Prevalência de doença pulmonar obstrutiva crônica e distribuição da contagem de eosinófilos sanguíneos em pacientes com fator de risco para DPOC (tabagismo e/ou exposição à biomassa) atendidos em quatro unidades básicas de saúde de três estados brasileiros
Arquivos
Data
2024-04-23
Autores
Barros, Juliana Oliveira 
Orientadores
Jardim, José Roberto de Brito
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Descrever prevalência de DPOC e distribuição da contagem de eosinófilos em pacientes com fatores de risco para DPOC, atendidos em quatro UBS de três estados brasileiros. Métodos: Estudo multicêntrico transversal em quatro UBS (Porto Alegre, Londrina, Araraquara, Botucatu). Após avaliação médica, incluímos pacientes com ≥35 anos, tabagistas e/ou expostos à biomassa que chegaram consecutivamente à UBS por qualquer motivo e que não tinham contraindicação aos procedimentos. As variáveis avaliadas foram: dados clínicos e sociodemográficos, exposição ambiental, história tabagística, mMRC, CAT, hemograma e espirometria. O diagnóstico de DPOC foi espirométrico pela relação fixa (RF) e limite inferior da normalidade (LIN). Resultados: Foram avaliados 737 pacientes consecutivos que compareceram às UBS do estudo. A prevalência de DPOC foi de 23,7% (RF) e 26,1% (LIN). O LIN diagnosticou mais pacientes com DPOC na faixa etária entre 35 e 39 anos (7,3% LIN vs 4,6% RF) e a RF diagnosticou mais pacientes com DPOC >70 anos (30,3% RF vs 24,5% LIN). Pelo menos 50% tinham DPOC grave a muito grave. Os pacientes eram bastante sintomáticos, porém a carga de sintomas era maior no grupo DPOC (p<0,01). A RF alcançou 76% de subdiagnóstico e 12% de sobrediagnóstico. A distribuição da contagem de eosinófilos no sangue foi semelhante a estudos internacionais em países desenvolvidos (228,4 ± 260,5). No grupo DPOC, ter utilizado antiparasitários nos últimos 3 meses foi associado a contagem de eosinófilos <100 (p=0,04). Não houve associação significante entre o número de eosinófilos e as exacerbações moderadas/graves nos 12 ou 24 meses prévios, porém indivíduos com contagem >300 células apresentam 20% mais exacerbações que as demais contagens. Conclusões: Um em cada quatro pacientes tinha diagnóstico de DPOC, com alto percentual de subdiagnóstico e alta carga de sintomas. A maioria apresentava doença moderada ou grave. A contagem de eosinófilos nos pacientes com/sem DPOC apresentou distribuição semelhante em todas as categorias de contagem de eosinófilos, porém pacientes com DPOC e >300 células apresentam 20% mais exacerbações.
Objectives: To describe the prevalence of COPD and the distribution of eosinophil counts in patients with risk factors for COPD, treated at four UBS in three Brazilian states. Methods: Cross-sectional multicenter study in four UBS (Porto Alegre, Londrina, Araraquara, Botucatu). After medical evaluation, we included patients aged ≥35 years, smokers and/or exposed to biomass who consecutively arrived at the UBS for any reason and who had no contraindication to the procedures. The variables evaluated were: clinical and sociodemographic data, environmental exposure, smoking history, mMRC, CAT, blood count and spirometry. The diagnosis of COPD was spirometric based on the fixed ratio (RF) and lower limit of normality (LIN). Results: 737 consecutive patients who attended the study´s Basic Health Units were evaluated. The prevalence of COPD was 23.7% (RF) and 26.1% (LIN). The LIN diagnosed more patients with COPD aged between 35 and 39 years (7.3% LIN vs 4.6% RF) and the RF diagnosed more patients with COPD >70 years (30.3% RF vs 24.5% LIN). At least 50% had severe to very severe COPD. The patients were quite symptomatic, but the symptom burden was higher in the COPD group (p<0.01). RF achieved 76% underdiagnosis and 12% overdiagnosis. The distribution of blood eosinophil counts was similar to international studies in developed countries (228.4 ± 260.5). In the COPD group, having used antiparasitics in the last 3 months was associated with an eosinophil count <100 (p=0.04). There was no significant association between the number of eosinophils and moderate/severe exacerbations in the previous 12 or 24 months, however individuals with counts >300 cells had 20% more exacerbations than those with other counts. Conclusions: One in four patients were diagnosed with COPD, with a high percentage of underdiagnosis and a high burden of symptoms. Most patients had moderate or severe disease. The eosinophil count in patients with/without COPD has a similar distribution across all eosinophil count categories, but patients with COPD and >300 cells presented 20% more exacerbations.
Objectives: To describe the prevalence of COPD and the distribution of eosinophil counts in patients with risk factors for COPD, treated at four UBS in three Brazilian states. Methods: Cross-sectional multicenter study in four UBS (Porto Alegre, Londrina, Araraquara, Botucatu). After medical evaluation, we included patients aged ≥35 years, smokers and/or exposed to biomass who consecutively arrived at the UBS for any reason and who had no contraindication to the procedures. The variables evaluated were: clinical and sociodemographic data, environmental exposure, smoking history, mMRC, CAT, blood count and spirometry. The diagnosis of COPD was spirometric based on the fixed ratio (RF) and lower limit of normality (LIN). Results: 737 consecutive patients who attended the study´s Basic Health Units were evaluated. The prevalence of COPD was 23.7% (RF) and 26.1% (LIN). The LIN diagnosed more patients with COPD aged between 35 and 39 years (7.3% LIN vs 4.6% RF) and the RF diagnosed more patients with COPD >70 years (30.3% RF vs 24.5% LIN). At least 50% had severe to very severe COPD. The patients were quite symptomatic, but the symptom burden was higher in the COPD group (p<0.01). RF achieved 76% underdiagnosis and 12% overdiagnosis. The distribution of blood eosinophil counts was similar to international studies in developed countries (228.4 ± 260.5). In the COPD group, having used antiparasitics in the last 3 months was associated with an eosinophil count <100 (p=0.04). There was no significant association between the number of eosinophils and moderate/severe exacerbations in the previous 12 or 24 months, however individuals with counts >300 cells had 20% more exacerbations than those with other counts. Conclusions: One in four patients were diagnosed with COPD, with a high percentage of underdiagnosis and a high burden of symptoms. Most patients had moderate or severe disease. The eosinophil count in patients with/without COPD has a similar distribution across all eosinophil count categories, but patients with COPD and >300 cells presented 20% more exacerbations.
Descrição
Citação
BARROS, Juliana Oliveira. Prevalência de doença pulmonar obstrutiva crônica e distribuição da contagem de eosinófilos sanguíneos em pacientes com fator de risco para DPOC (tabagismo e/ou exposição à biomassa) atendidos em quatro unidades básicas de saúde de três estados brasileiros. 2024. 190 f. Tese (Doutorado em Medicina Translacional) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.