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1.
Article in English | WPRIM | ID: wpr-880325

ABSTRACT

BACKGROUND@#Chronic obstructive pulmonary disease (COPD) has become a severe global burden in terms of both health and the economy. Few studies, however, have thoroughly assessed the influence of air pollution on COPD-related mortality among elderly people in developing areas in the hinterland of southwestern China. This study is the first to examine the association between short-term exposure to ambient airborne pollutants and COPD-related mortality among elderly people in the central Sichuan Basin of southwestern China.@*METHODS@#Data on COPD-related mortality among elderly people aged 60 and older were obtained from the Population Death Information Registration and Management System (PDIRMS). Data on airborne pollutants comprised of particulate matter < 2.5 μm in aerodynamic diameter (PM@*RESULTS@#A total of 61,058 COPD-related deaths of people aged 60 and older were obtained. Controlling the influences of daily temperature and relative humidity, interquartile range (IQR) concentration increases of PM@*CONCLUSIONS@#Increased concentrations of ambient airborne pollutants composed of PM


Subject(s)
Aged , Aged, 80 and over , Air Pollutants/adverse effects , China/epidemiology , Cities/epidemiology , Environmental Exposure/adverse effects , Female , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/mortality , Time Factors
2.
J. bras. pneumol ; 46(6): e20190158, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1134917

ABSTRACT

RESUMO Objetivo Avaliar a relação entre a adesão à oxigenoterapia domiciliar prolongada (ODP) e a mortalidade em pacientes com doença pulmonar obstrutiva crônica (DPOC) e insuficiência respiratória crônica e suas características clínicas. Métodos Análise retrospectiva longitudinal de 254 pacientes com DPOC e insuficiência respiratória crônica no período de 2008 a 2016. No início do estudo, avaliamos o diagnóstico, valores espirométricos, gasometria arterial, hemograma, oximetria de pulso, composição corporal e questionários de saúde (dispnéia, qualidade). vida, ansiedade e depressão). Para a análise de adesão referida ao ODP, foram incluídos 199 pacientes, divididos de acordo com a prescrição de oxigênio: 12h/dia (G1), 15h/dia (G2) e 24h/dia (G3). As causas e datas da morte foram estudadas durante o período de cinco anos. Resultados Em cinco anos, identificamos 124 óbitos (62,3%). Não houve diferença significativa na mortalidade entre os grupos de adesão (p = 0,75) e não encontramos diferenças nos parâmetros clínicos avaliados. A prescrição de ODP não foi associada à mortalidade (p = 0,07). Na análise de regressão de Cox, não houve associação entre mortalidade e não adesão ao ODP (HR: 0,75; IC95%: 0,21-2,70). O risco de mortalidade aumentou no G3 em comparação ao G1 (HR: 7,16; IC 95%: 1,44-35,38) e naqueles com maior escore de depressão (HR: 1,35; IC: 1,14-1,59). Conclusão Não foi encontrada associação entre adesão à ODP e mortalidade em pacientes com DPOC e insuficiência respiratória. Não houve diferenças clínicas entre os grupos de adesão.


ABSTRACT Objective Assess the relationship between adherence to long-term oxygen therapy (LTOT) with mortality in patients with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure and their clinical features. Methods Longitudinal retrospective analysis of 254 patients with COPD and chronic respiratory failure from 2008 to 2016. At baseline, we evaluated the diagnosis, spirometry values, arterial blood gas analysis, blood count, pulse oximetry, body composition and health questionnaires (dyspnea, quality of life, anxiety and depression). For referred adherence analysis to LTOT we included 199 patients, divided according to prescription of oxygen: 12h/day (G1), 15h/day (G2) and 24h/day (G3). The cause of death and dates were studied over the five-year period. Results In five years we identified 124 deaths (62.3%). No significant difference was found in mortality between the adherence groups (p=0.75) nor did we find differences in the clinical parameters evaluated. LTOT prescription was not associated with mortality (p=0.07). In Cox regression analysis, there was no association between mortality and non-adherence to LTOT (HR: 0.75; IC95%: 0.21-2.70). The risk of mortality was increased in G3 compared with G1 (HR: 7.16; IC 95%: 1.44-35.38) and in those with a higher depression score (HR: 1.35; IC: 1.14-1.59). Conclusion No association was found between LTOT adherence and mortality in patients with COPD and respiratory failure. There were no clinical differences between the adherence groups.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Oxygen/therapeutic use , Quality of Life , Pulmonary Disease, Chronic Obstructive/therapy , Biomarkers , Retrospective Studies , Treatment Outcome , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/psychology , Treatment Adherence and Compliance , Hyperbaric Oxygenation
4.
Rev. medica electron ; 41(6): 1471-1486, oct.-dic. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1094143

ABSTRACT

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).


Subject(s)
Humans , Middle Aged , Aged , Risk Factors , Pulmonary Disease, Chronic Obstructive/diagnosis , Intensive Care Units , Tobacco Use Disorder , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Environmental Pollution , Hospitalization , Hospitals , Length of Stay
5.
Geriatr., Gerontol. Aging (Impr.) ; 13(1): 36-38, jan-mar.2019.
Article in English | LILACS-Express | LILACS | ID: biblio-1005560

ABSTRACT

AIM: Chronic obstructive pulmonary disease (COPD) is a pro-inflammatory condition leading to wasting states such as sarcopenia. We aimed to describe the effect of COPD and sarcopenia on mortality in Costa Rican older adults in the Costa Rican Longevity and Healthy Aging Study (CRELES). METHOD: This is a secondary analysis of the CRELES, a cohort study consisting of three waves of interviews. For the current study, data from the first and third waves were used. The dependent variable was survival status. COPD and sarcopenia were independent variables. Bivariate analyses were used to compare mortality curves for each group. Association with 3-year mortality was tested with Cox regression models, and hazard ratios (HR) with 95% confidence intervals (CI) were estimated as a measure of the strength of association. RESULTS: Of a total of 2704 participants, 54.29% (n = 1468) were women. Overall mortality was 9.05%. Sarcopenic older adults had the strongest association with mortality (HR = 2.65; 95%CI, 1.81­3.90; p < 0.001), followed by those with both COPD and sarcopenia (HR = 2.59; 95%CI, 1.37­4.92; p = 0.003). The weakest association with mortality was found in patients with neither COPD nor sarcopenia. CONCLUSIONS: The synergistic effect of sarcopenia and COPD has been shown to independently increase mortality in older patients. Our results may be applicable to both Latin American residents and subjects of Hispanic descent living in developed countries. Sarcopenia should be assessed in all patients with COPD since the latter is not a disease limited to the lungs, but rather a systemic disease.


OBJETIVO: A doença pulmonar obstrutiva crônica (DPOC) é uma condição pró-inflamatória que conduz a estados de perda como a sarcopenia. Nosso objetivo foi descrever o efeito da DPOC e da sarcopenia sobre a mortalidade em idosos costa-riquenhos do estudo Costa Rican Longevity and Healthy Aging Study (CRELES). MÉTODO: Esta é uma análise secundária do CRELES, um estudo de coorte composto por três ondas de entrevistas. Para o presente estudo, foram utilizados dados da primeira e terceira ondas. A variável dependente foi o status de sobrevida. DPOC e sarcopenia foram variáveis independentes. Foram realizadas análises bivariadas para comparar as curvas de mortalidade para cada grupo. Testou-se a associação à mortalidade em 3 anos com modelos de regressão de Cox, e razões de risco (HR) com intervalos de confiança (IC) de 95% foram estimadas como medida da força da associação. RESULTADOS: De um total de 2704 participantes, 54,29% (n = 1468) eram mulheres. A mortalidade geral foi 9,05%. Idosos sarcopênicos apresentaram a associação mais forte à mortalidade (HR = 2,65; IC95%, 1,81­3,90; p < 0,001), seguidos por aqueles com DPOC e sarcopenia (HR = 2,59; IC95%, 1,37­4,92; p = 0,003). A associação mais fraca à mortalidade foi encontrada em pacientes sem DPOC e sarcopenia. CONCLUSÕES: Demonstrou-se que o efeito sinérgico da sarcopenia e da DPOC aumenta de forma independente a mortalidade em pacientes idosos. Nossos resultados podem ser aplicáveis a residentes latino-americanos e a descendentes de hispânicos que vivem em países desenvolvidos. A sarcopenia deve ser avaliada em todos os pacientes com DPOC, visto que esta não é uma doença limitada aos pulmões, mas sim uma doença sistêmica.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Aging/physiology , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/epidemiology , Sarcopenia/mortality , Sarcopenia/epidemiology , Aging/physiology , Comorbidity/trends , Health of the Elderly , Survival Rate , Risk Factors , Costa Rica/epidemiology
6.
Rev. bras. cir. cardiovasc ; 34(3): 279-284, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013475

ABSTRACT

Abstract Objective: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. Methods: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). Results: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). Conclusion: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/mortality , Endovascular Procedures/methods , Endovascular Procedures/mortality , Reference Values , Coronary Artery Disease/surgery , Coronary Artery Disease/mortality , Retrospective Studies , Follow-Up Studies , Age Factors , Treatment Outcome , Sex Distribution , Age Distribution , Pulmonary Disease, Chronic Obstructive/surgery , Pulmonary Disease, Chronic Obstructive/mortality , Renal Insufficiency, Chronic/surgery , Renal Insufficiency, Chronic/mortality , Peripheral Arterial Disease/surgery , Peripheral Arterial Disease/mortality
7.
Medicina (B.Aires) ; 79(1): 20-28, feb. 2019. graf, tab
Article in Spanish | LILACS | ID: biblio-1002583

ABSTRACT

Hasta el momento, no existe información sobre la evolución de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) de acuerdo con la nueva clasificación GOLD 2017. El objetivo de este estudio fue determinar, en una cohorte de pacientes con EPOC seguidos por veinte años, la influencia del cambio a la nueva clasificación en resultados de supervivencia por grupos y su asociación con otras variables como comorbilidades. Se evaluaron enfermos con EPOC (definición GOLD 2017) con seguimiento desde enero de 1996 a diciembre de 2016. Se usaron estadísticas convencionales y análisis de supervivencia de Log- Rank (Mantel-Cox). Se analizaron 354 pacientes: edad 66.5 ± 8.4, 66.7% hombres; ex-tabaquistas: 74.2% (56 paquetes-año); índice de Charlson 4.1 ± 1.7. A los 20 años, estaban vivos 219 (62%) y fallecidos 135 (38%), con un seguimiento de 28 meses (12-54.7). En el análisis uni y multivariado, el sexo masculino y la edad se asociaron a mayor mortalidad. Teniendo en cuenta solo la espirometría, a peor grado de obstrucción al flujo aéreo, la supervivencia es menor. Con la clasificación ABCD 2017, la peor supervivencia se encuentra en el grupo D y solo en este grupo es independiente del nivel de deterioro del VEF1 (p = 0.005). La nueva clasificación ABCD es predictora de mortalidad solo si está asociada a la función pulmonar.


Until now, there is no information on the evolution of patients with chronic obstructive pulmonary disease (COPD) according to the new GOLD classification. The objective of this study was to determine, in a cohort of patients with COPD followed by twenty years, the impact of the change to the new classification: survival by groups and their association with other variables such as comorbidities. COPD patients (GOLD 2017 definition) were evaluated with follow-up since January 1996 to December 2016. Conventional statistics and Log-Rank survival analysis (Mantel-Cox) were used. We analyzed 354 patients: age 66.5 ± 8.4, 66.7% men. Former smokers 74.2% (56 pack-year). Charlson index 4.1 ± 1.7. At the end of study 219 (62%) were alive and 135 (38%) died. The follow-up was 28 months (12-54.7). In the univariate and multivariate analysis, male sex and age were associated with higher mortality. Considering only the spirometry, to a worse degree of airflow obstruction, corresponded a lower survival. With the ABCD 2017 classification, the worst survival was observed in group D. Only in this group, survival is independent of the level of deterioration of FEV1 (p = 0.005). The new ABCD classification is a mortality predictor, only if it is associated to pulmonary function.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pulmonary Disease, Chronic Obstructive/classification , Pulmonary Disease, Chronic Obstructive/mortality , Argentina/epidemiology , Spirometry , Forced Expiratory Volume , Multivariate Analysis , Risk Factors , Cohort Studies , Pulmonary Disease, Chronic Obstructive/physiopathology , Kaplan-Meier Estimate
8.
Ethiop. j. health dev. (Online) ; 33(2): 81-87, 2019. ilus
Article in English | AIM | ID: biblio-1261802

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is common worldwide. COPD has negative effects on the quality of life of the patient due to restrictions on daily activities. It can cause a major healthcare burden according to the stage and grade of disease. Objective: The purpose of this study was to determine the physical and psychological functional capacity factors affecting patients' functional performance and to develop a COPD-specific functional status model using these factors. Methods: A group of randomly selected patients (n=183) diagnosed with COPD at a university hospital in Turkey comprised the study sample. Physical examinations were carried out on all patients and they completed questionnaires that included socio demographic and disease characteristics, the Hospital Anxiety and Depression Scale, Functional Performance Inventory and Short Form-36 Survey. The proposed theoretical model was analyzed in the LISREL program using the structural equation modeling approach. Results: We found that the independent latent variable of the physiological functional capacity yielded a significant positive effect on the dependent latent variable of functional performance, while the psychological functional capacity produced no significant effect. Conclusions: The COPD-specific functional status model should prove to be an effective and beneficial tool for issues such as treatment maintenance and for the preservation or improvement of patients' quality of life


Subject(s)
Patients , Physical Functional Performance , Pulmonary Disease, Chronic Obstructive , Pulmonary Disease, Chronic Obstructive/mortality , Quality of Life , Turkey
9.
Rev. medica electron ; 40(6): 1780-1800, nov.-dic. 2018. tab
Article in Spanish | LILACS, CUMED | ID: biblio-978703

ABSTRACT

RESUMEN Introducción: la enfermedad pulmonar obstructiva crónica es infradiagnosticada y presenta una elevada morbimortalidad. Constituye la sèptima causa de muerte en Cuba. En la Unidad de Cuidados Intensivos, del Hospital General Docente "Julio M. Aristegui" de Cárdenas, provincia de Matanzas, resulta una causa de ingresos frecuentes, con evolución desfavorable que prolonga la estadía y elevan la mortalidad. Objetivo: determinar el comportamiento de esta enfermedad en Unidad de Cuidados Intensivos. Materiales y métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo, en la Unidad de Cuidados Intensivos del Hospital General Docente "Julio M. Aristegui", de Cárdenas, durante el periodo de enero del 2015 a diciembre del 2016. El universo fue los pacientes ingresados por la enfermedad pulmonar obstructiva crónica. Las variables estudiadas fueron: sexo, edad, factores de riesgo, diagnóstico al ingreso, complicaciones, estadía, destino al egreso. Resultados: predominó el grupo etáreo de 65-74 años y el sexo masculino. El factor de riesgo más significativo fue el tabaquismo. La estadía y el número de días ventilados fue de 20-30 días. La gran mayoría de los pacientes fallecieron en la Unidad de Cuidados Intensivos. Conclusiones: La enfermedad pulmonar obstructiva crónica, por sus factores de riesgo y complicaciones, conlleva al cuidado hospitalario del paciente en Unidades de Cuidados Intensivos (AU).


ABSTRACT Introduction: the chronic obstructive pulmonary disease is under diagnosed and shows a high morbimortality. It is the fifth cause of death in Cuba. It is a frequent cause of admission in the Intensive Care Unit of the Teaching General Hospital "Julio M. Aristegui" of Cardenas, province of Matanzas, with an unfavorable evolution extending the staying and increasing mortality. Objective: to determine this disease behaviour in an intensive care unit. Materials and methods: a retrospective, longitudinal, descriptive study was carried out in the Intensive Care Unit of the General Teaching Hospital "Julio Aristegui" of Cardenas during the period January 2015- December 2016. The universe was the patients admitted due to chronic obstructive pulmonary disease. The studied variables were sex, age, risk factors, diagnosis at the admission, complications, staying, and destination at discharge. Results: the 65-74 years-old age group and male sex predominated. The most significant risk factor was tobacco smoking. Staying and number of days under ventilation were 20-30 days. Most of the patients died in the Intensive Care Unit. Conclusions: the chronic obstructive pulmonary disease, due to its risk factors and complications, leads to the hospital care of the patient in intensive care units (AU).


Subject(s)
Humans , Adult , Middle Aged , Aged , Pneumonia , Tobacco Use Disorder , Risk Factors , Morbidity , Pulmonary Disease, Chronic Obstructive/epidemiology , Hospitalization , Hypertension , Intensive Care Units , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Cuba , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/mortality
10.
Rev. méd. Maule ; 33(2): 40-50, sept. 2018. ilus
Article in Spanish | LILACS | ID: biblio-1292524

ABSTRACT

There are increasingly more data on the prevalence and distribution of Chronic Obstructive Pulmonary Disease (COPD) from around the world. COPD is predicted to be the third most frequent cause of death in the world by 2020. COPD is mainly caused by chronic tobacco smoking, which induces important changes in both the airways and lung parenchyma. COPD is a progressive, disabling condition that ultimately ends in respiratory failure and death. Is a multicomponent disease, there is evidence that systemic inflammation and extrapulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD has been associated with a nihilistic attitude. On the basis of current evidence, this nihilistic attitude is totally unjustified. The disease must be viewed through the lens of a new paradigm: COPD is not only preventable but also treatable. The past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientific evidence now documents the efficacy of various therapies for symptoms and exacerbations. It is clear that many patients with COPD can benefit from aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. In addition, basic and clinical scientists have now identified cells, mechanisms, and molecules that appear to play key roles in disease pathogenesis. Additional novel treatments are on the horizon and the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health. The good news about COPD is to increase awareness of the disease. COPD is now viewed under a new paradigm as preventable and treatable.


Subject(s)
Humans , History, 21st Century , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/mortality , Respiratory Function Tests , Tobacco Use Disorder , Bronchitis, Chronic , Pulmonary Disease, Chronic Obstructive/history , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/rehabilitation , Pulmonary Disease, Chronic Obstructive/therapy , Emphysema , Lymph Nodes
11.
Rev. méd. Chile ; 146(4): 422-432, abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961412

ABSTRACT

Background: Identifying risk factors for long-term mortality in patients with chronic obstructive pulmonary disease (COPD) could improve their clinical management. Aim: To examine the clinical variables associated to long-term mortality in a cohort of COPD patients. Patients and Methods: A clinical and respiratory functional assessment, chest computed tomography and clinical follow up for five years was carried out in 202 COPD patients aged 66 ± 9 years (59% males), active or former smokers of 10 or more pack-years. Results: Thirty four percent of patients were active smokers, consuming 46 ± 23 packs/year, 86% had comorbidities, especially chronic cardiovascular and metabolic diseases. Forty-six patients died in the five years follow-up (5-year mortality was therefore 22.8%). In the univariate analysis, the main risk factors associated to long-term mortality were an older age, male sex, dyspnea severity, severe exacerbation risk, chronic respiratory failure, magnitude of lung emphysema, airflow obstruction and lung hyperinflation, reduction of thigh muscle cross-sectional area and physical activity limitation. In the multivariate analysis, the three independent risk factors for long-term mortality were dyspnea severity, chronic hypoxemia and exercise limitation measured with the six minutes' walk test. Conclusions: Systematic clinical assessment allowed to identify the main risk factors associated with long-term mortality in patients with COPD, which could be used in planning preventive and management programs aimed at the high-risk population.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Smoking/physiopathology , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/mortality , Respiratory Function Tests , Smoking/mortality , Survival Analysis , Predictive Value of Tests , Prospective Studies , Risk Factors , Follow-Up Studies , Age Factors , Pulmonary Disease, Chronic Obstructive/blood , Dyspnea/physiopathology , Dyspnea/mortality , Exercise Test , Symptom Flare Up
13.
Epidemiol. serv. saúde ; 27(3): e2017139, 2018. graf
Article in Portuguese | LILACS | ID: biblio-953402

ABSTRACT

Objetivo: analisar o efeito da idade, período e coorte de nascimento (APC) na mortalidade por doença pulmonar obstrutiva crônica (DPOC) nos municípios de Porto Alegre, RS, e Rio de Janeiro, RJ, Brasil, entre 1980 e 2014. Métodos: estudo de séries temporais com dados corrigidos do Sistema de Informações sobre Mortalidade (SIM); o efeito APC foi estimado por regressão de Poisson, em relação à coorte de 1935. Resultados: o risco relativo (RR) de morte por DPOC para os homens foi decrescente na coorte de nascimento mais recente (1970-1974), em Porto Alegre (RR=0,39; IC95% 0,32;0,48) e no Rio de Janeiro (RR=0,42; IC95% 0,38;0,48); para mulheres, no Rio de Janeiro observou-se aumento do risco relativo para as coortes mais recentes (RR=1,41; IC95% 1,20;1,67). Conclusão: entre os homens, houve a diminuição do risco por morte por DPOC, enquanto para as mulheres houve aumento do risco no Rio de Janeiro.


Objetivo: analizar el efecto de la edad período y cohorte de nacimiento (EPOC) en las ciudades de Porto Alegre, RS, y Río de Janeiro, RJ, Brasil, entre 1980 y 2014. Métodos: estudio de series temporales con datos corregidos del Sistema de Informaciones sobre Mortalidad (SIM); el efecto APC fue estimado por regresión de Poisson, en relación a la cohorte de 1935. Resultados: el riesgo relativo (RR) de muerte para los hombres por EPOC fue disminuyendo en la cohorte de nacimiento más reciente (1970-1974), en Porto Alegre (RR=0,39; IC95% 0,32;0,48) y Rio de Janeiro (RR=0,42; IC95% 0,38;0,48); para las mujeres, en Río de Janeiro hubo un aumento del riesgo de muerte por EPOC para las cohortes más recientes (RR=1,41; IC95% 1,20;1,67). Conclusión: entre los hombres, hubo reducción del riesgo de muerte por EPOC, mientras que entre las mujeres de Rio de Janeiro hubo un aumento del riesgo.


Objective: to analyze age-period-cohort (APC) effects on mortality from chronic obstructive pulmonary disease (COPD) in the municipalities of Porto Alegre, RS, and Rio de Janeiro, RJ, Brazil, between 1980 and 2014. Methods: this was a time series study using corrected Mortality Information System (SIM) data; APC effects were estimated by Poisson regression, in relation to the 1935 cohort. Results: relative risk (RR) of death due to COPD for males decreased in the most recent birth cohort (1970-1974) in Porto Alegre (RR=0.39; 95%CI 0.32;0.48) and Rio de Janeiro (RR=0.42; 95%CI 0.38;0.48); while among women an increase in risk of death due to COPD was observed in Rio de Janeiro in more recent cohorts (RR=1.41; 95%CI 1.20;1.67). Conclusion: risk of death due to COPD decreased among men, while risk among women in Rio de Janeiro increased.


Subject(s)
Humans , Male , Female , Mortality Registries , Pulmonary Disease, Chronic Obstructive/mortality , Time Series Studies
15.
Braz. j. med. biol. res ; 48(11): 1023-1031, Nov. 2015. tab, graf
Article in English | LILACS | ID: lil-762899

ABSTRACT

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/prevention & control , Rural Population , Smoking Cessation/statistics & numerical data , Cluster Analysis , China/epidemiology , Health Personnel/education , Incidence , Life Style , Pulmonary Disease, Chronic Obstructive/mortality , Risk Management , Spirometry , Time Factors
16.
Rev. méd. Chile ; 143(4): 467-474, abr. 2015. tab
Article in Spanish | LILACS | ID: lil-747553

ABSTRACT

Background: Day hospitals can reduce health care costs without increasing the risks of patients with lower respiratory tract infection. Aim: To report the experience of a respiratory day hospital care delivered to adult patients with community-acquired pneumonia (CAP) in a public hospital. Material and Methods: During the fall and winter of 2011 and 2012, adult patients with CAP of intermediate risk categories were assessed in the emergency room, their severity was stratified according to confusion, respiratory rate, blood pressure, 65 years of age or older (CRB-65) score and the Chilean CAP Clinical Guidelines, and were admitted to the respiratory day hospital. Results: One hundred seventeen patients aged 67 ± 16 years, (62% females) with CAP were attended in the respiratory day hospital. Ninety percent had comorbidities, especially chronic obstructive pulmonary disease in 58%, heart disease in 32%, diabetes in 16% and asthma in 13%. Their most important risk factors were age over 65 years in 60%, comorbidities in 88%, failure of antibiotic treatment in 17%, loss of autonomy in 21%, vital sign abnormalities in 60%, mental confusion in 5%, multilobar CAP in 23%, pleural effusion in 15%, hypoxemia in 41% and a serum urea nitrogen over 30 mg/dL in 16%. Patients stayed an average of seven days in the day hospital with oxygen, hydration, chest physiotherapy and third-generation cephalosporins (89%) associated with quinolones (52%) or macrolides (4%). Thirteen patients required noninvasive ventilation, eight patients were hospitalized because of clinical deterioration and three died in hospital. Conclusions: Day hospital care reduced hospital admission rates of patients with lower respiratory tract infections.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Day Care, Medical , Immunocompromised Host/immunology , Primary Health Care , Pneumonia/mortality , Pulmonary Disease, Chronic Obstructive/mortality , Anti-Bacterial Agents/therapeutic use , Blood Pressure/physiology , Comorbidity , Community-Acquired Infections/immunology , Community-Acquired Infections/mortality , Community-Acquired Infections/therapy , Heart Diseases/mortality , Heart Diseases/therapy , Noninvasive Ventilation , Prospective Studies , Pneumonia/immunology , Pneumonia/therapy , Pulmonary Disease, Chronic Obstructive/therapy , Risk Factors , Respiratory Rate/physiology , Time Factors
17.
Medicina (B.Aires) ; 75(1): 11-17, Feb. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-750505

ABSTRACT

El objetivo del presente trabajo fue describir la población que ingresó en un centro de desvinculación de la ventilación mecánica y rehabilitación (CDVMR) en asistencia ventilatoria mecánica invasiva (AVMi), analizar su evolución y determinar los predictores de fracaso de la desvinculación de la AVMi. Se revisaron las historias clínicas de 763 pacientes que ingresaron en el servicio de Cuidados Respiratorios, en el período comprendido entre mayo 2005 y enero 2012, se seleccionaron 372 con traqueotomía y AVMi. Se analizaron diferentes variables como posibles predictores de desvinculación. La media de edad fue 69 años (DS 14.7), 57% fueron hombres. La mediana de días de internación en la unidad de terapia intensiva (UTI) fue de 33 (rango intercuartilo-RQ 26-46). El 86% de los ingresados a UTI fue por causa médica. Durante la internación en el CDVMR lograron desvincularse el 50%; mediana de días de desvinculación, 13 (RQ 5-38). La edad fue predictor de fracaso de desvinculación. Al estudiar a la subpoblación con desvinculación parcial, se sumó el antecedente de EPOC como predictor. Si bien un 25% de los pacientes falleció o requirió derivación a un centro de mayor complejidad antes de 2 semanas de internación, más de la mitad de los pacientes lograron ser desvinculados definitivamente de la AVMi; esto podría sustentar la atención de pacientes críticos crónicos en CDVMR en la Argentina, ya que los pacientes internados en estos centros tienen buena expectativa de desvinculación, a pesar de las altas chances de desarrollar complicaciones.


The aim of this study was to describe the population admitted to a weaning center (WC) to receive invasive mechanical ventilation (MV), analyze their evolution and identify weaning failure predictors. The medical records of 763 patients admitted to the respiratory care service in the period between May 2005 and January 2012 were reviewed; 372 were selected among 415 tracheotomized and mechanically ventilated. Different variables were analyzed as weaning failure predictors. The mean age of patients admitted was 69 years (SD 14.7), 57% were men. The median length of hospitalization in ICU was 33 days (IQR 26-46). Admission to ICU was due to medical causes in 86% of cases. During hospitalization in WC 186 (50%) patients achieved the successful weaning at a median of 13 days (interquartile range-IQR 5-38). A predictor of weaning failure was age. When we studied the subpopulation with partial disconnection of mechanical ventilation, we found a history of COPD and ageas predictors. Although 25% of the patients died, or required referral to a center of major complexity before 2 weeks of hospitalization, more than half of the patients were able to be removed permanently from the invasive mechanical ventilation (MV), this could support the care of chronic critical patients in MV and rehabilitation centers in Argentina because patients in these centers have a chance of weaning from MV, despite the high chances of developing complications.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Pulmonary Disease, Chronic Obstructive/complications , Respiration , Ventilator Weaning/statistics & numerical data , Age Factors , Argentina , Intensive Care Units , Length of Stay/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/mortality , Retrospective Studies , Time Factors , Ventilator Weaning/mortality
18.
Article in English | IMSEAR | ID: sea-159358

ABSTRACT

Primary tracheal tumors are rare neoplasms and often are hard to diagnose early due to the non-specific clinical presentations. Prolonged symptomatic treatment for these can often lead to missing out the diagnosis and can prove fatal. A 35-year-old male presented with gradually increasing breathlessness and dysphagia to solids and was being treated with bronchodilators and antibiotics. Chest computed tomography (CT) revealed an intratracheal mass in the lower part of the trachea and the patient was referred to our institution in view of a primary tracheal tumor where he expired within 10 min of admission. On autopsy, the gross findings and histological examination revealed a diagnosis of adenoid cystic carcinoma in the trachea. To conclude, primary tracheal tumors, even though rare, should be suspected in cases of refractory chronic obstructive pulmonary disease and chest CT and bronchoscopy must be done to aid correct diagnosis.


Subject(s)
Adult , Autopsy , Carcinoma, Adenoid Cystic/diagnosis , Carcinoma, Adenoid Cystic/mortality , Male , Humans , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/mortality , Tracheal Neoplasms/diagnosis , Tracheal Neoplasms/mortality
19.
Rev. Assoc. Med. Bras. (1992) ; 60(3): 255-261, May-Jun/2014. tab, graf
Article in English | LILACS | ID: lil-713062

ABSTRACT

Objective: the purpose of this study was to update and analyze data on mortality trend due to chronic obstructive pulmonary disease (COPD) in Brazil. Methods: initially, the specific COPD mortality rates were calculated from 1989 to 2009 using data collected from DATASUS (Departamento de Informática do SUS - Brazilian Health System Database). Then, the polynomial regression models from the observed functional relation were estimated based on mortality coefficients and study years. Results: we verified that the general mortality rates due to COPD in Brazil showed an increasing trend from 1989 to 2004, and then decreased. Both genders showed the same increasing tendencies until 2004 and decreased thereafter. The age group under 35 years old showed a linear decreasing trend. All other age groups showed quadratic tendencies, with increases until the years of 1998-1999 and then decreasing. The South and Southeast regions showed the highest COPD mortality rates with increasing trends until the years 2001-2002 and then decreased. The North, Northeast and Central-West regions showed lower mortality rates but increasing trend. Conclusion: this is the first report of COPD mortality stabilization in Brazil since 1980. .


Objetivo: o objetivo deste artigo foi de atualizar e analisar a tendência da mortalidade por doença pulmonar obstrutiva crônica (DPOC) no Brasil. Métodos: inicialmente, foram calculadas as taxas de mortalidade específica por DPOC entre 1989 e 2009 por meio do Departamento de Informática do SUS (Datasus). Depois, foram estimados os modelos de regressão polinomial a partir da relação funcional entre as taxas de mortalidade e os anos de estudo. Resultados: verificou-se que as taxas de mortalidade geral por DPOC no Brasil mostraram uma tendência de aumento de 1998 até 2004 e, depois, uma diminuição. Essa mesma tendência de aumento até 2004 e, em seguida, diminuição semelhante para ambos os sexos. A faixa etária abaixo de 35 anos mostrou tendência de queda linear, enquanto as outras faixas etárias mostraram tendências quadráticas com aumento entre os anos de 1998 e 1999 e, após, queda. As regiões Sul e Sudeste mostraram as taxas de mortalidade mais altas com tendências crescentes até os anos de 2001 e 2002 e, após, decrescentes. As regiões Norte, Nordeste e Centro - Oeste mostraram taxas de mortalidade mais baixas, mas com tendência de elevação. Conclusão: este é o primeiro relato de estabilização da mortalidade por DPOC no Brasil desde 1980. .


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Pulmonary Disease, Chronic Obstructive/mortality , Age Distribution , Brazil/epidemiology , Databases, Factual , International Classification of Diseases , Mortality/trends , Regression Analysis , Sex Distribution
20.
Fisioter. pesqui ; 20(4): 379-386, out.-dez. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-699056

ABSTRACT

O objetivo do estudo foi investigar se há relação entre o impacto da Doença Pulmonar Obstrutiva Crônica (DPOC) no estado de saúde com o nível de dispneia nas atividades de vida diária (AVD) e o índice preditor de mortalidade em pacientes em reabilitação pulmonar (RP). Trata-se de um estudo transversal, em que foram avaliados 32 pacientes com DPOC moderada a muito grave (23 homens; 66,6±12,0 anos; VEF1: 40,6±15,6% previsto) por meio do COPD Assessment Test (CAT), Índice de Massa Corpórea (IMC), Teste de Caminhada de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) e Índice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Observaram-se correlações positivas moderadas do CAT com o questionário mMRC (r=0,35; p=0,048), a pontuação total da LCADL (r=0,60; p<0,001) e com a porcentagem da pontuação total da LCADL (r=0,57; p=0,001). Apenas a pontuação total da LCADL é capaz de predizer independentemente a pontuação do questionário CAT (p<0,05; r²=0,61). Não foram constatadas correlações significativas entre o CAT e o Índice BODE, IMC, TC6 e VEF1. Dessa forma, quanto maior o nível de dispneia nas AVD, maior o impacto da DPOC no estado de saúde do paciente, entretanto, o mesmo não ocorre em relação ao prognóstico de mortalidade nos pacientes com DPOC em RP...


The aim of this study was to investigate if there is a relationship between the impact of Chronic Obstructive Pulmonary Disease (COPD) on health status and the level of dyspnea in Activities of Daily Living (ADL) and the mortality predictor index in patients undergoing Pulmonary Rehabilitation (PR). It is a cross-sectional study in which 32 patients with moderate to very severe COPD (23 men; 66.6±12.0 years; FEV1: 40.6±15.6% predicted) were assessed by: COPD Assessment Test (CAT), Body Mass Index (BMI), six-Minute Walking Test (6MWT), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) and BODE Index (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). The CAT score presented moderate correlation with the mMRC questionnaire (r=0.35; p=0.048), total score of LCADL (r=0.60; p<0.001) and total score LCADL percentage (r=0.57; p=0.001). Only the total score of LCADL is able to predict the CAT questionnaire scores (p<0.05; r²=0.61). There were no significant correlations between CAT and BODE index, BMI, FEV1 and 6MWT. Thus, the higher the level of dyspnea in ADL, the greater the impact of COPD on the patient's health status. However, this is not true in relation to mortality prognosis in patients with COPD in PR...


El objetivo del estudio fue investigar si hay relación entre el impacto de la Enfermedad Pulmonar Obstructiva Crónica (EPOC) en el estado de salud con el nivel de disnea en las actividades de la vida diaria (AVD) y el índice predictor de mortalidad en pacientes en rehabilitación pulmonar (RP). Se trata de un estudio transversal, en el que fueron evaluados 32 pacientes con EPOC moderada a muy grave (23 hombres; 66,6±12,0 años; VEF1: 40,6±15,6% previsto) por medio del COPD Assessment Test (CAT), Índice de Masa Corpórea (IMC), Test de Caminata de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), mo dified Medical Research Council (mMRC) e Índice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Se observaron correlaciones positivas moderadas del CAT con el cuestionario mMRC (r=0,35; p=0,048), la puntuación total de la LCADL (r=0,60; p<0,001) y con el porcentaje de la puntuación total de la LCADL (r=0,57; p=0,001). Apenas la puntuación total de la LCADL es capaz de predecir independientemente la puntuación del cuestionario CAT (p<0,05; r²=0,61). No fueron constatadas correlaciones significativas entre el CAT y el Índice BODE, IMC, TC6 e VEF1. De esa forma, cuanto mayor es el nivel de disnea en las AVD, mayor es el impacto de la EPOC en el estado de salud del paciente, entre tanto, lo mismo no ocurre en relación al pronóstico de mortalidad en los pacientes con EPOC en RP...


Subject(s)
Humans , Male , Female , Middle Aged , Activities of Daily Living , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/rehabilitation , Sickness Impact Profile , Cross-Sectional Studies , Dyspnea/epidemiology , Dyspnea/rehabilitation , Surveys and Questionnaires
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