RESUMEN
AIM OF THE STUDY: The aim of the study was to document the nutritional status and the calorie demands of patients suffering from severe chronic airflow obstruction (BPCO) who were on continuous domiciliary oxygen therapy (OCD) and to correlate this information with the clinical picture, the severity of the respiratory disease and the daily distance walked, this to be measured in a prospective manner. PATIENTS AND METHODS: Fifty clinically stable patients with chronic airflow obstruction on continuous oxygen therapy for 33 months (range 4-106) in whom the following measures were made at home: pulmonary function, maximal static inspiratory and expiratory pressure (PIMAX and PEMAX), strength of hand, grip, the mean distance walked daily (wearing a pedometer for one week), body mass index (IMC), and the body composition by electrical bio-impedence and calorie requirements. RESULTS: Thirty four per cent of patients presented with an excessive body mass (IMC > 27 kg/m2), 42 per cent had normal nutrition (IMC 20-27 kg/m2) and 24 per cent were malnourished (IMC < 20 kg/m2). Malnourished patients had, in a statistically significant manner, airflow obstruction of greater severity and a lower oxygen saturation and a PEMAX as well as a lower daily distance compared to over weight subjects. However, their net calorie requirements were markedly higher (39 +/- 5 Kcal/kg/j) compared to patients having normal weight (29 +/- 11 kcal/kg/j) or excess weight (25 +/- 8 kcal/kg/j). From the clinical standpoint no malnourished patient fulfilled the clinical criteria of chronic bronchitis. By contrast 61 per cent of subjects with normal nutrition and 94 per cent of subjects with excessive weight were chronic bronchitics. CONCLUSION: In the group of patients with severe airflow obstruction on domiciliary oxygen, 25 per cent were malnourished and this was in spite of netly increased calorie consumption which is superior to their theoretical need. This suggests that the solution of increasing supplements to their dietary requirements would be a difficult to realise. These subjects presented also with a more marked ventilatory handicap and a clinical picture characterised by the absence of the classical signs of chronic bronchitis.
Asunto(s)
Servicios de Atención de Salud a Domicilio , Enfermedades Pulmonares Obstructivas/terapia , Estado Nutricional , Terapia por Inhalación de Oxígeno , Caminata/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Composición Corporal , Índice de Masa Corporal , Peso Corporal , Bronquitis/metabolismo , Bronquitis/fisiopatología , Bronquitis/terapia , Enfermedad Crónica , Impedancia Eléctrica , Metabolismo Energético , Femenino , Estudios de Seguimiento , Fuerza de la Mano/fisiología , Humanos , Capacidad Inspiratoria/fisiología , Pulmón/fisiopatología , Enfermedades Pulmonares Obstructivas/sangre , Enfermedades Pulmonares Obstructivas/metabolismo , Enfermedades Pulmonares Obstructivas/fisiopatología , Masculino , Persona de Mediana Edad , Trastornos Nutricionales/sangre , Trastornos Nutricionales/fisiopatología , Oxígeno/sangre , Ápice del Flujo Espiratorio/fisiología , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: In dogs, vigabatrin (VGB) has been associated with intramyelinic edema producing delayed central conduction in somatosensory and visual evoked potentials (SEP, VEP). No such effects have been reported in humans. We assessed whether abnormalities of central conduction could be detected prospectively in patients with epilepsy treated with VGB as long-term add-on medication. METHODS: Two hundred one patients with refractory partial epilepsy were enrolled and monitored for as long as 2 years. VGB was added to the treatment at an average dose of 2-3g/day. Conduction in somatosensory and visual pathways was assessed by median nerve SEP and pattern VEP recordings performed at inclusion and once every 6 months. The upper limit and test-retest variability of EP latencies were evaluated at time of enrollment in the patient group. Prolonged N13-N20 or P14-N20 SEP intervals and P100 VEP latency >2.5 SD above the baseline mean, observed on repeated runs in the same session and exceeding the test-retest variability at enrollment were considered to indicate central conduction slowing. RESULTS: One hundred nine patients completed the 2-year study period, and 92 discontinued VGB, of whom 37 were monitored with regard to EP until the end of the study. No consistent change in SEP or VEP was observed in the entire group during VGB treatment. The number of occasional EP values outside the baseline range in patients treated with VGB similar to that in patients whose VGB treatment had been discontinued. CONCLUSIONS: We detected no evidence of changes in SEP and VEP attributable to altered neuronal conduction in the CNS during long-term VGB treatment.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Epilepsia/tratamiento farmacológico , Potenciales Evocados Somatosensoriales/efectos de los fármacos , Potenciales Evocados Visuales/efectos de los fármacos , Ácido gamma-Aminobutírico/análogos & derivados , Adolescente , Adulto , Anciano , Anticonvulsivantes/farmacología , Esquema de Medicación , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Nervio Mediano/efectos de los fármacos , Persona de Mediana Edad , Conducción Nerviosa/efectos de los fármacos , Vigilancia de Productos Comercializados , Estudios Prospectivos , Resultado del Tratamiento , Vigabatrin , Ácido gamma-Aminobutírico/farmacología , Ácido gamma-Aminobutírico/uso terapéuticoRESUMEN
Long-term home oxygen therapy (LTOT) improves survival of hypoxic patients with chronic respiratory insufficiency. However, the health-related quality of life (HRQL) of these patients, when LTOT is initiated, is severely impaired. The present study aims to describe the health-related quality of life (HRQL) of patients under LTOT, assessed at home, to identify parameters relevant to HRQL, and to describe changes over a 1-yr period. Seventy-nine patients (aged 68 +/- 11 years, under LTOT for 34 +/- 24 months) underwent pulmonary function testing, measurement of average daily distance walked, SaO2, dyspnoea scores (Borg scale and oxygen-cost diagram), and Hospital Anxiety and Depression scores. After 1 yr, measurements were repeated, and HRQL was measured with the St George Respiratory Questionnaire (SGRQ). Forced expiratory volume in 1 s (FEV1% of predicted) was 36 +/- 19; SaO2 (room air) was 87 +/- 5%, daily distance walked was 1202 +/- 1140 m; 21% suffered from anxiety and 27% from depression. After 1 yr, pulmonary function tests, dyspnoea or prevalence of anxiety or depression were unchanged. Mortality was high (31% 1-yr mortality). Daily distance walked (rho = -0.55, P = 0.01 vs. SGRQ) and number of days spent in hospital (rho = 0.5, P = 0.01 vs. SGRQ) were the parameters with the highest correlation with HRQL scores. Quality of life was poor in these patients, with high rates of emotional disorders. Restoring and maintaining sufficient exercise capacity for everyday life activities through outpatient rehabilitation programmes and support for emotional disturbances should be major goals in the care of these patients.