Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997-2007.

We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n = 4,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n = 3,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1-10.2%) in 1997 to 4.5% (95% CI 2.4-6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40-69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p<0.05) within this 10-yr frame. The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.

[Current utilization of anticholinergics in the chronic obstructive pulmonary disease treatment]. / Empleo actual de los anticolinérgicos en el tratamiento de la enfermedad pulmonar obstructiva crónica.

Only 20% of patients with chronic obstructive pulmonary disease receive appropriate treatment. The most utilized among anticholinergics has been ipratropium bromide in inhalation very valued for its safety but that should be utilized every 6 hours. In these setting the average dose is 26% and when the patient takes de drug every 24 hours the dose index is 84%. Tiotropium is the new anti-cholinergic administered through respiratory airways that should be taken every 24 hours. It is more effective for improving functional residual capacity with levels much higher than ipratropium bromide. Furthermore, tiotropium is better than ipratropium bromide for improving the quality of life and for diminishing the frequency of exacerbations, one of the causes for improving the quality of life.

Empleo actual de los anticolinérgicos en el tratamiento de la enfermedad pulmonar obstructiva crónica / Current utilization of anticholinergics in the chronic obstructive pulmonary disease treatment

Solamente el 20% de los pacientes con enfermedad pulmonar obstructiva crónica reciben un tratamiento correcto. Entre los anticolinérgicos, el más utilizado ha sido el bromuro de ipratropio en inhalación, muy apreciado por su seguridad pero que debe utilizarse cada 6 horas. En estas condiciones el promedio de toma es del 26% y cuando es cada 24 horas el índice de toma es del 84%. El tiotropio es el nuevo anticolinérgico por vía respiratoria que se debe tomar cada 24 horas. Es más eficaz, mejorando el valor de la capacidad residual funcional en forma muy superior al bromuro de ipratropio. Además es superior al bromuro de ipratropio en mejorar la calidad de vida y en disminuir la frecuencia de exacerbaciones, lo que es una de las consecuencias para mejorar la calidad de vida (AU)

Only 20% of patients with chronic obstructive pulmonary disease receive appropriate treatment. The most utilized among anticholinergics has been ipratropium bromide in inhalation very valued for its safety but that should be utilized every 6 hours. In these setting the average dose is 26% and when the patient takes de drug every 24 hours the dose index is 84%. Tiotropium is the new anti-cholinergic administered through respiratory airways that should be taken every 24 hours. It is more effective for improving functional residual capacity with levels much higher than ipratropium bromide. Furthermore, tiotropium is better than ipratropium bromide for improving the quality of life and for diminishing the frequency of exacerbations, one of the causes for improving the quality of life (AU)

Perspectivas en exploración funcional respiratoria. Presentación / No disponible

No disponible

Oxigenoterapia continua domiciliaria: un buen tratamiento si se hace bien / Continuous domiciliary oxigen therapy: a righ treatment if it is well done

No disponible

Recomendaciones para la organización y funcionamiento de las unidades especializadas en tabaquismo / Guidelines for organizing and operating specialized anti-smoking units

No disponible

La rehabilitación respiratoria en el paciente con enfermedad pulmonar obstructiva crónica

La rehabilitación respiratoria, especialmente en el paciente con enfermedad pulmonar obstructiva crónica (EPOC), ha demostrado su eficacia en la mejoría de la disnea de esfuerzo, de la capacidad de ejercicio y de la calidad de vida de estos enfermos. Los programas más complejos de rehabilitación respiratoria que incluyen numerosos profesionales y técnicas muy diversas, que van desde la eliminación del tabaquismo hasta la terapia ocupacional, son muy costosos y únicamente pueden realizarse a nivel hospitalario. Sin embargo, los aspectos más eficaces de la rehabilitación respiratoria como son el entrenamiento de los músculos de extremidades inferiores, superiores y respiratorios, pueden realizarse de forma ambulatoria y han demostrado su eficacia en el paciente con EPOC (AU)

[The effect of peroperative transfusion on survival in resected lung carcinomas]. / Influencia de la transfusión perioperatoria en la supervivencia de los carcinomas de pulmón resecados.

This paper analyzes the influence of perioperative transfusion on survival after lung cancer surgery. Between January 1991 and December 1995, we enrolled 405 patients, 196 of whom received transfusions and 209 of whom did not. Follow-up extended to December 1997. Excluded were patients undergoing exploratory thoracotomy (n = 92), those who died during the postoperative period (n = 19) and those lost to follow-up (n = 13). The final number of patients in the study was 281 (136 who received transfusions and 145 who did not). We analyzed age, sex, general clinical status measured on the Eastern Cooperative Oncology Group (ECOG) scale, histological type and TNM staging. Single and multiple variable analyses were performed. At the end of the study 158 patients were alive and 123 had died. Transfusions were used more often in pneumonectomies (p < 0.001) and in patients with an ECOG score of 2 (p < 0.01). Survival at 36 and 60 months, calculated using the Kaplan-Meier method was 52% and 30%, respectively, for those who had received transfusions, and 53% and 49%, respectively, for those who had not. The differences were not statistically significant (p > 0.1). Multivariant analysis failed to demonstrate an influence of transfusion on survival (relative risk of 1.08; 95% confidence interval 0.72-1.61; p > 0.1). We conclude that there is no negative prognostic effect of perioperative transfusion.

[Estimation of initial interobserver variability of forced spirometry in the multicenter epidemiological study IBERPOC. Scientific Committee of the IBERPOC study]. / Estimación de la variabilidad inicial interobservador de la espirometría forzada en el estudio epidemiológico multicéntrico IBERPOC. Comité Científico del Estudio IBERPOC.

To estimate the interobserver variability and degree of agreement for basic spirometric parameters before beginning field work for the IBERPOC Project. Study of agreement between 7 observers (pneumologists) and a gold standard, using a scheme of incomplete balanced and randomized blocks with an equal number of spirometric measurements (n = 3) per patient and an equal number of measurements (n = 9) per observer performed at the same session. The study population consisted of 14 patients with different degrees of air flow obstruction and 7 normal volunteers. Statistically significant differences attributable to subjects (inter-patient variability) were found for the three variables analyzed. Variability attributable to the observer was found for FVC and FEV1 but not for FEV1/FVC. The greatest interobserver differences were found for FEV1, such that 4 of the 7 observers recorded values that were significantly different from the mean (p < 0.05). The differences were less marked for FVC and for the FEV1/FVC ratio, with only 2 observers recording significantly different values for each variable. The high degree of reproducibility as well as the excellent interobserver agreement found in this standardization session provide an a priori guarantee of validity for spirometric measurements and rule out the existence of differential bias in data recorded at the various geographic areas involved in the study.

[Comparative study of procaterol and salbutamol in single inhaled doses]. / Estudio comparativo del procaterol y salbutamol en inhalación a dosis única.

The bronchodilator effect of 0.02 mg of procaterol compared to 0.2 mg of salbutamol as a reference drug administered by single dose inhalation, has been tested in 15 asthmatic patients with a stable clinical situation, using a double-blind study. The clinical value of the administered dose was determined by FEV1, FEV 25-75%, PEF, MEF 50% FVC, SRaw, VC and FRC. These functional tests together with the evaluation of secondary and cardiovascular effects were performed every hour during a 12 hour period. The results revealed that the procaterol aerosol was more potent (although not statistically significant) than the salbutamol, and had a longer activity time. There were no differences in the secondary effects which were mild and transitory. These results suggest that procaterol is a potent bronchodilator, with a long-lasting activity and minimal cardiovascular and adverse side effects.