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Introdução: A doença pulmonar obstrutiva crónica é definida como um estado patológico prevenível e tratável, caracterizado por limitação persistente do fluxo aéreo em resposta à inalação de partículas tóxicas. As estatísticas preveem que, até ao ano de 2020, passará para a terceira causa mais comum de morte no mundo, pelo que tem associada uma importância crescente como problema de saúde pública.
Quer estejamos ao nível do mar ou no alto de uma montanha, a atmosfera tem a mesma percentagem de oxigénio: 21%. O que acontece nas elevadas altitudes é uma diminuição da pressão atmosférica (barométrica) que se traduz num aumento do espaço entre as moléculas do ar, tornando toda a fisiologia da respiração mais difícil. Com a altitude ocorre naturalmente hipoxémia, o que pode levar a hipóxia. A ventilação é aumentada para que a homeostasia seja mantida, o que tem efeitos fisiológicos conhecidos. Existem no organismo humano outras alterações fisiológicas à altitude, tais como a diminuição da concentração sérica de bicarbonato, o aumento do hematócrito ou o aumento cerebral de 2,3 difosfoglicerato.
A qualidade do ar em ambientes de altitude é habitualmente boa.
A associação entre a Doença Pulmonar Obstrutiva Crónica e a altitude tornou-se um tema muito atual e de grande interesse uma vez que a prevalência da doença tem sofrido um aumento constante na população. Tendo em vista novas estratégias terapêuticas, torna-se emergente perceber a influência da altitude nesta patologia, sendo as relações de causalidade discutidas neste trabalho.
Objetivos: Existe uma evidência substancial da associação entre prevalência/gravidade da Doença Pulmonar Obstrutiva Crónica e altitude. O objetivo principal deste estudo consiste em rever a literatura recente sobre o efeito das alterações fisiológicas e patológicas provocadas pela exposição à altitude na doença pulmonar obstrutiva crónica. Numa fase posterior, será analisada a influência da altitude na doença pulmonar obstrutiva crónica, nomeadamente fatores protetores, agravantes e eventuais alterações na história natural da doença.
Métodos: Para realizar esta revisão bibliográfica, foi efetuada uma vasta pesquisa de artigos científicos através de várias bases de dados como o Pubmed, Sciencedirect ou B-on, entre o mês de Outubro de 2013 e o mês de Janeiro de 2014. A pesquisa abrangeu artigos e publicações científicas internacionais como artigos de revisão, ensaios clínicos e estudos observacionais, que foram selecionados segundo critérios de relevância e recência (a partir do ano 2000) para o tema proposto.
Introduction: Chronic Pulmonary Obstructive Disease is defined as a preventable and treatable disease state, characterized by persistent airflow limitation in response to toxic particles inhalation. Statistics predict that by the year 2020, it will be the third most common cause of death in the world, increasing its importance as a public health problem. Whether we are at sea level or on the top of a mountain, the atmosphere has the same 21% oxygen. What happens at high altitudes is a reduction in the atmospheric pressure which means an increase in the space between air molecules, making the whole physiology of breathing more difficult. With the altitude occurs hypoxaemia, which may lead to hypoxia. Ventilation is increased so that homeostasis can be maintained, which has known physiological effects. Human body suffers from others physiological changes in the altitude such as decreased bicarbonate concentration, increased hematocrit or cerebral proliferation of 2,3 diphosphoglycerate. Air quality conditions at higher altitude environments is often good. The association between Chronic Obstructive Pulmonary Disease and altitude became a very current topic of great interest since the prevalence of the disease in the population, has been constantly growing. Taking into consideration new therapeutic strategies, it becomes a priority to analyze the influence of altitude in this pathology, being discussed here the causal relationships between both. Objectives: There is substantial evidence within the association among prevalence and severity of chronic obstructive pulmonary disease and altitude. The main objective of this study is to review the recent literature regarding the effect of physiological and pathological changes, caused by exposure to altitude in chronic obstructive pulmonary disease. Afterwards, it will be analyzed the influence of altitude on chronic obstructive pulmonary disease, including protective, aggravating and changing factors in the natural history of the disease. Methods: To develop this literature review, an extensive search of scientific articles was conducted through databases such as Pubmed, Sciencedirect or B-on, between October 2013 and January 2014. The searches involve articles and international scientific publications such as reviews, clinical trials and observational studies, which were selected according to relevance and up to date (later than year 2000).
Introduction: Chronic Pulmonary Obstructive Disease is defined as a preventable and treatable disease state, characterized by persistent airflow limitation in response to toxic particles inhalation. Statistics predict that by the year 2020, it will be the third most common cause of death in the world, increasing its importance as a public health problem. Whether we are at sea level or on the top of a mountain, the atmosphere has the same 21% oxygen. What happens at high altitudes is a reduction in the atmospheric pressure which means an increase in the space between air molecules, making the whole physiology of breathing more difficult. With the altitude occurs hypoxaemia, which may lead to hypoxia. Ventilation is increased so that homeostasis can be maintained, which has known physiological effects. Human body suffers from others physiological changes in the altitude such as decreased bicarbonate concentration, increased hematocrit or cerebral proliferation of 2,3 diphosphoglycerate. Air quality conditions at higher altitude environments is often good. The association between Chronic Obstructive Pulmonary Disease and altitude became a very current topic of great interest since the prevalence of the disease in the population, has been constantly growing. Taking into consideration new therapeutic strategies, it becomes a priority to analyze the influence of altitude in this pathology, being discussed here the causal relationships between both. Objectives: There is substantial evidence within the association among prevalence and severity of chronic obstructive pulmonary disease and altitude. The main objective of this study is to review the recent literature regarding the effect of physiological and pathological changes, caused by exposure to altitude in chronic obstructive pulmonary disease. Afterwards, it will be analyzed the influence of altitude on chronic obstructive pulmonary disease, including protective, aggravating and changing factors in the natural history of the disease. Methods: To develop this literature review, an extensive search of scientific articles was conducted through databases such as Pubmed, Sciencedirect or B-on, between October 2013 and January 2014. The searches involve articles and international scientific publications such as reviews, clinical trials and observational studies, which were selected according to relevance and up to date (later than year 2000).
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Keywords
Altitude Doença Pulmonar Obstrutiva Crónica Fatores Ambientais Qualidade do Ar