Anelise Dumke

Osteoporosis Prevalence and Associated Factors in Patients With COPD: A Cross-Sectional Study

BACKGROUND: Osteoporosis is one of the systemic features of COPD. OBJECTIVE: To determine the prevalence of osteoporosis in a sample of COPD out-patients, and investigate the correlation between T-score (a comparison of the patients bone mineral density to that of a healthy 30-year-old of the same sex and ethnicity) and several factors suggested to be associated with osteoporosis. METHODS: In a cross-sectional study, we conducted dual-energy X-ray absorptiometry bone mineral density scans of the hips and lumbar spine, and collected data on smoking and alcohol habits, menopausal status, comorbidities, inhaled and oral corticosteroid dose and duration of treatment, previous bone fractures, pulmonary function tests, calcium intake (via questionnaire on food frequency), vitamin D intake (via questionnaire on sunlight exposure), and physical activity (via the International Physical Activity Questionnaire). RESULTS: We evaluated 95 patients. Forty (42%) were osteoporotic, 40 (42%) were osteopenic, and 15 (16%) had normal bone mass. We found significant bivariate correlations between femoral-neck T-score and body mass index (r = 0.551, P < .001), and femoral-neck T-score and International Physical Activity Questionnaire total activity score (r = 0.378, P < .001). There was a significant inverse relationship between femoral-neck T-score and BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) index (r = −0.246, P = .02). We also found significant correlations between T-score and FEV1 (r = 0.251, P = .01), forced vital capacity (r = 0.229, P = .03), percent-of-predicted functional residual capacity (r = −0.415, P < .001), inspiratory capacity (r = 0.252, P = .01), ratio of inspiratory capacity to total lung capacity (r = 0.241, P = .02), and absolute and percent-of-predicted diffusing capacity of the lung for carbon monoxide (r = 0.366, P < .001, and r = 0.338, P = .003, respectively). CONCLUSIONS: We identified a high prevalence of osteoporosis and osteopenia in out-patients with COPD. Patients with osteoporosis had more severe COPD than patients with normal bone mass.

Can the single-breath helium dilution method predict lung volumes as measured by whole-body plethysmography?

OBJECTIVE: To compare TLC and RV values obtained by the single-breath helium dilution (SBHD) method with those obtained by whole-body plethysmography (WBP) in patients with normal lung function, patients with obstructive lung disease (OLD), and patients with restrictive lung disease (RLD), varying in severity, and to devise equations to estimate the SBHD results. METHODS: This was a retrospective cross-sectional study involving 169 individuals, of whom 93 and 49 presented with OLD and RLD, respectively, the remaining 27 having normal lung function. All patients underwent spirometry and lung volume measurement by both methods. RESULTS: TLC and RV were higher by WBP than by SBHD. The discrepancy between the methods was more pronounced in the OLD group, correlating with the severity of airflow obstruction. In the OLD group, the correlation coefficient of the comparison between the two methods was 0.57 and 0.56 for TLC and RV, respectively (p < 0.001 for both). We used regression equations, adjusted for the groups studied, in order to predict the WBP values of TLC and RV, using the corresponding SBHD values. It was possible to create regression equations to predict differences in TLC and RV between the two methods only for the OLD group. The TLC and RV equations were, respectively, ∆TLCWBP-SBHD in L = 5.264 − 0.060 × FEV1/FVC (r2 = 0.33; adjusted r2 = 0.32) and ∆RVWBP-SBHD in L = 4.862 − 0.055 × FEV1/FVC (r2 = 0.31; adjusted r2 = 0.30). CONCLUSIONS: The correction of TLC and RV results obtained by SBHD can improve the accuracy of this method for assessing lung volumes in patients with OLD. However, additional studies are needed in order to validate these equations.

ESTUDO DO GRAU DE DISPNEIA NAS ATIVIDADES DE VIDA DIÁRIA E A UTILIZAÇÃO DE TÉCNICAS DE CONSERVAÇÃO DE ENERGIA NOS PORTADORES DA DOENÇA PULMONAR OBSTRUTIVA CRÔNICA

Aspectos como ansiedade, depressao, dispneia, intolerância ao exercicio fisico, estado nutricional, frequencia de tosse e gravidade da patologia sao fatores que predispoem uma piora na qualidade de vida do paciente. Os portadores de DPOC relatam um cansaco desproporcional ao realizarem atividades de vida diaria, desenvolvendo padrao respiratorio irregular, superficial e rapido durante a realizacao das atividades. Objetivos: analisar o grau de dispneia nas atividades de vida diaria com e sem a utilizacao de tecnicas de conservacao de energia nos portadores de DPOC de grau leve a grave. Metodos: os pacientes foram avaliados em cinco atividades de vida diaria sem e com utilizacao de tecnicas de conservacao de energia (TCE). Participam 12 individuos (66, 42 ± 9,71 anos), com diagnostico de DPOC leve a grave (VEF1% 56,7 ± 21,07). Resultados: as TCE proporcionaram resposta significativa (p<0,05) para variaveis de FR em escovar os dentes (0,020), pentear os cabelos (0,032), guardar utensilios (0,053). Na SpO2% pentear os cabelos (p 0,009), subir escadas (p 0,012) e guardar utensilios (p 0,005) foram significativas. Nao ocorreram alteracoes na atividade de amarrar os calcados (p 0,131). Conclusao: a utilizacao das TCE reduziu a sensacao de dispneia durante as atividades de vida diaria nos portadores de DPOC.