Dyspnea, Obstruction, Smoking, Exacerbation Index, and Chronic Obstructive Pulmonary Disease Test Score: Correlation in Predicting Outcomes in Patients with Chronic Obstructive Pulmonary Disease Exacerbations

Objectives: Chronic obstructive pulmonary disease (COPD) being a disease with systemic consequences necessitate the use of multidimensional indices for a comprehensive assessment of the disease's impact including the future risk of exacerbations and mortality. To study the role of dyspnea, obstruction, smoking, and exacerbation (DOSE) index as a predictor of future disease severity and its correlation with chronic obstructive pulmonary disease test (CAT) score. Measurements and results: A total of 60 inpatients with COPD exacerbations were followed up for 6 months to record the number of exacerbations of COPD. The DOSE index and CAT score were calculated after stabilization within 48 hours of admission, at 1 week, and again at 6 months. The mean difference between DOSE index score at admission and at 1 week was 1.382 � 0.561 and at admission and at 6 months was 2.15 � 0.988, both being statistically significant (p < 0.001). A high DOSE index score (?4) was associated with a greater risk of 2 or more exacerbations [odds ratio (OR), 12 (3.09�.60) and risk estimate, 3.75 (1.53�17)]. For the prediction of exacerbations, the area under the curve (AUC) was larger for the DOSE index (0.854) than the global initiative for chronic obstructive lung disease (GOLD) stage (0.789), p < 0.001 for both. Furthermore, DOSE index correlated significantly with the CAT score, an established health status measure, at all stages of disease severity; at the onset of exacerbation (r = 0.719, p < 0.001), after stabilization at 1 week (r = 0.736, p < 0.001) and at 6 months (r = 0.884, p < 0.001). Conclusion: The DOSE index is a simple, practical multidimensional grading tool for assessing current symptoms, health status, and future risk in COPD and acts as a guide to disease management as its component items can be modified by interventions. Its correlation with CAT, a well-known score is a novel observation, which further corroborates the validity of the DOSE index.

Reprodutibilidade intraobservador do teste Timed Up and Go para pacientes com DPOC / Intrarater reliability of Timed Up and Go Test to patients with COPD

| INTRODUÇÃO: O Timed UP and Go Test (TUG) é um importante teste utilizado para a avaliação de desfechos funcionais na DPOC, como mobilidade, equilíbrio dinâmico e risco de queda. No cenário clínico prático, a aplicação repetida do TUG é realizada muitas vezes pelo mesmo observador, no objetivo de avaliar diversas intervenções aplicadas na DPOC. OBJETIVO: Avaliar o grau de reprodutibilidade intraobservador do TUG em indivíduos com DPOC. METODOLOGIA: Estudo descritivo, de corte transversal, realizado com indivíduos com DPOC, atendidos ambulatorialmente na cidade de Salvador-Bahia. Foram verificadas características sociodemográficas e clínicas como a espirometria (VEF1/CVF), e tempo de realização de duas práticas no mesmo dia do teste TUG. A reprodutibilidade do TUG foi avaliada pelo Coeficiente de Correlação Intraclasse (CCI), CAAE número 38143214.0.0000.0057. RESULTADOS: Trinta e um pacientes voluntários foram avaliados; destes, 24 (77,4%) homens, média da idade de 68,6 ± 9,8 anos, com relação VEF1/CVF pós-broncodilatador de 59,0 ± 10,8 %. Na análise da reprodutibilidade intraobservador do TUG pelo CCI, obteve-se α = 0,897 (CI 95%: 0,786; 0,950; p < 0,0001). CONCLUSÃO: O teste TUG possui excelente reprodutibilidade intraobservador e uma pequena variabilidade quando aplicados duas vezes em pacientes com DPOC, sendo a aplicação para avaliação da mobilidade, na prática do cuidado em saúde considerada factível.

INTRODUCTION: The Timed UP and Go Test (TUG) is an important test used to assess functional outcomes in COPD, such as mobility, dynamic balance, and risk of falling. In clinical practice, the repeated application of the TUG is performed several times by the same observer to evaluate different interventions applied in COPD. OBJECTIVE: To assess the degree of intraobserver reproducibility of TUG in individuals with COPD. METHODOLOGY: Descriptive, cross-sectional study carried out with individuals with COPD treated in an outpatient clinic in the city of SalvadorBahia. Sociodemographic and clinical characteristics such as spirometry (FEV1/FVC) were verified, as well as two practices of the TUG Test on the same day. The reproducibility of TUG was evaluated fur Intraclass Correlation Coefficient (ICC). CAAE number 38143214.0.0000.0057. RESULTS: Thirty-one volunteer patients were evaluated, of which 24 (77.4%) men, mean age 68.6 ± 9.8 years, with post-bronchodilator FEV1//FVC ratio 59.0 ± 10.8%. In the analysis of intraobserver reproducibility of the TUG by the ICC, α = 0.897 (CI 95%: 0.786; 0.950; p < 0.0001) was obtained. CONCLUSION: The TUG test has excellent intraobserver reproducibility and a small variability when applied twice in patients with COPD, being the application for mobility assessment, in care practice, considered viable.