RESUMEN
It is not known whether COPD exacerbations contribute to an increased vascular risk already associated with the disease. For this reason, we prospectively evaluated 127 patients referred for a monographic COPD consultation. We classify as exacerbators those who had experienced two or more moderate exacerbations in the previous year, or who had had a hospital admission. All underwent a blood analysis, respiratory function tests, global cardiovascular and coronary risk estimates (with four of the most frequently used scores, and the Chronic Obstructive Pulmonary Disease Coronaropathy Risk (COPDCoRi) score, respectively); and an EcoDoppler to measure carotid intima-media thickness and the ankle-brachial index. Finally, we included 50 patients with exacerbator phenotypes and 57 with non-exacerbator phenotypes, ranging from 63⯱â¯7 years old, 74% of whom were male. The exacerbator phenotype increased the risk of carotid intima-media thickness above the 75th percentile range by a factor of almost three, independently of the severity of COPD and global cardiovascular risk. The association between the exacerbator phenotype and high c-IMT was more evident in patients under 65. In conclusion, the presence of subclinical atherosclerosis is independently associated with the exacerbator phenotype, with more pronounced differences in younger patient; which suggests that we should intensify control of vascular risk factors in these groups of patients.
Asunto(s)
Aterosclerosis/diagnóstico por imagen , Aterosclerosis/patología , Enfermedad de la Arteria Coronaria/patología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Anciano , Índice Tobillo Braquial/métodos , Aterosclerosis/complicaciones , Aterosclerosis/metabolismo , Grosor Intima-Media Carotídeo/estadística & datos numéricos , Comorbilidad , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estudios Transversales , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Enfermedad Pulmonar Obstructiva Crónica/sangre , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Factores de RiesgoRESUMEN
Objetivo: Evaluar la efectividad de un programa de rehabilitación respiratoria (RR) multidisciplinar en pacientes con enfermedad pulmonar obstructiva crónica grave o muy grave preprograma RR, al terminar el programa y al año de haber realizado la RR midiendo los cambios producidos en: la capacidad de ejercicio (test de marcha), mejoría en la tolerancia al esfuerzo (volumen espiratorio forzado [FEV1]) y en la calidad de vida relacionada con la salud. Método: Diseño cuasi experimental con un solo grupo. Se incluyeron a pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica grave o muy grave (estadios III y IV de la clasificación GOLD) que entraron en el programa de RR entre 2011 y 2012. Se recogieron datos demográficos, calidad de vida relacionada con la salud general (SF-36) y específica para enfermos respiratorios (Cuestionario Respiratorio St. George), FEV1% y test de capacidad de ejercicio (prueba de la marcha de 6min). La recogida de datos se realizó preprograma RR, al terminar el programa de RR y al año de haber acabado el programa. Resultados: No se observaron diferencias significativas en los valores de FEV1%. Respecto a la capacidad de ejercicio se observó un aumento de la distancia recorrida en el test de marcha, que se modificó significativamente después del entrenamiento, de 377±59,7 a 415±79m al año (p<0,01). Se observó una mejoría estadísticamente significativa en las 3 dimensiones del Cuestionario Respiratorio St. George. Las medias de las puntuaciones obtenidas de la calidad de vida relacionada con la salud mejoraron significativamente en todas las dimensiones excepto en la dimensión rol emocional del cuestionario SF-36. Conclusión Un programa de RR de 8 semanas de duración mejora la capacidad de realizar ejercicio, la disnea y la calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica grave y muy grave (AU)
Objective: To evaluate the effectiveness of the multidisciplinary respiratory rehabilitation (RR) programme in patients with severe or very severe chronic obstructive pulmonary disease pre the RR programme, at the end of the programme and one year after the RR, measuring changes in ability to exercise (walking test), effort tolerance(forced expiratory volume (FEV1)) and health-related quality of life. Method: Quasi-experimental single group design. We included patients diagnosed with severe or very severe chronic obstructive pulmonary disease (stages III and IV of the GOLD classification) who entered the rehabilitation programme for the years 2011 and 2012. Demographic data, questionnaires on general health-related quality of life (SF-36) and specific to respiratory patients (St George's Respiratory Questionnaire), FEV1% and exercise capacity test (running test 6minutes) were collected. Data were collected before the RR programme, at the end of the RR programme and a year after completing the program. Results: No significant differences in FEV1% values were observed. Regarding exercise capacity, an increase in distance walked in the walking test was noted, which changed significantly after training, 377±59.7 to 415±79 m after one year (P<.01). A statistically significant improvement in mean scores of HRQoL was observed, except for the emotional role dimension of the SF-36 questionnaire. Conclusion: A pulmonary rehabilitation programme for 8 weeks improved the exercise capacity, dyspnoea and quality of life of patients with severe and very severe chronic obstructive pulmonary disease (AU)
Asunto(s)
Humanos , Enfermería en Rehabilitación/organización & administración , Enfermedad Pulmonar Obstructiva Crónica/enfermería , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Calidad de Vida , Promoción de la Salud/organización & administración , Educación del Paciente como Asunto/organización & administración , Evaluación de Eficacia-Efectividad de Intervenciones , Encuestas y Cuestionarios , Disnea/complicaciones , Disnea/enfermería , Pletismografía/enfermería , 28599RESUMEN
OBJECTIVE: To evaluate the effectiveness of the multidisciplinary respiratory rehabilitation (RR) programme in patients with severe or very severe chronic obstructive pulmonary disease pre the RR programme, at the end of the programme and one year after the RR, measuring changes in ability to exercise (walking test), effort tolerance(forced expiratory volume (FEV1)) and health-related quality of life. METHOD: Quasi-experimental single group design. We included patients diagnosed with severe or very severe chronic obstructive pulmonary disease (stages III and IV of the GOLD classification) who entered the rehabilitation programme for the years 2011 and 2012. Demographic data, questionnaires on general health-related quality of life (SF-36) and specific to respiratory patients (St George's Respiratory Questionnaire), FEV1% and exercise capacity test (running test 6minutes) were collected. Data were collected before the RR programme, at the end of the RR programme and a year after completing the program. RESULTS: No significant differences in FEV1% values were observed. Regarding exercise capacity, an increase in distance walked in the walking test was noted, which changed significantly after training, 377±59.7 to 415±79 m after one year (P<.01). A statistically significant improvement in mean scores of HRQoL was observed, except for the emotional role dimension of the SF-36 questionnaire. CONCLUSION: A pulmonary rehabilitation programme for 8 weeks improved the exercise capacity, dyspnoea and quality of life of patients with severe and very severe chronic obstructive pulmonary disease.