Airway inflammation in the elite athlete and type of sport.

BACKGROUND: The prevalence of asthma and bronchial hyper-responsiveness is greater in elite athletes than in the general population, and its association with mild airway inflammation has recently been reported. OBJECTIVE: To study the relationship between the type of sport practised at the highest levels of competition (on land or in water) and sputum induction cell counts in a group of healthy people and people with asthma. MATERIAL AND METHODS: In total, 50 athletes were enrolled. Medical history, results of methacholine challenge tests and sputum induced by hypertonic saline were analysed RESULTS: Full results were available for 43 athletes, who were classified by asthma diagnosis and type of sport (land or water sports). Nineteen were healthy (10 land and 9 water athletes) and 24 had asthma (13 land and 11 water athletes). Although the eosinophil counts of healthy people and people with asthma were significantly different (mean difference 3.1%, 95% CI 0.4 to 6.2, p = 0.008), analysis of variance showed no effect on eosinophil count for either diagnosis of asthma or type of sport. However, an effect was found for neutrophil counts (analysis of variance: F = 2.87, p = 0.04). There was also a significant correlation between neutrophil counts and both duration of training and bronchial hyper-responsiveness among athletes exposed to water (Spearman's rank correlations, 0.36 and 0.47, p = 0.04 and 0.04, respectively). CONCLUSIONS: Elite athletes who practice water sports have mild neutrophilic inflammation, whether or not asthma is present, related to the degree of bronchial hyper-reactivity and the duration of training in pool water.

Anti-inflammatory effects of high-dose inhaled fluticasone versus oral prednisone in asthma exacerbations.

The objective of the present study was to investigate the kinetics of high doses of inhaled steroid fluticasone in comparison with oral steroid prednisone on plasma protein leakage and bronchial eosinophilia in adults with moderate asthma exacerbations. The study design was a randomised, double-blind, placebo-controlled prospective trial. In total, 45 patients treated at the emergency department for moderate asthma exacerbations were recruited and 39 were assigned to receive fluticasone and placebo of prednisone (19 patients), or prednisone and placebo of fluticasone (20 patients). Medication was administered to all patients via a metered-dose inhaler and spacer (16 puffs; 4,000 microg.day(-1) or placebo) plus one pill (prednisone 30 mg.day(-1) or placebo). Spirometry and induced sputum for differential cell counts, albumin and alpha(2)-macroglobulin levels and blood eosinophils, interleukin-5 and granulocyte-macrophage colony-stimulating factor levels were obtained before treatment and at 2, 6 and 24 h after treatment. Symptoms clearly improved after 24 h in both groups. No differences were seen between groups in peak expiratory flow or forced expiratory flow in one second, which improved progressively but then decayed slightly after 24 h. Eosinophil counts in sputum also improved over time in both groups. The effect was faster with fluticasone than with prednisone, but was partially lost at 24 h. However, plasma proteins in sputum and eosinophil count in blood both decreased until 24 h, with no significant differences between groups. There was no correlation between eosinophil counts and plasmatic protein levels. In conclusion, both treatments improved symptoms, airway obstruction and inflammation, and plasma protein leakage at 24 h. Prednisone reduced blood eosinophil counts, while fluticasone reduced airway eosinophil counts, suggesting that the anti-inflammatory performance of fluticasone is exerted locally.

[Type 2 diabetes mellitus and health-related quality of life: results from the Hortega Study]. / Diabetes mellitus tipo 2 y calidad de vida relacionada con la salud: resultados del Estudio Hortega.

OBJECTIVE: To evaluate which health-related quality of life (HRQOL) aspects are affected by type 2 diabetes mellitus (DM) and influence of glycemic control and associated cardiovascular risk factors (CVRF). METHOD: A descriptive cross-sectional study was carried out in the health coverage area of our hospital. Following a multiphase sampling a final sample of 495 people, representative of the general population, was analyzed. HRQOL was evaluated with the Short-Form 36 (SF-36). RESULTS: After adjustment for sociodemographic variables (age, sex, education level, marital status, number of persons residing together, labor situation, social class and rural or urban ambience), comorbidity and CVRF (smoking, systolic blood pressure, LDL-cholesterol level and body mass index), the patients with DM presented lower scores on four SF-36 scales: physical function, bodily pain, general health and vitality. Among people with diabetes systolic blood pressure, body mass index and glycosylated hemoglobin, but not lipid levels, were negatively correlated to some SF-36 scores. CONCLUSIONS: In our population patients with DM present a poorer HRQOL, specifically in the physical dimensions, but neither their social function nor their mental health was affected. Hypertension, obesity and poor glycemic control are associated with worst subjective state of health.

[Markers of airway remodeling in induced sputum from healthy smokers]. / Marcadores de remodelado bronquial en el esputo inducido de fumadores sanos.

OBJECTIVE: Airway remodeling in chronic obstructive pulmonary disease (COPD) has been linked to the equilibrium between matrix metalloproteinase (MMP) 9 and its inhibitor, tissue inhibitor of metalloproteinase (TIMP) 1. However, that equilibrium has not been analyzed in healthy smokers. The aim of this study was to assess the equilibrium between MMP-9 and TIMP-1 in induced sputum from healthy smokers, healthy nonsmokers (controls), and patients with COPD. PATIENTS AND METHODS: Samples of induced sputum were obtained from 35 individuals: 12 healthy smokers, 12 controls, and 11 patients with COPD. In each sample, a differential cell count was performed and enzyme-linked immunosorbent assays were used to analyze the concentrations of MMP-9 (total and active fraction) and TIMP-1. RESULTS: Compared with controls, healthy smokers were found to have a higher mean (SD) concentration of total MMP-9 (273 [277] ng/mL vs 128 [146] ng/mL) and a higher ratio of total MMP-9 to TIMP-1 (0.16 [0.14] vs 0.08 [0.06]). However, the ratio of active MMP-9 to TIMP-1 was similar in the 2 groups. Samples from patients with COPD had the highest concentrations of total MMP-9 (477 [262] ng/mL) and active MMP-9 (178 [126] ng/mL) and the lowest concentrations of TIMP-1 (1.044 [1.036] microg/mL). When all groups were considered together, there was an inverse relationship between the MMP-9/TIMP-1 ratio and the forced expiratory volume in the first second (FEV1). The relationship between the active MMP-9/TIMP-1 ratio and FEV1 was even stronger, and the relation of both ratios with FEV1 became stronger still when smoking was considered. CONCLUSIONS: Healthy smokers had a higher concentration of total MMP-9 and that concentration was correlated with their exposure to tobacco smoke. Maintenance of the active MMP-9/TIMP-1 ratio in healthy smokers may explain the absence of progressive airway obstruction. Measurement of active MMP-9 concentration could be useful for assessment of airway remodeling.

[Usefulness of the Guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) in identifying the causes of chronic cough]. / Eficacia de la normativa SEPAR en la identificación de las causas de tos crónica.

OBJECTIVE: The usefulness of the recently published guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) on the diagnosis and treatment of chronic cough has not yet been demonstrated. The objectives of the present study were a) to evaluate the usefulness of the SEPAR guidelines for identifying the possible causes of chronic cough, and b) to determine the most frequent causes of chronic cough treated by primary care physicians. METHODS: We carried out a prospective descriptive study that included 57 consecutive patients (mean age, 62 years) seeking medical attention for chronic cough in a primary health care area. The patients were evaluated using the algorithm proposed in the SEPAR guidelines, whereby the diagnostic procedure is divided into 3 phases in function of complexity. Phase I was carried out at the primary care level, and phases II and III at a hospital pneumology department. RESULTS: For 56 patients (98%), the potential cause of cough was identified: for 52 (91%) in phase I; for 3 (5%), in phase II; and for 1 (2%), in phase III. In 30 patients (53%), a single cause was identified; in 20 (36%), 2 causes; and in 6 (11%), more than 2 causes. Considered individually, the most common causes were postnasal drip in 26 cases (46%), the use of cough-inducing drugs (10 of them attributable to angiotensin-converting enzyme inhibitors) in 16 (28%), asthma in 15 (27%), infection in 13 (23%), gastroesophageal reflux in 12 (21%), and others in 9 (16%). CONCLUSIONS: The application of the SEPAR guidelines on chronic cough is useful for the identification of its causes. The use of angiotensin-converting enzyme inhibitors is a frequent cause of coughs diagnosed at the level of primary outpatient health care.

[Lung function in cardiac dysfunction]. / Función pulmonar en la disfunción cardíaca.

OBJECTIVE: The alterations in lung function caused by heart failure were first described some decades ago. The advent of new tools for the diagnosis and investigation of heart disease, such as echocardiography, has subsequently made it possible to classify cardiac dysfunction with greater precision. The objective of this study was to analyze and compare a series of lung function and gas exchange variables in patients who had been classified into 4 groups according to type of heart disease as diagnosed by echocardiography. MATERIALS AND METHOD: Emergency room patients whose main symptom was acute dyspnea caused by cardiac or respiratory disease were included in the study. The final sample comprised 71 patients whose echocardiogram revealed cardiac dysfunction. Spirometry was carried out and resting arterial blood gases measured in this group. RESULTS: Of the 71 patients with cardiopathy, 31 had systolic dysfunction, 27 diastolic dysfunction, 7 cor pulmonale, and 6 primary valve disease. Spirometry revealed a generally obstructive pattern, more marked in the group with cor pulmonale. Analysis of arterial blood gases revealed slight hypoxemia with normocapnia in all groups, but this was more accentuated in the patients with cor pulmonale and diastolic dysfunction. An analysis of the correlations (Pearson's r) between cardiac and pulmonary variables revealed the statistically significant associations between cardiac mass and other variables to be as follows: forced vital capacity r=0.34 (P=.02), forced expiratory volume in one second r=0.526 (P=.0001), forced expiratory volume in one second as a percentage of predicted r=0.3 (P=.037), and forced midexpiratory flow rate r=0.31 (P=.03). The correlation between left ventricular ejection fraction and PaO2 was r=-0.312 (P=.01); the correlation between left ventricular end-diastolic diameter and PaO2 was r=0.369 (p=.006). CONCLUSIONS: In patients with cardiac dysfunction, spirometry reveals a generally obstructive pattern, which is more accentuated in patients with right ventricular dysfunction owing to the existence of prior lung disease. The associations found between the cardiac and lung function variables do not help the physician to determine the predominant diagnosis for a patient more precisely or to establish a prognosis.

The SF-36 Questionnaire as a measurement of health-related quality of life: assessing short- and medium-term effects of exposure to tobacco versus the known long-term effects.

BACKGROUND: In order to determine the magnitude of the short- or medium-term effects of tobacco use on the health-related quality of life (HRQOL) of smokers and ex-smokers, and to compare them with the estimated long-term effects reported in other studies, a cross-sectional epidemiological study was designed. METHODS: A representative study of the general population over 14 years of age was conducted in the western health area of Valladolid, Spain. HRQOL was evaluated using the SF-36 Health Questionnaire. Differences in HRQOL among smokers, non-smokers, and former smokers were determined. Standardized scores from the general population and long-term effects of tobacco exposure were compared. RESULTS: Former smokers had a better HRQOL than smokers and non-smokers on the emotional dimensions, especially "vitality" and "role emotional", while differences between the groups on the physical and emotional dimensions did not reach statistical significance. Smokers displayed deterioration in "bodily pain", "general health", "vitality", "social function", and "role emotional", while deterioration in ex-smokers only occurred in "bodily pain" and "general health." The variable package/year was correlated with "general health." CONCLUSIONS: Short- and medium-range effects of tobacco consumption on HRQOL cannot be demonstrated with the SF-36 Health Questionnaire in the general Spanish population, whereas long-term effects can.

[Smoking in the general population: a description of prevalence, degree of consolidation and phase of cessation]. / Hábito tabáquico en una población general: descripción de la prevalencia, grado de consolidación y fase de abandono.

Smoking is a risk factor associated with high and preventable mortality and morbidity. An understanding of smoking consolidation and the desire to quit in specific subgroups of the general population will facilitate appropriate planning of health care resource utilization. We performed a multistage, random, stratified cross-sectional study in the general population of Valladolid (Spain) during 1998 and 1999 as part of a cardiovascular disease risk survey. Data collected by questionnaire and interview included number of cigarettes smoked per day, nicotine dependence and stage in the process of smoking cessation. Venous carboxyhemoglobin was also measured. The percentage of reported smokers in the general population was 29.3% (95% CI: 25.7-32.9%). Prevalence was 41.8% (95% CI: 39.2-44.5%) in the 26-to-45-year-old age group and fell to 6% (95% CI: 5.6-6.5%) among subjects over 66 years of age. Analysis by sex, 31.2% (95% CI: 26.1-36.4%) of men and 27.4% (95% CI: 24.1-30.7%) of women were smokers. In rural areas the percentage of smokers was 26.9% (95% CI: 20.2-33.5%) whereas the percentage in urban areas was 31.2% (95% CI: 26.1-36.4%). The number of cigarettes/day, venous carboxyhemoglobin and nicotine dependence differed by age range, sex and place of residence and helped to describe the degree of consolidation of smoking by strata. Phases of cessation were distributed similarly by age range but not by sex. The prevalence of smoking is still high, particularly among young people and women, although it is tending to decrease. Smoking is better established in the 26-45 year-old age range, among men, among those living in rural areas and among older smokers who, probably, can not quit smoking alone.

Report on five cases of tularaemic pneumonia in a tularaemia outbreak in Spain.

A report is given on five cases of atypical tularaemic pneumonia selected from among 140 cases of tularaemic infection in a previously reported outbreak occurring in 1997. Prior to this outbreak no human cases of tularaemia had been reported in Spain. All cases were diagnosed serologically. All five patients reported on here had a mild form of the disease, which was treated successfully with streptomycin in four cases and ciprofloxacin in one case. Tularaemic pneumonia should be considered in the differential diagnosis of atypical pneumonia in Spain, especially in hunters and other persons who handle animal carcasses.

[Trousseau's syndrome in lung adenocarcinoma. The rare appearance of venous gangrene]. / Síndrome de Trousseau en adenocarcinoma de pulmón. La infrecuente aparición de la gangrena venosa.

Trousseau's syndrome includes a wide range of coagulation disorders, migratory thrombotic phenomena being the main associated entities. Treatment is difficult and venous gangrene constitutes a rare but deadly final stage that is particularly painful for the patient. The outlook after treatment is poor.

[Long-course pneumonia as manifestation of transphrenic migration of a calcified hydatid cyst]. / Neumonía de larga evolución como manifestación de una migración transfénica de un quiste hidatídico calcificado.

The hydatidosis disease, which is caused by the larva of the granulosus equinococcus, is still a common zoonosis in countries like Spain. The observation of a calcified hydatid cyst of the liver in an asymptomatic patient suggest a very long clinical latency period of the disease. Acute complications have been reported. We present the case of a patient with clinical symptoms of nonresolving pneumonia and an old calcified hydatid cyst of the liver. The first approach to the diagnosis of community-acquired pneumonia was inconclusive. The high clinical suspect of equinococcus infection added to the bronchoscopy findings, computed tomographic (CT) study and serological test, permitted the correct preoperative diagnosis. The surgical removal confirmed the diagnosis of transphrenic migration of a hydatid cyst ruptured to the bronchial tree.

[Bronchioloalveolar carcinoma]. / Carcinoma bronquioloalveolar.

We studied 14 patients with bronchioalveolar carcinoma during the last 14 years. In all cases we evaluated the clinical history, the radiologic presentation, and the diagnostic procedures. The mean age of presentation of the illness was 58.5 years. The incidence of smokers was 35%. The time interval from clinical manifestations to diagnosis was 3,3 months. The most frequent symptoms were cough (57%) and dyspnea (43%). The 21% of the cases were asymptomatic. Two patients (14%) had copious amounts of sputum (bronchorrhea). The most revealing radiologic pattern was of alveolar type (43%), followed by multiple pulmonary nodules (29%) and solitary pulmonary nodule pattern (21%). The diagnosis was based in specimen obtained from transbronchial biopsy, bronchoalveolar lavage, transthoracic aspiration biopsy, thoracotomy, or during the necropsy study. Transbronchial biopsy was a sensitive diagnostic method. The 64% of patients were in a extent disease when the diagnosis was established.