Gender Differences in Original Archivos de Bronconeumología Publications, 2001-2018. / Diferencias de género en las publicaciones originales de Archivos de Bronconeumología en el periodo 2001-2018.

INTRODUCTION: Gender inequality exists in scientific publications. The aim of this study was to determine changing patterns in gender differences and factors associated with the positioning of authors' names in original articles published in Archivos de Bronconeumología (AB). METHODS: We performed a bibliometric study of articles published in AB between 2001 and 2018. Author gender was analysed in four scenarios: first author, last author, middle authors, and mentee authors. Comparisons were made by authors' specialties, funding received, multicentre studies, specialist areas, and others. Multivariate models adjusted for the percentage of registered physicians in the Spanish health system were created to predict the female gender of the first, middle, and last author. RESULTS: A total of 828 publications were analysed in which women appeared as first authors in 286 (34.5%) and last authors in 169 (20.4%). A gradual increase in women as first authors was observed (P = .0001), but not as last authors (P = .570). Overall, the average number of female authors increased over time (from 1.6 ± 1.4 in 2001-2005 to 3.3 ± 2.3 in 2016-2018, P = .0001), with no differences in male averages. The adjusted multivariate models reflected a positive bi-directional relationship between the first author and the middle authors, and a negative association between the first author being Spanish and the last author being female (OR 0.57; 95% CI 0.36-0.88, P = .012). CONCLUSIONS: Gender differences were found in various aspects of authorship in AB, summarized by a greater participation of women as first and intermediate authors, but not as last authors.

[All Roads Lead to Rome: Results of Non-Invasive Respiratory Therapies Applied in a Tertiary-Care Hospital Without an Intermediate Care Unit During the COVID-19 Pandemic]. / Todos los caminos llevan a Roma: resultados de las terapias respiratorias no invasivas aplicadas en un centro terciario sin Unidad de Cuidados Intermedios durante la pandemia de COVID-19.

Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.

Influence of Comorbidities on the Survival of COPD Patients According to Phenotypes.

Background: Chronic obstructive pulmonary disease (COPD) usually occurs alongside other conditions. Few studies on comorbidities have taken into account the phenotypes of COPD patients. The objective of this study is to evaluate the prevalence of comorbidities included in the Charlson index and their influence on the survival of patients with COPD, taking phenotypes into account. Methods: An observational study was conducted on a group of 273 patients who had COPD and underwent spirometry in the first half of 2011, with a median prospective follow-up period of 68.15 months. The survival of these patients was analyzed according to the presence of various comorbidities. Results: Of the 273 patients, 93 (34.1%) died within the follow-up period. An increased presence of chronic ischemic heart disease (CIHD), chronic heart failure (CHF), chronic kidney disease (CKD), and malignancy was found in deceased patients. All of these conditions shorten the survival of COPD patients globally; however, when considering phenotypes, only CHF influences the exacerbator with chronic bronchitis phenotype, CKD influences the non-exacerbator phenotype, and malignancy influences the positive bronchodilator test (BDT) and exacerbator with chronic bronchitis phenotypes. In the multivariate model, advanced age (hazard ratio, HR: 1.05; p=0.001), CHF (HR: 1.74; p=0.030), and the presence of malignancy (HR: 1.78; p=0.010) were observed as independent mortality risk factors. Conclusion: The survival is shorter in the presence of CIHD in overall COPD patients and also CHF, CKD, and malignancy for certain phenotypes. It is important to pay attention to these comorbidities in the comprehensive care of COPD patients.

Differences in the Outcome of Patients with COPD according to Body Mass Index.

BACKGROUND: In chronic obstructive pulmonary disease (COPD), the "obesity paradox" is a phenomenon without a clear cause. The objective is to analyze the complications of COPD patients according to their body mass index (BMI). METHODS: An observational study with a six-year prospective follow-up of 273 COPD patients who attended a spirometry test in 2011. Survival and acute events were analyzed according to the BMI quartiles. RESULTS: A total of 273 patients were included. BMI quartiles were ≤24.23; 24.24-27.69; 27.70-31.25; ≥31.26. During the follow-up, 93 patients died. No differences were found in exacerbations, pneumonia, emergency visits, hospital admissions or income in a critical unit . Survival was lower in the quartile 1 of BMI with respect to each of the 2-4 quartiles (p-value 0.019, 0.013, and 0.004, respectively). Advanced age (hazard ratio, HR 1.06; 95% confidence interval, CI 1.03-1.09), low pulmonary function (HR 0.93; 95% CI 0.86-0.99), exacerbator with chronic bronchitis phenotype (HR 1.76; 95% CI 1.01-3.06), high Charlson (HR 1.32, 95% CI 1.18-1.49), and the quartile 1 of BMI (HR 1.99, 95% CI 1.08-3.69) were identified as risk factors independently associated with mortality. CONCLUSIONS: In COPD, low BMI conditions a lower survival, although not for having more acute events.

Influence of Pneumonia on the Survival of Patients with COPD.

BACKGROUND: Pneumonia is a frequent infection. Chronic obstructive pulmonary disease (COPD) can present with comorbidities, including pneumonia. It is known that COPD worsens the evolution of pneumonia, but few studies describe the impact of pneumonia on COPD evolution. This study analyzes the influence of pneumonia on the survival of COPD patients. METHODS: Observational study of a cohort of 273 patients with COPD who attended spirometry in 2011, with a prospective follow-up of six years. Patients were divided into two groups according to their acquisition of pneumonia during follow-up. The difference in survival between the two groups was analyzed. RESULTS: Survival was lower in the group with pneumonia compared with that without pneumonia (p = 0.000), both globally and after stratification by COPD phenotype. Pneumonia (Hazard Ratio -HR- 2.65; 95% Confidence Interval -CI- 1.57-4.48), advanced age (HR 1.08; 95% CI 1.03-1.09), and high Charlson index (HR 1.31; 95% CI 1.17-1.47) were identified as risk factors independently associated with mortality, while a high body mass index (HR 0.92; 95% CI 0.87-0.96) was identified as a protective factor. CONCLUSIONS: Pneumonia is associated with worse prognosis in COPD patients. It is important to take into account this comorbidity for a comprehensive care of these patients.