Respiratory Manifestations in Patients With Inflammatory Bowel Disease in a Reference Center in Salvador, Bahia, Brazil
AIBD 2023
Background:
Inflammatory bowel diseases (IBD) are chronic diseases that may have a variety of extraintestinal manifestations, including pulmonary. As most of these patients are asymptomatic, this type of manifestation is less diagnosed than the other extraintestinal manifestations. Pulmonary dysfunction in patients with IBD can occur at any stage of the disease. In Brazil, there are still no studies evaluating pulmonary manifestations in patients with IBD, and it is important to assess whether there is an association between pulmonary manifestations and the clinical activity of IBD. The objective is to describe respiratory clinical manifestations in patients with IBD, the drugs used, in addition to analyzing the association between the presence of respiratory manifestations and clinical activity in these patients.
Methods:
Cross-sectional, analytical, single-center study, carried out from April/2021 to October/2022, with the application of a questionnaire and review of medical records of patients from an outpatient clinic specialized in IBD in Salvador/BA, at Hospital Geral Roberto Santos (HGRS). Study was approved by the HGRS Research Ethics Committee. Inclusion criteria: patients >18 years old, diagnosed with IBD and signed the informed consent form, and exclusion criteria: patients with an unestablished diagnosis of IBD, with unclassified colitis or without cognitive conditions to answer the questionnaires. Dyspnea symptoms were evaluated using the Modified Medical Research Council Dyspnea Scale (mMRC), dry or productive cough, chest pain and hemoptysis. Clinical activity of the inflammatory disease was evaluated using the Harvey-Bradshaw Index in Crohn’s disease and the Lichtiger Index in ulcerative colitis. To test the association between the presence of respiratory manifestations and the clinical activity of the inflammatory bowel disease, the chi-square test was used. Significant associations were considered at p < 0.05.
Results:
A total of 255 patients were included, 120 (47.1%) with CD and 135 (52.9%) with UC, of which 44 had respiratory symptoms. Current treatments were: mesalazine suppository (36.1%), azathioprine (29.8%), oral mesalazine (27.1%), infliximab (17.3%), sulfasalazine (15.7%), adalimumab (8.6%), prednisone (7.5%), ustekinumab (1.6%), methotrexate (1.6%), vedolizumab (0.8%), another immunosuppressant such as tacrolimus or cyclosporine (0.4%), tofacitinib (0.4%). Among the 211 patients without respiratory symptoms, most were male (66.4%), with a mean age of 44.38 ± 14.65 years. Most of these patients (70.6%) were in clinical remission of IBD at the time the questionnaire was collected, while a minority (29.5%) were in clinical activity, which could be mild, moderate or severe. In the 44 patients with respiratory symptoms, the majority are female (77.3%), with a mean age of 44.02 ± 14.23 years. Among these patients, 50% were in clinical remission and 50% in clinical IBD activity. Patients in clinical remission had respiratory symptoms in 12.9% (22/171), while patients in active remission had respiratory symptoms in 26.2% (22/74). Dyspnea was the most frequent symptom. A statistically significant association was found between the presence of respiratory manifestations and clinical disease activity (p=0.008).
Conclusions:
The frequency of respiratory symptoms was high in patients with IBD, with a higher prevalence in patients with active disease. This finding draws attention to a possible mechanism associated with the inflammatory activity of the underlying disease.
