Asociación del sexo con el estado de salud en respuesta a la oxigenoterapia crónica domiciliaria en pacientes con enfermedad pulmonar obstructiva crónica / Gender and Health Status Response to Long-Term Oxygen Therapy in COPD patients

Introducción: En la enfermedad pulmonar obstructiva crónica (EPOC)muygrave no está clara la asociacióndel sexo con el estado de salud (ES) en respuesta a la oxigenoterapia crónica domiciliaria (OCD). Losobjetivos del presente estudio fueron: 1) comparar la percepción de la disnea y del ES entre hombresy mujeres con EPOC muy grave en el período basal, y 2) proporcionar una evaluación prospectiva de larespuesta del estado de salud a la OCD, de acuerdo con el sexo.Pacientes y métodos: En un estudio longitudinal, prospectivo, se incluyeron pacientes con EPOC hipoxémica(n = 97, edad: 65,5±9,6 años, 53% de hombres) durante 12 meses o hasta su muerte. Se evaluaroncon el Cuestionario Respiratorio de St George (St. George’s Respiratory Questionnaire [SGRQ]) y el índicede disnea basal (IDB).Resultados: En el período basal, el deterioro del ES y la sensación de disnea fueron similares entre ambossexos. Después de 12 meses de OCD, en mujeres se detectó una mejoría de los síntomas (64,1±20,6 frentea 40,6±22,9; p < 0,0001) y de las puntuaciones totales obtenidas en el SGRQ. En hombres también sedemostró una mejoría de los síntomas después de 12 meses (62,7±23,3 frente a 49,6±22,8; p < 0,0005);sin embargo, presentaron un deterioro de las puntuaciones de la esfera de actividad, impacto y totalesdurante el período de estudio, con un declive destacado en la esfera de actividad (68,5±20,0 frentea 75,9±16,9; p = 0,008). Para el IDB no se demostraron diferencias significativas por sexos durante elperíodo del estudio.Conclusiones: Los resultados del presente estudio demuestran que, en pacientes con EPOC muy grave, elcurso del estado de salud difiere de acuerdo con el sexo, puesto que en las mujeres se demuestra unamayor respuesta longitudinal a la OCD(AU)

Introduction: The association of gender with health status (HS) response to long-term oxygen therapy(LTOT) in very severe COPD is unclear. The aims of this study were: (1) to compare dyspnea perceptionand HS between male and female with very severe COPD at baseline and (2) to provide a prospectiveassessment of HS response to LTOT, according to gender.Patients and methods: Hypoxemic COPD (n = 97, age: 65.5±9.6 years, 53% males) were enrolled in aprospective longitudinal study over 12 months or until death. St. George’s Respiratory Questionnaire(SGRQ) and baseline dyspnea index (BDI) were assessed.Results: At baseline, HS impairment and dyspnea sensation were similar between genders. After 12months of LTOT, women presented improvement in symptom (64.1±20.6 versus 40.6±22.9; P < 0.0001)and total SGRQ scores. Men also showed improvement in symptoms after 12 months (62.7±23.3 versus 49.6±22.8; P < 0.0005); however, they presented deterioration of activity, impact and total scores duringthe study period, with markedly decline of activity domain (68.5±20.0 versus 75.9±16.9; P = 0.008). BDIdid not show significant difference by gender over the study period.Conclusions: Our results show that the HS course in very severe COPD patients differs according to gender,as females show greater response longitudinally to LTOT(AU)

[Gender and health status response to long-term oxygen therapy in COPD patients]. / Asociación del sexo con el estado de salud en respuesta a la oxigenoterapia crónica domiciliaria en pacientes con enfermedad pulmonar obstructiva crónica.

INTRODUCTION: The association of gender with health status (HS) response to long-term oxygen therapy (LTOT) in very severe COPD is unclear. The aims of this study were: (1) to compare dyspnea perception and HS between male and female with very severe COPD at baseline and (2) to provide a prospective assessment of HS response to LTOT, according to gender. PATIENTS AND METHODS: Hypoxemic COPD (n = 97, age: 65.5 ± 9.6 years, 53% males) were enrolled in a prospective longitudinal study over 12 months or until death. St. George's Respiratory Questionnaire (SGRQ) and baseline dyspnea index (BDI) were assessed. RESULTS: At baseline, HS impairment and dyspnea sensation were similar between genders. After 12 months of LTOT, women presented improvement in symptom (64.1 ± 20.6 versus 40.6 ± 22.9; P < 0.0001) and total SGRQ scores. Men also showed improvement in symptoms after 12 months (62.7 ± 23.3 versus 49.6 ± 22.8; P < 0.0005); however, they presented deterioration of activity, impact and total scores during the study period, with markedly decline of activity domain (68.5 ± 20.0 versus 75.9 ± 16.9; P = 0.008). BDI did not show significant difference by gender over the study period. CONCLUSIONS: Our results show that the HS course in very severe COPD patients differs according to gender, as females show greater response longitudinally to LTOT.

Estudo da remodelação cardíaca em pacientes com doença pulmonar obstrutiva crônica / Study of cardiac remodeling in patients with chronic obstructive pulmonary disease

Pacientes com doença pulmonar obstrutiva crônica (DPOC) apresentam risco elevado para eventos cardiovasculares. Entretanto, existem poucos estudos sobre a função do ventrículo esquerdo (VE) nesses pacientes e os resultados são controversos. Os objetivos deste estudo foram: analisar a estrutura e função do ventrículo direito (VD) e câmaras cardíacas esquerdas, por meio de Doppler ecocardiografia, em pacientes com DPOC e avaliar a associação entre as variáveis ecocardiográficas e as variáveis clínicas relevantes. Foram avaliados 45 pacientes com DPOC (idade: 65,8 ± 10,6 anos, 64% homens): 17 pacientes com DPOC leve a moderada (grau I e II) provenientes do Serviço de Pneumologia da Faculdade de Medicina de Botucatu (FMB) e 28 pacientes com DPOC muito grave (grau IV) acompanhados no Ambulatório de Oxigenoterapia da FMB. Os critérios de inclusão foram: diagnóstico de DPOC, estabilidade clínica e, para os pacientes com DPOC IV, uso de oxigênio domiciliar por período mínimo de três meses. Para o grupo controle foram selecionados 15 indivíduos saudáveis (idade: 64,3 ± 10,1, 47% homens). Os critérios de exclusão foram: imagem ecocardiográfica inadequada, hipertensão arterial sistêmica, diabetes mellitus, doença coronariana, valvopatias, arritmias, patologias respiratórias associadas ou outras patologias cardíacas. Espirometria pré e pós-broncodilatador e oximetria de pulso foram realizadas por todos os sujeitos da pesquisa e gasometria arterial somente para os pacientes com DPOC...

Predictors of first-year survival in patients with advanced COPD treated using long-term oxygen therapy.

UNLABELLED: Little evidence-based guidance is available to aid clinicians in determining short-term prognoses in very severe COPD patients. Therefore, the present study was designed to provide a prospective assessment (1) of the mortality rates and (2) whether the baseline measurements may be determinants of 1-year mortality in hypoxemic COPD patients receiving long-term oxygen therapy (LTOT). Seventy-eight clinically stable patients with advanced COPD treated using LTOT were enrolled in a prospective cohort study. OUTCOME VARIABLE: first-year mortality. Baseline measurements: categorical variables: age (<60 or > or = 60 years); gender; body mass index (<20 or > or = 20 kg/m(2)); fat-free mass (FFM) index (<16 [men] and <15 kg/m(2) [women]; baseline dyspnea index (BDI) (< or = 3 or >3); and corticosteroid use. Continuous variables: smoking history; lung function; FFM; fat mass; hemoglobin; hematocrit; arterial blood gases; forearm muscle strength; St. George's Respiratory Questionnaire (SGRQ); and comorbidity score. By the end of 1-year of follow-up, 12 patients (15.4%) had died. Kaplan-Meier curves showed that BDI < or = 3 was the only variable associated with higher mortality. Cox proportional hazards analysis revealed that lower PaO(2) and SpO(2), higher PaCO(2) and SGRQ scores were associated with reduced survival. In the multivariate analysis, BDI remained predictive of mortality (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.31-0.81), as did PaO(2) (HR, 0.49; 95% CI, 0.26-0.95). These data suggest that readily available parameters as dyspnea intensity and hypoxemia severity may be useful in predicting first-year survival rates in advanced COPD patients receiving LTOT.