Assessment of religious coping in patients with COPD / Avaliação do coping religioso em pacientes com DPOC

ABSTRACT Objective: To compare religious coping (RC) in patients with COPD and healthy individuals, as well as to determine whether RC is associated with demographic characteristics, quality of life, depression, and disease severity in the patients with COPD. Methods: This was a cross-sectional study conducted between 2014 and 2016, involving outpatients with moderate to severe COPD seen at one of two hospitals in Fortaleza, Brazil, as well as gender- and age-matched healthy controls. The Brief RCOPE scale assessed RC in all of the participants. We also evaluated the COPD group patients regarding symptoms, quality of life, and depression, as well as submitting them to spirometry and a six-minute walk test. Results: A total of 100 patients were evaluated. The mean age was 67.3 ± 6.8 years, and 54% were men. In the COPD group, the mean positive RC score was significantly higher than was the mean negative RC score (27.17 ± 1.60 vs. 8.21 ± 2.12; p = 0.001). The mean positive RC score was significantly higher in women than in men (27.5 ± 1.1 vs. 26.8 ± 2.8; p = 0.02). Negative RC scores were significantly higher in the COPD group than in the control group (p = 0.01). Negative RC showed an inverse association with six-minute walk distance (6MWD; r = −0.3; p < 0.05) and a direct association with depressive symptoms (r = 0.2; p < 0.03). Positive RC correlated with none of the variables studied. Multiple regression analysis showed that negative RC was associated with 6MWD (coefficient = −0.009; 95% CI: −0.01 to −0.003). 6MWD explained the variance in negative RC in a linear fashion. Conclusions: Patients with COPD employ negative RC more often than do healthy individuals. Exercise capacity and depressive symptoms are associated with negative RC.

RESUMO Objetivo: Comparar o coping religioso (CR) entre pacientes portadores de DPOC e indivíduos saudáveis e investigar associações entre CR e características demográficas, qualidade de vida, depressão e gravidade da doença nesses pacientes. Métodos: Estudo transversal realizado entre 2014 e 2016 com pacientes ambulatoriais com DPOC moderada a grave de dois hospitais em Fortaleza (CE) e controles saudáveis pareados por sexo e idade. A escala Brief RCOPE avaliou a CR de todos os participantes. O grupo DPOC também foi avaliado quanto a sintomas, qualidade de vida e depressão e foi submetido a espirometria e teste de caminhada de seis minutos (TC6). Resultados: Foram avaliados 100 pacientes, com média de idade de 67,3 ± 6,8 anos (54% homens). A média dos escores de CR positivo no grupo DPOC foi significativamente maior que a de CR negativo (27,17 ± 1,60 vs. 8,21 ± 2,12; p = 0,001). A média dos escores de CR positivo foi significativamente maior nas mulheres que nos homens (27,5 ± 1,1 vs. 26,8 ± 2,8; p = 0,02). O grupo DPOC apresentou escores de CR negativo significativamente maiores que os controles (p = 0,01). O CR negativo apresentou uma associação inversa com a distância percorrida no TC6 (DTC6; r = −0,3; p < 0,05) e uma associação direta com sintomas depressivos (r = 0,2; p < 0,03). O CR positivo não apresentou correlações com nenhuma variável estudada. A análise de regressão múltipla mostrou que CR negativo associou-se com DTC6 (coeficiente = −0,009; IC95%: −0,01 a −0,003). A DTC6 explicou linearmente a variação do CR negativo. Conclusões: Pacientes com DPOC utilizam CR negativo mais frequentemente que indivíduos saudáveis. A capacidade de exercício e sintomas depressivos estão associados a CR negativo.

Influência da reabilitação pulmonar no paciente com Doença Pulmonar Obstrutiva Crônica fenótipo exacerbador / Influence of pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease exacerbator phenotype

RESUMO Objetivo Verificar se existem diferenças em pacientes com doença pulmonar obstrutiva crônica (DPOC) fenótipos exacerbador e não exacerbador submetidos a um programa de reabilitação pulmonar (PRP). Métodos Estudo retrospectivo de vida real que incluiu pacientes com DPOC da rede pública de atendimento ambulatorial em nível de atenção primária, que completaram o PRP, com duração de 12 semanas, três vezes por semana. Todos foram avaliados antes e depois do PRP, por meio do teste de caminhada dos seis minutos (TC6min), índice de dispneia (mMRC), qualidade de vida e índice BODE. Resultados Dos 151 pacientes analisados, a média de idade foi 65,0 ± 8,1 anos e a média VEF1% do predito foi de 39,8 ± 15,9. O gênero predominante foi o masculino (66,9%). Desses pacientes, 31 (20,5%) eram fenótipo exacerbador. Houve melhora significativa na média da distância percorrida no TC6min em ambos os grupos, sendo a maior mudança observada no grupo exacerbador [mΔ(IC95%): 84,9 (57,1-112,6) vs. 48,6 (37-60,2); p = 0,018]. Redução significativa da dispneia pela escala mMRC ocorreu em ambos os grupos, sendo de maior intensidade no grupo exacerbador [mΔ(IC95%): -0,8 (-1,11 a 0,51) vs. -1,6 (-2,20 a -1,13); p = 0,006]. Melhora no índice BODE ocorreu em ambos os grupos, mas a variação média também foi significativamente maior no grupo exacerbador [mΔ(IC95%): -1,44 (-2,17 a -0,70); p = 0,045]. Conclusão Os pacientes com DPOC fenótipo exacerbador apresentaram maior magnitude de resposta ao PRP (36 metros) quando comparados ao não exacerbador, independentemente da gravidade da obstrução do fluxo aéreo, impactando a melhora no prognóstico medido pelo índice BODE.

ABSTRACT Objective To verify if there are differences in Chronic Obstructive Pulmonary Disease (COPD) patient exacerbator and non-exacerbator phenotypes undergoing a Pulmonary Rehabilitation Program (PRP). Methods A real life retrospective study included outpatients with COPD from public primary care who completed a 12-weeks PRP, three times a week. All were assessed before and after PRP using the six-minute walk test (6MWT), the modified Medical Research Council (mMRC) dyspnea index, quality of life and Body-mass Index, airflow Obstruction, Dyspnea and Exercise (BODE index). Results A total of 151 patients were analyzed and mean age was 65.0 ± 8.1 years and mean Forced Expiratory Volume (FEV) 1% of predicted was 39.8 ± 15.9. The predominant gender was male (66.9%). Of these patients 31 (20.5%) were exacerbator phenotype There was a significant improvement in the mean distance in the 6MWT in both groups, with the largest change observed in the exacerbator group [mΔ (95% CI): 84.9 (57.1-112.6) vs. 48.6 (37-60.2) p= 0.018]. Significant reduction in dyspnea on the mMRC scale occurred in both groups, with the highest intensity in the exacerbator group [mΔ (95% CI): - 0.8 (-1.11 to 0.51) vs. -1.6 (-2.20 to -1.13) p = 0.006]. Improvement in the BODE index occurred in both groups, but the mean variation was also significantly greater in the exacerbator group [mΔ (95% CI): -1.44 (-2.17 to -0.70) p= 0.045]. Conclusion Patients with COPD exacerbator phenotype had a greater magnitude of response to PRP (36 meters) when compared to non-exacerbator phenotype regardless the severity of airflow obstruction, also showing improvement in prognosis measured by the BODE index.

Avaliação da associação da aderência à oxigenoterapia domiciliar prolongada e marcadores clínicos e mortalidade em cinco anos em pacientes com a doença pulmonar obstrutiva crônica / Evaluation of the association of adherence to long-term home oxygen therapy and clinical markers and five-year mortality in patients with Chronic obstructive pulmonary disease

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.

Análise de dois questionários sobre a qualidade de vida em pacientes com Doença Pulmonar Obstrutiva Crônica / Analysis of two questionnaires on quality of life of Chronic Obstructive Pulmonary Disease patients / Análisis de dos cuestionarios sobre la calidad de vida en pacientes con Enfermedad Pulmonar Obstructiva Crónica

Objetivo: avaliar a eficácia entre os questionários de qualidade de vida St. George Respiratory Questionnaire e Chronic Obstructive Pulmonary Disease Assessment Test em pacientes com doença pulmonar obstrutiva crônica a partir da análise de correlação e concordância, bem como identificar a ferramenta mais eficaz para avaliar sua qualidade de vida. Método: estudo analítico de coorte transversal com pacientes internados em um hospital espanhol para exacerbação de doença pulmonar obstrutiva crônica. A qualidade de vida relacionada à saúde foi avaliada com os dois questionários. Analisaram-se a correlação e a concordância entre ambos, bem como a consistência interna. As associações foram estabelecidas entre as variáveis clínicas e os resultados do questionário. Resultados: participaram 156 pacientes. Ambas as escalas mostram correlação e concordância entre elas e alta consistência interna. Uma maior sensibilidade do Chronic obstructive pulmonary disease Assessment Test foi observada para detectar a presença de tosse e expectoração. Conclusão: ambos os questionários têm a mesma confiabilidade e validade para medir a qualidade de vida em pacientes com doença pulmonar obstrutiva crônica aguda, sendo que o Chronic Obstructive Pulmonary Disease Assessment é mais sensível para detectar a tosse e a expectoração e com um tempo de preenchimento mais curto.

Objective: to evaluate the efficacy of quality of life questionnaires St. George Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test in patients with chronic obstructive pulmonary disease based on correlation and agreement analyses, and identify the most effective tool to assess their quality of life. Method: cross-sectional cohort study with patients hospitalized in a Spanish hospital for exacerbation of chronic obstructive pulmonary disease. Health-related quality of life was assessed with both questionnaires. The correlation and the agreement between the questionnaires were analyzed, as well as the internal consistency. Associations were established between the clinical variables and the results of the questionnaire. Results: one hundred and fifty-six patients participated in the study. The scales had a correlation and agreement between them and high internal consistency. A higher sensitivity of the Chronic Obstructive Pulmonary Disease Assessment Test was observed for the presence of cough and expectoration. Conclusion: the questionnaires have similar reliability and validity to measure the quality of life in patients with acute chronic obstructive pulmonary disease, and the Chronic Obstructive Pulmonary Disease Assessment Test is more sensitive to detect cough and expectoration and requires a shorter time to be completed.

Objetivo: evaluar la efectividad entre los cuestionarios de la calidad de vida St. George Respiratory Questionnaire y Chronic obstructive pulmonary disease Assessment Test en pacientes con enfermedad pulmonar obstructiva crónica a partir del análisis de su correlación y concordancia, e identificar la herramienta más efectiva para evaluar su calidad de vida. Método: estudio analítico transversal en pacientes ingresados en un hospital español por exacerbación de la enfermedad pulmonar obstructiva crónica. Se estudió la calidad de vida relacionada con la salud evaluada con los dos cuestionarios. Se analizó la correlación y concordancia entre ambos, así como su consistencia interna. Se establecieron asociaciones entre las variables clínicas y los resultados del cuestionario. Resultados: participaron 156 pacientes. Ambas escalas muestran correlación y concordancia entre ellas y consistencia interna elevada. Se observa una mayor sensibilidad del cuestionario Chronic obstructive pulmonary disease Assessment Test para detectar la presencia de tos y expectoración. Conclusión: ambos cuestionarios presentan la misma fiabilidad y validez para medir la calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica agudizada, siendo el Chronic obstructive pulmonary disease Assessment Test más sensible para detectar tos y expectoración y con un tiempo de cumplimentación más breve.

A Descriptive Study of Chronic Obstructive Pulmonary Disease in Tertiary Care Clinics of a Caribbean Island / Estudio descriptivo de la enfermedad pulmonar obstructiva crónica en clínicas de atención terciaria de una isla caribeña

ABSTRACT Objective: To determine the relationship between severity of chronic obstructive pulmonary disease (COPD) and quality of life as well as COPD's correlation with depressive symptoms in West Indian subjects. Methods: This is a cross-sectional, observational study of outpatients with COPD in tertiary care. The severity of COPD was determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, GOLD group, and body mass index, airflow obstruction, dyspnoea and exercise capacity (BODE) index. Quality of life was assessed by the St George Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT), and depression was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Results: A total of 105 patients (85.7% male, 37.1% Indo-Trinidadian, 42.9% Afro-Trinidadian, 64.8% primary level education) were recruited with a mean age of 66.9 years (standard deviation: 9.60 years). The median body mass index was 25 kg/m2; 26.7% were underweight. Risk factors identified were: ever-smokers (27.6%), marijuana (20%), biomass (81.9%), passive smoke (70.5%), occupational exposures (80%). The CES-D of 25% of the patients was ≥16. Co-morbidities included diabetes (22%), hypertension (29%), gastro-oesophageal reflux disease (10%) and previous myocardial infarction (15%). A total of 59% of the patients reported a monthly household income of less than US$800. Lower level of education was associated with worse SGRQ (total and impact), lower forced expiratory volume in one second, modified Medical Research Council scale (mMRC) of ≥ 2 and higher BODE index. Higher GOLD group correlated with worse SGRQ, CAT and CES-D. Higher CES-D was associated with shorter six-minute walk distance, worse SGRQ, CAT and mMRC scores, higher GOLD group and increased COPD admissions per year. Patients with a CES-D of ≥ 16 walked shorter distances. Higher BODE quartile was associated with worse SGRQ, CAT and CES-D scores. Conclusion: Higher GOLD group and higher BODE quartile were associated with worse quality of life scores and higher depression scores. Patients in higher GOLD groups should be screened for depression. Education on COPD should be targeted at those of lower socioeconomic status.

RESUMEN Objetivo: Determinar la relación entre la severidad de la enfermedad pulmonar obstructiva crónica (EPOC) y la calidad de vida, así como la correlación de la EPOC con síntomas depresivos en sujetos antillanos. Métodos: Se realizó un estudio observacional transversal de pacientes ambulatorios con EPOC en cuidados terciarios. La severidad de la EPOC fue determinada por la etapa de la Iniciativa Global para la Enfermedad Pulmonar Obstructiva Crónica (GOLD, en inglés), el grupo GOLD, así como el índice de masa corporal, la obstrucción del flujo de aire, la disnea y la capacidad de ejercicio (índice BODE). La calidad de vida fue evaluada mediante el Cuestionario Respiratorio de Saint George (CRSG) y la prueba de evaluación de la EPOC (CAT, en inglés), en tanto que la depresión fue evaluada por la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D). Resultados: Un total de 105 pacientes (85.7% varones, 37.1% indotrinitenses, 42.9% afrotrinitenses, 64.8% nivel de educación primaria) fueron reclutados con una edad promedio de 66.9 años (desviación estándar: 9.60 años). El índice de masa corporal promedio fue de 25 kg/m2; 26.7% por debajo del peso normal. Los factores de riesgo identificados fueron: fumar ocasionalmente (27.6%), marihuana (20%), biomasa (81.9%), humo pasivo (70.5%), exposición ocupacional (80%). El CES-D del 25% de los pacientes fue ≥ 16. Las comorbilidades incluyeron diabetes (22%), hipertensión (29%), enfermedad por reflujo gastroesofágico (10%), y previo infarto del miocardio (15%). Un total de 59% de los pacientes reportaron un ingreso mensual familiar de menos de $800 USD. El nivel más bajo de educación se asoció con un peor (CRSG) (total e impacto), menor volumen espiratorio forzado en un segundo, Escala del Consejo de Investigaciones Médicas modificada (mMRC) de ≥ 2, y más alto índice de BODE. Un grupo más alto de GOLD se correlacionó con peores resultados de CRSG, CAT y CES-D. El CES-D más alto se asoció con una caminata de una distancia más corta en seis minutos, peores puntuaciones de CRSG, CAT y mMRC, un grupo más alto de GOLD, y mayores ingresos de EPOC por año. Los pacientes con CES-D de ≥ 16 caminaron distancias más cortas. El cuartil más alto de BODE estuvo asociado con las puntuaciones peores de CRSG, CAT y CES-D. Conclusión: El grupo GOLD más alto y el cuartil más alto de BODE se asociaron con peores puntuaciones de calidad de vida y puntuaciones de depresión más altas. Los pacientes en los grupos de GOLD más altos deben ser tamizados para detectar si padecen depresión. La educación sobre la EPOC debe estar dirigida a aquellos que tienen una situación socioeconómica inferior.

Calidad de vida relacionada con la salud en personas chilenas con enfermedad pulmonar obstructiva crónica / Health-related quality of life in Chilean patients with chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) has a relevant impact on health-related quality of life (HRQoL). Short Form 6 dimensions (SF-6D) quality of life tool allows researchers to calculate preference-based utilities using data from SF-12 or SF-36 questionnaires. Aim: To provide normative values of SF-6D derived from SF-12 for Chilean patients with COPD. Material and Methods: SF-6D utility index was calculated using data from the 2009/2010 Chilean National Health Survey. Sixty-nine male and 120 female patients with COPD participated in the survey. Data was stratified by gender, age, region, marital status, smoking status, monthly incomes, educational level and area. Results: The mean (± SD) SF-6D utility index for Chilean patients with COPD was 0.65 ± 0.15. The scores for men and women were 0.68 ± 0.15 and 0.64 ± 0.15, respectively. Patients with high incomes and educational level reported higher SF-6D scores. Ceiling effect was not a limitation when SF-6D was used in these Chilean patients. Conclusions: The current study provides normative values of SF-6D derived from SF-12 for Chilean patients with COPD.

Cuidados paliativos en pacientes con enfermedad pulmonar obstructiva crónica terminal / Palliative care in patients with terminal chronic obstructive pulmonary disease

Many guidelines concerning management of COPD have been published, with special emphasis on improving the patients' quality of life. Definitions and ways of achieving this aim are not explained as clear as the guidelines to achieve the rest of the goals. Even in advanced stages of the disease, COPD patients have a better survival nowadays. This fact has led to the appearance of new clinical challenges, such as determining the prognosis and the moment to finish a treatment. This article defines concepts on palliative care and quality of life in terminal COPD patients, pointed out the importance of incorporating them in palliative care programs. It also proposes guidelines to address the topic together with the family. There are many limitations regarding the admission of COPD patients to these programs. An example of these limitations is that predictive models are not individually accurate to establish the exact prognosis of the disease. Also the decision of beginning palliative care to control physical and/or psychological symptoms should be based on the needs of the patient according to his/her expectations, the concept he or she has on life quality and the way his/her family deals with the situation, instead of only considering statistics and their life expectancy. All of this requires a continuous assessment of symptomatology and the gradual incorporation of palliative measures, in addition to the regular treatment of the base disease.

Se han publicado diversas guías y consensos acerca del manejo de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) poniéndose especial énfasis en lograr la mejor calidad de vida de los pacientes. Las definiciones y maneras de como conseguir este objetivo no son informadas con la misma claridad ni precisión que las directrices para lograr el resto de las metas. Los pacientes con EPOC, han aumentado su sobrevida, incluso en quienes se encuentran en las fases más avanzadas; esto propicia la aparición de nuevos problemas clínicos como, determinar el pronóstico y punto final de los tratamientos. Este artículo define conceptos sobre cuidados paliativos y calidad de vida en pacientes con EPOC terminal, reconociendo la importancia de incorporarlos en programas de cuidados paliativos y propone pautas para abordar el tema en conjunto con su familia. En el caso de la EPOC existen diversas limitaciones para su ingreso a estos programas; entre ellas, la dificultad para establecer el pronóstico preciso ya que los modelos predictivos son inexactos a nivel individual y la decisión de iniciar cuidados para el control de síntomas físicos y/o psicológicos no debe basarse en la esperanza de vida ni en datos numéricos, sino en las necesidades que presenta un paciente terminal en relación a sus expectativas, su visión sobre calidad de vida y la forma en que sus familiares la enfrentan. Esto requiere la valoración periódica de los síntomas y la incorporación progresiva de las medidas de paliación, sin abandonar el tratamiento reglado de la enfermedad de base.

Ansiedade, depressão e desesperança em pacientes com doença pulmonar obstrutiva crônica / Anxiety, depression and hopelessness in patients with Chronic Obstructive Pulmonary Disease (COPD)

A Doença Pulmonar Obstrutiva Crônica (DPOC) é altamente incapacitante. O reconhecimento de fatores emocionais comuns a esses pacientes pode fornecer subsídios importantes para os profissionais que atuam na área da saúde. Objetivos: avaliar o impacto do programa de reabilitação pulmonar (PRP) sobre os níveis de ansiedade, depressão e desesperança de pacientes com DPOC, por meio da logoterapia. Métodos: 17 pacientes foram avaliados no início e ao final do PRP com três instrumentos de medida: Inventário Beck de Ansiedade, Inventário Beck de Depressão e Escala de Desesperança de Beck. Resultados: Participaram deste estudo 17 pacientes (52,9% homens), idade média de 64,5±8,1 anos. Ansiedade e depressão foram constatadas em 29,4% da amostra; desesperança em 41,1%. Na comparação entre pré e pós testes, os resultados foram os seguintes:ansiedade (p=0,002); depressão (p=0,001); desesperança (p=0,03).Conclusões: a realização do PRP mostrou-se efetiva para reduzir os níveis de ansiedade, depressão e desesperança dos pacientes...

Chronic Obstructive Pulmonary Disease is a highly disabling disease. The recognition of the emotional factors common to these patients may provideimportant information for professionals working with such subjects. Objectives: to assess the impact of pulmonary rehabilitation program (PRP) on the levels of anxiety, depression and hopelessness in patients with COPD,through logotherapy. Methods: 17 COPD patients were assessed at baseline and at the end of PRP based on three scales: Beck Anxiety Inventory, Beck Depression Inventory and Beck Hopelessness Scale. Results: The studyincluded 17 patients (52.9% men) with mean age of 64.5 ± 8.1 years. Anxiety and depression were present in 29.4% of the sample, 41.1% in despair. In the comparison between the analyzed variables during the pre and post tests, the results were as follows: anxiety (p = 0.002), depression (p = 0.001), hopelessness (p = 0.03). Conclusions: The achievement of a pulmonary rehabilitation program has proven effective to reduce levels of anxiety, depression and hopelessness in patients with COPD...

The opinion of patients with COPD: the process of becoming chronically sick / Vozes das pessoas com DPOC: o processo de tornar-se doente crónico

Many earlier studies have contributed to a general understanding of the symptoms and signs of chronic obstructive pulmonary disease (COPD), yet very little is known about the transition from a healthy to a chronically sick individual. The scope of this study was to understand how people live with their chronic illness, using Grounded Theory¹. Twenty-two participants with COPD were interviewed. Findings revealed "the basic social process" of becoming sick with COPD: The significance of living with COPD; Stages of becoming a sick individual; Strategies for management of the process used by participants. The conclusion reached is that understanding the process of "becoming sick" from the person's perspective assists nurses to develop personalized interventions with individuals suffering from COPD, focussing on the subject of care.

Os vários estudos realizados no âmbito da DPOC têm focalizado o seu objeto de estudo na compreensão dos sinais e sintomas da doença, no entanto pouco se conhece sobre a transição de saudável a doente. Então como é que as pessoas com DPOC vivem o processo de transição de saudável a doente? O método utilizado foi a Teoria Fundamentada. Realizámos 22 entrevistas abertas a pessoas com DPOC. O Processo Social Básico (PSB), encontrado neste estudo é "tornar-se doente" expressa o conceito central do estudo e procura dar resposta à questão de investigação: O PSB é composto pelos seguintes códigos temáticos: O significado de viver com a DPOC; Estádios do processo de tornar-se doente; Estratégias de gestão do processo. Consideramos que o conhecimento do processo de "tornar-se doente", ajuda os enfermeiros a desenvolver intervenções individualizadas às pessoas com DPOC, focalizando-se no sujeito de cuidados.

Calidad de vida relacionada con la salud y factores psicológicos: un estudio desde la enfermedad pulmonar obstructiva crónica - EPOC / Health-related quality of life and psychological factors: a study from chronic obstructive pulmonary disease - COPD

El objetivo de este estudio fue evaluar las relaciones entre resiliencia, percepción de enfermedad, creencias y afrontamiento espiritual-religioso sobre la calidad de vida relacionada con la salud en 40 pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica de la ciudad de Medellín, Colombia. Instrumentos: escala de resiliencia RS, escala de resiliencia breve CD-RISC2, cuestionario breve de percepción de enfermedad IPQ-B, inventario de sistema de creencias SBI-15R, escala estrategias de afrontamiento espirituales SCS y cuestionario de salud MOS SF-36. A nivel de resultados hubo correlaciones positivas entre resiliencia y salud mental, y en el análisis de regresión lineal el control personal y las consecuencias de percepción de enfermedad tuvieron un peso significativo sobre el índice sumario mental de calidad de vida. En conclusión, la salud mental en crisis agudas se ve alterada por la preocupación en las consecuencias físicas, sociales, económicas y emocionales que acarrea la enfermedad, y el control personal y la resiliencia son variables que promueven la regulación emocional en pacientes con EPOC.

The purpose of this research was to evaluate the relationship of the resilience, illness perception, beliefs and spiritual-religious coping on health-related quality of life in 40 patients with chronic obstructive pulmonary disease diagnosis from the city of Medellín, Colombia. Instruments: resilience scale RS, the connor-davidson resilience Scale CD-RISC2, the brief illness perception questionnaire IPQ-B, systems of beliefs inventory SBI-15R, spiritual coping scale SCS, medical outcomes study short form 36 ítems MOS SF-36. To level results there were positive correlations between resilience and mental health and multiple linear regression analysis personal control and consequences of illness perception had significant weight on the summary mental index of the quality of life. In conclusion, the mental health in sharp crises meets altered by the worry in the physical, social, economic and emotional consequences that it brings the disease and personal control and resilience are variables that promote the emotional regulation in patients with COPD.

Aspectos psicológicos de la rehabilitación pulmonar en el paciente con enfermedad pulmonar obstructiva crónica / Psychological aspects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

We present a review of the literature available on the psychological issues of the rehabilitation of patients with chronic obstructive pulmonary disease (COPD). The review is organized around four main themes. First, we present the more commonly psychological manifestations described among patients with COPD, in particular depression and anxiety. Second, we discuss some psychosocial factors that may influence the treatment and course of the disease, including the following: social support, illness beliefs, self-efficacy and self- management (human agency). Third, we present treatments and interventions that are considered to be effective for the management of these psychological disorders in patients with COPD and discuss the evidence. The chapter ends with a discussion about the influence of the pulmonary rehabilitation on the psychological and psychiatric symptoms that these patients present.

Se realiza una revisión de la literatura sobre los aspectos psicológicos de la rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). La revisión está organizada en cuatro temas centrales. Primero, se presentan las manifestaciones psicológicas más habituales descritas en pacientes con EPOC, en particular trastornos depresivos y ansiosos. Segundo, se discuten algunos factores psicosociales que pueden influir en el tratamiento y curso de la enfermedad, incluyendo las siguientes: apoyo social, creencias de enfermedad, autoeficacia y autogestión en salud. Tercero, se presentan los tratamientos y las intervenciones que se consideran son más efectivas para el manejo de estos trastornos psicológicos en pacientes con EPOC y se discute su evidencia. El capítulo termina con una discusión sobre la influencia de la rehabilitación pulmonar en la sintomatología psicológica y psiquiátrica de estos pacientes.

Prevalence of depression in stable chronic obstructive pulmonary disease.

Background. Psychological impairment is a significant co-morbid condition of chronic obstructive pulmonary disease (COPD). No studies from India have been conducted to assess the prevalence of depression in COPD. Methods. We investigated the prevalence of depression in 100 consecutive stable COPD patients during their routine outpatient department visits. Patients diagnosed to have depression or chronic systemic diseases were excluded. Severity of the COPD was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Hindi translations of patient health questionnaire-9 (PHQ-9) were administered and severity of depression was assessed at each stage of the COPD. Results. All subjects were males with a mean age of 61.7±9.6 years. Six patients in stage I, 32 patients in stage II, 40 patients in stage III and 22 patients in stage IV of the COPD were enrolled. The cumulative prevalence of depression in the study population was 72 percent. Conclusions. Symptoms of depression were observed at all stages of COPD and its severity increased with an increase in severity of the COPD. High prevalence of depressive symptoms in Indian patients with COPD may be due to various confounding factors. Screening for symptoms of depression in patients with COPD by simple and quick validated questionnaires during their out-patient visits will be helpful in early diagnosis and appropriate treatment or referral.

Prevalência de asma e rinite alérgica em escolares no município de Santo Ângelo/RS / Prevalence of asthma and allergic rhinitis among students from Santo Ângelo/RS

Introdução: A asma é uma doença inflamatória crônica, caracterizada por hiper-responsividade das vias aéreas inferiores que se manifesta por episódios recorrentes de sibilância, dispnéia, aperto no peito e tosse. Objetivo: Determinar a prevalência de asma e rinite alérgica em adolescentes do município de Santo Ângelo/RS. Metodologia: Foi realizado um estudo observacional, prospectivo e transversal; a amostra foi constituída por estudantes de 13 a 14 anos. Foram investigadas as variáveis: sexo, idade e interferência dos sintomas das doenças nas atividades diárias através da aplicação de um questionário epidemiológico padronizado do ISAAC (International Study of Asthma and Allergies in Childhood). Resultados: O número de questionários aplicados foi de 1.031, sendo considerados válidos 979 (94,9 por cento). A prevalência de asma nos adolescentes foi de 10,5 por cento, baseada na questão “já teve ou tem asma”. A prevalência de rinite alérgica foi de 34,6 por cento, baseada na questão “já teve ou tem rinite alérgica”. Quanto à polinose “alergia ao pólen na primavera” a prevalência foi de 30,4 por cento. Considerando-se o sub-diagnóstico das doenças, a prevalência de prováveis asmáticos foi de 12 por cento e a de adolescentes com provável rinite de 12 por cento. Conclusão: A prevalência de asma no presente estudo mostrou-se entre os valores médios mundiais e nacionais, já as prevalências de rinite alérgica e polinose mostraram-se elevadas de acordo com as médias de outros estudos. Estes dados apontam que em Santo Ângelo/RS essas doenças constituem um problema de saúde pública entre os adolescentes.

Introduction: Asthma is an inflammatory chronic disease, characterized as a hyperresponsivity of the lower airways that manifests itself through recurrent episodes of sibilance, dyspnea, chest pressure, and coughing. Aim: To determine the prevalence of asthma and allergic rhinitis in adolescents living in the municipality of Santo Ângelo/RS. Methods: An observational transversal, prospective study was performed, the sample comprising 13- and 14-year-old students. The variables sex, age, and interference of the symptoms of the disease in the daily activities were investigated through the administration of the standardized epidemiological questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC). Results: Of the 1,031 questionnaires responded, 979 (94.9 percent) were considered as valid. The prevalence of asthma among the adolescents was 10.5 percent, based on the question: “Have you ever had asthma?”. The prevalence of allergic rhinitis was 34.6 percent, based on the question “Have you ever had allergic rhinitis?. As for pollen allergy during the spring, the prevalence was 30.4 percent. Considering the underdiagnosis of the diseases, the prevalence of probable asthmatics was 12 percent and of adolescents with probable rhinitis was 12 percent. Conclusion: The prevalence of asthma in the present study was consistent with the reported mean world and national values, but the prevalences of allergic rhinitis and pollen allergies were high as compared to the means reported elsewhere. The data indicate that in Santo Ângelo, RS these conditions are a public health problem among adolescents.

Repercussões tardias de um programa de reabilitação pulmonar sobre os índices de ansiedade, depressão, qualidade de vida e desempenho físico em portadores de DPOC / Long-term repercussions of a pulmonary rehabilitation program on the indices of anxiety, depression, quality of life and physical performance in patients with COPD

OBJETIVO: Analisar os efeitos, após 24 meses, de um programa de reabilitação pulmonar (PRP) sobre os níveis de ansiedade, depressão, qualidade de vida e desempenho físico em pacientes com DPOC. MÉTODOS: Trinta pacientes com DPOC (idade média, 60,8 ± 10 anos; 70 por cento do sexo masculino) participaram de um PRP com 12 semanas de duração, incluindo 24 sessões de exercício físico, 24 sessões de reeducação respiratória, 12 sessões de psicoterapia e 3 sessões educacionais. Os pacientes foram avaliados na linha de base (pré-PRP), ao término do PRP (pós-PRP) e dois anos mais tarde (momento atual) através de quatro instrumentos: Inventário de Ansiedade de Beck; Inventário de Depressão de Beck; Questionário Respiratório do Hospital Saint George; e teste da caminhada de 6 minutos (TC6). RESULTADOS: A comparação entre o pré-PRP e o pós-PRP revelou uma redução significativa dos níveis de ansiedade (pré-PRP: 10,7 ± 6,3; pós-PRP: 5,5 ± 4,4; p = 0,0005) e de depressão (pré-PRP: 11,7 ± 6,8; pós-PRP: 6,0 ± 5,8; p = 0,001), assim como melhoras na distância percorrida no TC6 (pré-PRP: 428,6 ± 75,0 m; pós-PRP: 474,9 ± 86,3 m; p = 0,03) e no índice de qualidade de vida (pré-PRP: 51,0 ± 15,9; pós-PRP: 34,7 ± 15,1; p = 0,0001). Não houve diferenças estatisticamente significativas entre os resultados do pós-PRP e os do momento atual. CONCLUSÕES: Os benefícios obtidos através do PRP sobre os índices de ansiedade, depressão e qualidade de vida, assim como no TC6, persistiram ao longo dos 24 meses.

OBJECTIVE: To assess the 24-month effects of a pulmonary rehabilitation program (PRP) on anxiety, depression, quality of life and physical performance of COPD patients. METHODS: Thirty patients with COPD (mean age, 60.8 ± 10 years; 70 percent males) participated in a 12-week PRP, which included 24 physical exercise sessions, 24 respiratory rehabilitation sessions, 12 psychotherapy sessions and 3 educational sessions. All patients were evaluated at baseline (pre-PRP), at the end of the treatment (post-PRP) and two years later (current) by means of four instruments: the Beck Anxiety Inventory; the Beck Depression Inventory; Saint George's Respiratory Questionnaire; and the six-minute walk test (6MWT). RESULTS: The comparison between the pre-PRP and post-PRP values revealed a significant decrease in the levels of anxiety (pre-PRP: 10.7 ± 6.3; post-PRP: 5.5 ± 4.4; p = 0.0005) and depression (pre-PRP: 11.7 ± 6.8; post-PRP: 6.0 ± 5.8; p = 0.001), as well as significant improvements in the distance covered on the 6MWT (pre-PRP: 428.6 ± 75.0 m; post-PRP: 474.9 ± 86.3 m; p = 0.03) and the quality of life index (pre-PRP: 51.0 ± 15.9; post-PRP: 34.7 ± 15.1; p = 0.0001). There were no statistically significant differences between the post-PRP and current evaluation values. CONCLUSIONS: The benefits provided by the PRP in terms of the indices of anxiety, depression and quality of life, as well as the improved 6MWT performance, persisted throughout the 24-month study period.

Influência da massa magra corporal nas repercussões cardiopulmonares durante o teste de caminhada de seis minutos em pacientes com DPOC / Influence of lean body mass on cardiopulmonary repercussions during the six-minute walk test in patients with COPD

OBJETIVO: A massa magra corporal (MMC) tem sido associada à mortalidade em pacientes com DPOC, mas seu impacto na limitação funcional é pouco conhecido. O objetivo deste trabalho foi analisar as variáveis cardiopulmonares em pacientes com DPOC, com ou sem depleção da MMC, antes e após a realização do teste de caminhada de seis minutos (TC6). MÉTODOS: Foram avaliados pacientes com DPOC, 36 sem depleção de MMC e 32 com depleção de MMC. Todos os pacientes foram submetidos à avaliação clínica, espirometria, avaliação da composição da massa corpórea e TC6 e responderam a questionários de qualidade de vida e de percepção de dispnéia. RESULTADOS: Não foram observadas diferenças significativas na gravidade de obstrução das vias aéreas, na percepção da dispnéia e na qualidade de vida entre os grupos. A distância percorrida no TC6 foi similar nos pacientes com DPOC com e sem depleção de MMC (470,3 ± 68,5 m vs. 448,2 ± 89,2 m). Entretanto, durante a realização do teste, os pacientes com depleção de MMC apresentaram aumento significativamente maior na diferença entre os valores final e basal da frequência cardíaca e do índice da escala de Borg para cansaço dos membros inferiores. A distância percorrida no TC6 apresentou correlação significativa positiva com o VEF1 (r = 0,381; p = 0,01). CONCLUSÕES: Não houve influência da depleção da MMC na capacidade funcional de exercício e na qualidade de vida dos pacientes estudados. Entretanto, os pacientes com depleção de MMC apresentam sintomas de fadiga dos membros inferiores mais acentuados durante o TC6, o que reforça a importância da avaliação e tratamento das manifestações sistêmicas da DPOC.

OBJECTIVE: Although lean body mass (LBM) has been associated with mortality in patients with COPD, its influence on functional limitation is not clear. The objective of this study was to analyze the cardiopulmonary variables in COPD patients with or without LBM depletion, prior to and after the six-minute walk test (6MWT). METHODS: We evaluated COPD patients, 32 with LBM depletion and 36 without. All patients underwent clinical evaluation, spirometry, evaluation of body mass composition and 6MWT, as well as completing questionnaires related to quality of life and perception of dyspnea. RESULTS: No significant differences in the severity of airway obstruction, perception of dyspnea and quality of life scores were found between the groups. The distance covered on the 6MWT was similar in COPD patients with and without LBM depletion (470.3 ± 68.5 m vs. 448.2 ± 89.2 m). However, patients with LBM depletion presented significantly greater differences between baseline and final values in terms of heart rate and Borg scale index for lower limb fatigue. There was a significant positive correlation between distance covered on the 6MWT and FEV1 (r = 0.381, p = 0.01). CONCLUSIONS: In the patients studied, functional exercise tolerance and quality of life were unaffected by LBM depletion. However, the patients with LBM depletion presented more pronounced lower limb fatigue during the 6MWT, which underscores the importance of the evaluation and treatment of systemic manifestations in COPD patients.

[Comparison of the quality of life in patients with chronic obstructive pulmonary disease and control group]

Chronic obstructive pulmonary disease [COPD] is the fourth cause of mortality and a leading cause of chronic disability worldwide. Given the nature of the disease and lack of any effective treatment, it can profoundly affect the quality of life [QOL] or patients. Studies about the effect of COPD on QOL have yielded contradictory results: however, most studies suggest that COPD negatively affects QOL. QOL is a concept which is influenced by bio-psycho-social factors. In this study, we assessed the effect of COPD on QOL of a group of Iranian patients. In this case we assessed QOL in two groups, each consisting of 80 COPD patients as cases and 80 healthy persons control group matched for age, sex, marital status and education and comparatively similar socioeconomic and cultural status. The brief WHO-QOL questionnaire was used. Data were analyzed with SPSS10 using control study, we as t-test. The results were expressed as mean and standard deviations and significance level was set at 0.05. Analysis of data showed, that mean QOL score and mean scores of the five aspects of QOL, i.e. disease, independent life, social relations, physical sensations and mental welfare in the COPD group was significantly lower than in the control group [P<0.05]. Our findings are indicative of the negative effect of COPD on QOL in particular. The significantly low levels of QOL in COPD patients demonstrates that COPD affects not only the patients' physical health but also other aspects of their lives, leading to decreased QOL. Thus, in spite of ongoing disease, interventions in these aspects of the patients' lives can improve QOL as a comprehensive and holistic therapeutic goal

Sopro de vida: experiência com a doença pulmonar obstrutiva crônica na pobreza urbana de Fortaleza, Ceará, Brasil / Breath of life: experience with chronic obstructive pulmonary disease in the context of urban poverty in Fortaleza, Ceará State, Brazil

Trata-se de estudo antropológico de pessoas com a doença pulmonar obstrutiva crônica vivenciada na pobreza urbana de Fortaleza, Ceará, Brasil. De março a novembro de 2006, conduzimos com seis pacientes o estudo de casos, a entrevista etnográfica, a narrativa da enfermidade, e a observação participante no atendimento hospitalar e visitas domiciliares. Utilizamos a análise de conteúdo temática e a interpretação semântica contextualizada para interligar a experiência individual aos sistemas de significação, ações tomadas e condicionantes estruturais. Conclui-se que a doença pulmonar obstrutiva crônica provoca sensações, sinais e significados subjetivos. O diagnóstico torna a vida "um sufoco", surgindo limitações e privações de atividades laborais, sexuais, domésticas, familiares e de lazer. Evitar o contato direto com "o catarro" do doente, deixar de fumar ou diminuir a freqüência e evitar fumaça, tratar os sintomas com remédios caseiros e terapias corporais populares, manter a calma durante as crises, rejeitar restrições categóricas e impostas e entregar-se às forças espirituais são estratégias leigas para enfrentar o cansaço, a crise e a baixa auto-estima. A subjetividade da enfermidade, portanto, jamais pode ser excluída na medição da "carga global da doença" no nordeste brasileiro.

This is an anthropological study on the experience of living with chronic obstructive pulmonary disease (COPD) for low-income individuals in the city of Fortaleza, Ceará State, Brazil. From March to November 2006, we conducted case studies of six patients, using ethnographic interviews, illness narratives, and participant-observation during hospital treatment and home visits. Thematic context analysis and contextualized semantic analysis were used to link individual experience to system of significance, actions taken, and structural constraints. Based on the findings, COPD provokes subjective sensations, signs, and meanings. The diagnosis "smothers" patients, provoking hardships and limitations in their manual, sexual, domestic, family, and leisure activities. Lay strategies used to confront acute shortness of breath and low self-esteem include: avoiding direct contact with the patient's "phlegm", quitting or reducing smoking, treating symptoms with home remedies and popular body therapies, remaining calm during attacks, rejecting imposed therapies, and surrendering one's self to spiritual powers. Thus, the subjectivity of illness cannot be excluded from the measurement of the "global burden of disease" in Northeast Brazil.

Evaluación de calidad de vida en pacientes EPOC controlados en policlínico enfermedades respiratorias; hospital Dr. Gustavo Fricke de Viña del Mar / Quality of life measurement in COPD patients under control in the department of respiratory diseases Dr. Gustavo Fricke of Viña del Mar

La evaluación de la calidad de vida en la enfermedad pulmonar obstructiva crónica (EPOC) mediante cuestionarios de disnea es una recomendación presente en la mayoría de las guías crónicas de manejo de la enfermedad, tanto como en el estudio de nuevas drogas. A 26 pacientes portadores de EPOC categorías 2 a 4, controlados en el policlínico de enfermedades respiratorias del Hospital Dr. Gustavo Fricke de Viña del Mar, se les realizó una espirometría basal y post-broncodilatador, el Saint George Respiratory Questionnaire (SGRQ) versión en español adaptada y una caminata de 6 minutos, de acuerdo con norma ATS (6MWT). El análisis estadístico de estas variables muestra una mejor correlación de SGRQ con 6MWT (rho=0.58) más que con VEF1 post-bd. (rho=0.511). La correlación del VEF1 post-broncodilatador con SGRQ es sólo significativa para la categoría síntomas (rho=0.63 p=0.0007), no para impacto en la calidad de vida ni en la actividad, resultados que son comparables a los descritos en la literatura.

The evaluation of the quality of life in chronic obstructive pulmonary disease (COPD) patients using questionnaires of dyspnea, is a recommendation present in most of the clinical guidelines for the management of the disease and for the study of new drugs. The study included 26 patients with COPD, categories 2 to 4, controlled in the respiratory diseases clinic at Gustavo Fricke Hospital in Viña del Mar. Studies applied to them included a pre and post-brochodilator spirometry, a saint George Respiratory Questionnaire (SGRQ) (spanish adapted version), and the six-minute walk test (6MWT) according to ATS guidelines. Statistical analysis showed a better correlation between SGRQ and 6MWT (rho = 0.58), than with FEV1 post-bronchodilator (rho = o.511). The correlation of FEV1 post-bronchodilatador with SGRQ is only significant for the category of symptoms (rho = 0.63; p = 0.0007), not for the impact in the quality of life and activity, results that are comparable to those described in literature.

Calidad de Vida y Apoyo Social de los Pacientes con Enfermedad Pulmonar Obstructiva Crónica / Quality of life and social support for patients suffering from chronic obstructive pulmonary disease

Objetivo: Describir en los pacientes con Enfermedad Pulmonar Obstructiva Crónica la calidad de vida y el apoyo social con que cuentan. Métodos: Estudio descriptivo, trasversal (n=22) sujetos que obedecieron a los criterios de inclusión. La salud calidad de vida se determinó a través del Cuestionario de Salud Nottingham Health Profile (NHP), y el apoyo social con la (Escala de Duke-Unc). Resultados: La edad media de los evaluados fue 67,0±9,9 años. La distribución por género fue 8 hombres 36,4 por ciento y 14 mujeres 63,6 por ciento. Las puntuaciones más altas de calidad de vida se reflejaron en los dominios Sueño 42,3±30,8, Reacciones Emocionales 40,2±5,7 y Movilidad 38,4±33,5, mientras que la puntuación más baja se demostró en el dominio Aislamiento Social con 23,6±19,4. El Apoyo Social Afectivo bueno: 55,1 por ciento de pacientes, Apoyo Social Confidencial escaso: 44,9 por ciento de pacientes. Conclusiones: Las mujeres muestran una percepción peor de su estado de salud y calidad de vida que los hombres principalmente en los dominios Sueño, Reacciones Emocionales, Energía y Movilidad. Algo más de la mitad de los pacientes referían buen apoyo social, siendo mayor el afectivo que el confidencial.

Objective: Describing patients suffering from chronic obstructive pulmonary disease, their quality of life and their respective social support network. Methods: This was a cross-sectional study of patients (n=22) fulfilling the inclusion criterion. Quality of life regarding health was determined by using the Nottingham Health Profile (NHP) and the Duke-UNC scale for the social support network. Results: The patients' average age was 67,0±9,9. Gender distribution was 8 male (36,4 percent) and 14 female patients (63,6 percent). The highest point-scores for quality of life on the Nottingham Health Profile subscales were obtained for sleep (42,3±30,8), emotional reactions (40,2±25,7) and mobility (38,4±33,5) whilst the lowest point-score was obtained on the social isolation subscale (23,6±19,4). There was good emotional social support (55,1 percent of patients) but limited confidential social support (44,9 percent of patients). Conclusions: Women showed worse perception regarding their state of health and quality of life than men. The following dimensions being mostly affected: sleep, emotional reactions, energy and mobility. Just over half the patients referred to having acceptable social support; emotional support was greater than confidential support.

Influência do sistema de fornecimento de oxigênio na qualidade de vida de pacientes com hipoxemia crônica / Influence of the oxygen delivery system on the quality of life of patients with chronic hypoxemia

OBJETIVO: Avaliar a qualidade de vida relacionada à saúde de pacientes com doença obstrutiva crônica das vias aéreas recebendo oxigenoterapia domiciliar prolongada (ODP) por meio de cilindros de oxigênio e comparar estes resultados com os obtidos após seis meses de modificação do sistema de fornecimento para concentradores de oxigênio. MÉTODOS: Um total de 45 pacientes, 24 com hipoxemia crônica e 21 sem evidências de hipoxemia, foram avaliados. Os pacientes com hipoxemia crônica estavam recebendo ODP regularmente durante pelo menos os últimos seis meses e foram avaliados no momento basal, em uso de cilindro, e após seis meses de transição para concentradores. Os pacientes não hipoxêmicos foram avaliados no mesmo intervalo de tempo que os pacientes hipoxêmicos. Para avaliar a qualidade de vida foi utilizada a versão validada para língua portuguesa (Brasil) do Questionário Respiratório Saint George (Saint George's Respiratory Questionnaire - SGRQ). RESULTADOS: No momento inicial, os pacientes hipoxêmicos apresentaram maior comprometimento da qualidade de vida, avaliada pelo escore total e pelos escores dos domínios sintomas e impacto do SGRQ, que os pacientes não hipoxêmicos. Após seis meses, houve melhora significativa da qualidade de vida dos pacientes hipoxêmicos e, neste momento, não foi encontrada diferença entre os pacientes com e sem hipoxemia. CONCLUSÃO: Nossos achados mostraram que os pacientes com doença obstrutiva crônica das vias aéreas e hipoxemia crônica apresentam prejuízo da qualidade de vida, que essa qualidade de vida pode ser melhorada com o uso regular de ODP e que o sistema de fornecimento de oxigênio tem influência nessa melhora.

OBJECTIVE: To evaluate the health-related quality of life of patients with chronic obstructive pulmonary disease receiving long-term oxygen therapy (LTOT) at home through oxygen cylinders and compare these results with those obtained six months after the transition from oxygen cylinders to oxygen concentrators. METHODS: A total of 45 patients were evaluated. Of those, 24 had chronic hypoxemia and 21 presented no evidence of hypoxemia. The patients with chronic hypoxemia had been regularly receiving LTOT for at least the last six months and were evaluated at baseline, while using cylinders, and six months after the transition from cylinders to concentrators. The non-hypoxemic patients were evaluated at the same time points as were the hypoxemic patients. In order to evaluate quality of life, a version of the Saint George's Respiratory Questionnaire (SGRQ), translated and validated for use in Brazil, was administered. RESULTS: At baseline, quality of life, as evaluated using the total score and the symptom and impact domain scores of the SGRQ, was more impaired in the hypoxemic patients than in the non-hypoxemic patients. After six months of using the concentrators, the hypoxemic patients presented a significant improvement in the quality of life, and, at that time, no difference was found between the patients with and without hypoxemia. CONCLUSION: Our findings show that quality of life is impaired in patients with chronic obstructive pulmonary disease and chronic hypoxemia, that their quality of life can be improved through regular use of LTOT, and that the oxygen delivery system has an influence on this improvement.