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1.
Respir Care ; 69(8): 953-958, 2024 07 24.
Artículo en Inglés | MEDLINE | ID: mdl-38565304

RESUMEN

BACKGROUND: In 2013, a new predictor of successful mechanical ventilation liberation named timed inspiratory effort (TIE) index was devised with the normalization of the maximum inspiratory pressure (obtained within 60 s of unidirectional airway occlusion) with the time at which the value was reached. The aim of this study was to verify whether the presence of a sequence of a certain number of inspiratory effort values between 30-60 s > 1.0 cm H2O/s could predict weaning success in a performance comparable to the TIE index. METHODS: This was a retrospective observational study using 4 databases of previous studies on the TIE index. All patients receiving mechanical ventilation for ≤ 24 h were eligible. Liberation from mechanical ventilation-extubation decisions was made based on performance with spontaneous breathing trials. P < .05 was considered significant. The performance of the TIE index was evaluated by calculating the area under the receiver operating characteristics (AUROC) curve. RESULTS: From 349 eligible patients, 165 subjects were selected for analysis. The AUROC for the TIE index in the studied sample was 0.92 (95% CI 0.87-0.97, P < .001). A sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s was found in 51.5% of the subjects, with successful ventilatory liberation occurring in 95.3%. The highest specificity values belonged to the sequence of ≤ 4 and ≤ 5 inspiratory efforts > 1.0 cm H2O/s; the highest positive predictive value and positive likelihood ratio belonged to the sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s. The mean time that could have been spared if the procedure were interrupted after the first sequence of 4 inspiratory efforts > 1.0 cm H2O/s was 23 ± 3 s. CONCLUSIONS: The presence of a sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s during the TIE index measurement was a reliable predictor of weaning success, which could allow timely interruption of the procedure and entail a substantial reduction in airway occlusion time.


Asunto(s)
Inhalación , Respiración Artificial , Desconexión del Ventilador , Humanos , Desconexión del Ventilador/métodos , Estudios Retrospectivos , Masculino , Femenino , Inhalación/fisiología , Persona de Mediana Edad , Anciano , Factores de Tiempo , Respiración Artificial/métodos , Curva ROC , Extubación Traqueal/métodos , Valor Predictivo de las Pruebas , Presiones Respiratorias Máximas , Obstrucción de las Vías Aéreas/terapia , Obstrucción de las Vías Aéreas/fisiopatología , Área Bajo la Curva
2.
Chest ; 160(3): 858-871, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33971144

RESUMEN

BACKGROUND: Smokers manifest varied phenotypes of pulmonary impairment. RESEARCH QUESTION: Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers? STUDY DESIGN AND METHODS: We analyzed data from the University of Pittsburgh COPD Specialized Center for Clinically Oriented Research (SCCOR) cohort (n = 481) and the Genetic Epidemiology of COPD (COPDGene) cohort (n = 2,580). Participants were current and former smokers with > 10 pack-years of tobacco exposure. Data from the two cohorts were analyzed separately because of methodologic differences. Lung hyperinflation was assessed by plethysmography in the SCCOR cohort and by inspiratory and expiratory CT scan lung volumes in the COPDGene cohort. Subclinical CAD was assessed as the coronary artery calcium score, whereas clinical CAD was defined as a self-reported history of CAD or myocardial infarction (MI). Analyses were performed in all smokers and then repeated in those with airflow obstruction (FEV1 to FVC ratio, < 0.70). RESULTS: Pulmonary phenotypes, including airflow limitation, emphysema, lung hyperinflation, diffusion capacity, and radiographic measures of airway remodeling, showed weak to moderate correlations (r < 0.7) with each other. In multivariate models adjusted for pulmonary phenotypes and CAD risk factors, lung hyperinflation was the only phenotype associated with calcium score, history of clinical CAD, or history of MI (per 0.2 higher expiratory and inspiratory CT scan lung volume; coronary calcium: OR, 1.2; 95% CI, 1.1-1.5; P = .02; clinical CAD: OR, 1.6; 95% CI, 1.1-2.3; P = .01; and MI in COPDGene: OR, 1.7; 95% CI, 1.0-2.8; P = .05). FEV1 and emphysema were associated with increased risk of CAD (P < .05) in models adjusted for CAD risk factors; however, these associations were attenuated on adjusting for lung hyperinflation. Results were the same in those with airflow obstruction and were present in both cohorts. INTERPRETATION: Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV1 and emphysema no longer were associated with CAD. Subsequent studies should consider measuring lung hyperinflation and examining its mechanistic role in CAD in current and former smokers.


Asunto(s)
Obstrucción de las Vías Aéreas , Enfermedad de la Arteria Coronaria , Vasos Coronarios/diagnóstico por imagen , Pulmón , Enfisema Pulmonar , Fumar/epidemiología , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/fisiopatología , Remodelación de las Vías Aéreas (Respiratorias) , Enfermedades Asintomáticas/epidemiología , Variación Biológica Poblacional , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Pletismografía/métodos , Enfisema Pulmonar/diagnóstico por imagen , Enfisema Pulmonar/fisiopatología , Pruebas de Función Respiratoria/métodos , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Estados Unidos/epidemiología
3.
Pediatr Pulmonol ; 55(3): 591-598, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31909900

RESUMEN

BACKGROUND: Asthma is a disease with reversible bronchoconstriction; however, some patients develop fixed airflow obstruction (FAO). Previous studies have reported the incidence and risk factors of FAO in adults; however, the corresponding factors in children remain poorly understood. AIM: To evaluate the incidence and risk factors of FAO in children and adolescents with asthma. METHOD: Observational and prospective cohort study with a 4-year follow-up of clinically stable patients with asthma (from 6-8 years old). Anthropometric data, history of asthma, number of hospitalizations, frequent exacerbations, asthma severity, asthma control, inhaled corticosteroid dose, atopy, and lung function were analyzed as potential risk factors for FAO. FAO was defined by a ratio of the forced expiratory volume in the first second to the forced vital capacity below the lower limit of normal, even after inhaled and oral corticosteroid treatment. RESULTS: Four hundred and twenty-eight patients were recruited, and 358 were analyzed. The FAO incidence in children and adolescents with asthma was 9.5% (n = 34), starting at 10 years of age. Age, body mass index, hospitalizations for asthma, bronchodilator response, frequent exacerbations, length of exacerbations, and asthma severity were associated with FAO. Frequent exacerbations (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.3-11.7) and asthma severity categorized as steps 4 to 5 (OR = 3.5; 95% CI = 1.6-7.6) remained risk factors. CONCLUSIONS: Frequent exacerbations and asthma severity are the risk factors for FAO in children and adolescents with asthma.


Asunto(s)
Obstrucción de las Vías Aéreas/epidemiología , Asma/epidemiología , Adolescente , Corticoesteroides/uso terapéutico , Obstrucción de las Vías Aéreas/tratamiento farmacológico , Obstrucción de las Vías Aéreas/fisiopatología , Asma/tratamiento farmacológico , Asma/fisiopatología , Broncodilatadores/uso terapéutico , Niño , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Factores de Riesgo , Capacidad Vital
4.
Sleep Breath ; 24(2): 751-760, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31758436

RESUMEN

Obstructive sleep apnea syndrome (OSAS) is a prevalent condition caused by dynamic upper airway collapse during sleep. The pathological impact and consequences are due to chronic intermittent hypoxia (CIH). Hypoxia increases the expression of several inflammatory stress markers and endothelial dysfunction. Recent studies suggest that patients with a similar AHI but with severe nocturnal hypoxia using oximetric parameters, such as the lowest saturation of oxygen during the night (min SaO2), percentage of total sleep time with oxygen saturation < 90% (T90) or the oxygen desaturation index (ODI-3%), commonly reported during the sleep study, are indicative of the increased expression of inflammatory markers due to severe nocturnal hypoxia and CIH during the night compared to subjects with moderate-severe OSAS without severe nocturnal hypoxia. The aim of this review is to describe physiological pathways involved in OSAS and their clinical consequences, focused in CIH and oximetric parameters showed in sleep study and their potential utility as inflammatory markers.


Asunto(s)
Hipoxia/fisiopatología , Apnea Obstructiva del Sueño/fisiopatología , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/fisiopatología , Obstrucción de las Vías Aéreas/terapia , Enfermedad Crónica , Correlación de Datos , Humanos , Mediadores de Inflamación/sangre , Análisis Multivariante , Medicina Narrativa , Oxígeno/sangre , Polisomnografía , Medicina de Precisión , Sueño/fisiología , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/terapia
5.
J Appl Physiol (1985) ; 127(6): 1579-1585, 2019 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-31465714

RESUMEN

Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (P = <0.001) among OSA patients than controls while awake (62 ± 44 vs. 5 ± 6%) and during sleep (59 ± 39 vs. 25 ± 21%, respectively). Oronasal breathing was associated with OSA severity (P = 0.009), age (P = 0.005), body mass index (P = 0.044), and neck circumference (P = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (κ = -0.12) and asleep (κ = -0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP.NEW & NOTEWORTHY Continuous positive airway pressure (CPAP) interface choice for obstructive sleep apnea (OSA) patients is often guided by nasal symptoms and self-reported breathing route. We showed that oronasal breathing can be predicted by anthropometric measurements and OSA severity but not by self-reported oronasal breathing. Self-reported breathing and nasal symptoms should not be considered for CPAP interface choice.


Asunto(s)
Obstrucción de las Vías Aéreas/fisiopatología , Nariz/fisiopatología , Apnea Obstructiva del Sueño/fisiopatología , Sueño/fisiología , Adulto , Índice de Masa Corporal , Presión de las Vías Aéreas Positiva Contínua/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía/métodos , Respiración , Encuestas y Cuestionarios , Resultado del Tratamiento
6.
Rev Invest Clin ; 71(3): 204-210, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31184336

RESUMEN

BACKGROUND: Osteoporosis (OP) is common in patients with chronic obstructive pulmonary disease (COPD). The relationship between OP and COPD has been primarily studied in male patients, and few reports are available in postmenopausal women. OBJECTIVE: The purpose of this study was to investigate the association between bone mineral density (BMD) and COPD in postmenopausal women. METHODS: This cross-sectional study included 133 clinically stable female ex-smokers with confirmed COPD, and 31 age-matched "ex-smoker" female controls. We analyzed groups according to their airway obstruction category. BMD was measured on dual-energy X-ray absorptiometry images of the left femoral neck. RESULTS: Patients with COPD had lower T-scores and higher prevalence of osteopenia/OP than the control group. In the COPD group, the airway obstruction category was significantly associated with the T-score after adjustment for confounders. Multivariate logistic regression analysis showed COPD was an independent marker for increased risk of osteopenia/OP in postmenopausal women. CONCLUSIONS: COPD and airway obstruction category were strongly related to BMD. Postmenopausal women with COPD, especially those with severe airway obstruction, had a higher prevalence rate and a higher risk of osteopenia and OP than female controls without COPD.


Asunto(s)
Densidad Ósea/fisiología , Osteoporosis Posmenopáusica/epidemiología , Posmenopausia , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Absorciometría de Fotón , Anciano , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/fisiopatología , Enfermedades Óseas Metabólicas/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Factores de Riesgo
7.
Rev. invest. clín ; Rev. invest. clín;71(3): 204-210, May.-Jun. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1289688

RESUMEN

Abstract Background Osteoporosis (OP) is common in patients with chronic obstructive pulmonary disease (COPD). The relationship between OP and COPD has been primarily studied in male patients, and few reports are available in postmenopausal women. Objective The purpose of this study was to investigate the association between bone mineral density (BMD) and COPD in postmenopausal women. Methods This cross-sectional study included 133 clinically stable female ex-smokers with confirmed COPD, and 31 age-matched “ex-smoker” female controls. We analyzed groups according to their airway obstruction category. BMD was measured on dual-energy X-ray absorptiometry images of the left femoral neck. Results Patients with COPD had lower T-scores and higher prevalence of osteopenia/OP than the control group. In the COPD group, the airway obstruction category was significantly associated with the T-score after adjustment for confounders. Multivariate logistic regression analysis showed COPD was an independent marker for increased risk of osteopenia/OP in postmenopausal women. Conclusions COPD and airway obstruction category were strongly related to BMD. Postmenopausal women with COPD, especially those with severe airway obstruction, had a higher prevalence rate and a higher risk of osteopenia and OP than female controls without COPD.


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Densidad Ósea/fisiología , Osteoporosis Posmenopáusica/epidemiología , Posmenopausia , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedades Óseas Metabólicas/epidemiología , Absorciometría de Fotón , Estudios de Casos y Controles , Prevalencia , Estudios Transversales , Factores de Riesgo , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/fisiopatología
8.
Braz. j. otorhinolaryngol. (Impr.) ; Braz. j. otorhinolaryngol. (Impr.);85(3): 379-387, May-June 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1011633

RESUMEN

Abstract Introduction: There is no consensus on a single classification system for the obstructive findings in drug-induced sleep endoscopy. Previous classification systems have neglected to address the upper retropalatal obstruction, the segmental division of the lateral pharyngeal wall and the primary or secondary nature of laryngeal collapse. Objective: To propose, illustrate and evaluate a more comprehensive and yet simple classification for drug-induced sleep endoscopy findings. Methods: Cross sectional study in a tertiary sleep surgery unit. A total of 30 patients with obstructive sleep apnea underwent drug-induced sleep endoscopy according to a new classification system called LwPTL, and its findings were analyzed according to obstructive sleep apnea severity and body mass index. LwPTL incorporates the description of upper retropalatal collapse, distinguishes the lateral pharyngeal wall collapse into three levels and clarify when laryngeal collapses are primary or secondary. Results: 93.3% of the patients presented lateral pharyngeal wall collapse, usually at the level of the velum (73.3%). 80% presented multilevel collapse. Regarding the upper retropalatal region, LwPTL identified 10% of the cases presenting lateral salpingopharyngeal obstruction and 6.6% with high palatal collapse. 3.3% presented epiglottic collapse. Patients presenting lower levels of collapse, either from the lateral wall and/or tongue and/or larynx, represented 30% of the cases and had significantly more severe obstructive sleep apnea, without significant differences in body mass indexes. Conclusion: LwPTL seems a simple and straightforward staging system for classifying drug-induced sleep endoscopy, distinguishing the important upper retopalatal obstruction and the primary and secondary laryngeal collapses, providing more information for appropriate treatment selection.


Resumo Introdução: Não há consenso sobre um sistema único de classificação para os achados obstrutivos da endoscopia do sono induzido por drogas. Os sistemas de classificação anteriores negligenciaram a abordagem da obstrução retropalatal alta, a divisão segmentar da parede lateral da faringe e a natureza primária ou secundária do colapso laríngeo. Objetivo: Propor, ilustrar e avaliar uma classificação mais abrangente e simples para os achados da endoscopia do sono induzido por drogas. Método: Estudo transversal em uma unidade terciária de cirurgia do sono. Foram submetidos à endoscopia do sono induzido por drogas 30 pacientes com apneia obstrutiva do sono, de acordo com um novo sistema de classificação denominado LwPTL, e seus achados foram analisados de acordo com a gravidade da apneia obstrutiva do sono e índice de massa corpórea. O LwPTL incorpora a descrição do colapso retropalatal alto, distingue o colapso da parede faríngea lateral em três níveis e esclarece quando os colapsos laríngeos são primários ou secundários. Resultados: Apresentaram colapso da parede faríngea lateral 93,3% dos pacientes, geralmente no nível do palato mole (73,3%). Em 80% dos pacientes o colapso foi multinível. Em relação à região retropalatal alta, o LwPTL identificou 10% dos casos com obstrução salpingo-faríngea lateral e 6,6% com colapso alto do palato. Em 3,3% ocorreu colapso epiglótico. Pacientes com colapso em regiões baixas, tanto da parede lateral e/ou língua como e/ou laringe, representaram 30% dos casos e apresentaram apneia obstrutiva do sono significativamente mais grave, sem diferenças significantes no índice de massa corpórea. Conclusão: O LwPTL parece um sistema de estadiamento simples e direto para classificar os achados da endoscopia do sono induzido por drogas, distingue a importante obstrução retropalatal alta e os colapsos laríngeos primários e secundários, fornece mais informações para uma seleção adequada do tratamento.


Asunto(s)
Humanos , Faringe/fisiopatología , Apnea Obstructiva del Sueño/fisiopatología , Obstrucción de las Vías Aéreas/fisiopatología , Endoscopía/métodos , Hipnóticos y Sedantes/administración & dosificación , Faringe/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Estudios Transversales , Polisomnografía/métodos , Apnea Obstructiva del Sueño/diagnóstico por imagen , Obstrucción de las Vías Aéreas/diagnóstico por imagen
10.
Braz J Otorhinolaryngol ; 85(3): 379-387, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30902587

RESUMEN

INTRODUCTION: There is no consensus on a single classification system for the obstructive findings in drug-induced sleep endoscopy. Previous classification systems have neglected to address the upper retropalatal obstruction, the segmental division of the lateral pharyngeal wall and the primary or secondary nature of laryngeal collapse. OBJECTIVE: To propose, illustrate and evaluate a more comprehensive and yet simple classification for drug-induced sleep endoscopy findings. METHODS: Cross sectional study in a tertiary sleep surgery unit. A total of 30 patients with obstructive sleep apnea underwent drug-induced sleep endoscopy according to a new classification system called LwPTL, and its findings were analyzed according to obstructive sleep apnea severity and body mass index. LwPTL incorporates the description of upper retropalatal collapse, distinguishes the lateral pharyngeal wall collapse into three levels and clarify when laryngeal collapses are primary or secondary. RESULTS: 93.3% of the patients presented lateral pharyngeal wall collapse, usually at the level of the velum (73.3%). 80% presented multilevel collapse. Regarding the upper retropalatal region, LwPTL identified 10% of the cases presenting lateral salpingopharyngeal obstruction and 6.6% with high palatal collapse. 3.3% presented epiglottic collapse. Patients presenting lower levels of collapse, either from the lateral wall and/or tongue and/or larynx, represented 30% of the cases and had significantly more severe obstructive sleep apnea, without significant differences in body mass indexes. CONCLUSION: LwPTL seems a simple and straightforward staging system for classifying drug-induced sleep endoscopy, distinguishing the important upper retopalatal obstruction and the primary and secondary laryngeal collapses, providing more information for appropriate treatment selection.


Asunto(s)
Obstrucción de las Vías Aéreas/fisiopatología , Endoscopía/métodos , Hipnóticos y Sedantes/administración & dosificación , Faringe/fisiopatología , Apnea Obstructiva del Sueño/fisiopatología , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Estudios Transversales , Humanos , Faringe/diagnóstico por imagen , Polisomnografía/métodos , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/diagnóstico por imagen
11.
Rev Invest Clin ; 71(1): 28-35, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30810541

RESUMEN

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. While the cut-off point to define airflow obstruction has been controversial, it is widely accepted that the spirometry test is vital, as well as performing it after using a bronchodilator. The 6-second spirometry and the forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6) have demonstrated validity for defining obstruction, and it would be advisable to incorporate them in the definitions of obstruction. Another relevant issue is that spirometry with borderline obstruction can vary over time, changing to above or below the cut-off point. Thus, surveillance should be considered over time, repeating the spirometry to have a greater certainty in the diagnosis. The objective of this article was to conduct an in-depth review of the controversies in the diagnosis of COPD. During the past years, COPD definition has been updated in different times; however, it is now considered more as a complex syndrome with systemic participation, requiring a multidimensional assessment, and not only a spirometry.


Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Espirometría/métodos , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/fisiopatología , Broncodilatadores/administración & dosificación , Volumen Espiratorio Forzado/fisiología , Humanos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Factores de Tiempo
12.
Rev. invest. clín ; Rev. invest. clín;71(1): 28-35, Jan.-Feb. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1289667

RESUMEN

Abstract Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. While the cut-off point to define airflow obstruction has been controversial, it is widely accepted that the spirometry test is vital, as well as performing it after using a bronchodilator. The 6-second spirometry and the forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6) have demonstrated validity for defining obstruction, and it would be advisable to incorporate them in the definitions of obstruction. Another relevant issue is that spirometry with borderline obstruction can vary over time, changing to above or below the cut-off point. Thus, surveillance should be considered over time, repeating the spirometry to have a greater certainty in the diagnosis. The objective of this article was to conduct an in-depth review of the controversies in the diagnosis of COPD. During the past years, COPD definition has been updated in different times; however, it is now considered more as a complex syndrome with systemic participation, requiring a multidimensional assessment, and not only a spirometry.


Asunto(s)
Humanos , Espirometría/métodos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Obstrucción de las Vías Aéreas/diagnóstico , Factores de Tiempo , Broncodilatadores/administración & dosificación , Volumen Espiratorio Forzado/fisiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/fisiopatología
13.
In. Boggia de Izaguirre, José Gabriel; Hurtado Bredda, Francisco Javier; López Gómez, Alejandra; Malacrida Rodríguez, Leonel Sebastián; Angulo Nin, Martín; Seija Alves, Mariana; Luzardo Domenichelli, Leonella; Gadola Bergara, Liliana; Grignola Rial, Juan Carlos. Fisiopatología: mecanismos de las disfunciones orgánicas. Montevideo, BiblioMédica, 2 ed; c2019. p.419-430, ilus, graf, tab.
Monografía en Español | LILACS, UY-BNMED, BNUY | ID: biblio-1437051
14.
Int J Chron Obstruct Pulmon Dis ; 13: 3281-3295, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30349233

RESUMEN

PURPOSE: The aim of the present study was to evaluate the performance of the forced oscillation technique (FOT) for the early diagnosis of the effects of smoking and COPD. The contributions of the integer-order (InOr) and fractional-order (FrOr) models were also evaluated. PATIENTS AND METHODS: In total, 120 subjects were analyzed: 40 controls, 40 smokers (20.3±9.3 pack-years) and 40 patients with mild COPD. RESULTS: Initially, it was observed that traditional FOT parameters and the InOr and FrOr models provided a consistent description of the COPD pathophysiology. Mild COPD introduced significant increases in the FrOr inertance, damping factor and hysteresivity (P<0.0001). These parameters were significantly correlated with the spirometric parameters of central and small airway obstruction (P<0.0001). The diagnostic accuracy analyses indicated that FOT parameters and InOr modeling may adequately identify these changes (area under the receiver operating characteristic curve - AUC >0.8). The use of FrOr modeling significantly improved this process (P<0.05), allowing the early diagnosis of smokers and patients with mild COPD with high accuracy (AUC >0.9). CONCLUSION: FrOr modeling improves our knowledge of modifications that occur in the early stages of COPD. Additionally, the findings of the present study provide evidence that these models may play an important role in the early diagnosis of COPD, which is crucial for improving the clinical management of the disease.


Asunto(s)
Resistencia de las Vías Respiratorias/fisiología , Diagnóstico Precoz , Oscilometría/métodos , Enfermedad Pulmonar Obstructiva Crónica , Fumar , Obstrucción de las Vías Aéreas/fisiopatología , Brasil , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Gravedad del Paciente , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/normas , Modelación Específica para el Paciente , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Mejoramiento de la Calidad , Pruebas de Función Respiratoria/métodos , Fumar/fisiopatología , Capacidad Vital
15.
Neumol. pediátr. (En línea) ; 13(2): 48-55, mar. 2018. tab, ilus
Artículo en Español | LILACS | ID: biblio-915484

RESUMEN

Exercise-induced dyspnea is a common pediatric question but difficult to address since usually symptoms are described ambiguously by the child or parents. Most of times dyspnea is secondary to poor training but sometimes may be due to an underlying condition like exercise-induced bronchoconstriction or vocal cord dysfunction. To provide clinicians with a practical approach about exercise-induced dyspnea we have review pathogenesis and clinical characteristics of respiratory diseases and proposed an algorithm for study.


Frecuentemente nos vemos enfrentados a evaluar un niño con síntomas vagos asociados al ejercicio que el mismo paciente o sus padres describen como ahogo o sensación de pecho apretado. La mayoría de las veces se trata de cansancio atribuible al ejercicio normal que solo refleja pobre condicionamiento físico del individuo; sin embargo, este cansancio puede ser desproporcionado al esfuerzo, lo que obliga a considerar enfermedades comunes como asma o poco comunes como disfunción de cuerdas vocales. El objetivo de esta revisión es actualizar el conocimiento aquellas enfermedades respiratorias que forman parte del diagnóstico diferencial de la disnea asociada al ejercicio y proponer un algoritmo de estudio que permita un acercamiento práctico según causas de origen.


Asunto(s)
Humanos , Niño , Asma Inducida por Ejercicio/fisiopatología , Obstrucción de las Vías Aéreas/fisiopatología , Disnea/fisiopatología , Disfunción de los Pliegues Vocales/fisiopatología , Asma Inducida por Ejercicio/diagnóstico , Asma Inducida por Ejercicio/terapia , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/terapia , Disnea/diagnóstico , Disnea/terapia , Disfunción de los Pliegues Vocales/diagnóstico , Disfunción de los Pliegues Vocales/terapia
16.
Eur Arch Otorhinolaryngol ; 275(2): 443-449, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29124360

RESUMEN

OBJECTIVES: To investigate whether disclosed symptoms (coughing, choking and throat clearing) can be used as early predictors of swallowing disorders in non-hospitalized elderly population. In addition, to determine the presence of early findings of swallowing disorders through fiber optic endoscopic evaluation of swallowing (FEES). MATERIALS AND METHODS: One hundred subjects older than 60 years were recruited from local community social meetings for seniors, they fulfilled inclusion criteria, and were given an oral interview and underwent FEES, with findings classified as: (1) saliva stasis; (2) pharyngeal residue; (3) penetration; (4) aspiration; (5) laryngeal sensitivity. RESULTS: Twenty-one percent of subjects declared previous choking, 10% coughing, and 7% throat clearing, 39% had pharyngeal residue; 6% saliva stasis; 9% penetration; 2% aspiration; and 92% laryngeal sensitivity present. Thirty-three percent showed pharyngeal residue without saliva stasis, while only 6% showed positivity for both (p = 0.003). CONCLUSIONS: Our data suggest that health care professionals should be aware that among an apparently healthy population, some subjects may have swallowing disorders without clinical complaints and that a nasolaryngoscopy exam may not be enough to predict dysphagia. We suggest that FEES should be performed to look for surrogate of dysphagia such as pharyngeal residue, laryngeal penetration, and aspiration.


Asunto(s)
Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Deglución/fisiología , Esofagoscopía/métodos , Laringoscopía/métodos , Anciano , Anciano de 80 o más Años , Obstrucción de las Vías Aéreas/fisiopatología , Tos/fisiopatología , Estudios Transversales , Femenino , Tecnología de Fibra Óptica , Humanos , Laringe/fisiopatología , Masculino , Persona de Mediana Edad
17.
Rev Alerg Mex ; 64 Suppl 1: s11-s128, 2017.
Artículo en Español | MEDLINE | ID: mdl-28441001

RESUMEN

BACKGROUND: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. METHODS: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. RESULTS: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. CONCLUSIONS: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.


Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.


Asunto(s)
Asma/terapia , Adolescente , Adulto , Factores de Edad , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/fisiopatología , Antiasmáticos/uso terapéutico , Asma/clasificación , Asma/diagnóstico , Asma/fisiopatología , Termoplastia Bronquial , Niño , Preescolar , Terapia Combinada , Diagnóstico Diferencial , Manejo de la Enfermedad , Medicina Basada en la Evidencia , Femenino , Humanos , Lactante , México , Terapia por Inhalación de Oxígeno , Educación del Paciente como Asunto , Embarazo , Complicaciones del Embarazo/terapia , Respiración Artificial , Autocuidado , Espirometría , Estado Asmático/terapia
18.
Int J Chron Obstruct Pulmon Dis ; 11: 3059-3067, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27994446

RESUMEN

BACKGROUND: COPD, asthma, and asthma-COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. OBJECTIVES: To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma-COPD overlap. METHODS: COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma-COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. RESULTS: Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma-COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma-COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. CONCLUSION: COPD, asthma, and asthma-COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.


Asunto(s)
Obstrucción de las Vías Aéreas/terapia , Asma/terapia , Recursos en Salud/estadística & datos numéricos , Pulmón/fisiopatología , Atención Primaria de Salud/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Adulto , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/fisiopatología , Asma/diagnóstico , Asma/fisiopatología , Estudios Transversales , Progresión de la Enfermedad , Femenino , Volumen Espiratorio Forzado , Medicina General , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/estadística & datos numéricos , Fenotipo , Valor Predictivo de las Pruebas , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Derivación y Consulta/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , América del Sur , Espirometría/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Síndrome , Factores de Tiempo , Resultado del Tratamiento , Capacidad Vital
19.
J Clin Sleep Med ; 12(10): 1339-1346, 2016 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-27448414

RESUMEN

STUDY OBJECTIVES: There is a growing interest to develop a simple method to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea (OSA). Critical closing pressure (Pcrit) during sleep is able to predict the anatomical component of OSA. However, Pcrit is a laborious method that is only used for research purposes. The application of negative expiratory pressure (NEP) is a simple method to assess upper airway collapsibility that can be easily performed during wakefulness. We hypothesized that NEP will be, similarly to Pcrit, associated with upper airway anatomy assessed by computed tomography (CT) scan. METHODS: Patients under investigation for OSA underwent polysomnography, CT of the upper airway, NEP while awake, and Pcrit during sleep. NEP was performed with -5 cm H2O in supine position using a nasal mask. Pcrit was measured during sleep induced by low doses of midazolam. RESULTS: Twenty-eight male subjects were studied (age 45 ± 13 y, body mass index 29.4 ± 4.9 kg/m2, apnea-hypopnea index (AHI) 30 ± 26, range 2 to 86 events/h). NEP and Pcrit were similarly associated with tongue area (r = 0.646 and r = 0.585), tongue volume (r = 0.565 and r = 0.613) and pharyngeal length (r = 0.580 and r = 0.611), respectively (p < 0.05 for all comparisons). NEP and Pcrit were also significantly correlated with AHI (r = 0.490 and r = 0.531). NEP and Pcrit were significantly higher in patients with severe OSA than the remaining population. CONCLUSIONS: NEP is a simple and promising method that is associated with the anatomical component of upper airway collapsibility. NEP may be valuable to select patients for noncontinuous positive airway pressure alternative therapies for OSA.


Asunto(s)
Obstrucción de las Vías Aéreas/fisiopatología , Espiración/fisiología , Faringe/anatomía & histología , Faringe/fisiopatología , Apnea Obstructiva del Sueño/fisiopatología , Vigilia , Adolescente , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Faringe/diagnóstico por imagen , Polisomnografía , Presión , Apnea Obstructiva del Sueño/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto Joven
20.
J Asthma ; 53(8): 801-7, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27050870

RESUMEN

OBJECTIVES: To evaluate whether irreversible airway obstruction (IAO) related to asthma is a risk factor for lack of symptoms control, poor quality of life and exacerbations. METHODS: We evaluated consecutive outpatients with asthma in a one-year cohort study. We excluded subjects with smoke history > 9 pack-years. Definition of IAO was post bronchodilator FEV1/CVF ratio below the lower limit of normality. Subjects received high dose of inhaled medications for asthma. We used logistic regression models, adjusted for the treatment offered during the study, to evaluate whether IAO related to asthma is a risk factor for symptoms control, quality of life, any emergency room visit, number of emergency room visits and hospital admission. RESULTS: We enrolled 248 subjects in the study. IAO was not a risk factor for poor symptoms control [OR 1.354, 95 CI (0.632-2.899)] or worse asthma related quality of life [OR 0.705, 95 CI (0.413-1.204)]. Subjects with IAO had higher odds of any emergency room visit [OR 2.214, 95 CI (1.300-3.768)] and hospital admission [OR 8.530, 95 CI (1.517-47.978)] and lower odds to reduce emergency room visits in the course of the follow-up period [OR 0.452, 95 CI (0.265-0.769)]. IAO did not predict the number of emergency room visits [OR 1.53, 95 CI (0.71-3.30). CONCLUSION: IAO is not a risk factor for poor symptoms control or poor quality of life, in a setting of proper treatment. It is a risk factor for emergency room visit and hospital admission. Subjects with IAO have poor response to treatment.


Asunto(s)
Obstrucción de las Vías Aéreas/epidemiología , Asma/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Adulto , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/fisiopatología , Asma/diagnóstico , Asma/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Calidad de Vida , Pruebas de Función Respiratoria , Rinitis Alérgica/diagnóstico , Rinitis Alérgica/epidemiología , Rinitis Alérgica/fisiopatología , Factores de Riesgo , Pruebas Cutáneas
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