Estudio epidemiológico de seguimiento de asma en adolescentes de la ciudad de huelva / Epidemiological study of the follow up of asthma in adolescents of Huelva city

Objetivo: Analizar y comparar la incidencia de asma en adolescentes y adultos de Huelva. Determinar los cambios (aparición, persistencia y remisión) de sibilancias, hiperreactividad bronquial (HB) y asma, así como esclarecer los posibles factores de riesgo de asma incidente. Metodología: Seguimiento de 9 años de la cohorte original tras el estudio transversal inicial. Se realizó una segunda evaluación de los 2 grupos analizados, 401 niños del Estudio de Enfermedades Respiratorias y 204 adultos del Estudio Europeo de Enfermedades Respiratorias. Ambos realizaron un cuestionario sobre síntomas respiratorios, una espirometría y una prueba de metacolina. Resultados: La incidencia anual acumulada de asma en los niños (15,69/1000 personas-año) fue tres veces superior a la de los adultos (4,76/1000 personas-año). En los niños hubo un 24,2% de apariciones y un 4,3% de remisiones de sibilancias en los últimos 12 meses. De esta forma, las apariciones superaban a las remisiones (p < 0.001). También se produjeron más apariciones que remisiones en HB (13,9% vs 5,4%;p = 0,02) y asma (9,3% vs 3%; p = 0,004). En los adultos se encontraron más apariciones que remisiones (15,7%vs6,9%;p= 0,011)de sibilancias e HB (10,1% vs3% ; p =0,017) no se hallaron cambios significativos en el seguimiento de asma. Los factores de riesgo más importantes relacionados con asma incidente fueron: tener sibilancias (RR: 8,12) y opresión torácica(RR: 9,17) al estar cerca de un animal. Conclusiones: La incidencia de asma en adolescentes es tres veces superior a la de los adulto (AU)

Objective: To analyse and to compare the incidence of asth main adolescents and adults of Huelva. To determine the changes (appearance, persistence and remission) of wheezing, bronchialhyper-responsiveness(BH) and asthma, as well as to clarify the potential risk factors for incidence of asthma. Methodology: Nine year follow-up of the original cohort after the initial cross-sectional study. A second evaluation was made of the 2 analysed groups, 401 children of the Respiratory Diseases Study and 204 adults of the European Respiratory Diseases Study. Both groups completed a questionnaire on respiratory symptoms, spirometry and methacholine challenge test. Results: The accumulated annual incidence of asthma in children(15.69/1000 persons / year) was three times higher than in adults (4.76/1000 persons / year). In children there were24.2% of occurrences and 4.3% of remissions of wheezing in the last 12 months. Thus, the occurrences exceeded remissions(p < 0.001). There were also more occurrences than remissions in BH (13.9% vs. 5.4%; p = 0.02) and asthma (9.3%vs. 3%; p = 0.004). In adults, there were more occurrences than remissions (15.7% vs. 6.9%; p= 0.011) of wheezing and BH (10.1% vs. 3%; p =0,017) with no significant changes found in the asthma follow-up. The most important risk factors associated with incident asthma were presence of wheezing (RR: 8.12) and thoracic oppression (RR: 9.17) when being near an animal. Conclusions: The incidence of asthma in adolescents is three times higher than in adults (AU)

Premenstrual asthma and leukotriene variations in the menstrual cycle.

BACKGROUND: Several authors have reported an increase in leukotriene C4 in the premenstrual phase in women with severe premenstrual asthma, indicating that antileukotrienes could be used in treatment. OBJECTIVE: To analyse the role of leukotrienes in premenstrual asthma. METHODS: A questionnaire on respiratory symptoms and peak flow during one complete menstrual cycle was given to women of fertile age to define them as asthmatics who suffered from premenstrual asthma or not. Premenstrual asthma (PMA) was defined as a clinical or functional deterioration (≥20%) in the premenstrual phase compared with the preovulatory phase. Blood samples to measure leukotriene C4 were taken during the preovulatory and premenstrual phases. RESULTS: Blood samples were taken in 62 asthmatic women, 34 of whom (54.3%) presented PMA criteria, all with a premenstrual deterioration of between 20 and 40%. There was no difference in leukotriene C4 levels between the preovulatory and premenstrual phases in the women who suffered from PMA (1.50ng/mL vs. 1.31ng/mL; p=0.32) and those who did not (1.40ng/mL vs. 1.29ng/mL; p=0.62). Neither were there any differences in leukotriene levels between women with or without PMA. The results were similar for each category of asthma severity. CONCLUSIONS: Our data show that leukotriene C4 does not appear to be involved in the pathogenesis of premenstrual asthma, or support the use of anti-leukotrienes in the specific treatment of premenstrual asthma, at least in women with a moderate premenstrual deterioration. No differences appeared in any of the categories of asthma severity.

Utilidad del omalizumab en un paciente con asma grave y aspergilosis broncopulmonar alérgica / Use of omalizumab in a patient with severe asthma and allergic bronchopulmonary aspergilosis

Mujer de 64 años diagnositicada de asma bronquial en la juventud, catalogada como asma de difícil control y corticode pendiente. En las pruebas complementarias se ha objetivado una eosinofilia mantenida (>7%), IgE total elevada con un pico (..) (AU)

A 64 year-old woman diagnosed with bronchial asthma, proven difficult to control and corticoid-dependent since an early age, was studied. Complementary test performed demonstrated (..) (AU)

Variability in the prevalence of premenstrual asthma.

Our aim is to analyse the differences in the prevalence of premenstrual asthma (PMA) according to a set of criteria, the relationship between them and the influence of asthma severity. The answer "Yes" to "Does your asthma get worse before menstruation?" was considered subjective PMA. A daily respiratory symptoms register of fertile asthmatic females was taken during two consecutive menstrual cycles. For the semi-objective diagnosis, an exacerbation of > or =20% was required in the symptoms register. Objective diagnosis was a premenstrual worsening of > or =20% of peak flow. We selected 103 patients. Subjective premenstrual deterioration was perceived in 43.7%. The semi-objective deterioration of symptoms in the first cycle occurred in 44.7%, and in 22.3% in both cycles. A total of 54.3% of females with semi-objective criteria in the first cycle perceived a subjective deterioration of symptoms, versus 35.1% of those without semi-objective criteria (p = 0.05). PMA was present at all levels of asthma severity, with no clear link to the degree of severity. The detection of PMA prevalence, the subjective perception of this deterioration and its presence at all levels of asthma severity lead us to urge research into possible premenstrual deterioration in all fertile asthmatic females.

Cambios en la prevalencia de síntomas de asma e hiperreactividad bronquial en el seguimiento de dos cohortes poblacionales de la ciudad de Huelva / Changes in the prevalence of asthma symptoms and bronchial hyper-reactivity in the follow-up of two population groups of the Huelva city

Objetivo: Analizar los cambios en la prevalencia de síntomas asmáticos e hiperreactividad bronquial (HB) que ocurren con la edad en dos cohortes de adolescentes y adultos jóvenes de la ciudad de Huelva. Material y métodos: Se ha realizado una segunda evaluación en el seguimiento de las dos poblaciones estudiadas entre 1991 y1993: jóvenes adolescentes de 11 a 16 años (n= 714), incluidos en el Estudio de Enfermedades Respiratorias de Huelva (EERH-I), y adultos jóvenes de 20-44 años (n=271), incluida en el Estudio Europeo de Enfermedades Respiratorias (ECRHS-I) de la ciudad de Huelva, a las que se realizaron cuestionario de síntomas respiratorios(SR) y prueba de hiperreactividad bronquial inespecífica con metacolina (MT). En la segunda evaluación, realizada con un seguimiento promedio de 9 años, se consiguió estudiar a 401 de los “niños - adolescentes” y 204 de los “adultos jóvenes”. Al igual que en la fase previa, se ha realizado en ambas población es el mismo cuestionario sobre síntomas respiratorios, una espirometría y una prueba de provocación bronquial inespecífica con metacolina. Se comparan las prevalencias de sibilancias (Sib), HB y asma encontradas en la misma población (niños o adultos), en ambos cortes trasversales (1991 y 2.001). Se comparan los resultados obtenidos entre ambas poblaciones. Resultados: Entre los años 1991 a 2001, tanto en jóvenes como en adultos, se incrementan los síntomas respiratorios, especialmente las sibilancias y la disnea, en reposo y al ejercicio. La hiperreactividad bronquial se incrementa claramente en los jóvenes(p<0.001) y sólo ligeramente en los adultos (NS). Como consecuencia de lo anterior, el diagnóstico epidemiológico de asma (sibilancias+ HB) se incrementó de forma significativa sólo en los jóvenes. Otro dato destacable en los niños era que recibían tratamiento para el asma sólo la mitad de los que estaban diagnosticados de asma por un médico y que éstos eran menos que los que referían haber tenido sibilancias en los últimos 12 meses. La discrepancia entre sibilancias y diagnóstico de asma era más evidente en adultos. Conclusiones: En la década de los 90 y en la ciudad de Huelva, una ciudad con elevada prevalencia de sibilancias (Sib) y nivel medio-bajo de hiperreactividad bronquial (HB) y asma, los SR y la HB se van incrementando durante la adolescencia y se estabilizan en la edad adulta. Esto podría explicarse tanto por la historia natural de la enfermedad como por la diferente influencia de las condiciones ambientales en las diferentes edades

Objective: To analyze the changes in the prevalence of asthmatic symptoms and bronchial hyper-reactive (BHR) conditions, which occur with age, in two groups of adolescents and young adults from the city of Huelva. Material and Methods: A second follow-up evaluation was performed on the two populations studied between 1991 and 1993:adolescents between 11 and 16 years of age (n = 714), included in the Study of Breathing Illnesses of Huelva (EERH-I), and young adults 20-44 years old (n=271), included in the European Study of Breathing Illnesses (ECRHS-I) of the city of Huelva. A questionnaire about breathing symptoms (BS) and a non-specific test of bronchial hyper-reactivity with methacholine (MT) were administered. In the second evaluation, carried out with an average follow up of 9 years, it was possible to study 401 of those “child-adolescents” and 204 of those “young adults.” The same as in the previous phase, both populations were administered the same questionnaire about breathing symptoms, aspirometry and a non-specific bronchial provocation test with methacholine was performed. The prevalence of wheezing, BHR and asthma found in the same population (children or adults) was compared in both cross samples (1991 and 2001). The results obtained were compared between both populations. Results: Between the years 1991 and 2001, both in adolescents and adults, the breathing symptoms increased, especially wheezing and dyspnea, at rest and at exercise. Bronchial hyper-reactivity had a clear increase in the adolescents (p < 0.001) and only a slight increase in the adults (NS). As a consequence of the above, the epidemiologic diagnosis of asthma (wheezing + BHR) increased significantly in adolescents. Another outstanding fact in the children was that only half of those medically diagnosed with asthma received treatment for their asthma, and amongst these, there were fewer that said they had experienced wheezing in the last 12 months. The discrepancy between wheezing and the diagnosis of asthma was more evident in adults. Conclusions: In the 90s and in the city of Huelva, a city with a high prevalence of wheezing and medium-low level of bronchial hyper-reactivity (BHR) and asthma, BS and the HR have increased during adolescence and stabilized in adulthood. This could be explained both by the natural evolution of the disease and by the different influences of the environmental conditions at the different ages

Causa inusual de tos crónica / Unusual cause of chronic cough

La tos crónica es un problema frecuente y tachado de idiopático en bastantes ocasiones al olvidar que su causa puede estar fuera de la vía aérea.Con nuestro caso ponemos de manifiesto que el estudio de la tos crónica no es fácil y que a veces es necesario ampliar las posibilidades más allá de las causas más habituales, recurriendo a los estudios complementarios.Con este objetivo presentamos a una paciente con implantación de placa de titanio a nivel cervical y que presentaba tos crónica que no respondía a tratamientos antitusígeno y antirreflujo. La pruebas de imagen en este caso son cruciales para el diagnóstico, pudiendo visualizar como el tejido blando desarrollado como respuesta inflamatoria a nivel retrofaríngeoes causa de la sintomatología

Chronic cough is a frequent problem that is labeled as idiopathic quite often when it is overlooked that its cause may be outside of the airways.With our case, we manifest that the study of chronic cough is not easy and that it is sometimes necessary to expand the possibilities beyond the most usual causes, resorting to complementary studies.With this objective, we present the case of a patient with a titanium plaque implantation on the cervical level who had chronic cough that did not respond to anti-cough and anti-reflex treatments. The imaging tests in this case are crucial for the diagnosis, it being possible to visualize how the soft tissue developed as an inflammatory response on the retropharyngeal level is the cause of the symptoms

[A man with lung cancer and tuberculosis: a false positive by positron emission tomography and its clinical repercussions]. / Paciente con cáncer de pulmón y tuberculosis: falso positivo en la PET y su repercusión clínica.

Positron emission tomography (PET) has come to play an increasingly important role in the evaluation of lung cancer patients, both for diagnostic staging and post-treatment follow-up. As is true for other techniques, PET gives false positive and negative results. False positives have been described in the presence of certain active infections and inflammatory lesions, such as tuberculous granulomas, coccidioidomycosis, aspergillosis and histoplasmosis. We report the case of a man whose PET gave a false positive and in whom both lung cancer and tuberculosis were present. A radical change in therapeutic approach was required, making the case interesting.

[Adaptation parameters in non-invasive mechanical ventilation. Experimental comparative study]. / Parámetros de adaptación en ventilación mecánica no invasiva. Estudio comparativo experimental.

OBJECTIVE: To evaluate response to pressure and flow triggering in an experimental model of the normal, obstructive and restrictive lung with six non-invasive mechanical ventilation units: Vintil+ (VP), Respironics STD20 (RR), Puritan Bennet 335 (PB), Quantum (QT), DP90 (DP) and Sullivan II ST (SV). METHOD: Analog signals of volume, pressure and flow from a lung simulator were recorded by a Mingograph 34 polygraph. Positive inspiratory pressure (PIP) was 12 cmH2O, respiratory rate was 17 cycles/min, end expiratory pressure (PEEP) was 4 cmH2O, and inspiratory effort (P0.1) was 4 cmH2O. Parameters calculated were negative trigger pressure, trigger time (or the flow wave delay in triggering), and the percentage of peak inspiratory flow at which a change to exhalation or cycle phase. RESULTS: The RR and PB units had the best trigger response with pressure triggering below -1 cmH2O and trigger times less than 100 ms. VP proved to have the poorest response. The cycle of the RR agreed most closely with the standard (5-25% of peak inspiratory flow), whereas change to exhalation occurred with the other units with zero flow (in all patterns with DP90, and in restrictive patterns with PB and VP) or greater than 50% of peak inspiratory flow (in all models with QT). Analysis of pressure curves showed great differences in slope, plateau and depressurization. CONCLUSIONS: The RR unit proved to have the most homogeneous behavior for all the phase parameters studied as being the ones that most influence a patient's adaptation to a ventilator.

Parámetros de adaptación en ventilación mecánica no invasiva. Estudio comparativo experimental / Non-invasive ventilation: an experimental study comparing parameters of adaptation

Objetivo: Evaluar experimentalmente la respuesta del trigger, de la presurización y del ciclado ante un modelo de pulmón normal, obstructivo y restrictivo de 6 equipos de ventilación mecánica no invasiva: Ventil + (VP), Respironics STD20 (RR), Puritan Bennett 335 (PB), Quantum (QT), DP90 (DP) y Sullivan II ST (SV). Método: Se utilizó un simulador pulmonar cuyas señales analógicas de volumen, presión y flujo eran registradas en un polígrafo Mingograph 34. Los datos se obtenían con una presión inspiratoria positiva (IPAP) de 12 cmH2O, una frecuencia respiratoria de 17 ciclos/min, una presión espiratoria final (EPAP) de 4 cmH2O y un esfuerzo inspiratorio equivalente a una P0,1 de 4 cmH2O. Se calculó la presión negativa de disparo, el retardo del mismo en la onda de flujo o tiempo de trigger y el flujo inspiratorio pico (FIpico) en el que se producía el cambio a espiración o punto de ciclado. Resultados: Los equipos con mejor sensibilidad de trigger fueron RR y PB que demostraron una presión de disparo inferior a -1 cmH2O y un tiempo de trigger menor de 100 ms, mientras que la peor respuesta se halló en VP. El ciclado más acorde con el estándar (5-25 por ciento del FIpico) se obtuvo con el respirador RR, mientras que en los demás ventiladores el paso a espiración se producía con flujo cero (DP90 en todos los patrones, y en PB y VP en los patrones restrictivos) o superior al 50 por ciento (en el caso de QT en todos los patrones). El análisis de las curvas de presión demostró diferencias importantes en la pendiente, meseta y despresurización. Conclusiones: El comportamiento más homogéneo en las variables de fases estudiadas, que son las que más influyen en la adaptación del paciente al ventilador, se evidenció en RR. (AU)

[The short-term effects of air pollution on mortality: the results of the EMECAM project in the city of Huelva, 1993-96. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en la ciudad de Huelva, 1993-96.

BACKGROUND: The objective of this study was to estimate the relationship between the levels of air pollution and the daily mortality in the city of Huelva for the 1993-1996 period using the EMECAM methodology. METHODS: The number of daily deaths for all causes except external ones, the death rate of those over age 69, due to diseases of the circulatory system and for respiratory diseases were used as rate indicators. Four pollutants--SO2, PM10, NO2 and CO--were analyzed, the daily levels of which were furnished by the air pollution monitoring network in Huelva. Autoregressive Poisson regression models were constructed controlling by tendency, seasonality, temperature, humidity, flue and events out of the ordinary. RESULTS: For the mortality rate for all causes, a significant association impact was found to exist for the NO2 for the entire period (RR10 microgram/m3: 1.0414; CI95%: 1.0047-1.0794) and for the particles (PM10) for the cold half of the year (RR10 microgram/m3: 1.0358; CI95%: 1.007-1.0722). For the mortality in people over age 69, a significant relationship was found to exist for SO2 throughout the entire period (RR10 microgram/m3: 1.0606; CI95%: 1.0020-1.1227). A significant relationship to the mortality from respiratory disease particles (PM10) was found to exist for the cold half of the year (RR10 microgram/m3: 1.1412; IC95%: 1.0300-1.2644). There was no association of contaminants with cardiovascular mortality; also there was no association between levels of CO and mortality indicators. CONCLUSIONS: In Huelva, significant relationships have been found to exist between the current levels of air pollution resulting from particles, SO2 and NO2 and the daily mortality. The impact of these pollutants on the mortality is coherent with scientific literature, although in the case of Huelva, the extremely small number of daily deaths due to its small population and other factors limit the consistency thereof.

[The short-term effects of air pollution on mortality. The results of the EMCAM project in the city of Seville, 1992-1996. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto EMECAM en la ciudad de Sevilla, 1992-1996

BACKGROUND: As part of the EMECAM Project, the objective of this study is that of assessing the impact of air pollution on the daily mortality in Seville throughout the 1992-1996 period. METHODS: During the 1992-1996 period, readings were taken daily of the amounts of SO2, particles in suspension (PM10) and NO2 present in the air in the city of Seville, in addition to the number of deaths daily due to different causes. For analyzing this data, a multivariable Poisson regression model was used for modeling each one of the causes of death in terms of the air immission readings, controlling other confusion-causing variables. RESULTS: A relationship was found to exist between the rises in the NO2 levels and the daily death rate throughout the months of May to October. For each 10 micrograms/m3 rise, the risk of death or all causes showed a 2% rise, the same rise in the NO2 levels leading to a 3% rise in the risk of death resulting from cardiovascular diseases. CONCLUSIONS: A relationship exists between the levels of NO2 air pollution and the daily death rate in Seville. The findings provide scientific knowledge and information which can be of use for preventing the impact of air pollution on human health.

[Relation between asthma and atopy markers in children and young adults]. / Relación entre asma y marcadores de atopia en niños y adultos jóvenes.

The aim of this study was to assess whether atopy, measured as total IgE level (IgEt) and/or skin test (ST) reactivity is related to bronchial asthma in the same way in children and young adults. Three hundred fifty-three children between 11 and 15 years of age (mean 12.6 years) and 208 adults between 20 and 44 years old (mean 32.1 years) were selected randomly as representative of persons living in the city of Huelva (Spain). All subjects filled out a questionnaire on respiratory symptoms (The European Community Respiratory Health Survey--[ECRHS]) and were given a methacholine challenge test (MT) with results expressed as PD20 as well as IgEt and ST assessments of atopy. We defined bronchial asthma as the association of having experienced wheezing within the last 12 months and having a positive ST. Among children, 4.5% suffered bronchial asthma. Among adults the proportion was 5.3%. The IgEt value that best discriminated between asthmatics and non asthmatics was 145.5 U/ml in children (sensitivity 75% and specificity 69.1%) and 96.6 U/ml in adults (sensitivity 90.9% and specificity 73.6%). A logarithmic transformation (log IgEt) was used to study the relation between bronchial asthma and IgEt. By simple analysis, IgEt and ST were related to bronchial asthma in children (p = 0.002 and p < 0.0001, respectively), while only IgEt (p < 0.001) was related in adults. By multiple regression analysis, controlling for both factors simultaneously as well as for smoking in adults, we found that ST (p = 0.023) but not IgEt was related in children, whereas IgEt (p = 0.0005) but not ST was related in adults. We conclude that the two markers of atopy studied are related to bronchial asthma differently and have different manifestations at different stages of life. ST is more useful in children, whereas IgE determination is of more use in adults.

[Respiratory symptoms in a pediatric population]. / Síntomas respiratorios en población infantil.

With the aim of determining the prevalence of respiratory symptoms and rhinitis among adolescents in Spain, we sent a brief questionnaire about respiratory symptoms to all school children (9,644) in the sixth, seventh and eight grades in our city. We identified a symptomatic group (SG) consisting of adolescents who reported having had one or more of the following three signs within the past 12 months: a) waking with a feeling of stuffiness; b) experiencing an asthma attack, or c) taking medication for asthma. Returned questionnaires accounted for 74.4% of those distributed. The following symptoms were reported: wheezing by 13.4%, nighttime oppression by 8.4%, stuffiness at night by 7.3%, nighttime coughing by 24.8%, asthma attack by 4.5%, taking asthma medication by 6.1% and seasonal rhinitis by 15.4%. The proportion of symptomatic children was 11.6% (833). All symptoms studied that were not required for inclusion in SG correlated highly with that group (p < 0.0001). Neither age nor sex were related to inclusion.