Pneumonia mortality, comorbidities matter?

© 2020 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U.Pneumonia remains one of the most important causes of mortality. In Portugal, it is the first cause of respiratory death, excluding lung cancer. This is a retrospective cohort study designed to seek for explanations, identifying the characteristics of patients and measure the impact of each one of them on the risk of dying from pneumonia. We analyzed demographic and clinical data of all patients (pts) with 18 years or older with pneumonia requiring hospitalization registered on the national health service registry of mainland Portugal over 2015. A total of 36366 patients corresponding to 40696 pneumonia hospital admissions in 2015 were analyzed. Most of the patients were very old (median age 80 years). Hospital mortality for pneumonia was higher among older (30,3% pts>75 years). Pneumococcus is the more frequent bacterial isolate, reaching 41.2% of the isolates of total pneumonia cases. The frequency of pneumococcus decreases with aging; conversely, gram-negative bacteria and staphylococcus increase. Pneumococcus is more frequently identified in the winter, closely related to influenza outbreaks. Gram-negative bacteria are more prevalent during the summer months. Diabetes, obesity, COPD, and tobacco smoking are not associated with an increased risk of dying from pneumonia. Patients older than 75 years; living in a senior house; or with chronic renal disease, lung cancer, metastatic disease, mobility impairment, cachexia, dementia, cerebrovascular disease, and ischemic heart disease are at greater risk of dying from pneumonia. Comorbidities contribute decisively to the risk of dying from pneumonia in the hospital, regardless of their type or origin.info:eu-repo/semantics/publishedVersio

Estudo comparativo do manuseamento dos vários dispositivos de inalação utilizados em Portugal**Trabalho concotTente ao Premia Thome Villar/Boehringer Ingelhcim, 1999 (Secção A)

ABSTRACTThe inhalation therapy has a fundamental role in the treatment of respiratory diseases. This importance is related to several facts: through this therapy, the drug has a direct action in the area under treatment, smaller amounts of the drug are needed, there are less side effects and there is a faster efficient result at beginning of the drug's action. When prescribing an inhaler, the physician has to consider several variables, namely their ability to be easily handled.The aim of this work is the study of the individual adjustment to each of the inhalation devices available in Portugal, the difficulty degree detected in the individual use of devices and their preferences about them.The population was constituted by eighty individuals, 49 (61,2%) males and 31 (38,8%) females, with ages ranging from 24 to 78 (mean 45 years), who never had contact with an inhaler before. After the presentation of the studied inhalers (MDI and the DPI's Rotahaler, Turbulzaler, Diskus, Diskhaler e Aerolizer), each of the individuals chooses the most and the least attractive. Then they were instructed how to handle each of the inhalers properly. They had three chances to handle each inhaler successfully after instruction. After the inhaling act, each individual had to select which inhaler were the easiest and the most difficult to handle and which one he/she would choose and would reject.The Diskus - 22 (27,5 %) and Aerolizer - 21 (26,2 %) were considered the most attractive; the Turbuhaler - 18 (22,5%) was considered the least attractive. The Turbuhaler followed by Diskus were the easiest to handle; on the contrary the MDI was the most difficult to handle. The Turbuhaler - 25 (31,2%) was elected as the easiest to handle; the MDI- 36 (45%) was selected as the most difficult to use. The Turbuhaler -25 (31,2%) followed by Diskus - 23 (28,7%) was the inhaler most chosen and the MDI - 38 (47,5%) was the most rejected. The study of the inhalers preferences according to some population characteristics showed us that the Turbuhaler is chosen preferentially by females and individuals with university grade while Diskus is chosen predominantly by males and individuals with less academic qualifications.The authors conclude that the Turbuhaler was the easiest to usc and the MDI was the most difficult. The choice of the inhaler was determined mainly by the easiness of the inhalation. There are some differences related to the inhalers preferences according to some population characteristics, namely sex and academic qualilications.REV PORT PNEU 2001; VII (:Nō ESPECIAI/BRASIL): 9-2

Aprendizagem da técnica inalatória em doentes com DPOC

Objetivos: Avaliar se o ensino correto da técnica inalatória em doentes com DPOC a pode melhorar de uma forma sustentada e quais as caraterísticas dos inaladores e dos doentes que lhe estão associados.Métodos: Doentes ≥ 40 anos com DPOC estável e diagnosticados de acordo com os critérios do GOLD foram avaliados em duas consultas médicas com um intervalo de dez a doze meses entre elas. Inicialmente foi aplicado um questionário demográfico e clínico e o Questionário de Crenças sobre Medicamentos. Na avaliação da técnica inalatória foi usada uma tabela de passos necessários para um correto uso dos inaladores e erros críticos. Posteriormente, a todos os participantes foi feito ensino e permitido treino com inaladores contendo placebo, até ao seu uso correto. Na segunda consulta foi feita uma reavaliação da técnica inalatória.Resultados: Avaliamos 170 participantes realizando 266 manobras inalatórias com 10 diferentes inaladores. Registou-se uma melhoria no número de erros críticos em todos os tipos de inaladores, com significado estatístico naqueles que mais facilmente informavam o doente de que a inalação fora correta. A melhoria da técnica inalatória relacionou-se significativamente com o score do CAT. No subgrupo de doentes que melhoraram sua técnica inalatória, os homens tiveram uma média do score de necessidades do BMQ significativamente maior do que as mulheres.Conclusões: Uma significativa melhoria da técnica inalatória foi observada nos inaladores que mais facilmente informam o doente sobre a correção da técnica inalatória. Os doentes mais sintomáticos mantiveram uma correta técnica inalatória de forma mais sustentada. As crenças sobre a necessidade do uso de inaladores estão associadas a uma melhor aprendizagem da técnica inalatória nos homens com DPOC

Insights into angiogenesis in non-small cell lung cancer : molecular mechanisms, polymorphic genes, and targeted therapies

We would like to thank Dr. Miguel Nunes from Department of Informatic of Faculty of Medicine of the University of Porto, Porto, Portugal, for his help in technical support, and Prof. Henrique Queiroga, Department of Pneumology of Faculty of Medicine of the University of Porto, Porto, Portugal, for his critical contribution in this manuscript reviewLung cancer is a highly prevalent disease worldwide. Currently, there are more than 150 million patients with lung cancer in the world, with more than 1 million new cases diagnosed per year. Tumoral angiogenesis is an important hallmark of this disease, but despite being extensively studied, the complete angiogenic mechanisms are not fully elucidated. Recent studies have reported a correlation between pharmacological inhibition of these angiogenic mechanisms and improvement of overall survival in lung cancer patients, mainly for those in advanced stages. The family of vascular endothelial growth factor (VEGF) proteins has critical roles in tumoral angiogenesis. An interaction between VEGF-A and VEGF receptor 2 (VEGFR-2) is the main pathway of activation and maintenance of angiogenesis. In tumors, this process is intimately correlative with progression and metastasis. Some studies suggested that serum levels of VEGF are higher in patients with lung cancer, especially in some types of non-small cell lung cancer (NSCLC). Other studies revealed that genetic polymorphisms of VEGF correlate with susceptibility, prognosis, and therapeutic response of some patients with NSCLC. This paper aims to review the impact of angiogenesis, especially on VEGF pathways, in NSCLC, and highlights the relevance of known and new patents disclosed of anti-angiogenic therapies in these patients

Study protocol : determinants of treatment success in chronic obstructive pulmonary disease

Study protocol - Determinants of Treatment Success in Chronic Obstructive Pulmonary DiseaseCOPD is a common, complex and heterogeneous disease. General objective is to identify factors which correction can be translated into improved health care for COPD patients. The study will take place in Guimarães hospital’s outpatient pulmonology care. COPD outpatients over 40 years of age, will be enrolled sequentially in order of appearance in the consultation during a one-year period. The most relevant demographic and clinical patients’ characteristics will be studied using appropriate tools, and will be transformed into variables, which will be used for descriptive and inferential analysis. The variables degree of severity, medication adherence, beliefs about the disease and about the inhaled medications, and the inhalation technique are intended to be related to each other, in order to understand the relative weight of each of these variables under study as factors of therapeutic success in COPD.info:eu-repo/semantics/publishedVersio

Discordance between old and new criteria for stratifying patients with COPD

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Es útil el concepto de control de la EPOC?: evaluación del éxito terapéutico a partir de la valoración del estado de salud en relación con la EPOC

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Misuse of inhalers devices in clinical practice

Misuse of inhalers devices in clinical practiceIn COPD, therapeutic success depends on a correct inhalation technique, and the choice of inhaler devices (ID) can be as determinant as the drug itself. We present the preliminary results of an ongoing prospective cross-sectional study aimed to assess the patient’s inhaler technique in COPD patients, diagnosed according to GOLD guidelines. We defined a check-list with five steps for each ID, for a correct inhalation technique, as well as essential steps and critical errors, and patient were asked to demonstrate their inhaler technique. A statistics analysis was then performed. We studied 203 COPD outpatients over 40 years-old (median 67,16 years), performing a total of 336 inhalations (30,4% incorrect). Ten types of IDs were examined, and misuse access according to priming/loading and inhalation procedures. Misuse ranged from 27,6% for soft-mist inhaler to 50,0% for pMDI, and in DPIs group from 0% for Aeroliser® to 48,3% for Handihaler®. Preference reasons for an inhaler were the ease of use (39,8%), their characteristics (25,2%) and seem more practical to use (25,2%). No significant relationship was found between correct use and patient preference (p=.236). There was also no significant relationship between the correct use and the number of inhalers used per patient (p=.531). Despite technological advances, inhalers mishandling remains an important clinical issue. A good inhalation technique depends on the type of ID. Poor coordination and inhalation failure remain cause of pMDI misuse. Soft-mist inhaler is the type of ID with the low rates of incorrect use. Misuse was not associated with multiple inhalers use nor to patient’ preference.info:eu-repo/semantics/publishedVersio

Loci identificados através de estudo de associação genômica ampla e risco de câncer do pulmão: existe algo mais?

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Clinical application of next-generation sequencing of plasma cell-free DNA for genotyping untreated advanced non-small cell lung cancer

Simple Summary Plasma ctDNA is a material source for molecular analysis particularly useful when tissue is not available or sufficient. NGS-based plasma genotyping should be integrated into the clinical workup of newly diagnosed advanced NSCLC. Background: Analysis of circulating tumor DNA (ctDNA) has remarkable potential as a non-invasive lung cancer molecular diagnostic method. This prospective study addressed the clinical value of a targeted-gene amplicon-based plasma next-generation sequencing (NGS) assay to detect actionable mutations in ctDNA in patients with newly diagnosed advanced lung adenocarcinoma. Methods: ctDNA test performance and concordance with tissue NGS were determined, and the correlation between ctDNA findings, clinical features, and clinical outcomes was evaluated in 115 patients with paired plasma and tissue samples. Results: Targeted-gene NGS-based ctDNA and NGS-based tissue analysis detected 54 and 63 genomic alterations, respectively; 11 patients presented co-mutations, totalizing 66 hotspot mutations detected, 51 on both tissue and plasma, 12 exclusively on tissue, and 3 exclusively on plasma. NGS-based ctDNA revealed a diagnostic performance with 81.0% sensitivity, 95.3% specificity, 94.4% PPV, 83.6% NPV, test accuracy of 88.2%, and Cohen's Kappa 0.764. PFS and OS assessed by both assays did not significantly differ. Detection of ctDNA alterations was statistically associated with metastatic disease (p = 0.013), extra-thoracic metastasis (p = 0.004) and the number of organs involved (p = 0.010). Conclusions: This study highlights the potential use of ctDNA for mutation detection in newly diagnosed NSCLC patients due to its high accuracy and correlation with clinical outcomes