Background. A community-based prevalence survey performed in two suburbs in Cape Town, South Africa (SA), in 2005, using the international Burden of Obstructive Lung Disease (BOLD) method, confirmed a prevalence of chronic airflow obstruction (CAO) in 23.1% of adults aged >40 years. Objectives. To study the clinical course and prognosis over 5 years of patients with CAO identified in the 2005 survey. Methods. Patients with CAO in 2005 were invited to participate. Standard BOLD and modified questionnaires were completed. Spirometry was performed using spirometers of the same make as in 2005. Results. Of 196 eligible participants from BOLD 2005, 45 (23.0%) had died, 8 from respiratory causes, 10 from cardiovascular causes and 6 from other known causes, while in 21 cases the cause of death was not known. On multivariate analysis, only age and Global initiative for Obstructive Lung Disease (GOLD) stage 4 disease at baseline were significantly associated with death. Of the 151 survivors, 11 (5.6% of the original cohort) were unavailable and 33 (16.8%) declined or had medical exclusions. One hundred and seven survivors were enrolled in the follow-up study (54.6%, median age 63.1 years, 45.8% males). Post-bronchodilator spirometry performed in 106 participants failed to confirm CAO, defined as a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of <0.7, in 16 participants (15.1%), but CAO was present in 90. The median decline in FEV1 was 28.9 mL/year (interquartile range –54.8 - 0.0) and was similar between GOLD stages. The median total decline in FVC was 75 mL, and was significantly greater in GOLD stage 1 (–350 mL) than in stages 2 or 3 (–80 mL and +140 mL, respectively; p<0.01). Fifty-eight participants with CAO in 2005 (64.4%) remained in the same GOLD stage, while 21 (23.3%) deteriorated and 11 (12.2%) improved by ≥1 stage. Only one-third were receiving any treatment for chronic obstructive pulmonary disease (COPD). Conclusions. The prevalence, morbidity and mortality of CAO and COPD in SA are high and the level of appropriate treatment is very low, pointing to underdiagnosis and inadequate provision of and access to effective treatments and preventive strategies for this priority chronic non-communicable disease.

Background Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. We reviewed the global literature reporting the main determinants for adherence on these patients. Methods Searches were made using the Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical, observational and epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Random-effects meta-analysis were used to summarise the numerical effect estimates. Results 47 studies were included, including a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: older age [RR = 1.07 (1.03–1.10); I2 = 94; p < 0.0001] good disease knowledge/literacy [RR = 1.37 (1.28–1.47); I2 = 14; p = 0.33]; obesity [RR = 1.30 (1.12–1.50); I2 = 0; p = 0.37]; good cognitive performance [RR = 1.28 (1.17–1.40); I2 = 0; p = 0.62]; higher income [RR = 1.63 (1.05–2.56); I2 = 0; p = 0.52]; being employed [RR = 0.87 (0.83–0.90); I2 = 0; p = 0.76] and using multiple drugs/inhalers [RR = 0.81 (0.79–0.84); I2 = 0; p = 0.80]. Overall, the strength of the underlying evidence was only low to moderate. Conclusions Many determinants may be associated to patient's adherence, and personalised interventions should be taken in clinical practice to address it by gaining an understanding of their individual features.

Respiratory disorders, such as Chronic Obstructive Pulmonary Disease (COPD) and acute asthma, are significant global health challenges, contributing to high morbidity, mortality, and healthcare costs. Traditional diagnostic tools, like spirometry, are limited to clinical settings, require trained professionals, and are unsuitable for continuous or home-based monitoring. This highlights the need for accessible, non-invasive solutions for early detection and proactive management. This dissertation introduces a wearable vest for real-time respiratory monitoring, integrating inertial measurement units (IMUs) and bioimpedance (BioZ) sensors to track thoracoabdominal motion and thoracic bioimpedance. Using Internet of Medical Things (IoMT) technologies, the system aims to enhance respiratory care through personalized, preventive health management. The methodology involved designing a smart vest to capture respiratory metrics such as respiratory rate and tidal volume surrogates. Data is transmitted via Bluetooth Low Energy (BLE) to a mobile application for real-time visualization. Firmware, developed using Nordic Semiconductor’s nRF Connect SDK and Zephyr RTOS, ensures reliable sensor integration. A WEB application was created for interactive data visualization and export. Preprocessing techniques, such as gravity removal and band-pass filtering, were applied to ensure data quality. The results demonstrated the system’s ability to capture valid respiratory metrics. The IMU-based respiratory proxy showed stable, breath-locked oscillations, while BioZderived signals exhibited consistent magnitude and phase changes during breathing cycles. The agreement between kinematic and electrical measurements validated the system’s accuracy. The analysis highlighted the system’s potential for continuous respiratory monitoring in real-life settings, though challenges like motion artifacts and electrode stability were noted. Lessons learned emphasized the importance of robust preprocessing pipelines and transparent data analysis. In conclusion, the wearable vest provides a promising solution for noninvasive respiratory monitoring, bridging the gap between clinical insight and daily patient care. Future work will focus on real-time data visualization, hardware optimization, clinical validation, and developing a stable mobile application to establish the vest as a reliable tool for personalized respiratory care.

Background. An association between chronic airflow limitation (CAL) and a history of pulmonary tuberculosis (PTB) has been confirmed in epidemiological studies, but the mechanisms responsible for this association are unclear. It is debated whether CAL in this context should be viewed as chronic obstructive pulmonary disease (COPD) or a separate phenotype. Objective. To compare lung physiology and high-resolution computed tomography (HRCT) findings in subjects with CAL and evidence of previous (healed) PTB with those in subjects with smoking-related COPD without evidence of previous PTB. Methods. Subjects with CAL identified during a Burden of Obstructive Lung Disease (BOLD) study performed in South Africa were studied. Investigations included questionnaires, lung physiology (spirometry, body plethysmography and diffusing capacity) and quantitative HRCT scans to assess bronchial anatomy and the presence of emphysema (<–950 HU), gas trapping (<–860 HU) and fibrosis (>–200 HU). Findings in subjects with a past history and/or HRCT evidence of PTB were compared with those in subjects without these features. Results. One hundred and seven of 196 eligible subjects (54.6%) were enrolled, 104 performed physiology tests and 94 had an HRCT scan. Based on history and HRCT findings, subjects were categorised as no previous PTB (NPTB, n=31), probable previous PTB (n=33) or definite previous PTB (DPTB, n=39). Subjects with DPTB had a lower diffusing capacity (Δ=–17.7%; p=0.001) and inspiratory capacity (Δ=–21.5%; p=0.001) than NPTB subjects, and higher gas-trapping and fibrosis but not emphysema scores (Δ=+6.2% (p=0.021), +0.36% (p=0.017) and +3.5% (p=0.098), respectively). Conclusions. The mechanisms of CAL associated with previous PTB appear to differ from those in the more common smoking-related COPD and warrant further study.

A Doença Pulmonar Obstrutiva Crónica (DPOC) é um problema de saúde pública a nível mundial que representa um elevado custo para os sistemas de saúde e cujo tratamento não farmacológico mais adequado é a reabilitação pulmonar. No sentido de eliminar barreiras de acessibilidade à reabilitação presencial têm surgido programas de telereabilitação que demonstraram benefícios semelhantes à reabilitação convencional sendo ainda necessário estudar a custo-efetividade desta tipologia de programas. Este estudo tem como grandes objetivos apurar o consumo económico dos episódios de urgência dos doentes com DPOC no Hospital de Espírito Santo de Évora (HESE) e demonstrar o potencial de redução do consumo económico associado aos episódios de urgência e internamento por DPOC agudizada através da implementação de um programa de telereabilitação pulmonar. Numa primeira fase, foi analisada uma amostra de 501 pessoas que recorreram 905 vezes ao Serviço de Urgência (SU) por sintomatologia compatível com DPOC Agudizada nos sete anos em estudo. Desses episódios de urgência, 60% terminaram em alta hospitalar e 40% em internamento o que correspondeu a um consumo económico médio total de 862.364,42€. Posteriormente, ao simular a criação de um programa de telereabilitação verificou-se que o investimento inicial com os recursos materiais necessários é de 4.304,80€ e que o custo total anual com recursos humanos e materiais rondará os 31.077,45€. Ao analisar os resultados, foi possível concluir que um programa de telereabilitação pulmonar no Hospital do Espírito Santo de Évora permitiria obter ganhos em saúde para o doente e ganhos económicos para a instituição.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, the main symptoms of which are dyspnoea and fatigue. Though exercise has been recommended for subjects with COPD, its benefits remain unclear. The aim of this study was to summarise, through a systematic review and meta-analysis, the available evidence on the effects of aerobic, resistance, stretching, and combined exercise on the main symptoms of COPD. Methods: Search was performed using the electronic databases PubMed and Web of Science. Randomised controlled trials (RCTs) with interventions based on aerobic, resistance and/or combined exercise published until July 2022 were identified. The effects were summarised based on standardised mean differences (95% confidence intervals) using random and fixed effect models. Results: Eight studies were selected, including a total of 375 subjects. The results obtained showed that resistance exercise, aerobic exercise and combined exercise seem to improve dyspnoea and fatigue symptoms in COPD subjects. Conclusions: In general, we can conclude that exercise-based interventions appear to improve the main COPD symptoms and may benefit quality of life in this population.

As pessoas com Doenças Pulmonares Obstrutivas Crónicas (DPOC) apresentam-se com algum grau de intolerância ao exercício físico e com diversas limitações nas atividades diárias. Nesse sentido, o objetivo deste estudo é realizar uma revisão sistemática sobre as características (intensidade, frequência, volume e tempo) e os efeitos de programas de exercício em sujeitos com DPOC. De um total de 45 estudos, a presente revisão sistemática inclui 11 estudos que foram revistos, analisados e os seus resultados extraídos. O treino cardiorrespiratório é recomendado que se sigam as indicações do ACSM (2018) para a população em geral, no sentido de ser realizado com uma frequência de 5 dias por semana, durante 30 minutos, com uma intensidade moderada a intensa. Os programas de treino, que integram exercício aeróbio e exercício de força, recomendam a realização de sessões de 60 minutos, 3 vezes por semana, durante 12 semanas, com uma intensidade moderada a pouco forte avaliada através da escala de Borg (entre os 3 – 5 pontos) numa escala de 10 pontos, integrando exercícios de força durante 15-30 minutos e um retorno à calma. Foram verificados benefícios com o aumento do nível da qualidade de vida e capacidade funcional associados a um aumento da resistência cardiorrespiratória e da força muscular em sujeitos com DPOC. A informação recolhida evidencia a existência de benefícios para este tipo de população decorrentes da prática de todos os tipos de treino, designadamente o exercício aeróbio, de força e resistência muscular, bem como de flexibilidade.

The chronic obstructive pulmonary disease (COPD) is a clinical condition with multiple comorbities. Among the most frequent and least treated are depression and sleep respiratory disorders. Our aim was to estimate the prevalence and predictive factors of obstructive sleep apnea (OSA) and isolated nocturnal hypoxemia, besides the predictors of major depression in clinically stable COPD subjects with mild daytime hypoxemia. A cross-sectional study followed by a case-control study was performed in clinically stable COPD subjects ≥ 40 years old, with mild daytime oxygen saturation visiting an Out Patient Chest Clinic in Goiania (Brazil). Patients were submitted to clinical and psychiatric evaluation, spirometry, 6-minute walk testing, polysomnography, echocardiography, arterial blood gas analysis and chest radiograph. During the period of study 61.4% (41/64) COPD patients were diagnosed with sleep respiratory disorders (23 with OSA and 18 with isolated nocturnal hypoxemia). PaO270mmHg (OR:4.91; 95% CI: 1.59-15.2) was significantly associated with sleep respiratory disorders and CAT score >20 was associated with major depression (OR 7.88; 95% CI 1.96 - 31.7). These findings suggests that COPD patients with mild daytime hypoxemia (PaO270mmHg) are candidate of a polysomnography and that COPD patients with CAT (COPD Assessment Test) score >20 should be submitted to an additional specific evaluation for the possible presence of major depression.

Introduction: The detection of patients with Chronic Obstructive Pulmonary Disease (COPD) on the primary health care network can be an important tool for an early diagnosis and better conduct management of these patients. Studies realized in Latin America (MENEZES, 2006) show that the COPD underdiagnosis is one of the great limiters for the control of this illness. It was also observed in a study in Canada (Hill et al., 2010) that half of the cases sub-diagnosed were of hypertensive patients. Thus, the analysis of the pulmonary function in hypertensive patients could be a useful strategy for the diagnosis of patients with COPD. Objective: To estimate the prevalence of COPD and its sub-diagnosis on hypertensive patients registered on the HIPERDIA Program of an unit of primary health care in Goiânia. Methodology: The transversal analytical study performed on the Novo Horizonte CIAMS in Goiânia from January/2011 to May/2012, with patients from both sex, aged between 18 and 80 years old and hypertensive registered on the HIPERDIA Program. The patients were evaluated as for the pulmonary function (spirometry) and the respiratory symptoms (questionnaire). The criteria used for the diagnosis f COPD were in fixed relation of the VEF1/CVT<0,70 or by the relation VEF1/CVF below the inferior limit of normality. For the statistical analysis, it was appealed to the SPSS 17.0 program, with the execution of the square Qui test, T test and analysis of the logistical regression. The level of statistic significance assumed was of p < 0,05. The present study was approved by the Ethical Committee of Human Research from the Clinical Hospital of the Federal University of Goiás, register n° 159/2010. Results: 301 patients were evaluated. The prevalence of COPD was of 22,2% and the sub-diagnosis rate was of 82%. The group with normal spirometry (n=165) was compared to the group with COPD (n=67) as for the social demographic variables, pulmonary function, risk factors, the respiratory symptoms and the co morbidity. There were significant differences only in relation to the sex (p<0,001), age (p=0,005), CVF, VEF1/CVF (p<0,001), smoking (p<0,001) and wheezing (p=0,006). The group of patients with sub-diagnosed with COPD (n=55) and with previous diagnosis (n=12) were similar as for all the variables of epidemiological characterization, except for the respiratory symptoms (wheezing and dyspnea) and pulmonary function. Conclusion: The COPD patients’ profile is similar to the literature. The high prevalence of COPD found in the patients on the HIPERDIA Program with the majority of the sub-diagnosed, shows that the implantation of management strategies with patients with COPD in this National Program of Public Health is already existent in the majority of the Brazilian cities.