Efecto de la retirada y/o sustitución de los corticoides inhalados a favor de doble broncodilatación en los pacientes con EPOC sintomáticos. Estudio RETICORTEPOC / Effect of withdrawal and/or replacement of inhaled corticosteroids in favor of double bronchodilation in symptomatic COPD patients. RETICORTEPOC study

Objetivo. Evaluar si el riesgo de exacerbación es similar y si se produce una mejoría sintomática cuando se realiza una retirada o sustitución de CI en pacientes con EPOC con sintomatología (GOLD B y D). Material y métodos. Diseño: Estudio experimental, longitudinal y prospectivo de 12 meses de duración. Emplazamiento: Centro de Salud Urbano de Atención Primaria. Participantes: 81 pacientes EPOC grupo GOLD B y D en tratamiento con corticoides inhalados. Intervenciones: se aleatorizan la mitad de pacientes en un grupo de control donde se mantiene el tratamiento con corticoide inhalado, y la otra mitad en un grupo de intervención donde se retira o sustituye el corticoide inhalado por una doble broncodilatación. Mediciones principales: Variables demográficas, número de pacientes con exacerbaciones y puntuación cuestionario CAT al inicio y final del estudio. Resultados. En los pacientes GOLD B la retirada o sustitución del corticoide inhalado por la combinación LABA+LAMA produce un menor número de exacerbaciones y menor puntuación CAT. En los pacientes GOLD D no se producen diferencias entre los grupos. Conclusiones. Parece aceptable sustituir los CI tanto en terapia dual (LABA+CI) como su retirada en triterapia (LABA+LAMA+CI) en pacientes EPOC GOLD B siempre que se mantenga en su lugar un tratamiento doble broncodilatador. En los pacientes EPOC GOLD D podemos concluir que no se produce un aumento del riesgo de exacerbaciones ni empeoramiento sintomático al retirar el CI

Objective. To evaluate if the risk of exacerbation is similar and if there is a symptomatic improvement when IC withdrawal or substitution is performed in patients with COPD with symptomatology (GOLD B and D). Material and methods. Design: Experimental, longitudinal and prospective study of 12 months duration. Location: Urban Health Center for Primary Care. Participants: 81 patients COPD group GOLD B and D in treatment with inhaled corticosteroids. Intervention: Half of the patients are randomized in a control group where treatment with inhaled corticosteroids is maintained and the other half in an intervention group where the inhaled corticosteroid is withdrawn or replaced by a double bronchodilation. Main measures: Demographic variables, number of patients with exacerbations and CAT questionnaire score at the beginning and end of the study. Results. In GOLD B patients the withdrawal or replacement of the inhaled corticosteroid by the LABA + LAMA combination produces a lower number of exacerbations and a lower CAT score. In GOLD D patients, there were no differences between groups. Conclusions. It seems acceptable to replace ICs in both dual therapy (LABA + CI) and their withdrawal in tritherapy (LABA + LAMA + CI) in COPD GOLD B patients provided that a double bronchodilator treatment is maintained instead. In patients with COPD GOLD D, we can conclude that there is no increased risk of exacerbations or symptomatic worsening when IC withdrawal occurs

[Profile and risk of mental illness in caregivers for home care patients]. / Perfil y riesgo de morbilidad psíquica en cuidadores de pacientes ingresados en su domicilio.

OBJECTIVES: To determine the profile of caregivers for patients in home hospitalization, and to investigate morbidity and strain in caregivers. DESIGN: Descriptive, cross-sectional study based on personal interviews.Setting. Health area in the community (autonomous region) of Valencia (Eastern Spain). PARTICIPANTD: Systematic sampling was used to select 215 caregivers who took care of home-hospitalized patients during the year 2001. MEASURES: Personal interview at home with a questionnaire that contained items on descriptive variables, psychological well-being (Goldberg Anxiety and Depression scale), social support (Duke-UNC Functional Social Support Questionnaire), caregiver strain index and profile of the care receiver. RESULTS: The typical caregiver was a 55-year-old woman who was a first-degree relative of the patient, with primary level education, who formed part of a normally functional family and who received good social support. Anxiety was found in 32%, depression in 22% and a high strain index in 11%. The patient was typically a 70-year-old man with chronic disease, a high degree of dependence and good mental status. Correlation analysis showed that the risk of anxiety, depression and strain in caretakers increased with the patient's degree of physical dependence and mental deterioration, and with lower degrees of social support and longer periods devoted to caregiving. The risk of anxiety and depression increased as the strain index and familial dysfunction increased. Strain index was the factor that explained most of the variability in anxiety and depression. CONCLUSIONS: Feelings of psychological distress (anxiety and depression) and strain were common among caregivers. Care for caregivers should form part of the measures to provide care to patients.