Rosa Güell

Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ)

The aim of this study was to translate the Chronic Respiratory Questionnaire (CRQ) into Spanish and to test its measurement properties. The study was performed in 60 patients with chronic obstructive pulmonary disease (forced expiratory volume in one second (FEV1) mean+/-SD 35+/-14% of reference value). A rigorous process of forward and back translation and review produced an easily comprehensible questionnaire, which was administered together with measures of pulmonary function and exercise capacity. The patients were randomly allocated to one of two groups: 30 received respiratory rehabilitation and the other 30 received standard community care only. Weak to moderate statistically significant correlations (0.2-0.38) were found between the domains of the CRQ and pulmonary function and exercise measures. For the three CRQ domains that measure differences between patients at a point in time, Crohnbachs alpha and intraclass correlation coefficients were: fatigue 0.80 and 0.80; emotional function 0.86 and 0.68; and mastery domains 0.84 and 0.67, respectively. Scores remained stable in patients who were deemed clinically stable, and showed large statistically significant improvement (p<0.0001) in patients in the rehabilitation programme. Only low correlations were found between the changes in CRQ and the changes in pulmonary function and exercise capacity. The index of responsiveness was 0.92 for fatigue, and 0.91 for dyspnoea, emotional function and mastery. In conclusion, the Spanish translation of the Chronic Respiratory Questionnaire is likely to be useful for measuring differences between patients, and particularly for measuring the effects of intervention on quality of life in chronic respiratory disease.

Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial

Pulmonary hypertension is a serious complication of chronic obstructive pulmonary disease (COPD) that currently has no established pharmacological treatment. This study aimed to assess whether concomitant treatment with sildenafil would enhance the results of pulmonary rehabilitation in patients with COPD and increased pulmonary arterial pressure (PAP). In this double-blind, randomised controlled trial patients received 20 mg sildenafil or placebo three times daily and underwent pulmonary rehabilitation for 3 months. The primary end-point was the gain in the cycle endurance time at a constant work-rate. Secondary end-points included performance in the incremental exercise test, 6-min walk distance and quality of life. 63 patients with severe COPD and moderately increased PAP were randomised. Cycle endurance time increased by 149 s (95% CI 26–518 s) in the sildenafil group and by 169 s (95% CI 0–768 s) in the placebo group (median change difference -7 s, 95% CI -540–244 s; p=0.77). Gains in the incremental exercise test, 6-min walk distance and quality of life at the end of the study did not differ between groups. Measurements of arterial oxygenation and adverse events were similar in both groups. In patients with severe COPD and moderately increased PAP, concomitant treatment with sildenafil does not improve the results of pulmonary rehabilitation in exercise tolerance. Sildenafil did not improve respiratory rehabilitation outcomes in patients with severe COPD and moderately increased PAP http://ow.ly/lh7cb

Factores de riesgo de mortalidad en la EPOC

Objetivo Aunque los factores que predicen la supervivencia en pacientes con enfermedad pulmonar obstructive cronica (EPOC) han sido ampliamente estudiados, no disponemos de un consenso establecido. El objetivo de este estudio ha sido contribuir a clarificar el papel que desempenan los parametros de funcion pulmonar, tolerancia al esfuerzo y calidad de vida en la supervivencia en la EPOC. Pacientes y metodos Se diseno un estudio prospectivo en el que se incluyo a 60 pacientes diagnosticados de EPOC. Al inicio del estudio realizaron pruebas funcionales respiratorias, prueba de esfuerzo maximo y prueba de la marcha de 6 min, y respondieron un cuestionario de enfermedad respiratoria cronica para determinar la calidad de vida relacionada con la salud. El seguimiento de los pacientes fue de 7 anos. Resultados Se retiraron del estudio 5 de los 60 pacientes. De los 55 restantes, 26 (47%) murieron durante el estudio. El analisis univariante con regresion de Cox mostro que existia relacion entre la supervivencia y la edad, el grado de obstruccion, la capacidad inspiratoria, la capacidad de difusion del monoxido de carbono y la tolerancia al ejercicio maximo; no se observo dicha relacion entre la supervivencia y el indice de masa corporal, la presion arterial de oxigeno y anhidrido carbonico, la capacidad pulmonar total, el volumen residual, las presiones maximas respiratorias, la prueba de la marcha de 6 min ni la calidad de vida relacionada con la salud. En el analisis multivariante con regresion de Cox con pasos hacia adelante, en el que se introdujeron la edad, el grado de obstruccion (medido con la relacion volumen espiratorio forzado en el primer segundo/capacidad vital forzada tras la administracion de broncodilatador) y la ventilacion minuto maxima en la prueba de esfuerzo, solo esta ultima entro en el modelo final (riesgo relativo = 0,926; p Conclusiones Nuestros hallazgos demuestran que la tolerancia al ejercicio maximo es el mejor predictor de supervivencia en los pacientes con EPOC.

Eficacia de la prueba de los 6 minutos de marcha en la valoración de la oxigenoterapia de deambulación

Objetivo: Comparar la saturacion de la oxihemoglobina (SpO2) observada durante la prueba de los 6 min de marcha (P6m) con la SpO2 de la pulsioximetria ambulatoria realizada durante las actividades de la vida diaria (AVD). Se analizo tambien la eficacia de la P6m en determinar el flujo de oxigeno adecuado para prevenir la desaturacion arterial durante las AVD. Pacientes y metodos: Se estudio a 37 pacientes diagnosticados de enfermedad pulmonar obstructiva cronica --valor medio (± desviacion estandar) del volumen espiratorio forzado en el primer segundo 26 ± 9% del valor de referencia-- en los que se compararon los valores de SpO2 obtenidos en la P6m y la pulsioximetria ambulatoria. De los 20 pacientes con desaturacion al esfuerzo, 11 aceptaron el oxigeno liquido portatil y realizaron la pulsioximetria ambulatoria de forma aleatorizada en 2 dias consecutivos con y sin la administracion de oxigeno. El flujo de oxigeno se establecio en la P6m con pruebas sucesivas hasta lograr una SpO2 media superior al 85%. Resultados: La SpO2 media en el total de pacientes fue del 84 ± 7% en la P6m y del 89 ± 4% en la pulsioximetria ambulatoria (p < 0,001). Los porcentajes de tiempo acumulado con SpO2 < del 90, del 88 y del 85% fueron superiores en la P6m (p < 0,001). Durante la P6m, en un 27% de los pacientes se detecto desaturacion, que no se confirmo con la pulsioximetria ambulatoria. En el subgrupo de 11 pacientes no se observaron diferencias significativas entre la P6m y la pulsioximetria ambulatoria realizadas con el flujo de oxigeno ajustado. Conclusion: La P6m es un metodo eficaz para detectar la desaturacion durante las AVD y establecer el flujo de oxigeno para corregir la desaturacion al esfuerzo.

Sleep hypoventilation due to increased nocturnal oxygen flow in hypercapnic COPD patients.

Background and objective:  Several COPD treatment guidelines recommend increasing oxygen flow during sleep to avoid nocturnal desaturation. However, such an increase could have deleterious clinical and gas exchange effects. The objective of this study was to evaluate short‐term gas exchange alterations produced by increasing the nocturnal oxygen flow rate.

Sistemas de ahorro de oxígeno. Una realidad olvidada

Los sistemas de ahorro de oxigeno agrupan el cateter transtraqueal, las canulas reservorio y los sistemas a demanda. Su objetivo es aumentar la autonomia de las fuentes de oxigeno portatiles consiguiendo una correccion de la hi-poxemia con menor flujo de oxigeno. El cateter transtraqueal aumenta la fraccion inspiratoria de oxigeno al proporcionar oxigeno directamente en la traquea, lo que evita el espacio muerto de la cavidad orofaringea y favorece que la via aerea superior actue como reservorio. Las canulas reservorio aumentan la fraccion inspiratoria de oxigeno al inicio de la inspiracion. Los sistemas a demanda cuentan con una valvula que se activa con la inspiracion, de modo que se administra oxigeno solo durante esta fase del ciclo respiratorio. Debido a sus diferentes caracteristicas, cada sistema presenta ventajas e inconvenientes. Para su correcta prescripcion debe ajustarse individualmente el flujo de oxigeno tanto en reposo como durante el ejercicio o el sueno con las pruebas pertinentes.

Duration of pulmonary rehabilitation to achieve a plateau in quality of life and walk test in COPD

OBJECTIVE To address the minimum duration of pulmonary rehabilitation necessary for patients with chronic obstructive pulmonary disease (COPD) to achieve a plateau in Health-Related Quality of Life (HRQL) and exercise tolerance. METHODS COPD patients with a dyspnea rating of at least 2 on the Medical Research Council scale participated in an outpatient rehabilitation program of 3 weekly sessions for 12 weeks. Measurements included HRQL and exercise tolerance 2 weeks before the program started and every 2 weeks thereafter. Patients were considered to have reached a plateau if they showed no improvement beyond 20% of the minimal important difference between 2 consecutive evaluations on HRQL score or walk tests. RESULTS Twenty-eight patients participated. The number of patients achieving stability after 8 weeks, showing continued improvement after 8 weeks, and demonstrating an erratic pattern of change was as follows: for physical function 16 (56%), 10 (37%) and 2 (7%) patients; for emotional function 22 (79%), 5 (18%) and 1 (4%); and for 6-min walk test 21 (75%), 5 (18%) and 2 (7%). More severe patients demonstrated a greater likelihood (76%) of achieving stability in physical function at 12 weeks than did less severe patients (27%; p on difference=0.003). The likelihood of stability at 12 weeks in emotional function and the 6-min walk test did not differ by severity. CONCLUSIONS A program of 3 weekly 3-h sessions of outpatient pulmonary rehabilitation program should last at least 8 weeks in order to achieve optimal HRQL and exercise tolerance for most patients.

Predicting nocturnal hypoventilation in hypercapnic chronic obstructive pulmonary disease patients undergoing long-term oxygen therapy.

Background: Chronic obstructive pulmonary disease (COPD) patients are very sensitive to changes in pulmonary mechanics and central ventilation control during sleep and may develop significant gas exchange alterations with increased hypoxemia and hypercapnia. Oxygen therapy improves nocturnal desaturation but can worsen hypoventilation. Objectives: To analyze the prevalence of nocturnal hypoventilation (NHV) in hypercapnic COPD patients and to determine predictive factors for this phenomenon. Methods: This was a prospective multicenter study which enrolled 80 clinically stable COPD patients with hypercapnic respiratory failure who fulfilled the conventional criteria for long-term oxygen therapy (LTOT). All patients had undergone pulmonary function testing, blood gas analysis, and respiratory polygraphy. Arterial blood gas samples were obtained while patients were awake and during sleep. NHV was considered when an increase in PaCO2 >10 mm Hg was observed in any nocturnal arterial blood gas sample as compared to the awake levels. Results: Seventeen patients (21%) developed NHV. NHV was associated with the values of BMI, hemoglobin, hematocrits, DLCO, and PaO2 reached after oxygen administration. In the logistic regression analysis BMI (OR 1.26, 95% CI 1.068–1.481; p = 0.006) and the diurnal increase of PaO2 after O2 (OR 0.89, 95% CI 0.807–0.972; p = 0.010) were the variables that best discriminated with a sensitivity of 82% and a specificity of 78%. Conclusions: NHV is a relatively common finding in stable hypercapnic COPD patients undergoing LTOT and it is related to a higher BMI and lower PaO2 after oxygen administration.

Mejor en casa: un programa de asistencia continuada para los pacientes con enfermedad respiratoria crónica avanzada

: The objective of this study was to analyze the effect of continuous health care on the frequency of readmissions of patients with advanced chronic respiratory disease. The study was prospective, enrolling 26 patients (16 with COPD, 7 with bronchiectasis and 3 with pachypleuritis) who had been admitted at least 3 times within the past year. The patients were assigned to 3 groups: group A was the ambulatory monitoring group, with 8 patients who were able to travel to the hospital for monthly outpatient checkups; group B was the ambulatory pulmonary rehabilitation group, with 10 patients who were able to travel to the hospital and who needed rebreathing training (one weekly group session); and group C was the home care group, with 8 patients who were unable to travel to the hospital and who received weekly or biweekly house calls. All patients had telephone contact with the program team. Mean lung function values for the whole population were FVC 40 (11)%, FEV1 23 (7)% of reference, PaO2 55 (7) and PaCO2 55 (10) mmHg. A significant decrease in number of admissions (79 versus 18, p < 0.0001) was observed in both the first and second halves of the year in all three treatment groups: A, 25 to 2; B, 28 to 8; and C, 26 to 8 (p < 0.001). The reduction in health care costs over the previous years expenditure was calculated to be 22,751,402 pesetas. We conclude that specialized health care that is continuous and personalized reduces the number of hospital readmissions of patients with advanced chronic respiratory disease. Moreover, the overall cost of care, without the need to make house calls to all patients.

Efficacy of the 6-Minute Walk Test in Evaluating Ambulatory Oxygen Therapy

OBJECTIVE To compare oxyhemoglobin saturation (SpO2) observed during the 6-minute walk test with that of pulse oximetry carried out during activities of daily living (ADLs). The efficacy of the 6-minute walk test for determining adequate oxygen flow to prevent arterial desaturation during ADLs was also analyzed. PATIENTS AND METHODS We studied 37 patients diagnosed with chronic obstructive pulmonary disease (COPD)--mean (SD) forced expiratory volume in 1 second, 26% (9%) of predicted--and compared SpO2 values obtained in the 6-minute walk test with those obtained with ambulatory pulse oximetry during ADLs. Eleven of the 20 patients with exercise-induced desaturation agreed to use portable liquid oxygen and were randomized to ambulatory pulse oximetry on 2 consecutive days, both with and without the administration of oxygen. Oxygen flow was adjusted on successive 6-minute walk tests until a mean SpO2 greater than 85% was reached. RESULTS The mean SpO2 for all patients was 84% (7%) during the 6-minute walk test and 89% (4%) during ADLs (P<.001). Cumulative percentages of time with SpO2 less than 90%, 88%, and 85% were higher during the 6-minute walk test than during ADLs (P<.001). During the walk test, desaturation was detected in 27% of patients, but was not confirmed by ambulatory pulse oximetry during ADLs. In the subgroup of 11 patients using portable liquid oxygen no significant differences were found between SpO2 values recorded during the walk test and during ADLs with the appropriate oxygen flow. CONCLUSION The 6-minute walk test is an effective method for detecting desaturation during ADLs and for establishing the oxygen flow needed to correct exercise-induced desaturation.