RESUMEN
Non-cystic fibrosis bronchiectasis (NCFB) is a chronic lung disease characterized by progressive and irreversible changes of the bronchial tree. The evaluation of exercise capacity is essential to manage this disease. This study aims to determine the within-subject repeatability of two Six Minute Walk Test (6MWT) in adults with NCFB. NCFB. This cross-sectional observational study included 66 NCFB subjects above 18 years-old (mean of 55 ± 17 years old, 68% women). 73% of the participants presented moderate to severe clinical condition classified by Bronchiectasis Severity Index. It showed that these participants walked 16.6 m less (95%CI 3.8 to 29.4; p < 0.01) in the second 6MWT when compared to the first test, with a within-subject coefficient variation of 9.4% (95%CI 7.2-11.2%) and an intra-test reliability with a high intraclass correlation coefficient of 0.88 (95%CI 0.80-0.93). Bland-Altman plot showed an agreement regarding test repeatability, besides presented a large limit of agreement (- 85 to 116 m). Respiratory rate and systolic blood pressure were significantly higher before starting the second test. In conclusion, 6MWT seems to be reproducible in NCFB subjects and vital sign verification should be attentively checked to assess if the patient is fully recovered to perform a second test, as well as the disease severity score. Other studies on this matter should be conducted with a larger number of participants to confirm the findings of the present study.
Asunto(s)
Bronquiectasia/fisiopatología , Tolerancia al Ejercicio/fisiología , Prueba de Paso , Caminata/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
BACKGROUND: Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous disease. There are few studies about prognostic factors in these patients. Our study aims to assess mortality rates and related factors in a cohort of patients and test the ability of the BSI and FACED scores in predicting mortality in this cohort. METHODS: This was a prospective cohort analysis of 70 patients with NCFB recruited from May 2008 to August 2010. At baseline, patients underwent clinical evaluation, pulmonary function tests, 6-min walk test, and quality of life assessment. Outcomes were defined as favorable (survivors) and unfavorable (survivors who underwent lung transplantation and death from all causes). Baseline records provided data for determination of BSI and FACED. RESULTS: Twenty-seven patients (38.57%) died and 1 (1.43%) underwent lung transplantation. Mean time for occurrence of unfavorable outcomes was 74.67 ± 4.00 months. Main cause of death was an acute infectious exacerbation of bronchiectasis (60.7). Cox regression identified age (p = 0.035; HR 1.04; CI 1.01-1.08), FEV1 % of predicted (p = 0.045; HR 0.97; CI 0.93-0.99), and MEP (p = 0.016; HR 0.96; CI 0.94-0.99) as independent predictors of unfavorable outcomes. FACED was better at predicting unfavorable outcomes in our cohort (log-rank test, FACED p = 0.001 and BSI p = 0.286). In ROC analysis, both scores were similar in predicting unfavorable outcomes (BSI 0.65; FACED 0.66). CONCLUSIONS: Older age, lower FEV1 % of predicted, and lower MEP were independently linked to unfavorable outcomes. FACED and BSI were not accurate in predicting mortality in our cohort.
Asunto(s)
Bronquiectasia/mortalidad , Bronquiectasia/fisiopatología , Índice de Severidad de la Enfermedad , Adulto , Factores de Edad , Anciano , Bronquiectasia/cirugía , Progresión de la Enfermedad , Femenino , Volumen Espiratorio Forzado , Humanos , Trasplante de Pulmón , Masculino , Presiones Respiratorias Máximas , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Curva ROC , Tasa de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate physical performance on the six-minute walk test (6MWT) in patients with non-cystic fibrosis bronchiectasis and to investigate its relationship with quality of life (QoL). To identify predictors of exercise performance, we also investigated whether six-minute walk distance (6MWD) is associated with clinical and spirometric findings. METHODS: This was a cross-sectional study involving patients with non-cystic fibrosis bronchiectasis (age, > 18 years), with at least one respiratory symptom for > 2 years and an FEV1 < 70% of predicted. Patients underwent clinical evaluation, pulmonary function tests, the 6MWT, and QoL assessment with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). RESULTS: We included 70 patients (48 females). Mean age was 54.5 ± 17.7 years, and mean FEV1 was 44.9 ± 14.5% of predicted. The patients were divided into two groups: 6MWD-low (6MWD below the predicted lower limit; n = 23); and 6MWD-norm (normal 6MWD; n = 47). The following variables were significantly lower in the 6MWD-low group than in the 6MWD-norm group: age; age at diagnosis of bronchiectasis; proportion of former smokers; body mass index (BMI); FEV1% of predicted; and MEP% of predicted. There were no significant differences in the SF-36 scores between the groups. In the logistic regression model, lower age and lower BMI were significantly associated with lower 6MWD. CONCLUSIONS: In this sample, there was a high proportion of patients who presented a lower than expected 6MWD. Although 6MWD was not related to QoL, it was associated with age and BMI.
Asunto(s)
Índice de Masa Corporal , Bronquiectasia/fisiopatología , Prueba de Esfuerzo/métodos , Actividad Motora/fisiología , Calidad de Vida , Caminata/fisiología , Adolescente , Adulto , Factores de Edad , Anciano , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Espirometría , Factores de Tiempo , Adulto JovenRESUMEN
OBJETIVO: Avaliar o desempenho físico de pacientes com bronquiectasias não fibrocísticas no teste de caminhada de seis minutos (TC6) e investigar sua associação com a qualidade de vida (QV). Secundariamente, analisar a associação entre a distância percorrida no TC6 (DTC6) com achados clínicos e espirométricos para se identificar preditores para esse desempenho. MÉTODOS: Estudo transversal envolvendo pacientes com bronquiectasias não fibrocísticas, com idade > 18 anos, pelo menos um sintoma respiratório por > 2 anos e VEF1 < 70% do previsto. Os pacientes foram submetidos a avaliação clínica, teste de função pulmonar, TC6 e avaliação da QV por Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). RESULTADOS: Foram incluídos 70 pacientes (48 mulheres; média de idade = 54,5 ± 17,7 anos; média de VEF1 = 44,9 ± 14,5% do previsto. Os pacientes foram divididos em dois grupos: DTC6-menor, com desempenho menor que o limite inferior previsto (n = 23); e DTC6-norm, com desempenho normal (n = 47). Em comparação ao grupo DTC6-norm, o grupo DTC6-menor apresentou menor idade, menor idade ao diagnóstico das bronquiectasias, menor proporção de ex-fumantes, menor índice de massa corpórea (IMC), menor VEF1 em % do previsto e menor PEmáx em % do previsto. Não houve diferenças significativas nos escores do SF-36 entre os grupos. No modelo de regressão logística, menor idade e menor IMC se associaram significativamente com menor DTC6. CONCLUSÕES: Nesta amostra, uma elevada proporção de pacientes apresentou uma DTC6 menor que o esperado. A DTC6 não se relacionou com a QV. Idade e IMC se associaram a DTC6.
OBJECTIVE: To evaluate physical performance on the six-minute walk test (6MWT) in patients with non-cystic fibrosis bronchiectasis and to investigate its relationship with quality of life (QoL). To identify predictors of exercise performance, we also investigated whether six-minute walk distance (6MWD) is associated with clinical and spirometric findings. METHODS: This was a cross-sectional study involving patients with non-cystic fibrosis bronchiectasis (age, > 18 years), with at least one respiratory symptom for > 2 years and an FEV1 < 70% of predicted. Patients underwent clinical evaluation, pulmonary function tests, the 6MWT, and QoL assessment with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). RESULTS: We included 70 patients (48 females). Mean age was 54.5 ± 17.7 years, and mean FEV1 was 44.9 ± 14.5% of predicted. The patients were divided into two groups: 6MWD-low (6MWD below the predicted lower limit; n = 23); and 6MWD-norm (normal 6MWD; n = 47). The following variables were significantly lower in the 6MWD-low group than in the 6MWD-norm group: age; age at diagnosis of bronchiectasis; proportion of former smokers; body mass index (BMI); FEV1% of predicted; and MEP% of predicted. There were no significant differences in the SF-36 scores between the groups. In the logistic regression model, lower age and lower BMI were significantly associated with lower 6MWD. CONCLUSIONS: In this sample, there was a high proportion of patients who presented a lower than expected 6MWD. Although 6MWD was not related to QoL, it was associated with age and BMI.