Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias

Introduction

The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking.

Materials and methods

A random group of 1,353 subjects aged between 40 and 70 years was selected from a sample population of 596,478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV₁/FVC ratio was less than 0.70.

Results

The prevalence of COPD was 7.3% (95% CI: 5.5-9.5) and was higher in males than in females (8.7% vs. 6.3%, P = .134). The incidence of smoking was 29.4% (95% CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P < .001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in group i, 69.9% in group ii, 10.4% in group iii and 3.3% in group iv. 71.6% of the subjects were underdiagnosed and 63.5% undertreated.

Conclusions

Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.     

Utilización excesiva de corticoides inhalados en la enfermedad pulmonar obstructiva crónica

Despite the fact that the recommendations of the main clinical guidelines have restricted the indications for inhaled corticosteroids in chronic obstructive pulmonary disease (COPD), currently more than 80% of patients are receiving this treatment in Spain, mostly with high doses. A detailed review of the literature does not justify the use of these high doses, a position that agrees with the recommendations of the FDA. A re-evaluation of their safety, the consistency of the data on their efficacy showing similar results with moderate doses and a better patient selection require the use of this treatment in COPD patients to be reconsidered.     

Utilización de glucosa en los músculos de pacientes con enfermedad pulmonar obstructiva crónica

Introduction

Muscle dysfunction is one of the most extensively studied manifestations of COPD. Metabolic changes in muscle are difficult to study in vivo, due to the lack of non-invasive techniques. Our aim was to evaluate metabolic activity simultaneously in various muscle groups in COPD patients.

Methods

Thirty-nine COPD patients and 21 controls with normal lung function, due to undergo computed axial and positron emission tomography for staging of localized lung lesions were included. After administration of 18-fluordeoxyglucose, images of 2 respiratory muscles (costal and crural diaphragm, and rectus abdominus) and 2 peripheral muscles (brachial biceps and quadriceps) were obtained, using the standard uptake value as the glucose metabolism index.

Results

Standard uptake value was higher in both portions of the diaphragm than in the other muscles of all subjects. Moreover, the crural diaphragm and rectus abdominus showed greater activity in COPD patients than in the controls (1.8 ± 0.7 vs 1.4 ± 0.8; and 0.78 ± 0.2 vs 0.58 ± 0.1; respectively, P < .05). A similar trend was observed with the quadriceps. In COPD patients, uptake in the two respiratory muscles and the quadriceps correlated directly with air trapping (r = 0.388, 0.427 and 0.361, respectively, P < .05).

Conclusions

There is greater glucose uptake and metabolism in the human diaphragm compared to other muscles when the subject is at rest. Increased glucose metabolism in the respiratory muscles (with a similar trend in their quadriceps) of COPD patients is confirmed quantitatively, and is directly related to the mechanical loads confronted.     

Enfermedad pulmonar obstructiva crónica en pacientes con tromboembolia de pulmón aguda sintomática

Background

The diagnosis of pulmonary embolism (PE) is often complicated by the presence of chronic obstructive pulmonary disease (COPD). Some studies have suggested that patients with PE and concomitant COPD have a worse prognosis than patients without COPD.

Patients and methods

Outpatients diagnosed with acute symptomatic PE at a university tertiary care hospital were prospectively included in the study. Clinical characteristics, time between onset of symptoms and diagnosis, and outcome were analyzed according to presence or absence of COPD. The primary endpoint was all-cause deaths at 3 months.

Results

Of 882 patients with a confirmed diagnosis of acute symptomatic PE, 8% (95% confidence interval [CI], 6%–9%) had COPD. Patients with COPD were significantly more likely to have a delay in diagnosis of more than 3 days and to have a low pretest probability of pulmonary embolism according to a standardized clinical score. The total number of deaths during 3 months of follow-up was 128 (14%; 95% CI, 12%–17%). Factors significantly associated with mortality from all causes were a history of cancer or immobilization, systolic blood pressure less than 100 mm Hg, and arterial oxyhemoglobin saturation less than 90%. COPD was significantly associated with PE-related death in the logistic regression analysis (relative risk, 2.2; 95% CI, 1.0–5.1).

Conclusions

Patients with COPD and PE more often have a lower pretest probability and a longer delay in diagnosis of PE. COPD is significantly associated with PE-related death in the 3 months following diagnosis.     

Intervención domiciliaria y variables predictoras para reingreso hospitalario en la enfermedad pulmonar obstructiva crónica agudizada

Background

Chronic obstructive pulmonary disease (COPD) exacerbation increases mortality and resources used associated with hospitalization. We studied whether early home monitoring reduces the rate of readmission and if there are any predictor variables.

Patients and methods

We performed a prospective, controlled, parallel-group study in patients who were hospitalized for COPD. Patients whose residence was within less than 15 km from the hospital were assigned to an interventional group (home visits by nurses about 48-72 hours after discharge), the remainder were assigned to a conventional care group. The rate of rehospitalization within the first month was compared between the two groups, as well as those variables that showed a predictive capability.

Results

Seventy one patients were included: 35 in the conventional care group and 36 in the interventional group. In the latter, the treatment was modified in 13 patients (36%). The hospital readmission rate was 17%, which was similar in both groups (P = .50). For every 5-year increase in age, the risk for readmission was 2.54 (95% CI, 1.06-5.07) and for each increase of 10 mmHg in PaCO₂, the risk of readmission was 8.34 (95% CI, 2.43-18.55).

Conclusions

Early home monitoring did not decrease the readmission rate during the first month. Older age and high PaCO₂ are factors that identify the group with a high risk for rehospitalization.     

Papel de la vitamina D en enfermedad pulmonar obstructiva crónica,asma y otras enfermedades respiratorias

There has been growing interest in recent years in the extraosseous effects of vitamin D.     

Efectividad de la vacunación antigripal para evitar el ingreso hospitalario por agudización de la enfermedad pulmonar obstructiva crónica

Introduction

The main objective was to determine the effectiveness of influenza vaccination in preventing hospitalization due to exacerbation of chronic obstructive pulmonary disease (COPD). One secondary objective was to estimate the prevalence of vaccination, and to describe the factors that were associated with being vaccinated.

Methods

A retrospective cohort study was conducted that included 1,323 patients diagnosed with COPD in the Health Centre of the Pla d’Urgell (Lleida, Spain). They were classified into two cohorts: cohort 1, patients vaccinated against seasonal influenza (campaign 2011/12), and cohort 2, non-vaccinated. The number of patients in both cohorts requiring hospital admission for exacerbation of the disease between the 12/01/2011 and the 03/15/2012 was quantified. Information about the variables of interest was recorded for each patient. A univariate and multivariate analysis was performed. The effectiveness of vaccination was calculated with the formula: E = (1 – OR) × 100. The ORs and their 95% confidence interval (95%CI) were determined by multivariate logistic regression models.

Results

Just over half (55.3%) of the patients had been vaccinated. Vaccinated patients were older and had more associated comorbidity. At the same time, they were less hospitalized (3.0% versus 8.9%; P = .001). The crude and adjusted effectiveness of influenza vaccination in this population subgroup was 68.4% (95%CI: 47.5-81.0) and 90.8 (95%CI: 96.8-88.2), respectively.

Conclusion

Influenza vaccination is effective in preventing hospitalization due to acute exacerbations in COPD patients. However, immunization coverage is not as high as desired. Designing programs to increase the rate of vaccination in this population would reduce the number of hospital admissions for COPD exacerbation.     

Infradiagnóstico de la enfermedad pulmonar obstructiva crónica en mujeres: cuantificación del problema,determinantes y propuestas de acción

Introduction

The distribution of chronic obstructive pulmonary disease (COPD) in women, and its underdiagnosis and determinants in the general population, have not been well described. The EPI-SCAN study is an epidemiologic, observational study conducted at 11 Spanish centers on the general population aged 40 to 80.

Patients and method

This paper describes the rates and extrapolates the population burden from the 3,802 participants of the EPI-SCAN study.

Results

With 2,005 female and 1,797 male participants, there was a lower prevalence of COPD in women (5.7%; 95% CI, 4.7-6.7) than in men (15.1%; 95% CI, 13.5-16.8; P < .05). Among the 386 participants with COPD, 114 (29.5%) were women, who were younger, currently smoked less and had lower tobacco smoke exposure, while reporting a lower level of education (P < .05). As for the respiratory symptoms, there were no differences between sexes for cough, dyspnea or wheezing, but the women with COPD reported sputum less frequently (P < .05). There were no differences in the spirometric severity of COPD between women and men. Overall, 73% of the patients with a spirometric COPD criteria were underdiagnosed, and this percentage is unevenly distributed by sex, being 1.27 times more frequent in women (86.0%) than in men (67.6%) (P < .05). By extrapolating the rates of prevalence and underdiagnosis of COPD to the general population, we estimate that there are 628,102 Spanish women between the ages of 40 and 80 with COPD, 540,168 of whom still have not been diagnosed.

Conclusions

There is a greater underdiagnosis of COPD in women than in men in Spain.     

Prevalencia de anemia asociada a la enfermedad pulmonar obstructiva crónica. Estudio de las variables asociadas

Background

Anaemia is one of the extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD). Its real prevalence, physiopathology and clinical repercussion are unknown. The objectives of our study were: to determine the prevalence of anaemia in patients with stable COPD not attributable to other causes and to establish the relationship of anaemia with clinical, prognostic and inflammatory markers with an important role in COPD.

Methods

The study included stable COPD patients with no other known causes of anaemia. The following tests were carried out: respiratory function tests; serum determination of erythropoietin and inflammatory markers: high sensitivity C-reactive protein (hs-CRP), fibrinogen, interleukin 6 (IL-6), interleukin 8 (IL-8) and tumour necrosis factor α (TNF-α). Body mass index (BMI), Charlson and BODE indices, the number of exacerbations in the previous year, dyspnoea and quality of life were also calculated.

Results

One hundred and thirty patients were included. Anaemia prevalence was 6.2%. Mean haemoglobin value in anaemic patients was 11.9 ± 0.95 g/dL. Patients with anaemia had a lower BMI (P = .03), higher Charlson index (P = .002), more elevated erythropoietin levels (P = .016), a tendency to present a lower FEV₁% value (P = .08) and significantly lower IL-6 values when compared to non-anaemic patients (P = .003).

Conclusions

In our series, the anaemia associated with COPD was less prevalent than that published in the literature to date, and was related to certain clinical and inflammatory markers.     

Asincronía e hiperinsuflación en pacientes con enfermedad pulmonar obstructiva crónica durante 2 tipos de ejercicio de las extremidades superiores

Introduction

Occurrence of dynamic hyperinflation during upper-limbs exercises in chronic obstructive pulmonary disease (COPD) patients it is not well established. We hypothesized that dynamic hyperinflation and thoracoabdominal asynchrony occurs in COPD patients accomplishing arms exercises. We assessed the occurrence and association of dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients during the accomplishment of two arm exercises.

Patients and methods

This was a prospective study with 25 COPD patients. A maximal and a sub-maximal upper limbs exercise test with 50% load were performed with the diagonal technique and the arm cycle ergometer technique. Respiratory pattern, thoracoabdominal configuration and dynamic hyperinflation were assessed in the exercise tests.

Results

Thirty per cent and 60% of patients hyperinflated at the end of the sub-maximum exercise tests with the diagonal and cycle ergometer techniques, respectively. Thoracoabdominal asynchrony occurred in 80% and 100% of patients who hyperinflated with the diagonal and cycle ergometer techniques, respectively. For both exercises we found enhancement of pulmonary ventilation, dyspnea, central respiratory drive and shortening of expiratory time (P < .05). Upper-limbs exercises with the diagonal technique presented less number of patients with these alterations.

Conclusions

Dynamic pulmonary hyperinflation and thoracoabdominal asynchrony association occurred in both upper-limbs exercises; however, the diagonal technique developed less dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients than the arm cycle ergometer.     

Comparación de la respiración con presión positiva intermitente y la presión espiratoria positiva temporal en pacientes con enfermedad pulmonar obstructiva crónica grave

Background

Results supporting the use and the effectiveness of positive expiratory, pressure devices in chronic obstructive pulmonary disease (COPD) patients are still controversial, We have tested the hypothesis that adding TPEP or IPPB to standard pharmacological therapy may provide additional clinical benefit over, pharmacological therapy only in patients with severe COPD.

Methods

Fourty-five patients were randomized in three groups: a group was treated; with IPPB,a group was treated with TPEP and a group with pharmacological; therapy alone (control group).Primary outcome measures included the measurement of scale or, questionnaire concerning dyspnea (MRC scale),dyspnea,cough, and, sputum (BCSS) and quality of life (COPD assessment test) (CAT). Secondary, outcome measures were respiratory function testing,arterial blood gas,analysis,and hematological examinations.

Results

Both patients in the IPPB group and in the TPEP group showed a significant, improvement in two of three tests (MRC,CAT) compared to the control, group.However,in the group comparison analysis for, the same variables between IPPB group and TPEP group we observed a, significant improvement in the IPPB group (P ≤ .05 for MRC and P ≤ .01 for, CAT).The difference of action of the two techniques are evident in the results of, pulmonary function testing: IPPB increases FVC, FEV1, and MIP; this reflects, its capacity to increase lung volume. Also TPEP increases FVC and FEV1 (less, than IPPB), but increases MEP, while decreasing total lung capacity and, residual volume.

Conclusions

The two techniques (IPPB and TPEP) improves significantly dyspnea; quality of; life tools and lung function in patients with severe COPD. IPPB demonstrated a greater effectiveness to improve dyspnea and quality of life tools (MRC, CAT) than TPEP.     

Estándares de calidad asistencial en rehabilitación respiratoria en pacientes con enfermedad pulmonar crónica

Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.     

Nocardiosis pulmonar en pacientes con EPOC: características y factores pronósticos

Introduction

Pulmonary nocardiosis (PN) is a severe infection with a high morbidity and mortality that mainly affects immunocompromised patients. In recent years, an increase in PN cases has been detected among patients with chronic obstructive pulmonary disease (COPD). The factors that are associated with its presence and determine its prognosis remain unknown.

Methods

Retrospective study of COPD patients diagnosed with PN over the period from 1997-2009 at the Hospital de la Santa Creu i Sant Pau, in Barcelona (Spain). Demographic, clinical, microbiological and evolution data were evaluated in all cases

Results

Thirty patients were identified with PN and COPD. Mean age (standard deviation) was 76 (7) years and the mean FEV₁ was 40 (14)%. Chronic respiratory failure was observed in 56,7% patients and 51,7% had received systemic corticosteroid therapy previous to the PN diagnosis. The most common symptoms were cough and dyspnea (90%). Alveolar infiltrates were observed in 60% of the cases. The most frequently isolated Nocardia species was N. cyriacigeorgica (68%). The one-month mortality rate was 17%, while the one-year mortality rate was 33%. The factors associated with mortality within the first year included previous systemic corticosteroid treatment, less than three months of specific antibiotic therapy and active associated neoplasm.

Conclusions

PN affects patients with moderate-severe COPD and has high short- and mid-term mortality rates. Previous corticosteroid treatment, specific antibiotic therapy for less than 3 months and active neoplasia were factors associated with mortality.     

Evolución del uso de la ventilación mecánica no invasiva en enfermedad pulmonar obstructiva crónica en una región española, 1997-2010

Introduction

Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).

Subjects and methods

A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.

Results

We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC] = −3.4, 95% CI: − 4.8; −2.0, P <.05) and in the group without ventilatory intervention (APC = −4.2%, −5.6; −2.8, P <.05); upward trend in the use of NIV (APC = 16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC = −4.5%, −10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC = 0.5, −1.3; 2.4) and in the group without intervention (APC = 0.1, −1.6; 1.9); downward trend with statistical significance in the NIV group (APC = −7.1, −11.7; −2.2, P <.05) and not statistically significant in the IMV group (APC = −0,8, −6, 1; 4.8). The mean stay did not change substantially.

Conclusions

The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.     

Clasificación de la gravedad de la enfermedad pulmonar obstructiva crónica según la nueva guía Iniciativa Global para la Enfermedad Obstructiva Crónica 2011: COPD Assessment Test versus modified Medical Research Council

Introduction

The GOLD 2011 revision proposes to stratify patients with chronic obstructive pulmonary disease (COPD) by measuring the impact of the disease using the modified Medical Research Council (mMRC) scale or COPD assessment test (CAT). Our aim was to determine whether both methods are equivalent.

Patients and methods

Observational study on a cohort of 283 patients diagnosed with COPD. We analyzed the demographic and lung function results. Patients were assessed by CAT and mMRC on the same day by the same interviewer, and divided into GOLD 2011 categories according to the result of the evaluation. The degree of concordance and Spearman correlation were determined. We used ANOVA on the clinical and functional variables of the four GOLD 2011 categories.

Results

Assessing the classification of patients according to the method used, an overall correlation ρ = 0.613 and a degree of concordance κ = 0.63 (moderate) were obtained. κ = 0.44 was obtained for the 152 patients in categories A and B (moderate-low), and 0.38 for the 131 patients in categories C and D (low). Differences were observed between categories in terms of functional parameters.

Conclusions

The classification of patients with COPD using the assessment proposed by GOLD 2011 varies according to the method used (CAT or mMRC); more than 25% of patients were reclassified into different categories, implying differences in the recommended therapeutic strategy. Longitudinal studies are needed to appraise which method better classifies patients, according to its prognostic ability.     

Conocimientos de la población general sobre la enfermedad pulmonar obstructiva crónica y sus determinantes: situación actual y cambios recientes

Background

The objective of this study was to determine the level of knowledge about chronic obstructive pulmonary disease (COPD) and its determinants in the general population of Spain, and to compare it with a similar survey conducted in 2002.

Methods

We conducted a cross-sectional, observational, epidemiological study in September 2011 by means of a telephone interview with a representative sample of individuals aged 40-80 years living in all 17 regions of Spain.

Results

A total of 6,528 responses were obtained (response rate of 13.1%), 53% of respondents were females with a mean age of 59.8 years. Regarding tobacco use, 19.4% were current smokers while 27.9% reported being former smokers. Only 17.0% spontaneously recognized the term «COPD». Valencia was the region with the highest degree of ignorance regarding COPD (91%), while Aragon had the lowest (73.7%). Nevertheless, COPD is considered a severe disease, following angina pectoris in severity. Upon comparing these results with the previous survey from 2002, we observed significant improvements in the knowledge and understanding of COPD (8.6% vs. 17.0%), with a marked variability between the regions (P < .05). Currently, only 4.7% of the Spanish population knows that there is a National Strategy for COPD, although 86.0% have a favorable or very favorable opinion about the new Anti-tobacco Law.

Conclusion

The lack of knowledge about COPD and its determinants in the general population remains high compared to 2002; thus, more and better educational and awareness programs are necessary.     

Enfermedad pulmonar obstructiva crónica e insuficiencia cardíaca

Chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure. Individuals with COPD have a 4.5-fold greater risk of developing heart failure than those without. The sensitivity and specificity of clinical judgment in the diagnosis of heart failure in patients with COPD can be enhanced by biological markers such as B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Correct interpretation of imaging results (mainly echocardiographic findings) and lung function tests can also help establish the co-occurrence of both conditions. There is little evidence on the management of patients with COPD and heart failure, although treatment of COPD undeniably affects the clinical course of patients with heart failure and viceversa.     

Calidad de vida relacionada con la salud en una cohorte nacional de pacientes con hipertensión arterial pulmonar o hipertensión pulmonar tromboembólica crónica

Background

Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) experience impaired health-related quality of life (HRQL). The objective of this study was to evaluate HRQL in a nation-wide sample.

Patients and methods

This is a prospective, multicenter, non-interventional study of HRQL including 139 (89%) PAH and 17 (11%) CTEPH patients (women 70.5%; mean age, 52.2) recruited from 21 Spanish hospitals. 55% had idiopathic PAH, 34% other PAH and 11% CTEPH. HRQL was measured using the Short Form 36 Health Survey (SF-36) and EuroQoL-5D (baseline and after 6 months).

Results

HRQL in the patients with PAH or CTEPH was impaired. The physical component of SF-36 and the EuroQol-5D correlated with the functional class (FC). Mean EuroQol-5D visual analogical scale (EQ-5D VAS) scores were 73.5 ± 18.4, 62.9 ± 20.7 and 51.3 ± 16.0 (P < .0001) in patients with FC I, II and III, respectively. Every increase of one FC represented a loss of 4.0 on the PCS SF-36 and a loss of 9.5 on the EQ-5D VAS. Eight patients who died or received a transplant during the study period presented poorer initial HRQL compared with the rest of the population. No significant changes in HRQL were observed in survivors after 6 months of follow-up.

Conclusions

HRQL is impaired in this population, especially in PAH/CTEPH patients near death. HRQL measurements could help predict the prognosis in PAH and CTPH and provide additional information in these patients.