The importance of knowing the home conditions of patients receiving long-term oxygen therapy

Ilda Godoy,1 Suzana Erico Tanni,2 Carme Hernández,3 Irma Godoy21Department of Nursing, Botucatu School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil; 2Department of Pulmonology, Botucatu School of Medicine, Universidade Estadual Paulista, São Paulo, Brazil; 3Integrated Care Unit, Hospital Clinic, Barcelona, SpainPurpose: Long-term oxygen therapy (LTOT) is one of the main treatments for patients with chronic obstructive pulmonary disease. Patients receiving LTOT may have less than optimal home conditions and this may interfere with treatment. The objective of this study was, through home visits, to identify the characteristics of patients receiving LTOT and to develop knowledge regarding the home environments of these patients.Methods: Ninety-seven patients with a mean age of 69 plus or minus 10.5 years were evaluated. This study was a cross-sectional descriptive analysis. Data were collected during an initial home visit, using a questionnaire standardized for the study. The results were analyzed retrospectively.Results: Seventy-five percent of the patients had chronic obstructive pulmonary disease, and 11% were active smokers. The patients’ mean pulse oximetry values were 85.9% plus or minus 4.7% on room air and 92% plus or minus 3.9% on the prescribed flow of oxygen. Most of the patients did not use the treatment as prescribed and most used a humidifier. The extension hose had a mean length of 5 plus or minus 3.9 m (range, 1.5–16 m). In the year prior to the visit, 26% of the patients received emergency medical care because of respiratory problems. Few patients reported engaging in leisure activities.Conclusion: The home visit allowed us to identify problems and interventions that could improve the way LTOT is used. The most common interventions related to smoking cessation, concentrator maintenance and cleaning, use of a humidifier, and adjustments of the length of the connector hose. Therefore, the home visit is a very important tool in providing comprehensive care to patients receiving LTOT, especially those who show lack of adequate progress and those who show uncertainty about the treatment method.Keywords: LTOT, home visits, chronic obstructive pulmonary disease (COPD), treatment complianc

Relation between systemic inflammatory markers, peripheral muscle mass, and strength in limb muscles in stable COPD patients

Renata Ferrari,1 Laura MO Caram,1 Marcia M Faganello,2 Fernanda F Sanchez,3 Suzana E Tanni,1 Irma Godoy1 1Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu, São Paulo, 2Paulista State University, Department of Physiotherapy and Occupational Therapy, Marilia, São Paulo, 3Federal University of Amazonas, Department of Physiotherapy, Manaus, Amazonas, Brazil Abstract: The aim of this study was to investigate the association between systemic inflammatory mediators and peripheral muscle mass and strength in COPD patients. Fifty-five patients (69% male; age: 64±9 years) with mild/very severe COPD (defined as forced expiratory volume in the first second [FEV1] =54%±23%) were evaluated. We evaluated serum concentrations of IL-8, CRP, and TNF-α. Peripheral muscle mass was evaluated by computerized tomography (CT); midthigh cross-sectional muscle area (MTCSA) and midarm cross-sectional muscle area (MACSA) were obtained. Quadriceps, triceps, and biceps strength were assessed through the determination of the one-repetition maximum. The multiple regression results, adjusted for age, sex, and FEV1%, showed positive significant association between MTCSA and leg extension (0.35 [0.16, 0.55]; P=0.001), between MACSA and triceps pulley (0.45 [0.31, 0.58]; P=0.001), and between MACSA and biceps curl (0.34 [0.22, 0.47]; P=0.001). Plasma TNF-α was negatively associated with leg extension (-3.09 [-5.99, -0.18]; P=0.04) and triceps pulley (-1.31 [-2.35, -0.28]; P=0.01), while plasma CRP presented negative association with biceps curl (-0.06 [-0.11, -0.01]; P=0.02). Our results showed negative association between peripheral muscle mass (evaluated by CT) and muscle strength and that systemic inflammation has a negative influence in the strength of specific groups of muscles in individuals with stable COPD. This is the first study showing association between systemic inflammatory markers and strength in upper limb muscles. Keywords: Inflammation, skeletal muscle, X-Ray Computed Tomograph

Predictors of mortality in patients with COPD after 9 years

Robson Prudente,1 Estefânia Aparecida Thomé Franco,2 Carolina Bonfanti Mesquita,1 Renata Ferrari,1 Irma de Godoy,1 Suzana Erico Tanni1 1Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil; 2University Hospital of São Paulo State University (UNESP), Medical School, Botucatu, São Paulo, Brazil Background: COPD is one of the leading causes of morbidity and mortality in the world; however, the most varied amounts of clinical and laboratory characteristics acts in different ways in the mortality among over time. Therefore, this study aimed to evaluate the predictors of mortality in patients with COPD after 9 years.Patients and methods: One hundred and thirty-three patients with COPD were assessed at baseline by spirometry, pulse oximetry (SpO2), body composition, intensity of dyspnea, distance walked in the 6-minute walk test (6MWT), and Charlson Comorbidity Index (CCI).Results: After 9 years, it was not possible to identify the lifetime of 4 patients who died and of 19 patients who stopped follow-up; thus, 110 patients were included in the analysis of predictors of mortality (67% male, 65±9 years old, and FEV1: 52.5 [40%–73%]). Male sex, age, SpO2, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, and frequency of exacerbations in the first 3 years of follow-up were considered in the model. Patients classified at baseline with BODE class 2 (HR: 2.62, 95% CI: 1.36–5.04; P=0.004), BODE class 3 (HR: 2.54, 95% CI: 1.15–5.61; P=0.02), and BODE class 4 (HR: 15.35, 95% CI: 3.11–75.75; P=0.001) showed increased risk of death compared to those with BODE class 1. The CCI (HR: 1.29, 95% CI: 1.00–1.68; P=0.04) and the number of exacerbations in the first 3 years (HR: 1.32, 95% CI: 1.00–1.76; P=0.04) also showed increased risk of death. By replacing the BODE index for the variables that compose it, those with body mass index ≤21 kg/m2 showed increased risk of death compared to those with body mass index (BMI)>21 kg/m2 (HR: 2.70, 95% CI: 1.38–5.25; P=0.003).Conclusion: After 9 years, we identified that those with high BODE index, greater CCI, greater frequency of exacerbations in the first 3 years, and BMI ≤21 kg/m2 showed increased risk of death. Keywords: COPD, disease severity index, mortality&nbsp

Tumor necrosis factor receptor 2 as a possible marker of COPD in smokers and ex-smokers

Laura Miranda de Oliveira Caram,1 R Ferrari,1 DL Nogueira,1 MRM Oliveira,2 FV Francisqueti,2 SE Tanni,1 CR Corrêa,2 I Godoy1 1Department of Internal Medicine, 2Department of Pathology, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu Campus, Botucatu-São Paulo, Brazil Introduction: Oxidative stress and systemic inflammation are higher in smokers and patients with COPD; however, markers that may help differentiate between smokers and patients with COPD have not yet been identified. We hypothesized that tumor necrosis factor-alpha receptor (TNFR) and soluble form of the receptor for advanced glycation end products (sRAGE) can be indicators of COPD in asymptomatic patients.Patients and methods: We evaluated 32 smokers (smoking history >10 pack-years), 32 patients with mild/moderate COPD (smokers and ex-smokers), and 32 never smokers. Concentrations of C-reactive protein (CRP), interleukin (IL)-6, TNFR1 and TNFR2, advanced glycation end products (AGEs), and the sRAGE were measured in serum.Results: There were higher CRP and AGEs concentrations in smokers and in patients with COPD (P<0.001 and P=0.01, respectively) compared to controls, without statistical difference between smokers and patients with COPD. Concentrations of sRAGE, IL-6, and TNFR1 did not differ between study groups. TNFR2 was significantly higher in patients with COPD than in smokers (P=0.004) and controls (P=0.004), and the presence of COPD (P=0.02) and CRP (P=0.001) showed a positive association with TNFR2. Positive associations for smoking (P=0.04), CRP (P=0.03), and IL-6 (P=0.03) with AGEs were also found. The interaction variable (smoking × COPD) showed a positive association with IL-6.Conclusion: Our data suggest that TNFR2 may be a possible marker of COPD in asymptomatic smokers and ex-smokers. Although smokers and patients with early COPD presented other increased systemic inflammation markers (eg, CRP) and oxidative stress (measured by AGEs), they did not differentiate smokers from COPD. Keywords: smoking, chronic obstructive pulmonary disease, inflammation mediators, oxidative stress&nbsp