Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997-2007.

We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n = 4,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n = 3,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1-10.2%) in 1997 to 4.5% (95% CI 2.4-6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40-69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p<0.05) within this 10-yr frame. The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.

Papel de la cirugía mínimamente invasiva en el manejo del carcinoma broncogénico / Sleep apnea-hypopnea syndrome (SAHS), chronic obstructive pulmonary disease (COPD) and non-invasive

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Costes de la EPOC en España. Estimación a partir de un estudio epidemiológico poblacional / Costs of chronic obstructive pulmonary disease in Spain. Estimation from a population-based study

OBJETIVO: En los estudios realizados hasta ahora, el coste de la enfermedad pulmonar obstructiva crónica (EPOC) puede estar sobrestimado porque han incluido a pacientes previamente diagnosticados que consultaron por sus síntomas, por lo que la gravedad puede ser superior a la que realmente tendría una población no seleccionada obtenida de la población general. El propósito del presente estudio fue estimar el coste directo de la EPOC basándose en una muestra representativa del conjunto de la población española de entre 40 y 69 años (estudio IBERPOC). MÉTODO: El coste se evaluó retrospectivamente a través de un cuestionario referido al último año en los 363 pacientes con EPOC del estudio IBERPOC. Un neumólogo realizó a todos ellos una espirometría estandarizada en cada una de las 7 áreas geográficas en las que se llevó a cabo el estudio. RESULTADOS: La asistencia hospitalaria fue el coste más elevado (41 por ciento del coste total), seguido del tratamiento farmacológico (37 por ciento). El coste por paciente fue de 98,39 , y por paciente previamente diagnosticado, de 909,5 . El coste de la EPOC grave por persona fue más de tres veces el coste de la EPOC moderada y más de 7 veces el coste de la EPOC leve. El coste anual estimado de la EPOC en España fue de 238,82 millones de euros (información referida a 1997). CONCLUSIÓN: Éste es el primer estudio que estima el coste de la EPOC en una muestra representativa de la población general, que es inferior al calculado por los estudios que han analizado una muestra seleccionada con diagnóstico previo de EPOC. La distribución del gasto no se ajusta a las prácticas asistenciales recomendables, por lo que son necesarias actuaciones que optimicen los recursos empleados en el seguimiento y en el tratamiento de la enfermedad, prestando especial atención a su diagnóstico temprano (AU)

[Costs of chronic obstructive pulmonary disease in Spain. Estimation from a population-based study]. / Costes de la EPOC en España. Estimación a partir de un estudio epidemiológico poblacional.

OBJECTIVE: In the studies carried out to date, the cost of chronic obstructive pulmonary disease (COPD) may have been overestimated due to the inclusion of previously diagnosed patients seeking medical attention for their symptoms. As a result, the severity of the cases included in these studies may have been greater than in an unselected sample of the general population. The aim of the present study was to estimate the direct cost of COPD on the basis of a representative sample of the overall Spanish population between 40 and 69 years of age (from the IBERPOC study). METHOD: The cost was evaluated retrospectively by means of a questionnaire completed by the 363 patients with COPD from the IBERPOC study with questions referring to the previous year. Standardized spirometry was performed on all the patients by a pneumologist in each of the 7 geographical areas in which the study was carried out. RESULTS: Hospitalization accounted for the greatest expenditure (41% of total), followed by drug therapy (37%). The cost was euro;98.39 per patient, and euro;909.50 per previously diagnosed patient. The cost per person of severe COPD was more than 3 times that of moderate COPD and more than 7 times that of mild COPD. The estimated annual cost of COPD in Spain was euro;238.82 million (for 1997). CONCLUSION: The present study, which was the first to estimate the cost of COPD in a representative sample of the general population, found the cost to be lower than in studies analyzing samples of patients with previous diagnoses of COPD. The cost distribution is not in line with recommended health care practices, underlining the need to optimize resources used to monitor and treat the disease, with an emphasis on early diagnosis.

Nódulo pulmonar solitario:¿qué ha cambiado en su evaluación diagnóstica? / Solitary pulmonary nodule: how has diagnostic assessment changed?

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[Respiratory symptoms and diagnosis of COPD in smokers of various types to tobacco. Results from the IBERPOC study]. / Síntomas respiratorios y diagnóstico de EPOC en fumadores de distintas labores de tabaco. Resultados del estudio IBERPOC.

BACKGROUND: The aim of this study was to investigate the sociodemographic characteristics, smoking habits, the prevalence of respiratory symptoms and chronic obstructive pulmonary disease (COPD) in four groups of smokers: of cigarettes (SCt), of cigars (SCigar), of both (SB), of cigars currently but of cigarettes in the past (SCigarExCt) and of cigarettes currently but of cigars in the past (SCtExCigar). METHOD: A multicenter epidemiological study enrolling 4,035 subjects aged between 40 and 69 years. One thousand nine hundred sixty-three were non-smokers and 1,146 were current smokers. Among the smokers, 869 were SCt, 37 were SCigar, 97 were SB, 86 were SCigarExCt and 57 were SCtExCigar. We analyzed sociodemographic characteristics, smoking and the prevalence of respiratory symptoms and COPD. RESULTS: Cigar smokers were usually men, of lower socioeconomic status (p < 0.001) and older than cigarette smokers (p < 0.001), but CO concentrations in expired air were lower in the SCigar group than in the SCt group (5 ppm vs 15.7; p < 0.001). Informants who believed their smoking was not detrimental to their health or to that of second-hand smokers made up 86.5% of the SCigar group and 79.1% of the SCigarExCt group. COPD was diagnosed in 13.2% of the SCt group, in 24.7% of the SB group, and in 12.8% of the SCigarExCt group, in comparison with 4% of the non-smokers (p < 0.001 for all comparisons). CONCLUSIONS: SCigar are mainly older men with lower educational levels. Their concentrations of CO in expired air are low and they have little awareness of the health risks posed by their habit. SCigar who were once smokers of cigarettes have a higher prevalence of respiratory symptoms and COPD than non-smokers and the same prevalence of COPD as SCt.

Síntomas respiratorios y diagnóstico de EPOC en fumadores de distintas labores de tabaco. Resultados del estudio IBERPOC / Respiratory symptoms and diagnosis of COPD in smokers of various types to tobacco. Results from the IBERPOC study

FUNDAMENTO: El objetivo de este estudio fue investigar las características sociodemográficas y de tabaquismo, así como la presencia de síntomas respiratorios y enfermedad pulmonar obstructiva crónica (EPOC) en cuatro grupos de fumadores: de cigarrillos (FC), de cigarros (FP), de cigarrillos y cigarros (FCP), de cigarros que fueron fumadores de cigarrillos (FPEC) y de cigarrillos que fueron fumadores de cigarros (FCEP).MÉTODO: Estudio epidemiológico multicéntrico que incluyó a 4.035 individuos entre 40 y 69 años; 1.963 no fumadores, y 1.146 fumadores activos. Entre estos últimos, 869 eran FC, 37 FP, 97 FCP, 86 FPEC y 57 FCEP. Se analizaron sus características sociodemográficas y de tabaquismo, así como los síntomas respiratorios y la presencia de EPOC.RESULTADOS: Los FP fueron con mayor frecuencia varones, de clases sociales más deprimidas (p < 0,001) y de mayor edad que los FC (p < 0,001), pero sus concentraciones de CO en aire espirado fueron inferiores a las de los FC (5 ppm frente a 15,7; p < 0,001). El 86,5 per cent de los FP y el 79,1 per cent de los FPEC pensaban que consumir este tipo de tabaco no era perjudicial para su salud ni para la de los fumadores pasivos. La EPOC se diagnosticó en el 13,2 per cent de los FC, en el 24,7 per cent de los FCP y en el 12,8 per cent de los FPEC, frente al 4 per cent de los no fumadores (p < 0,001 en todas las comparaciones).CONCLUSIONES: Los FP son mayoritariamente varones de más edad que los FC y pertenecen a estratos educacionales deprimidos. Tienen concentraciones bajas de CO en su aire espirado y escaso conocimiento de los riesgos que este hábito supone para su salud. Los FPEC tienen más alta incidencia de síntomas respiratorios y de EPOC que los no fumadores e idéntica incidencia de EPOC que los FC (AU)

[Multicenter experience of video-assisted thoracic surgery to treat mediastinal cysts and tumors]. / Experiencia multicéntrica de cirugía videotoracoscópica en el tratamiento de quistes y tumores del mediastino.

OBJECTIVE: In spite of improvements in imaging techniques, surgical procedures are often needed to diagnose and definitively treat mediastinal masses. The range of application of video-assisted thoracic surgery (VATS) in this context is still poorly defined. The present study describes and analyzes the experience of the Cooperative Group for Video-assisted Thoracoscopic Surgery of the Spanish Society of Pneumology and Thoracic Surgery (GCCVT-SEPAR), with the aim of determining the usefulness of the technique for treating mediastinal cysts and tumors. METHOD: For 2 years we gathered information prospectively on 1,573 consecutive VATS procedures in 17 hospitals. The data from 64 procedures performed for diagnosis and treatment of mediastinal cysts and tumors are analyzed. RESULTS: A definitive diagnosis was reached in all cases. Nineteen were malignant tumors and 45 were benign lesions. Twenty-five complete resections (39%) were performed: 6 pleuropericardial cysts, 4 bronchogenic cysts, 8 neurogenic tumors and other benign lesions. Radiologically poorly defined masses and those located in the anterior and median parts of the mediastinum were most often the object of diagnostic procedures, whereas cysts and well-defined solid lesions on the posterior mediastinum were usually the object of therapeutic interventions. Eleven percent of the cases required conversion to thoracotomy, mainly due to pleural adhesions. Four complications (6.3%) were recorded and no deaths occurred. The median hospital stay after surgery was 2.5 days; 7.8% of the procedures were performed on outpatients. CONCLUSIONS: VATS is performed on many mediastinal lesions in Spain. Cysts and benign tumors are selected for resection. Poorly defined and malignant lesions were diagnosed by biopsy. The experience reported demonstrates the efficacy and safety of this technique for selected cases.

Experiencia multicéntrica de cirugía videotoracoscópica en el tratamiento de quistes y tumores del mediastino / Multicenter experience of video-assisted thoracic surgery to treat mediastinal cysts and tumors

OBJETIVO: A pesar del perfeccionamiento de las técnicas de la imagen, se requiere con frecuencia algún procedimiento quirúrgico para la valoración diagnóstica y el tratamiento definitivo de las masas mediastínicas. El alcance de la cirugía videotoracoscópica (CVT) en este campo no está todavía bien definido. En el presente estudio se describe y se analiza la experiencia del Grupo Cooperativo de Cirugía Videotoracoscópica SEPAR (GCCVT-SEPAR), con el objetivo de conocer la utilidad de esta técnica en el tratamiento de quistes y tumores mediastínicos. MÉTODO: Durante 2 años y de forma prospectiva se han recogido datos de 1.573 procedimientos videotoracoscópicos consecutivos de 17 hospitales. Se analizan los datos completos de 64 procedimientos practicados para el diagnóstico y tratamiento de quistes y tumores del mediastino. RESULTADOS: Se obtuvo el diagnóstico definitivo en todos los casos. Hubo 19 tumores malignos y 45 lesiones benignas.Se realizaron 25 resecciones completas (39 per cent): seis quistes pleuropericárdicos, cuatro quistes broncogénicos, ocho tumores neurogénicos y otras lesiones benignas. Las masas radiológicamente mal definidas y las de localización en el mediastino anterior y medio fueron operadas con más frecuencia con fines diagnósticos, mientras que las lesiones quísticas y las sólidas bien delimitadas del mediastino posterior lo fueron más bien con intenciones terapéuticas. El 11 per cent de los casos precisó una conversión a toracotomía, debido principalmente a adherencias pleurales. Hubo cuatro complicaciones (6,3 per cent) y no hubo mortalidad en la serie. La mediana de hospitalización posquirúrgica fue de 2,5 días. El 7,8 per cent de los procedimientos se realizó mediante cirugía ambulatoria. CONCLUSIONES: La CVT se llevó a cabo en múltiples lesiones mediastínicas en España. Se seleccionaron las lesiones quísticas y los tumores benignos para la resección. Las lesiones mal delimitadas y malignas fueron diagnosticadas mediante biopsia. La experiencia demuestra la eficacia y la seguridad de esta técnica para los casos seleccionados (AU)

Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentre epidemiological study.

OBJECTIVES: To ascertain the prevalence, diagnostic level, and treatment of COPD in Spain through a multicenter study comprising seven different geographic areas. DESIGN AND PARTICIPANTS: This is an epidemiologic, multicenter, population-based study conducted in seven areas of Spain. A total of 4,035 men and women (age range, 40 to 69 years) who were randomly selected from a target population of 236,412 subjects participated in the study. INTERVENTIONS: Eligible subjects answered the European Commission for Steel and Coal questionnaire. Spirometry was performed, followed by a bronchodilator test when bronchial obstruction was present. RESULTS: The prevalence of COPD was 9.1% (95% confidence interval [CI], 8.1 to 10.2%), 15% in smokers (95% CI, 12.8 to 17.1%), 12.8% in ex-smokers (95% CI, 10.7 to 14.8%), and 4.1% in nonsmokers (95% CI, 3.3 to 5.1%). The prevalence in men was 14.3% (95% CI, 12.8 to 15. 9%) and 3.9% in women (95% CI, 3.1 to 4.8%). Marked differences were observed between sexes in smoking; the percentage of nonsmokers was 23% in men and 76.3% in women (p<0.0001). The prevalence of COPD varied among the areas, ranging from 4.9% (95% CI, 3.2 to 7.0%) in the area of the lowest prevalence to 18% (95% CI, 14.8 to 21.2%) in the area of the highest. There was no previous diagnosis of COPD in 78.2% of cases (284 of 363). Only 49.3% of patients with severe COPD, 11.8% of patients with moderate COPD, and 10% of patients with mild COPD were receiving some kind of treatment for COPD. Multivariate analysis showed that individuals had a higher probability of having received a previous diagnosis of COPD if they lived in urban areas, were of male gender, were > 60 years old, had higher educational levels, had > 15 pack-year smoking history, or had symptoms of chronic bronchitis. CONCLUSIONS: COPD is a very frequent disease in Spain, and presents significant geographic variations and a very low level of previous diagnosis and treatment, even in the most advanced cases.

[Prevalence of and attitudes towards smoking in a population over 40 years of age]. / Prevalencia y actitudes sobre tabaquismo en población mayor de 40 años.

OBJECTIVES: Smoking is the main cause of preventable death in developed countries. One of the most relevant health care interventions is convincing smokers to quit. To achieve that end, it is important to know, in addition to the prevalence of smoking, the degree of physical addiction to nicotine and smokers' attitudes toward tobacco. MATERIAL AND METHODS: This study collects results from a Spanish national epidemiological study (the IBERPOC study) related to smoking addiction, smokers' degree of addiction to nicotine and smokers attitudes toward their habits. The data has been obtained by surveying 4,035 individuals selected randomly from census data in seven different parts of the country. Information was obtained from questionnaires and CO in expired air was measured. RESULTS: One thousand fifty-nine respondents were smokers (26%) and 968 were ex-smokers (24%). Female smokers were younger (47 versus 51 years old) and had started smoking later (at age 22 versus 17 years), smoked fewer cigarettes per day (15 versus 21) and had lower concentrations of CO in expired air (13.4 versus 17 ppm) (p < 0.001 for all comparisons). Six hundred fifty-nine smokers (62.2%) had tried to quit at least once. The most important reasons given for trying to quit were related to improving health. CONCLUSIONS: The 26% of the surveyed population smoked. Women generally started later, smoked fewer cigarettes and were less physically addicted to nicotine. Most smokers had tried at least once to quit, particularly if motivated to improve health. These results should be considered when proposing strategies for smoking cessation.

Prevalencia y actitudes sobre tabaquismo en población mayor de 40 años / Prevalence of and attitudes toward smoking among over-40-year-olds

Objetivos: El tabaco es la principal causa evitable de muerte en los países desarrollados. Una de las actuaciones sanitarias más relevantes es conseguir que los fumadores abandonen su hábito. Para lograrlo, es importante conocer, además de la prevalencia del tabaquismo, el grado de dependencia física a la nicotina y las actitudes frente al tabaco de los fumadores. Material y métodos: El presente trabajo recoge los resultados derivados de un estudio epidemiológico nacional (estudio IBERPOC) relativos al hábito tabáquico, el grado de dependencia a la nicotina de los fumadores y las actitu des de este colectivo frente al tabaco. Los datos se han obtenido mediante la encuesta de 4.035 individuos seleccionados aleatoriamente a partir de los datos censales de 7 áreas geográficas distintas. Se ha recogido información a través de cuestionarios y se ha medido la concentración de CO en aire espirado. Resultados: Un total de 1.059 encuestados eran fumadores (26 por ciento) y 968 eran ex fumadores (24 por ciento). Las mujeres fumadoras eran más jóvenes (47 frente a 51 años), se iniciaron más tarde en el hábito (22 frente a 17 años), fuman menos cigarrillos por día (15 frente a 21) y presentan menores concentraciones de CO en aire espirado (13,4 frente a 17,1 ppm) (p < 0,0001 en todas las comparaciones). Un total de 659 fumadores (62,2 por ciento) ha realizado al menos un intento por dejar de fumar. Los motivos más importantes para intentarlo son los relacionados con un mejor estado de salud. Conclusiones: Un 26 por ciento de los sujetos de la población encuestada fueron fumadores. En general, las mujeres se inician a edad más tardía, fuman menos cigarrillos y presentan una menor dependencia física a la nicotina. La mayoría de los fumadores ha intentado dejar de fumar al menos en una ocasión, sobre todo motivados por alcanzar un mejor estado de salud. Estos resultados deben considerarse a la hora de plantear estrategias dirigidas a ayudar a los fumadores a abandonar su adicción. (AU)

[Epidemiological study of chronic obstructive pulmonary disease in Spain (IBERPOC): recruitment and field work]. / Estudio epidemiológico de la EPOC en España (IBERPOC): reclutamiento y trabajo de campo.

Chronic obstructive pulmonary disease (COPD) is a large-scale social and health problem. Because prevalence studies have been performed only in certain areas of Spain, the Spanish Society of Pneumology and Chest Surgery initiated the IBERPOC study with the aim of determining the prevalence of COPD in several parts of the country. IBERPOC is a multicenter, population-based epidemiological study in which subjects have been selected randomly. Seven full-time pneumologists work full-time in seven different areas of Spain. A study of this nature involves a series of difficulties that should be taken into account at the time of planning studies of a similar nature. After 5,827 attempts to reach subjects, a total of 4,967 useful contacts were made, to provide 97.3% of the 5,104 contacts expected. Of those 4,967 useful contacts, 4,035 subjects completed interviews. Among the 932 refusals, 882 (94.6%) agreed to answer a short telephone questionnaire. The field work took 13 months to complete, 30% more time than had been anticipated. The rates at which subjects could not be traced differed from one zone to another, ranging between 5% and 30%; higher rates were attributable to the absence of telephone data in the corresponding census report. In one zone, the dispersion of the census population over a very large area supposed greater difficulty and delay in carrying out the study. In conclusion, the rate of participation and the time required for recruitment can be considered satisfactory. The performance of field work by trained, full-time pneumologists has been essential to the development and quality of the study. Similar epidemiological studies should consider problems derived from the lack of adequate census data, as well as to avoid defining areas of extreme population dispersion in order to facilitate field work.

[Epidemiological study of chronic obstructive pulmonary disease in Spain (IBERPOC): prevalence of chronic respiratory symptoms and airflow limitation]. / Estudio IBERPOC en España: prevalencia de síntomas respiratorios habituales y de limitación crónica al flujo aéreo.

The prevalence of chronic respiratory symptoms and chronic airflow limitation (CAFL) was determined in a multicentric epidemiological study carried out in seven different areas of Spain. Based on a target population of 236,412 persons, a random census sample of 4,035 individuals between 40 and 69 years of age was chosen. Subjects answered several questionnaires and performed spirometric tests followed by a bronchodilation test if bronchial obstruction was detected. Respiratory symptoms were reported by 48% of the population (95% CI: 46.4-49.5%) with greater frequency of symptoms among men than women (55.2% versus 41%, p < 0.001). The following levels of prevalence of chronic symptoms were found: cough, 13.5% (95% CI: 12.5-14.6%); expectoration, 10.7% (95% CI: 9.7-11.6%); dyspnea after one flight of stairs, 10.4% (95% CI: 9.5-11.4%); and wheezing, 40.2% (95% CI: 38.7-41.7%). The prevalence of chronic bronchitis (CB) was 4.8% (95% CI: 4.1-5.4%) and was more frequent among men than among women (8.3% and 1.4%, respectively; p < 0.001). Asthma had been diagnosed previously in 4.9% (95% CI: 4.2-5.5%), more often in women than in men (5.8% and 3.8%, respectively; p < 0.003). CAFL was found in 10.6% (95% CI: 9.6-11.5%), 15.8% in men and 5.5% in women (p < 0.001). All respiratory symptoms except asthma were more frequent among smokers than among ex-smokers, and in turn were more common among ex-smokers than non-smokers. The frequency of symptoms increased in accordance with accumulated smoking. The prevalence of CB and CAFL was vastly different from one region to another. Multivariate analysis showed that factors associated independently with the appearance of CB were smoking, age over 60 years, male sex and having worked in industry. In conclusion, respiratory symptoms, including CB and CAFL, are common in the Spanish population. Smoking and amount of smoking are directly related to the frequency of such symptoms. Substantial differences were found in the prevalence of CB and CAFL among the regions where the study was performed.

[Mediastinal leiomyosarcoma]. / Leiomiosarcoma mediastínico.

Primary mediastinal leiomyosarcomas are malignant sarcomas with unknown etiology not deriving from the smooth muscle fiber of the esophagus, trachea or main vessels. Very few cases have been reported in the literature and, although they are clinically unspecific, their histology is unique. The case described here is a 66-year-old woman with a leiomyosarcoma localized at the medium and posterior mediastinum, clinically presented as a mediastinal emergency.