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      Utility of FEV 1/FEV 6 index in patients with multimorbidity hospitalized for decompensation of chronic diseases

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          Abstract

          Spirometry remains essential for the diagnosis of airway obstruction. Nevertheless, its performance in elderly hospitalized patients with multimorbidity can be difficult. The aim of this study is to assess the utility of the COPD-6 portable device in this population. We included all patients hospitalized for exacerbation of chronic diseases in a medical ward specialized in the care of multimorbidity patients, between September 2017 and May 2018. A questionnaire including sociodemographic, cognitive and functional impairment, among other variables, was completed the last day of admission. Subsequently, patients attempted to perform three valid respiratory manoeuvres with the COPD-6 device and then conventional spirometry. A total of 184 patients were included (mean age of 79.61 years, 55% men). Forty-seven (25.54%) patients were able to perform complete spirometric manoeuvres and 99 (53.8%) could perform a valid FEV1/FEV6 determination. The inability to perform a valid spirometry was related with the patient’s age, functional physical disability, cognitive impairment or the presence of delirium or dysphagia during admission. Only 9% of patients with a Mini Mental Cognitive Examination (MMEC) lower than 24 points could perform a valid spirometry. Of the patients with an MMEC < 24 points and unable to perform spirometry, 34% were able to complete the FEV1/FEV6 manoeuvres. No differences were found in the Charlson index, multimorbidity scale, number of domiciliary drugs, or length of stay between those patients able and those not able to perform respiratory manoeuvres. The agreement between the values for FEV1 measured with COPD-6 and those observed in the spirometry was good (r: 0.71; p<0.0001). Inability to perform a valid spirometry during hospitalization in elderly patients with multimorbidity is frequent and related with functional and cognitive impairment. FEV1/FEV6 determination using the COPD-6 portable device allows an important percentage of the patients with limitations to complete spirometric measurement.

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          Most cited references31

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          Post-hospital syndrome--an acquired, transient condition of generalized risk.

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            Defining and measuring multimorbidity: a systematic review of systematic reviews

            Multimorbidity, the coexistence of multiple health conditions, is a growing public health challenge. Research and intervention development are hampered by the lack of consensus regarding defining and measuring multimorbidity. The aim of this systematic review was to pool the findings of systematic reviews examining definitions and measures of multimorbidity.
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              New horizons in multimorbidity in older adults.

              The concept of multimorbidity has attracted growing interest over recent years, and more latterly with the publication of specific guidelines on multimorbidity by the National Institute for Health and Care Excellence (NICE). Increasingly it is recognised that this is of particular relevance to practitioners caring for older adults, where multimorbidity may be more complex due to the overlap of physical and mental health disorders, frailty and polypharmacy. The overlap of frailty and multimorbidity in particular is likely to be due to the widespread health deficit accumulation, leading in some cases to functional impairment. The NICE guidelines identify 'target groups' who may benefit from a tailored approach to care that takes their multimorbidity into account, and make a number of research recommendations. Management includes a proactive individualised assessment and care plan, which improves quality of life by reducing treatment burden, adverse events, and unplanned or uncoordinated care.
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                Author and article information

                Contributors
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Formal analysisRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2 August 2019
                2019
                : 14
                : 8
                : e0220491
                Affiliations
                [1 ] Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
                [2 ] Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
                National Yang-Ming University, TAIWAN
                Author notes

                Competing Interests: This study was supported in part by grant PAM-000-2017-01 to PA from Astra-Zeneca Spain. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                ‡ These authors also contributed equally to this work.

                Author information
                http://orcid.org/0000-0002-8476-4942
                Article
                PONE-D-19-13781
                10.1371/journal.pone.0220491
                6677320
                31374087
                123da6c0-c3c3-4398-a312-30f5d4da0fda
                © 2019 Komal et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 June 2019
                : 17 July 2019
                Page count
                Figures: 5, Tables: 3, Pages: 16
                Funding
                Funded by: AstraZeneca Spain
                Award ID: PAM-000-2017-01
                Award Recipient :
                This study was supported in part by Astra-Zeneca Spain grant PAM-000-2017-01 to PA. The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.
                Categories
                Research Article
                Research and Analysis Methods
                Bioassays and Physiological Analysis
                Respiratory Analysis
                Spirometry
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Biology and Life Sciences
                Neuroscience
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Neurology
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Geriatrics
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Medicine and Health Sciences
                Otorhinolaryngology
                Laryngology
                Dysphagia
                Medicine and Health Sciences
                Pulmonology
                Chronic Obstructive Pulmonary Disease
                Medicine and Health Sciences
                Cardiology
                Heart Failure
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Bronchodilators
                Custom metadata
                All relevant data are within the paper, its Supporting Information files, and in https://figshare.com/s/26bda0cc74a5f9d982bf.

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                Uncategorized

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