Telemedicina en el manejo de la enfermedad pulmonar obstructiva crónica: revisión sistemática / Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review

La telemedicina se define como el uso de la tecnología electrónica para la información y la comunicación de los profesionales de la salud con los pacientes, objetivando brindar y apoyar la atención médica a estos últimos fuera de las instituciones de salud. Esta revisión sistemática de la literatura durante la última década (2013-2022) investiga el uso de la telemedicina en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Identificamos 53 publicaciones relacionadas con: (1) telemonitorización domiciliaria; (2) teleeducación y autocuidados; (3) telerehabilitación, y (4) salud móvil (mHealth). Los resultados mostraron que, aunque la evidencia aún es débil en muchos de estos dominios, los resultados son positivos en términos de mejora del estado de salud, uso de recursos de atención médica, viabilidad y satisfacción del paciente. Destacamos que no se identificaron problemas de seguridad. Por lo tanto, la telemedicina puede considerarse actualmente como un complemento potencial a la atención sanitaria habitual. (AU)

Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at providing and supporting healthcare to patients away from healthcare institutions. This systematic review over the last decade (2013–2022) investigates the use of telemedicine in patients with chronic obstructive pulmonary disease (COPD). We identified 53 publications related to: (1) home tele-monitorization; (2) tele-education and self-management; (3) telerehabilitation; and (4) mobile health (mHealth). Results showed that, although evidence is still weak in many of these domains, results are positive in terms of improvement of health-status, use of health-care resources, feasibility, and patient satisfaction. Importantly, no safety issues were identified. Thus, telemedicine can be considered today as a potential complement to usual healthcare. (AU)

[Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review]. / Telemedicina en el manejo de la enfermedad pulmonar obstructiva crónica: revisión sistemática.

Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at providing and supporting healthcare to patients away from healthcare institutions. This systematic review over the last decade (2013-2022) investigates the use of telemedicine in patients with chronic obstructive pulmonary disease (COPD). We identified 53 publications related to: (1) home tele-monitorization; (2) tele-education and self-management; (3) telerehabilitation; and (4) mobile health (mHealth). Results showed that, although evidence is still weak in many of these domains, results are positive in terms of improvement of health-status, use of health-care resources, feasibility, and patient satisfaction. Importantly, no safety issues were identified. Thus, telemedicine can be considered today as a potential complement to usual healthcare.

Eficacia de la budesonida/formoterol comparado con la fluticasona/salmeterol en la mejoría de la capacidad pulmonar de personas mayores con Enfermedad Pulmonar Obstructiva Crónica: revisión sistemática de literatura / Effectiveness of budesonide/formoterol compared to fluticasone / salmeterol in improving the lung capacity of older people with Chronic Obstructive Pulmonary Disease: systematic literature review / Eficiência da budesonida/formoterol comparado com fluticasona/salmeterol na melhora da capacidade pulmonar de idosos com Doença Pulmonar Obstrutiva Crônica: revisão sistemática da literatura

Introducción. La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una patología no transmisible, caracterizada por una limitación de flujo de aire en las vías respiratorias debido a una respuesta inmunológica anormal frente a partículas. Objetivo. Conocer la eficacia que tiene la budesonida/formoterol comparado con la fluticasona/salmeterol en la mejoría de la capacidad pulmonar en personas mayores de 40 años con Enfermedad Pulmonar Obstructiva Crónica. Materiales y métodos. Se realizó una revisión sistemática de documentos producidos entre el año 2000 y 2018 en distintas bases de datos, donde se incluyeron ensayos clínicos. Se identificaron cuatro artículos para el análisis final. Resultados. Durante la evaluación comparativa de budesonida con formoterol, los artículos muestran un total de 709 personas evaluadas, con un promedio de edad de 53,5 años. El 65,4 % eran varones, el 21 % manifestaba no haber consumido tabaco, todos con diagnóstico de Enfermedad Pulmonar Obstructiva Crónica moderada-severa, según la escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Los estudios determinaron que al administrar budesonida/formoterol de 400/12 mcg y 320/9 mcg, los pacientes tuvieron una leve mejoría en el Volumen Espiratorio Forzado del primer segundo (VEF1). Solo dos pacientes presentaron efectos adversos. No obstante, para los resultados mencionados anteriormente no se encontró diferencias significativas. Conclusiones. El uso de budesonida/formoterol es eficaz al mejorar la capacidad ventilatoria pulmonar, disminuye el número de exacerbaciones anuales y genera un adecuado control de los síntomas, sin embargo, es igual de efectivo a la fluticasona/salmeterol.

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a not transmissible disease, characterized by a limitation of airflow in the respiratory tract, due to an abnormal immune response to particles. Objective. This article aims to show that the application of budesonide / formoterol improves lung capacity in people over 40 years with Chronic Obstructive Pulmonary Disease. Materials and methods. A systematic review was conducted in the period between 2000 and 2018 in different databases where clinical trials were included. Four articles were identified for the final analysis. Results. During the comparative evaluation of budesonide with formoterol, a total of 709 people were evaluated, with an average age of 53.5 years, 65.4% were male, 21% reported not having used tobacco, all with a diagnosis of moderate-severe Chronic Obstructive Pulmonary Disease according to the GOLD scale (Global Initiative For Chronic Obstrutive Lung Disease). The studies determined that when budesonide / formoterol of 400/12 mcg and 320/9 mcg was administered, the patients had a slight improvement in the Forced Expiratory Volume of the first second (FEV1). Only two patients presented adverse effects. However, for the results mentioned above no significant differences were found. Conclusions. The use of budesonide / formoterol is effective in improving pulmonary ventilatory capacity, decreases the number of annual exacerbations and generates adequate control of symptoms, however, it is equally effective in fluticasone / salmeterol.

Introdução. A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma patologia não transmissível, caraterizada por uma limitação do fluxo de ar nas vias aéreas devido a uma resposta imune anormal contra partículas. Objetivo. Conhecer a eficiência que apresenta a budesonida/formoterol comparado com fluticasona/salmeterol na melhora da capacidade pulmonar em pessoas com mais de 40 anos com Doença Pulmonar Obstrutiva Crônica. Materiais e métodos. Foi realizada uma revisão sistemática dos documentos produzidos entre 2000 e 2018 em diferentes bancos de dados, onde foram incluídos ensaios clínicos. Quatro artigos foram identificados para a análise final. Resultados. Durante a avaliação comparativa de budesonida com formoterol, os artículos mostram um total de 709 pessoas avaliadas, com uma idade média de 53,5 anos. O 65,4 % eram do sexo masculino, o 21 % disseram que não usavam tabaco, todos diagnosticados com Doença Pulmonar Obstrutiva Crônica moderada a grave, de acordo com a escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Os estudos determinaram que administrar budesonida/formoterol de 400/12 mcg e 320/9 mcg, os pacientes apresentaram uma leve melhora no Volume Expiratório Forçado no primeiro segundo (VEF1). Apenas dois pacientes tiveram efeitos adversos. No entanto, não foram encontradas diferenças significativas para os resultados mencionados acima. Conclusões. O uso de budesonida/formoterol é eficaz na melhora da capacidade ventilatória pulmonar, diminui o numero de exacerbações anuais e gera controle adequado dos sintomas, no entanto, é igualmente eficaz para a fluticasona/salmeterol.

The role of imaging in the diagnosis of bronchiectasis: the key is in the distribution. / Papel de los estudios de imagen en el diagnóstico etiológico de las bronquiectasias: la distribución es la clave.

Diseases that involve the medium caliber airways (segmental and subsegmental bronchi) are common and present clinically with nonspecific respiratory symptoms such as cough, recurrent respiratory infections and occasionally, hemoptysis. The abnormal and irreversible dilation of bronchi is known as "bronchiectasis". The diagnosis can be challenging and the analysis of the regional distribution of the bronchiectasis is the most useful diagnostic guide. The objective of this manuscript is to describe the main imaging findings of bronchiectasis and their classification, review the diseases that most commonly present with this abnormality, and provide an approach to the diagnosis based on their imaging appearance and anatomic distribution. Bronchiectasis is a frequent finding that may result from a broad range of disorders. Imaging plays a paramount role in diagnosis, both in the detection and classification, and in the diagnosis of the underlying pathology.

Actualización de la enfermedad pulmonar obstructiva crónica: claves clínicas y hallazgos radiológicos en tomografía Computarizada / Update in Chronic Obstructive Pulmonary Disease: Clinical and Radiologic Findings in Computed Tomography

La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad prevenible y tratable, que se caracteriza por síntomas respiratorios persistentes secundarios a la exposición crónica a partículas. Los pilares fundamentales son la enfermedad de la vía aérea y la destrucción del parénquima pulmonar. Los cambios no siempre ocurren simultáneamente y progresan a diferentes velocidades en cada individuo. Las imágenes diagnósticas pueden ser consideradas como parte del diagnóstico y la valoración de los pacientes con EPOC, teniendo en cuenta que la radiografía de tórax no es útil para su diagnóstico, pero facilita la exclusión de los diagnósticos diferenciales, mientras que la tomografía computarizada se reserva para aquellos pacientes en quienes se debe valorar el parénquima pulmonar por sospecha de bronquiectasias o quienes por sus riesgos exposicionales tienen mayor probabilidad de desarrollar cáncer de pulmón. El enfisema, la bronquitis crónica y el asma son la clave para realizar un abordaje radiológico para el diagnóstico.

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by the presence of persistent respiratory symptoms secondary to chronic exposure to particles. The main factors are airway disease and destruction of the lung parenchyma. Parenchymal abnormalities do not always occur simultaneously and progress at different speeds in each individual. Diagnostic imaging can be considered as part of the diagnosis and assessment in patients with COPD, taking into account that chest radiography is not useful for the diagnosis of COPD but is useful for the exclusion of differential diagnosis, while computed tomography is reserved for those patients in whom pulmonary parenchyma should be assessed for suspected bronchiectasis or those who are more likely to develop lung cancer due to expositional risk factors. Emphysema, chronic bronchitis and asthma are key to perform a radiological approach for diagnosis.

Efectividad del programa de rehabilitación respiratoria en pacientes con enfermedades mentales / Effectiveness of the respiratory rehabilitation program in patients with mental disorders

Fundamento: las afecciones respiratorias en los pacientes con enfermedades mentales constituyen un problema de salud, su tratamiento representa un reto en la práctica médica.Objetivo: determinar la efectividad del programa de rehabilitación respiratoria en pacientes con enfermedades mentales, atendidas en el Hospital Psiquiátrico Provincial Clodomira Acosta Ferrales de Las Tunas, de octubre de 2012 a octubre de 2015.Método: se realizó un estudio de intervención longitudinal prospectiva en una muestra de 60 pacientes del hospital y durante el período de tiempo ya declarados. Se aplicó el programa de rehabilitación respiratoria; se empleó la escala de disnea y una guía de autonomía para realizar la valoración antes y después de la intervención. Los datos fueron tratados según la estadística descriptiva.Resultados: el porciento más elevado de pacientes correspondió al grupo entre los 60 y 69 años de edad, siendo más frecuente el sexo masculino; la bronquitis crónica fue la enfermedad de mayor incidencia, seguida de la EPOC. En la mayoría de los pacientes se logró una disminución de la disnea y mejor tolerancia al ejercicio; se obtuvo mejoría en cuanto a los signos vitales, por lo que hubo un aumento de la capacidad funcional y de la autonomía.Conclusiones: el programa de rehabilitación respiratoria resultó ser de gran beneficio, pues se logró un incremento a la tolerancia al ejercicio físico, mejor capacidad funcional y mayor independencia para realizar las actividades de la vida diaria (AU)

Background: respiratory conditions in patients who suffer from mental disorders are a health problem. Treatment represents a challenge for the medical practice.Objective: to determine the effectiveness of the respiratory rehabilitation program in patients with mental disorders attended to at Clodomira Acosta Ferrales Provincial Psychiatric Hospital of Las Tunas, from October 2012 to October 2015.Methods: a longitudinal, prospective and interventional study was carried out in a sample of 60 patients of the hospital and during the period herein mentioned. The respiratory rehabilitation program was applied. The dyspnea scale and an autonomy guide were used in order to conduct the assessment before and after the intervention. The data were dealt with according to descriptive statistics.Results: the most elevated percentage of patients belonged to the 60 to 69 age group, being more frequent in the male sex. Chronic bronchitis was the condition with the highest incidence, followed by COPD. Most of the patients achieved a decrease of dyspnea and a better tolerance to exercise. An improvement concerning vital signs was obtained; therefore there was an increase in the functional capacity and autonomy.Conclusions: the respiratory rehabilitation program proved to be of great benefit, since there was an increase in the tolerance to exercise, better functional capacity and higher independence to carry out daily activities (AU)

Lack of Correlation Between Pulmonary and Systemic Inflammation Markers in Patients with Chronic Obstructive Pulmonary Disease: A Simultaneous, Two-Compartmental Analysis. / Ausencia de correlación entre marcadores de inflamación pulmonar y sistémica en pacientes con enfermedad pulmonar obstructiva crónica: un análisis bi-compartimental simultáneo.

INTRODUCTION: The origin of systemic inflammation in chronic obstructive pulmonary disease (COPD) patients remains to be defined, but one of the most widely accepted hypothesis is the 'spill over' of inflammatory mediators from the lung to the circulation. OBJECTIVE: To evaluate the relationship between pulmonary and systemic inflammation in COPD quantifying several inflammatory markers in sputum and serum determined simultaneously. METHODOLOGY: Correlations between various inflammatory variables (TNF-α, IL6, IL8) in sputum and serum were evaluated in 133 patients from the PAC-COPD cohort study. A secondary objective was the evaluation of relationships between inflammatory variables and lung function. RESULTS: Inflammatory markers were clearly higher in sputum than in serum. No significant correlation was found (absolute value, r=0.03-0.24) between inflammatory markers in blood and in sputum. There were no significant associations identified between those markers and lung function variables, such as FEV1, DLCO and PaO2 neither. CONCLUSIONS: We found no correlation between pulmonary and systemic inflammation in patients with stable COPD, suggesting different pathogenic mechanisms.

[Chronic obstructive pulmonary disease: The golden decade. Implications for the diagnosis, prevention and treatment of chronic obstructive pulmonary disease]. / Enfermedad pulmonar obstructiva crónica: la década prodigiosa. Implicaciones para su diagnóstico, prevención y tratamiento.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous illness, which causes an important socio-economic burden. The last decade has witnessed significant advances in the understanding and knowledge of COPD with a paradigm shift in both the assessment and management of the disease. The article here reviews these changes with a particular focus on the last revision (2013) of the Global Strategy for the Diagnosis, Management, and Prevention of chronic obstructive pulmonary disease.

Association Between Chronic Respiratory Diseases and Helicobacter pylori: A Meta-Analysis.

BACKGROUND: The prevalence of chronic respiratory diseases (CRDs), including chronic bronchitis and chronic obstructive pulmonary disease (COPD), has increased significantly over the past decades. Several studies suggest that Helicobacter pylori infection may be related to the development of CRDs, but the results were not consistent. We carried out a meta-analysis to evaluate the potential association of H.pylori infection with CRDs. METHODS: We conducted a systematic literature search in PubMed, Embase, Ovid, Google Scholar and CNKI from inception to October 31, 2013. The following search terms were used: "chronic respiratory disease," "chronic bronchitis," "chronic obstructive pulmonary disease" or "COPD" in combination with "Helicobacter pylori" or "Campylobacter pylori." According to established inclusion criteria, we selected all eligible published papers and then extracted essential data. To evaluate the association of H.pylori with chronic bronchitis and COPD, an overall analysis and subgroup analyses were conducted. RESULTS: A total of 9 case-control studies comprising 782 cases and 815 controls were included in the study. Pooled ORs were 2.30 (95%CI: 1.85-2.85) in the overall analysis, 2.90 (95%CI: 2.04-4.13) in the chronic bronchitis subgroup, and 2.11 (95%CI: 1.35-3.29) in the COPD subgroup. CONCLUSIONS: The results of the overall analysis and subgroup analyzed suggest a significant association between H.pylori and CRDs. Further studies are needed to clarify the pathogenetic mechanisms involved.

Epidemiologia hospitalaria del Epoc en un Hospital Militar. Lima, Perú / Epidemiology of COPD in Military Hospital

Describir la dinámica epidemiológica de las hospitalizaciones por enfermedad obstructiva crónica (EPOC) en un hospital militar. Material y Métodos: Estudio observacional retrospectivo de las hospitalizaciones por EPOC en un Hospital Militar nivel III-1 de Lima-Perú. El periodo analizado fue desde enero de 1991 a diciembre de 2013. Para el análisis de los datos se utilizó el software de STATA V12.1 y ms Excel 2013. Resultados: Se registraron 1350 egresos con EPOC lo que representa el 1.14% del total de egresos IC95% (0.10% - 1.20%); el 58.15% de los pacientes pertenecían al sexo masculino (p=0.001), el promedio de edad fue de 74 años IC95% (73 - 75 años), (P=0.001), el promedio de estancia hospitalaria fue de 11.3 días IC95% (10.6 - 11.9 días), (P=0.001). En relación al tipo de pacientes según su condición en el hospital, el 31.41% fueron pacientes militares (424/1350) y representaron el 1.32% de todas las hospitalizaciones en esta población. La letalidad por EPOC fue 3.93% IC95% (2.95% - 5.10%) siendo superior a nuestra tasa de mortalidad hospitalaria por todas las causas (2.81%) siendo estadísticamente significativo (p=0.012) odds ratio (OR) 1.4 IC95% (1.05 - 1.87). Conclusión: El perfil epidemiológico de las hospitalizaciones por EPOC en nuestro hospital es la de un paciente del sexo varón con un promedio de edad superior a los 65 años, quién permanecerá en promedio 11 días hospitalizados y donde el 3.93% de los mismo fallecerá en dicha proceso de hospitalización. Observamos también que existe una laguna del conocimiento sobre la Epidemiologia hospitalaria del EPOC en nuestro país; nuestro estudio contribuirá a la generación de este conocimiento...

Objective: To describe the epidemiological dynamics of hospitalizations for chronic obstructive pulmonary disease (COPD) in a military hospital. Material and Methods: Retrospective observational study of hospitalizations for COPD in a level III-1 military Hospital of Lima-Peru. The analyzed period was from January 1991 to December 2013. The data analysis was performed using STATA V12.1 and ms EXCEL 2013. Results: 1350 medical discharged patients with COPD were registered representing 1.14% of all medical discharges IC95% (0.10% - 1.20%); 58.15% of the patients were males (p=0.001), the average age was 74 years IC95% (73 - 75 years old), (P=0.001), the average hospital stay was 11.3 days IC95% (10.6 - 11.9 days), (P=0.001). Regarding the patient type, according to their status in the hospital 31.41% (424/1350) were military servers and represented 1.32% of all hospitalizations in this population. The COPD mortality was 3.93% IC95% (2.95% - 5.10%) which was higher than our hospital mortality rate from all causes (2.81%). This was statistically significant (p=0.012) odds ratio (OR) 1.4 IC95 % (1.05 - 1.87). Conclusion: The epidemiological profile of the COPD patient hospitalization in our hospital is a male patient, with an average age of more than 65 years, with an average length stay of hospitalizated of 11 days, with a 3.93% rate of mortality in the same hospitalization process. We also note that there is a gap of knowledge on hospital epidemiology of COPD in our country; our study will contribute to the generation of this knowledge...

Epoc, bronquiti crónica y síntomas respiratoris, asociados a la contaminaciónn por pm10 en la ciudad de medellín (Colombia) / Cop, chronic broonchitis and respirtory symptoms associated with ppm10 pollution in the city of medellin (Colombia) / Epoc, bronquite crônica e sintoms respiratórios, associados à contaminação por pm 10 na cidade de medellín (Colômbia)

Introducción: Existe una evidencia creciente de que la contaminación aérea en las ciudades tiene efectos de larga duración sobre la enfermedad respiratoria crónica en niños, pero hay pocos estudios con resultados no concluyentes en adultos. Nosotros examinamos las asociaciones entre la contaminación por PM10 y los síntomas respiratorios, la bronquitis crónica y el EPOC en la ciudad de Medellín (Colombia). Para saber si estos niveles se asocian a mayor prevalencia de enfermedades respiratorias crónicas en adultos. Objetivos: Evaluar la prevalencia de síntomas respiratorios, bronquitis crónica y EPOC en estas dos áreas. Comparar las prevalencias de estas patologías en las dos áreas. Comparar los riesgos relativos y determinar si su diferencia es estadísticamente representativa. Diseño: Se diseñó un estudio de corte transversal con un componente analítico. Métodos: La investigación se hizo en dos fases. En la primera (fase I) se evaluaron los aspectos ambientales y se seleccionaron las áreas de alta y baja contaminación de la ciudad por PM10. En la segunda (fase II) se diseñó una investigación epidemiológica de corte transversal con un componente analítico, se usó un cuestionario y se le realizo una espirometria antes y después de aplicar 200 ug de salbutamol inhalado, según el protocolo de la ATS/ERS. Las definiciones operativas que usamos son las siguientes: bronquitis crónica: tos y flema diariamente por tres meses durante dos años consecutivos. EPOC: VEF1/CVF < 70% post-broncodilatador. Síntomas respiratorios: tos, flema, sibilancias, disnea. El análisis se realizó usando un software SPSS. Resultados: Se incluyeron un total de 578 sujetos, 381 en el área de Guayabal y 197 sujetos en el área de Robledo. Después del análisis estadístico, se encontró que vivir por más de cinco (5) años en área con niveles de contaminación por PM10 de 75 ug/m3 en promedio, comparado con vivir por más de cinco (5) años en área con niveles de 45 ug/m3, está asociado con una mayor prevalencia de síntomas respiratorios de tos y flema, bronquitis crónica, obstrucción bronquial y EPOC. Conclusiones: Vivir en área contaminada por PM10, durante 5 años o más, está asociada a una mayor prevalencia de síntomas respiratorios, bronquitis crónica y EPOC. El riesgo relativo de desarrollar EPOC es significativamente mayor en el área de niveles altos de contaminación por PM10. Ésto indica que la contaminación aérea por PM10 tiene efectos de larga duración sobre la enfermedad respiratoria crónica en adultos. Estudios adicionales se requieren para confirmar estos hallazgos.

There is increasing evidence that air pollution in cities has long-term effects on chronic respiratory disease in children, yet there are scarce studies with non conclusive results in adults. We examined the associations between pollution resulting from PM10 and respiratory symptoms, chronic bronchitis and COPD in the city of Medellín (Colombia) in order to determine if these levels were associated with a higher prevalence of adult chronic respiratory diseases. The objectives of this study were: to assess the prevalence of respiratory symptoms, chronic bronchitis and COPD in these two areas, to compare the prevalence of these pathologies between the two areas, and make a comparison of the relative risks in order to determine if such difference is statistically significant. A cross-sectional study with an analytical component was designed. The research was performed in two stages. In the first stage (Phase I) the environmental issues were assessed and the areas of high and low pollution caused by PM10 were selected. In the second stage (Phase II) a cross-sectional epidemiological investigation with an analytical component was designed. A questionnaire was used and a spirometry was performed before and after administering inhaled salbutamol 200 mg, accordingly to ATS/ERS protocol. The used operative definitions were as follows: Chronic bronchitis: cough and phlegm for three months during two consecutive years. COPD: FEV/FVC < 70% post-bronchodilator. Respiratory symptoms: Cough phlegm, wheezing, dyspnea. The analysis was performed using a SPSS software. A total of 578 subjects (381 in the area of Guayabal and 197 subjects in the area of Robledo) were included. Following the statistical analysis, it was found that living for over five (5) years in an area with average pollution by PM10 levels of 75 mg/m3, in comparison with living for more than five (5) years in an area with levels of 45 mg/m3 is associated with a higher prevalence of respiratory symptoms namely cough and phlegm, chronic bronchitis, bronchial obstruction and COPD. It was concluded that living in an area polluted with PM10 during 5 years or more is associated with higher prevalence of respiratory symptoms, chronic bronchitis and COPD. The relative risk of developing COPD is significantly higher in the area with higher levels of pollution by PM10. This shows that air pollution resulting from PM10 has long-term effects on adult chronic respiratory disease. Additional studies are required to confirm these findings.

Existe uma evidência crescente de que a contaminação aérea nas cidades tem efeitos de longa duração sobre a doença respiratória crônica em crianças, mas há poucos estudos com resultados não concluintes em adultos. Nós examinamos as associações entre a contaminação por PM 10 e os sintomas respiratórios, a Bronquite crônica e o EPOC na cidade de Medellín (Colômbia). Para saber se estes níveis se associam a maior prevalência de Doenças Respiratórias crônicas em adultos. Os objetivos do apresente estudo são avaliar a prevalência de Sintomas Respiratórios, Bronquite Crônica e EPOC nestas duas áreas, comparar as prevalências destas patologias nas duas áreas e comparar os riscos relativos para determinar se a sua diferença é estatisticamente representativa. Desenhou-se um estudo de corte transversal com um componente analítico. A pesquisa se fez em duas fases. Na primeira (Fase I) se avaliaram os aspectos ambientais e se selecionaram as áreas de alta e baixa contaminação da cidade por PM10. Na segunda (Fase II) se desenhou uma pesquisa epidemiológica de corte transversal com um componente analítico. Usou-se um questionário e se lhe realizou uma espirometria antes e depois de aplicar 200 μg de salbutamol inalado, segundo o protocolo da ATS/ERS. As definições operativas que usamos são as seguintes: Bronquite crônica: tosse e fleg diariamente por três meses durante dois anos consecutivos. EPOC: VEF1/CVF < 70% pós broncodilatador. Sintomas respiratórios: tosse, flegma, sibilâncias, dispneia. A análise se realizou usando um software SPSS. Se incluiram um total de 578 sujeitos (381 na área de Guayabal e 197 sujeitos na área de Robledo. Depois da análise estatística se encontrou que morar por mais de cinco (5) anos em área com níveis de contaminação por PM 10 de 75 μg/m3 em média, comparado com morar por mais de cinco (5) anos em área com níveis de 45 μg/m3 está associado com uma maior prevalência de sintomas respiratórios de tosse e flegma, bronquite crônica, obstrução bronquial e EPOC. A conclusão à que se chegou foi que morar em uma área contaminada por PM 10 durante 5 anos ou mais, está associada a uma maior prevalência de Sintomas respiratórios, Bronquite Crônica e EPOC. O risco relativo de desenvolver EPOCO é significativamente maior na área de níveis altos de contaminação por PM10. Isto indica que a contaminação aérea por PM 10 tem efeitos de longa duração sobre a doença respiratória crônica em adultos. Estudos adicionais se requerem para confirmar estas descobertas.