Análisis de los costes directos durante un año de pacientes con EPOC seguidos en una consulta neumológica extrahospitalaria / Direct cost analisis of patients with stable COPD in a neumology consult. One year follow up

FUNDAMENTO: La elevada prevalencia de la Enfermedad pulmonar obstructiva crónica (EPOC) en nuestro medio provoca un considerable gasto sanitario. PACIENTES Y METODO: Se realizó un estudio prospectivo desde los años 1996-1999 en el que se analizan los gastos derivados de costes directos (medicación, exploraciones complementarias y asistencia, que incluye atención médica e ingresos hospitalarios) en 336 pacientes con EPOC seguidos durante un año en una consulta extrahospitalaria de neumología, y su relación con el grado de afectación funcional respiratoria de los mismos. RESULTADOS: El gasto medio global fue de 893 € por paciente/año, distribuyéndose el mismo en un 46% (409€), debidos a los gastos en asistencia, 43% (384€) por medicación y el 11% (100) por técnicas complementarias. El gasto total y sus apartados de medicación y técnicas complementarias se correlacionó con peor situación funcional. Este hecho no ocurrió con el apartado de gasto por asistencia. CONCLUSIÓN: El coste directo en pacientes EPOC es elevado, siendo el mayor porcentaje debido a la asistencia. Los pacientes más deteriorados funcionalmente presentan mayores gastos, pero no necesariamente mayor coste por ingreso (AU)

INTRODUCTION: Chronic obstructive disease is a high prevalece disease which is increased with age and elevated cost. OBJETIVE: To estimate the direct medical cost of patients with chronic obstructive pulmonary disease(COPD) followed one year in a neumology consult, and the relationship with their respiratory function status. We perform a prospective study in 1996 which include 336 patients, and was analized the cost due to medications, diagnosis procedures and physician services. RESULTS: mean cost were 893 €, including 46% (409€), derived for physician services, 43% (384€) for medications and 11% for diagnosis procedures. The global cost and each part of medication cost and diagnosis procedures cost were related with a deteriorated funcional status but we don’t found this correlation with physician services costs. We didn’t found correlation of mayor cost with age. CONCLUSION: The cost due of patients with COPD is high, especially the percentage of physician services. The more deteriorated functional status the more cost, but it not included hospital care cost (AU)

Effects of sex on sleep-disordered breathing in adolescents.

This study was conducted to determine the influence of puberty on features of sleep-disordered breathing (SDB) in adolescents. The study was performed in a general population sample of 226 adolescents of both sexes (aged 11-19 yrs) recruited from the secondary school population of the city of Seville, Spain. Subjects were divided into two groups: 1) postpubertal, i.e. females who had undergone menarche and males in whom axillary hair development or peak height velocity had occurred > 1 yr before the study; and 2) peripubertal, i.e. females who had not undergone menarche and males who had not developed axillary hair nor reached peak height velocity, or subjects in whom these pubertal changes had appeared < 1 yr before the study. All subjects answered a questionnaire on SDB and underwent overnight cardiorespiratory polygraphy. There were 50 males and 40 females (mean +/- SD age 13.5 +/- 1.2 yrs) in the peripubertal group, and 54 males and 82 females (age 16.3 +/- 1.7 yrs) in the postpubertal group. Males exhibited significantly higher neck circumference/height index and waist/hip index than females in both the peripubertal and postpubertal groups. In the postpubertal group, snoring and polygraphic alterations (respiratory events and oximetric parameters) were significantly more frequent in males than in females. Postpubertal adolescents showed sex differences in clinical and polygraphic parameters that were not observed at earlier pubertal stages. These findings support the influence of sex hormones on sex differences in sleep-disordered breathing.

[Evaluation of clinical diagnostic guidelines for idiopathic pulmonary fibrosis]. / Evaluación de los criterios diagnósticos clínicos de fibrosis pulmonar idiopática.

OBJECTIVES: To analyze the international consensus statement on diagnostic criteria for idiopathic pulmonary fibrosis. METHODS: All patients diagnosed of any interstitial lung disease by means of open lung biopsy since 1980 were included. The patients' clinical records were examined to determine whether they fulfilled the diagnostic criteria, and their biopsies were reviewed to find those with the usual interstitial pneumonia pattern. We calculated sensitivity, specificity, positive and negative predictive values and likelihood ratios for the diagnostic criteria in the consensus statement. Afterwards, we performed the analyses again using only one of the two conditions for fulfilling the function criterion. RESULTS: Of 39 patients enrolled in the study, 17 had idiopathic pulmonary fibrosis. Specificity and positive predictive value were both 100%, but sensitivity was 41.2% and negative predictive value was 68.7%. The likelihood ratio for a negative result was 0.59. In the second analysis, sensitivity was 64.7% and negative predictive value was 78.5%, while specificity and positive predictive value remained unchanged. The likelihood ratio for a negative result was 0.35. CONCLUSIONS: The criteria are sufficiently specific to allow us to diagnose confidently when the criteria are fulfilled. However, a slight change in the function criterion should be considered in order to increase diagnostic yield.

Evaluación de los criterios diagnósticos clínicos de fibrosis pulmonar idiopática / Evaluation of clinical diagnostic guidelines for idiopathic pulmonary fibrosis

OBJETIVOS: Estudiar los criterios diagnósticos de la fibrosis pulmonar idiopática según el último Consenso Internacional. PACIENTES Y MÉTODO: Se incluyó a todos los pacientes diagnosticados de cualquier enfermedad intersticial por medio de biopsia pulmonar abierta desde 1980. Se revisaron sus historias clínicas para averiguar si cumplían los criterios diagnósticos, así como sus biopsias pulmonares en busca del patrón de neumonía intersticial usual. Se calcularon la sensibilidad, la especificidad, los valores predictivos positivo y negativo y los cocientes de probabilidad. Posteriormente, se realizó el mismo análisis requiriendo sólo una de las dos condiciones funcionales para cumplir el criterio funcional. RESULTADOS: Se incluyó a 39 pacientes, 17 de los cuales presentaban una fibrosis pulmonar idiopática. La especificidad y el valor predictivo positivo fue del 100 per cent, mientras que la sensibilidad y el valor predictivo negativo fueron del 41,2 y del 68,7 per cent, respectivamente. El cociente de probabilidad para un resultado negativo fue de 0,59. En el segundo análisis, la sensibilidad y el valor predictivo negativo fueron del 64,7 y del 78,5 per cent, respectivamente, con idéntica especificidad y valor predictivo positivo. El cociente de probabilidad para un resultado negativo fue de 0,35. CONCLUSIONES: Los criterios diagnósticos son lo suficientemente específicos como para estar seguros del diagnóstico cuando se cumplen. Debería considerarse un pequeño cambio en el criterio funcional para aumentar la rentabilidad del diagnóstico (AU)

Actuaciones de los médicos y guías de práctica clínica / Clinical practice gudielines and the practice of medicine

No disponible

[Risk factors for bronchial asthma in patients with rhinitis]. / Factores de riesgo asociados con asma bronquial en pacientes con rinitis.

OBJECTIVES: To identify risk factors for bronchial asthma in a large sample of patients with rhinitis. PATIENTS AND METHODS: One thousand seven hundred sixty patients with rhinitis treated at the respiratory medicine out-patient service of Hospital Universitario Virgen de Rocío in Seville (Spain) in 1997 and 1998 were studied. Six hundred forty-one (36.4%) had isolated rhinitis and 1,119 (63.6%) had rhinitis and bronchial asthma. The following variables were analyzed for both groups: 1) age, 2) sex, 3) clinical diagnosis, 4) age of onset of symptoms, 5) a family history of asthma and/or atopy, 6) housing conditions, 7) smoking, 8) a history of skin allergy, 9) recurrent episodes of respiratory infection with wheezing during early childhood, 10) a diagnosis of nasosinus polyposis, 11) atopy and sensitivity (pollens and/or household allergens), 12) peripheral blood eosinophil count. RESULTS: The variables that best differentiated the group with rhinitis from the group with both rhinitis and asthma were age, family history of asthma and/or atopy, exposure to household humidity or damp, a history of skin allergy, recurrent episodes of respiratory infection with wheezing in early childhood, atopy, sensitivity to household allergens and peripheral blood eosinophil count. The probability of correctly classifying patients in the appropriate group using this model was 69.7%. Among atopic patients, the best predictive variables were the same, with the exception of household humidity/damp. The probability of correct classification using this model was 69.7%. CONCLUSIONS: Patients with rhinitis have risk factors for bronchial asthma. As many such patients as possible should be identified so that long-term follow-up can take place and strategies to prevent bronchial asthma can be implemented.

Factores de riesgo asociados con asma bronquial en pacientes con rinitis / Risk factors for bronchial asthma in patients with rhinitis

OBJETIVOS: Identificar, en una amplia muestra de pacientes con rinitis, aquellos factores asociados con asma bronquial. PACIENTES Y MÉTODOS: Se incluyó en el estudio a 1.760 pacientes diagnosticados de rinitis en nuestras Consultas Externas de Neumología del Hospital Universitario Virgen del Rocío de Sevilla, en un período de 2 años (1997-1998). Seiscientos cuarenta y uno (36,4 por ciento) tenían rinitis aislada y 1.119 (63,6 por ciento) rinitis y asma bronquial. En ambos grupos se analizaron las siguientes variables: edad, sexo, diagnóstico clínico, edad de comienzo de los síntomas, antecedentes familiares de asma y/o atopia, condiciones de la vivienda, hábito tabáquico, antecedentes alérgicos dermatológicos, episodios de infecciones respiratorias con sibilancias recurrentes durante la primera infancia, diagnóstico de poliposis nasosinusal, atopia y tipo de sensibilización (pólenes y/o alergenos domésticos), y porcentaje de eosinófilos en sangre periférica. RESULTADOS: Las mejores variables predictoras para diferenciar el grupo con rinitis del grupo con rinitis y asma fueron la edad, los antecedentes familiares de asma y/o atopia, la exposición a humedad/moho en su vivienda habitual, los antecedentes alérgicos dermatológicos, los episodios de infecciones respiratorias con sibilancias recurrentes en la primera infancia, la atopia, la sensibilización a alergenos domésticos y el porcentaje de eosinófilos en sangre periférica. La probabilidad de clasificar correctamente a los pacientes en cada grupo siguiendo este modelo fue del 69,7 por ciento. Entre los atópicos, las mejores variables predictoras fueron las mismas, exceptuando la exposición a humedad/moho en la vivienda. La probabilidad de clasificación correcta siguiendo este modelo fue del 69,7 por ciento. CONCLUSIONES: En los pacientes riníticos existe una serie de factores de riesgo que van asociados con asma bronquial. Es necesario identificar el mayor número posible de ellos para poder hacer un seguimiento a largo plazo y poner en práctica medidas estratégicas de prevención en aquellos pacientes que presenten más probabilidad de desarrollar asma bronquial (AU)

[Asthma as presentation form of relapsing polychondritis]. / Asma como forma de presentación de policondritis recidivante.

Relapsing polychondritis is a systemic disease of unknown etiology characterised by relapsing inflammation affecting cartilaginous structures, cardiovascular system, eyes and ears. Respiratory involvement occurs in 56% of patients during the disease progression, but only in 14% of cases as an initial presentation. Patients develop severe symptoms due to the disease affecting the glottis and the tracheobronchial tree, which represents the cause of death in 50% of cases. The unspecificity of respiratory symptoms makes that the disease may be confounded with some other if it is not accompanied with a typical presentation, which may cause a delay in the diagnosis. Pulmonary function tests are of great importance, since an obstructive pattern not reversible after bronchodilator administration and a plateau in flow-volume curves are of great help when assessing the severity of the obstruction. High resolution computed tomography is a non-invasive test more precise than bronchoscopy in identifying tracheal and bronchi abnormalities, so it should be performed at the onset of the respiratory symptoms together with the pulmonary function tests. We present the case of a patient, whose disease started with respiratory semiology suggesting bronchial asthma, which preceded in six months the main sign nasal chondritis.

[Reproducibility of the technique for measuring nitric oxide in exhaled air in healthy subjects]. / Estudio de la reproducibilidad de la técnica de medición de óxido nítrico en aire exhalado en sujetos sanos.

UNLABELLED: Exhaled nitric oxide (NO) has become established as the principal non-invasive marker of airway inflammation. Exhaled NO levels reported in the literature vary greatly, with differences sometimes attributable to measurement technique. OBJECTIVE: To determine the reproducibility of the technique used by our department to measure exhaled NO and to know whether results vary with diet and patient characteristics. METHOD: We studied 20 healthy subjects (10 men and 10 women; mean age 28.21 years). Exhaled NO was measured when the patient was fasting(N1), 30 minutes after intake of vegetables (N2) and 30 minutes after intake of meat/fish (N3). For each measure N1, N2 and N3 we took the average of three consecutive measurements separated by 10 minutes. Exhaled NO was assessed by controlled-flow chemoluminescence after adjusting for trapped air and after generating pressure in the oral cavity that was sufficient to close the soft palate(Eco Physics CLD 77 AM analyzer). RESULTS: The mean concentration was 3.40 1.30 ppb for N1, 4.03 1.00 ppb for N2 and 3.71 1.05 ppb for N3. The differences between measurements were not statistically significant(p > 0.05). Nor were differences between the sets of three measurements significant. The mean concentration was 3.13 0.41 ppb for women and 3.72 0.31 ppb for men (ns). No significant differences were related to body mass index 25 (n = 15) or > 25 (n = 5). CONCLUSIONS: The technique our department uses for measuring exhaled NO is reproducible and differences are unrelated to food intake, sex or body mass index.

[Community acquired pneumonia in patients older than 60 years. Incidence of atypical agents and clinical-radiological progression]. / Neumonías adquiridas en la comunidad en pacientes mayores de 60 años. Incidencia de gérmenes atípicos y evolución clinicorradiológica.

BACKGROUND: Seventy five patients older than 60 years with a community acquired pneumonia followed up in an outpatient clinic, were prospectively studied in order to determine the incidence of atypical agents, clinical-radiological characteristics, progression and the differences with pneumonia in younger patients. METHOD: Clinical-radiological evaluation protocols were activated in the first visit and in two subsequent controls. Etiological diagnosis was made by means of serology (in the first visit and three weeks later). RESULTS: Initially, 85 patients older than 60 years were included of which 75 non hospitalized were fully followed up. Also, in the comparative study, 216 outpatient clinic patients 60 years old or younger were followed up during the same period. In the first group the frequency of atypical agents was 33.3%. The most frequently isolated bacteria was Coxiella burnetii (13.3%)followed by virus and Legionella pneumophila. No case of Mycoplasma pneumoniae was diagnosed. The most frequent radiological onset was alveolar infiltrate (85%). The comparative study between the two populations (older or younger than 60 years), found few clinical differences (dyspnea more frequent in older,feverish chill in younger) and auscultation (crackles more frequent in older). We did not find differences remaining clinical-radiological or laboratory data. Most patients presented a favourable clinical and radiological progression. Only 2 patients needed hospital admission (2.7%). CONCLUSIONS: In outpatient clinic patients older than 60 years with community acquired pneumonia a high number of atypical agents have been found. The clinical-radiological evolution was satisfactory for most of them. Age was not a decisive element in determining hospital admissions.

Estudio de la reproducibilidad de la técnica de medición de óxido nítrico en aire exhalado en sujetos sanos / Reproducibility of a technique for measuring nitric oxide in exhaled air in healthy subjects

El óxido nítrico exhalado (NOe) ha quedado establecido como el primer marcador no invasivo de inflamación en las vías aéreas. Las cifras de NOe publicadas ponen de manifiesto una gran variabilidad, y en ocasiones estas diferencias son debidas a la técnica de medición empleada.OBJETIVO: Determinar la reproducibilidad de la técnica utilizada por nuestro grupo y si la concentración de NOe obtenida está sometida a variaciones dependientes de características antropométricas y dieta.MÉTODO: Estudiamos a 20 sujetos sanos (10 varones y 10 mujeres) con una edad media de 28,21 años. A todos se les realizaron mediciones seriadas de NOe en ayunas (N1), 30 min tras la ingestión de verduras (N2) y 30 min tras la ingesta de carne/pescado (N3). Cada valor (N1, N2, N3) era la media aritmética de tres mediciones consecutivas separadas 10 min entre sí. Medimos el NOe por método directo de quimioluminiscencia con flujo controlado descartando el aire del espacio muerto y con generación de presión en cavidad oral suficiente para cerrar el paladar blando (analizador Eco Physics CLD 77AM). RESULTADOS: Obtuvimos una concentración media ñ desviación estándar (DE) para N1 de 3,40 ñ 1,30 ppb; para N2 de 4,03 ñ 1,00 ppb y para N3 de 3,71 ñ 1,05 ppb. Las diferencias observadas entre estas tres determinaciones no fueron estadísticamente significativas (p > 0,05). Las mediciones seriadas (separadas 10 min) realizadas tampoco evidenciaron cambios significativos entre las mismas. Al estudiar la influencia del sexo sobre el NOe, encontramos que en ayunas la concentración media ñ DE en las mujeres era de 3,13 ñ 0,41 ppb y en los varones 3,72 ñ 0,31 ppb sin que estas diferencias fueran significativas. Por último, estudiamos la influencia del índice de masa corporal (IMC) en el NOe, sin encontrar diferencias significativas entre los sujetos con IMC 25 (n = 15) y aquellos con IMC > 25 (n = 5).CONCLUSIONES: La técnica empleada por nuestro grupo es reproducible y las concentraciones obtenidas de NOe son independientes de la dieta, sexo e IMC. (AU)

Inspiratory muscle training in patients with COPD: effect on dyspnea, exercise performance, and quality of life.

OBJECTIVE: The aim of the study was to assess the effect of target-flow inspiratory muscle training (IMT) on respiratory muscle function, exercise performance, dyspnea, and health-related quality of life (HRQL) in patients with COPD. PATIENTS AND METHODS: Twenty patients with severe COPD were randomly assigned to a training group (group T) or to a control group (group C) following a double-blind procedure. Patients in group T (n = 10) trained with 60 to 70% maximal sustained inspiratory pressure (SIPmax) as a training load, and those in group C (n = 10) received no training. Group T trained at home for 30 min daily, 6 days a week for 6 months. MEASUREMENTS: The measurements performed included spirometry, SIPmax, inspiratory muscle strength, and exercise capacity, which included maximal oxygen uptake (VO(2)), and minute ventilation (VE). Exercise performance was evaluated by the distance walked in the shuttle walking test (SWT). Changes in dyspnea and HRQL also were measured. RESULTS: Results showed significant increases in SIPmax, maximal inspiratory pressure, and SWT only in group T (p < 0.003, p < 0.003, and p < 0.001, respectively), with significant differences after 6 months between the two groups (p < 0.003, p < 0.003, and p < 0.05, respectively). The levels of VO(2) and VE did not change in either group. The values for transitional dyspnea index and HRQL improved in group T at 6 months in comparison with group C (p < 0.003 and p < 0.003, respectively). CONCLUSIONS: We conclude that targeted IMT relieves dyspnea, increases the capacity to walk, and improves HRQL in COPD patients.

Sleep-related breathing disorders in adolescents aged 12 to 16 years : clinical and polygraphic findings.

STUDY OBJECTIVES: To determine the frequency, symptoms, and polygraphic features of sleep-related breathing disorders (SRBD) in adolescents aged 12 to 16 years. DESIGN: Cross-sectional study. SETTING: Randomly selected secondary schools in the city of Seville, SPAIN: PARTICIPANTS: A general population sample of adolescents (n = 101; mean [+/- SD] age, 13.2 +/- 0.8 years). INTERVENTIONS: An 82-item questionnaire regarding anthropometric data and nocturnal and daytime symptoms suggestive of SRBD was administered. Symptoms were evaluated according to a 4-point frequency scale. Snorers answered "sometimes" or "often" in the question about snoring, and nonsnorers answered "never" or "rarely." All subjects underwent an overnight cardiorespiratory polygraphy at home. RESULTS: Twenty-nine percent of the subjects were snorers. Excessive daytime sleepiness was present in 14% of subjects, and sleep apnea was present in 3%. Polygraphy showed a respiratory disturbance index > or = 10 in 18 subjects (17.8%), but concurrent symptoms highly suggestive of SRBD were found in only 2 subjects (1.9%). Snorers had higher waist-to-hip ratios and a higher frequency of witnessed apnea or labored breathing as well as higher values of respiratory events as compared with nonsnorers. However, oximetry data were similar in both groups. CONCLUSIONS: In a nonselected group of adolescents aged 12 to 16 years, the frequency of symptoms potentially associated with SRBD was similar to that reported for younger children. Snoring was associated with a higher occurrence of other nocturnal symptoms, a more central pattern of body fat distribution, and a higher respiratory disturbance index as compared with nonsnorers. Although polygraphic abnormalities were mild, two cases of probable SRBD were found with a prevalence rate of 1.9%.

Asma como forma de presentación de policondritis recidivante / Asthma as presentation form of relapsing polychondritis

La policondritis recidivante es una enfermedad sistémica, de etiología desconocida, que se caracteriza por una inflamación recurrente, que afecta a estructuras cartilaginosas, aparato cardiovascular, ojos y oidos. La afectación respiratoria ocurre en el 56 por ciento de los pacientes durante el curso de la enfermedad, pero como forma inicial de presentación sólo ocurre en el 14 por ciento de los casos. Los pacientes desarrollan síntomas severos devidos a la afectación de la glotis y del árbol traqueobronquial, siendo la causa de muerte en el 50 por ciento de los casos. La inespecificidad de los sintomas respiratorios da lugar a que, si el cuadro no se acompaña inicialmente de signos característicos, pueda confundirse con otro proceso, retrasándose el diagnóstico. Las pruebas de función pulmonar son de enorme importancia, apareciendo un patrón obstructivo no reversible tras broncodilatador, y un plateaud en la curva flujo-volumen que va a ayudar a localizar y evaluar la severidad de la obstrucción.La TAC de alta resolución es una exploración no invasiva que identifica las anormalidades de la tráquea y de los bronquios con mas precisión que la broncofibroscopia, por lo que debe realizarse al inicio de los síntomas respiratorios junto con las pruebas de función pulmonar.Presentamos el caso de una paciente cuyo proceso debutó con sintomatología respiratoria sugestiva de asma bronquial, que precedió en seis meses a la aparición del signo guía la condritis nasal. (AU)

[Prospective study of 221 community acquired pneumonias followed up in an outpatient clinic. Etiology and clinical-radiological progression]. / Estudio prospectivo de 221 neumonías adquiridas en la comunidad seguidas de forma ambulatoria. Etiología y evolución clinicorradiológica.

BACKGROUND: All the community acquired pneumonia followed up in an outpatient clinic were prospectively studied in order to determine: etiology, clinical-radiological characteristics and its progression with diagnostic and therapeutic protocols. PATIENTS AND METHOD: We arranged clinical evaluation protocols, etiological diagnosis by means of serology (in the first visit and three weeks later); and when necessary, by means of fiberbronchoscopy (protected microbiological brush), as well as clinical and radiological progression (up to three visits) after empirical treatment. RESULTS: Initially, 240 patients were included, of which 221 were fully followed up. Etiological diagnosis was obtained in 86 patients (39%). The bacteria most frequently isolated was Coxiella burnetii (12.2%), followed up Mycoplasma pneumoniae and Legionella pneumophila. Two cases of Strepcococus pneumoniae were diagnosed. The most frequent radiological onset was alveolar infiltrate (86%). The initial empiric treatment were macrolids (71%) or second generation cephalosporines (22%). Most patients presented a favourable clinical and radiological progression. Only 2 patients needed admission to the hospital (< 1%). CONCLUSIONS: In community acquired pneumonias studied in our outpatient clinic we found a high number of "atypical" agents. Treatment with macrolids or second generation cephalosporines are appropriate for these patients.

[Results of a psychotherapeutic program for smoking after 12 months of follow-up]. / Resultados de un programa psicoterapéutico de deshabituación tabáquica tras 12 meses de seguimiento.

OBJECTIVE: To compare the efficacy of psychological counseling for smokers in a cessation program in comparison with treatment based only on providing information about damage caused by tobacco and advice for quitting, and to determine the reasons patients started to smoke. PATIENTS AND METHODS: We studied 249 patients who came to a preliminary interview; 226 began treatment for smoking cessation. The average level of dependence, quantified the Fagerstrom test was 7.26 +/- 1.85 points. Two treatment groups were formed: the first patients seen made up the control group (n = 37), which received information about the dangers of tobacco and strategies for quitting, and the psychological counseling group (n = 189). Follow-up examinations were performed three, six and twelve months after treatment, with abstinence checked by measurement of CO in exhaled air. Only patients with CO levels less than 5 ppm (particles per million) in exhaled air were considered non-smokers. RESULTS: Most patients of both sexes named social pressure as the reason for starting to smoke. The rate of abstinence in the information and strategies group was 8.1% at all three follow-up visits, whereas the rate was 37%, 25.4% and 24.3% at three, six and twelve months, respectively, in the group receiving counseling. The differences between the two groups were significant at all visits. CONCLUSIONS: Social pressure is the main reason for starting to smoke. We observed a success rate of 24.3% after one year of follow-up after psychological treatment only, a rate that was significantly higher than that of the group that received only information. We believe that psychological counseling is an effective alternative for smokers who want to quit.

Resultados de un programa psicoterapéutico de deshabituación tabáquica tras 12 meses de seguimiento / Psychological cunseling for smoking cessation: results after twelve months

Objetivo: El objetivo de nuestro estudio ha sido conocer la efectividad de un programa psicoterapéutico de deshabituación tabáquica en relación con una intervención basada en información sobre el daño del tabaco y consejos para su abandono, así como los motivos de inicio del tabaquismo. Pacientes y métodos: Estudiamos a un total de 249 pacientes que acudieron a una entrevista preliminar, de los cuales 226 comenzaron un tratamiento para la deshabituación tabáquica. El nivel medio de dependencia, cuantificado por el test de Fagerström, fue de 7,26 ñ 1,85 puntos. Se formaron dos grupos de estudio: un grupo control de información sobre los peligros del tabaco y diversas estrategias de abandono (n = 37) con los primeros pacientes, y un grupo de intervención psicoterapéutica (n = 189) en el que se incluyeron de forma consecutiva el resto. Se efectuaron revisiones a los 3, 6 y 12 meses una vez finalizado el tratamiento, objetivándose mediante cooximetría la situación de abstinencia. Fueron considerados como no fumadores exclusivamente aquellos individuos en que se pudieron objetivar valores iguales o menores a 5 ppm (partículas por millón) de CO en aire espirado. Resultados: La mayoría de los pacientes en ambos sexos indicaron como motivo de inicio del tabaquismo la presión social. El porcentaje de abstinencia en el grupo de información y estrategias de abandono fue del 8,1 por ciento en las tres revisiones efectuadas, mientras que en el grupo de intervención psicoterapéutica fue del 37, 25,4 y 24,3 por ciento, respectivamente, a los 3, 6 y 12 meses, existiendo diferencias significativas respecto al primer grupo en todas las revisiones. Conclusiones: Los factores de presión social son fundamentales en el inicio del tabaquismo. Hemos objetivado un 24,3 por ciento de éxitos en la abstinencia al año de seguimiento exclusivamente con tratamiento psicológico, existiendo diferencias significativas en relación con el grupo que sólo recibió información. Creemos que la terapia psicológica se presenta como alternativa eficaz en el abandono del tabaquismo. (AU)

[Assessment of excessive day-time sleepiness in professional drivers with suspected obstructive sleep apnea syndrome]. / Evaluación de la somnolencia diurna excesiva en conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño.

Excessive daytime sleepiness is a common symptom of obstructive sleep apnea syndrome (OSAS) and can be a cause of traffic accidents, creating a problem of particular importance for professional drivers given the associated death, disability and professional repercussions. We assessed whether the Epworth sleepiness scale (ESS), which is a subjective measure of daytime sleepiness, correlates well with multiple sleep latency (MSL) testing, which gives an objective measure of daytime sleepiness. We also compared each method with the results of polysomnography (apnea-hypopnea index, arousal index and minimum oxygen saturation). We studied 55 professional drivers suspected of OSAS. All answered the ESS questionnaire and underwent polysomnographic and MSL testing. We found a significant, though not relevant, correlation between the degree of excessive daytime sleepiness estimated by the ESS and by MSL testing (r = -0.41; p = 0.002). A significant, though weak, correlation was found between the ESS score and the arousal index (r = 0.26; p < 0.05). Our results do not clarify which method is best for measuring excessive daytime sleepiness in professional drivers suspected of OSAS.

Evaluación de la somnolencia diurna excesiva en conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño / Assessment of excessive daytime sleepiness in professional drivers suspected of obstructive sleep apnea syndrome

La somnolencia diurna excesiva es un síntoma frecuente en el síndrome de apnea obstructiva durante el sueño, y puede ser causante de accidentes de tráfico. Este aspecto tiene especial importancia en los conductores profesionales, por la morbimortalidad y repercusión laboral que puede suponer. Hemos evaluado si la escala de somnolencia de Epworth (ESE) (medida subjetiva de la somnolencia diurna) se correlaciona bien con el test de latencia múltiple del sueño (TLMS) (medida objetiva de la somnolencia diurna). Además, hemos comparado ambos métodos con algunos parámetros de la polisomnografía (PLSG) (índice de apnea-hipopnea, índice de arousals y saturación de oxígeno mínima). Hemos estudiado a 55 conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño. A todos se les aplicó la ESE y se les realizó una PLSG y un TLMS. Encontramos una correlación significativa, aunque no relevante, entre el grado de somnolencia diurna excesiva estimada mediante la ESE y la medida por el TLMS (r = -0,41; p = 0,002). Al comparar ambos métodos con la PLSG, tan sólo encontramos una correlación significativa, aunque muy débil, entre la ESE y el índice de arousals (r = 0,26; p < 0,05). Según nuestros resultados, no está claro cuál es el mejor método para medir la somnolencia diurna excesiva en conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño (AU)