ABSTRACT
Los anticolinérgicos (AC) son escasamente utilizados en el asma a diferencia de lo que ocurre en la enfermedad pulmonar obstructiva crónica (EPOC) en la que está muy extendido su uso. Las directrices para el manejo del asma recomiendan el uso de AC únicamente durante las exacerbaciones, ya que los beneficios del uso de estos fármacos en la fase estable del asma aún no se han establecido. Estudios recientes han sugerido la implicación del sistema colinérgico en la fisiopatología y la patogenia del asma, al demostrar la capacidad de las células epiteliales bronquiales e inflamatorias para sintetizar y liberar acetilcolina (ACh) y para expresar receptores muscarínicos. La implicación de estos receptores en la modulación de determinados mecanismos inflamatorios en el asma y en los cambios estructurales que conducen al remodelado apoya este concepto. Estas consideraciones sugieren que los AC que actúan bloqueando determinados receptores muscarínicos constituirían una alternativa terapéutica en esta enfermedad. En este sentido, una serie de trabajos, recientemente publicados, han demostrado que los AC podrían ser eficaces en el tratamiento del asma estable (AU)
Anticholinergic agents are not usually chose for asthma treatment, compared with its widely use in Chronic Obstructive Pulmonary Disease. The asthma guidelines only recommend its use in acute asthma exacerbations, and has not been fully investigated its role in stable asthma. Recent studies have related the cholinergic system and asthma pathophysiology, as it has been observed the secretion of acetylcholine and the expression of muscarinic receptors by the airway ephitelium cells and inflammatory cells. These receptors play a regulatory role in inflammatory mechanisms and airway smooth muscle remodeling. These findings suggest that anticholinergics are an alternative therapeutic agent and probably are useful in stable asthma as adjuncts to other bronchodilator therapies (AU)
Subject(s)
Humans , Asthma/drug therapy , Cholinergic Antagonists/therapeutic use , Cholinergic Agents/pharmacokinetics , Ipratropium/therapeutic use , Recurrence/prevention & controlABSTRACT
The tracheopathia osteochondroplastica (TO) is a benign and rare disorder, characterized by the deposit of cartilaginous tissue in the submucosa of the larynx, trachea and occasionally the bronchi. Both the etiology and pathogenesis, as well as the incidence and prevalence, of this disease are unknown. In a large series of 16888 bronchoscopies described, the incidence of TO was 1:1299. This is usually an incidental finding when a bronchoscopy is performed for another reason as in the cases presented. Endoscopically, a cobblestone mucosa with yellowish-white nodules protruding into the tracheal lumen and main bronchi is observed. Other symptoms have been hemoptysis and treatment-refractory cough. Despite the low prevalence of this disease, we describe two cases presented in the same hospital, diagnosed by chance when performing a fibrobroncoscopia for the study of a solitary pulmonary nodule (AU)
Subject(s)
Humans , Osteochondritis/diagnosis , Tracheal Diseases/diagnosis , Bronchial Diseases/diagnosis , Incidental Findings , Solitary Pulmonary Nodule/diagnosis , Lovastatin/therapeutic use , Doxazosin/therapeutic use , Hemoptysis/etiologyABSTRACT
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Subject(s)
Humans , Respiration, Artificial/methods , Respiratory Insufficiency/therapyABSTRACT
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Subject(s)
Humans , Lung Diseases, Interstitial/pathology , Lung Diseases, Interstitial/drug therapy , Pulmonary Fibrosis/pathology , Cryptogenic Organizing Pneumonia/pathologyABSTRACT
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Subject(s)
Humans , Asthma/epidemiology , Evaluation of Results of Therapeutic Interventions/methods , Asthma/therapy , Hypersensitivity/epidemiology , Spain/epidemiology , Patient ComplianceABSTRACT
Objetivo: Determinar las características sociodemográficas, clínicas, funcionales y de tratamiento de los pacientesatendidos en una consulta monográfica de asma.Metodología: De un total de 400 pacientes registrados en primera visita en nuestra consulta, se seleccionó aleatoriamenteuna muestra de 50 pacientes y se revisaron las historias clínicas.Resultados: Los pacientes evaluados presentaron una media de edad de 40,7 ± 18,9 años, siendo el 60% mujeres. El 82%estaban en situación laboral activa y en su mayoría (76%) procedían de zona urbana. Un 14% eran fumadores activos y un 24% exfumadores, siendo el resto no fumadores. La media de inicio de los síntomas fue de 24,6 ± 20 años. La mitad de los pacientes tenían antecedentes familiares de asma y/o atopia, presentando como factores asociados: sinusitis derepetición (10%), urticaria y/o eczema (8%), rinitis (38%), pólipos nasales (8%), intolerancia a la aspirina (18%) y clínica de reflujo gastroesofágico (6%). 42 pacientes tenían tests cutáneos realizados, siendo positivos en un 83%. Un 36% de los pacientes habían estado hospitalizados por asma en el último año (3 de ellos en UCI) y habían acudido a urgenciasuna media de 1,4 ± 2,04 veces. En cuanto a función pulmonar, se observó una media de FEV1 de 90 ± 21,4%, FEV1/FVC 76,6 ± 11,9. Por lo que respecta al tratamiento, un 16% tenían β2 a demanda como único tratamiento, un 16% tomaban corticoides inhalados solos y el resto tenían una combinación de β2 de larga más corticoides, siendo en un 54% del total de pacientes con corticoides a dosis altas. 14 pacientes recibían, además, antileucotrienos.Conclusiones: Encontramos un considerable número de asmáticos fumadores activos. Muchos pacientes habían sidohospitalizados en el año previo. Más de la mitad de los pacientes recibían tratamiento con corticoides inhalados a altas dosis
Introduction: The purpose of this study was to determine demographic characteristics, lung function, treatment andclinical status of asthmatics patients who were treated in an asthma monographic outpatient consult.Methods: A sample of 50 patients was randomly, select from 400 patients who had visited the asthma monographicoutpatient consult at first time with asthma symptoms. Data were registered from clinical history.Result: The mean age was 40.7 ±18.9, 60% were women. 82% were working people and most of them come from the city.Moreover a 14% were smokers, 24% ex-smokers and the remainders were non-smokers. Mean age of asthma symptomsonset was 24.6 ± 20 years. Family history of asthma and/or atopy was present in 50% cases. Other asthma associated factors were reported in form of sinusitis (10%), eczema (8%), rhinitis (38%), nasal polyposis (8%), AAS intolerance (18%) and gastroesophageal reflux symptoms (6%). An 83% of prick test performed was positive for aeroallergens. A 36% of patients have been previous hospitalized due to asthma within the last year (3 sujects at the critical care unit) and the mean of visits to emergency rooms were 1.4 ±2.04 times. Mean FEV1 was 90 ±21.4% of predicted. Mean of FEV1/FVCratio was 76.6 ± 11.9. A 16% of patients were receiving treatment with short acting β2 agonists alone; other 16% with inhaled corticosteroids (ICSs). Most of patients (57%) were receiving long acting β2-agonists combined with ICSs (54% of total patients were being treated with high doses of ICSs). 14 patients were treated with Cysteinyl leukotrienes inhibitors.Conclusions: We are found an important number of smokers between asthmatics patients. A lot of patients were hospitalized within last year. Most patients were receiving high doses of ICSs (AU)
Subject(s)
Humans , Asthma/epidemiology , Patients/statistics & numerical data , Hypersensitivity, Immediate/epidemiology , Sinusitis/epidemiology , Rhinitis/epidemiology , Urticaria/epidemiology , Tobacco Use Disorder/epidemiology , Adrenal Cortex Hormones/therapeutic useABSTRACT
The increasing importance of sleep apnea syndrome (SAS) is shown by the potentially lethal consequences of the development of apneic episodes during sleep. The presentation of SAS may be manifold, and the primary health care teams play a crucial role in the detection of their basic symptoms. The adequate approach to these patients depends on primary care teams, thus facilitating early diagnosis and the most adequate therapy in all cases. In the present study we report the features of 60 patients diagnosed of SAS in our unit for the investigation of this condition, to contribute to their diffusion among the professionals of primary health care.
