Consensus Document on the Diagnosis and Treatment of Chronic Bronchial Infection in Chronic Obstructive Pulmonary Disease. / Documento de consenso sobre el diagnóstico y tratamiento de la infección bronquial crónica en la enfermedad pulmonar obstructiva crónica.

Although the chronic presence of microorganisms in the airways of patients with stable chronic obstructive pulmonary disease (COPD) confers a poor outcome, no recommendations have been established in disease management guidelines on how to diagnose and treat these cases. In order to guide professionals, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has prepared a document which aims to answer questions on the clinical management of COPD patients in whom microorganisms are occasionally or habitually isolated. Since the available scientific evidence is too heterogeneous to use in the creation of a clinical practice guideline, we have drawn up a document based on existing scientific literature and clinical experience, addressing the definition of different clinical situations and their diagnosis and management. The text was drawn up by consensus and approved by a large group of respiratory medicine experts with extensive clinical and scientific experience in the field, and has been endorsed by the SEPAR Scientific Committee.

Bronquiectasias en EPOC y asma. ¿Algo más que una casualidad? / Bronchiectasis in COPD and Asthma. More Than Just a Coincidence

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Cost of Hospitalizations due to Exacerbation in Patients with Non-Cystic Fibrosis Bronchiectasis.

BACKGROUND: Knowing the cost of hospitalizations for exacerbation in bronchiectasis patients is essential to perform cost-effectiveness studies of treatments that aim to reduce exacerbations in these patients. OBJECTIVES: To find out the mean cost of hospitalizations due to exacerbations in bronchiectasis patients, and to identify factors associated with higher costs. METHODS: Prospective, observational, multicenter study in adult bronchiectasis patients hospitalized due to exacerbation. All expenses from the patients' arrival at hospital to their discharge were calculated: diagnostic tests, treatments, transferals, home hospitalization, admission to convalescence centers, and hospitals' structural costs for each patient (each hospital's tariff for emergencies and 70% of the price of a bed for each day in a hospital ward). RESULTS: A total of 222 patients (52.7% men, mean age 71.8 years) admitted to 29 hospitals were included. Adding together all the expenses, the mean cost of the hospitalization was EUR 5,284.7, most of which correspond to the hospital ward (86.9%), and particularly to the hospitals' structural costs. The adjusted multivariate analysis showed that chronic bronchial infection by Pseudomonas aeruginosa, days spent in the hospital, and completing the treatment with home hospitalization were factors independently associated with a higher overall cost of the hospitalization. CONCLUSIONS: The mean cost of a hospitalization due to bronchiectasis exacerbation obtained from the individual data of each episode is higher than the cost per process calculated by the health authorities. The most determining factor of a higher cost is chronic bronchial infection due to P. aeruginosa, which leads to a longer hospital stay and the use of home hospitalization.

Estudio del gasto energético en adultos con fibrosis quística: concordancia entre la calorimetría indirecta y diversas fórmulas estimativas / Analysis of energy expenditure in adults with cystic fibrosis: comparison of indirect calorimetry and prediction equations

Objetivo: La desnutrición es frecuente en pacientes con fibrosis quística (FQ) e implica un desequilibrio entre la ingesta y los requerimientos. Nuestro objetivo ha sido calcular el gasto energético en reposo (GER) mediante calorimetría indirecta en adultos con FQ, compararlo con las fórmulas estimativas habitualmente empleadas y valorar la influencia de parámetros clínicos sobre el GER. Pacientes y métodos: Estudiamos a 21 pacientes con FQ que se encontraban estables clínicamente. Se efectuaron medidas de parámetros antropométricos, dinamometría de mano, impedanciometría bioeléctrica y del GER medido por calorimetría indirecta (CI). Estudiamos la concordancia entre los valores del GER medidos y estimados por las fórmulas de la Organización Mundial de la Salud (OMS) y de Harris-Benedict (HB) mediante el coeficiente de correlación intraclase y el método de Bland-Altman. Resultados: Las ecuaciones infraestimaron el GER en más del 90% de los casos. La concordancia entre la CI y la estimada por las fórmulas fue escasa (para OMS, 0,47, y para HB, 0,41). Mediante el método de Bland-Altman observamos un sesgo variable entre la CI y las fórmulas, independiente de los valores del GER. La diferencia entre la CI respecto de la estimada por la fórmula de la OMS fue significativamente mayor en homocigóticos DeltaF508 y en los pacientes con insuficiencia pancreática exocrina frente al resto. Conclusiones: En adultos con FQ, las fórmulas de la OMS y de HB infraestiman el GER. Hay una baja concordancia entre los valores del GER medidos y estimados. La infraestimación fue mayor en pacientes con insuficiencia pancreática exocrina y en homocigóticos DeltaF508

Objective: Undernutrition, which implies an imbalance between energy intake and energy requirements, is common in patients with cystic fibrosis. The aim of this study was to compare resting energy expenditure determined by indirect calorimetry with that obtained with commonly used predictive equations in adults with cystic fibrosis and to assess the influence of clinical variables on the values obtained. Patients and methods: We studied 21 patients with clinically stable cystic fibrosis, obtaining data on anthro-pometric variables, hand grip dynamometry, electrical bioimpedance, and resting energy expenditure by indirect calorimetry. We used the intraclass correlation coefficient (ICC) and the Bland­Altman method to assess agreement between the values obtained for resting energy expenditure measured by indirect calorimetry and those obtained with the World Health Organization (WHO) and Harris­Benedict prediction equations. Results: The prediction equations underestimated resting energy expenditure in more than 90% of cases. The agreement between the value obtained by indirect calorimetry and that calculated with the prediction equations was poor (ICC for comparisons with the WHO and Harris­Benedict equations, 0.47 and 0.41, respectively). Bland­Altman analysis revealed a variable bias between the results of indirect calorimetry and those obtained with prediction equations, irrespective of the resting energy expenditure. The difference between the values measured by indirect calorimetry and those obtained with the WHO equation was significantly larger in patients homozygous for the DeltaF508 mutation and in those with exocrine pancreatic insufficiency. Conclusions: The WHO and Harris­Benedict prediction equations underestimate resting energy expenditure in adults with cystic fibrosis. There is poor agreement between the values for resting energy expenditure determined by indirect calorimetry and those estimated with prediction equations. Underestimation was greater in patients with exocrine pancreatic insufficiency and patients who were homozygous for DeltaF508