Effect of Sex Differences on Computed Tomography Findings in Adults With Cystic Fibrosis: A Multicenter Study.

BACKGROUND: The survival of women with cystic fibrosis (CF) is lower than that of men by approximately 5 years. While various factors have been put forward to account for this discrepancy, no specific reasons have been established. Our hypothesis was that anatomical-structural involvement is more pronounced in women with CF than in men and that this is reflected in thoracic HRCT findings. MATERIAL AND METHODS: We performed a prospective multicentre study, in which adult patients were consecutively included over 18 months. Chest HRCT was performed, and findings were scored by 2 thoracic radiologists using the modified Bhalla system. We also studied respiratory function, applied the CFQR 14+ questionnaire, and collected clinical variables. RESULTS: Of the 360 patients followed up in the participating units, 160 were eventually included. Mean age was 28 years, and 47.5% were women. The mean±SD global score on the modified Bhalla score was 13.7±3.8 in women and 15.2±3.8 in men (p=0.024). The highest scores were observed for sacculations, bronchial generations, and air trapping in women. Women had lower BMI, %FEV1, %FVC, and %DLCO. Similarly, the results for the respiratory domain in CFQR 14+ were worse in women, who also had more annual exacerbations. CONCLUSIONS: This is the first study to provide evidence of the implication of sex differences in HRCT findings in patients with CF. Women with CF present a more severe form of the disease that results in more frequent exacerbations, poorer functional and nutritional outcomes, deterioration of quality of life, and greater structural damage.

[The tuberculosis in 2020: challenges and opportunities.] / La tuberculosis en el año 2020: retos y oportunidades.

Despite the progress achieved in recent decades, tuberculosis continues to be a major public health problem in wide areas of the world geography, and caused more than 1.6 million deaths in 2017. The eruption of cases with multidrug-resistant tuberculosis and extremely resistant hinders its healing and its progressive eradication. Fortunately, in the past few years, molecular techniques capable of diagnosing the disease in a few hours have been introduced, also detecting genetic mutations that encode resistance to the most active drugs in its cure. With the incorporation of bedaquiline and delamanide, we count on new shorter, more effective and less toxic treatment schemes for resistant cases. The future of the fight against tuberculosis must be based on clinical suspicion in the most vulnerable groups (elderly, immunosuppressed and immigrants), an accurate and early diagnosis, a short treatment with oral drugs and the inclusion of solidarity socioeconomic strategies that improve the situation of the most vulnerable countries and groups.

A pesar de los avances obtenidos en las últimas décadas, la tuberculosis sigue siendo un importante problema de salud pública en amplias zonas de la geografía mundial, y produjo más de 1,6 millones de muertes en 2017. La irrupción de casos con tuberculosis multirresistente y extremadamente resistente dificulta su curación y su progresiva erradicación. Afortunadamente, en los últimos años se han introducido técnicas moleculares capaces de diagnosticar la enfermedad en pocas horas, detectando también mutaciones genéticas que codifican resistencias a los fármacos más activos en su curación. Con la incorporación de la bedaquilina y la delamanida contamos con nuevos esquemas de tratamiento más cortos y eficaces, así como menos tóxicos, para los casos resistentes. El futuro de la lucha contra la tuberculosis debe basarse en la sospecha clínica en los grupos más vulnerables (ancianos, inmunodeprimidos e inmigrantes), el diagnóstico preciso y precoz, el tratamiento corto con fármacos orales y la incorporación de estrategias socioeconómicas solidarias que mejoren la situación de los países y colectivos más vulnerables.

[Network against tuberculosis and for solidarity: the commitment of civil society]. / Red contra la Tuberculosis y por la Solidaridad: el compromiso de la sociedad civil.

Despite the progress made in the last years, the Tuberculosis remains a relevant public health problem in many geographic areas of the world. Tuberculosis is the paradigm of infectious disease with a high social component, and in its approach, measures aimed at reducing poverty, economic inequality and the integration of the most vulnerable groups cannot be ignored. Therefore, solidarity and social justice are terms associated with the control of this disease. The TBS Network, made up of various institutions born from civil society, tries to inform society and professionals about aspects of tuberculosis prevention, control, diagnosis, treatment and investigation, trying to avoid the stigma that still accompanies many patients. Among the activities organized by the TBS Network are, among others, the Solidarity Cinema Forum (in prisons, Red Cross premises and NGOs), Informa TB and Update Days.

A pesar de los avances obtenidos en los últimos años, la tuberculosis sigue siendo un problema relevante de salud pública en muchas zonas geográficas del mundo. La tuberculosis es el paradigma de enfermedad infecciosa con un alto componente social, y en su abordaje no pueden soslayarse las medidas tendentes a disminuir la pobreza, las desigualdades económicas y la integración de los colectivos más vulnerables. Por ello, la solidaridad y la justicia social son términos asociados al control de esta enfermedad. La Red TBS, integrada por diversas instituciones nacidas de la sociedad civil, intenta informar a la sociedad y a los profesionales sobre aspectos de prevención, control, diagnóstico, tratamiento e investigación de la tuberculosis, intentando evitar el estigma que acompaña todavía a muchos pacientes. Entre las actividades que organiza la Red TBS se encuentran, entre otras, el Cinefórum Solidario (en prisiones, locales de Cruz Roja y ONGs), Informa TB y Jornadas de Actualización.

Adecuación del nivel de intervención en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) según la estratificación de riesgo propuesta por la Guía española de la EPOC (GesEPOC) versión 2017 / Adjusting the Level of Intervention in Patients with Chronic Obstructive Pulmonary Disease According to the Risk Stratification Proposed by the Spanish COPD Guidelines (GesEPOC) Version 2017

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Red contra la Tuberculosis y por la Solidaridad: el compromiso de la sociedad civil / Network against Tuberculosis and for Solidarity: the commitment of civil society

A pesar de los avances obtenidos en los últimos años, la tuberculosis sigue siendo un problema relevante de salud pública en muchas zonas geográficas del mundo. La tuberculosis es el paradigma de enfermedad infecciosa con un alto componente social, y en su abordaje no pueden soslayarse las medidas tendentes a disminuir la pobreza, las desigualdades económicas y la integración de los colectivos más vulnerables. Por ello, la solidaridad y la justicia social son términos asociados al control de esta enfermedad. La Red TBS, integrada por diversas instituciones nacidas de la sociedad civil, intenta informar a la sociedad y a los profesionales sobre aspectos de prevención, control, diagnóstico, tratamiento e investigación de la tuberculosis, intentando evitar el estigma que acompaña todavía a muchos pacientes. Entre las actividades que organiza la Red TBS se encuentran, entre otras, el Cinefórum Solidario (en prisiones, locales de Cruz Roja y ONGs), Informa TB y Jornadas de Actualización

Despite the progress made in the last years, the Tuberculosis remains a relevant public health problem in many geographic areas of the world. Tuberculosis is the paradigm of infectious disease with a high social component, and in its approach, measures aimed at reducing poverty, economic inequality and the integration of the most vulnerable groups cannot be ignored. Therefore, solidarity and social justice are terms associated with the control of this disease. The TBS Network, made up of various institutions born from civil society, tries to inform society and professionals about aspects of tuberculosis prevention, control, diagnosis, treatment and investigation, trying to avoid the stigma that still accompanies many patients. Among the activities organized by the TBS Network are, among others, the Solidarity Cinema Forum (in prisons, Red Cross premises and NGOs), Informa TB and Update Days

La tuberculosis en el año 2020: retos y oportunidades / The tuberculosis in 2020: challenges and opportunities

A pesar de los avances obtenidos en las últimas décadas, la tuberculosis sigue siendo un importante problema de salud pública en amplias zonas de la geografía mundial, y produjo más de 1,6 millones de muertes en 2017. La irrupción de casos con tuberculosis multirresistente y extremadamente resistente dificulta su curación y su progresiva erradicación. Afortunadamente, en los últimos años se han introducido técnicas moleculares capaces de diagnosticar la enfermedad en pocas horas, detectando también mutaciones genéticas que codifican resistencias a los fármacos más activos en su curación. Con la incorporación de la bedaquilina y la delamanida contamos con nuevos esquemas de tratamiento más cortos y eficaces, así como menos tóxicos, para los casos resistentes. El futuro de la lucha contra la tuberculosis debe basarse en la sospecha clínica en los grupos más vulnerables (ancianos, inmunodeprimidos e inmigrantes), el diagnóstico preciso y precoz, el tratamiento corto con fármacos orales y la incorporación de estrategias socioeconómicas solidarias que mejoren la situación de los países y colectivos más vulnerables

Despite the progress achieved in recent decades, tuberculosis continues to be a major public health problem in wide areas of the world geography, and caused more than 1.6 million deaths in 2017. The eruption of cases with multidrug-resistant tuberculosis and extremely resistant hinders its healing and its progressive eradication. Fortunately, in the past few years, molecular techniques capable of diagnosing the disease in a few hours have been introduced, also detecting genetic mutations that encode resistance to the most active drugs in its cure. With the incorporation of bedaquiline and delamanide, we count on new shorter, more effective and less toxic treatment schemes for resistant cases. The future of the fight against tuberculosis must be based on clinical suspicion in the most vulnerable groups (elderly, immunosuppressed and immigrants), an accurate and early diagnosis, a short treatment with oral drugs and the inclusion of solidarity socioeconomic strategies that improve the situation of the most vulnerable countries and groups

Estudio de una cohorte de paciente con fibrosis quística y Scedosporium spp / Study of a Cohort of Patients With Cystic Fibrosis and Isolation of Scedosporium spp

Introducción: En los últimos años se observa un aumento de la prevalencia de colonización e infección por Scedosporium spp. en pacientes con fibrosis quística (FQ). En el presente estudio se registra la frecuencia de aislamiento de Scedosporium spp. en una Unidad de FQ de adultos, analizándose las características de los pacientes y los factores predisponentes. Métodos: Se realizó un estudio observacional retrospectivo en 87 pacientes adultos con FQ en los que se valoró la presencia de cultivo positivo para Scedosporium spp. durante 5 años (enero de 2012-julio de 2017). Se recogieron las siguientes variables clínicas: edad, sexo, índice de masa corporal, genotipo, presencia de insuficiencia pancreática, colonizaciones bacterianas, función pulmonar, complicaciones, exacerbaciones y tratamiento, así como puntuación Bhalla modificada de la última tomografía computarizada axial de alta resolución. Los resultados se analizaron con el paquete estadístico IBM SPSS Statistics Version 22.0. Resultados: En un 25,3% de los pacientes se aisló Scedosporium spp. En el análisis bivariante se observó en estos enfermos más frecuencia de Pseudomonas aeruginosa, peor puntuación en la clasificación de Bhalla (destacando los ítems presencia de bronquiectasias, tapones mucosos y generaciones bronquiales), un descenso leve en la capacidad de difusión pulmonar (DLCO) y que recibían con más frecuencia antibioterapia inhalada. En el análisis multivariante de regresión logística únicamente el ítem generaciones bronquiales fue significativo. Conclusiones: Scedosporium spp. debe considerarse un patógeno oportunista emergente en pacientes con FQ del que se desconoce su implicación clínica, factores de riesgo o necesidad de tratamiento

Introduction: In recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors. Methods: A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software. Results: Scedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant. Conclusion: Scedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown

Paciente exacerbador con enfermedad pulmonar obstructiva crónica: recomendaciones en procesos diagnósticos, terapéuticos y asistenciales / Patients with Chronic Obstructive Pulmonary Disease Exacerbations: Recommendations for Diagnosis, Treatment and Care

Objetivo: Describir un acuerdo entre expertos basado en la evidencia y la experiencia sobre los aspectos más relevantes del paciente exacerbador con EPOC. Métodos: Se siguió la metodología Delphi. Tras revisar la evidencia por un comité científico y 60 expertos, se elaboró un cuestionario con 3 apartados: diagnóstico del paciente exacerbador; tratamiento, y proceso asistencial. La encuesta fue respondida online en 2 rondas por 60 neumólogos. El grado de acuerdo siguió la escala Likert de 1 (total desacuerdo) a 9 (total acuerdo), definiéndose acuerdo y desacuerdo como una puntuación de 7-9 o 1-3, respectivamente, otorgada por más de dos tercios de los participantes. Resultados: Se incluyeron un total de 48 aseveraciones, una añadida en la segunda ronda. Hubo consenso en 37 (78,7%) tras la primera ronda (acuerdo), y en 43 (89,5%) tras la segunda (42 acuerdo y 1 desacuerdo). Las afirmaciones con mayor proporción de expertos en el rango de acuerdo se refirieron a que, en el paciente exacerbador, la infección bronquial crónica favorece el deterioro de la función pulmonar (93,1%), a que no se deben retirar los broncodilatadores de larga duración (93,1%), a la conveniencia de personalizar el tratamiento si se dan nuevas exacerbaciones pese a un tratamiento broncodilatador óptimo (96,6%), o al cuidado y manejo de este paciente, que debe ser coordinado entre atención primaria y neumología (93,1%) y controlado en programas integrados específicos multicomponente (94,8%). Conclusiones: La información proporcionada por este consenso puede facilitar el diagnóstico y tratamiento del paciente exacerbador con EPOC en nuestro ámbito

Objective: To describe an evidence- and experience-based expert consensus on the most relevant issues of patients with COPD exacerbations. Methods: The Delphi technique was used. Evidence was reviewed by a scientific committee and 60 experts. A questionnaire was prepared containing 3 sections: diagnosis of the exacerbator; treatment, and healthcare processes. The survey was answered in 2 rounds by 60 pneumologists on an online platform. Statements were scored on a Likert scale from 1 (total disagreement) to 9 (total agreement). Agreement and disagreement were defined as a score of 7-9 or 1-3, respectively, given by more than two thirds of the participants. Results: A total of 48 statements were included, one of which was added in the second round. Consensus was reached in 37 items (78.7%) after the first round (agreement), and in 43 (89.5%) after the second round (42 agreement, 1 disagreement). The statements with the highest proportion of experts agreeing were as follows: in exacerbators, chronic bronchial infection favors lung function decline (93.1%); long-acting bronchodilators should not be withdrawn (93.1%); treatment must be personalized if new exacerbations occur despite optimal bronchodilator treatment (96.6%); management must be coordinated between primary care and the respiratory medicine department (93.1%), and patients must be followed up in specific integrated multicomponent programs (94.8%). Conclusions: The findings of this study could assist in the diagnosis and treatment of COPD exacerbators in our area

Vaccines for the prevention of infections in adults: an opinion paper on the situation in Spain / Vacunas para la prevención de infecciones en adultos: artículo de opinión sobre la situación en España

The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial. The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table

El calendario de vacunación infantil es bien conocido y generalmente bien implementado en los países desarrollados. Por varias razones, no ocurre lo mismo en el caso de las vacunas destinadas a prevenir las infecciones en adultos, en los que la cobertura vacunal es incompleta y generalmente muy deficiente. Con el fin de evaluar la situación de la vacunación de adultos en España, la Fundación de Ciencias de la Salud ha reunido a una serie de expertos en diferentes campos, incluyendo médicos, enfermeras, representantes de asociaciones de pacientes, gestores sanitarios, economistas, autoridades sanitarias y periodistas para discutir este asunto. El formato fue el de una mesa redonda en la que una serie de preguntas, formuladas previamente por los coordinadores, debían ser contestadas y debatidas. El documento presentado no es una revisión exhaustiva del tema, ni tiene por objeto hacer recomendaciones, simplemente pretende dar una opinión multidisciplinar sobre aspectos que pueden ser debatibles o controvertidos. El documento revisa las principales enfermedades de los adultos que pueden prevenirse con vacunas, su impacto clínico y económico, las posibilidades de reducirlos con los programas de vacunación y las dificultades para llevarlos a cabo. Se discutió el papel de la enfermería, la farmacia, los servicios de salud, las asociaciones de pacientes y la propia administración sanitaria para cambiar la situación actual. Se evaluaron las perspectivas para nuevas vacunas y se especuló sobre el futuro en este campo. Por último, se discutieron los aspectos éticos especialmente relevantes en la toma de decisiones con respecto a la vacunación, que deben ser afrontados tanto por los individuos como por los estados. Hemos intentado resumir, al final de la presentación de cada pregunta, la opinión que representaba el consenso de todos los miembros de la mesa

Study of a Cohort of Patients With Cystic Fibrosis and Isolation of Scedosporium spp. / Estudio de una cohorte de paciente con fibrosis quística y Scedosporium spp.

INTRODUCTION: In recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors. METHODS: A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software. RESULTS: Scedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant. CONCLUSION: Scedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown.

Patients with Chronic Obstructive Pulmonary Disease Exacerbations: Recommendations for Diagnosis, Treatment and Care. / Paciente exacerbador con enfermedad pulmonar obstructiva crónica: recomendaciones en procesos diagnósticos, terapéuticos y asistenciales.

OBJECTIVE: To describe an evidence- and experience-based expert consensus on the most relevant issues of patients with COPD exacerbations. METHODS: The Delphi technique was used. Evidence was reviewed by a scientific committee and 60 experts. A questionnaire was prepared containing 3 sections: diagnosis of the exacerbator; treatment, and healthcare processes. The survey was answered in 2 rounds by 60 pneumologists on an online platform. Statements were scored on a Likert scale from 1 (total disagreement) to 9 (total agreement). Agreement and disagreement were defined as a score of 7-9 or 1-3, respectively, given by more than two thirds of the participants. RESULTS: A total of 48 statements were included, one of which was added in the second round. Consensus was reached in 37 items (78.7%) after the first round (agreement), and in 43 (89.5%) after the second round (42 agreement, 1 disagreement). The statements with the highest proportion of experts agreeing were as follows: in exacerbators, chronic bronchial infection favors lung function decline (93.1%); long-acting bronchodilators should not be withdrawn (93.1%); treatment must be personalized if new exacerbations occur despite optimal bronchodilator treatment (96.6%); management must be coordinated between primary care and the respiratory medicine department (93.1%), and patients must be followed up in specific integrated multicomponent programs (94.8%). CONCLUSIONS: The findings of this study could assist in the diagnosis and treatment of COPD exacerbators in our area.

Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease.

BACKGROUND: External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores for 3-year all-cause mortality in mostly multimorbid patients with COPD. METHODS: We relied on 24 cohort studies of the COPD Cohorts Collaborative International Assessment consortium, corresponding to primary, secondary, and tertiary care in Europe, the Americas, and Japan. These studies include globally 15,762 patients with COPD (1871 deaths and 42,203 person years of follow-up). We used network meta-analysis adapted to multiple score comparison (MSC), following a frequentist two-stage approach; thus, we were able to compare all scores in a single analytical framework accounting for correlations among scores within cohorts. We assessed transitivity, heterogeneity, and inconsistency and provided a performance ranking of the prognostic scores. RESULTS: Depending on data availability, between two and nine prognostic scores could be calculated for each cohort. The BODE score (body mass index, airflow obstruction, dyspnea, and exercise capacity) had a median area under the curve (AUC) of 0.679 [1st quartile-3rd quartile = 0.655-0.733] across cohorts. The ADO score (age, dyspnea, and airflow obstruction) showed the best performance for predicting mortality (difference AUCADO - AUCBODE = 0.015 [95% confidence interval (CI) = -0.002 to 0.032]; p = 0.08) followed by the updated BODE (AUCBODE updated - AUCBODE = 0.008 [95% CI = -0.005 to +0.022]; p = 0.23). The assumption of transitivity was not violated. Heterogeneity across direct comparisons was small, and we did not identify any local or global inconsistency. CONCLUSIONS: Our analyses showed best discriminatory performance for the ADO and updated BODE scores in patients with COPD. A limitation to be addressed in future studies is the extension of MSC network meta-analysis to measures of calibration. MSC network meta-analysis can be applied to prognostic scores in any medical field to identify the best scores, possibly paving the way for stratified medicine, public health, and research.

Ventilación mecánica no invasiva en una población anciana que ingresa en una unidad de monitorización respiratoria: causas, complicaciones y evolución al año de seguimiento / Non-invasive Ventilation in an Elderly Population Admitted to a Respiratory Monitoring Unit: Causes, Complications and One-year Evolution

Objetivo: Determinar la utilidad de la ventilación mecánica no invasiva (VMNI) en pacientes ancianos (≥75 años) que ingresan en una unidad de monitorización respiratoria (UMR) durante el ingreso y al año del alta. Comparamos los resultados con el grupo de pacientes de menor edad (<75 años). Material y métodos: Estudio prospectivo observacional realizado en el Hospital La Princesa (Madrid, España). Se reclutaron todos los pacientes ≥75 años que ingresaron en nuestra UMR en acidosis respiratoria (pH <7,35 y PaCO2 >45mmHg) y que recibieron tratamiento con VMNI. Se recogieron variables relativas a características sociodemográficas y de la vida basal, antecedentes patológicos previos, motivos de ingreso y gravedad, datos analíticos al ingreso y evolución gasométrica al inicio de la VMNI, en la primera hora y tras 24h, complicaciones y evolución al año de seguimiento. Resultados: La edad media fue de 80,6 años. El índice de Charlson fue de 3,27. Aproximadamente la mitad de los pacientes presentaban alguna limitación para las actividades de la vida diaria. Los principales motivos de ingreso fueron la agudización de la EPOC y la insuficiencia cardíaca. En 36 casos se registraron complicaciones (11 insuficiencia renal, 6 fibrilación auricular). La supervivencia al año del seguimiento fue del 63,21%. Conclusiones: La VMNI es una buena alternativa en pacientes ancianos que ingresan en acidosis respiratoria. No detectamos diferencias en la mortalidad durante el ingreso con el grupo <75 años. Los pacientes ancianos ingresan más entre los 6-12 meses posteriores al alta, y esto podría deberse a una peor situación funcional tras un ingreso que requiere VMNI(AU)

Objective: To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and one year later in comparison with the results from the younger age group (<75). Material and methods: Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH <7.35 and PaCO2 >45mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24hours), complications and evolution at the one-year follow-up. Results: Mean age of the sample was 80.6 years. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the one-year follow-up was 63.21%. Conclusions: NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV(AU)

Non-invasive ventilation in an elderly population admitted to a respiratory monitoring unit: causes, complications and one-year evolution.

OBJECTIVE: To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and 1 year later in comparison with the results from the younger age group (<75). MATERIAL AND METHODS: Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH<7.35 and PaCO(2)>45 mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24 h), complications and evolution at the 1-year follow-up. RESULTS: Mean age of the sample was 80.6. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the 1-year follow-up was 63.21%. CONCLUSIONS: NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV.

[Cardiovascular risk factors in chronic obstructive pulmonary disease: results of the ARCE study]. / Asociación de factores de riesgo cardiovascular y EPOC. Resultados de un estudio epidemiológico (estudio ARCE).

OBJECTIVE: Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD). It is not clear whether the high cardiovascular comorbidity is due to an increase in traditional risk factors or whether, in contrast, COPD can be considered an independent risk factor. The aim of this study was to analyze the prevalence of risk factors and cardiovascular comorbidity in a community-based population treated for COPD. PATIENTS AND METHODS: This was a concurrent multicenter, cross-sectional study that included 572 patients with confirmed diagnosis of COPD. Information on cardiovascular risk factors and comorbidity was collected by extracting data from the medical records of the participating center. RESULTS: The mean (SD) forced expiratory volume in 1 second (FEV1) was 53.7% (16.85%) of predicted and the ratio of FEV1 to forced vital capacity was 57.9% (10.9%). Hypertension was reported in 53%, obesity in 27%, dyslipidemia in 26%, and diabetes in 23% of the patients. The prevalence of risk factors was not related to disease severity, but there was a trend towards an association with age. In the study group, 16.4% had ischemic heart disease, 7% cerebrovascular disease, and 17% peripheral vascular disease. Cardiovascular disease was not associated with COPD severity, but such an association was reported for age and traditional risk factors. CONCLUSIONS: Cardiovascular risk factors are highly prevalent in patients with COPD. The prevalence of cardiovascular and cerebrovascular disease exceeds that reported in the general population. No relationship was found between the severity of airflow obstruction and the presence of cardiovascular comorbidity.

Asociación de factores de riesgo cardiovascular y EPOC. Resultados de un estudio epidemiológico (estudio ARCE) / Cardiovascular risk factors in Chronic Obstructive Pulmonary Disease: results of the ARCE study

Objetivo: La enfermedad cardiovascular es una causa de muerte frecuente en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). No está claro si el exceso de comorbilidad cardiovascular se relaciona con un incremento de factores de riesgo clásicos o si, por el contrario, la EPOC puede considerarse un factor de riesgo independiente. El objetivo de este estudio ha sido analizar la prevalencia de factores de riesgo y comorbilidad cardiovascular en una población atendida en la comunidad por presentar EPOC. Pacientes y métodos: Se ha realizado un estudio multicéntrico, concurrente y transversal, en el que se incluyó a 572 pacientes con diagnóstico confirmado de EPOC. Se recogieron datos de factores de riesgo y comorbilidad cardiovascular extraídos de la historia clínica del centro. Resultados: El valor medio ± desviación estándar del volumen espiratorio forzado en el primer segundo era del 53,7 ± 16,85% y la relación volumen espiratorio forzado en el primer segundo/capacidad vital forzada del 57,9 ± 10,9%. La prevalencia de hipertensión arterial era del 53%, la de obesidad del 27%, la de dislipemia del 26% y la de diabetes del 23%. La prevalencia de factores de riesgo no se relacionó con la gravedad de la enfermedad, pero sí había una tendencia de asociación con la edad. La prevalencia de cardiopatía isquémica fue del 16,4%, la de enfermedad cerebrovascular del 7% y la de enfermedad vascular periférica del 17%. La prevalencia de comorbilidad vascular no se relacionó con la gravedad de la enfermedad, pero sí con la edad y los factores de riesgo clásicos. Conclusiones: Los pacientes con EPOC muestran una elevada prevalencia de factores de riesgo cardiovascular. La prevalencia de enfermedad cardiovascular y cerebrovascular excede la comunicada en población general. No se ha observado relación entre la gravedad de la obstrucción al flujo aéreo y la presencia de comorbilidad cardiovascular

Objective: Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD). It is not clear whether the high cardiovascular comorbidity is due to an increase in traditional risk factors or whether, in contrast, COPD can be considered an independent risk factor. The aim of this study was to analyze the prevalence of risk factors and cardiovascular comorbidity in a community-based population treated for COPD. Patients and methods: This was a concurrent multicenter, cross-sectional study that included 572 patients with confirmed diagnosis of COPD. Information on cardiovascular risk factors and comorbidity was collected by extracting data from the medical records of the participating center. Results: The mean (SD) forced expiratory volume in 1 second (FEV1) was 53.7% (16.85%) of predicted and the ratio of FEV1 to forced vital capacity was 57.9% (10.9%). Hypertension was reported in 53%, obesity in 27%, dyslipidemia in 26%, and diabetes in 23% of the patients. The prevalence of risk factors was not related to disease severity, but there was a trend towards an association with age. In the study group, 16.4% had ischemic heart disease, 7% cerebrovascular disease, and 17% peripheral vascular disease. Cardiovascular disease was not associated with COPD severity, but such an association was reported for age and traditional risk factors. Conclusions: Cardiovascular risk factors are highly prevalent in patients with COPD. The prevalence of cardiovascular and cerebrovascular disease exceeds that reported in the general population. No relationship was found between the severity of airflow obstruction and the presence of cardiovascular comorbidity

Año SEPAR 2007: año para la prevención y el control del tabaquismo / Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) Annual campaign for 2007: the year for smoking prevention and control

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Herencia y ambiente en la EPOC / No disponible

La enfermedad pulmonar obstructiva crónica (EPOC) se caracteriza por una obstrucción progresiva, y no totalmente reversible, del flujo aéreo. Se trata de una enfermedad compleja de etiología multifactorial. El hábito tabáquico es su principal causa, pero sólo el 15% de los fumadores desarrolla la enfermedad, lo que sugiere otros factores de riesgo implicados. Se han relacionado varias alteraciones genéticas en la patogenia de la enfermedad, como el déficit de alfa-1 antitripsina o polimorfismos génicos de varias enzimas implicadas en los procesos de oxidación-reducción y de inflamación. A su vez, se han identificado varios factores de riesgo ambientales, como la contaminación medioambiental, las infecciones virales en la infancia y las infecciones latentes por adenovirus. Se considera que la interacción de varios de estos mecanismos aumenta la susceptibilidad del sujeto a desarrollar la enfermedad (AU)

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