Calidad de vida relacionada a la salud en pacientes con enfermedad pulmonar obstructiva crónica en Pereira, Colombia

La Enfermedad Pulmonar Obstructiva Crónica (EPOC) se caracteriza por limitación crónica al flujo aéreo con cambios patológicos pulmonares y significativos cambios extrapulmonares ocasionando importantes cambios en la calidad de vida de quien la padece. Objetivo: describir la calidad de vida relacionada a la salud (CVRS) en pacientes con EPOC que asisten a consulta en un centro de atención primaria en la ciudad de Pereira, Colombia. Materiales y método: se realizó un estudio descriptivo transversal que incluyó a 43 pacientes de ambos sexos con 40 años de edad o más, con diagnóstico confirmado de EPOC, que asistieron a consulta en un centro de atención primaria de la ciudad de Pereira entre junio a diciembre del 2019 y cumplieron criterios de inclusión; se evaluó CVRS mediante el cuestionario Chronic Respiratory Disease Questionnaire. Resultados: la caracterización sociodemográfica de los pacientes reportó edades promedio 67,8 ±7,8 años, y el género que predominó fue el masculino con un 67,4%. El puntaje total del cuestionario en CVRS, tuvo como mediana para el grupo de estudio de 4,9 (Irq, ±1,1). No hubo diferencias significativas por sexo ni edad. La disnea fue la dimensión con menor puntaje, comparativamente con las demás dimensiones del cuestionario. Conclusión: la Disnea es el principal síntoma con mayor impacto en las actividades de la vida cotidiana de los pacientes e induce a la sensación de fatiga y agrava la percepción del impacto de la enfermedad en sus vidas.

Validación del puntaje de valoración de la gravedad de la enfermedad pulmonar obstructiva crónica en población colombiana en un servicio de atención primaria

Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es un importante problema de salud mundial con una alta morbimortalidad. Se requiere la medición de la gravedad de la enfermedad mediante una herramienta de fácil aplicación, bajo costo y fácil disponibilidad en áreas rurales.Objetivo. Evaluar la validez y confiabilidad del puntaje de valoración de la gravedad de la EPOC (Chronic Obstructive Pulmonary Disease Severity Score, COPDSS) en una población de atención primaria en Colombia.Materiales y métodos. Se hizo un estudio de corte transversal en una muestra de 100 pacientes con diagnóstico de EPOC según las guías GOLD. La validez concurrente se evaluó correlacionando los resultados del COPDSS con otras variables de importancia como las del cuestionario sobre la enfermedad respiratoria crónica (Chronic Respiratory Disease Questionnaire, CRQ) y el volumen espiratorio forzado en el primer segundo (Forced Expiratory Volume in one second, FEV1).Resultados. El COPDSS presentó una correlación significativa con el FEV1 (r=-0,33), con el CRQ (r=-0,57) y sus dimensiones: disnea (r=0,51), fatiga (r=0,53), función emocional (r=0,43) y control de la enfermedad (r=0,50). En el análisis factorial se determinó un solo factor con una varianza acumulada de 59,1 %. El análisis de coherencia interna mostró un alfa de Cronbach de 0,76, valor este considerado adecuado.Conclusiones. Se observó que el uso del COPDSS como cuestionario de valoración de la gravedad de pacientes con EPOC en Colombia tenía validez y confiabilidad adecuadas y que es de fácil aplicación en la atención primaria.

Supervised pulmonary rehabilitation using minimal or specialist exercise equipment in COPD: a propensity-matched analysis

BackgroundMany trials supporting the benefits of pulmonary rehabilitation (PR) have used specialist exercise equipment, such as treadmills and cycle ergometers. However, access to specialist equipment may not be feasible in some settings. There is growing interest in delivering PR programmes with minimal, low-cost equipment, but uncertainty remains regarding their efficacy compared with programmes using specialist equipment.MethodsUsing propensity score matching, 318 consecutive patients with COPD undergoing supervised PR using minimal equipment (PR-min) were compared 1:1 with a control group of 318 patients with COPD who underwent supervised PR using specialist equipment (PR-gym). A non-inferiority analysis was performed for the primary outcome (incremental shuttle walk (ISW)) and secondary outcomes (Chronic Respiratory Disease Questionnaire (CRQ)—domain and total scores).ResultsSimilar improvements in ISW and CRQ-domains were observed in PR-min and PR-gym groups (mean difference ISW: 3 m (95% CI −16 to 9); CRQ-total: 0.9 (95% CI −2.7 to 4.5)). The 95% CI between group differences for ISW and CRQ-total did not cross the predefined non-inferiority margins. However, completion rates were lower in PR-min compared with PR-gym (64% vs 73%; p=0.014).ConclusionsIn patients with COPD, PR delivered using minimal equipment produces clinically significant benefits in exercise capacity and health-related quality of life that are non-inferior to rehabilitation delivered using specialist equipment. This study provides support for the provision of PR using minimal exercise equipment, particularly in areas where access to specialist exercise equipment is limited.

Short-Term Effects of Comprehensive Pulmonary Rehabilitation and its Maintenance in Patients with Idiopathic Pulmonary Fibrosis: A Randomized Controlled Trial

The recommendation for pulmonary rehabilitation (PR) in idiopathic pulmonary fibrosis (IPF) is weak with low-quality evidence. Therefore, the aim of this study is to investigate short-term PR effects and their maintenance after a 3-month follow-up. Fifty-four IPF patients were randomized into a group receiving a 3-week comprehensive, inpatient PR (n = 34, FVC: 74 ± 19% pred.) or usual care (UC) (n = 17, FVC: 72 ± 20%pred.). Outcomes were measured at baseline (T1), after intervention (T2), and 3 months after T2 (T3). A 6-min walk distance (6MWD) was used as the primary outcome and chronic respiratory disease questionnaire (CRQ) scores as the secondary outcome. Change in 6MWD from T1 to T2 (Δ = 61 m, 95% CI (18.5–102.4), p = 0.006) but not from T1 to T3 (∆ = 26 m, 95% CI (8.0–61.5), p = 0.16) differed significantly between groups. Higher baseline FVC and higher anxiety symptoms were significant predictors of better short-term 6MWD improvements. For the change in CRQ total score, a significant between-group difference from T1 to T2 (∆ = 3.0 pts, 95% CI (0.7–5.3), p = 0.01) and from T1 to T3 (∆ = 3.5 pts, 95% CI (1.5–5.4), p = 0.001) was found in favour of the PR group. To conclude, in addition to the short-term benefits, inpatient PR is effective at inducing medium-term quality of life improvements in IPF. PR in the early stages of the disease seems to provoke the best benefits.

Efectos de la rehabilitación pulmonar sobre calidad de vida y tolerancia al esfuerzo

Introducción: La rehabilitación pulmonar (RP) es una intervención que disminuye los síntomas de la Enfermedad Pulmonar Obstructiva Crónica (EPOC), incrementa la tolerancia al ejercicio, el estado emocional, la funcionalidad, la participación y la percepción de control de la enfermedad, mejorando la calidad de vida. Objetivo: Describir los efectos de la RP sobre dos escalas de calidad de vida y su influencia en la capacidad aeróbica funcional en pacientes con EPOC. Materiales y métodos: Estudio cuasiexperimental en pacientes que asistieron a RP. La capacidad aeróbica funcional se evaluó con el test de caminata de 6 minutos y la calidad de vida relacionada con la salud con los cuestionarios St. George Respiratory Questionnaire (SGRQ) y Chronic Respiratory Disease Questionnaire (CRQ-SAS). Resultados: Diferencias significativas en test de caminata de 6 minutos 51.9±44.5 metros; p<0.001. El SGRQ en actividad (inicial:65.9±16.8 y final 50.8±19.5; p<0.001), síntomas (inicial 45±17.9; final 33.6±16.8; p=0.005), impacto (inicial 40.5±16.4; final 31.8±18.1; p=0.004) y total (inicial 49.8±14.8; final 40.7±17.7; p=0.002). El CRQ-SAS en disnea (inicial 3.8±1.3; final 4.7±1.1; p<0.001), emocional (inicial 5.1±1 final 5.7±0.9; p<0.001) y total (inicial 4.6±0.9 final 5.3±0.8; p<0.001). Conclusiones: La RP favorece la calidad de vida evaluada con el SGRQ y el CRQ-SAS y la capacidad aeróbica funcional de los pacientes con EPOC.

0529 Behavioral Therapy Components for Insomnia and Fatigue in COPD

Introduction Insomnia contributes to fatigue, a common symptom in COPD. Our study aims were: (1) to determine the efficacy of a) cognitive behavioral therapy for insomnia (CBT-I) and b) COPD education (COPD-ED) on insomnia and fatigue, and (2) to define potential mechanistic contributors to pre/post intervention change in insomnia and fatigue in patients with COPD and insomnia. Methods A randomized 2x2 factorial design was used with factors representing CBT-I (yes/no) and COPD-ED (yes/no). Attention control (health videos) were used in the absence of CBT-I or COPD-ED. All patients received 6, 75-minute weekly sessions. Dependent variables included insomnia severity (Sleep Impairment Index (SII), range 0-28) and fatigue (Chronic Respiratory Disease Questionnaire (CRQ) range 1-7) measured at baseline, just post-intervention, and at 3-months post-intervention. Results One hundred nine patients (FEV1% predicted 67 ± 24% (mean ± SD), age 65 ± 8 years, SII 15.9 ± 8, CRQ 3.7 ± 1.1) participated in the study. After 6 sessions, insomnia decreased more in patients who received CBT-I (-5.8) than those who did not (-2.2; p=0.0002). This effect was sustained at the 3-month follow-up (p=0.0003). Fatigue showed no significant differences for CBT-I at 6-weeks (p=.27) but at 3-months patients receiving CBT-I showed marginally better improvement (.75, a clinically important difference) compared to those who did not receive CBT-I (.43; p=.09). COPD-ED showed no effect on insomnia or fatigue. Two main effects suggest mechanisms for the pre-post efficacy of CBT-I: improved sleep beliefs (p=0.0257) and self-efficacy for sleep (p=0.0619) after 6 sessions which were sustained at 3 months (p=0.0184 and p=0.0431 respectively). Conclusion CBT-I produced sustained decreases in insomnia in patients with COPD. Results suggest that changes in beliefs about sleep and improved self-efficacy for managing sleep may mediate CBT-I associated decreases in insomnia. Support This research was supported by the National Institute of Nursing Research of the National Institutes of Health R01NR013937.

Pulmonary rehabilitation in bronchiectasis: a propensity-matched study

International guidelines recommend pulmonary rehabilitation for patients with bronchiectasis, supported by small trials and data extrapolated from chronic obstructive pulmonary disease (COPD). However, it is unknown whether real-life data on completion rates and response to pulmonary rehabilitation are similar between patients with bronchiectasis and COPD.Using propensity score matching, 213 consecutive patients with bronchiectasis referred for a supervised pulmonary rehabilitation programme were matched 1:1 with a control group of 213 patients with COPD. Completion rates, change in incremental shuttle walk (ISW) distance and change in Chronic Respiratory Disease Questionnaire (CRQ) score with pulmonary rehabilitation were compared between groups.Completion rate was the same in both groups (74%). Improvements in ISW distance and most domains of the CRQ with pulmonary rehabilitation were similar between the bronchiectasis and COPD groups (ISW distance: 70 versus 63 m; CRQ-Dyspnoea: 4.8 versus 5.3; CRQ-Emotional Function: 3.5 versus 4.6; CRQ-Mastery: 2.3 versus 2.9; all p>0.20). However, improvements in CRQ-Fatigue with pulmonary rehabilitation were greater in the COPD group (bronchiectasis 2.1 versus COPD 3.3; p=0.02).In a real-life, propensity-matched control study, patients with bronchiectasis show similar completion rates and improvements in exercise and health status outcomes as patients with COPD. This supports the routine clinical provision of pulmonary rehabilitation to patients with bronchiectasis.

Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial

BackgroundStandardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD.MethodsA total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units.ResultsThere was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: −0.24, 95% CI −0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks.ConclusionsThe standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation.Trial registration numberISRCTN81189044.