Sleep apnea and oxygen saturation in adults at 2640 m above sea level.

PURPOSE: To describe the SpO2 in wakefulness, sleep and during the apnea-hypopnea in adults living in Bogotá, located at 2640 m above sea level. METHODS: Descriptive observational study in adults referred for polysomnogram (PSG). A normal Apnea hypopnea index (AHI) was defined as ≤5 and obstructive sleep apnea (OSA) was classified as mild (AHI 5-15), moderate (AHI 15-30), and severe (AHI >30). T-test or ANOVA test for SpO2 differences between groups was used. RESULTS: 1799 patients, 33% women. 222 (12.8%) did not have OSA (normal IAH), 268 (14.9%) mild OSA, 315 (17.5%) moderate ,and 993 (55.2%) severe. In all cases a low SpO2 (SpO2<90%) was found. The SpO2 was lower when the AHI was higher, in wakefulness, in non-REM and in REM (p<0.001). For all grades of severity, SpO2 decreased significantly from wakefulness to non-REM sleep and to REM sleep (p<0.001). Patients with severe OSA had higher desaturation during wakefulness (85.2±6.6%), non-REM sleep (83.1±7.7%), REM sleep (78.8±10.2), and during events (75.1±9.1%). CONCLUSIONS: Patients with OSA at 2640 m have nocturnal desaturation lower than 88%, which decreases with higher severity of OSA. The clinical impact of sleep disorders at this point may be greater than at sea level and should be studied.

Tomographic and functional findings in severe COPD: comparison between the wood smoke-related and smoking-related disease.

OBJECTIVE: Wood smoke exposure is a risk factor for COPD. For a given degree of airway obstruction, the reduction in DLCO is smaller in individuals with wood smoke-related COPD than in those with smoking-related COPD, suggesting that there is less emphysema in the former. The objective of this study was to compare HRCT findings between women with wood smoke-related COPD and women with smoking-related COPD. METHODS: Twenty-two women with severe COPD (FEV1/FVC ratio < 70% and FEV1 < 50%) were divided into two groups: those with wood smoke-related COPD (n = 12) and those with smoking-related COPD (n = 10). The two groups were compared regarding emphysema scores and airway involvement (as determined by HRCT); and functional abnormalities-spirometry results, DLCO, alveolar volume (VA), the DLCO/VA ratio, lung volumes, and specific airway resistance (sRaw). RESULTS: There were no significant differences between the two groups in terms of FEV1, sRaw, or lung hyperinflation. Decreases in DLCO and in the DLCO/VA ratio were greater in the smoking-related COPD group subjects, who also had higher emphysema scores, in comparison with the wood smoke-related COPD group subjects. In the wood smoke-related COPD group, HRCT scans showed no significant emphysema, the main findings being peribronchial thickening, bronchial dilation, and subsegmental atelectasis. CONCLUSIONS: Female patients with severe wood smoke-related COPD do not appear to develop emphysema, although they do show severe airway involvement. The reduction in DLCO and VA, with a normal DLCO/VA ratio, is probably due to severe bronchial obstruction and incomplete mixing of inspired gas during the determination of single-breath DLCO.

Diferencias tomográficas y funcionales entre la EPOC severa relacionada con humo de leña y con cigarrillo: comparison between the wood smoke-related and smoking-related disease / Tomographic and functional findings in severe COPD

OBJETIVO: La exposición a humo de leña es factor de riesgo para EPOC. A diferencia de la EPOC por cigarrillo (EPOC-C), para un mismo nivel de obstrucción, en la EPOC por leña (EPOC-L), la DLCO está menos disminuida, sugiriendo menos enfisema. Por tanto, el objetivo de este estudio fue comparar los hallazgos en la TCAR en mujeres con EPOC-L y con EPOC- C. MÉTODOS: Veintidós mujeres con EPOC severa (VEF1/CVF < 70% y VEF1 < 50%) fueron divididas en dos grupos: las expuestas a leña (EPOC-L; n = 12) y las expuestas a cigarrillo (EPOC-C; n = 10). Se compararon los dos grupos con respecto al puntaje de enfisema y el compromiso de la vía aérea en la TCAR, las anormalidades funcionales en la espirometría, la DLCO, los volúmenes pulmonares y la resistencia específica de la vía aérea (sRaw). RESULTADOS: Los dos grupos tuvieron VEF1, sRaw e hiperinflación pulmonar similares. En el grupo EPOC-C, hubo mayor disminución de la DLCO y de la DLCO/VA y mayor puntaje de enfisema. En el grupo EPOC-L, no encontramos enfisema significativo en la TCAR. Los hallazgos principales fueron engrosamiento peribronquial, dilataciones bronquiales y atelectasias subsegmentarias. CONCLUSIONES: En pacientes con EPOC-L severa no hay enfisema en la TCAR. El hallazgo más importante es el compromiso severo de la vía aérea. La disminución de la DLCO y del VA con DLCO/VA normal es probablemente determinada por la obstrucción bronquial severa y la mezcla incompleta del gas inspirado en la maniobra de la respiración única de la prueba de difusión.

OBJECTIVE: Wood smoke exposure is a risk factor for COPD. For a given degree of airway obstruction, the reduction in DLCO is smaller in individuals with wood smoke-related COPD than in those with smoking-related COPD, suggesting that there is less emphysema in the former. The objective of this study was to compare HRCT findings between women with wood smoke-related COPD and women with smoking-related COPD. METHODS: Twenty-two women with severe COPD (FEV1/FVC ratio < 70% and FEV1 < 50%) were divided into two groups: those with wood smoke-related COPD (n = 12) and those with smoking-related COPD (n = 10). The two groups were compared regarding emphysema scores and airway involvement (as determined by HRCT); and functional abnormalities-spirometry results, DLCO, alveolar volume (VA), the DLCO/VA ratio, lung volumes, and specific airway resistance (sRaw). Results: There were no significant differences between the two groups in terms of FEV1, sRaw, or lung hyperinflation. Decreases in DLCO and in the DLCO/VA ratio were greater in the smoking-related COPD group subjects, who also had higher emphysema scores, in comparison with the wood smoke-related COPD group subjects. In the wood smoke-related COPD group, HRCT scans howed no significant emphysema, the main findings being peribronchial thickening, bronchial dilation, and subsegmental atelectasis. CONCLUSIONS: Female patients with severe wood smoke-related COPD do not appear to develop emphysema, although they do show severe airway involvement. The reduction in DLCO and VA, with a normal DLCO/VA ratio, is probably due to severe bronchial obstruction and incomplete mixing of inspired gas during the determination of single-breath DLCO.

Acceso asmatico severo: fisiopatologia, clinica y tratamiento / Severe asthmatic access: physiopathology, clinical manifestations and treatment

El acceso asmatico severo constituye una verdadera emergencia medica por cuanto se acompana de morbilidad y mortalidad significativa y quizas cada dia mas frecuente. Su manejo apropiado requiere un conocimiento adecuado de sus caracteristicas clinicas y su fisiopatologia y de la farmacologia de las drogas empleadas para el tratamiento que debe individualizarse segun las circunstancias de cada caso. El tratamiento ideal lo constituye la prevencion del mismo mediante el manejo meticuloso del asmatico a base de drogas supresivas de la reaccion inflamatoria, evitando alergenos y control de broncoespasmo en la adicion intermitente de corticosteroides orales antes de que se presente el acceso severo y el paciente debe recibir instruccion apropiada sobre la forma como debe iniciar su tratamiento y donde y a quien recurir rapidamente cuando se presente. El medico que atiende el paciente debe valorar la severidad del acceso y ademas el tratamiento de la misma. El acceso leve o moderado puede manejarse con epinefrina subcutanea o beta-2 adrenergicos por inhalacion que puede repetirse en 15 minutos si el paciente no mejora. Si el paciente no mejora o se presenta a urgencias en estado 3 grado A debe recibir ademas de beta-2 adrenergicos por inhalacion corticoesteroides I.V., y oxigeno por canula nasal.Se el acceso recurre, persiste o aumenta deben iniciarse liquidos I.V., considerarse el uso de aminofilina I.V. y considerar su utilizacion. El acceso severo debe hospitalizarse y recibir de entrada broncodilatador, beta-2 adrenergico por inhalacion, aminofilina...

Rifampicilina - Trimetoprin y Ampicilina en el tratamiento de las exacerbaciones agudas de la bronquitis crónica / Rifampicilina - Trimetoprin and Ampicilina in the treatment of the acute exacerbaciones of the chronic bronchitis

En un estudio anterior se encontró que la respuesta clínica al tratamiento de la exacerbación aguda en la bronquitis crónica y el infisema no guardaba relación con la bacteriología del esputo espontáneo que se contamina a su paso por la faringe por lo cual se empleó un cateter telescópico de doble camisa introducido a través de un fibrobroncoscopio para obtener secreciones traqueo-bronquiales. Con esta técnica se aisló flora faríngea en las secreciones traqueo-bronquiales en el 50 por ciento de los casos lo cual sugiere que esta flora puede tener algún papel todavía no bien definido. En solo 20 por ciento de los casos se aislaron st. pneumonía o H. influenzas lo cual sugiere que estos gérmenes no son tan frecuentes entre nosotros como lo sugiere la literatura. Fué más frecuente el estafilococo aureus. Los Gram negativos patógenos fueron mucho menos frecuentes que cuando se cultivo el esputo espontáneo. Las dos drogas empleadas disminuyeron la intensidad de la tos, el volumen y purulencia del esputo pero no modificaron la función respiratoria.