Documento de consenso sobre la docencia del tabaquismo en las facultades de Medicina / Consensus Document on Medical Faculty Education on the Treatment of Smoking

Se presentan los resultados del consenso alcanzado por diferentes expertos en representación de sociedades médicas respiratorias de la Comunidad Latinoamericana y de la Península Ibérica sobre cuáles deben ser los objetivos docentes y competencias asociadas (conocimientos y habilidades), así como los contenidos concretos y la necesaria dedicación horaria que las escuelas de Medicina de dicho ámbito geográfico deberían tener sobre el abaquismo. El documento desarrolla los siguientes aspectos, que cubren todo el espectro del área de conocimiento sobre tabaquismo: epidemiología, bases neurofisiológicas de la dependencia a la nicotina, factores asociados con el inicio y mantenimiento de dicho consumo, enfermedades asociadas con el tabaquismo, diagnóstico, intervención mínima, medidas terapéuticas no farmacológicas, tratamiento farmacológico y prevención

We report the results of a consensus reached by an expert group of representatives from different medical societies in Latin America on the objectives, competencies (knowledge, and skills), content, and duration of smoking cessation education in Latin American medical schools. The document discusses the following aspects: epidemiology, nicotine dependence, factors for initiation and maintenance of tobacco use, smoking-related disorders, diagnosis, minimal intervention, non-pharmacological and pharmacological interventions for smoking cessation, and prevention of smoking

Consensus Document on Medical Faculty Education on the Treatment of Smoking. / Documento de consenso sobre la docencia del tabaquismo en las facultades de Medicina.

We report the results of a consensus reached by an expert group of representatives from different medical societies in Latin America on the objectives, competencies (knowledge, and skills), content, and duration of smoking cessation education in Latin American medical schools. The document discusses the following aspects: epidemiology, nicotine dependence, factors for initiation and maintenance of tobacco use, smoking-related disorders, diagnosis, minimal intervention, non-pharmacological and pharmacological interventions for smoking cessation, and prevention of smoking.

Prognostic Value of Frequent Exacerbations in Bronchiectasis: The Relationship With Disease Severity / Valor pronóstico de las exacerbaciones en las bronquiectasias: relación con la gravedad de la enfermedad

Introduction: Bronchiectasis is a very heterogeneous disease but some homogeneous groups with similar clinical characteristics and prognosis have been identified. Exacerbations have been shown to have a negative impact on the natural history of bronchiectasis. The objective of this study was to identify the definition and characteristics of the "frequent exacerbator patient" with the best prognostic value and its relationship with the severity of bronchiectasis.Methods : A historical cohort of 651 patients diagnosed with bronchiectasis was included. They had all received 5 years of follow-up since their radiological diagnosis. Exacerbation was defined as a worsening of the symptoms derived from bronchiectasis that required antibiotic treatment. The main outcome was all-cause mortality at the end of follow-up. Results: The mean age was 48.2 (16) years (32.9% males). 39.8% had chronic infection by Pseudomonas aeruginosa. Mean BSI, FACED, and E-FACED were 7 (4.12), 2.36 (1.68), and 2.89 (2.03), respectively. There were 95 deaths during follow-up. The definition of the "frequent exacerbator patient" that presented the greatest predictive power for mortality was based on at least two exacerbations/year or one hospitalization/year (23.3% of patients; AUC-ROC: 0.75 [95% CI: 0.69-0.81]). Its predictive power was independent of the patient's initial severity. The clinical characteristics of the frequent exacerbator patient according to this definition varied according to the initial severity of bronchiectasis, presence of systemic inflammation, and treatment. Conclusions: The combination of two exacerbations or one hospitalization per year is the definition of frequent exacerbator patient that has the best predictive value of mortality independent of the initial severi

Las bronquiectasias son una enfermedad muy heterogénea en la que se han identificado algunos grupos homogéneos con características clínicas y pronóstico similares. El objetivo de este estudio fue establecer la definición y características del "paciente exacerbador frecuente" que presenta mejor valor pronóstico y su relación con la gravedad de las bronquiectasias. Métodos: Se analizó una cohorte histórica de 651 pacientes diagnosticados de bronquiectasias. Se siguió a todos ellos durante cinco años desde su diagnóstico radiológico. La exacerbación se definió como un empeoramiento de los síntomas de las bronquiectasias para el que se requiera tratamiento antibiótico. El principal resultado analizado fue la mortalidad por todas las causas al final del seguimiento. Resultados: La edad media fue 48,2 (16) años (39,2% de hombres). El 38,9% tuvo infección por Pseudomonas aeruginosa. Los valores medios de BSI, FACED y E-FACED fueron 7 (4,12), 2,36 (1,68) y 2,89 (2,03), respectivamente. Hubo 96 muertes durante el seguimiento. La definición de "paciente exacerbador frecuente" que presentó el mayor valor predictivo para la mortalidad incluía la aparición de al menos dos exacerbaciones/año o un ingreso hospitalario/año (23.3% de los pacientes; AUC-ROC:0.75 [IC 95%: 0.69-0.81]). Su valor predictivo fue independiente de la gravedad inicial del paciente. Las características clínicas del "paciente exacerbador frecuente", de acuerdo con esta definición, variaron según la gravedad inicial de la bronquiectasia, la presencia de inflamación sistémica y el tratamiento. Conclusiones: La combinación de dos exacerbaciones o un ingreso hospitalario al año constituye la mejor definición de "paciente exacerbador frecuente" con mayor valor predictivo para la mortalidad, independientemente de la gravedad inicial de las bronquiectasias

Prognostic Value of Frequent Exacerbations in Bronchiectasis: The Relationship With Disease Severity.

INTRODUCTION: Bronchiectasis is a very heterogeneous disease but some homogeneous groups with similar clinical characteristics and prognosis have been identified. Exacerbations have been shown to have a negative impact on the natural history of bronchiectasis. The objective of this study was to identify the definition and characteristics of the "frequent exacerbator patient" with the best prognostic value and its relationship with the severity of bronchiectasis. METHODS: A historical cohort of 651 patients diagnosed with bronchiectasis was included. They had all received 5 years of follow-up since their radiological diagnosis. Exacerbation was defined as a worsening of the symptoms derived from bronchiectasis that required antibiotic treatment. The main outcome was all-cause mortality at the end of follow-up. RESULTS: The mean age was 48.2 (16) years (32.9% males). 39.8% had chronic infection by Pseudomonas aeruginosa. Mean BSI, FACED, and E-FACED were 7 (4.12), 2.36 (1.68), and 2.89 (2.03), respectively. There were 95 deaths during follow-up. The definition of the "frequent exacerbator patient" that presented the greatest predictive power for mortality was based on at least two exacerbations/year or one hospitalization/year (23.3% of patients; AUC-ROC: 0.75 [95% CI: 0.69-0.81]). Its predictive power was independent of the patient's initial severity. The clinical characteristics of the frequent exacerbator patient according to this definition varied according to the initial severity of bronchiectasis, presence of systemic inflammation, and treatment. CONCLUSIONS: The combination of two exacerbations or one hospitalization per year is the definition of frequent exacerbator patient that has the best predictive value of mortality independent of the initial severity of bronchiectasis.

Latin America validation of FACED score in patients with bronchiectasis: an analysis of six cohorts.

BACKGROUND: The FACED score is an easy-to-use multidimensional grading system that has demonstrated an excellent prognostic value for mortality in patients with bronchiectasis. A Spanish group developed the score but no multicenter international validation has yet been published. METHODS: Retrospective and multicenter study conducted in six historical cohorts of patients from Latin America including 651 patients with bronchiectasis. Clinical, microbiological, functional, and radiological variables were collected, following the same criteria used in the original FACED score study. The vital status of all patients was determined in the fifth year of follow-up. The area under ROC curve (AUC-ROC) was used to calculate the predictive power of the FACED score for all-cause and respiratory deaths and both number and severity of exacerbations. The discriminatory power to divide patients into three groups of increasing severity was also analyzed. RESULTS: Mean (SD) age of 48.2 (16), 32.9% of males. The mean FACED score was 2.35 (1.68). During the follow up, 95 patients (14.6%) died (66% from respiratory causes). The AUC ROC to predict all-cause and respiratory mortality were 0.81 (95% CI: 0.77 to 0.85) 0.84 (95% CI: 0.80 to 0.88) respectively, and 0.82 (95% CI: 078-0.87) for at least one hospitalization per year. The division into three score groups separated bronchiectasis into distinct mortality groups (mild: 3.7%; moderate: 20.7% and severe: 48.5% mortality; p < 0.001). CONCLUSIONS: The FACED score was confirmed as an excellent predictor of all-cause and respiratory mortality and severe exacerbations, as well as having excellent discriminative capacity for different degrees of severity in various bronchiectasis populations.