Prevalência de multimorbidades e polifarmácia em pacientes com DPOC de um ambulatório especializado
Data
2024-06-11
Autores
Fleury, Ana Carolina 
Orientadores
Jardim, José Roberto
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A doença pulmonar obstrutiva crônica (DPOC) é uma condição pulmonar heterogênea, caracterizada por sintomas respiratórios crônicos e limitação ao fluxo de ar. Multimorbidade, pode estar associada a pacientes com DPOC, o que faz com que tomem várias medicações diárias diferentes. Até onde sabemos, não há descrições de polifarmácia em pacientes com DPOC. Diante disso nosso objetivo foi estabelecer a prevalência da multimorbidades em pacientes com DPOC de um ambulatório especializado, avaliar a sua polifarmácia e relacionar as multimorbidades e a polifarmácia com idade, sexo, gravidade da DPOC, status tabagístico, carga tabagística e índice de massa corpórea. MÉTODOS: Foram analisados dados de 181 pacientes com DPOC que participaram de ensaios clínicos em nosso Centro de Pesquisa entre 2009 e 2019. Foram avaliados o número de morbidades, medicamentos e doses diárias necessárias para o seu tratamento. RESULTADOS: A maioria dos pacientes era do sexo masculino (58,6%), com média de idade de 65 anos (± 8,5), 89,5% eram ex-fumantes e 10,5% eram fumantes ativos com alta carga tabágica (54,8 ± 30,0 maços-ano). Os pacientes apresentaram medianas de cinco multimorbidades, sete medicamentos de uso diário e nove doses diárias de medicamentos. Setenta e três doenças foram relatadas. As comorbidades mais prevalentes foram DPOC (100% pelos critérios de inclusão), hipertensão arterial (66%), dislipidemia (32%), rinite (26%), DRGE (25%), diabetes (22%), osteoporose (19%), hiperplasia prostática benigna (16%) e asma (15%). Não houve correlação significativa entre multimorbidades e idade, maços-ano e VEF1 (%); encontrou-se correlação moderada e significativa entre multimorbidades e número de medicamentos (r = 0,63, p<0,001). Em relação à polifarmácia, indivíduos fumantes por 20 anos/maço ou mais estão 9 vezes mais propensos a usar mais medicamentos, e a cada morbidade adicional aumenta, 4,02 vezes de uso de polifarmácia. As medicações inalatórias mais prevalentes foram LABA+CI (92,2%), SABA (73,4%), LAMA (61,8%) e terapia tríplice (LABA, LAMA e CI) (60,7%). Outros 114 medicamentos foram citados. A maioria dos medicamentos foi distribuída em quatro sistemas: cardiovascular (24,5%), psiquiátrico (20,1%), aparelho digestivo (11,4%) e aparelho respiratório (8,7%). CONCLUSÕES: A multimorbidade é comum em pacientes com DPOC, independentemente da idade, sexo, IMC, tabagismo e tabagismo. A associação mais frequente em nosso estudo foi com hipertensão arterial (66%). Os pacientes com DPOC tomam um número bastante alto de medicamentos diários.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms and limited airflow. Multimorbidity may be associated with patients with COPD, which causes them to take several different daily medications. To the best of our knowledge, there are no descriptions of polypharmacy in patients with COPD. Therefore, our objective was to establish the prevalence of multimorbidities in patients with COPD from a specialized outpatient clinic, to evaluate their polypharmacy, and to relate multimorbidities and polypharmacy to age, gender, COPD severity, smoking status, smoking burden, and body mass index. METHODS: We analyzed data from 181 patients with COPD who participated in clinical trials in our Research Center between 2009 and 2019. We evaluated the number of morbidities, and the medications and daily doses required for their treatment. RESULTS: Most patients were male (58.6%), with a mean age of 65 years ( ± 8.5), 89.5% were former smokers and 10.5% were active smokers with a high smoking burden (54.8 ± 30.0 pack years). The patients had the medians of five multimorbidities, seven medications of daily use, and nine daily doses of medications. Seventy-three diseases were reported. The most prevalent comorbidities were COPD (100% by inclusion criteria), hypertension (66%), dyslipidemia (32%), rhinitis (26%), GERD (25%), diabetes (22%), osteoporosis (19%), benign prostatic hyperplasia (16%) and asthma (15%). There was no significant correlation between multimorbidities and age, pack-years and FEV1 (%); we found a moderate and significant correlation between multimorbidities and number of medications (r = 0.63, p<0.001). Regarding polypharmacy, individuals who smoke for 20 years/pack or more are 9 times more prone to use more medications, and each additional morbidity increases, 4.02 times of polypharmacy use. The most prevalent inhaled medications were LABA+ICS (92.2%), SABA (73.4%), LAMA (61.8%) and triple therapy (LABA, LAMA and ICS) (60.7%). Another 114 medications were cited. Most medications were distributed among four systems: cardiovascular (24.5%), psychiatric (20.1%), digestive system (11.4%) and respiratory system (8.7%). CONCLUSIONS: Multimorbidity is common in patients with COPD, regardless of age, sex, BMI, smoking status, and tobacco tburden. The most frequent association in our study was with hypertension (66%). Patients with COPD take a rather high number of daily medications.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms and limited airflow. Multimorbidity may be associated with patients with COPD, which causes them to take several different daily medications. To the best of our knowledge, there are no descriptions of polypharmacy in patients with COPD. Therefore, our objective was to establish the prevalence of multimorbidities in patients with COPD from a specialized outpatient clinic, to evaluate their polypharmacy, and to relate multimorbidities and polypharmacy to age, gender, COPD severity, smoking status, smoking burden, and body mass index. METHODS: We analyzed data from 181 patients with COPD who participated in clinical trials in our Research Center between 2009 and 2019. We evaluated the number of morbidities, and the medications and daily doses required for their treatment. RESULTS: Most patients were male (58.6%), with a mean age of 65 years ( ± 8.5), 89.5% were former smokers and 10.5% were active smokers with a high smoking burden (54.8 ± 30.0 pack years). The patients had the medians of five multimorbidities, seven medications of daily use, and nine daily doses of medications. Seventy-three diseases were reported. The most prevalent comorbidities were COPD (100% by inclusion criteria), hypertension (66%), dyslipidemia (32%), rhinitis (26%), GERD (25%), diabetes (22%), osteoporosis (19%), benign prostatic hyperplasia (16%) and asthma (15%). There was no significant correlation between multimorbidities and age, pack-years and FEV1 (%); we found a moderate and significant correlation between multimorbidities and number of medications (r = 0.63, p<0.001). Regarding polypharmacy, individuals who smoke for 20 years/pack or more are 9 times more prone to use more medications, and each additional morbidity increases, 4.02 times of polypharmacy use. The most prevalent inhaled medications were LABA+ICS (92.2%), SABA (73.4%), LAMA (61.8%) and triple therapy (LABA, LAMA and ICS) (60.7%). Another 114 medications were cited. Most medications were distributed among four systems: cardiovascular (24.5%), psychiatric (20.1%), digestive system (11.4%) and respiratory system (8.7%). CONCLUSIONS: Multimorbidity is common in patients with COPD, regardless of age, sex, BMI, smoking status, and tobacco tburden. The most frequent association in our study was with hypertension (66%). Patients with COPD take a rather high number of daily medications.
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Citação
ARAUJO, Ana Carolina de Carvalho Fleury. Prevalência de multimorbidades e polifarmácia em pacientes com DPOC de um ambulatório especializado. 2024. 82 f. Dissertação (Mestrado em Pneumologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.