Asthma exacerbations: risk factors for hospital readmissions.

OBJECTIVE: The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase. STUDY DESIGN: We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. METHODS: The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge. RESULTS: This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment. CONCLUSIONS: About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation.

Expansion of a CD26 low effector TH subset and reduction in circulating levels of sCD26 in stable allergic asthma in adults

Background: The pathogenesis of asthma is dependent on the balance between regulatory and effector T cells, which display differential expression of CD25 and CD26. Therefore, alteration of circulating levels of sCD25 and sCD26 during allergic asthma could be conditioned by changes in leukocyte phenotype. Objectives: To analyze expression of CD25 and CD26 on T lymphocytes and their soluble derivatives (sCD25, sCD26) during stable phases of moderate-severe allergic asthma. Methods: Cross-sectional study with 2 adult cohorts of allergic asthmatics. Clinical, anthropometric, pulmonary, hematological, and biochemical parameters were measured. Phenotyping was performed with flow cytometry in both circulating and cultured leukocytes. Dipeptidyl peptidase 4 (DPP4) activity was assayed in culture supernatants. Results: In vitro studies revealed upregulation of CD26 on human T lymphocytes upon activation, especially under TH17-favoring conditions, and a correlation with soluble DPP4 activity (rs=0.641; P<.001). CD26 expression on lymphocytes was higher in asthmatics, while serum sCD26 was lower in women and patients. The latter finding could be associated with an expanded CD25 low/CD26 low /CD127 low subset of effector CD4 + T cells in allergic asthma, with no changes in Treg percentages. However, women showed an increased Teff/Treg ratio, which could explain their greater susceptibility to asthma. Conclusions: Allergic asthma causes an increment in CD25 low CD26Low helper T cells detected in stable stages. These changes are mirrored in serum and should be considered in the light of the downmodulating role of CD26 in major chemokines related to the pathogenesis of asthma such as CCL11 (eotaxin), CCL5 (RANTES), and CXCL12a (SDF-1alfa) (AU)

Introducción: La patogénesis del asma depende del equilibrio entre células T reguladoras y T efectoras, las cuales presentan distintos niveles de CD25 y CD26. Por tanto, la alteración de la concentración de sCD25 y sCD26 durante el asma alérgica podría estar condicionada por cambios en el fenotipo de los leucocitos. Objetivos: Analizar la expresión de CD25 y CD26 en linfocitos T y sus derivados solubles (sCD25 y sCD26) durante asma alérgica moderada-severa y en fases estables. Métodos: Estudio transversal con dos cohortes de adultos con asma alérgica. Se han medido parámetros clínicos, antropométricos, de función pulmonar, hematológicos y bioquímicos. Se ha hecho el fenotipado de leucocitos circulantes y en cultivo mediante citometría de flujo. Se ha analizado la actividad Dipeptidil peptidasa 4 (DPP4) en sobrenadantes de cultivo. Resultados: Los estudios in vitro mostraron un aumento de expresión de CD26 en linfocitos T humanos tras activación, especialmente en condiciones favorables para TH 17, y una correlación con la actividad DPP4 soluble (rs=0,641; p < 0,001). La expresión de CD26 en linfocitos fue mayor en asmáticos, mientras que sCD26 estaba reducido en sueros de mujeres y pacientes. Este último hallazgo podría ser relacionado con la expansión de una subpoblación CD25 low/CD26 low/CD127 low de células T CD4 + efectoras en asma alérgica, sin cambios en los porcentajes de Treg. Sin embargo, las mujeres mostraron un incremento del cociente Tef/Treg, lo cual podría explicar su mayor susceptibilidad al asma. Conclusiones: El asma alérgica causa un incremento de células TH CD25 low CD26 low durante fases no activas. Estos cambios se reflejan en suero y deberían tenerse en cuenta a la luz de la función inhibidora de CD26 sobre quimioquinas importantes relacionadas con la patogénesis del asma, como CCL11 (eotaxina), CCL5 (RANTES) o CXCL12a (SDF-1alfa)

Comportamiento de las células nucleadas en los distintos tipos de derrame pleural / Behaviour of nucleated cells in various types of pleural effusion

Introducción. El conocimiento del comportamiento de los componentes celulares del líquido pleural puede ayudar a enfocar el diagnóstico diferencial de un derrame pleural. El objetivo es evaluar su composición en los distintos tipos de derrames y valorar si proporciona información clínica relevante. Pacientes y métodos. Estudio observacional, transversal y retrospectivo en el que se analiza el componente celular de derrames pleurales de diversa etiología. Los derrames se clasificaron como neutrofílicos, linfocíticos (≥50% de cada uno de ellos), eosinofílicos (≥10%) o mesoteliales (>5%) y se agruparon en 6 categorías diagnósticas. Resultados. Se estudiaron 1.467 pacientes (354 insuficiencia cardiaca; 59 otros trasudados; 349 paraneumónicos; 133 tuberculosos; 397 neoplásicos y 175 otros exudados). El predominio celular fue linfocítico en la insuficiencia cardiaca (44,4%), paraneumónicos no complicados (29,2%), tuberculosis (88%) y neoplasias (49,6%); neutrofílico en los paraneumónicos (57%) y neoplásicos (9,6%); eosinofílico en las neoplasias (6,3%) y mesotelial en las tuberculosis (12%). Las etiologías más frecuentes con un recuento linfocitario ≥80% fueron tuberculosis (35,1%) y neoplasias (23,3%). Los parámetros con mayor capacidad discriminante fueron: leucocitos (trasudados: AUC 0,835) y porcentaje de neutrófilos (empiemas: AUC 0,906 y paraneumónicos complicados + empiemas: AUC 0,907). Conclusiones. Los recuentos de células nucleadas ayudan a enfocar la etiología del derrame pleural, ya que cada etiología suele tener un predominio celular característico. El porcentaje de células nucleadas en el líquido pleural no puede descartar tuberculosis si existe un recuento elevado de células mesoteliales, ni un derrame paraneumónico ante un predominio linfocítico, o malignidad con un recuento de linfocitos ≥80% (AU)

Introduction. To know the behavior of cellular components of pleural fluid can help focus the differential diagnosis of a pleural effusion. Our objective was to assess their composition in different types of pleural effusions and assess whether it provides relevant clinical information. Patients and methods. Observational, cross-sectional and retrospective study in which the cellular components of pleural effusions of different etiology were analyzed. Pleural effusions were classified as neutrophilic, lymphocytic (≥50% of each one of them), eosinophilic (≥10%) or mesothelial (>5%) and were grouped into six diagnostic categories. Results. 1.467 patients were studied (354 heart failure; 59 other transudates; 349 paraneumonic; 133 tuberculous; 397 malignant and 175 other exudates). The predominance cell was lymphocytic in heart failure (44,4%), uncomplicated parapneumonic (29,2%), tuberculosis (88%) and malignant (49,6%); neutrophilic in parapneumonic (57%) and malignant (9,6%); eosinophilic in malignant (6,3%) and mesotelial in tuberculosis (12%). The most frequent etiologies with lymphocyte count ≥80% were tuberculosis (35,1%) and malignant (23,3%). Parameters with higher discriminating accuracy were: leukocytes (transudates: AUC 0,835) and percentage of neutrophils (empyemas: AUC 0,906 and complicated parapneumonic+empyemas: AUC 0,907). Conclusions. Nucleated cell counts will help focus the etiology of pleural effusions, since each etiology often have a characteristic cell predominance. The percentage of nucleated cells in pleural fluid not ruled out tuberculosis if there is a high count of mesothelial cells, nor a parapneumonic effusion with lymphocytic predominance, or malignancy with ≥80% lymphocytes (AU)

Cross-sectional study about impact of parental smoking on rhinitis symptoms in children.

OBJECTIVE: Assess the prevalence of rhinitis and exposure to environmental tobacco smoke (ETS) of children in our community and its relationship with symptoms of rhinitis METHODS (DESIGN, SETTING, PARTICIPANTS, MAIN OUTCOME MEASURES): Cross-sectional study using questionnaire on rhinitis of the International Study of Asthma and Allergies in Childhood, in children (6-7 years) and adolescents (13-14 years). Categories: "rhinitis ever", "recent rhinitis", "recent rhinoconjunctivitis", "severe rhinoconjunctivitis". Parental smoking: (i) neither parent smokes; (ii) only the mother smokes; (iii) only the father smokes; and (iv) both parents smoke. Odds ratio of the prevalence of symptoms of rhinitis according to ETS exposure was calculated using logistic regression. RESULTS: 10 690 children and 10 730 adolescents. The prevalence of "rhinitis ever" in children: 29.4%, "recent rhinitis" 24%, "recent rhinoconjunctivitis" 11.5% and "severe rhinoconjunctivitis" 0.1%. In adolescents: 46.2%, 34.5%, 16.2% and 0.2%, respectively. Environmental tobacco smoke exposure in the home occurred in 51% of cases. Parental smoking was associated with a higher prevalence of forms of rhinitis in adolescents when only the mother was a smoker. In children when both parents were smokers. CONCLUSION: Rhinitis is highly prevalent in our community. Environmental tobacco smoke exposure is still very common. The relationship between ETS and rhinitis symptoms in children of this community is not as robust as that found for asthma.

Factors associated with the incidence of serious adverse events in patients admitted with COPD acute exacerbation.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospitalization. Patient outcome and prognosis following AECOPD are variable. The aim of this study is to identify the factors associated with the incidence of serious adverse events (SAE), defined as need for ICU admission, noninvasive ventilation, death during hospitalization or early readmission, in those patients admitted with AECOPD. METHODS: We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD in the University Hospital Complex of Santiago de Compostela in 2007 and 2008. To identify variables independently associated with SAE incidence, we conducted a logistic regression including those variables which proved to be significant in the univariate analysis. RESULTS: 757 patients were assessed (mean age 74.8 years, SD 11.26), 77.2 % male, and 186 (24.6 %) of the patients assessed experienced an SAE. Factors associated with SAE in multivariate analysis were anticholinergic therapy (OR 3.19; CI 95 %: 1.16; 8.82), oxygen therapy at home (OR 3.72; CI 95 %: 1.62; 8.57), oxygen saturation at admission (OR 0.93; CI 95 %: 0.88; 0.99) and serum albumin (OR 0.26; CI 95 %: 0.1; 0.66). CONCLUSION: Oxygen therapy at home, anticholinergic therapy as baseline treatment, lower oxygen saturation at admission and lower serum albumin level seem to be associated with higher incidence of SAE in patients with AECOPD.

Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos / Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases

Introducción: El cáncer de pulmón es la causa más frecuente de muerte por cáncer en el mundo. Su presentación clínica corresponde habitualmente a estadios avanzados. Desde hace años persiste la controversia sobre la indicación de programas de cribado para el diagnóstico en fases tempranas. Objetivos: Conocer las características clínicas en la presentación del cáncer de pulmón en nuestra área sanitaria. Material y métodos: Se recogieron retrospectivamente todos los casos incidentes de cancer de pulmón durante 3 años (1 de enero de 1997 a 31 de diciembre de 1999), de pacientes con residencia habitual en el área sanitaria de Santiago de Compostela, a partir de la información disponible en el servicio de codificación. El tipo histológico se clasificó según la clasificación de la Organización Mundial de la Salud. La fecha de fallecimiento se obtuvo de la historia clínica del paciente, el registro de mortalidad o de llamadas telefónicas al domicilio del paciente. El resto de la información se obtuvo de la historia clínica del paciente y del servicio de anatomía patológica. Resultados: Se diagnosticaron 481 casos de cáncer de pulmón (tasa bruta de incidencia de 41,79 por 100.000 habitantes y año). La mediana de edad fue 66,9 años (rango intercuartil 60,5-74,4), siendo el 92,77% varones. El 94,1% correspondía a fumadores o exfumadores. Los síntomas más prevalentes como motivo de consulta fueron el síndrome general (20%), el dolor torácico (19%) y la hemoptisis (17%). Existe un grupo de pacientes (56), fundamentalmente varones, de diagnóstico incidental. Conclusiones: La incidencia de cáncer de pulmón parece elevada en nuestra área sanitaria. El paciente tipo con cáncer de pulmón en esta área sanitaria corresponde a un varón de 67 años, fumador, diagnosticado en estadios avanzados, que consulta por síndrome general y/o dolor torácico. Algunos de los síntomas se presentan con diferencias significativas entre sexos. Asimismo, hay diferencias entre histologías, siendo llamativa la elevada frecuencia de dolor torácico en adenocarcinoma, aunque también es la primera causa de consulta en microcítico. Por el contrario, la hemoptisis es el motivo de consulta más frecuente en epidermoide y el síndrome general en el tipo células grandes o con diagnóstico clínico-radiológico (AU)

Introduction: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. Aims: To know the clinical characteristics in the presentation of the lung cancer in our health care area. Material and methods: All of the incident lung cancer cases for 3 years (January l, 1997 to December 3l, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. Results: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. Conclusions: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis (AU)

Dermatitis atópica infantil: revisión y actualización / review and update of current understanding of childhood atopic dermatitis

La dermatitis atópica infantil es una enfermedad de distribución mundial, con una elevada prevalencia en los países desarrollados, lo que la ha convertido en una prioridad de salud. A pesar de que es una entidad que ha sido estudiada durante años todavía existen numerosas controversias en distintas áreas. En esta revisión se comentan los principales trabajos publicados sobre el tema, actualizando diversos conceptos: terminología aplicada (diferencia entre atópica y atopiforme), epidemiología, etiopatogenia (estudios moleculares, genes implicados y factores ambientales), medida de la gravedad, influencia en la calidad de vida del paciente y la familia, impacto económico y tratamientos (AU)

Although childhood atopic dermatitis is reported throughout the world, it has become a health priority in developed countries, where its prevalence is particularly high. Despite extensive study for many years, various aspects of the disease are still subject to debate. This review will discuss the main studies published on the topic and update certain concepts such as the terminology used (the difference between atopic and atopiform), epidemiology, etiopathogenesis (molecular mechanisms, implicated genes, and environmental factors), assessment of severity, influence on the quality of life of the patients and their families, economic impact, and treatment (AU)

Exposure to furry pets and the risk of asthma and allergic rhinitis: a meta-analysis.

BACKGROUND: Exposure to pets has been implicated as a risk factor for asthma. However, this relation has been difficult to assess in individual studies because of the large potential of selection bias. We sought to examine the association between exposure to furry pets and asthma and allergic rhinitis by means of a meta-analysis. METHODS: We retrieved studies published in any language by searching systematically Medline (1966-March 2007), Embase, LILACS and ISI Proceedings computerized databases, and by examining manually the references of the original articles and reviews retrieved. We included cohort and case-control studies reporting relative risk estimates and confidence intervals of exposure to cats, dogs and unspecified furry animals and subsequent asthma and allergic rhinitis. We excluded cross-sectional studies and those studies that did not measure exposure but rather sensitization to pets. RESULTS: Thirty-two studies were included. For asthma, the pooled relative risk related to dog exposure was 1.14 (95% CI 1.01-1.29), that related to exposure to any furry pet was 1.39 (95% CI 1.00-1.95). Among cohort studies, exposure to cats yielded a relative risk of 0.72 (95% CI 0.55-0.93). For rhinitis, the pooled relative risk of exposure to any furry pet was 0.79 (95% CI 0.68-0.93). CONCLUSIONS: Exposure to cats exerts a slight preventive effect on asthma, an effect that is more pronounced in cohort studies. On the contrary, exposure to dogs increases slightly the risk of asthma. Exposure to furry pets of undermined type is not conclusive. More studies with exact measurement of exposure are needed to elucidate the role of pet exposures in atopic diseases.

Predictors of the persistence of childhood asthma

Background. The factors relevant to the prognosis of childhood asthma differ from one population to another. Objectives. To characterize the course of childhood asthma in the catchment area of our hospital, and to identify prognostic factors for this population. Methods. All children given a diagnosis of asthma in the paediatric pulmonology service of a tertiary hospital were followed up for 5 years. Results. Satisfactory control of asthma was achieved in 69 % of cases. The factors identified as associated with poor control were allergy to cats and pollen, a large number of crises in the year prior to diagnosis, and younger age at onset. Conclusions. In our region, childhood asthma has a relatively favourable prognosis. The subsequent course of the disease appears to be determined in childhood. The persistence of symptoms appears to depend to a significant extent on the degree of atopy

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¿A qué pacientes con insuficiencia cardíaca debemos ofertar la resincronización cardíaca? / Which patients with heart failure should be offered cardiac resynchronization?

La insuficiencia cardíaca crónica (ICC) es una patología muy prevalente en países desarrollados. En las últimas décadas se han producido avances muy importantes en el tratamiento farmacológico, pero a pesar de ello las cifras de mortalidad siguen siendo muy elevadas. Casi la tercera parte de los pacientes con fracción de eyección (FE) baja y clase funcional III-IV de la New York Heart Association (NYHA) presentan un QRS ancho, lo que se traduce en muchas ocasiones en disincronía en la contracción y una mayor mortalidad. Con el propósito de mejorar el pronóstico ha surgido la terapia basada en el dispositivo de resincronización cardíaca (TRC), que como coadyuvante del tratamiento médico ha demostrado mejoría clínica, hemodinámica y en las cifras de mortalidad. Pretendemos en este artículo dar a conocer el fundamento, resultados de ensayos clínicos y recomendaciones de las principales guías sobre esta terapia (AU)

Chronic heart failure is a very prevalent disease in developed countries. In recent decades, very important advances in drug therapy have occurred. However, mortality is still very high. One third of patients with a low ejection fraction and New York Heart Association (NYHA) functional class IIII-IV have a wide QRS. This means that there is often resynchronization of contraction and higher mortality. In order to improve the prognosis, the therapy based on cardiac resynchronization device has bee4n shown to be a complementary medical treatment and has contributed to clinical, hemodynamic and mortality improvements. In this article, we aim to show the results of clinical trials and recommendations of the main guidelines regarding this therapy (AU)

Prevalencia de síntomas de asma y rinitis en la población de A Coruña / Prevalence of asthma and rhinitis symptoms in a Coruña (Spain)

Introducción El asma y la rinitis son dos enfermedades con elevada prevalencia en la infancia, con tendencia a incrementarse en los últimos años. En ambas es frecuente el infradiagnóstico. Objetivo Verificar la prevalencia de síntomas de asma y rinitis en la población infantil. Material y métodos Hemos realizado, mediante cuestionario escrito, un estudio transversal siguiendo la metodología del International Study of Asthma and Allergies in Childhood (ISAAC), de prevalencia de sintomatología de asma y rinitis en el área de A Coruña. Resultados Han sido incluidos 3.017 niños y niñas de 6 y 7 años (tasa de respuesta del 73,9 %), y 2.981 de 13 y 14 años (tasa de respuesta del 93,6 %). Refirieron haber presentado sibilancias alguna vez el 25,3 % de los niños y niñas de 13 y 14 años y el 37,2 % de los de 6 y 7 años. Han presentado asma en alguna ocasión el 18,5 % de los adolescentes y el 13,7 % del grupo de menor edad. La prevalencia de rinitis alguna vez fue del 30,4 % a los 6 y 7 años y del 47,3 % a los 13 y 14 años. La mayor prevalencia de rinitis se produjo en el otoño. Conclusiones El asma y la rinitis son especialmente frecuentes en nuestra población

Introduction The prevalence of asthma and rhinitis is high in childhood and has been increasing in the last few years. In both diseases underdiagnosis is frequent. Objective To asses the prevalence of asthma and rhinitis symptoms in childhood. Material and methods We performed a cross-sectional study using a written questionnaire, following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), on the prevalence of symptoms of asthma and rhinitis in La Coruña. Results A total of 3017 boys and girls aged 6-7 years old (response rate 73.9 %) and 2981 boys and girls aged 13-14 years old (response rate 93.6 %) were included. The prevalence of 'wheezing at some time' was 25.3 % in adolescents aged 13-14 years old and was 37.2 % in children aged 6-7 years. The prevalence of "asthma at some time" was 18.5 % in adolescents and 13.7 % in children. The prevalence of "rhinitis at some time" was 30.4 % in the group aged 6-7 years and 47.3 % in the group of adolescents. The prevalence of rhinitis was highest in autumn. Conclusions The prevalence of asthma and rhinitis is high in our population and is higher than that observed in most Spanish populations studied