Effects of simvastatin in chronic obstructive pulmonary disease: Results of a pilot, randomized, placebo-controlled clinical trial.

INTRODUCTION: Statins may have pleiotropic effects in COPD, but mechanisms remain unclear. OBJECTIVES: To assess the pleiotropic effect of statins in patients with stable COPD on (1): lung function (2); pulmonary and systemic inflammation (3); endothelial function (vascular stiffness) and circulating vascular growth factors; and (4), serum uric acid levels. METHOD: Pilot, double-blind, randomized, placebo-controlled clinical trial in 24 patients with stable COPD, all statin-naïve, who were randomized (1:1) to receive simvastatin 40 mg/24 h during 12 weeks (n = 12; 69.0 ± 7.3 years; post-bd FEV1 53.4 ± 10.0% pred.) or placebo (n = 12; 66.4 ± 4.6 years; post-bd FEV1 48.2 ± 12.6% pred.). Nine patients per group (total n = 18) completed the study. RESULTS: Lung function, pulmonary and systemic inflammatory markers and the degree of vascular stiffness did not change significantly in any group. However, treatment with simvastatin increased the plasma levels of erythropoietin (Epo) (4.2 ± 2.2 mIU/mL to 6.8 ± 3.2 mlU/mL, p < 0.05) and reduced those of serum uric acid (7.1 ± 1.3 mg/dL to 6.5 ± 1.4 mg/dL, p < 0.01). CONCLUSIONS: Short-term treatment with simvastatin in stable COPD patients did not modify lung function, pulmonary and systemic inflammation, or vascular stiffness, but it changed Epo and uric acid levels.

Abnormal levels of circulating endothelial progenitor cells during exacerbations of COPD.

Cardiovascular morbidity and mortality is increased in patients with chronic obstructive pulmonary disease (COPD). Reduced levels of circulating endothelial progenitor cells (EPCs) are associated with increased risk of death in patients with stable coronary artery disease (CAD). Likewise, during acute events of CAD, the number of circulating EPCs increases under the influence of vascular endothelial growth factor (VEGF) and systemic inflammation. Abnormal levels of circulating EPCs have been reported in patients with COPD. However, the response of EPCs to episodes of exacerbation of the disease (ECOPD) has not been investigated yet. We hypothesized that similar to what occurs during acute events of CAD, levels of circulating EPCs would increase during ECOPD. We compared levels of circulating EPCs (assessed by the % of CD34(+)KDR(+) cells determined by flow cytometry) in patients hospitalized because of ECOPD (n = 35; 65 +/- 9 years [mean +/- SD]; FEV(1) = 46 +/- 15% predicted), patients with stable COPD (n = 44; 68 +/- 8 years; FEV(1) = 49 +/- 17% predicted), smokers with normal lung function (n = 10; 60 +/- 9 years), and healthy never smokers (n = 10; 62 +/- 4 years). To investigate potential mechanisms of EPC regulation, we assessed both VEGF and high-sensitivity C-reactive protein (hsC-RP) in plasma. Our results show that EPC levels were higher (p < 0.05) in patients with ECOPD (1.46 +/- 1.63%) than in those with stable disease (0.68 +/- 0.83%), healthy smokers (0.65 +/- 1.11%), and healthy never smokers (1.05 +/- 1.36%). The percentage of circulating EPCs was positively related to VEGF plasma levels during ECOPD (r = 0.51, p = 0.003). In a subset of 12 patients who could be studied during both ECOPD and clinical stability, the EPCs levels increased during ECOPD. We conclude that EPC levels are increased during ECOPD, likely in relation to VEGF upregulation.

Low erythropoietin plasma levels during exacerbations of COPD.

BACKGROUND: It is known that pro-inflammatory cytokines suppress in vitro the gene expression and protein production of erythropoietin (Epo). We hypothesized that systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) may influence Epo production, particularly during episodes of exacerbation of the disease (ECOPD) where an inflammatory burst is known to occur. OBJECTIVES: We compared the plasma levels of Epo and high-sensitivity (hs) C-reactive protein (hsC-RP) in patients hospitalized because of ECOPD (n = 26; FEV(1): 48 +/- 15% predicted), patients with clinically stable COPD (n = 31; FEV(1): 49 +/- 17% predicted), smokers with normal lung function (n = 9), and healthy never smokers (n = 9). METHODS: Venous blood samples were taken between 9 and 10 a.m. after an overnight fast into tubes with EDTA (10 ml) or without EDTA (10 ml). Plasma levels of Epo (R&D Systems Inc., Minneapolis, Minn., USA) and hsC-RP (BioSource, Belgium) were determined by ELISA. RESULTS: Log-Epo plasma levels were significantly lower (0.46 +/- 0.32 mU/ml) in ECOPD than in stable COPD (1.05 +/- 0.23 mU/ml), smokers (0.95 +/- 0.11 mU/ml) and never smokers with normal lung function (0.92 +/- 0.19 mU/ml) (p < 0.01, each). In a subset of 8 COPD patients who could be studied both during ECOPD and clinical stability, log-Epo increased from 0.49 +/- 0.42 mU/ml during ECOPD to 0.97 +/- 0.19 mU/ml during stability (p < 0.01). In patients with COPD log-Epo was significantly related to hsC-RP (r = -0.55, p < 0.0001) and circulating neutrophils (r = -0.48, p < 0.0001). CONCLUSIONS: These results show that the plasma levels of Epo are reduced during ECOPD likely in relation to a burst of systemic inflammation.

Tabaco y trastornos del sueño / Smoking and Sleep Disorders

El ronquido y el síndrome de apneas-hipopneas durante el sueño (SAHS)son dos enfermedades con una importante relevancia, debido a su elevada prevalencia en lapoblación general y a su destacablemorbimortalidad, asociada sobre todo a sus consecuencias nocivas sobre el sistema cardiovascular. Ademásdel sexo, la edad, el peso, las malformaciones craneofaciales, el consumo de alcohol y los fármacoshipnóticos, se ha postulado que el tabaco puede constituir un factor de riesgo para desarrollar trastornosrespiratorios durante el sueño. Si bien existe una evidencia sólida de la asociación independiente entreronquido y tabaco tanto en niños como en adultos, en el caso del SAHS, a pesar de haber numerosos trabajos que evalúan dicha cuestión, todavía no está suficientemente claro si el tabaco constituye un factor de riesgo independiente para el desarrollo de SAHS, probablemente porque, si tal asociación existe, debe deser muy débil(AU)

Snoring and sleep apnea-hypopnea syndrome (SAHS)are two disorders of considerable relevance due to their high prevalence in the general population and their notable morbidity and mortality, particularly in association with their harmful effects on the cardiovascular system. As well as sex, age, weight, craniofacialmalformations, alcohol consumption, and use of hypnotic drugs, it has been suggested that smoking may be a risk factor for developing sleep-disordered breathing. While there is solid evidence for the independent association between snoring and smoking in both children and adults, it is still unclear whether smoking constitutes an independent risk factor for developing SAHS, despite the many studies carried out to assess this link. This is probably because the association, ifitexists, is very weak(AU)

[Smoking and sleep disorders]. / Tabaco y trastornos del sueño.

Snoring and sleep apnea-hypopnea syndrome (SAHS) are two disorders of considerable relevance due to their high prevalence in the general population and their notable morbidity and mortality, particularly in association with their harmful effects on the cardiovascular system. As well as sex, age, weight, craniofacial malformations, alcohol consumption, and use of hypnotic drugs, it has been suggested that smoking may be a risk factor for developing sleep-disordered breathing. While there is solid evidence for the independent association between snoring and smoking in both children and adults, it is still unclear whether smoking constitutes an independent risk factor for developing SAHS, despite the many studies carried out to assess this link. This is probably because the association, if it exists, is very weak.

Actividad de una unidad de cuidados respiratorios intermedios dependiente de un servicio de neumología / Activity of an Intermediate Respiratory Care Unit Attached to a Respiratory Medicine Department

Introducción y objetivo: El desarrollo de la ventilación no invasiva (VNI) ha aumentado la complejidad de los pacientes ingresados en los servicios de neumología. Por ello, en España y Europa se están incorporando unidades especiales para el seguimiento y tratamiento de pacientes con enfermedades respiratorias graves: las unidades de cuidados respiratorios intermedios (UCRI). El objetivo del presente estudio ha sido describir la actividad de una UCRI dependiente de un servicio de neumología. Esta información puede ser un punto de referencia útil que facilite la implementación de las UCRI en otros hospitales del Sistema Nacional de Salud español. Métodos: De enero a diciembre de 2006, ambos inclusive, se recogió de forma prospectiva y sistemática la actividad realizada en la UCRI del Hospital Universitario Son Dureta. Resultados: Ingresaron 206 pacientes, cuya edad media (±desviación estándar) era de 65±14 años. Los Servicios de Urgencias y Neumología y la Unidad de Cuidados Intensivos (UCI) aportaron, respectivamente, el 67, el 14 y el 12% de todos los ingresos. Los principales diagnósticos de ingreso fueron: agudización de la enfermedad pulmonar obstructiva crónica (EPOC, con 97 casos; 47,1%), neumonía (n=39; 18,9%) e insuficiencia cardíaca (n=17; 8,2%). Del total de pacientes, 121 (59%) precisaron VNI. La estancia media fue de 5±5 días. El 79,1% recibió el alta a camas de hospitalización convencional del propio Servicio de Neumología, el 7,8% requirió ingreso posterior en la UCI y el 9,7% falleció. De los pacientes con agudización de la EPOC (edad media: 66,5±10 años; estancia media: 4,6±4,5 días), el 67% precisó VNI, el 7,2% requirió un ingreso posterior en la UCI y el 8,2% falleció(AU)

Conclusiones: En nuestro país es viable la creación de una UCRI dependiente del servicio de neumología. Estas unidades permiten desarrollar una alta actividad asistencial con un bajo porcentaje de fracasos terapéuticos. La agudización de la EPOC fue el diagnóstico de ingreso más habitual en nuestra UCRI, y la necesidad de tratamiento con VNI, el criterio de ingreso más frecuente(AU)

Background and objectiveWith the development of noninvasive ventilation (NIV), patients with increasingly complex needs have been admitted to respiratory medicine departments. For this reason, such departments in Spain and throughout Europe have been adding specialized respiratory intermediate care units (RICUs) for monitoring and treating patients with severe respiratory diseases. The aim of the present study was to describe the activity of such a RICU. The description may be of use in facilitating the setting up of RICUs in other hospitals of the Spanish National Health Service. MethodsA systematic record of activity carried out in the RICU of the Hospital Universitario Son Dureta between January and December 2006 was kept prospectively. ResultsOf 206 patients with a mean (SD) age of 65 (14) years admitted to the unit, 67% came from the emergency department, 14% from the respiratory medicine department, and 12% from the intensive care unit (ICU). The most common admission diagnoses were exacerbated chronic obstructive pulmonary disease (COPD) (n=97, 47.1%), pneumonia (n=39, 18.9%), heart failure (n=17, 8.2%), and pulmonary vascular diseases (n=18, 8.7%). One hundred twenty-one patients (59%) required NIV. Mean length of stay in the RICU was 5 (5) days. Patients were discharged to the conventional respiratory ward in 79.1% of the cases; 7.8% required subsequent admission to the ICU, and 9.7% died. Of the patients with exacerbated COPD (mean age, 66.5 [10] years; mean length of stay, 4.6 [4.5] days), 67% required NIV, 7.2% required subsequent admission to the ICU, and 8.2% died. ConclusionsThe creation of a RICU by a respiratory medicine department is viable in Spain. Such units make it possible to treat a large number of patients with a low rate of therapeutic failures. Exacerbated COPD was the most common diagnosis on admission to our RICU, and the need for NIV the most common criterion for admission(AU)

[Activity of an intermediate respiratory care unit attached to a respiratory medicine department]. / Actividad de una unidad de cuidados respiratorios intermedios dependiente de un servicio de neumología.

BACKGROUND AND OBJECTIVE: With the development of noninvasive ventilation (NIV), patients with increasingly complex needs have been admitted to respiratory medicine departments. For this reason, such departments in Spain and throughout Europe have been adding specialized respiratory intermediate care units (RICUs) for monitoring and treating patients with severe respiratory diseases. The aim of the present study was to describe the activity of such a RICU. The description may be of use in facilitating the setting up of RICUs in other hospitals of the Spanish National Health Service. METHODS: A systematic record of activity carried out in the RICU of the Hospital Universitario Son Dureta between January and December 2006 was kept prospectively. RESULTS: Of 206 patients with a mean (SD) age of 65 (14) years admitted to the unit, 67% came from the emergency department, 14% from the respiratory medicine department, and 12% from the intensive care unit (ICU). The most common admission diagnoses were exacerbated chronic obstructive pulmonary disease (COPD) (n=97, 47.1%), pneumonia (n=39, 18.9%), heart failure (n=17, 8.2%), and pulmonary vascular diseases (n=18, 8.7%). One hundred twenty-one patients (59%) required NIV. Mean length of stay in the RICU was 5 (5) days. Patients were discharged to the conventional respiratory ward in 79.1% of the cases; 7.8% required subsequent admission to the ICU, and 9.7% died. Of the patients with exacerbated COPD (mean age, 66.5 [10] years; mean length of stay, 4.6 [4.5] days), 67% required NIV, 7.2% required subsequent admission to the ICU, and 8.2% died. CONCLUSIONS: The creation of a RICU by a respiratory medicine department is viable in Spain. Such units make it possible to treat a large number of patients with a low rate of therapeutic failures. Exacerbated COPD was the most common diagnosis on admission to our RICU, and the need for NIV the most common criterion for admission.

[Impact of an on-duty pulmonologist on the activity of a respiratory medicine department]. / Impacto de la presencia de un neumólogo de guardia sobre la actividad de un servicio de neumología.

OBJECTIVE: To evaluate the impact on health care and clinical management of 24-hour coverage by an on-site pulmonologist in a respiratory medicine department. METHODS: In February 2004, a new respiratory medicine 24-hour duty service was started in our hospital. The activity of the on-duty pulmonologist during the following 12 months was systematically and prospectively recorded. The results were put into perspective by comparing the number of monthly admissions and the mean length of stay during the study period with those of the previous 12-month period. RESULTS: During the study period, the on-duty pulmonologist received a mean (SD) of 9.02 (5.27) emergency calls every day, performed 202 diagnostic or therapeutic interventions, and discharged 342 patients. During this period, 1305 patients were admitted to the department (mean length of stay, 8.1 days), whereas in the previous 12 months, with no on-site pulmonologist, 1680 patients were admitted (mean length of stay, 9.0 days). This represents a 22.3% reduction in the annual number of admissions and a reduction in the mean stay by almost 1 day (0.9 days). CONCLUSIONS: The provision of an on-duty pulmonologist was efficient because it facilitated patient turnaround.

Impacto de la presencia de un neumólogo de guardia sobre la actividad de un servicio de neumología / Impact of an on-duty pulmonologist on the activity of a respiratory medicine department

OBJETIVO: Analizar qué impacto asistencial y de gestión clínica tiene la implantación de guardias de presencia física continuada en un servicio de neumología. MÉTODOS: En febrero de 2004 se introdujeron las guardias de neumología en el Hospital Universitario Son Dureta. Durante un año, hasta enero de 2005, se recogió de forma prospectiva y sistemática la actividad realizada por el/la neumólogo/a de guardia. Con objeto de situar estos resultados en perspectiva, se ha comparado el número de ingresos mensuales y su estancia media durante los 12 meses en que se ha dispuesto de guardia de neumología y los 12 meses inmediatamente anteriores. RESULTADOS: Durante los 12 meses evaluados, el/la neumólogo/a de guardia recibió una media ± desviación estándar de 9,02 ± 5,27 avisos urgentes cada día, realizó 202 técnicas diagnósticas/terapéuticas y dio de alta a 342 pacientes. Durante este período ingresaron en el servicio 1.305 pacientes (estancia media: 8,1 días), mientras que en los 12 meses previos, sin guardia de la especialidad, habían ingresado en el servicio 1.680 pacientes (estancia media: 9,0 días); esto supone una reducción del 22,3% del número anual de ingresos y una disminución de la estancia media de los pacientes ingresados de prácticamente un día (0,9 días). CONCLUSIONES: La implantación de guardias de neumología ha sido una medida eficiente, que ha contribuido a agilizar la rotación de los pacientes ingresados

OBJECTIVE: To evaluate the impact on health care and clinical management of 24-hour coverage by an on-site pulmonologist in a respiratory medicine department. METHODS: In February 2004, a new respiratory medicine 24-hour duty service was started in our hospital. The activity of the on-duty pulmonologist during the following 12 months was systematically and prospectively recorded. The results were put into perspective by comparing the number of monthly admissions and the mean length of stay during the study period with those of the previous 12-month period. RESULTS: During the study period, the on-duty pulmonologist received a mean (SD) of 9.02 (5.27) emergency calls every day, performed 202 diagnostic or therapeutic interventions, and discharged 342 patients. During this period, 1305 patients were admitted to the department (mean length of stay, 8.1 days), whereas in the previous 12 months, with no on-site pulmonologist, 1680 patients were admitted (mean length of stay, 9.0 days). This represents a 22.3% reduction in the annual number of admissions and a reduction in the mean stay by almost 1 day (0.9 days). CONCLUSIONS: The provision of an on-duty pulmonologist was efficient because it facilitated patient turnaround