Diagnóstico del déficit de alfa-1 antitripsina en atención primaria

Alpha-1 antitrypsin deficiency; Primary careDèficit d'alfa-1 antitripsina; Atenció primàriaDéficit de alfa-1 antitripsina; Atención primariaThe World Health Organization and respiratory societies such as the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)3 and the Europeran Respiratory Society (ERS)4 recommend testing of all COPD patients. Due to its great variability in the clinical expression of pulmonary disease, they also recommend testing for AATD adults with non-completely reversible asthma or with bronchiectasis of unknown etiolog

Residual pulmonary infiltrates, symptoms and diffusion impairment at one‐year after severe COVID‐19 infection have different associated factors

Menendez R, Mendez R, Latorre A, Gonzalez-Jimenez P, Peces-Barba G, Molina M, et al. Residual pulmonary infiltrates, symptoms and diffusion impairment at 1-year after severe COVID-19 infection have different associated factors. J Intern Med. 2023;00:1-13. Introduction. After severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, patients may show lung sequelae on radiology and functional impairment at the 1-year followup. We aimed to describe the persistence of symptoms, radiological alterations, or reduced diffusing capacity of the lung for carbon monoxide (DLCO) at 1-year follow-up in patients from the Spanish Registry RECOVID. Methods. RECOVID collected symptom and radiological and functional lung tests data on hospitalized patients with coronavirus disease 2019 during the acute phase and at the 6- and 12-month follow-up visits. Results. Of the 2500 enrolled survivors (90% admitted to the ward), 1874 had follow-up visits for up to a year. Of these, 42% continued to present with symptoms, 27% had radiological sequelae and 31% had reduced DLCO. Independently associated factors included female sex, asthma and the requirement for invasive or non-invasive mechanical ventilation. Complete radiological resolution was 72.2% at 12 months; associated factors with incomplete recovery were age, male sex, oxygen or respiratory support, corticosteroids and an initial SpO(2)/FiO(2) = 2. Reduced D-LCO was observed in 31% of patients at 12 months; associated factors were older age, female sex, smoking habit, SpO(2)/FiO(2) = 2 and the requirement of respiratory support.At 12 months, a proportion of the asymptomatic patients showed reduced D-LCO (9.5%), radiological findings (25%) or both (11%). Conclusions. The factors associated with symptom persistence, incomplete radiological resolution and D-LCO <80% differed according to age, sex, comorbidities and respiratory support. The burden of symptoms, reduced D-LCO and incomplete radiological resolution were considerable in patients with SARS-CoV-2 pneumonia at the 1-year follow-up after hospitalisation

Evaluation of the multimorbidity network and its relationship with clinical phenotypes in chronic obstructive pulmonary disease: The GALAXIA study

Abstract Background Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition, in which taking into consideration clinical phenotypes and multimorbidity is relevant to disease management. Network analysis, a procedure designed to study complex systems, allows to represent connections between the distinct features found in COPD. Methods Network analysis was applied to a cohort of patients with COPD in order to explore the degree of connectivity between different diseases, taking into account the presence of two phenotypic traits commonly used to categorize patients in clinical practice: chronic bronchitis (CB+/CB−) and the history of previous severe exacerbations (Ex+/Ex−). The strength of association between diseases was quantified using the correlation coefficient Phi (ɸ). Results A total of 1726 patients were included, and 91 possible links between 14 diseases were established. Although the four phenotypically defined groups presented a similar underlying comorbidity pattern, with special relevance for cardiovascular diseases and/or risk factors, classifying patients according to the presence or absence of CB implied differences between groups in network density (mean ɸ: 0.098 in the CB− group and 0.050 in the CB+ group). In contrast, between‐group differences in network density were small and of questionable significance when classifying patients according to prior exacerbation history (mean ɸ: 0.082 among Ex− subjects and 0.072 in the Ex+ group). The degree of connectivity of any given disease with the rest of the network also varied depending on the selected phenotypic trait. The classification of patients according to the CB−/CB+ groups revealed significant differences between groups in the degree of conectivity between comorbidities. On the other side, grouping the patients according to the Ex−/Ex+ trait did not disclose differences in connectivity between network nodes (diseases). Conclusions The multimorbidity network of a patient with COPD differs according to the underlying clinical characteristics, suggesting that the connections linking comorbidities between them vary for different phenotypes and that the clinical heterogeneity of COPD could influence the expression of latent multimorbidity. Network analysis has the potential to delve into the interactions between COPD clinical traits and comorbidities and is a promising tool to investigate possible specific biological pathways that modulate multimorbidity patterns