Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.

BACKGROUND: Community pharmacies (CP) have access to subjects at high-risk of suffering Chronic Obstructive Pulmonary Disease (COPD). We investigated if a COPD case finding program in CP could be a new strategy to reduce COPD underdiagnosis. METHODS: Prospective, cross-sectional, descriptive, uncontrolled, remotely supported study in 100 CP in Barcelona, Spain. Pharmacists were trained in a four-day workshop on spirometry and COPD, and each was provided with a spirometer for 12 weeks. The program included questionnaires and forced spirometry measurements, whose quality was controlled and monitored by web-assistance. FINDINGS: Overall 2295 (73.5%), of 3121 CP customers invited to participate in the program accepted, and 1.456 (63.4%) were identified as "high risk" for COPD using the GOLD questionnaire. Only 33 could not conduct spirometry, and a pre-bronchodilator airflow limitation (FEV1/FVC ratio <0.7) was confirmed in 282 (19.8%); 244 of these were referred to their primary care (PC) physician for further diagnostic and therapeutic work-up, but only 39 of them (16%) fed-back this information to the pharmacist. Clinically acceptable quality spirometries (grade A or B) were obtained in 69.4% of the cases. CONCLUSION: This study shows that adequately trained and supported community pharmacists can effectively identify individuals at high risk of having COPD and can thus contribute to ameliorate underdiagnosis in this disease. Links between PC and CP should be improved to achieve a useful program.

Factors affecting quality of life of asthma patients in Spain: the importance of patient education.

OBJECTIVES: Assessment of demographic and clinical factors that have an impact on the quality of life (QoL) of patients with asthma in Spain. PATIENTS AND METHODS: Multicenter, prospective, observational, cohort study, conducted in 40 Spanish Pneumology Units during a 12-month period. Data on sociodemographic, clinical variables, asthma treatment and QoL were collected in a case report form. RESULTS: 536 patients (64.6% women, mean age: 54) were recruited. Reported QoL was better for patients from Northern and Central Spain as compared with those from the South and the East (p<0.001), students and employed patients as compared with housewives and unemployed (p<0.01), for those who had received asthma information (p<0.01), for those with milder daytime symptoms (p<0.01) and for patients with higher level of education (p<0.05). CONCLUSIONS: Among the factors that have a significant effect on patients' QoL only symptom control and patient education on asthma control are modifiable. Therefore, all the strategies should be tailored to improve such factors when managing asthma patients.

Profile of patients treated with omalizumab in routine clinical practice in Spain.

BACKGROUND: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain. OBJECTIVE: To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment. METHODS: Retrospective, multicentre study, recording the data on patients of either sex and ≥12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit. RESULTS: 214 patients were evaluable (mean age=48.2±17.7 years; mean age at the time of diagnosis=26.6±16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273±205.4IU/ml. The mean monthly dose was 380.5±185.4mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7±15.9% vs. 70.8±18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC). CONCLUSIONS: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies.

[Electrical impedance tomography in acute lung injury]. / Tomografía de impedancia eléctrica en la lesión pulmonar aguda.

Electrical impedance tomography has been described as a new method of monitoring critically ill patients on mechanical ventilation. It has recently gained special interest because of its applicability for monitoring ventilation and pulmonary perfusion. Its bedside and continuous implementation, and the fact that it is a non-ionizing and non-invasive technique, makes it an extremely attractive measurement tool. Likewise, given its ability to assess the regional characteristics of lung structure, it could be considered an ideal monitoring tool in the heterogeneous lung with acute lung injury. This review explains the physical concept of bioimpedance and its clinical application, and summarizes the scientific evidence published to date with regard to the implementation of electrical impedance tomography as a method for monitoring ventilation and perfusion, mainly in the patient with acute lung injury, and other possible applications of the technique in the critically ill patient. The review also summarizes the limitations of the technique and its potential areas of future development.

Airway and alveolar nitric oxide measurements in obstructive sleep apnea syndrome.

STUDY OBJECTIVES: The process of intermittent hypoxia-reoxygenation produces airway inflammation and endothelial dysfunction that favors the development of cardiovascular disorders in obstructive sleep apnea syndrome (OSAS). Nitric oxide (NO) is an important mediator in airway inflammation and the regulation of endothelium-dependent vasodilation. DESIGN: This study compared airway NO (FE(NO)) and alveolar NO (CA(NO)) measurements in exhaled breath in 30 OSAS patients to those of 30 healthy (non-OSAS) individuals and determined the relationship between NO levels and OSAS severity. Additionally, NO measurements were analyzed after 3 months of CPAP treatment. MEASUREMENTS AND RESULTS: The mean (±SD) FE(NO) level in the OSAS group (27.2 ± 18 ppb) was higher than in the healthy non-OSAS group (p = 0.006). The mean CA(NO) level was 1.65 ± 0.90 ppb, lower than in the non-OSAS group (p = 0.001). A significant correlation was found between FE(NO) and CA(NO) levels and the apnea-hypopnea index (AHI) in the OSAS group (r = 0.8, p < 0.05; r = -0.9, p = 0.01, respectively). FE(NO) levels decreased and CA(NO) levels increased significantly after CPAP treatment. CONCLUSIONS: Severe OSAS patients have higher FE(NO) and lower CA(NO) levels and these are restored to normal after CPAP treatment, reflecting the correction of local upper airway inflammation and endothelial dysfunction present in OSAS patients. Exhaled breath techniques can be useful to identify airway inflammation and endothelial dysfunction in severe OSAS patients.

COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.

BACKGROUND: COPD case finding is currently recommended at primary and tertiary care levels only. AIM: To evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry. METHODS: Pilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV(1)/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry. RESULTS: Of the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV(1)/FVC ratio<0.7. When these subjects with airflow limitation were offered referral to a hospital respiratory function laboratory for further assessments, 11 (52%) attended the appointment. Over 70% of spirometries were rated as being of acceptable quality. No significant differences were observed in lung function parameters between the pharmacy and hospital measurements. CONCLUSIONS: COPD case finding by spirometry in high-risk customers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.

Carbon dioxide rebreathing in non-invasive ventilation. Analysis of masks, expiratory ports and ventilatory modes.

BACKGROUND AND AIM: Carbon dioxide (CO2) rebreathing is a complication of non-invasive ventilation (NIV). Our objectives were to evaluate the ability of masks with exhaust vents (EV) to avoid rebreathing while using positive pressure (PP) NIV with different levels of expiratory pressure (EPAP). Concerning volume-cycled NIV, we aimed to determine whether cylindrical spacers located in the circuit generate rebreathing. MATERIALS AND METHODS: 5 healthy volunteers were evaluated. Bi-level PP was used with 3 nasal and 2 facial masks with and without EV. Spacers of increasing volume attached to nasal hermetic masks were evaluated with volume NIV. Inspired CO2 fraction was analyzed. RESULTS: Rebreathing was zero with all nasal masks and EPAP levels. Using facial masks 1 volunteer showed rebreathing. There was no rebreathing while using all the spacers. CONCLUSIONS: In healthy volunteers, nasal and facial masks with EV prevent rebreathing. In addition, the use of spacers did not generate this undesirable phenomenon.

[The application of new technologies to solving maths problems for students with learning disabilities: the 'underwater school']. / Aplicación de nuevas tecnologías con estudiantescon dificultades de aprendizaje en la solución deproblemas matemáticos: la 'escuela submarina'.

INTRODUCTION: Different procedures have demonstrated efficacy to teach cognitive and metacognitive strategies to problem solving in mathematics. Some studies have used computer-based problem solving instructional programs. AIM: To analyze in students with learning disabilities the efficacy of a cognitive strategies training for problem solving, with three instructional delivery formats: a teacher-directed program (T-D), a computer-assisted instructional (CAI) program, and a combined program (T-D + CAI). SUBJECTS AND METHODS: Forty-four children with mathematics learning disabilities, between 8 and 10 years old participated in this study. The children were randomly assigned to one of the three instructional formats and a control group without cognitive strategies training. In the three instructional conditions which were compared all the students learnt problems solving linguistic and visual cognitive strategies trough the self-instructional procedure. Several types of measurements were used for analysing the possible differential efficacy of the three instructional methods implemented: solving problems tests, marks in mathematics, internal achievement responsibility scale, and school behaviours teacher ratings. RESULTS AND CONCLUSIONS: Our findings show that the T-D training group and the T-D + CAI group improved significantly on math word problem solving and on marks in Maths from pre- to post-testing. In addition, the results indicated that the students of the T-D + CAI group solved more real-life problems and developed more internal attributions compared to both control and CAI groups. Finally, with regard to school behaviours, improvements in school adjustment and learning problems were observed in the students of the group with a combined instructional format (T-D + CAI).

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.

[High frequency of anemia in COPD patients admitted in a tertiary hospital]. / Alta frecuencia de anemia en pacientes con EPOC ingresados en un hospital de tercer nivel.

INTRODUCTION: Anemia is related to chronic and inflammatory diseases. Moreover, it is a factor of worse outcome in heart failure or myocardial infarction. Despite the importance of hemoglobin as a globular oxygen carrying protein, there are few studies on anemia and chronic obstructive pulmonary disease (COPD). OBJECTIVE: To determine the frequency and the characteristics of the anemia in COPD patients admitted to a tertiary hospital within a one year period. METHODS: Anthropometric and clinical data, tobacco habit, lung function tests, arterial blood gases and a basic study of anemia (BSA) were collected from digital clinical files. RESULTS: A total of 177 patients were enrolled. Mean age was 70 (range 44-95), FEV1 was 35 (15%) and hemoglobin (Hb) 136(22) g/dl. Sixty-six (37%) patients had chronic respiratory failure (CRF) and 59 (33%) were receiving long-term oxygen therapy. A total of 56 (31%) had anemia (Hb < 130 g/dl in men or < 120 g/dl in women) with a mean Hb of 111(13). Anemia was normocytic normochromic in 32 cases (58%). BSA was obtained in 24 patients (42.85%) and showed that 10 patients (41%) had anemia of chronic disease, 6 patients (25%) had iron deficiency and 8 (34%) had other causes. It should be mentioned that 35 patients (53%) had CRF had anemia but only 8 patients had erythrocytosis (4.5%). CONCLUSION: Anemia was frequent in these patients and was an underdiagnosed comorbidity.

[The relationship between lung function and health-related quality of life in patients with generalized myasthenia gravis]. / Relación entre función pulmonar y calidad de vida relacionada con la salud en la miastenia gravis generalizada.

OBJECTIVE: To study lung function abnormalities and health-related quality of life (HRQL) in a group of patients diagnosed with generalized myasthenia gravis, and to analyze the relationship between these 2 sets of variables. PATIENTS AND METHODS: In a prospective study of 20 patients diagnosed with generalized myasthenia gravis, the following parameters were measured: spirometry, static lung volumes, breathing pattern, maximal respiratory pressures, and maximum voluntary ventilation. HRQL was assessed using the 36-item short form general health questionnaire (SF-36). RESULTS: The mean (SD) age of the patients was 64 (11) years. Patients were classified into 2 groups depending on whether they had IIa (12 patients) or IIb (8 patients) type disease. A small decrease in total lung capacity (86%) and slight reductions in maximal inspiratory pressure (88%) and maximum voluntary ventilation (63% in group IIb) were observed. The HRQL domains most affected were those related to physical activity and self-perceived health status in all groups, although women were more affected. The scores relating to vitality and physical activity were found to be significantly associated with forced vital capacity and lung volumes. Tidal volume was associated with maximal inspiratory and expiratory pressures, inspiratory capacity, and maximum voluntary ventilation. The respiratory rate to tidal volume ratio was inversely associated with the first three of these variables. CONCLUSIONS: A very slight restrictive pattern and a reduction in inspiratory muscle strength were observed. The HRQL domains most affected were those related to physical activity and the patients' self-perceived health status. The weakness of the respiratory muscles contributes to the abnormalities observed in lung function and to the deterioration of health-related quality of life.

[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.

Inspired oxygen fraction achieved with a portable ventilator: determinant factors.

INTRODUCTION: Non-invasive positive pressure ventilation (NIPPV) is an effective treatment in respiratory failure. Continuous positive pressure (CPAP) may also be useful in acute hypoxaemic patients. Supplementary oxygen is usually necessary in both systems. However, the inspired oxygen fraction (FiO2) delivered by a NIV portable ventilator is unknown. The main objectives of this study were to establish the maximal FiO2 that could be achieved by these devices and to analyse the FiO2 determinant factors. METHOD: Ten healthy volunteers were evaluated using a BiPAP ST30 ventilator (Respironics, USA) with a single-limb circuit, expiratory port and nasal mask (Respironics, USA). Oxygen (15 L/min) was administered at two connection points (proximal and distal). Each volunteer carried out a NIPPV (inspiratory pressure 20 cmH2O [1.95 kPa]-expiratory pressure 8 cmH2O [0.78 kPa]) and a CPAP (10 cmH2O [0.981 kPa]) session. FiO2 was analysed by a probe located in the mask. Minute volume (MV) was measured using a pneumotachograph. RESULTS: Maximal FiO2 was obtained with CPAP and distal oxygen connection point (67.39 +/- 15.39%). NIPPV achieved higher MV than CPAP. FiO2 was inversely correlated with MV. CONCLUSIONS: FiO2 obtained while using a NIPPV portable ventilator depends on the ventilatory assistant mode, the oxygen connection point and the MV reached.

[Exhaled breath condensate: standardized collection of samples from healthy volunteers]. / Condensado de aire espirado: estandarización de la recogida de muestras en voluntarios sanos.

Expired breath condensate collection is a noninvasive technique for obtaining a sample in which to analyze substances that reflect the functional status of the lung and other tissues. Twenty healthy volunteers provided 3 expired breath samples: the second was collected 20 minutes after the first and the third 48 hours after the first. The air and condensate volumes were assessed. The mean (SD) volume of condensate in exhaled air over a period of 15 minutes was 1.8 (0.5) mL (95% confidence interval [CI], 1.5-2 mL) and the coefficient of variation was 29%. Analysis of variance in the 3 samples demonstrated no significant differences. The mean volume of air inhaled over 15 minutes was 119 (25) L (95% CI, 112-125 L). These results indicate that it takes at least 15 minutes and the inhalation of some 120 L of air to collect a condensate volume that exceeds 1.5 mL, sufficient to allow distribution in aliquots to analyze fundamental physical and chemical properties (conductivity, pH) and certain relevant biomarkers.

[Expansion of primary bronchial epithelial cell cultures]. / Método para amplificar cultivos primarios de células epiteliales bronquiales.

OBJECTIVE: Cell cultures provide a good model for studying lung diseases but they are difficult to reproduce and the number of cells obtained is limited. The aim of this study was to develop a way to increase the production of human bronchial epithelial cells (BEC) in primary cultures. MATERIAL AND METHODS: A total of 12 samples (9 from surgical specimens and 3 from endoscopic biopsies) were processed on plates coated with type I collagen with growth medium supplemented for BEC. When cell proliferation started, the explants were removed for successive subculturing. The remaining cells were left to proliferate and were trypsinized after 50% confluence. We recorded the number of cells obtained, cell viability, and the percentage positive for cytokeratin 7. RESULTS: The total number of cells obtained by this method was 3-fold the number of human BEC obtained with simple primary cultures. The maximum number of subcultures was 5, mean (SD) cell viability was 91.9% (11.7%), and the percentage of cells positive for cytokeratin 7 was 30.71% (10.68%). CONCLUSIONS: The described method for expanding primary BEC cultures increases cell production.

[Bronchial exudate of serum proteins during asthma attack]. / Exudado bronquial de proteínas séricas en las crisis de asma.

OBJECTIVE: Although altered vascular permeability and edema of the bronchial mucosa are associated with asthma attack, their influence on its severity remains unknown. We address this issue by comparing relative indices for the concentration of albumin (RIAlb) and alpha2-macroglobulin (RIalpha2M) in induced sputum and peripheral blood from patients with exacerbated asthma, patients with stable asthma, and control subjects. PATIENTS AND METHODS: Forty-six volunteers participated in the study: 14 with exacerbated asthma (forced expiratory volume in the first second [FEV1] 74.3% [SD, 20.8%] of reference), 23 with stable asthma (FEV1 93.6% [7.5%]), and 9 controls (FEV1 101.1% [9.9%]). The concentrations of albumin and alpha2-macroglobulin were quantified by immunoturbidimetry and immunonephelometry, respectively. The relative index was then calculated by dividing the concentration in sputum supernatant by the concentration in peripheral blood. RESULTS: The mean RIAlb was 1.2 (1.1) in the control group, 2.9 (3.1) in the stable asthma group, and 6.0 (6.7) in the exacerbated asthma group. The RIalpha2M values were 11.7 (10.9), 11.9 (14.7), and 3.2 (3.8) for the control group and stable and exacerbated asthma groups, respectively. The increases in the RIAlb values between all groups, and the decrease in the RIalpha2M value between the exacerbated asthma and control groups were statistically significant (P<.05). The percentage of neutrophils, but not of eosinophils, in sputum was correlated with the RIAlb (r=0.39; P=.008) but not the RIalpha2M (r=-0.035; P=.82). FEV1 displayed an inverse relationship with the RIAlb (r=-0.43; P=.009) but not with the RIalpha2M (r=-0.206; P=.24). No correlation was found between oxyhemoglobin saturation and either the RIAlb (r=-0.33; P=.19) or the RIalpha2M (r=-0.12; P=.84). CONCLUSIONS: Vascular permeability is altered during asthma exacerbations and appears to be correlated with the presence of neutrophils and the degree of bronchial obstruction.

[Total IgE in the sputum and serum of patients with asthma]. / IgE total en el esputo y suero de pacientes con asma.

BACKGROUND: The correlation between total IgE in induced sputum (IS) and serum is not well defined. The aim of this study was to investigate the relationship between total IgE in IS and total IgE in serum and airway inflammation. METHODS: Twenty-one patients with stable asthma and thirteen healthy controls were studied. Clinical and spirometric data were collected and a skin prick test to the 13 most common aeroallergens in our area was performed in all subjects. Total IgE in IS and serum was determined by the UNICAP immunoanalysis system (Pharmacia Uppsala, Sweden) while albumin concentration in IS and serum was determined using the Cobas Integra turbidimetric method (Roche Diagnostics, Basel, Switzerland). RESULTS: The percentage of eosinophils in EI was 8.7 (11.8) in asthmatic subjects and was 0.5 (1) in healthy controls. Total IgE (KU/L) was 43.2 (23) in asthmatics vs 25.6 (3) in healthy controls in IS, and was 329 (413) in asthmatics vs 57 (78) in controls in serum. Total IgE in IS was significantly correlated with total IgE in serum; r = 0.71 (p = 0.048), but not with the albumin relative index. No correlation was found between IgE and the number of eosinophils in IS. CONCLUSIONS: Total IgE can be measured in IS. Total IgE in IS is mildly correlated with total IgE measured in serum. The lack of correlation between total IgE and albumin in IS suggests that IgE in IS could be locally produced, at least in part.

[Comparison of arterial blood sample kits]. / Comparación de equipos para obtener muestras de sangre arterial.

Most inaccuracies in the analysis of gases and electrolytes in arterial blood samples are due to preanalytic factors, among which is the type of equipment used for blood collection. Our objective was to compare arterial blood gas sample kits used under clinical conditions and to evaluate the impact of delay in estimation on variability in results. In 2 types of study we compared 5 kits (Radiometer's Pico 70, Becton Dickinson's Preset, SIMS Portex's Pro-Vent, SIMS-Concord's Pulsator, and Marquest's Quick ABG). In the first study kitsyringe assignment was randomized for collecting arterial blood samples from 160 consecutive patients to evaluate practical aspects of using them and the presence of bubbles in the samples taken. The second study evaluated the effects of delays of 30 and 60 minutes in estimation and of the type of heparin used in 54 blood samples. The kits which produced the fewest bubbles, gave samples with the greatest stability, and had the least impact on ion concentration were Radiometer's Pico 70 and SIMS-Portex's Pro-vent.