Profile of Pneumopathic Elderly Persons Admitted to a Pulmonary Rehabilitation Center

Introducao: Pneumopatias sao definidas como grupo de doencas respiratorias. Centros de fisioterapia surgem como tratamento convencional que contribui para prevenir e tratar variadas condicoes pulmonares. Objetivo: Caracterizar idosos com pneumopatias admitidos para reabilitacao pulmonar. Metodos: A amostra foi composta por 84 pacientes admitidos para reabilitacao pulmonar no departamento de fisioterapia cardiopulmonar de uma clinica escola. Pacientes com diagnostico de doenca pulmonar e idade ≥60 anos foram incluidos no estudo. As seguintes variaveis foram analisadas: sexo, idade, estado civil, profissao, diagnostico medico, queixa principal, doenca associada, e fatores de risco cardiovascular. Resultados: A pneumopatia mais comum foi doenca pulmonar obstrutiva cronica (DPOC) (26,2%). Mulheres mostraram maior associacao com asma [Odds Ratio (OR)=5,875; p=0,010]. Dispneia foi a queixa principal mais prevalente na populacao (50%). Entre as queixas principais, dificuldade de deambular foi mais associada com homens (OR=2,85; p=0,055). Acidente vascular cerebral (AVC) foi a doenca principal mais associada com pneumopatias (12,1%). Mulheres tiveram maior associacao com outras doencas (OR=5,34, p=0,068), especialmente, quando apresentaram mais que dois quadros simultaneamente com a pneumopatia (OR=2,32, p=0,041). Entre os fatores de risco, a inatividade fisica (OR=3,33), o consumo de alcool (OR=0,046) e o historico de tabagismo (OR=3,00) foram significativamente associados ao sexo masculino, enquanto depressao (OR=5,67) ao feminino. Mulheres apresentaram 3,28 mais associacao entre alergias e pneumopatias que os homens (p=0,013). A pratica de atividade fisica foi mais associada com o sexo feminino (OR=3,89; p=0,03). Osteoporose foi mais prevalente em mulheres idosas com doenca pulmonar (OR=10,75; p<0,0001), e tambem significativamente, enquanto associada ao historico de tabagismo (OR=4,31; p=0,009). Conclusao: O diagnostico, a queixa principal e a doenca associada mais frequentes foram DPOC, dispneia e AVC, respectivamente. Idosas apresentam maior associacao com diagnostico de asma bronquica e mais doencas associadas a pneumopatia. Sedentarismo, dificuldade de deambular, etilismo e historico de tabagismo sao mais associados ao sexo masculino, enquanto que depressao, presenca de alergias, pratica de atividade fisica e osteoporose, ao feminino. Assim, os resultados demonstram que esses idosos apresentam caracteristicas especificas.


INTRODUCTION
Life expectancy has increased significantly in recent years and with it the goal of healthy and successful aging and good quality of life.Yet disorders related to aging affect elderly individuals, requiring improved treatment and increased knowledge of this population. 1eumopathies are defined as a set of respiratory system diseases and include acute infections, chronic or pleural lung diseases and respiratory tract malignancies. 2They are a major global cause of morbidity, and represent approximately 16% of hospitalizations in Brazil. 3It has been noted that patients with pulmonary disease who are admitted for rehabilitation are mostly elderly. 4thin this context, respiratory therapy centers have emerged as conventional treatment centers that help prevent and treat various lung conditions such as airway obstruction, pulmonary hypersecretion, changes in lung ventilation, physical deconditioning and dyspnea.However, there are few studies that characterize lung disease among elderly persons in pulmonary rehabilitation centers. 4udies that characterize different populations are essential and of great importance as they provide relevant knowledge about these individuals and enable national healthcare guidelines be developed or restructured in order to meet the particular needs of a specific population. 4erefore, the present study aimed to characterize elderly people with lung disease admitted to a pulmonary rehabilitation center.

METHOD
A retrospective, nonrandomized exploratory study was performed of elderly patients with lung diseases.The sample consisted of 84 patients admitted for pulmonary rehabilitation in the cardiopulmonary physical therapy department of a medical college in the city of São José do Rio Preto, from March 2002 to December 2010.Patients with a diagnosis of lung disease and aged 60 years or older were included in the survey.During admission to the medical college, patients underwent triage and were forwarded to the Cardiorespiratory Physiotherapy sector.Patients with incomplete admissions records were excluded.
For data collection a specific form based on the data included on the admissions form was created.The following variables were analyzed: gender, age, marital status, profession, medical diagnosis, chief health complaint, associated diseases and the cardiovascular risk factors presented by patients.The cardiovascular risk factors analyzed were: diabetes mellitus (DM), systemic arterial hypertension (SAH), sedentary lifestyle (no regular physical activity), alcohol consumption (constant alcohol intake reported by the patient), depression (with use of medication) and history of smoking ("yes", "no", "passive" and "ex-smoker").The presence of allergies, regular physical activity (≥ three times/week), dependent mobility and a medical diagnosis of osteoporosis were also evaluated.
Descriptive and inferential statistics were used for data analysis.Descriptive results were expressed as mean, standard deviation (±), and absolute and walking, and a history of alcohol consumption and smoking are more associated with men, while depression, the presence of allergies, regular physical activity and osteoporosis are more associated with women.Thus, the results demonstrate that these individuals have specific characteristics.
relative frequencies.Welch's unpaired t-test was used to compare age between men and women and to verify the similarity between the groups, while Odds Ratio (OR) was calculated with the Chi-squared test to compare the variables.A significance level of p≤0.05 was adopted.Statistical analysis was performed using the Instat program (version 3.0; GraphPad, Inc., San Diego, CA, USA).
This study was approved by the Ethics Research Committee of the Instituto de Moléstias Cardiovasculares (Institute of Cardiovascular Diseases Committee) (IMC/SP), under Protocol.No. 015.08.010.Data was cataloged using a registration code only to preserve the privacy of patients.

RESULTS
The sample consisted of 84 patients (49 men and 35 women) with a median age of 72 (60-94) years.The sample showed similarities in terms of age, as shown in Table 1.About 61% of the elderly persons were married and 56% were retired (Table 1).Men were more associated with being married (OR=2.97;p=0.009) and retired (OR=2.05;p=0.055).
With regard to medical diagnosis, five patients presented two associated pneumopathies (Table 2).The most common lung disease was COPD (26%).Women were more associated with asthma (OR=5.875;p=0.010).Dyspnea was the most prevalent main health complaint among this population (50%).Around 29 individuals had two associated complaints and six individuals had three, totaling 125 complaints.Among the main complaints, difficulty in walking was most associated with elderly men (OR=2.85;p=0.055).
Cerebrovascular accidents (CVA) were the main disease associated with these pneumopathies (12%) (Table 3).About 26 of the elderly persons had two diseases associated with the pneumopathies and six had three, totaling 89 associated diseases.Women were more associated with other diseases (OR=5.34,p=0.068), especially when they had more than two associated lung pathologies (OR=2.32;p=0.041).
With regard to risk factors, physical inactivity was present among 85.7% of subjects, followed by a history of smoking (66.7%) (Table 4).Among the risk factors, physical inactivity, alcohol consumption and a history of smoking were significantly more associated with men; while depression was more associated with women (Table 4).
History of smoking, presence of allergies, dependent mobility, physical activity and osteoporosis are described in Table 5. Women had a 3.28 times greater association between allergies and lung disease than men ( p=0.013).Physical activity was more associated with women (OR=3.89;p=0.03).Osteoporosis was more prevalent among elderly women with pneumopathies (OR=10.75;p<0.0001) and was significantly associated with smoking (OR=4.31;p=0.009).

DISCUSSION
We previously observed a prevalence of pneumopathies among elderly patients. 4With population aging, the installation of such diseases and a change in the health profile of the population can be identified, with chronic diseases and their morbidities being most prevalent, requiring the direct use of health services. 5It is therefore important to study this population specifically, given the high prevalence of this condition and associated socioeconomic costs.
COPD was the most pneumopathy and a history of smoking was one of the main risk factors, with the latter being more associated with men.The same results were previously observed in individuals from different age groups. 4Tobacco has been found to increase the risk of developing COPD, although there is also a need for individual susceptibility for a pathological condition to be installed. 6Among the Brazilian population, morbidity and mortality rates from COPD have been increasing in the last twenty years, which is a worrying scenario considering that the disease is preventable.It is therefore important to invest in anti-smoking policies. 7,8spnea was the main health complaint.According to the American Thoracic Society, 9 this term refers to respiratory distress of varying intensity diagnosed from the subjective experience of the individuals.It is based on behavioral and physiological responses that are influenced by the environment, psyche and physiological factors. 91][12][13] Recognition of this pathological condition improves the diagnosis and notification process and optimizes diagnostic tests for these patients, as well as reducing errors during admission. 12There is a significant association between asthma and allergies in women, 14 explaining the greater association identified between these two clinical profiles and women.
A sedentary lifestyle was the main cardiovascular risk factor presented by the patients, with men more associated with sedentary lifestyles and difficulty walking, and women exhibiting greater physical activity.Physical inactivity is a characteristic factor of some lung diseases and a risk factor for the worsening of symptoms, and consequently a marker for health condition. 15Greater life expectancy is expected within this context.
Strokes were the most frequent disease among patients admitted for pulmonary rehabilitation.Lung diseases such as pneumonia and pulmonary embolism are prevalent post-stroke complications, directly related to immobility. 16Therefore, early physical therapy in a hospital environment is of fundamental importance.
Depression was more prevalent in elderly persons with lung disease.This result has also been observed in the general elderly population and is related to the decline in physical function and a poor quality of life. 17Another prevalent chronic disease in women is osteoporosis. 17In the present study, it was observed that osteoporosis was also associated with a history of smoking, a result also found in another article. 18Smoking reduces bone mineral density due to changes in estradiol, serum parathyroid and vitamin D levels, altering calcium absorption in the digestive system and the renewal of bone cells. 19ring the development of the research, it was noted that analysis based on medical records hinders data collection, as it leads to a loss of individuals included in the study due to failures during the admission assessment.However, the results of the study proved to be extremely important, especially given the lack of studies on the theme.We suggest that future prospective studies that evaluate the effectiveness of prevention and treatment programs for elderly patients are carried out based on the results of the present study.

CONCLUSION
The most frequent main diagnosis and health complaint were COPD and dyspnea, respectively.Elderly women were more associated with the diagnosis of bronchial asthma and other diseases associated with pneumopathies.Strokes were the disease most associated with pulmonary illness.Physical inactivity, difficulty walking, alcohol consumption and a history of smoking history were more associated with men, while depression, presence of allergies, physical activity and osteoporosis were more associated with women.The present study highlights the need for investment in prevention and health promotion among the elderly, as well as new treatment protocols and the improvement of physiotherapy treatments that can result in a better quality of life for these patients.
* Different professions that exhibited only one occurrence in their category.
a: Medical diagnoses that occurred only once per category; b: Main health complaints that occurred less than three times per category.
* Associated illnesses that occurred less than three times per category.

Table 4 .
Risk factors presented by elderly pneumopathy sufferers.São José do Rio Preto, São Paulo, 2012.Level of association between gender and risk factors; *Significant association between gender and the presence of a cardiovascular risk factor in elderly sufferers of pneumopathies, evaluated by chi-squared test (χ²).