Bakgrund: Kroniskt obstruktiv lungsjukdom (KOL) är ett sjukdomstillstånd som kännetecknas av ett begränsat luftflöde, främst vid utandning, till följd av exponering av giftiga ämnen i inandningsluften. Sjuksköterskan möter dessa patienter i primärvården, allmän medicinavdelning och specialiserad lungmedicinsk avdelning.   Syfte: Syftet med denna litteraturstudie var att utifrån vetenskaplig litteratur beskriva upplevelser av att leva med kroniskt obstruktiv lungsjukdom (KOL) utifrån ett psykiskt perspektiv. Syftet var även att beskriva artiklarnas datainsamlingsmetoder.   Metod: Deskriptiv design. Tio stycken vetenskapliga artiklar söktes i databaserna CINAHL och Medline via Pubmed. Dessa användes som underlag till resultatet.   Huvudresultat: Många patienter med KOL upplevde oro, rädsla, depression, en känsla av förlorad identitet, förändrad familjesituation och en känsla av otillräcklighet. Resultatet visade även att flertalet patienter med KOL påvisade symtom liknande PTSD-symtom. Generellt tyckte alla KOL-patienter att andnöden var den främsta orsaken till deras oro. Patienterna upplevde att deras familjer blev drabbade då diagnos ställdes. Familjeaktiviteter och individens potential att bidra till hushållet ändrades vilket bidrog till en förändrad familjesituation, en känsla av förlorad identitet och otillräcklighet.   Slutsats: Upplevelsen hos KOL-patienter definieras av oro, rädsla, depression, en känsla av förlorad identitet, förändrad familjesituation och en känsla av otillräcklighet. Symtom liknande PTSD-symtom påvisades dessutom hos denna patientgrupp. Andnöden generaliserades som den främsta orsaken till deras upplevda psykiska ohälsa.

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical sciences Student: Veronika Krčmářová Supervisor of master thesis: PharmDr. Miroslav Kovařík Ph.D. Title of master thesis: Resting energy expenditure in patients with chronic obstructive pulmonary disease II The aim of this study was to compare the resting energy expenditure (REE) and nutritional substrate utilization among patients with chronic obstructive pulmonary disease (COPD) and control group. Previous studies have confirmed increased values of REE in COPD patients. On the basis of the increase of this parameter there was a loss of lean and muscle mass. The utilization of nutritional substrates in patients with COPD is not yet known. Our study by a total of 20 patients includes 11 patients with COPD, and 9 from the control group . The age of patients ranged from 55 to 71 years. Each patient was examined once. We determined the value of REE by indirect calorimetry and utilization of nutritional substrates. According to our results, there was an increase in REE in 82 % of patients with COPD, while only 33 % of patients from the control group was hypermetabolic. Comparing the results of REE between groups we observed REE increase by about 20 % in patients with COPD compared with the control...

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Lucie Sehnalová Supervisor of master thesis: PharmDr. Miroslav Kovařík Ph.D. Title of master thesis: Determination of body composition by bioelectrical impedance method in patients with chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is one of the top leading causes of death and its morbidity and mortality worldwide is still increasing. Besides the respiratory symptoms there are often developed alterations in metabolism and body composition in COPD patients. Clinically important are mainly malnutrition and skeletal muscle protein loss. Especially if the respiratory muscles are affected, the lung function is negatively influenced. The main aim of this study was to compare the body composition between 15 patients with COPD 3rd and 4th stage and 9 patients of control group without respiratory impairment and comparable anthropometric characteristics (age, body height and weight). By means of bioelectrical impedance analysis we determined the composition of main body compartments. In patients with COPD was the mean amount of lean tissue of body weight (rel LTM) 47.2 ± 8.4 %, amount of fat mass (rel Fat) 37.8 ± 6.4 % and mean overhydration (OH) 0.31...

1 Abstract Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Martin Jenšík Supervisor of master thesis: PharmDr. Miroslav Kovařík Ph.D. Title of master thesis: Resting energy expenditure in patients with chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is step by step moving ahead in public and scientific interest due to its fast rising in mortality rate. Contemporary studies observed a phenomena that patients with COPD have increased resting energy expenditure (REE) that leads to loss of fat free mass and total weight. Our goal was to confirm or disprove this hypothesis. Our research ran in Department of research and development at University hospital Hradec Králové. In our study participated 30 patients, 26 men and 4 women, mean age 67 ± 8 let. Every patient was once examined after twelve-hour fasting. We determined REE and substrate utilization by method of indirect calorimetry. We confirmed increased REE from the average value of REE - 122 ± 14 % predicted by Harris - Benedict equation. None patient was hypometabolic, 7 were normometabolic and 23 hypermetabolic. Substrate utilization did not differ contrary to physiological values. Furthermore we discovered correlation among fat mass, fat free mass,...

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Barbora Malinová Supervisor of Diploma thesis: PharmDr. Miroslav Kovařík Ph.D. Title of diploma thesis: Densitometric determination of body composition in patients with chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in 2004 according to the WHO Global Burden of Disease Project and its morbidity and mortality worldwide is still increasing. Besides the lung function impairment, there are often described changes in body composition in COPD patients e.g. the skeletal muscle protein loss. The main aim of the study was determining the body composition by DEXA in patients diagnosed with COPD and comparing them with physiological values or studies dealing with this issue. On each patient was performed one examination, patients were coming after twelve-hour fasting. Average age was 66 ± 8 years. The amount of fat-free mass was not reduced. There was not therefore a loss of muscle tissue due to COPD. When evaluating total fat, we find that men have more fat than normal levels. This is also indicated by BMI that has been in the majority in the range of overweight and obesity. We did not confirm the link between COPD...

Background: This study explored the differences between the seasonal mortality rates (by age and gender) between the two jurisdictions (the Republic of Ireland (RoI) and Northern Ireland (NI)). The study assessed the relationship between cold temperatures and daily mortality, and assessed for effect modification of the cold weather-mortality relationship by age and gender. Methods: Mortality rates were calculated for each cause-specific mortality group during various seasons in both jurisdictions. A time-stratified case-crossover approach was applied to examine the cold weather-mortality relationship, 1984-2007. The daily mortality risk was explored in association with exposure to daily maximum temperatures on the same day and up to 6 weeks preceding death, during the winter months and extended cold period (October-March), using distributed lag models. Model stratification by age and gender assessed for modification of the cold weather-mortality relationship. Results: The winter mortality rates were significantly greater than the summer rates. NI experienced higher mortality from cardiovascular disease, respiratory disease and stroke. The impact of cold weather in the winter months persisted up to 35 days in the RoI, with a cumulative mortality increase for all-cause of 6.4% (95%CI: 4.8%-7.9%) with regards to every 1oC drop in the daily maximum temperature with similar associations for cardiovascular disease and stroke with twice as much for respiratory diseases. The associations were less pronounced and less persistent in NI. Conclusions: The study observed excess winter mortality. The cold weather-mortality associations increased with age with some suggestion of gender differences. There were strong cold weather-mortality associations in both jurisdictions, with suggestive differences in associations by age and gender. The findings suggest the potential contribution of societal differences, and require further exploration. These findings will hopefully contribute to the current efforts to modify fuel policy and reduce winter mortality in both jurisdictions.

La réponse de l’organisme contre un agent pathogène nécessite la mise en jeu d’interactions complexes entre cellules immunitaires et environnement. La matrice extra-cellulaire est remodelée au cours de la réponse immunitaire pour permettre la migration des cellules vers le site infectieux. Les peptides issus de la dégradation de la matrice peuvent influencer les fonctions biologiques des cellules immunitaires. Dans les pathologies impliquant des tissus riches en élastine, les cellules de la réponse inflammatoire et immunitaire, notamment les polynucléaires neutrophiles (PN) et les cellules dendritiques se retrouvent dans un environnement riche en produits issus de la dégradation de l’élastine. Le travail de thèse présenté ici nous a permis de montrer que les peptides d’élastine (PE) régulent les fonctions des PN de sujets sains en augmentant de façon significative leur capacité migratoire, leur capacité à produire des cytokines pro-inflammatoire et à phagocyter les agents pathogènes. Les effets régulateurs des PE sont moindres chez les sujets BPCO et varient en fonction de l’état clinique des patients. Les propriétés biologiques des PN de patients BPCO en exacerbation ne sont pas affectées par les PE. Cette différence de réponse aux PE des PN de patients BPCO à l’état stable ou à l’état exacerbé est proportionnellement liée au niveau d’expression du récepteur S-Gal à la surface des PN. Dans un second travail nous avons montré que les PE sont capables d’attirer les CD au niveau du site infectieux sans influencer la maturation des cellules induite par une activation antigénique. L’effet des PE sur la migration des CD met en jeu le récepteur S-Gal présent à la surface des cellules. Par ailleurs, les PE orientent la réponse cytokinique des CD activées par le LPS vers un profil de type Th-2 et favorisent l’émergence d‟un profil tolérogénique des CD. Ces effets régulateurs des PE sont médiés via l’interaction PE/S-Gal et conduisent au développement d’une réponse adaptative T régulatrice. L’ensemble de ces résultats suggère que les PE participent activement à la régulation de la réponse immunitaire innée et adaptative / Organisme defense against pathogens needs complexe interactions interactions between immune cells and environnement. The extracellular matrix is being remodeled to aloww cells to migrate to infectious site. Peptides generated by this degradation can influence biological fonctions of immune cells. In pathologies involving elastin rich tissue degradation inflammatory and immune cells, especially neutrophils and dendritic cells are in an environnement including numbers of matrix degradation products. This work shows that Elastin Peptides (EP) can regulate the fonctions of neutrophils from healthy subjects, by increasing significantly their migration, their cytokines production and their phagocytic capacity. These EP effects are howeever less important en stable COPD subject and depends on the clinical state of these patients. Indeed the biological properties of neutrophils from COPD patients in exacerbation are not affected by EP. This discrepancy considering the clinical state can be explained by the level of the S-Gal receptor expression. In a second part we have shown the ability of the EP to attract dendritic cell (DC) on the infection site without couetracting DC maturation. This effect involves the S-Gal receptor present on the surface of the cells. EP can also oriente the cytokine production by LPS-induced toward a Th-2 profil and favorise the emergence of DC with tolerogenic features. These effects are mediated throug EP/S-Gal interaction and leads to the developement of a T regulatory response. All of these results suggest that EP are involved in the regulation of innate and adaptative immunity.

A doença pulmonar obstrutiva crônica (DPOC) promove limitações mecânicas e encurtamento muscular que determinam a elevação do tórax, o aumento do volume residual e da capacidade residual funcional dos pulmões. Alterações do padrão torácico e na complacência pulmonar se correlacionar com as funções estomatognáticas por meio do osso hióide e da mandíbula. O objetivo deste estudo foi analisar a influência das desordens respiratórias decorrentes da DPOC no sistema estomatognático por meio de análise eletromiográfica. Participaram do estudo 40 indivíduos de ambos os gêneros com idade entre 40 e 80 anos, divididos em dois grupos: GD, grupo DPOC (n=20), média de idade de 65,65±8,11 anos e IMC de 24,92±2,97, estádio GOLD II a IV; e GC, grupo controle (n=20), idade média de 65,80±8,18 anos e IMC de 26,19±2,38, composto por indivíduos sem a doença. Os indivíduos foram submetidos as avaliações de eletromiografia de superfície para análise dos músculos do sistema respiratório e estomatognático; e força muscular respiratória por meio da manovacuometria. Os valores obtidos foram normalizados, tabulados e submetidos à análise estatística (SPSS versão 22.0) por meio do test t-student de amostras independentes (p<0,05). Em relação aos resultados, o sistema respiratório apresentou diferenças significativas (p<0,05) entre o GD e GC, em especial para o músculo diafragma nas condições clínicas de repouso, ciclo respiratório e inspiração máxima com menor atividade das fibras musculares, expiração máxima com maior atividade e redução da força muscular respiratória. O sistema estomatognático apresentou maior atividade (p<0,05) das fibras dos músculos masseteres nas condições clínicas de repouso e protrusão, e na lateralidade esquerda para os músculos temporal e esternocleidomastoideo direito, quando comparados os grupos GD e GC. Sugere-se, que as alterações encontradas na atividade do músculo diafragma decorrentes da restrição da mobilidade torácica, parecem estar relacionadas com alterações nas condições posturais da mandíbula, ocasionando aumento na atividade das fibras musculares relacionadas ao sistema estomatognático de indivíduos com DPOC. / Chronic obstructive pulmonary disease (COPD) promotes mechanical limitations and muscle shortening that determine chest elevation, leading to increased residual volume and functional residual capacity of the lungs. Changes in the thoracic pattern and pulmonary complacency are related to the stomatognathic functions through the hyoid bone and the mandible. We aimed to analyze the influence of respiratory disorders due to chronic obstructive pulmonary disease in the stomatognathic system. We divided 40 participants of both genders, ranging from 40 to 80 years old, into two groups: DG, COPD group (n = 20), average age 65.65 ± 8.11 years and body mass index (BMI) 24.92 ± 2.97, GOLD II to IV; and CG, control group (n=20), average age 65.80 ± 8.18 years and BMI 26.19 ± 2.38, composed of individuals without the disease. The participants underwent respiratory and stomatognathic surface electromyography evaluations, and respiratory muscle strength tests through manovacuometry. The values were subjected to t-student test of independent samples (p<0.05). The respiratory system showed significant alterations (p<0.05) between the DG and CG groups, especially for the diaphragm muscles in the clinical conditions of rest, respiratory cycle, and maximal inspiration with a lower recruitment of muscle fibers, greater muscle activity during maximal expiration, and reduction of respiratory muscle strength. The stomatognathic system indicated greater activity (p<0.05) in the recruitment of the fibers of the masseter in the clinical conditions of rest and protrusion, and in the left laterality to the temporal and right sternocleidomastoid muscles, when comparing the DG and CG groups. It was concluded that alterations in diaphragm muscle activity influence the postural conditions of the mandible due to the restriction of thoracic mobility, causing an increase in the recruitment of muscle fibers related to the stomatognathic system in individuals with COPD.

As transformações demográficas e epidemiológicas do século anterior trouxeram significativas modificações sociodemográficas e de saúde, em todo o mundo, com o aumento de idosos na população. Ao processo de envelhecimento pode estar associado às doenças crônicas não transmissíveis, dentre elas a doença pulmonar obstrutiva crônica (DPOC), um problema de saúde pública, parcialmente reversível, progressivo e incapacitante. Assim, os objetivos do estudo foram caracterizar os idosos com diagnóstico de DPOC nos estádios I a IV, atendidos no Ambulatório de Pneumologia Geral do HCFMRP/USP, segundo as variáveis sociodemográficas, história de tabagismo e condição de saúde; identificar o grau de independência funcional; identificar a presença de sintomas de depressão; analisar a correlação entre o grau de independência funcional, idade, número de morbidades, tempo e grau de DPOC e a associação entre a presença de sintomas de depressão, as variáveis sociodemográficas, o grau de DPOC e as comorbidades. Trata-se de um estudo descritivo, transversal e correlacional. A coleta dos dados ocorreu no período de março a maio de 2010. Utilizou-se um instrumento para caracterização da amostra, a Medida da Independência Funcional (MIF) e a Escala de rastreamento de sintomas depressivos (CES-D). Foram estudados 84 idosos, média de idade 70,4 anos (s=7,3); 61,9% homens; 51,2% casados; 36,9% viúvos; 36,9% sabiam ler e escrever informalmente/analfabetos; 82,8% eram aposentados; 73,2% recebiam um salário mínimo; 54,8% moravam com a família; 75% deixaram de fumar, 20,2% ainda fumavam e 4,8% nunca fumaram; a carga tabágica foi superior para os homens, sendo a diferença significativa (p<000,1); 100% tinham DPOC, 51,2% pressão alta, 39,3% problemas para dormir e 33,3 problemas cardíacos; a média de morbidades foi de 3,4(s=2,4); 41,7% referiram internação nos últimos 12 meses; 34,5% por exacerbação da DPOC e 34,3% por pneumonia. Houve predomínio da DPOC nos estádios III (40,5%) e II (35,7%), verificou-se prevalência de homens (79,5%) no estádio III e de mulheres (56,7%) no II; os homens apresentaram níveis de DPOC mais elevados que as mulheres, sendo a diferença estatisticamente significativa (p=0,05); tempo médio de DPOC foi 8,3 anos (s=6,4). O escore médio da MIF total foi 117,0 pontos; 96,4% com nível de Independência completa/modificada; a correlação de Pearson entre número de morbidade e MIF (total e motora) foi inversa e significativa (p=0,02). A CES-D classificou 71,4% com sintomas de depressão. Houve diferenças significativas entre presença de sintomas de depressão e as variáveis, sexo (p=0,01), estado conjugal (p=0,02) e problemas para dormir (p=0,01). O estudo revelou que a maioria dos idosos apresentava independência completa/modificada e presença de sintomas de depressão. Apesar de não ter encontrado diferenças significativas na correlação entre os escores da MIF e as variáveis, idade, tempo e grau de DPOC, bem como entre a associação de sintomas depressivos com idade, grau de DPOC e comorbidades, os resultados são relevantes para discussões entre os profissionais da área da saúde, uma vez que a identificação correta de fatores que podem influenciar no tratamento, reabilitação e qualidade de vida do idoso com DPOC torna efetiva as praticas assistenciais voltadas para as necessidades dos mesmos. / The demographic and epidemiological transformations of the previous century brought significant sociodemographic and health changes, globally, with an increase of the elderly population. The aging process can be associated to non transmissible chronic diseases, among them the chronic obstructive pulmonary disease (COPD), which is a partially reversible, progressive and debilitating public health problem. Thus, this descriptive, cross-sectional and correlational study aimed to characterize the elderly with diagnosis of COPD at stages I to IV, who receive care at the Outpatient Clinic of General Pneumology of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School (HCFMRP/USP), according to sociodemographic variables, history of smoking and health conditions; to identify the degree of functional independence; to identify the presence of symptoms of depression; to analyze the correlation among the degree of functional independence, age, number of morbidities, time and stage of COPD and the association between the presence of symptoms of depression, the sociodemographic variables, the stage of COPD and the comorbidities. Data collection was carried out between March and May 2010. An instrument was used for the characterization of the sample, as well as the Measure of Functional Independence (MFI) and the Center for Epidemiologic Studies Depression Scale (CES-D). In total, 84 elderly adults were studied, with average age of 70.4 years (sd=7,3); 61.9% men; 51.2% married; 36.9% widower; 36.9% could read and write and were informally illiterate; 82.8% were retired; 73.2% received one minimum wage monthly; 54.8% lived with the family; 75% quit smoking, 20.2% still smoked and 4.8% never smoked; the tobacco load was higher for men, with significant difference (p<0.001); 100% had COPD, 51.2% had high blood pressure, 39.3% problems to sleep and 33.3 heart problems; the average of reported morbidities was 3.4 (sd=2.4); 41.7% reported being hospitalized in the last 12 months; 34.5% for aggravation of COPD and 34.3% pneumonia. There was predominance of COPD at stages III (40.5%) and stage II (35.7%), with prevalence of men (79.5%) at stage III and women (56.7%) at stage II; men presented higher levels of COPD than women, with statistically significant difference (p=0.05); average time of COPD was 8.3 years (sd=6.4). The average score of total MIF was 117.0 points; 96.4% with level of complete/altered independence; Person correlation between number of morbidity and MIF (total and motor) was inverse and significant (p=0.02). CES-D classified 71.4% of the participants with symptoms of depression. There were significant differences between the presence of symptoms of depression and the variables gender (p=0.01), marital status (p=0.02) and problems to sleep (p=0.01). The study revealed that most elderly adults presented complete/altered independence and presence of symptoms of depression. Although there were no significant differences between the correlation of the scores of MIF and the variables age, time and stage of COPD, as well as the association of depressive symptoms with age, stage of COPD and comorbidities, results are relevant for discussions among health professionals, once the correct identification of factors that can influence on the treatment, rehabilitation and quality of life of the elderly with COPD make care practices targeting the needs of the elderly more effective.

Introdução: A doença pulmonar obstrutiva crônica (DPOC) é caracterizada por limitação ao fluxo aéreo, sendo progressiva e contínua, com diagnóstico baseado na avaliação clínica dos sintomas e espirometria. O tabagismo e a exposição à fumaça de biomassa são alguns dos fatores etiológicos para esta doença. Objetivo: Conhecer as diferenças clínicas, funcionais e tomográficas em voluntários com DPOC por exposição ao tabagismo e por exposição ambiental e/ou ocupacional. Material e Método: É um estudo observacional, transversal e analítico de indivíduos com diagnóstico de DPOC realizado no HCFMRP-USP. Todos os participantes foram submetidos à tomografia computadorizada de alta resolução (TCAR), gasometria arterial, espirometria, mensuração da difusão pulmonar de monóxido de carbono, indução de escarro, coleta de sangue venoso e responderam a um instrumento construído, a escala de dispnéia mMRC, escala de gravidade de DPOC CAT e questionário sócio-demográfico. Foi utilizado o teste exato de Fisher para as variáveis qualitativas e foi realizado para as variáveis quantitativas o teste \"t\" de Student para amostras independentes ou teste não paramétrico de Wilcoxon para amostras independentes. Resultados: Para o estudo, foram incluídos 31 pacientes, 16 pacientes do grupo ambiental e/ ou ocupacional e 15 pacientes do grupo tabagista. Foi observado predomínio do sexo feminino em ambos os grupos. No grupo com DPOC ambiental e/ou ocupacional, foi observada maior média de idade (p = 0,00003); menor grau de instrução (p = 0,02); maior frequência de dispneia (p = 0,015); menor SpO2 no final do teste da caminhada de 6 minutos (p = 0,02), menor pO2 corrigida pela idade e SaO2 (p = 0,02, em ambas as variáveis) e no escarro induzido maior número de células (p = 0,04) e no grupo com DPOC por exposição ao tabagismo foi observado maior ocorrência de enfisema (p < 0,025) e no escarro induzido, maior concentração de IL8 (p = 0,04) e IL6 (p = 0,03). Conclusão: A DPOC ambiental e/ou ocupacional difere da DPOC de etiologia tabagista em relação à gasometria (PaO2 e SaO2), mesmo quando os grupos são semelhantes em gravidade da DPOC e também ocorreu maior frequência de dispneia, mostrando maior acometimento deste grupo. Este grupo apresenta um comportamento de paciente com fenótipo de bronquite crônica e nesta doença a hipoxemia é mais grave e inspira maior atenção por parte da equipe multidisciplinar / Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, being progressive and continuous, with a diagnosis based on the clinical evaluation of the symptoms and spirometry. Smoking and exposure to biomass smoke are some of the etiological factors for this disease. Objective: Identify clinical, functional and tomographic differences in volunteers with COPD due to exposure to smoking and environmental and / or occupational exposure. Material and Method: Observational, transversal and analytical study with individuals with COPD diagnosis performed at HCFMRP-USP. All participants underwent high-resolution computed tomography (HRCT), arterial blood gas analysis, spirometry, pulmonary diffusion of carbon monoxide measurement, sputum induction, venous blood collection and responded to a built instrument, mMRC dyspnea scale, severity of COPD CAT and socio-demographic questionnaire. Fisher\'s exact test was used for qualitative variables and Student\'s t-test for independent samples or Wilcoxon\'s non-parametric test for independent samples was performed for the quantitative variables. Results: For the study, 31 patients were included, 16 patients from the environmental and/or occupational group and 15 from the smoking group. Females predominated in both groups. In the group with environmental and/or occupational COPD, a higher mean age (p = 0.00003) was observed; lower level of education (p = 0.02); higher frequency of dyspnea (p = 0.015); lower SpO2 at the end of the 6-minute walk test (p = 0.02), lower age-corrected pO2 and SaO2 (p = 0.02, in both variables) and in sputum induced higher levels of IL8 (p = 0.04), and IL6 (p = 0.03), respectively. The highest incidence of emphysema (p < 0.025) and induced sputum was observed in the group with COPD. Conclusion: Environmental and/or occupational COPD differs from COPD of smoking etiology in relation to arterial blood gas (pO2 and SaO2), even when the groups are similar in severity of COPD, and also a higher frequency of dyspnea occurred, showing a greater involvement of this group. The group presents a behavior of patients with phenotype of chronic bronchitis and in this disease the hypoxemia is more serious and inspires greater attention on the part of the multidisciplinary team