Risco de reinternamento na doença pulmonar obstrutiva crónica – Estudo prospectivo com ênfase no valor da avaliação da qualidade de vida e depressão

Abstract

To identify demographic, clinical, functional and inherent quality of life (QOL) and depression factors with impact on use of the Emergency Services (ES) or readmission after hospital discharge for acute exacerbation of chronic obstructive pulmonary disease (COPD) over a period of 66 weeks. QOL was evaluated by the St. George's Respiratory Questionnaire (SGRQ). The Beck Depression Inventory assessed depression. We prospectively evaluated 45 patients (84.4% male, median age 73 years, stage IV 51%). The median total SGRQ score was 50.6, with a greater impact on symptoms, especially in younger patients (r=-0.425; p=0.043), and activity limitation than emotional impact of the disease. More than half were depressed. Worse QOL meant depression (R=0.699; p=0.02). Low FEV1 correlated with depression (r=-0.46; p =0.05) but not with QOL. Long-acting anti-cholinergic bronchodilator and inhaled steroids improved QOL. Almost 85% of patients used ES (25.8% for exacerbated COPD). Rate of hospital readmission for all reasons and exacerbated COPD was 64.9% and 33.3%. The number of readmissions (all reasons) was correlated with age (R=0.48; p=0003), cor pulmonale (R=-0.46; p=0.03) and QOL (R=0.67; p=0.004). Depressed patients (R=0.51; p=004), with low FEV1 (R=-0413; p=0.04) and with cor pulmonale (R=-046, p=0.005) had more inhospital days for exacerbation of COPD. QOL and depression are variables to consider in the evaluation and treatment of patients with COPD as part of a set of clinical and functional data that can predict the risk of readmission after hospital discharge for exacerbated COPD.

Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review

“…Mediating factors observed to be significant in this relationship between the comorbidities of anxiety, depression, and the acute exacerbation of COPD included: lower BODE scores;19,32,33 perceived quality of life, which also had a direct correlation with worsening depression and increased risk of exacerbations;19 lower socioeconomic status;37 increased severity of anxiety; female sex;19,34,44,45 increasing rate of decline in lung function;36 less improvement in dyspnea; increased partial pressure of carbon dioxide (PaCO 2 ); decreased partial pressure of oxygen (PaO 2 ); and increased pH from admissions to discharge 34,43,46…”

Understanding fear and anxiety in patients at the time of an exacerbation of chronic obstructive pulmonary disease: a qualitative study

“… 8 Unmanaged anxiety is associated with fear, hopelessness and confusion and seems to be particularly distressing for patients with chronic obstructive pulmonary disease when they are stable, 13 and it can only worsen at the time of an exacerbation. A number of studies have shown that patients with co-morbid depression and/or anxiety are more likely to have exacerbations requiring hospitalisation, 14 – 18 while others have shown that hospitalisation is also longer in patients with depression. 8 People with negative beliefs about chronic obstructive pulmonary disease, low perceived control over symptoms and those who use emotional coping strategies such as denial and avoidance are more prone to panic.…”

Association of Serum Magnesium Levels with Frequency of Acute Exacerbations in Chronic Obstructive Pulmonary Disease: A Prospective Study

“…Few studies have investigated the factors leading to exacerbations. Advanced age, low FEV1%, advanced stage of disease, poor performance status, accompanying anxiety and/or depression, poor quality of life, history of frequent exacerbation, hypercapnia, and prolonged duration of disease have all been identified as factors causing frequent exacerbation [ 5 – 8 ].…”