Deposition and Clinical Impact of Inhaled Particles in the Lung

Particles suspended in the air we breathe are deposited in the airways as a function of the properties of the particle itself (shape, size and hydration), inspiratory air flow, airway anatomy, breathing environment, and mucociliary clearance. The scientific study of the deposition of inhaled particles in the airways has been conducted using traditional mathematical models and imaging techniques with particle markers. In recent years, the integration of statistical and computer methods, giving rise to a new discipline called digital microfluidics, has led to significant advances. In routine clinical practice, these studies are of great use for optimizing inhaler devices in line with particular characteristics of the drug to be inhaled and the pathology of the patient. (AU)

Síndrome de obesidad-hipoventilación: situación hemodinámica basal e impacto de la ventilación no invasiva / Obesity-Hypoventilation Syndrome: Baseline Hemodynamic Status and Impact of non-Invasive Ventilation

INTRODUCCIÓN: El síndrome de obesidad-hipoventilación (SOH) es un factor de riesgo para presentar insuficiencia cardiaca (IC). Algunos estudios relacionan el uso de ventilación no invasiva (VNI) con la alteración de parámetros hemodinámicos. Nuestro objetivo fue describir la situación hemodinámica de un grupo de pacientes con SOH y estudiar el efecto de la VNI. PACIENTES Y MÉTODOS: Con un diseño transversal de mediciones repetidas, se incluyó a pacientes con SOH tratados con VNI en situación estable. Se estudió su hemodinámica con bioimpedancia: 30 min basales y otros 30 con VNI. Se midieron el gasto cardiaco (GC), el índice cardiaco y el volumen sistólico. Se tomó como referencia el GC calculado para cada paciente expresado como porcentaje sobre su límite inferior de normalidad (LIN) y se establecieron 2 grupos: sin IC con GC conservado (≥ 100% sobre LIN) y con IC y GC bajo (< 100% del LIN). Se utilizaron la U de Mann-Whitney para comparación de variables independientes y el test de Wilcoxon para variables apareadas, se consideró significativo p < 0,05. RESULTADOS: La muestra final fue de 36 casos, de 66 (8) años, 19 (52%) varones. En 17 (46%) detectamos IC con GC de 3,7 l/min (66%) frente al grupo sin IC con 7 l/min (107%). Tras VNI, los pacientes en IC mejoraron su GC (4,5 l/min [77%] p = 0,009) y no lo modificó el grupo sin IC: 6,8 l/min (104%), p = 0,2. CONCLUSIÓN: Un 46% de pacientes con SOH estable presenta IC. La VNI mejora su hemodinámica y no influye en los pacientes con GC conservado

INTRODUCTION: Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV. PATIENTS AND METHODS: Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30minutes at baseline and another 30minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (< 100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P < .05. RESULTS: The final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P = .009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P = .2. CONCLUSION: A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO

Obesity-Hypoventilation Syndrome: Baseline Hemodynamic Status and Impact of non-Invasive Ventilation. / Síndrome de obesidad-hipoventilación: situación hemodinámica basal e impacto de la ventilación no invasiva.

INTRODUCTION: Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV. PATIENTS AND METHODS: Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30minutes at baseline and another 30minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (< 100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P<.05. RESULTS: The final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P=.009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P=.2. CONCLUSION: A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO.

Recomendaciones para la evaluación médica de la capacidad laboral en el enfermo respiratorio crónico / Recommendations for Fitness for Work Medical Evaluations in Chronic Respiratory Patients

Las enfermedades respiratorias crónicas con frecuencia provocan alteraciones en las funciones y/o en la estructura del aparato respiratorio que condicionan limitaciones en diferentes actividades de la vida de las personas que las padecen. En los pacientes más jóvenes y con una vida laboral activa estas limitaciones pueden suponer dificultades para el desempeño de su trabajo habitual. El artículo 41 de la Constitución Española establece que «los poderes públicos mantendrán un régimen público de Seguridad Social para todos los ciudadanos que garantice la asistencia y prestaciones sociales suficientes en casos de necesidad». En este marco se encuadra la evaluación de la incapacidad laboral como un proceso de naturaleza mixta (médico-legal) que tiene por objeto determinar si procede o no el reconocimiento del derecho a una prestación que sustituya las rentas que deja de percibir una persona al no poder desempeñar su trabajo, como consecuencia de una pérdida de la salud. El papel de neumólogo es imprescindible en la evaluación del diagnóstico, tratamiento, pronóstico y capacidad funcional de los enfermos respiratorios. Estas recomendaciones tratan de acercar el complejo ámbito de la valoración de la capacidad laboral a los neumólogos y cirujanos torácicos, ofreciendo unas pautas de actuación que les permitan asesorar a sus propios pacientes acerca de su incorporación a la vida laboral (AU)

Chronic respiratory diseases often cause impairment in the functions and/or structure of the respiratory system, and impose limitations on different activities in the lives of persons who suffer them. In younger patients with an active working life, these limitations can cause problems in carrying out their normal work. Article 41 of the Spanish Constitution states that “the public authorities shall maintain a public Social Security system for all citizens guaranteeing adequate social assistance and benefits in situations of hardship”. Within this framework is the assessment of fitness for work, as a dual-nature process (medico-legal) that aims to determine whether it is appropriate or not to recognize a person's right to receive benefits which replace the income that they no longer receive as they cannot carry out their work, due to loss of health. The role of the pulmonologist is essential in evaluating the diagnosis, treatment, prognosis, and functional capacity of respiratory patients. These recommendations seek to bring the complex setting of fitness for work evaluation to pulmonologists and thoracic surgeons, providing action guidelines that allow them to advise their own patients about their incorporation into working life (AU)

Recommendations for fitness for work medical evaluations in chronic respiratory patients. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).

Chronic respiratory diseases often cause impairment in the functions and/or structure of the respiratory system, and impose limitations on different activities in the lives of persons who suffer them. In younger patients with an active working life, these limitations can cause problems in carrying out their normal work. Article 41 of the Spanish Constitution states that «the public authorities shall maintain a public Social Security system for all citizens guaranteeing adequate social assistance and benefits in situations of hardship¼. Within this framework is the assessment of fitness for work, as a dual-nature process (medico-legal) that aims to determine whether it is appropriate or not to recognise a person's right to receive benefits which replace the income that they no longer receive as they cannot carry out their work, due to loss of health. The role of the pulmonologist is essential in evaluating the diagnosis, treatment, prognosis and functional capacity of respiratory patients. These recommendations seek to bring the complex setting of fitness for work evaluation to pulmonologists and thoracic surgeons, providing action guidelines that allow them to advise their own patients about their incorporation into working life.

[Noninvasive, indirect measurement of pulmonary artery pressure]. / Determinación indirecta y no invasiva de la presión arterial pulmonar.

OBJECTIVE: The gold standard for measuring pulmonary artery pressure (PAP) is right heart catheterization. However, the usefulness of this technique is limited in patients with lung disease because of a poor acoustic window. The aim of this study was to assess PAP in a group of healthy persons using a noninvasive, indirect measurement procedure derived from the venous return flow velocity wave. MATERIAL AND METHODS: Twenty-three healthy volunteers with a mean (SD) age of 34 (9) years were evaluated. Measurements were made with a Hitachi EUB 5000 ultrasound device (3.5 MHz wave). The subject was placed in supine decubitus with neck hyperextended and head turned to one side. B-mode images were used to locate the point in the internal jugular vein 1 cm higher than its union with the subclavian vein. A color flow image was obtained of the vessel and a pulsed wave was then used to measure velocities. After 5 identical cycles, an estimate of PAP was derived from the ratio of maximum diastolic and systolic flow rates. RESULTS: On the right side, the mean (SD) ratio between flow rates was 0.50 (0.08), corresponding to a mean PAP of 15 (2.4) mm Hg. On the left side, the ratio was 0.55 (0.09), corresponding to a mean PAP of 16 (2.8) mm Hg. The nonsignificant difference between mean PAP values on the right and left was 1.3 (3.1) mm Hg, and higher values were on the left. CONCLUSIONS: Mean PAP values obtained with the described procedure are within the normal range for a healthy population. Transcutaneous venous Doppler ultrasound is useful for estimating PAP in healthy individuals.

Determinación indirecta y no invasiva de la presión arterial pulmonar / Noninvasive, indirect measurement of pulmonary artery pressure

Objetivo: El procedimiento de referencia para determinar la presión arterial pulmonar (PAP) es el cateterismo derecho. Clínicamente se usa la ecocardiografía, que presenta limitaciones en pacientes con neumopatía, por mala ventana ecográfica. El objetivo del presente estudio ha sido determinar la PAP en un grupo de personas sanas mediante un procedimiento indirecto e incruento que se basa en la curva de velocidad del retorno venoso. Material y métodos: Se evaluó a 23 voluntarios sanos, con una edad media ± desviación estándar de 34 ± 9 años. Las medidas se realizaron con un ecógrafo Hitachi EUB 5000 (sonda de 3,5 MHz). El procedimiento consiste en situar al sujeto en decúbito supino con el cuello hiperextendido y lateralizado. Se localiza en modo B la vena yugular interna 1 cm por encima de la unión con la subclavia. Con la Doppler color se sigue dicho trayecto y con la Doppler de onda pulsada se obtienen las curvas de velocidades. Tras 5 ciclos idénticos se procede a estimar la PAP a través de la relación de velocidades máximas diastólica y sistólica. Resultados: En el lado derecho, el valor medio de la relación de velocidades fue de 0,50 ± 0,08, que equivale a una PAP media de 15 ± 2,4 mmHg. En el lado izquierdo la relación de velocidades fue de 0,55 ± 0,09, con una PAP media de 16 ± 2,8 mmHg. La diferencia entre las PAP medias derecha e izquierda fue de 1,3 ± 3,1 mmHg, y los valores, más elevados en el lado izquierdo (p no significativo). Conclusiones: Los valores medios de PAP obtenidos con el procedimiento descrito están en el margen de referencia para la población sana. La ecografía Doppler venosa y transcutánea es un procedimiento útil para obtener los valores de PAP en personas sanas

Objective: The gold standard for measuring pulmonary artery pressure (PAP) is right heart catheterization. However, the usefulness of this technique is limited in patients with lung disease because of a poor acoustic window. The aim of this study was to assess PAP in a group of healthy persons using a noninvasive, indirect measurement procedure derived from the venous return flow velocity wave. Material and methods: Twenty-three healthy volunteers with a mean (SD) age of 34 (9) years were evaluated. Measurements were made with a Hitachi EUB 5000 ultrasound device (3.5 MHz wave). The subject was placed in supine decubitus with neck hyperextended and head turned to one side. B-mode images were used to locate the point in the internal jugular vein 1 cm higher than its union with the subclavian vein. A color flow image was obtained of the vessel and a pulsed wave was then used to measure velocities. After 5 identical cycles, an estimate of PAP was derived from the ratio of maximum diastolic and systolic flow rates. Results: On the right side, the mean (SD) ratio between flow rates was 0.50 (0.08), corresponding to a mean PAP of 15 (2.4) mm Hg. On the left side, the ratio was 0.55 (0.09), corresponding to a mean PAP of 16 (2.8) mm Hg. The nonsignificant difference between mean PAP values on the right and left was 1.3 (3.1) mm Hg, and higher values were on the left. Conclusions: Mean PAP values obtained with the described procedure are within the normal range for a healthy population. Transcutaneous venous Doppler ultrasound is useful for estimating PAP in healthy individuals