Krislainy de Sousa Corrêa

Can the Glittre ADL test differentiate the functional capacity of COPD patients from that of healthy subjects

BACKGROUND The Glittre ADL (TGlittre) test is a specifically designed to assess functional limitation in chronic obstructive pulmonary disease (COPD) patients. However, it is not known if it can differentiate the performance of these patients from healthy subjects. OBJECTIVES To investigate whether the Glittre ADL test is able to differentiate the functional capacity of COPD patients from that of healthy subjects and to compare the cardiorespiratory response between Glittre ADL and the six-minute walk test (6MWT). METHODS The study included 10 patients with COPD (GOLD 2 to 4) and 10 healthy subjects matched by age who performed the following: spirometry pre- and post-bronchodilator, a Glittre ADL test and two 6MWT on two consecutive days. RESULTS The performance of COPD (FEV1%pred= 38.1±11.8, age=64±10 years, BMI=23.7±5.2 kg/ m²) was worse than the control group on TGlittre (5.26±2.9 min, 3.3±0.3 min, p<0.05) and 6MWT (434.97±105.18 m vs. 593.25±87.36 m, p<0.05). TGlittre correlated with the physical activity domain of the London Chest Activity of Daily Living (LCADL) scale (r=0.67, p<0.05) and with 6MWT when the total sample was analyzed (r=-0.64, p<0.05). The COPD group had a statistically higher (p<0.05) increase in dyspnea (Borg scale) than the control group for both TGlittre and 6MWT, with a similar heart rate and peripheral oxygen saturation variation in both groups (p>0.05). CONCLUSIONS The performance of COPD patients is worse than that of healthy subjects on the Glittre ADL test, with a greater increase in dyspnea and similar heart rates.

Relação entre a limitação nas atividades de vida diária (AVD) e o índice BODE em pacientes com doença pulmonar obstrutiva crônica

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that reduces functional capacity, deteriorating the ability to perform activities of daily living (ADL). A close relationship between morbidity and mortality with functional limitation is observed in patients with COPD. OBJECTIVES: To determine if there is a relationship between ADL limitation and the BODE index, which is a predictor of mortality, in patients with moderate to severe COPD. METHODS: Thirty-nine patients with COPD GOLD 2 to 4 recruited by convenience, were submitted to the following tests: spirometry, body mass index (BMI), the London Chest Activity of Daily Living (LCADL) scale, six-minute walking test (6MWT), the Medical Research Council (MRC) scale and the BODE index was calculated. The total score and the percentage of the total score LCADL (LCADL%total) were compared between patients of the four quartiles of the BODE using the Analysis of Variance test. The Spearman correlation coefficient was used to investigate the association between scores of LCADL and BODE index. RESULTS: Patients had an average of FEV1%pred=37±12% and were on average 66±8 years-old. The LCADL%total correlated with the BODE index (r=0.65, p<0.05) as well as with the variables FEV1, dyspnea and walked distance in the 6MWT (r=-0.42, r=0.76 and r=-0.67, p<0.05, respectively). The comparison of the average scores of the LCADL%total between BODE quartiles 1, 2, 3 and 4, demonstrated that only the 4th quartile differed significantly from the others (p<0.05). CONCLUSIONS: ADL limitation has a strong association with the BODE index in patients with moderate to severe COPD and with three of the four variables that composes it.

Interleukin-6 and interleukin-8 blood levels’ poor association with the severity and clinical profile of ex-smokers with COPD

Background The role of interleukins in the severity and clinical profile of chronic obstructive pulmonary disease (COPD) is not known, but evidence supports the contribution of systemic inflammation to disease pathophysiology. This study evaluated the relationship of serum biomarkers to the severity and clinical parameters of COPD. Methods and findings Serum levels of high-sensitivity C-reactive protein, interleukin-6 (IL-6), and interleukin-8 (IL-8) were measured in 50 patients with stable COPD and in 16 controls. The levels of these biomarkers were compared with parameters of severity, such as the grading of flow obstruction using the recommendations of the Global initiative for chronic Obstructive Lung Disease, the BMI (body mass index), obstruction, dyspnea, exercise capacity (health index) index, the number of exacerbations within the last year, and peripheral oxygen saturation after the six-minute walk test, and with clinical parameters, such as bronchitis and non-bronchitis phenotypes, the number of associated comorbidities, and the smoking burden. COPD patients exhibited higher levels of IL-6 and IL-8 compared to the control group. Higher levels of IL-6 occurred in COPD groups with body mass index <21 kg/m2, with more than two exacerbations in the past year, with a higher smoking burden, and with bronchitis. The increase in serum IL-8 was found only in the group with the highest number of exacerbations within the previous year. Conclusion Increased IL-6 was mainly associated with smoking burden, in patients who had smoked for more than 30 pack-years and exhibited a bronchitis phenotype. No direct association was observed for both IL-6 and IL-8 blood levels with the severity of COPD in ex-smokers.

Perfil epidemiológico, clínico e terapêutico da insuficiência cardíaca em hospital terciário

FUNDAMENTO: A insuficiencia cardiaca e uma sindrome complexa com multiplos fatores de risco envolvidos em sua genese, tornando dificil a prevencao e o manejo. OBJETIVO: Identificar as principais etiologias e os fatores de risco na insuficiencia cardiaca; comparar caracteristicas clinicas e demograficas dos pacientes conforme a etiologia; analisar se o tratamento utilizado esta de acordo com o preconizado pelas diretrizes brasileiras. METODOS: Estudo retrospectivo, descritivo e observacional realizado no Hospital das Clinicas da Universidade Federal de Goias. Os pacientes foram reunidos em quatro grupos, conforme etiologia, para comparacao: cardiomiopatia chagasica, cardiomiopatia hipertensiva, cardiomiopatia dilatada e outras e cardiomiopatia isquemica. Os testes de Qui-quadrado e Exato de Fisher, a ANOVA e o teste de Kruskal-Wallis foram utilizados na analise dos grupos e das formas de tratamento. RESULTADOS: Foram analisados 144 prontuarios de pacientes, com media de idade 61 ± 15 anos, sendo 54,2% do sexo masculino. A cardiomiopatia chagasica destacou-se como principal etiologia (41%). Hipertensao arterial (48,6%), anemia (22,9%), doenca coronariana (19,4%), dislipidemia (17,3%) e diabete (16,6%) foram os principais fatores de risco. Os hipertensos apresentaram prevalencia maior do sexo feminino (p=0,044) e maior frequencia de estertores pulmonares (p<0,01). A frequencia cardiaca foi menor nos chagasicos (p<0,001). Os medicamentos prescritos foram diureticos (81,2%), inibidores da enzima conversora da angiotensina ou bloqueadores dos receptores da angiotensina (77,7%), betabloqueadores (45,8%), espironolactona (35,4%), digitalicos (30,5%) e vasodilatadores (8,3%). CONCLUSAO: A cardiomiopatia chagasica foi a principal causa de insuficiencia cardiaca. Nao se observou diferencas clinicas entre pacientes dos quatro grupos etiologicos.

Chester step test: assessment of functional capacity and magnitude of cardiorespiratory response in patients with COPD and healthy subjects

BACKGROUND the assessment of functional capacity in patients with chronic obstructive pulmonary disease (COPD) has been performed by simple and easy to apply methods that mimic everyday activities, such as the Chester step test (TChester). OBJECTIVES to investigate whether TChester is able to differentiate functional capacity and the magnitude of cardiorespiratory response of patients with COPD from healthy subjects; and to compare it with the cardiorespiratory response induced by shuttle test (TShuttle) and six-minute walk test (6MWT). METHOD 10 patients with COPD (64±10 years, and forced expiratory volume at the first second - FEV1 38.1±11.8% predicted) and 10 healthy subjects (63±7 years, and FEV1 of 95.8±18.0% predicted) underwent evaluation of pulmonary function, functional status and capacity (6MWT, TShuttle and TChester). RESULTS COPD patients had worst performance in all tests, when compared to healthy subjects (TChester 2,1±0,9 vs. 4,1±1,1 completed levels; TC6min: 435±105,1 vs. 593±87,3 m; TShuttle 251±84,6 vs. 436±55,4 m; p<0.05). TChester correlated with TShuttle and 6MWT (r =0.67 and 0.83, respectively, p<0.05). There were no differences in heart rate and dyspnea in TChester levels between groups (p>0.05). SpO2 was lower in COPD patients since the first TChester level (p<0.05). CONCLUSION TChester is valid in the assessment of functional capacity of COPD patients, being able to distinguish them from healthy subjects, inducing similar cardiovascular demand and greater desaturation in COPD patients.

Aplicabilidade de testes de atividades de vida diária em indivíduos com insuficiência cardíaca

Limitation in activities of daily living (ADL) caused by dyspnea is a common finding in patients with heart failure (HF), functional class III and IV. Specific assessment of ADL limitation could be used as a parameter of the disease progression and the therapy response. However, there is a shortage of instruments to assess ADL in this population. This study aimed to determine the applicability of the London Chest Activity of Daily Living (LCADL) and the Glittre ADL-test (TGlittre), to evaluate functional limitations of individuals with HF functional class III and IV. Ten patients (57±9 years, 27.5±4.5kg/m2) of both genders with a clinical diagnosis of HF functional class III and IV and left ventricle ejection fraction (LVEF) 34±7% participated in the study. Spirometry, body mass index (BMI), LCADL, six-minute walking test (6MWT), TGlittre, Medical Research Council Scale (MRC) and SF-36 were performed. The patients had an average score of the LCADLtotal from 27.7±12.1 (LCADL%total: 41.5±16.9) and time of TGlittre 6.3±4.8 minutes. A positive correlation was found between them (r = 0.88, p<0.05). LCADL%total correlated with 6MWT (r =-0.83), LVEF (r =-0.64), MRC (r =0.68) and Functional Capacity (FC) of the SF-36 (r =-0.63) (p<0.05). TGlittre correlated with 6MWT (r =-0.90), LVEF (r =-0.66) and CF of the SF-36 (r =-0.69) (p<0.05). In conclusion, the LCADL scale and TGlittre have applicability in patients with HF class III and IV, demonstrating association with LVEF, distance on the 6MWT, degree of dyspnea and quality of life.

Epidemiological, clinical e therapeutic profile of heart failure in a tertiary hospital

FUNDAMENTO: A insuficiencia cardiaca e uma sindrome complexa com multiplos fatores de risco envolvidos em sua genese, tornando dificil a prevencao e o manejo. OBJETIVO: Identificar as principais etiologias e os fatores de risco na insuficiencia cardiaca; comparar caracteristicas clinicas e demograficas dos pacientes conforme a etiologia; analisar se o tratamento utilizado esta de acordo com o preconizado pelas diretrizes brasileiras. METODOS: Estudo retrospectivo, descritivo e observacional realizado no Hospital das Clinicas da Universidade Federal de Goias. Os pacientes foram reunidos em quatro grupos, conforme etiologia, para comparacao: cardiomiopatia chagasica, cardiomiopatia hipertensiva, cardiomiopatia dilatada e outras e cardiomiopatia isquemica. Os testes de Qui-quadrado e Exato de Fisher, a ANOVA e o teste de Kruskal-Wallis foram utilizados na analise dos grupos e das formas de tratamento. RESULTADOS: Foram analisados 144 prontuarios de pacientes, com media de idade 61 ± 15 anos, sendo 54,2% do sexo masculino. A cardiomiopatia chagasica destacou-se como principal etiologia (41%). Hipertensao arterial (48,6%), anemia (22,9%), doenca coronariana (19,4%), dislipidemia (17,3%) e diabete (16,6%) foram os principais fatores de risco. Os hipertensos apresentaram prevalencia maior do sexo feminino (p=0,044) e maior frequencia de estertores pulmonares (p<0,01). A frequencia cardiaca foi menor nos chagasicos (p<0,001). Os medicamentos prescritos foram diureticos (81,2%), inibidores da enzima conversora da angiotensina ou bloqueadores dos receptores da angiotensina (77,7%), betabloqueadores (45,8%), espironolactona (35,4%), digitalicos (30,5%) e vasodilatadores (8,3%). CONCLUSAO: A cardiomiopatia chagasica foi a principal causa de insuficiencia cardiaca. Nao se observou diferencas clinicas entre pacientes dos quatro grupos etiologicos.

COPD Assessment Test (CAT) score as a predictor of major depression among subjects with chronic obstructive pulmonary disease and mild hypoxemia: a case–control study

BackgroundDepression is a common comorbidity among patients with Chronic Obstructive Pulmonary Disease (COPD) and has a significant impact on the course of the disease. The aim of this study is to determine association between COPD Assessment Test (CAT) and major depression among clinically stable out-patient COPD subjects with mild hypoxemia.MethodsCase–control study. Cases were 30 patients with major depression and controls were 30 patients without depression. Major depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders criteria by a psychiatric evaluation. All possible predictive variables were included in a multivariate logistic regression model to assess the association between major depression and each independent variable, while controlling for the sleep parameters.ResultsCAT score >20 was associated with major depression (OR 7.88; 95% CI 1.96 - 31.7; p = 0.004).ConclusionCAT score >20 was associated with major depression, suggesting CAT as a predictor variable of major depression among COPD patients with mild hypoxemia, and indicating that an additional specific evaluation for the presence of major depression should be done.

Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms.

Background The diagnosis of chronic obstructive pulmonary disease (COPD) is often delayed until later stages of the disease. The purpose of the present study was to determine the prevalence of COPD among adults on treatment for systemic arterial hypertension independently of the presence of respiratory symptoms. Methods This cross-sectional study included adults aged ≥40 years with tobacco/occupational exposure and systemic arterial hypertension diagnosed at three Primary Health Care facilities in Goiania, Brazil. Patients were evaluated using a standardized respiratory questionnaire and spirometry. COPD prevalence was measured considering the value of forced vital capacity and/or forced expiratory volume in 1 second <0.70. Results Of a total of 570 subjects, 316 (55%) met inclusion criteria and were invited to participate. Two hundred and thirty-three (73.7%) patients with arterial hypertension reported at least one respiratory symptom, while 83 (26.3%) reported no respiratory symptoms; 41 (17.6%) patients with arterial hypertension and at least one respiratory symptom, and 10 (12%) patients with arterial hypertension but no respiratory symptoms were diagnosed with COPD (P=0.24). The prevalence of COPD in people with no previous COPD diagnosis was greater among those with no respiratory symptoms (100%) than among those with respiratory symptoms (56.1%) (P=0.01). Conclusion Our findings suggest that regardless of the presence of respiratory symptoms, individuals aged ≥40 years with tobacco/occupational exposure and arterial hypertension may benefit from spirometric evaluation.

Elaboração e validação de questionário sobre o conhecimento da Doença Pulmonar Obstrutiva Crônica entre profissionais da atenção primária

Objetivo: Elaborar e validar um questionario para avaliacao do conhecimento sobre a Doenca Pulmonar Obstrutiva Cronica para os profissionais da Atencao Primaria. Metodos: Estudo metodologico com profissionais da Atencao Primaria. Elaborou-se o questionario com 16 itens cujas respostas foram estruturadas utilizando a escala Likert. A construcao do questionario contemplou diferentes aspectos da Doenca Pulmonar Obstrutiva Cronica: prevencao, diagnostico, tratamento e monitoramento. Tres itens passaram por reconstrucao frasica antes de ser aplicado, por apresentar 57,1% de discordância entre os pesquisadores. Apos adaptacao frasica e validacao semântica o questionario foi aplicado em 89 profissionais. O instrumento foi aplicado em dois momentos com intervalo de 15 a 20 dias. Avaliou-se a reprodutibilidade pelo Kappa e a confiabilidade pelo alfa de Cronbach. Resultados: Participaram do estudo 26 (29,5%) agentes comunitarios, 10 (11,4%) medicos, 13 (14,8%) enfermeiros, 25 (28,4%) tecnicos de enfermagem, 6 (6,8%) auxiliares de cirurgioes-dentistas e 8 (9,1%) cirurgioes-dentistas. Sobre o nivel de escolaridade destaca-se: 48 (54,5%) possuiam ensino medio completo e 21 (23,9%) superior completo. O questionario apresentou confiabilidade com α Cronbach = 0,763 e reprodutibilidade na maioria dos itens (87,5%) de bom a excelente (Kappa: 0,61 – 0,88). Conclusao: O questionario foi elaborado conforme as recomendacoes do Designing questionnaires and interviews. E atendeu as propriedades psicometricas mostrando-se confiavel e reprodutivel na avaliacao do conhecimento sobre Doenca Pulmonar Obstrutiva Cronica entre profissionais da Atencao Primaria.