Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Enferm. clín. (Ed. impr.) ; 30(2): 108-113, mar.-abr. 2020. tab
Artigo em Espanhol | IBECS-Express | ID: ibc-FGT-3073

RESUMO

Objetivo: Evaluar si el conocimiento de la enfermedad asmática puede ser un factor protector frente al riesgo de neumonía adquirida en la comunidad (NAC) en las personas con asma mayores de 18 años que reciben tratamiento inhalado. Método: Estudio observacional de casos y controles en población con asma. Se reclutaron 123 personas con asma diagnosticadas de neumonía por criterios clínicos y radiológicos (casos) y 246 personas con asma no diagnosticados de neumonía durante el último año (controles), apareados por edad. El principal factor de estudio fue la valoración del conocimiento sobre la enfermedad asmática mediante un cuestionario ad hoc, de 7 preguntas con 2 posibles respuestas (conoce, no conoce). Resultados: El análisis bivariado muestra que el conocimiento de la enfermedad asmática tiene una asociación estadísticamente significativa como factor protector de NAC. En el análisis multivariante muestra una asociación del conocimiento de la enfermedad asmática como factor protector de NAC (OR = 0,24), independientemente de la edad, nivel de estudios, funcionalidad y gravedad del asma. Conclusiones: Un buen conocimiento de la enfermedad asmática permite reducir el riesgo de NAC en pacientes asmáticos con tratamiento inhalado


Objective: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. Method: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). Results: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. Conclusions: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment

5.
J Clin Med ; 8(1)2019 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-30621152

RESUMO

BACKGROUND: current algorithms for the detection of heart failure (HF) and chronic obstructive pulmonary disease (COPD) exacerbations have poor performance. METHODS: this study was designed as a prospective longitudinal trial. Physiological parameters were evaluated at rest and effort (walking) in patients who were in the exacerbation or stable phases of HF or COPD. Parameters with relevant discriminatory power (sensitivity (Sn) or specificity (Sp) ≥ 80%, and Youden index ≥ 0.2) were integrated into diagnostic algorithms. RESULTS: the study included 127 patients (COPD: 56, HF: 54, both: 17). The best algorithm for COPD included: oxygen saturation (SaO2) decrease ≥ 2% in minutes 1 to 3 of effort, end-of-effort heart rate (HR) increase ≥ 10 beats/min and walking distance decrease ≥ 35 m (presence of one criterion showed Sn: 0.90 (95%, CI(confidence interval): 0.75⁻0.97), Sp: 0.89 (95%, CI: 0.72⁻0.96), and area under the curve (AUC): 0.92 (95%, CI: 0.85⁻0.995)); and for HF: SaO2 decrease ≥ 2% in the mean-of-effort, HR increase ≥ 10 beats/min in the mean-of-effort, and walking distance decrease ≥ 40 m (presence of one criterion showed Sn: 0.85 (95%, CI: 0.69⁻0.93), Sp: 0.75 (95%, CI: 0.57⁻0.87) and AUC 0.84 (95%, CI: 0.74⁻0.94)). CONCLUSIONS: effort situations improve the validity of physiological parameters for detection of HF and COPD exacerbation episodes.

6.
Med. clín (Ed. impr.) ; 150(12): 455-459, jun. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173646

RESUMO

Introducción y objetivo: El asma es una enfermedad crónica que precisa tratamiento inhalado y que, a su vez, es factor de riesgo (FR) de neumonía. En la cavidad orofaríngea existen numerosas especies de bacterias que podrían ser arrastradas a nivel broncoalveolar. Objetivo: determinar si la salud bucodental es un FR de neumonía adquirida en la comunidad (NAC) en pacientes asmáticos que realizan tratamiento inhalado y determinar si la frecuencia de utilización de los dispositivos de inhalación y el tipo de fármaco inhalado son FR de NAC. Pacientes y método: Estudio de casos y controles en población asmática con tratamiento inhalado. Se seleccionaron 126 pacientes asmáticos diagnosticados de neumonía por criterios clínicos y radiológicos (casos) y 252 asmáticos no diagnosticados de neumonía durante el último año (controles), emparejados por edad. El principal factor de estudio fue la puntuación del General Oral Health Assessment Index (GOHAI). Resultados: El análisis bivariado muestra una asociación estadísticamente significativa de la NAC con un índice de GOHAI≤57 puntos (mala salud bucodental) (OR 1,69), el tratamiento anticolinérgico (OR 2,41), realizar 6 o más inhalaciones al día (OR 3,23), el uso de cámara (OR 1,62), el FEV1 (OR 0,98), una alteración de la funcionalidad (OR 2,08) y los trastornos psiquiátricos o la depresión (OR 0,41). El análisis multivariante muestra una asociación independiente de realizar 6 o más inhalaciones al día (OR 2,74) y de las alteraciones de la funcionalidad (OR 1,67). Conclusiones: Los resultados evidencian que una mala salud bucodental podría ser un FR de NAC


Introduction and objective: Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. Objective: to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. Patients and method: Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. Results: Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). Conclusions: The results suggest that poor oral health may be a CAP RF


Assuntos
Humanos , Masculino , Feminino , Higiene Bucal/efeitos adversos , Pneumonia Bacteriana/etiologia , Asma/complicações , Estudos de Casos e Controles , Fatores de Risco , Administração por Inalação , Nebulizadores e Vaporizadores , Infecções Comunitárias Adquiridas
7.
Med Clin (Barc) ; 150(12): 455-459, 2018 06 22.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28947297

RESUMO

INTRODUCTION AND OBJECTIVE: Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. OBJECTIVE: to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. PATIENTS AND METHOD: Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. RESULTS: Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). CONCLUSIONS: The results suggest that poor oral health may be a CAP RF.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Infecções Comunitárias Adquiridas/etiologia , Saúde Bucal , Pneumonia/etiologia , Administração por Inalação , Idoso , Antiasmáticos/administração & dosagem , Asma/complicações , Asma/fisiopatologia , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/epidemiologia , Inquéritos de Saúde Bucal , Placa Dentária/microbiologia , Suscetibilidade a Doenças , Relação Dose-Resposta a Droga , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Boca/microbiologia , Nebulizadores e Vaporizadores/estatística & dados numéricos , Pneumonia/epidemiologia , Prevalência , Utilização de Procedimentos e Técnicas , Risco , Fatores Socioeconômicos
8.
Enferm Clin ; 2018 Dec 29.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30600151

RESUMO

OBJECTIVE: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. METHOD: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). RESULTS: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. CONCLUSIONS: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment.

9.
Med. clín (Ed. impr.) ; 149(3): 107-113, ago. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-164957

RESUMO

Objetivos: Se pretende evaluar los niveles de la fracción de gammaglobulinas en suero como un marcador biológico para valorar la gravedad y predecir la mortalidad y nuevas agudizaciones en los pacientes ingresados por una agudización de la EPOC. Pacientes y métodos: El estudio VIRAE es una cohorte de pacientes ingresados por una agudización de probable causa infecciosa de la EPOC en un período de 2 años. Se analizaron los niveles de la fracción de gammaglobulinas del proteinograma en 120 pacientes. Se evaluaron los principales indicadores clínicos de gravedad. Se compararon las características principales en 2 grupos (mayor o menor de 6,6g/dl de la fracción gamma del proteinograma). Resultados: Los niveles de la fracción gamma del proteinograma se correlacionan con el valor del FEV1 (p=0,009), la PCR (p=0,04) y el número de reingresos a los 6 meses de la hospitalización (p=0,04). Se demuestra una buena asociación con la escala GOLD, el índice BODE y la escala de disnea de mMRC; y también con el tratamiento con corticoides orales y la oxigenoterapia domiciliaria. No hemos observado que sea un buen predictor de mortalidad, aun observando una mayor mortalidad al año del ingreso hospitalario en los pacientes con niveles bajos. Conclusiones: Los niveles de la fracción de gammaglobulinas en el proteinograma tienen una buena correlación con el FEV1. Además, se asocian a una mayor gravedad de los pacientes con EPOC. Este biomarcador sencillo puede ser útil para identificar pacientes de alto riesgo (AU)


Objectives: To evaluate the levels of the serum gamma globulin fraction in proteinograms as a biomarker to assess the severity, and to predict the mortality and new exacerbations in patients admitted for an exacerbation of a COPD. Patients and methods: The VIRAE study was carried out on a cohort of patients hospitalized for an exacerbation of probable infectious origin of COPD over a period of 2 years. The levels of the serum gamma globulin fraction were analyzed in the proteinogram of 120 patients. The main clinical indicators of severity were also evaluated. Key features were compared in 2 groups (gamma fraction in the proteinogram greater or less than 6.6g/dl). Results: The levels of the serum gamma fraction in the proteinogram correlated with the FEV1 (P=.009), the CRP (P=.04), and the number of readmissions after 6 months of hospitalization (P=.04). We observed a good association with the GOLD scale, the BODE index and the mMRC dyspnea scale; and also with treatment with oral corticoids and home oxygen therapy. We did not find it to be a good predictor of mortality, despite observing increased mortality rates one year after hospital admission in patients with low levels of the factor. Conclusions: The levels of the gamma globulin fraction in proteinograms has a good correlation with the FEV1. In addition, they are associated with a greater severity of patients with COPD. This simple biomarker may be useful in identifying high-risk patients (AU)


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , gama-Globulinas/análise , Infecções Respiratórias/epidemiologia , Índice de Gravidade de Doença , Biomarcadores/análise , Oxigenoterapia , Corticosteroides/uso terapêutico , Recidiva , Bronquite/epidemiologia , Estudos de Coortes
10.
Med Clin (Barc) ; 149(3): 107-113, 2017 Aug 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28233558

RESUMO

OBJECTIVES: To evaluate the levels of the serum gamma globulin fraction in proteinograms as a biomarker to assess the severity, and to predict the mortality and new exacerbations in patients admitted for an exacerbation of a COPD. PATIENTS AND METHODS: The VIRAE study was carried out on a cohort of patients hospitalized for an exacerbation of probable infectious origin of COPD over a period of 2 years. The levels of the serum gamma globulin fraction were analyzed in the proteinogram of 120 patients. The main clinical indicators of severity were also evaluated. Key features were compared in 2 groups (gamma fraction in the proteinogram greater or less than 6.6g/dl). RESULTS: The levels of the serum gamma fraction in the proteinogram correlated with the FEV1 (P=.009), the CRP (P=.04), and the number of readmissions after 6 months of hospitalization (P=.04). We observed a good association with the GOLD scale, the BODE index and the mMRC dyspnea scale; and also with treatment with oral corticoids and home oxygen therapy. We did not find it to be a good predictor of mortality, despite observing increased mortality rates one year after hospital admission in patients with low levels of the factor. CONCLUSIONS: The levels of the gamma globulin fraction in proteinograms has a good correlation with the FEV1. In addition, they are associated with a greater severity of patients with COPD. This simple biomarker may be useful in identifying high-risk patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico , gama-Globulinas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Índice de Gravidade de Doença , Análise de Sobrevida
11.
Artigo em Inglês | MEDLINE | ID: mdl-26664106

RESUMO

OBJECTIVE: To determine in patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) the association between the isolation of potential pathogens in a conventional sputum culture and comorbidities. PATIENTS AND METHODS: The ESMI study is a multicenter observational study. Patients with AE-COPD admitted to the Internal Medicine departments of 70 hospitals were included. The clinical characteristics, treatments, and comorbidities were gathered. The results of conventional sputum cultures were recorded. RESULTS: A total of 536 patients were included, of which 161 produced valid sputum and a potentially pathogenic microorganism was isolated from 88 subjects (16.4%). The isolation of Pseudomonas aeruginosa (30.7%) was associated with a greater severity of the lung disease (previous admissions [P= 0.026], dyspnea scale [P=0.047], post-broncodilator forced expiratory volume in 1 second (FEV1) [P=0.005], and the BODEx index [P=0.009]); also with higher prevalence of cor pulmonale (P=0.017), heart failure (P=0.048), and cerebrovascular disease (P=0.026). Streptococcus pneumoniae (26.1%) was associated with more comorbidity according to number of diseases (P=0.018); notably, peripheral artery disease (P=0.033), hypertension (P=0.029), dyslipidemia (P=0.039), osteoporosis (P=0.0001), and depression (P=0.005). CONCLUSION: Patients with AE-COPD and P. aeruginosa present higher severity of COPD, while those with S. pneumoniae present greater comorbidity. The potentially pathogenic microorganism obtained in the sputum culture depends on the associated comorbidities.


Assuntos
Pulmão/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/patogenicidade , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/microbiologia , Escarro/microbiologia , Streptococcus pneumoniae/patogenicidade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Progressão da Doença , Feminino , Volume Expiratório Forçado , Humanos , Medicina Interna , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Infecções Pneumocócicas/terapia , Prognóstico , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/fisiopatologia , Infecções por Pseudomonas/terapia , Pseudomonas aeruginosa/isolamento & purificação , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Risco , Espanha/epidemiologia , Streptococcus pneumoniae/isolamento & purificação
12.
Arch. bronconeumol. (Ed. impr.) ; 51(12): 627-631, dic. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-147007

RESUMO

Introducción: La neumonía adquirida en la comunidad (NAC) no se considera una enfermedad profesional, por lo que se desconoce la influencia que puedan tener las distintas profesiones y condiciones laborales sobre el riesgo de desarrollar una NAC. El objetivo del estudio es conocer si las profesiones y determinadas condiciones laborales se pueden comportar como factores de riesgo de NAC. Metodología: Estudio de casos (n = 1.336) y controles (n = 1.326) de base poblacional. Se estudiaron todos los casos de NAC con confirmación radiológica, diagnosticados en una base poblacional, durante un año. Los factores de riesgo de NAC, incluyendo las profesiones y las condiciones laborales actuales, fueron estudiados mediante entrevista individual. Resultados: El análisis bivariado mostró que trabajar como administrativo es un factor protector de NAC, mientras que trabajar en la construcción, estar expuesto al polvo y sufrir cambios bruscos de temperatura en el trabajo son factores de riesgo de NAC. El efecto de las profesiones desaparece cuando se ajusta por las condiciones laborales en el análisis multivariado. El contacto con polvo (último mes) y cambios bruscos de temperatura recientes (últimos 3 meses) son factores de riesgo de NAC sin que ello guarde relación con el número de años trabajados en estas condiciones, lo que sugiere un carácter reversible. Conclusión: Algunas condiciones laborales recientes, como el contacto con polvo y cambios bruscos de temperatura, son factores de riesgo de NAC reversibles y potencialmente prevenible


Introduction: Community-acquired pneumonia (CAP) is not considered a professional disease, and the effect of different occupations and working conditions on susceptibility to CAP is unknown. The aim of this study is to determine whether different jobs and certain working conditions are risk factors for CAP. Methodology: Over a 1-year period, all radiologically confirmed cases of CAP (n = 1,336) and age- and sex-matched controls (n = 1,326) were enrolled in a population-based case-control study. A questionnaire on CAP risk factors, including work-related questions, was administered to all participants during an in-person interview. Results: The bivariate analysis showed that office work is a protective factor against CAP, while building work, contact with dust and sudden changes of temperature in the workplace were risk factors for CAP. The occupational factor disappeared when the multivariate analysis was adjusted for working conditions. Contact with dust (previous month) and sudden changes of temperature (previous 3 months) were risk factors for CAP, irrespective of the number of years spent working in these conditions, suggesting reversibility. Conclusion: Some recent working conditions such as exposure to dust and sudden changes of temperature in the workplace are risk factors for CAP. Both factors are reversible and preventable


Assuntos
Humanos , Masculino , Feminino , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Fatores de Risco , Modelos Logísticos , Inquéritos e Questionários , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle
14.
Arch Bronconeumol ; 51(12): 627-31, 2015 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25544548

RESUMO

INTRODUCTION: Community-acquired pneumonia (CAP) is not considered a professional disease, and the effect of different occupations and working conditions on susceptibility to CAP is unknown. The aim of this study is to determine whether different jobs and certain working conditions are risk factors for CAP. METHODOLOGY: Over a 1-year period, all radiologically confirmed cases of CAP (n=1,336) and age- and sex-matched controls (n=1,326) were enrolled in a population-based case-control study. A questionnaire on CAP risk factors, including work-related questions, was administered to all participants during an in-person interview. RESULTS: The bivariate analysis showed that office work is a protective factor against CAP, while building work, contact with dust and sudden changes of temperature in the workplace were risk factors for CAP. The occupational factor disappeared when the multivariate analysis was adjusted for working conditions. Contact with dust (previous month) and sudden changes of temperature (previous 3 months) were risk factors for CAP, irrespective of the number of years spent working in these conditions, suggesting reversibility. CONCLUSION: Some recent working conditions such as exposure to dust and sudden changes of temperature in the workplace are risk factors for CAP. Both factors are reversible and preventable.


Assuntos
Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Pneumonia Bacteriana/epidemiologia , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
15.
Arch Bronconeumol ; 50(12): 514-20, 2014 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25443591

RESUMO

INTRODUCTION: Pneumonia is considered an independent entity in chronic obstructive pulmonary disease (COPD), to be distinguished from an infectious exacerbation of COPD. The aim of this study was to analyze the clinical characteristics and progress of the exacerbation of COPD (ECOPD) compared to pneumonia in COPD (PCOPD) patients requiring hospitalization. PATIENTS AND METHODS: Prospective, longitudinal, observational cohort study including 124 COPD patients requiring hospital admission for lower respiratory tract infection. Patients were categorized according to presence of ECOPD (n=104) or PCOPD (n=20), depending on presence of consolidation on X-ray. Demographic, clinical, laboratory, microbiological and progress variables were collected. RESULTS: Patients with ECOPD showed more severe respiratory disease according to the degree of obstruction (P<.01) and need for oxygen therapy (P<.05). PCOPD patients showed increased presence of fever (P<.05), lower blood pressure (P<.001), more laboratory abnormalities (P<.05; leukocytosis, elevated CRP, low serum albumin) and increased presence of crepitus (P<.01). Microbiological diagnosis was achieved in 30.8% of cases of ECOPD and 35% of PCOPD; sputum culture yielded the highest percentage of positive results, predominantly Pseudomonas aeruginosa. Regarding the progress of the episode, no differences were found in hospital stay, need for ICU or mechanical ventilation. CONCLUSIONS: Our data confirm clinical and analytical differences between ECOPD and PCOPD in patients who require hospital admission, while there were no differences in subsequent progress.


Assuntos
Pneumonia Bacteriana/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Aguda , Corticosteroides/uso terapêutico , Idoso , Antibacterianos/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Diagnóstico Diferencial , Emergências , Feminino , Volume Expiratório Forçado , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Leucocitose/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Oxigenoterapia , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/estatística & dados numéricos
16.
Arch. bronconeumol. (Ed. impr.) ; 50(12): 514-520, dic. 2014. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-130996

RESUMO

Introducción: La neumonía se considera una entidad propia, diferente a la exacerbación de la enfermedad pulmonar obstructiva crónica (EPOC) de causa infecciosa. El objetivo de nuestro estudio fue analizar las características clínicas y la evolución según se presentara una agudización de la EPOC (AEPOC) o una neumonía (NEPOC) en los pacientes con EPOC que precisaban un ingreso hospitalario. Pacientes y métodos: Estudio de cohortes, prospectivo, longitudinal y observacional que incluyó 124 pacientes con EPOC que precisaron ingreso hospitalario por una infección respiratoria baja. Se categorizaron según presentaran una AEPOC (n = 104) o una NEPOC (n = 20), en función de la aparición de condensación radiológica. Recogida de variables demográficas, clínicas, de laboratorio, microbiológicas y evolutivas. Resultados: Los pacientes con AEPOC mostraban mayor gravedad de la enfermedad respiratoria según el grado de obstrucción (p < 0,01) y necesidad de oxigenoterapia crónica (p < 0,05). Los pacientes con NEPOC mostraban mayor presencia de fiebre (p < 0,05), mayor hipotensión arterial (p < 0,001), mayor alteración analítica (p < 0,05; leucocitosis, elevación de la PCR, hipoalbuminemia), así como mayor presencia de crepitantes (p < 0,01). El diagnóstico microbiológico se obtuvo en el 30,8% de los casos de AEPOC y en el 35% de las NEPOC, siendo el cultivo de esputo la técnica con mayor porcentaje de resultados positivos, mostrando una preponderancia de Pseudomonas aeruginosa. La evolución del episodio no mostró diferencias en la estancia hospitalaria, ni la necesidad de UCI o ventilación mecánica. Conclusiones: Nuestros datos confirman diferencias clínicas y analíticas entre una AEPOC y una NEPOC en los pacientes que precisan ingreso hospitalario, aunque sin diferencias en la evolución posterior


Introduction: Pneumonia is considered an independent entity in chronic obstructive pulmonary disease (COPD), to be distinguished from an infectious exacerbation of COPD. The aim of this study was to analyze the clinical characteristics and progress of the exacerbation of COPD (ECOPD) compared to pneumonia in COPD (PCOPD) patients requiring hospitalization. Patients and methods: Prospective, longitudinal, observational cohort study including 124 COPD patients requiring hospital admission for lower respiratory tract infection. Patients were categorized according to presence of ECOPD (n = 104) or PCOPD (n = 20), depending on presence of consolidation on X-ray. Demographic, clinical, laboratory, microbiological and progress variables were collected. Results: Patients with ECOPD showed more severe respiratory disease according to the degree of obstruction (P < .01) and need for oxygen therapy (P < .05). PCOPD patients showed increased presence of fever (P < .05), lower blood pressure (P < .001), more laboratory abnormalities (P < .05; leukocytosis, elevated CRP, low serum albumin) and increased presence of crepitus (P < .01). Microbiological diagnosis was achieved in 30.8% of cases of ECOPD and 35% of PCOPD; sputum culture yielded the highest percentage of positive results, predominantly Pseudomonas aeruginosa. Regarding the progress of the episode, no differences were found in hospital stay, need for ICU or mechanical ventilation. Conclusions: Our data confirm clinical and analytical differences between ECOPD and PCOPD in patients who require hospital admission, while there were no differences in subsequent progress


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Pneumonia/epidemiologia , Infecções Respiratórias/epidemiologia , Recidiva , Progressão da Doença , Fatores de Risco , Hospitalização/estatística & dados numéricos
17.
Chest ; 145(5): 972-980, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24077342

RESUMO

BACKGROUND: No valid tools exist for evaluating the prognosis in the short and medium term after hospital discharge of patients with COPD. Our hypothesis was that a new index based on the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index can accurately predict mortality, hospital readmission, and their combination for the period from 3 months to 1 year after discharge in patients hospitalized for COPD. METHODS: A multicenter study of patients hospitalized for COPD exacerbations was used to develop the CODEX index, and a different patient cohort was used for validation. Comorbidity was measured using the age-adjusted Charlson index, whereas dyspnea, obstruction, and severe exacerbations were calculated according to BODEX (BMI, airfl ow obstruction, dyspnea, and previous severe exacerbations) thresholds. Information about mortality and readmissions for COPD or other causes was collected at 3 and 12 months after hospital discharge. RESULTS: Two sets of 606 and 377 patients were included in the development and validation cohorts, respectively. The CODEX index was associated with mortality at 3 months ( P < .0001; hazard ratio [HR], 1.5; 95% CI, 1.2-1.8) and 1 year ( P < .0001; HR, 1.3; 95% CI, 1.2-1.5 ), hospital readmissions in the same periods, and their combination (all P < .0001). All CODEX C statistics were superior to those of the BODEX, DOSE (dyspnea, airfl ow obstruction, smoking status, and exacerbation frequency), and updated ADO (age, dyspnea, and airfl ow obstruction) indexes. CONCLUSIONS: The CODEX index was a useful predictor of survival and readmission at both 3 months and 1 year after hospital discharge for a COPD exacerbation, with a prognostic capacity superior to other previously published indexes.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Dispneia/diagnóstico , Pacientes Internados , Alta do Paciente/tendências , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de Doença , Idoso , Obstrução das Vias Respiratórias/etiologia , Progressão da Doença , Dispneia/etiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Readmissão do Paciente/tendências , Prognóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
19.
Artigo em Inglês | MEDLINE | ID: mdl-22745532

RESUMO

PURPOSE: Respiratory infection is the most common cause for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). The aim of this work was to study the etiology of the respiratory infection in order to assess the usefulness of the clinical and analytical parameters used for COPD identification. PATIENTS AND METHODS: We included 132 patients over a period of 2 years. The etiology of the respiratory infection was studied by conventional sputum, paired serology tests for atypical bacteria, and viral diagnostic techniques (immunochromatography, immunofluorescence, cell culture, and molecular biology techniques). We grouped the patients into four groups based on the pathogens isolated (bacterial versus. viral, known etiology versus unknown etiology) and compared the groups. RESULTS: A pathogen was identified in 48 patients. The pathogen was identified through sputum culture in 34 patients, seroconversion in three patients, and a positive result from viral techniques in 14 patients. No significant differences in identifying etiology were observed in the clinical and analytical parameters within the different groups. The most cost-effective tests were the sputum test and the polymerase chain reaction. CONCLUSION: Based on our experience, clinical and analytical parameters are not useful for the etiological identification of COPD exacerbations. Diagnosing COPD exacerbation is difficult, with the conventional sputum test for bacterial etiology and molecular biology techniques for viral etiology providing the most profitability. Further studies are necessary to identify respiratory syndromes or analytical parameters that can be used to identify the etiology of new AE-COPD cases without the laborious diagnostic techniques.


Assuntos
Doença Pulmonar Obstrutiva Crônica/microbiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/virologia , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Escarro/microbiologia , Escarro/virologia , Irrigação Terapêutica
20.
Med. clín (Ed. impr.) ; 138(11): 461-467, abr. 2012.
Artigo em Espanhol | IBECS | ID: ibc-100050

RESUMO

Fundamento y objetivo: Las hospitalizaciones por enfermedad pulmonar obstructiva crónica (EPOC) se producen mayoritariamente en pacientes de edad avanzada. Nuestro objetivo es describir las características y el tratamiento de los pacientes ancianos hospitalizados por EPOC en los servicios de Medicina Interna, comparados con el grupo de menor edad. Pacientes y método: Estudio observacional, prospectivo y multicéntrico. Se comparan las diferencias entre los pacientes mayores de 80 años y el resto respecto a comorbilidad, gravedad de la EPOC, ingresos previos, días de estancia y tratamiento prescrito. La comorbilidad se valoró mediante el índice de Charlson y un cuestionario diseñado al efecto.Resultados: Se incluyeron 398 sujetos, 353 de ellos varones (89%), con una edad media (DE) de 73,7 (8,8) años, de los que 107 (26,9%) eran mayores de 80 años. Estos pacientes tenían menor gravedad de la EPOC según la clasificación GOLD (p<0,02). Aunque la comorbilidad global fue similar en ambos grupos, los pacientes ancianos tenían mayor presencia de arritmias (p<0,01), de hipertrofia ventricular izquierda (p<0,01) y recibían más diuréticos (p<0,05). La disnea, días de estancia y mortalidad fueron similares entre ambas poblaciones. La oxigenoterapia domiciliaria previa al ingreso y el uso de corticoides inhalados y la oxigenoterapia domiciliaria fueron menores en los pacientes mayores, incluso cuando estaban clínicamente indicados.Conclusiones: Una cuarta parte de los pacientes hospitalizados por EPOC en los servicios de Medicina Interna tienen más de 80 años. Aunque presentan menor obstrucción, tienen un grado de disnea similar, mayor comorbilidad cardiaca y su tratamiento se ajusta menos a las recomendaciones de las guías (AU)


Background and objective: Hospitalizations for chronic obstructive pulmonary disease (COPD) occur mostly in elderly patients. We describe the characteristics and treatment of elderly patients hospitalized for COPD in Internal Medicine Services, compared with the younger age group. Patients and methods: Observational, prospective, multicenter study. We compared the differences between patients older than 80 years and the rest regarding comorbidity, severity of COPD, previous admissions, length of stay and treatment prescribed. Comorbidity was assessed by the Charlson index and a questionnaire was designed for this purpose.Results: We included 398 subjects, 353 men (89%) with a mean age of 73.7 years (SD 8.8), of whom about 107 (26.9%) were older than 80 years. These patients had less severe COPD according to the GOLD classification (P<.02). Although the overall morbidity was similar in both groups, elderly patients had greater presence of arrhythmias (P<.01), left ventricular hypertrophy (P<.01) and received more diuretics (P<.05). Dyspnoea, length of stay and mortality were similar between both populations. Home oxygen therapy prior to and use of inhaled corticosteroids and oxygen therapy was lower in older patients, even when they were clinically indicated. Conclusions: A quarter of patients hospitalized for COPD in Internal Medicine Services are over 80 years. Although they present less obstruction, they have a similar degree of dyspnea, increased cardiac morbidity and their treatment is less consistent with the recommendations of the guidelines (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , /estatística & dados numéricos , Recidiva , Comorbidade , Estatísticas Hospitalares , Índice de Gravidade de Doença
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA