Combined resistance and endurance training at a moderate-to-high intensity improves physical condition and quality of life in liver transplant patients.

Although currently moderate and high intensity concurrent physical exercise is prescribed in populations with special needs due to its greater effect on physical condition and health-related quality of life (HRQOL), there are no data in the liver transplantation (LT) setting. The aim of this study is to evaluate changes in maximal strength, aerobic capacity, body composition, liver function, and HRQOL in LT patients after a moderate-to-high intensity combined resistance-endurance training. Six months after LT, 54 patients were randomized into 2 groups: intervention group (IG) and control group (CG). A total of 50 patients completed the study with repeat testing at 6 and 12 months after LT. The IG completed a 6-month exercise training program, consisting of exercising 2 days for 24 weeks in the hospital facilities, whereas the CG followed usual care recommendations. Patients completed a 5-multijoint exercise circuit with elastic bands involving the major muscle groups. The effects of the concurrent training program on maximal oxygen consumption, overall and regional maximal strength, body composition, liver function, and HRQOL were analyzed. The IG showed a significant improvement (P < 0.05) in outcome measurements compared with the CG in aerobic capacity, hip extension, elbow flexion, overall maximal strength, physical functioning, and vitality of HRQOL, whereas no changes were observed in body composition and liver function tests. In conclusion, this is the first study that combines supervised resistance and aerobic training performed at moderate-to-high intensity in LT recipients. It results in significant improvements in aerobic capacity, maximal strength, and HRQOL. Liver Transplantation 23 1273-1281 2017 AASLD.

Normativa sobre el estudio de la hiperrespuesta bronquial inespecífica en el asma / Guidelines for the Study of Nonspecific Bronchial Hyperresponsiveness in Asthma

No disponible

Riesgo de neumonía en pacientes con enfermedad pulmonar obstructiva crónica estable en tratamiento con terapia inhalada con glucocorticoides / Risk of pneumonia with inhaled corticosteroids for stable chronic obstructive pulmonary disease patients

Fundamento y objetivo: El uso de los corticoides inhalados se asocia a neumonías e infecciones agudas respiratorias. El objetivo de esta revisión es cuantificar el efecto sobre las neumonías en enfermos con enfermedad pulmonar obstructiva crónica (EPOC) estable.Material y método: Revisión sistemática de las revisiones sistemáticas existentes que analizan este efecto adverso.Resultados: El número de tratamientos necesarios para dañar (NNTH) de las diferentes revisiones sistemáticas oscila desde 12, en sujetos expuestos a más de tres años, hasta 80 en sujetos con un año de seguimiento. Budesonida parece no verse afectada por este efecto secundario. Conclusión: Sería aconsejable informar al paciente sobre el riesgo/beneficio de estas terapias tan habituales (AU)

Background and objective: Treatment with inhaled steroids is related to pneumonia and acute respiratory infection. The aim of this review is to quantify the effect inhaled steroids in pneumonia in stable chronic obstructive pulmonary disease (COPD) patients.Material and method: We performed a systematic review of the systematic reviews that have studied inhaled corticosteroids in stable COPD patients. Results: Inhaled steroid therapy in patients with clinically stable COPD causes an increase in the number of pneumonia. The NNTH of the analysed systematic reviews ranged from 12 subjects exposed to more than three years, to 80 subjects with one year follow up. Budesonide did not show this side effect. Conclusion: It would be advisable to inform patients about the risk/benefit of these therapies (AU)

[Risk of pneumonia with inhaled corticosteroids for stable chronic obstructive pulmonary disease patients]. / Riesgo de neumonía en pacientes con enfermedad pulmonar obstructiva crónica estable en tratamiento con terapia inhalada con glucocorticoides.

BACKGROUND AND OBJECTIVE: Treatment with inhaled steroids is related to pneumonia and acute respiratory infection. The aim of this review is to quantify the effect inhaled steroids in pneumonia in stable chronic obstructive pulmonary disease (COPD) patients. MATERIAL AND METHOD: We performed a systematic review of the systematic reviews that have studied inhaled corticosteroids in stable COPD patients. RESULTS: Inhaled steroid therapy in patients with clinically stable COPD causes an increase in the number of pneumonia. The NNTH of the analysed systematic reviews ranged from 12 subjects exposed to more than three years, to 80 subjects with one year follow up. Budesonide did not show this side effect. CONCLUSION: It would be advisable to inform patients about the risk/benefit of these therapies.

Adaptation and follow-up to noninvasive home mechanical ventilation: ambulatory versus hospital.

BACKGROUND AND OBJECTIVES: Noninvasive home mechanical ventilation (HMV) has been shown to be beneficial for certain forms of respiratory failure, improving symptoms and quality of life. Adaptation and follow-up are usually conducted within the hospital framework. Our objective was to verify whether the same results could be obtained in the patient's home by the Home Hospitalization Unit. METHODS: This was a prospective study of patients with stable restrictive ventilatory disorders, who met the criteria to receive HMV. They underwent hospital adaptation (group 1) or ambulatory adaptation (group 2) based on geographical area. The following tests were performed throughout the follow-up: Borg scale, respiratory function, arterial blood gases, nocturnal pulse oximetry, a health survey questionnaire (SF-36), and initially, the Barthel index. Adaptation and follow-up were performed identically in both groups in accordance with the adaptation and follow-up protocol of our hospital. Independent and intergroup comparisons were made for both groups. RESULTS: Forty-two patients (21 at hospital and 21 at home) were included. No initial differences were found between the two groups. Improvements were noted on the Borg scale and for nocturnal pulse oximetry within the groups, with no differences between them. No improvement in pulmonary function was observed in either group. Arterial blood gases improved in both groups, but the ambulatory group recorded significantly higher values (PO(2), P=0.033; PCO(2), P=0.020). Most domains of the SF-36 questionnaire improved in both groups, although some intergroup differences were noted. CONCLUSIONS: HMV improved arterial blood gases and quality of life in patients with restrictive ventilatory disorders. Arterial blood gases were better in the ambulatory group and the quality of life was similar in both groups.

[Impact of baseline and induced dyspnea on the quality of life of patients with COPD]. / Importancia de la disnea basal e inducida en la calidad de vida de los pacientes con EPOC.

OBJECTIVE: Dyspnea is the main symptom of chronic obstructive pulmonary disease (COPD) and as such is an important determinant of health-related quality of life. It is, however, weakly correlated to severity of obstruction and there is little information available on how it exercises its effect on health-related quality of life. The aims of this study were to identify the determinants of baseline dyspnea and to ascertain how that factor influences the health-related quality of life of patients with COPD. PATIENTS AND METHODS: A total of 101 patients with COPD were studied. Tests included full lung function assessment, the bronchial provocation test (n=70), and the 6-minute walk test. The following variables were measured: Baseline dyspnea, bronchoconstriction-induced dyspnea, exertional dyspnea, health-related quality of life, and levels of anxiety and depression. RESULTS: Determinants of baseline dyspnea were anxiety (explained variance, 17%), maximal inspiratory pressure (4%), and PaO2 (4%). In patients with mild to moderate COPD (forced expiratory volume in 1 second, >50% of predicted), the main determinant of health-related quality of life was anxiety (explained variance, 43%). Other determinants were the number of meters walked in the 6-minute-walk test, age, and Baseline dyspnea (variance explained by both factors, 26%). Baseline dyspnea and bronchoconstriction-induced dyspnea were both identified as independent determinants of health-related quality of life (on the activity and impact subscales of the St George's Respiratory Questionnaire, respectively). The main determinant of health-related quality of life in patients with severe COPD (forced expiratory volume in 1 second, < or =50% of predicted) was baseline dyspnea. Finally, the main determinants of anxiety were exertional dyspnea (variance, 42%) and baseline dyspnea (6%). CONCLUSIONS: Anxiety is the main determinant of health-related quality of life in patients with COPD, and it is triggered mainly by baseline dyspnea and exertional dyspnea.

[Arterial oxygen saturation at high altitude. A study on unacclimatised mountaineers and mountain dwellers]. / Saturación arterial de oxígeno a gran altitud. Estudio en montañeros no aclimatados y en habitantes de alta montaña.

BACKGROUND AND OBJECTIVE: We decided to determine how arterial oxygen saturation (SaO2) diminishes with altitude in unacclimatized mountaineers and in mountain dwellers. SUBJECTS AND METHOD: Pulseoximetric measurements in unacclimatized mountaineers (214 measurements in several Spanish mountains and in the Alps up to 4,164 m) and in mountain dwellers (209 measurements in several Spanish and Bolivian villages up to 4,230 m). We performed pulseoximetric measurements for three consecutive days in eight mountaineers on the summit of Aneto (3,404 m) to ascertain whether SaO2 increases or not during early acclimatization. RESULTS: Equations describing the SaO2 reduction with altitude are as follows: a) for unacclimatized mountaineers, SaO2 = 98.8183 - 0.0001.h - 0.000001.h2, b) for mountain dwellers, SaO2 = 98.2171 + 0.0012.h - 0.0000008.h2. (SaO2 in %; h: altitude in m. Lower limit of 95% confidence intervals given in the text). SaO2 of mountain dwellers is higher than that of unacclimatized mountaineers studied at the same altitude (p < 0.05 for any altitude over 1,692 m). SaO2 of mountaineers increased during early acclimatization (p < 0.05) to reach in few days the SaO2 of mountain dwellers. Unacclimatized mountaineers who spent the previous night over 2,000 m had higher SaO2 in altitude than those who slept under 2,000 m (p < 0.05). Mountaineers who performed any high-mountain activity (i.e. over 2,500 m) in the previous 12 months had higher SaO2 on the summit of Aneto than those who have never been over 2,500 m before (p < 0.05). CONCLUSION: SaO2 increases during the acclimatization process. Our equations serve to calculate the SaO2 which can be considered normal for healthy people for every altitude below 4,200 m, both before and after the acclimatization process.

Saturación arterial de oxígeno a gran altitud: estudio en montañeros no aclimatados y en habitantes de alta montaña / Arterial oxygen saturation at high altitude: a study on unacclimatised mountaineers and mountain dwellers

FUNDAMENTO Y OBJETIVO: Determinar cómo disminuye la saturación arterial de oxígeno (SaO 2 ) con la altitud en los montañeros no aclimatados y en los habitantes de las montañas. SUJETOS Y MÉTODO: Se realizó una pulsioximetría a montañeros no aclimatados (214 mediciones en diversas montañas españolas y en los Alpes hasta 4.164 m) y a habitantes de las montañas (209 mediciones en diversas poblaciones españolas y bolivianas hasta 4.230 m) y una pulsioximetría durante 3 días consecutivos a 8 montañeros en la cumbre del Aneto (3.404 m) para comprobar si la SaO 2 aumenta precozmente durante la aclimatación. RESULTADOS: Las ecuaciones que describen la disminución de la SaO 2 con la altitud son: a) para los montañeros no aclimatados, SaO 2 = 98,8183 - 0,0001·h - 0,000001·h 2 , y b) para los habitantes de las montañas, SaO 2 = 98,2171 + 0,0012·h - 0,0000008·h 2 (SaO 2 en %; h: altitud en m. El límite inferior de los intervalos de confianza del 95% figura en el texto). La SaO 2 delos habitantes de las montañas es mayor que la de los montañeros no aclimatados estudiados ala misma altitud (p < 0,05 para cualquier altitud por encima de 1.692 m). La SaO 2 de los montañeros aumenta precozmente durante la aclimatación (p < 0,05) hasta igualar la que tienen los habitantes de las montañas. Los montañeros que pasan la noche por encima de 2.000m tienen al día siguiente mayor SaO 2 en altitud que los que la pasan por debajo de esa altitud(p < 0,05). Los montañeros con experiencia de alta montaña en los 12 meses previos tienen en la cumbre del Aneto mayor SaO 2 que los que nunca antes han hecho alta montaña (p < 0,05). CONCLUSIÓN: La SaO 2 aumenta durante el proceso de aclimatación. Nuestras ecuaciones permiten calcular, para cualquier altitud hasta 4.200 m, cuál es la SaO 2 que puede considerarse normal en personas sanas, antes y después de la aclimatación

BACKGROUND AND OBJECTIVE: We decided to determine how arterial oxygen saturation (SaO 2 ) diminishes with altitude in unacclimatized mountaineers and in mountain wellers. SUBJECTS AND METHOD: Pulseoximetric measurements in un acclimatized mountaineers (214 measurements in several Spanish mountains and in the Alps up to 4,164 m) and in mountain dwellers(209 measurements in several Spanish and Bolivian villages up to 4,230 m). We performed pulseoximetric measurements for three consecutive days in eight mountaineers on the summit of Aneto (3,404 m) to ascertain whether SaO 2 increases or not during early acclimatization. RESULTS: Equations describing the SaO 2 reduction with altitude are as follows: a) for acclimatized mountaineers, SaO 2 = 98.8183 - 0.0001·h - 0.000001·h 2 , b) for mountain dwellers, SaO2 = 98.2171 + 0.0012·h - 0.0000008·h 2. (SaO 2 in %; h: altitude in m. Lower limit of 95% confidence intervals given in the text). SaO 2 of mountain dwellers is higher than that of una climatized montaineers studied at the same altitude (p < 0.05 for any altitude over1,692 m). SaO 2 of mountaineers increased during early acclimatization (p < 0.05) to reach infew days the SaO 2 of mountain dwellers. Un acclimatized mountaineers who spent the previousnight over 2,000 m had higher SaO 2 in altitude than those who slept under 2,000 m (p <0.05). Mountaineers who performed any high-mountain activity (i.e. over 2,500 m) in the previous12 months had higher SaO 2 on the summit of Aneto than those who have never been over2,500 m before (p < 0.05). CONCLUSION: SaO 2 increases during the acclimatization process. Our equations serve to calculate the SaO 2 which can be considered normal for healthy people for every altitude below 4,200 m, both before and after the acclimatization process

Home mechanical ventilation for restrictive thoracic diseases: effects on patient quality-of-life and hospitalizations.

Forty-five patients with restrictive respiratory diseases, including thoracic wall diseases (TWD, n = 27) and neuromuscular diseases (NMD, n = 18), underwent 18 months of home mechanical ventilation (HMV) treatment. Treatment consisted of a two-level pressure system for 7h at night, with oxygen available if needed. Questionnaire-based assessments of health-related quality-of-life (HRQL) were evaluated before treatment and at 3, 6, 9, 12 and 18 months of follow-up. Hospitalization rates pre- and post-treatment were recorded, and the numbers need to treat (NNT) to avoid hospitalization and absolute risk reduction (ARR) rates were calculated. Several categories of HRQL, including physical function and vitality, improved significantly with treatment in both groups of patients; these improvements persisted over the entire 18 months. In contrast, other categories such as social function and mental health improved initially and declined subsequently. Hospitalizations decreased significantly with treatment. NNT calculations indicated that treatment would be needed for two TWD patients (ARR 63%) and one NMD patient (ARR 78%) to prevent one hospitalization per year per disease group. We conclude that improved quality-of-life and decreased hospitalizations make home non-invasive mechanical ventilation an useful treatment for patients with restrictive respiratory disorders.

Analysis of the stability of stored adenosine 5'-monophosphate used for bronchoprovocation.

Adenosine 5'-monophosphate (AMP) bronchial challenge has been shown to be very useful tool in the diagnosis of asthma. Freshly test solutions are prepared just prior to each test in most of the studies. The objective of this study was to assess the stability of AMP solutions at different temperatures using a reversed-phase high-performance liquid chromatography assay. Sodium salt AMP solutions in concentrations of 0.03 mg/ml and 400 mg/ml were analyzed. One aliquot was kept at room temperature (20-25 degrees C) and the others were refrigerated at 4 degrees C. Room temperature stored samples were analyzed daily. Refrigerated stored samples were analyzed daily for first 15 days and then weekly. The duration of the study was 25 weeks. Samples were injected into the chromatograph column in quadruplicate and quantification was based on the arithmetic mean and standard deviation (+/-SD) of four measurements. Room temperature stored samples at concentrations of 0.03 mg/ml showed a mean percent variation greater than 10% at day 9 and greater than 75% at day 14. Samples at concentrations of 400 mg/ml maintained almost the initial concentration during the first 10 days, but decomposition occurred thereafter. In contrast, there was no significant degradation of refrigerated stored samples throughout the study period. We conclude the exposure to room temperature of AMP solutions results in a substantial loss of the initial concentration, but the shelf life of adequately prepared stock AMP solutions stored at 4 degrees C is at least 25 weeks.

[Respiratory changes during ascension to 8,000 meters mountain]. / Cambios respiratorios durante la ascensión a una montaña de más de 8.000 metros.

BACKGROUND: Our goal was to determine whether spirometric alterations occur during expeditions to 8,000-metre peaks, and whether these are modified by acclimatization or are related to acute mountain sickness, to arterial oxygen saturation (SaO2) or to muscular deterioration due to chronic hypoxic exposure. SUBJECTS AND METHOD: Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), inspiratory (MIP) and expiratory (MEP) maximal static pressures, grip strength in both hands, and SaO2 at rest and exercise were measured in eight subjects during an expedition to Gasherbrum II (8,035 m). RESULTS: Upon arrival at the base camp (5,200 m), both FVC and FEV1 decreased, with no changes in the FEV1/FVC ratio. FVC did not improve after a brief pressurisation in a portable hyperbaric chamber. A month later, FVC in the base camp returned to normal values. FVC fall correlated with both the severity of acute mountain sickness and weight loss. Resting SaO2 improved with acclimatisation and correlated with the previous hypoxic ventilatory response, both before and after acclimatisation. Acclimatisation led to a decrease in the exercise-induced SaO2 fall. Stay at a high altitude lowered body weight and grip strength, although MIP and MEP remained unchanged. CONCLUSIONS: We observed a restrictive alteration was corrected by with acclimatisation. This phenomenon seems to be related to a subclinical high-altitude pulmonary oedema rather than to an increase in the pulmonary vascular volume. Despite the high-altitude muscular deterioration, respiratory muscle weakness was not

Cambios respiratorios durante la ascensión a una montaña de más de 8.000 metros / Respiratory changes during ascension to 8,000 meters mountain

FUNDAMENTO: Conocer si durante las expediciones a montañas de más de 8.000 m ocurren alteraciones espirométricas y si éstas se modifican por la aclimatación, se relacionan con el mal agudo de montaña, con la saturación arterial de oxígeno (SaO2) o con el deterioro muscular por la hipoxia crónica. SUJETOS Y MÉTODO: En 8 sujetos participantes en una expedición al Gasherbrum II (8.035 m) estudiamos la capacidad vital forzada (CVF), el volumen espiratorio máximo por segundo (VEMS), las presiones máximas inspiratoria (PIM) y espiratoria (PEM), la fuerza prensil en ambas manos y la SaO2 en reposo y durante el ejercicio. RESULTADOS: Al llegar al campamento base (5.200 m) observamos un descenso de la CVF y del VEMS, sin cambios en la relación VEMS/CVF por ciento. La CVF no mejoró tras la presurización en una cámara hiperbárica. Un mes después, la CVF se había normalizado. La caída de la CVF se corelacionó con la aparición de mal agudo de montaña y con la pérdida de peso. La SaO2 en reposo mejoró con la aclimatación y se correlacionó con la respuesta ventilatoria a la hipoxia, tanto antes como después de la aclimatación. La aclimatación corrigió la caída de la SaO2 por el ejercicio. La permanencia a gran altitud disminuyó la fuerza en ambas manos, pero no redujo la PIM ni la PEM. CONCLUSIONES: Durante la ascensión a una montaña de más de 8.000 m, apreciamos una alteración restrictiva que mejora con la aclimatación, atribuible más a edema pulmonar subclínico que a incremento del volumen vascular. Pese al deterioro muscular de la gran altitud, no hallamos debilidad de la musculatura respiratoria (AU)