RESUMO
BACKGROUND: To analyse changes in trends in mortality due to chronic obstructive pulmonary disease (COPD) in Spain by Autonomous Community (AC) and sex during the period 1980-2021.METHODS: Data on population and COPD death records (International Classification of Diseases, 10th edition, codes J40â-"J44 and J47) were retrieved from the National Institute of Statistics for the study period. Age-standardised mortality rates by AC and sex were assessed using joinpoint regression models.RESULTS: There were 562,668 deaths due to COPD (423,855 in men and 138,813 in women), with an average annual increase of 1.6%. COPD deaths in men increased in most ACs, except for Asturias (â-"0.5% per year). The Canary Islands (14% per year) and Madrid (6.5% per year) had the highest increases. In women, the figures show a wide range of values at the AC level (from a â-"1.4% decrease to 7.9% increase). Nationally, the sex ratio increased from 1980 to 2021. In men, six ACs showed a significant decrease, while in women only two ACs showed a significant decrease.CONCLUSION: A steady decrease in COPD mortality was observed in most ACs for men, while a different trend was observed in women in several ACs. Despite past and ongoing tobacco control initiatives, this condition remains a leading cause of death.
Assuntos
Doença Pulmonar Obstrutiva Crônica , Masculino , Humanos , Feminino , Espanha/epidemiologia , Análise de Sobrevida , Classificação Internacional de Doenças , MortalidadeRESUMO
BACKGROUND: The relationship between cancer and venous thromboembolic disease (VTD) are complex because the activated coagulation factors are not only involved in thrombosis but also in malignant processes, such as angiogenesis and metastasis. OBJECTIVE: To compare phenotypes of extracellular vesicles (EVs), and levels of D-dimer, soluble P-selectin (sP-selectin) and antigenic tissue factor (TF) between unprovoked VTD patients, who did not develop cancer during one-year follow-up, and those with advanced stage of cancer but not associated with VTD. METHODS: A prospective study in which we included 138 unprovoked VTD patients and 67 advanced cancer patients, who did not develop thrombosis. Levels of EVs of different cellular origin (platelet, endothelium and leukocyte), EVs positive for tissue factor (TF) and P-selectin glycoprotein ligand 1 were quantified by flow cytometry. D-dimer, soluble P-selectin (sP-selectin) and antigenic TF were determined by ELISA. RESULTS: TF-positive EVs, D-dimer, and sP-selectin were markedly elevated in unprovoked VTD patients compared to cancer patients without association with thrombosis. CONCLUSIONS: Levels of TF-positive EVs, D-dimer and sP-selectin are able to discriminate between unprovoked VTD patients not related to cancer and cancer patients not associated with VTD. These results could lead to the application of EVs as biomarkers of both diseases. Key messages: Circulating EVs, specifically TF-positive EVs, in combination with plasmatic markers of hypercoagulable states, such as D-dimer, sP-selectin and antigen TF, are able to discriminate between cancer patients without thrombosis and patients with unprovoked VTD. Research fields could be opened. Future studies will assess if these biomarkers together serve as predicting thrombotic events in cancer populations.
Assuntos
Vesículas Extracelulares/metabolismo , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Neoplasias/sangue , Tromboembolia/sangue , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Glicoproteínas de Membrana/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Tromboplastina/análiseRESUMO
Exposure to air pollutants has been correlated with an increase in the severity of asthma and in the exacerbation of pre-existing asthma. However, whether or not environmental pollution can cause asthma remains a controversial issue. The present review analyzes the current scientific evidence of the possible causal link between diesel exhaust particles (DEP), the solid fraction of the complex mixture of diesel exhaust, and asthma. The mechanisms that influence the expression and development of asthma are complex. In children prolonged exposure to pollutants such as DEPs may increase asthma prevalence. In adults, this causal relation is less clear, probably because of the heterogeneity of the studies carried out. There is also evidence of physiological mechanisms by which DEPs can cause asthma. The most frequently described interactions between cellular responses and DEP are the induction of pulmonary oxidative stress and inflammation and the activation of receptors of the bronchial epithelium such as toll-like receptors or increases in Th2 and Th17 cytokines, which generally orchestrate the asthmatic response. Others support indirect mechanisms through epigenetic changes, pulmonary microbiome modifications, or the interaction of DEP with environmental antigens to enhance their activity. However, in spite of this evidence, more studies are needed to assess the harmful effects of pollution - not only in the short term in the form of increases in the rate of exacerbations, but in the medium and long term as well, as a possible trigger of the disease.
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Poluentes Atmosféricos/toxicidade , Asma/epidemiologia , Material Particulado/toxicidade , Emissões de Veículos/toxicidade , Poluentes Atmosféricos/análise , Asma/imunologia , Asma/metabolismo , Incidência , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/imunologia , Material Particulado/análise , Prevalência , Emissões de Veículos/análiseRESUMO
INTRODUCTION: Exposure to many environmental conditions, apart from tobacco, as a risk factor for developing chronic obstructive pulmonary disease (COPD) has been comprehensively studied. AREAS COVERED: Global estimates of air pollution depict a scenario of a considerable burden on respiratory health. Exposure to biomass smoke and occupational inhaled agents have been described as potentially related to causing or aggravating COPD. A number of emerging natural or accidental disasters have been suggested as a new source of exposure. Management of COPD patients exposed to different substances should include avoidance, especially in the more susceptible populations and proper pharmacological treatment considering potential association with particular clinical presentations. Expert commentary: Altogether, the available information indicates that appraisal of different environmental pollution exposures is clinically relevant, and should be systematically evaluated in COPD.
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Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/etiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de RiscoRESUMO
BACKGROUND: Previous studies have demonstrated significant variability in the processes of care and outcomes of chronic obstructive pulmonary disease (COPD) exacerbations. The AUDIPOC is a Spanish nationwide clinical audit that identified large between-hospital variations in care and clinical outcomes. Here, we test the hypothesis that these variations can be attributed to either patient characteristics, hospital characteristics and/or the so-called hospital-clustering effect, which indicates that patients with similar characteristics may experience different processes of care and outcomes depending on the hospital to which they are admitted. METHODS: A clinical audit of 5178 COPD patients consecutively admitted to 129 Spanish public hospitals was performed, with a 90-day follow-up. Multilevel regression analysis was conducted to model the probability of patients experiencing adverse outcomes. For each outcome, an empty model (with no independent variables) was fitted to assess the clustering effect, followed by a model adjusted for the patient- and hospital-level covariables. The hospital-clustering effect was estimated using the intracluster correlation coefficient (ICC); the cluster heterogeneity was estimated with the median odds ratio (MOR), and the coefficients of predictors were estimated with the odds ratio (OR). RESULTS: In the empty models, the ICC (MOR) for inpatient mortality and the follow-up mortality and readmission were 0.10 (1.80), 0.08 (1.65) and 0.01 (1.24), respectively. In the adjusted models, the variables that most represented the patients' clinical conditions and interventions were identified as outcome predictors and further reduced the hospital variations. By contrast, the resource factors were primarily unrelated with outcomes. CONCLUSIONS: This study demonstrates a noteworthy reduction in the observed crude between-hospital variation in outcomes after accounting for the hospital-cluster effect and the variables representing patient's clinical conditions. This emphasises the predictor importance of the patients' clinical conditions and interventions, and understates the impacts of hospital resources and organisational factors.
Assuntos
Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Auditoria Clínica , Feminino , Mortalidade Hospitalar , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Espanha/epidemiologiaRESUMO
The incidence and prevalence of asthma are increasing. One reason for this trend is the rise in adult-onset asthma, especially occupational asthma, which is 1 of the 2 forms of work-related asthma. Occupational asthma is defined as asthma caused by agents that are present exclusively in the workplace. The presence of pre-existing asthma does not rule out the possibility of developing occupational asthma. A distinction has traditionally been made between immunological occupational asthma (whether IgE-mediated or not) and nonimmunological occupational asthma caused by irritants, the most characteristic example of which is reactive airway dysfunction syndrome. The other form of work-related asthma is known as work-exacerbated asthma, which affects persons with pre-existing or concurrent asthma that is worsened by work-related factors. It is important to differentiate between the 2 entities because their treatment, prognosis, and medical and social repercussions can differ widely. In this review, we discuss diagnostic methods, treatment, and avoidance/nonavoidance of the antigen in immunological occupational asthma and work-exacerbated asthma. Key words: Specific inhalation challenge. Peak expiratory flow. Workplace. Irritants.
Assuntos
Asma Ocupacional/diagnóstico , Asma Ocupacional/fisiopatologia , Asma Ocupacional/terapia , Humanos , Prontuários Médicos , Exposição Ocupacional , Prognóstico , Testes de Função Respiratória , Local de TrabalhoRESUMO
OBJECTIVES: To describe chronic obstructive pulmonary disease (COPD) mortality rates in Andalusia, Spain, between 1975 and 2010 using a joinpoint regression analysis. DESIGN: Mortality figures for Andalusian residents aged >40 years from 1975 to 2010 were obtained from the National Institute of Statistics. Causes of death were classified based on the 8th, 9th and 10th revisions of the International Classification of Diseases. Crude, standardised (SMR) and 40- to 70-year truncated mortality rates were calculated. Trends were analysed using joinpoint regression analysis to identify significant trend changes, and an annual percentage of change (APC) was computed from each trend. RESULTS: Mortality rates showed a downward trend for both sexes. The SMR ranged from 109.9 to 98.0 deaths/100 000 males, and between 35.8 and 12.0 deaths/100 000 females. An increase in the average age at death for men and women with COPD was also observed. Both sexes experienced an increase in SMR in the early 1980s, although female mortality rates began to decline in 1985 (APC -5.8% thereafter), whereas those for males remained high until 1998 (APC -4% thereafter). CONCLUSIONS: COPD mortality remains higher in male than female inhabitants of Andalusia. These rates have decreased following different sex- and age-dependent patterns.
Assuntos
Doença Pulmonar Obstrutiva Crônica/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Espanha/epidemiologia , Fatores de TempoRESUMO
OBJECTIVE: To use lung cancer mortality rates from 1979 to 2008 in Andalusia, southern Spain (population >8,000,000), to provide an estimate of the future number of deaths for the period 2009-2028. DESIGN: The numbers of lung cancer deaths from 1979 to 2008 were obtained from the Andalusian Institute for Statistics (AIS). Data were arranged in 5-year age groups using an age-period-cohort model. Age-standardised rates (ASR) per 100, 000 were calculated for males and females. Population projections for Andalusia 2009-2028 were downloaded from the AIS database. RESULTS: In males, the ASR varied from 46.1 in 2004-2008 to 34.6 in 2024-2028, with a projected 33% decrease. In females, the ASR varied from 4.9 in 2004-2008 to 8.9 per 100,000 in 2024-2028, with a projected 45% increase. This reflects an annual change of -1.3% for males and of +2.7% for females for the period 2009-2028. The sex ratio is projected to drop from a male:female ratio of 11 (1979-1983) to 3.8 (2024-2028). CONCLUSIONS: Our projections emphasise the significance of a continuously increasing trend in female lung cancer mortality, with a drop in the projected sex ratio.
Assuntos
Neoplasias Pulmonares/mortalidade , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Previsões , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Espanha/epidemiologia , Fatores de TempoRESUMO
It has been suggested that sleep-related breathing disorders (SRBD) involve a continuum that develops over the course of life. If modifiable factors could be identified, the progression of SRBD could perhaps be addressed early in life. Although some studies have looked at the evolution of SRBD in pre-pubertal children, very few studies obtained data in adolescents. Anthropometric, clinical and polygraphic variables were collected during a 4-yr follow-up study among 148 normal adolescents after initial cross-sectional analysis. From a total of 267 adolescents studied at baseline (mean+/-sd age 14.3+/-2.1 yrs), 148 (55.4%) were followed up for 4 yrs. During follow-up, there were no significant changes in snoring and polygraphic parameters. However, a tendency toward weight gain with centrally distributed fat was observed. Habitual snorers had a significantly higher body mass index and more centrally distributed fat than nonsnorers. Males had a higher snoring prevalence and a higher number of respiratory events than females. Snoring at baseline, male sex and poor academic performance were significant predictors of snoring at follow-up. Snoring tends to persist during adolescence and male sex acts as a risk factor. A relationship between snoring and academic performance was observed. These findings may have implications for long-term management of sleep-related breathing disorders.
Assuntos
Polissonografia/métodos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Ronco/epidemiologia , Adolescente , Adulto , Criança , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Fatores de TempoRESUMO
OBJECTIVE: To provide up-to-date information and analyse recent changes in lung cancer mortality trends among women. DESIGN: The present study analysed subjects by geographical area in Spain during the period 1980-2005 using joinpoint regression models. Age-standardised mortality rates (ASR) for lung cancer were computed from death certificate data obtained from the official authorities in Spain. Joinpoint regression analysis was used to identify the years when significant changes in the linear slope of the temporal trend occurred. RESULTS: The overall ASR changed during the period studied from 5.7 per 100,000 women in 1980 to 8.2/100,000 in 2005, with an average annual increase of 1.7%. Joinpoint regression analysis detected different trends in most Spanish communities. These changes occurred in the late 1980s or early 1990s. ASR among those women aged 35-64 years doubled during the period of study, from 5.6 in 1980 to 11.3 in 2005. CONCLUSIONS: Time trends in lung cancer mortality among women are increasing sharply, especially in the age group 35-64 years, indicating the start of an epidemic phenomenon of lung cancer in women.
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Neoplasias Pulmonares/mortalidade , Feminino , Humanos , Mortalidade/tendências , Espanha/epidemiologiaRESUMO
Our objective is to describe lung cancer mortality trends in Andalusia, Spain, during the period 1975-2004 using age-period-cohort analysis (APC). For each gender, age-standardised (European Standard Population) mortality rates from lung cancer were computed based on the causes of death on the death certificates from the official registry of vital statistics in Andalusia. In men, after climbing considerably from 1975 to 1994, adjusted lung cancer mortality rates, have been declining by 0.8% per year since 1994. For women, the mortality from lung cancer was almost constant but tended to increase after 1994 (average annual increase of 2.1%). Among males, the cohort effect was steadily and appreciably upwards to the cohort born around 1905, then levelled off, and declined in the youngest generations. An increasing period effect was also observed until 1995. For females, cohort values decreased until the cohort born around 1930, then levelled off, and increased for women born since 1940. Period effect trend was downward until 1990, and upward thereafter. In conclusion, the cohort effect observed for women born since 1940 suggests the start of a lung cancer epidemic associated with a higher prevalence of smokers in women. The decrease in prevalence of smokers among males and the decrease in mortality in younger age groups suggest that the trend initiated in 1994 will continue as long as smoking prevalence continues to decrease.
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Neoplasias Pulmonares/mortalidade , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologiaRESUMO
OBJECTIVE: To analyse the variability of long term oxygen therapy (LTOT) prevalence according to several organisational and population factors. METHODS: Prospective multicentre survey in 29 public hospitals (population 6,796,964) recording data on the organisational structure of the participating centres and factors related to LTOT prevalence. Official figures were also obtained from local health authorities on the prevalence and cost of LTOT. RESULTS: The overall prevalence of LTOT was 184 per 100000 population (range 71-473). There was a specific unit or staff member for LTOT supervision in 17 (58.6%) centres, giving a lower prevalence (169 vs. 237/ 100000; P = 0.03). The altitude of the participating centres (median 92 m, mean 275 m; range 4-848 m) was found to influence LTOT prevalence (r = 0.73; P = 0.005). In the linear regression analysis, the coefficient of determination for altitude was 0.504. Other factors, such as percentage of population aged over 65 years, the attitude of prescribers towards patients with low adherence, current smokers or those with a PaO2 = 61 mmHg, were not related to LTOT prevalence. CONCLUSIONS: Altitude and the existence of a specific unit or staff member for LTOT supervision significantly influence LTOT prevalence.
Assuntos
Oxigenoterapia/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Altitude , Pesquisas sobre Atenção à Saúde , Hospitais Públicos , Humanos , Oxigenoterapia/instrumentação , Cooperação do Paciente , Prescrições , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar , Espanha/epidemiologiaRESUMO
BACKGROUND: Although non-invasive ventilation (NIV) efficacy in the treatment of acute hypercapnic respiratory failure (AHRF) have been previously demonstrated, not all the studies reveal this fact in the same degree, with some variability in the results. This study aimed to analyse variables related to NIV outcome for AHRF. METHODS: A group of consecutive patients requiring NIV due to AHRF were included in a prospective observational cohort study performed in conventional wards. Variables considered included those reported in the literature, as well as staff problems during the management of the ventilators. The study aimed to include all patients during one year, but after the initial results, it had to be suspended. RESULTS: Fifteen patients were included in the study: 10 males, mean age 68+/-12. APACHE-II score was 17.6+/-6.5. pH and pCO2 before NIV were 7.22+/-0.11 and 110+/-72 mmHg respectively. pH, corticosteroids use, APACHE score, and EPAP were found to influence outcome. Besides, an inadequate use of NIV due to lack of personnel training was detected in all patients with NIV failure (RR 3.5; 95% CI: 1.08-11.2; p = 0.007). In the light of these results, the study had to be suspended and patients were transferred to the respiratory ward. CONCLUSIONS: NIV is a life-saving respiratory treatment influenced by several factors, of which staff training is a key one. Centres attending acute respiratory patients should have an area in which this requirement is fulfilled.
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Hipercapnia/terapia , Respiração com Pressão Positiva/métodos , Insuficiência Respiratória/terapia , APACHE , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Estudos de Coortes , Interpretação Estatística de Dados , Feminino , Pessoal de Saúde , Humanos , Máscaras Laríngeas , Masculino , Máscaras , Pessoa de Meia-Idade , Seleção de Pacientes , Respiração com Pressão Positiva/efeitos adversos , Respiração com Pressão Positiva/instrumentação , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Previous analyses of lung cancer mortality were based on models of death rates within one time period, assuming that rates increase or decrease with time at a constant rate. The aim of this work is to analyse recent changes in lung cancer mortality trends in Andalusia (Spain) during the period of 1975-2000 using joinpoint regression models. PATIENTS AND METHODS: Mortality data were obtained from the Death Registry of Andalusia. For each gender, age group-specific and standardised (overall and truncated) rates were calculated by the direct method (using the world standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: Lung cancer is the leading cause of cancer mortality in men, with an increasing trend up to 1994. After that year, rates began to decrease significantly (-1.8% yearly from 1994 to 2000). Standardised rates in women exhibited a downward trend until the early 1990s, after which they levelled off (overall standardised rates) or increased significantly (truncated rates 35-64 years). CONCLUSIONS: An increase in lung cancer mortality has been observed in young women. There seems to be a relationship with the prevalence in smoking in men and women.
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Neoplasias Pulmonares/mortalidade , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos Epidemiológicos , Feminino , História do Século XX , Humanos , Neoplasias Pulmonares/história , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Análise de Regressão , Espanha/epidemiologiaRESUMO
Our objective was to study agreement between the compression ultrasound images taken in our respiratory medicine department and the duplex ultrasound images obtained by radiologists at our hospital for patients admitted to our ward with suspected diagnoses of venous thromboembolism.Seventy-eight consecutive patients admitted to our respiratory medicine ward suspected of venous thromboembolism were enrolled. Both types of images were available for all patients studied. Agreement was 90% with a Kappa coefficient of 0.81. Agreement between the two techniques was good. Therefore, compression ultrasonography is a technique that can be handled by respiratory medicine specialists for the diagnosis of venous thromboembolism.
Assuntos
Pneumologia , Tromboembolia/diagnóstico por imagem , Ultrassonografia/métodos , Trombose Venosa/diagnóstico por imagem , Humanos , Ultrassonografia Doppler Dupla/normasRESUMO
Relapsing polychondritis is a systemic disease of unknown etiology characterised by relapsing inflammation affecting cartilaginous structures, cardiovascular system, eyes and ears. Respiratory involvement occurs in 56% of patients during the disease progression, but only in 14% of cases as an initial presentation. Patients develop severe symptoms due to the disease affecting the glottis and the tracheobronchial tree, which represents the cause of death in 50% of cases. The unspecificity of respiratory symptoms makes that the disease may be confounded with some other if it is not accompanied with a typical presentation, which may cause a delay in the diagnosis. Pulmonary function tests are of great importance, since an obstructive pattern not reversible after bronchodilator administration and a plateau in flow-volume curves are of great help when assessing the severity of the obstruction. High resolution computed tomography is a non-invasive test more precise than bronchoscopy in identifying tracheal and bronchi abnormalities, so it should be performed at the onset of the respiratory symptoms together with the pulmonary function tests. We present the case of a patient, whose disease started with respiratory semiology suggesting bronchial asthma, which preceded in six months the main sign nasal chondritis.
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Asma/diagnóstico , Policondrite Recidivante/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Testes de Função RespiratóriaRESUMO
This study aims to assess mortality trends of nonmalignant respiratory diseases from 1975 through 1997 in the population of Andalusia (a region of Spain in the southwest, population 7,000,000). The death records containing codes 460-519 of the International Classification of Diseases, Eighth Revision (ICD-8) and Ninth Revision (ICD-9) in effect through the 23-year period were used in this study. Deaths from nonmalignant respiratory diseases accounted for 12.4 and 10% of all deaths in males and females in 1975 and for 12.1 and 8.3% in 1997. Crude death rates decreased from 107.5 to 102.7 per 100,000 amongst men, and from 76.9 to 62.2 per 100,000 amongst women. Age-adjusted death rates decreased from 167.6 to 111.6 per 100,000 in men and from 84.4 to 41.2 per 100,000 in women. Age-adjusted death rate by potential years of life lost decreased from 5.8 to 2.4 per 1000 in men and from 2.4 to 0.8 per 1000 in women. Total percentage of change, adjusted by age, showed a decrease of 24.3% in men and 45.9% in women. Gender-adjusted rates for each category of nonmalignant respiratory disorders showed an upward trend of obstructive lung diseases in men and a downward trend of diseases of the upper airways and pneumonia both in men and women. Specific death rates by age groups for 1975-1985 and 1986-1997 showed an increased in mortality in infants under 1 year of age and in abrupt decrease up to the age of 50 followed by an exponential increase up to the age of 85.