Avaliação da fragilidade em pacientes com doença pulmonar obstrutiva crônica

• Ano de defesa: 2020
• Autor(a) principal: Dias, Lara de Souza
• Orientador(a): Rabahi, Marcelo Fouad
• Banca de defesa: Rabahi, Marcelo Fouad, Silva, Daniela Graner Schuwartz Tannus, Lira, Claudio Andre Barbosa de
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Goiás
• Programa de Pós-Graduação: Programa de Pós-graduação em Ciências da Saúde (FM)
• Departamento: Faculdade de Medicina - FM (RG)
• País: Brasil
• Palavras-chave em Português: Fragilidade; Doença pulmonar obstrutiva crônica; Doenças crônicas
• Palavras-chave em Inglês: Frailty; Pulmonary disease; Chronic obstructive; Chronic disease
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::SAUDE COLETIVA::SAUDE PUBLICA
• Link de acesso: http://repositorio.bc.ufg.br/tede/handle/tede/10832

Introduction: Frailty has been recognized as a prognostic factor for chronic diseases, despite being mostly age-related, in patients with Chronic Obstructive Pulmonary Disease (COPD), frailty has been implicated in worse survival. Objectives: To assess the prevalence of frailty and associated factors in patients with COPD. Methods: Cross-sectional study in COPD patients registered for public access to pharmacological treatment. Data were collected in Goiânia, at the High Cost Medication Center, from January to December 2018, after approval by the CEP. Demographic data, lung function, medication in use for COPD were collected; number of exacerbations, emergency consultations in the last 12 months; MRC, CAT, Charleston Index (ICCI) and frailty was assessed by applying FRAIL-BR and classified as Frail (3 to 5 points), Pre- Frail (1 or 2 points) and robust (0 points). A significance level of 5% was assigned. The descriptions used proportion, median and interquartile range (IQR). The categorical variables: sex, origin, race and drugs in use and the linear variables: medians of age and time in the program; were analyzed using the Chi-square test and Mann-Whitney, respectively. For the correlations between FRAIL and CAT, MRC and FEV1 variables, Spearman's correlation coefficient was used. Results: 153 patients were evaluated, predominantly elderly (83.0%), with a median age of 68 years (IIQ: 63-72) and male (54.9%). The prevalence of frailty in the sample was 50.3%, the pre-frail corresponded to 35.3%, only 14.3% of the patients were normal. The fragile, pre-frail and normal groups were similar with respect to age, sex, income, race / skin color, the presence of comorbidities, BMI, the medications used, exacerbations in the last 12 months, current smoking, hospitalizations, FEV (l) and vef1 / cvf (p-value> 0.05). The median of years of schooling was statistically higher in the normal than in the frail group (6.5 versus 5.0; p-value = 0.011), frail patients had worse lung function than normal patients with respect to FEV% (p- value = 0.011), highest median mMRC and CAT score (p-value <0.001), (p-value <0.001) respectively, finally, the groups were different regarding GOLD staging (p-value <0.001). GOLD A was more frequent in normals, while GOLD D was more prevalent in pre-frail and frail. After ordinal regression, the chances of frailty increased with increasing MRC (Model 1: ORaj = 1.94; p-value <0.001; Model 2: ORaj = 1.63; p-value <0.001), with the increase in CAT (ORaj = 1.12; p-value <0.001) and in individuals GOLD B (ORaj = 3.42; p-value = 0.011) and D (ORaj = 4.74; p-value = 0.003) when compared to A. Conclusion: Frailty is very prevalent in COPD patients, correlates with worse symptoms of the disease and worse lung function.