Prevalence and Management of Chronic Obstructive Pulmonary Disease in the Gulf Countries with a Focus on Inhaled Pharmacotherapy.

Background: Chronic obstructive pulmonary disease (COPD) is a preventable, progressive disease and the third leading cause of death worldwide. The epidemiological data of COPD from Gulf countries are very limited, as it remains underdiagnosed and underestimated. Risk factors for COPD include tobacco cigarette smoking, water pipe smoking (Shisha), exposure to air pollutants, occupational dusts, fumes, and chemicals. Inadequate treatment of COPD leads to worsening of disease. The 2024 GOLD guidelines recommend use of inhaled bronchodilators, corticosteroids, and adjunct therapies for treatment and management of COPD patients based on an individual assessment of the severity of symptoms and risk of exacerbations. This article reviews COPD pharmacotherapy in the Gulf countries and explores the role of nebulization in the management of COPD in this region. Methods: To review the COPD pharmacotherapy in the Gulf Countries, literature search was conducted using PubMed, Medline, Cochrane Systematic Reviews, and Google Scholar databases (before December 2022), using search terms such as COPD, nebulization, inhalers/inhalation, aerosols, and Gulf countries. Relevant articles from the reference list of identified studies were reviewed. Consensus statements, expert opinion, and other published review articles were included. Results: In the Gulf countries, pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), soft mist inhalers, and nebulizers are used for drug delivery to COPD patients. pMDIs and DPIs are most prone to errors in technique and other common device handling errors. Nebulization is another mode of inhalation drug delivery, which is beneficial in certain patient populations such as the elderly and patients with cognitive impairment, motor or neuromuscular disorders, and other comorbidities. Conclusion: There is no major difference between Gulf countries and rest of the world in the approach to management of COPD. Nebulizers should be considered for patients who have difficulties in accessing or using MDIs and DPIs, irrespective of geographical location.

Prediction Equations for Maximal Aerobic Capacity on Cycle Ergometer for the Spanish Adult Population.

BACKGROUND: Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake (V?O2) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. METHODS: 182 men and women, 20-85 years old, were included and exercised on cycle-ergometer to exhaustion. (V?O2) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. RESULTS: Height, sex and age resulted predictive of both V?O2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V?O2peak=0.017·height?(cm)-0.023·age?(years)+0.864·sex?(female=0/male=1)±179?l?min-1, and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony. CONCLUSIONS: This study provides new and accurate V?O2 peak and WR rate reference values for individuals of European Spanish descent.

Prediction Equations for Maximal Aerobic Capacity on Cycle Ergometer for the Spanish Adult Population.

BACKGROUND: Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake (V˙O2) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. METHODS: 182 men and women, 20-85 years old, were included and exercised on cycle-ergometer to exhaustion. (V˙O2) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. RESULTS: Height, sex and age resulted predictive of both V˙O2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V˙O2peak=0.017⋅height(cm)-0.023⋅age(years)+0.864⋅sex(female=0/male=1)±179lmin-1, and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony. CONCLUSIONS: This study provides new and accurate V˙O2 peak and WR rate reference values for individuals of European Spanish descent.

Prediction Equations for Maximal Aerobic Capacity on Cycle Ergometer for the Spanish Adult Population / Ecuaciones de referencia de la capacidad aeróbica máxima ciclo-ergoespirometría para la población española adulta

Background: Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria.Our objective was to obtain population based reference values for peak oxygen uptake (V?O2) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. Methods: 182 men and women, 20–85 years old, were included and exercised on cycle-ergometer to exhaustion. (V?O2) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. Results: Height, sex and age resulted predictive of both V?O2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V?O2peak=0.017·height?(cm)-0.023·age?(years)+0.864·sex?(female=0/male=1)±179?l?min-1, and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony. Conclusions: This study provides new and accurate V?O2 peak and WR rate reference values for individuals of European Spanish descent. (AU)

Antecedentes: Los valores de referencia utilizados con frecuencia para las pruebas de esfuerzo clínicas derivan de muestras no aleatorias y los criterios máximos para algunos de ellos están mal definidos. Nuestro objetivo fue obtener valores de referencia basados en la población general para el consumo máximo de oxígeno (VO2) y la carga de trabajo (CT) para las pruebas de ejercicio cardiopulmonar a partir de una muestra representativa de varones y mujeres caucásicos españoles. Métodos: Se incluyeron 182 varones y mujeres, de entre 20 y 85 años, que realizaron ejercicio en el cicloergómetro hasta el agotamiento. Se midieron el VO2 y la CT. Las ecuaciones obtenidas de esta muestra se validaron en una cohorte independiente de 69 individuos, seleccionados aleatoriamente de la misma población. A continuación, se creó una ecuación final que fusionó las dos cohortes (n=251). Resultados: La altura, el sexo y la edad resultaron predictivos tanto del V?O2 máximo como de la CT. El peso y la actividad física contribuyeron muy poco a la precisión de las ecuaciones. Las fórmulas V?O2 máximo=0,017×altura (cm)-0,023×edad (años)+0,864×sexo (mujer=0/varón=1)±179 L×min-1; y CT máxima=1,345×altura (cm)-2,074×edad (años)+76,54×sexo (mujer=0/varón=1)±21,2W fueron el mejor equilibrio entre precisión y parsimonia. Conclusiones: Este estudio proporciona valores de referencia del V?O2 máximo y la CT nuevos y precisos para personas de ascendencia española europea. (AU)

Anthracofibrosis or anthracostenosis.

Anthracofibrosis is a bronchial stenosis due to local mucosal fibrosis that also presents anthracotic pigment in the mucosa. The cause has not been well clarified, although there is a frequent association with tuberculosis and the exposure to smoke from biofuel or biomass combustion. It is an entity that has not been reported in Spain, although the influx of people from rural areas of developing countries or rural areas of our own country should make us contemplate this entity in the differential diagnosis of our patients. We present 3 cases detected in Spain (2 of them natives) diagnosed by bronchoscopy and bronchial biopsy, which are techniques necessary to confirm the diagnosis. There is no specific treatment, except for tuberculostatic treatment in cases with coexisting tuberculosis.

[Pulmonary paragonimiasis]. / Paragonimiasis pulmonar.

Paragonimiasis is a food-borne zoonosis caused by a trematode of the genus Paragonimus(1,2). Infestation is rare in Spain, but the influx of people from endemic areas should make us keep this condition in the differential diagnosis of our patients(2,5). We report the case a patient from Ecuador and resident in Spain for 7 years with active pulmonary tuberculosis on arrival in Spain and later diagnosed with of pulmonary paragonimiasis due to persistent haemoptysis. The diagnosis was established by surgical lung specimen showing granulomas containing parasite eggs and the macroscopic view of the fluke within a lung cavity. Initial tuberculosis treatment and current treatment with praziquantel controlled both conditions.

Hypersensitivity pneumonitis caused by esparto dust in a young plaster worker: a case report and review of the literature.

We report a case of a 25-year-old, white, male plaster worker who started developing fever, severe dyspnea and cough during the manipulation of esparto fibers. The functional lung study showed restrictive lung disease and decreased single-breath carbon monoxide transfer lung capacity. High-resolution computed tomography revealed a diffuse 'ground-glass' pattern. The histopathological findings were interstitial inflammation with a marked predominance of lymphocytes and microgranulomas. Bronchoalveolar lavage showed a significant predominance of lymphocytes, with an increase in the level of CD8. Serum precipitins against fungal antigens confirmed that Aspergillus fumigatus was the cause of the patient's hypersensitivity pneumonitis.

Antracofibrosis o antracoestenosis / Anthracofibrosis or Anthracostenosis

La antracofibrosis es una estenosis bronquial debida a una fibrosis mucosa local que presenta además una mucosa con pigmento antracótico. La causa no está bien aclarada, y se da una frecuente asociación con la tuberculosis y la exposición a humos de combustión de biocombustibles (o biomasa). Se trata de una entidad no descrita en España, aunque la afluencia de personas originarias de zonas rurales de países en desarrollo o de zonas rurales de nuestro medio debe hacernos tener presente esta entidad en el diagnóstico diferencial de nuestros pacientes. Se presentan 3 casos detectados en España (2 de ellos autóctonos) diagnosticados mediante broncoscopia y biopsia bronquial, técnicas necesarias para su confirmación. No hay tratamiento específico, salvo el tuberculostático en el caso de coexistencia de ambas entidades(AU)

Anthracofibrosis is a bronchial stenosis due to local mucosal fibrosis that also presents anthracotic pigment in the mucosa. The cause has not been well clarified, although there is a frequent association with tuberculosis and the exposure to smoke from biofuel or biomass combustion. It is an entity that has not been reported in Spain, although the influx of people from rural areas of developing countries or rural areas of our own country should make us contemplate this entity in the differential diagnosis of our patients. We present 3 cases detected in Spain (2 of them natives) diagnosed by bronchoscopy and bronchial biopsy, which are techniques necessary to confirm the diagnosis. There is no specific treatment, except for tuberculostatic treatment in cases with coexisting tuberculosis(AU)

Paragonimiasis pulmonar / Pulmonary Paragonimiasis

La paragonimiasis es una zoonosis de transmisión alimentaria causada por un trematodo del género Paragonimus1,2. Se trata de infestación excepcional en España, pero la afluencia de personas originarias de áreas endémicas debe hacernos tener presente esta entidad en el diagnóstico diferencial de nuestros pacientes2,5.Presentamos el caso de un paciente natural de Ecuador y residente en España desde hace 7 años con tuberculosis pulmonar activa a su llegada a España y posterior diagnóstico de paragonimiasis pulmonar a raíz de hemoptisis persistente. El diagnóstico se estableció por muestra quirúrgica pulmonar, objetivando granulomas, englobando los huevos del parásito, así como la visualización macroscópica del trematodo dentro de una cavidad. El tratamiento antituberculoso inicialmente y con prazicuantel en la actualidad controló ambas entidades(AU)

Paragonimiasis is a food-borne zoonosis caused by a trematode of the genus Paragonimus1,2. Infestation is rare in Spain, but the influx of people from endemic areas should make us keep this condition in the differential diagnosis of our patients2,5.We report the case a patient from Ecuador and resident in Spain for 7years with active pulmonary tuberculosis on arrival in Spain and later diagnosed with of pulmonary paragonimiasis due to persistent haemoptysis. The diagnosis was established by surgical lung specimen showing granulomas containing parasite eggs and the macroscopic view of the fluke within a lung cavity. Initial tuberculosis treatment and current treatment with praziquantel controlled both conditions(AU)