Carlos Villasante

Estudio IBERPOC en España: prevalencia de síntomas respiratorios habituales y de limitación crónica al flujo aéreo

Se ha estudiado la prevalencia de los sintomas respiratorios habituales y de la limitacion cronica al flujo aereo mediante un estudio epidemiologico multicentrico realizado en 7 zonas geograficas diferentes de Espana. A partir de una poblacion diana de 236.412 personas, se ha seleccionado aleatoriamente una muestra censal de 4.035 individuos de entre 40 y 69 anos. Se les pasaron varios cuestionarios y se realizo una espirometria seguida de una prueba broncodilatadora cuando existia una obstruccion bronquial. El 48% de la poblacion referia algun sintoma respiratorio (IC del 95% = 46,4-49,5%), con mayor frecuencia entre los varones que entre las mujeres (el 55,2 frente al 41%; p

Interpretation of quality of life scores from the St George's Respiratory Questionnaire

The aim of the study was to obtain the general population norms for the St. Georges Respiratory Questionnaire (SGRQ), a specific questionnaire for respiratory diseases. The IBERPOC project was a cross-sectional study of representative samples of the general population aged between 40–69 yrs. The study sample was composed of 862 individuals. All participants considered as “probable cases” of chronic obstructive pulmonary disease (COPD) (n=460) were eligible to complete the SGRQ and among the rest of the nonprobable COPD participants (n=3,571), 10 individuals from each defined age and sex group were eligible (n=402). Weights were applied to restore general population representativity of the sample. Mean forced expiratory volume in one second (FEV1) predicted was 89.4% (sd=16.5%; range: 16–131%). Chronbachs alpha coefficients were >0.7 in the symptoms, activity and impact scales, and >0.9 in the overall scale. Symptom scale score was significantly higher among males (11.6 versus 7.8; p<0.01) and activity scale score was significantly higher among females (12.2 versus 14.6; p=0.04). In a multiple linear regression model, respiratory diseases (asthma and COPD) and FEV1 % over pred showed the strongest association with the SGRQ total score. Smoking, sex, age and education were independently associated with the total SGRQ score. These results indicate that individuals from the general population presented some of the problems that are important when measuring health-related quality of life in respiratory patients, and provide St Georges Respiratory Questionnaire norms, a useful method for interpreting the St Georges Respiratory Questionnaire score in a given patient or study samples.

Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997–2007

We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n = 4,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n = 3,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1–10.2%) in 1997 to 4.5% (95% CI 2.4–6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40–69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p<0.05) within this 10-yr frame. The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.

Costes de la EPOC en España. Estimación a partir de un estudio epidemiológico poblacional

Objetivo En los estudios realizados hasta ahora, el coste de la enfermedad pulmonar obstructiva cronica (EPOC) puede estar sobrestimado porque han incluido a pacientes previamente diagnosticados que consultaron por sus sinto-mas, por lo que la gravedad puede ser superior a la que re-almente tendria una poblacion no seleccionada obtenida de la poblacion general. El proposito del presente estudio fue estimar el coste directo de la EPOC basandose en una mues-tra representativa del conjunto de la poblacion espanola de entre 40 y 69 anos (estudio IBERPOC). Metodo El coste se evaluo retrospectivamente a traves de un cuestionario referido al ultimo ano en los 363 pacien-tes con EPOC del estudio IBERPOC. Un neumologo realizo a todos ellos una espirometria estandarizada en cada una de las 7 areas geograficas en las que se llevo a cabo el estudio. Resultados La asistencia hospitalaria fue el coste mas elevado (41% del coste total), seguido del tratamiento farma-cologico (37%). El coste por paciente fue de 98,39 €, y por paciente previamente diagnosticado, de 909,5 €. El coste de la EPOC grave por persona fue mas de tres veces el coste de la EPOC moderada y mas de 7 veces el coste de la EPOC leve. El coste anual estimado de la EPOC en Espana fue de 238,82 millones de euros (informacion referida a 1997). Conclusiones Este es el primer estudio que estima el coste de la EPOC en una muestra representativa de la poblacion general, que es inferior al calculado por los estudios que han analizado una muestra seleccionada con diagnostico previo de EPOC. La distribucion del gasto no se ajusta a las practi-cas asistenciales recomendables, por lo que son necesarias actuaciones que optimicen los recursos empleados en el se-guimiento y en el tratamiento de la enfermedad, prestando especial atencion a su diagnostico temprano.

Prognostic Value of the Objective Measurement of Daily Physical Activity in Patients With COPD

BACKGROUND Subjective measurement of physical activity using questionnaires has prognostic value in COPD. However, their lack of accuracy and large individual variability limit their use for evaluation on an individual basis. We evaluated the capacity of the objective measurement of daily physical activity in patients with COPD using accelerometers to estimate their prognostic value. METHODS In 173 consecutive subjects with moderate to very severe COPD, daily physical activity was measured using a triaxial accelerometer providing a mean of 1-min movement epochs as vector magnitude units (VMUs). Patients were evaluated by lung function testing and 6-min walk, incremental exercise, and constant work rate tests. Patients were followed for 5 to 8 years, and the end points were all-cause mortality, hospitalization for COPD exacerbation, and annual declining FEV(1). RESULTS After adjusting for relevant confounders, a high VMU decreased the mortality risk (adjusted hazard ratio [HR], 0.986; 95% CI, 0.981-0.992), and in a multivariate model, comorbidity, endurance time, and VMU were retained as independent predictors of mortality. The time until first admission due to COPD exacerbation was shorter for the patients with lower levels of VMU (adjusted HR, 0.989; 95% CI, 0.983-0.995). Moreover, patients with higher VMU had a lower hospitalization risk than those with a low VMU (adjusted incidence rate ratio, 0.099; 95% CI, 0.033-0.293). In contrast, VMU was not identified as an independent predictor of the annual FEV(1) decline. CONCLUSION The objective measurement of the daily physical activity in patients with COPD using an accelerometer constitutes an independent prognostic factor for mortality and hospitalization due to severe exacerbation.

Estudio epidemiológico de la EPOC en España (IBERPOC): reclutamiento y trabajo de campo

La enfermedad pulmonar obstructiva cronica constituye un problema sociosanitario de primera magnitud. Hasta el momento solo existen estudios de prevalencia realizados en determinadas areas geograficas de Espana; por este motivo, la Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) impulso el estudio IBERPOC destinado a conocer la prevalencia de la enfermedad pulmonar obstructiva cronica en diversas zonas de Espana. Se trata de un estudio epidemiologico multicentrico, de base poblacional y seleccion aleatoria de los participantes que se desarrollo en 7 areas distintas por 7 neumologos investigadores dedicados a tiempo completo al trabajo de campo. Un estudio de esta naturaleza comporta una serie de dificultades que se deben conocer para planear estudios de similares caracteristicas. A partir de 5.827 intentos de contacto se consiguio un total de 4.967 contactos utiles, lo que supone un 97,3% de los 5.104 esperados; de estos 4.035 fueron entrevistas completas. Entre las 932 negativas, 882 (94,6%) aceptaron contestar un cuestionario telefonico breve. El tiempo necesario para completar el trabajo de campo fue de 13 meses, un 30% superior al planeado. Las tasas de individuos no localizados fueron diferentes entre las zonas, oscilando entre el 5 y el 30%. Los casos con mayor tasa de no localizados se debieron a la ausencia de datos telefonicos en el censo correspondiente. En una de las zonas, la gran dispersion de la poblacion contenida en el censo condiciono una mayor dificultad y retraso en la realizacion del estudio. En conclusion, las tasas de participacion y el ritmo de reclutamiento se pueden considerar satisfactorios. La realizacion del trabajo de campo por neumologos entrenados con dedicacion completa ha sido fundamental en el desarrollo y en la calidad del estudio. En investigaciones epidemiologicas similares se deberian considerar los problemas derivados de la existencia de datos insuficientes en el censo, asi como evitar la dispersion de la poblacion para facilitar el trabajo de campo.

Costs of Chronic Obstructive Pulmonary Disease in Spain: Estimation From a Population-Based Study

OBJECTIVE In the studies carried out to date, the cost of chronic obstructive pulmonary disease (COPD) may have been overestimated due to the inclusion of previously diagnosed patients seeking medical attention for their symptoms. As a result, the severity of the cases included in these studies may have been greater than in an unselected sample of the general population. The aim of the present study was to estimate the direct cost of COPD on the basis of a representative sample of the overall Spanish population between 40 and 69 years of age (from the IBERPOC study). METHOD The cost was evaluated retrospectively by means of a questionnaire completed by the 363 patients with COPD from the IBERPOC study with questions referring to the previous year. Standardized spirometry was performed on all the patients by a pneumologist in each of the 7 geographical areas in which the study was carried out. RESULTS Hospitalization accounted for the greatest expenditure (41% of total), followed by drug therapy (37%). The cost was euro;98.39 per patient, and euro;909.50 per previously diagnosed patient. The cost per person of severe COPD was more than 3 times that of moderate COPD and more than 7 times that of mild COPD. The estimated annual cost of COPD in Spain was euro;238.82 million (for 1997). CONCLUSION The present study, which was the first to estimate the cost of COPD in a representative sample of the general population, found the cost to be lower than in studies analyzing samples of patients with previous diagnoses of COPD. The cost distribution is not in line with recommended health care practices, underlining the need to optimize resources used to monitor and treat the disease, with an emphasis on early diagnosis.

Value of CT-guided fine needle aspiration in solitary pulmonary nodules with negative fiberoptic bronchoscopy.

The usefulness of fine needle aspiration (FNA) with CT-guidance was evaluated in the diagnosis of solitary pulmonary nodules (SPN) following negative fiberoptic bronchoscopy in 84 patients. The records were analyzed for all patients with SPN who had undergone chest FNA in the years 1988 to 1990, showing previous nondiagnostic fiberoptic bronchoscopy. A final diagnosis was made by biopsy (transbronchial, thoracotomy or necropsy), response to therapy or follow-up of the lesions. The patients had medium-sized lesions, 2.87 ± 1.11 cm, adherent to the pleura in 62%. In the diagnosis of malignancy FNA showed 76% sensitivity, 100% specificity, 100% positive predictive value, 52% negative predictive value and 81% accuracy. These results were correlated with histology in 84% of the cases. One pulmonary hemorrhage, which resolved spontaneously, and 12 cases of pneumothorax, requiring a thoracic tube in 4 patients, were noted.

Lung volume reference values for women and men 65 to 85 years of age.

RATIONALE In elderly subjects, static lung volumes are interpreted using prediction equations derived from primarily younger adult populations. OBJECTIVES To provide reference equations for static lung volumes for European adults 65 to 85 years of age and to compare the predicted values of this sample with those from other studies including middle-aged adults. We compare the lung volumes by plethysmography and helium dilution in elderly subjects. METHODS Reference equations were derived from a randomly selected sample from the general population of 321 healthy never-smoker subjects 65 to 85 years of age. Spirometry and lung volume determinations by plethysmography and multibreath helium equilibration method were performed following the American Thoracic Society/European Respiratory Society recommendations. Reference values and lower and upper limits of normal were derived using a piecewise polynomial model. MEASUREMENTS AND MAIN RESULTS Plethysmography provided higher values than the dilutional method for all lung volumes, with wide limits of agreement. In addition to height, our reference equations confirm the age- and body size dependence of lung volumes in older subjects. Practically all the estimations performed by extrapolating reference equations of middle-aged adults overpredicted the true lung volumes of our healthy elderly volunteers. Middle-aged reference equations classify subjects as being below the total lung capacity lower limit of normal between 17.9 and 62.5% of the women and between 12.5 and 42.2% of the men of the current study. CONCLUSIONS These results underscore the importance of using prediction equations appropriate to the origin, age, and height characteristics of the subjects being studied.

Can cumulative tobacco consumption, FTND score, and carbon monoxide concentration in expired air be predictors of chronic obstructive pulmonary disease?

Between 15% and 20% of smokers develop chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine which characteristics of smoking, particularly the Fagerström Test for Nicotine Dependence (FTND) score, were associated with the risk of developing COPD. Data from the IBERPOC epidemiological study were analyzed. IBERPOC was a multicenter epidemiological study including 4035 individuals aged 40-69 years, 1023 (25%) of whom were active smokers. We analyzed the association between smoking characteristics--such as the cumulative consumption of tobacco, FTND score, and expired-air carbon monoxide levels--and the diagnosis of COPD. Among the smokers, 153 (15%) were diagnosed with COPD. A cumulative tobacco consumption of more than 30 pack-years (OR=4.24, 95% CI=2.83-6.36) and the FTND score (OR=1.11, 95% CI=1.02-1.21, for each point increase) were significantly associated with the diagnosis of COPD in the model obtained by logistic regression analysis with the full sample of smokers. Cumulative consumption of tobacco was associated with the diagnosis of COPD. For each point increase in the FTND score, the probability of a smoker developing COPD increased by 11%.