59 research outputs found
A proposal for the withdrawal of inhaled corticosteroids in the clinical practice of chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease; Exacerbations; Inhaled corticosteroidsMalaltia pulmonar obstructiva crònica; Empitjorament; Corticoesteroides inhalatsEnfermedad pulmonar obstructiva crónica; Empeoramiento; Corticoesteroides inhaladosAccording to the current clinical practice guidelines for chronic obstructive pulmonary disease (COPD), the addition of inhaled corticosteroids (ICS) to long-acting β2 agonist therapy is recommended in patients with moderate-to-severe disease and an increased risk of exacerbations. However, ICS are largely overprescribed in clinical practice, and most patients are unlikely to benefit from long-term ICS therapy.Evidence from recent randomized-controlled trials supports the hypothesis that ICS can be safely and effectively discontinued in patients with stable COPD and in whom ICS therapy may not be indicated, without detrimental effects on lung function, health status, or risk of exacerbations. This article summarizes the evidence supporting the discontinuation of ICS therapy, and proposes an algorithm for the implementation of ICS withdrawal in patients with COPD in clinical practice.Given the increased risk of potentially serious adverse effects and complications with ICS therapy (including pneumonia), the use of ICS should be limited to the minority of patients in whom the treatment effects outweigh the risks
Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study
Background
Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing.
Methods
EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics.
Results
A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05).
Conclusion
Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.SEPA
Circulating epithelial cell as viral infection and tissue origin marker in patients with severe COVID-19
Liquid biopsy (LB) is a minimally invasive procedure that detects biomarkers in body fluids for real-time monitoring of patients. This study developed a new LB approach to analyze Circulating Epithelial Cells (CECs) in Intensive Care Unit (ICU) patients with severe COVID-19 and High-Exposure Negative Population to COVID-19 (HENPC) as the control group. The CECs were characterized by multispectral imaging flow cytometry, and an anti-SARS-CoV-2 Spike S1 protein (ProtS) antibody was used to detect infection. The results showed that CECs were present in most ICU patients (p = 0.0412), and their median number was significantly higher (p = 0.0004) than in controls. CEC clusters were only identified in patients, and high positive ProtS expression was observed in CECs from ICU patients compared to negative controls. In conclusion, LB could be a minimally invasive tool for detecting tissue damage caused by infectious agents and could provide real-time biological information about disease status and evolution. However, further validation in a larger population of patients is needed
Efecto de los tratamientos inhalados sobre la cavidad oral en pacientes con asma bronquial
Se concibe el asma en la actualidad como un síndrome que incluye diversos
fenotipos clínicos que comparten manifestaciones clínicas similares, pero de
etiologías probablemente diferentes, lo que condiciona la falta de una definición
precisa, y que las habitualmente utilizadas sean meramente descriptivas de sus
características clínicas y fisiopatológicas. Desde un punto de vista pragmático,
se la podría definir como una enfermedad infamatoria crónica de las vías
respiratorias, en cuya patogenia intervienen diversas células y mediadores de
la inflamación, condicionada en parte por factores genéticos y que cursa con
hiperrespuesta bronquial (HRB) y una obstrucción variable del flujo aéreo, total
o parcialmente reversible, ya sea por la acción medicamentosa o
espontáneamente 1 . Dentro de esta definición se intuyen varios aspectos
importantes tanto en la fisiopatología, como el diagnóstico o el tratamiento.
Estos aspectos incluyen la cronicidad de la enfermedad (lo que tiene
implicaciones en cuanto a la carga que supone para los pacientes, y el impacto
que tiene en los sistemas de salud), la heterogeneidad de la enfermedad (que
la hace presentarse de formas y modos diferentes así como en diferentes
épocas de la vida), la presencia de inflamación en la vía aérea (que tiene
implicaciones tanto en el diagnóstico por la medición de mediadores
inflamatorios en el aire o el esputo como en el tratamiento por los efectos de los
fármacos antiinflamatorios utilizados habitualmente como base del tratamiento
como son los corticoides inhalados) y la presencia de obstrucción bronquial reversible (que implica la necesidad de objetivar estas alteraciones en las
pruebas de función respiratoria y la utilidad de fármacos que alivian el
broncoespasmo).Tesis Univ. Granada. Programa Oficial de Doctorado en Medicina Clínica y Salud Públic
Air pollution and health prevention: A document of reflection
Ambient air quality, pollution and its implication on
health is a topic of enormous importance that is normally
dealt with by major specialists in their particular areas of interest.
In general, it is not discussed from multidisciplinary approaches
or with a language that can reach everyone. For this
reason, the Health Sciences Foundation, from its prevention
area, has formulated a series of questions to people with very
varied competences in the area of ambient air quality in order
to obtain a global panorama of the problem and its elements
of measurement and control. The answers have been produced
by specialists in each subject and have been subjected to a
general discussion that has allowed conclusions to be reached on each point. The subject was divided into three main blocks:
external ambient air, internal ambient air, mainly in the workplace,
and hospital ambient air and the consequences of its
poor control. Along with the definitions of each area and the
indicators of good and bad quality, some necessary solutions
have been pointed out. We have tried to know the current legislation
on this problem and the competences of the different
administrations on it. Despite its enormous importance, ambient
air quality and health is not usually a topic of frequent
presence in the general media and we have asked about the
causes of this. Finally, the paper addresses a series of reflections
from the perspective of ethics and very particularly in the
light of the events that the present pandemic raises. This work
aims to provide objective data and opinions that will enable
non-specialists in the field to gain a better understanding of
this worrying reality
Microspirometers in the Follow-Up of COPD: Advantages and Disadvantages
Sin financiación4.872 JCR (2020) Q2, 18/64 Respiratory System0.262 SJR (2021) Q3, 102/144 Pulmonary and Respiratory MedicineNo data IDR 2020UE
El uso de los microespirómetros en el seguimiento de la EPOC: ventajas e inconvenientes
Sin financiación4.872 JCR (2020) Q2, 18/64 Respiratory System0.262 SJR (2021) Q3, 102/144 Pulmonary and Respiratory MedicineNo data IDR 2020UE
Comparaciones entre asociaciones de broncodilatadores de larga duración para la enfermedad pulmonar obstructiva crónica
A pesar de la aparición de numerosas revisiones sistemáticas y metaanálisis sobre el uso de la doble
terapia broncodilatadora para el tratamiento de la enfermedad pulmonar obstructiva crónica, la eficacia
comparada de estas combinaciones entre sí no se ha explorado tan exhaustivamente. En la presente revi-
sión narrativa se revisan los primeros estudios de doble terapia broncodilatadora y se evalúan los estudios
que comparan dobles terapias broncodilatadoras en dispositivos por separado y en un único dispositivo.
Los primeros ensayos de doble terapia en dispositivos separados se realizaron como una prueba de con-
cepto sobre la función pulmonar con escaso tiempo de seguimiento o un número de pacientes reducido.
Estos estudios mostraban mejorías no consistentes en función pulmonar, con escasa repercusión en sín-
tomas u otros resultados clínicos. Los estudios que han comparado de forma directa la combinación de
dos broncodilatadores de acción prolongada a dosis fijas en un único dispositivo han explorado principal-
mente las diferencias entre umeclidinio-vilanterol y diversas asociaciones. Estos trabajos muestran una
mayor capacidad broncodilatadora de umeclidinio-vilanterol, con una reducción del uso de medicación
de rescate. Por otro lado, no se observan diferencias aparentes en el control sintomático que ofrecen estas
combinaciones entre sí y existen dudas sobre su impacto en la prevención de agudizaciones moderadas
o graves. En el futuro sería interesante poder disponer de estudios que indiquen el efecto a largo plazo
de estas combinaciones en el curso de la enfermedad, así como estudios encaminados a investigar los
determinantes de las respuestas a estos fármacos tanto en función pulmonar como en síntomas, calidad
de vida y exacerbacionesDespite the publication of numerous systematic reviews and meta-analyses on the use of dual bronchodi-
lator therapy in the treatment of chronic obstructive pulmonary disease, the comparative efficacy of the
different combinations has not been explored in depth. In this narrative review, we revisit the initial dual
bronchodilator therapy studies and evaluate studies that compare dual bronchodilator therapies admi-
nistered in separate devices and in a single device. The first trials on dual therapy delivered in separate
devices were conducted as proof of concept studies, exploring lung function in limited patient numbers
with short follow-up periods. These studies showed inconsistent improvements in lung function with
little impact on symptoms or other clinical outcomes. Studies that directly compared fixed doses of long-
acting bronchodilators in a single device investigated differences between umeclidinium/vilanterol and
other combinations. These studies show increased bronchodilator capacity of umeclidinium/vilanterol
with reduced use of rescue medication. However, no apparent differences were observed in the sympto-
matic control achieved by these different combinations, raising doubts about their impact on preventi
The concept of control of COPD in clinical practice.
Journal Article;Treatment of chronic obstructive pulmonary disease (COPD) requires a personalized approach according to the clinical characteristics of the patients, the level of severity, and the response to the different therapies. Furthermore, patients with the same level of severity measured by the degree of airflow obstruction or even with multidimensional indices may have very different symptoms and limitations for daily activities. The concept of control has been extensively developed in asthma but has not been defined in COPD. Here, we propose a definition of COPD control based on the concepts of impact and stability. Impact is a cross-sectional concept that can be measured by questionnaires such as the COPD Assessment Test or the Clinical COPD Questionnaire. Alternatively, impact can be assessed by the degree of dyspnea, the use of rescue medication, the level of physical activity, and sputum color. Stability is a longitudinal concept that requires the absence of exacerbations and deterioration in the aforementioned variables or in the COPD Assessment Test or Clinical COPD Questionnaire scores. Control is defined by low impact (adjusted for severity) and stability. The concept of control in COPD can be useful in the decision making regarding an increase or decrease in medication in the stable state.Ye
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