Factors associated with bronchiectasis in patients with uncontrolled asthma; the NOPES score: a study in 398 patients.

BACKGROUND: Some studies have reported a high prevalence of bronchiectasis in patients with uncontrolled asthma, but the factors associated with this condition are unknown. The objective of this study was to determine the prevalence of bronchiectasis in uncontrolled moderate-to-severe asthma and to identify risk factors and their correlation with bronchiectasis in these patients. METHODS: This is a prospective study of data from consecutive patients with uncontrolled moderate-to-severe asthma. Diagnosis of bronchiectasis was based on high-resolution computed tomography. A prognostic score was developed using a logistic regression model, which was used to determine the factors associated with bronchiectasis. RESULTS: A total of 398 patients (60% with severe asthma) were included. The prevalence of bronchiectasis was 28.4%. The presence of bronchiectasis was associated with a higher frequency of chronic expectoration (OR, 2.95; 95% CI, 1.49-5.84; p = 0.002), greater severity of asthma (OR, 2.43; 95% CI, 1.29-4.57; p = 0.006), at least one previous episode of pneumonia (OR, 2.42; 95% CI, 1.03-5.69; p = 0.044), and lower levels of FeNO (OR, 0.98; 95% CI, 0.97-0.99; p = 0.016). The NOPES score was developed on the basis of these variables (FeNO[cut off point 20.5 ppb], Pneumonia, Expectoration and asthma Severity), and it ranges from 0 to 4 points, where 0 means "no risk" and 4 corresponds to "high risk". The NOPES score yielded an AUC-ROC of 70% for the diagnosis of bronchiectasis, with a specificity of 95%. CONCLUSIONS: Almost a third of the patients with uncontrolled moderate-to-severe asthma had bronchiectasis. Bronchiectasis was related to the severity of asthma, the presence of chronic expectoration, a previous history of pneumonia, and lower levels of FeNO. The NOPES score is an easy-to-use scoring system with a high prognostic value for bronchiectasis in patients with uncontrolled moderate-to-severe asthma.

Papel de la prueba de esfuerzo cardiopulmonar en el diagnóstico de la disnea crónica de origen desconocido / Role of the cardiopulmonary stress test in the diagnosis of chronic dyspnoea of unknown aetiology

FUNDAMENTO: El objetivo principal de este trabajo ha sido describir el espectro y frecuencia de causas que provocan disnea de origen desconocido en nuestro medio mediante la realización de la prueba de esfuerzo cardiopulmonar y demostrar su utilidad en el diagnóstico de la disnea crónica, tanto para esclarecer su etiología como para orientar las pruebas posteriores. MÉTODOS: Se ha realizado un estudio descriptivo durante cinco años de los enfermos remitidos a nuestro servicio por disnea crónica de origen desconocido. Todos presentaban una historia clínica, exploración física y pruebas complementarias básicas que no aclaraban su etiología. Se les realizó una prueba de esfuerzo cardiopulmonar, registrándose una serie de parámetros funcionales y arrojando finalmente un diagnóstico ergométrico siguiendo el algoritmo de Wasserman et al.1 RESULTADOS: Fueron incluidos 178 pacientes (92 hombres; edad media 42,5 ± 16,7 años). Por orden de frecuencia los diagnósticos obtenidos fueron: normal o disnea psicógena (71,9%), hiperreactividad bronquial (8,4%), limitación ventilatoria (6,7%),sobrepeso y sedentarismo (3,9%), crisis de HTA (3,9%), limitación cardiocirculatoria (3,4%) y alteración vascular pulmonar (1,7%).No encontramos diferencias entre sexos o entre distintos grupos de edad en cuanto a los diagnósticos ergométricos. CONCLUSIONES: Hemos comprobado que en la mayoría delos casos un diagnóstico de normalidad ha permitido excluir la existencia de enfermedad significativa. Algunos pacientes cuyos resultados fueron patológicos precisaron la realización de nuevas pruebas, sin embargo, al orientar el diagnóstico, el test de esfuerzo permitió hacer una selección más precisa de las mismas, con los consiguientes ahorros en tiempo, dinero y molestias a los pacientes

INTRODUCTION: The principal goal of this study has been to describe the spectrum and frequency of diseases presenting as unexplained dyspnea in our area by means of performing graded cardiopulmonary exercise test and demonstrate its utility in the diagnosis of chronic dyspnea, so much to clear up its etiology as to guide further tests. METHODS: A descriptive study has been performed for five years based in the patients referred to our service with chronic explained dyspnea. All of them presented clinical history, physical examination and basic complementary tests that didn’t clear up its etiology. A graded cardiopulmonary exercise test was performed, recording a series of functional parameters and yielding finally an ergometric diagnosis following the algorithm by Wasserman et al.1RESULTS: 178 patients were entered (92 male; mean age 42,5± 16,7 years). Obtained diagnosis in order or frequency were: normal or psichogenic dyspnea (71,9%), bronchial hyper reactivity (8,4%), pulmonary limitation (6,7%), overweight and deconditioning(3,9%), hypertensive crisis (3,9%), cardiocirculatory limitation(3,4%) and pulmonary vascular alterations (1,7%). We didn’t found significant differences between both sexs or between different groups of age as for the ergometric diagnosis. CONCLUSIONS: After assessing all the results of our study, we saw that in most of cases a normal diagnosis could reject the existence of a significant disease. Some patients whose results were pathological needed the performing of new tests, however, the cardiopulmonary exercise test, thanks to guiding the diagnosis, allowed a more correct selection of them, with the consequent savingsin time, money and bothers to the patients

La broncoscopia flexible con fines diagnósticos: indicaciones, recomendaciones y principales técnicas / No disponible

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