Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain.
Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain.
PLoS One. 2019 Aug 2;14(8):e0220491. doi: 10.1371/journal.pone.0220491. eCollection 2019.
Spirometry remains essential for the diagnosis of airway obstruction. Nevertheless, its performance in elderly hospitalized patients with multimorbidity can be difficult. The aim of this study is to assess the utility of the COPD-6 portable device in this population. We included all patients hospitalized for exacerbation of chronic diseases in a medical ward specialized in the care of multimorbidity patients, between September 2017 and May 2018. A questionnaire including sociodemographic, cognitive and functional impairment, among other variables, was completed the last day of admission. Subsequently, patients attempted to perform three valid respiratory manoeuvres with the COPD-6 device and then conventional spirometry. A total of 184 patients were included (mean age of 79.61 years, 55% men). Forty-seven (25.54%) patients were able to perform complete spirometric manoeuvres and 99 (53.8%) could perform a valid FEV1/FEV6 determination. The inability to perform a valid spirometry was related with the patient's age, functional physical disability, cognitive impairment or the presence of delirium or dysphagia during admission. Only 9% of patients with a Mini Mental Cognitive Examination (MMEC) lower than 24 points could perform a valid spirometry. Of the patients with an MMEC < 24 points and unable to perform spirometry, 34% were able to complete the FEV1/FEV6 manoeuvres. No differences were found in the Charlson index, multimorbidity scale, number of domiciliary drugs, or length of stay between those patients able and those not able to perform respiratory manoeuvres. The agreement between the values for FEV1 measured with COPD-6 and those observed in the spirometry was good (r: 0.71; p<0.0001). Inability to perform a valid spirometry during hospitalization in elderly patients with multimorbidity is frequent and related with functional and cognitive impairment. FEV1/FEV6 determination using the COPD-6 portable device allows an important percentage of the patients with limitations to complete spirometric measurement.
肺量计仍然是诊断气道阻塞的基本方法。然而，对于患有多种合并症的住院老年患者，其表现可能较为困难。本研究旨在评估 COPD-6 便携式设备在该人群中的应用价值。我们纳入了 2017 年 9 月至 2018 年 5 月期间在专门治疗多种合并症的医疗病房因慢性疾病加重而住院的所有患者。在住院的最后一天，完成了包括社会人口学、认知和功能障碍等变量在内的问卷。随后，患者尝试使用 COPD-6 设备进行三次有效的呼吸动作，然后进行常规肺功能检查。共纳入 184 例患者（平均年龄 79.61 岁，55%为男性）。47 例（25.54%）患者能够完成完整的肺量计动作，99 例（53.8%）能够进行有效的 FEV1/FEV6 测定。无法进行有效的肺功能检查与患者的年龄、身体功能障碍、认知障碍或入院期间是否出现谵妄或吞咽困难有关。只有 9%的简易精神状态检查（MMEC）得分低于 24 分的患者能够进行有效的肺功能检查。在 MMEC 得分低于 24 分且无法进行肺功能检查的患者中，34%能够完成 FEV1/FEV6 动作。能够进行和不能进行呼吸动作的患者之间，Charlson 指数、合并症量表、家庭用药数量或住院时间均无差异。使用 COPD-6 测量的 FEV1 值与肺功能检查观察到的 FEV1 值之间具有良好的一致性（r：0.71；p<0.0001）。在患有多种合并症的老年住院患者中，无法进行有效的肺功能检查很常见，且与功能和认知障碍有关。使用 COPD-6 便携式设备进行 FEV1/FEV6 测定可以使具有限制的患者中很大一部分能够完成肺功能测定。
