Afectación corneal debido a enfermedad de Erdheim-Chester / Corneal involvement due to Erdheim-Chester disease

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Changes in clinical, pulmonary function, quality of life and costs in a cohort of asthmatic patients followed for 10 years.

UNLABELLED: Few studies have comprehensively assessed the evolution asthma disease in recent years. OBJECTIVES: To determine changes in morbidity, lung function and quality of life and to establish the impact in terms of cost in a cohort of patients with asthma. METHODS: Prospective, descriptive and realistic study that included 220 asthma patients evaluated 10 years after their inclusion (1994-2004). For all the patients, data for symptoms, lung function, quality of life and financial cost were collected. RESULTS: There was a decrease in the frequency of health service visits, including: emergency room visits for asthma exacerbations, 0.3 (0.9) versus 0.6 (1) visits per patient per year (P=.003); a reduction in the severity of the disease, with a greater proportion of patients with mild asthma, 121 (54.8%) versus 94 (42.7%) (P=.001); a decrease (improvement in quality of life) in the total SGRQ, 30.1 (16.5) versus 37 (19.6) (P<.001); and reduced total costs, 1,464€ (3,415.8) compared to 2,267€ (4.174) per patient/year (P<.001), mainly due to indirect costs, 617.50€ (2855.9) compared to 1,320.10€ (3,685.3) per patient/year (P=.001). When assessing the changes observed according to asthma severity, no differences were observed between groups. CONCLUSIONS: The evolution of the morbidity and quality of life of asthma patients between 1994 and 2004 are clearly favorable. This improvement provided a significant reduction in the total costs of disease treatment.

Consumo de tabaco en adolescentes. Estudio poblacional sobre las influencias parenterales y escolares / Smoking among adolescents: population study on parental and school influences

Objetivo: El consumo de tabaco es un problema de salud pública cuya iniciación ocurre en la adolescencia. El objetivo principal de este estudio fue analizar la asociación entre consumo de tabaco y factores parentales y escolares. Sujetos y método: La muestra del estudio fueron los 20 centros que imparten educación secundaria obligatoria en la comarca de Osona (Barcelona). Se utilizó un cuestionario autoadministrado que contenía las siguientes variables: consumo de tabaco, edad de inicio, frecuencia de consumo, tipo de centro (público o concertado), sexo, edad, convivencia, población, utilización del comedor escolar y si habitualmente comían o cenaban solos en su domicilio. Resultados: Un total de 2.280 alumnos participaron en el estudio (91% de participación). La edad media fue de 15,5 años. Un 20% de los adolescentes se declararon fumadores, un 5% ex fumadores, un 34% lo había probado alguna vez y un 41% no había fumado nunca. Los factores asociados significativamente al consumo de tabaco en el análisis multivariado fueron: edad, población rural, asistir a un centro público, estructura familiar monoparental, comer en solitario y no utilizar el comedor escolar. Conclusiones: El consumo de tabaco entre los adolescentes de nuestro medio es elevado y no existen diferencias por sexo. Nuestros resultados indican que la estructura y dinámica familiares podrían influir en el consumo de tabaco en la adolescencia. La utilización del comedor escolar se asocia a un menor consumo de tabaco

Objective: Smoking represents a public health problem, one which begins during adolescence. The main objective of this study was to analyze the association between smoking and parental and school factors. Subjects and methods: The study sample consisted of the students from the 20 secondary schools in the region of Osona, Barcelona, Spain. A self-report questionnaire was used to obtain information on the following variables: smoking habit, age of initiation, frequency, type of school (state school or private-subsidized), sex, age, persons living in the home, town, whether the student had lunch at school, whether the student often had lunch or dinner alone at home. Results: A total of 2280 students participated in the study (91%). Mean age was 15.5 years. Of the participants, 20% said they were smokers; 5%, ex-smokers; 34% had tried smoking at least once, and 41% had never smoked. Factors significantly associated with smoking in the multivariate analysis were age, rural town, state school, single parent family, eating alone, and not lunching at school. Conclusions: Smoking prevalence is high among adolescents in our society and there is no gender difference. Our results show that family structure and dynamics can influence smoking in adolescents. Smoking is less prevalent among adolescents who have lunch at school

[Smoking among adolescents: population study on parental and school influences]. / Consumo de tabaco en adolescentes. Estudio poblacional sobre las influencias parentales y escolares.

OBJECTIVE: Smoking represents a public health problem, one which begins during adolescence. The main objective of this study was to analyze the association between smoking and parental and school factors. SUBJECTS AND METHODS: The study sample consisted of the students from the 20 secondary schools in the region of Osona, Barcelona, Spain. A self-report questionnaire was used to obtain information on the following variables: smoking habit, age of initiation, frequency, type of school (state school or private-subsidized), sex, age, persons living in the home, town, whether the student had lunch at school, whether the student often had lunch or dinner alone at home. RESULTS: A total of 2280 students participated in the study (91%). Mean age was 15.5 years. Of the participants, 20% said they were smokers; 5%, ex-smokers; 34% had tried smoking at least once, and 41% had never smoked. Factors significantly associated with smoking in the multivariate analysis were age, rural town, state school, single parent family, eating alone, and not lunching at school. CONCLUSIONS: Smoking prevalence is high among adolescents in our society and there is no gender difference. Our results show that family structure and dynamics can influence smoking in adolescents. Smoking is less prevalent among adolescents who have lunch at school.

Rupatadine 10 mg and ebastine 10 mg in seasonal allergic rhinitis: a comparison study.

BACKGROUND: The aim of this study is to establish the efficacy and safety of rupatadine vs ebastine and placebo in the treatment of seasonal allergic rhinitis (SAR). Rupatadine is a new second generation H(1)-antihistamine with once-daily dosing that may provide better control of symptoms than the currently used H(1)-receptor blockers because of its dual pharmacological profile (anti-PAF and anti-H(1)). METHODS: In a multicentre study, 250 patients with SAR were included in a double-blind, randomized, parallel-group and placebo-controlled study. Patients received either rupatadine 10 mg, ebastine 10 mg or placebo once daily for 2 weeks. The main efficacy outcome was based on the patient's record of severity of nasal symptoms (sneezing, nasal itching, runny nose and nasal obstruction) and nonnasal symptoms (conjunctival itching, tearing and pharyngeal itching). The daily total symptom score (DTSS) was the mean of the DSS recorded for each of the seven symptoms assessed, and the mean DTSS (mDTSS) was the mean of the DTSS values for each study day. RESULTS: Significant differences in mDTSS were detected between rupatadine and placebo (33% lower for rupatadine group; P = 0.005) after 2 weeks of treatment. The TSS for rupatadine were 22% lower than for ebastine, although the differences were not statistically significant. No serious adverse events were reported during the study period. CONCLUSIONS: Rupatadine 10 mg once daily was clearly superior to placebo in alleviating the symptoms of SAR over a 2-week period. In comparison with ebastine, rupatadine shows a trend towards a better profile as regard several secondary efficacy variables.

Quality of life and economic features in elderly asthmatics.

BACKGROUND: In the geriatric population, asthma tends to be overlooked. Moreover, typical symptoms of asthma may mimic chronic bronchitis and emphysema. OBJECTIVE: To compare the characteristics of asthma between elderly (>/=65 years) and adult (<65 years) asthma patients with regard to asthma severity, health-related quality of life, and direct expenditures for medical care generated by the disease. METHODS: A cross-sectional study was made in the asthmatic population older than 14 years in the area of Barcelona, Spain. Asthma severity was determined according to the International Consensus criteria of 1992. St. George's Respiratory Questionnaire (SGRQ) was used to measure the quality of life. Direct costs were calculated registering all costs generated by each patient per year. RESULTS: The study population consisted of 282 adult asthmatics and 51 elderly asthmatics. Asthma was more severe in the elderly group (mild 10%, moderate 35%, severe 55%) than in the adult group (mild 47%, moderate 35%, severe 18%). Elderly asthmatics had significantly higher total SGRQ scores (48 vs. 35, p < 0.001) than adult asthmatics, as well as significantly higher scores for all subscales. Asthma-derived direct costs in elderly asthmatics (mean USD 1,490 vs. USD 773) were double those in adult asthmatics, mainly due to higher costs of hospitalization and medication in the elderly. CONCLUSIONS: Asthma in elderly people as compared with asthma in adulthood was more severe and was associated with a worse health-related quality of life, and significantly higher expenditures for medical care.

Costs of asthma according to the degree of severity.

An increase in asthma-related morbidity and mortality has been reported recently, resulting in a substantial increase in the economic impact of this condition. Little information is available relating to the costs of asthma depending on the degree of severity of the disease. Total, direct and indirect costs generated by asthma patients who sought medical care for asthma control over a one-year period in a northern area of Spain were determined. Data were obtained from the patients themselves and severity of illness was classified into mild, moderate and severe according to the International Consensus Report on Diagnosis and Treatment of Asthma, 1992. The average total annual asthma-derived cost was estimated at US$2,879 per patient, with averages of US$1,336 in mildly asthmatic patients, US$2,407 in moderate asthma and US$6,393 in severe asthma. At all levels of severity, indirect costs were twice as high as direct costs, and at the same degree of severity, direct costs due to medication and hospitalization were higher among females than males. A minority of severe asthmatics incurred some 41% of the total costs. The cost of asthma was surprisingly high and varied substantially depending on the degree of severity of the disease. Further knowledge of the costs of asthma across various levels of severity will contribute to a better characterization of optimal intervention strategies for asthma care.

[Clinical characteristics and morbidity in stable asthma. A descriptive analysis of asthma in a Mediterranean community]. / Características clínicas y morbilidad en el asma estable. Análisis descriptivo del asma en una comunidad mediterránea.

UNLABELLED: Scarce clinical and epidemiological data related to asthma are available in Spain. OBJECTIVES: a) to determine the severity of disease and morbidity among symptomatic asthmatics, and b) to determine whether international recommendations for the treatment of asthma are being followed. A prospective descriptive study enrolling asthmatics older than 14 years of age who experienced symptoms within the past year. The study was performed in the Osona district, a semi-rural area north of Barcelona. Spirometric tests were given and case histories taken, including symptoms caused by the disease. The international guidelines analyzed were those published in 1992 by the National Institutes of Health for the International Consensus Report on Diagnosis and Treatment of Asthma. We studied 333 patients; 214 (64%) were women and 119 (36%) men. Asthma was mild in 140 (42%), moderate in 116 (35%) and severe in 77 (23%). The need for short-term oral corticosteroids, visits to primary care physicians, and missed work days were all significantly greater among patients with severe asthma than for those with mild or moderate asthma. However, 23% of the patients with mild asthma missed work at least once. Drugs used were beta-adrenergic agonists of short duration of effect (76%) and inhaled corticosteroids (66%). CONCLUSIONS: a) in most symptomatic asthma patients, disease is mild; b) although patients with severe asthma have higher rates or morbidity, patients with mild disease also have marked symptoms; c) the drugs used for treatment are in compliance with the 1992 international guidelines.

High adenosine deaminase level in pleural effusion due to Waldenström's macroglobulinemia.

A case with a high adenosine deaminase (ADA) level in pleural effusion due to Waldenström's macroglobulinemia is reported. This is the first case of this disease which is described as a cause of an increased pleural ADA.

[Have the causes of hemoptysis changed? An analysis of 213 patients undergoing fiber bronchoscopic exploration]. / Han variado las causas de hemoptisis? Análisis de 213 pacientes sometidos a exploración fibrobroncoscópica.

For decades the most frequent causes of hemoptysis have been bronchiectasis, tuberculosis and bronchogenic carcinoma. A recent study, however, has shown that the etiology has changed, as the incidence of hemoptysis due to tuberculosis or bronchiectasis has decreased while that due to bronchitis has increased. To determine the causes of hemoptysis in patients who underwent fiberoptic bronchoscopy (FB). We conducted a retrospective analysis of clinical profiles and radiologic and FB findings for 213 patients who came to our hospital with hemoptysis between 1990 and 1994. The site of bleeding was located by FB in 139 (64%) patients and a conclusive diagnosis of the cause of hemoptysis was achieved in 170 (78%) cases. The main causes were chronic bronchitis in 64 (29%) patients, neoplasia in 61 (28%) and bronchiectasis in 22 (10%). Tuberculosis was responsible for hemoptysis in only 7 patients (3%). The incidences of the various causes of hemoptysis requiring FB for diagnosis have changed substantially in recent years. Chronic bronchitis and neoplasia are now the most frequent causes. Tuberculosis has become less important. Bronchiectasis, on the other hand, continues to cause of a significant number of cases of hemoptysis in our area.

CT of pulmonary epithelioid hemangioendothelioma.

OBJECTIVE: To describe the radiological findings of long-standing pulmonary epithelioid hemangioendothelioma. MATERIALS AND METHODS: Serial radiography and CT, including high-resolution CT scans, were performed in two patients. RESULTS: The tumor has remained radiographically stationary for 10 and 20 years, respectively. On CT, both patients showed multiple calcified pulmonary nodules, up to 1 cm in size with a perivascular distribution. Interstitial involvement was seen in one case. CONCLUSION: Calcification and perivascular location of the tumoral nodules were characteristic CT findings in our cases.

[Effectiveness of the treatment of spontaneous pneumothorax using small caliber pleural catheter]. / Eficacia del tratamiento del neumotórax espontáneo mediante catéter pleural de pequeño calibre.

BACKGROUND: The aim of this study was to evaluate the efficacy of the treatment of spontaneous pneumothorax (PT) by small caliber pleural catheter (SCPC) carried out by physicians with no surgical experience in the emergency department. METHODS: Forty-eight patients with spontaneous PT (23 total, 4 of them tensional) were included in the study. An 8 French caliber polyethylene SCPC was inserted in all the patients requiring pleural drainage. RESULTS: Thirty-two patients (67%) required pleural drainage. The catheter was carried for a mean of 4 days (1-7) resolving PT in 27 (84%) with no resolution being achieved in 5 (15%) and posterior surgical treatment being required. No major complications were observed during the evolution. CONCLUSIONS: The use of small caliber pleural catheters in the treatment of spontaneous pneumothorax (both total and to pressure) performed by physicians with no previous surgical knowledge is safe and effective.

Response of the nose to exercise in healthy subjects and in patients with rhinitis and asthma.

BACKGROUND: Although the nose and the bronchi are both involved in the process of regulating respiratory heat exchange, thermal changes may precipitate airway obstruction during exercise but rarely cause nasal obstruction in patients with rhinitis. The cause of the different response of the nose and bronchial tree has hardly been investigated. This study was performed to assess the response of the nose during exercise in the presence of rhinitis, asthma, and in normal controls. METHODS: Ten healthy subjects (group 1), 15 patients with asthma and rhinitis (group 2), 10 with rhinitis only (group 3), and 11 with asthma only (group 4) were included in the study. Exercise was performed on a bicycle ergometer for six minutes, reaching a heart rate of 80% of predicted. Bronchial and nasal responses were measured by forced expiratory volume in one second (FEV1) and posterior rhinomanometry, respectively. A drop in the FEV1 of 20% or more was considered a positive exercise induced asthma challenge test. RESULTS: Heart rate and ventilation increased by a similar proportion in the four groups. The FEV1 significantly decreased in asthmatic patients (groups 2 and 4) but it did not change in healthy subjects (group 1) or in those with rhinitis (group 3). Thirteen asthmatic patients developed exercise induced asthma. Nasal patency increased with exercise by a similar proportion in all groups, and no differences were detected between those with rhinitis (groups 2 and 3) and those without (groups 1 and 4). Nasal patency had returned to basal values at 25 minutes after completion of exercise in the four groups. The nose of patients with exercise induced asthma, however, remained significantly more patent than in patients without exercise induced asthma between 10 and 30 minutes after exercise. CONCLUSIONS: These results suggest that the nose responds differently from the bronchi during exercise induced airway obstruction: whereas the bronchial tree responds by becoming narrowed, the nose becomes more patent. These findings suggest that the mechanisms regulating the response of the nose to exercise are different from those involved in the response of the bronchial tree.

[Inhalation chambers: an alternative to the conventional inhalator?]. / Cámaras de inhalación: alternativa al inhalador convencional?

BACKGROUND: Aerosol inhalers constitute the most commonly used form of administration of medication by most of the patients with respiratory disease although incorrect usage is a demonstrated fact in many studies. A previous study demonstrated that, despite correct instruction by health care staff and the patients, 30% of the same use these inhalers incorrectly. In the present study, the efficacy of inhalation chambers (750 ml) and spacers (50 ml) versus the conventional inhaler was evaluated by quantification of bronchodilator response. METHODS: Fifty-six stable patients with chronic obstruction to air flow in habitual treatment with aerosol inhalers (AI) were studied. For this study 27 patients used the chamber and 29 the spacer. The patients using the maneuvers correctly (n = 42) and those that did not (n = 14) were studied together and separately. RESULTS: Patients using the inhaler incorrectly were found to benefit significantly from either of the procedures. Upon comparison of the chambers (750 ml) with the spacers (50 ml) a significant improvement was observed with the former. CONCLUSIONS: The response to bronchodilator treatment in patients not using aerosol inhalers correctly improves significantly upon use of either inhalation chambers or spacers with the former demonstrating the best results.

Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position.

OBJECTIVE: To determine if the semirecumbent position (45-degree angle) decreases aspiration of gastric contents to the airways in intubated and mechanically ventilated patients. DESIGN: A randomized, two-period crossover trial. SETTING: Respiratory intensive care unit. PATIENTS: Nineteen patients requiring intubation and mechanical ventilation. INTERVENTIONS: Patients were studied in the supine and semirecumbent positions on two separate days. MEASUREMENTS: After technetium (Tc)-99m sulphur colloid labeling of gastric contents, sequential radioactive counts in endobronchial secretions were measured at 30-minute intervals over a 5-hour period. Samples of endobronchial secretions, gastric juice, and pharyngeal contents were obtained for qualitative bacterial cultures. RESULTS: Mean radioactive counts in endobronchial secretions were higher in samples obtained while patients were in the supine position than in those obtained while patients were in the semirecumbent position (4154 cpm compared with 954 cpm; P = 0.036). Moreover, the aspiration pattern was time-dependent for each position: For the supine position, radioactivity was 298 cpm at 30 min and 2592 cpm at 300 min (P = 0.013); for the semirecumbent position, radioactivity was 103 cpm at 30 min and 216 cpm at 300 min (P = 0.04). The same microorganisms were isolated from stomach, pharynx, and endobronchial samples in 32% of studies done while patients were semirecumbent and in 68% of studies done while patients were in the supine position. CONCLUSIONS: We conclude that the supine position and length of time the patient is kept in this position are potential risk factors for aspiration of gastric contents. Elevating the head of the bed for patients who can tolerate the semirecumbent position may be a simple, no-cost prophylactic measure.

Severe community-acquired pneumonia. Epidemiology and prognostic factors.

Over a period of 4 consecutive yr, 92 nonimmunosuppressed patients (21 women and 71 men aged 53 +/- 16 yr, means = SD) with critical acute respiratory failure (PaO2/FiO2, 209 +/- 9 mm Hg) caused by severe community-acquired pneumonia were admitted to the respiratory intensive care unit (RICU) of a general hospital. The most frequent underlying clinical condition was chronic obstructive pulmonary disease (44 patients, 48%). A total of 56 patients (61%) required mechanical ventilation for a mean period of 10.7 +/- 12.5 days, 29 of them (52%) needing PEEP (9.9 +/- 3.8 cm H2O). A group of 23 (25%) patients had criteria of adult respiratory distress syndrome (ARDS). A causal microorganism was identified in 48 patients (52%), the two most frequent etiologies being Streptococcus pneumoniae (14, 15%) and Legionella pneumophila (13, 14%). Pseudomonas aeruginosa (5, 5%) was always associated with bronchiectasis. Mortality due to severe community-acquired pneumonia was 22% (20 patients). According to univariate analysis, mortality was associated with anticipated death within 4 to 5 yr, inadequate antibiotic treatment before RICU admission, mechanical ventilation requirements, use of PEEP, FIO2 greater than 0.6, coexistence of ARDS, radiographic spread of the pneumonia during RICU admission, septic shock, bacteremia, and P. aeruginosa as the cause of the pneumonia. Further, recursive partitioning analysis selected two factors significantly related to the prognosis: the radiographic spread of the pneumonia during RICU admission and the presence of septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)