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Vol. 41. Issue 5.
Pages 260-266 (May 2005)
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Vol. 41. Issue 5.
Pages 260-266 (May 2005)
Original Articles
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Survival in a Cohort of Patients With Chronic Obstructive Pulmonary Disease: Comparison Between Primary and Tertiary Levels of Care
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F.G. Rico-Méndeza,
Corresponding author
flavior@servidor.unam.mx

Correspondence: Dr. F.G. Rico-Méndez. Departamento de Neumología. Hospital General Gaudencio González Garza. Centro Médico Nacional La Raza IMSS. Calzada de las Brujas, 55-II. Edificio Pino, departamento 203. Ex Hacienda Coapa. 14330 Tlalpan. México DF. México
, S. Barquerab, J.J. Múgica-Hernándezc, J.L. Espinosa Péreza, S. Ortegad, L.G. Ochoaa
a Departamento de Neumología, Hospital General Gaudencio González Garza, Centro Médico Nacional La Raza IMSS, México DF, Mexico
b Departamento de Enfermedades Crónicas y Dieta, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
c Departamento de Urgencias, Hospital General Gaudencio González Garza, Centro Médico Nacional La Raza IMSS, Mexico
d División de Neumología y Medicina Interna, Hospital General Gaudencio González Garza, Centro Médico Nacional La Raza IMSS, México DF, Mexico
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Objective

TO compare the cumulative probability of survival in a cohort of patients with chronic obstructive pulmonary disease (COPD) attended at primary and tertiary levels of health care.

Patients and methods

A cohort study was carried out at the Department of Pneumology of the Centro Médico Nacional La Raza (Mexico DF) on 87 of the 114 patients with confirmed diagnosis of COPD.

All patients followed a 6-month physical activity and educational program. Patients underwent the COPD diagnostic tests recommended by the American Thoracic Society and were randomized and distributed in 2 groups Group A had 44 patients who received tertiary care, and Group B had 43 who received primary care. Follow up lasted from 1993 to 2001. Exacerbations, hospital admissions, exercise duration, hospital stay, and death or study abandonment were recorded for all patients. Respiratory function tests were performed annually. Annual and total mortality, distribution by sex, loss in life expectancy, mean age at death, and cumulative probability of survival were analyzed.

Results

NO differences were found between the groups in population or initial characteristics. Respiratory function declined in both groups, although the decline was smaller in Group A: mean (SD) forced expired volume in 1 second, 8.93% (8.72%) compared with 17.71% (2.51%) and annual drop in blood pressure of 1.39 mm Hg compared with 1.95 mm Hg. Annual exacerbations were 0.23 in Group A compared with 2.07 in Group B; hospitalizations, 0.06 compared with 0.92, and length of stay, 15.76 days compared with 17.32 days. Mean age at death was 66.12 compared with 60.6; loss of life expectancy was 13.88 years lost compared with 19.4, and the cumulative probability of survival was 0 compared with 0.224.

Conclusions

There are many reasons for the differences found: better medical management, health education, and family involvement at the tertiary level. These factors, included in international COPD guidelines, must be incorporated into primary health care.

Key Words:
COPD
Survival
Mortality
Objetivo

Comparar la probabilidad de supervivencia acumulada en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) atendidos en primer y tercer niveles.

Patientes y métodos

En el Departamento de Neumología del Centro Médico Nacional La Raza (México DF) se efectuó un estudio de cohortes en 87 enfermos de 114 con diagnóstico confirmado de EPOC. Todos entraron en un programa de ac-tividad física y educacional de 6 meses; se les efectuaron prue-bas diagnósticas recomendadas por la American Thoracic Society para la EPOC y se formaron 2 grupos: grupo A, form ado por 44 pacientes atendidos en el tercer nivel, y grupo B, compuesto por 43 pacientes atendidos en el primer nivel. El seguimiento se llevó de 1993 a 2001. En todos se contabilizaron las exacerbaciones, los ingresos hospitalarios, el tiempo de ejercicio, la estancia hospitalaria y las defunciones o abandono del estudio. Anualmente se realizaron pruebas de la función respiratoria. Se analizaron la mortalidad anual y total, la dis-tribución por sexos, los años potenciales de vida perdidos, la edad media de fallecimiento y la probabilidad acumulada de supervivencia.

Resultados

NO hubo diferencia entre las características poblacionales ni iniciales. Ambos grupos mostraron un declive de la función respiratoria, aunque fue menor en el grupo A (volumen espiratorio forzado en el primer segundo del 8,93 ± 8,72 frente al 17,71 ± 2,51%; caída anual de la presión arterial de oxígeno de 1,39 frente a 1,95 mmHg). Las exacerbaciones anuales fueron 0,23 frente a 2,07; las hospitalizaciones, 0,06 frente a 0,92, y los días de estancia, 15,76 frente a 17,32. La edad media de fallecimiento fue de 66,12 frente a 60,6; los años de vida perdidos de 13,88 frente a 19,4, y la probabilidad acumulada de supervivencia de 0 frente a 0,224.

Conclusiones

Las razones de las diferencias encontradas son múltiples: mejor control médico, educación para la salud y corresponsabilidad familiar. Estos factores, incluidos en las guías internacionales de la EPOC, deben difun-dirse al primer nivel de atención.

Palabras clave:
EPOC
Supervivencia
Mortalidad
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REFERENCES
[1]
SS Hurd.
International efforts directed at attacking the problem of COPD.
Chest, 117 (2000), pp. 336-338
[2]
FG Rico-Méndez, SB Vázquez, V Díaz, S Barquera, JJ Múgica.
Uso y abuso de la prescripción de oxígeno domiciliario en un Centro Médico Nacional de Salud Pública de México.
Rev Med IMSS, 41 (2003), pp. 473-480
[3]
S Sullivan, A Elixhauser, S Buist, BR Luce, J Eisenberg, K Weiss.
National asthma education and prevention program. Working group report on the cost effectiveness of asthma care.
Am J Respir Crit Care Med, 154 (1996), pp. 84-95
[4]
N Anthonisen.
Epidemiology and Lung Health Study.
Eur Resp Rev, 45 (1997), pp. 202-205
[5]
American Thoracic Society.
Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma.
Am Rev Resp Dis, 136 (1987), pp. 225-244
[6]
S Hulley, S Cummings.
Diseño de la investigación científica, pp. 216
[7]
American Thoracic Society Statement.
Lung function testing: selection of reference values and interpretative strategies.
Am Rev Respir Dis, 144 (1991), pp. 1202-1218
[8]
HI Goldman, M Beclake.
Respiratory function tests: normal values at medium altitudes and the prediction of normal results.
Am Rev Tuberc, 79 (1959), pp. 454-467
[9]
JE Cotes, AM Hall.
The transfer factors for the lung: normal values in adults.
Normal values for respiratory function in man, pp. 327-343
[10]
GT Ferguson, R Cherniack.
Management of chronic obstructive pulmonary disease.
N Engl J Med, 328 (1993), pp. 1017-1022
[11]
G Norman, D Streiner.
Bioestadística, pp. 187-194
[12]
National Heart, Lung and Blood Institute-World Health Organization Global Strategy for Diagnosis Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD). September 2000.
[13]
S Hurd.
The impact of COPD on lung health worldwide: epidemiology and incidence.
Chest, 117 (2000), pp. 1-4
[14]
National Heart, Lung, and Blood Institute.
Morbidity and mortality: 2000 chart book on cardiovascular, lung, and blood disease, National Institute of Health, National Heart, Lung, and Blood Institute, (2000),
[15]
B Rijcken, J Britoon.
Epidemiology of chronic obstructive pulmonary disease.
Eur Respir J, 7 (1998), pp. 41-73
[16]
Medical Research Council.
Value of chemoprophylaxis for chronic bronchitis.
Br Med J, 1 (1966), pp. 1317-1322
[17]
CA Camargo.
The relationship between COPD exacerbation and other outcomes.
Eur Resp Rev, 82 (2002), pp. 9-10
[18]
JJ Soler, M Sánchez, M Latorre, J Alamar, P Román, M Perpiña.
Impacto asistencial hospitalario de la EPOC. Peso específico del paciente con EPOC de alto consumo sanitario.
Arch Bronconeumol, 37 (2001), pp. 375-381
[19]
M Miravitlles, C Murio, T Guerrero.
Dafne Group. Factors associated with increased risk of hospital admission in a cohort of ambulatory COPD.
Eur Resp J, 16 (2000), pp. 31
[20]
Informe Lasist.
Impacto en estancias por diferencias de estancias medias, Conselleria de Sanitat i Consum. Generalitat Valenciana, (1998),
[21]
AF Connors, NV Dawson, C Thomas, FE Harell, N Desbiens, WJ Fulkerson.
Outcomes following acute exacerbation of severe chronic obstructive lung disease: The SUPPORT Investigation.
Am J Respir Crit Care Med, 154 (1996), pp. 959-967
[22]
J Zielinski, W MacNee, J Wedzicha.
Causes of death in patient with COPD and chronic respiratory failure.
Monaldi Arch Chest, 52 (1997), pp. 43-47
[23]
P Almagro, E Calbo, A Ochoa de Echegüen, B Barreiroi, S Quintana, JL Heredia.
Mortality after hospitalization for COPD.
Chest, 121 (2002), pp. 1441-1448
[24]
ML Fernández Pérez, GI Otero, M Blanco, MC Montero, P Valiño, V Hernández.
Comorbilidad y mortalidad en pacientes con EPOC. XXXIV Congreso Nacional de la Sociedad Española de Neumología y Cirugía Torácica. La Coruña, España. Junio 2001.
Arch Bronconeumol, 37 (2001), pp. 10-11
[25]
R Peto, A López, J Boreham, M Thun, C Heath.
Mortality from tobacco in development countries: indirect estimation from national vital statistic.
Lancet, 339 (1992), pp. 1268-1278
[26]
C Murray, A López.
Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study.
Lancet, 349 (1997), pp. 1498-1504
[27]
Grupo de Trabajo de la SEPAR.
Normativa sobre rehabilitación respiratoria.
Arch Bronconeumol, 36 (2000), pp. 257-274
[28]
P Mayo, J Richman, W Harris.
Results of a program to reduce admission for adult asthma.
Ann Intern Med, 112 (1990), pp. 864-871
[29]
J Sans-Torres, C Domingo, J Solá, A Marín.
Efectividad de una consulta monográfica para pacientes con EPOC evolucionado.
Arch Bronconeumol, 37 (2001), pp. 14
[30]
JM Antoñana, V Sobradillo, D de Marcos, JB Chic, JB Galdiz, M Iriberri.
Programa de altas precoces y asistencia domiciliaria en pacientes con exacerbación de enfermedad pulmonar obstructiva crónica y asma bronquial.
Arch Bronconeumol, 37 (2001), pp. 489-494
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