Shuttle walking versus maximal cycle testing: clinical correlates in patients with kyphoscoliosis.

A cross-sectional prospective design was used to compare the effectiveness of the shuttle walking test (SWT) and the maximal cycle ergometry test (CET) to assess the functional capacity of patients with chronic hypercapnic respiratory failure due to severe kyphoscoliosis. Twenty-four patients completed both the SWT and CET. Heart rate, blood pressure, leg fatigue, chest pain and dyspnea (Borg's scale) were measured immediately after each test. Correlation coefficients and Bland-Altman analysis were used to compare the two methods. Borg's dyspnea, leg and chest pain after exercise were not significantly different between tests. Only heart rate (SWT 130[20.7] versus CET 116[28.75]; p = 0.048) and diastolic blood pressure (SWT: 85.5[13.75] versus CET 95[17.5]; p = 0.021) were slightly but significantly different between the two protocols. There was a good positive correlation between the distance walked in SWT and maximal oxygen consumption (r = 0.675; p < 0.001). SWT and CET testing elicited similar clinical and hemodynamic responses. SWT is a feasible measure of functional capacity in this patient group.

[Home vs hospital-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a Spanish multicenter trial]. / Comparación de un programa de rehabilitación domiciliario con uno hospitalario en pacientes con EPOC: estudio multicéntrico español.

OBJECTIVE: To compare the effects of a simple home pulmonary rehabilitation program and an intensive hospital-based program in terms of the exercise tolerance and health-related quality of life (HRQL) of patients with severe chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: Patients in this prospective, multicenter trial were randomized to 2 groups to receive hospital or home pulmonary rehabilitation. Patients in both groups attended 2 informative sessions about the disease and 4 physical therapy sessions. Patients in the hospital group then carried out a structured exercise program while home group patients performed low intensity exercises at home without supervision. RESULTS: Twenty-eight patients were randomized to the hospital rehabilitation group and 23 to the home group. Both groups showed a similar improvement on the 6-minute walk test (mean difference, 8.7 m; P=.61). HRQOL measured with the Chronic Respiratory Questionnaire also improved in both groups, but the change was greater on the emotional function domain in the hospital rehabilitation group (mean difference between groups, 0.58 on a scale for which the smallest clinically relevant difference is 0.5 points). The benefits were maintained in both groups 6 months after the programs ended. CONCLUSIONS: This study demonstrates that the improvement in exercise tolerance achieved by COPD patients with an unsupervised home pulmonary rehabilitation program is similar to the gains of patients in an intensive hospital-based program. However, the hospital program afforded greater benefit on the HRQOL emotional function domain.

Chronic respiratory symptoms, spirometry and knowledge of COPD among general population.

RATIONALE: Infradiagnosis of chronic obstructive pulmonary disease (COPD) may be related to the lack of knowledge about the disease and/or the scarce use of diagnostic procedures. This study analyses the frequency of respiratory symptoms and the knowledge about COPD in the general population, together with the use of spirometry in individuals at risk of COPD. POPULATION AND METHOD: A telephone survey was carried out in 6758 subjects older than 40 years, stratified by age, habitat (urban or rural) and region, screened by random-digit dialling. RESULTS: Up to 24% reported having at least one chronic respiratory symptom and 20.9% had a self-reported respiratory diagnosis. A total of 19.2% were active smokers and 40% had never tried to quit. Only 60% of the individuals with chronic symptoms had consulted a physician and, of them, only 45% had undergone spirometry. Spirometry was mentioned more frequently by subjects attended by pulmonologists than by GPs (67.6 vs. 28.6%; P<0.001). The term COPD was identified only by 8.6% of the participants. CONCLUSIONS: Many individuals with respiratory symptoms do not request medical attention and do not attempt to quit smoking. There is a lack of knowledge about COPD. Physicians should more actively inform about the disease and increase the use of spirometry for early detection.

The general public's knowledge of chronic obstructive pulmonary disease and its determinants: current situation and recent changes.

BACKGROUND: The objective of this study was to determine the level of knowledge about chronic obstructive pulmonary disease (COPD) and its determinants in the general population of Spain, and to compare it with a similar survey conducted in 2002. METHODS: We conducted a cross-sectional, observational, epidemiological study in September 2011 by means of a telephone interview with a representative sample of individuals aged 40-80 years living in all 17 regions of Spain. RESULTS: A total of 6,528 responses were obtained (response rate of 13.1%), 53% of respondents were females with a mean age of 59.8 years. Regarding tobacco use, 19.4% were current smokers while 27.9% reported being former smokers. Only 17.0% spontaneously recognized the term «COPD¼. Valencia was the region with the highest degree of ignorance regarding COPD (91%), while Aragon had the lowest (73.7%). Nevertheless, COPD is considered a severe disease, following angina pectoris in severity. Upon comparing these results with the previous survey from 2002, we observed significant improvements in the knowledge and understanding of COPD (8.6% vs. 17.0%), with a marked variability between the regions (P<.05). Currently, only 4.7% of the Spanish population knows that there is a National Strategy for COPD, although 86.0% have a favorable or very favorable opinion about the new Anti-tobacco Law. CONCLUSION: The lack of knowledge about COPD and its determinants in the general population remains high compared to 2002; thus, more and better educational and awareness programs are necessary.

Consensus document on the overlap phenotype COPD-asthma in COPD.

INTRODUCTION: Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. METHODS: A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured "brainstorming" method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale. RESULTS: Consensus was reached about the existence of a differential clinical phenotype known as"Overlap Phenotype COPD-Asthma", whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV(1) ≥ 15% and ≥ 400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV(1) ≥ 12% and ≥ 200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. CONCLUSIONS: It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.

[Geographical variations in the prevalence of COPD in Spain: relationship to smoking, death rates and other determining factors]. / Diferencias geográficas en la prevalencia de EPOC en España: relación con hábito tabáquico, tasas de mortalidad y otros determinantes.

BACKGROUND: The EPI-SCAN study (Epidemiologic Study of COPD in Spain), conducted from May 2006 to July 2007, determined that the prevalence of COPD in Spain according to the GOLD criteria was 10.2% of the 40 to 80 years population. Little is known about the current geographical variation of COPD in Spain. OBJECTIVES: We studied the prevalence of COPD, its under-diagnosis and under-treatment, smoking and mortality in the eleven areas participating in EPI-SCAN. COPD was defined as a post-bronchodilator FEV1/FVC ratio <0.70 or as the lower limit of normal (LLN). RESULTS: The ratio of prevalences of COPD among the EPI-SCAN areas was 2.7-fold, with a peak in Asturias (16.9%) and a minimum in Burgos (6.2 %) (P<0.05). The prevalence of COPD according to LLN was 5.6% (95% CI 4.9-6.4) and the ratio of COPD prevalence using LLN was 3.1-fold, but with a peak in Madrid-La Princesa (10.1%) and a minimum in Burgos (3.2%) (P<0.05). The ranking of prevalences of COPD was not maintained in both sexes or age groups in each area. Variations in under-diagnosis (58.6% to 72.8%) and under-treatment by areas (24.1% to 72.5%) were substantial (P<0.05). The prevalence of smokers and former smokers, and cumulative exposure as measured by pack-years, and the age structure of each of the areas did not explain much of the variability by geographic areas. Nor is there any relation with mortality rates published by Autonomous Communities. CONCLUSION: There are significant variations in the distribution of COPD in Spain, either in prevalence or in under-diagnosis and under-treatment.

Exercise training in mitochondrial myopathy: a randomized controlled trial.

Patients with mitochondrial myopathies (MM) usually suffer from exercise intolerance due to their impaired oxidative capacity and physical deconditioning. We evaluated the effects of a 12-week supervised randomized rehabilitation program involving endurance training in patients with MM. Twenty MM patients were assigned to a training or control group. For three nonconsecutive days each week, patients combined cycle exercise at 70% of their peak work rate with three upper-body weight-lifting exercises performed at 50% of maximum capacity. Training increased maximal oxygen uptake (28.5%), work output (15.5%), and minute ventilation (40%), endurance performance (62%), walking distance in shuttle walking test (+95 m), and peripheral muscle strength (32%-62%), and improved Nottingham Health Profile scores (21.47%) and clinical symptoms. Control MM patients did not change from baseline. Results show that our exercise program is an adequate training strategy for patients with mitochondrial myopathy.

Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease.

We determined the effect of different exercise training modalities in patients with chronic obstructive pulmonary disease, including strength training (n = 17), endurance training (n = 16), and combined strength and endurance (n = 14) (half of the endurance and half of the strengthening exercises). Data were compared at baseline, the end of the 12-week exercise-training program, and 12 weeks later. Improvement in the walking distance was only significant in the strength group. Increases in submaximal exercise capacity for the endurance group were significantly higher than those observed in the strength group but were of similar magnitude than those in the combined training modality, which in turn were significantly higher than for the strength group. Increases in the strength of the muscle groups measured in five weight lifting exercises were significantly higher in the strength group than in the endurance group but were of similar magnitude than in the combined training group, which again showed significantly higher increases than subjects in the endurance group. Any training modality showed significant improvements of the breathlessness score and the dyspnea dimension of the chronic respiratory questionnaire. In conclusion, the combination of strength and endurance training seems an adequate training strategy for chronic obstructive pulmonary disease patients.

Conocimientos de la población general sobre la enfermedad pulmonar obstructiva crónica y sus determinantes: situación actual y cambios recientes / The General Public’s Knowledge of Chronic Obstructive Pulmonary Disease and Its Determinants: Current Situation and Recent Changes

Antecedentes: El objetivo de este estudio fue determinar el nivel de conocimiento actual sobre la enfermedad pulmonar obstructiva crónica (EPOC) y sus determinantes en la población general de España, y compararlo con una encuesta similar realizada en 2002. Métodos: En septiembre de 2011 se realizó un estudio epidemiológico observacional transversal, mediante entrevista telefónica, con una muestra representativa de entre 40 y 80 años de edad en las 17 comunidades autónomas. Resultados: Se obtuvo un total de 6.528 respuestas (porcentaje de respuesta del 13,1%), con el 53% de mujeres y una edad media de 59,8 años. Respecto al tabaco, el 19,4% eran fumadores actuales, mientras que el 27,9% referían ser exfumadores. Solo el 17,0% refería espontáneamente que conocía el término EPOC. La Comunidad Valenciana era la que tenía un mayor grado de desconocimiento de la EPOC (91%), mientras que Aragón era la que lo tenía menor (73,7%). Pese a todo, la EPOC está considerada una enfermedad grave, solo por debajo de la angina de pecho. Comparando estos resultados con la encuesta anterior de 2002, se aprecian mejoras significativas respecto al conocimiento de la EPOC (8,6 vs. 17,0%), con una marcada variabilidad según la comunidad autónoma (p<0,05). Actualmente tan solo el 4,7% de la población española conoce que existe la Estrategia Nacional de EPOC, aunque el 86,0% tiene una opinión favorable/muy favorable sobre la nueva Ley antitabaco. Conclusión: El desconocimiento sobre la EPOC y sus determinantes en la población general se mantiene elevado respecto a 2002, por lo que son necesarias más y mejores intervenciones divulgativas y de concienciación(AU)

Background: The objective of this study was to determine the level of knowledge about chronic obstructive pulmonary disease (COPD) and its determinants in the general population of Spain, and to compare it with a similar survey conducted in 2002. Methods: We conducted a cross-sectional, observational, epidemiological study in September 2011 by means of a telephone interview with a representative sample of individuals aged 40-80 years living in all 17 regions of Spain. Results: A total of 6,528 responses were obtained (response rate of 13.1%), 53% of respondents were females with a mean age of 59.8 years. Regarding tobacco use, 19.4% were current smokers while 27.9% reported being former smokers. Only 17.0% spontaneously recognized the term «COPD». Valencia was the region with the highest degree of ignorance regarding COPD (91%), while Aragon had the lowest (73.7%). Nevertheless, COPD is considered a severe disease, following angina pectoris in severity. Upon comparing these results with the previous survey from 2002, we observed significant improvements in the knowledge and understanding of COPD (8.6% vs. 17.0%), with a marked variability between the regions (P<.05). Currently, only 4.7% of the Spanish population knows that there is a National Strategy for COPD, although 86.0% have a favorable or very favorable opinion about the new Anti-tobacco Law. Conclusion: The lack of knowledge about COPD and its determinants in the general population remains high compared to 2002; thus, more and better educational and awareness programs are necessary(AU)

Documento de consenso sobre el fenotipo mixto EPOC-asma en la EPOC / Consensus Document on the Overlap Phenotype COPD-Asthma in COPD

Introducción: Aunque asma y EPOC son enfermedades distintas, muchos pacientes comparten características de ambas entidades. Estos casos pueden tener una evolución y una respuesta al tratamiento diferente. Sin embargo, la evidencia disponible es escasa, y es necesario valorar si representan un fenotipo diferencial y aportar recomendaciones sobre su diagnóstico y tratamiento, además de identificar posibles lagunas de conocimiento. Método: Consenso nacional de expertos en EPOC en dos etapas: 1) Se establecieron los bloques temáticos a tratar y se elaboró una primera propuesta de aseveraciones, mediante una reunión presencial con metodología de «tormenta de ideas» estructurada. 2) Se realizaron dos rondas de consenso vía correo electrónico, utilizando una escala tipo Likert. Resultados: Se consensua la existencia de un fenotipo clínico diferencial denominado «fenotipo mixto EPOC-asma», cuyo diagnóstico se realizará si se cumplen 2 criterios mayores o uno mayor y 2 menores (criterios mayores: prueba broncodilatadora muy positiva [aumento del FEV1≥15% y≥400ml], eosinofilia en esputo y antecedentes personales de asma; criterios menores: IgE total elevada, antecedentes personales de atopia y prueba broncodilatadora positiva [aumento del FEV1≥12% y≥200ml] en dos o más ocasiones). Se recomienda el uso precoz de corticoides inhalados (CI) ajustados individualmente, ser cautos con la retirada brusca de CI y, en casos graves, valorar el uso de la triple terapia. Finalmente, queda patente la falta de estudios específicos sobre la historia natural y el tratamiento de estos pacientes. Conclusiones: Es preciso profundizar en el conocimiento de este fenotipo para establecer pautas y recomendaciones adecuadas para su diagnóstico y tratamiento(AU)

Introduction: Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. Methods: A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured «brainstorming» method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale. Results: Consensus was reached about the existence of a differential clinical phenotype known as «Overlap Phenotype COPD-Asthma», whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV1 ≥15% and ≥400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV1 ≥12% and ≥200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. Conclusions: It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment(AU)

Diferencias geográficas en la prevalencia de EPOC en España: relación con hábito tabáquico, tasas de mortalidad y otros determinantes / Geographical Variations in the Prevalence of COPD in Spain: Relationship to Smoking, Death Rates and other Determining Factors

AntecedentesEl estudio EPI-SCAN (Epidemiologic Study of COPD in Spain), realizado entre mayo de 2006 y julio de 2007, ha determinado que la prevalencia de la EPOC en España según los criterios GOLD es del 10,2% (IC95% 9,2–11,1) de la población de 40 a 80 años. Se desconoce la variabilidad geográfica actual de la EPOC en España.ObjetivosDescribir la prevalencia de EPOC, su infradiagnóstico e infratratamiento, y los datos de tabaquismo y mortalidad en las once áreas participantes en el estudio EPI-SCAN. Se definió EPOC como un cociente FEV1/FVC posbroncodilatador <0,70 o menor del límite inferior de la normalidad (LIN).ResultadosLa razón de prevalencias de EPOC según criterios GOLD entre áreas fue de 2,7 veces, con un máximo en Asturias (16,9%) y un mínimo en Burgos (6,2%) (p<0,05). La prevalencia de EPOC según el LIN fue del 5,6% (IC 95% 4,9–6,4) y la razón de prevalencias utilizando el LIN fue de 3,1 veces, pero con un máximo en Madrid-La Princesa (10,1%) y un mínimo en Burgos (3,2%) (p<0,05). El orden de prevalencias de EPOC por áreas no se mantuvo en ambos sexos ni por edades en cada área. Las variaciones en infradiagnóstico (58,6% a 72,8%) e infratratamiento por áreas (24,1% a 72,5%) fueron substanciales (p<0,05). La prevalencia de fumadores y ex-fumadores, y la exposición acumulada medida por paquetes-año, así como la estructura de edad de cada una de las áreas, no explican la variabilidad por áreas geográficas. Tampoco existe relación con las tasas de mortalidad publicadas por comunidad autónoma.ConclusiónExisten importantes variaciones en la distribución de la EPOC en España, tanto en prevalencia como en infradiagnóstico e infratratamiento(AU)

BackgroundThe EPI-SCAN study (Epidemiologic Study of COPD in Spain), conducted from May 2006 to July 2007, determined that the prevalence of COPD in Spain according to the GOLD criteria was 10.2% of the 40 to 80 years population. Little is known about the current geographical variation of COPD in Spain.ObjectivesWe studied the prevalence of COPD, its under-diagnosis and under-treatment, smoking and mortality in the eleven areas participating in EPI-SCAN. COPD was defined as a post-bronchodilator FEV1/FVC ratio <0.70 or as the lower limit of normal (LLN).ResultsThe ratio of prevalences of COPD among the EPI-SCAN areas was 2.7-fold, with a peak in Asturias (16.9%) and a minimum in Burgos (6.2 %) (P<0.05). The prevalence of COPD according to LLN was 5.6% (95% CI 4.9–6.4) and the ratio of COPD prevalence using LLN was 3.1-fold, but with a peak in Madrid-La Princesa (10.1%) and a minimum in Burgos (3.2%) (P<0.05). The ranking of prevalences of COPD was not maintained in both sexes or age groups in each area. Variations in under-diagnosis (58.6% to 72.8%) and under-treatment by areas (24.1% to 72.5%) were substantial (P<0.05). The prevalence of smokers and former smokers, and cumulative exposure as measured by pack-years, and the age structure of each of the areas did not explain much of the variability by geographic areas. Nor is there any relation with mortality rates published by Autonomous Communities.ConclusionThere are significant variations in the distribution of COPD in Spain, either in prevalence or in under-diagnosis and under-treatment(AU)

Comparación de un programa de rehabilitación domiciliario con uno hospitalario en pacientes con EPOC: estudio multicéntrico español / Home vs hospital-based pulmonary rehabilitation for patients with Chronic Obstructive Pulmonary Disease: a spanish multicenter trial

OBJETIVO: Estudiar el impacto de un programa simple de rehabilitación respiratoria domiciliario, comparado con uno intensivo hospitalario, sobre la capacidad de esfuerzo y la calidad de vida relacionada con la salud (CVRS) de los pacientes con enfermedad pulmonar obstructiva crónica. PACIENTES Y MÉTODOS: Se ha realizado un estudio prospectivo y multicéntrico en el que se aleatorizó a pacientes con EPOC grave en 2 grupos: hospital (GH) o domicilio (GD). En ambos los pacientes recibieron 2 sesiones de educación y 4 de fisioterapia. Los del GH realizaron un programa estructurado de ejercicio en el hospital y los del GD, un programa de ejercicio de baja intensidad en el domicilio, sin supervisión. RESULTADOS: Se aleatorizó a 28 pacientes en el GH y a 23 en el GD. Ambos grupos mostraron una mejoría similar en la prueba de la marcha de 6 min (diferencia media de 8,7 m; p = 0,61). A pesar de que en ambos grupos mejoró la CVRS, medida con el Cuestionario de Enfermedad Respiratoria Crónica (CRQ), se objetivó un incremento mayor en el área de función emocional para el GH (diferencia media entre grupos: 0,58, en una escala donde un valor de 0,5 representa la diferencia mínima importante). Los beneficios del programa se mantuvieron en ambos grupos hasta 6 meses después de finalizarlo. CONCLUSIONES: El estudio muestra que un programa domiciliario de rehabilitación respiratoria sin supervisión produce una mejoría similar en la capacidad de esfuerzo de los pacientes con EPOC que un programa intensivo hospitalario. Sin embargo, éste alcanza mayores beneficios en el área de la función emocional de la CVRS

OBJECTIVE: To compare the effects of a simple homepulmonary rehabilitation program and an intensivehospital-based program in terms of the exercise toleranceand health-related quality of life (HRQL) of patients withsevere chronic obstructive pulmonary disease (COPD).PATIENTS AND METHODS: Patients in this prospective,multicenter trial were randomized to 2 groups to receivehospital or home pulmonary rehabilitation. Patients in bothgroups attended 2 informative sessions about the disease and4 physical therapy sessions. Patients in the hospital groupthen carried out a structured exercise program while homegroup patients performed low intensity exercises at homewithout supervision.RESULTS: Twenty-eight patients were randomized to thehospital rehabilitation group and 23 to the home group. Bothgroups showed a similar improvement on the 6-minute walktest (mean difference, 8.7 m; P=.61). HRQOL measured withthe Chronic Respiratory Questionnaire also improved in bothgroups, but the change was greater on the emotional functiondomain in the hospital rehabilitation group (mean differencebetween groups, 0.58 on a scale for which the smallestclinically relevant difference is 0.5 points). The benefits weremaintained in both groups 6 months after the programs ended.CONCLUSIONS: This study demonstrates that theimprovement in exercise tolerance achieved by COPD patientswith an unsupervised home pulmonary rehabilitation programis similar to the gains of patients in an intensive hospital-basedprogram. However, the hospital program afforded greaterbenefit on the HRQOL emotional function domain

Guía clínica SEPAR-ALAT de diagnóstico y tratamiento de la EPOC / Diagnosis and management of Chronic Obstructive Pulmonary Disease: joint guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Latin American Thoracic Society (ALAT)

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