Chronic respiratory failure in obstructive ventilatory dysfunction

Abstract

Introduction: The obstructive ventilatory dysfunction characterized by increased resistance to airflow in expiration develops belatedly in the evolution of chronic broncho-obstructive diseases and represents the starting point of an important disability and deterioration of quality of life. We present the preliminary results of a validation study of Dijon score and St. George score in correlation with obstructive ventilatory dysfunction and its sub-pathologies. The study is based on establishing a final score that depends on the physical activity and respiratory capacities of the patients. The indices denoting the physio-pathological disorder are represented by: VEMS (forced expiratory volume in one second), IT (VEMS/CV) and the correlation with the scores of quality of life and physical activity self-declared. Background and aim of the study is to highlight the correlation between functional indices and the subjective statement of the patients on an alteration of their daily activities. Materials and Methods: We assessed 50 patients diagnosed with the obstructive ventilatory dysfunction, bronchial asthma or COPD (chronic obstructive pulmonary disease). In median age patients (53.21) VEMS, CV, VER, IT were evaluated in order to establish the difficulties regarding the respiration and level of physical activity of the patients using Dijon score and St. George score. Dijon score represents self-declared physical activity (the maximum score of 30 represents a good physical activity, and St. George score represents the alteration of life quality in chronic patients, a high score meaning a more severe impairment (3 domains: symptoms, activity, impact) Results and Discussion: In the studied patients, the correlation between the age and symptoms gives a negative value (r = -0.035). It was noticed that older patients (>60) have a higher symptomatic index. The most marked symptom is cough associated with heavy breathing. Patients aged over 50 years shows a moderate or small physical activity, the correlation between age and activity having an index <1 (0.03). The severity of all symptoms is directly proportional with the age. It was noticed in COPD patients that the correlation between VEMS and symptomatology had a strongly negative value (r = -0.034), found in chronic bronchitis characterized by reduced physical activity. Most patients with IT < 0.5 have been diagnosed with COPD, the main symptom that influences health being dyspnea. Contrary to expectations, the patients with IT between 0.5 - 0.2 have normal VEMS accompanied by a decreased vital capacity.For the group of patients analyzed the average Dijon score is 13, age being directly proportional to its values while symptomatology is inversely proportional to the same values. In patients with Dijon score <11 physical activity causes fatigue due to important lack of air, the main symptom being dyspnea. The best correlation was noticed between IT and IMPACT score of ST G (r = -0.77) Conclusions: Dijon score approach with respiratory indices (VEMS, CV, IT) represents a stable method of analysis for respiratory failure and their associated diseases. The impact score of the questionnaire of St George is a good indicator of the obstructive level.