[Survival in a cohort of patients with chronic obstructive pulmonary disease: comparison between primary and tertiary levels of care]. / Supervivencia en una cohorte con EPOC. Análisis comparativo entre el primer y tercer niveles de atención.

OBJECTIVE: To compare the cumulative probability of survival in a cohort of patients with chronic obstructive pulmonary disease (COPD) attended at primary and tertiary levels of health care. PATIENTS AND METHOD: A cohort study was carried out at the Department of Pneumology of the Centro Medico Nacional La Raza (Mexico DF) on 87 of the 114 patients with confirmed diagnosis of COPD. All patients followed a 6-month physical activity and educational program. Patients underwent the COPD diagnostic tests recommended by the American Thoracic Society and were randomized and distributed in 2 groups: Group A had 44 patients who received tertiary care, and Group B had 43 who received primary care. Follow up lasted from 1993 to 2001. Exacerbations, hospital admissions, exercise duration, hospital stay, and death or study abandonment were recorded for all patients. Respiratory function tests were performed annually. Annual and total mortality, distribution by sex, loss in life expectancy, mean age at death, and cumulative probability of survival were analyzed. RESULTS: No differences were found between the groups in population or initial characteristics. Respiratory function declined in both groups, although the decline was smaller in Group A: mean (SD) forced expired volume in 1 second, 8.93% (8.72%) compared with 17.71% (2.51%) and annual drop in blood pressure of 1.39 mm Hg compared with 1.95 mm Hg. Annual exacerbations were 0.23 in Group A compared with 2.07 in Group B; hospitalizations, 0.06 compared with 0.92, and length of stay, 15.76 days compared with 17.32 days. Mean age at death was 66.12 compared with 60.6; loss of life expectancy was 13.88 years lost compared with 19.4, and the cumulative probability of survival was 0 compared with 0.224. CONCLUSIONS: There are many reasons for the differences found: better medical management, health education, and family involvement at the tertiary level. These factors, included in international COPD guidelines, must be incorporated into primary health care.

[Bronchial nodules produced by Strongyloides stercoralis as the cause of bronchial obstruction]. / Nódulos bronquiales producidos por Strongyloides stercoralis como causa de obstrucción bronquial.

Infection by Strongyloides stercoralis can cause asthma-like symptoms through mechanisms that have not yet been clarified. A 55-year-old male farm worker with a 2-year history of illness diagnosed as asthma and treated unsuccessfully with bronchodilators and corticosteroids was referred to our hospital with severe dyspnea. The initial chest radiograph showed mild air trapping, and pulmonary function tests detected airway obstruction that did not respond to salbutamol. Bronchoscopy revealed multiple nodules protruding into the airway lumen. S. stercoralis larvae were detected in bronchoalveolar lavage fluid and stool samples. Although treatment with albendazole was initiated, the patient's condition worsened over the next 3 days, hemoptysis presented, and the process ended in death. Autopsy demonstrated Strongyloides larvae in the bronchial nodules. Infection by S. stercoralis should be considered in the differential diagnosis of asthmatic-like symptoms refractory to treatment. In such cases nodules may be responsible for obstruction.

[Sensitivity and specificity of a questionnaire about respiratory symptoms similar to asthma]. / Sensibilidad y especificidad de un cuestionario de síntomas respiratorios similares al asma.

INTRODUCTION: Questionnaires are an epidemiological instrument to detect patients with asthma. MATERIALS AND METHODS: Worldwide standardized questionnaires were selected, taking the most important points for making the diagnosis of asthma. A questionnaire was applied to outpatients who attend to pulmonary disease service. The answers were compared with a "gold standard" proposed, consisted in clinical screening and pulmonary function tests. STATISTICAL ANALYSIS: Kappa coefficient, sensitivity, specificity and predictive values were obtained, with intervals of confidence of 95%. RESULTS: The questionnaires were applied to 120 patients, 70.83% women, the answering percentage was 99%. Mean age was 32 years with a range of 24-40. In 62.5% patients there was already a previous diagnosis of asthma. Positive Familial history was present in 65.83, cough in 85%, dyspnea in 80.83%, sneezes in 53.33% and wheezes in 77.5%. The was of kappa coefficient for previous medical diagnosis 0.96%, followed by positive familial history, wheezes and cough in 0.90%. The greatest specificity was for wheezes, dyspnea and previous medical diagnosis. The greatest specificity for previous medical diagnosis was wheezes and sneezes. CONCLUSIONS: The use of questionnaires for respiratory symptoms similar to asthma can be an option to detect groups of high risk.

[Effect of 2 pesticides indoors on the respiratory function of a Mexican population]. / Efecto de dos plaguicidas intramuros en la función respiratoria de una población mexicana.

INTRODUCTION: The utilisation of pesticides in the large cities has been increased. Exist few studies that determine the damage in the respiratory appliance. OBJECTIVE: Determined on a healthy population of Mexico City with two known products used for the control of the insecticides in household, with the main objective to determine the clinical and functional manifestations that its use implies. MATERIAL AND METHODS: They were included 70 sound volunteers with residence in the City of Mexico that lived in apartments with 100 square meters of construction, tobacco negative and without previous antecedents of cardiovascular disease, without acute infectious process. They were split into 2 groups one that inhaled pesticides for combustion and the group b in electric form, In them I accomplished study espirometric to the beginning and during 3 exposed hours. The analysis by T Student. RESULTS: In group A was observed a meaningful difference of 0.01 in the first hour and of p < 0.028 in the second and third hours, with collateral effects as irritation eyes (74%) disnea (57%) cough (43%) and headaches (28%). Group B with a small difference of the VEF-1 in the first hour p < 0.03 and without differences on the following hours. We haven't observed secondary effects according to this group. The analysis en both group we have only differences in the first hours with p < 0.004. CONCLUSION: The exposition to pesticides our group for combustion produces a lot of clinical and functional alterations than the electric pesticides.

Bronchial asthma healthcare costs in Mexico: analysis of trends from 1991-1996 with information from the Mexican Institute of Social Security.

Cost trends for bronchial asthma have not been previously estimated in Mexico. The increasing prevalence of bronchial asthma as well as its elevated costs make it necessary to expand the availability of information for health planners. This is a growing problem which has been given little attention in national health reports. We did a descriptive, retrospective analysis using national data from the Mexican Institute for Social Security. We estimated the number of medical consultations provided by the state family medicine and specialty areas. A total of 756,843 consultations due to bronchial asthma were provided between 1991 and 1996 in the service areas under study. The healthcare expenditure for bronchial asthma showed an ascending and sustained trend during the study period. When analyzing the trends by type of service, a significant increase in in-hospital care was observed, ranging from US $14.5 (1991) to $19.8 (1996) million and a maximum of $28.4 (1994) million. A similar increase was found in specialty consultation, from $3.96 (1991) to $8.5 (1996) million; in emergencies, from $1. 1 (1991) to $2.9 (1996) million; and family medicine, from $0.66 (1991) to $0.79 (1996) million. Bronchial asthma follows the same pattern as other noncommunicable chronic diseases, increasing in highly urbanized areas and nationwide. In order to improve healthcare and maximize results with scarce resources, a set of strategies is presented to reduce bronchial asthma recurrence, decrease healthcare costs, and improve quality of life.

[Dry powdered formoterol, twice a day versus aerosolized salbutamol, four times a day, in patients with stable asthma]. / Formoterol en polvo seco, dos veces al día versus salbutamol aerosol, cuatro veces al día, en pacientes con asma estable.

MATERIAL AND METHODS: The objective of this multicenter, open randomized study was to compare the effect of inhaled formoterol (dry powder with ISF system) 12 mcg twice daily versus salbutamol (200 mg qid) in patients with bronchial asthma. A total of 160 patients were evaluated with such diagnosis in four specialized centers; the main variable was the maximal respiratory flow (MEF) assessed prior to drug administration (morning and afternoon). In addition to this, vital capacity (VC), forced respiratory volume over one second (FEV-1), and other safety variables were also determined. RESULTS: With regard to MEF the administration of formoterol showed better results (P < 0.05) ever since the first month of treatment. The frequency of adverse events was similar between treatment groups; the formoterol group had fewer nightly wake up periods. CONCLUSIONS: That formoterol is a safe, efficacious and long-acting Beta 2 agonist which can be administered twice daily.

[Comparative study of secretory IgA]. / Estudio comparativo de la IgA secretora.

OBJECTIVE: The aim of this study was measure and compare Secretory IgA levels in the respiratory tract. DESIGN: Cross-sectional study. SETTING: Neumology Department of General Hospital. La Raza Medical Center Mexico. MATERIAL AND METHOD: There were 35 volunteers. Samples of sputum, washings nasopharyngeal and bronchial was obtained from thirty five patients with COPD. Measurement of SIgA levels was performed by nephelometric technique. Results is reported as ratio of SIgA concentration/Total proteins concentration named SIgA relative concentration. Correlation index was obtained of three type of samples. RESULTS: The SIgA values of sputum, washings nasopharyngeal and bronchial was similar similar +/- 0.011, 0.064 +/- 0.007 and 0.082 +/- 0.017 respectively). Multiple correlation was r = 0.508 (p < 0.01).

[Measurement of sIgA in patients with chronic stable bronchitis]. / Cuantificación de la SIgA en pacientes con bronquitis crónica estable.

As we know secretory IgA of respiratory system has a very important role in defense mechanism. We studied 100 human beings, 50 healthy persons and 50 chronic bronchitis patients. Lavage nasal samples were tacked from healthy persons and sputum samples from chronic bronchitis patients. The laboratory test was nefelometry laser. Samples were analyzed was 1 student. Our results showed light increased of IgA in chronic bronchitis patients not significative. We concluded that this light increased is secondary to continuous stimulus of bronchial mucous as a part of defense mechanism.