Octogenarian patients with chronic obstructive pulmonary disease: Characteristics and usefulness of prognostic indexes. / Pacientes octogenarios con enfermedad pulmonar obstructiva crónica: características y utilidad de los índices pronósticos.

BACKGROUND AND OBJECTIVE: Most studies on chronic obstructive pulmonary disease (COPD) exclude octogenarian patients. Therefore, the disease is not well characterized in this age group. The objective of this study is to analyze the clinical characteristics of octogenarian patients with COPD and the usefulness of the prognostic indexes used most frequently in this age group. PATIENTS AND METHOD: Retrospective study of consecutive patients seen at a clinic between 2009 and 2017. The following variables were analyzed: lung function parameters, distribution of clinical phenotypes, income history, mortality, comorbidities and usefulness of the Charlson, BODEX, COTE and CODEX indexes to predict mortality. RESULTS: The sample comprised 698 patients, 82 aged (11.7%)≥80 years old. Mean follow-up time was 47.9±21.8 months. In octogenarian patients, the severity of the COPD, assessed by means of the FEV1% or BODEX index, was similar to that of younger patients, but dyspnea was worse in the elderly group. In these patients, the chronic bronchitis and frequent exacerbator phenotypes were the most frequent, whilst the emphysema phenotype was the least common. Octogenarians had a greater prevalence of cardiovascular comorbidities and renal diseases. Moreover, hospital admissions were more frequent and mortality was higher in these elderly patients. Most prognostic indexes were useful in predicting mortality in elderly patients. CODEX was the most useful index to predict mortality, both in octogenarian and younger patients. CONCLUSION: Octogenarian patients with COPD have differential characteristics which could imply the need for different therapeutic approaches. Prognostic indexes are useful for predicting mortality in this population.

Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome.

OBJECTIVE: To assess the outcome of 54 patients with obesity-hypoventilation syndrome (OHS) who were treated with nasal intermittent positive-pressure ventilation (NIPPV). DESIGN: Descriptive analysis of retrospectively collected clinical data. MATERIALS AND METHODS: From March 1995 to December 2002, OHS (defined as a body mass index [BMI] of > 30 kg/m2, a daytime Pa(CO2) of > or = 50 mm Hg, and a Pa(O2) of < 60 mm Hg in the absence of COPD) was diagnosed in 69 cases. Fifteen patients (21.7%) refused to be treated with NIPPV, and 20 patients were started on NIPPV therapy electively and 34 following an acute exacerbation. We employed daytime arterial blood gas values and overnight pulse oximetry to determine the initial NIPPV modes and settings. The outcome measures were survival, clinical status, and arterial blood gas levels. RESULTS: Among the 54 study patients (18 women), the mean (+/- SD) age was 56 +/- 13 years. The mean BMI was 44 +/- 8.8 kg/m2. Sleep apnea syndrome (apnea-hypopnea index, > 5) was present in 87% of the patients. At presentation, 22 of the 54 patients had experienced an acute hypercapnic respiratory failure (pH < 7.34). None of these patients required orotracheal intubation after NIPPV treatment. Initially, 2 patients were treated with volume-preset ventilation, 49 patients used pressure-preset equipment, and 3 patients employed continuous positive airway pressure (CPAP). Forty-seven patients required supplemental oxygen. At the end of the follow-up period (mean duration, 50 months), Pa(O2) had increased by 24 mm Hg from baseline (95% confidence interval [CI], 21 to 28 mm Hg; p < 0.0001) and Pa(CO2) had decreased by 17 mm Hg (95% CI, 13 to 20 mm Hg; p < 0.0001). NIPPV therapy improved subjective sleepiness (mean Epworth sleepiness scale score decrease, 16 +/- 5 to 6 +/- 2; p < 0.001), and dyspnea decreased in all but four patients. During follow-up, three patients died (one of them due to the progression of respiratory failure). NIPPV therapy could be withdrawn in 5 patients who had achieved a sufficient weight loss, and the conditions of 16 patients could be maintained without respiratory failure by the use of simple therapy with CPAP. CONCLUSIONS: NIPPV therapy is effective in the treatment of patients with OHS, providing a significant improvement in clinical status and gas exchange.

Prognostic value of walk distance, work, oxygen saturation, and dyspnea during 6-minute walk test in COPD patients.

BACKGROUND: Distance walked during the 6-min walk test (6MWT) predicts mortality in COPD. The body weight of the patient affects the work required to walk. Calculated work during the 6MWT (6MWT work) may account for differences in walk distance resulting from change in body weight. Thus, 6MWT work might be a better predictor of mortality than distance walked. This study was designed to test this hypothesis and to assess if other variables measured during the 6MWT, like continuous oximetry recording, offered additional prognostic information. METHODS: This was a retrospective analysis of prospectively collected data; 104 COPD patients were studied. 6MWT was performed in all cases. 6MWT work was calculated as body weight (in kg) × distance walked (in m). Receiver operating characteristic curves were used to assess the value of variables to predict mortality. Additional analysis was performed using Kaplan-Meier survival plots and Cox proportional hazards regression models. RESULTS: Mean follow-up was 590 ± 472 d. Eleven subjects (10.6%) died. 6MWT work was not better than distance walked to predict mortality (area under the curve 0.77 for 6MWT work vs 0.80 for distance; difference 0.03, 95% CI -0.05 to 0.12, P = .45). Subjects who died had more dyspnea (measured using the Borg scale) after the 6MWT (8.5 vs 4.0, P < .001), lower baseline SpO2 (85% vs 93%, P = .001), worse oxygen saturation during the 6MWT (mean SpO2 while walking 74.0% vs 86.6%, P = .02) and walked less distance (255 m vs 480 m, P = .001). On multivariate analysis, only 6MWT distance and dyspnea after the test correlated independently with mortality (P = .005 for both variables). CONCLUSIONS: 6MWT work was not more useful than 6MWT distance to predict mortality. The study confirms that 6MWT distance and dyspnea on exertion are key elements in prognostic evaluation in COPD, while the value of exercise oxygen desaturation is less clear.

Exposure to residential radon and lung cancer in never-smokers: the preliminary results of the LCRINS study.

INTRODUCTION AND OBJECTIVE: Residential radon is the second most important risk factor for lung cancer and the first among never-smokers. The objective of this study is to report the concentrations of residential radon in a series of never-smoker cases recruited in a multicenter study of cases and controls in northwestern Spain. In this study, all the hospitals in the Spanish province of Galicia and one from Asturias participated. PATIENTS AND METHODS: The present article includes a series of cases with residential radon measurements. All the subjects were personally interviewed, 3 ml of blood were taken from each, and they were each given instructions about how to place a residential radon detector in their homes. RESULTS: Sixty-nine case subjects were recruited, 84% of whom were women with a mean age of 71, and 81% of whom had adenocarcinoma. The average concentration of residential radon in the cases was 237 Bq/m(3), while the average concentration in the Galician population is 79 Bq/m(3). No relationship was observed between the concentration of residential radon and either sex or age at the time of diagnosis of the cases, but there was a tendency towards having a greater concentration in those diagnosed with small-cell and large-cell carcinoma. CONCLUSIONS: The concentrations of residential radon in the cases included are very high at about three times the average concentration of residential radon to which the general population of Galicia is exposed.

Right ventricle dysfunction and pulmonary hypertension in hemodynamically stable pulmonary embolism.

BACKGROUND: The main objectives of this study were to determine the incidence of echocardiography-detected right ventricle dysfunction (RVD) or pulmonary hypertension (PHT) and its correlation with computed tomography pulmonary angiography (CTPA) in hemodynamically stable patients with pulmonary embolism (PE), both at diagnosis and after 6 months follow-up. METHODS: Prospective, descriptive, single-center follow-up study. STUDY POPULATION: 103 consecutive patients, with a life expectancy of >6 months, presenting with PE and a systolic blood pressure> or =90mmHg. Echocardiography and CTPA were performed at diagnosis and after 6 months. RESULTS: At diagnosis, RVD and isolated PHT were found in 24.5% and 19.6% of patients, respectively. CTPA and echocardiography correlated significantly at diagnosis. However, CTPA could not predict accurately RVD or PHT. Persistence of RVD and isolated PHT was observed in 7.9% and 11.8% of cases, respectively, 6 months later. Intraluminal filling defects disappeared in 79%. No new filling defects were seen in any patient. Excluding cases with comorbidities that might account for PHT, CTPA was normal at the 6th month in 23.1% of patients with and in 87.8% of cases without persistent RVD or PHT, respectively (p<0.0001). CONCLUSIONS: RVD or PHT are a frequent finding at diagnosis in patients with hemodynamically stable pulmonary embolism and they persist at 6 months in a significant proportion of cases. We have observed a relationship between the persistence of residual vascular obstruction in CTPA and RVD or PHT 6 months after PE.