Smoking-related interstitial lung disease.

Exposure to smoke is associated with the development of diseases of the airways and lung parenchyma. Apart from chronic obstructive pulmonary disease (COPD), in some individuals, tobacco smoke can also trigger mechanisms of interstitial damage that result in various pathological changes and pulmonary fibrosis. A causal relation has been established between tobacco smoke and a group of entities that includes respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell histiocytosis (LCH), and acute eosinophilic pneumonia (AEP). Smoking is considered a risk factor for idiopathic pulmonary fibrosis (IPF); however, the role and impact of smoking in the development of this differentiated clinical entity, which has also been called combined pulmonary fibrosis and emphysema (CPFE) as well as nonspecific interstitial pneumonia (NIP), remains to be determined. The definition of smoking-related interstitial fibrosis (SRIF) is relatively recent, with differentiated histological characteristics. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features in the same patient that can sometimes lead to radiological patterns of interstitial lung disease that are impossible to classify. For this reason, a combined approach to diagnosis is recommendable. This combined approach should be based on the joint interpretation of the histological and radiological findings while taking the clinical context into consideration. This paper aims to describe the high-resolution computed tomography (HRCT) findings in this group of disease entities in correlation with the clinical manifestations and histological changes underlying the radiological pattern.

Incidencia de enfermedad pulmonar obstructiva crónica en pacientes con el virus de la inmunodeficiencia humana. Análisis post-hoc del estudio viva / Incidence of chronic obstructive pulmonary disease in patients with human immunodeficiency virus. Post-hoc analysis of the viva study

Introducción: desde la aparición de la terapia antiretroviral la supervivencia de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) ha aumentado considerablemente tomando importancia la aparición de otras patologías crónicas en estos pacientes como puede ser la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo fue conocer la incidencia de EPOC en una cohorte de pacientes VIH derivados en un programa de detección de hipertensión pulmonar (HTP). Material y Métodos: análisis post-hoc, de un prospectivo, pseudo-experimental de pacientes con infección del VIH a los que se les preguntaba por disnea y en caso afirmativo eran derivados a consultas de neumología para despistaje de HTP. Resultado: desde 2014 hasta 2016, reclutamos un total de 32 pacientes, con un predominio de varones (75%). La disnea según la mMRC (Medical Reserach Council) fue grado 1, 2 y 3 en el 37,5%, 43,8% y 18,8%, respectivamente. La prevalencia de tabaquismo fue del 87,1% (intervalo de confianza [IC] 95%: 71- 96,4%), y 18 pacientes fueron catalogados de EPOC (62%; IC95%: 42,2 - 79,3%). Conclusión: la incidencia de EPOC en nuestra serie fue muy superior a la de la población general. Es necesario plantear estrategias de búsqueda activa de EPOC en estos pacientes para un diagnóstico y tratamiento precoz

Introduction: Since the advent of antiretroviral therapy, the survival of patients infected with the human immunodeficiency virus (HIV) has considerably increased, with the occurrence of other chronic diseases such as chronic obstructive pulmonary disease (COPD) gaining importance in these patients. Our objective was to find out the incidence of COPD in a cohort of HIV patients that were referred to a program to detect pulmonary hypertension (PH). Materials and Methods: Post hoc analysis of a prospective, quasi-experimental study on HIV-infected patients who were asked whether they had dyspnea. If this was the case, they were referred to a pulmonologist for PH screening. Results: From 2014 to 2016, we recruited a total of 32 patients, with a predominance of male recruits (75%). According to the mMRC (Modified Medical Research Council) Dyspnea Scale, 37.5%, 43.8% and 18.8% were classified as Grade 1, 2 and 3, respectively. The prevalence of smoking was 87.1% (95% confidence interval [CI]: 71 - 96.4%), and 18 patients were classified with COPD (62%; 95% CI: 42.2 - 79.3%). Conclusion: The incidence of COPD in our sample was much higher than that of the general population. It is necessary to plan active search strategies for COPD in these patients for early diagnosis and treatment

Tratamiento antifibrótico en la fibrosis pulmonar idiopática. Nuestra experiencia en la vida real / Anti-fibrotic treatment in idiopathic pulmonary fibrosis; Our real-life experience

La fibrosis pulmonar idiopática (FPI) es la forma más común de las neumonías intersticiales idiopáticas. Es una neumonía fibrosante, crónica y progresiva, limitada al pulmón, de causa desconocida, con mal pronóstico y, hasta el momento, sin tratamiento curativo. Se caracteriza por un patrón radiológico e histológico de Neumonía Intersticial Usual (NIU).Afecta sobre todo a adultos mayores de 50 años. Su evolución es impredecible en el momento del diagnóstico, condicionando una disminución progresiva de la función pulmonar. Actualmente, existen tratamientos antifibróticos que han demostrado eficacia en frenar la progresión de la enfermedad y, por tanto, mejorando el pronóstico1 . Existe poca información con respecto al uso de estos tratamientos en la vida real, fuera del ámbito de los ensayos clínicos. Presentamos los resultados del seguimiento de 27 pacientes diagnosticados de fibrosis pulmonar idiopática, según los criterios de la ATS/ERS 20112 , 8 de ellos en tratamiento con pirfenidona y 19 en tratamiento con nintedanib. Ambos tratamientos han sido bien tolerados, siendo sus efectos adversos más comunes los síntomas digestivos y la fotosensibilidad, de carácter leve

Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonias, It is a fibrosing, chronic and progressive pneumonia, limited to the lung, cause unknown, with malicious prognosis, without curative treatment in this moment. Is characterized for a radiological and histological pattern of Usual Interstitial Pneumonia (UIP). Especially affects over 50 years old. Its evolution is unpredictable at the time of diagnosis conditioning a progressive decrease in lung function. Currently, there are antifibrotic treatments that have proven effective in Progression of the disease and, therefore, improving the prognosis Regarding the use of these treatments in real life, outside the clinical trials. Objective: We present the results of the follow-up of 27 patients diagnosed with idiopathic pulmonary fibrosis, according to ATS / ERS 2011 criteria, 8 of them being treated with pirfenidone and 19 on treatment with nintedanib. Both treatments have been well tolerated, its adverse events have been digestive symptoms and photosensibility

Usefulness of cardio MRI on thrombosis of coronary aneurysm as an infrequent cause of ST-elevation coronary syndrome.

We present an unusual case of thrombosis of coronary aneurysm causing myocardial infarction with ST-elevation in precordial leads. Emergent coronary angiography showed thrombotic occlusion of an aneurysm in the proximal segment of the left anterior descendent coronary artery (LAD). After the administration of tenecteplase, pain and ST-elevation disappeared with no overt complications. Cardiac magnetic resonance imaging (MRI) performed two weeks after admission showed thrombi partially filling the aneurysm together with further information regarding coronary anatomy, as well as a preserved global function even though delayed enhancement of the myocardium was patent throughout the territory irrigated by LAD. This case supports cardio MR usefulness in Kawasaki disease in order not only to depict coronary abnormalities, but also to provide accurate information regarding function and viability in a non-invasive way. It also highlighted the relevance of a proper selection of the sequence technique when thrombus is suspected. All these advantages point out to cardiac MRI as the modality of choice in the follow-up of patients in this clinical scenario.

Efectos de diferentes estrategias de entrenamiento al ejercicio sobre parámetros antropométricos según el fenotipo del paciente con EPOC / Effects of different exercise training strategies on anthropometric parameters according to the prenotype of the patient with EPOC

OBJETIVO: Analizar el efecto sobre dos parámetros antropométricos de la aplicación de distintas modalidades de entrenamiento al ejercicio en un grupo de pacientes con enfermedad pulmonar obstructiva crónica (EPOC), categorizados según su fenotipo (con o sin predominio de enfisema). METODOLOGIA: 64 pacientes con EPOC estable (edad media de 64,1 ± 6,8 años) que presentan obstrucción moderada severa al flujo aéreo, realizaron un programa de entrenamiento al ejercicio, aleatoriamente distribuidos en tres grupos: resistencia (n=21; entrenamiento aeróbico en bicicleta al 70% de su VO2 máximo inicial), fuerza (n=22; cinco ejercicios de levantamiento de pesas al 70-85% del test 1 RM inicial, incluyendo grupos musculares de MMSS y MMII) y mixto (n=21; combinación de los anteriores).Se subdividieron en pacientes EPOC con predominio de enfisema(n=32) o sin enfisema (n=32) según criterios clínicos, funcionales y radiológicos. Inicialmente y tras 12 semanas de entrenamiento se midieron los cambios en el peso y en el índice de masa corporal (IMC) como parámetros antropométricos. RESULTADOS: Los pacientes EPOC sin enfisema cuyo entrenamiento incluía ejercicios de tipo aeróbico (grupos resistencia y mixto) experimentaron una disminución del IMC (-0,43 ± 1,45 y -0,82 ± 1,04; p<0,05) y del peso (-0,96 ± 4,15 y -2,44 ± 2,96 kg). Los EPOC tipo enfisema cuyo entrenamiento incluía ejercicios de fuerza (fuerza y mixto) presentaron un aumento del IMC (0,42 ± 0,50 y 0,35± 1,04; p<0,05) y del peso (0,91 ± 1,08 y 1,25 ± 2,83 kg; p<0,05). CONCLUSIONES: Distintas estrategias de entrenamiento alejercicio producen efectos diferentes sobre índices antropométricos en pacientes con EPOC, dependiendo del fenotipo que presenten (AU)

OBJECTIVE: To analyse the effect of the application of different modes of exercise training on two anthropometric parameters in a group of patients with chronic obstructive pulmonary disease (COPD), categorised according to their phenotype (with or without predominance of emphysema). METHODOLOGY: Sixty-four patients with stable COPD (average age of 64.1 ± 6.8 years) that presented moderate-severe air flow obstruction, undertook an exercise training programme, randomly distributed in three groups: resistance (n=21; aerobicbicycle training to 70% of their initial maximum VO2), strength(n=22; five weight raising exercises to 70-85% of the initial 1-RMtest, including arm and leg muscle groups) and mixed (n=21; combination of the previous). They were subdivided into COPD patients with predominance of emphysema (n=32) or without emphysema (n=32) according to clinical, functional and radiological criteria. The changes in weight and body mass index (BMI) were measured as anthropometric parameters initially, and after12 weeks of training. RESULTS: COPD patients without emphysema whose training included aerobic type exercises (resistance and mixed groups) experienced a reduction of BMI (-0.43 ± 1.45 and -0.82 ± 1.04;p<0.05) and weight (-0.96 ± 4.15 and – 2.44 ± 2.96 kg). The COPD patients with emphysema whose training included strength exercises (strength and mixed) displayed an increase in BMI (0.42 ± 0.50and 0.35 ± 1.04; p<0.05) and weight (0.91 ± 1.08 and 1.25 ± 2.83 kg; p<0.05). CONCLUSIONS: Different exercise training strategies produce different effects on anthropometric indices in patients with COPD, depending on the phenotype they present (AU)