Validity of spirometry performed online.

Spirometry is essential for the diagnosis and management of common respiratory diseases. However, its use and quality are low in primary care. An important reason for this is the technical difficulty in performing conventional spirometry. If high-quality spirometry could be performed online, from the pulmonary function laboratory in hospitals, most of the technical problems could be solved. The aim of the present study was to compare spirometries performed online by remote technicians with conventional spirometry. This was a controlled, randomised crossover study of 261 patients referred from primary care centres for pulmonary consultation. They were randomised to undergo either conventional or online spirometry. The technician, located remotely, controlled the spirometer computer. Using a teleconference link, the technician guided the patient through the spirometry. The comparison between conventional and online spirometries was performed on intention to treat and per protocol bases for spirometric values and quality criteria. Agreement between the two spirometric methods was assessed with a Bland-Altman plot. A subpopulation of off-range patients was also characterised. Finally, intra- and interobserver agreement was evaluated using the intraclass correlation coefficient. No clinically significant differences were seen between the online and conventional spirometric values in both the intention to treat and per protocol analyses. The agreement in Bland-Altman analysis was poorer for intention to treat than for the per protocol analysis. The latter had a lower percentage of off-range patients and high agreement to determine abnormal spirometry in the off-range group. Conventional spirometry had a higher percentage of patients with spirometric quality criteria although the quality criteria difference was only 5.9%, when both procedures were the first to start. Very good agreement was found between intra- and interobserver reliability. Spirometry performed online from a hospital can be an adequate alternative to conventional spirometry for primary care centres.

Guía SEPAR para el tratamiento del tabaquismo en la empresa / SEPAR guide for treatment of smoking habit in the work sites

No disponible

Reducción en el consumo de tabaco como paso previo a la cesación: evidencias científicas disponibles / Reduction in consumption of tobacco as previous step to stopping smoking: available scientific evidence

No disponible

Relación entre la abstinencia puntual a los quince días y el abandono del tabaco a los seis meses / Relationship between punctual abstinence at fifteen days and giving up smoking at six months

Objetivo: valorar la capacidad predictiva del resultado a los 15, 30,60 y 90 días en el resultado obtenido a medio plazo (180 días), en una cohorte de fumadores tratados con terapia sustitutiva (TSN), bupropión (BPP) o terapia combinada (TC), según la normativa SEPAR, en las condiciones clínicas habituales. Pacientes y métodos: estudio multicéntrico, prospectivo, longitudinal, en pacientes mayores de 18 años. Se efectuaron controles a los15, 30, 60, 90 y 180 días, determinándose la abstinencia mediante autorrespuesta y CO en aire espirado conjuntamente. Se ha calculado la probabilidad de haber estado abstinente a los 15, 30, 60 y 90 días, frente a la probabilidad de no haberlo estado a los seis meses (odds ratio y límites de confianza exactos del 95%). En todos los contrastes el nivel de significación estadística aceptado fue de p < 0,05. Resultados: Se incluyeron 904 fumadores, 476 varones y 428 mujeres, edad media de 42,51 ± 10,09 años. No se observó que sexo, edad, comorbilidad, número de cigarrillos/día, historia de paquetes-año, intentos previos de abandono, nivel de dependencia o la concentración inicial de CO guardaran relación con el éxito o fracaso terapéutico. Para el total de los pacientes, solamente permanecer abstinente a los quince días se relacionó de forma independiente con mayor probabilidad de éxito en el tratamiento en el análisis de regresión: la OR ajustada fue 3,11,(LC 95% de 2,80-3,46). El modelo predice el 65,14 % de los eventos. Conclusión: Los resultados del estudio indican que la abstinencia a los 15 días es el predictor más consistente del resultado final (AU)

Objective: To identify the predictive values of smoking abstinence at 15, 30, 60 and 90 days in the outcome at the 180 days in smokers treated with NRT, bupropion or combined therapy (NRT + bupropión)according with the SEPAR guidelines. Patients and methods: multicenter, longitudinal and prospective study in smokers older than 18 years. Evaluations were made at 15,30, 60, 90, and 180 days. In each visit, abstinence was determined by SR and CO measurement in expired air. The probability of abstinence at 15, 30, 60 and 90 days has been calculated against the probability of not have been at 180 days (odds ratio and confiance interval 95 %). The statistic significance level are p < 0,05. Results: The study group included 904 smokers, 476 men and 428 women, with a mean age of 42.5±10.1 years. None of the personal variables(gender, age, comorbility, number of cigarettes smoked per day, Fagerström, CO in aspired air) are predictors of abstinence. Subjects who smoked during weeks 1 and 2 were significantly less likely to be abstinent from smoking at 180 days than those who did not smoke during weeks 1 and 2. The abstinence at 15 days are the better predictive variable with the outcomes at the 180 days (OR 3.11, CI 95%: 2.80-3.46). Conclusión: The 15 days abstinence were the better predictive variable of outcomes at the 180 days (AU)

[Veracity of smokers' reports of abstinence at smoking cessation clinics]. / Veracidad de la respuesta de los fumadores sobre su abstinencia en las consultas de deshabituación tabáquica.

OBJECTIVE: To assess the reliability of smokers' response as criteria for measuring abstinence and the necessity or not of confirming abstinence with carbon monoxide (CO) measurement. PATIENTS AND METHODS: A multicenter, prospective, longitudinal study was carried out on patients over 18 years of age from 5 smoking cessation clinics who underwent treatment with nicotine or bupropion. When the patient attended the clinic at 15, 30, 60, 90, and 180 days, abstinence was checked by self-reporting and expired-air CO levels. Sensitivity, specificity, and positive, negative, and overall predictive value of patient reporting, measured CO levels, and the 2 procedures in combination were calculated. RESULTS: A total of 904 smokers (476 men and 428 women) with a mean (SD) age of 42.51 (10.09) years were enrolled in the study. Of the 904 patients that made up the study population, 820, 776, 687, 719, and 679, respectively, attended the scheduled visits to check abstinence. Self-reported point-prevalence abstinence at 15 days was 74.5% and at 180 days was 57.6% while abstinence determined by expired-air CO was 75.7% and 59.4% respectively. Results according to self-reporting, CO measurement, and the 2 methods in combination were not significantly different (P<.05) at any of the points in time. Neither sensitivity nor specificity showed significant differences in relation to patient variables. CONCLUSION: The reliability of self-reported abstinence from smoking is high. Measurement of CO is therefore not essential, although it could be advisable for motivating patients rather than as a way of confirming abstinence.

Veracidad de la respuesta de los fumadores sobre su abstinencia en las consultas de deshabituación tabáquica / Veracity of smokers´ report of abstinence at smoking cessation clinics

OBJETIVO: Valorar la fiabilidad de la respuesta del fumador como criterio de medida de abstinencia y el carácter de prescindible o indispensable de la determinación de monóxido de carbono (CO) para corroborar dicho criterio. PACIENTES Y MÉTODOS: Se ha realizado un estudio multicéntrico, prospectivo y longitudinal en pacientes mayores de 18 años que acudieron a 5 consultas de tabaquismo y a quienes se pautó tratamiento sustitutivo con nicotina o bupropión. Se efectuaron controles a los 15, 30, 60, 90 y 180 días. En cada control se determinó la abstinencia mediante la respuesta dada por el paciente, la determinación de CO en aire espirado y ambos procedimientos conjuntamente. Se calcularon la sensibilidad, especificidad, valor predictivo positivo, negativo y global de la respuesta dada por el paciente respecto de la determinación de CO. RESULTADOS: Se incluyó en el estudio a 904 fumadores (476 varones y 428 mujeres), con una edad media (± desviación estándar) de 42,51 ± 10,09 años. De los 904 acudieron a los controles programados 820, 776, 687, 719 y 679, respectivamente, que constituyen la población objeto de estudio. La abstinencia puntual a los 15 y 180 días determinada por la respuesta de los pacientes fue del 74,5 y del 57,6%, y mediante determinación de CO en aire espirado del 75,7 y del 59,4%, respectivamente. No se observaron diferencias significativas (p < 0,05) entre los 3 procedimientos a los 15, 30, 60, 90 y 180 días. Ni la sensibilidad ni la especificidad mostraron diferencias estadísticamente significativas entre las distintas categorías de las variables. CONCLUSIÓN: La fiabilidad de la respuesta dada por los pacientes sobre la abstinencia tabáquica es elevada. Por ello la determinación de CO es prescindible y no resulta indispensable, si bien en el seguimiento del proceso puede ser recomendable como factor motivador para el paciente más que como una forma de comprobar la abstinencia

OBJECTIVE: To assess the reliability of smokers’ response as criteria for measuring abstinence and the necessity or not of confirming abstinence with carbon monoxide (CO) measurement. PATIENTS AND METHODS: A multicenter, prospective, longitudinal study was carried out on patients over 18 years of age from 5 smoking cessation clinics who underwent treatment with nicotine or bupropion. When the patient attended the clinic at 15, 30, 60, 90, and 180 days, abstinence was checked by self-reporting and expired-air CO levels. Sensitivity, specificity, and positive, negative, and overall predictive value of patient reporting, measured CO levels, and the 2 procedures in combination were calculated. RESULTS: A total of 904 smokers (476 men and 428 women) with a mean (SD) age of 42.51 (10.09) years were enrolled in the study. Of the 904 patients that made up the study population, 820, 776, 687, 719, and 679, respectively, attended the scheduled visits to check abstinence. Self-reported point-prevalence abstinence at 15 days was 74.5% and at 180 days was 57.6% while abstinence determined by expired-air CO was 75.7% and 59.4% respectively. Results according to self-reporting, CO measurement, and the 2 methods in combination were not significantly different (P<.05) at any of the points in time. Neither sensitivity nor specificity showed significant differences in relation to patient variables. CONCLUSION: The reliability of self-reported abstinence from smoking is high. Measurement of CO is therefore not essential, although it could be advisable for motivating patients rather than as a way of confirming abstinence

Assessment of thoracoabdominal bands to detect respiratory effort-related arousal.

It would be helpful to be able to identify respiratory effort-related arousal (RERA) without needing to measure oesophageal pressure. Thoracoabdominal movements yield an indirect flow measurement from which reduction of amplitude and alteration of the inspiratory flow curve can be detected. The aim of this study was to evaluate the accuracy of using the shape and amplitude of signals from thoracoabdominal bands (inductance plethysmography) to detect RERAs. Altogether, 94 subjects suspected of having sleep apnoea but with an apnoea/hypopnoea index < or = 10 in full polysomnography with oesophageal pressure were studied. A routine polysomnographical analysis was carried out. The polysomnographies were then reanalysed at random to determine which of the identified arousals were due to RERA, as determined either by oesophageal pressure or by induction bands without an oesophageal pressure signal. Altogether, 14,617 arousals were analysed. The sensitivity and specificity to find RERA (arousal by arousal) from bands versus oesophageal pressure were both 94%. The average difference of RERA index between oesophageal pressure and bands was -0.6. The correlation between RERA index determined by oesophageal pressure and bands was 0.98. To evaluate the intra and interobserver agreement, 1183 arousals were additionally analysed. The intraobserver agreement was 91% for RERAs by oesophageal pressure and 80% by bands. The interobserver agreement was 89% by oesophageal pressure and 85% by bands. The thoracoabdominal bands can be used to identify respiratory effort-related arousal (obstructive events not detected by thermistor) with similar efficacy to oesophageal pressure measurement. Since bands are routinely used in most polysomnographies, they can be used as the usual method to detect respiratory effort-related arousal, using a thermistor to evaluate apnoeas and hypopnoeas or as a complement to other methods, such as nasal cannula, which can detect apnoeas, hypopnoeas and respiratory effort-related arousal.

The obesity hypoventilation syndrome can be treated with noninvasive mechanical ventilation.

STUDY OBJECTIVES: To assess the effectiveness of nasal noninvasive mechanical ventilation (NIMV) in patients with obesity hypoventilation syndrome (OHS). DESIGN: Clinical assay that compares two groups of patients with hypercapnic respiratory failure, one group with OHS and the other group with kyphoscoliosis, in their basal situation and after 4 months of treatment with nocturnal NIMV. Thirty-six patients (22 patients with OHS and 14 patients with kyphoscoliosis) completed the study protocol. RESULTS: The frequency of symptoms, such as morning headache, morning drowsiness, dyspnea, and leg edema, improved in a statistically significant way in both groups of patients. The sleepiness improved only in the group with OHS. The comparison of frequency of symptoms between both groups of patients after NIMV treatment did not present statistically significant differences. In the resting situation and without nasal ventilation in place, the PO(2) (mean +/- SD) changed from 51 +/- 10 to 64 +/- 11 mm Hg (p < 0.001) and PCO(2) from 58 +/- 10 to 45 +/- 5 mm Hg (p < 0.001) when the patients with OHS were treated with NIMV. In the group of patients with kyphoscoliosis, likewise without nasal ventilation in place, PO(2) changed from 53 +/- 6 to 65 +/- 5 mm Hg (p < 0.001) and PCO(2) from 59 +/- 11 to 45 +/- 4 mm Hg (p < 0.001) with NIMV treatment. When we compared PO(2) and PCO(2) in both groups of patients at the beginning and at the end of NIMV treatment, we did not find statistically significant differences between OHS and kyphoscoliosis. CONCLUSIONS: NIMV improves the clinical symptoms and the respiratory failure of patients with OHS to a similar degree to that reported for diseases in which its use is completely established, such as kyphoscoliosis. Therefore, NIMV could be an alternative to the treatment of patients with OHS.

Noninvasive positive pressure ventilation and not oxygen may prevent overt ventilatory failure in patients with chest wall diseases.

Some patients with chest wall diseases (CWD) without respiratory failure manifest important alterations in nocturnal gas exchange, as a previous stage to the future development of daytime respiratory failure. The purpose of this study was to evaluate the efficacy of nasal intermittent positive pressure ventilation (NIPPV) during sleep in a group of obese patients and in another group with restrictive thoracic diseases (RTD), comparing the results with those obtained from conventional nocturnal oxygen therapy. From a total of 42 patients with CWD free of daytime respiratory failure, 27 (64%) were considered nocturnal oxygen desaturators without sleep apnea and were included in the study. The study protocol was completed by 21 of these patients. After 2 weeks of treatment, symptoms of dyspnea, morning headaches, and morning obnubilation improved significantly (p<0.05) in both groups of patients after NIPPV but not with oxygen. Baseline daytime PaO2 was 68+/-7 mm Hg in the obese group of patients and 73+/-11 mm Hg in the RTD group. It improved significantly with NIPPV to 73+/-5 mm Hg in obese patients (p<0.05) and to 77+/-12 mm Hg in the RTD group (p<0.05) but did not change with oxygen (68+/-8 mm Hg in the obese group and 73+/-12 mm Hg in the RTD group). Both treatments improved oxygen saturation during sleep, but oxygenation tends to be higher with oxygen than with NIPPV. Only NIPPV was able to normalize the baseline nocturnal alveolar hypoventilation. From the 21 patients treated, 19 decided to continue with long-term NIPPV, one with oxygen, and one refused treatment. We conclude that in patients with CWD who manifest nighttime oxygen desaturation and hypoventilation, early initiation of NIPPV is preferable to supplemental oxygen. Our results also suggest that NIPPV initiated before overt ventilatory failure could prevent its onset.

[Primary ciliary dyskinesia. Electron microscopy study of ciliary ultrastructure]. / Discinesia ciliar primaria. Estudio por microscopia electrónica de la ultraestructura ciliar.

A 75 year old patient with respiratory infections since childhood, bronchiectasis and situs inversus is presented. Fiberoptic bronchoscopy was performed obtaining samples of bronchial mucosa which allowed the observation of the existence of ultrastructural lesions such as ciliary fusion, changes in the form of the cilia, microtubular changes and changes of the dynein arms by electronic microscopic study. Diagnosis of Kartagener's syndrome was established. In the case presented moderate clinical involvement was present which allowed the survival of the patient despite his advanced age.

[Oxygen therapy at a hospital. A routine treatment?]. / Oxigenoterapia en el hospital. Un tratamiento de rutina?

We have studied the use of Oxygen (O2) in our hospital, evaluating the prescription criteria and also the control and degree of therapeutic compliance. The study was completed with an opinion survey to physicians and nurses on different aspects of oxygen-therapy at the hospital. 50 inpatients under treatment with O2 have been studied. Clinical records and therapeutic prescriptions were reviewed. 47 patients had a previous gasometry, of them 44 had Respiratory Insufficiency (RI). 26 patients were controlled during oxygen-therapy: 15 were still on RI and two had their treatment modified. The compliance of treatment was evaluated through a visit in a non regular hour, 18 patients (36%) were not following oxygen therapy. When a new gasometry was performed it was observed that 21 patients (42%) continued in RI. The survey showed that a high number of physicians and nurses consider that oxygen therapy is done inadequately, being this fact attributed to several factors. There are errors in the handling of O2 at the hospital, possible related with the routine associated to an established therapy and also because O2 is a continuous therapy which requires a permanent level of attention both from the health care personnel and from the patient.