Orientador: Dionei Ramos / Banca: José Roberto Brito Jardim / Banca: Ercy Mara Cipulo Ramos / Resumo: Pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) apresentam comumente intolerância ao exercício físico de intensidade variável e relacionada à disfunção muscular esquelética. Assim, o exercício físico tornou-se importante no processo de reabilitação desses pacientes. Objetivo: avaliar a eficácia de um programa de treino resistido com corda elástica na força muscular periférica, capacidade funcional e qualidade de vida de pacientes com DPOC. Métodos: foram avaliados 34 pacientes (24 homens; 10 mulheres) com DPOC, idade de 62 ± 8,27 anos e IMC de 21,29 ± 3,73, alocados em dois grupos: treino resistido convencional e com corda elástica pelo período de oito semanas e frequência de três vezes semanais. As varáveis avaliadas foram força muscular periférica com dinamômetro, capacidade funcional pelo teste de caminhada de seis minutos e qualidade de vida pelo questionário Chronic Respiratory Questionnaire (CRQ). Resultados: a avaliação da força muscular periférica apresentou melhoras nos dois grupos estudados para todos os movimentos realizados durante o protocolo. O desempenho no TC6 (metros) apresentou melhora após oito semanas de treinamento, tanto no grupo corda elástica... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In general, patients with Chronic Obstructive Pulmonary Disease (COPD) patients have intolerance to exercise of variable intensity and related to skeletal muscle dysfunction. So, the exercise has become important in the process of rehabilitation. Objective: To evaluate the effectiveness of a program of resistance training with elastic band in peripheral muscle strength, functional capacity and quality of life of patients with COPD. Methods: We evaluated 34 patients (24 men, 10 women) with COPD, age 62 ± 8.27 years and BMI 21.29 ± 3.73 divided into two groups: conventional resistance training and with elastic band for the period of eight weeks and frequency of three times weekly. Peripheral muscle strength was assessed with a dynamometer, the functional capacity for the six-minute walking test and quality of life for the Chronic Respiratory Questionnaire (CRQ). Results: the assessment of peripheral muscle strength had improved in both groups for all muscle groups exercised during the protocol. Performance on the 6MWT (meters) showed improvement after eight weeks of training, both in the elastic band... (Complete abstract click electronic access below) / Mestre

Background: Chronic obstructive pulmonary disease (COPD) is a devastating illness that affects 4.3% of the population of British Columbia over the age of 45 years. Asthma is known to coexist in 10-20% of individuals with obstructive lung disease, and adds to the substantial burden of illness posed by COPD alone. Inhaled corticosteroids (ICS) are currently recommended for the management of COPD among individuals with frequent exacerbations; however, the ability of inhaled corticosteroids to reduce death and hospitalizations among individuals with COPD is controversial. Less is known about the effectiveness of ICS among individuals who are afflicted with both COPD and asthma. Methods: We used a retrospective cohort study design and administrative data to estimate the relative effectiveness of ICS in reducing hospitalizations or death among individuals with concomitant asthma and COPD, compared with individuals with COPD alone. We used an extended Cox model to estimate this association, with a time-varying measure of exposure to ICS. Results: We did not find any association between ICS and hazard of death or hospitalization among individuals with COPD alone (HR = 0.99; 95% CI: 0.94 – 1.05), however the hazard was 18% lower (HR = 0.82; 95% CI: 0.69-0.99) among individuals with concomitant disease. Conclusions: Individuals with combined COPD and asthma show significant benefit from the use of ICS and are more responsive to the effects of ICS than individuals with COPD alone. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

Background Pulmonary diseases are the leading causes of mortality globally amongst children under five years of age. Economic evaluations (EEs) guide decision-makers on which health care intervention to adopt to reduce paediatric pulmonary disease burden. Methods We systematically reviewed EEs for paediatric pulmonary diseases published globally between 2010 and 2020. We searched PubMed, Web of Science, MEDLINE, Paediatric Economic Database Evaluation (PEDE), and the Cochrane library. EEs included were specific to paediatric pulmonary diseases in a hospital setting and of children aged from zero to six years old. We extracted data items guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. We collected qualitative and quantitative data which we analysed in Microsoft Excel and R Software. Results 22 studies met the inclusion criteria. Seven of the articles were cost-effectiveness analyses, five cost-utility analyses, two cost-minimisation analyses, and eight cost analyses. Fourteen studies were conducted in high-income countries, eight in low-middle-income countries (LMICs). Ten studies were on asthma, nine on pneumonia, two on asthma and pneumonia, and one on tuberculosis. Quality assessment of the articles revealed some methodological inconsistencies across the articles. Conclusion Fewer EEs were conducted in LMICs, yet children from these countries are disproportionately affected by pulmonary diseases. Developing standardised methods for EEs and conducting more EEs and for paediatric pulmonary diseases in LMICs could allow for more evidence-based decision-making.

Rationale: The prevalence of obesity among individuals with chronic obstructive pulmonary disease (COPD) is increasing, which contributes to further ventilatory limitations, and compromised exercise capacity, and health-related quality of life (HRQOL) compared to COPD alone. Objective: To conduct a systematic review to evaluate the effects of exercise interventions on walking capacity, ventilatory parameters, anthropometrics and HRQOL in individuals with COPD and elevated weight. Methods: A search was conducted on March 16, 2018 of Embase, Medline, CINAHL, AMED and PsycINFO for controlled trials of exercise interventions, involving adults with any stage of severity and stability of COPD with concurrent obesity or overweight. Overall effects were determined with standardized (SMD) and weighted (WMD) mean difference, using Review Manager 5.3. Results: Nineteen studies with 1716 participants (BMI mean ± SD 28.2 ± 5.1 kg/m2) were included. Exercise interventions were effective in improving walking capacity measured by the 6-Minute Walk Test (6MWT), Endurance Shuttle Walk Test and Incremental Shuttle walk Test (12 studies, 1215 participants, SMD 0.25 (95% CI [0.06, 0.43]); p=0.01), fat-free mass index (2 studies, 285 participants, WMD 0.33 kg/m2 (95% CI [0.21, 0.46]); p<0.00001), St. George Respiratory Questionnaire (6 studies, 648 participants, WMD -7.49 points (95% CI [-13.01, -1.98]); p=0.008) and Chronic Respiratory Disease Questionnaire Dyspnea (5 studies, 478 participants, WMD 0.51 points (95% CI [0.00, 1.02]); p=0.05), Emotion (4 studies, 404 participants, WMD 0.28 points, 95% CI [0.03, 0.54]); p=0.03), and Mastery domains (4 studies, 404 participants, WMD 0.31 points (95% CI [0.02, 0.59]); p=0.03). There were no effects on ventilatory parameters or anthropometric measures. Conclusions: Exercise interventions were effective in improving walking capacity and HRQOL in individuals with COPD and elevated weight. There is an important opportunity to establish effective interventions to minimize the functional and health effects in this subset of the COPD population. / Thesis / Master of Health Sciences (MSc)

The study, using a quasi-experimental design, examined the relationship between participation in a comprehensive pulmonary rehabilitation program, locus of control, and the psychological and social concomitants of chronic obstructive pulmonary disease. The study investigated the following questions. To what degree participation in a comprehensive pulmonary rehabilitation program emphasizing a psychosocial component would: (1) generally produce a shift in persons from an external locus of control toward an internal locus of control, (2) specifically decrease the perception of chance, fate, or powerful others to influence and determine personal health; and (3) will result in the lessening of perceived negative effects of the psychological and social concomitants of chronic obstructive pulmonary disease. Two sample groups were evaluated in the study: (1) a group of 35 moderate to severe chronic obstructive pulmonary disease patients enrolled in a 96-hour comprehensive pulmonary rehabilitation program with a 32-hour psychosocial instructional component, and (2) a group of 35 moderate to severe chronic obstructive pulmonary disease patients receiving standard medical care at a Veterans Administration Hospital. Research instruments used for the study were the Multidimensional Health Locus of Control Scale and the Sickness Impact Profile. The research instruments were administered to each study group at approximately 16-week intervals. Results of the study indicated that participation in a comprehensive pulmonary rehabilitation program emphasizing a psychosocial component did not produce a significant shift in program participants from an external locus of control toward an internal locus of control, nor did it produce a significant decrease in the perception of chance, fate, or powerful others to influence and determine personal health. However, the study results indicated that participation in a comprehensive pulmonary rehabilitation program did produce a significant (P < .05) lessening of perceived negative physical and psychosocial effects of chronic obstructive pulmonary disease as measured by the physical scale, psychosocial scale, and total score of the Sickness Impact Profile.

BACKGROUND Inhalation therapy has proven to be the best way to control the asthma and chronic obstructive pulmonary disease symptoms. The most commonly used delivery system to control these symptoms is the metered-dose inhaler. The primary goal of this study is to demonstrate an association between incorrect inhaler use and patient age. METHODS This is a cross-sectional study, performed at Centro Médico Naval “Cirujano Mayor Santiago Távara”, in Callao, Peru, in 2014. Patients older than 18 years that used metered-dose inhalers were included. We used film recordings of patients using a metered-dose inhaler and compared their technique with the recommendations on the guidelines on the correct use of inhalers of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). The main variables measured were age and incorrect inhaler use. The results were analyzed with the Chi squared test for bivariate analysis, and for multivariate analysis we used the Poisson regression model with robust variance. RESULTS We included 378 patients in the analysis; 167 were older than 60 years. An association was found between incorrect inhalator technique and age (p=0.014) (PR 1.19 95% CI 1.03 to 1.37). The highest prevalence of incorrect technique was found in the young adult population (88%). There was no association between the incorrect technique and the person who taught it (p=0.114). Finally, this study showed that 81.2% of the study population presented an incorrect inhalation technique. CONCLUSIONS The percentage of incorrect inhaler use, in the general population is high. Even if we found no association between an incorrect technique and the person who taught it; still, there is a high percentage of errors and it was even demonstrated that being instructed by a pulmonologist does not guarantee a correct performance of metered-dose inhaler inhalations. / INTRODUCCIÓN La terapia inhalatoria ha demostrado ser la más rápida y eficaz para el control del asma y la enfermedad pulmonar obstructiva crónica. El inhalador de dosis medida es el más usado por la población. El objetivo de este estudio es evidenciar la asociación entre la técnica inhalatoria incorrecta y la edad. MÉTODOS Estudio observacional, analítico, de corte transversal realizado en Perú durante 2014. Se incluyeron pacientes desde los 18 años que utilizaran inhalador de dosis medida. Se utilizó una lista de verificación de pasos establecidos por la Sociedad Española de Neumología y Cirugía Torácica y filmaciones para evaluar la técnica inhalatoria de los pacientes. Las variables principales fueron la edad y la mala técnica inhalatoria práctica. Para el análisis bivariado se utilizó la prueba Chi cuadrado y para el análisis multivariado regresión de Poisson con varianza robusta. RESULTADOS Se incluyeron 378 pacientes; 167 fueron mayores de 60 años. El estudio reveló que el 81,2% de la población presentó una incorrecta técnica inhalatoria. Se encontró asociación entre la edad y la técnica inhalatoria incorrecta (p=0,014) (PR 1,19 con IC 95% 1,03-1,37). El grupo etario con mayor frecuencia de técnica incorrecta fue el de adultos jóvenes (88%). CONCLUSIONES La frecuencia de uso incorrecto del inhalador en la población es alta y esta característica predomina en el grupo de adultos jóvenes. A pesar de no haber asociación entre la persona que enseña la técnica inhalatoria y el desempeño de la misma, se demostró que existe alta frecuencia de errores, incluso en aquellos pacientes instruidos por un médico especialista.

Title: Analysis of Pharmacotherapy by patients with diagnosis of COPD Student: Marilena Kartali-Kaouni Tutor: Prof. RNDr. Jiri Vlcek, CSc Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove Background: " Chronic Obstructive Pulmonary Disease (COPD) is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases". Tobacco smoking is the major risk factor in the development of COPD. COPD is a leading cause of morbidity and mortality worldwide. Aim: 1st from the current literature to understand the nature of COPD and obtain information about the aetiopathogenesis of the disease, diagnosis options and summarize the current view of strategies for achieving the goals of treatment. 2nd in a pilot study to analyze drug therapy in COPD patients visiting a pharmacy in Greece. Methods: 56 prescriptions with the diagnosis of COPD were collected during a period of 8 months from a Greek pharmacy. Information from the prescriptions with regard to COPD medications prescribed (active substances, trade names, strength, dosage scheme, pack size), patients characteristics (age and gender) and prescribing...

Orientador: Dionei Ramos / Resumo: Introdução: Entre as condições crônicas de saúde, cerca de um terço dos atendimentos nas unidades de atenção básica em todo o mundo se devem às Doenças Respiratórias Crônicas. Entre elas, a asma e doença pulmonar obstrutiva crônica (DPOC) são as mais comuns. É necessário, portanto, que os profissionais das equipes da saúde da família estejam preparados para lidar com a doença, e que possam ofertar um melhor tratamento e acompanhamento do doente. Objetivos: verificar a associação das variáveis espirométricas e sintomas respiratórios com diagnóstico clínico prévio de doença respiratória crônica em idosos na atenção primária à saúde; avaliar a eficácia de três questionários de sintomas respiratórios para indicar a possibilidade de distúrbio ventilatório obstrutivo de idosos com diagnóstico prévio de DPOC. Métodos: estudo transversal, observacional com idosos com diagnóstico clínico de doença respiratória crônica como enfisema, bronquite crônica, DPOC e asma brônquica, em oito unidades de Estratégia Saúde da Família randomizadas no interior de São Paulo. Os idosos com DPOC foram divididos em dois grupos a partir dos critérios espirométricos: grupo controle com espirometria normal (G1) e grupo DPOC com distúrbio ventilatório obstrutivo (G2). Foram avaliados dados socioeconômicos, medicação prescrita e exacerbações, função pulmonar por espirometria e o impacto dos sintomas por COPD Assessment Test (CAT), dispneia pela escala do Medical Research Council modificada (mMRC) e percepção... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Among chronic health conditions, about one third of primary care units around the world are due to Chronic Respiratory Diseases. Among them, asthma and chronic obstructive pulmonary disease (COPD) are the most common. Therefore, it is necessary that family health team professionals are prepared to deal with the disease, and that they can offer better treatment and monitoring of the patient. Objectives: to verify the association of spirometric variables and respiratory symptoms with a previous clinical diagnosis of chronic respiratory disease in elderly in primary health care; to evaluate the efficacy of three respiratory symptom questionnaires to indicate obstructive ventilatory disorder in elderly with a previous diagnosis of COPD. Methods: cross-sectional, observational study of elderly with clinical diagnosis of chronic respiratory disease as emphysema, chronic bronchitis, COPD and bronchial asthma, in eight Family Health Strategy units randomized in the interior of Sao Paulo. The elderly with COPD were divided into two groups based on spirometric criteria: control group with normal spirometry (G1) and COPD group with obstructive ventilatory disorder (G2). Socioeconomic data, prescribed medication and exacerbations, lung function by spirometry and the impact of symptoms by COPD Assessment Test (CAT), dyspnea to Medical Research Council modified scale (mMRC) and perception of quality of life by Chronic Respiratory Questionnaire (CRQ). Results: 89 elderly were ... (Complete abstract click electronic access below) / Doutor

Among those subjects admitted with AECOPD and concomitant pneumonia, a total of 118 patients (91 males) with 150 episodes were identified. Haemophilus influenzae was the commonest organism found in sputum (26.0%), followed by Pseudomonas aeruginosa (5.5%), Streptococcus pneumoniae (3.4%), and Moraxella catarrhalis (3.4%). In contrast to most studies from other countries reporting Streptococcus pneumoniae as the most likely bacterial pathogen, Haemophilus influenzae was the commonest bacterium isolated in sputum in this cohort of patients with AECOPD and concomitant pneumonia. / Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. / Exhaled breath condensate (EBC) analysis is a novel tool which has been developed in recent years and the technique is believed to reflect the lower airway lining fluid. My previous work has demonstrated the repeatability of certain inflammatory markers in the EBC of stable asthma and COPD patients. / Hypothesis 1: Bacterial pathogens are the major cause of AECOPD with and without concomitant pneumonia in patients requiring hospitalization. In the one-year retrospective bacteriology study, there were 329 patients with 418 episodes of AECOPD without concomitant pneumonia. These result noted that H. influenzae was the commonest bacterium isolated in sputum in patients with AECOPD without concomitant pneumonia. In areas endemic of tuberculosis, it is advisable to use fluoroquinolones for AECOPD with caution in view of the positive sputum culture of mycobacterium tuberculosis in some patients. / Hypothesis 2: Viral pathogens are an important cause of AECOPD in patients hospitalized with AECOPD. For the prospective infectious aetiology study, there were 643 episodes of AECOPD among 373 patients (307 males). Severe airflow obstruction (stable state spirometry) was associated with a higher chance of positive sputum culture (28.2% for FEV1 &ge;30% vs. 40.4% for FEV1 &lt;30% predicted normal, p=0.006). In this study, Haemophilus influenzae and influenza A were the commonest aetiological agents in patients hospitalized with AECOPD. More severe airflow obstruction was associated with a higher chance of positive sputum culture. / Hypothesis 3: The rates of hospital admissions due to AECOPD are associated with indices of air pollution in Hong Kong. Concerning the effect of air pollutants on AECOPD, significant associations were found between hospital admissions for COPD with all 5 air pollutants. Adverse effects of ambient concentrations of air pollutants on hospitalization rates for COPD are evident, especially during the winter season in Hong Kong. / Hypothesis 4: During the course of AECOPD, it is possible to assess inflammation in the airway by measuring biomarkers non-invasively using the method of EBC collection. To explore the course of inflammation in the airway during AECOPD, 26 patients (22 male) with AECOPD (mean percentage predicted FEV1, 44.8 +/- 14.3), 11 stable COPD and 14 age and sex-matched healthy controls were studied. Repeatability measurements of TNFalpha and LTB4 in 6 stable COPD patients were satisfactory. EBC TNFalpha level was low in patients receiving systemic steroid and antibiotic therapy for AECOPD whereas EBC TNFalpha level was also lower in stable patients receiving ICS post AECOPD than those who were not. These findings suggest a potential role for serial EBC TNFalpha for non-invasive monitoring of disease activity. / Summary. The above studies have shown that bacterial pathogens are the major cause of AECOPD with and without concomitant pneumonia in patients requiring hospitalization and the commonest bacterium found in the sputum of the patients was Haemophilus influenzae. Viral pathogens are also an important cause of AECOPD in patients hospitalized with AECOPD in Hong Kong and the commonest virus identified in the NPA of the patients was influenza A. Concerning the effect of air pollutants on AECOPD, significant associations were found between hospital admissions for AECOPD with the air pollutants of SO2, NO3, O3, PM10 and PM2.5. Finally, TNFalpha could be measured in the EBC of patients during the course of AECOPD and its level was low in patients receiving systemic steroid and antibiotic therapy for AECOPD. The results suggest that it is possible to assess inflammation in the airway by measuring biomarkers non-invasively using the method of EBC collection. (Abstract shortened by UMI.) / Ko, Wai-san Fanny. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0926. / Thesis (M.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 207-250). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.