Condición clínica, capacidad funcional, ansiedad/depresión y calidad de vida en pacientes con EPOC con diferentes rangos de edad / Clinical Condition, Functional Capacity, Anxiety or Depression, and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in Different Age Groups

Introducción: La enfermedad pulmonar obstructiva crónica genera una discapacidad progresiva en el sujeto que la padece a causa de la disnea frecuente, lo que conlleva a limitaciones y restricciones en la participación con el incremento de la edad, lo que finalmente le desencadena estados de ansiedad y depresión, secundarios a su condición clínica. Objetivo: Establecer las diferencias en la condición clínica, capacidad funcional, ansiedad/depresión y calidad de vida en un grupo de pacientes que se encuentran entre la prevejez, senectud y la ancianidad diagnosticados con enfermedad pulmonar obstructiva crónica. Métodos: Estudio descriptivo en pacientes con enfermedad pulmonar obstructiva crónica, quienes se dividieron en grupos edad. Se tuvieron en cuenta variables las clínicas: capacidad funcional, ansiedad/depresión y calidad de vida. Resultados: Se distribuyeron los pacientes en grupos de edad de la siguiente manera: 45-59 años (prevejez) n = 16; 60-79 años (senectud) n = 89; y 80 años y más (ancianidad) n = 24. Se vincularon mayor cantidad de hombres (61,3 por ciento), todos los grupos erar mayormente casados. Hubo diferencias significativas en la distacia recorrida siendo el grupo ancianidad quien presentó un peor resultado (235,25±106,8). La ansiedad y depresión no presentaron diferencias y la calidad de vida mostró mayor afección del dominio actividades. Conclusión: Los pacientes del grupo prevejez presentaron mejor desempeño en la capacidad funcional comparado con los grupos senectud y ansianidad. A su vez, la ansiedad y depresión es mayor en pacientes en prevejez, sin embargo, no resulta ser significativa entre los grupos(AU)

Introduction: Chronic obstructive pulmonary disease produces progressive disability in the person who presents the disease, because of frequent dyspnea, leading to limitations and restrictions in participation with age increase, which finally triggers anxiety and depression states secondary to their clinical condition. Objective: To establish the differences in clinical condition, functional capacity, anxiety or depression, and quality of life in a group of patients between late adulthood, senescence and old age diagnosed with chronic obstructive pulmonary disease. Methods: Descriptive study carried out in patients with chronic obstructive pulmonary disease, who were divided into age groups. Clinical variables were taken into account: functional capacity, anxiety or depression, and quality of life. Results: Patients were distributed into age groups as follows: 45-59 years (old age), n=16; 60-79 years (senescence); n=89; and 80 years and older (old age); n=24. There were significant differences in the distance traveled, with the old age group presenting the worst result (235.25±106.8). Anxiety or depression did not show differences, and quality of life showed greater repercussion in the activity domain. Conclusion: Patients in the late adulthood group presented better functional capacity compared to the senescence and old age groups. In turn, anxiety and depression were higher in patients in the late adulthood group; however, it was not significant between the groups(AU)

Frecuencia de hipertensión pulmonar en pacientes con enfermedad pulmonar obstructiva crónica / Frequency of pulmonary hypertension in patients with chronic obstructive pulmonary disease

Introducción: La enfermedad pulmonar obstructiva crónica es uno de los padecimientos pulmonares más frecuente a nivel mundial. Tiene repercusión sobre la mortalidad, causa importante discapacidad y afecta un número considerable de sujetos en edad productiva. La hipertensión pulmonar es una complicación usual de las enfermedades respiratorias crónicas y en particular de la pulmonar obstructiva crónica. Objetivo: Caracterizar a pacientes con enfermedad pulmonar obstructiva crónica y sospecha de hipertensión pulmonar. Métodos: Se realizó un estudio descriptivo, prospectivo en 50 pacientes atendidos en el Hospital Neumológico Benéfico Jurídico desde noviembre 2016 a enero 2018. Se analizaron variables tales como la edad, el sexo, la prueba de función ventilatoria, la radiografía de tórax, el electrocardiograma y el ecocardiograma. Resultados: De 700 pacientes portadores de enfermedad pulmonar crónica, se sospechó hipertensión pulmonar en 7 por ciento y fue confirmada en 34. Las frecuencias por sexo fueron similares y primaron los mayores de 60 años. El 41,6 por ciento de los pacientes tuvo afectación respiratoria severa, 70,6 por ciento presentó hipertensión pulmonar ligera y 64,7 por ciento tenía disnea grado 3. Los índices kappa entre las técnicas utilizadas para el diagnóstico de la hipertensión pulmonar superaron la cifra de 0,74. Conclusiones: La frecuencia de hipertensión pulmonar en pacientes con enfermedad pulmonar obstructiva crónica fue elevada. Primaron pacientes con afectación severa de la función respiratoria e hipertensión pulmonar ligera. El grado de enfermedad pulmonar obstructiva crónica no determinó la severidad de hipertensión pulmonar. Los mayores valores de concordancia entre las técnicas diagnósticas se obtuvieron para la radiografía y el ecocardiograma(AU)

Introduction: Chronic obstructive pulmonary disease is one of the most frequent, worldwide. It has impact on mortality, causing significant disability and affecting a considerable number of subjects of productive age. Pulmonary hypertension is a common complication of chronic respiratory diseases, particularly chronic obstructive pulmonary disease. Objective: To describe patients with chronic obstructive pulmonary disease and suspected pulmonary hypertension. Methods: A descriptive, prospective study was carried out in 50 patients treated at Benéfico Jurídico Pneumological Hospital from November 2016 to January 2018. Variables such as age, sex, ventilatory function test, chest X-ray, electrocardiogram and the echocardiogram were analyzed. Results: Out of 700 patients with chronic lung disease, pulmonary hypertension was suspected in 7 por ciento and confirmed in 34. The frequencies by sex were similar and those older than 60 years prevailed. 41.6 por ciento of the patients had severe respiratory involvement, 70.6 por ciento had mild pulmonary hypertension and 64.7 por ciento had grade 3 dyspnea. The kappa indices between the techniques used for the diagnosis of pulmonary hypertension exceeded the figure of 0.74. Conclusions: The frequency of pulmonary hypertension in patients with chronic obstructive pulmonary disease was high. Patients with severe impairment of respiratory function and mild pulmonary hypertension predominated. The degree of chronic obstructive pulmonary disease did not determine the severity of pulmonary hypertension. The highest concordance values between diagnostic techniques were obtained for radiography and echocardiography(AU)

Validación externa y reproducibilidad del cuestionario PUMA para el diagnóstico de EPOC en una población latinoamericana: validación externa del cuestionario PUMA / External validation and reproducibility of the PUMA questionnaire for the diagnosis of COPD in a Latin American population: external validation of the PUMA questionnaire

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.

Enfermedad pulmonar obstructiva crónica y comportamiento sedentario: revisión sistemática / Chronic obstructive pulmonary disease and sedentary behavior: a systematic review

INTRODUCCIÓN: A pesar del progreso de la investigación mundial sobre el comportamiento sedentario, sabemos poco aún acerca de sus relaciones y efectos en la población con enfermedad pulmonar obstructiva crónica (EPOC), por eso el objetivo de esta revisión fue analizar la evidencia actual y más frecuente disponible sobre este tema. MÉTODO: Se utilizaron cinco bases de datos electrónicas para realizar una revisión cualitativa diagnóstica. Los documentos elegibles de los últimos cinco años se analizaron descriptivamente en una tabla de extracción de datos y analizaron por separados los distintos temas encontrados. RESULTADOS: Se evidenció en varios artículos el alto comportamiento sedentario en EPOC, y cómo se relaciona con el nivel de severidad de la enfermedad y con mortalidad. La estrategia principal sugerida fue reemplazar el tiempo sedente con actividad física. Discusión: Los resultados de la revisión son similares a lo estudiado en población de variada comorbilidad. Sin embargo, los precedentes de éstos son más específicos en cuanto a recomendaciones. Deben tomarse en cuenta aquellos hallazgos previos como directriz de estudio en la EPOC, ya que se comparte la base fisiopatológica de inflamación crónica sistémica. CONCLUSIÓN: Algunos hallazgos encontrados con mayor frecuencia, son la relación del comportamiento sedentario con la mortalidad y el desarrollo de mayor comorbilidad en la EPOC, además de la intervención a través de la actividad física, por lo cual es necesario profundizar en esta temática buscando estrategias y recomendaciones específicas para esta población.

INTRODUCTION: Despite the progress of global research on sedentary behavior, we know little about its relationships and its effects on the population with chronic obstructive pulmonary disease (COPD). therefore, the purpose of this review was to analyze the current and most common evidence available on these issues. METHOD: Five electronic databases were used to conduct a qualitative diagnostic review. eligible documents from the past five years were descriptively analyzed in a data extraction table and analyzed separately the various topics found. RESULTS: High sedentary behavior in COPD was evident in several articles, and how it relates to the severity level of the disease and mortality. the main suggested strategy was to replace sedentary time with physical activity. Discussion: The results of this review are similar to what is studied in a population of varied co-morbility. However, their precedents are more specific in terms of recommendations. previous findings should be considered as a study guideline in COPD, as the pathological basis of chronic systemic inflammation is shared. CONCLUSION: Some findings found more frequently are the relationship of sedentary behavior with mortality and the development of greater co-morbility in COPD, in addition to intervention through physical activity, so it is necessary to deepen this topic by looking for strategies and recommendations specific to this population.

Fenotipos clínicos de la enfermedad pulmonar obstructiva crónica en los pacientes atendidos en el Hospital neumológico de La Habana / Clinical phenotypes of chronic obstructive pulmonary disease in patients treated at the Hospital Neumológico de La Habana

Introducción: La identificación de los fenotipos clínicos son claves en la modulación de la expresión clínica, para un tratamiento integrado de la EPOC. Objetivos: Caracterizar los fenotipos clínicos de la EPOC en los pacientes atendidos en el Hospital Neumológico Benéfico Jurídico. Métodos:Se realizó un estudio observacional descriptivo retrospectivo, en 172 pacientes con diagnóstico de EPOC, en el Hospital Neumológico Benéfico Jurídico durante el año 2017.Resultados: El 38,4 % de los pacientes tenían edad entre 70-79 años. Del total de pacientes, el 54,6 % eran del sexo masculino. El 52,9 % eran fumadores activos y el 41,3 % exfumadores. Aunque las diferencias no fueron significativas, la edad avanzada y el sexo masculino fueron más frecuentes en el fenotipo enfisematoso agudizador y agudizador bronquítico crónico. El tabaquismo activo fue más frecuente en el fenotipo enfisematoso agudizador. Todos los pacientes con el fenotipo agudizador bronquítico crónico tuvieron dos o más exacerbaciones, mientras que el enfisematoso agudizador se relacionó con una severidad grave de la EPOC (46,7 %). Conclusiones: El sexo masculino y la edad avanzada muestran una tendencia a relacionarse con el fenotipo enfisematoso agudizador y agudizador bronquítico crónico, mientras que el tabaquismo activo es más frecuente en el fenotipo enfisematoso agudizador. El fenotipo agudizador bronquítico crónico se relaciona con mayores exacerbaciones y el enfisematoso agudizador con una mayor severidad de la EPOC.

Introduction: The identification of clinical phenotypes are key in the modulation of clinical expression, for an integrated treatment of COPD. Objectives: To characterize the clinical phenotypes of COPD in patients treated at the Hospital Neumológico Benéfico Jurídico. Methods: A retrospective descriptive observational study was carried out in 172 patients with a diagnosis of COPD at the Hospital Neumológico Benéfico Jurídico in 2017. Results: 38.4 % of the patients were between 70-79 years of age. Of the total number of patients, 54.6 % were male. 52.9 % were active smokers and 41.3 % ex-smokers. Although the differences were not significant, advanced age and male sex were more frequent in the exacerbator emphysematous and chronic bronchial exacerbator phenotype. Active smoking was more frequent in the exacerbating emphysematous phenotype. All patients with the chronic bronchial exacerbator phenotype had two or more exacerbations, while exacerbation emphysematous was associated with severe severity of COPD (46.7 %). Conclusions: Male sex and advanced age show a tendency to be related to the exacerbating emphysematous phenotype and chronic bronchitis exacerbator, while active smoking is more frequent in the exacerbating emphysematous phenotype. The chronic bronchitis exacerbator phenotype is related to greater exacerbations and exacerbation emphysematous with a greater severity of COPD

Comportamiento de volúmenes pulmonares estáticos por pletismografía en enfermedad pulmonar obstructiva crónica con disociación clínico-espirométrica / Behavior of static lung volumes due to plethysmography in chronic obstructive pulmonary disease with clinical-spirometric dissociation

Introducción: La enfermedad pulmonar obstructiva crónica es un problema sanitario mundial por su elevada prevalencia, morbilidad y cuantioso costo económico. Objetivo: Caracterizar mediante la pletismografía a los pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica que presentaron una discrepancia clínica espirométrica. Métodos: Se realizó un estudio descriptivo y transversal en 33 pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica que acudieron a consulta externa del Hospital Neumológico Benéfico Jurídico y el Centro de Investigaciones Clínicas. Se les realizaron volúmenes pulmonares por pletismografía corporal y espirometría en el período comprendido de noviembre 2016 a marzo 2018. Resultados: El sexo masculino (69,7 por ciento) resultó el más frecuente y el grupo de edad predominante fue mayor de 65 años (60,6 por ciento). El 41,2 por ciento de los pacientes presentaron grado de obstrucción moderadamente severo. La capacidad pulmonar total y el volumen residual fueron normales (72,7 por ciento y 42,5 por ciento) respectivamente. El 43,8 por ciento de los pacientes presentaron hiperinsuflación leve. El grado 3 de disnea fue el que predominó en los pacientes. El 12,1 por ciento de los pacientes presentaron aumento del volumen residual dado por atrapamiento aéreo grave con la disminución del volumen espiratorio forzado en el primer segundo. Conclusiones: El comportamiento de los volúmenes pulmonares por pletismografía corporal en la enfermedad pulmonar obstructiva crónica con disociación clínico-espirométrica, evidenció la disminución del volumen espiratorio forzado en el primer segundo y el aumento del volumen residual relacionándose con el grado de disnea(AU)

Introduction: Chronic obstructive pulmonary disease is a global health problem due to its high prevalence, morbidity and high economic cost. Objective: By using plethysmography, to describe patients with diagnosis of chronic obstructive pulmonary disease that had spirometric clinical discrepancy. Methods: A descriptive and cross-sectional study was carried out in 33 patients with diagnosis of chronic obstructive pulmonary disease who attended the outpatient clinic at Benéfico Jurídico Pneumologic Hospital and the Clinical Research Centre. Lung volumes were performed by body plethysmography and spirometry from November 2016 to March 2018. Results: The male sex (69.7 percent) was the most frequent and the predominant age group was older than 65 years (60.6 percent). 41.2 percent of the patients had moderately severe degree of obstruction. Total lung capacity and residual volume were normal, 72.7 percent and 42.5 percent, respectively. 43.8 percent of the patients had mild hyperinflation. Grade 3 dyspnea was the one that predominated in the patients. 12.1 percent of the patients showed increased residual volume due to severe air trapping with decreased forced expiratory volume in the first second. Conclusions: The behavior of lung volumes by body plethysmography in chronic obstructive pulmonary disease with clinical-spirometric dissociation, evidenced decrease in forced expiratory volume in the first second and increased in residual volume related to the degree of dyspnea(AU)

Caracterización clínica, funcional e imagenológica de pacientes egresados por enfermedad pulmonar obstructiva crónica / Clinical, functional and imaging characterization of discharged patients with chronic obstructive pulmonary disease / Caracterização clínica, funcional e de imagem de pacientes que receberam alta por doença pulmonar obstrutiva crônica

RESUMEN Introducción: La enfermedad pulmonar obstructiva crónica es una patología frecuente, prevenible y tratable. La prevalencia está entre el 2,5 - 3,5 % de la población en general y asciende al 19 % en los mayores de 65 años. Objetivos: Describir las características clínicas, funcionales e imagenológicas de los pacientes diagnosticados con enfermedad pulmonar obstructiva crónica en el servicio de Neumología del Hospital Clínico Quirúrgico "Hermanos Ameijeiras" en el período diciembre de 2018 a marzo de 2020. Método: Se realizó un estudio descriptivo y transversal en 171 pacientes egresados por enfermedad pulmonar obstructiva crónica. Las variables medidas fueron: edad, sexo, evaluación nutricional, adicción tabáquica, ocupación laboral, síntomas y signos clínicos, clasificación de la enfermedad según su severidad espirométrica y hallazgos imagenológicos. Resultados: Predominaron los pacientes del sexo masculino (56,9 %) con edad entre 60 a 69 años (26,9 %) y normopesos (39,2 %). El 64,9 % fueron fumadores y el 49,1 % presentaron exposición a sustancias inorgánicas como ocupación laboral. Predominó la tos húmeda y la disnea grado 3 (56,14 y 55,0 %). Según la gravedad de la enfermedad, la forma moderada fue la más frecuente (46,2 %). En relación a los hallazgos tomográficos predominó el patrón enfisematoso, en su variante centrolobulillar (55,6 %). Conclusiones: Las manifestaciones clínicas más evidentes son la disnea y la tos húmeda. La gravedad moderada fue la variante espirométrica más reportada y el patrón enfisematoso a forma centrolobulillar fue el hallazgo tomográfico más evidente.

ABSTRACT Introduction: Chronic obstructive pulmonary disease is a common, preventable and treatable pathology. The prevalence is between 2.5-3.5% of the population in general and rises up to 19% in those over 65 years of age. Objectives: To describe the clinical, functional and imaging characteristics of patients diagnosed with chronic obstructive pulmonary disease in the pneumology service of the Hospital Clínico Quirúrgico "Hermanos Ameijeiras" in the period December 2018 to March 2020. Method: A descriptive cross-sectional study was carried out in 171 patients discharged for chronic obstructive pulmonary disease. The variables measured were: age, gender, nutritional evaluation, smoking addiction, occupation, clinical symptoms and signs, classification of the disease according to its spirometric severity and imaging findings. Results: Male patients (56.9%) with ages between 60 and 69 years (26.9%) and normal weight (39.2%) predominated. 64.9% were smokers and 49.1% had exposure to inorganic substances at work. Wet cough (56.14) and grade 3 dyspnea (55.0%) predominated. According to the severity of the disease, the moderate form was the most frequent (46.2%). Regarding the tomographic findings, the emphysematous pattern prevailed in its centrilobular variant (55.6%). Conclusions: The most obvious clinical manifestations are dyspnea and wet cough. Moderate severity was the most reported spirometric variant and the centrilobular emphysematous pattern was the most evident tomographic finding.

RESUMO Introdução: A doença pulmonar obstrutiva crônica é uma patologia comum, evitável e tratável. A prevalência está entre 2,5 - 3,5 % da população em geral e aumenta para 19% nas pessoas com mais de 65 anos de idade. Objetivo: Descrever as características clínicas, funcionais e de imagem dos pacientes com diagnóstico de doença pulmonar obstrutiva crônica atendidos no Serviço de Pneumologia do Hospital Clínico Quirúrgico "Hermanos Ameijeiras" no período de dezembro de 2018 a março de 2020. Método: Estudo descritivo e transversal, realizado em 171 pacientes que receberam alta por doença pulmonar obstrutiva crônica. As variáveis mensuradas foram: idade, sexo, avaliação nutricional, tabagismo, ocupação laboral, sintomas e sinais clínicos, classificação da doença quanto à gravidade espirométrica e achados de imagem. Resultados: Predominaram pacientes do sexo masculino (56,9%) com idade entre 60 e 69 anos (26,9%) e peso normal (39,2%). 64,9% eram fumantes e 49,1% tinham exposição a substâncias inorgânicas como ocupação laboral. Predominaram tosse úmida e dispneia grau 3 (56,14 e 55,0%). De acordo com a gravidade da doença, a forma moderada foi a mais frequente (46,2%). Quanto aos achados tomográficos, prevaleceu o padrão enfisematoso, em sua variante centrolobular (55,6%). Conclusões: As manifestações clínicas mais evidentes são dispneia e tosse úmida. Gravidade moderada foi a variante espirométrica mais relatada e o padrão enfisematoso centrolobular foi o achado tomográfico mais evidente.

Spirometry for the diagnosis of airway obstruction in patients with risk factors for COPD: the GOLD and lower limit of normal criteria / Espirometria para o diagnóstico de obstrução das vias aéreas em pacientes com fatores de risco para DPOC: os critérios GOLD e limite inferior da normalidade

ABSTRACT Objective: The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC ratio < 70%-to define obstruction, although other guidelines suggest that a post-bronchodilator FEV1/FVC ratio < the lower limit of normal (LLN) is the most accurate criterion. Methods: This was an observational study of individuals ≥ 40 years of age with risk factors for COPD who were referred to our pulmonary function laboratory for spirometry. Respiratory symptoms were also recorded. We calculated the prevalence of airway obstruction and of no airway obstruction, according to the GOLD criterion (GOLD+ and GOLD−, respectively) and according to the LLN criterion (LLN+ and LLN−, respectively). We also evaluated the level of agreement between the two criteria. Results: A total of 241 individuals were included. Airway obstruction was identified according to the GOLD criterion in 42 individuals (17.4%) and according to the LLN criterion in 23 (9.5%). The overall level of agreement between the two criteria was good (k = 0.67; 95% CI: 0.52-0.81), although it was lower among the individuals ≥ 70 years of age (k = 0.42; 95% CI: 0.12-0.72). The proportion of obese individuals was lower in the GOLD+/LLN+ category than in the GOLD+/LLN− category (p = 0.03), as was the median DLCO (p = 0.04). Conclusions: The use of the GOLD criterion appears to be associated with a higher prevalence of COPD. The agreement between the GOLD and LLN criteria also appears to be good, albeit weaker in older individuals. The use of different criteria to define airway obstruction seems to identify individuals with different characteristics. It is essential to understand the clinical meaning of discordance between such criteria. Until more data are available, we recommend a holistic, individualized approach to, as well as close follow-up of, patients with discordant results for airway obstruction.

RESUMO Objetivo: A identificação de obstrução persistente das vias aéreas é fundamental para o diagnóstico de DPOC. As diretrizes da GOLD sugerem um critério fixo - relação VEF1/CVF pós-broncodilatador < 70% - para definir obstrução, embora outras diretrizes sugiram que a relação VEF1/CVF pós-broncodilatador < o limite inferior da normalidade (LIN) é o critério mais preciso. Métodos: Estudo observacional com indivíduos ≥ 40 anos de idade com fatores de risco para DPOC encaminhados ao nosso laboratório de função pulmonar para espirometria. Também foram registrados sintomas respiratórios. Calculamos a prevalência de obstrução e de ausência de obstrução das vias aéreas segundo o critério GOLD (GOLD+ e GOLD−, respectivamente) e segundo o critério LIN (LIN+ e LIN−, respectivamente). Avaliamos também o grau de concordância entre os dois critérios. Resultados: Foram incluídos 241 indivíduos. Obstrução das vias aéreas foi identificada segundo o critério GOLD em 42 indivíduos (17,4%) e segundo o critério LIN em 23 (9,5%). A concordância global entre os dois critérios foi boa (k = 0,67; IC95%: 0,52-0,81), embora tenha sido menor entre os indivíduos ≥ 70 anos de idade (k = 0,42; IC95%: 0,12-0,72). A proporção de obesos foi menor na categoria GOLD+/LIN+ do que na categoria GOLD+/LIN− (p = 0,03), assim como a mediana de DLCO (p = 0,04). Conclusões: A utilização do critério GOLD parece estar associada a uma maior prevalência de DPOC. A concordância entre os critérios GOLD e LIN também parece ser boa, embora seja mais fraca em indivíduos mais velhos. A utilização de diferentes critérios para definir obstrução das vias aéreas parece identificar indivíduos com diferentes características. É essencial compreender o significado clínico da discordância entre esses critérios. Até que mais dados estejam disponíveis, recomendamos uma abordagem holística e individualizada e também um acompanhamento cuidadoso dos pacientes com resultados discordantes para obstrução das vias aéreas.

Clinical, laboratory, and functional characteristics of asthma-COPD overlap in patients with a primary diagnosis of COPD / Características clínicas, laboratoriais e funcionais da sobreposição asma-DPOC em pacientes previamente diagnosticados com DPOC

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.

Association between socioeconomic status and chronic obstructive pulmonary disease in Jiangsu province, China: a population-based study / 中华医学杂志(英文版)

BACKGROUND@#Chronic obstructive pulmonary disease (COPD) is a common public health problem worldwide. Recent studies have reported that socioeconomic status (SES) is related to the incidence of COPD. This study aimed to investigate the association between SES and COPD among adults in Jiangsu province, China, and to determine the possible direct and indirect effects of SES on the morbidity of COPD.@*METHODS@#A cross-sectional study was conducted among adults aged 40 years and above between May and December of 2015 in Jiangsu province, China. Participants were selected using a multistage sampling approach. COPD, the outcome variable, was diagnosed by physicians based on spirometry, respiratory symptoms, and risk factors. Education, occupation, and monthly family average income (FAI) were used to separately indicate SES as the explanatory variable. Mixed-effects logistic regression models were introduced to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for examining the SES-COPD relationship. A pathway analysis was conducted to further explore the pulmonary function impairment of patients with different SES.@*RESULTS@#The mean age of the 2421 participants was 56.63 ± 9.62 years. The prevalence of COPD was 11.8% (95% CI: 10.5%-13.1%) among the overall sample population. After adjustment for age, gender, residence, outdoor and indoor air pollution, body weight status, cigarette smoking, and potential study area-level clustering effects, educational attainment was negatively associated with COPD prevalence in men; white collars were at lower risk (OR: 0.60, 95% CI: 0.43-0.83) of experiencing COPD than blue collars; compared with those within the lower FAI subgroup, participants in the upper (OR: 0.68, 95% CI: 0.49-0.97) tertiles were less likely to experience COPD. Such negative associations between all these three SES indicators and COPD were significant among men only. Education, FAI, and occupation had direct or indirect effects on pulmonary function including post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), FEV1, FVC, and FEV1 percentage of predicted. Education, FAI, and occupation had indirect effects on pulmonary function indices of all participants mainly through smoking status, indoor air pollution, and outdoor air pollution. We also found that occupation could affect post-bronchodilator FEV1/FVC through body mass index.@*CONCLUSIONS@#Education, occupation, and FAI had an adverse relationship with COPD prevalence in Jiangsu province, China. SES has both direct and indirect associations with pulmonary function impairment. SES is of great significance for COPD morbidity. It is important that population-based COPD prevention strategies should be tailored for people with different SES.

Epidemiology of Chronic Obstructive Pulmonary Disease in Brazil: a systematic review and meta-analysis / Epidemiologia da Doença Pulmonar Obstrutiva Crônica no Brasil: uma revisão sistemática e metanálise

Abstract Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of morbidity and mortality in developing countries; however, few systematic reviews are available in the literature. This review examines the prevalence of COPD in the Brazilian population. For this purpose, a systematic review and meta-analysis was conducted of epidemiological observational studies indexed in the databases PubMed, Cochrane, Ovid, Scopus, ScienceDirect, SciELO, Lilacs, and Google Scholar published up to May 2018. The prevalence was estimated using a random effects model. Of the 1,182 articles identified, 12 were eligible. The prevalence of COPD in Brazil was 17% (95%CI: 13-22; I2 = 94%) and the region with the highest prevalence of COPD was the Center-western region (25%), followed by the Southeastern region (23%). The Southern region had the lowest prevalence among the studies (12%). We found that Brazil has a high occurrence of COPD, higher than the estimates of Latin American and world population Hence, additional studies are necessary to support intervention strategies, as well as formulation of specific public health policies to control and prevent COPD.

Resumo A Doença Pulmonar Obstrutiva Crônica (DPOC) encontra-se entre as principais causas de morbidade e mortalidade em países em desenvolvimento, contudo, poucos estudos de revisão sistemática estão disponíveis na literatura. Neste sentido, sumarizamos a prevalência de DPOC na população brasileira. Para tanto, foi realizada revisão sistemática e metanálise de estudos epidemiológicos observacionais indexados nas bases de dados PubMed, Cochrane, Ovid, Scopus, ScienceDirect, SciELO, Lilacs, Google Scholar, publicados até maio de 2018. As prevalências foram estimadas utilizando modelo de efeitos aleatórios. Identificaram-se 1.182 e 12 artigos foram elegíveis. A prevalência de DPOC no Brasil foi de 17% (IC95%: 13-22; I2 = 94%) entre adultos maiores de 40 anos e a região de maior prevalência de DPOC é o Centro-Oeste (25%), seguida pela Região Sudeste (23%). A Região Sul registrou a menor prevalência entre os estudos (12%). Conclui-se que o Brasil apresenta elevada ocorrência de DPOC. Desta forma, estudos adicionais são necessários para subsidiar estratégias de intervenção, bem como formulação de políticas públicas de saúde especificas voltadas ao controle e prevenção da DPOC.

Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment / Prevalencia de enfermedad pulmonar obstructiva crónica en pacientes con diagnóstico de VIH sin tratamiento antirretroviral previo

Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. Objective: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. Method: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon’s test. Results: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. Conclusion: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

Resumen Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. Objetivo: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. Método: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. Resultados: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. Conclusión: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.

Impact of comorbidities in mexican SARS-COV-2-positive patients: a retrospective analysis in a national cohort

ABSTRACT Background: The coronavirus disease 2019 outbreak is a significant challenge for health-care systems around the world. Objective: The objective of the study was to assess the impact of comorbidities on the case fatality rate (CFR) and the development of adverse events in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Mexican population. Materials and methods: We analyzed the data from 13,842 laboratory-confirmed SARS-CoV-2 patients in Mexico between January 1, 2020, and April 25, 2020. We investigated the risk of death and the development of adverse events (hospitalization, pneumonia, orotracheal intubation, and intensive care unit [ICU] admission), comparing the number of comorbidities of each patient. Results: The patient mean age was 46.6 ± 15.6 years, 42.3% (n = 5853) of the cases were women, 38.8% of patients were hospitalized, 4.4% were intubated, 29.6% developed pneumonia, and 4.4% had critical illness. The CFR was 9.4%. The risk of hospitalization (odds ratio [OR] = 3.1, 95% confidence interval [CI]: 2.7-3.7), pneumonia (OR = 3.02, 95% CI: 2.6-3.5), ICU admission (OR = 2, 95% CI: 1.5-2.7), and CFR (hazard ratio = 3.5, 95% CI: 2.9-4.2) was higher in patients with three or more comorbidities than in patients with 1, 2, or with no comorbidities. Conclusions: The number of comorbidities may be a determining factor in the clinical course and its outcomes in SARS-CoV-2-positive patients.

Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study / Variabilidade dos sintomas diários de pacientes com DPOC estável no Brasil: um estudo observacional de vida real

ABSTRACT Objective: To analyze symptoms at different times of day in patients with COPD. Methods: This was a multicenter, cross-sectional observational study conducted at eight centers in Brazil. We evaluated morning, daytime, and nighttime symptoms in patients with stable COPD. Results: We included 593 patients under regular treatment, of whom 309 (52.1%) were male and 92 (15.5%) were active smokers. The mean age was 67.7 years, and the mean FEV1 was 49.4% of the predicted value. In comparison with the patients who had mild or moderate symptoms, the 183 (30.8%) with severe symptoms were less physically active (p = 0.002), had greater airflow limitation (p < 0.001), had more outpatient exacerbations (p = 0.002) and more inpatient exacerbations (p = 0.043), as well as scoring worse on specific instruments. The most common morning and nighttime symptoms were dyspnea (in 45.2% and 33.1%, respectively), cough (in 37.5% and 33.3%, respectively), and wheezing (in 24.4% and 27.0%, respectively). The intensity of daytime symptoms correlated strongly with that of morning symptoms (r = 0.65, p < 0.001) and that of nighttime symptoms (r = 0.60, p < 0.001), as well as with the COPD Assessment Test score (r = 0.62; p < 0.001), although it showed only a weak correlation with FEV1 (r = −0.205; p < 0.001). Conclusions: Dyspnea was more common in the morning than at night. Having morning or nighttime symptoms was associated with greater daytime symptom severity. Symptom intensity was strongly associated with poor quality of life and with the frequency of exacerbations, although it was weakly associated with airflow limitation.

RESUMO Objetivo: Analisar os sintomas em diferentes momentos do dia em pacientes com DPOC. Métodos: Estudo observacional multicêntrico de corte transversal em oito centros brasileiros. Foram avaliados os sintomas matinais, diurnos e noturnos em pacientes com DPOC estável. Resultados: Foram incluídos 593 pacientes em tratamento regular, sendo 309 (52,1%) do sexo masculino e 92 (15,5%) fumantes ativos. A média de idade foi de 67,7 anos, e a média de VEF1 foi de 49,4% do valor previsto. Os pacientes com sintomas mais graves (n = 183; 30,8%), em comparação com aqueles com sintomas leves e moderados, apresentaram pior nível de atividade física (p = 0,002), maior limitação ao fluxo aéreo (p < 0,001), exacerbações ambulatoriais (p = 0,002) e hospitalares (p = 0,043) mais frequentemente e piores resultados em instrumentos específicos. Os sintomas matinais e noturnos mais frequentes foram dispneia (em 45,2% e 33,1%, respectivamente), tosse (em 37,5% e 33,3%, respectivamente) e chiado (em 24,4% e 27,0%, respectivamente). Houve forte correlação da intensidade dos sintomas diurnos com sintomas matinais (r = 0,65, p < 0,001), sintomas noturnos (r = 0,60, p < 0,001), bem como com o escore do COPD Assessment Test (r = 0,62; p < 0,001); porém, houve uma correlação fraca com VEF1 (r = −0,205; p < 0,001). Conclusões: A dispneia foi mais frequente no período matinal do que no período noturno. Ter sintomas matinais e/ou noturnos foi associado à pior gravidade dos sintomas diurnos. A intensidade dos sintomas foi fortemente associada a pior qualidade de vida e frequência de exacerbações, mas fracamente associada à limitação ao fluxo aéreo.

Conduta terapêutica em pacientes com doença pulmonar obstrutiva crônica: monoterapia ou terapia cominada? / Therapy for chronic obstructive pulmonary disease patients: monotherapy or combination therapy?

Objetivo: Comparar a dupla terapia broncodilatadora com glicopirrônio mais indacaterol à monoterapia com glicopirrônio em pacientes portadores de doença pulmonar obstrutiva crônica. Métodos: Estudo clínico prospectivo, unicêntrico, controlado, cruzado, randomizado e duplo-cego realizado com 14 pacientes com diagnóstico de doença pulmonar obstrutiva crônica grau II. Os participantes receberam cada um dos tratamentos durante 30 dias. Antes de cada terapia, realizou-se período de wash-out por 7 dias, com broncodilador de curta ação. Antes e após cada intervenção, os pacientes passaram por exame de espirometria e responderam ao questionário COPD Assessment Test. Resultados: Observou-se melhora na função pulmonar medida por meio do volume expiratório forçado no primeiro segundo de 19mL (±36) para a monoterapia e 87mL (±33) para a terapia dupla. O ganho foi de 67mL (p=0,042) da associação dos medicamentos em relação ao glicopirrônio isolado. A melhora na qualidade de vida, medida a partir das pontuações do questionário, foi de 4,7 (±8,9) pontos para a monoterapia e 5,2 (±11) pontos para a dupla terapia (p=0,08). Conclusão: Ambos os tratamentos demonstram melhora na função pulmonar dos pacientes.

Objective: To compare dual bronchodilator therapy (Glycopyrronium with Indacaterol) versus Glycopyrronium monotherapy in patients with chronic obstructive pulmonary disease. Methods: This was a prospective, unicentric, controlled, crossover, randomized, and double-blind clinical trial with 14 patients diagnosed with grade II chronic obstructive pulmonary disease. The participants received each treatment during the period of 30 days. Before each therapy, a 7-day wash-out period with a short-acting bronchodilator was instituted. Before and after each intervention, the patients underwent spirometry and answered the COPD Assessment Test questionnaire. Results: An improvement in pulmonary function measured by forced expiratory volume during the first second of 19mL (±36) for monotherapy, and 87mL (±33) for dual therapy was observed. The gain was of 67mL (p=0.042) in the association of the drugs in relation to Glycopyrronium alone. The mean improvement in quality of life measured from the questionnaire scores was 4.7 (±8.9) points for monotherapy and 5.2 (± 11) points for dual therapy (p=0.08). Conclusion: Both treatments show improvement in the patients' pulmonary function.

La enfermedad pulmonar obstructiva crónica es un problema de salud / Chronic obstructive pulmonary disease is a health problem

RESUMEN La enfermedad pulmonar obstructiva crónica se caracteriza por una limitación crónica al flujo aéreo poco reversible y asociada en particular al humo de tabaco. Se trata de una enfermedad infradiagnosticada y con una elevada morbimortalidad, lo que implica un problema de salud pública de gran magnitud. Constituye la cuarta causa de muerte en los países del Caribe y se prevé que su prevalencia siga en aumento, lo que representa un elevado costo sanitario. En Cuba la enfermedad pulmonar obstructiva crónica constituye la quinta causa de muerte con una tendencia ascendente en los próximos años, por lo que es un problema de salud, del que no se excluye la provincia de Matanzas, como causa de ingresos frecuentes en sus unidades de atención al grave, las cuales en ocasiones presentan una evolución desfavorable. Entre los factores de riesgo que incrementan esta entidad se encuentran el tabaquismo y la contaminación ambiental, que aumentan la morbilidad por esta entidad con complicaciones que prolongan la estadía hospitalaria y elevan la mortalidad (AU).

SUMMARY Chronic obstructive pulmonary disease is characterized by the chronic limitation of the airflow, almost irreversible and mainly associated to tobacco smoke. It is an underdiagnosed disease with a high morbimortality, meaning a health problem of high magnitude. It is the fourth cause of death in the Caribbean countries and it is expected its prevalence will still increase, representing a high sanitary cost. In Cuba, it is the fifth cause of death with an increasing tendency in the next years, being a health problem because it causes frequent admissions in the Seriously-ill Care Units, frequently having an unfavorable evolution. The province of Matanzas is not excluded from this. Smoking and environmental pollution are among the risk factors favoring this entity, increasing this entity morbidity with complications that make hospital staying longer and mortality higher (AU).

Comparación clínica y funcional entre pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica severa y muy severa / Clinical and functional comparison between patients diagnosed with severe and very severe chronic obstructive pulmonary disease

Introducción: La enfermedad pulmonar obstructiva crónica es el problema respiratorio de mayor prevalencia e impacto socioeconómico en el mundo a pesar de ser una enfermedad potencialmente prevenible. Objetivo: Comparar clínica y funcionalmente pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica severa y muy severa. Métodos: Se realizó un estudio descriptivo en pacientes con diagnóstico clínico-espirométrico de enfermedad pulmonar obstructiva crónica severa o muy severa según sexo que acudieron al Hospital Neumológico Benéfico Jurídico en el periodo de septiembre de 2015 a marzo de 2017. Se empleó para las variables cuantitativas la media y la desviación estándar y el análisis de significación estadística mediante la prueba t de student. La muestra estuvo constituida por 50 pacientes, 25 hombres y 25 mujeres. Resultados: Las mujeres tuvieron menos exacerbaciones con una diferencia de las medias de 0,7 (IC 95 por ciento masculino 2.4-3.1; femenino 1,6-2.5; p=0,01). La sensación de disnea fue mayor en los hombres, con una diferencia de las medias de 0,6 (IC 95 por ciento masculino 2,4-3,1; femenino 1,8-2,5; p=0,00). En la capacidad al ejercicio según la PM6M las mujeres alcanzaron mejores porcentajes del predicho con una diferencia de las medias de 12,8 por ciento (IC 95 por ciento masculino 49,2-63,5; femenino 62,6-75,7; p=0.00). Conclusiones: Los hombres presentan más complicaciones que las mujeres con iguales características espirométricas(AU)

Introduction: Chronic obstructive pulmonary disease is a respiratory problem with the highest prevalence and socioeconomic impact in the world, despite being a potentially preventable disease. Objective: To compare clinically and functionally patients diagnosed with severe and very severe chronic obstructive pulmonary disease. Methods: A descriptive study was carried out in patients with a clinical-spirometric diagnosis of severe or very severe chronic obstructive pulmonary disease, according to sex. They were assisted at the Benéfico Jurídico Neurologic Hospital from September 2015 to March 2017. It was used for the quantitative variables the mean and standard deviation and the statistical significance analysis using the student's t test. Fifty patients formed the sample, 25 men and 25 women. Results: Women had fewer exacerbations with a means difference of 0.7 (95 percent CI male 2.4-3.1; female 1.6-2.5; p = 0.01). The dyspnea sensation was greater in men, with a means difference of 0.6 (95 percent CI male 2.4-3.1; female 1.8-2.5; p = 0.00). In the exercise capacity according to PM6M, women achieved better percentages than predicted with a means difference of 12.8 percent from (95 percent CI male 49.2-63.5; female 62.6-75.7; p = 0.00). Conclusions: Men present more complications than women with the same spirometrical characteristics(AU)

Prevalence of carotid stenosis and incidence of ischemic stroke in patients undergoing non-coronary cardiac surgery

Abstract Introduction: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. Objectives: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. Objectives: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. Results: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. Conclusion: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.