Subdiagnóstico da doença pulmonar obstrutiva crônica na atenção primária
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Data
2012-05-02
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Universidade Federal de Goiás
Resumo
The chronic obstructive pulmonary disease (COPD) is a disease with systemic
manifestations, mainly caused by smoking and is characterized by progressive
bronchial obstruction irreversible or partially reversible. Respiratory symptoms
include dyspnea, wheezing, coughing and expectoration. The characteristics include
systemic skeletal muscle dysfunction, weight loss, anxiety, depression, osteoporosis,
increased risk of cardiovascular disease. Is mainly related to smoking and exposure
to biomass. The spirometry in high-risk populations is a simple and effective method
for the detection of COPD. The diagnosis at the initial stage of the disease allows the
application of preventive measures in relation to smoking and the workplace. In
Brazil, the underdiagnosis of COPD is due, among other factors, the underutilization
of spirometry, the low rate of medical diagnosis in primary care units and the lack of
knowledge about the patient's disease risk. The objective of this study is to
investigate the underdiagnosis of Chronic Obstructive Pulmonary Disease (COPD) in
primary care units and the factors associated with them, to identify individuals with
clinical and functional criteria of COPD, to detect cases of underdiagnosis in subjects
with COPD and assess the degree use of spirometry as a diagnostic method for
COPD in the primary network. We recruited individuals aged 40 years or older and
who had a smoking history of at least 20 pack / years. Participants answered a
questionnaire on demographics, symptoms, previous medical diagnosis and
underwent post bronchodilator spirometry. COPD was defined as a forced expiratory
volume in one second over forced vital capacity less than 0.7. It was considered
previously diagnosed individuals who responded affirmatively to one of the questions
about whether they had received previous medical diagnosis of emphysema, chronic
bronchitis or COPD. We evaluated 200 individuals, of which 63 met the criteria for
COPD. In these subjects, there was a percentage of underdiagnosis of 71.4%, mean
age was 65.9 ± 10.5 years, male predominance. There was no difference between
subgroups with and without previous diagnosis regarding demographics and risk
factors. Individuals with COPD and with prior diagnosis had a statistically significant
difference with regard to sputum, wheezing and breathlessness, when compared to
the subgroup without previous diagnosis (p = 0.047, p = 0.005 and p = 0.047).
Dyspnea in patients with previous diagnosis was classified as 44.4% in the second
MRC. FEV1 and FEV1/FVC, percentage of predicted was significantly lower in
individuals with prior diagnosis and COPD was predominantly mild to moderate in
both groups. There is a considerable percentage of underdiagnosis of COPD in the
units studied, a third of patients with risk factors evaluated showed clinical and
functional criteria for COPD and the degree of use of spirometry to diagnose COPD
was insignificant.
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QUEIROZ, Maria Conceição de Castro Antonelli Monteiro de. Underdiagnosis of chronic obstructive pulmonary disease in primary care. 2012. 107 f. Dissertação (Mestrado em Ciências da Saúde - Medicina) - Universidade Federal de Goiás, Goiânia, 2012.