Prevalence of Frailty and Evaluation of Associated Variables Among COPD Patients.

Rationale: Frailty in chronic obstructive pulmonary disease (COPD) patients has been associated with a higher rate of incidents, longer duration of hospitalization, poorer quality of life, and higher mortality. Objective: To measure the prevalence of frailty among COPD patients and to evaluate associated variables. Methods: A cross-sectional study. Subjects who visited a State Center for High-Cost Medicines to obtain free monthly COPD medicines were considered eligible. Individuals ≥40 years old who had a FEV1/FVC ratio of <0.7 post-bronchodilation were enrolled. The Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale, Medical Research Council dyspnea scale (MRC), COPD Assessment Test (CAT), a combination of CAT/MRC [(CAT/8)+MRC], and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity scale were used to evaluate the enrolled subjects. Variables associated with frailty were analyzed using an ordered logistic regression and a multivariate logistic regression. Results: The prevalence of frailty and pre-frailty among the 153 COPD subjects enrolled was 50.3% (77/153) and 35.3% (54/153), respectively. Frailty scores were correlated with CAT (correlation coefficient [cc]: 0.52, p <0.001) and MRC (cc: 0.48, p <0.001). Ordinal regression models showed that MRC and CAT were associated with fragility (p <0.0001 for both models). Higher odds of frailty were observed in GOLD groups B (p = 0.04) and D (p = 0.02). Multiple logistic regression revealed that the combination CAT/MRC≥5.5 was associated with frailty (OR 6.73; p <0.0001) and had a specificity of 80.3%, sensitivity of 62.3%, and positive and negative predictive values of 76.2% and67.8%, respectively. Conclusion: Frailty prevalence was high and was correlated with higher MRC and CAT scores. The CAT/MRC combination [(CAT/8)+MRC] ≥5.5 was highly associated with frailty, suggesting that an additional specific evaluation for the presence of frailty is indicated.

Análise de pico de fluxo de tosse voluntária de pacientes em um hospital de urgências / Analysis of voluntary cough flow peak of patients in an emergency hospital

INTRODUÇÃO: A tosse, voluntária ou reflexa, é um dos principais mecanismos de depuração para proteção das vias aéreas. O pico de fluxo de tosse (PFT) é um método de avaliação específica, mas que vem demonstrando utilidade para avaliar riscos de complicação pulmonares bem como sua gravidade. Variável muito semelhante ao pico de fluxo expiratório cuja principal diferença consiste no fechamento da glote durante a manobra de tosse. Então avaliar a tosse é importante para identificar pacientes com alterações no pico de fluxo de tosse, e consequente risco de complicações pulmonares. OBJETIVO: Analisar o PFT voluntário e parâmetros clínicos e epidemiológicos em uma população internada nas enfermarias de um hospital de urgências. MÉTODOS: Estudo transversal com pacientes internados nas enfermarias de um Hospital Público de Goiânia. Foram coletados dados epidemiológicos e clínicos. O PFT foi mensurado pelo peak flow meter e a avaliação de dor através da Escala de Dor Visual Numérica associada à Escala de Dor de Faces. RESULTADOS: A amostra foi composta em sua maioria por homens 288 (81,36). A média de idade da população estudada foi de 45,91 anos (±20,14). Sessenta e um por cento dos pacientes (219) apresentaram tosse eficaz, e 43 (12,15%) tosse ineficaz, revelou associação com idade, sexo e diagnóstico. CONCLUSÃO: Os pacientes que mais apresentaram alterações na força de tosse foram os idosos, sexo feminino e vítimas acometidas por desordens neurológicas e toracoabdominais. [AU]

INTRODUCTION. Cough, whether voluntary or reflex, is one of the major clearance mechanisms for airway protection. Peak cough flow is a recent and specific evaluation method, but it has been useful for evaluating pulmonary complications as well as their severity. Variable very similar to the peak of expiratory flow whose main difference consists in the closure of the glottis during the maneuver of cough. Therefore, assessing cough is important to identify patients with changes in peak cough flow, and the consequent risk of pulmonary complications. OBJECTIVE: To analyze the peak flow of voluntary cough and its association with clinical and epidemiological parameters in a population hospitalized in the wards of an emergency hospital. METHODS: A cross-sectional study with 354 patients admitted to the wards of a Public Hospital of Goiânia. Epidemiological and clinical data were collected. Optic cough flow was measured by the peak flow meter and the pain assessment using the Numerical Visual Pain Scale associated with the Face Pain Scale. RESULTS: The sample consisted mostly of 288 (81,36) men. The mean age of the study population was 45,91 years (± 20,14). 61, 86% (219) of the patients had effective cough, and 43 (12,15%) had an ineffective cough. CONCLUSION: Patients who presented the greatest changes in coughing strength were the elderly, females and victims of neurological and thoracoabdominal disorders. [AU]