RESUMO
OBJECTIVE: To apply a case-finding strategy in Mexico to identify chronic airway obstruction among individuals with risk factors and/or symptoms compatible with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: Individuals aged ≥ 40 years with known risk factors and/or symptoms compatible with COPD were referred for an interview and spirometry. RESULTS: Of 2293 subjects included, 472 (20.6%) had a post-bronchodilator forced expiratory volume in one second/forced vital capacity ratio of <70% (for Global Initiative for Chronic Obstructive Lung Disease [GOLD] Stages II-IV, prevalence was 17.1%). Those with airflow obstruction had smoked more cigarettes for more years than subjects without (19 vs. 13 cigarettes/day, P < 0.001, and 32 vs. 23 years, P < 0.001); they also had a more frequent history of exposure to biomass smoke (23.3% vs. 18.3%, P = 0.002). Females were exposed to biomass smoke for more years (24 vs. 19 years; P < 0.0001) and more hours per day than males (6.2 vs. 5.1; P < 0.001). In multiple logistic regression analysis, increasing age, male sex, ever smoking, pack-years of smoking and years of exposure to biomass smoke were significantly associated with COPD prevalence. CONCLUSIONS: Airflow obstruction was identified in one in five of Mexican individuals with risk factors and/or COPD symptoms. Exposure to biomass smoke was significantly associated with the presence of airflow obstruction.
Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Volume Expiratório Forçado , Humanos , Modelos Logísticos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Fumar/efeitos adversos , Fumar/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Espirometria , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: This study characterized mortality in a group of Mexican children (n = 18, mean [+/- SD] age 9.9 +/- 3 years) with primary pulmonary hypertension and investigated the factors associated with their survival. BACKGROUND: Primary pulmonary hypertension is a progressive, fatal disease of unknown cause. Establishing the diagnosis earlier in life may influence prognosis. METHODS: A dynamic cohort of children with primary pulmonary hypertension were enrolled between December 1977 and May 1991 and followed up through September 1992. Measurements included hemodynamic and pulmonary function variables in addition to demographic data, medical history and response to vasodilator treatment. We also compared the survival estimates of these children with those of our adult patients with primary pulmonary hypertension (n = 42, mean age 27.9 +/- 8.5 years). RESULTS: Baseline mean (+/- SD) pulmonary artery pressure was similar in children and adults (66 +/- 15 vs. 65 +/- 18 mm Hg, p = NS), but a higher cardiac index resulted in a lower mean pulmonary vascular resistance index in children (18 +/- 7 vs. 26 +/- 12 U/m2, p < 0.01). The proportion of patients who had a positive hemodynamic response to vasodilator treatment was higher in children than in adults (41% vs. 25%). Estimated median survival in children was 4.12 years (95% confidence interval [CI] 0.75 to 8.66) and 3.12 years in adults (95% CI 0.5 to 13.25, chi-square log-rank 0.81, p = NS). Elevated right atrial pressure (rate ratio 10.2) and decreased stroke volume index (rate ratio 32.9) were the only significant predictors of mortality (Cox proportional hazards model). CONCLUSIONS: Children with primary pulmonary hypertension have a poor survival expectancy, which does not appear to differ from that in adults with primary pulmonary hypertension. Mortality in childhood primary pulmonary hypertension is also associated with variables that assess right ventricular dysfunction.
Assuntos
Hipertensão Pulmonar/mortalidade , Adulto , Criança , Estudos de Coortes , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Masculino , México/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Análise de Sobrevida , Vasodilatadores/uso terapêuticoRESUMO
BACKGROUND: The prognosis of patients with primary pulmonary hypertension (PPH) remains a major problem for the planning and assessment of therapeutic interventions. The objectives of this study were (1) to characterize mortality in a Mexican population of patients with PPH and to investigate factors associated with survival and (2) to test the applicability in this population of the prognostic equation proposed by the US National Institutes of Health study on PPH. METHODS AND RESULTS: A dynamic cohort of patients with PPH at our institution were enrolled between June 1977 and August 1991 and prospectively followed at regular intervals through September 1992. Measurements at diagnosis included hemodynamic and pulmonary function variables in addition to information on demographic data and medical history. The response to vasodilator treatment was also analyzed. The estimated median survival of the group was 4.04 years (95% confidence interval, 2.98 to 5.08 years). Variables associated with poor survival (univariate analysis) included an elevated mean right atrial pressure, a decreased cardiac index, and a decreased mixed venous PO2. A reduced forced vital capacity and the absence of vasodilator treatment were also associated with poor survival. A multivariate Cox proportional-hazards regression analysis was used to assess the adjusted hazard ratios, hence the relative contributions of the variables controlling for confounding. Reduced forced vital capacity and cardiac index and increased right atrial pressure were still significantly associated as risk factors for survival in patients with PPH. Survival as computed by the equation correlated with real survival of PPH patients with positive predictive values of 87%, 91%, and 89% at 1, 2, and 3 years, respectively. The equation, however, was relatively unable to predict deaths in our population, in part because of the strict limits of poor prognosis. CONCLUSIONS: Mortality in PPH is largely associated with hemodynamic variables that assess right ventricular function. The proposed prognostic equation had a high sensitivity and a relatively low specificity to predict survival in our PPH population. To improve this specificity it may be necessary to increase the limits of poor prognosis as defined by the equation.