Trombosis venosa pulmonar idiopática: un diagnóstico infrecuente / No disponible

La trombosis venosa pulmonar es una enfermedad potencialmente mortal. Este síndrome puede simular clínicamente un embolismo pulmonar arterial, pero tiene una estrategia de investigación y pronóstico distinto. La trombosis de la vena pulmonar es difícil de diagnosticar clínicamente y, por lo general, requiere una combinación de métodos diagnósticos utilizados convencionalmente. Presentamos la imagen radiológica de una trombosis venosa pulmonar en un varón de 70 años en el que la sospecha clínica inicial fue de tromboembolismo pulmonar arterial

Pulmonary vein thrombosis (PVT) represents a potentially fatal disease. This syndrome may clinically mimic pulmonary embolism but has a different investigation strategy and prognosis. Pulmonary vein thrombosis is difficult to diagnose clinically and usually requires a combination of conventionally used diagnostic modalities. We present the radiological images of a pulmonary vein thrombosis in a 70 year old patient with the initial clinical suspicion of a pulmonary artery thromboembolism

Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.

BACKGROUND: Community pharmacies (CP) have access to subjects at high-risk of suffering Chronic Obstructive Pulmonary Disease (COPD). We investigated if a COPD case finding program in CP could be a new strategy to reduce COPD underdiagnosis. METHODS: Prospective, cross-sectional, descriptive, uncontrolled, remotely supported study in 100 CP in Barcelona, Spain. Pharmacists were trained in a four-day workshop on spirometry and COPD, and each was provided with a spirometer for 12 weeks. The program included questionnaires and forced spirometry measurements, whose quality was controlled and monitored by web-assistance. FINDINGS: Overall 2295 (73.5%), of 3121 CP customers invited to participate in the program accepted, and 1.456 (63.4%) were identified as "high risk" for COPD using the GOLD questionnaire. Only 33 could not conduct spirometry, and a pre-bronchodilator airflow limitation (FEV1/FVC ratio <0.7) was confirmed in 282 (19.8%); 244 of these were referred to their primary care (PC) physician for further diagnostic and therapeutic work-up, but only 39 of them (16%) fed-back this information to the pharmacist. Clinically acceptable quality spirometries (grade A or B) were obtained in 69.4% of the cases. CONCLUSION: This study shows that adequately trained and supported community pharmacists can effectively identify individuals at high risk of having COPD and can thus contribute to ameliorate underdiagnosis in this disease. Links between PC and CP should be improved to achieve a useful program.

Factors affecting quality of life of asthma patients in Spain: The importance of patient education

OBJECTIVES: Assessment of demographic and clinical factors that have an impact on the quality of life (QoL) of patients with asthma in Spain. PATIENTS AND METHODS: Multicenter, prospective, observational, cohort study, conducted in 40 Spanish Pneumology Units during a 12-month period. Data on sociodemographic, clinical variables, asthma treatment and QoL were collected in a case report form. RESULTS: 536 patients (64.6% women, mean age: 54) were recruited. Reported QoL was better for patients from Northern and Central Spain as compared with those from the South and the East (p < 0.001), students and employed patients as compared with housewives and unemployed (p < 0.01), for those who had received asthma information (p < 0.01), for those with milder daytime symptoms (p < 0.01) and for patients with higher level of education (p < 0.05). CONCLUSIONS: Among the factors that have a significant effect on patients' QoL only symptom control and patient education on asthma control are modifiable. Therefore, all the strategies should be tailored to improve such factors when managing asthma patients

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Profile of patients treated with omalizumab in routine clinical practice in Spain

BACKGROUND: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain. OBJECTIVE:To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment. METHODS: Retrospective, multicentre study, recording the data on patients of either sex and ≥12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit. RESULTS: 214 patients were evaluable (mean age = 48.2 ± 17.7 years; mean age at the time of diagnosis = 26.6 ± 16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273 ± 205.4 IU/ml. The mean monthly dose was 380.5 ± 185.4 mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7 ± 15.9% vs. 70.8 ± 18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC). CONCLUSIONS: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies

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Profile of patients treated with omalizumab in routine clinical practice in Spain.

BACKGROUND: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain. OBJECTIVE: To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment. METHODS: Retrospective, multicentre study, recording the data on patients of either sex and ≥12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit. RESULTS: 214 patients were evaluable (mean age=48.2±17.7 years; mean age at the time of diagnosis=26.6±16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273±205.4IU/ml. The mean monthly dose was 380.5±185.4mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7±15.9% vs. 70.8±18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC). CONCLUSIONS: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies.

Factors affecting quality of life of asthma patients in Spain: the importance of patient education.

OBJECTIVES: Assessment of demographic and clinical factors that have an impact on the quality of life (QoL) of patients with asthma in Spain. PATIENTS AND METHODS: Multicenter, prospective, observational, cohort study, conducted in 40 Spanish Pneumology Units during a 12-month period. Data on sociodemographic, clinical variables, asthma treatment and QoL were collected in a case report form. RESULTS: 536 patients (64.6% women, mean age: 54) were recruited. Reported QoL was better for patients from Northern and Central Spain as compared with those from the South and the East (p<0.001), students and employed patients as compared with housewives and unemployed (p<0.01), for those who had received asthma information (p<0.01), for those with milder daytime symptoms (p<0.01) and for patients with higher level of education (p<0.05). CONCLUSIONS: Among the factors that have a significant effect on patients' QoL only symptom control and patient education on asthma control are modifiable. Therefore, all the strategies should be tailored to improve such factors when managing asthma patients.

Tomografía de impedancia eléctrica en la lesión pulmonar aguda / Electrical impedance tomography in acute lung injury

La tomografía de impedancia eléctrica se ha descrito como un nuevo método de monitorización en el paciente crítico en ventilación mecánica. Recientemente ha cobrado especial interés, debido a su aplicabilidad para la monitorización de la ventilación y la perfusión pulmonar. Su implementación continua a pie de cama y el ser una técnica no ionizante y no invasiva son propiedades particulares que la convierten en un recurso extremadamente atractivo. Asimismo, por su capacidad de evaluar las características regionales de la estructura pulmonar, podría constituir una herramienta de monitorización ideal en el heterogéneo pulmón con lesión pulmonar aguda. En el presente artículo de revisión, se explica el concepto físico de la bioimpedancia y su aplicación clínica y se resume la evidencia científica publicada hasta la fecha en lo referido a la utilización de la tomografía de impedancia eléctrica como método de monitorización de la ventilación y de la perfusión, fundamentalmente en el enfermo con lesión pulmonar aguda, así como otras aplicaciones posibles de la técnica en el enfermo crítico. Asimismo, se resumen las limitaciones de la técnica y sus potenciales áreas de desarrollo en el futuro (AU)

Electrical impedance tomography has been described as a new method of monitoring critically ill patients on mechanical ventilation. It has recently gained special interest because of its applicability for monitoring ventilation and pulmonary perfusion. Its bedside and continuous implementation, and the fact that it is a non-ionizing and non-invasive technique, makes it an extremely attractive measurement tool. Likewise, given its ability to assess the regional characteristics of lung structure, it could be considered an ideal monitoring tool in the heterogeneous lung with acute lung injury This review explains the physical concept of bioimpedance and its clinical application, and summarizes the scientific evidence published to date with regard to the implementation of electrical impedance tomography as a method for monitoring ventilation and perfusion, mainly in the patient with acute lung injury, and other possible applications of the technique in the critically ill patient. The review also summarizes the limitations of the technique and its potential areas of future development (AU)

[Electrical impedance tomography in acute lung injury]. / Tomografía de impedancia eléctrica en la lesión pulmonar aguda.

Electrical impedance tomography has been described as a new method of monitoring critically ill patients on mechanical ventilation. It has recently gained special interest because of its applicability for monitoring ventilation and pulmonary perfusion. Its bedside and continuous implementation, and the fact that it is a non-ionizing and non-invasive technique, makes it an extremely attractive measurement tool. Likewise, given its ability to assess the regional characteristics of lung structure, it could be considered an ideal monitoring tool in the heterogeneous lung with acute lung injury. This review explains the physical concept of bioimpedance and its clinical application, and summarizes the scientific evidence published to date with regard to the implementation of electrical impedance tomography as a method for monitoring ventilation and perfusion, mainly in the patient with acute lung injury, and other possible applications of the technique in the critically ill patient. The review also summarizes the limitations of the technique and its potential areas of future development.

Airway and alveolar nitric oxide measurements in obstructive sleep apnea syndrome.

STUDY OBJECTIVES: The process of intermittent hypoxia-reoxygenation produces airway inflammation and endothelial dysfunction that favors the development of cardiovascular disorders in obstructive sleep apnea syndrome (OSAS). Nitric oxide (NO) is an important mediator in airway inflammation and the regulation of endothelium-dependent vasodilation. DESIGN: This study compared airway NO (FE(NO)) and alveolar NO (CA(NO)) measurements in exhaled breath in 30 OSAS patients to those of 30 healthy (non-OSAS) individuals and determined the relationship between NO levels and OSAS severity. Additionally, NO measurements were analyzed after 3 months of CPAP treatment. MEASUREMENTS AND RESULTS: The mean (±SD) FE(NO) level in the OSAS group (27.2 ± 18 ppb) was higher than in the healthy non-OSAS group (p = 0.006). The mean CA(NO) level was 1.65 ± 0.90 ppb, lower than in the non-OSAS group (p = 0.001). A significant correlation was found between FE(NO) and CA(NO) levels and the apnea-hypopnea index (AHI) in the OSAS group (r = 0.8, p < 0.05; r = -0.9, p = 0.01, respectively). FE(NO) levels decreased and CA(NO) levels increased significantly after CPAP treatment. CONCLUSIONS: Severe OSAS patients have higher FE(NO) and lower CA(NO) levels and these are restored to normal after CPAP treatment, reflecting the correction of local upper airway inflammation and endothelial dysfunction present in OSAS patients. Exhaled breath techniques can be useful to identify airway inflammation and endothelial dysfunction in severe OSAS patients.

COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.

BACKGROUND: COPD case finding is currently recommended at primary and tertiary care levels only. AIM: To evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry. METHODS: Pilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV(1)/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry. RESULTS: Of the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV(1)/FVC ratio<0.7. When these subjects with airflow limitation were offered referral to a hospital respiratory function laboratory for further assessments, 11 (52%) attended the appointment. Over 70% of spirometries were rated as being of acceptable quality. No significant differences were observed in lung function parameters between the pharmacy and hospital measurements. CONCLUSIONS: COPD case finding by spirometry in high-risk customers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.

Carbon dioxide rebreathing in non-invasive ventilation. Analysis of masks, expiratory ports and ventilatory modes.

BACKGROUND AND AIM: Carbon dioxide (CO2) rebreathing is a complication of non-invasive ventilation (NIV). Our objectives were to evaluate the ability of masks with exhaust vents (EV) to avoid rebreathing while using positive pressure (PP) NIV with different levels of expiratory pressure (EPAP). Concerning volume-cycled NIV, we aimed to determine whether cylindrical spacers located in the circuit generate rebreathing. MATERIALS AND METHODS: 5 healthy volunteers were evaluated. Bi-level PP was used with 3 nasal and 2 facial masks with and without EV. Spacers of increasing volume attached to nasal hermetic masks were evaluated with volume NIV. Inspired CO2 fraction was analyzed. RESULTS: Rebreathing was zero with all nasal masks and EPAP levels. Using facial masks 1 volunteer showed rebreathing. There was no rebreathing while using all the spacers. CONCLUSIONS: In healthy volunteers, nasal and facial masks with EV prevent rebreathing. In addition, the use of spacers did not generate this undesirable phenomenon.

[The application of new technologies to solving maths problems for students with learning disabilities: the 'underwater school']. / Aplicación de nuevas tecnologías con estudiantescon dificultades de aprendizaje en la solución deproblemas matemáticos: la 'escuela submarina'.

INTRODUCTION: Different procedures have demonstrated efficacy to teach cognitive and metacognitive strategies to problem solving in mathematics. Some studies have used computer-based problem solving instructional programs. AIM: To analyze in students with learning disabilities the efficacy of a cognitive strategies training for problem solving, with three instructional delivery formats: a teacher-directed program (T-D), a computer-assisted instructional (CAI) program, and a combined program (T-D + CAI). SUBJECTS AND METHODS: Forty-four children with mathematics learning disabilities, between 8 and 10 years old participated in this study. The children were randomly assigned to one of the three instructional formats and a control group without cognitive strategies training. In the three instructional conditions which were compared all the students learnt problems solving linguistic and visual cognitive strategies trough the self-instructional procedure. Several types of measurements were used for analysing the possible differential efficacy of the three instructional methods implemented: solving problems tests, marks in mathematics, internal achievement responsibility scale, and school behaviours teacher ratings. RESULTS AND CONCLUSIONS: Our findings show that the T-D training group and the T-D + CAI group improved significantly on math word problem solving and on marks in Maths from pre- to post-testing. In addition, the results indicated that the students of the T-D + CAI group solved more real-life problems and developed more internal attributions compared to both control and CAI groups. Finally, with regard to school behaviours, improvements in school adjustment and learning problems were observed in the students of the group with a combined instructional format (T-D + CAI).

Aplicación de nuevas tecnologías con estudiantes con dificultades de aprendizaje en la solución de problemas matemáticos: la ‘escuela submarina’ / The application of new technologies to solving maths problems for students with learning disabilities: The Underwater school

Introducción. Diferentes procedimientos basados en desarrollos informáticos han demostrado ser eficaces para enseñar estrategias cognitivas y metacognitivas para la resolución de problemas en matemáticas. Objetivo. Analizar en estudiantes con dificultades de aprendizaje la eficacia del entrenamiento en estrategias cognitivas, con tres formatos instruccionales: programa de instrucción directa del profesor (T-D), instrucción basada en un programa informático (CAI) y programa combinado (T-D + CAI). Sujetos y métodos. 44 niños con dificultades de aprendizaje en las matemáticas, entre 8 y 10 años de edad, fueron asignados al azar a cada uno de los tres formatos de instrucción, así como a un grupo control sin entrenamiento en estrategias cognitivas. En las tres condiciones que se compararon, los estudiantes aprendieron estrategias lingüísticas y visuales para la solución de problemas con autoinstrucciones. Se utilizaron diferentes tipos de medidas para analizar la posible eficacia diferencial de los tres métodos de instrucción implementados: test de solución de problemas, calificaciones en matemáticas, escala de responsabilidad interna del rendimiento y valoración del profesor de las conductas en la escuela. Resultados y conclusiones. El grupo con entrenamiento T-D y el grupo con T-D + CAI mejoraron significativamente en solución de problemas de texto y en sus calificaciones matemáticas de la pre a la postevaluación. Además, los estudiantes del grupo T-D + CAI resolvieron más problemas de la vida diaria y desarrollaron más atribuciones internas en comparación con el grupo control y el grupo CAI. Finalmente, en relación con las conductas en la escuela, se observaron mejoras en el ajuste escolar y en problemas de aprendizaje en los estudiantes del grupo con instrucción combinada (T-D + CAI) (AU)

Introduction. Different procedures have demonstrated efficacy to teach cognitive and metacognitive strategies to problem solving in mathematics. Some studies have used computer-based problem solving instructional programs. Aim. To analyze in students with learning disabilities the efficacy of a cognitive strategies training for problem solving, with three instructional delivery formats: a teacher-directed program (T-D), a computer-assisted instructional (CAI) program, and a combined program (T-D + CAI). Subjects and methods. Forty-four children with mathematics learning disabilities, between 8 and 10 years old participated in this study. The children were randomly assigned to one of the three instructional formats and a control group without cognitive strategies training. In the three instructional conditions which were compared all the students learnt problems solving linguistic and visual cognitive strategies trough the self-instructional procedure. Several types of measurements were used for analysing the possible differential efficacy of the three instructional methods implemented: solving problems tests, marks in mathematics, internal achievement responsibility scale, and school behaviours teacher ratings. Results and conclusions. Our findings show that the T-D training group and the T-D + CAI group improved significantly on math word problem solving and on marks in Maths from pre- to post-testing. In addition, the results indicated that the students of the T-D + CAI group solved more real-life problems and developed more internal attributions compared to both control and CAI groups. Finally, with regard to school behaviours, improvements in school adjustment and learning problems were observed in the students of the group with a combined instructional format (T-D + CAI) (AU)

Airway inflammation in the elite athlete and type of sport.

BACKGROUND: The prevalence of asthma and bronchial hyper-responsiveness is greater in elite athletes than in the general population, and its association with mild airway inflammation has recently been reported. OBJECTIVE: To study the relationship between the type of sport practised at the highest levels of competition (on land or in water) and sputum induction cell counts in a group of healthy people and people with asthma. MATERIAL AND METHODS: In total, 50 athletes were enrolled. Medical history, results of methacholine challenge tests and sputum induced by hypertonic saline were analysed RESULTS: Full results were available for 43 athletes, who were classified by asthma diagnosis and type of sport (land or water sports). Nineteen were healthy (10 land and 9 water athletes) and 24 had asthma (13 land and 11 water athletes). Although the eosinophil counts of healthy people and people with asthma were significantly different (mean difference 3.1%, 95% CI 0.4 to 6.2, p = 0.008), analysis of variance showed no effect on eosinophil count for either diagnosis of asthma or type of sport. However, an effect was found for neutrophil counts (analysis of variance: F = 2.87, p = 0.04). There was also a significant correlation between neutrophil counts and both duration of training and bronchial hyper-responsiveness among athletes exposed to water (Spearman's rank correlations, 0.36 and 0.47, p = 0.04 and 0.04, respectively). CONCLUSIONS: Elite athletes who practice water sports have mild neutrophilic inflammation, whether or not asthma is present, related to the degree of bronchial hyper-reactivity and the duration of training in pool water.

Nuevos tratamientos para el asma: anticuerpos monoclonales anti-IgE / New treatments for asthma: anti-IgE monoclonal antibodies

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Alta frecuencia de anemia en pacientes con EPOC ingresados en un hospital de tercer nivel / High frequency of anemia in COPD patients admitted in a tertiary hospital

Introducción. La anemia está relacionada con varias patologías crónicas e inflamatorias y es un factor de mal pronóstico cuando se asocia a la insuficiencia cardiaca o al infarto de miocardio. A pesar de la importancia de la hemoglobina como molécula transportadora de oxígeno, no hay suficientes estudios que recojan la prevalencia de la anemia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Objetivo. Determinar el porcentaje y las características de la anemia en pacientes con EPOC ingresados en un hospital de tercer nivel durante un año. Métodos. De las historias clínicas digitales se recogieron datos antropométricos y clínicos, historia de tabaquismo, hemograma, analítica de rutina, función pulmonar, gasometría arterial y los estudios básicos de anemia (EBA) disponibles. Resultados. Se incluyeron 177 pacientes con una edad media de 70 años (rango 44-95) que presentaban un volumen máximo espirado en el primer segundo de una espiración forzada (FEV1) media (DE) del 35(15)% y un nivel de hemoglobina (Hb) de 136(22) g/dl. Entre ellos, 66 pacientes (37%) estaban en insuficiencia respiratoria crónica (IRC) y 59 recibían oxigenoterapia domiciliaria (33%). De los pacientes incluidos, 56 (31%) presentaron anemia (Hb < 130 g/dl en hombres y < 120 g/dl en mujeres), con una Hb media de 111(13) g/dl, y la normocítica normocrómica fue el tipo morfológico más frecuente en 32 casos (58%). En 24 (42,85%) pacientes se disponía de un EBA que mostró una anemia de trastornos crónicos en 10 casos (41%), ferropénica en 6 (25%) y de otros tipos en 8 (34%). De los pacientes con IRC, 35 (53%) eran anémicos y sólo 8 (4,5%) tenían eritrocitosis. Conclusión. La anemia fue un hallazgo frecuente en estos pacientes y fue una comorbilidad infradiagnosticada

Introduction. Anemia is related to chronic and inflammatory diseases. Moreover, it is a factor of worse outcome in heart failure or myocardial infarction. Despite the importance of hemoglobin as a globular oxygen carrying protein, there are few studies on anemia and chronic obstructive pulmonary disease (COPD). Objective. To determine the frequency and the characteristics of the anemia in COPD patients admitted to a tertiary hospital within a one year period. Methods. Anthropometric and clinical data, tobacco habit, lung function tests, arterial blood gases and a basic study of anemia (BSA) were collected from digital clinical files. Results. A total of 177 patients were enrolled. Mean age was 70 (range 44-95), FEV1 was 35 (15%) and hemoglobin (Hb) 136(22) g/dl. Sixty-six (37%) patients had chronic respiratory failure (CRF) and 59 (33%) were receiving long-term oxygen therapy. A total of 56 (31%) had anemia (Hb < 130 g/dl in men or < 120 g/dl in women) with a mean Hb of 111(13). Anemia was normocytic normochromic in 32 cases (58%). BSA was obtained in 24 patients (42.85%) and showed that 10 patients (41%) had anemia of chronic disease, 6 patients (25%) had iron deficiency and 8 (34%) had other causes. It should be mentioned that 35 patients (53%) had CRF had anemia but only 8 patients had erythrocytosis (4.5%). Conclusion. Anemia was frequent in these patients and was an underdiagnosed comorbidity

Anti-inflammatory effects of high-dose inhaled fluticasone versus oral prednisone in asthma exacerbations.

The objective of the present study was to investigate the kinetics of high doses of inhaled steroid fluticasone in comparison with oral steroid prednisone on plasma protein leakage and bronchial eosinophilia in adults with moderate asthma exacerbations. The study design was a randomised, double-blind, placebo-controlled prospective trial. In total, 45 patients treated at the emergency department for moderate asthma exacerbations were recruited and 39 were assigned to receive fluticasone and placebo of prednisone (19 patients), or prednisone and placebo of fluticasone (20 patients). Medication was administered to all patients via a metered-dose inhaler and spacer (16 puffs; 4,000 microg.day(-1) or placebo) plus one pill (prednisone 30 mg.day(-1) or placebo). Spirometry and induced sputum for differential cell counts, albumin and alpha(2)-macroglobulin levels and blood eosinophils, interleukin-5 and granulocyte-macrophage colony-stimulating factor levels were obtained before treatment and at 2, 6 and 24 h after treatment. Symptoms clearly improved after 24 h in both groups. No differences were seen between groups in peak expiratory flow or forced expiratory flow in one second, which improved progressively but then decayed slightly after 24 h. Eosinophil counts in sputum also improved over time in both groups. The effect was faster with fluticasone than with prednisone, but was partially lost at 24 h. However, plasma proteins in sputum and eosinophil count in blood both decreased until 24 h, with no significant differences between groups. There was no correlation between eosinophil counts and plasmatic protein levels. In conclusion, both treatments improved symptoms, airway obstruction and inflammation, and plasma protein leakage at 24 h. Prednisone reduced blood eosinophil counts, while fluticasone reduced airway eosinophil counts, suggesting that the anti-inflammatory performance of fluticasone is exerted locally.

[High frequency of anemia in COPD patients admitted in a tertiary hospital]. / Alta frecuencia de anemia en pacientes con EPOC ingresados en un hospital de tercer nivel.

INTRODUCTION: Anemia is related to chronic and inflammatory diseases. Moreover, it is a factor of worse outcome in heart failure or myocardial infarction. Despite the importance of hemoglobin as a globular oxygen carrying protein, there are few studies on anemia and chronic obstructive pulmonary disease (COPD). OBJECTIVE: To determine the frequency and the characteristics of the anemia in COPD patients admitted to a tertiary hospital within a one year period. METHODS: Anthropometric and clinical data, tobacco habit, lung function tests, arterial blood gases and a basic study of anemia (BSA) were collected from digital clinical files. RESULTS: A total of 177 patients were enrolled. Mean age was 70 (range 44-95), FEV1 was 35 (15%) and hemoglobin (Hb) 136(22) g/dl. Sixty-six (37%) patients had chronic respiratory failure (CRF) and 59 (33%) were receiving long-term oxygen therapy. A total of 56 (31%) had anemia (Hb < 130 g/dl in men or < 120 g/dl in women) with a mean Hb of 111(13). Anemia was normocytic normochromic in 32 cases (58%). BSA was obtained in 24 patients (42.85%) and showed that 10 patients (41%) had anemia of chronic disease, 6 patients (25%) had iron deficiency and 8 (34%) had other causes. It should be mentioned that 35 patients (53%) had CRF had anemia but only 8 patients had erythrocytosis (4.5%). CONCLUSION: Anemia was frequent in these patients and was an underdiagnosed comorbidity.

Novedades en el diagnóstico de asma / Novelties in the diagnosis of asthma

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