PIMA Study. Improvement of adherence and quality of life of obstructive sleep apnea under CPAP treatment through anintervention based on the stratifcation and personalization of care plans: a randomized controlled trial / Estudio pima. Mejora de la adherencia y de la calidad de vida de la apnea obstructiva del sueño en tratamiento con cpap a través de una intervención basada en la estratificación y personalización de los planes de atención: un ensayo controlado aleatorizado

Introducción. El tratamiento de primera línea para la apnea obstructiva del sueño (AOS) es la terapia de presión positiva continua en las vías respiratorias (CPAP). La falta de adherencia es el principal problema de la CPAP. Se necesita un paciente motivado. El objetivo de este estudio es determinar la adherencia a la CPAP y los resultados relacionados con la salud en pacientes con AOS a través de un programa integral basado en estratificación y planes de atención individualizados, utilizando entrevista motivacional. Métodos. Ensayo controlado aleatorizado multicéntrico realizado en 3 hospitales. El grupo de control siguió el tratamiento habitual. El grupo de intervención (PIMA) siguió el tratamiento con un plan de cuidados adaptado basado en variables sociodemográficas, clínicas y psicológicas, utilizando entrevista motivacional. El resultado principal fue la adherencia (90 y 180 días de tratamiento) y los secundarios fueron la calidad de vida, el estado emocional, las actividades, las relaciones sociales, la competencia percibida y la motivación. Resultados. Se aleatorizaron 213 pacientes (grupo PIMA: 108; grupo de control: 105). Se encontró una diferencia estadísticamente significativa en el grupo PIMA versus el grupo control en la adherencia a los 90 y 180 días: 129.24 (IC95% 77.25-181.22) p < 0.0001 y 288.30 (IC95% 187.146-389.47) p < 0.0001. La adherencia (horas/día) fue mayor en el grupo PIMA comparado con el grupo control (90 días) con una diferencia de 1.74 horas/día (IC95% 1.18-2.30) p < 0.0001 y a los 180 días con una diferencia de 2.31 (IC95% 1.72-2.91) p < 0.001. Los resultados secundarios mostraron diferencias significativas a favor del grupo PIMA. Conclusiones. Se encontró evidencia de que un programa basado en estratificación y planes de atención personalizados, utilizando entrevistas motivacionales, mejora la adherencia a la CPAP y la calidad de vida (AU)

Introduction. The first-line treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP) therapy. Lack of adherence is the main problem with CPAP. A motivated patient is needed. The objective of this study is to determine adherence to CPAP and health-related outcomes in patients with OSA through a comprehensive program based on stratification and individualized care plans, using motivational interviewing. Methods. Multicenter randomized controlled trial (RCT) conducted in 3 hospitals. Control group followed the usual treatment. Intervention group (PIMA) followed the treatment with an adapted care based on sociodemographic, clinical and psychological variables, using motivational interview. The main outcome was adherence (90 and 180 days of treatment), and the secondary outcomes were quality of life, emotional state, activities, social relationships, perceived competence, and motivation. Results. 213 patients were randomized (intervention group: 108; control group: 105). A statistically significant difference was found in the intervention group versus the control group in adherence at 90 and 180 days: 129.24 (IC95% 77.25-181.22) p< 0.0001 and 288.30 (IC95% 187.146-389.47) p< 0.0001. Adherence (hours/day) was higher in the PIMA group compared to the control group at 90 days with a difference of 1.74 hours/day (IC95% 1.18-2.30) p< 0.0001 and at 180 days with a difference of 2.31 (IC95% 1.72-2.91) p< 0.001. The secondary results showed significant differences in favour of the PIMA group. Conclusions. Evidence was found that a program based on stratification and personalized care plans, using motivational interviewing, improves adherence to CPAP and quality of life (AU)

Chronic obstructive pulmonary disease (COPD) in Spain and the different aspects of its social impact: a multidisciplinary opinion document.

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the World, and one of the most important causes of mortality and morbidity. In adults 40 years and older, it affects more than 10% of the population and has enormous personal, family and social burden. Tobacco smoking is its main cause, but not the only one, and there is probably a genetic predisposition that increases the risk in some patients. The paradigm of this disease is changing in Spain, with an increase of women that has occurred in recent years. Many of the physio pathological mechanisms of this condition are well known, but the psychological alterations to which it leads, the impact of COPD on relatives and caregivers, the limitation of daily life observed in these patients, and the economic and societal burden that they represent for the health system, are not so well-known. A major problem is the high under-diagnosis, mainly due to difficulties for obtaining, in a systematic way, spirometries in hospitals and health-care centers. For this reason, the Fundación de Ciencias de la Salud and the Spanish National Network Center for Research in Respiratory Diseases (CIBERES) have brought together experts in COPD, patients and their organizations, clinical psychologists, experts in health economics, nurses and journalists to obtain their opinion about COPD in Spain. They also discussed the scientific bibliometrics on COPD that is being carried out from the CIBERES and speculated on the future of this condition. The format of the meeting consisted in the discussion of a series of questions that were addressed by different speakers and discussed until a consensus conclusion was reached.

20 años en enfermedad intersticial pulmonar / 20 years in pulmonary interstitial disease

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Fibrosis pulmonar idiopática y emociones. Una revisión sobre los aspectos psicológicos de la Enfermedad / Idiopathic pulmonary fibrosis and emotions. A review about psychological aspects of the disease

La fibrosis pulmonar idiopática (FPI) es una enfermedad grave con muy mal pronóstico con una prevalencia estimada de 13 casos/100.000 habitantes en mujeres y 20 casos/100.000 habitantes en varones. La aparición de reacciones psicológicas tales como la ansiedad y la depresión es innegable. Sin embargo, apenas hay estudios sobre el perfil psicológico de pacientes con FPI y por tanto existe una limitación en cuanto a su conocimiento. Otros aspectos psicológicos como la desmoralización, espiritualidad, dignidad, apoyo social y calidad de vida, además de la interrelación en estos constructos, son una incógnita para nosotros en estos pacientes. Su conocimiento permitiría dar una mejor cobertura de sus necesidades de cara a mejorar su calidad de vida. En esta revisión repasamos los trabajos que han atendido los aspectos psicológicos de los pacientes con FPI además de aportar nuestra experiencia en una consulta monográfica en el Hospital Universitario de La Princesa

Idiopathic pulmonary fibrosis (IPF) is a serious disease with a very poor prognosis with an estimated prevalence of 13 cases/100,000 inhabitants in women and 20 cases/100,000 inhabitants in men. The appearance of psychological reactions such as anxiety and depression is undeniable. However, there are hardly any studies on the psychological profile of patients with IPF and therefore there is a limitation regarding their knowledge. Other psychological aspects such as demoralization, spirituality, dignity, social support and quality of life, as well as the interrelation in these constructs, are an unknown to us in these patients. Their knowledge would allow a better coverage of their needs in order to improve their quality of life. In this review, we review the works that have addressed the psychological aspects of patients with IPF, in addition to contributing our experience in a monographic consultation at the Hospital University La Princesa

Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key?

Maxillomandibular advancement (MMA) can be effective for managing obstructive sleep apnoea (OSA); however, limited information is available on the predictor surgical variables. This study investigated whether normalization of the mandibular occlusal plane (MOP) was a determinant factor in curing OSA. Patients with moderate or severe OSA who underwent MMA were evaluated by preoperative and postoperative three-dimensional (3D) scans and polysomnograms. The postoperative value of MOP and the magnitude of skeletal advancement were the predictor variables; change in the apnoea-hypopnoea index (AHI) was the main outcome variable. Thirty-four subjects with a mean age of 41±14years and 58,8% female were analysed. The Epworth Sleepiness Scale (ESS) was 17.4±5.4 and AHI was 38.3±10.7 per hour before surgery. Postoperative AHI was 6.5±4.3 per hour (P<0.001) with 52.94% of the patients considered as cured, and 47.06% suffering from a mild residual OSA with ESS 0.8±1.4 (P<0.001). 3D changes revealed a volume increase of 106.3±38.8%. The mandible was advanced 10.4±3.9mm and maxilla 4.9±3.2mm. MOP postoperative value was concluded to be the best predictor variable. Treatment planning should include MOP normalization and a mandibular advancement between 6 and 10mm. The maxillary advancement would depend on the desired aesthetic changes and final occlusion.

Guía española de la enfermedad pulmonar obstructiva crónica (GesEPOC) 2017: tratamiento farmacológico en fase estable / Spanish guidelines for management of chronic obstructive pulmonary disease (GesEPOC) 2017: pharmacological treatment of stable phase

La enfermedad pulmonar obstructiva crónica (EPOC) presenta una gran heterogeneidad clínica, por lo que su tratamiento se debe individualizar según el nivel de riesgo y el fenotipo. La Guía española de la EPOC (GesEPOC) estableció por primera vez en 2012 unas pautas de tratamiento farmacológico basadas en fenotipos clínicos. Estas pautas han sido adoptadas posteriormente por otras normativas nacionales, y han sido respaldadas por nuevas evidencias publicadas desde entonces. En esta actualización 2017 se ha sustituido la clasificación de gravedad inicial por una clasificación de riesgo mucho más sencilla (bajo o alto riesgo), basándose en la función pulmonar, el grado de disnea y la historia de agudizaciones, y se recomienda la determinación del fenotipo clínico únicamente en pacientes de alto riesgo. Se mantienen los mismos fenotipos clínicos: no agudizador, EPOC-asma (ACO), agudizador con enfisema y agudizador con bronquitis crónica. La base del tratamiento farmacológico de la EPOC es la broncodilatación, y también es el único tratamiento recomendado en pacientes de bajo riesgo. En los pacientes con alto riesgo se añadirán diversos fármacos a los broncodilatadores según el fenotipo clínico. GesEPOC supone una aproximación al tratamiento de la EPOC más individualizado según las características clínicas de los pacientes y su nivel de riesgo o de complejidad.(AU)

The clinical presentation of chronic obstructive pulmonary disease (COPD) varies widely, so treatment must be tailored according to the level of risk and phenotype. In 2012, the Spanish COPD Guidelines (GesEPOC) first established pharmacological treatment regimens based on clinical phenotypes. These regimens were subsequently adopted by other national guidelines, and since then, have been backed up by new evidence. In this 2017 update, the original severity classification has been replaced by a much simpler risk classification (low or high risk), on the basis of lung function, dyspnea grade, and history of exacerbations, while determination of clinical phenotype is recommended only in high-risk patients. The same clinical phenotypes have been maintained: non-exacerbator, asthma-COPD overlap (ACO), exacerbator with emphysema, and exacerbator with bronchitis. Pharmacological treatment of COPD is based on bronchodilators, the only treatment recommended in low-risk patients. High-risk patients will receive different drugs in addition to bronchodilators, depending on their clinical phenotype. GesEPOC reflects a more individualized approach to COPD treatment, according to patient clinical characteristics and level of risk or complexity.(AU)

Tobramycin inhalation powder (TOBI Podhaler) for the treatment of lung infection in patients with cystic fibrosis.

Cystic fibrosis (CF) is an autosomal recessive inherited disease secondary to a defect in the CF transmembrane conductance regulator gene (CFTR). Mortality in CF is associated with impairment of lung function in which bacterial infection plays a fundamental role. The microorganism Pseudomonas aeruginosa (P. aeruginosa) is a marker of poor prognosis. Tobramycin was the first parenteral antibiotic to be used as inhaled medication in CF. Owing to its beneficial effects; it was subsequently used in designed inhaled formulations. The first formulation was the inhalation solution, which improved lung function, lowered hospitalization rates, and reduced the courses of intravenous antibiotic. However, the high associated costs and time necessary to administer the medication negatively affected quality of life. The recent development of tobramycin inhalation powder has optimized treatment. The dry powder inhaler is a simple device that reduces administration time and improves adherence. As there is no risk of bacterial contamination, disinfection is unnecessary.

Valoración de bronquiectasias en pacientes con asma / No disponible

Introducción: Las bronquiectasias (BQ) son la consecuencia final de muchas enfermedades, entre las que se encuentra el asma, sin embargo han sido poco estudiadas. El objetivo principal de este estudio fue evaluar la presencia de BQ mediante una tomografía computarizada de alta resolución (TCAR) en un subgrupo de pacientes con asma mediante el sistema de clasificación de Bhalla. Asimismo, se comparó si existían diferencias clínicas entre los asmáticos que presentaban o no BQ y si estas se relacionaban con las puntuaciones obtenidas en la escala de Bhalla modificada. Material y métodos: Una TCAR pulmonar se realizó a pacientes con asma, durante un periodo de reclutamiento de 2 años, que cumplían las siguientes condiciones: tres o más exacerbaciones respiratorias al año, historia de expectoración habitual o hemoptoica en alguna ocasión, o asma de larga evolución. Los escáneres fueron evaluados por 2 radiólogos siguiendo la puntuación de Bhalla modificada. Resultados: Se observaron BQ en 48 pacientes de los 65 estudios realizados; el 88% de las BQ fueron cilíndricas y el 62% bilaterales, siendo los lóbulos más afectos los lóbulos inferiores y el lóbulo medio. En todos los enfermos que padecían reflujo gastroesofágico (RGE) se evidenciaron BQ. Los enfermos con BQ mostraron peor FVC (p=0,04) y FEV1 (p=0,05) y mayor frecuencia de rinitis. La puntuación total obtenida por la puntuación de Bhalla modificada se relacionó con la media del porcentaje del valor FEV1/FVC (p=0,01), con el número de exacerbaciones (p=0,01), y con la presencia de colonización bacteriana (p=0,001). Conclusiones: Una alta proporción de pacientes asmáticos de control difícil muestran BQ, que suelen ser cilíndricas y bilaterales. Los enfermos con BQ presentan peor función pulmonar. La puntuación total mediante el sistema de Bhalla se relaciona con la presencia de colonización bacteriana y con el número de exacerbaciones

Introduction: Bronchiectasis (BQ) are the final consequence of many diseases, including asthma is, however this has been inconsiderate. The main objective was to evaluate the presence of BQ by high resolution computerized tomography (HRCT) in a subgroup of patients with asthma using a modified Bhalla score. We compared also whether there were clinical differences between asthmatics who presented or not BQ and clinical variables were associated with modified Bhalla scores. Material and methods: Pulmonary HRCT was performed in patients with asthma during a recruitment period of 2 years, who had the following conditions: three or more respiratory exacerbations per year history of coughing or hemoptysis usual on occasion, asthma longstanding and images suggestive of BQ in the chest radiograph. The HRCT were evaluated by 2 radiologists according to the modified Bhalla score. Results: We observed 48 patients with BQ in 65 studies, 88% were cylindrical and bilateral in 62%. The more affected were the lower and middle lobes. All patients suffering from gastroesophageal reflux had evident BQ. Patients with BQ showed worse FEV1 (p = 0.04), FVC (p=0.05) and rhinitis more often. The total modified Bhalla score was related to the average percentage of FEV1/FVC value (p=0.01), the number of exacerbations (p = 0.01), and the presence of bacterial colonization (p = 0.01). Conclusions: A high proportion of patients with difficult asthma clinic have BQ. Usually these BQ are bilateral and cylindrical and the patients with BQ present worse respiratory functional state. Bhalla total score correlated with the presence of bacterial colonization and the number of exacerbations

Sirolimus, una opción terapéutica en la linfangioleiomiomatosis / No disponible

La linfangioleiomiomatosis (LAM) es una enfermedad rara que se caracteriza por la proliferación anormal de células musculares lisas atípicas (células LAM) que condicionan la destrucción del parénquima pulmonar con formación de quistes. A pesar de que el trasplante pulmonar se considera la única opción terapéutica cuando la enfermedad progresa, ensayos clínicos recientes muestran que el tratamiento con sirolimus, fármaco inhibidor de mTOR (mammalian target of rapamycin), puede tener un efecto beneficioso sobre la función pulmonar y la reducción del tamaño de los angiomiolipomas renales que se asocian a la LAM. Presentamos el caso de una mujer de 20 años, diagnosticada de linfangioleiomiomatosis asociada a esclerosis tuberosa, en tratamiento con sirolimus

Lymphangioleiomyomatosis (LAM) is a rare disease that affects young females in their reproductive years. It is characterized by proliferation of abnormal smooth muscle-like cells (LAM cells) leading to progressive cystic destruction of the lung. Even though lung transplantation is considered the only treatment for severe LAM, some recent trials of sirolimus (mTOR inhibitor) showed that there was an improvement in lung function and a reduction in the size of renal angiomyolipomas. We report the case of a twenty years old woman with LAM associated to the tuberous sclerosis complex, who is being treated with sirolimus

Profile of patients treated with omalizumab in routine clinical practice in Spain

BACKGROUND: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain. OBJECTIVE:To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment. METHODS: Retrospective, multicentre study, recording the data on patients of either sex and ≥12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit. RESULTS: 214 patients were evaluable (mean age = 48.2 ± 17.7 years; mean age at the time of diagnosis = 26.6 ± 16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273 ± 205.4 IU/ml. The mean monthly dose was 380.5 ± 185.4 mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7 ± 15.9% vs. 70.8 ± 18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC). CONCLUSIONS: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies

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Diagnóstico precoz de la fibrosis pulmonar idiopática / Early diagnosis of idiopathic pulmonary fibrosis

No disponible

Fibrosis pulmonar idiopática: un reto para la atención primaria / Idiopathic pulmonary fibrosis: A challenge for primary care

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Utilidad de la ventilación mecánica no invasiva (VMNI) en una población anciana con insuficiencia cardíaca aguda / No disponible

Objetivo: Comprobar la eficacia de la ventilación mecánica no invasiva (VMNI) en pacientes ancianos con órdenes de no intubación que ingresan en una Unidad de Monitorización Respiratoria (UMR) en situación de acidosis respiratoria (AR) secundario a insuficiencia cardíaca (IC). Diseño: Estudio prospectivo observacional realizado en la UMR del Hospital Universitario La Princesa (Madrid) durante el periodo comprendido entre octubre 2009 y diciembre 2010. Incluimos un total de 28 pacientes (≥ 70 años) con diagnóstico de ingreso de IC y AR (pH < 7,35 y PaCO2 > 45 mmHg). Resultados: El 64,3% de los pacientes incluidos fueron mujeres. La edad media fue de 79,6 años. Los pacientes tenían comorbilidades frecuentes (índice de Charlson 3,8) y estaban polimedicados (media de fármacos 6). El pH al ingreso fue de 7,24 y la PaCO2 de 82,6 mmHg (7,19 y 88,3 mmHg respectivamente en el grupo de pacientes que fallecieron). Las principales complicaciones durante el ingreso fueron cardiovasculares. La tasa de fallecimientos fue del 25%. La principal causa de reingreso fue la IC. La superviviencia global fue de 60,7%. Discusión: La VMNI es eficaz en el tratamiento de pacientes ancianos con IC y órdenes de no IOT. Los principales factores asociados a mortalidad en nuestro estudio fueron: bajo pH y PaCO2 elevado al inicio de la VMNI, frecuencia respiratoria elevada, mala situación basal, recibir oxigenoterapia crónica domiciliaria (OCD) y presentar ingreso previo con acidosis. Los pacientes que fallecieron tenían una proteína C reactiva (PCR) y recuento leucocitario más bajo

The aim of the study was to evaluate the usefulness of non-invasive ventilation (NIV) in elderly with multiple comorbidities that was taken to hospital with respiratory acidosis (RA) due to heart failure (HF) and survivor after one year follow-up. Design: Observational prospective trial made at the Monitoring Respiratory Unit (MRU) in the Hospital Universitario La Princesa (Madrid) between 2009th October and 2010th December. We included 28 elderly (≥70 years) patients with HF and AR that needed NIV. Results: 64.3% was women. The median age was 79.6 years. Charlson Index was 3.8 and the median of drugs that patients taken was about 6. The aim complication during income was cardiovascular disease. 25% died during admission. The principal diagnosed of re-admission was HF. Global survivor was 60,7%. Discussion: NIV is a good treatment for elderly patients with HF and non-intubation orders. The principal factor associated with mortality was: low pH and high PaCO2 at Emergency department, high respiratory frequency, bad basal situation, home oxygen and previous income with RA

A home telehealth program for patients with severe COPD: the PROMETE study.

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOP) are key events in the natural history of the disease. Patients with more AECOPD have worse prognosis. There is a need of innovative models of care for patients with severe COPD and frequent AECOPD, and Telehealth (TH) is part of these programs. METHODS: In a cluster assignment, controlled trial study design, we recruited 60 patients, 30 in home telehealth (HT) and 30 in conventional care (CC). All participants had a prior diagnosis of COPD with a post-bronchodilator forced expiratory volume (FEV1)% predicted <50%, age ≥ 50 years, were on long-term home oxygen therapy, and non-smokers. Patients in the HT group measured their vital signs on a daily bases, and data were transmitted automatically to a Clinical Monitoring Center for followed-up, and who escalated clinical alerts to a Pneumologist. RESULTS: After 7-month of monitoring and follow-up, there was a significant reduction in ER visits (20 in HT vs. 57 in CC), hospitalizations (12 vs. 33), length of hospital stay in (105 vs. 276 days), and even need for non-invasive mechanical ventilation (0 vs. 8), all p < 0.05. Time to the first severe AECOPD increased from 77 days in CC to 141 days in HT (K-M p < 0.05). There was no study withdrawals associated with technology. All patients showed a high level of satisfaction with the HT program. CONCLUSIONS: We conclude that HT in elderly, severe COPD patients with multiple comorbidities is safe and efficacious in reducing healthcare resources utilization.

Profile of patients treated with omalizumab in routine clinical practice in Spain.

BACKGROUND: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain. OBJECTIVE: To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment. METHODS: Retrospective, multicentre study, recording the data on patients of either sex and ≥12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit. RESULTS: 214 patients were evaluable (mean age=48.2±17.7 years; mean age at the time of diagnosis=26.6±16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273±205.4IU/ml. The mean monthly dose was 380.5±185.4mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7±15.9% vs. 70.8±18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC). CONCLUSIONS: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies.

Treatment switching in idiopathic pulmonary fibrosis: from triple therapy to enrollment into a clinical investigational drug trial.

A number of pharmacological agents have been the focus of clinical trials over the past years. Although no single pharmacological agent is recommended by current guidelines, preliminary negative findings regarding the safety of a triple therapy regimen consisting of prednisone, azathioprine and N-acetylcysteine have raised the question of whether it is no longer a treatment option. More recent data have resulted in the approval of pirfenidone in Europe. Pirfenidone shows a favourable risk-benefit profile and a beneficial effect in reducing the decline in lung function in patients with IPF. This case study describes the diagnosis and initial treatment of a patient with IPF with triple therapy of prednisone, azathioprine and N-acetylcysteine (NAC) followed by inclusion into a double-blind, randomised, placebo-controlled study and subsequent open-label extension trial of pirfenidone in IPF.

Entrenamiento respiratorio en pacientes ingresados en el Servicio de Neumología / No disponible

Introducción: El paciente con patología respiratoria crónica realiza poca actividad física, incluso en fases estables. Durante las exacerbaciones y los ingresos hospitalarios, esa inactividad se incrementa, repercutiendo negativamente en su estado de salud. Objetivo: Describir la aplicación y puesta en marcha de un programa de entrenamiento respiratorio adaptado a diferentes perfiles de pacientes hospitalizados con patología pulmonar, en una sala ubicada de forma innovadora en el Servicio de Neumología y creada con la intención de optimizar el proceso de recuperación del enfermo e incorporación a su vida habitual. Pacientes y Métodos: Se incluyeron los pacientes que ingresaron en el Área de hospitalización del Servicio de Neumología y fueron tratados, una vez estables clínicamente, por el servicio de Rehabilitación y la Unidad de Fisioterapia, desde el 5 de enero de 2010 hasta el 31 de mayo del 2011, con un nuevo protocolo que incorporaba la sala de “Entrenamiento Respiratorio” del servicio de Neumología. Se clasificaron los pacientes en 3 niveles, según el balance muscular del cuádriceps femoral, aplicándose un programa de entrenamiento adaptado a cada paciente y grupo, que incluía fisioterapia respiratoria y cinesiterapia. Se realizó un análisis descriptivo de los datos obtenidos respecto a la muestra y al tratamiento de todos los pacientes. Resultados: Se han tratado 481 pacientes ingresados en el Servicio de Neumología del Hospital Universitario de La Princesa de Madrid. La edad media fue de 69.85 (rango, 15-96), 289 hombres y 192 mujeres, encontrándose el mayor porcentaje de pacientes en el rango entre 80 y 89 años con un 30%, entre 60 y 89 años el 75%, entre 60 y 96 años el 80%. Los diagnósticos principales de los enfermos incluidos fueron: agudizaciones de EPOC 54%, neumonía 12%, fibrosis quística 8%. El 73% de los pacientes presentaban déficit muscular. Con el 100% de los pacientes se realizaron técnicas de fisioterapia respiratoria y con más del 78% cinesiterapia. Conclusiones: Un programa precoz de entrenamiento respiratorio sencillo, que incluya fisioterapia respiratoria y cinesiterapia, es aplicable a un número elevado de pacientes ingresados en un Servicio de Neumología, la mayor parte varones con EPOC, de edad elevada y en el 2/3 de los casos con déficit de fuerza muscular. El programa consigue mantener el balance muscular de los pacientes durante el ingreso, sin que empeore su actividad muscular. Además, logra el aprendizaje de las técnicas de fisioterapia y un cambio de actitud con respecto a la actividad física (AU)

Introduction: A patient with respiratory pathology will develop a low level of physical activity, even in stable stages. In acute stages and during hospital admission the deficiency of physical activity increases significantly, having a negative impact on the general wellbeing of the patient. Objective: To describe the application and implementation of a respiratory training program adapted to different in-patients profiles with pulmonary pathology, on a ward located in Pneumology Service and created with the intention of speeding up the patient’s recovery process and therefore their integration into their normal every day routine. Patients and Methods: Patients form the Pneumology Service were included and were treated by the Rehabilitation Section and the Physiotherapy Unit, between January 5th of 2010 and May 31st of 2011, with the new protocol which incorporates a “Respiratory Training Room” in the Pneumology Service. There were classified in three levels according to the Muscular balance of the quadriceps femoris, applying a training program that was adapted to each individual patient and group, which includes chest physiotherapy and kinesiotherapy. A descriptive analysis was carried out for the data obtained with respect to the sample and the treatment of all patients. Results: We treated 481 patients admitted to the Pneumology Service of La Princesa University Hospital in Madrid. The average age was between 69.85 (range, 15-96), 289 men and 192 women, the biggest percentage of patients being between 80 and 89 years old at 30%, 75% would be between 60 and 89 and 80% would be between 60 and 96 years old. The main diagnoses of patients were: An escalation of EPOC 54%, pneumonia, 12%, cystic fibrosis, 8%.73% of the patients presented a deficit of muscle tone. The 100% of patients underwent chest physiotherapy and somewhat more than 78% underwent kinesitherapy. Conclusions: An early, simple program of chest training which includes chest therapy and kinesitherapy is applicable to a vast number of patients who have been admitted to the Neumology Service, the majority being very elderly men, suffering rom EPOC, two thirds of which present lack of muscle tone and strength. The program achieves maintaining muscular balance of the patients during hospitalization, without worse their muscle activity. Also it achieves learning of physiotherapy techniques and a change of attitude regarding physical activity (AU)