A distância entre o domicílio e o centro de reabilitação não influencia a adesão ao programa de reabilitação pulmonar: um estudo retrospectivo / Distance from home to rehabilitation center did not influence adherence to pulmonary rehabilitation program: a retrospective study

Background: Adherence to treatment is critical when dealing with chronic diseases. One of the difficulties in maintain long-term adherence is the distance from home to rehabilitation center. Objective: To determine the influence of the distance from subjects' residence to rehabilitation center on adherence of a 12-week pulmonary rehabilitation program in chronic respiratory disease. Methods: This retrospective study analyzed patients' medical records with chronic respiratory diseases from a pulmonary rehabilitation center. Driving distance between patients' home and rehabilitation center was calculated with Google maps. The home-rehabilitation center distances were classified in three levels: up to 10, 10-30 and more than 30 km. Results: 280 medical records from patients with chronic pulmonary diseases with medical indication to follow the pulmonary rehabilitation program were found and 148 medical records were included in our study. Out of them, the majority (n = 93) had chronic obstructive pulmonary disease (COPD). Seventy percent of patients lived up to 10 km, 24% lived between 10 and 30 km and 6% lived more than 30 km. No difference in adherence was found comparing the three groups based on the distance from home to rehabilitation center. Conclusion: In this study, distance between home and rehabilitation center did not influence adherence to pulmonary rehabilitation program. (AU)

FEV1/FEV6 y FEV6 una alternativa para FEV1/FVC y FVC en la detección de obstrucción de vías respiratorias / FEV1/FEV6 and FEV6 an alternative for FEV1/FVC and FVC in the detection of airway obstruction

INTRODUCCIÓN: el objetivo de este estudio fue verificar si los puntos de corte fijos y el límite inferior de lo normal (LLN) para el volumen espiratorio forzado en un segundo (FEV1) y el volumen espiratorio forzado en 6 segundos (FEV6) FEV1/FEV6 y el FEV6 son una medida alternativa para el FEV1 y la capacidad vital forzada (FVC), FEV1/FVC y la FVC en la detección de la enfermedad pulmonar obstructiva crónica (EPOC), en una muestra de pacientes del oriente boliviano. MÉTODOS: se analizaron un total de 92 pruebas espirométricas, 66 varones y 26 mujeres con riesgo de EPOC. La población del estudio incluyó a residentes de la ciudad de Santa Cruz de la Sierra-Bolivia (ciudad cosmopolita) de 35 a 90 años de edad. RESULTADOS: la sensibilidad y la especificidad fueron del 97,0% y el 96,9%, respectivamente, cuando se compararon los valores de corte fijos de FEV1/FEV6 de 0,73 con los de FEV1/FVC < 0,7 como regla estándar, según las recomendaciones del global obstructive lung diseases (GOLD) para detectar la obstrucción de las vías respiratorias. La sensibilidad y la especificidad fueron de 93,4% y 81,2%, respectivamente, cuando el LLN de FEV1/FVC y FEV1/FEV6 fueron utilizados. CONCLUSIONES: en conclusión, el FEV6 es un sustituto válido de la CVF para detectar la obstrucción de las vías respiratorias, ya sea utilizando puntos de corte fijos o el LLN. Se necesitan más estudios para verificar estos resultados en una población más grande y para establecer los valores predictivos espirométricos locales.

INTRODUCTION: the aim of this study was to verify if fixed cut-off points and lower limit of normal (LLN) for forced expiratory volume in one second (FEV1)/FEV6 and FEV6 as an alternative for FEV1/forced vital capacity (FVC) and FVC are valid for the detection of obstructive lung disease in a sample of Bolivian subjects. METHODS: a total of 92 spirometric consecutive tests from subjects, 66 males and 26 females at risk for COPD were analyzed. The study population included residents of city Santa Cruz de la Sierra, (Bolivia) aged from 35 to 90 yrs., from various ethnical origins (cosmopolitan city). RESULTS: sensibility and specificity were 97.0% and 96.9%, respectively when fixed cut-off values of FEV1/FEV6 of 0.73 was compared to FEV1/FVC<0.7 as standard, according to GOLD recommendations to detect airway obstruction. Sensibility and specificity were 100% and 89.5%, respectively when LLN of FEV1/FVC and FEV1/FEV6 were used. CONCLUSIONS: in conclusion, FEV6 is a valid surrogate for FVC to detect airway obstruction, either using fixed cut-off points or LLN. Further study is needed to verify these results in a larger population and to establish local spirometric predicted values

Benefit of educational feedback for the use of positive expiratory pressure device

BACKGROUND: Positive expiratory pressure (PEP) is regularly used as a self-administered airway clearance technique. OBJECTIVE: The aim of this study was to evaluate the need to teach the correct use of the PEP device and to measure the progress of the success rate of the maneuver after training. METHOD: A PEP system (PariPEP-S Sytem) was used to generate PEP in 30 healthy volunteers. They were instructed by a qualified physical therapist to breathe correctly through the PEP device. Then they were evaluated during a set of ten expirations. Two other evaluations were performed at day 2 and day 8 (before and after feedback). The mean PEP and the success rate were calculated for each set of expirations. The number of maneuvers needed to obtain a correct use was calculated on the first session. RESULTS: An optimal PEP was reached after 7.5 SD 2.7 attempts by all subjects. Success rates and mean pressures were similar between the different sets of expirations (p=0.720 and p=0.326, respectively). Pressure variability was around 10%. After one week, 30% of subjects generated more than two non-optimal pressures in the set of ten expirations. No difference in success rate was observed depending on the evaluations. CONCLUSION: This study demonstrates that good initial training on the use of the PEP device and regular follow-up are required for the subject to reach optimal expiratory pressure.