Prevalência, variabilidade e repercussões dos sintomas em tabagistas, ex- tabagistas e pacientes com Doença Pulmonar Obstrutiva Crônica
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2019-02-25
Autores
Bianzeno, Guilherme
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Universidade Estadual Paulista (Unesp)
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Resumo Introdução: A Doença Pulmonar Obstrutiva Crônica (DPOC) apresenta impacto global e sintomas como dispneia, tosse e expectoração levam ao comprometimento da qualidade de vida (QV) e das atividades de vida diária. Objetivos: Avaliar a prevalência, variabilidade e repercussões dos sintomas em tabagistas, ex- tabagistas e pacientes com DPOC. Métodos: Foram avaliados 108 indivíduos de ambos os sexos com idade ≥ 40 anos (tabagista e ex-tabagistas: 32; DPOC leve/moderado: 36; DPOC grave/muito grave: 40) provenientes dos ambulatórios de Pneumologia do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Todos foram submetidos à avaliação clínica, responderam a questionário elaborado para o estudo para avaliação dos sintomas, a variabilidade dos mesmos durante o dia e semana durante períodos de estabilidade da doença. Foi realizada a avaliação do estado tabágico confirmada pela medida do monóxido de carbono no ar expirado, espirometria antes e após broncodilatador, avalição da composição do corpo por meio da impedância bioelétrica e da sensação de dispneia por meio do instrumento do Medical Research Council modificado (mMRC). O teste de avaliação da DPOC (CAT) foi aplicado e foi avaliada a distância caminhada em 6 minutos (DP6), a força muscular periférica por meio do dimamômetro manual e do dinamômetro portátil Microfet 2, a qualidade de vida por meio do Questionário de Qualidade de Vida do Hospital Saint George (SGRQ) e os sintomas de ansiedade e depressão por meio da Escala Hospitalar de Ansiedade e Depressão (HAD) Análise Estatística: Foi utilizada análise descritiva, as variáveis expressas em média ± DP ou mediana (quartil 25% a 75%) as variáveis categóricas em porcentagem. A comparação entre os grupos foi realizada pelo teste t de student (paramétrica) ou Mann-Whitney (não paramétrica). A análise de variância foi realizada por (ANOVA) seguida do teste de Tukey ou Kruskal-Wallis seguido pelo teste de Dunn’s. O teste Chi-quadrado foi utilizado na comparação de variáveis categóricas, seguido da comparação de pares por ajuste de p. A análise de regressão linear múltipla foi utilizada para avaliar associação entre os sintomas e os desfechos. Resultados: Os pacientes com DPOC (leve/muito grave) eram mais velhos e apresentavam menor massa magra do corpo quando comparados aos tabagistas/extabagistas. O valores dos escores de CAT, mMRC, SGRQ e a DP6 foram similares nos grupos tabagistas/ex-tabagistas e DPOC I/II. Os pacientes do grupo DPOC III/IV apresentaram maiores valores de CAT, mMRC e menores valores de DP6 e maior comprometimento da qualidade de vida comparado aos demais grupos. Escores do questionário CAT ≥10 pontos foram encontrados em 75% do grupo tabagista/ex-tabagista e 69,4% do grupo DPOC I-II. A falta de ar foi o sintoma mais experimentado, relatado por 59% a 95% dos participantes, a tosse foi relatado por 62,5% a 75%, o catarro por 52,7% a 62,5% e o chiado por 50% a 60% dos pacientes. Os sintomas foram na maioria das vezes de intensidade leve ou moderado e variaram durante o dia e semana, com predomínio nos períodos matutino e à noite. A análise de regressão múltipla mostrou que a presença e intensidade dos sintomas tem associação positiva com os escores de CAT e total do SGRQ. Conclusão: Os resultados mostram que tabagistas, ex-tabagistas e pacientes com DPOC apresentam sintomas respiratórios frequentes independentemente da intensidade de obstrução das vias aéreas, que ocorreram principalmente no período matutino e noturno e em menor proporção no período da tarde. Pacientes nos estágios mais graves da DPOC apresentaram comprometimento significativamente maior na maioria dos desfechos avaliados. O questionamento detalhado sobre os sintomas auxiliam na avaliação do impacto negativo do tabagismo e da DPOC na vida diária dos pacientes.
Introduction: Chronic obstructive pulmonary disease (COPD) performs a global impact and symptoms such as dyspnea, cough and expectoration which imply on quality of life and daily activities commitment. Objectives: Assess the prevalence, variability and repercussions of symptoms in smokers, former smokers and COPD patients. Methods: 108 subjects of both gender aged ≥ 40 years old were evaluated (smokes/former smokers:32; mild/moderate COPD:36; severe/very severe COPD:40) from the outpatient clinics of Pulmonology of the Clinical Hospital at the Faculty of Medicine of Botucatu. All were submitted to clinical evaluation, answered a questionnaire prepared for the study to evaluate the symptoms, their variability during the day and week during the periods of disease stability. The biochemically confirmed smoking status was determined by the measurement of carbon monoxide in the expired air, spirometry before and after bronchodilator, nutritional assessment through bioelectrical impedance and dyspnea through the modified Medical Research Council instrument (mMRC). The COPD evaluation test (CAT) was applied and the walking distance was evaluated in 6 minutes (6MWD), the peripheral muscle strength by means of the hand dimmer and the Microfet, the quality of life by means of the Quality of Life Questionnaire Saint George Hospital (SGRQ) and symptoms of anxiety and depression through the Hospital Anxiety and Depression Scale (HAD). Statistical Analysis: descriptive analysis was performed, the variables were expressed in mean ± SD or median (quartile 25% to 75%) and categorical variables in percentage. The comparison between the groups was performed by the t student test (parametric) or Mann-Whitney test (nonparametric). Analysis of variance was carried out by (ANOVA) followed by the Tukey or KruskalWallis test and Dunn's test. The Chi-square test was used for the comparison of categorical variables, and then comparisons of pairs with adjustment of p by Bonferroni. Multiple linear regression analysis was used to evaluate the association between the symptoms and the other variables. Results: Patients with COPD were older and had lower body mass compared to smokers/former smokers. The values of CAT, mMRC, SQRQ and 6MWD scores were similar in the smokers/former smokers and COPD I / II groups. Patients in the COPD III / IV group had higher values of CAT, mMRC and lower values of DP6, and higher quality of life impairment compared to the other groups. CAT scores ≥ 10 points were found in 75% at the smoker / former smoker group and 69.4% at the COPD I-II group. Shortness of breath was the most experienced symptom, reported by 59% to 95% of participants, cough was reported by 62.5% to 75%, phlegm by 52.7% to 62.5%, and wheezing by 50 % to 60% of the patients. The symptoms were mostly of mild or moderate intensity and varied during the day and week, predominantly in the morning and at night. Multiple regression analysis showed that the presence and intensity of symptoms were positively associated with CAT and total SGRQ scores. Conclusion: The results show that smokers, former smokers and patients with COPD show frequent respiratory symptoms regardless of the intensity of airway obstruction, which occurred mainly in the morning and at night, and to a lesser extent in the afternoon. Patients in the more severe stages of COPD had significantly greater impairment in most of the outcomes evaluated. Detailed questioning of symptoms helps assess the negative impact of smoking and COPD on patients' daily lives.
Introduction: Chronic obstructive pulmonary disease (COPD) performs a global impact and symptoms such as dyspnea, cough and expectoration which imply on quality of life and daily activities commitment. Objectives: Assess the prevalence, variability and repercussions of symptoms in smokers, former smokers and COPD patients. Methods: 108 subjects of both gender aged ≥ 40 years old were evaluated (smokes/former smokers:32; mild/moderate COPD:36; severe/very severe COPD:40) from the outpatient clinics of Pulmonology of the Clinical Hospital at the Faculty of Medicine of Botucatu. All were submitted to clinical evaluation, answered a questionnaire prepared for the study to evaluate the symptoms, their variability during the day and week during the periods of disease stability. The biochemically confirmed smoking status was determined by the measurement of carbon monoxide in the expired air, spirometry before and after bronchodilator, nutritional assessment through bioelectrical impedance and dyspnea through the modified Medical Research Council instrument (mMRC). The COPD evaluation test (CAT) was applied and the walking distance was evaluated in 6 minutes (6MWD), the peripheral muscle strength by means of the hand dimmer and the Microfet, the quality of life by means of the Quality of Life Questionnaire Saint George Hospital (SGRQ) and symptoms of anxiety and depression through the Hospital Anxiety and Depression Scale (HAD). Statistical Analysis: descriptive analysis was performed, the variables were expressed in mean ± SD or median (quartile 25% to 75%) and categorical variables in percentage. The comparison between the groups was performed by the t student test (parametric) or Mann-Whitney test (nonparametric). Analysis of variance was carried out by (ANOVA) followed by the Tukey or KruskalWallis test and Dunn's test. The Chi-square test was used for the comparison of categorical variables, and then comparisons of pairs with adjustment of p by Bonferroni. Multiple linear regression analysis was used to evaluate the association between the symptoms and the other variables. Results: Patients with COPD were older and had lower body mass compared to smokers/former smokers. The values of CAT, mMRC, SQRQ and 6MWD scores were similar in the smokers/former smokers and COPD I / II groups. Patients in the COPD III / IV group had higher values of CAT, mMRC and lower values of DP6, and higher quality of life impairment compared to the other groups. CAT scores ≥ 10 points were found in 75% at the smoker / former smoker group and 69.4% at the COPD I-II group. Shortness of breath was the most experienced symptom, reported by 59% to 95% of participants, cough was reported by 62.5% to 75%, phlegm by 52.7% to 62.5%, and wheezing by 50 % to 60% of the patients. The symptoms were mostly of mild or moderate intensity and varied during the day and week, predominantly in the morning and at night. Multiple regression analysis showed that the presence and intensity of symptoms were positively associated with CAT and total SGRQ scores. Conclusion: The results show that smokers, former smokers and patients with COPD show frequent respiratory symptoms regardless of the intensity of airway obstruction, which occurred mainly in the morning and at night, and to a lesser extent in the afternoon. Patients in the more severe stages of COPD had significantly greater impairment in most of the outcomes evaluated. Detailed questioning of symptoms helps assess the negative impact of smoking and COPD on patients' daily lives.
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Palavras-chave
Doença Pulmonar Obstrutiva Crônica, Tabagismo, Sintomas, Qualidade de Vida, Chronic Obstructive Pulmonary Disease, Smokers, Symptoms, Quality life