Decalogue for the selection of oral antibiotics for lower respiratory tract infections.

Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options beta-lactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected.

[Oral antibiotic treatment of exacerbation of COPD. Beyond COVID-19]. / Tratamiento antibiótico oral de la exacerbación de la EPOC. Más allá de la COVID-19.

COPD (chronic obstructive pulmonary disease) includes patients with chronic bronchitis and / or emphysema who have in common the presence of a chronic and progressive airflow obstruction, with symptoms of dyspnea and whose natural history is modified by acute episodes of exacerbations. Exacerbation (EACOPD) is defined as an acute episode of clinical instability characterized by a sustained worsening of respiratory symptoms. It is necessary to distinguish a new EACOPD from a previous treatment failure or a relapse. EACOPD become more frequent and intense over time, deteriorating lung function and quality of life. The diagnosis of EACOPD consists of 3 essential steps: a) differential diagnosis; b) establish the severity, and c) identify its etiology. The main cause of exacerbations is infection, both bacterial and viral. Antibiotics are especially indicated in severe EACOPD and the presence of purulent sputum. Beta-lactams (amoxicillin-clavulanate and cefditoren) and fluoroquinolones (levofloxacin) are the most widely used antimicrobials. This review updates the problem of acute exacerbation with infectious origin from the perspective of etiology, antimicrobial resistance, microbiological studies, risk stratification, and antimicrobial management. The risk, prognosis and characteristics of COPD patients who develop COVID19 are analyzed.

Are serotonergic system genes associated to smoking cessation therapy success in addition to CYP2A6?

Despite progress made in the treatment of tobacco dependence, currently available treatments are effective for only a fraction of smokers. The aim of this study was to evaluate the association between the effectiveness of treatment with nicotine or bupropion in heavy smokers (n=70), and 6 candidate polymorphisms in CYP2A6, 5-HTT and HTR2A genes. Analysis revealed a significant association between "favourable" genotype combination carriers (CYP2A6 "slow metabolizer" or 5HTT L-allele or HTR2A-1438GG) and nicotine treatment outcome (OR=2.69, 95% CI=1.28-5.64). Genetic variations in CYP2A6 gene or genotypes associated with reduced synaptic serotonin activity may influence the success of smoking cessation treatment.

Humidificación del aire inspirado y oxigenoterapia crónica domiciliaria / Humidification of inspired air and long term domicilliary oxygen therapy

La utilización de humidificadores en el domicilio es una práctica habitual en pacientes en programas de oxigenoterapia domiciliaria, probablemente derivada de su amplio uso en el ámbito hospitalario. Sin embargo, las evidencias disponibles y las guías clínicas aconsejan que cuando se utiliza oxigenoterapia mediante gafas nasales a flujos inferiores a 4 l/min no es necesario que los pacientes dispongan de dispositivos de humidificación, ni en el hospital ni en el domicilio. Su empleo generalizado, además de suponer un coste añadido, puede presentar riesgos para la salud (contaminación bacteriana) y favorecer que existan fugas de O2. Por el contrario, en enfermos con vía aérea artificial (traqueostomías) o cuando se empleen flujos más altos de O2 sí que se debe utilizar un dispositivo de humidificación (simple, térmico o una nariz artificial) (AU)

Gripe A: la primera pandemia del siglo XXI / Swine flu: the first pandemic of the XXI century

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Fenotipos en la EPOC / COPD phenotypes

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Impact of COPD severity on physical disability and daily living activities: EDIP-EPOC I and EDIP-EPOC II studies.

AIMS: The severity of chronic obstructive pulmonary disease (COPD) is associated to patients' health-related quality of life (HRQL). Physical impairment increasingly affects daily activities creating economic, social and personal burden for patients and their families. This burden should be considered in the management of COPD patients; therefore, we intended to assess the impact of the disease severity on physical disability and daily activities. METHODS: Two epidemiological observational cross-sectional descriptive studies were carried out in 1596 patients with moderate COPD and 2012 patients with severe or very severe COPD in the routine clinical practice. Demographic and basic clinical-epidemiological data were collected and patients completed questionnaires to assess their physical disability because of COPD [Medical Research Council (MRC)], COPD repercussion on daily activities [London Chest Activity of Daily Living (LCADL)], job, economy and family habits and their health status [EQ-5D visual analogue scale (VAS)]. RESULTS: In all, 37% of severe/very severe COPD patients and 10% of moderate (p < 0.0001) had MRC grades 4 and 5. Mean global LCADL was significantly higher in severe/very severe than in moderate patients [29.6 (CI 95%: 28.91-30.25) vs. 21.4 (CI 95%: 20.8-21.9); p < 0.0001]. COPD job impact and economic and family habits repercussions were significantly higher and health status significantly worse in severe/very severe cases than in patients with moderate COPD. CONCLUSIONS: COPD severity is highly associated with physical disability by MRC grading, with functionality on daily activities and with impairment of other social and clinical activities. Moderate COPD patients show already a significant degree of impairment in all these parameters.

[Has the treatment of COPD changed in Spain? Results of a community multicenter study (VICE)]. / Ha cambiado el manejo de la EPOC en España? Resultados de un estudio multicéntrico comunitario (VICE).

INTRODUCTION: Many Clinical Practical Guides (CPG) that have specifically focused on the diagnosis and treatment of chronic obstructive pulmonary disease (COPD) have been elaborated over the last 5 years. However, their grade of application and effectiveness have not been verified. METHOD: In order to evaluate if the diagnosis and treatment of COPD have been modified in our setting since their publication, a comparative analysis was proposed between the results of the IDENTEPOC study (n = 898) conducted in the year 2000 and the VICE study (n = 10,782), whose data were collected in 2005. RESULTS: In the year 2000, 38.6% of the patients in primary health care were initially diagnosed of COPD using clinical and/or radiological criteria, with no functional confirmation versus 10.2% in the pneumology setting (p < 0.001). In 2005, 31% of the subjects had been diagnosed of COPD using spirometry in primary health care and 14% in pneumology did not show an obstructive pattern. In 2005, only 4.1% of the patients were receiving specific treatment for their smoking habit and the establishment of rehabilitation programs was not very relevant. No large differences in drug treatments were observed between both studies. The main difference in 2005 was a wide use of tiotropium and of combinations of beta2 agonists with inhaled corticosteroids. Although a mild escalation of treatment based on seriousness is observed in both series, the prescription guidelines do not adjust to the criteria established by the regulations. CONCLUSIONS: The results of this analysis indicate that although the CPGs may be useful tools to improve the clinical management of COPD, the absence of relevant qualitative changes in the management of COPD after their publication suggests that their impact in the clinical practice is currently irrelevant.

Resultados en la EPOC. ¿Ha llegado el momento de hablar de mortalidad? / Results in COPD. Has the time come to speak of mortality?

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Avances en el tratamiento de la EPOC / Advances in the treatment of COPD

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¿Debe incluirse la EPOC entre los factores de riesgo cardiovascular? / Should COPD be included among cardiovascular risk factors?

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La EPOC. Valoración global en urgencias / COPD. Overall assessment in emergencies

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Seguridad y efectividad de claritromicina de liberación modificada en el tratamiento de la infección respiratoria / Safety and effectiveness of modified release clarithromycin in the treatment of respiratory infection

La infección respiratoria aguda constituye una causa habitual de consulta tanto en atención primaria como en los servicios de neumología. Las localizaciones más frecuentes son faringoamigdalitis, bronquitis aguda, neumonía y exacerbaciones de enfermedad pulmonar obstructiva crónica y los patógenos más comúnmente implicados son virus, s. pneumoniae, s. pyogenes y bacterias atípicas intracelulares El tratamiento antimicrobiano habitualmente se establecede acuerdo con estudios epidemiológicos disponibles. A la hora de decidir el antibiótico a utilizar resulta fundamental considerar, además de la efectividad, la seguridad del fármaco y el grado de adhesión al tratamiento. El objetivo de este estudio ha sido valorar la seguridad y efectividad en la práctica clínica habitual de un macrólido de reciente introducción:la claritromicina de liberación modificada. Se incluyeron en el estudio 9.645 pacientes, diagnosticadosde infección respiratoria aguda, que recibieron tratamiento con CLM en dosis única diaria entre 500 y 1.500 mg, durante 1 a 14 días. El cumplimiento del tratamiento fue calificado de bueno en el 89% de los casos y la tolerancia en el 97%, sólo un 1,1% de los pacientes comunicaron efectos adversos, y sólo en 4 casos éstos fueron considerados graves. La efectividad del tratamiento se consideró buena o muy buena en el 97% de los casos. En conclusión, claritromicinade liberación modificada se consolida como una opción terapéutica segura y eficaz en el manejo de la infecciónrespiratoria aguda de la comunidad

Acute respiratory infection is a common cause of consultation both in primary care and in the pneumology services. The most frequent sites are pharyngoamygdalitis, acute bronchitis, pneumonia and exacerbations of chronic obstructivepulmonary disease and the most commonly involved pathogens are virus, s. pneumoniae, s. pyogenes and atypical intercellular bacteria. Antimicrobian treatment is generally established according to the available epidemiological studies. When deciding on the antibiotic to use, it is essential to not only consider effectiveness but also drug safety and degreeof treatment adherence. This study aims to assess the safety and effectiveness in the usual clinical practice of a recently introduced macrolide: modified release clarithomycin. A total of 9645 patients, diagnosed of acute respiratory infection, who received treatment with MRC in single daily doses between 500 and 1500 mg for 1 to 14 days were enrolled. Treatment adherence was scored as good in 89% of the cases and tolerability in 97%. Only 1.1% of the patients reported adverseevents and these were considered serious in only 4 cases. Treatment effectiveness was considered good or very good in 97% of the cases. In conclusion, modified release clarithromycin is consolidated as a safe and effective therapeutic optionin the management of community acute respiratory infection

Consejo antitabaco y función pulmonar / Antitobacco advise and pulmonary function

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Controversias farmacológicas reflejadas en las guías y normativas nacionales e internacionales / No disponible

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[Factors affecting drug prescription in patients with stable COPD: results from a multicenter Spanish study (IDENTEPOC)]. / Factores determinantes de la prescripción farmacológica en los pacientes con EPOC estable. Resultados de un estudio multicéntrico español (IDENTEPOC).

OBJECTIVE: To determine what factors are associated with prescription of drugs to patients with stable chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We studied 568 patients with stable COPD. Assessments included determination of the severity of dyspnea, body mass index, health-related quality of life, and spirometry testing. RESULTS: The forced expiratory volume in 1 second was significantly associated with prescription of long-acting beta2-adrenergic agonists (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.96-1) and inhaled corticosteroids (OR=0.98; 95% CI, 0.96-1). Quality of life was related to administration of short-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), long-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), ipratropium bromide (OR=1.03; 95% CI, 1-1.04), theophylline drugs (OR=1.02; 95% CI, 1-1.03), and inhaled corticosteroids (OR=1.02; 95% CI, 1-1.03). The severity of dyspnea was significantly associated with prescription of oral corticosteroids (for grade IV dyspnea, OR=15.25; 95% CI, 2.40-97.02). Body mass index was not related to drug administration. CONCLUSIONS: Drug prescription in patients with stable COPD correlates not only with forced expiratory volume in 1 second but also with other parameters such as health-related quality of life and dyspnea.

Factores determinantes de la prescripción farmacológica en los pacientes con EPOC estable. Resultados de un estudio multicéntrico español (IDENTEPOC) / Factors affecting drug prescription in patients with stable COPD: Results from a multicenter Spanish study (IDENTEPOC)

OBJETIVO: Determinar qué factores se relacionan con la prescripción de fármacos en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. MATERIAL Y MÉTODOS: Se estudió a 568 pacientes con EPOC estable. La evaluación realizada incluyó la medición del grado de disnea, la determinación del índice de masa corporal, el estudio de la calidad de vida relacionada con la salud y la realización de una espirometría. RESULTADOS: El volumen espiratorio forzado en el primer segundo se asoció significativamente con la prescripción de β2-adrenérgicos de acción larga (odds ratio [OR] = 0,98; intervalo de confianza [IC] del 95%, 0,96-1) y corticoides inhalados (OR = 0,98; IC del 95%, 0,96-1). La calidad de vida se relacionó con la administración de β2-adrenérgicos de acción corta (OR = 1,02; IC del 95%, 1-1,03), β2-adrenérgicos de acción larga (OR = 1,02; IC del 95%, 1-1,03), bromuro de ipratropio (OR = 1,03; IC del 95%, 1-1,04), teofilinas (OR = 1,02; IC del 95%, 1-1,03) y corticoides inhalados (OR = 1,02; IC del 95%, 1-1,03). El grado de disnea mostró una asociación significativa con la prescripción de corticoides orales (para disnea grado IV, OR = 15,25; IC del 95%, 2,40-97,02). No se encontró ninguna relación entre la administración de fármacos y el índice de masa corporal. CONCLUSIONES: La prescripción farmacológica de los pacientes con EPOC estable viene determinada no sólo por el volumen espiratorio forzado en el primer segundo, sino también por otros parámetros, entre los que se incluyen la calidad de vida relacionada con la salud y la disnea

OBJECTIVE: To determine what factors are associated with prescription of drugs to patients with stable chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We studied 568 patients with stable COPD. Assessments included determination of the severity of dyspnea, body mass index, health-related quality of life, and spirometry testing. RESULTS: The forced expiratory volume in 1 second was significantly associated with prescription of long-acting ß2-adrenergic agonists (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.96-1) and inhaled corticosteroids (OR=0.98; 95% CI, 0.96-1). Quality of life was related to administration of short-acting β2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), long-acting β2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), ipratropium bromide (OR=1.03; 95% CI, 1-1.04), theophylline drugs (OR=1.02; 95% CI, 1-1.03), and inhaled corticosteroids (OR=1.02; 95% CI, 1-1.03). The severity of dyspnea was significantly associated with prescription of oral corticosteroids (for grade IV dyspnea, OR=15.25; 95% CI, 2.40- 97.02). Body mass index was not related to drug administration. CONCLUSIONS: Drug prescription in patients with stable COPD correlates not only with forced expiratory volume in 1 second but also with other parameters such as health-related quality of life and dyspnea

Obesidad y función pulmonar / No disponible

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