ABSTRACT
INTRODUCTION: The prognosis of COPD patients can be calculated using multidimensional indexes that improve the predictive capacity of the individual variables. The CODEX index can be calculated using iCODEX, a digital support tool available on the web and in an app. The aim of this study was to evaluate how the usefulness and applicability of iCODEX and its recommendations in routine clinical practice are perceived by specialists in internal medicine, pneumology, and primary care. METHODS: A cross-sectional study was conducted from November 2019 to February 2020 with the participation of specialists in internal medicine, primary care, and pneumology. All respondents completed a survey consisting of 104 questions on their perception of the iCODEX tool. RESULTS: Overall, 335 physicians responded. Of these, 95.2% had no difficulty accessing the tool and 83.1% were quite or very satisfied with it. Regarding the applicability and implementation of iCODEX recommendations in routine clinical practice, respondents reported that the recommendations were generally applicable: most questions obtained a median score of ≥ 4 out of 5. The recommendations with the greatest expected clinical benefit are listed. CONCLUSIONS: Our study shows that the iCODEX tool is easy for participating specialists to use and identifies the recommendations that have the greatest clinical impact in areas such as lung obstruction, severe exacerbations, exercise, smoking, and patient follow-up.
Subject(s)
Physicians , Pulmonary Disease, Chronic Obstructive , Cross-Sectional Studies , Humans , Internal Medicine , Pulmonary Disease, Chronic Obstructive/drug therapy , Spain , Surveys and QuestionnairesABSTRACT
Sarcopenia (loss of muscle mass and function) implies a worse prognosis. However, its diagnosis is complex and is not made in routine clinical care. A biomarker has been proposed as a surrogate estimator of skeletal muscle mass, the so-called sarcopenia index ([serum creatinine/cystatine C] x100) which is associated with prognostic features in various diseases including patients with stable chronic obstructive pulmonary disease (COPD). The aim of our study was to prospectively evaluate the potential clinical and prognostic information of this biomarker in COPD exacerbation. This is a one-year prospective study of consecutive patients admitted for COPD exacerbation. A total of 89 patients, 70 men (79%) and 19 women (21%) were included. Those with lower values of the sarcopenia index had a higher level of dyspnoea and a longer hospitalization. In the correlation analysis, the index had statistically significant values with FEV1 (r = 0.23), PaCO2 (r = -0.30), bicarbonate (r = -0.31), dyspnoea (r = -0.25) and length of admission (r = -0.30). In patients admitted for COPD exacerbation, the sarcopenia index was related to prognostic characteristics, so that lower values were associated with longer duration of hospital admission, more dyspnoea and greater functional impairment. As this is an index associated with muscle mass, its determination may identify patients who could be the subject of a differentiated therapeutic plan.
La presencia de sarcopenia (pérdida de masa y función muscular) implica peor pronóstico. Sin embargo, su diagnóstico es complejo y no se realiza en la atención clínica habitual. Se ha propuesto un biomarcador como estimador subrogado de la masa muscular esquelética, el denominado índice de sarcopenia ([creatinina sérica/cistatina C] x100) que se asocia a características pronósticas en diversas enfermedades incluyendo pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. El objetivo de nuestro estudio ha sido evaluar de forma prospectiva la potencial información clínica y pronóstica de este biomarcador en agudización de la EPOC. Se trata de un estudio prospectivo, durante un año, de los pacientes consecutivos que ingresan por agudización de su EPOC. Se incluyeron 89 pacientes, 70 varones (79%) y 19 mujeres (21%). Aquellos con valores disminuidos del índice de sarcopenia tenían más disnea y requerían una internación más prolongada. En el análisis de correlación se obtuvo valores con significación estadística del índice con FEV1 (r = 0.23), PaCO2 (r = -0.30) y bicarbonato (r = -0.31), y con la disnea (r = -0.25) y la duración del ingreso (r =- 0.30). En los ingresados por agudización de la EPOC el índice de sarcopenia se relacionó con características pronósticas, de modo que los valores inferiores se asociaron a mayor duración de la internación, más disnea y mayor afectación funcional. Al tratarse de un índice asociado a la masa muscular, su determinación podría identificar a pacientes a incluir en un plan terapéutico diferenciado.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Sarcopenia , Disease Progression , Female , Hospitalization , Humans , Male , Prognosis , Prospective Studies , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Sarcopenia/diagnosisABSTRACT
Resumen La presencia de sarcopenia (pérdida de masa y función muscular) implica peor pronóstico. Sin embargo, su diagnóstico es complejo y no se realiza en la atención clínica habitual. Se ha propuesto un biomarcador como estimador subrogado de la masa muscular esquelética, el denominado índice de sarcopenia ([creatinina sérica/cistatina C] x100) que se asocia a características pronósticas en diversas enfermedades incluyendo pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. El objetivo de nuestro estudio ha sido evaluar de forma prospectiva la potencial información clínica y pronóstica de este biomarcador en agudización de la EPOC. Se trata de un estudio prospectivo, durante un año, de los pacientes consecutivos que ingresan por agudización de su EPOC. Se incluyeron 89 pacientes, 70 varones (79%) y 19 mujeres (21%). Aquellos con valores disminuidos del índice de sarcopenia tenían más disnea y requerían una internación más prolongada. En el análisis de correlación se obtuvo valores con significación estadística del índice con FEV1 (r = 0.23), PaCO (r = -0.30) y bicarbonato (r = -0.31), y con la disnea (r = -0.25) y la duración del ingreso (r =0.30). En los ingresados por agudización de la EPOC el índice de sarcopenia se relacionó con características pronósticas, de modo que los valores inferiores se asociaron a mayor duración de la internación, más disnea y mayor afectación funcional. Al tratarse de un índice asociado a la masa muscular, su determinación podría identificar a pacientes a incluir en un plan terapéutico diferenciado.
Abstract Sarcopenia (loss of muscle mass and function) implies a worse prognosis. However, its diagnosis is complex and is not made in routine clinical care. A biomarker has been proposed as a surrogate estimator of skeletal muscle mass, the so-called sarcopenia index ([serum creatinine/cystatine C] x100) which is associated with prognostic features in various diseases including patients with stable chronic obstructive pulmonary disease (COPD). The aim of our study was to prospectively evaluate the potential clinical and prognostic information of this biomarker in COPD exacerbation. This is a one-year prospective study of consecutive patients admitted for COPD exacerbation. A total of 89 patients, 70 men (79%) and 19 women (21%) were included. Those with lower values of the sarcopenia index had a higher level of dyspnoea and a longer hospitalization. In the correlation analysis, the index had statistically significant values with FEV1 (r = 0.23), PaCO (r = -0.30), bicarbonate (r = -0.31), dyspnoea (r = -0.25) and length of admission (r = -0.30). In patients admitted for COPD exacerbation, the sarcopenia index was related to prognostic characteristics, so that lower values were associated with longer duration of hospital admission, more dyspnoea and greater functional impairment. As this is an index associated with muscle mass, its determination may identify patients who could be the subject of a differentiated therapeutic plan.
Subject(s)
Humans , Male , Female , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Sarcopenia/diagnosis , Prognosis , Prospective Studies , Disease Progression , HospitalizationABSTRACT
OBJETIVO: Diseñar un formato estandarizado de la guía PRAXIS de buena práctica que facilite su publicación como artículo en una revista científica. METODOLOGÍA: A partir de una guía piloto elaborada con fines académicos, se utilizó una técnica Delphi mediante cuestionario para consensuar con expertos los componentes que deberían reflejarse en el formato de artículo y la adecuación de sus contenidos. RESULTADOS: Se obtuvieron doce elementos básicos agrupados en tres bloques: partes preliminares, cuerpo del artículo y partes finales. Se propone un tamaño de 5.500 palabras, con mayor dedicación a los contenidos aplicados a la práctica. UTILIDAD ESPERADA: La tecnología de síntesis de conocimiento propuesta en el modelo PRAXIS es sencilla y asumible desde la práctica clínica, empoderando así a los profesionales. La singularidad y ejemplaridad de los casos garantiza la creación de conocimiento y hará posible la realización de metasíntesis cualitativas sobre problemas complejos de salud en entornos de cuidado compartido
AIM: To design a standardized format of the PRAXIS good practice guideline that facilitates its publication as a article in a scientific journal. METHODOLOGY: Based on a pilot guide prepared for academic purposes, Delphi technique was used in conjunction with a questionnaire to support experts' agreement of the components that should be included in the article format and of the adequacy of its contents. RESULTS: Twelve basics elements were obtained and grouped into three blocks: preliminary part, body of the article and final part. The extension of 5,500 words is proposed, with greater dedication on the practical contents. EXPECTED UTILITY: Knowledge synthesis technology achieved by the PRAXIS model is simple and acceptable for clinical practice, empowering health professionals. The uniqueness and illustrative nature of the cases guarantees the generation of knowledge and will make it possible to carry out qualitative meta-synthesis on complex health problems in shared-care settings
Subject(s)
Humans , Periodicals as Topic/standards , Research Report/standards , Nursing Research/standards , Evidence-Based Nursing/trends , Nursing Care/trendsABSTRACT
Background: Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose: To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods: A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results: A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion: This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Anxiety , Comorbidity , Consensus , Health Services , Humans , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/epidemiologyABSTRACT
In patients with chronic obstructive pulmonary disease (COPD), cardiovascular comorbidities are highly prevalent and associated with considerable morbidity and mortality. This coincidence is increasingly seen in the context of a "cardiopulmonary continuum" rather than being simply attributed to shared risk factors, in particular, cigarette smoking. Both disease entities are centrally linked to systemic inflammation as well as aging, arterial stiffness, and several common biomarkers that led to the development of pulmonary hypertension, left ventricular diastolic dysfunction, atherosclerosis, and reduced physical activity and exercise capacity. For these reasons, COPD should be considered an independent factor of high cardiovascular risk, and efforts should be directed to early identification of cardiovascular disease (CVD) in COPD patients. Assessment of the overall cardiovascular risk is especially important in patients with severe exacerbation episodes, and the same therapeutic target levels for glycosylated hemoglobin, low-density lipoprotein cholesterol (LDL-C), or blood pressure than those recommended by clinical practice guidelines for patients at high cardiovascular risk, should be achieved. In this review, we will discuss the most recent evidence of the role of COPD as a critical cardiovascular risk factor and try to find new insights and potential prevention strategies for this disease.
Subject(s)
Cardiovascular Diseases , Cardiovascular System , Pulmonary Disease, Chronic Obstructive , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Comorbidity , Humans , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Risk FactorsABSTRACT
Background: Chronic obstructive pulmonary disease (COPD) is one of the diseases that leads to a higher number of hospitalizations in internal medicine departments. These patients are usually older and have greater multimorbidity than COPD patients hospitalized in other departments, which hinders the implementation of clinical guidelines necessarily focused on the management of a single disease.Aims: To ascertain the opinion of Spanish internists on the management of COPD in scenarios in which the available evidence is sparse and to produce a consensus document designed to assist in decision-making in COPD patients with comorbidities treated in internal medicine services.Methods: After identifying the clinical areas of greatest uncertainty by consensus, a survey was designed with 89 questions on the epidemiology and diagnosis of COPD, its management both in stable phase and during decompensation, and the treatment of the associated comorbidities in outpatients and inpatients. The consensus process was carried out using the Delphi method in an anonymized two-round process.Results: The survey was completed by 67 internists experienced in the clinical management of COPD. Of all the questions posed, a consensus was reached for 51 (57.3%) in the first round and for 67 (75.3%) in the second round. The result of the process is a series of 67 suggestions that may assist in the care of these patients.Conclusions: Our study allows us to ascertain the views of a large number of internists experienced in the management of COPD and to learn how the recommendations for guidelines are applied in clinical practice.
Subject(s)
Consensus , Internal Medicine , Pulmonary Disease, Chronic Obstructive/drug therapy , Comorbidity , Delphi Technique , Humans , Practice Guidelines as Topic , Pulmonary Disease, Chronic Obstructive/diagnosis , SpainABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Anemia, Macrocytic/complications , Anemia, Macrocytic/diagnosis , Anemia, Macrocytic/drug therapy , Hyperkalemia/complications , Hyperkalemia/drug therapy , Hyponatremia/complications , Hyponatremia/diagnosis , Hyponatremia/drug therapy , Hyponatremia/diet therapy , Hyperkalemia/diet therapy , Asthenia/complications , Fatigue/complications , Anorexia/complications , Vitamin B 12 Deficiency/complications , Vitamin B 12 Deficiency/diet therapySubject(s)
Anemia, Macrocytic/complications , Hyperkalemia/complications , Hyponatremia/complications , Aged , Female , HumansSubject(s)
Polypharmacy , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/physiopathology , Aged , Cross-Sectional Studies , Disease Progression , Female , Hospitalization , Humans , Male , Middle Aged , Patient Admission , Pulmonary Disease, Chronic Obstructive/mortality , Treatment OutcomeABSTRACT
Chronic obstructive pulmonary disease (COPD) and the metabolic syndrome (MetS) are considered public health challenges of the 21st century. The coexistence of MetS in COPD patients and any clinical differences between COPD patients with and without MetS have not been extensively studied. We aimed to describe the clinical characteristics of patients with MetS and COPD. An observational, multicenter study of 375 patients hospitalized for a COPD exacerbation with spirometric confirmation was performed. We measured the components of the MetS and collected comorbidity information using the Charlson index and other conditions. Dyspnea, use of steroids, exacerbations, and hospitalizations were also investigated. The overall prevalence of MetS in COPD patients was 42.9 %, was more frequent in women (59.5 %) than men (40.8 %), p = 0.02, but with no differences in age and smoking history. COPD patients with MetS had greater % predicted FEV1, more dyspnea, and more comorbidity and used more inhaled steroids (all p < 0.05). Diabetes, osteoporosis, coronary artery disease, and heart failure were more frequent in patients with MetS. They had been hospitalized more frequently for any cause but not for COPD. In multivariate analysis, the presence of MetS was independently associated with greater FEV1, inhaled steroids use, osteoporosis, diabetes, and heart failure. MetS is a frequent condition in COPD patients, and it is associated with greater FEV1, more dyspnea, and more comorbidities.
Subject(s)
Metabolic Syndrome/complications , Pulmonary Disease, Chronic Obstructive/complications , Aged , Cross-Sectional Studies , Female , Humans , Male , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathologyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Aged , Pulmonary Disease, Chronic ObstructiveABSTRACT
Fundamento y objetivo: Las hospitalizaciones por enfermedad pulmonar obstructiva crónica (EPOC) se producen mayoritariamente en pacientes de edad avanzada. Nuestro objetivo es describir las características y el tratamiento de los pacientes ancianos hospitalizados por EPOC en los servicios de Medicina Interna, comparados con el grupo de menor edad. Pacientes y método: Estudio observacional, prospectivo y multicéntrico. Se comparan las diferencias entre los pacientes mayores de 80 años y el resto respecto a comorbilidad, gravedad de la EPOC, ingresos previos, días de estancia y tratamiento prescrito. La comorbilidad se valoró mediante el índice de Charlson y un cuestionario diseñado al efecto.Resultados: Se incluyeron 398 sujetos, 353 de ellos varones (89%), con una edad media (DE) de 73,7 (8,8) años, de los que 107 (26,9%) eran mayores de 80 años. Estos pacientes tenían menor gravedad de la EPOC según la clasificación GOLD (p<0,02). Aunque la comorbilidad global fue similar en ambos grupos, los pacientes ancianos tenían mayor presencia de arritmias (p<0,01), de hipertrofia ventricular izquierda (p<0,01) y recibían más diuréticos (p<0,05). La disnea, días de estancia y mortalidad fueron similares entre ambas poblaciones. La oxigenoterapia domiciliaria previa al ingreso y el uso de corticoides inhalados y la oxigenoterapia domiciliaria fueron menores en los pacientes mayores, incluso cuando estaban clínicamente indicados.Conclusiones: Una cuarta parte de los pacientes hospitalizados por EPOC en los servicios de Medicina Interna tienen más de 80 años. Aunque presentan menor obstrucción, tienen un grado de disnea similar, mayor comorbilidad cardiaca y su tratamiento se ajusta menos a las recomendaciones de las guías (AU)
Background and objective: Hospitalizations for chronic obstructive pulmonary disease (COPD) occur mostly in elderly patients. We describe the characteristics and treatment of elderly patients hospitalized for COPD in Internal Medicine Services, compared with the younger age group. Patients and methods: Observational, prospective, multicenter study. We compared the differences between patients older than 80 years and the rest regarding comorbidity, severity of COPD, previous admissions, length of stay and treatment prescribed. Comorbidity was assessed by the Charlson index and a questionnaire was designed for this purpose.Results: We included 398 subjects, 353 men (89%) with a mean age of 73.7 years (SD 8.8), of whom about 107 (26.9%) were older than 80 years. These patients had less severe COPD according to the GOLD classification (P<.02). Although the overall morbidity was similar in both groups, elderly patients had greater presence of arrhythmias (P<.01), left ventricular hypertrophy (P<.01) and received more diuretics (P<.05). Dyspnoea, length of stay and mortality were similar between both populations. Home oxygen therapy prior to and use of inhaled corticosteroids and oxygen therapy was lower in older patients, even when they were clinically indicated. Conclusions: A quarter of patients hospitalized for COPD in Internal Medicine Services are over 80 years. Although they present less obstruction, they have a similar degree of dyspnea, increased cardiac morbidity and their treatment is less consistent with the recommendations of the guidelines (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pulmonary Disease, Chronic Obstructive/epidemiology , /statistics & numerical data , Recurrence , Comorbidity , Hospital Statistics , Severity of Illness IndexABSTRACT
BACKGROUND AND OBJECTIVE: Hospitalizations for chronic obstructive pulmonary disease (COPD) occur mostly in elderly patients. We describe the characteristics and treatment of elderly patients hospitalized for COPD in Internal Medicine Services, compared with the younger age group. PATIENTS AND METHODS: Observational, prospective, multicenter study. We compared the differences between patients older than 80 years and the rest regarding comorbidity, severity of COPD, previous admissions, length of stay and treatment prescribed. Comorbidity was assessed by the Charlson index and a questionnaire was designed for this purpose. RESULTS: We included 398 subjects, 353 men (89%) with a mean age of 73.7 years (SD 8.8), of whom about 107 (26.9%) were older than 80 years. These patients had less severe COPD according to the GOLD classification (P<.02). Although the overall morbidity was similar in both groups, elderly patients had greater presence of arrhythmias (P<.01), left ventricular hypertrophy (P<.01) and received more diuretics (P<.05). Dyspnoea, length of stay and mortality were similar between both populations. Home oxygen therapy prior to and use of inhaled corticosteroids and oxygen therapy was lower in older patients, even when they were clinically indicated. CONCLUSIONS: A quarter of patients hospitalized for COPD in Internal Medicine Services are over 80 years. Although they present less obstruction, they have a similar degree of dyspnea, increased cardiac morbidity and their treatment is less consistent with the recommendations of the guidelines.
Subject(s)
Hospitalization/statistics & numerical data , Pulmonary Disease, Chronic Obstructive , Acute Disease , Adrenal Cortex Hormones/therapeutic use , Age Factors , Aged , Aged, 80 and over , Female , Guideline Adherence , Humans , Internal Medicine , Male , Oxygen Inhalation Therapy/statistics & numerical data , Practice Guidelines as Topic , Prospective Studies , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/therapy , Severity of Illness Index , Spain , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Lymphoma, B-Cell, Marginal Zone/diagnosis , /diagnosis , Diabetes Mellitus, Type 2/complicationsSubject(s)
Echinococcosis/diagnosis , Muscular Diseases/diagnosis , Adult , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Combined Modality Therapy , Echinococcosis/drug therapy , Echinococcosis/surgery , Female , Hemagglutination Tests , Humans , Muscular Diseases/drug therapy , Muscular Diseases/parasitology , Muscular Diseases/surgery , ThighABSTRACT
No disponible
Subject(s)
Female , Adult , Humans , Muscular Diseases/diagnosis , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Combined Modality Therapy , Echinococcosis/drug therapy , Echinococcosis/surgery , Muscular Diseases/drug therapy , Muscular Diseases/parasitology , Muscular Diseases/surgery , Hemagglutination TestsABSTRACT
No disponible
