Visualización de cavidad pleural a través de broncoscopia flexible debido a gran fístula broncopleural / Visualization of the Pleural Space During a Flexible Bronchoscopy due to Bronchopleural Fistula

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[Translated article] Visualization of the Pleural Space During a Flexible Bronchoscopy due to Bronchopleural Fistula / Visualización de cavidad pleural a través de broncoscopia flexible debido a gran fístula broncopleural

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Estudio de marcadores de inflamación en el aire exhalado de pacientes con bronquiectasias no asociadas a fibrosis quística / Inflammation Markers in the Exhaled Air of Patients with Bronchiectasis Unassociated with Cystic Fibrosis

IntroducciónEl propósito del estudio ha sido analizar la relación entre la intensidad de la inflamación de las vías aéreas respiratorias, expresada por marcadores de estrés oxidativo, y la gravedad de la enfermedad en pacientes con bronquiectasias no asociadas a fibrosis quística.Pacientes y métodosSe ha estudiado a 25 pacientes con bronquiectasias estables (15 mujeres y 10 varones). Como determinantes de gravedad se recogieron las siguientes variables: grado de disnea, número de exacerbaciones/ingresos en el último año, volumen diario medio de esputo, color del esputo (escala gradual de color), colonización bacteriana, exploración de la función respiratoria, calidad de vida (cuestionario St. George) y extensión radiológica de las lesiones (escala de Bhalla). La inflamación se analizó mediante la medición del óxido nítrico, pH y concentración de nitritos, nitratos e isoprostano en el condensado de aire exhalado. Asimismo se determinaron los valores de proteína C reactiva y velocidad de sedimentación globular en sangre periférica.ResultadosNo hubo relaciones significativas entre los marcadores en condensado de aire exhalado y la afectación clínica, radiológica, funcional o de calidad de vida de los pacientes. Sólo la colonización bacteriana (16 casos) se relacionó con valores más altos de nitratos en aire exhalado (media±desviación estándar: 18±4 frente a 7±2μM; r2=0,6) y un mayor número de exacerbaciones (3,1±1,9 frente a 1,7±1,9; r2=0,3).ConclusionesEn nuestra muestra, el estudio de marcadores de inflamación en aire exhalado sólo se relaciona con algunos parámetros de gravedad en pacientes con bronquiectasias colonizadas(AU)

IntroductionThe aim of the study was to analyse the relationship between the intensity of the respiratory tract inflammation, expressed by oxidative stress markers, and the severity of the disease in patients with bronchiectasis unassociated with cystic fibrosis.Patients and methodsThe study included 25 patients with stable bronchiectasis (15 females and 10 males). As determining factors of severity, the following parameters were collected: degree of dyspnoea, number of exacerbations/admissions in the last year, mean daily sputum volume, sputum colour (graduated colour scale), bacterial colonisation, respiratory function tests, quality of life (St. George questionnaire) and radiological extension of the lesions (Bhalla scale). Inflammation was analysed using the measurement of nitric oxide, pH and concentration of nitrites, nitrates and isoprostane in the exhaled air condensate. The C reactive protein and erythrocyte sedimentation rate were also determined in peripheral blood.ResultsThere were no significant relationships between the markers in the exhaled air condensate and the clinical, radiological and functional involvement or the quality of life of the patients. Only bacterial colonisation (16 cases) was associated with higher values of nitrates in exhaled air (mean±standard deviation: 18±4 compared to 7±2μM; r2=0.6) and a higher number of exacerbations (3.1±1.9 compared to 1.7±1.9; r2=0.3).ConclusionsIn our study, the measurement of inflammation markers in exhaled air is only associated with some parameters of severity in patients with bacterial bronchiectasis(AU)

[Inflammation markers in the exhaled air of patients with bronchiectasis unassociated with cystic fibrosis]. / Estudio de marcadores de inflamación en el aire exhalado de pacientes con bronquiectasias no asociadas a fibrosis quística.

INTRODUCTION: The aim of the study was to analyse the relationship between the intensity of the respiratory tract inflammation, expressed by oxidative stress markers, and the severity of the disease in patients with bronchiectasis unassociated with cystic fibrosis. PATIENTS AND METHODS: The study included 25 patients with stable bronchiectasis (15 females and 10 males). As determining factors of severity, the following parameters were collected: degree of dyspnoea, number of exacerbations/admissions in the last year, mean daily sputum volume, sputum colour (graduated colour scale), bacterial colonisation, respiratory function tests, quality of life (St. George questionnaire) and radiological extension of the lesions (Bhalla scale). Inflammation was analysed using the measurement of nitric oxide, pH and concentration of nitrites, nitrates and isoprostane in the exhaled air condensate. The C reactive protein and erythrocyte sedimentation rate were also determined in peripheral blood. RESULTS: There were no significant relationships between the markers in the exhaled air condensate and the clinical, radiological and functional involvement or the quality of life of the patients. Only bacterial colonisation (16 cases) was associated with higher values of nitrates in exhaled air (mean+/-standard deviation: 18+/-4 compared to 7+/-2microM; r(2)=0.6) and a higher number of exacerbations (3.1+/-1.9 compared to 1.7+/-1.9; r(2)=0.3). CONCLUSIONS: In our study, the measurement of inflammation markers in exhaled air is only associated with some parameters of severity in patients with bacterial bronchiectasis.

[Perception of dyspnea and treatment adherence in asthmatic patients]. / Percepción de la disnea y cumplimiento terapéutico en pacientes con asma.

OBJECTIVE: The majority of studies show that treatment adherence in chronic diseases such as asthma does not exceed 50%. Although the reasons may vary, it is clear that lack of treatment adherence is a determining factor in poor disease control. An association has also been observed between lack of perception of dyspnea and difficult-to-control asthma and with the occurrence of fatal or near-fatal asthma attacks. In this study we therefore attempted to demonstrate that one of the reasons that asthmatic patients do not adhere to treatment is a failure to perceive dyspnea associated with bronchial obstruction. PATIENTS AND METHODS: We analyzed 2 groups of patients with moderate persistent asthma who had all been prescribed the same chronic treatment (a dose of inhaled drug administered with a dry powder inhaler every 12 hours). The first group comprised 24 patients (16 women and 8 men; mean [SD] age, 44 [15] years) who took the medication almost every day. The second group contained 24 patients (16 women and 8 men; mean [SD] age, 48 [14] years) who did not use the medication or only took it occasionally. There were no significant differences between the groups in terms of age, sex, percentage of smokers, socioeconomic and educational level, anxiety, depression, or spirometry variables. A histamine challenge test was carried out in all patients and the dyspnea perceived after each dose of the drug was measured on a modified Borg scale. The dose of histamine leading to a 20% reduction in forced expiratory volume in 1 second (FEV(1)), perception of dyspnea associated with a 20% reduction in FEV(1) (PS(20)), and the change in dyspnea measured on the Borg scale between baseline and 20% reduction in FEV(1) were analyzed. Patients were also classified as poor perceivers of dyspnea if the change in perception of dyspnea on the modified Borg scale was less than or equal to zero. RESULTS: The group of patients with poor treatment compliance had a lower PS(20) (2.27 [1.9] vs 3.51 [1.8], P=.03) and change in Borg score (1.64 [1.9] vs 2.7 [1.84], P=.057), and they were more often poor perceivers of dyspnea (50% vs 21%, P=.034). CONCLUSIONS: There is a relationship between treatment adherence and dyspnea perception, such that poor perception is among the reasons for poor treatment adherence in patients with asthma.

Percepción de la disnea y cumplimiento terapéutico en pacientes con asma / Perception of dyspnea and treatment adherence in asthmatic patients

OBJETIVO: El cumplimiento terapéutico en una enfermedad crónica como el asma no supera el 50% en la mayoría de las series. Aunque las razones sean de muy diversa índole, es evidente que el incumplimiento es un factor determinante en el mal control de la enfermedad. Por otra parte, la falta de percepción de la disnea se ha asociado con el asma de control difícil y con la aparición de crisis de asma fatal o casi fatal. Así pues, el objetivo del presente estudio ha sido intentar demostrar que una de las razones por las cuales los asmáticos no toman su medicación es que no tienen percepción de disnea cuando sus bronquios se obstruyen. PACIENTES Y MÉTODOS: Hemos estudiado a 2 grupos de pacientes con asma persistente y moderada, a quienes se había prescrito el mismo tratamiento de forma continuada (una dosis de medicación inhalada en polvo seco cada 12 h). El primero estaba formado por 24 pacientes (16 mujeres y 8 varones; edad media ± desviación estándar: 44 ± 15 años) que tomaban casi todos los días la medicación, y el segundo, por otros 24 pacientes (16 mujeres y 8 varones; edad media: 48 ± 14 años) que no tomaban la medicación o lo hacían sólo de vez en cuando. No había diferencias significativas entre los grupos en cuanto a edad, sexo, porcentaje de fumadores, niveles económico y educativo, ansiedad, depresión y parámetros espirométricos. A todos ellos se les realizó una prueba de broncoprovocación con histamina, y se midió la disnea experimentada tras cada dosis del fármaco en una escala modificada de Borg. Se determinaron la dosis de histamina con la que se alcanzó una caída del 20% en el volumen espiratorio forzado en el primer segundo (FEV1), la percepción de disnea con una caída del FEV1 del 20% (PS20) y el cambio de disnea en la escala de Borg desde la situación inicial hasta la caída del 20% de FEV1 (cambio en Borg). Además, se clasificó a los pacientes como hipoperceptores de disnea cuando su cambio en Borg fue igual o inferior a 0. RESULTADOS: El grupo de incumplidores tenía menor PS20 (2,27 ± 1,9 frente a 3,51 ± 1,8 en el grupo de cumplidores; p = 0,030) y cambio en Borg (1,64 ± 1,9 frente a 2,7 ± 1,84; p = 0,057), y eran con mayor frecuencia hipoperceptores de disnea (el 50% frente al 21%; p = 0,034). CONCLUSIONES: Existe relación entre el cumplimiento del tratamiento y la percepción de disnea, de forma que uno de los motivos del incumplimiento terapéutico en los pacientes con asma es la hipopercepción de disnea

OBJECTIVE: The majority of studies show that treatment adherence in chronic diseases such as asthma does not exceed 50%. Although the reasons may vary, it is clear that lack of treatment adherence is a determining factor in poor disease control. An association has also been observed between lack of perception of dyspnea and difficult-to-control asthma and with the occurrence of fatal or near-fatal asthma attacks. In this study we therefore attempted to demonstrate that one of the reasons that asthmatic patients do not adhere to treatment is a failure to perceive dyspnea associated with bronchial obstruction. PATIENTS AND METHODS: We analyzed 2 groups of patients with moderate persistent asthma who had all been prescribed the same chronic treatment (a dose of inhaled drug administered with a dry powder inhaler every 12 hours). The first group comprised 24 patients (16 women and 8 men; mean [SD] age, 44 [15] years) who took the medication almost every day. The second group contained 24 patients (16 women and 8 men; mean [SD] age, 48 [14] years) who did not use the medication or only took it occasionally. There were no significant differences between the groups in terms of age, sex, percentage of smokers, socioeconomic and educational level, anxiety, depression, or spirometry variables. A histamine challenge test was carried out in all patients and the dyspnea perceived after each dose of the drug was measured on a modified Borg scale. The dose of histamine leading to a 20% reduction in forced expiratory volume in 1 second (FEV1), perception of dyspnea associated with a 20% reduction in FEV1 (PS20), and the change in dyspnea measured on the Borg scale between baseline and 20% reduction in FEV1 were analyzed. Patients were also classified as poor perceivers of dyspnea if the change in perception of dyspnea on the modified Borg scale was less than or equal to zero. RESULTS: The group of patients with poor treatment compliance had a lower PS20 (2.27 [1.9] vs 3.51 [1.8], P=.03) and change in Borg score (1.64 [1.9] vs 2.7 [1.84], P=.057), and they were more often poor perceivers of dyspnea (50% vs 21%, P=.034). CONCLUSIONS: There is a relationship between treatment adherence and dyspnea perception, such that poor perception is among the reasons for poor treatment adherence in patients with asthma