Análise comparativa entre pacientes portadores de doença pulmonar obstrutiva crônica submetidos a programa de reabilitação pulmonar em clínica especializada e em regime domiciliar

Abstract

COPD is a common cause of morbidity and mortality comprising a large number of subjects in both developed and underdeveloped countries. It represents a significant cost to patients, families and society. The pulmonary rehabilitation program (PRP) is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and it promotes self-care, being effective in COPD because it results in improvement in dyspnea, fatigue and quality of life. PRP offers therefore the possibility of improvement of clinical outcomes and reduces the aggregate costs of direct and indirect costs associated with COPD. Despite its proven effectiveness and the strong scientific recommendations for routine use in the care of COPD, the PR is widely underutilized. Strategies to increase access to PR are necessary. Therefore, home-based self-monitoring pulmonary rehabilitation is an alternative to outpatient rehabilitation. On this assumption, we investigated patients with mild, moderate and severe COPD, submitted to an outpatient and home-based PRP for 12 weeks. The sample consisted of 207 patients. The main cause related to the development of COPD was the current or prior smoking (92% of cases); the most frequently reported symptom was dyspnea (95.0%), followed by cough (86.1%), wheezing (69, 4%) and bronchial secretions (40.0%). Evaluating the clinical history of cases in follow-up, it was identified, in addition to COPD, a significant number of comorbidities, being cardiovascular disease and neurological disorders the most prevalent. Patients who fulfilled the inclusion criteria were divided into 3 distinct groups, a group of patients called as outpatient PRP (RPA) which performed all the activities at the clinic, other group called home-based PRP (RPD) who performed the activities at home and a control group (CON). Outpatient PRP consisted of a combination of aerobic exercises and upper and lower limbs strengthening, 3 times a week for 12 weeks. The change in the 6MWD after participating in the rehabilitation program was shown to be different (p<0.05) in the RPA and RPD regardless to the control group, which was also observed in the BODE index (p<0.001). After this study, we conclude that the home-based self-monitoring pulmonary rehabilitation program is as effective as the outpatient pulmonary rehabilitation, and a valid alternative in the management of patients with COPD.