Actividad física y su relación con el estado de salud en pacientes EPOC estables / Physical Activity and its Relationship with the State of Health of Stable Copd Patients

Introducción: Estudios previos han resaltado que la actividad física (AF) en la EPOC se asocia a mejorcalidad de vida y menor morbimortalidad. Nuestro objetivo ha sido conocer los hábitos de AF en la vidadiaria de pacientes EPOC estables fuera de un programa de rehabilitación respiratoria.Material y métodos: Estudio observacional descriptivo transversal multicéntrico en pacientes EPOC establescontrolados ambulatoriamente por neumólogos. Para conocer el índice de AF (IAF) se utilizó elMinnesota Leisure Time Physical Activity Questionnaire (MLTPAQ), diferenciando según el gasto energético,los siguientes grupos: inactivos (menos de 1.000 kcal/semana), moderadamente activos (entre1.000 y 3.000 kcal/semana) y muy activos (más de 3.000 kcal/semana). Se analizó la relación entre el IAFy variables socioeconómicas, de severidad de la enfermedad y de nivel de salud de los pacientes.Resultados: Se incluyó a 132 pacientes (121 varones). Edad media: 66,3 años, FEV1 medio 45%. Un 32,6%de ellos realizaba una AF menor de 1.000 kcal/semana, un 38,6% entre 1.000 y 3.000 y el 28,8% másde 3.000. Los pacientes EPOC más inactivos, tenían mayor obstrucción bronquial, una enfermedad mássevera, referían más disnea y caminaban menos metros en el 6MWT.Conclusiones: Los pacientes EPOC estables realizan un bajo nivel de AF. Una menor AF se asocia con unpeor estado de salud y con una mayor gravedad de la enfermedad(AU)

Introduction: Previous studies have shown that physical activity (PA) in COPD is associated with a betterquality of life and less morbidity and mortality. Our aim was to study the daily PA in the lives of stableCOPD patients, outside the setting of a pulmonary rehabilitation program.Material and methods: Observational, descriptive and transversal multi-center study in patients with stableCOPD controlled in an outpatient clinic by pneumologists. In order to determine the Physical ActivityIndex (PAI), the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) was used to differentiatethe following groups according to the energy expenditure: inactive (less than 1,000 kilocalories perweek), moderately active (between 1,000 and 3,000 kilocalories per week) and very active (more than3,000 kilocalories per week).Weanalyzed the relationship between PAI and disease severity, health level and socioeconomic variables of the patients. Results: A total of 132 patients (121 men) were included in the study. Mean age was 66; mean FEV1was 45%. Regarding PA, 32.6% had energy expenditures of less than 1,000 kilocalories/week, 38.6% between1,000 and 3,000 and 28.8% more than 3,000. The most inactive COPD patients had more bronchialobstruction, more severe disease, more dyspnea and walked fewer meters in the 6MWT.Conclusions: Stable COPD patients perform low levels of PA. Lower PA is associated with poorer healthand with more severe disease(AU)

[Physical activity and its relationship with the state of health of stable COPD patients]. / Actividad física y su relación con el estado de salud en pacientes EPOC estables.

INTRODUCTION: Previous studies have shown that physical activity (PA) in COPD is associated with a better quality of life and less morbidity and mortality. Our aim was to study the daily PA in the lives of stable COPD patients, outside the setting of a pulmonary rehabilitation program. MATERIAL AND METHODS: Observational, descriptive and transversal multi-center study in patients with stable COPD controlled in an outpatient clinic by pneumologists. In order to determine the Physical Activity Index (PAI), the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) was used to differentiate the following groups according to the energy expenditure: inactive (less than 1,000 kilocalories per week), moderately active (between 1,000 and 3,000 kilocalories per week) and very active (more than 3,000 kilocalories per week). We analyzed the relationship between PAI and disease severity, health level and socioeconomic variables of the patients. RESULTS: A total of 132 patients (121 men) were included in the study. Mean age was 66; mean FEV1 was 45%. Regarding PA, 32.6% had energy expenditures of less than 1,000 kilocalories/week, 38.6% between 1,000 and 3,000 and 28.8% more than 3,000. The most inactive COPD patients had more bronchial obstruction, more severe disease, more dyspnea and walked fewer meters in the 6MWT. CONCLUSIONS: Stable COPD patients perform low levels of PA. Lower PA is associated with poorer health and with more severe disease.

Calidad del diagnóstico de la enfermedad pulmonar obstructiva crónica en el ámbito hospitalario / Diagnosis of COPD in hospitalised patients

ObjetivoConocer la calidad del diagnóstico de enfermedad pulmonar obstructiva crónica (EPOC) en pacientes hospitalizados.Material y métodosAuditoría multicéntrica transversal de revisión retrospectiva de historias clínicas en pacientes a los que se dio de alta con diagnóstico de EPOC. Se consideró diagnóstico correcto (DxC) de EPOC en los casos donde pudo documentarse la combinación de obstrucción bronquial volumen espiratorio forzado en el primer segundo/capacidad vital forzada (FEV1/FVC<70%) y tabaquismo (>10paquetes/año). En el resto de los casos se consideró diagnóstico deficiente (DxD). Se exigió un DxC en al menos el 60% de los pacientes para considerar una calidad asistencial diagnóstica aceptable. Se registraron los datos demográficos, el tabaquismo, la espirometría, el especialista que daba el alta (neumólogos [N], especialistas en Medicina Interna [EM] y especialistas quirúrgicos [EQ]) y el nivel asistencial (hospitales de baja complejidad [H1], hospitales de intermedia complejidad [H2] y hospitales de alta complejidad [H3]).ResultadosSe analizaron 840 casos (718hombres y 122 mujeres), edad media (desviación estándar) de 73 (10), procedentes de 10 hospitales (3 H1, 4 H2 y 3 H3). Se obtuvo un DxD en 597 pacientes (71,1%), motivado bien por falta de criterio espirométrico (538 [64%]) o tabáquico (319 [38%]) (p<0,001). Sólo 2 de los 10 hospitales cumplían el criterio de calidad asistencial diagnóstica aceptable. Se observaron diferencias significativas (p<0,0001) al comparar DxC y DxD por nivel asistencial (DxC: el 56,2% en H1, el 29,9% en H2 y el 20,9% en H3) y por especialista (DxC: el 47,6% por N, el 24,6% por EQ y el 17,4% por EM). Un análisis multivariado relacionó DxC con sexo masculino, H1 e informes neumológicos.Conclusiones1) La calidad asistencial para el diagnóstico de EPOC en hospitales es deficiente y 2) la falta de espirometría es la causa más frecuente de DxD(AU)

ObjectiveTo examine the quality of COPD diagnosis in hospitalised patients.Material and methodsRetrospective multicentre cross-sectional audit review of the clinical histories of patients discharged with a diagnosis of COPD. The diagnosis of COPD was considered correct (DxC) in cases where the combination of a bronchial obstruction (FEV1/FVC<70%) and smoking (>10packets/year) could be documented. In the rest of the cases the diagnosis was considered deficient (DxD). A DxC in at least 60% of patients was required to be considered an acceptable quality health care diagnosis. Demographic data such as, smoking, spirometry, the specialist who discharged the patient (P: Pneumologist; MS: Medical Specialty; CS: Surgical Specialty), and health care level (hospital complexity; low (H1), intermediate (H2) and high (H3)).ResultsA total of 840 cases were analysed (718 males, 122 females); mean age (SD) 73 (10), from 10 hospitals (3 H1, 4 H2, 3 H3). A DxD was obtained in 597 (71.1%), due to either lack of spirometry (538, 64%) or smoking criteria (319, 38%), (P<0.001). Only two of the ten hospitals complied with the criteria of an acceptable quality health care diagnosis. Significant differences (P<0.0001) were seen on comparing DxC and DxD by health care level (DxC: 56.2% in H1, 29.9% in H2, 20.9% in H3), and by specialist (DxC: 47.6% en P, 24.6% in SP, 17.4% in MS). A multivariate analysis associated DxC with the male sex, H1 and pneumology reports.Conclusions1. The quality health care for the diagnosis of COPD is deficient. 2. The lack of spirometry is the most common cause of DxD(AU)

Diagnosis of COPD in hospitalised patients.

OBJECTIVE: To examine the quality of COPD diagnosis in hospitalised patients. MATERIAL AND METHODS: Retrospective multicentre cross-sectional audit review of the clinical histories of patients discharged with a diagnosis of COPD. The diagnosis of COPD was considered correct (DxC) in cases where the combination of a bronchial obstruction (FEV1/FVC<70%) and smoking (>10 packets/year) could be documented. In the rest of the cases the diagnosis was considered deficient (DxD). A DxC in at least 60% of patients was required to be considered an acceptable quality health care diagnosis. Demographic data such as, smoking, spirometry, the specialist who discharged the patient (P: Pneumologist; MS: Medical Specialty; CS: Surgical Specialty), and health care level (hospital complexity; low (H1), intermediate (H2) and high (H3)). RESULTS: A total of 840 cases were analysed (718 males, 122 females); mean age (SD) 73 (10), from 10 hospitals (3 H1, 4 H2, 3 H3). A DxD was obtained in 597 (71.1%), due to either lack of spirometry (538, 64%) or smoking criteria (319, 38%), (P<0.001). Only two of the ten hospitals complied with the criteria of an acceptable quality health care diagnosis. Significant differences (P<0.0001) were seen on comparing DxC and DxD by health care level (DxC: 56.2% in H1, 29.9% in H2, 20.9% in H3), and by specialist (DxC: 47.6% en P, 24.6% in SP, 17.4% in MS). A multivariate analysis associated DxC with the male sex, H1 and pneumology reports. CONCLUSIONS: 1. The quality health care for the diagnosis of COPD is deficient. 2. The lack of spirometry is the most common cause of DxD.

[Changes in patient profiles at a regional respiratory medicine clinic over a 10-year period]. / Cambios en el perfil de una consulta neumológica comarcal. Perspectiva de 10 años.

OBJECTIVE: To analyze the quantitative and qualitative changes in demand for health care services at a regional respiratory medicine clinic over the last 10 years. PATIENTS AND METHODS: During the years 1992-1993 (group A) and 2002-2003 (Group B), the following information was recorded for all new patients: referring physician s initial diagnosis, pneumologist's definitive diagnosis, age, sex, and source of referral (primary care clinic, emergency department, hospital admission, other specialist services, and other sources). The recorded data was then compared between groups. RESULTS: Group A comprised 616 patients and group B 424. Most subjects were men (60%) aged 40 to 80 years (71.9% of group A; 75.7% of group B). In both groups, most referrals came from primary care. The number of patients in group B who were referred by primary care and by emergency departments decreased in comparison with group A, while referrals from all other sources increased (P< .001). Initial diagnosis of airway disorders and associated symptoms produced most of the demand for health care services (group A, 58%; group B, 62.2%). When the 2 groups were compared, the following changes were observed in group B: a) an increase in hospital-referred cases with right heart disease (P< .001; relative risk [RR]=7.3) and in cases of obstructive sleep apnea syndrome (OSAS) (P< .001; RR=24.3)--the most common diagnosis in group B--referred from primary care and other specialist services and b) an overall decrease in cases of tuberculosis (P< .001; RR=0.3) and in referrals made without a recorded initial diagnosis by primary care physicians. When definitive diagnoses were analyzed, the initial diagnosis was confirmed in a high percentage of patients with airway disorders (group A, 47.2%; group B, 53.1%). An increase in cases with a definitive diagnosis of OSAS was observed in group B (P< .001; RR=18.3) compared to group A. In addition, a 2-fold increase was recorded for right heart disease and consultations for radiographic abnormalities. The number of patients diagnosed with tuberculosis decreased. CONCLUSIONS: The changes observed over the 10-year period analyzed were as follows: a) a decrease in referrals made by primary care centers and emergency departments and an increase in referrals from other sources; b) a significant increase in referrals for OSAS, which became the most common reason for consultation; c) an increase in referrals for right heart disease; and d) a decrease in tuberculosis cases.

Cambios en el perfil de una consulta neumológica comarcal. Perspectiva de 10 años / Changes in patient profiles at a regional respiratory medicine clinic over a 10-year period

Objetivo: Analizar los cambios cuantitativos y cualitativos de la demanda asistencial generada en una consulta neumológica comarcal en los últimos 10 años. Pacientes y métodos: Durante los períodos correspondientes a los años 1992-1993 (grupo A) y 2002-2003 (grupo B), de todos los pacientes remitidos como primera visita se registraron los siguientes datos: diagnóstico del médico que remitía al paciente (DI), diagnóstico final del neumólogo, edad, sexo y procedencia (atención primaria, urgencias, hospitalización, otra especialidad y otra procedencia). Se describen las variables y se comparan éstas entre los grupos A y B. Resultados: El grupo A constó de 616 pacientes y el grupo B de 424, con predominio de varones (60%) y mayor demanda entre 40 y 80 años (grupo A: 71,9%; grupo B: 75,7%). Atención primaria remitía la mayor parte de los pacientes, pero con una disminución de ésta y de urgencias en el grupo B, frente a un aumento del resto de procedencias (p < 0,001). En cuanto al perfil de los DI, las enfermedades de la vía aérea y los síntomas generaban la mayor demanda (grupo A: 58%; grupo B: 62,2%), pero al comparar ambos grupos, en el B se observaron: a) un aumento de síndrome de apneas obstructivas durante el sueño (SAOS) (p < 0,001; riesgo relativo [RR] = 24,3), que procedía de atención primaria y otras especialidades y constituía el diagnóstico más frecuente, así como de enfermedad cardiovascular de origen derecho (p < 0,001; RR = 7,3), procedente de hospitalización, y b) una disminución de enfermedad tuberculosa (p < 0,001; RR = 0,3), de diversas procedencias, así como de los pacientes remitidos desde atención primaria sin que constara el motivo de consulta. Por lo que se refiere al perfil de los diagnósticos finales, se confirmó el perfil del DI con una elevada frecuencia en las enfermedades de la vía aérea (grupo A: 47,2%; grupo B: 53,1%), aumento de SAOS en el grupo B (p < 0,001; RR = 18,3); además, se duplicaron los casos de enfermedades cardiovasculares derechas y de consulta por alteraciones radiológicas, y disminuyó la enfermedad tuberculosa. Conclusiones: Los cambios observados en el período de 10 años analizado son los siguientes: a) pérdida de pacientes procedentes de atención primaria y urgencias, junto a aumento del resto de procedencias; b) importante aumento del SAOS, que pasa a ser la causa más frecuente de consulta; c) aumento de enfermedades cardiovasculares derechas, y d) disminución de la enfermedad tuberculosa

Objective: To analyze the quantitative and qualitative changes in demand for health care services at a regional respiratory medicine clinic over the last 10 years. Patients and methods: During the years 1992-1993 (group A) and 2002-2003 (Group B), the following information was recorded for all new patients: referring physician´s initial diagnosis, pneumologist's definitive diagnosis, age, sex, and source of referral (primary care clinic, emergency department, hospital admission, other specialist services, and other sources). The recorded data was then compared between groups. Results: Group A comprised 616 patients and group B 424. Most subjects were men (60%) aged 40 to 80 years (71.9% of group A; 75.7% of group B). In both groups, most referrals came from primary care. The number of patients in group B who were referred by primary care and by emergency departments decreased in comparison with group A, while referrals from all other sources increased (P<.001). Initial diagnosis of airway disorders and associated symptoms produced most of the demand for health care services (group A, 58%; group B, 62.2%). When the 2 groups were compared, the following changes were observed in group B: a) an increase in hospital-referred cases with right heart disease (P<.001; relative risk [RR]=7.3) and in cases of obstructive sleep apnea syndrome (OSAS) (P<.001; RR=24.3)--the most common diagnosis in group B--referred from primary care and other specialist services and b) an overall decrease in cases of tuberculosis (P<.001; RR=0.3) and in referrals made without a recorded initial diagnosis by primary care physicians. When definitive diagnoses were analyzed, the initial diagnosis was confirmed in a high percentage of patients with airway disorders (group A, 47.2%; group B, 53.1%). An increase in cases with a definitive diagnosis of OSAS was observed in group B (P<.001; RR=18.3) compared to group A. In addition, a 2-fold increase was recorded for right heart disease and consultations for radiographic abnormalities. The number of patients diagnosed with tuberculosis decreased. Conclusions: The changes observed over the 10-year period analyzed were as follows: a) a decrease in referrals made by primary care centers and emergency departments and an increase in referrals from other sources; b) a significant increase in referrals for OSAS, which became the most common reason for consultation; c) an increase in referrals for right heart disease; and d) a decrease in tuberculosis cases