units in all SGRQ domains. The control group showed no difference in any variable. CONCLUSIONS: This study demonstrates that a simple, low-cost, home-based pulmonary rehabilitation program adapted to real-life situations leads to improvement in exercise capacity and quality of life.