Association between measurements of functionining and multidimensional severity indexes in COPD
Associação entre medidas de funcionalidade e índices multidimensionais de gravidade em DPOC
Filipe Tadeu Santanna Athayde, Eliane Viana Mancuzo, Luiza Costa Villela Ferreira, Lucas Banterli Vinhas, Ricardo Amorim Corrêa
Abstract
Introduction: The Chronic Obstructive Pulmonary Disease (COPD) develops as a multifactorial and complex disorder with highly varied clinical and functional manifestations. Objective: To verify correlations between functional variables and three classifications of disease severity and health risk in COPD patients. Methods: Forty-five stable COPD patients were enrolled in a cross-sectional study that assessed the level of activity of daily living by the London Chest Activity of Daily Living questionnaire (LCADL); disability by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); level of airway obstruction by the forced expiratory volume in the first second (FEV1 ); assessment of prognostic risk by the BODE index (Body mass index, airway Obstruction, Dyspnea and Exercise capacity); GOLD-COPD risk assessment (ABCD groups by FEV1 , dyspnea and history of exacerbations). Results: Significant correlations were found between LCDAL and BODE index (r=0.528; p=0.0001) and ABCD groups (r=0.491; p=0.001) as well as WHODAS 2.0 and BODE index (r=0.484; p=0.001) and ABCD groups (r=0.481; p=0.001). There was a significant negative correlation between FEV1 and LCADL was observed (r = -0.314; p=0.036), but not between FEV1 and WHODAS 2.0 (r = -0.225, p=0.138). Significant differences were found when comparing the LCADL and the WHODAS 2.0 between groups using the three classifications of disease severity and health risk. Conclusions: Patients with COPD present disabilities in terms of activities and social participation that correlate better with multidimensional severity indices than severity using spirometry. The usefulness of measurements of functioning and their correlation with the combined assessment of COPD risk requires evaluation in prospective studies.
Keywords
Resumo
Introdução: A Doença Pulmonar Obstrutiva Crônica (DPOC) desenvolve-se como uma afecção multifacetada e complexa, com manifestações clínicas e funcionais bastante variadas. Objetivo: Verificar a relação entre as variáveis funcionais e três formas de medir a gravidade da doença e do grau de risco para a saúde em pacientes com DPOC. Método: Quarenta e cinco pacientes com DPOC estáveis foram incluídos e avaliados, segundo nível de atividade de vida diária pelo London Chest Activity of Daily Living (LCADL); nível de incapacidade pelo World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); grau de obstrução do fluxo aéreo pelo volume expiratório forçado no primeiro segundo (VEF1 ); escore prognóstico BODE (Body mass index, airway Obstruction, Dyspnea and Exercise capacity); avaliação combinada de risco em DPOC, segundo GOLD (grupos ABCD por VEF1 , grau de dispneia e histórico de exacerbações). Resultados: Foram encontradas correlações significativas entre LCADL e BODE (r=0,528; p=0,0001) e grupos ABCD (r=0,491; p=0,001), assim como WHODAS 2.0 e BODE (r=0,484; p=0,001) e grupos ABCD (r=0,481; p=0.001). O VEF1 não se correlacionou com WHODAS 2.0 (r= -0,225, p=0,138), mas, sim, com LCADL (r= -0,314; p=0,036). Diferenças significativas foram encontradas ao comparar o LCADL e o WHODAS 2.0, entre os grupos, utilizando as três formas de estratificação de gravidade. Conclusões: Pacientes com DPOC apresentam incapacidades, em termos de atividades e participação social, que se correlacionam melhor com os índices multidimensionais de gravidade, mas, de modo pior, no caso do critério espirométrico. A utilidade do uso de instrumentos de medidas de funcionalidade e sua correlação com a avaliação combinada de risco da DPOC necessitam de avaliação em estudos prospectivos.
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