RESUMEN
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist, increasing the prevalence of both entities and impacting on symptoms and prognosis. CVD should be suspected in patients with COPD who have high/very high risk scores on validated scales, frequent exacerbations, precordial pain, disproportionate dyspnea, or palpitations. They should be referred to cardiology if they have palpitations of unknown cause or angina pain. COPD should be suspected in patients with CVD if they have recurrent bronchitis, cough and expectoration, or disproportionate dyspnea. They should be referred to a pulmonologist if they have rhonchi or wheezing, air trapping, emphysema, or signs of chronic bronchitis. Treatment of COPD in cardiovascular patients should include long-acting muscarinic receptor antagonists (LAMA) or long-acting beta-agonists (LABA) in low-risk or high-risk non-exacerbators, and LAMA/LABA/inhaled corticosteroids in exacerbators who are not controlled with bronchodilators. Cardioselective beta-blockers should be favored in patients with CVD, the long-term need for amiodarone should be assessed, and antiplatelet drugs should be maintained if indicated. (AU)
Asunto(s)
Humanos , Enfermedades Pulmonares , Enfermedad Pulmonar Obstructiva Crónica , Enfermedades Cardiovasculares , Pronóstico , Dolor en el PechoRESUMEN
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist, increasing the prevalence of both entities and impacting on symptoms and prognosis. CVD should be suspected in patients with COPD who have high/very high risk scores on validated scales, frequent exacerbations, precordial pain, disproportionate dyspnea, or palpitations. They should be referred to cardiology if they have palpitations of unknown cause or angina pain. COPD should be suspected in patients with CVD if they have recurrent bronchitis, cough and expectoration, or disproportionate dyspnea. They should be referred to a pulmonologist if they have rhonchi or wheezing, air trapping, emphysema, or signs of chronic bronchitis. Treatment of COPD in cardiovascular patients should include long-acting muscarinic receptor antagonists (LAMA) or long-acting beta-agonists (LABA) in low-risk or high-risk non-exacerbators, and LAMA/LABA/inhaled corticosteroids in exacerbators who are not controlled with bronchodilators. Cardioselective beta-blockers should be favored in patients with CVD, the long-term need for amiodarone should be assessed, and antiplatelet drugs should be maintained if indicated.
Asunto(s)
Enfermedades Cardiovasculares , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedades Cardiovasculares/complicaciones , Administración por Inhalación , Antagonistas Muscarínicos/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Quimioterapia Combinada , Corticoesteroides/uso terapéutico , Disnea , Dolor/tratamiento farmacológico , Agonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Broncodilatadores/uso terapéuticoAsunto(s)
Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Broncodilatadores/uso terapéutico , Exposición a Riesgos Ambientales/efectos adversos , Volumen Espiratorio Forzado , Humanos , Pulmón/embriología , Pulmón/crecimiento & desarrollo , Guías de Práctica Clínica como Asunto , Enfermedad Pulmonar Obstructiva Crónica/etiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , EspañaRESUMEN
No disponible
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/historia , Instituciones de Salud/historia , Instituciones de Salud/normas , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Fumar/epidemiología , Fumar/historia , Fumar/legislación & jurisprudenciaRESUMEN
La calidad de la atención que recibe el paciente es un aspecto fundamental de la medicina actual. Los residentes son esenciales en la organización sanitaria, pero su falta de experiencia produce la preocupación de que descienda la calidad asistencial entregada. Un adjunto tiene mayores conocimientos y habilidades, un residente mayor motivación y entusiasmo. El objetivo de los programas formativos es preparar a los residentes para proporcionar unos cuidados de alta calidad. Es fundamental para ello su supervisión, que parece ser inadecuada e influye tanto en la calidad asistencial como en sus resultados académicos. La disminución de la calidad asistencial en los meses de recambio de residentes es el llamado «efecto julio», y aunque los estudios que analizan dicho efecto tengan resultados heterogéneos, la efectividad parece verse realmente afectada en estos meses. Neumología es una de las últimas especialidades médicas en adjudicar sus plazas MIR, sin que podamos precisar si eso influye en la calidad asistencial. La alta prevalencia de las enfermedades respiratorias y los últimos avances diagnósticos y terapéuticos podrían producir un cambio de esta situación en los próximos años
The quality of care received by patients is a basic element of modern medicine. Medical residents or interns are essential within the healthcare system, but their lack of experience can raise concerns about the quality of care given. A registrar or specialist has greater knowledge and skills, while a resident has greater motivation and enthusiasm. The aim of training programs is to prepare residents to provide high quality care. This requires close supervision that seems to be lacking, with the consequent impact on both healthcare quality and academic results. The so-called "July effect" refers to the diminished quality of care during the summer months when resident physicians switch over. The results of studies analysing this effect vary widely, but the loss of efficacy during these months does seem to be real. Pulmonology is one of medical specialties that generates the least demand for internships and residencies, but it is impossible to determine if this affects the quality of care. The high prevalence of respiratory diseases and the latest diagnostic and therapeutic advances may mean that this situation will change in coming years
Asunto(s)
Femenino , Humanos , Masculino , Calidad de la Atención de Salud/organización & administración , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud , 50230 , Internado y Residencia , Internado y Residencia/organización & administración , Internado y Residencia/estadística & datos numéricos , Neumología , Neumología/estadística & datos numéricos , Calidad de la Atención de Salud/tendencias , Indicadores de MorbimortalidadRESUMEN
The quality of care received by patients is a basic element of modern medicine. Medical residents or interns are essential within the healthcare system, but their lack of experience can raise concerns about the quality of care given. A registrar or specialist has greater knowledge and skills, while a resident has greater motivation and enthusiasm. The aim of training programs is to prepare residents to provide high quality care. This requires close supervision that seems to be lacking, with the consequent impact on both healthcare quality and academic results. The so-called "July effect" refers to the diminished quality of care during the summer months when resident physicians switch over. The results of studies analysing this effect vary widely, but the loss of efficacy during these months does seem to be real. Pulmonology is one of medical specialties that generates the least demand for internships and residencies, but it is impossible to determine if this affects the quality of care. The high prevalence of respiratory diseases and the latest diagnostic and therapeutic advances may mean that this situation will change in coming years.