Approach to interstitial lung disease associated with systemic sclerosis-A survey to pulmonologists and rheumatologists in Colombia.

INTRODUCTION: Interstitial lung disease is a leading cause of mortality in patients with systemic sclerosis. Currently, there is a lack of consensus regarding screening, rescreening, diagnosis, and follow-up practices in interstitial lung disease associated with systemic sclerosis (SSc-ILD) in Colombia. METHODS: A structured survey focused on clinical practices in patients with SSc-ILD was conducted. Members of the Asociación Colombiana de Neumología y Cirugía de Tórax (Asoneumocito) and the Asociación Colombiana de Reumatología (Asoreuma) were invited to participate from March 2023 to May 2023. RESULTS: We surveyed 51 pulmonologists and 44 rheumatologists. Overall, 51.6% reported having access to multidisciplinary team discussion in ILD. Among the 95 participants, 78.9% would routinely perform a high-resolution computed tomography scan of the chest once a diagnosis of systemic sclerosis was established. This practice is more frequent among rheumatologists (84.1%) than among pulmonologists (74.5%). Approximately half of the participants would rescreen patients annually with computed tomography scan (56.8%) if baseline images were negative. Spirometry (81.1%), diffusing capacity of the lung for carbon monoxide (80.0%), and 6-min walk test (55.8%) were the most frequently performed tests upon diagnosis of systemic sclerosis. During follow-up, participants would consider repeating pulmonary function tests mostly every 6 months. CONCLUSIONS: Screening of SSc-ILD is high among pulmonologists and rheumatologists. Decision-making on diagnosis and follow-up is similar between specialties, but there are variations in their frequency and indications. Further research is needed to evaluate how to adapt recommendations for assessing SSc-ILD in different settings.

Mapping the Common Barriers to Optimal COPD Care in High and Middle-Income Countries: Qualitative Perspectives from Clinicians.

Purpose: Chronic obstructive pulmonary disease (COPD) poses a significant global health burden despite being largely preventable and treatable. Despite the availability of guidelines, COPD care remains suboptimal in many settings, including high-income countries (HICs) and upper-middle-income countries (UMICs), with varied approaches to diagnosis and management. This study aimed to identify common and unique barriers to COPD care across six countries (Australia, Spain, Taiwan, Argentina, Mexico, and Russia) to inform global policy initiatives for improved care. Methods: COPD care pathways were mapped for each country and supplemented with epidemiological, health-economic, and clinical data from a targeted literature review. Semi-structured interviews with 17 respiratory care clinicians were used to further validate the pathways and identify key barriers. Thematic content analysis was used to generate the themes. Results: Six themes were common in most HICs and UMICs: "Challenges in COPD diagnosis", "Strengthening the role of primary care", "Fragmented healthcare systems and coordination challenges", "Inadequate management of COPD exacerbations", "Limited access to specialized care" and, "Impact of underfinanced and overloaded healthcare systems". One theme, "Insurance coverage and reimbursement challenges", was more relevant for UMICs. HICs and UMICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and availability of specialized care. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. In addition, UMICs also grapple with resource limitations and healthcare infrastructure challenges. Conclusion: Many challenges to COPD care are the same in both HICs and UMICs, underscoring the pervasive nature of these issues. While country-specific issues require customized solutions, there are untapped possibilities for implementing global respiratory strategies that support countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritization of COPD to allocate the essential resources it requires.

Lung Cancer Screening in Community-Based Practice in Puerto Rico: A Survey of Puerto Rico Pulmonologists.

OBJECTIVE: Lung Cancer (LC) in Puerto Rico (PR) is the fifth most common malignancy (5.2%), the third most common among men (5.9%) and the fifth among women (4.6%), with a mortality of 11.3%. Despite current data demonstrating the importance and clinical value for lung cancer screening LDCT Screening among high risk patients remains low regardless of the potential to prevent thousands of lung cancer deaths per year. Due to significant disparities in health care in PR it is believed that LDCT use for lung cancer screening in PR is not been enforced in the private sector. METHODS: A self-administered anonymous survey was provided to a group of pulmonologists at the annual meeting of the PR Pneumology Society. The survey contained questions regarding characteristics of their practice and implementation of lung cancer screening. Provided information was tabulated in percentages. RESULTS: A total of 31 pulmonologists participated in the administration of the survey. Most participants had their medical practice in the metropolitan area (52%), which is the most populated area with best access to physicians and health care services. The sample from the north area comprised 19% of the subjects. All respondents were affiliated to health care institutions. As most of them served 1-3 health care centers (96%) with access to specialized equipment such as Chest CT. Most of the physicians (99%) had availability of chest CT scan within 1 hour from their practices and 97% were aware of the U.S. Preventive Services Task Force lung cancer screening recommendations. Their age range was 41 and over (55%). Despite the above there were discrepancies when asked about lung cancer screening implementation. Sixteen (16) percent did not perform lung cancer screening at all, and 77% that performed screening, reported limitations to it. CONCLUSION: This data suggests that although lung cancer screening has shown to reduce mortality and is recommended by the USPTF, it is not been conducted appropriately in PR. The main limitation identified was what the health insurance had to offer rather than lack of health insurance. Other factor to take in consideration is the lack of a comprehensive screening program for Lung Cancer anywhere in the island. In addition, costs associated with staff and implementation were noted as a significant barrier among the surveyed pulmonologists.

Estruturação de currículo baseado em competências e atividades profissionais confiáveis para formação do Especialista em pneumologia da Santa Casa de Belo Horizonte / Structuring a curriculum based on competencies and entrustable professional activities for the training of pulmonology specialists at Santa Casa de Belo Horizonte

O programa de especialização em Pneumologia da Santa Casa de Belo Horizonte (SCBH), criado em 1984, propôs ter bem estabelecidas as competências que caracterizam o médico pneumologista ali formado, assim como as atividades profissionais a ele confiadas. O presente trabalho teve como propósito estruturar um currículo baseado em atividades profissionais confiáveis (EPA - entrustable professional activities) para formação do médico especialista em pneumologia da Santa Casa de Belo Horizonte. O estudo envolveu elaboração de uma matriz de competências essenciais à formação de um especialista a partir do perfil almejado para o egresso do programa de especialização em pneumologia. Esta matriz de competência foi embasada na matriz de competências de Pneumologia publicada pela Comissão Nacional de Residência Médica do Ministério da Educação do Brasil (CNRM/MEC), no programa educacional baseado em competências desenvolvido pela Unidade de Ensino e Pesquisa da SCBH e na matriz do Royal College of Physicians and Surgeons of Canada (CanMeds). As competências foram agrupadas em seis grandes domínios: 1. Autogestão do Conhecimento; 2. Comunicação; 3. Expertise Técnica; 4. Liderança Colaborativa; 5. Profissionalismo; 6. Responsabilidade Social. Posteriormente, foram definidas e elaboradas as Atividades Profissionais Confiáveis (EPA ­ entrustable professional activities) que foram usadas para a formação do espectro de construção e atuação do especialista em pneumologia da SCBH. Em um segundo momento, as EPAs elaboradas foram discutidas e aprimoradas com um comitê de especialistas em pneumologia. Obteve-se uma matriz de competências com 143 objetivos educacionais distribuídos pelos seis domínios: autogestão do conhecimento (4%), comunicação (17%), expertise técnica (64%), liderança colaborativa (4%), profissionalismo (5%) e responsabilidade social (5%). A partir desta matriz, foram elaboradas 11 EPAs: 1 ­ Cuidado clínico ao paciente com problemas respiratórios em qualquer cenário; 2 ­ Registro em prontuário médico; 3 ­ Prescrição médica do paciente com problemas respiratórios; 4 ­ Solicitação e interpretação de exames complementares; 5 ­ Cuidado ao paciente com insuficiência respiratória; 6 ­ Interconsulta e cuidado ambulatorial de pacientes com problemas respiratórios complexos; 7 ­ Cuidado ao paciente crítico; 8 ­ Manejo dos testes de função pulmonar; 9 ­ Análise diagnóstica do tórax pela imagem; 10 ­ Condução na alta responsável; 11 ­ Procedimento em situação de óbito. A obtenção do currículo baseado em EPAs para formação do especialista em pneumologia da Santa Casa BH favorecerá a avaliação dos especializandos no cenário do serviço e contribuirá para a excelência do cuidado aos portadores de doenças respiratórias

The specialization program in Pulmonology at Santa Casa de Belo Horizonte (SCBH), created in 1984, needed to have well-established skills that characterize the pulmonologists trained there, as well as the professional activities entrusted to them. This work aimed at structuring a curriculum based on entrustable professional activities (EPA) for the training of the pulmonology specialists at Santa Casa de Belo Horizonte. This is a study applied to the reality of the health service, which involved the organization of a matrix of essential competencies for the formation of a specialist in pulmonology from the desired profile of the egress of the pulmonology specialization program, using as reference the matrix of competencies of Pulmonology published by the National Commission of Medical Residency of the Brazilian Ministry of Education (CNRM/MEC - Comissão Nacional de Residência Médica do Ministério da Educação do Brasil), the competency-based educational program developed by the Teaching and Research Unit of SCBH, and the matrix of the Royal College of Physicians and Surgeons of Canada (CanMeds). The competencies were grouped into six major domains: 1. Self-Management of Knowledge; 2. Communication; 3. Technical Expertise; 4. Collaborative Leadership, 5. Professionalism; 6. Social Responsibility. Sequentially, the Entrustable Professional Activities (EPA) were defined and elaborated, characterizing the spectrum of training and practice of specialists in pulmonology by the SCBH. The elaborated EPAs were then discussed and improved by a committee of specialists in pulmonology. A competency matrix was obtained with 143 educational objectives distributed across the six domains: self-management of knowledge (4%), communication (17%), technical expertise (64%), collaborative leadership (4%), professionalism (5%) and social responsibility (5%). From the matrix, 11 EPAs were developed: 1 - Clinical care for patients with respiratory problems in any scenario; 2 - Data entry in medical records; 3 - Medical prescription for the patient with respiratory problems; 4 - Request and interpretation of complementary tests; 5 - Care of the patient with respiratory failure; 6 - Referral and outpatient care of patients with complex respiratory problems; 7 - Care of the critically ill patient; 8 - Management of pulmonary function tests; 9 - Diagnostic image analysis of the thorax; 10 - Responsible discharge; 11 - Procedure in the event of death. The development of the curriculum based on EPAs in the formation of pulmonology specialists at SCBH will favor the evaluation of future specialists in the service scenario and contribute to the excellent care of those with respiratory diseases

Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment?

OBJECTIVE: To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. METHODS: This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. RESULTS: 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). CONCLUSIONS: Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.

Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment? / A baixa escolaridade é um fator limitante para o controle da asma em uma população com acesso a pneumologista e tratamento?

ABSTRACT Objective: To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. Methods: This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. Results: 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). Conclusions: Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.

RESUMO Objetivo: Avaliar se a baixa escolaridade é um fator de risco para asma não controlada em uma população de pacientes que tem acesso a um pneumologista e ao tratamento. Métodos: Estudo transversal com pacientes com diagnóstico de asma, com idade > 10 anos, acompanhados por ao menos três meses por um pneumologista em ambulatórios na cidade de Jundiaí (SP). Os indivíduos responderam a um questionário específico do estudo, ao Questionário de Controle da Asma com seis questões para avaliar o controle dos sintomas da asma e a um questionário para avaliar a adesão ao tratamento. Avaliou-se a correção no uso de dispositivos inalatórios, e os pacientes realizaram espirometria. Resultados: Foram incluídos 358 pacientes. A escolaridade não foi fator de risco para sintomas de asma não controlados (OR = 0,99; IC95%: 0,94-1,05), presença de distúrbio ventilatório obstrutivo na espirometria (OR = 1,00; IC95%: 0,99-1,01), asma não controlada (OR = 1,03; IC95%: 0,95-1,10) e necessidade de dose moderada/alta de medicações inalatórias (OR = 0,99; IC95%: 0,94-1,06). O número de anos de escolaridade foi semelhante nos grupos com e sem adesão ao tratamento (p = 0,08) e nos grupos com e sem erros na utilização do dispositivo inalatório (p = 0,41). Conclusões: Nesta amostra de pacientes com asma que têm acesso a pneumologista e tratamento, a baixa escolaridade não foi um fator limitante para o controle adequado da asma.

Smoking control: challenges and achievements.

Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases. RESUMO O tabagismo é o fator de risco mais prevenível e controlável em saúde e, por isso, precisa ter a máxima atenção e ser muito mais enfocado por todos os profissionais da saúde. O tabaco é um produto de alta rentabilidade pela sua grande produção e pelo elevado número de consumidores. As políticas de controle e os recursos terapêuticos para o tabagismo avançaram muito nos últimos anos e têm mostrado resultados altamente satisfatórios, particularmente no Brasil. Entretanto, ainda resta um longo caminho a ser percorrido para que se possa considerar o tabagismo como uma doença controlada sob o ponto de vista da saúde pública. Já se observam modificações do comportamento da sociedade com relação ao tabagismo, mas ainda em escala muito lenta, de modo que os pneumologistas têm nesse setor um campo muito promissor para atuar junto a seus pacientes e a população em geral. É preciso atuar com maior ímpeto em prol das políticas de saúde e das normas de convívio social que contribuem diretamente para melhorar a saúde e a vida. Nesse aspecto, os pneumologistas podem ter um papel de maior destaque na medida em que se envolvam com o tratamento dos fumantes, a aplicação da lei antifumo e as políticas de saúde relacionadas às doenças respiratórias.

Smoking control: challenges and achievements / Controle do tabagismo: desafios e conquistas

ABSTRACT Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

RESUMO O tabagismo é o fator de risco mais prevenível e controlável em saúde e, por isso, precisa ter a máxima atenção e ser muito mais enfocado por todos os profissionais da saúde. O tabaco é um produto de alta rentabilidade pela sua grande produção e pelo elevado número de consumidores. As políticas de controle e os recursos terapêuticos para o tabagismo avançaram muito nos últimos anos e têm mostrado resultados altamente satisfatórios, particularmente no Brasil. Entretanto, ainda resta um longo caminho a ser percorrido para que se possa considerar o tabagismo como uma doença controlada sob o ponto de vista da saúde pública. Já se observam modificações do comportamento da sociedade com relação ao tabagismo, mas ainda em escala muito lenta, de modo que os pneumologistas têm nesse setor um campo muito promissor para atuar junto a seus pacientes e a população em geral. É preciso atuar com maior ímpeto em prol das políticas de saúde e das normas de convívio social que contribuem diretamente para melhorar a saúde e a vida. Nesse aspecto, os pneumologistas podem ter um papel de maior destaque na medida em que se envolvam com o tratamento dos fumantes, a aplicação da lei antifumo e as políticas de saúde relacionadas às doenças respiratórias.

Tabagismo entre penumologistas resultados preliminares

O autor apresenta os resultados preliminares do inquérito sobre tabagismo que está sendo realizado entre os pneumologistas do Brasil.os números e estimativas expostos representam trinta e oito porcento do universo de cerca de 2.400 membros da Sociedade Brasileira de Penumologia e Tisiologia(SBPT).Com base nas respostas ao questionário padronizado enviado a todos,pode-se estimar que a proporção de fumantes entre os espcialistas seja da ordem de oito,sete porcento,e que vinte,oito porcento sejam ex-fumantes.Comparativamente,é menor que a média nacional vinte e cinco porcento;equivalente entre os sexos,e menor entre os mais jovens(<31anos) ( Resumo na íntegra vide documento)