Valores de corte de FEV1/FVC para el diagnóstico de obstrucción al flujo aéreo en población pediátrica: estudio PAO (Pediatric Airflow Obstruction) / FEV1/FVC Cut-off Values for the Diagnosis of Airflow Obstruction in Pediatric Patients: The Pediatric Airflow Obstruction (PAO) Study

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[Translated article] FEV1/FVC Cut-off Values for the Diagnosis of Airflow Obstruction in Pediatric Patients: The Pediatric Airflow Obstruction (PAO) Study / Valores de corte de FEV1/FVC para el diagnóstico de obstrucción al flujo aéreo en población pediátrica: estudio PAO (Pediatric Airflow Obstruction)

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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.

Calidad del diagnóstico de la enfermedad pulmonar obstructiva crónica en el ámbito hospitalario / Diagnosis of COPD in hospitalised patients

ObjetivoConocer la calidad del diagnóstico de enfermedad pulmonar obstructiva crónica (EPOC) en pacientes hospitalizados.Material y métodosAuditoría multicéntrica transversal de revisión retrospectiva de historias clínicas en pacientes a los que se dio de alta con diagnóstico de EPOC. Se consideró diagnóstico correcto (DxC) de EPOC en los casos donde pudo documentarse la combinación de obstrucción bronquial volumen espiratorio forzado en el primer segundo/capacidad vital forzada (FEV1/FVC<70%) y tabaquismo (>10paquetes/año). En el resto de los casos se consideró diagnóstico deficiente (DxD). Se exigió un DxC en al menos el 60% de los pacientes para considerar una calidad asistencial diagnóstica aceptable. Se registraron los datos demográficos, el tabaquismo, la espirometría, el especialista que daba el alta (neumólogos [N], especialistas en Medicina Interna [EM] y especialistas quirúrgicos [EQ]) y el nivel asistencial (hospitales de baja complejidad [H1], hospitales de intermedia complejidad [H2] y hospitales de alta complejidad [H3]).ResultadosSe analizaron 840 casos (718hombres y 122 mujeres), edad media (desviación estándar) de 73 (10), procedentes de 10 hospitales (3 H1, 4 H2 y 3 H3). Se obtuvo un DxD en 597 pacientes (71,1%), motivado bien por falta de criterio espirométrico (538 [64%]) o tabáquico (319 [38%]) (p<0,001). Sólo 2 de los 10 hospitales cumplían el criterio de calidad asistencial diagnóstica aceptable. Se observaron diferencias significativas (p<0,0001) al comparar DxC y DxD por nivel asistencial (DxC: el 56,2% en H1, el 29,9% en H2 y el 20,9% en H3) y por especialista (DxC: el 47,6% por N, el 24,6% por EQ y el 17,4% por EM). Un análisis multivariado relacionó DxC con sexo masculino, H1 e informes neumológicos.Conclusiones1) La calidad asistencial para el diagnóstico de EPOC en hospitales es deficiente y 2) la falta de espirometría es la causa más frecuente de DxD(AU)

ObjectiveTo examine the quality of COPD diagnosis in hospitalised patients.Material and methodsRetrospective multicentre cross-sectional audit review of the clinical histories of patients discharged with a diagnosis of COPD. The diagnosis of COPD was considered correct (DxC) in cases where the combination of a bronchial obstruction (FEV1/FVC<70%) and smoking (>10packets/year) could be documented. In the rest of the cases the diagnosis was considered deficient (DxD). A DxC in at least 60% of patients was required to be considered an acceptable quality health care diagnosis. Demographic data such as, smoking, spirometry, the specialist who discharged the patient (P: Pneumologist; MS: Medical Specialty; CS: Surgical Specialty), and health care level (hospital complexity; low (H1), intermediate (H2) and high (H3)).ResultsA total of 840 cases were analysed (718 males, 122 females); mean age (SD) 73 (10), from 10 hospitals (3 H1, 4 H2, 3 H3). A DxD was obtained in 597 (71.1%), due to either lack of spirometry (538, 64%) or smoking criteria (319, 38%), (P<0.001). Only two of the ten hospitals complied with the criteria of an acceptable quality health care diagnosis. Significant differences (P<0.0001) were seen on comparing DxC and DxD by health care level (DxC: 56.2% in H1, 29.9% in H2, 20.9% in H3), and by specialist (DxC: 47.6% en P, 24.6% in SP, 17.4% in MS). A multivariate analysis associated DxC with the male sex, H1 and pneumology reports.Conclusions1. The quality health care for the diagnosis of COPD is deficient. 2. The lack of spirometry is the most common cause of DxD(AU)

Diagnosis of COPD in hospitalised patients.

OBJECTIVE: To examine the quality of COPD diagnosis in hospitalised patients. MATERIAL AND METHODS: Retrospective multicentre cross-sectional audit review of the clinical histories of patients discharged with a diagnosis of COPD. The diagnosis of COPD was considered correct (DxC) in cases where the combination of a bronchial obstruction (FEV1/FVC<70%) and smoking (>10 packets/year) could be documented. In the rest of the cases the diagnosis was considered deficient (DxD). A DxC in at least 60% of patients was required to be considered an acceptable quality health care diagnosis. Demographic data such as, smoking, spirometry, the specialist who discharged the patient (P: Pneumologist; MS: Medical Specialty; CS: Surgical Specialty), and health care level (hospital complexity; low (H1), intermediate (H2) and high (H3)). RESULTS: A total of 840 cases were analysed (718 males, 122 females); mean age (SD) 73 (10), from 10 hospitals (3 H1, 4 H2, 3 H3). A DxD was obtained in 597 (71.1%), due to either lack of spirometry (538, 64%) or smoking criteria (319, 38%), (P<0.001). Only two of the ten hospitals complied with the criteria of an acceptable quality health care diagnosis. Significant differences (P<0.0001) were seen on comparing DxC and DxD by health care level (DxC: 56.2% in H1, 29.9% in H2, 20.9% in H3), and by specialist (DxC: 47.6% en P, 24.6% in SP, 17.4% in MS). A multivariate analysis associated DxC with the male sex, H1 and pneumology reports. CONCLUSIONS: 1. The quality health care for the diagnosis of COPD is deficient. 2. The lack of spirometry is the most common cause of DxD.