Impacto das recomendações de distanciamento social por Covid-19 sobre a função pulmonar, estado nutricional e morbidade em pacientes com fibrose cística

Abstract

Introduction: Cystic fibrosis (CF) is a chronic disease that alters several systems in such a way that the interaction with the Coronavirus-Sars-Cov-2 infection may pose an additional health risk. For that, social distancing recommendations were adopted, but their impact is not yet known. Objective: To assess the impact of recommendations for social distancing measures due to COVID-19, lung function, on nutritional status, and morbidity in patients with CF. Methods: This is a retrospective cohort study with a sample of patients with CF, older than 6 years, of both sexes, being followed up at a reference center for CF. For inclusion, medical records should have the following information: demographic data (age, sex and ethnicity), anthropometric data (height, weight and body mass index [BMI]), clinical data (pancreatic insufficiency, genotyping, colonization of the airways), lung function (spirometry), and the total number of days of antibiotic use (oral and intravenous) and hospitalizations. Variables were extracted from outpatient consultation register in three different periods: T-1 (14 months before the start of the social distancing recommendations), T0 (start of the recommendations) and T1 (14 months after the start of the recommendations). Deltas (Δ) were calculated for each of the periods: Δ1 (pre-pandemic, T0-T-1) and Δ2 (pandemic, T1-T0). The study was approved by the PUCRS Research Ethics Committee. For statistical purposes, descriptive statistics were used, deltas (Δ) were calculated for each of the periods (pre-pandemic - Δ1 and pandemic - Δ2), and the Wilcoxon test was used for comparisons. The significance level was set at p<0.05. Results: 25 patients were selected, 64% male, with a mean age of 11.7±4.3 years, 76% of whom were homozygous for the Δf508 mutation. 28% of the sample had colonization by Pseudomonas aeruginosa. The median BMI (kg/m2) was 17.5±3.0 and the z-score was 0.2±0.9, indicating good nutritional status. When comparing pre-pandemic and pandemic periods, there were no significant differences in deltas for absolute BMI (Δ1: 0.8±1.2 vs. Δ2: 0.9±1.4; p=0.63), BMI z-score (Δ1: -0.0±-0.4 vs. Δ2: -0.1±0.6; p=0.70), FEV1 (Δ1: -2.8±12.1 vs. Δ2: - 2.1±20.1; p=0.89) and FVC (Δ1: -0.8±13.8 vs. Δ2: -3.7±18.8; p=0.61). However, there was a significant increase in FEV1/FVC (Δ1: -0.03±0.0 vs. Δ2: 0.02±0.0; p=0.01) and FEF25-75% (Δ1: -8.9±17.5 vs. Δ 2: 3.0±23.6; p=0.03) between the analyzed periods. Regarding morbidity, there was a significant reduction (p=0.005) in the use of antibiotics in the pandemic period (0.0 [0.0 – 14.0]) compared to the pre-pandemic period (21.0 [7.0 – 30.0]). There was no significant difference (p=0.62) in total hospitalization days. Conclusion: The results demonstrate that recommendations for social distancing due to COVID-19 had a positive impact (reduction) on morbidity (use of antibiotics) and small airway obstruction in patients with CF.