Efecto de la obstrucción de la vía aérea en la medición de la fracción de óxido nítrico exhalado / Effect of airway obstruction when testing exhaled nitric oxide fractionfeno

INTRODUCCIÓN: numerosos trabajos han intentado ver la aplicabilidad de la FeNO para el diagnóstico o para el control y regulación del tratamiento en el asma bronquial. Dado que el significado real de los valores de la FeNO en relación a la obstrucción bronquial sigue siendo incierto, intentar esclarecer esta circunstancia tiene un enorme interés en la práctica clínica diaria. MATERIAL Y MÉTODO: se realizó un estudio de corte trasversal de pacientes diagnosticados de asma leve-moderada, según criterios de la GEMA 2009, durante 9 meses. Se recogieron datos de control de asma (ACQ), FeNO basal, espirometría basal (FEV1), test de metacolina (PD20) y tras broncodilatación. En un subgrupo de pacientes se realizaron espirometrías seriadas. RESULTADOS: Se analizaron 48 asmáticos. La puntuación de ACQ fue de 1,7 ± 0,3 (0,7 - 2) puntos. El FEV1 basal fue 2,93 ± 0,8 (92 ± 16%). Al final del test de la metacolina, tanto el FEV1 como el FeNO caían significativamente respecto a los basales. Los pacientes que estaban en tratamiento con corticoides inhalados tenían unas cifras de FeNO menores que los que estaban sin corticoides: 21,4 ± 10 ppb, frente a 50,2 ± 29 ppb; p0,001. Se encontró una correlación significativa entre la disminución de FeNO, expresado en % del basal y la disminución de FEV1, expresado tanto en cifras absolutas como en % (R = 0,52 y 0,583, respectivamente). Se diseñó una curva ROC, recodificando la variable de disminución de FeNO en dos grupos, según disminuyesen más o menos de un 10% (área bajo la curva de 0,928, p < 0,001). Considerando como punto de corte un 18% de disminución de FEV1, se obtuvo una sensibilidad del 85% y una especificidad del 87%. No se encontraron diferencias en el subgrupo donde se realizaron maniobras espirométricas repetidas. CONCLUSIONES: Existe una afectación de la medida de la FeNO tras las variaciones agudas del calibre bronquial, con pruebas de metacolina y tras broncodilatadores, utilizando sistemas portátiles con sensor electroquímico, debiendo valorarse el impacto de estos hallazgos en el seguimiento de los pacientes asmáticos

INTRODUCTION: several studies have tried to implementFeNOfor diagnosis or to control and regulate bronchial asthma treatments. Given that the significance of FeNO values regardingbronchial obstruction continues to be uncertain, clarifying this circumstance is extremely interesting for daily clinical practice. MATERIAL AND METHOD: across-sectional study was carried out with patients who were diagnosed with mild to moderate asthma, in keeping with the GEMA 2009 criteria, for 9 months. Asthma control data was collected (ACQ), basal FeNO, basal spirometry (FEV1), methacholine test (PD20) and post-bronchodilation. In a sub-group of patients, serial spirometry was carried out. RESULTS: 48 asthmatic patients were analyzed. The ACQ score was 1.7 ± 0.3 (0.7 - 2) points. Basal FEV1 was 2.93 ± 0.8 (92 ± 16%). Upon concluding the methacholine test, both FEV1 andFeNOfell significantly with regards to basal values. Patients treated with inhaled corticosteroids had lower FeNOlevels thanthose not oncorticosteroids: 21.4 ± 10 ppb, compared to 50.2 ± 29 ppb; p < 0.001. A significant correlation was seen between the decrease in FeNO, expressed in percentage of basal values, and the decrease of FEV1, expressed both in absolute values as well as in percentages, R = 0.52 and 0.583, respectively). A ROC (receiver operative curve) analysis was performed, recoding the decreased variable for FeNOinto two groups, based on a reduction of more or less than 10% (area under the curve was 0.928, p <0.001).A 18% cutoff for FEV1 decline had a 85% sensitivity and 87% specificity. No differences were found in the sub-group where repeated spirometrictests were performed. CONCLUSIONS: there is anaffectationwhen measuring FeNOafter acute variations of the bronchial caliber, with methacholine tests and after bronchodilators, using portable systems with electrochemical sensors. The impact of these findings for the follow-up of asthmatic patients must be assessed

[Disparity between cytohistopathological results of diagnostic specimens and the resected tumor piece in bronchopulmonary carcinoma]. / Disparidad entre los resultados citohistopatológicos de los especímenes diagnósticos y la pieza tumoral resecada en el carcinoma broncopulmonar.

In 88 patients diagnosed and intervened of lung carcinoma, we evaluate the security of the Diagnostic method--cytology: sputum, brushed bronchial, bronchial aspiration, puncture pulmonary aspiration and histology of the bronchial biopsy--when we correlate them with the histology of the dried up tumour. From the 88 patient, in 11 (12.5%) there was a disparity between some specimen and the piece tumour. If we analyze the specimen: the bronchial biopsy, was different in 3 cases, (4.8%); the brushed and the bronchial biopsy, aspiration in 2, (2.7% and 2.3% respectively); the puncture pulmonary aspiration in 6, (26%) and the cytology of sputum in 2 cases, (2.4%). In 8 patients (9%), the outputs of some specimen were not conclusive, if we remove these we find that: the bronchial biopsy was not conclusive in 2 cases, (3.2%), the brushed bronchial in 5, (6.8%); the bronchial aspiration in 9 (10.2%) and the cytology of sputum in 2 cases, (2.4%). With this data we could infer that sometimes the positive outputs of the specimen have no correlation with the histology of the tumour dried up. This disparity has not been observed in the oat-cells. Therefore when we send the specimens to the pathologist, it would always be advisable for him to inform us if there are any different cells belonging to the principal group of the tumor.