Physical Activity Levels and Associated Factors in a Latin American COPD Population of Patients. The LASSYC Study.

Reduced physical activity (PA) is an independent risk factor for lung function decline, hospitalization and mortality in chronic obstructive pulmonary disease (COPD) and affects a large proportion of patients from Europe and the United States. However, little is known of the level of PA of COPD patients in Latin America. The aim of this study was to provide information of the level of PA and its determinants in COPD patients in Latin America. This is an observational, cross-sectional study on patients with COPD in seven Latin American countries. PA level was evaluated with the short version of the International Physical Activity Questionnaire (IPAQ) and the association between PA and other variables was investigated. Complete information of PA level was obtained in 734 COPD patients consecutively recruited from specialized outpatient clinics; 448 (61%) were men, with a mean age of 69.6 years (standard deviation [SD] = 8.7) and a mean FEV1 (% predicted) = 49.1% (17.5%). In 37.9% the level of PA was low, and the average sitting time was 36.1 h per week. Patients with low levels of PA were older, with higher levels of dyspnea and higher CAT scores. Additionally, we found that patients with low level of PA presented more symptoms during the day. Low levels of PA have been observed in a large proportion of COPD patients of Latin America, which is higher in women and older patients and it is related with worse functional and clinical characteristics.

External validation of the PUMA COPD diagnostic questionnaire in a general practice sample and the PLATINO study population.

Background: A seven-item prescreening questionnaire (gender, age, pack-years smoking, dyspnea, sputum, cough, previous spirometry data) was developed for COPD detection in the primary care setting (PUMA Study) of four Latin America countries. Objectives: To validate the PUMA prescreening COPD questionnaire externally in two different populations (primary care and general). Methods: The PUMA prescreening COPD questionnaire score was applied to subjects from the Hospital Maciel, Montevideo (primary care), case-finding program and the PLATINO population (general) using PUMA study inclusion criteria. Post-bronchodilator FEV1/FVC <0.70 and lower limit of normal (LLN) criteria were used to define COPD. Area under the received operator curve (ROCAUC), sensitivity, specificity, predictive positive and negative values (PNV), number needed to treat (NNT), and best cut-points of the score were calculated. Results: 974 individuals from Hospital Maciel and 2512 from the PLATINO population were eligible, using post-bronchodilator FEV1/FVC <0.70, 45.1% and 18.7% had COPD, respectively, and using LLN 38.4% and 15.4% had COPD, respectively. From Hospital Maciel (post-bronchodilator FEV1/FVC <0.70), the best cut-point of ≥6 had moderate discriminatory power (ROCAUC 0.70), sensitivity 69.9%, specificity 62.1%, PNV 70.9%, and NNT of 3. The discriminatory power was 0.73 (ROCAUC) in the PLATINO population with three potential cut-points (Youden's index): ≥3 (sensitivity 85.4%, specificity 46.9%), ≥4 (sensitivity 66.7%, specificity 66.5%), and ≥5 (sensitivity 51.5%, specificity 81.6%); the PNV at each cut-point was 93.3%, 89.9%, and 88.0%, respectively. The NNT was 5 for scores ≥3 and ≥4, and 4 for ≥5. The mean accuracy using the LLN for Hospital Maciel and PLATINO was 0.67 and 0.70, respectively. Conclusion: External validation of the PUMA prescreening questionnaire in two Latin American populations (general and primary care) suggests moderate accuracy, similar to the original study in which the questionnaire was developed.

Respiratory medication used in COPD patients from seven Latin American countries: the LASSYC study.

Background: Limited information is available regarding medication use in COPD patients from Latin America. This study evaluated the type of medication used and the adherence to different inhaled treatments in stable COPD patients from the Latin American region. Methods: This was an observational, cross-sectional, multinational, and multicenter study in COPD patients attended by specialist doctors from seven Latin American countries. Adherence to inhaled therapy was assessed using the Test of Adherence to Inhalers (TAI) questionnaire. The type of medication was assessed as: short-acting ß-agonist (SABA) or short-acting muscarinic antagonist (SAMA) only, long-acting muscarinic antagonist (LAMA), long-acting ß-agonist (LABA), LABA/LAMA, inhaled corticosteroid (ICS), ICS/LABA, ICS/LAMA/LABA, or other. Results: In total, 795 patients were included (59.6% male), with a mean age of 69.5±8.7 years and post-bronchodilator FEV1 of 50.0%±18.6%. The ICS/LAMA/LABA (32.9%) and ICS/LABA (27.7%) combinations were the most common medications used, followed by LABA/LAMA (11.3%), SABA or SAMA (7.9%), LABA (6.4%), LAMA (5.8%), and ICS (4.3%). The types of medication most commonly used in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 category were ICS/LABA (A: 32.7%; B: 19.8%; C: 25.7%; D: 28.2%) and ICS/LAMA/LABA (A: 17.3%; B: 30.2%; C: 33%; D: 41.1%). The use of long-acting bronchodilators showed the highest adherence (good or high adherence >50%) according to the TAI questionnaire. Conclusion: COPD management in specialist practice in Latin America does not follow the current guideline recommendations and there is an overuse of ICSs in patients with COPD from this region. Treatment regimens including the use of long-acting bronchodilators are associated with the highest adherence.

Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study.

BACKGROUND: This study assessed the adherence profiles to inhaled therapies and the agreement between two patient self-report adherence methods in stable COPD lpatients from seven Latin American countries. METHODS: This observational, cross-sectional, multinational, multicenter study involved 795 COPD patients (post-bronchodilator forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] <0.70). Adherence to inhaled therapy was assessed using the specific Test of Adherence to Inhalers (10-item TAI) and the generic 8-item Morisky Medication Adherence Scale (MMAS-8) questionnaires. The percentage agreement and the kappa index were used to compare findings. RESULTS: 59.6% of patients were male (69.5±8.7 years); post-bronchodilator FEV1 percent predicted was 50.0±18.6%. Mean values for 10-item TAI and MMAS-8 questionnaires were 47.4±4.9 and 6.8±1.6, respectively. Based on the TAI questionnaire, 54.1% of patients had good, 26.5% intermediate, and 19.4% poor adherence. Using the MMAS-8 questionnaire, 51% had high, 29.1% medium, and 19.9% low adherence. According to both questionnaires, patients with poor adherence had lower smoking history, schooling but higher COPD Assessment Test score, exacerbations in the past-year and post-bronchodilator FEV1. The agreement between 10-item TAI and MMAS-8 questionnaires was moderate (Kappa index: 0.42; agreement: 64.7%). CONCLUSION: Suboptimal adherence to medication was frequent in COPD patients from Latin America. Low adherence was associated with worse health status impairment and more exacerbations. There was inadequate agreement between the two questionnaires. Greater effort should be made to improve COPD patients' adherence to treatment, and assessment of adherence with more specific instruments, such as the TAI questionnaire, would be more convenient in these patients. CLINICAL TRIAL REGISTRATION: NCT02789540.

Smoke, Biomass Exposure, and COPD Risk in the Primary Care Setting: The PUMA Study.

BACKGROUND: The evidence indicates that risk factors other than smoking are important in the development of COPD. It has been postulated that less traditional risk factors (eg, exposure to coal and/or biomass smoke) may interact with smoking to further increase COPD risk. This analysis evaluated the effect of exposure to biomass and smoking on COPD risk in a primary care setting in Latin America. METHODS: Subjects attending routine primary care visits, ≥40 y old, who were current or former smokers or were exposed to biomass smoke, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator FEV1/FVC < 0.70 and the lower limit of normal. Smoking was defined by pack-years (≤ 20, 20-30, or > 30), and biomass exposure was defined as an exposure to coal or wood (for heating, cooking, or both) for ≥ 10 y. RESULTS: One thousand seven hundred forty-three individuals completed the questionnaire, and 1,540 performed spirometry. Irrespective of COPD definition, approximately 40% of COPD subjects reported exposure to biomass versus 30% of those without COPD. A higher proportion of COPD subjects (post-bronchodilator FEV1/FVC < 0.70) than those without COPD smoked > 30 pack-years (66% vs 39%); similar results were found with the lower limit of normal definition. Analysis of exposure to biomass > 10 y plus smoking > 20 pack-years (reference was no exposure) found that tobacco smoking (crude odds ratio [OR] 4.50, 95% CI 2.73-7.41; adjusted OR 3.30, 95% CI 1.93-5.63) and biomass exposure (crude OR 3.66, 95% CI 2.00-6.73; adjusted OR 2.28, 95% CI 1.18-4.41) were risk factors for COPD, with smoking a possible confounder for the association between biomass and COPD (post-bronchodilator FEV1/FVC < 0.70); similar results were found with the lower limit of normal definition. CONCLUSIONS: Subjects with COPD from primary care had a higher exposure to biomass and smoking compared with non-COPD subjects. Smoking and biomass are both risk factors for COPD, but they do not appear to have an additive effect.

Lung function decline in subjects with and without COPD in a population-based cohort in Latin-America.

BACKGROUND: Lung-function decline is one of the possible mechanisms leading to Chronic Obstructive Pulmonary Disease (COPD). METHODS: We analyzed data obtained from two population-based surveys of adults (n = 2026) conducted in the same individuals 5-9 years (y) after their baseline examination in three Latin-American cities. Post BronchoDilator (postBD) FEV1 decline in mL/y, as %predicted/y (%P/y) and % of baseline/y (%B/y) was calculated and the influence of age, gender, BMI, baseline lung function, BD response, exacerbations rate evaluated using multivariate models. RESULTS: Expressed in ml/y, the mean annual postBD FEV1 decline was 27 mL (0.22%P, 1.32%B) in patients with baseline COPD and 36 (0.14%P, 1.36%B) in those without. Faster decline (in mL/y) was associated with higher baseline lung function, with significant response to bronchodilators, older age and smoking at baseline, also in women with chronic cough and phlegm, or ≥2 respiratory exacerbations in the previous year, and in men with asthma. CONCLUSIONS: Lung function decline in a population-based cohort did not differ in obstructed and non-obstructed individuals, it was proportional to baseline FEV1, and was higher in smokers, elderly, and women with respiratory symptoms.

Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study.

BACKGROUND: COPD, asthma, and asthma-COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. OBJECTIVES: To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma-COPD overlap. METHODS: COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma-COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. RESULTS: Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma-COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma-COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. CONCLUSION: COPD, asthma, and asthma-COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.

Development of a simple screening tool for opportunistic COPD case finding in primary care in Latin America: The PUMA study.

BACKGROUND AND OBJECTIVE: Opportunistic chronic obstructive pulmonary disease (COPD) case finding approaches for high-risk individuals with or without symptoms is a feasible option for disease identification. PUMA is an opportunistic case finding study conducted in primary care setting of Argentina, Colombia, Venezuela and Uruguay. The objectives were to measure COPD prevalence in an at-risk population visiting primary care for any reason, to assess the yield of this opportunistic approach and the accuracy of a score developed to detect COPD. METHODS: Subjects attending routine primary care visits, ≥40 years of age, current or former smokers or exposed to biomass smoke, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 s (FEV1 )/forced vital capacity (FVC) < 0.70 and the lower limit of normal of FEV1 /FVC. RESULTS: A total of 1743 subjects completed the interview; 1540 performed acceptable spirometry. COPD prevalence was 20.1% (n = 309; ranging from 11.0% in Venezuela to 29.6% in Argentina) when defined using post-BD FEV1 /FVC < 0.70, and 14.7% (n = 226; ranging from 8.3% in Venezuela to 21.8% in Colombia) using the lower limit of normal. Logistic regression analysis for both definitions showed that the risk of COPD was significantly higher for persons >50 years, heavy smokers (>30 pack-years), with dyspnoea, and having prior spirometry. A simple score and a weighted score constructed using the following predictive factors: gender, age, pack-years smoking, dyspnoea, sputum, cough and spirometry, had a mean accuracy for detecting COPD (post-BD FEV1 /FVC < 0.70) of 76% and 79% for the simple and weighted scores, respectively. CONCLUSION: This simple seven-item score is an accurate screening tool to select subjects for spirometry in primary care.

COPD Underdiagnosis and Misdiagnosis in a High-Risk Primary Care Population in Four Latin American Countries. A Key to Enhance Disease Diagnosis: The PUMA Study.

BACKGROUND: Acknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay. OBJECTIVES: To assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting. METHODS: COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed. RESULTS: 1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV1/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV1/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients (69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV1/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m2), milder airway obstruction (GOLD I-II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry. CONCLUSIONS: COPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting.

FEV1 is a better predictor of mortality than FVC: the PLATINO cohort study.

OBJECTIVE: To determine whether the presence of chronic obstructive lung disease (COPD) and reduction of lung function parameters were predictors of mortality in a cohort. MATERIALS/PATIENTS AND METHODS: Population based cohorts were followed in Montevideo, Santiago and Sao Paulo during 5, 6 and 9 years, respectively. Outcomes included all-cause, cardiovascular, respiratory and cancer mortality; exposures were COPD, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cox regression was used for analyses. Sensitivity, specificity, positive and negative predictive values, receiver operator characteristics curves and Youden's index were calculated. RESULTS: Main causes of death were cardiovascular, respiratory and cancer. Baseline COPD was associated with overall mortality (HR = 1.43 for FEV1/FVC

Reliability of FEV1/FEV6 to diagnose airflow obstruction compared with FEV1/FVC: the PLATINO longitudinal study.

QUESTION: A 6-second spirometry test is easier than full exhalations. We compared the reliability of the ratio of the Forced expiratory volume in 1 second/Forced expiratory volume in 6 seconds (FEV1/FEV6) to the ratio of the FEV1/Forced vital capacity (FEV1/FVC) for the detection of airway obstruction. METHODS: The PLATINO population-based survey in individuals aged 40 years and over designed to estimate the prevalence of post-Bronchodilator airway obstruction repeated for the same study participants after 5-9 years in three Latin-American cities. RESULTS: Using the FEV1/FVC

Perceptions of short and long sleep duration and comorbid conditions: the PLATINO study.

OBJECTIVES: We aimed to describe the distribution of self-reported sleep duration in adults over the age of 40 years and to analyze the associated risk factors, comorbid conditions, and quality of life (QoL). METHODS: Our study was constructed as a cross-sectional population-based study and is part of the PLATINO (Spanish acronym for the Latin American Project for Research in Pulmonary Obstruction) study. It includes data from Mexico City (Mexico), Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). Data from 4533 individuals were analyzed using a single questionnaire entitled, PLATINO, which was designed to collect data on self-reported sleep symptoms. Spirometry also was performed in accordance with international standards. All statistical analyses took the study design into consideration with adjustments for each city. RESULTS: The prevalence of subjects who reported sleeping <7h was 38.4%, ≥ 7 to <9h was 51.4%, and ≥ 9h was 10.2%. In the multivariate analysis, individuals with shorter sleep duration had higher frequencies of insomnia, increased forced expiratory volume in one second in liters and percentage/forced vital capacity in liters (FEV1/FVC) of predicted ratios, and a higher presence of coughing and phlegm. The main risk factor associated with longer duration of sleep was the number of comorbidities. CONCLUSIONS: Self-reported sleep duration discriminated among groups that differed in sleep-related symptoms, respiratory symptoms, QoL and comorbid conditions.

Airflow obstruction in never smokers in five Latin American cities: the PLATINO study.

BACKGROUND: Although chronic obstructive pulmonary disease (COPD) is mostly related to tobacco smoking, a variable proportion of COPD occurs in never smokers. We investigated differences between COPD in never smokers compared with smokers and subjects without COPD. METHODS: PLATINO is a cross-sectional population-based study of five Latin American cities. COPD was defined as postbronchodilator FEV(1)/FVC <0.70 and FEV(1) <80% of predicted values. RESULTS: Among 5,315 subjects studied, 2278 were never smokers and 3036 were ever smokers. COPD was observed in 3.5% of never smokers and in 7.5% of ever smokers. Never smokers with COPD were most likely older and reported a medical diagnosis of asthma or previous tuberculosis. Underdiagnosis was as common in obstructed patients who never smoked as in ever smokers. CONCLUSIONS: Never smokers comprised 26% of all individuals with airflow obstruction. Obstruction was associated with female gender, older age and a diagnosis of asthma or tuberculosis.

[Treatment of chronic obstructive pulmonary disease in 5 Latin American cities: the PLATINO study]. / Tratamiento de la EPOC en 5 ciudades de América Latina: estudio PLATINO.

OBJECTIVE: PLATINO project is a population-based study designed to determine the prevalence of chronic obstructive pulmonary disease (COPD) in São Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago de Chile, Chile; and Caracas, Venezuela. The objective of this portion of PLATINO was to describe preventive and pharmacological treatment of COPD patients and factors associated with such treatment. PATIENTS AND METHODS: Eligible subjects completed a questionnaire and underwent postbronchodilator spirometry. RESULTS: Of the total of 5529 individuals who answered items referring to treatment, 758 had COPD (ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity of <0.7), and 86 of them had been previously diagnosed by a physician. Among all COPD patients, only half of smokers or former smokers had been advised to quit and 24.7% had received some type of respiratory medication. Only 13.5% had used inhaled corticosteroids, and those were the patients with the most severe disease. In the group of patients who had a previous medical diagnosis of COPD, 69% of the smokers or former smokers had been advised to quit by a physician and 75.6% had received respiratory medication in the preceding year: 43% reported having used inhaled medication and 36% had used bronchodilators. Rates of vaccination against influenza and the use of mucolytic drugs and inhalers varied from one health care facility to another. All drug prescriptions were based on previous spirometry. CONCLUSIONS: Spirometry emerged not only as a diagnostic tool, but also as a factor associated with treatment, against a background of uneven use of available health care resources in these 5 Latin American cities.

Factores asociados con la abstinencia y eficacia de un programa de cesación de tabaquismo / Risk factors associated with abstinence. Efficacy of a smoking cessation program

El tabaquismo es la primera causa de morbimortalidad evitable en el mundo occidental. Objetivo: evaluar la eficacia de un programa de cesación de tabaquismo y factores asociados con la cesación. Material y método: 517 individuos ingresaron al programa, 357 completaron al menos dos sesiones. Se consignó: sexo, edad, estado civil, nivel de educación, enfermedades asociadas, entorno familiar de fumadores, intentos previos para dejar de fumar, historia de tabaquismo y grado de dependencia por escala de Fagerstrõm. Se aplicó un programa de ocho semanas multicomponente: cognitivo-conductual, farmacológico (bupropión o terapia de reemplazo nicotínico) y terapia grupal. La abstinencia fue confirmada por medida del CO exhalado. Resultados: los individuos tuvieron una edad entre 20 y 77 años (media de 50,58 ± 11,24), fueron 61,1 por ciento mujeres, 82,9 por ciento con intentos previos para dejar de fumar, fumadores de 44,22 ± 26,30 paquetes/año, edad de inicio media de 17,93 ± 3,65 años, consumo de 28,38 ± 13,45 cigarrillos/día, dependencia por Fagerstrõm de 5,99 ± 2,12, 89,4 por ciento recibieron medicación; 113 participantes (31,6 por ciento) se mantuvieron sin fumar al año. Un menor índice de cesación se asoció significativamente con: sexo femenino, mayor dependencia por escala de Fagerstrõm, y seguir fumando en las primeras semanas y a los tres meses de inicio del programa. Conclusiones: se comprobó la eficacia del programa con una tasa de cesación al año de 31,6 por ciento, comparable con los datos publicados por otros centros y asociada al género, la dependencia a la nicotina y el cese precoz, al inicio del programa.(AU)

Factores asociados con la abstinencia y eficacia de un programa de cesación de tabaquismo / Risk factors associated with abstinence. Efficacy of a smoking cessation program

El tabaquismo es la primera causa de morbimortalidad evitable en el mundo occidental. Objetivo: evaluar la eficacia de un programa de cesación de tabaquismo y factores asociados con la cesación. Material y método: 517 individuos ingresaron al programa, 357 completaron al menos dos sesiones. Se consignó: sexo, edad, estado civil, nivel de educación, enfermedades asociadas, entorno familiar de fumadores, intentos previos para dejar de fumar, historia de tabaquismo y grado de dependencia por escala de Fagerstrõm. Se aplicó un programa de ocho semanas multicomponente: cognitivo-conductual, farmacológico (bupropión o terapia de reemplazo nicotínico) y terapia grupal. La abstinencia fue confirmada por medida del CO exhalado. Resultados: los individuos tuvieron una edad entre 20 y 77 años (media de 50,58 ± 11,24), fueron 61,1 por ciento mujeres, 82,9 por ciento con intentos previos para dejar de fumar, fumadores de 44,22 ± 26,30 paquetes/año, edad de inicio media de 17,93 ± 3,65 años, consumo de 28,38 ± 13,45 cigarrillos/día, dependencia por Fagerstrõm de 5,99 ± 2,12, 89,4 por ciento recibieron medicación; 113 participantes (31,6 por ciento) se mantuvieron sin fumar al año. Un menor índice de cesación se asoció significativamente con: sexo femenino, mayor dependencia por escala de Fagerstrõm, y seguir fumando en las primeras semanas y a los tres meses de inicio del programa. Conclusiones: se comprobó la eficacia del programa con una tasa de cesación al año de 31,6 por ciento, comparable con los datos publicados por otros centros y asociada al género, la dependencia a la nicotina y el cese precoz, al inicio del programa.

[Functional status and survival in patients with chronic obstructive pulmonary disease following pulmonary rehabilitation]. / Estado funcional y supervivencia de los pacientes con EPOC tras rehabilitación respiratoria.

OBJECTIVES: To study functional status and survival in patients with chronic obstructive pulmonary disease (COPD) following a pulmonary rehabilitation program. PATIENTS AND METHODS: We assessed lung function, 6-minute walk distance, Borg score for dyspnea upon completion of the 6-minute walk, workload in watts on a cycle ergometer, quality of life using the St George's Respiratory Questionnaire (SGRQ); the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index; and survival. RESULTS: One hundred five patients participated in the pulmonary rehabilitation program. The patients had a mean (SD) age of 63.9 (9.3) years, body mass index of 24.5 (4.56) kg/m2, and forced expiratory volume in 1 second (FEV1) of 0.91 (0.46) L. The mean distances walked in 6 minutes were 412.8 (79.4) m before the pulmonary rehabilitation program and 443.46 (81.57) m after rehabilitation. The mean workloads on the cycle ergometer before and after rehabilitation, respectively, were 47.9 (29.6) W and 77.76 (20.88) W. The mean Borg scores were 2.2 (1.37) before and 1.47 (1.37) after rehabilitation, and the SGRQ scores at the same times were 27.63 (16.02) and 25.45 (15.12). Mortality due to respiratory disease (105 months) was 19%. Cumulative survival rates at 1 year, 3 years, and 6 years were 91%, 86.7%, and 6.75%, respectively. Survival was related to an FEV1 greater than 1.02 L (P = .05), a 6-minute walk distance over 448 m before rehabilitation (P = .04) and 454 m after rehabilitation (P = .05), and a workload on the cycle ergometer of over 54 W before rehabilitation (P = .01) and 72 W (P = .02) afterwards. The correlations between survival and both SGRQ and BODE scores were weaker. CONCLUSIONS: We observed improved exercise capacity, dyspnea ratings, and, to a lesser extent, better SGRQ scores in our COPD patients following pulmonary rehabilitation. The best predictors of survival were FEV1, the 6-minute walk distance, and the cycle ergometer workloads.