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Abstract Introduction: Therapy choice and its progression for patients with Chronic Obstructive Pulmonary Disease (COPD) should be based on their symptoms and clinical condition according to reports of dyspnea and fatigue. Therefore patient-reported scales have presented a key role during the communication with the patient. Objective: To verify if patients with COPD prefer the Modified Borg Scale (MBS), Visual Analogue Scale (VAS), Glasses Scale (GS), Faces Scale (FS) or Ratings of Perceived Exertion (RPE) during the six-minute walk test(6MWT), and to compare and correlate the scales with each other, with peripheral oxygen saturation (SpO2) and heart rate (HR). Methods: 28 patients with COPD (50% had mild to moderate COPD and 50% had severe to very severe) were evaluated by a respiratory and cognitive assessment. Additionally, they performed the 6MWT, in which the scales were applied simultaneously (random order) and patients reported their preference in the end of the test. Results: 57% of patients were illiterate or presented incomplete primary education and most of them (67%) chose the FS or GS. Significant positive correlations were observed between instruments for both dyspnea and fatigue in the end of the 6MWT, which the strongest was between MBS and FS (r = 0.95). Nevertheless, there was no correlation between the scales and SpO2 and HR. Conclusion: As the majority of patients preferred pictured to numerical scales we suggest their use as a resource for therapeutic evaluation; MBS might be replace by FS, even though they have different scores and not scaled proportionally. However, this change must be carefully considered because there is the risk of dubious interpretation.
Resumo Introdução: A escolha terapêutica e sua progressão ao intervir em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) devem ser baseadas nos seus sintomas e quadro clínico, considerando relatos de dispneia e fadiga; assim, escalas perceptivas assumem papel fundamental na comunicação com o paciente. Objetivo: Verificar se pacientes com DPOC preferem a Escala de Borg Modificada (EBM), Escala Visual Analógica (EVA), Escala de Copos (EC), Escala de Faces (EF) ou Ratings of perceived exertion (RPE) durante o teste de caminhada de seis minutos (TC6), bem como comparar e correlacionar as escalas entre si e com saturação periférica de oxigênio e frequência cardíaca. Métodos: Foram avaliados 28 pacientes com DPOC (50% deles com DPOC leve a moderada e 50% com DPOC grave a muito grave) por meio de uma avaliação respiratória e cognitiva, além do TC6, onde aplicou-se as escalas simultaneamente em ordem aleatória, posteriormente o paciente indicou sua escala preferida. Resultados: 57% dos pacientes eram analfabetos ou com ensino fundamental incompleto e a maioria (67%) elegeu a EF ou EC. Correlações positivas significantes foram observadas interinstrumentos tanto para dispneia quanto para fadiga nos membros inferiores ao final do TC6, sendo mais forte entre EBM e EF (r = 0,95). Entretanto, não foi observada correlação significante entre as escalas e a SpO2 e FC. Conclusão: Como a maioria dos pacientes preferiu escalas caricaturizadas às numéricas, sugerimos inseri-las como recurso de avaliação terapêutica; é possível substituir a EBM pela EF, ainda que tenham escores diferenciados e não escalonados proporcionalmente, atentando-se ao risco de interpretação dúbia.
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OBJECTIVE: To compare the measurements of spirometric peak expiratory flow (PEF) from five different PEF meters and to determine if their values are in agreement. Inaccurate equipment may result in incorrect diagnoses of asthma and inappropriate treatments. METHODS: Sixty-eight healthy, sedentary and insufficiently active subjects, aged from 19 to 40 years, performed PEF measurements using Air Zone®, Assess®, Galemed®, Personal Best® and Vitalograph® peak flow meters. The highest value recorded for each subject for each device was compared to the corresponding spirometric values using Friedman's test with Dunn's post-hoc (p<0.05), Spearman's correlation test and Bland-Altman's agreement test. RESULTS: The median and interquartile ranges for the spirometric values and the Air Zone®, Assess®, Galemed®, Personal Best® and Vitalograph® meters were 428 (263-688 L/min), 450 (350-800 L/min), 420 (310-720 L/min), 380 (300-735 L/min), 400 (310-685 L/min) and 415 (335-610 L/min), respectively. Significant differences were found when the spirometric values were compared to those recorded by the Air Zone® (p<0.001) and Galemed ® (p<0.01) meters. There was no agreement between the spirometric values and the five PEF meters. CONCLUSIONS: The results suggest that the values recorded from Galemed® meters may underestimate the actual value, which could lead to unnecessary interventions, and that Air Zone® meters overestimate spirometric values, which could obfuscate the need for intervention. These findings must be taken into account when interpreting both devices' results in younger people. These differences should also be considered when directly comparing values from different types of PEF meters.