Diferencias geográficas en la prevalencia de EPOC en España: relación con hábito tabáquico, tasas de mortalidad y otros determinantes / Geographical Variations in the Prevalence of COPD in Spain: Relationship to Smoking, Death Rates and other Determining Factors

AntecedentesEl estudio EPI-SCAN (Epidemiologic Study of COPD in Spain), realizado entre mayo de 2006 y julio de 2007, ha determinado que la prevalencia de la EPOC en España según los criterios GOLD es del 10,2% (IC95% 9,2–11,1) de la población de 40 a 80 años. Se desconoce la variabilidad geográfica actual de la EPOC en España.ObjetivosDescribir la prevalencia de EPOC, su infradiagnóstico e infratratamiento, y los datos de tabaquismo y mortalidad en las once áreas participantes en el estudio EPI-SCAN. Se definió EPOC como un cociente FEV1/FVC posbroncodilatador <0,70 o menor del límite inferior de la normalidad (LIN).ResultadosLa razón de prevalencias de EPOC según criterios GOLD entre áreas fue de 2,7 veces, con un máximo en Asturias (16,9%) y un mínimo en Burgos (6,2%) (p<0,05). La prevalencia de EPOC según el LIN fue del 5,6% (IC 95% 4,9–6,4) y la razón de prevalencias utilizando el LIN fue de 3,1 veces, pero con un máximo en Madrid-La Princesa (10,1%) y un mínimo en Burgos (3,2%) (p<0,05). El orden de prevalencias de EPOC por áreas no se mantuvo en ambos sexos ni por edades en cada área. Las variaciones en infradiagnóstico (58,6% a 72,8%) e infratratamiento por áreas (24,1% a 72,5%) fueron substanciales (p<0,05). La prevalencia de fumadores y ex-fumadores, y la exposición acumulada medida por paquetes-año, así como la estructura de edad de cada una de las áreas, no explican la variabilidad por áreas geográficas. Tampoco existe relación con las tasas de mortalidad publicadas por comunidad autónoma.ConclusiónExisten importantes variaciones en la distribución de la EPOC en España, tanto en prevalencia como en infradiagnóstico e infratratamiento(AU)

BackgroundThe EPI-SCAN study (Epidemiologic Study of COPD in Spain), conducted from May 2006 to July 2007, determined that the prevalence of COPD in Spain according to the GOLD criteria was 10.2% of the 40 to 80 years population. Little is known about the current geographical variation of COPD in Spain.ObjectivesWe studied the prevalence of COPD, its under-diagnosis and under-treatment, smoking and mortality in the eleven areas participating in EPI-SCAN. COPD was defined as a post-bronchodilator FEV1/FVC ratio <0.70 or as the lower limit of normal (LLN).ResultsThe ratio of prevalences of COPD among the EPI-SCAN areas was 2.7-fold, with a peak in Asturias (16.9%) and a minimum in Burgos (6.2 %) (P<0.05). The prevalence of COPD according to LLN was 5.6% (95% CI 4.9–6.4) and the ratio of COPD prevalence using LLN was 3.1-fold, but with a peak in Madrid-La Princesa (10.1%) and a minimum in Burgos (3.2%) (P<0.05). The ranking of prevalences of COPD was not maintained in both sexes or age groups in each area. Variations in under-diagnosis (58.6% to 72.8%) and under-treatment by areas (24.1% to 72.5%) were substantial (P<0.05). The prevalence of smokers and former smokers, and cumulative exposure as measured by pack-years, and the age structure of each of the areas did not explain much of the variability by geographic areas. Nor is there any relation with mortality rates published by Autonomous Communities.ConclusionThere are significant variations in the distribution of COPD in Spain, either in prevalence or in under-diagnosis and under-treatment(AU)

[Geographical variations in the prevalence of COPD in Spain: relationship to smoking, death rates and other determining factors]. / Diferencias geográficas en la prevalencia de EPOC en España: relación con hábito tabáquico, tasas de mortalidad y otros determinantes.

BACKGROUND: The EPI-SCAN study (Epidemiologic Study of COPD in Spain), conducted from May 2006 to July 2007, determined that the prevalence of COPD in Spain according to the GOLD criteria was 10.2% of the 40 to 80 years population. Little is known about the current geographical variation of COPD in Spain. OBJECTIVES: We studied the prevalence of COPD, its under-diagnosis and under-treatment, smoking and mortality in the eleven areas participating in EPI-SCAN. COPD was defined as a post-bronchodilator FEV1/FVC ratio <0.70 or as the lower limit of normal (LLN). RESULTS: The ratio of prevalences of COPD among the EPI-SCAN areas was 2.7-fold, with a peak in Asturias (16.9%) and a minimum in Burgos (6.2 %) (P<0.05). The prevalence of COPD according to LLN was 5.6% (95% CI 4.9-6.4) and the ratio of COPD prevalence using LLN was 3.1-fold, but with a peak in Madrid-La Princesa (10.1%) and a minimum in Burgos (3.2%) (P<0.05). The ranking of prevalences of COPD was not maintained in both sexes or age groups in each area. Variations in under-diagnosis (58.6% to 72.8%) and under-treatment by areas (24.1% to 72.5%) were substantial (P<0.05). The prevalence of smokers and former smokers, and cumulative exposure as measured by pack-years, and the age structure of each of the areas did not explain much of the variability by geographic areas. Nor is there any relation with mortality rates published by Autonomous Communities. CONCLUSION: There are significant variations in the distribution of COPD in Spain, either in prevalence or in under-diagnosis and under-treatment.

Comparación de 2 métodos de entrenamiento muscular inspiratorio en pacientes con EPOC / Comparison of 2 methods for inspiratory muscle training in patients with chronic obstructive pulmonary disease

Objetivo: Con el objetivo de comparar el entrenamiento muscular respiratorio (EMR) con dispositivos de umbral de presión (U) y de carga resistiva (CR) en pacientes con enfermedad pulmonar obstructiva crónica (EPOC), se ha diseñado un estudio prospectivo y aleatorizado que incluyó ambas modalidades y un grupo control (C). Pacientes y métodos: Los 33 pacientes con EPOC grave-moderada incluidos se asignaron aleatoriamente a realizar entrenamiento en el domicilio con un dispositivo de U, de CR o un nivel mínimo de ambos durante 6 semanas, a razón de 2 sesiones diarias de 15 min. En los grupos U (n = 12) y CR (n = 11) se ajustó semanalmente la carga hasta la máxima tolerada como estrategia más equitativa para no favorecer a ningún grupo. Se exploraron medidas de función respiratoria, musculares y de calidad de vida antes y después del EMR y se compararon los patrones de presión en el entrenamiento. Resultados: Mejoraron las presiones inspiratorias máximas y las puntuaciones del cuestionario para enfermedad respiratoria crónica (CRQ) en U y CR respecto a C: la presión inspiratoria estática máxima pasó de 86 a 104,25 cmH2O (p < 0,01)en el grupo U, y de 91,36 a 105,7 cmH2O (p < 0,01) en CR, que fue el grupo que presentó mayores incrementos en áreas de calidad de vida del CRQ. La diferencia respecto a la disnea fue de 3 puntos en CR, de 2,58 en U y de 2,5 en C. Se observaron diferencias significativas entre grupos en el ciclo respiratorio durante el EMR (de 0,31 en U, frente a 0,557 de CR), si bien las mayores presiones pico y media en U rindieron índices presión-tiempo finales equivalentes: de 0,11 en U y de 0,11 en CR. Conclusiones: Mediante el reajuste de carga se consiguieron intensidades de entrenamiento equivalentes con patrones de presión diferentes. Nuestro planteamiento demostró la eficacia de un EMR no controlado, pero no la superioridad de una modalidad de entrenamiento sobre otra

Objective: The aim of this study was to compare the use of threshold and resistive load devices for inspiratory muscle training in patients with chronic obstructive pulmonary disease (COPD). A randomized prospective trial was designed to compare use of the 2 devices under training or control conditions. Patients and methods: Thirty-three patients with moderate or severe COPD were randomly assigned to home treatment with a threshold device, a resistive load device, or a control situation in which either of those devices was maintained at a minimum load throughout the study. Training was performed daily in 2 sessions of 15 minutes each for 6 weeks. In the patients who underwent training with threshold (n=12) and resistive load (n=11) devices, the loads used were adjusted weekly until the maximum tolerated load was reached to ensure that the interventions were as equivalent as possible. Respiratory function, respiratory muscle function, and quality of life were assessed before and after training and the different inspiratory pressure profiles were compared between training groups. Results: Both peak inspiratory pressure and scores on the Chronic Respiratory Questionnaire (CRQ) improved in the groups that received inspiratory muscle training compared with control subjects: maximal static inspiratory pressure increased from 86 cmH2O to 104.25 cmH2O (P<.01) in the threshold device group and from 91.36 cm H2O to 105.7 cmH2O (P<.01) in the resistive load device group. The resistive load group showed the largest increase in CRQ quality-of-life scores. Differences between the dyspnea score on the CRQ at the beginning and end of the training period were as follows: 3 points in the resistive load group, 2.58 in the threshold group, and 2.5 in the control group. Significant differences in duty cycle measured during training sessions were observed between groups at the end of training (0.31 in the threshold group and 0.557 in the resistive load group), but the mean pressure­time index was similar (0.11) in both groups because of the greater peak and mean inspiratory pressures in the threshold device group. Conclusions: Load readjustment allowed equivalent training intensities to be achieved with different inspiratory pressure profiles. Our study demonstrated the effectiveness of inspiratory muscle training without control of breathing pattern but showed no superiority of one training method over another

¿Es inocuo el campo? / Is the countryside harmless?

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