Chronic obstructive pulmonary disease (COPD) is now a major public health concern; deaths attributable to COPD in Latin America have increased by 65.0% in the last decade. This study was aimed at evaluating COPD prevalence and associated factors in adults (> 40 years) living in Greater Metropolitan São Paulo, Brazil. The study is part of the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (The PLATINO Project), a multi-center survey on COPD burden in Latin America, with São Paulo as the first center where the project has been carried out. A population-based sample was selected in multiple stages. Spirometry tests were performed in each subject pre- and post-bronchodilator and COPD was mainly defined as the ratio of forced expiratory volume to forced vital capacity below 70.0% (fixed ratio definition). Other spirometric criteria were also used for the diagnosis of COPD. COPD prevalence was 15.8% (95%CI: 13.5-18.1) using the fixed ratio definition. COPD was positively associated with age and smoking and inversely with body mass index. Utilization of different COPD spirometry criteria resulted in different percentages of COPD, but similar associated factors.

BACKGROUND: The aim of this study was to develop an efficient, low-cost, home-based pulmonary rehabilitation program and to evaluate the impact of the program on exercise as measured by the 6-min walk test (6MWT) and treadmill endurance test. METHODS: Twenty-nine subjects with COPD (FEV ₁ = 62.4 ± 10.7% of predicted, 62.4 ± 10.7 y old) were included in a randomized and prospective pulmonary rehabilitation program, and they performed 24 sessions, 5 d/week. The control group included 15 subjects (FEV ₁ = 54 ± 26.2% of predicted, 65.3 ± 8 y old). They were evaluated pre-intervention and post-intervention by the 6MWT, St George Respiratory Questionnaire (SGRQ), treadmill endurance test, and spirometry. The home-based pulmonary rehabilitation program consisted of walking for 40 min along a corridor or a street, climbing stairs for 15 min, and exercising the arms with an oil can (1 kg) using diagonal movements for 15 min. Subjects were called once each week for encouragement and verification of adherence. Both groups received the usual pharmacologic treatment; in addition, the control group received a telephone call without guidance on exercise. RESULTS: The 2 groups were similar regarding age, FEV ₁ , and FVC. The home-based pulmonary rehabilitation group increased by 65 m in the 6MWT ( P < .05) and 316.6 ± 81.8 m in the endurance test ( P < .05) and decreased by > 4 units in all SGRQ domains. The control group showed no difference in any variable. CONCLUSIONS: This study demonstrates that a simple, low-cost, home-based pulmonary rehabilitation program adapted to real-life situations leads to improvement in exercise capacity and quality of life.

Patients with chronic obstructive pulmonary disease (COPD) fall frequently, although the risk of falls may seem less important than the respiratory consequences of the disease. Nevertheless, falls are associated to increased mortality, decreased independence and physical activity levels, and worsening of quality of life. The aims of this systematic review was to evaluate information in the literature with regard to whether impaired postural control is more prevalent in COPD patients than in healthy age-matched subjects, and to assess the main characteristics these patients present that contribute to impaired postural control. Methods: Five databases were searched with no dates or language limits. The MEDLINE, PubMed, EMBASE, Web of Science, and PEDro databases were searched using “balance”, “postural control”, and “COPD” as keywords. The search strategies were oriented and guided by a health science librarian and were performed on March 27, 2014. The studies included were those that evaluated postural control in COPD patients as their main outcome and scored more than five points on the PEDro scale. Studies supplied by the database search strategy were assessed independently by two blinded researchers. Results: A total of 484 manuscripts were found using the “balance in COPD or postural control in COPD” keywords. Forty-three manuscripts appeared more than once, and 397 did not evaluate postural control in COPD patients as the primary outcome. Thus, only 14 studies had postural control as their primary outcome. Our study examiners found only seven studies that had a PEDro score higher than five points. The examiners’ interrater agreement was 76.4%. Six of those studies were accomplished with a control group and one study used their patients as their own controls. The studies were published between 2004 and 2013. Conclusion: Patients with COPD present postural control impairment when compared with age-matched healthy controls. Associated factors contributing to impaired postural control were muscle weakness, physical inactivity, elderly age, need for supplemental oxygen, and limited mobility.

OBEJETIVO: O objetivo deste estudo foi avaliar a aplicabilidade da versão modificada do Questionário do Hospital Saint George na Doença Respiratória. Esta versão possui adaptação nas respostas de algumas perguntas com duplas negativas, substituindo as respostas "sim" e "não" por "concordo" e "não concordo", com o intuito de facilitar a compreensão destas questões, e o período de recordação de sintomas passando de um ano para três meses. MÉTODOS: Foram avaliados 30 pacientes com diagnóstico de doença pulmonar obstrutiva crônica, estáveis clinicamente. Foram aplicados o Questionário do Hospital Saint George na Doença Respiratória e a sua versão modificada em duas situações, separadas por quinze dias. RESULTADOS: Todos os indivíduos apresentaram alteração da qualidade de vida relacionada à saúde. A comparação de médias das pontuações dos domínios dos dois questionários mostrou maior alteração no domínio Sintomas do questionário original em relação a sua versão modificada. Os demais domínios e a pontuação total não apresentaram diferenças significativas. Todos os domínios apresentaram correlações significativas: Sintomas, r = 0,71 (p < 0,001); Atividade, r = 0,75 (p < 0,001); Impacto, r = 0,73 (p < 0,001) e Total r = 0,86 (p <0,001). CONCLUSÃO: A versão do SGRQm possui propriedades de mensuração de qualidade de vida semelhantes à versão original, porém deve-se escolher qual o melhor tempo de recordação de sintomas a ser utilizado na avaliação.