Exercise Capacity and Physical Activity in Non-Cystic Fibrosis Bronchiectasis after a Pulmonary Rehabilitation Home-Based Programme: A Randomised Controlled Trial.

BACKGROUND: Patients with chronic respiratory disease have low exercise capacity and limited physical activity (PA), which is associated with worsening dyspnoea, exacerbations, and quality of life. The literature regarding patients with non-cystic fibrosis bronchiectasis (non-CF BQ) is scarce, especially regarding the use of cardiopulmonary exercise tests (CPET) to assess the effects of home-based pulmonary rehabilitation programmes (HPRP). The aim was to evaluate the effect of an HPRP on the exercise capacity of non-CF BQ patients using CPET and PA using an accelerometer. METHODS: Our study describes a non-pharmacological clinical trial in non-CF BQ patients at the Virgen Macarena University Hospital (Seville, Spain). The patients were randomised into two groups: a control group (CG), which received general advice on PA and educational measures, and the intervention group (IG), which received a specific 8-week HPRP with two hospital sessions. The variables included were those collected in the CPET, the accelerometer, and others such as a 6 min walking test (6MWT) and dyspnoea. The data were collected at baseline and at an 8-week follow-up. RESULTS: After the intervention, there was a significant increase in peak VO2 in the IG, which was not evidenced in the GC (IG 66.8 ± 15.5 mL/min p = 0.001 vs. CG 62.2 ± 14.14 mL/min, p = 0.30). As well, dyspnoea according to the mMRC (modified Medical Research Council), improved significantly in IG (2.19 ± 0.57 to 1.72 ± 0.05, p = 0.047) vs. CG (2.07 ± 0.7 to 2.13 ± 0.64, p = 0.36). In addition, differences between the groups in walked distance (IG 451.19 ± 67.99 m, p = 0.001 vs. CG 433.13 ± 75.88 m, p = 0.981) and in physical activity (IG 6591 ± 3482 steps, p = 0.007 vs. CG 4824 ± 3113 steps, p = 0.943) were found. CONCLUSION: Participation in a specific HPRP improves exercise capacity, dyspnoea, walked distance, and PA in non-CF BQ patients.

Síndrome posneumonectomía en paciente con síndrome de Swyer-James-MacLeod / Postpneumonectomy Syndrome in a Patient With Swyer-James-MacLeod Syndrome

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[Translated article] Postpneumonectomy Syndrome in a Patient With Swyer–James–MacLeod Syndrome / Síndrome posneumonectomía en paciente con síndrome de Swyer-James-MacLeod

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Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study / Eficacia y seguridad de los antibióticos inhalados en pacientes con enfermedad pulmonar obstructiva crónica. Estudio observacional multicéntrico

Background We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment.Methods Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. Primary outcome: COPD exacerbations. Secondary outcomes: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication.Results Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (−33.3%; P<.001), hospital admissions (−33.3%; P<.001) and hospitalization days (−26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (−33.1%; P=.024), mucopurulent/purulent sputum (−53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (−16.7%; P<.001), CBI by any PPM (−37.4%; P<.001) and CBI by PA (−49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%).Conclusions In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.

Antecedentes Nuestro objetivo fue describir la efectividad y seguridad de los antibióticos inhalados en enfermedad pulmonar obstructiva crónica (EPOC), así como el perfil de pacientes en los que se prescriben habitualmente y los grupos de pacientes que más pueden beneficiarse de este tratamiento. Métodos Estudio de cohorte observacional retrospectivo multicéntrico en pacientes con EPOC que habían recibido ≥1 dosis de antibióticos inhalados en los últimos 5 años. Se compararon los datos clínicos de los 2 años anteriores y posteriores al inicio del tratamiento. Criterio primario: exacerbaciones de EPOC. Criterios secundarios: efectos secundarios, sintomatología (purulencia del esputo, disnea), perfil microbiológico y erradicación de patógenos. Resultados De los 693 pacientes con EPOC analizados (74,1 años; 86,3% hombres; FEV1 medio=43,7%) el 71,7% presentaba bronquiectasias y el 46,6% presentaba infección bronquial crónica (IBC) por Pseudomonas aeruginosa (PA). Después de un año de tratamiento con antibióticos inhalados se produjo una disminución significativa en el número de exacerbaciones (−33,3%; p<0,001), ingresos hospitalarios (−33,3%; p<0,001) y días de hospitalización (−26,2%; p=0,003). No encontramos diferencias en la efectividad entre los pacientes con o sin bronquiectasias asociadas. Los resultados positivos fueron más pronunciados en los pacientes que erradicaron la PA. Encontramos una reducción significativa de la expectoración diaria (−33,1%; p=0,024), el esputo mucopurulento/purulento (−53,9%; p<0,001), el aislamiento de cualquier microorganismo potencialmente patógeno (MPP) (−16,7%; p<0,001), IBC por cualquier MPP (−37,4%; p<0,001) e ICB por PA (−49,8%; p<0,001). La IBC por cualquier MPP y más de 3 exacerbaciones previas se asociaron con una mejor respuesta al tratamiento. El 25,4% de los pacientes presentó efectos secundarios no graves, siendo los más frecuentes el broncoespasmo (10,5%), la disnea (8,8%) y la tos (1,7%). Conclusiones En los pacientes con EPOC con múltiples exacerbaciones o IBC por cualquier MPP (especialmente PA), los antibióticos inhalados parecen ser un tratamiento eficaz y seguro, independientemente de la presencia de bronquiectasias.

Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study.

BACKGROUND: We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment. METHODS: Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. PRIMARY OUTCOME: COPD exacerbations. SECONDARY OUTCOMES: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication. RESULTS: Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (-33.3%; P<.001), hospital admissions (-33.3%; P<.001) and hospitalization days (-26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (-33.1%; P=.024), mucopurulent/purulent sputum (-53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (-16.7%; P<.001), CBI by any PPM (-37.4%; P<.001) and CBI by PA (-49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%). CONCLUSIONS: In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.

Percepción y consecuencias verbales: un análisis interconductual / Perception and Verbal Consequences: An Interbehavioral Analysis / Percepção verbal e consequências: uma análise intercomportamental

Para evaluar el efecto de distintos tipos de consecuencias verbales sobre la percepción de trayectorias en estudiantes universitarios de optometría, se utilizó la tarea de "encontrar un móvil extraviado" consistente en presentar en la pantalla de una computadora a "Caperucita Roja" caminando con dirección a un bosque siguiendo distintas trayectorias (horizontal, vertical, diagonal a 15º, diagonal a 45º y en zigzag). Transcurrido un tiempo desde el internamiento y desaparición en el bosque (demoras de 1, 2 o 4 segundos), se solicitó a los participantes colocar el puntero en la zona del bosque donde podría encontrarse Caperucita (i.e., respuesta de localización). Los grupos independientes de estudiantes universitarios recibieron puntos por sus respuestas correctas, pero también diferentes consecuencias verbales: (a) correcto/incorrecto, (b) especificación de parámetros del error, y (c) consecuencias autoadministradas. Un grupo control solo recibió puntos por sus respuestas correctas. Los resultados muestran mayor precisión de la respuesta de localización en los participantes que recibieron consecuencias que especificaban los parámetros del error, en las trayectorias horizontal y vertical, y con las demoras más breves. Se discute la función disposicional de las consecuencias verbales como mediadoras de la percepción de trayectorias

To evaluate the effects of different types of verbal con-sequences on trajectory perception, a task of "finding a lost mobile object" was used. In that task, Little Red Riding Hood was presented on a computer screen, walking towards a forest, following different paths (horizontal, vertical, diagonal at 15º, diagonal at 45°, and zigzag). Few seconds after her entry and disap-pearance in the forest (delays of 1, 2, or 4 seconds), participants were asked to place the pointer on the area of the forest where she might be found. Indepen-dent groups of university students received different verbal consequences for their responses: a) correct/incorrect, b) specification of error parameters, and c) self-administered consequences. A control group only received points for their correct responses. The results show higher accuracy in the participants who received consequences that specified the error parameters in the horizontal and vertical trajectories with the shortest de-lays. The dispositional function of verbal consequences as mediators in trajectory perception is discussed

Para avaliar o efeito de diferentes tipos de consequên-cias verbais na percepção de trajetórias, foi utilizada a tarefa de "encontrar o objeto móbil perdido", que con-siste em apresentar "chapeuzinho vermelho" na tela de um computador caminhando em direção a uma floresta seguindo diferentes trajetórias (horizontal , vertical, 15º diagonal, 45º diagonal e ziguezague). Após algum tempo decorrido desde a entrada e desaparecimento na floresta (atrasos de 1, 2 ou 4 segundos), os participantes foram solicitados a colocar o ponteiro na área da flores-ta onde chapeuzinho vermelho poderia ser encontrada (ex. resposta de localização). Grupos independentes de estudantes universitários receberam pontos por suas respostas corretas, mas também diferentes consequên-cias verbais: a) correto / incorreto, b) especificação de parâmetros de erro, e c) consequências autoadminis-tradas. Um grupo de controle só recebeu pontos por suas respostas corretas. Os resultados mostram maior precisão da resposta de localização nos participantes que receberam consequências que especificaram os parâmetros de erro, nas trajetórias horizontal e vertical, e com os menores atrasos. Discute-se a função dispo-sicional das consequências verbais como mediadoras da percepção das trajetórias

Influence of climatic variables on chronic obstructive pulmonary disease patient attendance to a pulmonary rehabilitation program.

PURPOSE: Implementing adherence to pulmonary rehabilitation (PR) programs is key to obtaining the best results. The objective of our study was to evaluate the influence of weather conditions (humidity, temperature, and precipitation) on attendance to a PR program in chronic obstructive pulmonary disease (COPD) patients. METHODS: This prospective observational study, carried out in Seville (Spain), included COPD patients who participated in a 36-session outpatient mixed (strength and endurance) training program for 12 weeks. The program included educational sessions as well. The attendance at the program scheduled sessions during 1 year was evaluated in relation to the meteorological conditions of relative humidity in percentage (%), temperature in degree centigrade (°C), and precipitation in millimeters (mm) according to the data from the State Meteorological Agency (AEMET) and the meteorological center of La Rinconada. RESULTS: A total of 81 COPD patients who underwent 2903 sessions were analyzed. The annual average attendance of the program was 78.6%. No differences were found in the attendance to the program depending on the climatic conditions evaluated throughout the year. CONCLUSIONS: In a specific geographical area such as Seville, meteorological conditions are not a determining factor of attendance to the PR program for COPD patients.

¿Mienten los pacientes con EPOC sobre su hábito tabáquico? / Do COPD patients lie about their smoking habit?

OBJETIVO: Determinar la tasa de decepción o concordancia entre la respuesta de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) sobre su hábito tabáquico y la medición del mismo por cooximetría en una consulta monográfica EPOC. DISEÑO: Estudio observacional prospectivo para determinar la concordancia entre los valores de cooximetría y la respuesta a entrevista clínica sobre hábito tabáquico. EMPLAZAMIENTO: Consulta monográfica de EPOC, Neumología, Sevilla. PARTICIPANTES: Pacientes con diagnóstico confirmado de EPOC en cualquier grado. INTERVENCIONES: Entrevista clínica y medición de monóxido de carbono mediante cooximetría. MEDICIONES PRINCIPALES: Valores de cooximetría, respuestas sobre hábito tabáquico, variables sociodemográficas. RESULTADOS: Se incluyó un total de 169 pacientes (n: 169) de los cuales, 107 presentaron valores menores o iguales 6 ppm frente a 62 con valores mayores a 6 ppm, determinando una prevalencia de tabaquismo activo del 36,7%. La tasa de decepción fue del 19,5% del total de la muestra (24,3% de entre todos los que afirmaban no fumar), con una kappa de Cohen de 0,48 y p < 0,000. El 40% de los pacientes confesó no haber dicho la verdad. No se encontró ninguna relación de este dato con la edad, el consumo acumulado de tabaco ni el FEV1. Se halló una relación significativa con el sexo (tasa de decepción: 31,8% en las mujeres vs. 15,2% en los hombres, p 0,017). CONCLUSIONES: A pesar de nuestros intentos para que los pacientes dejen de fumar, la tasa de decepción en nuestra consulta fue considerable, mayor entre las mujeres, exfumadores recientes o en proceso de abandono, por lo que sería fundamental incorporar medidas objetivas como el cooxímetro en el abordaje de este tipo de pacientes

OBJECTIVE: To determine the deception rate or concordance between the interview on smoking and cooximetry in COPD patients from a monographic consultation. DESIGN: Prospective observational study to evaluate the concordance between the values of cooximetry and the response to a clinical interview on smoking. SETTING: COPD monographic consultation, Pneumology, Seville. PARTICIPANTS: Patients with a confirmed diagnosis of COPD in any degree. INTERVENTIONS: Clinical interview and measurement of carbon monoxide by cooximetry. MAIN MEASUREMENTS: Cooximetry values, responses on smoking, sociodemographic variables. RESULTS: n: 169. 107 patients presented values less than or equal to 6 ppm compared to 62 with values greater than 6 ppm, determining a prevalence of active smoking of 36.7%. The deception rate was 19.5% of the total sample (24.3% of all those who claimed not to smoke), with a Cohen kappa of 0.48 and p < 0.000. 40% of patients confessed not having told the truth. No relationship of this data was found with age, accumulated tobacco consumption or FEV1. A significant relationship with sex was found (deception rate: 31.8% in women vs. 15.2% in men, p 0.017). CONCLUSIONS: In spite of our attempts to make patients stop smoking, a considerable deception rate was found in our consultation; higher among women, recent ex-smokers or in the process of abandonment, so it would be essential to incorporate objective measures such as the cooximeter in the approach of this type of patient

[Do COPD patients lie about their smoking habit?] / ¿Mienten los pacientes con EPOC sobre su hábito tabáquico?

OBJECTIVE: To determine the deception rate or concordance between the interview on smoking and cooximetry in COPD patients from a monographic consultation. DESIGN: Prospective observational study to evaluate the concordance between the values of cooximetry and the response to a clinical interview on smoking. SETTING: COPD monographic consultation, Pneumology, Seville. PARTICIPANTS: Patients with a confirmed diagnosis of COPD in any degree. INTERVENTIONS: Clinical interview and measurement of carbon monoxide by cooximetry. MAIN MEASUREMENTS: Cooximetry values, responses on smoking, sociodemographic variables. RESULTS: n: 169. 107 patients presented values less than or equal to 6 ppm compared to 62 with values greater than 6 ppm, determining a prevalence of active smoking of 36.7%. The deception rate was 19.5% of the total sample (24.3% of all those who claimed not to smoke), with a Cohen kappa of 0.48 and p < 0.000. 40% of patients confessed not having told the truth. No relationship of this data was found with age, accumulated tobacco consumption or FEV1. A significant relationship with sex was found (deception rate: 31.8% in women vs. 15.2% in men, p 0.017). CONCLUSIONS: In spite of our attempts to make patients stop smoking, a considerable deception rate was found in our consultation; higher among women, recent ex-smokers or in the process of abandonment, so it would be essential to incorporate objective measures such as the cooximeter in the approach of this type of patient.

The Effect of Hospital Discharge with Empiric Noninvasive Ventilation on Mortality in Hospitalized Patients with Obesity Hypoventilation Syndrome. An Individual Patient Data Meta-Analysis.

Rationale: Hospitalized patients with acute-on-chronic hypercapnic respiratory failure due to obesity hypoventilation syndrome (OHS) have increased short-term mortality. It is unknown whether prescribing empiric positive airway pressure (PAP) at the time of hospital discharge reduces mortality compared with waiting for an outpatient evaluation (i.e., outpatient sleep study and outpatient PAP titration).Objectives: An international, multidisciplinary panel of experts developed clinical practice guidelines on OHS for the American Thoracic Society. The guideline panel asked whether hospitalized adult patients with acute-on-chronic hypercapnic respiratory failure suspected of having OHS, in whom the diagnosis has not yet been made, should be discharged from the hospital with or without empiric PAP treatment until the diagnosis of OHS is either confirmed or ruled out.Methods: A systematic review with individual patient data meta-analyses was performed to inform the guideline panel's recommendation. Grading of Recommendations, Assessment, Development, and Evaluation was used to summarize evidence and appraise quality.Results: The literature search identified 2,994 articles. There were no randomized trials. Ten studies met a priori study selection criteria, including two nonrandomized comparative studies and eight nonrandomized noncomparative studies. Individual patient data on hospitalized patients who survived to hospital discharge were obtained from nine of the studies and included a total of 1,162 patients (1,043 discharged with PAP and 119 discharged without PAP). Empiric noninvasive ventilation was prescribed in 91.5% of patients discharged on PAP, and the remainder received empiric continuous PAP. Discharge with PAP reduced mortality at 3 months (relative risk 0.12, 95% confidence interval 0.05-0.30, risk difference -14.5%). Certainty in the estimated effects was very low.Conclusions: Hospital discharge with PAP reduces mortality following acute-on-chronic hypercapnic respiratory failure in patients with OHS or suspected of having OHS. Well-designed clinical trials are needed to confirm this finding.

Fibrosis quística del adulto, una causa de bronquiectasias a considerar en el paciente con EPOC / Adult Cystic Fibrosis: A Possible Cause of Bronchiectasis in COPD Patients

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Elección entre ayudar vs no ayudar: nivel de dominio en la tarea / Choice between helping vs not helping: level of mastery in the task

Los estudios llevados a cabo para identificar las condiciones que promueven el altruismo han sugerido que factores como las consecuencias situacionales y la introducción de componentes verbales en una tarea probabilizan la elección de los individuos de trabajar bajo contingencias compartidas. No obstante, se ha encontrado que no basta la presencia de dichas variables para garantizar que los individuos ayuden. Se ha considerado que la capacidad conductual para desempeñarse de manera efectiva en una tarea (i.e. nivel de dominio) es una variable disposicional que puede facilitar o impedir la elección de los individuos de trabajar bajo contingencias compartidas. Con base en esto, el objetivo del presente trabajo consistió en evaluar los efectos de distintos niveles de dominio en una tarea aritmética (alto y bajo) sobre la elección ayudar/ no ayudar a un compañero a realizar operaciones aritméticas. La tarea consistía en realizar distintos tipos de operaciones aritméticas (sumas, restas, multiplicaciones y divisiones) para obtener puntos. Una vez que acumulaban 20 puntos, se le presentaba a los participantes la opción de elegir entre ayudar a un compañero a resolver operaciones o continuar con su tarea. Los resultados muestran que los participantes con dominio aritmético alto eligieron ayudar a su compañero con mayor frecuencia que los participantes con dominio aritmético bajo (40% vs 23%, respectivamente). Se discute la importancia del nivel de dominio de tarea como un factor disposicional en la elección entre ayudar o no ayudar.

Studies carried out to identify conditions that promote altruism have suggested that factors such as situational consequences and the introduction of verbal components in a task probabilize the individuals' choice to work under shared contingencies. However, it has been found that the presence of these variables is not enough to guarantee that individuals help. It has been considered that the behavioral capacity to perform effectively in a task (i.e. domain level) is a dispositional variable that can facilitate or impede the choice of individuals to work under shared contingencies. Based on this, the objective of this work consisted of evaluating the effects of different levels of domain in an arithmetic task (high and low) on the choice of helping / not helping a partner to perform arithmetic operations. The task was to perform different types of arithmetic operations (addition, subtraction, multiplication and division) to obtain points. Once they accumulated 20 points, participants were presented with the option to choose between helping a partner to solve operations or continue with their task. The results show that participants with high arithmetic domain chose to help their partner more frequently than the participants with low arithmetic domain (40% vs. 23%, respectively). The importance of the task domain level as a dispositional factor in the choice between helping or not helping is discussed.