Impacto de las deficiencias pulmonares y no pulmonares en el estado y progresión de la enfermedad y la discapacidad en personas con enfermedad pulmonar obstructiva crónica

Abstract

1. To determine the transition frequency between groups of GOLD 2011 classification, and to explore several non-pulmonary factors as possible predictors of worsening transitions, among patients with COPD over a 2-year follow-up. 2. To determine the impact of pulmonary impairment on non-pulmonary deficiencies and limitations on mobility activities in an elderly population with COPD.3. To describe the stability of the low and acceptable performance of the 6-minute walk test in COPD patients followed for 2 years. 4. To explore several non-pulmonary factors for their ability to predict poor 6MWT performance in stable COPD patients over a 2-year period.4 Potential eligible subjects were identified in the hospital&apos;s computer registry system. After review electronic files, they were contacted within the first 48-96 hours of admission. 107 patients and 87 caregivers participated. Methods: Longitudinal study. Area of Pneumology of Morales Meseguer Clinical Hospital in Murcia. A consecutive sample of patients were recruited from 2015 to 2016. of patients. Criteria for inclusion were: aged between 40 and 80 years and a diagnosis of stable COPD. Potential eligible subjects were identified in the hospital&apos;s registry system. After review electronic files, they were contacted, if they fulfilled the inclusion criteria, they were invited to participate. A sample of 137 subjects participated in the study, of which a subsample of 110 subjects was selected, with an age between 60 and 80 years to respond to objective 2. Sociodemographic, clinical and pulmonary and non-pulmonary data were collected, both at baseline (T0) and in the annual follow-up visits (T1 and T2). The sociodemographic variables were age, sex, and educational level. The clinical and pulmonary variables included: smoking history, number of exacerbations, number of comorbidities (Functional Comorbidities Index), spirometry tests, perceived health status (COPD Assessment Test), dyspnea (mMRC), anxiety and depression (HADS scale), and the GOLD 2011 classification. Non-pulmonary variables included: Short Physical Performance Battery (SPPB), strength tests (quadriceps, elbow, and handgrip), tolerance exercise (6-minute walk) and limitations in mobility activities (questionnaire described by Sternfeld). Conclusions: 1. Approximately one third of the patients in groups A, B and C present annual worsening transitions towards other more severe diagnostic groups in the GOLD 2011 classification. In contrast, around one fifth of the patients in groups B, C and D, which are susceptible to improvement, present improvement transitions. In general, there is a greater proportion of transitions from worsening than from improvement. 2. The non-pulmonary factors that predispose to an annual worsening towards a more severe state of the GOLD 2011 are: low quadriceps strength, a high number of limited mobility activities and a higher score on the BODE index. 3. The deterioration of lung function (FEV1) in elderly patients with COPD is associated with a decrease in the distance walked in the 6MM test and the SPPB, and with an increase in limited mobility activities. 4. Most COPD patients keep their performance on the 6MM test stable every two years. However, a third show relevant dynamics of change, both negative (towards a low performance <350 m) and positive. 5. The patients most predisposed to offering a low performance on the 6MM test biannually are those with lower quadriceps strength, poor performance on the 5STS test and with a greater number of limited mobility activities.