Made available in DSpace on 2017-07-21T14:35:53Z (GMT). No. of bitstreams: 1 KATHIANE CRISTINA DA SILVA RECHE.pdf: 1442031 bytes, checksum: 73be2f3a6bf6010a6bdd91352e31db6e (MD5) Previous issue date: 2016-03-18 / The heart rate variability (HRV), defined as temporal variation between consecutive heart beats, provides information about cardiac autonomic regulation. It is known that the physiological parameter can be influenced by chronic obstructive pulmonary disease (COPD), however more information to assist in elucidating this context are necessary, especially focused on the reality of the Brazilian population. This study aimed to investigate whether the airflow limitation compromises cardiac autonomic function and if autonomic function limits the COPD patients functional capacity. Therefore, participants underwent spirometry, anthropometry, assessment of HRV and six-minute walk test (6MWT). For HRV, the GOLD CD group and GOLD AB group were compared with each other and between control group (normal spirometry); addittionaly, it was evaluated whether treatment situation (ET- in treatment and NT - untreated) is associated with HRV. The statistical analyses of the data were performed using STATA 7.0 program. The Kolmogorov-Smirnov, Spearman rank correlation, simple and multiple linear regression and analysis of variance were applied. The logarithmic transformation was applied to the non-normal distribution variables. About sample population of COPD patients (60 individuals), 53% of participants are men; age 63.7 ± 9.45 years; GOLD (A 15%, B 13%, C - 20%, D - 52%); FEV1 (% predicted): 46.6 ± 19.8; BMI: 25.5 ± 5.0 kg/m²; 6MWT: 391.5 ± 107.0 m; A correlation between FEV1 and HRV (RR, r = 0.33; p <0.001 and LF, r = 0.30; p <0.02), BMI (r = 0.33; p <0.01) CC (r = 0.30; p <0.02) 6MWD (r = 0.57; p <0.001); Regression analysis indicated that sex (β = 0.02 p <0.1) and age (β = 0.02 p <0.5) are not associated with HRV, indicated an association between severity disease and RR index (β = 101.1;. p <0.01), an association between the HRV (RR β = 132.9; p <0.01;.TP β = 0,8 p <0.04;. LF β = 13.1; p <0.03; HF β = 1.3; p <0.001;. HFun β = 13.1; p < 0.03; LF/HF β = 0.7; p <0.02) and the treatment situation, association between sex (β = 96.5; p < 0.03), and HRV (RR β = 0.5; p <0.01; SDNN β = 256.1;. RMSSD β = -49454.3; p < 0.01;. LF β = -49.5; p <0.05; SD1 β = 49248.8 p <0,01) with functional capacity. The variance analysis of HRV indexes showed differences only RR index (p <0.05) GOLD GOLD AB and CD, but between ET and NT groups showed differences (p <0.05) of the indexes LF, HF, HFun, and LF/HF. Thus, the results of this study indicated that lung function is related to the functional capacity and this may be limited by sympathetic predominance in the cardiac function modulation. Sex and age were not significantly associated with HRV, but the disease severity was associated with RR index. The treatment situation was variable with more strength of association with HRV, suggesting that sympathetic predominance in the heart rate modulation is higher in the ET group. / A variabilidade da frequência cardíaca (VFC) definida como a variação entre os batimentos cardíacos consecutivos ao longo do tempo fornece informações sobre a regulação autonômica do coração. Sabe-se que este parâmetro fisiológico pode ser influenciado pela doença pulmonar obstrutiva crônica (DPOC), todavia mais informações que auxiliem na elucidação deste contexto se fazem necessárias, em especial voltados à realidade da população brasileira. Este estudo teve por objetivo investigar se a limitação do fluxo aéreo compromete a função autonômica cardíaca e se a função autonômica limita a capacidade funcional dos pacientes com DPOC. Para tanto, os participantes foram submetidos à espirometria, antropometria, avaliação da VFC e teste de caminhada de seis minutos (TC6M). Quanto à VFC, o grupo de sujeitos mais graves (GOLD C e D) e o grupo menos grave (GOLD A e B) foram comparados entre si e com sujeitos de espirometria normal (controle); considerou-se também a situação de tratamento (ET- em tratamento e NT - não tratado) para comparar a VFC. O tratamento estatístico dos dados foi realizado através do programa STATA 7.0 e aplicou-se testes de Kolmogorov-Smirnov, correlação de postos de Spearman, regressão linear simples e múltipla e análise de variância. A transformação logarítmica foi aplicada para as variáveis que não teve distribuição normal. Da população amostral de pacientes com DPOC (60 indivíduos), 53% dos participantes são homens; idade 63,7 ± 9,45 anos; GOLD (A -15%, B -13%, C - 20%, D - 52%); Volume exiratório forçado no 1° segundo -VEF1 (%predito): 46,6 ± (19,8); Índice de massa coporal - IMC: 25,5 ± 5,0 kg/m²; TC6M: 391,5 ± 107,0 m; observou-se correlação entre o VEF1 e a VFC (RR, r = 0,33 p < 0,001 e LF, r = 0,30 p < 0,02), IMC (r = 0,33; p <0,01), CC (r = 0,30 p < 0,02), TC6M (r = 0,57 p <0,001). A análise de regressão indicou que sexo (β = 0,02; p < 0,1) e idade (β = 0,02; p <0,5) não estão associados à VFC, indicou associação entre a severidade da doença e o índice RR (β = 101,1; p < 0,01), associação entre a VFC (RR β = 132,9 p < 0,9; TP β = 0,8 p < 0,04; LF β = 13,1 p < 0,03; HF β = 1,3 p < 0,001; HFun β = 13,1 p < 0,03; LF/HF β = 0,7 p < 0,02) e a situação de tratamento, associação entre sexo (β = 96,5 p < 0,03) e VFC (RR β = 0,5 p < 0,01; SDNN β = 256,1; RMSSD β = -49454,3 p < 0,01; LF β = -49,5 p < 0,05; SD1 β = 49248,8 p < 0,01) com a capacidade funcional (R² = 51%). A análise de variância dos índices da VFC apontou diferença apenas do índice RR (p < 0,05) entre GOLD AB e GOLD CD, mas entre os grupos ET e NT apontou diferença (p < 0,05) dos índices LF, HF, HFun, e LF/HF. Assim, os resultados deste trabalho indicam que, a função pulmonar relaciona-se com a capacidade funcional e esta pode ser limitada pelo predomínio simpático na modulação da função cardíaca. As variáveis sexo e idade não foram significativamente associadas à VFC, mas a severidade da doença teve associação com o índice RR. A situação de tratamento foi a variável com mais força de associação com a VFC, sugerindo que o predomínio simpático na modulação da frequência cardíaca é maior no grupo tratado.

INTRODUÇÃO: A administração de medicamentos inalatórios é um componente fundamental no tratamento clínico de pacientes com doença pulmonar. Tem-se afirmado na literatura que o seu uso incorreto é um problema significante para o manejo da asma e da doença pulmonar obstrutiva crônica (DPOC). E que a falta de habilidade do paciente em usar corretamente seu dispositivo pode resultar na diminuição do efeito terapêutico e em baixo controle dos sintomas. A não aderência ao tratamento pode influenciar negativamente o controle clínico e a qualidade de vida desses pacientes, contribuir na necessidade de hospitalizações e visitas aos serviços de emergência. Neste estudo foi avaliado o conhecimento dos pacientes portadores de asma e DPOC, submetidos ao processo de atenção farmacêutica, quanto ao uso dos dispositivos inalatórios, a aderência ao tratamento, controle clínico e qualidade de vida. MÉTODOS: Estudo prospectivo aberto de grupos paralelos realizado no ambulatório de Pneumologia do Hospital das Clínicas da FMUSP. Foram selecionados pacientes asmáticos e portadores de DPOC avaliados em quatro visitas (0, 1, 2 e 3) quando foi necessário utilizar corticóide oral por curto período de tempo, ou três visitas (1, 2 e 3) quando não foi necessário utilizar esse medicamento. Durante as visitas o farmacêutico avaliou: a qualidade de vida pelo Questionário do Hospital Saint George na Doença Respiratória (SGRQ); o controle da asma, pelo teste de controle da asma (ACT), o controle da DPOC, pelo questionário clínico sobre DPOC (CCQ) e questionário para doença respiratória crônica (CRQ); a técnica inalatória pelo Checklist e pelo Escore da técnica do aerossol. RESULTADOS: 15 pacientes com asma e 15 com DPOC foram incluídos. A avaliação da técnica inalatória pelo método do Checklist, a mediana da pontuação obtida na primeira visita foi 66,7% e na última visita, pós orientações, foi de 100%(p<0,05); a análise pelo Escore da técnica do aerossol, a pontuação geral do grupo inicialmente foi 4 e na última visita pós orientações foi de 9(p<0,05). A proporção de pacientes aderentes do grupo como todo foi de 53,3% na visita 1 e de 89,7% na última visita(p=0,006). A análise do controle clínico dos pacientes asmáticos, obtida pela aplicação ACT foi inicialmente 12,7±5,2, e na última visita 17,1±6,5 (p=0,002). A avaliação do controle clínico dos pacientes com DPOC, pontuação obtida pela aplicação do CRQ e CCQ foi, respectivamente, 4,9±1,8 e 3,2±1,5 na visita inicial e de 6,4±1,7 e 2,0±1,4 na visita final (p<0,001). A avaliação da qualidade de vida, a pontuação obtida pelo SGRQ foi 63,8±18,3 na visita inicial e 51,5±21,8 na visita final (p=0,022). CONCLUSÕES: Os pacientes apresentaram melhora na técnica inalatória, na aderência ao tratamento, no controle clínico e na qualidade de vida após a intervenção farmacêutica / INTRODUCTION: The administration of inhaled medications is a fundamental component in treatment of patients with lung disease. It has been affirmed in the literature that its incorrect use is a significant problem for the management of asthma and chronic obstructive pulmonary disease (COPD). And the lack of patients inability to properly use your device may result in decreased therapeutic effect and poor control of symptoms. The non-adherence to treatment may influence the clinical control and quality of life of these patients, to contribute in requirement for hospitalizations and visits to emergency services. This study evaluated the knowledge of patients with asthma and COPD undergoing the process of pharmaceutical care, about the use of inhalation devices, adherence to treatment, clinical control and quality of life. METHODS: Prospective open parallel group study at outpatient clinic of Pneumology of Clinics Hospital. We selected patients with asthma and COPD, assessed at four visits (0, 1, 2 and 3) when was necessary to use oral corticosteroids for short period of time, or three visits (1, 2 and 3) when there was not necessary to use this drug. During visits, the pharmacist assessed: quality of life questionnaire by Saint George\'s Respiratory (SGRQ), the control of asthma at Asthma Control Test (ACT), the control of COPD by clinical COPD questionnaire (CCQ) and chronic respiratory disease questionnaire (CRQ), the inhalation technique by the Checklist and the Inhalation technique score of aerosol. RESULTS: 15 patients with asthma and 15 with COPD were included. The assessing the inhalation technique by method of the Checklist, the median score in the first visit was 66.7% and last visit after the instruction were 100% (p<0,05). The analysis of the inhalation technique score of aerosol, the rate of group\'s general, was initially 4 and the last visit was 9 post instructions (p <0.05). The proportion of adherent patients the whole group was 53,3% at visit 1 and 89,7% at last visit (p=0,006). The analysis of clinical control of asthma patients, obtained by applying ACT was initially 12.7 ± 5.2 and the last visit 17.1 ± 6.5 (p = 0.002), in assessing the clinical control of patients with COPD, the rates obtained by applying QCC and CRQ was respectively 4.9 ± 1.8 and 3.2 ± 1.5 at baseline and 6.4 ± 1.7 and 2.0 ± 1.4 at final visit (p <0.001). The evaluating the quality of life, the SGRQ score was 63.8 ± 18.3 at baseline and 51.5 ± 21.8 at final visit (p=0.022). CONCLUSIONS: Patients showed improvement in inhalation technique, treatment adherence, clinical control and quality of life after pharmaceutical intervention

INTRODUÇÃO: A doença pulmonar obstrutiva crônica (DPOC) apresenta obstrução crônica ao fluxo aéreo e evolui com perda da capacidade funcional. A intolerância ao exercício é um marcador prognóstico da doença. OBJETIVO: Investigar as respostas fisiológicas no teste incremental com cicloergômetro (TECP), teste do degrau de 6 minutos (TD6), teste da caminhada de 6 minutos (TC6) e teste senta e levanta de um minuto (TSL) em pacientes com DPOC. MÉTODOS: Foram incluídos 24 pacientes com DPOC (VEF1/CVF<70 e VEF1 pós bd <80%), clinicamente estáveis. Todos os pacientes realizaram provas de função pulmonar e os quatro protocolos de exercício. Durante os testes foram medidos: consumo de oxigênio (VO2), produção de CO2 (VCO2), ventilação (VE), frequência cardíaca (FC), frequência respiratória (FR), oximetria de pulso (SpO2), e sensação de dispneia e de desconforto nas pernas (escala de BORG modificada). RESULTADOS: Quinze pacientes eram homens, a média de idade foi de 63,7 ± 6,6 anos e do VEF1 foi de 1,20 ± 0,60 L, 42,5 ± 17,8 % do predito. O VO2pico observado no TD6 (1,01±0,40 L.min-1) não diferiu do VO2 medido no TECP (0,86±0,32 L.min-1) e no TC6 (0,99±0,46; L.min-1;p>0,05). Entretanto, o VO2 pico do TSL foi significativamente inferior (0,66±0,32 L.min-1, p<0,05). A VE foi comparável no TECP, TD6 e TC6. O estresse cardiovascular foi mais intenso no TECP, porém o pulso de oxigênio (VO2/FC) foi inferior no TECP e no TSL. Dessaturação (queda da SpO2 ³4% e SpO2 £88%) foi mais frequente no TC6 e no TD6. Dispneia e desconforto em pernas foram mais intensos no TECP. No TD6 14 pacientes interromperam o teste e no TC6 um paciente interrompeu. CONCLUSÕES: A dessaturação durante o exercício foi mais evidente no TD6 e no TC6 e estes testes reproduziram respostas fisiológicas equivalentes às do TECP. / BACKGROUND: Chronic obstructive pulmonary disease (COPD) has chronic obstruction of airflow and loss of functional capacity. Exercise intolerance is a prognostic marker of the disease. OBJECTIVE: To investigate the physiological responses to incremental cycle ergometry (CPET), six-minute step test (SMST), sixminute walk test (SMWT), and one-minute sit-to-stand test (STST) in patients with COPD. METHODS: We included 24 patients with COPD (FEV1/FVC ratio <70 and FEV1 post bd <80%), stable. All patients underwent pulmonary function tests and the four exercise protocols. Peak oxygen uptake (VO2peak), CO2 production (VCO2), ventilation (VE), heart rate (HR), respiratory rate (RR), pulse oximetry (SpO2), dyspnea and leg disconfort (modified Borg scale) were measured during the tests. RESULTS: Fifteen patients were men, mean age was 63.7 ± 6.6 years and FEV1 was 1.20 ± 0.60 L, 42.5 ± 17.8 % predicted. VO2 peak in SMST (1.01±0.40 L.min-1), measured during CPET (0.86±0.32 L.min-1) or SMWT (0.99±0.46; L.min-1) was not different (p>0.05). However, peak VO2 of STST was lower (0.66±0.32 L.min-1, p<0.05). VE was comparable among CPET, SMST and SMWT. The cardiovascular stress was more intense during CPET and oxygen pulse (VO2/HR) was lower during CPET and STST. Desaturation (decrease of SpO2 ³4% and SpO2 £88%) was more frequent during SMWT and STST. Dyspnea and leg disconfort were higher on CPET. The SMST was interrupted by 14 patients and the SMWT by one. CONCLUSIONS: Desaturation during exercise was more evident on SMWT and SMST and these tests elicited similar physiological responses as the CPET.

Submitted by GIOVANNA HASS BUENO null (giovannahass@uol.com.br) on 2017-02-17T18:51:48Z No. of bitstreams: 1 DEFESA GIOVANNA HASS BUENO (pós defesa).pdf: 2166823 bytes, checksum: 0b75b021e61c018ad5c824251b548ecd (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2017-02-21T14:53:52Z (GMT) No. of bitstreams: 1 bueno_gh_me_bot.pdf: 2166823 bytes, checksum: 0b75b021e61c018ad5c824251b548ecd (MD5) / Made available in DSpace on 2017-02-21T14:53:52Z (GMT). No. of bitstreams: 1 bueno_gh_me_bot.pdf: 2166823 bytes, checksum: 0b75b021e61c018ad5c824251b548ecd (MD5) Previous issue date: 2017-02-14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A Oxigenoterapia Domiciliar Prolongada (ODP) é um tratamento utilizado para pacientes com DPOC grave. O tratamento apresenta inúmeras vantagens, como o aumento da capacidade funcional, melhoras nos sintomas, mas os usuários também reconhecem que há desvantagens no uso deste. Identificam-se alguns problemas, como barreiras físicas e psicossociais e desafios emocionais. Muitas vezes os usuários necessitam de auxílios para desenvolver atividades cotidianas, precisando de cuidados de parentes e amigos, exercendo o cuidado informal. É fundamental que a equipe tenha conhecimento das mudanças na vida do paciente e de seus cuidadores, dos enfrentamentos dos desafios com a terapia, de forma a otimizar o cuidado, fazendo as adaptações necessárias a eles e com a equipe, proporcionando qualidade de vida para ambos. Também é essencial reconhecer as vantagens que a terapia causa tanto para o usuário tanto para o cuidador, fortalecendo o uso da ODP e incentivando os cuidadores nas tarefas prestadas ao paciente. Objetivo: Conhecer a visão dos pacientes com diagnóstico de DPOC sobre o uso da ODP e de seus cuidadores sobre o cuidado com um paciente em uso da ODP. Método: Trata-se de estudo de caráter qualitativo. Foram entrevistados 14 pacientes com seus respectivos cuidadores, atendidos no Ambulatório de Oxigenoterapia do Hospital das Clínicas de Botucatu, da Faculdade de Medicina de Botucatu com diagnóstico de DPOC durante o segundo semestre de 2015. Foi utilizada para os pacientes uma entrevista semi-estruturada, com as seguintes questões norteadoras: “O que significa para você usar o Oxigênio?”, “O que mudou em sua vida depois que você começou a usar a ODP?”, “O que mudou na vida das pessoas que convivem com você em sua casa depois de começar a usar ODP?” e “ você tem atividade de lazer?” . Para os cuidadores, foi utilizada também uma entrevista semi-estruturada, com as seguintes questões norteadoras: “O que significa para você cuidar de uma pessoa que depende do uso da ODP?”, “O que mudou em sua vida depois que você começou a cuidar desse usuário?”, “O que mudou na vida das pessoas que convivem com você depois que começou a cuidar?” e “você tem atividade de lazer?”. Foi aplicada também a escala Caregiver Burden scale (CB scale), para medir o impacto subjetivo das doenças crônicas na vida dos cuidadores. As entrevistas foram avaliadas pela “Análise do Conteúdo de Bardin” e a CS scale foi analisada através do cálculo da média aritmética dos escores atribuídos aos 22 itens. Resultados: Os pacientes tinham idade média de 73 + 10,4anos, sendo 6 do sexo feminino, 1 analfabeto e 13 com escolaridade inferior ao ensino médio. Todos ex tabagistas, fumava em média 25 + 15,9 cigarros ao dia. O tempo médio de uso de O2 foi 3,5 ±2,0 anos, a média diária de horas de uso foi 18,8 ± 4,6. Das falas surgiram quatro categorias: Fortalezas da terapia: melhora nos sintomas, da qualidade de vida e do aspecto emocional. Desafios da terapia: isolamento social, dificuldade no envolvimento emocional, piora no autocuidado, funcionalidade do concentrador O2 e acessórios e aspectos econômicos. Alterações emocionais, sociais, da vida cotidiana e econômicas na vida do usuário: processo de adaptação com dificuldades de aceitação, mudança na autoestima e da personalidade e mudança das atividades de lazer. Alterações na relação familiar do usuário: isolamento social do cuidador, envolvimento emocional dos familiares e comprometimento do cuidador. Os cuidadores tinham idade média de 63 +11 anos, sendo 11 do sexo feminino e todos alfabetizados. O tempo médio de cuidado diário prestado foi de 19 + 8,2 horas, e a média em anos dedicados ao cuidado foi 2,7 + 2, apenas 1 cuidador tinha o trabalho remunerado, e 2 tiveram seu estado de saúde piorado depois que passaram a ser cuidador. A categoria mais sobrecarregada da CB scale foi o ambiente, seguido da decepção, tensão geral, envolvimento emocional, e por último isolamento. Das falas surgiram quatro categorias: Fortalezas do cuidador: melhora do estado geral e da capacidade funcional do usuário, facilidades no manuseio do equipamento e importância do aspecto emocional do cuidador. Desafios do cuidador: envolvimento emocional, capacidade funcional do cuidador, mudança na vida cotidiana, funcionalidade do concentrador O2 e acessórios, aspecto econômico, aspectos da personalidade do usuário. Alterações emocionais, sociais, da vida cotidiana e econômicas na vida do cuidador: isolamento social, envolvimento emocional, autonomia, aspectos da personalidade do cuidador, alteração na vida cotidiana, sexualidade, autoestima, atividades de lazer. Alterações na relação familiar do cuidador: aspecto da personalidade, estrutura familiar. Conclusão: Diante desse estudo, são nítidas as mudanças no cotidiano e do comportamento dos usuários e de seus cuidadores. Frente a isso, é fundamental que a equipe esteja preparada para fornecer educação adequada a eles, para otimizar a utilização e o cuidado, diminuindo medo e barreiras com o tratamento. / Introduction: Long-term Oxygen Therapy (LTOT) is a treatment used for patients with severe COPD. The treatment has numerous advantages, such as increased functional capacity and improvements in symptons, but users also recognize that there are disadvantages in using it. Some problems like physical and psychosocial barriers and emotional challenges can be identified. Users often need help to develop everyday activities, needing care from relatives and friends, practicing informal care. It is essential that the team is aware of all the changes in the life of the patients and their caregivers and the challenges of the therapy itself, in order to optimize care, making necessary adjustments to them and the team, providing quality of life for both. It is also essential to recognize the benefits that the therapy brings to both, the user and the caregiver, by strengthening the use of LTOT and encouraging caregivers in the tasks provided to the patient. Objective: Identify the vision of patients with COPD about the use of LTOT as well as the vision of the caregivers about the care of a patient using LTOT. Methodology: This is a qualitative study. During the second semester of 2015, fourteen patients attended at the Oxygen Therapy Outpatient of Botucatu Clinic Hospital, of Botucatu Medicine College, and their respective caregivers were interviewed. A semi-structured interview was used for the patients, with the following guiding questions: “What does it mean for you to use oxygen?”, “What has changed in your life after you started using LTOT”, “What has changed in the lives of people who live with you in your home after you start using LTOT” and “Do you have any leisure activity?”. For the caregivers, a semi-structured interview was also used, with the following guiding questions: “What does it mean for you to take care of a person who depends on LTOT”, “What has changed in your life after you started taking care of this user?”, “What has changed in the lives of the people who live with you after you sarted taking care?” and “Do you have any leisure activity?”. The Caregiver Burden Scale (CB scale) was also applied to measure the subjective impact of chronic diseases on caregivers’ lives. The interviews were evaluated by the “Bardin Content Analysis” and the CB scale was anallyzed by calculating the arithmetic mean of the scores attributed to the 22 items. Results: Patients had a mean age of 73 + 10.4 years, of whom 6 were female, 1 was illiterate and 13 were under secondary school. All ex-smokers smoked, on average, 25 + 15.9 cigarettes a day. The mean time of O2 use was 3.5 ±2 years and the mean of daily hours use was 18.8 ± 4.6. Four categories emerged from the speeches: Strengths of therapy: Improvement in symptoms, quality of life and emotional aspects. Therapy challenges: Social isolation, difficulty in emotional involvement, worsening in self-care, functionality of the O2 concentrator and economic aspects. Emotional, social, daily and economic changes in the user’s life: Adaptation process with acceptance difficulties, changes in self-esteem, personality and leisure activities. User’s family relationship changes: Social isolation of the caregiver, emotional involvement of the family and commitment of the caregiver. The caregivers had a mean age of 63 + 11 years, of which 11 were female and all were literate. The daily care time mean was 19 + 8.2 hours and the mean of the years dedicated to care was 2.7 ± 2, only 1 caregiver had paid work and 2 had their health status worsened after becoming a caregiver. The most overloaded category of CB scale was the environment, followed by disappointment, general tension, emotional involvement and, ultimately, isolation. Four categories emerged from the speeches: Strengths of the caregiver: Improvement of the user’s general state and functional capacity, facility in the handling of the equipment and importance of the caregiver’s emotional aspect. Caregiver’s challenges: emotional involvement, functional capacity of the caregiver, change in daily life, functionality of the O2 concentrator and accessories, economic aspects and user’s personality aspects. Emotional, social, daily and economic changes in the caregiver’s life: Social isolation, emotional involvement, autonomy, caregiver’s personality aspects, change in daily life, sexuality, self-esteem and leisure activities. Caregiver’s family relationship changes: personality aspects and family structure. Conclusion: In face of this study, daily life changes and user’s and caregiver’s behavior changes are very clear. Therefore, the team needs to be prepared to provide adequate education to them in order to optimize use and care, reducing fear and barriers to use the treatment.

Made available in DSpace on 2014-07-29T15:25:14Z (GMT). No. of bitstreams: 1 Tese Maria Auxiliadora Carmo Moreira.pdf: 2046053 bytes, checksum: 33431c948efec3b7643a3fd04554d200 (MD5) Previous issue date: 2011-05-05 / Introduction: Exposure to smoke from wood combustion contributes significantly to the prevalence of COPD in many countries. Findings from studies in other countries are not fully applicable to Brazil due to the diversity of vegetation used as firewood, the almost exclusive use of firewood for cooking, and limited use of other types of biomass in Brazil. The importance of high-resolution computed thorax tomography (HRCT) as an adjuvant tool to complement spirometry for COPD diagnosis has increased and studies of diseases caused by wood smoke are still scarce. Objectives: Identify women with COPD and a history of wood smoke exposure and to characterize this group in terms of exposure and clinically, demographically, spirometrically and tomographically. Particularly in regard to tomography, the goal was to add to the limited literature on this subject, both in Brazil and internationally. Methods: One hundred sixty female non-smokers exposed to smoke from burning wood and 31 normal controls with no history of exposure to wood smoke were included in the study. Through a validated questionnaire, demographic and clinical data (respiratory symptoms) and information about environmental exposures were obtained. Spirometries were carried out on all the women and the lung volume of those with COPD was measured. Forty-two patients with COPD and all of the control group underwent HRCT. / Introdução: A exposição à fumaça da combustão de lenha contribui, de maneira significativa, para prevalência da DPOC em muitos países. Achados desses estudos podem não ser totalmente aplicáveis ao Brasil, tendo em vista, no país, a diversidade da vegetação utilizada como lenha, o emprego praticamente restrito à cocção de alimentos e a limitada utilização de outros tipos de biomassa. Tem crescido a importância da tomografia computadorizada de tórax de alta resolução (TCAR) como ferramenta adjuvante à espirometria para diagnóstico da DPOC e os estudos sobre a doença provocada por fumaça de lenha ainda são escassos. Objetivos: Identificar mulheres com DPOC e história de exposição à fumaça de lenha e caracterizar esse grupo do ponto de vista da exposição, do aspecto clínico, demográfico, espirométrico e tomográfico, contribuindo, especialmente em relação a este último aspecto, para somar informações à restrita literatura sobre o assunto, tanto no Brasil quanto internacionalmente. Métodos: Foram incluídas 160 mulheres não tabagistas, expostas à fumaça da combustão lenha e 31 controles normais, sem história de exposição à fumaça de lenha. Por meio de questionário validado, obtiveram-se dados demográficos, clínicos (sintomas respiratórios) e informações sobre exposições ambientais. Todas as mulheres fizeram espirometria e naquelas com DPOC, foram feitas medidas de volumes pulmonares. Foi realizada TCAR em 42 pacientes com DPOC e em todas do grupo controle.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A DoenÃa Pulmonar Obstrutiva CrÃnica (DPOC) e um problema de saÃde mundial com altos Ãndices de mortalidade, sendo o tabagismo o principal causador desta. Apesar da DPOC ser uma doenÃa de Ãmbito mundial Ã, geralmente, subestimada e subdiagnosticada, levando desta forma ao subtratamento. Para evitar um aumento de casos patolÃgicos com diagnÃsticos incorretos, a tomografia computadorizada deve ser utilizada jà que esta constitui uma excelente ferramenta para diagnÃstico precoce da componente de enfisema pulmonar na DPOC. PorÃm, as anÃlises nas imagens feitas pelos radiologistas ou mÃdicos à subjetiva levando-os a realizarem mediÃÃes imprecisas, devido à limitaÃÃo da visÃo humana. O objetivo deste trabalho à desenvolver um sistema de VisÃo Computacional para anÃlise de imagens tomogrÃficas (SDEP) capaz de segmentar automaticamente as imagens de Tomografia Computadorizada de Alta ResoluÃÃo (TCAR) dos pulmÃes, detectar e quantificar a presenÃa de enfisema pulmonar de modo preciso e automÃtico, possibilitando sua visualizaÃÃo. TambÃm, neste trabalho sÃo analisados os resultados, buscando avaliar a eficiÃncia do sistema SDEP comparando-o com o sistema Osiris 4, e com dois algoritmos de segmentaÃÃo. Os resultados da segmentaÃÃo sÃo analisados atravÃs da visualizaÃÃo de 102 imagens de 8 voluntÃrios saudÃveis e 141 imagens de 11 pacientes com DPOC. O sistema SDEP apresenta-se mais eficiente do que os outros mÃtodos considerados neste trabalho, tomando-se como base segmentaÃÃo correta, sobre-segmentaÃÃo, segmentaÃÃo com perdas e segmentaÃÃo errada. Este sistema realiza a segmentaÃÃo das faixas das densidades pulmonares atravÃs da mÃscara colorida, aplicando vÃrias cores em uma Ãnica imagem e quantifica cada cor por Ãrea e porcentagem, enquanto que o sistema Osiris usa apenas uma cor por vez em cada imagem. O sistema SDEP possui tambÃm uma ferramenta que faz a sobreposiÃÃo dos histogramas, o qual permite uma anÃlise visual mais adequada da evoluÃÃo da componente do enfisema. Este sistema possibilita auxÃlio ao diagnÃstico, bem como mostra-se ser uma ferramenta de pesquisa para anÃlise do enfisema pulmonar. / The Chronic Obstructive Pulmonary Disease (COPD) is a worldwide public health problem with high rates of mortality, being the tabacco the main causer of this disease. COPD is underestimated and underdiagnosed globally, and consequently the patient receives an undertreatment. To avoid an increase of pathological cases with incorrect diagnoses, the computerized tomography should be used as an excellent tool for premature diagnosis of pulmonary emphysema component from COPD. However, the analysis on images accomplished by radiologists or doctors is subjective,leading them to accomplish inaccurate measurements, due to human vision limitation. The objective of this work is to develop a Computational Vision System for Detection and Quantification of the Pulmonary Emphysema (SDEP) capable of segment automatically the images of High-Resolution Computerized Tomography (HRCT) of the lungs, allowing its better view. Also, in this study are analysed the obtained results to evaluate the eÂciency of SDEP system comparing it with the Osiris 4 system, and with two segmentation algorithms. Results of the segmentation are analysed through the viewing of 102 images of 8 healthy volunteers and 141 images of 11 COPD patients. The SDEP system presents more eÂcient than other methods considered in this work, evaluating the correct segmentation, the over segmentation, segmentation with losses, and wrong segmentation. The proposed system accomplishes the segmentation of zone from lung densities using colorful mask, applying several colors in a single image quantifying each color per area and percentage, while the Osiris system uses only one color on each image. The SDEP system has, beside of advantage presented, a tool that accomplish the overlap of histograms, which permit a more appropriate visual analysis of evolution of component on the emphysema. The proposed system offers to aided diagnosis, researchers, engineers, medical doctors and specialist and others of Medical Digital Image Processing field, one valid option for pulmonary emphysema analysis from HRCT images.

This thesis investigated lifestyle characteristics including cigarette smoking, alcohol consumption, dietary supplements intake, physical activity, and urinary incontinence status for Japanese patients with chronic obstructive pulmonary disease (COPD). Field studies were conducted in the middle of Japan. The study was conducted using a cross-sectional survey and all patients were recruited from the outpatient departments of six hospitals in three districts/prefectures, namely, Aichi, Gifu, and Kyoto. Three hundred referred COPD patients diagnosed by respiratory physicians were recruited in 2006. Inclusion criteria were (i) aged between 50 and 75 years; and (ii) had COPD as the primary functionally limiting illness which was diagnosed within the past four years. Diagnosis of COPD was confirmed by spirometry with FEV1/FVC < 70%, where FEV1 = forced expiratory volume in one second and FVC = forced vital capacity. A structured questionnaire was administered to collect information on lifestyle characteristics. All interviews, averaging 40 minutes, took place in the hospital outpatient departments. Clinical characteristics, height, weight and presence of any co-morbidity (e.g. diabetes, hypertension, cardiovascular disease), were retrieved from medical records. / A total of 278 eligible participants (244 men and 34 women) were available for analysis. The majority were men (88%) with mean age 66.5 (SD 6.7) years and mean body mass index (BMI) 21.9 (SD 3.6). Most of them were married (84%), had high school or below education (80%) and retired (55%). In relation to cigarette smoking, 62 (53 male and 9 female) participants (22.5%) were current smokers of whom the great majority (89%) smoked daily. Only six (2.1%) participants were never smokers. The prevalence of smoking by time from diagnosis was: 24.5% (< 1 year), 20.6% (1-2 years), and 18.9% (2-4 years). Continuous smoking was inversely associated with age (odds ratio (OR) = 0.94, 95% confidence interval (CI) 0.90-0.98), BMI (OR = 0.88, 95% CI 0.80-0.97) and disease severity vii (OR = 0.29, 95% CI 0.12-0.74 for severe COPD and OR = 0.29, 95% CI 0.09-0.92 for very severe COPD). For alcohol consumption, 158 (150 male and 8 female) patients (56.8%) drank alcohol regularly on at least a monthly basis, the majority of them (73.4%) being daily drinkers. Beer was the most preferred alcoholic beverage drank (30.9%). Alcohol intake appeared to be positively associated with the habit of adding soy sauce to foods, whereas dyspnoea of patients posed significant limitations for them to drink alcoholic beverages. / Also, female patients tended to have lower alcohol consumption levels than male patients. Regarding dietary supplements, 117 (101 male and 16 female) participants (42.1%) were dietary supplement users, but the prevalence for female patients (47.1%) was higher than male patients (41.4%). Younger patients (≤ 60 years) and those with severe COPD had relatively low proportion of users (27.3% and 28.9%, respectively). Dietary supplementation was found to be affected by age (p = 0.04), COPD severity (p = 0.03) and presence of co-morbidity (p = 0.03). Older patients over 60 years were more likely to take dietary supplements (OR = 2.44, 95% CI 1.03-5.80), whereas severe COPD patients (OR = 0.41, 95% CI 0.18-0.95) and those with a co-morbidity (OR = 0.54, 95% CI 0.32-0.94) tended not to use. With respect to physical activity of COPD patients, 198 (175 male and 23 female) of them (77%) participated in physical activities on at least weekly basis, but only 22% and 4% engaged in moderate and vigorous activities, respectively. Over 2/3 of them walked at least weekly. Regression analysis showed that perceived life-long physical activity involvement appeared to be positively associated with total physical activity, whereas patients with very severe COPD tended to have significantly lower total physical activity levels. / Besides COPD severity, both age and smoking exhibited a negative impact on walking. It is evident that walking activities decreased among very severe patients, current smokers and those in advanced age. The prevalence of urinary incontinence was 12.6% (10% for men and 32% for women). The most common occurrence of urine loss was before reaching the toilet (54%) followed by coughing/sneezing (23%). While urge incontinence was reported viii by 63% of male incontinent patients, 82% of female incontinent patients experienced stress incontinence. Incontinence was more likely among female patients (OR = 8.7, 95% CI 3.2-23.4) and older patients over 70 years (OR = 2.3, 95% CI 1.0-5.2). COPD severity was also found to be a significant factor (p = 0.007), with very severe patients at slightly higher risk of urinary incontinence (OR = 1.1, 95% CI 0.3-3.5) than mild COPD patients, though the relationship appeared not to be linear across the severity classifications. It is alarming to find mild and moderate COPD patients continue to smoke. The implementation of a co-ordinated tobacco control program immediately post diagnosis is needed for the effective pulmonary rehabilitation of COPD patients. The high alcohol consumption by COPD patients is also alarming. Alcohol control programs targeting male patients should be promoted during pulmonary rehabilitation in order to minimise the harm due to excessive drinking. Dietary supplements are popular for patients with COPD especially among older patients. / The findings are important to clinical trials and experimental interventions advocating nutritional supplementation therapy for pulmonary rehabilitation. Patients with COPD had lower physical activity levels than the general elderly population. Older patients with very severe COPD and those who currently smoke should be targeted for intervention and encouraged to increase their participation in physical activity so as to maintain their health and well being. The high prevalence yet underreporting of urinary incontinence suggested that education and regular assessment are needed after COPD diagnosis. Appropriate exercise and treatment tailored for the specific type of incontinence incurred should be incorporated within the rehabilitation program of COPD patients. To maintain a healthy lifestyle and to achieve optimal outcomes during the pulmonary rehabilitation of COPD patients, the identified factors should be taken into consideration and health awareness programs should be promoted in conjunction with respiratory physicians and allied health professionals.

Bakgrunden till studien bygger på ett samarbete mellan sjukgymnastprogrammet på Mälardalens högskola och ett sjukhus i Sörmlands läns landsting. Syftet var att utvärdera om behandling bestående av fyra veckors KOL-skola haft effekt på patienternas hälsa, välbefinnande och fysiska kapacitet. KOL-skolan bestod utav fyra tillfällen under vilka olika vårdprofessioner gav patienterna information om bl.a. symptompåverkan, känslomässiga upplevelser och vikten av fysisk aktivitet. Det var tio patienter med kronisk obstruktiv lungsjukdom (KOL) i stadium två till fyra som deltog i interventionen. Utvärderingsinstrument som användes var The St George’s Respiratory Questionnaire och sex minuters gångtest. Resultaten visade att ingen signifikant skillnad i enkäten eller sex minuters gångtest förelåg efter intervention för gruppen. Tidigare forskning har visat att de psykosociala faktorerna har en stor inverkan på patienter med KOL och deras välbefinnande. Författarna anser därför att framtida forskning och verksamhetsutveckling bör utforma behandlingsstrategier för patienter med KOL utifrån den biopsykosociala modellen. / The background of this study is based on a cooperation between the physiotherapy program at Mälardalen University and a hospital in the county of Södermanland. The aim of the study was to evaluate whether a four week treatment of COPD-school have had an impact on patient health, well being and physical capacity. The COPD-school consisted of four occasions in which different health care professionals gave patients information on subjects including; symptom impact, emotional experiences and the importance of physical activity. There were ten patients with chronic obstructive pulmonary disease (COPD) in stage two to four who participated in the intervention. The instruments for evaluation that were used were The St. George's Respiratory Questionnaire and six minute walk test. The results showed no significant difference in the survey or six minute walk test for the group after the intervention. Previous research has shown that psychosocial factors have a profound effect on patients with COPD and their wellbeing. The authors therefore believe that future research should focus on designing treatment for patients with COPD based on the biopsychosocial model.

Bakgrund: Kronisk obstruktiv lungsjukdom (KOL) är en världsomfattande sjukdom. År 2012 dog mer än tre miljoner människor världen över till följd av sjukdomen. Av de dödsfall som sker till följd av sjukdomen, sker 90 % i låg- och medelinkomstländer. Den huvudsakliga orsaken till att sjukdomen utvecklas är rökning. Sjukdomen kan leda till b.la. depression, utmattning, ångest och smärta. Sjuksköterskans arbete innefattar att tillgodose basala och specifika omvårdnadsbehov. KASAM (känslan av sammanhang) består av tre dimensioner begriplighet, hanterbarhet och meningsfullhet. Alla dessa bidrar till en känsla av sammanhang. Syfte: Att beskriva upplevelsen av att leva med kronisk obstruktiv lungsjukdom (KOL). Metod: Litteraturöversikten genomfördes med hjälp av 11 kvalitativa artiklar. Artiklarna analyserades med hjälp av Fribergs femstegsmodell. Resultat: Fem teman framkom, Upplevd andfåddhet, Upplevd påverkan av aktivitetsförmågan, Upplevd ensamhet och social isolering, Upplevd meningslöshet och suicidala tankar och Upplevd kontroll. KOL är en svår sjukdom som involverar många olika negativa känslor. Rädsla, panik, ångest och depression var förekommande. Slutsatser: KOL är en sjukdom som innefattar många negativa känslor och medför problem som påverkar hela livet i stor utsträckning. De som är drabbade av KOL kunde ha en låg känsla av sammanhang. Dessa fynd ger sjuksköterskan en viktig insikt i de upplevelser vårdtagarna upplever i sin sjukdom. / Background: COPD is a worldwide disease. Year 2012 more than three million people died as a result of the disease worldwide. Of the deaths that occur as a result of the disease, 90 % occur in low- and middle-wealth countries. The main cause of the illness is smoking. The disease can lead to for instance depression, fatigue, anxiety and pain. The nurse profession involves satisfying basic and specific nursing needs. SOC (sense of coherence) is comprised of three dimensions of comprehensibility, manageability and meaningfulness. All these contribute to a sense of coherence. Aim: To describe the experience of living with chronic obstructive pulmonary disease (COPD) Method: Literature review was conducted using 11 qualitative articles. The articles were analysed with Friberg´s five-stage model. Results: Five themes emerged, Perceived breathlessness, Perceived loneliness and social isolation, Perceived meaninglessness and suicidal thoughts and Perceived control. These themes indicate that COPD is a difficult disease involving many different negative emotions. Fear, panic, anxiety and depression were frequent. Conclusion: COPD is a disease involving many negative feelings and poses problems that effects the entire life extensively. Those who are afflicted with COPD could have a low sense of coherence. These findings give nurses an important insight into the experiences patients have in their illness.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Besides abnormities within the respiratory system COPD is also associated with effects outside the lungs, so called systemic effects. One systemic effect that has been highlighted is skeletal muscle dysfunction which has also been associated with reduced exercise capacity. Apart from changes in muscle morphology, low levels of physical activity have also been suggested as a plausible mediator of reduced exercise capacity in COPD. The aim of this thesis was to study muscle morphology and physical activity patterns in patients with different degrees of COPD and to examine the associations between muscle morphology, physical activity and exercise capacity in these patients. Skeletal muscle morphology was found to shift towards a more glycolytic muscle profile in COPD patients and changes in muscle morphology were found to be correlated to disease severity and to exercise capacity. Muscle capillarization was also found to be lower in COPD compared with healthy subjects and to be correlated to disease severity and exercise capacity. When studying signalling pathways involved in muscle capillarization, an overexpression of VHL was found in patients with mild and moderate COPD compared with healthy subjects. Furthermore, COPD patients were found to be less physically active compared with healthy subjects and the level of physical activity was associated with exercise capacity.In conclusion, changes in skeletal muscle morphology and low levels of physical activity are present in COPD patients and may partly explain the lower exercise capacity observed in these patients. The more glycolytic muscle profile in COPD is suggested to be mediated by hypoxia and low levels of physical activity in this patient group. Furthermore, increased levels of VHL may lead to impaired transduction of the hypoxic signalling pathway, which may contribute to the decreased muscle capillarization observed in COPD.