Caracterización de los pacientes hospitalizados por primera vez por exacerbación de la Enfermedad Pulmonar Obstructiva Crónica
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Author
Director
García Aymerich, Judith
Gea Guiral, Joaquim
Gea Guiral, Joaquim
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Publication Date
Pages
115 p.
Embargo date
Citation
Balcells Vilarnau, E. Caracterización de los pacientes hospitalizados por primera vez por exacerbación de la Enfermedad Pulmonar Obstructiva Crónica. Universitat Pompeu Fabra; 2016. handle: http://hdl.handle.net/10803/350810
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Citation
Doctoral program
Programa de doctorat en Biomedicina
Abstract
Introducción: Hay poca información sobre la primera hospitalización por exacerbación de la Enfermedad Pulmonar Obstructiva Crónica (EPOC), a pesar de ser un evento importante en la historia natural de esta enfermedad. El objetivo de esta tesis fue estudiar el perfil clínico de los pacientes hospitalizados por primera vez por una exacerbación de la EPOC, con especial atención a la comorbilidad psicológica y su relación con la calidad relacionada con la salud de la vida (CVRS), y también investigar el grado y las características del infradiagnóstico de la EPOC, en este momento. Métodos: El estudio incluyó una amplia muestra de pacientes hospitalizados por primera vez por exacerbación de la EPOC (2004-2006). Un total de 342 pacientes fueron ampliamente caracterizados con variables sociodemográficas, clínicas y funcionales. Se evaluó la asociación entre ansiedad, depresión o ambos, y la CVRS, después de ajustar por posibles factores de confusión y se identificaron factores modificadores del efecto de esta asociación. Se investigaron las características y el pronóstico (rehospitalizaciones y mortalidad) de los pacientes con EPOC no diagnosticada. Resultados: (1) los pacientes con EPOC tenían un amplio espectro de gravedad, con una proporción importante de pacientes con EPOC leve a moderada, y de fumadores activos; más de un tercio de pacientes tenían EPOC no diagnosticada; (2) los pacientes con EPOC no diagnosticada tenían una enfermedad menos grave y menor riesgo de rehospitalización en comparación con los pacientes con EPOC conocida; (3) este estudio mostró una asociación significativa entre ansiedad, depresión, o ambas y deterioro de la CVRS; los factores clínicamente relevantes que afectaron a la magnitud de esta asociación fueron la situación laboral, la gravedad de la EPOC, y la presencia de comorbilidades. Conclusiones: La presente tesis es el primer estudio que describe las características de una muestra amplia y representativa de pacientes hospitalizados por primera vez por exacerbación de la EPOC; la tesis enfatiza que esta primera hospitalización abre una ventana de oportunidad para el diagnóstico de la EPOC y el inicio de un tratamiento adecuado.
Introduction: There is little information about the first hospitalisation for an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), although it is an important event in the natural history of this disease. The aim of this thesis was to study the clinical profile of patients hospitalised for the first time for an exacerbation of COPD, with special attention to the psychological comorbidity and their relationship to health related quality of life (HRQoL), and also to investigate the extent and characteristics of underdiagnosis of COPD, at this time. Methods: The study included a large sample of patients hospitalised for the first time for an exacerbation of COPD (2004-2006). A total of 342 patients were extensively characterised using sociodemographic, clinical and functional variables. We evaluated the association between anxiety, depression or both, and HRQoL, after adjusting for potential confounders and identified effect modifiers of this association. We also investigated the characteristics and prognosis (re-hospitalisations and mortality) of patients with undiagnosed COPD. Results: (1) COPD patients had a wide range of severity, with a large proportion of patients with mild-to-moderate COPD, and current smokers; more than one third of patients had undiagnosed COPD; (2) undiagnosed COPD patients had less severe disease and lower risk of re-hospitalisation when compared with patients with known COPD; (3) this study showed a significant association between anxiety, depression, or both conditions and impaired HRQoL; clinically relevant factors modifying the magnitude of this association included work status, COPD severity, and the presence of comorbidities. Conclusions: The present thesis is the first study that describes the characteristics of a large and representative sample of patients hospitalised for the first time for an exacerbation of COPD. The thesis emphasizes that this first hospitalisation opens a window of opportunity for the COPD diagnosis and the initiation of appropriate therapy.
Introduction: There is little information about the first hospitalisation for an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), although it is an important event in the natural history of this disease. The aim of this thesis was to study the clinical profile of patients hospitalised for the first time for an exacerbation of COPD, with special attention to the psychological comorbidity and their relationship to health related quality of life (HRQoL), and also to investigate the extent and characteristics of underdiagnosis of COPD, at this time. Methods: The study included a large sample of patients hospitalised for the first time for an exacerbation of COPD (2004-2006). A total of 342 patients were extensively characterised using sociodemographic, clinical and functional variables. We evaluated the association between anxiety, depression or both, and HRQoL, after adjusting for potential confounders and identified effect modifiers of this association. We also investigated the characteristics and prognosis (re-hospitalisations and mortality) of patients with undiagnosed COPD. Results: (1) COPD patients had a wide range of severity, with a large proportion of patients with mild-to-moderate COPD, and current smokers; more than one third of patients had undiagnosed COPD; (2) undiagnosed COPD patients had less severe disease and lower risk of re-hospitalisation when compared with patients with known COPD; (3) this study showed a significant association between anxiety, depression, or both conditions and impaired HRQoL; clinically relevant factors modifying the magnitude of this association included work status, COPD severity, and the presence of comorbidities. Conclusions: The present thesis is the first study that describes the characteristics of a large and representative sample of patients hospitalised for the first time for an exacerbation of COPD. The thesis emphasizes that this first hospitalisation opens a window of opportunity for the COPD diagnosis and the initiation of appropriate therapy.
Keywords
Chronic obstructive pulmonary disease, Underdiagnosis, Anxiety, Depression, Health related quality of life, Enfermedad pulmonar obstructiva crónica, Infradiagnóstico, Ansiedad, Depresión, Calidad de v ida relacionada con la salud
Subjects
616.2 - Pathology of the respiratory system
Publisher
Universitat Pompeu Fabra
