Intervención terapéutica multimodal en pacientes con sintomatología respiratoria crónica

Zusammenfassung

hronic respiratory diseases continue to be one of the main causes of death and disability worldwide, with an annual growth in absolute figures. It is estimated that 4 million people die prematurely each year due to these pathologies. Among these diseases, chronic obstructive pulmonary disease (COPD) is the most prevalent worldwide. To this situation of great social and health importance, we must also add the 2019 coronavirus disease pandemic (COVID-19) that has so far affected more than 763 million people worldwide, resulting in 6.9 million deaths. This pandemic will generate important long-term health repercussions, due to the development in patients of the clinical condition known as Long-COVID, characterized by the presence of chronic symptoms up to three months after acute infection. Long-COVID and COPD are respiratory pathologies with different etiologies and, therefore, different clinical courses. However, at the pathophysiological basis of the chronic symptomatology of both diseases, there is a chronic inflammatory process that is not only localized at the level of the respiratory tract, but also spreads to other locations. Thus, both pathologies have chronic respiratory symptoms and an important systemic repercussion, generating a wide variety of symptoms that result in a significant impact on function and deterioration of the quality of life of the patients. Therefore, the study of the pathologies that generate chronic respiratory symptomatology will allow the establishment of specific clinical profiles, establishing a frame of reference on which to develop multimodal therapeutic interventions adjusted to the needs of these patients. The general objective of this doctoral thesis was the characterization of patients with chronic respiratory pathology and the study of multimodal therapeutic interventions that best fit their clinical needs. The development of this doctoral thesis was carried out in line with these objectives. To this end, three studies were developed with different methodologies. The first study consisted of a cross-sectional case-control study that aimed to evaluate health-related quality of life and pain characteristics in patients with Long-COVID. The results show that patients with Long-COVID have higher pain intensity and interference, as well as worse quality of life compared to controls. The second study consisted of a cross-sectional case-control study aimed at identifying the clinical and psychosocial profile associated with pain in non-hospitalized patients with Long-COVID. The results show that patients with Long-COVID present high pain intensity and interference, central sensitization, increased severity of insomnia, fear of movement, catastrophizing, depression, anxiety, and stress. The third study consisted of a systematic review and meta-analysis aimed at identifying the effects of telerehabilitation-based multimodal therapeutic interventions on the quality of life of COPD patients. The results showed that telerehabilitation interventions can complement or replace face-to-face treatments in COPD patients, generating improvements in their quality of life. In conclusion, this thesis shows that patients with respiratory diseases present chronic symptomatology with important repercussions at a systemic level, which considerably limit their functionality and quality of life, influencing their prognosis. In addition, the efficacy of telerehabilitation to develop multimodal therapeutic programs that fit the therapeutic needs of these patients is evidenced.