Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment.

COPD is a typical example of chronic disease. As such, treatment adherence tends to be as low as between 30% and 50%, with specific issues in COPD due to the use of inhaled therapies. Decreased adherence in COPD is associated with worse outcomes, with increased risk for exacerbations and long-term mortality. Factors that impact adherence are multiple, some related to patient, some related to clinicians and finally some related to healthcare system. Among clinician factors, prescription of simplified treatment regimens delivered by an inhaler adapted to the patient's characteristics is crucial. Although it has been observed a huge improvement in the design and usability of inhaler devices for COPD in the last two centuries, there is still a clear gap in this field. Smart inhalers as well as simplified treatment regimens could improve adherence and therefore improve long-term outcomes in COPD.

Lung function and radiological findings 1 year after COVID-19: a prospective follow-up.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has already affected more than 400 million people, with increasing numbers of survivors. These data indicate that a myriad of people may be affected by pulmonary sequelae of the infection. The aim of this study was to evaluate pulmonary sequelae in patients with bilateral COVID-19 pneumonia according to severity 1 year after hospital discharge. METHODS: COVID-FIBROTIC is a multicenter prospective observational cohort study for admitted patients with bilateral COVID-19 pneumonia. Pulmonary functional outcomes and chest computed tomography sequelae were analyzed 12 months after hospital discharge and we classified patients into three groups according to severity. A post hoc analysis model was designed to establish how functional test changed between groups and over time. A multivariable logistic regression model was created to study prognostic factors for lung diffusion impairment and radiological fibrotic-like changes at 12 months. RESULTS: Among 488 hospitalized patients with COVID-19 pneumonia, 284 patients had completed the entire evaluation at 12 months. Median age was 60.5 ± 11.9 and 55.3% were men. We found between-group differences in male sex, length of hospital stay, radiological involvement and inflammatory laboratory parameters. The functional evaluation of pulmonary sequelae showed that severe patients had statistically worse levels of lung diffusion at 2 months but no between group differences were found in subsequent controls. At 12-month follow up, however, we found impaired lung diffusion in 39.8% unrelated to severity. Radiological fibrotic-like changes at 12 months were reported in 22.7% of patients (102/448), only associated with radiological involvement at admission (OR: 1.55, 95% CI 1.06-2.38; p = 0.02) and LDH (OR: 0.99, 95% CI 0.98-0.99; p = 0.046). CONCLUSION: Our data suggest that a significant percentage of individuals would develop pulmonary sequelae after COVID 19 pneumonia, regardless of severity of the acute process. Trial registration clinicaltrials.gov NCT04409275 (June 1, 2020).

[Telephone Support for Copd Patients During COVID-19]. / Soporte telefónico al paciente con EPOC en tiempos de la COVID-19.

The state of alarm declared by the Spanish government as the main measure for preventing contagion has involved a change in the clinical management of chronic patients. Although new communication technologies offer us many ways to establish direct but remote contact, the peculiarities of the COPD patient often mean that their healthcare is reduced to telephone calls. The challenge of caring for COPD patients is made even more complex when it has to be delivered over the phone. The interview must be conducted without examining the patient, without performing additional tests, and without checking their inhalation technique. Therefore, healthcare providers who conduct these interviews must be trained to perform them properly in order to make the right decisions. This document is aimed at healthcare professionals who need to provide some form of telephone care to COPD patients during the SARS-CoV-2 pandemic and is based on the authors' experience in telephone interviews conducted during this period. It summarizes essential aspects of how this interview should be approached, how to conduct it, what factors should be kept in mind, how to organize the interview, and how to keep patients informed. It is very likely that from now on this type of interview will be common practice in the care of our patients, so we need to learn how to structure a new model of healthcare for many of the clinical visits that have until now been conducted face-to-face.

Actividad física y su relación con el estado de salud en pacientes EPOC estables / Physical Activity and its Relationship with the State of Health of Stable Copd Patients

Introducción: Estudios previos han resaltado que la actividad física (AF) en la EPOC se asocia a mejorcalidad de vida y menor morbimortalidad. Nuestro objetivo ha sido conocer los hábitos de AF en la vidadiaria de pacientes EPOC estables fuera de un programa de rehabilitación respiratoria.Material y métodos: Estudio observacional descriptivo transversal multicéntrico en pacientes EPOC establescontrolados ambulatoriamente por neumólogos. Para conocer el índice de AF (IAF) se utilizó elMinnesota Leisure Time Physical Activity Questionnaire (MLTPAQ), diferenciando según el gasto energético,los siguientes grupos: inactivos (menos de 1.000 kcal/semana), moderadamente activos (entre1.000 y 3.000 kcal/semana) y muy activos (más de 3.000 kcal/semana). Se analizó la relación entre el IAFy variables socioeconómicas, de severidad de la enfermedad y de nivel de salud de los pacientes.Resultados: Se incluyó a 132 pacientes (121 varones). Edad media: 66,3 años, FEV1 medio 45%. Un 32,6%de ellos realizaba una AF menor de 1.000 kcal/semana, un 38,6% entre 1.000 y 3.000 y el 28,8% másde 3.000. Los pacientes EPOC más inactivos, tenían mayor obstrucción bronquial, una enfermedad mássevera, referían más disnea y caminaban menos metros en el 6MWT.Conclusiones: Los pacientes EPOC estables realizan un bajo nivel de AF. Una menor AF se asocia con unpeor estado de salud y con una mayor gravedad de la enfermedad(AU)

Introduction: Previous studies have shown that physical activity (PA) in COPD is associated with a betterquality of life and less morbidity and mortality. Our aim was to study the daily PA in the lives of stableCOPD patients, outside the setting of a pulmonary rehabilitation program.Material and methods: Observational, descriptive and transversal multi-center study in patients with stableCOPD controlled in an outpatient clinic by pneumologists. In order to determine the Physical ActivityIndex (PAI), the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) was used to differentiatethe following groups according to the energy expenditure: inactive (less than 1,000 kilocalories perweek), moderately active (between 1,000 and 3,000 kilocalories per week) and very active (more than3,000 kilocalories per week).Weanalyzed the relationship between PAI and disease severity, health level and socioeconomic variables of the patients. Results: A total of 132 patients (121 men) were included in the study. Mean age was 66; mean FEV1was 45%. Regarding PA, 32.6% had energy expenditures of less than 1,000 kilocalories/week, 38.6% between1,000 and 3,000 and 28.8% more than 3,000. The most inactive COPD patients had more bronchialobstruction, more severe disease, more dyspnea and walked fewer meters in the 6MWT.Conclusions: Stable COPD patients perform low levels of PA. Lower PA is associated with poorer healthand with more severe disease(AU)

[Physical activity and its relationship with the state of health of stable COPD patients]. / Actividad física y su relación con el estado de salud en pacientes EPOC estables.

INTRODUCTION: Previous studies have shown that physical activity (PA) in COPD is associated with a better quality of life and less morbidity and mortality. Our aim was to study the daily PA in the lives of stable COPD patients, outside the setting of a pulmonary rehabilitation program. MATERIAL AND METHODS: Observational, descriptive and transversal multi-center study in patients with stable COPD controlled in an outpatient clinic by pneumologists. In order to determine the Physical Activity Index (PAI), the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) was used to differentiate the following groups according to the energy expenditure: inactive (less than 1,000 kilocalories per week), moderately active (between 1,000 and 3,000 kilocalories per week) and very active (more than 3,000 kilocalories per week). We analyzed the relationship between PAI and disease severity, health level and socioeconomic variables of the patients. RESULTS: A total of 132 patients (121 men) were included in the study. Mean age was 66; mean FEV1 was 45%. Regarding PA, 32.6% had energy expenditures of less than 1,000 kilocalories/week, 38.6% between 1,000 and 3,000 and 28.8% more than 3,000. The most inactive COPD patients had more bronchial obstruction, more severe disease, more dyspnea and walked fewer meters in the 6MWT. CONCLUSIONS: Stable COPD patients perform low levels of PA. Lower PA is associated with poorer health and with more severe disease.