Parámetros basales de la espirometría que pueden influir en la prueba de broncodilatación / Baseline spirometry parameters that can influence the bronchodilation test

OBJETIVO: Estudiar si los parámetros basales de la espirometría forzada pueden influir en la positividad de la prueba de broncodilatación (PBD) y si esto pudiera influir en futuros criterios de positividad. MATERIAL Y MÉTODOS: Estudio descriptivo transversal multicéntrico con emplazamiento en Atención Primaria. Fueron incluidos todos los pacientes derivados por su médico de familia, para la realización de espirometría forzada por tabaquismo, síntomas respiratorios o seguimiento de enfermedades respiratorias, entre los meses de junio de 2015 y febrero de 2017. A todos ellos se les realizó una espirometría forzada con PBD. RESULTADOS: Se incluyeron 295 pacientes, con una edad media de 53,4+/-15,5 años, el 62% fueron hombres. En el 20% de las espirometrías se obtuvo un patrón obstructivo; presentando el 67,5% una obstrucción leve, 18% moderada, 9,6% moderada-grave y un 4,8% muy grave. El 8,8% de las espirometrías obtuvieron PBD positiva; 11,2% fueron positivas únicamente en volumen y el 17,6% fueron positivas únicamente en porcentaje. Se observó que los pacientes con una PBD positiva en porcentaje presentaban de forma basal menor volumen espiratorio forzado en el primer segundo (1,66 l/sg vs.2,74 l/sg; p <0,001), y menor capacidad vital forzada (2,85 l vs.3,73 l; p < 0,001). Los pacientes con PBD positiva en volumen presentaban menor volumen espiratorio forzado en el primer segundo (2,59 l/sg vs.2,62 l/sg; p <0,001), y mayor capacidad vital forzada (3,89 l vs.3,58 l; p < 0,001). CONCLUSIONES: El volumen espiratorio forzado en el primer segundo y la capacidad vital forzada basales influyen en la positividad de la PBD. Debería valorarse esta circunstancia a la hora de establecer los criterios de positividad de la PBD

OBJECTIVE: To determine whether the baseline parameters of forced spirometry can influence the positivity of the bronchodilation test (BDT), and whether this could have an influence in future positivity criteria. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted in a Primary Care setting. It included all patients referred by their family doctor to perform a forced spirometry test due to smoking, respiratory symptoms, or follow-up of respiratory diseases, between the months of June 2015 and February 2017. All of them were subjected to a forced spirometry with a BDT. RESULTS: A total of 295 patients were included, with a mean age 53.4+/-15.5 years, and 62% were male. An obstructive pattern was obtained in 20% of the spirometries, with 67.5% presenting with a mild obstruction, 18% a moderate, 9.6% moderate to severe, and 4.8% very severe. The BDT was positive in 8.8% of the spirometries, with 11.2% only positive in volume, and 17.6% were only positive in percentage. It was observed that the patients with a BDT positive in percentage had a lower base forced expiry volume in the first second (1.66 L/sec vs.2.74 L/sec; P<.001), and a lower forced vital capacity (2.85 l vs.3.73 l; P<.001). The patients with a positive BDT in volume had a lower forced expiry volume in the first second (2.59 l/sec vs.2.62 l/sec; P<.001), and a higher forced vital capacity (3.89 l vs.3.58 l; P<.001). CONCLUSIONS: The baseline forced expiry volume in the first second and forced vital capacity have an influence in the positivity of the BDT. This circumstance should be assessed when establishing the positivity of the BDT

Riesgo de declive funcional en pacientes ancianos no institucionalizados / Functional decline risk in elderly patients not institutionalized

OBJETIVO: Valorar el riesgo de declive funcional (DF) mediante varias escalas de predicción. MATERIAL Y MÉTODOS: Estudio multicéntrico, observacional y corte transversal, dirigido a una población de 70 años o más del área de salud de Toledo. Se excluyeron los pacientes institucionalizados, terminales y dependientes para 3 o más actividades básicas de la vida diaria. La muestra (480 pacientes), fue calculada para: prevalencia DF estimada del 15%, precisión 2%, nivel de confianza 95 y 10% de pérdidas estimadas. Muestreo estratificado, primero por conglomerados (centros de salud) y posteriormente muestreo sistemático (1/15) por listado de pacientes ordenados por edad. Tasa de respuesta: 98%. VARIABLES: Sociodemográficas, de morbilidad, cuestionarios para evaluar la capacidad funcional para las actividades básicas (índice de Katz) e instrumentales (índice de Lawton-Brody) de la vida diaria y reglas de predicción de riesgo de DF (SHERPA, TRST, ISAR-PC e Inouye). Aprobado por el Comité Ético de Investigación Clínica de Toledo. RESULTADOS: Media de edad: 77,94 (DS: 6,27) años, el 54,4% mujeres. Media de enfermedades: 4,38 (DS: 2,17) y de fármacos: 5,57 (DS: 3,35). Riesgo de DF según las reglas de predicción: SHERPA: 32,7% (IC95%: 28,52-36,88) (riesgo leve: 17,2% [IC95%: 13,83-20,57]; moderado: 9,7% [IC95%: 7,06-12,34] y alto: 5,8% [IC95%: 3,72-7,88]); TRST: 42% (IC95%: 37,6-46,4); ISAR-PC: 75,4% (IC95%: 71,14-78,86); Inouye: 49,3% (IC95% 44,84-53,76) (riesgo medio: 44,5% [IC95%: 40,07-48,93] y riesgo alto: 4,8% [IC95%: 2,89-6,71]). CONCLUSIONES: Porcentaje importante de pacientes en riesgo de DF, pero gran variabilidad entre las distintas reglas. En general, el riesgo es inferior al encontrado en otros estudios, siendo necesario validar nuevas reglas adaptadas a nuestro medio

OBJECTIVE: To assess the risk of functional decline (DF) by using several prediction scales. MATERIAL AND METHODS: A multicentre, observational, cross-sectional study was conducted on a population of 70 years or more in the health area of ??Toledo. Institutionalised, terminal ill, and patients dependent for three or more basic activities of daily life, were excluded. The sample (480 patients) was calculated for an estimated DF prevalence of 15%, accuracy 2%, confidence level 95%, and 10% of estimated losses. Stratified sampling; first by conglomerates (Health Centres) and then systematic sampling (1/15) by list of patients ordered by age. Response rate: 98%. VARIABLES: Sociodemographic, morbidity, questionnaires to assess the functional capacity for basic activities (Katz index), and tools (Lawton-Brody index) of daily life and risk prediction rules of DF (SHERPA, TRST, ISAR-PC and Inouye). Approved by the Clinical Research Ethics Committee of Toledo. RESULTS: The mean age was 77.94 (SD: 6.27), with 54.4% women. Mean number of illnesses: 4.38 (SD: 2.17) and drugs: 5.57 (SD: 3.35). Risk of DF according to the prediction rules: SHERPA: 32.7% (95% CI: 28.52-36.88) (slight risk: 17.2% [95% CI: 13.83-20.57]; moderate: 9.7% [95% CI: 7.06-12.34] and high: 5.8% [95% CI: 3.72-7.88]); TRST: 42% (95% CI: 37.6-46.4); ISAR-PC: 75.4% (95% CI: 71.14-78.86); Inouye: 49.3% (95% CI: 44.84-53.76) (mean risk: 44.5% [95% CI: 40.07-48.93], and high: risk 4.8% [95% CI: 2.89-6.71]). CONCLUSIONS: A significant percentage of patients are at risk of DF, but there is a wide variation between the different rules. In general, the risk is lower than that found in other studies, and it is necessary to validate new rules adapted to our environment

[Functional decline risk in elderly patients not institutionalized]. / Riesgo de declive funcional en pacientes ancianos no institucionalizados.

OBJECTIVE: To assess the risk of functional decline (DF) by using several prediction scales. MATERIAL AND METHODS: A multicentre, observational, cross-sectional study was conducted on a population of 70 years or more in the health area of ??Toledo. Institutionalised, terminal ill, and patients dependent for three or more basic activities of daily life, were excluded. The sample (480 patients) was calculated for an estimated DF prevalence of 15%, accuracy 2%, confidence level 95%, and 10% of estimated losses. Stratified sampling; first by conglomerates (Health Centres) and then systematic sampling (1/15) by list of patients ordered by age. Response rate: 98%. VARIABLES: Sociodemographic, morbidity, questionnaires to assess the functional capacity for basic activities (Katz index), and tools (Lawton-Brody index) of daily life and risk prediction rules of DF (SHERPA, TRST, ISAR-PC and Inouye). Approved by the Clinical Research Ethics Committee of Toledo. RESULTS: The mean age was 77.94 (SD: 6.27), with 54.4% women. Mean number of illnesses: 4.38 (SD: 2.17) and drugs: 5.57 (SD: 3.35). Risk of DF according to the prediction rules: SHERPA: 32.7% (95% CI: 28.52-36.88) (slight risk: 17.2% [95% CI: 13.83-20.57]; moderate: 9.7% [95% CI: 7.06-12.34] and high: 5.8% [95% CI: 3.72-7.88]); TRST: 42% (95% CI: 37.6-46.4); ISAR-PC: 75.4% (95% CI: 71.14-78.86); Inouye: 49.3% (95% CI: 44.84-53.76) (mean risk: 44.5% [95% CI: 40.07-48.93], and high: risk 4.8% [95% CI: 2.89-6.71]). CONCLUSIONS: A significant percentage of patients are at risk of DF, but there is a wide variation between the different rules. In general, the risk is lower than that found in other studies, and it is necessary to validate new rules adapted to our environment.

[Baseline spirometry parameters that can influence the bronchodilation test]. / Parámetros basales de la espirometría que pueden influir en la prueba de broncodilatación.

OBJECTIVE: To determine whether the baseline parameters of forced spirometry can influence the positivity of the bronchodilation test (BDT), and whether this could have an influence in future positivity criteria. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted in a Primary Care setting. It included all patients referred by their family doctor to perform a forced spirometry test due to smoking, respiratory symptoms, or follow-up of respiratory diseases, between the months of June 2015 and February 2017. All of them were subjected to a forced spirometry with a BDT. RESULTS: A total of 295 patients were included, with a mean age 53.4±15.5 years, and 62% were male.An obstructive pattern was obtained in 20% of the spirometries, with 67.5% presenting with a mild obstruction, 18% a moderate, 9.6% moderate to severe, and 4.8% very severe. The BDT was positive in 8.8% of the spirometries, with 11.2% only positive in volume, and 17.6% were only positive in percentage. It was observed that the patients with a BDT positive in percentage had a lower base forced expiry volume in the first second (1.66 L/sec vs. 2.74 L/sec; P<.001), and a lower forced vital capacity (2.85 l vs.3.73 l; P<.001). The patients with a positive BDT in volume had a lower forced expiry volume in the first second (2.59 l/sec vs. 2. 62 l/sec; P<.001), and a higher forced vital capacity (3.89 l vs. 3.58 l; P<.001). CONCLUSIONS: The baseline forced expiry volume in the first second and forced vital capacity have an influence in the positivity of the BDT. This circumstance should be assessed when establishing the positivity of the BDT.