severe obstructive disease: similarities and differences between smoker and non-smoker patients with copd and/or bronchiectasis

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ID: 258899
2013
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Abstract
Introduction: Poorly reversible airflow obstruction may or may not be related to smoking. Objectives: To describe patients with severe obstructive lung disease including etiology, imaging, functional aspects, systemic manifestations, and the pattern of bronchodilator response. Methods: Sixty-eight patients (age 55.9 ± 13.7 years, FEV1 [forced expiratory volume in one second] 31.9 ± 10.2% predicted) underwent spirometry, evaluation of body mass composition, 6-minute walk test, X-ray, thorax high-resolution CT scanning, and clinical evaluation. Results: Of 68 patients enrolled, 37 had chronic obstructive pulmonary disease (COPD) and 31, extensive bronchiectasis. Among COPD patients the CT scans showed emphysema in 78.4%, and bronchiectasis in 48.6%. There were no significant differences between smokers and non-smokers, except for vital capacity, significantly smaller in non-smokers (p < 0.001). We found 29 and 20 volume responders (VR) according to Paré et al. (FEV1/FVC > 1 = flow responder or <1 = VR) and ATS/ERS criteria, respectively. According to Paré et al. criteria, there were 18 patients with FEV1 < 30% predicted among 29 VR, and 12 with FEV1 < 30% predicted among 39 without volume response (p = 0.0101). Conclusions: In patients with severe obstruction, smoking does not appear to be relevant in determining functional or systemic differences, and Paré et al. criteria can detect more VR. Bronchiectasis is a common finding in severe COPD. Resumo: Introdução: A obstrução das vias respiratórias pouco reversível pode ou não estar relacionada com o tabagismo. Objetivos: Descrever pacientes com doença pulmonar obstrutiva grave, incluindo etiologia, aspectos dos exames de imagem, parâmetros funcionais, manifestações sistémicas, e o padrão da resposta ao broncodilatador. Métodos: Sessenta e oito pacientes (idades de 55,9±13,7 anos, FEV1 [volume expiratório forçado num segundo] 31,9±10,2% previsto) foram submetidos a espirometria, avaliação da composição de massa corporal, teste de caminhada de 6 minutos, radiografia, tomografia computorizadas (TAC) de alta resolução do tórax, e avaliação clínica. Resultados: Dos 68 pacientes inscritos, 37 sofriam de doença pulmonar obstrutiva crónica (DPOC) e 31 de bronquiectasias extensa. Entre os pacientes com DPOC, as tomografias computadorizadas apresentaram enfisema em 78,4% e bronquietasias em 48,6%. Não existiram diferenças significativas entre os fumadores e os não-fumadores, exceto para a capacidade vital, significativamente inferior nos não-fumadores (p < 0,001). Encontramos 29 respondedores de volume (RV) pelos criterios de Paré et al. (VEF1/CVF > 1= respondedor de fluxo, se > 1 respondedor de volume), e 20 RV pelos criterios da ATS/ERS. De acordo com os critérios de Paré et al., existiam 18 pacientes com FEV1< 30% previsto entre os 29 RV, e 12 com FEV1 < 30% previsto entre os 39 sem resposta a uma prova de volume (p = 0,0101). Conclusões: Em pacientes com obstrução grave, o tabagismo não parece ser relevante na determinação de diferenças funcionais ou sistémicas, e os critérios de Paré et al. podem detetar mais RV. A bronquiectasias é uma descoberta comum em DPOC grave. Keywords: Airway obstruction, Respiratory function tests, Bronchitis, Bronchiectasis, Bronchodilator tests, Computed tomography of the thorax, Palavras-chave: Obstrução das Vias Respiratórias, Testes de Função Respiratória, Bronquite, Bronquiectasias, Testes de Broncodilatador, Tomografia de tórax
Reference Key
gon§alves2013revistasevere Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;J. Rezende Gonçalves;M. Corso Pereira;E.M. Figueiras Pedreira De Cerqueira;D. Oliveira Magro;M. Mello Moreira;I.A. Paschoal
Journal the journal of applied psychology
Year 2013
DOI
DOI not found
URL
http://www.sciencedirect.com/science/article/pii/S0873215912000979
Keywords
diseases of the respiratory system

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