Investigation of phenotype in exacerbated COPD: do the major impact and symptomatology reflect worst heart autonomic modulation?

• Grant number: 19/23548-8
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: March 01, 2020
• End date: February 28, 2022
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Renata Gonçalves Mendes
• Grantee: Nicole Marques Sgarbosa
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• Associated research grant: 15/26501-1 - Study of limiting factors to physical exercise and adjunct effects to rehabilitation on cardiorespiratory disease: a multicentre approach, AP.TEM

Abstract

Patients with chronic obstructive pulmonary disease (COPD) often present exacerbations that culminate in hospitalizations. These events add a negative impact to COPD including alterations in symptomatology and cardiac autonomic function. There is currently interest in differentiating these patients in phenotypes using findings or combining common characteristics. However, there is no knowledge if patients who in this period report greater impact and symptomatology of the disease have a worse profile in cardiac autonomic control. Objective: To investigate whether in patients with COPD in exacerbation, the impact of the disease and the symptoms reported influence cardiac autonomic control. Methods: Patients with COPD of both sexes who are hospitalized for exacerbation of the disease will be evaluated. The impact of the disease will be assessed by the COPD Assessment Test questionnaire, consisting of eight evaluative items with a response scale from 0 to 5 that can reach the final score from 0 to 40 points, the higher the score, the worse the impact of the disease on the patient's life. The mMRC scale will be used to quantify the dyspnea reported by the patients. This contains 5 items (0 to 4) that correspond to the perception of dyspnea limiting daily life. The groups will be divided into two groups: 1) According to the values obtained in the mMRC and CAT tool in GMRCAT 1 (N = 10 with patients with mMRCd2; CATd20), i.e. patients with less impact of the disease and symptomatology and 2) GMRCAT 2 (N = 10 with patients with mMRCe2; CATe20), i.e. patients with greater impact of the disease and symptomatology. In both groups, an eosinophil count of d 150 céls/œ L will be considered. The assessment of cardiac autonomic modulation will be performed by analyzing the heart rate variability (HRV) considering the linear indices in the time domain (mean HR, mean RR, STDRR, rMSSD, RRtri, TINN) and in the frequency domain (BF, HF and BF/AF); and nonlinear (correlation dimension, Shannon and sample entropy, and Poincaré graphic analysis in the dynamic HR process at rest in hospitalized patients due to exacerbation of the disease. Statistical analysis: The software SPSS Statistics 17.0 will be used. The level of significance established will be 5% (P < 0.05). Expected results: The differentiation of patients through clinical and functional aspects and their influences on cardiac autonomic control may help to identify more singular and specific needs, as well as on the risk of patients with COPD and to influence Future rehabilitative strategies. (AU)