ABSTRACT
Objetivo: Evaluar la capacidad de ejercicio, utilizando la prueba de la marcha de 6 minutos (6MWT), en pacientes con silicosis complicada, e identificar factores relacionados con dicho resultado, así como su valor pronóstico de hospitalización y mortalidad. Método: Estudio observacional prospectivo en 143 pacientes diagnosticados de silicosis complicada atendidos en consulta de neumología desde 2009 hasta diciembre 2016, sin limitación para hacer la 6MWT. Se evaluaron las pruebas de función pulmonar, los hallazgos de la tomografía computarizada y los parámetros de la 6MWT (distancia caminada y desaturación de oxígeno). Resultados: Los pacientes con silicosis complicada caminaban una media de 387 ± 92m. Los resultados fueron peores al aumentar la gravedad de la enfermedad; en silicosis A: 407 ± 97; B: 370 ± 88, y C: 357 ± 68 (p=0,022). La 6MWT mostraba una correlación positiva con la función pulmonar e inversa con la disnea (p < 0,001). Los pacientes con enfisema moderado/severo y un mayor tiempo con saturación nocturna de oxígeno por debajo del 90% presentaban resultados significativamente peores en la 6MWT. Los pacientes que caminaban < 350 m tenían más hospitalizaciones (3,7 ± 4,0) que los que caminaban>350 (1,1 ± 2,9). Los fallecidos al final del seguimiento caminaron 327,9 ± 73,0 frente a los que sobreviven, que caminaron 404,5 ± 89,7 m (p < 0,001). Conclusiones: Los valores de la espirometría y la categoría de la silicosis se relacionan con el resultado de la 6MWT, que resultó ser factor pronóstico para hospitalización y mortalidad. La 6MWT se perfila como una herramienta útil en salud ocupacional para el seguimiento de pacientes con silicosis
Objective: To evaluate exercise capacity using the 6-minute walk test (6MWT) in patients with complicated silicosis, and to determine how results shape the prognostic value of 6MWT for hospitalization and mortality. Method: Prospective observational study in 143 patients with complicated silicosis who performed the 6MWT in our outpatient pulmonology clinic between 2009 and the end of 2016. Lung function tests, computed tomography findings and 6MWT parameters (distance walked and oxygen desaturation) were evaluated. Results: Patients with complicated silicosis walked 387±92m. Results deteriorated as silicosis severity increased; category A: 407 ± 97m, B: 370±88m, and C: 357 ± 68m (P=.022). The 6MWT correlated positively with lung function and inversely with dyspnea determined by mMRC (P < .001). Patients with moderate/severe emphysema and greater CT90 presented a worse result on 6MWT. Patients who walked < 350m had more hospitalizations (3.7 ± 4.0) than those who walked > 350m (1.1 ± 2.9). There was an impact on survival: non-survivors walked 327.9 ± 73.0m, while survivors walked 404.5 ± 89.7m (P < .001). Conclusions: Spirometry values and category of complicated silicosis correlated with 6MWT and distance walked was a prognostic factor for hospitalization and mortality. The 6MWT is a useful tool in occupational health for monitoring patients with silicosis
Subject(s)
Humans , Male , Adult , Middle Aged , Walk Test/methods , Prognosis , Silicosis/diagnosis , Exercise/physiology , Respiratory Function Tests/methods , Hospitalization , Prospective Studies , Silicosis/complications , Silicosis/mortality , Observational Study , Spirometry/methodsABSTRACT
OBJECTIVE: To evaluate exercise capacity using the 6-minute walk test (6MWT) in patients with complicated silicosis, and to determine how results shape the prognostic value of 6MWT for hospitalization and mortality. METHOD: Prospective observational study in 143 patients with complicated silicosis who performed the 6MWT in our outpatient pulmonology clinic between 2009 and the end of 2016. Lung function tests, computed tomography findings and 6MWT parameters (distance walked and oxygen desaturation) were evaluated. RESULTS: Patients with complicated silicosis walked 387±92m. Results deteriorated as silicosis severity increased; category A: 407±97m, B: 370±88m, and C: 357±68m (P=.022). The 6MWT correlated positively with lung function and inversely with dyspnea determined by mMRC (P<.001). Patients with moderate/severe emphysema and greater CT90 presented a worse result on 6MWT. Patients who walked<350m had more hospitalizations (3.7±4.0) than those who walked>350m (1.1±2.9). There was an impact on survival: non-survivors walked 327.9±73.0m, while survivors walked 404.5±89.7m (P<.001). CONCLUSIONS: Spirometry values and category of complicated silicosis correlated with 6MWT and distance walked was a prognostic factor for hospitalization and mortality. The 6MWT is a useful tool in occupational health for monitoring patients with silicosis.
Subject(s)
Exercise Tolerance/physiology , Hospitalization , Silicosis/physiopathology , Walk Test , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Pulmonary Emphysema/physiopathology , Silicosis/mortality , SpirometryABSTRACT
BACKGROUND: The Air-Smart Spirometer is the first portable device accepted by the European Community (EC) that performs spirometric measurements by a turbine mechanism and displays the results on a smartphone or a tablet. METHODS: In this multicenter, descriptive and cross-sectional prospective study carried out in 2 hospital centers, we compare FEV1, FVC, FEV1/FVC ratio measured with the Air Smart-Spirometer device and a conventional spirometer, and analyze the ability of this new portable device to detect obstructions. Patients were included for 2 consecutive months. We calculate sensitivity, specificity, positive and negative predictive value (PPV and NPV) and likelihood ratio (LR +, LR-) as well as the Kappa Index to evaluate the concordance between the two devices for the detection of obstruction. The agreement and relation between the values of FEV1 and FVC in absolute value and the FEV1/FVC ratio measured by both devices were analyzed by calculating the intraclass correlation coefficient (ICC) and the Pearson correlation coefficient (r) respectively. RESULTS: 200 patients (100 from each center) were included with a mean age of 57 (± 14) years, 110 were men (55%). Obstruction was detected by conventional spirometry in 73 patients (40.1%). Using a FEV1/FVC ratio smaller than 0.7 to detect obstruction with the Air Smart-Spirometer, the kappa index was 0.88, sensitivity (90.4%), specificity (97.2%), PPV (95.7%), NPV (93.7%), positive likelihood ratio (32.29), and negative likelihood ratio (0.10). The ICC and r between FEV1, FVC, and FEV1 / FVC ratio measured by the Air Smart Spirometer and the conventional spirometer were all higher than 0.94. CONCLUSION: The Air-Smart Spirometer is a simple and very precise instrument for detecting obstructive airway diseases. It is easy to use, which could make it especially useful non-specialized care and in other areas.
