Obstructive sleep apnea is associated with cancer mortality in younger patients.

OBJECTIVE: The association between obstructive sleep apnea (OSA) and cancer mortality has scarcely been studied. The objective of this study was to investigate whether OSA is associated with increased cancer mortality in a large cohort of patients with OSA suspicion. METHODS: This was a multicenter study in consecutive patients investigated for suspected OSA. OSA severity was measured by the apnea-hypopnea index (AHI) and the hypoxemia index (% night-time spent with oxygen saturation <90%, TSat90). The association between OSA severity and cancer mortality was assessed using Cox's proportional regression analyses after adjusting for relevant confounders. RESULTS: In all, 5427 patients with median follow-up of 4.5 years were included. Of these, 527 (9.7%) were diagnosed with cancer. Log-transformed TSat90 was independently associated with increased cancer mortality in the entire cohort (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.42), as well as in the group of patients with cancer (HR, 1.19; 95% CI, 1.02-1.41). The closest association was shown in patients <65years in both the AHI (continuous log-transformed AHI: HR, 1.87; 95% CI, 1.1-3.2; upper vs lower AHI tertile: HR, 3.98; 95% CI, 1.14-3.64) and the TSat90 (continuous log-transformed TSat90: HR, 1.73; 95% CI, 1.23-2.4; upper vs. lower TSat90 tertile: HR, 14.4; 95% CI, 1.85-111.6). CONCLUSIONS: OSA severity was associated with increased cancer mortality, particularly in patients aged <65 years.

Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease.

RATIONALE: The prevalence of bronchiectasis is high in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and it has been associated with exacerbations and bacterial colonization. These have demonstrated some degree of prognostic value in patients with COPD but no information about the relationship between bronchiectasis and mortality in patients with COPD is currently available. OBJECTIVES: To assess the prognostic value of bronchiectasis in patients with moderate-to-severe COPD. METHODS: Multicenter prospective observational study in consecutive patients with moderate-to-severe COPD. Bronchiectasis was diagnosed by high-resolution computed tomography scan. A complete standardized protocol was used in all patients covering general, anthrophometric, functional, clinical, and microbiologic data. After follow-up, the vital status was recorded in all patients. Multivariate Cox analysis was used to determine the independent adjusted prognostic value of bronchiectasis. MEASUREMENTS AND MAIN RESULTS: Ninety-nine patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) II, 85 in GOLD III, and 17 in GOLD IV stages were included. Bronchiectasis was present in 115 (57.2%) patients. During the follow-up (median, 48 mo [interquartile range, 35-53]) there were 51 deaths (43 deaths in the bronchiectasic group). Bronchiectasis was associated with an increased risk of fully adjusted mortality (hazard ratio, 2.54; 95% confidence interval, 1.16-5.56; P = 0.02). CONCLUSIONS: Bronchiectasis was associated with an independent increased risk of all-cause mortality in patients with moderate-to-severe COPD.

[Inhaled antibiotics in the treatment of noncystic fibrosis bronchiectasis]. / Antibióticos inhalados en el tratamiento de las bronquiectasias no debidas a fibrosis quística.

Inhaled antibiotics are increasingly used in patients with non-cystic fibrosis (CF) bronchiectasis. Currently, there is no formal indication for the use of this therapy in these patients as inhaled antibiotics are currently only indicated in patients with CF. Therefore, prescription in patients with non-CF bronchiectasis will continue to be based on compassionate use until scientific evidence from ongoing clinical trials becomes available. However, the studies performed to date have shown several positive effects on some key parameters such as a reduction in the number of colonies and the quantity and purulence of sputum, improved quality of life and fewer exacerbations, although this therapy has little impact on accelerated loss of pulmonary function. The percentage of eradication varies, with a low rate of resistance. The clearest use of inhaled antibiotics in patients with non-CF bronchiectasis is probably colonization, especially chronic infection with Pseudomonas aeruginosa. Adverse effects are usually mild and consist of local irritation of the airway, although their frequency is greater than that in patients with CF. Currently, various clinical trials are being carried out that aim to establish the indications for inhaled antibiotic therapy in these patients. Due to its special characteristics (high local concentrations of the drug with scarce systemic adverse effects), inhaled antibiotic therapy will undoubtedly be an excellent future option for the management of bronchiectasis, as well as of many other diseases of the airways.

[Multidimensional impact of COPD exacerbations]. / Impacto multidimensional de las exacerbaciones de la EPOC.

One of the inherent characteristics of chronic obstructive pulmonary disease (COPD) is the occurrence of exacerbations. These episodes of clinical decompensation, which used to be considered epiphenomena of the disease, are now viewed as key elements in the natural history of COPD. Exacerbations generate huge clinical workload and enormous costs, impair patients' quality of life, make a decisive contribution to the multidimensional progression of the disease and affect prognosis. The present article reviews the current scientific evidence on the multifaceted impact of COPD exacerbations. However, the effects of exacerbations are not homogeneous. Not all patients suffer exacerbations and not all exacerbations have the same repercussions. This review highlights the need to standardize the definition of exacerbation, as well as that of concepts such as the frequency, severity, and duration of the episode. These factors influence the effect of the exacerbation itself and introduce variables that may affect treatment. Indeed, there is an increasing need to identify specific clinical phenotypes and personalize treatment. Consequently, an "exacerbating" phenotype is postulated as a therapeutic target of special importance.