Efficacy of the FEV1/FEV6 ratio compared to the FEV1/FVC ratio for the diagnosis of airway obstruction in subjects aged 40 years or over

The present cross-sectional, population-based study was designed to evaluate the performance of the FEV1/FEV6 ratio for the detection of airway-obstructed subjects compared to the FEV1/FVC <0.70 fixed ratio test, as well as the lower limit of normality (LLN) for 1000 subjects ³40 years of age in the metropolitan area of São Paulo, SP, Brazil. After the exclusion of 37 (3.7%) spirometries, a total of 963 pre-bronchodilator (BD) and 918 post-BD curves were constructed. The majority of the post-BD curves (93.1%) were of very good quality and achieved grade A (762 curves) or B (93 curves). The FEV1/FEV6 and FEV1/FVC ratios were highly correlated (r² = 0.92, P < 0.000). Two receiver operator characteristic curves were constructed in order to express the imbalance between the sensitivity and specificity of the FEV1/FEV6 ratio compared to two FEV1/FVC cut-off points for airway obstruction: equal to 70 (area under the curve = 0.98, P < 0.0001) and the LLN (area under the curve = 0.97, P < 0.0001), in the post-BD curves. According to an FEV1/FVC <0.70, the cut-off point for the FEV1/FEV6 ratio with the highest sum for sensitivity and specificity was 0.75. The FEV1/FEV6 ratio can be considered to be a good alternative to the FEV1/FVC ratio for the diagnosis of airway obstruction, both using a fixed cut-off point or below the LLN as reference. The FEV1/FEV6 ratio has the additional advantage of being an easier maneuver for the subjects and for the lung function technicians, providing a higher reproducibility than traditional spirometry maneuvers.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de Pneumologia e Centro de Reabilitação PulmonarUniversidade Católica do SalvadorFaculdade de Tecnologia e CiênciasNational Institute of Respiratory DiseasesUniversidade Federal da Bahia Disciplina de PneumologiaUniversidade Federal de Pelotas Programa de Pós-graduação em EpidemiologiaPLATINO GroupUNIFESP, EPM, Disciplina de Pneumologia e Centro de Reabilitação PulmonarSciEL

Chronic obstructive pulmonary disease is underdiagnosed and undertreated in São Paulo (Brazil): results of the PLATINO study

Chronic obstructive pulmonary disease (COPD) is a common disease in adults over 40 years of age and has a great social and economic impact. It remains little recognized and undertreated even in developed countries. However, there are no data about its diagnosis and treatment in Brazil. The objectives of the present study were to evaluate the proportion of COPD patients who had never been diagnosed and to determine if the COPD patients who had been identified were receiving appropriate treatment. The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was a randomized epidemiological study of adults over 40 years living in five metropolitan areas, including São Paulo. The studied sample was randomly selected from the population after a division of the metropolitan area of São Paulo in clusters according to social characteristics. All subjects answered a standardized questionnaire on respiratory symptoms, history of smoking, previous diagnosis of lung disease, and treatments. All subjects performed spirometry. The criterion for the diagnosis of COPD was defined by a post-bronchodilator FEV1/FVC ratio lower than 0.7. A total of 918 subjects were evaluated and 144 (15.8%) met the diagnostic criterion for COPD. However, 126 individuals (87.5%) had never been diagnosed. This undiagnosed group of COPD patients had a lower proportion of subjects with respiratory symptoms than the previously diagnosed patients (88.9 vs 54.8%) and showed better lung function with greater FEV1 (86.8 ± 20.8 vs 68.5 ± 23.6% predicted) and FVC (106.6 ± 22.4 vs 92.0 ± 24.1% predicted). Among the COPD patients, only 57.3% were advised to stop smoking and 30.6% received the influenza vaccine. In addition, 82.3% did not receive any pharmacological treatment. In conclusion, COPD is underdiagnosed and a large number of COPD patients are not treated appropriately.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Centro de Reabilitação PulmonarUniversidade Federal da BahiaUniversidade Católica de Salvador Faculdade de Tecnologia e CiênciasUniversidade Federal de Pelotas Programa de Pós-graduação em EpidemiologiaNational Institute of Respiratory DiseasesPLATINO GroupUNIFESP, EPM, Centro de Reabilitação PulmonarSciEL

Prevalência de doenças crônicas autorrelatadas em indivíduos acima de 40 anos em São Paulo, Brasil: estudo Platino

Few studies have been conducted to determine the prevalence of chronic diseases and its impact in individuals aged 40 years or over in Brazil. The objective of this study is to evaluate the prevalence of some common chronic diseases in the Brazilian subgroup assessed by the PLATINO study using a self-reported survey. A total of 918 individuals (55% women) with a mean age of 54.6 ± 10.9 years were evaluated. The most prevalent diseases were obesity (62.5%), hypertension (39.2%) and gastritis (30.9%). We conclude from this study that there is a high prevalence of chronic diseases in the population over 40 years of age: 88% of the population suffers from a minimum of one disease and 26% of the sample suffers from at least three diseases. We also observed that the number of comorbidities increases with age.Poucos estudos foram desenvolvidos para determinar a prevalência de doenças crônicas e suas associações em indivíduos com mais de 40 anos de idade no Brasil. O objetivo deste trabalho foi avaliar a prevalência de algumas doenças crônicas altamente prevalentes no país, de modo autorreferido, avaliadas no Estudo PLATINO em São Paulo, em uma amostra de base populacional. Novecentos e dezoito indivíduos (55% mulheres) com média de idade de 54,6 ± 10,9 anos foram avaliados. As três doenças mais prevalentes foram obesidade (62,5%), hipertensão (39,2%) e gastrite (30,9%). Há uma alta prevalência de doenças crônicas na população acima de 40 anos: 88% da amostra apresentaram pelo menos uma doença e 26%, pelo menos, três doenças; e o número de doenças apresentava tendência a aumentar com a idade.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP)Lar Escola São FranciscoUniversidade Federal de Pelotas Faculdade de MedicinaInstituto Nacional de Enfermedades RespiratoriasUNIFESPSciEL

PLATINO, estudo de seguimento de nove anos sobre DPOC na cidade de São Paulo: o problema do subdiagnóstico

OBJECTIVE:To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase.METHODS:The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase.RESULTS:The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD.CONCLUSIONS:The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention.OBJETIVO:Determinar a taxa de subdiagnóstico em novos casos de DPOC em uma amostra de pacientes após nove anos de seguimento do estudo Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO) e compará-la à taxa de subdiagnóstico obtida na fase inicial do estudo, assim como identificar as características clínicas dos indivíduos subdiagnosticados na fase de seguimento.MÉTODOS:A população desse estudo foi composta por 1.000 residentes na cidade de São Paulo que fizeram parte do estudo PLATINO. Desses, 613 indivíduos participaram da fase de seguimento. Os indivíduos foram avaliados utilizando-se os mesmos instrumentos e equipamentos na fase inicial do estudo. O teste do qui-quadrado ou o teste t para amostras independentes foi utilizado para analisar a taxa de subdiagnóstico e identificar as características dos indivíduos subdiagnosticados durante a fase de seguimento.RESULTADOS:A taxa de subdiagnóstico para novos casos da DPOC após nove anos de acompanhamento foi de 70,0%. A taxa de subdiagnóstico na fase de seguimento foi 17,5% menor que a da fase inicial do estudo. Os indivíduos subdiagnosticados na fase de seguimento apresentavam poucos sintomas respiratórios, função pulmonar mais preservada e menor gravidade da doença do que aqueles previamente diagnosticados com DPOC.CONCLUSÕES:A taxa de subdiagnóstico na fase de seguimento foi menor que a da fase inicial do estudo. Os indivíduos subdiagnosticados na fase de seguimento do estudo PLATINO apresentavam o mesmo perfil clínico daqueles subdiagnosticados na fase inicial. Esses achados reforçam a necessidade da utilização da espirometria para o diagnóstico de DPOC e possibilitar a intervenção precoce.Federal University of São PauloSao Camilo University Center Department of Physical TherapyFederal University of São Paulo Department of PulmonologyInstituto Nacional de Enfermedades RespiratoriasFederal University of Pelotas School of Medicine Department of Clinical MedicineUNIFESP, Department of PulmonologySciEL

Competencias enfermeras en el ámbito clínico en una Unidad de Cuidados Intensivos Polivalente mediante un estudio fenomenológico

Ponencia presentada en CUALISALUD 2017, XII Reunión Internacional de Investigación Cualitativa en Salud "Narrativas, fuente de evidencias cualitativas", reunión digital celebrada del 16 al 17 de noviembre de 2017, organizada por Fundación Index.Algunos estudios apoyan que la especialización en cuidados mejora los resultados en la atención, es por tanto, que se debe asegurar una formación acorde a determinados puestos laborales(1). En muchos países, se está optando por la creación de programas formativos al respecto. Sobre todo, ante las evidencias demostradas por Aiken et al, donde los niveles educativos del personal de enfermería afectan a la mortalidad(2). A pesar de que estamos en el Espacio Europeo de Educación Superior (EEES), las diferentes soluciones propuestas por Lakanmaa et al desde Finlandia, no son simétricas a las que se pueden desarrollar en el Sistema Nacional de Salud Español(3,4). En el ámbito del cuidado al paciente crítico se han diseñado diferentes instrumentos de medida como el Intensive and Critical Care Nursing Competence Scale (ICCN-CS)(3,4) y el Basic Knowledge Assesment Tool, versión 7 (BKAT-7) (5), todos ellos surgidos a partir de las necesidades detectadas al respecto por la European Federation of Critical Care Nurses Association (EfCCNa), para homogeneizar los cuidados intensivos en Europa(6). La necesidad de formación detectada no procede únicamente de las asociaciones y sociedades científicas, sino también de las propias enfermeras, quienes observan carencias en formación en competencias específicas. Existe la necesidad de preguntarse, que competencias son necesarias en cada unidad (4) e incluso valorar, que demandan las propias enfermeras en su propio contexto laboral(7– 9) sin dejar atrás, que la formación continua es un puente hacia la excelencia de los cuidados, que se practican en estas áreas supertecnificadas(10), y esto puede evitar el riesgo que puede suponer la falta de formación en estas unidades(11). Es por ello, que se plantea como objetivo conocer las competencias en el ámbito clínico que detectan enfermeras de UCI son necesarias en su realidad laboral a través de sus vivencias y experiencias laborales

Health status perception and airflow obstruction in five Latin American cities: the PLATINO study

Background: COPD is a highly prevalent disease but underdiagnosed, undertreated and possibly under-recognized by patients. Limited information exists regarding patients' perception of COPD severity. We compared patients' general, health status perception, degree of breathlessness and physical activity limitation with the severity of their respiratory condition measured by airway obstruction, in a population-based sample.Methods: We used postbronchodilator FEV(1)/FVC < 0.70 to define COPD. Patients' perception of their general. health status was derived from the question in general, you would say that your health is: excellent, very good, good, fair or poor?Results: Spirometry was performed in 5314 subjects: an FEV(1)/FVC ratio below 0.70 was found in 759 subjects. in persons with COPD, general. health status decreased with increasing GOLD stages. Over one-half of subjects with stage 2 and one third of those with stages 3 and 4 reported their health status as good to excellent. There was also a disparity between airway obstruction severity and breathlessness intensity. Although the more severe COPD stages were frequently associated with significant compromise of work and everyday activities, patients often tended to provide an optimistic self evaluation of their health status.Conclusions: the discrepancy observed between general health status, dyspnea severity, physical activity limitation and airway obstruction most likely reflect patients' underperception of disease severity, emphasizing the need for improving case-finding measures and multi-component evaluation of COPD subjects. (C) 2009 Elsevier B.V. All rights reserved.Boehringer Ingelheim GmbHCent Univ Venezuela, Hosp Univ Caracas, Serv Neumonol, Caracas 1030, VenezuelaUniv Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90066 USAInst Resp Dis, Mexico City 14080, DF, MexicoUniv Republica, Hosp Maciel, Montevideo, UruguayUniversidade Federal de São Paulo, BR-04021070 São Paulo, BrazilPontificia Univ Catolica Chile, Dept Salud Publ, Santiago, ChilePontificia Univ Catolica Chile, Catedra Neumol, Santiago, ChileUniv Fed Pelotas, Fac Med, BR-96030002 Pelotas, RS, BrazilUniversidade Federal de São Paulo, BR-04021070 São Paulo, BrazilWeb of Scienc

Chronic obstructive pulmonary disease and body mass index in five Latin America cities: the PLATINO study

Background: the body mass index (BMI) is a prognostic factor for chronic obstructive pulmonary disease (COPD). Despite its importance, little information is available regarding BMI alteration in COPD from a population-based study. We examined characteristics by BMI categories in the total and COPD populations in five Latin-American cities, and explored the factors influencing BMI in COPD.Methods: COPD was defined as a postbronchodilator forced expiratory volume in the first second/forced vital capacity (FEV(1)/FVC)= 30.0 kg/m(2)).Results: Interviews were completed in 5571 subjects from 6711 eligible individuals, and spirometry was performed in 5314 subjects. There were 759 subjects with COPD and 4555 without COPD. Compared with the non-COPD group, there was a higher proportion of COPD subjects in the underweight and normal weight categories, and a lower proportion in the obese category. Over one-half COPD subjects had BMI over 25 kg/m(2). No differences in BMI strata among countries were found in COPD subjects. Factors associated with lower BMI in mates with COPD were aging, current smoking, and global initiative for chronic obstructive lung disease (GOLD) stages III - IV, whereas wheeze and residing in Santiago and Montevideo were associated with higher BMI. in females with COPD, current smoking, lower education, and GOLD stages II - IV were associated with lower BMI, while dyspnea and wheeze were associated with higher BMI.Conclusions: BMI alterations are common in COPD with no significant differences among countries. Current smoking, age, GOLD stages, education level, residing in Santiago and Montevideo, dyspnea and wheeze were independently associated with BMI in COPD. (c) 2008 Elsevier B.V. All rights reserved.Cent Univ Venezuela, Fac Med, Hosp Univ Caracas, Serv Neumonol, Caracas 1030, VenezuelaInst Resp Dis, Mexico City 14080, DF, MexicoUniversidade Federal de São Paulo, BR-04021070 São Paulo, BrazilUniv Republica, Hosp Maciel, Fac Med, Montevideo 2610, UruguayPontificia Univ Catolica Chile, Fac Med, Dept Salud Publ, Santiago, ChileUniv Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90066 USAUniv Fed Pelotas Duque Caxias, Fac Med, Pelotas, RS, BrazilUniversidade Federal de São Paulo, BR-04021070 São Paulo, BrazilWeb of Scienc

Accelerated Variant of Idiopathic Pulmonary Fibrosis: Clinical Behavior and Gene Expression Pattern

Idiopathic pulmonary fibrosis (IPF) is characterized by the insidious onset of dyspnea or cough. However, a subset of patients has a short duration of symptoms with rapid progression to end-stage disease. In this study, we evaluated clinical and molecular features of "rapid" and "slow" progressors with IPF

La altitud modifica la relación entre la PaO2/FiO2 y el cortocircuito: impacto en la valoración de la lesión pulmonar aguda

El cociente presión arterial de oxígeno/fracción inspiratoria de oxígeno (PaO2/FiO2) se utiliza comúnmente para definir el grado de lesión pulmonar y el síndrome de insuficiencia respiratoria progresiva del adulto. En el presente trabajo se analizan las modificaciones que experimenta el índice con la altura sobre el nivel del mar y con los cortocircuitos en modelos computacionales de pulmón. El cociente PaO2/FiO2 disminuye con la altura sobre el nivel del mar al mismo cortocircuito. Por lo tanto, los pacientes que residen a alturas considerables sobre el nivel del mar tienen un cortocircuito menor y presumiblemente un grado de daño pulmonar menor que los residentes al nivel del mar en el momento de cumplir el criterio de síndrome de insuficiencia respiratoria progresiva del adulto con un cociente PaO2/FiO2 de 200 Torr. Esta variación debe tomarse en cuenta para la comparación de pacientes cuando provienen de alturas diferentes e indica que se ha de utilizar más frecuentemente la medición directa del cortocircuito o bien el cortocircuito calculado, asumiendo una diferencia arteriovenosa del contenido de oxígeno constant