Alberto Fernández Villar

Normativa sobre el diagnóstico y tratamiento del derrame pleural. Actualización

Although during the last few years there have been several important changes in the diagnostic or therapeutic methods, pleural effusion is still one of the diseases that the respiratory specialist have to evaluate frequently. The aim of this paper is to update the knowledge about pleural effusions, rather than to review the causes of pleural diseases exhaustively. These recommendations have a longer extension for the subjects with a direct clinical usefulness, but a slight update of other pleural diseases has been also included. Among the main scientific advantages are included the thoracic ultrasonography, the intrapleural fibrinolytics, the pleurodesis agents, or the new pleural drainages techniques.

Normativa sobre el manejo del nódulo pulmonar solitario

The aim of the proposed recommendations is be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated. The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8mm and those who have a subsolid SPN, for which specific recommendations are established. SPN larger than 8mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy.

Validation of the portable Air-Smart Spirometer

Background The Air-Smart Spirometer is the first portable device accepted by the European Community (EC) that performs spirometric measurements by a turbine mechanism and displays the results on a smartphone or a tablet. Methods In this multicenter, descriptive and cross-sectional prospective study carried out in 2 hospital centers, we compare FEV1, FVC, FEV1/FVC ratio measured with the Air Smart-Spirometer device and a conventional spirometer, and analyze the ability of this new portable device to detect obstructions. Patients were included for 2 consecutive months. We calculate sensitivity, specificity, positive and negative predictive value (PPV and NPV) and likelihood ratio (LR +, LR-) as well as the Kappa Index to evaluate the concordance between the two devices for the detection of obstruction. The agreement and relation between the values of FEV1 and FVC in absolute value and the FEV1/FVC ratio measured by both devices were analyzed by calculating the intraclass correlation coefficient (ICC) and the Pearson correlation coefficient (r) respectively. Results 200 patients (100 from each center) were included with a mean age of 57 (± 14) years, 110 were men (55%). Obstruction was detected by conventional spirometry in 73 patients (40.1%). Using a FEV1/FVC ratio smaller than 0.7 to detect obstruction with the Air Smart-Spirometer, the kappa index was 0.88, sensitivity (90.4%), specificity (97.2%), PPV (95.7%), NPV (93.7%), positive likelihood ratio (32.29), and negative likelihood ratio (0.10). The ICC and r between FEV1, FVC, and FEV1 / FVC ratio measured by the Air Smart Spirometer and the conventional spirometer were all higher than 0.94. Conclusion The Air-Smart Spirometer is a simple and very precise instrument for detecting obstructive airway diseases. It is easy to use, which could make it especially useful non-specialized care and in other areas.

Cambios en la tendencia sobre la mortalidad por enfermedad pulmonar obstructiva crónica: ¿realidad o ficción?

Because of its high prevalence, morbidity and mortality and associated costs, chronic obstructive pulmonary disease (COPD) is today a major health problem.1 The cumulative effects of exposure to tobacco smoke, progressive population ageing, less under-diagnosis and the effect of new treatments and better living conditions are all factors that could change COPD prevalence and mortality rate. Both prevalence and mortality are expected to peak in the next 20–30 years1–3 but several Spanish, European and US cohort studies in COPD mortality trends have raised doubts as to whether prevalence really is stabilising or even falling.2,4,5 Of particular relevance is the work of López-Campos et al.5 in analysing COPD mortality patterns in 27 European countries (including Spain) between 1994 and 2010. The study shows a steady downward trend in mortality among men, although far less so among women, in most of the countries studied, suggesting a rather more optimistic view of the future of the disease. The discrepancies between these results and those of other studies force us to reflect on the findings and consider whether COPD mortality rates are actually falling, or whether the study methodology is flawed, since it is notoriously difficult to establish the specific cause of death and precipitating factors in patients with this disease, particularly those of more advanced age and disease severity.3,5,6 Several studies have shown that mortality from COPD is under-reported in patients with very severe COPD, so that only 22% of death certificates list this as the primary causes of death.7 Paradoxically, in nearly half of all cases in which COPD is given as the cause of death, obstruction was not detected on spirometry, illustrating the prevalence of diagnostic imprecision in COPD.7 Factors such as improvements in systems used to register and encode causes of death together with greater accuracy in diagnosing COPD could, according to the authors,5,8 be affecting these results. The steady increase in the mean age of patients dying from COPD in