Prepandemic viral community-acquired pneumonia: Diagnostic sensitivity and specificity of nasopharyngeal swabs and performance of clinical severity scores.

The objectives of this work were to assess the diagnostic sensitivity and specificity of nasopharyngeal (NP) swabs for viral community-acquired pneumonia (CAP) and the performance of pneumonia severity index (PSI) and CURB-65 severity scores in the viral CAP in adults. A prospective observational cohort study of consecutive 341 hospitalized adults with CAP was performed between January 2018 and March 2020. Demographics, comorbidities, symptoms/signs, analytical data, severity scores, antimicrobials, and outcomes were recorded. Blood, NP swabs, sputum, and urine samples were collected at admission and assayed by multiplex real time-PCR, bacterial cultures, and Streptococcus pneumoniae and Legionella pneumophila antigens detection, to determine the etiologies and quantify the viral load. The etiology was identified in 174 (51.0%) patients, and in 85 (24.9%) it was viral, the most frequent rhinovirus and influenza virus. The sensitivity of viral detection in sputum (50.7%) was higher than in NP swabs (20.9%). Compared with sputum, the positive predictive value and specificity of NP swabs for viral diagnosis were 95.8% and 96.9%, respectively. Performance of PSI and CURB-65 scores in all CAP with etiologic diagnosis were as expected, with mortality associated with higher values, but they were not associated with mortality in patients with viral pneumonia. NP swabs have lower sensitivity but high specificity for the diagnosis of viral CAP in adults compared with sputum, reinforcing the use NP swabs for the diagnostic etiology work-up. The PSI and CURB-65 scores did not predict mortality in the viral CAP, suggesting that they need to be updated scores based on the identification of the etiological agent.

Inflammatory response in human lung cells stimulated with plasma from COPD patients.

Background: Chronic obstructive pulmonary disease (COPD) is a condition resulting from a persistent inflammatory state in the airways even after smoking cessation. Intriguingly, the reasons behind this persistence of the inflammatory influx without smoking exposure have not been fully unraveled. We aimed to explore the hypothesis that systemic inflammation in COPD patients influences lung cell inflammatory response. Methods: We cultured human lung fibroblast and human airway epithelial cell lines with plasma from COPD patients (four emphysematous-COPD, four asthma-COPD overlap, four chronic bronchitis-COPD, and four bronchiectasis- COPD), and four smokers or ex-smokers without COPD as controls. Non-stimulated cells were used as controls. We measured Interleukine-8 (IL-8), C-reactive protein (CRP) and matrix metalloproteinase-9 (MMP-9) in plasma and culture supernatants by ELISA. Results: Cells stimulated with plasma from COPD patients and non-COPD smoker subjects produced higher CRP, IL- 8 and MMP-9 levels, an increase for COPD in CRP (p=0.029) in epithelial cells and IL-8 (p=0.039) in fibroblasts and decrease for MMP-9 (p=0.039) in fibroblasts, compared with non-stimulated cells. The response was higher in epithelial cells for IL-8 (p=0.003) and in fibroblasts for MMP-9 (p=0.063). The plasma from chronic bronchitis and bronchiectasis phenotypes induced higher IL-8 in fibroblasts. Conclusions: Plasma from COPD patients increases the inflammatory response in lung epithelial cells and lung fibroblasts, with a different response depending on the cell type and clinical phenotype.

Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study / Eficacia y seguridad de los antibióticos inhalados en pacientes con enfermedad pulmonar obstructiva crónica. Estudio observacional multicéntrico

Background We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment.Methods Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. Primary outcome: COPD exacerbations. Secondary outcomes: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication.Results Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (−33.3%; P<.001), hospital admissions (−33.3%; P<.001) and hospitalization days (−26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (−33.1%; P=.024), mucopurulent/purulent sputum (−53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (−16.7%; P<.001), CBI by any PPM (−37.4%; P<.001) and CBI by PA (−49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%).Conclusions In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.

Antecedentes Nuestro objetivo fue describir la efectividad y seguridad de los antibióticos inhalados en enfermedad pulmonar obstructiva crónica (EPOC), así como el perfil de pacientes en los que se prescriben habitualmente y los grupos de pacientes que más pueden beneficiarse de este tratamiento. Métodos Estudio de cohorte observacional retrospectivo multicéntrico en pacientes con EPOC que habían recibido ≥1 dosis de antibióticos inhalados en los últimos 5 años. Se compararon los datos clínicos de los 2 años anteriores y posteriores al inicio del tratamiento. Criterio primario: exacerbaciones de EPOC. Criterios secundarios: efectos secundarios, sintomatología (purulencia del esputo, disnea), perfil microbiológico y erradicación de patógenos. Resultados De los 693 pacientes con EPOC analizados (74,1 años; 86,3% hombres; FEV1 medio=43,7%) el 71,7% presentaba bronquiectasias y el 46,6% presentaba infección bronquial crónica (IBC) por Pseudomonas aeruginosa (PA). Después de un año de tratamiento con antibióticos inhalados se produjo una disminución significativa en el número de exacerbaciones (−33,3%; p<0,001), ingresos hospitalarios (−33,3%; p<0,001) y días de hospitalización (−26,2%; p=0,003). No encontramos diferencias en la efectividad entre los pacientes con o sin bronquiectasias asociadas. Los resultados positivos fueron más pronunciados en los pacientes que erradicaron la PA. Encontramos una reducción significativa de la expectoración diaria (−33,1%; p=0,024), el esputo mucopurulento/purulento (−53,9%; p<0,001), el aislamiento de cualquier microorganismo potencialmente patógeno (MPP) (−16,7%; p<0,001), IBC por cualquier MPP (−37,4%; p<0,001) e ICB por PA (−49,8%; p<0,001). La IBC por cualquier MPP y más de 3 exacerbaciones previas se asociaron con una mejor respuesta al tratamiento. El 25,4% de los pacientes presentó efectos secundarios no graves, siendo los más frecuentes el broncoespasmo (10,5%), la disnea (8,8%) y la tos (1,7%). Conclusiones En los pacientes con EPOC con múltiples exacerbaciones o IBC por cualquier MPP (especialmente PA), los antibióticos inhalados parecen ser un tratamiento eficaz y seguro, independientemente de la presencia de bronquiectasias.

Deconstruyendo los fenotipos en la EPOC: un análisis de la cohorte TRACE / Deconstructing Phenotypes in COPD: an Analysis of the TRACE Cohort

Objetivos: En una estrategia de manejo de la enfermedad pulmonar obstructiva crónica (EPOC) basada en fenotipos clínicos sería deseable que todos los pacientes pudieran adscribirse al menos a un fenotipo sin adscribirse a otro. El objetivo de este trabajo fue evaluar si todos los pacientes tienen un fenotipo y sólo uno asignado según la actual guía española de la EPOC (GesEPOC 2017) y evaluar los criterios que los definen. Método: El estudio Time-based Register and Analysis of COPD Endpoints (TRACE; clinicaltrials.gov NCT03485690) es una cohorte prospectiva de pacientes con EPOC en visitas anuales desde 2012 que recoge los fenotipos GesEPOC. A pesar de que GesEPOC recomienda no fenotipar a los pacientes considerados de bajo riesgo, se realizó un análisis de los criterios de identifican los fenotipos en alto y bajo riesgo, comparando la distribución de los fenotipos y sus criterios en estos dos grupos. Resultados: La cohorte incluye 970 pacientes con diagnóstico confirmado de EPOC, divididos en 427 (44,02%) pacientes de bajo riesgo y 543 (55,9%) de alto riesgo. El fenotipo más frecuente fue el no agudizador (44,9% de los pacientes de alto riesgo). Un 20,6% de los pacientes de bajo riesgo cumplían criterios de solapamiento entre EPOC y asma. Un 9,2% de la cohorte no cumplía los criterios diagnósticos de ningún fenotipo y el 19,1% cumplía los criterios de dos fenotipos, sin diferencias entre grupos de riesgo. Conclusiones: Nuestros datos ponen de manifiesto algunas de las debilidades de la actual estrategia basada en fenotipos clínicos, existiendo solapamiento en algunos casos y pacientes sin fenotipos.

Objectives: In a clinical phenotype-based management strategy for COPD, it would be preferable to at least assign all patients to a phenotype, but to a single phenotype only. The aim of this study was to evaluate whether all patients are assigned to one and only one phenotype using the Spanish COPD guidelines (GesEPOC) and to evaluate the criteria that define these categories. Method: The Time-based Register and Analysis of COPD Endpoints study (TRACE; clinicaltrials.gov NCT03485690) is a prospective cohort of COPD patients attending annual visits since 2012, which collects GesEPOC phenotypes. Although the GesEPOC recommends that patients considered to be at low risk are not phenotyped, an analysis of the criteria for identifying high- and low-risk phenotypes was performed, comparing the distribution of phenotypes and the criteria applied between these 2 groups. Results: The cohort included 970 patients with a confirmed diagnosis of COPD, divided into 427 (44.02%) low-risk and 543 (55.9%) high-risk patients. The most frequent phenotype was the non-exacerbator (44.9% of high-risk patients). Overall, 20.6% of low-risk patients met criteria for asthma-COPD overlap syndrome, while 9.2% of the cohort did not meet the diagnostic criteria for any phenotype, and 19.1% met the criteria for 2 phenotypes, with no differences between risk groups.Conclusions: Our data highlight some of the weaknesses of the current clinical phenotype strategy, revealing overlapping categories in some cases, and patients to whom no phenotype was assigned.

Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study.

BACKGROUND: We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment. METHODS: Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. PRIMARY OUTCOME: COPD exacerbations. SECONDARY OUTCOMES: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication. RESULTS: Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (-33.3%; P<.001), hospital admissions (-33.3%; P<.001) and hospitalization days (-26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (-33.1%; P=.024), mucopurulent/purulent sputum (-53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (-16.7%; P<.001), CBI by any PPM (-37.4%; P<.001) and CBI by PA (-49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%). CONCLUSIONS: In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.

Deconstructing Phenotypes in COPD: an Analysis of the TRACE Cohort. / Deconstruyendo los fenotipos en la EPOC: un análisis de la cohorte TRACE.

OBJECTIVES: In a clinical phenotype-based management strategy for COPD, it would be preferable to at least assign all patients to a phenotype, but to a single phenotype only. The aim of this study was to evaluate whether all patients are assigned to one and only one phenotype using the Spanish COPD guidelines (GesEPOC) and to evaluate the criteria that define these categories. METHOD: The Time-based Register and Analysis of COPD Endpoints study (TRACE; clinicaltrials.gov NCT03485690) is a prospective cohort of COPD patients attending annual visits since 2012, which collects GesEPOC phenotypes. Although the GesEPOC recommends that patients considered to be at low risk are not phenotyped, an analysis of the criteria for identifying high- and low-risk phenotypes was performed, comparing the distribution of phenotypes and the criteria applied between these 2 groups. RESULTS: The cohort included 970 patients with a confirmed diagnosis of COPD, divided into 427 (44.02%) low-risk and 543 (55.9%) high-risk patients. The most frequent phenotype was the non-exacerbator (44.9% of high-risk patients). Overall, 20.6% of low-risk patients met criteria for asthma-COPD overlap syndrome, while 9.2% of the cohort did not meet the diagnostic criteria for any phenotype, and 19.1% met the criteria for 2 phenotypes, with no differences between risk groups. CONCLUSIONS: Our data highlight some of the weaknesses of the current clinical phenotype strategy, revealing overlapping categories in some cases, and patients to whom no phenotype was assigned.

Predictors of Single Bronchodilation Treatment Response for COPD: An Observational Study with the Trace Database Cohort.

Chronic obstructive pulmonary disease (COPD) patients constitute a heterogeneous population in terms of treatment response. Our objective was to identify possible predictive factors of response to treatment with single bronchodilation monotherapy in patients diagnosed with COPD. The Time-based Register and Analysis of COPD Endpoints (TRACE; clinicaltrials.gov NCT03485690) is a prospective cohort of COPD patients who have been attending annual visits since 2012. Patients who were kept on a single bronchodilator during the first year of follow-up were selected. The responders were defined according to all of the following variables: any improvement in morning post-dose forced expiratory volume in 1 s or deterioration <100 mL, no change or improvement in dyspnea score, and no occurrence of exacerbations. Significant and plausible variables were analyzed using a proportional hazard Cox regression for single bronchodilator responders. We analyzed 764 cases, of whom 128 (16.8%) were receiving monotherapy with one bronchodilator. Of these, 85 patients (66.4%) were responders. Factors affecting responder status were: female gender (hazard ratio (HR) 0.276; 95% confidence interval (CI) 0.089-0.858), dyslipidemia (HR 0.436; 95%CI 0.202-0.939), not performing regular exercise (HR 0.523; 95%CI 0.254-1.076), active smoking (HR 0.413; 95%CI 0.186-0.920), and treatment adherence (HR 2.527; 95%CI 1.271-5.027). The factors associated with a single bronchodilation response are mainly non-pharmacological interventions and comorbidities.

Triple therapy for COPD: a crude analysis from a systematic review of the evidence.

We systematically reviewed the current knowledge on fixed-dose triple therapies for the treatment of chronic obstructive pulmonary disease (COPD), with a specific focus on its efficacy versus single bronchodilation, double fixed dose combinations, and open triple therapies. Articles were retrieved from PubMed, Embase, and Scopus up to 3 August 2018. We selected articles with randomized controlled or crossover design conducted in patients with COPD and published as full-length articles or scientific letters, evaluating triple therapy combinations in a single or different inhaler, and with efficacy data versus monocomponents, double combinations, or open triple therapies. Our systematic search reported 108 articles, of which 24 trials were finally selected for the analysis. A total of 7 studies with fixed dose triple therapy combinations, and 17 studies with open triple therapies combinations. Triple therapy showed improvements in lung function [trough forced expiratory volume (FEV1) ranging from not significant (NS) to 147 ml], health status using the St. George's Respiratory Questionnaire [(SGRQ) from NS to 8.8 points], and exacerbations [risk ratio (RR) from NS to 0.59 for all exacerbations] versus single or double therapies with a variability in the response, depending the specific combination, and the comparison group. The proportion of adverse effects was similar between study groups, the exception being the increase in pneumonia for some inhaled corticosteroid (ICS) containing groups. The reviews of this paper are available via the supplementary material section.

Evaluación del grado de acuerdo transversal y el pronóstico longitudinal de la nueva clasificación GOLD 2017: un análisis de la cohorte TRACE / Evaluation of the level of transversal agreement and longitudinal prognosis of the new GOLD 2017 classification: a TRACE cohort analysis

Objetivo: evaluar la clasificación de los pacientes con EPOC según la versión 2016 y 2017 del documento GOLD, estudiar su grado de acuerdo y valorar el impacto pronóstico de su utilización. Método: el estudio "Registro y análisis en el tiempo de resultados clínicos en EPOC" (Proyecto TRACE: Timebased Register and Analysis of COPD Endpoints) es una cohorte de pacientes prospectiva que tiene por objetivo la descripción de la evolución clínica de los pacientes con EPOC con las herramientas básicas del clínico, en la que se recoge sistemáticamente los síntomas, la función pulmonar y las agudizaciones. En la visita basal se clasificaron a los pacientes según las versiones 2016 y 2017 de la GOLD y se estudió su grado de acuerdo mediante el coeficiente kappa. Durante 4 años de visita anuales, se siguieron a los pacientes y se estudió la capacidad pronóstica de cada clasificación mediante curvas de Kaplan-Meier. Resultados: la cohorte inicial estaba compuesta por 391 pacientes en la visita basal de los que se seleccionaron 357 para el análisis. La distribución de los pacientes según los tipos GOLD de la versión 2016 y 2017 mostraba un coeficiente kappa de 0,665 (p < 0,001), sugiriendo un grado de acuerdo bueno. El análisis de la supervivencia aportó curvas similares entre las dos clasificaciones con diferencias significativas del nuevo grupo D frente al A y B, pero sin diferencias entre los grupos más leves. Conclusiones: el presente estudio evalúa el grado de acuerdo y la capacidad pronóstica de los dos documentos GOLD más recientes. Los resultados indican un comportamiento similar tanto en la valoración transversal como en la longitudinal a largo plazo

Objective: To evaluate the classification of patients with COPD according to the 2016 and 2017 versions of the GOLD document, to study the level of agreement and to evaluate the prognostic impact of their use. Methods: The "Time-based Register and Analysis of COPD Endpoints" (TRACE Project) is a prospective patient cohort whose objective is to describe the clinical evolution of patients with COPD using the basic tools for the disease, which systematically records symptoms, lung function and exacerbations. Patients were classified during the baseline visit according to the 2016 and 2017 versions of GOLD and the level of agreement was studied using Cohen's kappa coefficient. Patients were monitored throughout four years of annual visits and the prognostic capacity of each classification was studied using Kaplan-Meier curves. Results: The initial cohort consisted of 391 patients at the baseline visit, of which 357 were selected for the analysis. The distribution of patients according to GOLD group in the 2016 and 2017 versions showed a kappa coefficient of 0.665 (p < 0.001), suggesting a good level of agreement. The survival analysis provided similar curves between the two classifications with significant differences in the new group D compared to groups A and B, but without differences between the milder groups. Conclusion: This study evaluates the level of agreement and the prognostic ability of the most recent GOLD documents. The results indicate similar behavior in both the transversal and long-term longitudinal evaluation

Understanding of COPD among final-year medical students.

Objective: Several previous studies have shown a suboptimal level of understanding of COPD among different population groups. Students in their final year of Medicine constitute a population that has yet to be explored. The evaluation of their understanding provides an opportunity to establish strategies to improve teaching processes. The objective of the present study is to determine the current level of understanding of COPD among said population. Methods: A cross-sectional observational study was done using digital surveys given to medical students in their final year at the Universidad de Sevilla. Those surveyed were asked about demographic data, smoking habits as well as the clinical manifestation, diagnosis and treatment of COPD. Results: Of the 338 students contacted, responses were collected from 211 of them (62.4%). Only 25.2% had an accurate idea about the concept of the disease. The study found that 24.0% of students were familiar with the three main symptoms of COPD. Tobacco use was not considered a main risk factor for COPD by 1.5% of students. Of those surveyed, 22.8% did not know how to spirometrically diagnose COPD. Inhaled corticosteroids were believed to be part of the main treatment for this disease among 51.0% of the students. Results show that 36.4% of respondents believed that home oxygen therapy does not help COPD patients live longer. Only 15.0% considered the Body-mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index to be an important parameter for measuring the severity of COPD. Giving up smoking was not believed to prevent worsening COPD among 3.4% of students surveyed. Almost half of students (47.1%) did not recommend that those suffering from COPD undertake exercise. Conclusion: The moderate level of understanding among the population of medical students in their final year shows some strengths and some shortcomings. Teaching intervention is required to reinforce solid knowledge among this population.

Double bronchodilation in chronic obstructive pulmonary disease: a crude analysis from a systematic review.

OBJECTIVE: The combination of a long-acting muscarinic antagonist (LAMA) and a long-acting ß2-agonist (LABA) in a single inhaler is a viable treatment option for patients with chronic obstructive pulmonary disease (COPD). Here, we systematically review the current knowledge on double bronchodilation for the treatment of COPD, with a specific focus on its efficacy versus placebo and/or monotherapy bronchodilation. METHODS: A systematic review of clinical trials investigating LABA/LAMA combination therapies was conducted. Articles were retrieved from PubMed, Embase, and Scopus on June 26, 2016. We specifically selected clinical trials with a randomized controlled or crossover design published in any scientific journal showing the following characteristics: 1) comparison of different LABA/LAMA combinations in a single inhaler for patients with COPD, 2) dose approved in Europe, and 3) focus on efficacy (versus placebo and/or bronchodilator monotherapy) in terms of lung function, respiratory symptoms, or exacerbations. RESULTS: We analyzed 26 clinical trials conducted on 24,338 patients. All LABA/LAMA combinations were consistently able to improve lung function compared with both placebo and bronchodilator monotherapy. Improvements in symptoms were also consistent versus placebo, showing some lack of correlation for some clinical end points and combinations versus monotherapy bronchodilation. Albeit being an exploratory end point, exacerbations showed an improvement with LABA/LAMA combinations over placebo in some trials; however, scarce information was available in comparison with bronchodilator monotherapy in most studies. CONCLUSION: Our data show consistent improvements for LABA/LAMA combinations, albeit with some variability (depending on the clinical end point, the specific combination, and the comparison group). Clinicians should be aware that these are average differences. All treatments should be tailored at the individual level to optimize clinical outcomes.

Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit.

OBJECTIVES: Clinical practice in chronic obstructive pulmonary disease (COPD) can be influenced by weather variability throughout the year. To explore the hypothesis of seasonal variability in clinical practice, the present study analyzes the results of the 2013-2014 Andalusian COPD audit with regard to changes in clinical practice according to the different seasons. METHODS: The Andalusian COPD audit was a pilot clinical project conducted from October 2013 to September 2014 in outpatient respiratory clinics of hospitals in Andalusia, Spain (8 provinces with more than 8 million inhabitants) with retrospective data gathering. For the present analysis, astronomical seasons in the Northern Hemisphere were used as reference. Bivariate associations between the different COPD guidelines and the clinical practice changes over the seasons were explored by using binomial multivariate logistic regression analysis with age, sex, Charlson comorbidity index, type of hospital, and COPD severity by forced expiratory volume in 1 second as covariates, and were expressed as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS: The Andalusian COPD audit included 621 clinical records from 9 hospitals. After adjusting for covariates, only inhaler device satisfaction evaluation was found to significantly differ according to the seasons with an increase in winter (OR, 3.460; 95% CI, 1.469-8.151), spring (OR, 4.215; 95% CI, 1.814-9.793), and summer (OR, 3.371; 95% CI, 1.391-8.169) compared to that in autumn. The rest of the observed differences were not significant after adjusting for covariates. However, compliance with evaluating inhaler satisfaction was low. CONCLUSION: The various aspects of clinical practice for COPD care were found to be quite homogeneous throughout the year for the variables evaluated. Inhaler satisfaction evaluation, however, presented some significant variation during the year. Inhaler device satisfaction should be evaluated during all clinical visits throughout the year for improved COPD management.

Specific networks of plasma acute phase reactants are associated with the severity of chronic obstructive pulmonary disease: a case-control study.

Objectives. A detailed understanding of the intricate relationships between different acute phase reactants (APRs) in chronic obstructive pulmonary disease (COPD) can shed new light on its clinical course. In this case-control study, we sought to identify the interaction networks of a number of plasma APRs in COPD, with a special focus on their association with disease severity. Methods. COPD cases and healthy smoking controls (3:1 ratio) were recruited in our outpatient pulmonary clinic. Cardiopulmonary exercise testing was used to rule out the presence of ischemic heart disease. All subjects were males as per protocol. Multiple plasma APRs - including α-2-macroglobulin, C-reactive protein (CRP), ferritin, fibrinogen, haptoglobin, procalcitonin (PCT), serum amyloid A (SAA), serum amyloid P, and tissue plasminogen activator (tPA) - were measured using commercial Acute Phase Bio-Plex Pro Assays and analyzed on the Bio-Plex manager software. Correlations between different APRs were investigated using a heat map. Network visualization and analyses were performed with the Cytoscape software platform. Results. A total of 96 COPD cases and 33 controls were included in the study. Plasma A2M, CRP, and SAP levels were higher in COPD patients than in controls. Circulating concentrations of haptoglobin and tPA were found to increase in parallel with the severity of the disease. Increasing disease severity was associated with distinct intricate networks of APRs, which were especially evident in advanced stages. Conclusions. We identified different networks of APRs in COPD, which were significantly associated with disease severity.

Exposición laboral y a biomasa en la enfermedad pulmonar obstructiva crónica: resultados de un análisis transversal del estudio On-Sint / Occupational and biomass exposure in chronic obstructive pulmonary disease: results of a cross-sectional analysis of the On-Sint study

Introducción: Aunque el humo del tabaco es el principal factor de riesgo de la enfermedad pulmonar obstructiva crónica (EPOC), también se han relacionado con la enfermedad otros agentes tóxicos inhalados. El presente estudio analiza datos de la exposición a estas sustancias y evalúa su impacto sobre la presentación clínica de la enfermedad en una cohorte de pacientes con EPOC. Métodos: Se trata de un análisis transversal del estudio Presentación clínica, diagnóstico y evolución de la enfermedad pulmonar obstructiva crónica (On-Sint). De conformidad con el protocolo, todos los pacientes eran fumadores o exfumadores. Durante la visita de inclusión se interrogó a los pacientes acerca de sus antecedentes de exposición laboral y a combustión de biomasa. Las características clínicas de los pacientes que presentaban algún factor de riesgo además del tabaco se compararon con las de los pacientes que no presentaban factores de riesgo adicionales, y los factores que indicaron ser significativos fueron incluidos en un análisis de regresión logística multivariante, expresado como odds ratio (OR). Resultados: La muestra incluyó 1.214 pacientes con EPOC, en 1.012 (83,4%) de los cuales el tabaco era el único factor de riesgo. En 202 (16,6%) se constataron otros factores, en 174 (14,3%) principalmente la exposición a gases en el ámbito laboral y en 32 (2,6%) la exposición a combustión de biomasa. La distribución geográfica de esta exposición fue mayor en la zona norte y la costa este del país. La exposición a humo de biomasa fue relativamente baja. El análisis multivariante mostró asociaciones entre la presentación de un factor de riesgo adicional y el sexo masculino (OR: 2,180), la puntuación CAT (OR: 1,036) y el uso de oxigenoterapia crónica (OR: 1,642). Conclusiones: En España, la exposición laboral a tóxicos inhalados es más frecuente que la exposición a humo de biomasa. La EPOC causada por el tabaco y otros productos inhalados tiene algunas características diferenciales y provoca un mayor deterioro de la calidad de vida

Background: Although tobacco smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), other inhaled toxics have also been associated with the disease. The present study analyzes data from exposure to these substances in a cohort of patients with COPD and assesses their impact on the clinical presentation of the disease. Methods: This is a cross-sectional analysis of the Clinical presentation, diagnosis and course of chronic obstructive pulmonary disease (On-Sint) study. All patients were smokers or ex-smokers as per protocol. In addition, during the inclusion visit patients were enquired about their occupational and biomass exposure history. The clinical features of patients with and without an added risk factor to tobacco were compared and those significant were entered in a multivariate logistic regression analysis, expressed as odds ratio (OR). Results: The sample size was 1214 patients with COPD, of which 1012 (83.4%) had tobacco as the only risk factor and 202 (16.6%) had additional ones, mainly 174 (14.3%) with occupational gases and 32 (2.6%) with biomass exposure. The geographical distribution of this exposure showed a preference for the northern parts of the country and the East coast. The biomass exposure was rather low. Male gender (OR: 2.180), CAT score (OR: 1.036) and the use of long-term oxygen therapy (OR: 1.642) were associated with having an additional risk factor in the multivariate analysis. Conclusions: Occupational exposures are more common than biomass in Spain. COPD caused by tobacco plus other inhalants has some differential features and a more impaired quality of life

Occupational and Biomass Exposure in Chronic Obstructive Pulmonary Disease: Results of a Cross-Sectional Analysis of the On-Sint Study. / Exposición laboral y a biomasa en la enfermedad pulmonar obstructiva crónica: resultados de un análisis transversal del estudio On-Sint.

BACKGROUND: Although tobacco smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), other inhaled toxics have also been associated with the disease. The present study analyzes data from exposure to these substances in a cohort of patients with COPD and assesses their impact on the clinical presentation of the disease. METHODS: This is a cross-sectional analysis of the Clinical presentation, diagnosis and course of chronic obstructive pulmonary disease (On-Sint) study. All patients were smokers or ex-smokers as per protocol. In addition, during the inclusion visit patients were enquired about their occupational and biomass exposure history. The clinical features of patients with and without an added risk factor to tobacco were compared and those significant were entered in a multivariate logistic regression analysis, expressed as odds ratio (OR). RESULTS: The sample size was 1214 patients with COPD, of which 1012 (83.4%) had tobacco as the only risk factor and 202 (16.6%) had additional ones, mainly 174 (14.3%) with occupational gases and 32 (2.6%) with biomass exposure. The geographical distribution of this exposure showed a preference for the northern parts of the country and the East coast. The biomass exposure was rather low. Male gender (OR: 2.180), CAT score (OR: 1.036) and the use of long-term oxygen therapy (OR: 1.642) were associated with having an additional risk factor in the multivariate analysis. CONCLUSIONS: Occupational exposures are more common than biomass in Spain. COPD caused by tobacco plus other inhalants has some differential features and a more impaired quality of life.