Fumadores y riesgo de muerte hospitalaria por COVID calculado con el procesamiento de lenguaje natural de SAVANA en el ámbito de Castilla-La Mancha / Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area

Introducción Durante la pandemia de COVID se especuló que los pacientes con el virus que tenían relación con el tabaco podrían tener una menor probabilidad de agravamiento de la enfermedad o muerte. Para evaluar si existe una asociación entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnología de Big Data y Procesamiento del Lenguaje Natural (PLN) de SAVANA. Método Se llevó a cabo un estudio de cohortes retrospectivo, observacional y sin intervención basado en datos de vida real extraídos de registros médicos de toda Castilla-La Mancha utilizando las técnicas de PLN e inteligencia artificial desarrolladas por SAVANA. El estudio abarcó toda la población de esta Comunidad con historia clínica electrónica en SESCAM que presentara diagnóstico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021. Resultados Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular (hipertensión arterial, dislipemia y diabetes), EPOC, asma, EPID, CI, ECV, TEP, cáncer en general y cáncer de pulmón en particular, bronquiectasias, insuficiencia cardíaca y antecedentes de neumonía, de forma significativa (p<0,0001). Los pacientes exfumadores, fumadores y no fumadores tienen una diferencia de edad significativa. En cuanto a las muertes hospitalarias, fueron más frecuentes en el caso de los exfumadores, siguiendo los fumadores y luego los no fumadores (p<0,0001). Conclusión Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado. (AU)

Introduction During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and natural language processing (NLP) technology is used. Method A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. Results Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (P<.0001). Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (P<.0001). Conclusion There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past. (AU)

Fumadores y riesgo de muerte hospitalaria por COVID calculado con el procesamiento de lenguaje natural de SAVANA en el ámbito de Castilla-La Mancha / Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area

Introducción Durante la pandemia de COVID se especuló que los pacientes con el virus que tenían relación con el tabaco podrían tener una menor probabilidad de agravamiento de la enfermedad o muerte. Para evaluar si existe una asociación entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnología de Big Data y Procesamiento del Lenguaje Natural (PLN) de SAVANA. Método Se llevó a cabo un estudio de cohortes retrospectivo, observacional y sin intervención basado en datos de vida real extraídos de registros médicos de toda Castilla-La Mancha utilizando las técnicas de PLN e inteligencia artificial desarrolladas por SAVANA. El estudio abarcó toda la población de esta Comunidad con historia clínica electrónica en SESCAM que presentara diagnóstico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021. Resultados Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular (hipertensión arterial, dislipemia y diabetes), EPOC, asma, EPID, CI, ECV, TEP, cáncer en general y cáncer de pulmón en particular, bronquiectasias, insuficiencia cardíaca y antecedentes de neumonía, de forma significativa (p<0,0001). Los pacientes exfumadores, fumadores y no fumadores tienen una diferencia de edad significativa. En cuanto a las muertes hospitalarias, fueron más frecuentes en el caso de los exfumadores, siguiendo los fumadores y luego los no fumadores (p<0,0001). Conclusión Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado. (AU)

Introduction During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and natural language processing (NLP) technology is used. Method A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. Results Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (P<.0001). Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (P<.0001). Conclusion There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past. (AU)

[Oral antibiotic treatment of exacerbation of COPD. Beyond COVID-19]. / Tratamiento antibiótico oral de la exacerbación de la EPOC. Más allá de la COVID-19.

COPD (chronic obstructive pulmonary disease) includes patients with chronic bronchitis and / or emphysema who have in common the presence of a chronic and progressive airflow obstruction, with symptoms of dyspnea and whose natural history is modified by acute episodes of exacerbations. Exacerbation (EACOPD) is defined as an acute episode of clinical instability characterized by a sustained worsening of respiratory symptoms. It is necessary to distinguish a new EACOPD from a previous treatment failure or a relapse. EACOPD become more frequent and intense over time, deteriorating lung function and quality of life. The diagnosis of EACOPD consists of 3 essential steps: a) differential diagnosis; b) establish the severity, and c) identify its etiology. The main cause of exacerbations is infection, both bacterial and viral. Antibiotics are especially indicated in severe EACOPD and the presence of purulent sputum. Beta-lactams (amoxicillin-clavulanate and cefditoren) and fluoroquinolones (levofloxacin) are the most widely used antimicrobials. This review updates the problem of acute exacerbation with infectious origin from the perspective of etiology, antimicrobial resistance, microbiological studies, risk stratification, and antimicrobial management. The risk, prognosis and characteristics of COPD patients who develop COVID19 are analyzed.

[Phosphodiesterase-4 inhibitors: roflumilast]. / Inhibidores de la PDE4: roflumilast.

Chronic obstructive pulmonary disease (COPD) encompasses a group of diseases characterized by chronic airway obstruction. This broad diagnostic umbrella includes several clinical phenotypes that overlap and respond differently to each type of therapeutic intervention. Roflumilast is a drug belonging to the new therapeutic class of phosphyldiesterase-4 (PDE4) inhibitors and can be considered the first drug to be developed for a specific COPD phenotype (COPD associated with chronic bronchitis). In preclinical models, roflumilast has shown potent antiinflammatory action against a wide variety of cells and inflammatory mediators, as well as against the etiopathogenic mechanisms of COPD. The present article reviews the evidence generated during the clinical development of roflumilast, with special emphasis on studies evaluating the drug in a context similar to that of routine clinical practice.

EPOC e inflamación sistémica. Una vía de enlace para la comorbilidad / No disponible

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Impact of COPD severity on physical disability and daily living activities: EDIP-EPOC I and EDIP-EPOC II studies.

AIMS: The severity of chronic obstructive pulmonary disease (COPD) is associated to patients' health-related quality of life (HRQL). Physical impairment increasingly affects daily activities creating economic, social and personal burden for patients and their families. This burden should be considered in the management of COPD patients; therefore, we intended to assess the impact of the disease severity on physical disability and daily activities. METHODS: Two epidemiological observational cross-sectional descriptive studies were carried out in 1596 patients with moderate COPD and 2012 patients with severe or very severe COPD in the routine clinical practice. Demographic and basic clinical-epidemiological data were collected and patients completed questionnaires to assess their physical disability because of COPD [Medical Research Council (MRC)], COPD repercussion on daily activities [London Chest Activity of Daily Living (LCADL)], job, economy and family habits and their health status [EQ-5D visual analogue scale (VAS)]. RESULTS: In all, 37% of severe/very severe COPD patients and 10% of moderate (p < 0.0001) had MRC grades 4 and 5. Mean global LCADL was significantly higher in severe/very severe than in moderate patients [29.6 (CI 95%: 28.91-30.25) vs. 21.4 (CI 95%: 20.8-21.9); p < 0.0001]. COPD job impact and economic and family habits repercussions were significantly higher and health status significantly worse in severe/very severe cases than in patients with moderate COPD. CONCLUSIONS: COPD severity is highly associated with physical disability by MRC grading, with functionality on daily activities and with impairment of other social and clinical activities. Moderate COPD patients show already a significant degree of impairment in all these parameters.

Variación del gasto sanitario por la participación de pacientes en ensayos clínicos. Estudio piloto en asma bronquial / Variation of health care cost by the participation of patients in clinical trials. Pilot study in bronchial asthma

En Europa occidental la incidencia de asma se ha duplicado en los últimos 10 años, generando una gran carga económica para los sistemas de salud. El objetivo de este estudio fue cuantificar el ahorro para el sistema sanitario derivado de la participación de un paciente asmático en un ensayo clínico (EC) en un hospital de nivel terciario. El análisis se realizó con un diseño descriptivo y retrospectivo. Como variable principal se tomó el coste total para el sistema de salud durante los periodos de participación en el EC y durante el periodo control y como variables secundarias el coste por pruebas complementarias, el coste por consultas y el coste por fármacos antiasmáticos. En promedio, la participación de un paciente asmático en un EC supuso un ahorro total (fármacos, consultas y pruebas complementarias) para el sistema sanitario de 21,18 € por semana. Si se contabiliza como ahorro sólo la medicación que reciben los pacientes durante el período de tratamiento del ensayo, el ahorro asciende a 9,71 € por paciente y semana. El ahorro bruto y neto no pudieron explicarse adecuadamente a partir de los factores considerados: costes control, gravedad, tipo de ensayo, edad y sexo. Para el ahorro bruto, sólo el nivel de gravedad del paciente reveló una cierta influencia. Concluimos que la participación de un paciente en un EC de asma en un hospital terciario genera un beneficio económico para el sistema sanitario que se hace más patente a medida que aumenta la gravedad del proceso (AU)

In Western Europe, the incidence of asthma has doubled in the last 10 years, generating a greater economic burden for the health care systems. The purpose of this study was to quantify the savings for the health care system derived from the participation of an asthmatic patient in a clinical trial (CT) in a tertiary level hospital. The analysis was conducted with a descriptive and retrospective design. As principal variable, the total cost was obtained for the health care system during the periods of participation in the CT and during the control period as the secondary variables were cost per complementary tests, cost per consultation and cost per anti-asthma drugs. On an average, participation of an asthma patient in a CT meant a total savings (drugs, consultations, and complementary tests) for the health care system of 21,18 € per week. When analyzing the medication by itself that the patients receive during the trial treatment period, the savings reaches 9,71 € per patient and week. The gross and net savings could not be adequately explained from the factors considered: control costs, severity, type of trial, age and gender. We conclude that the participation of a patient in an Asthma CT in a tertiary hospital generates a financial benefit for the health care system that becomes clearer as the severity of the condition increases (AU)

[Has the treatment of COPD changed in Spain? Results of a community multicenter study (VICE)]. / Ha cambiado el manejo de la EPOC en España? Resultados de un estudio multicéntrico comunitario (VICE).

INTRODUCTION: Many Clinical Practical Guides (CPG) that have specifically focused on the diagnosis and treatment of chronic obstructive pulmonary disease (COPD) have been elaborated over the last 5 years. However, their grade of application and effectiveness have not been verified. METHOD: In order to evaluate if the diagnosis and treatment of COPD have been modified in our setting since their publication, a comparative analysis was proposed between the results of the IDENTEPOC study (n = 898) conducted in the year 2000 and the VICE study (n = 10,782), whose data were collected in 2005. RESULTS: In the year 2000, 38.6% of the patients in primary health care were initially diagnosed of COPD using clinical and/or radiological criteria, with no functional confirmation versus 10.2% in the pneumology setting (p < 0.001). In 2005, 31% of the subjects had been diagnosed of COPD using spirometry in primary health care and 14% in pneumology did not show an obstructive pattern. In 2005, only 4.1% of the patients were receiving specific treatment for their smoking habit and the establishment of rehabilitation programs was not very relevant. No large differences in drug treatments were observed between both studies. The main difference in 2005 was a wide use of tiotropium and of combinations of beta2 agonists with inhaled corticosteroids. Although a mild escalation of treatment based on seriousness is observed in both series, the prescription guidelines do not adjust to the criteria established by the regulations. CONCLUSIONS: The results of this analysis indicate that although the CPGs may be useful tools to improve the clinical management of COPD, the absence of relevant qualitative changes in the management of COPD after their publication suggests that their impact in the clinical practice is currently irrelevant.

Enfermedad pulmonar obstructiva crónica y riesgo cardiovascular / Chronic obstructive pulmonary disease and cardiovascular disease

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Mortalidad en la EPOC / Mortality in COPD

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Nuevos conceptos en la enfermedad pulmonar obstructiva crónica / New concepts in chronic obstructive pulmonary disease

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¿Debe incluirse la EPOC entre los factores de riesgo cardiovascular? / Should COPD be included among cardiovascular risk factors?

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EPOC y riesgo cardiovascular / Chronic obstructive pulmonary disease and cardiovascular risk

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[Factors affecting drug prescription in patients with stable COPD: results from a multicenter Spanish study (IDENTEPOC)]. / Factores determinantes de la prescripción farmacológica en los pacientes con EPOC estable. Resultados de un estudio multicéntrico español (IDENTEPOC).

OBJECTIVE: To determine what factors are associated with prescription of drugs to patients with stable chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We studied 568 patients with stable COPD. Assessments included determination of the severity of dyspnea, body mass index, health-related quality of life, and spirometry testing. RESULTS: The forced expiratory volume in 1 second was significantly associated with prescription of long-acting beta2-adrenergic agonists (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.96-1) and inhaled corticosteroids (OR=0.98; 95% CI, 0.96-1). Quality of life was related to administration of short-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), long-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), ipratropium bromide (OR=1.03; 95% CI, 1-1.04), theophylline drugs (OR=1.02; 95% CI, 1-1.03), and inhaled corticosteroids (OR=1.02; 95% CI, 1-1.03). The severity of dyspnea was significantly associated with prescription of oral corticosteroids (for grade IV dyspnea, OR=15.25; 95% CI, 2.40-97.02). Body mass index was not related to drug administration. CONCLUSIONS: Drug prescription in patients with stable COPD correlates not only with forced expiratory volume in 1 second but also with other parameters such as health-related quality of life and dyspnea.

Factores determinantes de la prescripción farmacológica en los pacientes con EPOC estable. Resultados de un estudio multicéntrico español (IDENTEPOC) / Factors affecting drug prescription in patients with stable COPD: Results from a multicenter Spanish study (IDENTEPOC)

OBJETIVO: Determinar qué factores se relacionan con la prescripción de fármacos en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. MATERIAL Y MÉTODOS: Se estudió a 568 pacientes con EPOC estable. La evaluación realizada incluyó la medición del grado de disnea, la determinación del índice de masa corporal, el estudio de la calidad de vida relacionada con la salud y la realización de una espirometría. RESULTADOS: El volumen espiratorio forzado en el primer segundo se asoció significativamente con la prescripción de β2-adrenérgicos de acción larga (odds ratio [OR] = 0,98; intervalo de confianza [IC] del 95%, 0,96-1) y corticoides inhalados (OR = 0,98; IC del 95%, 0,96-1). La calidad de vida se relacionó con la administración de β2-adrenérgicos de acción corta (OR = 1,02; IC del 95%, 1-1,03), β2-adrenérgicos de acción larga (OR = 1,02; IC del 95%, 1-1,03), bromuro de ipratropio (OR = 1,03; IC del 95%, 1-1,04), teofilinas (OR = 1,02; IC del 95%, 1-1,03) y corticoides inhalados (OR = 1,02; IC del 95%, 1-1,03). El grado de disnea mostró una asociación significativa con la prescripción de corticoides orales (para disnea grado IV, OR = 15,25; IC del 95%, 2,40-97,02). No se encontró ninguna relación entre la administración de fármacos y el índice de masa corporal. CONCLUSIONES: La prescripción farmacológica de los pacientes con EPOC estable viene determinada no sólo por el volumen espiratorio forzado en el primer segundo, sino también por otros parámetros, entre los que se incluyen la calidad de vida relacionada con la salud y la disnea

OBJECTIVE: To determine what factors are associated with prescription of drugs to patients with stable chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We studied 568 patients with stable COPD. Assessments included determination of the severity of dyspnea, body mass index, health-related quality of life, and spirometry testing. RESULTS: The forced expiratory volume in 1 second was significantly associated with prescription of long-acting ß2-adrenergic agonists (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.96-1) and inhaled corticosteroids (OR=0.98; 95% CI, 0.96-1). Quality of life was related to administration of short-acting β2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), long-acting β2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), ipratropium bromide (OR=1.03; 95% CI, 1-1.04), theophylline drugs (OR=1.02; 95% CI, 1-1.03), and inhaled corticosteroids (OR=1.02; 95% CI, 1-1.03). The severity of dyspnea was significantly associated with prescription of oral corticosteroids (for grade IV dyspnea, OR=15.25; 95% CI, 2.40- 97.02). Body mass index was not related to drug administration. CONCLUSIONS: Drug prescription in patients with stable COPD correlates not only with forced expiratory volume in 1 second but also with other parameters such as health-related quality of life and dyspnea

[Quality of life with chronic obstructive pulmonary disease: the influence of level of patient care]. / Calidad de vida en la enfermedad pulmonar obstructiva crónica. Influencia del nivel de asistencia de los pacientes.

OBJECTIVE: The aim of the study was to determine the factors related to the health-related quality of life (HRQL) of patients with stable chronic obstructive pulmonary disease (COPD) and to assess the degree of influence of level of patient care (primary or specialized). MATERIAL AND METHOD: An observational descriptive, cross-sectional, multicenter study was carried out. The study sample was a randomized selection taken from a stratified sample of patients treated by primary care physicians and pneumologists from each Spanish region. Only those patients whose level of health care was indicated and whose diagnosis of COPD was confirmed by spirometry were enrolled in the study. RESULTS: Five hundred sixty patients were assessed, 100 from primary health care and 460 from pneumology practices. No significant differences between the 2 levels of care were found in the scores on the HRQL questionnaire (Spanish version of the St George's Respiratory Questionnaire). There was a weak correlation between patients' perception of health and lung function parameters. Factors related to HRQL in the multivariate analysis were dyspnea, the presence of COPD exacerbations in the previous year, consequent visits to the emergency department, age, and degree of airflow restriction, but not level of patient care. CONCLUSIONS: Stable COPD patients' HRQL is not related to their level of care, be it primary or specialized, but is related to other factors such as dyspnea, presence of exacerbations or consequent visits to the emergency department, age, and degree of airflow restriction.

[Bacterial colonization and home mechanical ventilation: prevalence and risk factors]. / Colonización bacteriana y ventilación mecánica domiciliaria. Prevalencia y factores de riesgo.

OBJECTIVE: To investigate the prevalence of bacterial contamination of ventilators and colonization of patients, the bacteria implicated, and predisposing factors in noninvasive home ventilation. MATERIAL AND METHODS: Forty patients on a home noninvasive ventilation program (mean [SD] age: 63.1 [12] years; time on ventilation: 30.7 [25] months; daily use: 8.1 [2] hours) were enrolled in this descriptive cross-sectional study. Microbiological samples for semiquantitative cultures were swabbed from the ventilator (mask and tubing) and the nostrils. A questionnaire was completed on the underlying disease, time on the ventilation program, type of ventilator, presence of a humidifier, and attention to ventilator cleanliness and maintenance. We defined "colonization" as the presence of microorganisms in the nostrils without evidence of a host immune response, and "contamination" as the presence of surface microorganisms (on tubing or the nasal mask). RESULTS: Potentially pathogenic bacteria were isolated from 6 ventilators (15%) and the nasal swabs of 10 patients (25%). Staphylococcus aureus was the most frequently isolated one (in 5 ventilators and 6 patients--contamination coinciding with colonization in 3 cases). Other potentially pathogenic bacteria isolated were Proteus species (from the nostrils of 2 patients) and an unidentified gram-negative bacillus from the ventilator. On analysis by underlying disease, 60% of the patients with obesity had been colonized. No other findings of note were obtained for other diseases. Contamination and colonization correlated with attention to cleanliness and maintenance of the ventilator but not with type of ventilator, time on the ventilation program, or use of a humidifier. CONCLUSIONS: Home mechanical ventilators are a potential source of nasal colonization. The most frequently encountered microorganism was S. aureus. The degree of ventilator cleaning and disinfection seems to affect contamination; thus it is necessary to impress on patients the need for adequate maintenance of their ventilators.

Benefits at 1 year of nocturnal intermittent positive pressure ventilation in patients with obesity-hypoventi lation syndrome.

BACKGROUND: Patients with the obesity-hypoventilation syndrome (OHS) benefit from non-invasive ventilatory support. We assessed the long-term physiopathological response to 12-months of nocturnal ventilatory assistance at home with bi-level positive airway pressure (BiPAP) via nasal mask in patients with this disease. METHODS: A series of 13 non-consecutive patients diagnosed of OHS (5 men and 8 women) with a mean (SD) age of 61.9 (8) years, underwent the following studies before (baseline) and after 12 months of non-invasive domiciliary mechanical ventilation: arterial blood gases, nocturnal digital pulse oximetry, spirometry, body plethysmography, maximum muscular respiratory pressures and ventilatory pattern with measurement of occlusion pressure (P0.1) before and after hypercapnia. An overnight cardiorespiratory polygraphy was done at baseline. RESULTS: After 12 months of non-invasive mechanical ventilation, there were significant (P < 0.05) reductions of arterial carbon dioxide tension (PaCO2) and increases in arterial oxygen tension, forced vital capacity and ventilatory response to hypercapnia, as measured by the relationship between changes of P0.1 and PaCO2 (deltaP0.1 / deltaPaCO2) as well as respiratory minute volume (V(E)) and PaCO2 (deltaV(E) / deltaPaCO2). Changes of the PaCO2 correlated significantly with those in the (deltaP0.1 / deltaPaCO2) slope (r = 0.576, P < 0.05). CONCLUSIONS: The present results confirm that non-invasive home mechanical ventilation is an effective approach for long-term treatment of OHS.

Otras formas de broncodilatación / No disponible

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