Papel de la prueba de esfuerzo cardiopulmonar en el diagnóstico de la disnea crónica de origen desconocido / Role of the cardiopulmonary stress test in the diagnosis of chronic dyspnoea of unknown aetiology

FUNDAMENTO: El objetivo principal de este trabajo ha sido describir el espectro y frecuencia de causas que provocan disnea de origen desconocido en nuestro medio mediante la realización de la prueba de esfuerzo cardiopulmonar y demostrar su utilidad en el diagnóstico de la disnea crónica, tanto para esclarecer su etiología como para orientar las pruebas posteriores. MÉTODOS: Se ha realizado un estudio descriptivo durante cinco años de los enfermos remitidos a nuestro servicio por disnea crónica de origen desconocido. Todos presentaban una historia clínica, exploración física y pruebas complementarias básicas que no aclaraban su etiología. Se les realizó una prueba de esfuerzo cardiopulmonar, registrándose una serie de parámetros funcionales y arrojando finalmente un diagnóstico ergométrico siguiendo el algoritmo de Wasserman et al.1 RESULTADOS: Fueron incluidos 178 pacientes (92 hombres; edad media 42,5 ± 16,7 años). Por orden de frecuencia los diagnósticos obtenidos fueron: normal o disnea psicógena (71,9%), hiperreactividad bronquial (8,4%), limitación ventilatoria (6,7%),sobrepeso y sedentarismo (3,9%), crisis de HTA (3,9%), limitación cardiocirculatoria (3,4%) y alteración vascular pulmonar (1,7%).No encontramos diferencias entre sexos o entre distintos grupos de edad en cuanto a los diagnósticos ergométricos. CONCLUSIONES: Hemos comprobado que en la mayoría delos casos un diagnóstico de normalidad ha permitido excluir la existencia de enfermedad significativa. Algunos pacientes cuyos resultados fueron patológicos precisaron la realización de nuevas pruebas, sin embargo, al orientar el diagnóstico, el test de esfuerzo permitió hacer una selección más precisa de las mismas, con los consiguientes ahorros en tiempo, dinero y molestias a los pacientes

INTRODUCTION: The principal goal of this study has been to describe the spectrum and frequency of diseases presenting as unexplained dyspnea in our area by means of performing graded cardiopulmonary exercise test and demonstrate its utility in the diagnosis of chronic dyspnea, so much to clear up its etiology as to guide further tests. METHODS: A descriptive study has been performed for five years based in the patients referred to our service with chronic explained dyspnea. All of them presented clinical history, physical examination and basic complementary tests that didn’t clear up its etiology. A graded cardiopulmonary exercise test was performed, recording a series of functional parameters and yielding finally an ergometric diagnosis following the algorithm by Wasserman et al.1RESULTS: 178 patients were entered (92 male; mean age 42,5± 16,7 years). Obtained diagnosis in order or frequency were: normal or psichogenic dyspnea (71,9%), bronchial hyper reactivity (8,4%), pulmonary limitation (6,7%), overweight and deconditioning(3,9%), hypertensive crisis (3,9%), cardiocirculatory limitation(3,4%) and pulmonary vascular alterations (1,7%). We didn’t found significant differences between both sexs or between different groups of age as for the ergometric diagnosis. CONCLUSIONS: After assessing all the results of our study, we saw that in most of cases a normal diagnosis could reject the existence of a significant disease. Some patients whose results were pathological needed the performing of new tests, however, the cardiopulmonary exercise test, thanks to guiding the diagnosis, allowed a more correct selection of them, with the consequent savingsin time, money and bothers to the patients

[Smoking prevention intervention among secondary school students in the Spanish province of Malaga]. / Intervención sobre tabaquismo en estudiantes de enseñanza secundaria de la provincia de Málaga.

OBJECTIVE: To assess the prevalence of smoking among 13- to 18-year-old students, analyze smoking-related factors in this population, and design an intervention program to reduce smoking. POPULATION AND METHODS: A 6-month smoking prevention intervention was designed for students at a public secondary school in the Spanish province of Malaga. The objective of the intervention was to inform students of the gravity of smoking and its deleterious effects on health. The efficacy of the intervention was subsequently assessed. RESULTS: Of the 337 students who completed the questionnaire, 27% declared they were smokers. Smoking prevalence was significantly higher among girls (36.1%) than boys (18.1%) (P<.001) and progressively increased with age. Initiation occurred at 13 to 14 years of age. The most common reason for starting was to try something new (52.2% of students). The greatest risk factor in the family environment was having a smoking sibling. After the program, 78% of smokers admitted that the intervention had not affected their smoking but had made them more aware of its detrimental effects, and 66.8% planned to quit in the future. CONCLUSIONS: The study shows the high prevalence of smoking among adolescents, particularly among girls. It also shows that health education increases understanding of the problems related to smoking, causing changes of attitude with regard to whether they will smoke in the future.

Intervención sobre tabaquismo en estudiantes de enseñanza secundaria de la provincia de Málaga / Smoking prevention intervention among secondary school students in the Spanish province of Malaga

Objetivo: Conocer el consumo de tabaco en jóvenes de entre 13 y 18 años, analizar los factores asociados con el tabaquismo en esta población y desarrollar un programa de intervención para reducir su consumo. Población y métodos: Se ha diseñado un programa de intervención sobre tabaquismo de 6 meses de duración, dirigido a estudiantes de Enseñanza Secundaria Obligatoria de un instituto de la provincia de Málaga, orientado a informarles sobre la magnitud del problema del tabaquismo y sus efectos patológicos. Posteriormente se ha evaluado la eficacia de dicha intervención. Resultados: De los 337 alumnos que cumplimentaron la encuesta, el 27% se declaraba fumador. El consumo era significativamente (p < 0,001) mayor en las mujeres (36,1%) que en los varones (18,1%) y se incrementaba de forma progresiva con la edad. La edad de comienzo se situaba entre los 13 y 14 años. El motivo más frecuente por el que iniciaban al consumo era probar algo nuevo (un 52,2% de los alumnos). En el entorno familiar el mayor factor de riesgo para el adolescente era tener un hermano fumador. Una vez finalizado el programa, aunque el 78% reconocía que éste no había influido directamente sobre su consumo, tenía más conciencia de los efectos perjudiciales del tabaco y el 66,8% de los fumadores se planteaba dejarlo en el futuro. Conclusiones: El estudio pone de manifiesto el elevado consumo de tabaco en los adolescentes, fundamentalmente en las chicas. Además, demuestra que la educación sanitaria es útil para mejorar el conocimiento sobre el problema del tabaquismo, ya que provoca un cambio de actitud en los adolescentes fumadores respecto a su futuro consumo

Objective: To assess the prevalence of smoking among 13- to 18-year-old students, analyze smoking-related factors in this population, and design an intervention program to reduce smoking. Population and Methods: A 6-month smoking prevention intervention was designed for students at a public secondary school in the Spanish province of Malaga. The objective of the intervention was to inform students of the gravity of smoking and its deleterious effects on health. The efficacy of the intervention was subsequently assessed. Results: Of the 337 students who completed the questionnaire, 27% declared they were smokers. Smoking prevalence was significantly higher among girls (36.1%) than boys (18.1%) (P<.001) and progressively increased with age. Initiation occurred at 13 to 14 years of age. The most common reason for starting was to try something new (52.2% of students). The greatest risk factor in the family environment was having a smoking sibling. After the program, 78% of smokers admitted that the intervention had not affected their smoking but had made them more aware of its detrimental effects, and 66.8% planned to quit in the future. Conclusions: The study shows the high prevalence of smoking among adolescents, particularly among girls. It also shows that health education increases understanding of the problems related to smoking, causing changes of attitude with regard to whether they will smoke in the future

Repercusiones del síndrome de apneas e hipopneas obstructivas del sueño sobre el rendimiento físico / Effects of obstructive sleepapnoea-hypopnoea syndrome on physical performance

OBJETIVOS: comprobar si el Síndrome de apneas/hipopneas del sueño (SAOS) provoca un bajo rendimiento físico y si éste mejora con el tratamiento con CPAP nasal y objetivar si existe correlación entre dicho deterioro y los parámetros de severidad del mismo. MÉTODOS: Incluimos 32 pacientes diagnosticados de SAOS (24 severos con un índice apneas/hipopneas (IAH)≥50 y 8 moderados con un IAH entre 27 y 49), a los que se les realizó hemograma, proteínograma, gasometría arterial y prueba de ejercicio sobre tapiz rodante hasta esfuerzo máximo con determinación del consumo de oxígeno, antes y después de 30 días de tratamiento con CPAPn. RESULTADOS: La potencia máxima alcanzada fue en severos de 191,83±54 vatios antes y 215±57 después del tratamiento (p<0,001) y en moderados de 136,75±54 y 145,87±65 (p<0,05) respectivamente, el consumo de oxígeno máximo pasó de 2.851±575 ml/min a 3.220±569 (p<0,001) en severos y de 2.199±727 a 2.330±678 en moderados (p<0,05), el consumo de oxígeno en el umbral anaerobio de 1.647±277 ml/min a 2.012±328 (p<0,001) y de 1.316±489 a 1.432±602 (p<0,05) respectivamente, y la ventilación minuto máxima de 85,83±19 litros a 92,25±22 (p<0,05) en los severos, no siendo significativa en los moderados. La PaO2 aumentó de 84,87±8,4 a 93,31±6,5 (p<0,05) en severos y de 79,97±8,6 a 87,8±8,1 (p<0,001) en moderados, la PaCO2 disminuyó de 43,33±2,1 a 40,77±2,7 (p<0,05) y de 44,38±3,5 a 42,73±3,4 (p<0,05) respectivamente, la hemoglobina lo hizo en un 8,41% (p<0,001) en los severos y el hematocrito en un 3,55% (p<0,001) en los severos. No hemos encontrado correlaciones lineales entre los parámetros de severidad del SAOS y los deterioros y mejorías objetivadas. CONCLUSIONES: En los pacientes estudiados, tras un mes de tratamiento con CPAP, mejoraron su rendimiento físico, pero ninguno de los parámetros ergométricos se correlacionó con la gravedad del SAOS (AU)

OBJECTIVES: to determine if Sleep Apnea-Hypopnea Syndrome (SAHS) is a cause of low physical performance, if physical performance is improved with nasal CPAP treatment and to study if there is a relationship between deterioration in physical performance and increased severity parameters of SAHS . METHODS: we conducted 32 patients diagnosed with SAHS (24 patients with severe SAHS measured as an apnea-hypopnea index –AHI- of ? 50 and 8 with moderate SAHS with AHI between 27-49) to undergo an exercise test on a treadmill up to maximum force before and after 30 days of treatment with nasal CPAP. Blood samples were taken at each test (haemogram, proteinogram, arterial gasometry) and measure of oxygen consumption was registered, before and after treatment. RESULTS: patients with severe SAHS reached a maximum potential of 191,83 ± 54 Watts before and 215 ± 57 Watts after treatment (p<0.001), while moderate SAHS patients reached 136,75 ± 54 and 145,87 ± 65 (p<0.05) respectively. Maximun oxygen consumption ranged from 2.851 ± 575 ml/min to 3.220 ± 569 (p<0.001) in patients with severe SAHS and from 2.199± 727 ml/min to 2.330 ± 678 (p<0.05) in moderate SAHS patients. Oxygen consumption in the anaerobic threshold varied from 1,647±277 ml/min to 2,012±328 (p<0.001) and from 1,316±489 to 1,432±602 (p<0.05) respectively, and the maximum ventilation per minute from 85.83±19 litres to 92.25±22 (p<0.05) in the severe and with no significant change in the moderates. The PaO2 increased from 84.87±8.4 to 93.31±6.5 (p<0.05) in the severe and from 79.97±8.6 to 87.8±8.1 (p<0.001) in the moderates, the PaCO2 reduced from 43.33±2.1 to 40.77±2.7 (p<0.05) and from 44.38±3.5 to 42.73±3.4 (p<0.05) respectively, the haemoglobin was 8.41% (p<0.001) and the haematocrit 3.55% (p<0.001) in the severe. No lineal correlations were found between the SAHS severity parameters and the objective deteriorations and improvements. CONCLUSIONS: In our patients, after a month of treatment with CPAP, improvement in physical performance was observed, but no correlation between the the ergometric parameters and severity of SAHS was found (AU)