Subdiagnóstico da doença pulmonar obstrutiva crônica na atenção primária

• Autor(a) principal: QUEIROZ, Maria Conceição de Castro Antonelli Monteiro de
• Data de Publicação: 2012
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UFG
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tde/1753
• topic: DPOC; Atenção Primária; Diagnóstico; Espirometria; COPD; Primary; Diagnosis; Spirometry; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::PNEUMOLOGIA

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.