RESUMO
La enfermedad pulmonar obstructiva crónica (EPOC) es la tercera causa de muerte en todo el mundo. Sin embargo, ante la falta de herramientas diagnósticas precisas en el primer nivel de atención médica, como la espirometría, es difícil determinar la prevalen-cia real de la EPOC.Por otro lado, la falta de una definición clara y precisa de las exacerbaciones de la EPOC hace que se subestime su impacto en la salud pública; habitualmente, los pacien-tes con EPOC que cursan una exacerbación retrasan la búsqueda de atención médica inmediata porque se acostumbran al deterioro asociado a la enfermedad o lo confun-den con cambios por la edad avanzada. Esto puede provocar un aumento de la mor-bilidad y la mortalidad, asimismo, mayor utilización de los recursos sanitarios y mayor carga económica. Por lo tanto, es importante sensibilizar sobre la importancia del diagnóstico temprano y el tratamiento adecuado de las exacerbaciones de la EPOC, del mismo modo que el mayor conocimiento público de los síntomas, las causas y los factores de riesgo de la EPOC. Con ello, se podrán aplicar estrategias de prevención, diagnóstico y tratamiento más eficaces que mejoren la calidad de vida de los pacientes y disminuyan la carga de la enfermedad para la sociedad.Esta revisión ofrece un análisis crítico de la definición más reciente y esboza las impli-caciones del comportamiento de las exacerbaciones, su impacto en los distintos ám-bitos del sistema sanitario, así como en las diferentes esferas de la vida de los pacien-tes con EPOC. (AU)
Chronic Obstructive Pulmonary Disease (COPD) is a common disease and the third leading cause of death worldwide. However, due to the lack of accurate diagnostic tools at the first level of care, such as spirometry, the true prevalence of COPD is difficult to determine.In addition, the lack of a clear definition of COPD exacerbations means that its pub-lic health impact is underestimated. Patients with COPD often do not seek immediate medical attention because they become used to the deterioration associated with the disease. This can lead to increased patient morbidity and mortality, as well as increased utilization of healthcare resources and higher economic costs. Therefore, it is important to promote greater awareness of the importance of early di-agnosis and proper management of COPD exacerbations, as well as increased public awareness of COPD symptoms, etiologic agents, and risk factors.By better understanding COPD exacerbations, more effective prevention, diagnosis and treatment strategies can be implemented to improve the quality of life of patients and reduce the burden of the disease on society.This review aims to provide a critical analysis of the most recent definition and to out-line the implications of the behavior of COPD exacerbations and their impact on the dif-ferent settings of the health care system, as well as on the different spheres of patients' lives. (AU)
Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Dispneia/diagnóstico , Qualidade de Vida , Fatores de Risco , Diagnóstico Precoce , MéxicoRESUMO
The fractional exhaled nitric oxide (FeNO) is related to the level of eosinophilic inflammation in the airways and the levels of interleukin-13, as such it could be a diagnostic and monitoring tool in asthma. A working group was convened between pulmonologists, respiratory physiology experts, and allergists to establish criteria for the use of FeNO in asthma in Mexico. Through a simplified Delphi method and group discussion, seven key points regarding the use of FeNO were agreed upon. We agree that the measurement of FeNO serves for the diagnosis of asthma in specialized clinics, both in children and adults, as well as to determine the level of corticosteroid treatment. In severe asthma, we recommend FeNO for endotyping, for detecting poor therapeutic adherence, undertreatment, and the risk of crisis. We suggest FeNO can be used to determine the level of corticosteroid treatment and to identify patients at risk of loss of lung function. We also recommend it in adults to improve the selection of biological therapy and, in this context, we only suggest it in selected cases for children.
La fracción exhalada de óxido nítrico (FeNO) se relaciona con el nivel de inflamación eosinofílica en las vías aéreas y los niveles de interleucina-13, por lo que podría ser una herramienta diagnóstica y de seguimiento en el asma. Se convocó un grupo de trabajo integrado por neumólogos, expertos en fisiología de la respiración y alergólogos, con la finalidad de establecer criterios para el uso de la FeNO en asma en México. Mediante un método Delphi simplificado y discusión grupal, se consensaron varios puntos clave en relación con el uso de la FeNO. Sugerimos que la medición de la FeNO sirve para el diagnóstico de asma en clínicas especializadas, tanto en niños como adultos, así como para determinar el nivel de tratamiento con corticosteroides. En asma grave, recomendamos la FeNO para la endotipificación, detectar la mala adherencia terapéutica, el subtratamiento y el riesgo de crisis. Sugerimos su uso para determinar el nivel de tratamiento con corticosteroides e identificar pacientes con riesgo de tener una pérdida de la función pulmonar. También la recomendamos en el adulto para mejorar la elección de medicamentos biológicos y, en este contexto, solo la sugerimos en casos selectos en niños.
Assuntos
Asma/diagnóstico , Asma/terapia , Óxido Nítrico/análise , Adulto , Asma/metabolismo , Criança , Expiração , Humanos , México , Índice de Gravidade de DoençaRESUMO
Mexican specialists in oncology, oncologic surgery, thoracic surgery, pneumology, pathology, molecular biology, anesthesiology, algology, psychology, nutrition, and rehabilitation (all of them experts in lung cancer treatment) in order to develop the National Consensus on Lung Cancer. The consensus has been developed as an answer to the need of updated Mexican guidelines for the optimal treatment of the disease, as well as to the requirements that such guidelines be established by multidisciplinary panel, depicting the current attention given to cancer lung cases in Mexico. Thus, this paper analyses the epidemiological review, screening, diagnosis, staging, pathology, translational medicine, and the suitable therapies for early, locally advanced, and metastatic disease in the first, second, and third lines of management, as well as rehabilitation and palliative measures.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Algoritmos , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/etiologia , Carcinoma Pulmonar de Células não Pequenas/secundário , Árvores de Decisões , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/etiologia , México , Estadiamento de Neoplasias , Fumar/efeitos adversosRESUMO
Foreign body aspiration represents an emergency event that usually requires immediate medical intervention. In some cases this event may be misdiagnosed with few, or absence of, clinical symptoms, but it can result in serious consequences. The continuous technical improvements in minimally invasive procedures such as bronchoscopy have permitted success in foreign body removal. We present a case of aspiration of unusual foreign body (river stones) lodged in the left bronchial tree, in a patient with epilepsy, and that were removed by rigid bronchoscopy.
