Atenção ao idoso com doenças respiratórias crônicas no contexto da estratégia saúde da família
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Data
2019-06-18
Autores
Ferreira, Aline Duarte [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Entre as condições crônicas de saúde, cerca de um terço dos atendimentos nas unidades de atenção básica em todo o mundo se devem às Doenças Respiratórias Crônicas. Entre elas, a asma e doença pulmonar obstrutiva crônica (DPOC) são as mais comuns. É necessário, portanto, que os profissionais das equipes da saúde da família estejam preparados para lidar com a doença, e que possam ofertar um melhor tratamento e acompanhamento do doente. Objetivos: verificar a associação das variáveis espirométricas e sintomas respiratórios com diagnóstico clínico prévio de doença respiratória crônica em idosos na atenção primária à saúde; avaliar a eficácia de três questionários de sintomas respiratórios para indicar a possibilidade de distúrbio ventilatório obstrutivo de idosos com diagnóstico prévio de DPOC. Métodos: estudo transversal, observacional com idosos com diagnóstico clínico de doença respiratória crônica como enfisema, bronquite crônica, DPOC e asma brônquica, em oito unidades de Estratégia Saúde da Família randomizadas no interior de São Paulo. Os idosos com DPOC foram divididos em dois grupos a partir dos critérios espirométricos: grupo controle com espirometria normal (G1) e grupo DPOC com distúrbio ventilatório obstrutivo (G2). Foram avaliados dados socioeconômicos, medicação prescrita e exacerbações, função pulmonar por espirometria e o impacto dos sintomas por COPD Assessment Test (CAT), dispneia pela escala do Medical Research Council modificada (mMRC) e percepção da qualidade de vida pelo Chronic Respiratory Questionnaire (CRQ). Resultados: Foram registrados 4.332 idosos e prevalência de 3,12% com doença respiratória crônica. Foram incluídos 89 idosos (48 mulheres, 70,7±6,4 anos e 41 homens, 72,6±7,3 anos). Apenas 24% dos idosos faziam uso de medicação para doenças respiratórias e 12% sofreram exacerbação uma vez no último ano. Destes idosos, 46 apresentaram diagnóstico clínico de DPOC e 37% apresentaram espirometria normal (VEF1/CVF=0,798±0,06). O G1 obteve menor pontuação no CAT que o G2 (p=0,005). Notou-se tendência de sensibilidade e especificidade do CAT para detectar obstrução (p=0,050). O mMRC e CAT se correlacionaram (r=0,61; p˂0,0001). Houve correlação negativa entre CAT e espirometria: VEF1 (r=-0,387; p=0,012) e VEF1/CVF (r=-0,422; p=0,006). O mMRC apresentou correlação negativa apenas com VEF1 (r=-0,353; p=0,023). Conclusão: o CAT mostrou tendência de confiabilidade para indicar obstrução de vias aéreas, o que direciona com maior precisão a necessidade de se realizar espirometria. Além disso, o mMRC pode ser utilizado em conjunto com o CAT. O uso desses instrumentos deve ser encorajado na rotina de atendimentos na atenção primária.
Introduction: Among chronic health conditions, about one third of primary care units around the world are due to Chronic Respiratory Diseases. Among them, asthma and chronic obstructive pulmonary disease (COPD) are the most common. Therefore, it is necessary that family health team professionals are prepared to deal with the disease, and that they can offer better treatment and monitoring of the patient. Objectives: to verify the association of spirometric variables and respiratory symptoms with a previous clinical diagnosis of chronic respiratory disease in elderly in primary health care; to evaluate the efficacy of three respiratory symptom questionnaires to indicate obstructive ventilatory disorder in elderly with a previous diagnosis of COPD. Methods: cross-sectional, observational study of elderly with clinical diagnosis of chronic respiratory disease as emphysema, chronic bronchitis, COPD and bronchial asthma, in eight Family Health Strategy units randomized in the interior of Sao Paulo. The elderly with COPD were divided into two groups based on spirometric criteria: control group with normal spirometry (G1) and COPD group with obstructive ventilatory disorder (G2). Socioeconomic data, prescribed medication and exacerbations, lung function by spirometry and the impact of symptoms by COPD Assessment Test (CAT), dyspnea to Medical Research Council modified scale (mMRC) and perception of quality of life by Chronic Respiratory Questionnaire (CRQ). Results: 89 elderly were included (48 women, 70.7 ± 6.4 years and 41 men, 72.6 ± 7.3 years). Only 24% of the elderly were taking medication for respiratory diseases and 12% were exacerbated once in the last year. Of these elderly, 46 had a clinical diagnosis of COPD and 37% had normal spirometry (FEF1/FVC=0,798±0,06). G1 scored lower on CAT than G2 (p=0,005). CAT sensitivity and specificity tendency to detect obstruction (p=0,050). MMRC and CAT correlated (r=0,61; p˂0,0001). There was a negative correlation between CAT and spirometry: FEV1 (r=-0,387; p=0,012) e FEV1/FVC (r=-0,422; p=0,006). MMRC was negatively correlated with FEV1 only (r=-0,353; p=0,023). Conclusion: CAT showed a tendency for reliability to indicate airway obstruction, which more accurately addresses the need for spirometry. In addition, mMRC can be used in conjunction with CAT. The use of these instruments should be encouraged in routine care in primary care.
Introduction: Among chronic health conditions, about one third of primary care units around the world are due to Chronic Respiratory Diseases. Among them, asthma and chronic obstructive pulmonary disease (COPD) are the most common. Therefore, it is necessary that family health team professionals are prepared to deal with the disease, and that they can offer better treatment and monitoring of the patient. Objectives: to verify the association of spirometric variables and respiratory symptoms with a previous clinical diagnosis of chronic respiratory disease in elderly in primary health care; to evaluate the efficacy of three respiratory symptom questionnaires to indicate obstructive ventilatory disorder in elderly with a previous diagnosis of COPD. Methods: cross-sectional, observational study of elderly with clinical diagnosis of chronic respiratory disease as emphysema, chronic bronchitis, COPD and bronchial asthma, in eight Family Health Strategy units randomized in the interior of Sao Paulo. The elderly with COPD were divided into two groups based on spirometric criteria: control group with normal spirometry (G1) and COPD group with obstructive ventilatory disorder (G2). Socioeconomic data, prescribed medication and exacerbations, lung function by spirometry and the impact of symptoms by COPD Assessment Test (CAT), dyspnea to Medical Research Council modified scale (mMRC) and perception of quality of life by Chronic Respiratory Questionnaire (CRQ). Results: 89 elderly were included (48 women, 70.7 ± 6.4 years and 41 men, 72.6 ± 7.3 years). Only 24% of the elderly were taking medication for respiratory diseases and 12% were exacerbated once in the last year. Of these elderly, 46 had a clinical diagnosis of COPD and 37% had normal spirometry (FEF1/FVC=0,798±0,06). G1 scored lower on CAT than G2 (p=0,005). CAT sensitivity and specificity tendency to detect obstruction (p=0,050). MMRC and CAT correlated (r=0,61; p˂0,0001). There was a negative correlation between CAT and spirometry: FEV1 (r=-0,387; p=0,012) e FEV1/FVC (r=-0,422; p=0,006). MMRC was negatively correlated with FEV1 only (r=-0,353; p=0,023). Conclusion: CAT showed a tendency for reliability to indicate airway obstruction, which more accurately addresses the need for spirometry. In addition, mMRC can be used in conjunction with CAT. The use of these instruments should be encouraged in routine care in primary care.
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Palavras-chave
Pneumopatias obstrutivas, Atenção primária à saúde, Espirometria, Obstructive pulmonary disease, Spirometry