Reliability and Validity of Computerized Adventitious Respiratory Sounds in People with Bronchiectasis.

Background: Computerized adventitious respiratory sounds (ARS), such as crackles and wheezes, have been poorly explored in bronchiectasis, especially their measurement properties. This study aimed to test the reliability and validity of ARS in bronchiectasis. Methods: Respiratory sounds were recorded twice at 4 chest locations on 2 assessment sessions (7 days apart) in people with bronchiectasis and daily sputum expectoration. The total number of crackles, number of wheezes and wheeze occupation rate (%) were the parameters extracted. Results: 28 participants (9 men; 62 ± 12 y) were included. Total number of crackles and wheezes showed moderate within-day (ICC 0.87, 95% CI 0.74−0.94; ICC 0.86, 95% CI 0.71−0.93) and between-day reliability (ICC 0.70, 95% CI 0.43−0.86; ICC 0.78, 95% CI 0.56−0.90) considering all chest locations and both respiratory phases; wheeze occupation rate showed moderate within-day reliability (ICC 0.86, 95% CI 0.71−0.93), but poor between-day reliability (ICC 0.71, 95% CI 0.33−0.87). Bland−Altman plots revealed no systematic bias, but wide limits of agreement, particularly in the between-days analysis. All ARS parameters correlated moderately with the amount of daily sputum expectoration (r > 0.4; p < 0.05). No other significant correlations were observed. Conclusion: ARS presented moderate reliability and were correlated with the daily sputum expectoration in bronchiectasis. The use of sequential measurements may be an option to achieve greater accuracy when ARS are used to monitor or assess the effects of physiotherapy interventions in this population.

Variation in Assignment of the COPD Patients into a GOLD Group According to Symptoms Severity.

Introduction: The Global Organization of Lung Disease (GOLD) classifies patients with chronic obstructive pulmonary disease (COPD) taking into account the symptoms. The modified Medical Research Council's dyspnea scale (mMRC) and the COPD assessment test (CAT) are used to assess these symptoms. In this study, we analyze the concordance of GOLD classification using mMRC and CAT. Patients and Methods: This is an observational study of a cohort of 169 patients with COPD, who were classified following the GOLD 2017 recommendations, using both mMRC and CAT. A concordance analysis was applied, and a ROC curve was generated to identify the CAT score that best concorded with the mMRC scale. Results: The concordance for the GOLD groups classified by CAT and mMRC was moderate (kappa 0.492). For mMRC score of 1 and 2, a CAT score of ≥9 and ≥16 showed the maximum value of the Youden index, respectively. By reclassifying the patients with the new cut-off points obtained, the best concordance was obtained between the cut-off point for CAT of 16 and for mMRC of 2, followed by CAT of 9 and mMRC of 1. Conclusion: Because of the deficient concordance between CAT and mMRC, we propose the use of new cut-off points in future updates of the GOLD strategy.

Enfermedades intersticiales relacionadas con el consumo de tabaco / Interstitial lung diseases related with smoking habit

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Características sociodemográ cas y su relación con las recaídas al año en una cohorte de fumadores / No disponible

Objetivos: Analizar la relación entre las recaídas que sufren un grupo de fumadores y las características sociodemográ - cas, de consumo y entorno de los mismos. Material y métodos: Estudio descriptivo prospectivo sobre 1.503 pacientes atendidos en una consulta especializada en tabaquismo durante 10 años, realizando un seguimiento durante 12 meses consecutivos. El programa de tratamiento consistió en una combinación de tratamiento farmacológico y tratamiento conductual. El tratamiento se desarrolló en 7 sesiones individuales: una visita inicial y seis de seguimiento. Resultados: 1503 fumadores, siendo 47,7% hombres (n=716) y 52,3% mujeres (n=787), con una edad media de 49,6 años (DE=11,6). Sufren recaídas, el 71,2% del total, siendo las mujeres (74,9%) las que signi cativamente (p=0,022) presentan más recaídas que los hombres (67,5%). Conclusiones: Son los factores sociodemográ cos por encima de los factores de consumo, entorno o motivacionales, los que determinan y condicionan las recaídas en el proceso de deshabituación tabáquica (AU)

Objective: Analyze the relationship between smokers relapse and sociodemographical, consumptional and environmental characteristics. Patients and methods: Prospective study in 1503 patients who attended a smoking cessation service for along 10 years, and who were followed up during 12 consecutive months. The programe consisted in combination of pharmacological treatment and cognitive-behavioural treatment. This treatment was developed in 7 individual sessions: 1 basal session and 6 follow up visit. Results: 1503 patients were studied.47,7% men (n=716) and women 52,3% (n=787). Mean age 49,6 years (DE=11,6). Suffer relapse 71,2%, and it was the women group which showed signi cativaly more relapse. Conclusions: The sociodemographical factors determine, over consumption and environmental ones, more relapse during smoking cessation (AU)

Mortalidad atribuible al consumo de tabaco en España en 2006 / Smoking-attributable deaths in Spain, 2006

Fundamento y objetivo: Estimar la mortalidad atribuible al consumo de tabaco en España en 2006, y compararla con las estimaciones de años anteriores. Población y método:A partir de la prevalencia de tabaquismo y la mortalidad correspondientes a España, y los riesgos relativos de muerte por enfermedades causadas por el tabaquismo, procedentes del Cancer Prevention Study II, se ha calculado la mortalidad atribuible al tabaquismo en los individuos de edad ≥ 35 años. Resultados: En el año 2006 se produjeron 53.155 muertes atribuibles al tabaquismo en individuos ≥ 35 años, lo que supone el 14,7% (25,1% en varones y 3,4% en mujeres) de todas las muertes ocurridas en los mismos. El 88,7% (47.174) de estas muertes atribuibles corresponde a varones y el 11,3% (5.981) a mujeres. Por causas, destacan las muertes atribuibles por: tumores malignos (24.058), especialmente cáncer de pulmón (16.482), enfermedades cardiovasculares (17.560), especialmente cardiopatía isquémica (6.263) e ictus (4.283), y enfermedades respiratorias (11.537), especialmente enfermedad pulmonar obstructiva crónica (9.886). Desde el año 2001 prosigue el descenso en la mortalidad atribuible en los varones y el ascenso en las mujeres.Conclusiones: Una de cada 7 muertes ocurridas cada año en individuos mayores de 35 años en España es atribuible al consumo de tabaco (una de cada 4 en varones y una de cada 29 en mujeres). A pesar del descenso de las muertes atribuibles al tabaquismo respecto a años anteriores (excepto en las mujeres, en quienes aumenta), este número de muertes y el porcentaje de la mortalidad total que representa sigue siendo muy elevado (AU)

Background and objective: This study estimates smoking-attributable mortality in Spain in 2006. Population and method: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older. Results: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals ≥ 35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women. Conclusions:About one out of 7 deaths occurring annually in individuals ≥ 35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high (AU)

[Smoking-attributable deaths in Spain, 2006]. / Mortalidad atribuible al consumo de tabaco en España en 2006.

BACKGROUND AND OBJECTIVE: This study estimates smoking-attributable mortality in Spain in 2006. POPULATION AND METHOD: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older. RESULTS: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women. CONCLUSIONS: About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high.

[Guidelines for the diagnosis and treatment of spontaneous pneumothorax]. / Normativa sobre el diagnóstico y tratamiento del neumotórax espontáneo.

This is the fourth update of the guidelines for the diagnosis and treatment of pneumothorax published by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Spontaneous pneumothorax, or the presence of air in the pleural space not caused by injury or medical intervention, is a significant clinical problem. We propose a method for classifying cases into 3 categories: partial, complete, and complete with total lung collapse. This classification, together with a clinical assessment, would provide sufficient information to enable physicians to decide on an approach to treatment. This update introduces simple aspiration in an outpatient setting as a treatment option that has yielded results comparable to conventional drainage in the management of uncomplicated primary spontaneous pneumothorax; this technique is not, as yet, widely used in Spain. For the definitive treatment of primary spontaneous pneumothorax, the technique most often used by thoracic surgeons is video-assisted thoracoscopic bullectomy and pleural abrasion. Hospitalization and conventional tube drainage is recommended for the treatment of secondary spontaneous pneumothorax. This update also has a new section on catamenial pneumothorax, a condition that is probably underdiagnosed. The definitive treatment for a recurring or persistent air leak is usually surgery or the application of talc through the drainage tube when surgery is contraindicated. Our aim in proposing algorithms for the management of pneumothorax in these guidelines was to provide a useful tool for clinicians involved in the diagnosis and treatment of this disease.

Normativa sobre el diagnóstico y tratamiento del neumotórax espontáneo / Guidelines for the diagnosis and treatment of spontaneous pneumothorax

Se presenta la cuarta puesta al día de la 'Normativa sobre diagnóstico y tratamiento del neumotórax', de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). La presencia de aire dentro de la cavidad pleural de causa no traumática o iatrógena es un problema clínico relevante. Se propone un método de cuantificación del neumotórax mediante su clasificación en parcial, completo o total, que junto a la valoración clínica parece suficiente para adoptar las diversas actitudes terapéuticas. En la presente actualización se incorpora la aspiración simple ambulatoria, como método equiparable en resultados al drenaje convencional, para el tratamiento del neumotórax espontáneo primario no complicado, cuyo uso no está todavía muy extendido en España. Para el tratamiento definitivo del neumotórax espontáneo primario, la cirugía videotoracoscópica con bullectomía y abrasión pleural es la técnica más ampliamente utilizada por la mayoría de cirujanos torácicos. En el tratamiento del neumotórax espontáneo secundario se recomienda el ingreso y la colocación de drenaje torácico convencional. Se ha introducido también una referencia al neumotórax catamenial, probablemente infradiagnosticado. En caso de recidiva o fuga aérea persistente, el tratamiento definitivo suele ser el quirúrgico o el uso de talco a través del drenaje en caso de contraindicación. Los algoritmos de estrategia terapéutica aquí propuestos pretenden convertirse en una herramienta de trabajo útil para todos los implicados en el diagnóstico y tratamiento de esta enfermedad (AU)

This is the fourth update of the guidelines for the diagnosis and treatment of pneumothorax published by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Spontaneous pneumothorax, or the presence of air in the pleural space not caused by injury or medical intervention, is a significant clinical problem. We propose a method for classifying cases into 3 categories: partial, complete, and complete with total lung collapse. This classification, together with a clinical assessment, would provide sufficient information to enable physicians to decide on an approach to treatment. This update introduces simple aspiration in an outpatient setting as a treatment option that has yielded results comparable to conventional drainage in the management of uncomplicated primary spontaneous pneumothorax; this technique is not, as yet, widely used in Spain. For the definitive treatment of primary spontaneous pneumothorax, the technique most often used by thoracic surgeons is video-assisted thoracoscopic bullectomy and pleural abrasion. Hospitalization and conventional tube drainage is recommended for the treatment of secondary spontaneous pneumothorax. This update also has a new section on catamenial pneumothorax, a condition that is probably underdiagnosed. The definitive treatment for a recurring or persistent air leak is usually surgery or the application of talc through the drainage tube when surgery is contraindicated. Our aim in proposing algorithms for the management of pneumothorax in these guidelines was to provide a useful tool for clinicians involved in the diagnosis and treatment of this disease (AU)

Recomendaciones para el tratamiento farmacológico del tabaquismo. Propuestas de financiación / Recommendations for pharmacological tobacco cessation treatments: proposals for financing

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[Benefit of brief interventions and pharmacotherapies for smoking cessation in teenagers]. / Valor de la intervención breve y los tratamientos farmacológicos para dejar de fumar en adolescentes.

Management of smoking includes approaches such as health advice against smoking, brief or intensive interventions, and pharmacotherapy. However, we do not have enough information on the use of such approaches in teenagers. School programs aimed at children and adolescents are perhaps the most widely used intervention and the one for which we have the most experience. Such programs should meet a series of well-defined criteria, but in recent years their effectiveness has been questioned. Currently, information is lacking on how effective these interventions are in young smokers who wish to stop. Several clinical guidelines recommend advice and a brief intervention in adolescents but are less specific regarding pharmacotherapy. By integrating advice and a brief intervention into existing smoking prevention and control programs in schools, such approaches could be used to combat smoking in children and adolescents. However, the information available on the use of such interventions in children and adolescents is insufficient and more research needs to be done, particularly by health care professionals specialized in the identification of susceptible individuals and treatment of smoking.

Valor de la intervención breve y los tratamientos farmacológicos para dejar de fumar en adolescentes / Benefit of brief interventions and pharmacotherapies for smoking cessation in teenagers

El tratamiento del tabaquismo incluye conceptos como el consejo sanitario antitabáquico, la intervención breve o la intervención intensiva y el tratamiento farmacológico, pero carecemos de información suficiente acerca de su empleo en adolescentes. Los programas escolares destinados a niños y jóvenes, que son quizá los más ampliamente utilizados y los que cuentan con mayor experiencia, deben cumplir una serie de características muy bien definidas y en los últimos años se ha cuestionado su eficacia. En la actualidad no se dispone de información suficiente acerca de la eficacia de los tratamientos en niños y jóvenes fumadores que desean dejar el tabaco. Diversas guías clínicas recomiendan el consejo y la intervención mínima en adolescentes, pero se muestran menos categóricas en lo que respecta a la utilización de los tratamientos farmacológicos. La integración del consejo y de la intervención breve en los programas de prevención y control del tabaquismo que se realizan en los centros escolares posibilitaría la utilización de este instrumento de tratamiento del tabaquismo en niños y jóvenes, aunque la información disponible acerca de este tipo de tratamientos en niños y adolescentes es insuficiente y debería ser objeto de investigación, especialmente por parte de los profesionales especializados en diagnóstico y tratamiento del tabaquismo

Management of smoking includes approaches such as health advice against smoking, brief or intensive interventions, and pharmacotherapy. However, we do not have enough information on the use of such approaches in teenagers. School programs aimed at children and adolescents are perhaps the most widely used intervention and the one for which we have the most experience. Such programs should meet a series of well-defined criteria, but in recent years their effectiveness has been questioned. Currently, information is lacking on how effective these interventions are in young smokers who wish to stop. Several clinical guidelines recommend advice and a brief intervention in adolescents but are less specific regarding pharmacotherapy. By integrating advice and a brief intervention into existing smoking prevention and control programs in schools, such approaches could be used to combat smoking in children and adolescents. However, the information available on the use of such interventions in children and adolescents is insufficient and more research needs to be done, particularly by health care professionals specialized in the identification of susceptible individuals and treatment of smoking

Atención y prestación de servicios en materia de tabaquismo / Tobacco addiction: care and services

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[New perspectives in the diagnosis and evolution of the consumption of tobacco: markers of susceptibility and damage]. / Nuevas perspectivas en el diagnóstico y la evolución del consumo de tabaco: marcadores de susceptibilidad y lesión.

The smoking represents a serious problem of public health. It is in and of itself high-priority to describe the genetic bases of the addiction, the susceptibility to begin the consumption, to be smoking and to develop pathologies related with the tobacco. Markers of susceptibility (I begin, consolidation, modulation and ceasing of the habit), of damage potential -chronic obstructive pulmonary disease (COPD), lung carcinoma-, and of valuation of the adverse goods of the exhibition. Dependence markers, motivation, depression, anxiety and stress are reviewed. As well as tests to value syndrome of abstinence, breathing analytic and functional parameters and quality of life.

Nuevas perspectivas en el diagnóstico y la evolución del consumo de tabaco: marcadores de susceptibilidad y lesión / New perspectives in the diagnosis and evolution of the consumption of tobacco: markers of susceptibility and damage

El tabaquismo representa un grave problema de salud pública. Resulta por ello prioritario describir las bases genéticas de la adicción y la susceptibilidad para iniciar el consumo, ser fumador y desarrollar enfermedades relacionadas con el tabaco, así como buscar marcadores de susceptibilidad (inicio, consolidación, modulación y cese del hábito), de daño potencial ­enfermedad pulmonar obstructiva crónica (EPOC) o carcinoma pulmonar­ y de valoración de los efectos adversos de la exposición. Se repasan los marcadores de dependencia, motivación, depresión, ansiedad y estrés, además de los tests para valorar el síndrome de abstinencia, los parámetros analíticos y funcionales respiratorios y la calidad de vida

The smoking represents a serious problem of public health. It is in and of itself high-priority to describe the genetic bases of the addiction, the susceptibility to begin the consumption, to be smoking and to develop pathologies related with the tobacco. Markers of susceptibility (I begin, consolidation, modulation and ceasing of the habit), of damage potential ­chronic obstructive pulmonary disease (COPD), lung carcinoma­, and of valuation of the adverse goods of the exhibition. Dependence markers, motivation, depression, anxiety and stress are reviewed. As well as tests to value syndrome of abstinence, breathing analytic and functional parameters and quality of life

[Correlation between carbon-monoxide levels in exhaled air and nicotine-dependence measurements systems (DSM-IV, Fagerström test and ARU-SMQ-9) in adolescent smokers]. / Correlación entre los valores de monóxido de carbono en el aire espirado y los sistemas de medición de dependencia nicotínica DSM-IV, test de Fagerström y ARUSMQ-9 en adolescentes fumadores.

BACKGROUND AND OBJECTIVE: If we are capable of 1) determining the correlation, in young smokers, between carbon-monoxide levels in exhaled air (CO) and carboxihemoblobine (COHb) (cooximetrically determined) and 2) adapting the versions of the nosologic criteria DSM-IV for nicotine-depencence (DSM-IVa), Fagerström Test (FTNDa), and ARU-SMQ-9a Test to adolescents, then we may be able to establish how useful such tests are to measure nicotine-ependences in adolescents. SUBJECTS AND MEHTOD: Cross-sectional, observation-based study carried out in 41 schools. 2,647 students aged 10 to 17 years were surveyed. The size of the sample was calculated for eacha nd using the equation of finite population. For each age, the sample was stratified according to sex and type of school. Schools and students were chosen by using the table of random numbers. Teenagers filled up a questionnaire which included DSM-IVa, FTNDa, and ARU-SMQ-9a and were subsequently given a cooximery. RESULTS: 23.1% were smokers. The correlation between the levels of CO and the nicotine-dependence tests was: DSM-IVa rho o = 0.3390 (p = 0.0000); FTNDa rho o = 0.5853 (p 0 0.000); ARU-SMQ-9a rho o = 0.4670 (p = 0.000). The correlation with the levels of carboxihemoglobine was: DSM-IVa rho o = 0.3369 (p = 0.000); FTNDa *o = 0.5498 (p = 0-000); ARU-SMQ-9a rho o = 0.4460 (p 0 0-000). The study was based on 583 smoking scholars who underwent the cooximetry. CONCLUSIONS: The correlation between DSM-IVa, FTNDa, and ARU-SMQ-9a and the levels of CO and COHb in young smokers is low but meaninful. In our opinion, research to find new, simple, cheap, and easily-accessible tools allowing the correct diagnosis and follow-up of young smokers must continue.