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1.
Radiol. bras ; 55(4): 209-215, Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394566

ABSTRACT

Abstract Objective: To perform a quantitative assessment of bronchial wall thickening and the emphysema score in patients with stable chronic obstructive pulmonary disease (COPD), comparing the eosinophilic and non-eosinophilic COPD phenotypes. Materials and Methods: This was a retrospective observational study of patients with COPD followed between August 2018 and July 2019. The patients were divided into two groups by the eosinophil count in peripheral blood: eosinophilic (≥ 300 cells/µL); and non-eosinophilic (< 300 cells/µL). Quantitative, automated assessments of emphysema and bronchial wall thickness were performed by evaluating computed tomography scans of the chest. Results: We evaluated the records of 110 patients diagnosed with COPD: 28 (25.5%) in the eosinophilic group; and 82 (74.5%) in the non-eosinophilic group. The demographic, clinical, functional, and therapeutic variables were comparable between the two groups. There were no significant differences between the two groups in terms of the emphysema score or bronchial wall thickness (p > 0.05 for both). Conclusion: Patients with eosinophilic COPD do not appear to have lower emphysema scores or greater bronchial wall thickening than do those with non-eosinophilic phenotypes of the disease.


Resumo Objetivo: Avaliar quantitativamente o escore de enfisema e o espessamento da parede brônquica de pacientes com doença pulmonar obstrutiva crônica (DPOC) estável e comparar os fenótipos eosinofílico e não eosinofílico. Materiais e Métodos: Estudo observacional, transversal, retrospectivo, que avaliou pacientes com DPOC no período de agosto de 2018 a julho de 2019. Os pacientes foram separados dois grupos, de acordo com o número de eosinófilos periféricos: os eosinofílicos (≥ 300 células/µL) e os não eosinofílicos (< 300 células/µL). Foram realizadas avaliações quantitativas e automatizadas de enfisema e de espessamento brônquico para os dois grupos por meio de tomografia computadorizada de tórax. Resultados: Foram coletados dados de 110 pacientes com o diagnóstico de DPOC, dos quais 28 (25,5%) apresentaram perfil eosinofílico. As variáveis demográficas, clínicas, funcionais e terapêuticas do grupo dos pacientes com perfil eosinofílico foram semelhantes às do grupo não eosinofílico. Não se observaram diferenças significativas em relação ao escore de enfisema e à medida de espessura de parede brônquica entre os dois grupos (p > 0,05). Conclusão: Neste estudo, os pacientes com fenótipo eosinofílico não apresentaram menor escore de enfisema e nem maior espessamento parietal brônquico.

3.
Int. j. cardiovasc. sci. (Impr.) ; 35(3): 329-339, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1375636

ABSTRACT

Abstract Background: Right ventricular dysfunction is a major complication in chronic obstructive pulmonary disease (COPD) and, despite its prognostic implications, is rarely considered in routine clinical analysis. Objectives: To compare RV function variables with standard and advanced echocardiographic techniques in patients with stable COPD and controls. Methods: Twenty COPD patients classified as GOLD ≥ II (13 men aged 68.4 ± 8.3 years) and 20 matched controls were compared. Myocardial strain/strain rate indices were obtained by tissue Doppler and two-dimensional speckle tracking echocardiography. Right ventricular ejection fraction was obtained with three-dimensional software. Free wall myocardial thickness (FWMT) and tricuspid annular systolic excursion (TAPSE) were also measured. Numerical variables were compared between groups with Student's t-test or the Mann-Whitney test. Associations between categorical variables were determined with Fisher's exact test. P-values < 0.05 were considered statistically significant. Results: All myocardial deformation indices, particularly global longitudinal strain (-17.2 ± 4.4 vs -21.2: ± 4.4 = 0.001) and 3D right ventricular ejection fraction (40.8 ± 9.3% vs 51.1 ± 6.4% p <0.001) were reduced in COPD patients. These patients presented higher right ventricular FWMT and lower TAPSE values than controls. Conclusion: Myocardial deformation indices, either tissue Doppler or speckle tracking echocardiography and 3D right ventricular ejection fraction, are robust markers of right ventricular dysfunction in patients with stable COPD. Assessing global longitudinal strain by speckle tracking echocardiography is a more practical and reproducible method.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Ventricular Dysfunction, Right/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Case-Control Studies , Cross-Sectional Studies , Ventricular Dysfunction, Right/etiology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/therapy , Myocardium
4.
MedUNAB ; 25(1): 42-51, 202205.
Article in Spanish | LILACS | ID: biblio-1372552

ABSTRACT

Introducción. La enfermedad pulmonar obstructiva crónica es un problema de salud pública a nivel mundial y el cese del consumo de tabaco es la medida más efectiva para disminuir la incidencia y su progresión. Esta medida es especialmente eficaz en personas envejecidas, en quienes las consecuencias son más agudas a causa de los cambios biopsicosociales, cambios que aumentan la probabilidad de infecciones, dependencia funcional y fragilidad. El objetivo de este reporte es describir los cambios en el hábito tabáquico de una persona mayor con enfermedad pulmonar obstructiva crónica, tras ser incluida en un plan de cuidado organizado y según las etapas del proceso de Enfermería dirigido al cese del hábito tabáquico. Metodología. Reporte de caso de Enfermería bajo el Modelo de Promoción de la Salud de Nola Pender y el proceso de Enfermería, articulado con la taxonomía diagnóstica North American Nursing Diagnosis Association International, la Clasificación de Resultados de Enfermería (Nursing Outcomes Classification) y la Clasificación de Intervenciones de Enfermería (Nursing Interventions Classification). Resultados. Tras el proceso de Enfermería se evidencia la cesación del hábito tabáquico en la persona mayor y se destaca en el proceso la participación del núcleo familiar y el reconocimiento de los riesgos en salud asociados. Conclusiones. Se reconoce el rol de Enfermería como preponderante en la prevención y el abandono del hábito tabáquico que, orientado por un proceso de cuidado organizado, con respaldo disciplinar y científico, ayuda a mejorar el estado de salud y manejo de los factores de riesgo.


Introduction. Quitting tobacco consumption is the most effective measure for reducing the incidence and progression of chronic obstructive pulmonary disease, which is a global public health issue. This measure is especially effective in seniors, in whom the consequences are more acute due to biopsychosocial changes, changes that increase the probability of infection, functional dependence and fragility. The objective of this report is to describe the changes in the tobacco habits of a senior with chronic obstructive pulmonary disease after being included in an organized health care plan according to the Nursing process' stages for quitting tobacco habits. Methodology. A nursing case report under Nola Pender's Health Promotion Model and the Nursing process, articulated with the diagnostic taxonomy North American Nursing Diagnosis Association International, Nursing Outcomes Classification and Nursing Interventions Classification. Results. It was evident the senior quit their tobacco habits after the Nursing process was carried out, and participation from family members and recognition of the associated health risks stood out in the process. Conclusions. The role of Nursing is pivotal in preventing and quitting tobacco habits, which, guided by an organized health care process with disciplinary and scientific support, helps improve health conditions and manage risk factors.


Introdução. A doença pulmonar obstrutiva crônica é um problema de saúde pública global e a cessação do consumo de tabaco é a medida mais eficaz para reduzir sua incidência e progressão. Essa medida é especialmente eficaz em idosos, nos quais as consequências são mais agudas devido a alterações biopsicossociais, alterações que aumentam a probabilidade de infecções, dependência funcional e fragilidade. O objetivo deste relato é descrever as mudanças no hábito de fumar de um idoso com doença pulmonar obstrutiva crônica, após a inclusão em um plano de cuidados organizado e de acordo com as etapas do processo de Enfermagem visando a cessação do tabagismo. Metodologia. Relato de caso de Enfermagem sob o Modelo de Promoção da Saúde de Nola Pender e o processo de Enfermagem, articulado com a taxonomia diagnóstica North American Nursing Diagnosis Association International, a Classificação de Resultados de Enfermagem Nursing Outcomes Classification e a Classificação de Intervenções de Enfermagem Nursing Interventions Classification. Resultados. Após o processo de Enfermagem, evidencia-se a cessação do tabagismo no idoso e destaca-se a participação do núcleo familiar e o reconhecimento dos riscos à saúde associados no processo. Conclusões. O papel da Enfermagem é reconhecido como preponderante na prevenção e cessação do tabagismo, o que, pautado por um processo assistencial organizado, com respaldo disciplinar e científico, auxilia na melhoria do estado de saúde e no manejo dos fatores de risco.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Aged , Smoking Cessation , Evidence-Based Nursing , Standardized Nursing Terminology , Nursing Process
5.
Rev. chil. enferm. respir ; 38(1): 11-19, mar. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388167

ABSTRACT

Resumen El uso de escalas de predicción clínica puede incrementar la detección temprana de enfermedad pulmonar obstructiva crónica (EPOC). Su rendimiento en población latinoamericana ha sido pobremente estudiado. Nuestro objetivo fue determinar la validez y reproducibilidad del cuestionario PUMA, como herramienta de tamización en atención primaria en población colombiana, mediante un estudio tipo corte transversal; donde se establecieron las características operativas del cuestionario, área bajo la curva de características operativas del receptor (ACOR) y el mejor punto de corte para esta población. 1.980 sujetos fueron incluidos en el análisis. La prevalencia de EPOC correspondió a 18,9%. La capacidad discriminatoria del cuestionario fue de 0,69 (IC95%: 0,66-0,72), para un punto de corte óptimo mayor de 5, con una sensibilidad del 60%, especificidad 66% y un valor predictivo negativo de 88%. La escala PUMA para tamizaje de pacientes en riesgo de EPOC tiene una capacidad discriminatoria moderada y una excelente reproducibilidad en la población estudiada.


The use of clinical prediction scales may increase the early detection of chronic obstructive pulmonary disease (COPD). The performance characteristics of these scales in the Latin American population is poorly studied. We aimed to evaluate validity and reproducibility of PUMA questionnaire as a screening tool in primary care in a Colombian population. A cross-sectional study was performed. Operational characteristics of the questionnaire, the area under the received operator curve (AUROC), and the best cut-off point of the score were calculated. 1,980 individuals were included in this analysis. Prevalence of COPD was 18.9%. AUROC of the questionary was 0.69 (CI95%: 0.66-0.72), with an optimal cut-off point greater than 5 (sensitivity 60%, specificity 66%); predictive negative value was 88%. PUMA's scale for the screening of patients at risk of COPD has a moderate accuracy and an excellent reproducibility in the studied population.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Primary Health Care , Surveys and Questionnaires , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Mass Screening , Prevalence , Cross-Sectional Studies , Predictive Value of Tests , Reproducibility of Results , Sensitivity and Specificity , Colombia/epidemiology
6.
J. bras. pneumol ; 48(3): e20210340, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1375742

ABSTRACT

ABSTRACT Objective: To evaluate clinical predictors of poor sleep quality in COPD patients with and without obstructive sleep apnea (OSA). Methods: Consecutive stable patients with COPD were evaluated for OSA by means of overnight polysomnography; for sleep quality by means of the Pittsburgh Sleep Quality Index (PSQI); and for disease impact by means of the COPD Assessment Test. COPD severity was graded in accordance with the 2020 GOLD guidelines. Predictors of poor sleep quality were evaluated by multivariate logistic regression analysis. Results: We studied 51 patients with COPD alone and 51 patients with COPD and OSA. Both groups had similar age (66.2 ± 9.2 years vs. 69.6 ± 10.7, p = 0.09) and airflow limitation (p = 0.37). Poor sleep quality was present in 74.8% of the study participants, with no significant difference between COPD patients with and without OSA regarding PSQI scores (p = 0.73). Polysomnography showed increased stage 1 non-rapid eye movement sleep and arousal index, as well as reduced sleep efficiency and stage 3 non-rapid eye movement sleep, in the group of patients with COPD and OSA (p < 0.05). Independent predictors of poor sleep quality were GOLD grade C/D COPD (OR = 6.4; 95% CI, 1.79-23.3; p < 0.01), a COPD Assessment Test score ≥ 10 (OR = 12.3; 95% CI, 4.1-36.5; p < 0.01), and lowest SaO2 < 80% (p < 0.0001). Conclusions: Poor sleep quality is quite common in patients with COPD and is associated with severe COPD and poor health status, having a negative impact on overall quality of life. Despite changes in polysomnography, OSA appears to have no impact on subjective sleep quality in COPD patients.


RESUMO Objetivo: Avaliar os preditores clínicos de má qualidade do sono em pacientes com DPOC, com e sem apneia obstrutiva do sono (AOS). Métodos: Pacientes estáveis consecutivos com DPOC foram avaliados quanto à AOS por meio de polissonografia noturna; quanto à qualidade do sono por meio do Índice de Qualidade do Sono de Pittsburgh (IQSP) e quanto ao impacto da doença por meio do Teste de Avaliação da DPOC. A gravidade da DPOC foi classificada conforme as diretrizes de 2020 da GOLD. Os preditores de má qualidade do sono foram avaliados por meio de análise de regressão logística multivariada. Resultados: Foram estudados 51 pacientes com DPOC apenas e 51 pacientes com DPOC e AOS. Ambos os grupos eram semelhantes quanto à idade (66,2 ± 9,2 anos vs. 69,6 ± 10,7, p = 0,09) e limitação do fluxo aéreo (p = 0,37). Sono de má qualidade esteve presente em 74,8% dos participantes, sem diferença significativa entre os pacientes com DPOC, com e sem AOS, quanto à pontuação no IQSP (p = 0,73). A polissonografia mostrou aumento do estágio 1 do sono non-rapid eye movement e do índice de despertares, bem como redução da eficiência do sono e do estágio 3 do sono non-rapid eye movement nos pacientes com DPOC e AOS (p < 0,05). Os preditores independentes de má qualidade do sono foram DPOC grau C/D da GOLD (OR = 6,4; IC95%: 1,79-23,3; p < 0,01), pontuação ≥ 10 no Teste de Avaliação da DPOC (OR = 12,3; IC95%: 4,1-36,5; p < 0,01) e menor SaO2 < 80% (p < 0,0001). Conclusões: O sono de má qualidade é bastante comum em pacientes com DPOC e apresenta relação com DPOC grave e estado de saúde ruim, além de ter impacto negativo na qualidade de vida global. Não obstante as alterações na polissonografia, a AOS aparentemente não tem impacto na qualidade do sono referida por pacientes com DPOC.

7.
HU rev ; 48: 1-9, 2022.
Article in Portuguese | LILACS | ID: biblio-1371593

ABSTRACT

Introdução: A doença pulmonar obstrutiva crônica (DPOC) possui alta prevalência e gera altos custos aos sistemas de saúde. A reabilitação pulmonar (RP) é uma intervenção não-farmacológica que gera benefícios clínicos para os pacientes e economia de gastos para o sistema de saúde devido a redução do número de exacerbações da doença e internações hospitalares. Embora fortemente recomendada, a RP tem sido subutilizada havendo um baixo índice de indicações. Objetivo: Identificar as barreiras e os facilitadores para o encaminhamento de pacientes com DPOC à RP e à prática de atividade física. Métodos: Estudo qualitativo, realizado com médicos atuantes na atenção primária à saúde (APS) e uso de entrevistas semiestruturadas. As entrevistas foram gravadas e transcritas literalmente e submetidas a análise de conteúdo. Itens (trechos) identificados nos discursos e relacionados ao encaminhamento de pacientes com DPOC à RP e à prática de atividade física foram classificados como barreiras ou facilitadores. Tal classificação se baseou entre os quatorze domínios da Theoretical Domains Framework (TDF) e suas definições para identificar determinantes de comportamento entre os participantes relevantes para a mudança na prática clínica. Resultados: Setecentos e cinquenta e seis itens foram identificados nos discursos de vinte e um participantes e classificados como sendo barreiras (n= 279, 37%) ou facilitadores (n= 477, 63%) relacionados principalmente aos domínios da TDF de "Conhecimento" (n= 245, 32%), "Contexto e recursos ambientais" (n= 124, 16%) e "Papel e identidade social/profissional" (n= 107, 14%). Conclusão: As principais barreiras identificadas foram relacionadas aos programas de RP devido ao conhecimento restrito dos profissionais médicos sobre programas de RP, a disponibilidade reduzida de locais que oferecem estes programas e as dificuldades de acesso dos pacientes à RP. Os principais facilitadores identificados foram relacionados a orientação e o conhecimento pelos médicos sobre os benefícios da atividade física e a presença dos grupos de exercícios fornecidos na APS.


Introduction: Chronic obstructive pulmonary disease (COPD) has a high prevalence and entails high costs to health systems. Pulmonary rehabilitation (PR) is a non-pharmacological intervention that generates clinical benefits for patients and cost savings for the health system due to a reduced number of exacerbations and hospitalizations. Although strongly recommended, PR has been underutilized, with a low rate of indications. Objective: To identify barriers and facilitators for referring patients with COPD to PR and physical activity. Method: Qualitative study was carried out with medical staff working in primary health care using semi-structured interviews. The interviews were recorded, transcribed literally and underwent content analysis. Items (text excerpts) identified in the speeches and related to the referral of patients with COPD to PR and physical activity were classified according to as barriers or facilitators, and among the fourteen domains of the Theoretical Domains Framework (TDF) and its definitions; aiming to identify the determinants of behaviour which were relevant to change in clinical practice. Results: Seven hundred and fifty-six items were identified in the speeches of twenty-one participants and classified as barriers (n= 279, 37%) or facilitators (n= 477, 63%) mainly related to the TDF domains of "Knowledge" (n= 245, 32%), "Context and environmental resources" (n=124, 16%) and "Role and social/professional identity" (n= 107, 14%). Conclusion: The main barriers identified were related to referring patients PR due to lack of knowledge by medical staff about PR programs, the limited number of programs available, and the restricted access to PR program locations. The main facilitators were related to physical activity, mainly the medical staff's knowledge on physical activity benefits and availability of exercise group activities delivered at primary health care centres.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Primary Health Care , Rehabilitation , Exercise , Prevalence , Health Resources
8.
Rev. saúde pública (Online) ; 56: 46, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1377219

ABSTRACT

ABSTRACT OBJECTIVE To evaluate the relationship between ambient air pollutants and chronic obstructive pulmonary disease in relatively low-polluted areas in China. METHODS Atmospheric pollutants levels and meteorological data were obtained from January 2016 to December 2020. The medical database including daily hospital admissions for chronic obstructive pulmonary disease (ICD10: J44) was derived from the First Affiliated Hospital of Gannan Medical University. The generalized additive model was used to analyze the percentage change with 95% confidence interval in daily hospital admissions for chronic obstructive pulmonary disease associated with a 10 µg/m3 increase in atmospheric pollutants levels. RESULTS In total, occurred 4,980 chronic obstructive pulmonary disease hospital admissions (not including emergency department visits) during 2016-2020. The mean concentrations of daily PM2.5, PM10, SO2, NO2, O3, and CO were 37.5 μg/m3, 60.1 μg/m3, 18.7 μg/m3, 23.5 μg/m3, 70.0 μg/m3, and 1.2 mg/m3 in Ganzhou. Each 10 µg/m3 increment of PM2.5, PM10, NO2, and O3 were significantly associated with 2.8% (95%CI: 1.0-4.7), 1.3% (95%CI: 0.3-2.4), 2.8% (95%CI: 0.4-5.4), and 1.5% (95%CI: 0.2-2.7) elevation in daily chronic obstructive pulmonary disease hospital admissions. The estimates of delayed effects of PM2.5, PM10, NO2, and O3 were observed at lag6, lag6, lag8, lag1, respectively. The health effects of particulate pollutants (PM2.5 and PM10) may be independent of other pollutants. The adverse effects of air pollutants were more evident in the warm season (May-Oct) than in the cold season (Nov-Apr). CONCLUSION Our study demonstrated that elevated concentrations of atmospheric pollutant (PM2.5, PM10, NO2, and O3), especially particulate pollutants, can be associated with increased daily count of hospital admissions for chronic obstructive pulmonary disease , which may promote further understanding of the potential hazards of relatively low levels of air pollution on chronic obstructive pulmonary disease and other respiratory disorders.

9.
Fisioter. Pesqui. (Online) ; 28(2): 145-150, abr.-jun. 2021. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1339912

ABSTRACT

RESUMO A doença pulmonar obstrutiva crônica (DPOC) é altamente limitante, tanto nos aspectos físicos, quanto socioemocionais, causando dificuldades significativas no cotidiano dos pacientes. Além de afetar os pacientes, a DPOC também influência na vida dos familiares e amigos próximos, pois deles vem a rede de apoio de que os pacientes necessitam. O objetivo deste artigo é avaliar a funcionalidade da família no cotidiano de pacientes acometidos por DPOC. É um estudo transversal que avaliou a funcionalidade de família de pacientes com DPOC em diferentes estágios da doença e que realizam Programa Reabilitação Cardiorrespiratória (PRC). Utilizou-se o instrumento APGAR de Família, sendo este, um acrônimo caracterizado por A = (Adaptation/Adaptação), P = (Partnership/Companheirismo), G = (Grow/Desenvolvimento), A = (Affection/Afetividade), R = (Resolve/Capacidade resolutiva), composto por 5 questões avaliadas em "sempre", "algumas vezes" e "nunca", o que somados resultam em "elevada disfunção familiar", moderada disfunção familiar" e "boa funcionalidade familiar". Foram avaliados 21 pacientes DPOC [sexo masculino (n=11; 52,3%); idade média 66,3±10 anos], com estadiamento entre moderado a muito severo. Através do APGAR da Família identificamos 2 pacientes com elevada disfunção familiar; 2 pacientes com moderada disfunção familiar; 17 pacientes com boa funcionalidade familiar. Dos que relataram elevada e moderada disfunção familiar, os acrômios mais comprometidos foram "companheirismo", "afetividade" e "desenvolvimentos". O grau de obstrução das vias áreas associou-se moderada e positivamente com a funcionalidade da família (r = 0,697; p = 0,004). Pacientes com DPOC participantes do PRC apresentaram boa funcionalidade familiar no seu cotidiano e a gravidade da doença esteve associada a esta funcionalidade. Pacientes que apresentaram maior disfunção familiar relataram falta de "companheirismo", "afetividade" e "desenvolvimentos".


RESUMEN La enfermedad pulmonar obstructiva crónica (EPOC) es muy limitante, tanto en aspectos físicos como socioemocionales, causando dificultades significativas en la vida diaria de los pacientes. Además de afectar a los pacientes, la EPOC también influye en la vida de los familiares y amigos cercanos, ya que de ellos proviene la red de apoyo que los pacientes necesitan. El objetivo de este artículo es evaluar la funcionalidad de la familia en la vida cotidiana de los pacientes afectados por EPOC. Se trata de un estudio transversal que evaluó la funcionalidad familiar de pacientes con EPOC en diferentes etapas de la enfermedad y que realizan un Programa de Rehabilitación Cardiaca (PRC). Se utilizó el instrumento APGAR familiar, que es un acrónimo caracterizado por A = (Adaptation/Adaptación), P = (Partnership/Compañerismo), G = (Grow/Desarrollo), A = (Affection/Afectividad), R = (Resolve/Capacidad de resolución), compuesto por 5 preguntas evaluadas en "siempre", "a veces" y "nunca", que combinadas resultan en "disfunción familiar severa", "disfunción familiar moderada" y "buena funcionalidad familiar". Se evaluaron 21 pacientes con EPOC [sexo masculino (n=11; 52,3%); edad media 66,3±10 años], con una estadificación que varía de moderada a muy grave. A través del APGAR familiar identificamos 2 pacientes con severa disfunción familiar; 2 pacientes con disfunción familiar moderada; 17 pacientes con buena funcionalidad familiar. De los que relataron disfunción familiar severa y moderada, los acrónimos más comprometidos fueron "compañerismo", "afectividad" y "desarrollo". El grado de obstrucción de las vías se asoció moderada y positivamente con la funcionalidad de la familia (r=0,697; p=0,004). Los pacientes con EPOC que participaron en el PCR presentaron una buena funcionalidad familiar en su vida diaria y la gravedad de la enfermedad se asoció a esta funcionalidad. Los pacientes que presentaron mayor disfunción familiar relataron falta de "compañerismo", "afectividad" y "desarrollo".


ABSTRACT Background: Chronic Obstructive Pulmonary Disease (COPD) is highly limiting, both physically and socio-emotionally, causing significant difficulties in the daily lives of patients. In addition, COPD also influences the lives of family and friends, because theirs who come to the support network that patient need. Objective: To evaluate the family functionality in the daily life of COPD patients. Methods: This cross-sectional study evaluated the family functionality in COPD patients with different stages of disease and underwent Cardiorespiratory Rehabilitation Program (CRP). The Family APGAR instrument was used and it is an acronym characterized by A = (Adaptation / Adaptation), P = (Partnership / Companionship), G = (Grow / Development), A = (Affection / Affectivity), R = (Resolve / Resolving capacity), composed of 5 questions assessed in "always", "sometimes" and "never", which together result in "high family dysfunction", moderate family dysfunction "and" good family functionality". We evaluated 21 COPD patients [male gender (n = 11; 52.3%); mean age 66.3 ± 10 years], status disease between moderate to very severe. Through of the Family APGAR we identified 2 patients with high family dysfunction; 2 patients with moderate family dysfunction; 17 patients with good family functionality. Among those who reported high and moderate family dysfunction, the most compromised acromia's were "companionship", "affection" and "developments". The degree of airway obstruction was moderately and positively associated with family functionality (r = 0.697; p = 0.004). Patients with COPD who participated in CRP had good family functionality in their daily lives and the severity of the disease was associated with this functionality. Patients with high family dysfunction reported lack of "companionship", "affection" and "developments".

10.
Rev. cir. traumatol. buco-maxilo-fac ; 21(2): 14-21, abr.-jun. 2021. ilus, tab
Article in Portuguese | LILACS, BBO | ID: biblio-1382252

ABSTRACT

Objetivo: O objetivo dessa revisão sistematizada da literatura foi analisar a associação entre o uso de próteses dentárias removíveis e doenças respiratórias prevalentes. Materiais e métodos: Este estudo foi conduzido seguindo os critérios do PRISMA check-list (Preferred Reporting Items for Systematic Review and Meta-Analysis). A base de dados eletrônica selecionada foi a PubMed/MEDLINE, sem restrições do ano de publicação. Estudos prospectivos e retrospectivos (ensaios clínicos randomizados, ensaios clínicos controlados, estudos de coorte, estudos caso-controle e estudos transversais), estudos in vitro e publicados em inglês foram escolhidos como critérios de elegibilidade. Resultados: A busca inicial na base de dados obteve 553 artigos e 8 deles foram selecionados baseados nos critérios de elegibilidade e subdivididos em dois tópicos: doença pulmonar obstrutiva crônica e pneumonia por aspiração. Conclusão: Com base nos estudos avaliados existe associação entre as próteses dentárias removíveis contaminadas e doenças respiratórias... (AU)


Objective: The purpose of this review was to analyze the association between the use of removable dental prostheses and the prevalence of respiratory diseases. Methodology: This study was conducted following the criteria of PRISMA check-list (Preferred Reporting Items for Systematic Review and Meta-Analysis). The database selected was PubMed/MEDLINE, with no restrictions on the year of publication. Prospective and retrospective studies (randomized clinical trials, controlled clinical trials, cohort studies, case-control studies and cross-sectional studies), in vitro studies and published in English were selected in tehe eligibility criteria. Results: The search in the database obtained 553 articles and 8 of them were selected based on the eligibility criteria and subdivided into two topics: chronic obstructive pulmonary disease and aspiration pneumonia. Conclusion: Based on the studies evaluated, there is an association between contaminated removable dental prostheses and respiratory diseases... (AU)


Subject(s)
Pneumonia, Aspiration , Prostheses and Implants , Respiratory Tract Diseases , Pulmonary Disease, Chronic Obstructive
12.
Arq. bras. cardiol ; 116(2): 295-302, fev. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1152994

ABSTRACT

Resumo Fundamento O padrão pressórico não-dipper é definido por uma redução inferior a 10% na pressão arterial noturna e está associado a doenças cardiovasculares. Acredita-se que a inflamação desempenhe um papel na patogênese da doença pulmonar obstrutiva crônica (DPOC) e no padrão pressórico não-dipper e ambas as doenças estão associadas a uma qualidade de vida mais baixa. Objetivo O objetivo deste estudo foi o de investigar os efeitos do padrão pressórico não-dipper em pacientes com DPOC. Métodos Foi realizado um estudo transversal incluindo 142 pacientes com DPOC. O Questionário Respiratório de Saint George e a Escala de Qualidade de Vida Euro foram utilizados para a coleta de dados. Para entender a rigidez arterial, o índice de aumento e a velocidade da onda de pulso foram medidos; subsequentemente, foi realizada a monitorização ambulatorial da pressão arterial de 24 horas. Foi aplicado um modelo de regressão logística multivariável para entender a relação entre as diferentes variáveis independentes e o padrão pressórico. Foram considerados estatisticamente significativos valores de p inferiores a 0,05. Resultados Como resultado, 76,1% (n = 108) dos pacientes apresentaram o padrão pressórico não-dipper. Os pacientes com padrão não-dipper apresentaram valores mais altos de proteína C reativa (OR: 1,123; IC 95%: 1,016;1,242), índice de aumento (OR: 1,057; IC 95%: 1,011;1,105) e pontuação total no Questionário Respiratório de Saint George (OR: 1,021; IC 95%: 1,001;1,042), em comparação com os pacientes com padrão dipper. Adicionalmente, com o aumento do número de pessoas que habitavam o domicílio, verificou-se que o padrão pressórico não-dipper era mais frequente (OR: 1,339; IC 95%:1,009;1,777). Conclusão O padrão pressórico não-dipper pode aumentar o risco cardiovascular ao desencadear a inflamação e pode afetar adversamente o prognóstico da DPOC diminuindo a qualidade de vida relacionada à doença. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Non-dipper blood pressure is defined by less than a 10% reduction in nighttime blood pressure, and it is associated with cardiovascular disease. Inflammation is thought to play a role in the pathogenesis of both chronic obstructive pulmonary disease (COPD) and non-dipper blood pressure pattern, and both diseases are associated with lower quality of life. Objective The aim of this study was to investigate the effects of non-dipper blood pressure pattern in patients with COPD. Methods A cross-sectional study was carried out with 142 patients with COPD. The Saint George Respiratory Questionnaire and the Euro Quality of Life Scale were used to collect data. To understand arterial stiffness, the augmentation index and pulse wave velocity were measured, and 24-hour ambulatory blood pressure monitoring was subsequently performed. A multivariable logistic regression model was used to understand the relationship between different independent variables and blood pressure pattern. P values lower than 0.05 were considered statistically significant. Results As a result, 76.1% (n = 108) of the patients had non-dipper blood pressure pattern. Non-dipper patients had higher C-reactive protein (OR:1.123; 95% CI:1.016;1.242), augmentation index (OR: 1.057; 95% CI: 1.011;1.105) and Saint George Respiratory Questionnaire total score (OR: 1.021; 95% CI: 1.001;1.042) than dipper patients. Also, as the number of people living at home increased, non-dipper blood pressure pattern was found to be more frequent (OR: 1.339; 95% CI: 1.009;1.777). Conclusion Non-dipper blood pressure pattern may increase cardiovascular risk by triggering inflammation and may adversely affect the prognosis of COPD by lowering the disease-related quality of life. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive , Hypertension , Quality of Life , Blood Pressure , Cross-Sectional Studies , Circadian Rhythm , Blood Pressure Monitoring, Ambulatory , Pulse Wave Analysis
13.
Arq. bras. cardiol ; 116(2): 259-265, fev. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1152999

ABSTRACT

Resumo Fundamento A dispneia por esforço é uma queixa comum de pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP) e doença pulmonar obstrutiva crônica (DPOC). A ICFEP é comum na DPOC e é um fator de risco independente para a progressão e exacerbação da doença. A detecção precoce, portanto, tem grande relevância clínica. Objetivos O objetivo deste estudo foi detectar a frequência de ICFEP mascarada em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular manifesta, e analisar a correlação entre ICFEP mascarada e os parâmetros do teste cardiopulmonar de exercício (TCPE). Métodos Aplicamos o TCPE em 104 pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. A ecocardiografia foi realizada antes e no pico do TCPE. Os valores de corte para disfunção diastólica ventricular esquerda e direita induzida por estresse (DDVE/DDVD) foram E/e' >15; E/e' >6, respectivamente. A análise de correlação foi feita entre os parâmetros do TCPE e o estresse E/d'. Valor de p<0,05 foi considerado significativo. Resultados 64% dos pacientes tinham DDVE induzida por estresse; 78% tinham DDVD induzida por estresse. Ambos os grupos com estresse DDVE e DDVD obtiveram carga menor, V'O2 e pulso de O2 mais baixos, além de apresentarem redução na eficiência ventilatória (maiores inclinações de VE/VCO2). Nenhum dos parâmetros do TCPE foram correlacionados com E/e' DDVE/DDVD induzida por estresse. Conclusão Há uma alta prevalência de disfunção diastólica induzida por estresse em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. Nenhum dos parâmetros do TCPE se correlaciona com E/e' induzida por estresse. Isso demanda a realização de Ecocardiografia sob estresse por exercício (EES) e TCPE para detecção precoce e manejo adequado da ICFEP mascarada nesta população. (Arq Bras Cardiol. 2021; 116(2):259-265)


Abstract Background Exertional dyspnea is a common complaint of patients with heart failure with preserved ejection fraction (HFpEF) and chronic obstructive pulmonary disease (COPD). HFpEF is common in COPD and is an independent risk factor for disease progression and exacerbation. Early detection, therefore, has great clinical relevance. Objectives The aim of the study is to detect the frequency of masked HFpEF in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease, and to analyze the correlation between masked HFpEF and the cardiopulmonary exercise testing (CPET) parameters. Methods We applied the CPET in 104 non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. Echocardiography was performed before and at peak CPET. Cut-off values for stress-induced left and right ventricular diastolic dysfunction (LVDD/ RVDD) were E/e'>15; E/e'>6, respectively. Correlation analysis was done between CPET parameters and stress E/e'. A p-value <0.05 was considered significant. Results 64% of the patients had stress-induced LVDD; 78% had stress-induced RVDD. Both groups with stress LVDD and RVDD achieved lower load, lower V'O2 and O2-pulse, besides showing reduced ventilatory efficiency (higher VE/VCO2 slopes). None of the CPET parameters were correlated to stress-induced left or right E/e'. Conclusion There is a high prevalence of stress-induced diastolic dysfunction in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. None of the CPET parameters correlates to stress-induced E/e'. This demands the performance of Exercise stress echocardiography (ESE) and CPET for the early detection and proper management of masked HFpEF in this population. (Arq Bras Cardiol. 2021; 116(2):259-265)


Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Heart Failure/diagnostic imaging , Stroke Volume , Exercise Tolerance , Echocardiography, Stress
14.
J. bras. pneumol ; 47(3): e20200612, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286950

ABSTRACT

ABSTRACT Objective: Impaired respiratory mechanics and gas exchange may contribute to sleep disturbance in patients with COPD. We aimed to assess putative associations of different domains of lung function (airflow limitation, lung volumes, and gas exchange efficiency) with polysomnography (PSG)-derived parameters of sleep quality and architecture in COPD. Methods: We retrospectively assessed data from COPD 181 patients ≥ 40 years of age who underwent spirometry, plethysmography, and overnight PSG. Univariate and multivariate linear regression models predicted sleep efficiency (total sleep time/total recording time) and other PSG-derived parameters that reflect sleep quality. Results: The severity of COPD was widely distributed in the sample (post-bronchodilator FEV1 ranging from 25% to 128% of predicted): mild COPD (40.3%), moderate COPD (43.1%), and severe-very severe COPD (16.6%). PSG unveiled a high proportion of obstructive sleep apnea (64.1%) and significant nocturnal desaturation (mean pulse oximetry nadir = 82.2% ± 6.9%). After controlling for age, sex, BMI, apnea-hypopnea index, nocturnal desaturation, comorbidities, and psychotropic drug prescription, FEV1/FVC was associated with sleep efficiency (β = 25.366; R2 = 14%; p < 0.001), whereas DLCO predicted sleep onset latency (β = −0.314; R2 = 13%; p < 0.001) and rapid eye movement sleep time/total sleep time in % (β = 0.085; R2 = 15%; p = 0.001). Conclusions: Pulmonary function variables reflecting severity of airflow and gas exchange impairment, adjusted for some potential confounders, were weakly related to PSG outcomes in COPD patients. The direct contribution of the pathophysiological hallmarks of COPD to objectively measured parameters of sleep quality seems to be less important than it was previously assumed.


RESUMO Objetivo: O comprometimento da mecânica respiratória e das trocas gasosas pode contribuir para distúrbios do sono em pacientes com DPOC. Objetivamos avaliar associações putativas de diferentes domínios da função pulmonar (limitação do fluxo aéreo, volumes pulmonares e eficiência das trocas gasosas) com parâmetros da qualidade e arquitetura do sono na DPOC derivados da polissonografia (PSG). Métodos: Avaliamos retrospectivamente dados de 181 pacientes com DPOC e idade ≥ 40 anos que foram submetidos a espirometria, pletismografia e PSG de noite inteira. Modelos de regressão linear univariada e multivariada foram utilizados para avaliar a associação de variáveis de função pulmonar com a eficiência do sono (tempo total de sono/tempo total de registro) e outros parâmetros derivados da PSG que refletem a qualidade do sono. Resultados: A gravidade da DPOC foi bem distribuída na amostra (VEF1 pós-broncodilatador variando de 25% a 128% do previsto): DPOC leve (40,3%), DPOC moderada (43,1%) e DPOC grave-muito grave (16,6%). A PSG revelou uma alta frequência de apneia obstrutiva do sono (64,1%) e dessaturação noturna significativa (nadir médio da oximetria de pulso = 82,2% ± 6,9%). Após controle para idade, sexo, IMC, índice de apneia-hipopneia, dessaturação noturna, comorbidades e prescrição de psicotrópicos, a relação VEF1/CVF apresentou associação com a eficiência do sono (β = 25,366; R2 = 14%; p < 0,001), enquanto a DLCO previu a latência para o início do sono (β = −0,314; R2 = 13%; p < 0,001) e o tempo de sono rapid eye movement/tempo total de sono em % (β = 0,085; R2 = 15%; p = 0,001). Conclusões: As variáveis de função pulmonar que refletem a gravidade do comprometimento do fluxo aéreo e das trocas gasosas, ajustadas para alguns potenciais fatores de confusão, apresentaram fraca relação com os resultados da PSG nos pacientes com DPOC. A contribuição direta das características fisiopatológicas da DPOC para os parâmetros da qualidade do sono medidos objetivamente parece ser menos importante do que se supunha anteriormente.


Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive , Sleep , Retrospective Studies , Polysomnography , Lung
15.
J. bras. pneumol ; 47(3): e20200371, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250212

ABSTRACT

ABSTRACT Objective: To test the reliability, validity, and interpretability of the Brazilian version of the Clinical COPD Questionnaire (CCQ) in patients with COPD. Methods: Fifty patients with COPD completed the CCQ by interview on two occasions. At the first visit, the CCQ was administered twice, by two different raters, approximately 10 min apart; the patients also underwent spirometry and were administered the COPD Assessment Test, the modified Medical Research Council scale, and Saint George's Respiratory Questionnaire (SGRQ). At the second visit (1-2 weeks later), the CCQ was readministered. We tested the hypothesis that the CCQ total score would correlate positively with the total and domain SGRQ scores (r ≥ 0.5). Results: Of the 50 patients, 30 (60%) were male. The mean age was 66 ± 8 years, and the mean FEV1 was 44.7 ± 17.9% of the predicted value. For all CCQ items, Cronbach's alpha coefficient (95% CI) was 0.93 (0.91-0.96). To analyze the interrater reliability and test-retest reliability of the CCQ, we calculated the two-way mixed effects model/single measure type intraclass correlation coefficient (0.97 [95% CI: 0.95-0.98] and 0.92 [95% CI: 0.86-0.95], respectively); the agreement standard error of measurement (0.65 for both); the smallest detectable change at the individual level (1.81 and 1.80, respectively) and group level (0.26 and 0.25, respectively); and the limits of agreement (−0.58 to 0.82 and −1.14 to 1.33, respectively). The CCQ total score correlated positively with all SGRQ scores (r ≥ 0.70 for all). Conclusions: The Brazilian version of the CCQ showed an indeterminate measurement error, as well as satisfactory interrater/test-retest reliability and construct validity.


RESUMO Objetivo: Testar a confiabilidade, validade e interpretabilidade da versão brasileira do Clinical COPD Questionnaire (CCQ) em pacientes com DPOC. Métodos: Cinquenta pacientes com DPOC preencheram o CCQ por meio de entrevista em duas ocasiões. Na primeira visita, o CCQ foi aplicado duas vezes, por dois avaliadores, com intervalo de aproximadamente 10 min; os pacientes também foram submetidos a espirometria e aplicação do COPD Assessment Test, da escala modificada do Medical Research Council e do Saint George's Respiratory Questionnaire (SGRQ). Na segunda visita (1-2 semanas depois), o CCQ foi reaplicado. Testamos a hipótese de que a pontuação total no CCQ se correlacionaria positivamente com a pontuação total e a pontuação nos domínios do SGRQ (r ≥ 0,5). Resultados: Dos 50 pacientes, 30 (60%) eram do sexo masculino. A média de idade foi de 66 ± 8 anos, e a média do VEF1 foi de 44,7 ± 17,9% do valor previsto. Para todos os itens do CCQ, o coeficiente alfa de Cronbach (IC95%) foi de 0,93 (0,91-0,96). Para analisar a confiabilidade interavaliadores e teste-reteste do CCQ, calculamos o coeficiente de correlação intraclasse de duas vias modelo de efeitos mistos para medidas únicas (0,97 [IC95%: 0,95-0,98] e 0,92 [IC95%: 0,86-0,95], respectivamente); erro-padrão de medida do tipo concordância (0,65 para ambas); a mínima mudança detectável individual (1,81 e 1,80, respectivamente) e no grupo (0,26 e 0,25, respectivamente); e os limites de concordância (−0,58 a 0,82 e −1,14 a 1,33, respectivamente). A pontuação total no CCQ correlacionou-se positivamente com todas as pontuações no SGRQ (r ≥ 0,70 para todas). Conclusões: A versão brasileira do CCQ apresentou erro de medida indeterminado, assim como confiabilidade interavaliadores/teste-reteste e validade de construto satisfatórias.


Subject(s)
Humans , Male , Middle Aged , Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Quality of Life , Spirometry , Brazil , Surveys and Questionnaires , Reproducibility of Results
16.
J. bras. pneumol ; 47(1): e20200267, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154684

ABSTRACT

ABSTRACT Environmental air pollution is a major risk factor for morbidity and mortality worldwide. Environmental air pollution has a direct impact on human health, being responsible for an increase in the incidence of and number of deaths due to cardiopulmonary, neoplastic, and metabolic diseases; it also contributes to global warming and the consequent climate change associated with extreme events and environmental imbalances. In this review, we present articles that show the impact that exposure to different sources and types of air pollutants has on the respiratory system; we present the acute effects—such as increases in symptoms and in the number of emergency room visits, hospitalizations, and deaths—and the chronic effects—such as increases in the incidence of asthma, COPD, and lung cancer, as well as a rapid decline in lung function. The effects of air pollution in more susceptible populations and the effects associated with physical exercise in polluted environments are also presented and discussed. Finally, we present the major studies on the subject conducted in Brazil. Health care and disease prevention services should be aware of this important risk factor in order to counsel more susceptible individuals about protective measures that can facilitate their treatment, as well as promoting the adoption of environmental measures that contribute to the reduction of such emissions.


RESUMO A poluição do ar ambiental é um dos principais fatores de risco de morbidade e mortalidade global. Ela tem impacto direto na saúde humana, sendo responsável pelo aumento de incidência e de óbitos por doenças cardiorrespiratórias, neoplásicas e metabólicas; também contribui para o aquecimento global e para as consequentes alterações do clima associadas a eventos extremos e aos desequilíbrios ambientais. Nesta revisão, apresentamos artigos que evidenciam o impacto da exposição a diferentes fontes e tipos de poluentes do ar no sistema respiratório; apresentamos os efeitos agudos — como aumento de sintomas e no número de atendimentos em serviços de emergência, internações e óbitos — e crônicos — como o aumento da incidência de asma, DPOC e câncer de pulmão, assim como o declínio acelerado da função pulmonar. Também são apresentados e discutidos os efeitos da poluição atmosférica em populações mais suscetíveis e dos efeitos associados à realização de exercícios físicos em ambientes poluídos. Por fim, apresentamos os principais estudos brasileiros sobre o assunto. Os serviços de atenção à saúde e de prevenção de doenças devem ficar atentos a esse importante fator de risco para orientar indivíduos mais suscetíveis sobre medidas de proteção que possam facilitar seu tratamento, além de estimular a adoção de medidas ambientais que contribuam para a redução dessas emissões.


Subject(s)
Humans , Asthma , Air Pollutants/adverse effects , Air Pollution/adverse effects , Respiratory System , Brazil
17.
J. bras. pneumol ; 47(1): e20200033, 2021. tab
Article in English | LILACS | ID: biblio-1134930

ABSTRACT

ABSTRACT Objective: To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. Methods: The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. Results: Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). Conclusions: In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.


RESUMO Objetivo: Avaliar a frequência de asthma-COPD overlap (ACO, sobreposição asma-DPOC) em pacientes com DPOC e comparar, do ponto de vista clínico, laboratorial e funcional, os pacientes com e sem essa sobreposição conforme diferentes critérios diagnósticos. Métodos: Os participantes foram submetidos à avaliação com pneumologista, espirometria e exame sanguíneo, sendo orientados a manter o registro do PFE duas vezes ao dia. O diagnóstico de ACO deu-se através dos critérios Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO), American Thoracic Society (ATS) Roundtable e Espanhol. Foram investigados os históricos de exacerbações e hospitalizações e aplicados os instrumentos COPD Assessment Test e escala Medical Research Council modificada, utilizados para a classificação de risco e sintomas da GOLD. Resultados: Entre os 51 pacientes com DPOC, 14 (27,5%), 8 (12,2%) e 18 (40,0) foram diagnosticados com ACO segundo os critérios PLATINO, ATS Roundtable e Espanhol, respectivamente. Pacientes com sobreposição significativamente apresentaram pior CVF pré-broncodilatador (1,9 ± 0,4 L vs. 2,4 ± 0,7 L), CVF pós-broncodilatador (2,1 ± 0,5 L vs. 2,5 ± 0,8 L) e VEF1 pré-broncodilatador (1,0 ± 0,3 L vs. 1,3 ± 0,5 L) quando comparados a pacientes com DPOC. Os níveis de IgE foram significativamente mais elevados em pacientes com sobreposição diagnosticados pelo critério Espanhol (363,7 ± 525,9 kU/L vs. 58,2 ± 81,6 kU/L). O histórico de asma foi mais frequente em pacientes com a sobreposição (p < 0,001 para todos os critérios). Conclusões: Nesta amostra, pacientes com ACO relataram asma prévia com maior frequência e possuíam pior função pulmonar quando comparados a pacientes com DPOC. O critério ATS Roundtable aparenta ser o mais criterioso em sua definição, enquanto os critérios PLATINO e Espanhol apresentaram maior concordância entre si.


Subject(s)
Humans , Asthma/complications , Asthma/diagnosis , Asthma/epidemiology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Spirometry , Forced Expiratory Volume , Hospitalization , Laboratories
18.
Article in Chinese | WPRIM | ID: wpr-909219

ABSTRACT

Objective:To investigate the clinical effect of compound Xianzhuliye combined with compound ipratropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease. Methods:160 patients with acute exacerbation of chronic obstructive pulmonary disease who received treatment in Zhejiang Putuo Hospital from December 2019 to December 2020 were included in this study. They were randomly assigned to receive either routine treatment combined with compound ipratropium bromide (control group, n = 80) or routine treatment, compound ipratropium bromide and compound Xianzhuliye in combination (observation group, n = 80) for 14 successive days. Curative effects, blood gas analysis indexes (arterial partial pressure of oxygen, oxygenation index and arterial partial pressure of carbon dioxide), respiratory mechanics indexes (peak airway pressure, airway resistance and mean airway pressure), changes in lung function [percentage of predicted forced expiratory volume in 1 second forced expiratory volume in one second (FEV 1%), FEV 1/forced vital capacity], inflammatory factors (C-reactive protein, interleukin-6 and procalcitonin) before and after treatment were compared between the control and observation groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [90.00% vs. 76.25%, χ2 = 5.391, P < 0.05]. After treatment, arterial partial pressure of oxygen and oxygenation index in the observation group were (62.17 ± 6.19) mmHg and (258.83 ± 25.45) mmHg, respectively, which were significantly higher than those in the control group [(53.86 ± 5.46) mmHg, (210.93 ± 23.12) mmHg, t = 9.005, 12.460, both P < 0.05]. After treatment, arterial partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group [(46.89 ± 5.25) mmHg vs. (57.12 ± 4.12) mmHg, t = 13.711, P < 0.05]. After treatment, peak airway pressure in the observation group was significantly higher than that in the control group [(37.87 ± 3.25) cmH 2O vs. (30.82 ± 4.26) cmH 2O, t = 11.768, P < 0.05]. After treatment, airway resistance and mean airway pressure in the observation group were (6.75 ± 1.82) cm H 2O/L/s and (7.34 ± 1.30) cm H 2O, respectively, which were significantly lower than those in the control group [(9.82 ± 2.10) cm H 2O/L/s and (9.12 ± 1.23) cm H 2O, t = 9.881, 8.896, both P < 0.05). After treatment, FEV 1%, FEV 1/ forced vital capacity in the observation group were (67.31 ± 4.56)% and (61.23 ± 3.67)%, respectively, which were significantly higher than those in the control group [(58.98 ± 3.67)%, (52.18 ± 4.68)%, t = 12.729, 13.610, both P < 0.05). After treatment, C-reactive protein, interleukin-6 and procalcitonin in the observation group were (8.86 ± 1.53) mg/L, (65.87 ± 12.90) ng/L and (0.15 ± 0.04) μg/L, respectively, which were significantly lower than those in the control group [(19.90 ± 3.56) mg/L, (109.32 ± 19.76) ng/L and (0.34 ± 0.07) μg/L, t = 25.484, 16.469, 21.079, all P < 0.05). Conclusion:Compound Xianzhuliye combined with compound ipratropium bromide in the treatment of acute exacerbation of chronic obstructive pulmonary disease can acquire good clinical curative effects through improving blood gas analysis indexes, respiratory mechanics indexes and lung function, and reduce inflammatory reactions.

19.
Article in Chinese | WPRIM | ID: wpr-909188

ABSTRACT

Objective:To investigate the effects of noninvasive positive pressure ventilation combined with positive expiratory pressure device on pulmonary function, inflammatory factors and short-term prognosis in older adult patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), which provide objective evidence for clinical treatment and prognosis evaluation of this disease.Methods:Eighty-three older adult patients with AECOPD who received treatment in Taizhou Central Hospital, China between January 2016 and December 2018 were included in this study. They were randomly assigned to undergo either noninvasive positive pressure ventilation (control group, n = 38) or noninvasive positive pressure ventilation combined with positive expiratory pressure device (study group, n = 45) for 7 days. Pulmonary function, blood gas indexes, inflammatory factor levels and curative effect were compared between the two groups. Results:After treatment, partial pressure of oxygen (PaO 2) and oxygenation index (PaO 2/FiO 2) in each group were significantly increased, and partial pressure of carbon dioxide (PaCO 2) was significantly decreased, compared with before treatment (all P < 0.05). The degree of improvement in PaO 2, PaCO 2 and PaO 2/FiO 2 in the study group was greater than that in the control group ( t = 2.261, 6.854, 2.040, all P < 0.05). The ratio of forced expiratory volume in the first second (FEV 1) to forced vital capacity (FEV 1/FVC), the ratio of FEV1 to predicted value (FEV 1/Pre), and the maximum voluntary ventilation (MVV) per minute in each group were significantly increased compared with before treatment. After treatment, the degree of increase in FEV 1/FVC, FEV 1/Pre, and MVV in the study group was greater than that in the control group ( t = 2.442, 2.120, 2.944, all P < 0.05). After treatment, serum levels of inerleukin-8, tumor necrosis factor-α, and high-sensitivity C-reactive protein in each group were significantly decreased compared with before treatment (all P < 0.05). After treatment, the degree of decrease in serum levels of inerleukin-8, tumor necrosis factor-α, and high-sensitivity C-reactive protein in the study group was significantly greater than that in the control group ( t =7.978, 10.857, 8.543, all P < 0.05). Length of hospital stay, duration of antibiotic use, chronic obstructive pulmonary disease assessment test score and St. George's Respiratory Questionnaire score in the study group were (7.52 ± 1.38) days, (7.14 ± 1.38) days, (18.95 ± 4.76) points, (1.73 ± 4.21) points, respectively, which were significantly shorter/lower than those in the control group [(8.55 ± 1.47) days, (8.25 ± 1.45) days, (8.07 ± 5.81) points, (55.97 ± 5.28) points, t = -2.510, -2.722, -7.943, -10.351, all P < 0.05]. Conclusion:Noninvasive positive pressure ventilation combined with positive expiratory pressure device can effectively improve the pulmonary function of older adult patients with AECOPD, decrease the level of inflammatory factors, and improve short-term prognosis. This study is highly innovative and scientific and is of significance for clinical promotion.

20.
Article in Chinese | WPRIM | ID: wpr-908736

ABSTRACT

Objective:to investigate the therapeutic effect of low molecular weight heparin combined with average volumeassuredpressuresupport (AVAPS) on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type Ⅱ respiratory failure.Methods:A total of 82 patients with AECOPD combined with type Ⅱ respiratory failure in the Second People′s Hospital of Xindu District of Chengdu from February 2018 to April 2020 were selected as the research objects, and they were randomly divided into two groups with 41 cases in each group. The control group was given AVAPS mode, and the observation group was given low molecular weight heparin combined with AVAPS mode. The arterial partial pressure of oxygen (PaO 2), arterial carbon dioxide (PaCO 2), and forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), maximum peak expiratory flow rate (PEF), interleukin (IL)-6, IL-8, tumor necrosis factor-(TNF-α), 16 kDa Clara cell protein (CC16), surfactant protein D(SP-D), adiponectin (APN), superoxide dismutase (SOD), D-dimer, fibrinogen before and after treatment were compared between the two groups and the incidence of adverse reactions were observed. Results:After treatment, the levels of FEV 1, FVC, PEF, PaO 2 in the observation group were higher than those in the control group: (1.78 ± 0.29) L vs. (1.47 ± 0.25) L, (2.47 ± 0.29) L vs.(2.20 ± 0.25) L, (5.14 ± 0.37) ml/s vs. (4.69 ± 0.35) ml/s, (88.37 ± 10.52) mmHg (1 mmHg = 0.133 kPa) vs. (80.16 ± 9.87) mmHg; and the level of PaCO 2 was lower than that in the control group: (65.07 ± 6.71) mmHg vs. (70.84 ± 6.50) mmHg; and the differences were statistically significant ( P<0.05). After treatment, the levels of IL-6, IL-8 and TNF-α in the observation group were lower than those in the control group: (0.47 ± 0.09) ng/L vs. (0.58 ± 0.10) ng/L, (64.37 ± 7.25) ng/L vs. (88.24 ± 8.34) ng/L, (45.37 ± 4.63) ng/L vs. (66.31 ± 4.92) ng/L; and the levels of SOD and APN were higher than those in the control group: (92.37 ± 10.85) U/mg vs. (76.13 ± 9.84) U/mg, (13.94 ± 0.76) mg/L vs. (11.58 ± 1.21) mg/L; and the differences were statistically significant ( P<0.05). After treatment, the level of CC16 in the observation group was higher than that in the control group: (114.78 ± 12.15) μg/L vs. (107.41 ± 11.06) μg/L; while the levels of SP-D, D-dimer and FIB were lower than those in the control group: (93.24 ± 9.85) μg/L vs. (103.25 ± 10.78) μg/L, (0.58 ± 0.07) mg/L vs. (0.79 ± 0.11) mg/L, (1.98 ± 0.29) g/L vs. (2.56 ± 0.34) g/L; and the differences were statistically significant ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Low-molecular-weight heparin combined with AVAPS mode in the treatment of AECOPD complicated with type Ⅱ respiratory failure can significantly improve the lung inflammation and coagulation function in patients, adjust blood gas analysis and CC16, SP-D levels, and promote the recovery of patients′ lung function.

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