Lorenzo Hernández María Vanesa, Yun Sergi, Acosta Eva, Almagro Pere
Escuela de fisioterapia Gimbernat, Universidad Autónoma de Barcelona, Sant Cugat del Vallés, Barcelona, España.
Unidad de pacientes crónicos complejos, Servicio de medicina interna, Hospital Universitario Mutua de Terrassa, Universidad de Barcelona, Terrassa, España.
Rev Esp Geriatr Gerontol. 2017 Jul-Aug;52(4):193-196. doi: 10.1016/j.regg.2016.08.006. Epub 2016 Oct 28.
The prevalence of lung obstruction increases with age and the presence of comorbidities. Although a complete spirometry is necessary to confirm the diagnosis, this may be impractical in elderly patients with cognitive impairment or functional dependence. Recently, the use of portable devices using the FEV/FEV ratio have shown to be useful for assessing the presence of lung obstruction, with greater ease of use, but its usefulness has not been established in the elderly population with multiple morbidities.
A cross-sectional study was conducted on patients hospitalised in the complex chronic patients Unit of the University Hospital Mútua de Terrassa. All of them completed a questionnaire that included -among other things- measurements of functional dependence and cognitive impairment. Three manoeuvres validated with the Piko-6 device were attempted before discharge, and considering an FEV/FEV<0.75 as criteria for obstruction. An analysis was performed on the characteristics of the population that was able to perform the tests, as well as the prevalence of pulmonary obstruction.
A total of 54 patients were included in the study, of which 35 (64.81%) performed the manoeuvres correctly. Patients who were unable to complete the manoeuvres of the Piko-6 had more functional dependence (Barthel 19 vs. 72, P<.0001) and cognitive impairment (Pfeiffer 1 vs. 9, P<.0001; MEC 28/35 vs. 3/35, P<.010). The prevalence of obstruction was 71.43%, with an underdiagnosis of 72%.
The FEV/FEV ratio was not determined in 35.18% of the patients due to cognitive impairment or functional dependence. The prevalence of obstruction and underdiagnosis exceeded 70%.
肺阻塞的患病率随年龄增长和合并症的出现而增加。尽管完整的肺功能测定对于确诊是必要的，但这对于有认知障碍或功能依赖的老年患者可能不切实际。最近，使用基于FEV/FEV比值的便携式设备已显示出有助于评估肺阻塞的存在，且使用更方便，但其在患有多种疾病的老年人群中的效用尚未得到证实。
对巴塞罗那自治大学医院穆图阿德特拉萨斯分院复杂慢性病单元住院的患者进行了一项横断面研究。他们都完成了一份问卷，其中包括功能依赖和认知障碍的测量等内容。在出院前尝试用Piko-6设备进行三项验证操作，并将FEV/FEV<0.75作为阻塞标准。对能够进行测试的人群特征以及肺阻塞患病率进行了分析。
该研究共纳入54例患者，其中35例（64.81%）正确完成了操作。无法完成Piko-6操作的患者有更多的功能依赖（Barthel评分19分对72分，P<0.0001）和认知障碍（Pfeiffer评分1分对9分，P<0.0001；简易精神状态检查表28/35对3/35，P<0.010）。阻塞患病率为71.43%，漏诊率为72%。
35.18%的患者由于认知障碍或功能依赖未测定FEV/FEV比值。阻塞患病率和漏诊率超过70%。
