Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias / Prevalence of Chronic Obstructive Pulmonary Disease in the Canary Islands

Introducción: La prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) varía considerablemente entre las diferentes áreas geográficas estudiadas. En España hay 2 estudios epidemiológicos que muestran una prevalencia entre el 9 y el 10% en población mayor de 40 años. No obstante, ninguno de ellos ha incluido a las Islas Canarias, región de interés por sus características climáticas y su alta prevalencia de tabaquismo. Material y métodos: A partir de una muestra poblacional de 596.478 personas se seleccionó una muestra aleatorizada de 1.353 individuos entre 40 y 70 años. Los participantes rellenaron un cuestionario y posteriormente realizaron una espirometría con test de broncodilatación si existía obstrucción. Se diagnosticó EPOC cuando el cociente FEV1/FVC después de la broncodilatación era menor de 0,70. Resultados: La prevalencia de EPOC fue del 7,3% (IC 95%: 5,5-9,5), siendo mayor en varones que en mujeres (8,7% vs. 6,3%, p = 0,134). La tasa de tabaquismo fue del 29,4% (IC 95%: 25,4-33,1), también mayor en los varones que en las mujeres (35,1% vs 25,4%, p < 0,001). La prevalencia de EPOC estratificada según la gravedad de la obstrucción, en base a los criterios GOLD, fue del 16% en el grupo I , del 69,9% en el II , del 10,4% en el III y del 3,3% en el IV . El infradiagnóstico fue del 71,6% y el infratratamiento, del 63,5%. Conclusiones: A pesar de tener una de las tasas de tabaquismo más altas de España, la prevalencia de EPOC en las Islas Canarias es menor que en la mayoría de las zonas españolas estudiadas

Introduction: The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking. Materials and methods: A random group of 1353 subjects aged between 40 and 70 years was selected from a sample population of 596 478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV1/FVC ratio was less than 0.70. Results: The prevalence of COPD was 7.3% (95%CI: 5.5-9.5) and was higher in males than in females (8.7% vs 6.3%, P = .134). The incidence of smoking was 29.4% (95%CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P < 0.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in group I, 69.9% in group II, 10.4% in group III and 3.3% in group IV. 71.6% of the subjects were underdiagnosed and 63.5% undertreated. Conclusions: Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied

Prevalence of chronic obstructive pulmonary disease in the Canary Islands.

INTRODUCTION: The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking. MATERIALS AND METHODS: A random group of 1,353 subjects aged between 40 and 70years was selected from a sample population of 596,478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV1/FVC ratio was less than 0.70. RESULTS: The prevalence of COPD was 7.3% (95%CI: 5.5-9.5) and was higher in males than in females (8.7% vs. 6.3%, P=.134). The incidence of smoking was 29.4% (95%CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P<.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in groupi, 69.9% in groupii, 10.4% in groupiii and 3.3% in groupiv. 71.6% of the subjects were underdiagnosed and 63.5% undertreated. CONCLUSIONS: Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.

Ventilación mecánica domiciliaria: dependencia y carga de cuidados en el domicilio / Home Mechanical Ventilation: Dependency and Burden of Care in the Home

IntroducciónLa ventilación mecánica domiciliaria (VMD) aumenta la supervivencia en grupos seleccionados de pacientes, pero se asocia a dependencia progresiva para las actividades básicas y muchos pacientes necesitarán cuidadores informales en su domicilio. Éstos asumen una carga de trabajo que puede tener repercusiones económicas, físicas y/o psíquicas. Nuestro objetivo has sido estudiar a pacientes con VMD y dependencia, y describir el impacto sobre sus cuidadores.Pacientes y métodosEn noviembre de 2007 estudiamos de forma descriptiva y transversal a pacientes con un mínimo de 6 meses en VMD, en situación estable. Se identificó a los dependientes aplicando el índice de Katz (índice C y superiores). En este grupo se estudiaron variables socioeconómicas, de comorbilidad y de necesidad de cuidados. Para establecer la sobrecarga del cuidador se aplicó el índice de Zarit.ResultadosDe los 66 pacientes incluidos, 20 (30%) mostraban dependencia (edad media±desviación estándar: 60±12 años; 46% mujeres), llevaban una media de 45 meses en VMD y el 40% recibía ventilación durante más de 12h al día. Entre los cuidadores, el 58% era cuidador único, la mayoría eran mujeres (77%), la edad media era de 51 años y un 70% trabajaba además fuera del domicilio. El índice de Zarit en 7 casos (35%) era superior a 40.ConclusionesEn nuestra serie, una tercera parte de los pacientes precisan cuidadores informales para poder permanecer en su entorno. El cuidador es mayoritariamente del sexo femenino, y un tercio tiene sobrecarga real o corre el riesgo de presentarla. Para adecuar la asistencia a este colectivo harán falta cambios que impliquen a los médicos y a la Administración sanitaria(AU)

BackgroundWhile home mechanical ventilation (HMV) prolongs survival in selected groups of patients, its use is associated with progressive dependency in basic activities, and many users will require informal care in their homes. The workload assumed by the informal caregivers can have financial, physical, and psychological repercussions. Our objective was to study dependent patients on HMV, and to describe the impact of the situation on their caregivers.Patients and MethodsIn November 2007, we undertook a descriptive cross-sectional study of patients in stable condition who had been receiving HMV for at least 6 months. Using the Katz index, we identified dependent patients (class C and higher). In this group we studied social and economic variables, comorbidity, and need for care. The Zarit interview was used to evaluate the caregiver burden.ResultsOf the 66 patients enrolled, 20 (30%) were dependent. The mean (SD) age in this group was 60 (12) years and 46% were women. These patients had been on HMV for a mean of 45 months, and 40% were using ventilatory support for over 12 hours per day. Care was provided by women in the majority of cases (77%), and 58% were sole caregivers. The mean age of these carers was 51 years, and 70% of them also worked outside the home. In 7 cases (35%), the caregiver scored over 40 on the Zarit index.ConclusionsOne third of the patients required informal care in order to remain in their homes. Most of the caregivers were women, and one third were overburdened or were at risk of becoming so. Changes involving both physicians and the health authorities are needed to provide satisfactory care to this group of patients(AU)

[Home mechanical ventilation: dependency and burden of care in the home]. / Ventilación mecánica domiciliaria: dependencia y carga de cuidados en el domicilio.

BACKGROUND: While home mechanical ventilation (HMV) prolongs survival in selected groups of patients, its use is associated with progressive dependency in basic activities, and many users will require informal care in their homes. The workload assumed by the informal caregivers can have financial, physical, and psychological repercussions. Our objective was to study dependent patients on HMV, and to describe the impact of the situation on their caregivers. PATIENTS AND METHODS: In November 2007, we undertook a descriptive cross-sectional study of patients in stable condition who had been receiving HMV for at least 6 months. Using the Katz index, we identified dependent patients (class C and higher). In this group we studied social and economic variables, comorbidity, and need for care. The Zarit interview was used to evaluate the caregiver burden. RESULTS: Of the 66 patients enrolled, 20 (30%) were dependent. The mean (SD) age in this group was 60 (12) years and 46% were women. These patients had been on HMV for a mean of 45 months, and 40% were using ventilatory support for over 12 hours per day. Care was provided by women in the majority of cases (77%), and 58% were sole caregivers. The mean age of these carers was 51 years, and 70% of them also worked outside the home. In 7 cases (35%), the caregiver scored over 40 on the Zarit index. CONCLUSIONS: One third of the patients required informal care in order to remain in their homes. Most of the caregivers were women, and one third were overburdened or were at risk of becoming so. Changes involving both physicians and the health authorities are needed to provide satisfactory care to this group of patients.