Día Mundial de la Enfermedad Pulmonar Obstructiva Crónica (EPOC)

 

Artículo de Leire Hierrezuelo Otero

Cada tercer miércoles de Noviembre se celebra el día mundial de la Enfermedad Pulmonar Obstructiva Crónica (EPOC). Una enfermedad que afecta a más de 250 millones de personas en el mundo según datos de la Organización Mundial de la Salud (OMS). Se estima que el 10% de la población entre 40-60 años padece esta enfermedad.

Otro dato que nos da la OMS para que nos hagamos idea de su magnitud es que en 2015 murieron por esta causa cerca de 3.17 millones de personas en todo el mundo, lo que representa un 5% del total de las muertes registradas ese año.

La EPOC es la cuarta causa de muerte en el mundo y la OMS estima que será la tercera en el año 2030.

Es una enfermedad infradiagnosticada, esto quiere decir que hay muchos pacientes que desconocen que padecen la enfermedad. Según algunos estudios de nuestro entorno, entre el 50-75% de los pacientes con EPOC no están diagnosticados.

Antes, la EPOC afectaba a más hombres que mujeres pero hoy la afectación es similar en ambos. Las causas para que haya aumentado la prevalencia en mujeres son que en los países de ingresos altos ha aumentado la tasa de tabaquismo y que en los países de ingresos bajos, las mujeres están más expuestas a aires interiores contaminados.

 

¿QUÉ ES LA EPOC?

La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una enfermedad progresiva y de evolución, potencialmente mortal. Los síntomas suelen hacerse más evidentes a partir de los 40-50 años. Aunque inicialmente pueden pasar desapercibidos y no les damos importancia, atribuyéndolos a la edad o al hecho de estar en baja forma física.

Está caracterizada por una reducción persistente del flujo de aire. La disnea (fatiga) es el principal síntoma. Acompañada de tos y expectoración crónicas.

Al principio la disnea puede aparecer al caminar o aumentar la actividad física habitual, como por ejemplo subir escaleras o caminar cuesta arriba. Es decir, al principio la sensación de ahogo aumenta o se hace más aguda con el esfuerzo.

Poco a poco la persona que tiene la enfermedad deja de hacer aquellas actividades que le suponen un esfuerzo y le ocasionan fatiga.

Con el paso del tiempo las actividades básicas de la vida diaria, como vestirse o asearse, pueden suponer un gran esfuerzo y conllevar una disnea importante. Incluso puede aparecer sensación de ahogo en reposo.

PUEDE LLEGAR A SER MUY INCAPACITANTE.

Según avanza la enfermedad puede hacer que la persona enferma puede verse muy limitada para realizar sus actividades básicas de la vida diaria. Además la enfermedad cursa con exacerbaciones, periodos en los que los síntomas se agudizan y son más fuertes. Estos episodios pueden llegar a ser muy incapacitantes, impidiendo a la persona moverse de la cama al baño, por ejemplo.

La incidencia de la EPOC puede aumentar en los próximos años a causa de una mayor prevalencia del tabaquismo y al envejecimiento de la población en muchos países. Todo ello hace que esta enfermedad acarree un alto impacto económico y social, de hecho se sitúa como la 5ª causa a nivel mundial en cuanto a su repercusión social.

Como hemos mencionado, esta enfermedad es un proceso que puede llegar a ser causante de un importante grado de limitación funcional en las personas que lo padecen. Sin embargo, hay dos conceptos claves que se repiten en todas las guías clínicas de esta enfermedad; que se trata de una enfermedad prevenible y tratable.

¿TIENE CURA EL EPOC?

No tiene cura. Se trata de una enfermedad crónica. Pero sí existen tratamientos que pueden aliviar los síntomas, mejorar la calidad de vida y reducir el riesgo de defunción.

La persona que padece la enfermedad tiene un papel muy importante en el tratamiento de esta enfermedad. Debe aprender a convivir con ella, para que la fatiga le condicione lo menos posible sus actividades diarias. Los síntomas de la EPOC pueden reducirse si se toman las medidas adecuadas y sobre todo si la persona colabora activamente en ello.

FATORES DE RIESGO Y PREVENCIÓN.

  • Tabaquismo activo y/o pasivo.
  • Contaminación del aire de interiores (combustibles sólidos de cocinas y calefacciones).
  • Contaminación del aire exterior.
  • Exposición laboral a vapores o inhalaciones irritantes.
  • Infecciones respiratorias de repetición en la infancia.
  • Algunos casos son consecuencia del asma crónica.

Una vez conocemos los factores de riesgo, podemos deducir que es una enfermedad que puede prevenirse en gran medida. Muchos de los casos de EPOC se podrían evitar abandonando pronto el hábito tabáquico y evitando que los jóvenes lo adquieran. La OMS nos recuerda que “por eso es importante que los países adopten el Convenio Marco para el Control del Tabaco (CMCT) y apliquen el programa de medidas MPOWER, a fin de que no fumar sea la norma en todo el mundo”.

VIVIR CON EPOC

Es importante que la persona afectada de esta enfermedad se mantenga en las mejores condiciones de salud posible.  Es importante estar activo, se puede empezar por actividades suaves y sencillas y después aumentar progresivamente esta actividad.

Hacer ejercicio ayuda a respirar mejor. Con los ejercicios de respiración fortalecemos la caja torácica y movilizamos las secreciones ayudando a que éstas puedan ser expulsadas con facilidad. Los ejercicios recomendados son; caminar en llano, hacer bicicleta estática y ejercicios ligeros con pesas para hombros y brazos.

También es importante estar bien alimentado, evitando el sobrepeso y la malnutrición. Para ello, se recomienda, entre otras, realizar comidas ligeras preparando alimentos de fácil masticación.

Mantenerse bien hidratado con una buena ingesta de líquidos es una cuestión a tener en cuenta porque hace que las secreciones sean menos espesas y así se expulsen con mayor facilidad.

SERVICIO DE OSAKIDETZA PARA SEGUIMIENTO DE ENFERMOS CRÓNICOS: TELEPOC

Desde hace unos años existe en Osakidetza un Servicio de seguimiento para enfermos crónicos de EPOC. Se trata de un Servicio en el que trabajan personal de enfermería y medicina que hacen una valoración diaria telemática de los pacientes que forman parte de este programa. Voy a hablar en concreto del Hospital de Basurto, que es el Servicio que conozco de primera mano.

¿Cuáles son los objetivos del programa?

Dentro de los objetivos del programa están el de reducir el número de ingresos hospitalarios de los pacientes que forman parte, previniendo las exacerbaciones y/o tratándolas de manera muy temprana. De este modo, mejora la calidad de vida de los enfermos y a largo plazo, se persigue reducir las cifras de mortalidad causadas por esta enfermedad.

¿Cuáles son los criterios de inclusión en el programa?

No todos los pacientes con EPOC son subsidiarios de entrar en este programa. Los criterios fundamentales para ello se basan en el número de ingresos en los últimos años. Así, una persona con dos o más ingresos en el último año o tres o más ingresos en los últimos dos años, sería candidata para que le hagan seguimiento telemático.

Telemedicina.

Los pacientes que entren a formar parte de este programa deben adquirir un compromiso importante para realizar las actividades requeridas diariamente así como cumplir con el tratamiento y las recomendaciones generales, como por ejemplo, abandonar el hábito tabáquico y seguir una buena alimentación.

Para hacer el seguimiento los pacientes dispondrán en su domicilio de una tableta o PDA que enviará los datos requeridos al programa informático, desde el que los sanitarios harán la posterior valoración.

Dispondrán también de un pulsioxímetro que medirá la frecuencia cardiaca y los niveles de oxígeno en sangre y un podómetro para medir los pasos del día anterior.

Cada día enviarán los siguientes datos a través de la tableta o PDA.

  • Temperatura corporal.
  • Frecuencia cardiaca.
  • Frecuencia respiratoria.
  • Niveles de Saturación de oxígeno en sangre.
  • Número de pasos del día anterior.

Y responderán a las siguientes preguntas.

  • ¿Tiene usted fatiga?
  • En caso afirmativo, ¿Más de lo habitual?
  • ¿Tiene usted tos?
  • En caso afirmativo, ¿Más de lo habitual?
  • ¿Tiene usted flemas?
  • En caso afirmativo, ¿Más de lo habitual?
  • ¿Cómo son las secreciones?
  • ¿Cómo se encuentra usted con respecto a su situación habitual? Pudiendo responder: mejor, similar o peor.

Los datos enviados al programa serán analizados por el propio programa, que generará una serie de alarmas codificadas por colores y también serán analizados por el personal de enfermería.

Las alarmas nos indican con qué urgencia debemos atender a esa persona, siendo la alarma de color rojo las que debemos atender de manera inmediata, las naranjas de manera urgente, las amarillas con preferencia y las verdes, no requerirían de actuación.

Cuando el personal de enfermería valora los datos realiza una llamada al paciente para comprobar los datos y ampliar la información sobre lo que está sucediendo. Con toda esa información el equipo sanitario decide cómo actuar.

Las actuaciones que se generan con las alarmas pueden ser:

  • Recomendaciones telefónicas cuyo resultado será evaluado telefónicamente.
  • Derivación a su médico de Atención Primaria.
  • Derivación a su neumólogo.
  • Derivación a urgencias del centro sanitario adecuado.
  • Envío de un recurso de asistencia extrahospitalaria al domicilio (ambulancia o médico para valoración).

También se realizan llamadas de seguimiento sin necesidad de que se haya generado una alarma. Serían llamadas de confort en las que se realiza:

  • Refuerzo de los conocimientos sobre su enfermedad.
  • Recuerdo de los signos de alarma.
  • Recomendaciones nutricionales, de actividad física y ejercicios respiratorios.
  • Comprobación de que cumple de manera correcta con los tratamientos prescitos y las vacunaciones.
  • Aclaración de dudas sobre la enfermedad crónica, los procesos agudos, el uso de los dispositivos tecnológicos, etc.
  • Recuerdo de fechas para citas médicas.

La puesta en marcha de este programa de seguimiento ha permitido a los pacientes mejorar su calidad de vida reduciendo considerablemente el número de ingresos hospitalarios, por ejemplo.

El grado de satisfacción de los pacientes que forman parte es muy alto, expresando que han aprendido más sobre su enfermedad, pudiendo así reconocer los signos de alarma rápidamente y evitando reagudizaciones. Además, manifiestan que gracias al programa sienten mayor seguridad y menos miedo que antes de formar parte de este seguimiento.

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