Carlos Martínez-Rivera

Usefulness of truncal obesity indices as predictive factors for obstructive sleep apnea syndrome.

Background: Optimization of the indications for nocturnal polysomnography in the diagnosis of obstructive sleep apnea syndrome (OSAS) could lead to significant reductions in health expenditure. To this end, we assessed the usefulness of truncal obesity measurements in the diagnosis of OSAS.

Anemia is a Mortality Predictor in Hospitalized Patients for COPD Exacerbation

Abstract Background. Anemia is a recognized prognostic factor in many chronic illnesses, but there is limited information about its impact on outcomes in patients hospitalized for acute COPD exacerbation (AECOPD). Aim. To investigate whether anemia exerts an effect on mortality in patients admitted for AECOPD after one year of follow-up. Methods. From November 2007 to November 2009 we recruited 117 patients who required hospitalization due to an AECOPD. Clinical, functional and laboratory parameters on admission were prospectively assessed. Patients were followed up during one year. Mortality and days-to-death were collected. Results. Mean age 72 (SD ± 9); FEV1 37.4 (SD ± 12); mortality after 1 year was 22.2%. Mean survival: 339 days. Comparing patients who died to those who survived we found significant differences (p < 0,000) in hemoglobin (Hb) (12.4 vs 13.8 mg/dl) and hematocrit (Ht) (38 vs 41%). Anemia (Hb < 13 g.dl-1) prevalence was 33%. Those who died had experienced 3.5 exacerbations in previous year vs 1.5 exacerbations in the case of the survivors (p = 0.000). Lung function and nutritional status were similar, except for percentage of muscle mass (%) (35 vs 39%; p = 0.015) and albumin (33 vs 37mg/dl; p = 0.039). These variables were included in a Multivariate Cox Proportional Hazards Model; anemia and previous exacerbations resulted as independent factors for mortality. Mortality risk for patients with anemia was 5.9(CI: 1.9–19); for patients with > 1 exacerbation in the previous year was 5.9(CI: 1.3–26.5). Conclusion. Anemia and previous exacerbations were independent predictors of mortality after one year in patients hospitalized for AECOPD.

Factors associated with high healthcare resource utilisation among COPD patients

BACKGROUND Chronic obstructive pulmonary disease (COPD) places a huge economic burden on healthcare systems, especially patients with frequent exacerbations and co-morbidities. OBJECTIVES To identify factors associated with high utilisation of healthcare resources in a population of patients with COPD. METHOD We conducted an observational, cross-sectional, multicentre study with the aim of identifying the factors associated with high resource utilisation among patients with COPD. Sociodemographic and anthropometric characteristics of the study population, as well as data on health-related quality of life, respiratory symptoms, presence of anxiety and depression, physical activity and lung function were collected. We examined the relationship between these variables and high utilisation of healthcare resources, by performing a multivariate analysis based on a logistic regression model. RESULTS 115 patients (64 were high users of healthcare resources, and 51 control patients) from 13 hospitals were selected. Patients presenting high resource utilisation had worse FEV₁, worse basal SpO₂, less distance walked in the 6-minute walk test, and increased dyspnoea. They also had a worse BODE index, worse scores in all dimensions of the EURO-QOL 5D and the LCADL scale, and displayed a higher prevalence of depression. Multivariate analysis yielded a statistically significant association between SpO₂, LCADL scores, serum fibrinogen values and total leukocyte count, and high healthcare resource utilisation. CONCLUSIONS COPD patients who incur higher healthcare resource utilisation show reduced physical activity, increased respiratory failure and increased systemic inflammation.

Anaemia in chronic obstructive pulmonary disease. Does it really matter

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic diseases, with an increasing rate in morbidity and mortality. In recent years, there has been a greater awareness about the clinical importance of systemic effects and other chronic conditions associated with COPD, as these significantly impact on the course of disease. The most studied extrapulmonary manifestations in COPD include the presence of concomitant cardiovascular disease, skeletal muscle wasting, osteoporosis and lung cancer. Anaemia is a recognised independent marker of mortality in several chronic diseases. Recent studies have shown that anaemia in patients with COPD may be more frequent than expected, with a prevalence ranging from 5% to 33%. Some evidence suggests that systemic inflammation may play an important pathogenic role, but anaemia in COPD is probably multifactorial and may be caused by others factors, such as concealed chronic renal failure, decreased androgenic levels, iron depletion, angiotensin‐converting enzyme inhibitor treatment and exacerbations. Low levels of haemoglobin and haematocrit in COPD patients have been associated with poor clinical and functional outcomes as well as with mortality and increased healthcare costs. Despite the potential clinical benefit of successfully treating anaemia in these patients, evidence supporting the importance of its correction on the prognosis of COPD is uncertain.

Perfil psicológico de los pacientes con asma bronquial y disnea funcional: comparación con población no asmática e impacto sobre la enfermedad

BACKGROUND Few studies have analysed the relationship between anxiety and alexithymia with functional dyspnea (FD) and its impact on quality of life and asthma control. The aim of this study was to assess the prevalence of DD in asthma, its impact on quality of life and asthma control and its relationship with anxiety and alexithymia. PATIENTS AND METHODS We performed a cross-sectional study of 264 asthmatic patients and 111 controls. Both groups completed the following questionnaires: quality of life (AQLQ), alexithymia (TAS-20), anxiety (STAI) and FD (Nijmegen). In asthmatics were evaluated: asthma severity, dyspnoea, exacerbation and control of the disease (ACT test). RESULTS 38% of asthmatics and 5.5% of non-asthmatics had FD. Asthmatics had more anxiety and were more alexithymic. Asthmatics with FD had significantly more anxiety, more alexithymia, poor control of asthma, more exacerbations and poorer quality of life, that asthma without DD. Asthmatics with an ACT<19, a score >3 in the emotion subscale of the AQLQ, who were being treated for anxiety and scored >19 on the alexithymia subscale that assesses difficulty in identifying emotions, showed ORs for FD of 2.6 (1.1-5.9), 6.8 (2.9-15.8), 4.4 (1.9-9.8) and 3.3 (1.5-7), respectively. A predictive model of FD was constructed. CONCLUSIONS We demonstrated the close relationship between anxiety, alexithymia and DD in asthmatics, as well as the significant impact of FD on the control and quality of life of this asthmatics.

Asociación entre factores ambientales e ingresos por bronquiectasias en Badalona, Barcelona (2007-2015)

INTRODUCTION The relationship between environmental factors and the exacerbation of respiratory diseases has been widely studied. However, there are no studies examining the relationship between these factors and bronchiectasis exacerbations. Our objective was to analyse the association between various environmental factors and hospitalisation for bronchiectasis. MATERIAL AND METHODS This was a retrospective observational study conducted at two hospitals in Badalona (Barcelona). The number of hospital admissions for exacerbation of bronchiectasis between 2007 and 2015 was obtained. Through multiple regression we analysed the relationship between the number of exacerbations and mean monthly values of temperature, SO2, NO, NO2, O3 and CO. RESULTS Temperature, SO2, NO, NO2, O3 and CO were significantly associated with an increase in admissions due to exacerbation of bronchiectasis. By controlling the effect of temperature on the pollution variables, only SO2 maintained statistical significance (P=.008). CONCLUSION We have detected an increase in hospital admissions for exacerbation of bronchiectasis with increases in the atmospheric concentration of SO2 and the decrease in temperature. Prospective studies with different geographical locations to confirm these results are needed.

Mucus hypersecretion in asthma is associated with rhinosinusitis, polyps and exacerbations.

BACKGROUND Bronchial hypersecretion is a poorly studied symptom in asthma. The aim of the study was to determine the specific characteristics of asthmatics with bronchial hypersecretion. METHODS A total of 142 asthmatics (21.8% men; mean age 49.8 years) were prospectively followed for one year. Mucus hypersecretion was clinically classified into two severity categories: daily sputum production and frequent expectoration but not every day. Clinical and pulmonary function variables associated with mucus hypersecretion were assessed by multiple logistic regression analysis. RESULTS Daily cough was recorded in 28.9% of patients and sputum production daily or most of the days in 52.1%. Patients with mucus hypersecretion had more dyspnoea, poorer asthma control and quality of life, had suffered from more exacerbations and showed anosmia associated with chronic rhinosinusitis and nasal polyposis more frequently. Factors associated to mucus hypersecretion were anosmia, one exacerbation or more in the previous year and FEV1/FVC <70% (AUC 0.75, 95% CI 0.66-0.85) for the first definition of hypersecretion, and anosmia, poor asthma control and age (AUC 0.75, 95% CI 0.67-0.83) for the second definition. CONCLUSIONS Mucus hypersecretion is frequent in patients with asthma, and is associated with chronic upper airways disease, airway obstruction, poor asthma control and more exacerbations.

Effect of Air Pollution on Exacerbations of Bronchiectasis in Badalona, Spain, 2008–2016

Introduction: Air pollution has been widely associated with respiratory diseases. Nevertheless, the association between air pollution and exacerbations of bronchiectasis has been less studied. Objective: To analyze the effect of air pollution on exacerbations of bronchiectasis. Methods: This was a retrospective observational study conducted in Badalona. The number of daily hospital admissions and emergency room visits related to exacerbation of bronchiectasis (ICD-9 code 494.1) between 2008 and 2016 was obtained. We used simple Poisson regressions to test the effects of daily mean temperature, SO2, NO2, CO, and PM10 levels on bronchiectasis-related emergencies and hospitalizations on the same day and 1–4 days after. All p values were corrected for multiple comparisons. Results: SO2 was significantly associated with an increase in the number of hospitalizations (lags 0, 1, 2, and 3). None of these associations remained significant after correcting for multiple comparisons. The number of emergency room visits was associated with higher levels of SO2 (lags 0–4). After correcting for multiple comparisons, the association between emergency room visits and SO2 levels was statistically significant for lag 0 (p = 0.043), lag 1 (p = 0.018), and lag 3 (p = 0.050). Conclusions: The number of emergency room visits for exacerbation of bronchiectasis is associated with higher levels of SO2.