ABSTRACT
BACKGROUND: The body mass index/airflow obstruction/dyspnea/exercise capacity (BODE) index and global initiative for chronic obstructive lung disease (GOLD) staging system are validated measures to define disease severity and to predict survival in chronic obstructive pulmonary disease (COPD). We aimed to investigate the influence of BODE classes (score: 0-2, 3-4, 5-7, and 7-10) and GOLD stages (I, II, III, and IV) on the moderate/severe exacerbation occurrence risk in a cohort of 120 mild/very severe stable patients with COPD. METHODS: Demographics, clinical evaluation, spirometry, peripheral oxygen saturation, body composition, 6-minute walking distance, dyspnea, and quality of life measurements were obtained at baseline. Patients were followed up for 1 year or until death, and information on exacerbation was collected. RESULTS: The median annual exacerbation rate was 0.8. Logistic regression showed that the relationship between the risk for moderate/severe exacerbations during a 1-year follow-up for the GOLD stage was odds ratio: 2.01; 95% confidence interval: 1.39-2.98 and for the BODE index was odds ratio: 2.08; 95% confidence interval: 1.27-3.61. The area under the receiver-operator curve to predict exacerbation during the 1-year follow-up was 0.69 for the GOLD stage and 0.62 for the BODE index. Adjusted multiple logistic regression selected only older age and lower peripheral oxygen saturation as risk factors for COPD exacerbation in the 1-year follow-up. CONCLUSIONS: In summary, our study shows that unidimensional GOLD classification and multidimensional BODE index staging systems seem to have similar clinical utility in predicting exacerbation in ambulatory COPD patients with COPD. However, variables not included in both systems seem to be the main predictors of the exacerbation risk.
Subject(s)
Disease Progression , Pulmonary Disease, Chronic Obstructive/classification , Pulmonary Disease, Chronic Obstructive/diagnosis , Severity of Illness Index , Aged , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Pulmonary Disease, Chronic Obstructive/physiopathology , Spirometry/standardsABSTRACT
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.
Subject(s)
Blood Pressure/physiology , Body Mass Index , Exercise Tolerance/physiology , Oxygen Consumption/physiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Thinness/physiopathology , Aged , Case-Control Studies , Cross-Sectional Studies , Dyspnea/diagnosis , Exercise Test , Female , Heart Rate/physiology , Humans , Leg/physiology , Male , Middle Aged , Muscle Fatigue/physiology , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/psychology , Quality of Life , Walking/physiologyABSTRACT
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.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Body Mass Index , Blood Pressure/physiology , Exercise Tolerance/physiology , Oxygen Consumption/physiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Thinness/physiopathology , Case-Control Studies , Cross-Sectional Studies , Dyspnea/diagnosis , Exercise Test , Heart Rate/physiology , Leg/physiology , Muscle Fatigue/physiology , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/psychology , Quality of Life , Walking/physiologyABSTRACT
OBJETIVO: O aumento do índice de massa corporal (IMC) tem sido associado a uma maior prevalência da asma em adultos. O presente estudo tem o objetivo de avaliar a associação entre a prevalência da obesidade e a gravidade da asma. MÉTODOS: Prontuários de duzentos asmáticos acima dos 20 anos de idade foram avaliados retrospectivamente. A asma foi classificada quanto à gravidade através da história clínica e do diagnóstico registrados, dos resultados da espirometria e da medicação prescrita. O IMC foi calculado e foram considerados obesos os pacientes com IMC > 30 kg/m². RESULTADOS: 23 por cento dos pacientes apresentavam asma intermitente, 25,5 por cento, asma persistente leve, 24 por cento, asma persistente moderada e 27,5 por cento, asma persistente grave. O IMC < 29,9 kg/m² foi observado em 68 por cento dos pacientes e em 32 por cento o IMC foi > 30 kg/m². O odds ratio da relação entre a obesidade e a gravidade da asma foi de 1,17 (CI95 por cento: 0,90-1,53; p > 0,05). CONCLUSÕES: Na amostra estudada não foi encontrada correlação entre a obesidade e a gravidade da asma nem no sexo masculino, nem no feminino.
OBJECTIVE: Elevated values of body mass index (BMI) have been associated with higher prevalence of asthma in adults. The aim of the present study is to evaluate the association between obesity and asthma severity. METHODS: Medical records of two hundred patients older than 20 years of age were evaluated retrospectively. Asthma severity was established after the evaluation of the medical history and diagnosis recorded, spirometry results and the medicines prescribed. BMI was calculated and patients were classified as obese when the BMI was > 30 kg/m². RESULTS: 23 percent of the patients presented intermittent asthma, 25.5 percent presented mild persistent asthma, 24 percent presented moderate persistent asthma, and 27.5 percent presented severe persistent asthma. Values of BMI < 29.9 kg/m² were observed in 68 percent of the patients and in 32 percent the BMI was > 30 kg/m². The odds ratio of the correlation between obesity and asthma severity was 1.17 (95 percent CI: 0.90-1.53; p > 0.05). CONCLUSIONS: In the sample evaluated in this study no correlation between obesity and asthma severity was found for either gender.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Asthma/complications , Body Mass Index , Obesity/complications , Epidemiologic MethodsABSTRACT
OBJECTIVE: Elevated values of body mass index (BMI) have been associated with higher prevalence of asthma in adults. The aim of the present study is to evaluate the association between obesity and asthma severity. METHODS: Medical records of two hundred patients older than 20 years of age were evaluated retrospectively. Asthma severity was established after the evaluation of the medical history and diagnosis recorded, spirometry results and the medicines prescribed. BMI was calculated and patients were classified as obese when the BMI was > 30 kg/m(2). RESULTS: 23% of the patients presented intermittent asthma, 25.5% presented mild persistent asthma, 24% presented moderate persistent asthma, and 27.5% presented severe persistent asthma. Values of BMI < or = 29.9 kg/m(2) were observed in 68% of the patients and in 32% the BMI was > or = 30 kg/m(2). The odds ratio of the correlation between obesity and asthma severity was 1.17 (95% CI: 0.90-1.53; p > 0.05). CONCLUSIONS: In the sample evaluated in this study no correlation between obesity and asthma severity was found for either gender.
Subject(s)
Asthma/complications , Body Mass Index , Obesity/complications , Adult , Aged , Aged, 80 and over , Epidemiologic Methods , Female , Humans , Male , Middle AgedABSTRACT
Neste artigo os autores definem a doença pulmonar obstrutiva crônica (DPOC) e apresentam alguns dados sobre a epidemiologia e os fatores de risco para a doença. A abordagem diagnóstica, incluindo os principais achados clínicos, as alteraçöes de funçäo pulmonar típicas da doença, os achados radiológicos e de gases sangüíneos, é apresentada e discutida. Além disso, os autores apresentam a proposta de classificaçäo da doença de acordo com a gravidade e os tratamentos recomendados para os pacientes acometidos.(au)
Subject(s)
Humans , Lung Diseases, ObstructiveABSTRACT
O derrame pleural é o acúmulo de líquido no espaço pleural e indica estado fisiopatológico anormal resultante do desequilíbrio entre a formação e a remoção do fluido pleural. Neste artigo são apresentados aspectos relacionados à anatomia da pleura e à fisiologia e fisiopatologia do movimento do líquido pleural. As manifestações clínicas, radiológicas, de função pulmonar e os testes necessários para diferenciar exsudato de transudato e estabelecer o diagnóstico definitivo da etiologia do derrame são apresentados e discutidos
