No description available.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. COPD is of particular concern in certain sectors of the country, including Central Appalachia where our clinic is located. Assessing patients with COPD presents many challenges as symptoms range from those considered "typical" such as shortness of breath and sputum production to those less often identified like anxiety and social isolation. We conducted a pilot study comparing physician standard assessment of COPD to patient self-assessment using the COPD Assessment Test (CAT). The CAT is an eight-item questionnaire that measures the impact COPD has on an individual patient’s well-being and daily life. Based on our small sample size, physicians tend to underestimate the impact of COPD on a patient’s daily life. This discrepancy did not differ significantly by year of residency. Potential clinical impact of these findings include the need for more formalized and frequent patient self-assessment of disease burden as well as increased COPD assessment training within the residency curriculum.

No description available.

BACKGROUND: Constipation is highly prevalent in older adults and may be associated with greater frequency of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We investigated the prevalence of lower defecation frequency (DF) and risk factors (including AECOPD) associated with lower DF among hospitalized elderly patients. METHODS: We conducted a retrospective case-control study in a community hospital of Southeast Ohio. Adults aged 65 years or older admitted during 2004 and 2006 were reviewed (N = 1288). Patients were excluded (N = 212) if their length of stay was less than 3 days, discharge diagnosis of Clostridium difficile-associated diarrhea, death or ventilator- dependent respiratory failure during hospitalization. Lower DF was defined as either an average DF of 0.33 or less per day or no defecation in the first three days of hospitalization; cases (N = 406) and controls (N = 670) were included for the final analysis. RESULTS: Approximately 38% had lower DF in this patient population. Fecal soiling/smearing of at least two episodes was documented in 7% of the patients. With the adjustment of confounders, AECOPD (adjusted odds ratio [AOR] =1.47, 95% confidence interval [CI] =1.01-2.13) and muscle relaxant use (AOR =2.94; 95% CI =1.29-6.69) were significantly associated with lower DF. Supplementation of potassium and antibiotic use prior to hospitalization was associated with lower risk of lower DF. CONCLUSIONS: Approximately 38% of hospitalized older adults had lower DF. AECOPD and use of muscle relaxant were significantly associated with lower DF; while supplementation of potassium and antibiotic use were protective for lower DF risk after adjusting for other variables.

Introduction: This dissertation aims to explore, in a clinical setting, the effectiveness of pursed lips breathing (PLB), in the management of dyspnoea in stable COPD. Methodology: A mixed methodology that comprised a randomised controlled trial (RCT), a predominantly qualitative follow-up (FU) study and two measurement studies was used. The RCT intervention group was taught PLB at home over 8 weeks. Primary outcome measures were the Self Report Chronic Respiratory Disease Questionnaire (CRQ-SR) dyspnoea and mastery domains and Endurance Shuttle Walk Test (ESWT). The FU study investigated the long-term experience of PLB in a subset of RCT participants through telephone interview, focus group and observation of PLB technique at home visit. Prior to the RCT a study using limits of agreement (LoA) methodology was conducted to investigate reliability of hand-held spirometric measurement of inspiratory capacity (IC) with a view to using it as an outcome measure. Following the RCT a retrospective analysis of data collected from the ESWT was performed comparing a 1-walk protocol with the published 2-walk protocol. Results: Forty-one patients with COPD were recruited to the RCT (PLB n = 22, control n =19); mean age 68 years (SD 11), mean FEV1% predicted 47% (SD 15.80) and 13 were approached to participate in the FU; 11 of 13 agreed to telephone interview, 5 to attend the focus group and 6 to home visit. The median time since learning PLB was 17 months (6 - 23). The RCT found no statistically significant difference between groups in the primary outcome measures and in retrospect was insufficiently powered. Post hoc analysis found effect sizes for primary outcome measures were: CRQ-SR dyspnoea 0.05, CRQ-SR mastery 0.48 and ESWT 0.44. For secondary outcome measures the PLB group showed a significant (p = 0.02) improvement in oxygen saturation on ESWT. Long-term follow-up found 9 of 11 still used PLB, 8 reported definite benefit. Those using PLB used it for breathlessness with four themes identified: use of PLB with physical activity (8/11), to increase confidence and reduce panic (4/11), as an exercise (3/11), at night (3/11). Discontinuation of PLB (2/11) was due to no benefit. Hand-held spirometric measurement of IC found LoA for same-day IC measurement in healthy volunteers (n = 20) ± 0.630L (95%CI ± 0.255) and over 3 weeks (n = 11) ± 0.560L (95%CI ± 0.326). In COPD, same day LoA (n = 26) were ± 0.582L (95%CI ± 0.169) and over 6 weeks (n = 8) ± 0.486L (95%CI ± 0.302). Retrospective analysis of ESWT data identified that completion rates improved by 17% for the 1-walk protocol but that the ceiling-effect was 12.2% compared to 7.3% for the 2-walk protocol. LoA between protocols when measuring change over time (n = 31) was ±80% (95%CI 25.56); less than the difference described as "somewhat better" (113%) following pulmonary rehabilitation (PR) but greater than the m.c.i.d. of 68%. Conclusions: LoA for IC exceeded the clinically significant reported 0.3L; the protocol tested here was not sufficiently reliable for use as an outcome measure. Analysis of ESWT data showed the 1-walk protocol was adequate for identify change in clinical practice but, for research purposes the 2-walk protocol should be retained. From the RCT learning PLB resulted in reduced physiological stress with respect to oxygen desaturation when performing ESWT compared to the control group. Long-term follow-up showed that, in severe COPD perceived benefits persisted in 62% of patients.

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...

Introdução: A doença pulmonar obstrutiva crônica (DPOC) é uma doença muito prevalente nos indivíduos acima de 40 anos. É uma doença com grande impacto social e econômico, podendo levar a um declínio na qualidade de vida de seus portadores. Objetivos: Avaliar as características da DPOC, a frequência do subdiagnóstico e a influência da doença sobre a qualidade de vida em um centro de convivência da comunidade. Casuística e Método: É um estudo observacional, transversal e analítico realizado na cidade de Uberaba MG. Todos os participantes responderam questionários sobre as características demográficas, socioeconômicas, de trabalho, da qualidade de vida e do estado de saúde. Foram realizadas também a avaliação antropométrica e a espirometria. Foi utilizado o teste t de Student não pareado e bicaudal para a comparação de médias de variáveis quantitativas entre dois grupos independentes: grupo DPOC e grupo sem DPOC (na 1ª parte da análise); e grupo DPOC com diagnóstico prévio e grupo com DPOC sem diagnóstico (na 2ª parte da análise). A comparação das proporções das variáveis qualitativas entre dois grupos independentes foi realizada com o Teste Qui Quadrado. Regressão logística e regressão logística múltipla foram utilizadas para identificar associações entre as variáveis qualitativas independentes e a variável qualitativa dependente (ter diagnóstico prévio de DPOC). Regressão linear simples e a múltipla foram utilizadas para identificar variáveis independentes que pudessem proporcionar mudanças significativas (explicativas) na variável resposta (escore total e escores dos domínios do questionário WHOQOL-bref). Resultados: 315 indivíduos com idade acima de 50 anos foram recrutados e 298 completaram o estudo, sendo 72 (24,2%) portadores de DPOC e, desses, 58 (80,6%) não relataram diagnóstico prévio da doença. Quando realizada a 1ª parte da análise (grupo com DPOC e sem DPOC) foi observado predomínio do gênero masculino (p 0,001), média de idade superior (p 0,001), menor aderência à atividade física nas dependências do centro de convivência (p 0,01) e maior prevalência de tabagismo (p 0,001) no grupo com DPOC. Quando comparados os domínios da qualidade de vida entre os grupos, 8 nossos resultados mostram comprometimento do domínio físico no grupo com DPOC (p 0,05). O domínio físico da qualidade de vida foi influenciado positivamente pelo gênero masculino (coef. = 1,319 e IC = 0,394; 2,243), e negativamente pela DPOC (coef. = -1,118 e IC = -2,002; -0,234) e pela inatividade por problemas de saúde (coef. = -1,983 e IC = -2,918; -0,868). Na 2ª parte da análise (grupo DPOC com diagnóstico prévio e grupo DPOC sem diagnóstico) foi observado que não houve associação entre as características socioeconômicas, antropométricas e fatores de risco com diagnóstico prévio da doença. Em relação aos sintomas, houve associação entre sibilos e diagnóstico prévio (p 0,05). Os valores espirométricos VEF1 e VEF1/CVF mostraram diferenças estatisticamente significantes (p<0,01) entre os grupos, sendo menores no grupo com diagnóstico prévio da doença. O estadiamento 2 da doença foi o mais encontrado em ambos os grupos e ocorreu associação entre os estadiamentos 3/4 (grave/muito grave) e diagnóstico prévio (p 0,05). Conclusões: A utilização da espirometria em usuários de centros de convivência pode ser uma estratégia simples e útil para aumentar o número de diagnósticos de DPOC. Como resultado, medidas efetivas para o tratamento e controle da doença poderiam ser implantadas diminuindo o impacto da doença avançada, melhorando a qualidade de vida do doente e de seus familiares. / Introduction: The chronic obstructive pulmonary disease (COPD) is a highly prevalent disease in individuals aged over 40 years. It is a disease with great social and economic impact that may lead to a decline in the quality of life of its patients. Objectives: To evaluate the characteristics of COPD, the frequency of underdiagnosis and the influence of the disease on the quality of life in a community center. Method: It is an observational, analytical and cross-sectional study conducted in the city of Uberaba-MG. All participants answered questionnaires on demographic, socioeconomic and labor characteristics, quality of life and health status. The anthropometric evaluation and the spirometry were also carried out. We used the unpaired two-tailed Student t-test to compare means of quantitative variables between two independent groups: COPD group and the group without COPD (in the first part of the analysis); COPD group previously diagnosed and group with COPD undiagnosed (in the second part of the analysis). To compare the proportions of the qualitative variables between two independent groups, we used the Chi-Square Test. Logistic regression and multiple logistic regression were used to identify associations between the independent qualitative variables and the dependent qualitative variable (having a previous diagnosis of COPD). Simple logistic regression and multiple analyses were carried out to identify independent variables that could provide significant changes (explanatory) in the response variable (total score and scores of the domains of the WHOQOL-BREF questionnaire). Results: 315 individuals aged 50 years or older were recruited and 298 completed the protocol, 72 (24.2%) patients with COPD and, of those, 58 (80.6%) had no previous diagnosis of the disease. When the first part of the analysis was performed, (COPD group and the group without COPD), we observed a predominance of males (p 0,001), higher mean age (p 0.001), lower adherence to physical activity in the premises of the community center (p 0.01) and a higher prevalence of tobacco smoking (p 0.001) in the group of patients with COPD. When comparing the domains of quality of life between groups, our results show a worse score of the 10 physical domain in the group of patients with COPD (p 0.05). The physical domain of quality of life was positively influenced by males (coef. = 1.319 and CI = 0.394; 2.243) and negatively by COPD (coef. = -1.118 and CI = -2.002; -0.234) and by inactivity by health problems (coef. = -1.983 and CI = -2.918; -0.868). In the second part of the analysis, (COPD group previously diagnosed and group with COPD undiagnosed), it was observed that there was no association between socioeconomic and anthropometric characteristics and risk factors with a previous diagnosis of the disease. Regarding symptoms, there was an association between wheezing and previous diagnosis (p 0.05). Spirometric values FEV1 and FEV1/FVC showed statistically significant differences (p 0.01) between groups, being lower in the group with a previous diagnosis of the disease. Stage 2 COPD was the most common severity level in both groups. We found association of stage 3/4 severe COPD with a previous diagnosis (p 0.05). Conclusions: The use of spirometry in users of community centers can be a simple and useful strategy to increase the number of diagnoses of COPD. As a result, effective measures for treatment and control of the disease could be implanted, reducing the impact of advanced disease, improving the quality of life of the patients and their relatives.

Introdução: A doença pulmonar obstrutiva crônica (DPOC) é uma doença muito prevalente nos indivíduos acima de 40 anos. É uma doença com grande impacto social e econômico, podendo levar a um declínio na qualidade de vida de seus portadores. Objetivos: Avaliar as características da DPOC, a frequência do subdiagnóstico e a influência da doença sobre a qualidade de vida em um centro de convivência da comunidade. Casuística e Método: É um estudo observacional, transversal e analítico realizado na cidade de Uberaba MG. Todos os participantes responderam questionários sobre as características demográficas, socioeconômicas, de trabalho, da qualidade de vida e do estado de saúde. Foram realizadas também a avaliação antropométrica e a espirometria. Foi utilizado o teste t de Student não pareado e bicaudal para a comparação de médias de variáveis quantitativas entre dois grupos independentes: grupo DPOC e grupo sem DPOC (na 1ª parte da análise); e grupo DPOC com diagnóstico prévio e grupo com DPOC sem diagnóstico (na 2ª parte da análise). A comparação das proporções das variáveis qualitativas entre dois grupos independentes foi realizada com o Teste Qui Quadrado. Regressão logística e regressão logística múltipla foram utilizadas para identificar associações entre as variáveis qualitativas independentes e a variável qualitativa dependente (ter diagnóstico prévio de DPOC). Regressão linear simples e a múltipla foram utilizadas para identificar variáveis independentes que pudessem proporcionar mudanças significativas (explicativas) na variável resposta (escore total e escores dos domínios do questionário WHOQOL-bref). Resultados: 315 indivíduos com idade acima de 50 anos foram recrutados e 298 completaram o estudo, sendo 72 (24,2%) portadores de DPOC e, desses, 58 (80,6%) não relataram diagnóstico prévio da doença. Quando realizada a 1ª parte da análise (grupo com DPOC e sem DPOC) foi observado predomínio do gênero masculino (p 0,001), média de idade superior (p 0,001), menor aderência à atividade física nas dependências do centro de convivência (p 0,01) e maior prevalência de tabagismo (p 0,001) no grupo com DPOC. Quando comparados os domínios da qualidade de vida entre os grupos, 8 nossos resultados mostram comprometimento do domínio físico no grupo com DPOC (p 0,05). O domínio físico da qualidade de vida foi influenciado positivamente pelo gênero masculino (coef. = 1,319 e IC = 0,394; 2,243), e negativamente pela DPOC (coef. = -1,118 e IC = -2,002; -0,234) e pela inatividade por problemas de saúde (coef. = -1,983 e IC = -2,918; -0,868). Na 2ª parte da análise (grupo DPOC com diagnóstico prévio e grupo DPOC sem diagnóstico) foi observado que não houve associação entre as características socioeconômicas, antropométricas e fatores de risco com diagnóstico prévio da doença. Em relação aos sintomas, houve associação entre sibilos e diagnóstico prévio (p 0,05). Os valores espirométricos VEF1 e VEF1/CVF mostraram diferenças estatisticamente significantes (p<0,01) entre os grupos, sendo menores no grupo com diagnóstico prévio da doença. O estadiamento 2 da doença foi o mais encontrado em ambos os grupos e ocorreu associação entre os estadiamentos 3/4 (grave/muito grave) e diagnóstico prévio (p 0,05). Conclusões: A utilização da espirometria em usuários de centros de convivência pode ser uma estratégia simples e útil para aumentar o número de diagnósticos de DPOC. Como resultado, medidas efetivas para o tratamento e controle da doença poderiam ser implantadas diminuindo o impacto da doença avançada, melhorando a qualidade de vida do doente e de seus familiares. / Introduction: The chronic obstructive pulmonary disease (COPD) is a highly prevalent disease in individuals aged over 40 years. It is a disease with great social and economic impact that may lead to a decline in the quality of life of its patients. Objectives: To evaluate the characteristics of COPD, the frequency of underdiagnosis and the influence of the disease on the quality of life in a community center. Method: It is an observational, analytical and cross-sectional study conducted in the city of Uberaba-MG. All participants answered questionnaires on demographic, socioeconomic and labor characteristics, quality of life and health status. The anthropometric evaluation and the spirometry were also carried out. We used the unpaired two-tailed Student t-test to compare means of quantitative variables between two independent groups: COPD group and the group without COPD (in the first part of the analysis); COPD group previously diagnosed and group with COPD undiagnosed (in the second part of the analysis). To compare the proportions of the qualitative variables between two independent groups, we used the Chi-Square Test. Logistic regression and multiple logistic regression were used to identify associations between the independent qualitative variables and the dependent qualitative variable (having a previous diagnosis of COPD). Simple logistic regression and multiple analyses were carried out to identify independent variables that could provide significant changes (explanatory) in the response variable (total score and scores of the domains of the WHOQOL-BREF questionnaire). Results: 315 individuals aged 50 years or older were recruited and 298 completed the protocol, 72 (24.2%) patients with COPD and, of those, 58 (80.6%) had no previous diagnosis of the disease. When the first part of the analysis was performed, (COPD group and the group without COPD), we observed a predominance of males (p 0,001), higher mean age (p 0.001), lower adherence to physical activity in the premises of the community center (p 0.01) and a higher prevalence of tobacco smoking (p 0.001) in the group of patients with COPD. When comparing the domains of quality of life between groups, our results show a worse score of the 10 physical domain in the group of patients with COPD (p 0.05). The physical domain of quality of life was positively influenced by males (coef. = 1.319 and CI = 0.394; 2.243) and negatively by COPD (coef. = -1.118 and CI = -2.002; -0.234) and by inactivity by health problems (coef. = -1.983 and CI = -2.918; -0.868). In the second part of the analysis, (COPD group previously diagnosed and group with COPD undiagnosed), it was observed that there was no association between socioeconomic and anthropometric characteristics and risk factors with a previous diagnosis of the disease. Regarding symptoms, there was an association between wheezing and previous diagnosis (p 0.05). Spirometric values FEV1 and FEV1/FVC showed statistically significant differences (p 0.01) between groups, being lower in the group with a previous diagnosis of the disease. Stage 2 COPD was the most common severity level in both groups. We found association of stage 3/4 severe COPD with a previous diagnosis (p 0.05). Conclusions: The use of spirometry in users of community centers can be a simple and useful strategy to increase the number of diagnoses of COPD. As a result, effective measures for treatment and control of the disease could be implanted, reducing the impact of advanced disease, improving the quality of life of the patients and their relatives.

Il existe plusieurs types d’agressions environnementales : biologiques (virus, bactéries…), chimiques (gaz, fumées, métaux…), physiques (bruits, rayonnements…), et d’autres telles que le stress par exemple. L’appareil respiratoire, qui représente une interface majeure avec l’environnement, est particulièrement vulnérable vis-à-vis de ces agressions, qui ont souvent des conséquences pulmonaires, pouvant parfois conduire au décès. Le tabac notamment est la cause de près de 100 millions de décès au cours du XXème siècle d’après l’Organisation Mondiale de la Santé (OMS), et sera la cause d’environ un milliard de décès au prochain siècle. L’exposition à la fumée de cigarette engendre une inflammation chronique et est souvent corrélée au développement de cancers (1), mais induit aussi de nombreuses autres pathologies pulmonaires telles que la broncho-pneumopathie chronique obstructive (BPCO) / There are several types of environmental attacks: biological (viruses, bacteria …), chemical (gases, smokes, metals …), physical appearances (rumours, brilliances …), and others such as the stress for example. The respiratory system, which represents a major interface with the environment, is particularly vulnerable towards these attacks, which often have lung consequences, being able to sometimes lead to the death. The tobacco in particular is the cause of about 100 million deaths during the XXth century according to the World Health Organization (WHO), and will be the cause about a billion deaths in the next century. The exhibition in the smoke of cigarette engenders a chronic inflammation and is often correlated in the development of cancers (1), but also leads of numerous

Orientador: Suzana Erico Tanni Minamoto / Resumo: Introdução: A exacerbação aguda é uma importante causa de perda de função em pacientes com doença pulmonar obstrutiva crônica (DPOC). Afeta negativamente a qualidade de vida, a função pulmonar, a fraqueza muscular, o uso de recursos de saúde e a sobrevivência. Acredita-se que o exercício físico realizado durante a exacerbação pode melhorar a qualidade de vida e a capacidade física do paciente sem aumento do processo inflamatório. Objetivo: Avaliar a influência do exercício físico aeróbico de curta duração durante a internação em marcadores inflamatórios, qualidade de vida e capacidade física, além de re-hospitalização e taxas de mortalidade seis meses após a alta hospitalar em pacientes com DPOC exacerbada. Pacientes e Métodos: 26 pacientes foram avaliados 24 horas após a hospitalização por características demográficas, história de tabagismo, índice de Charlson, qualidade de vida, marcadores inflamatórios sistêmicos e composição corporal. Após 48 horas de internação, todos os pacientes realizaram o teste de caminhada de 6 minutos e um novo teste de espirometria, sendo calculado o índice BODE. Após 72 horas de internação, os pacientes do grupo de intervenção foram submetidos a exercícios aeróbicos em esteira por 15 minutos, duas vezes ao dia. Por fim, um mês após a alta hospitalar, todos os pacientes foram reavaliados segundo a qualidade de vida, marcadores inflamatórios sistêmicos, composição corporal, espirometria, teste de caminhada de 6 minutos e índice BODE. Resultados: O... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Acute exacerbation is an important cause of loss of function in patients suffering from chronic obstructive pulmonary disease (COPD). It negatively affects the quality of life, lung function, muscle weakness, use of health resources and survival. It is believed that the physical exercise performed during the exacerbation can improve the quality of life and the physical capacity of the patient without an increase in the inflammatory process. Objective: To evaluate the influence of short-term aerobic physical exercise during hospitalization on inflammatory markers, quality of life and physical capacity, as well re-hospitalization and mortality rates six months after hospital discharge in patients with exacerbated COPD. Patients and Methods: 26 patients were evaluated 24 hours after hospitalization for demographic characteristics, smoking history, Charlson index, quality of life, systemic inflammatory markers and body composition. After 48 hours hospitalization, all patients performed a 6-minute walk test and a new spirometry test, and BODE index was calculated. After 72 hours of hospitalization, patients in the intervention group underwent aerobic exercise on a treadmill for 15 minutes twice daily. Finally, a month after hospital discharge, all patients were re-evaluated according to quality of life, systemic inflammatory markers, body composition, spirometry, 6-minute walk test and BODE index. Results: Patients in the intervention and control group did not differ... (Complete abstract click electronic access below) / Doutor