Evaluating of Red Blood Cell Distribution Width, Comorbidities and Electrocardiographic Ratios as Predictors of Prognosis in Patients with Pulmonary Hypertension.

Pulmonary hypertension is a rare condition that impairs patients' quality of life and life expectancy. The development of noninvasive instruments may help elucidate the prognosis of this cardiorespiratory disease. We aimed to evaluate the utility of routinely performed noninvasive test results as prognostic markers in patients with pulmonary hypertension. We enrolled 198 patients with mean pulmonary artery pressure >25 mmHg measured at cardiac catheterisation or echocardiographic pulmonary artery systolic pressure > 40 mmHg and tricuspid regurgitation Vmax >2.9 m/s, and clinical information regarding management and follow-up studies from the date of diagnosis. Multivariate analysis revealed that female sex [HR: 0.21, (95% CI: 0.07-0.64); p = 0.006], the presence of collagenopathies [HR: 8.63, (95% CI: 2.38-31.32); p = 0.001], an increased red blood cell distribution width [HR: 1.25, (95% CI: 1.04-1.49); p = 0.017] and an increased electrocardiographic P axis (P°)/T axis (T°) ratio [HR: 0.93, (95% CI: 0.88-0.98); p = 0.009] were severity-associated factors, while older age [HR: 1.57, (95% CI: 1.04-1.28); p = 0.006], an increased QRS axis (QRS°)/T° ratio [HR: 1.21, (95% CI: 1.09-1.34); p < 0.001], forced expiratory volume in 1 s [HR: 0.94, (95% CI: 0.91-0.98); p = 0.01] and haematocrit [HR: 0.93, (95% CI: 0.87-0.99); p = 0.04] were mortality-associated factors. Our results support the importance of red blood cell distribution width, electrocardiographic ratios and collagenopathies for assessing pulmonary hypertension prognosis.

Highlights of an Expert Advisory Board on Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD) in Latin America.

Background: Chronic obstructive pulmonary disease (COPD) is a preventable and usually progressive lung disease that affects millions of people worldwide and is the sixth leading cause of death in the Americas. Viral and bacterial respiratory tract infections and air pollution may cause acute exacerbations of COPD (AE-COPD) ranging from mild, moderate to severe. The greatest proportion of the overall COPD burden on the health system is due to disease exacerbations. There is limited evidence regarding the etiology and burden of AE-COPD in Latin America (LATAM). Methods: To respond to this gap in evidence, an Advisory Board with regional pneumologists and infectious disease experts was convened in September 2018 in Panama City, Panama, to: 1) review the burden of AE-COPD in LATAM; 2) evaluate the etiology of AE-COPD in LATAM; and 3) assess and compare the local/regional guidelines to confirm the etiology, characterize, and manage AE-COPD. Results: The results of the meeting showed that there is a high prevalence of AE-COPD in LATAM countries, limited evidence on etiology data, and discrepancies in the case definitions and symptomology (ie, severity) classifications used in LATAM. Conclusion: The Advisory Board discussions further resulted in recommendations for future research on the impact on the epidemiology and burden of disease, on establishing standardized AE-COPD case definition guidelines, and on studying the etiology of both moderate and severe AE-COPD cases.

Varenicline for long term smoking cessation in patients with COPD.

BACKGROUND: Quitting smoking is key for patients with Chronic Obstructive Pulmonary Disease (COPD). Standard recommendations for quitting smoking are implemented for COPD as well. Varenicline Tartrate (VT) is the most effective drug to help quit smoking, but few studies have analysed its effectiveness. AIM OF THE STUDY: To determine the Abstinence Rate (AR) at 12 months, in COPD and non-COPD smokers. METHODS: Observational study in 31 COPD (post bronchodilator-BD FEV1/FVC <0.70) and in 63 non-COPD smokers, were invited to receive treatment with Varenicline Tartrate (VT). Fourteen subjects with COPD and 46 non-COPD subjects received additionally Cognitive-Behavioral Therapy (CBT). Abstinence rate (AR) was validated by exhaled carbon monoxide CO (COe), in addition to a phone or face-to-face interview. Motivation score was measured with a visual analogue scale (MS). RESULTS: Differences between COPD and non-COPD, mean FEV1/FVC ratio 0.52 ±â€¯0.10 vs. 0.90 ±â€¯0.15, age 60 ±â€¯10 vs. 47 ±â€¯10 years, smoking pack-years 37 ±â€¯3.5 vs. 22 ±â€¯12, and COe 16 ±â€¯11 vs. 12 ±â€¯9 ppm were statistically significant (p < 0.05); for MS the score was 93 ±â€¯11 vs. 93 ±â€¯11 and for attempts to quit (AQ) 2 ±â€¯2 vs. 2 ±â€¯3 were not. AR was not significantly different at 12 months (61.2 vs. 42.8% p = 0.072). Motivation was the only significant one-year AR predictor. CONCLUSIONS: COPD smokers had a similar response (higher tendency) to VT regardless of the presence of airflow obstruction and stronger nicotine addiction.

FEV1 decline in patients with chronic obstructive pulmonary disease associated with biomass exposure.

RATIONALE: Biomass exposure is an important risk factor for chronic obstructive pulmonary disease (COPD). However, the time-course behavior of FEV1 in subjects exposed to biomass is unknown. OBJECTIVES: We undertook this study to determine the FEV1 rate decline in subjects exposed to biomass. METHODS: Pulmonary function was assessed every year in a Mexican cohort of patients with COPD associated with biomass or tobacco during a 15-year follow-up period. MEASUREMENTS AND MAIN RESULTS: The mean rate of decline was significantly lower for the biomass exposure COPD group (BE-COPD) than for the tobacco smoke COPD group (TS-COPD) (23 vs. 42 ml, respectively; P < 0.01). Of the TS-COPD group, 11% were rapid decliners, whereas only one rapid decliner was found in the BE-COPD group; 69 and 21% of smokers versus 17 and 83% of the BE-COPD group were slow decliners and sustainers, respectively. A higher FEV1 both as % predicted and milliliters was a predictive factor for decline for BE-COPD and TS-COPD, whereas reversibility to bronchodilator was a predictive factor for both groups when adjusted by FEV1% predicted and only for the TS-COPD group when adjusted by milliliters. CONCLUSIONS: In the biomass exposure COPD group the rate of FEV1 decline is slower and shows a more homogeneous rate of decline over time in comparison with smokers. The rapid rate of FEV1 decline is a rare feature of biomass-induced airflow limitation.

Usefulness of inhaled magnesium sulfate in the coadjuvant management of severe asthma crisis in an emergency department.

RATIONALE: Treatment of severe asthma may be difficult despite the use of several medications including parenteral corticosteroids. Intravenous magnesium sulfate (MgSO(4)) is one ancillary drug for severe crisis; its inhaled use is controversial. OBJECTIVES: To evaluate the usefulness of inhaled MgSO(4) compared to placebo in improving lung function, oxygen saturation, and reducing hospital admission as an adjunct to standard treatment in severe asthma crisis. PATIENTS AND METHODS: We conducted a placebo-controlled, double-blind clinical trial with asthmatic patients >18 years of age with asthmatic crisis and FEV(1)<60% of predicted (%p). All subjects received 125 mg of IV methylprednisolone followed by nebulization with the combination of albuterol (7.5mg) and ipratropium bromide (1.5mg) diluted in 3 ml of isotonic saline solution (as placebo) or 3 ml (333 mg) of MgSO(4). After 90 min, subjects with FEV(1)<60%p or SpO(2)<88% or persistent symptoms were admitted to the emergency department (ED). RESULTS: We included 30 patients per group who were similar at baseline. The MgSO(4) group showed higher post-bronchodilator (post-BD) FEV(1)%p (69+/-13 vs. 61+/-12, p<0.014) and SpO(2) (92+/-4 vs. 88+/-5%, p<0.006) than the placebo group. Fewer treated patients were admitted to the ED (5 vs. 13) (p<0.047), with relative risk (RR) of 0.26 (95% CI 0.079-0.870). CONCLUSIONS: Adding inhaled MgSO(4) treatment to standard therapy in severe asthma crisis improves FEV(1)%p and SpO(2) post-BD and reduces the rate of ED admissions.

Normal breathing during sleep at an altitude of 2240 meters.

BACKGROUND: Mexico City is located at an altitude of 2240 meters (m) above sea level with a mean barometric pressure of 585 mmHg. Normal PaO2 and PaCO2 values in young subjects are 67 and 31 mmHg, respectively. Sleep desaturation, present in normal subjects at sea level, may be more frequent and severe at moderate altitudes. Our objective was to describe breathing during sleep in normal residents at an altitude of 2240 m above sea level. METHODS: Non-obese, long-term residents of Mexico City with normal pulmonary function and without sleep-related symptoms completed a nocturnal polysomnogram. RESULTS: A total of 23 subjects (12 males and 11 females) were studied. Mean age was 45 years (range 20-76 years). Seven subjects (four >60 years of age) presented sleep-disordered breathing (SDB) with apnea-hypopnea index >or=5 h(-1). Mean SaO2 during sleep was 93 +/- 2% and in all subjects was >or=90%. Five subjects without SDB monitored for PO2 tc maintained values of PO2 tc <60 mmHg during one half of the night. During sleep, mean PCO2et was 35 +/- 3 mmHg, breathing frequency 16 +/- 3, and heart rate 65 +/- 9. These values were maintained throughout sleep stages. CONCLUSIONS: Normal long-term residents of Mexico City had slightly lower mean oxygen saturation than that at sea level but >or=90% saturation and experienced transient desaturations. Breathing frequency and heart rate were similar to residents at sea level.