Gabriel Juliá Serdá

Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias

INTRODUCTION The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking. MATERIALS AND METHODS A random group of 1,353 subjects aged between 40 and 70years was selected from a sample population of 596,478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV1/FVC ratio was less than 0.70. RESULTS The prevalence of COPD was 7.3% (95%CI: 5.5-9.5) and was higher in males than in females (8.7% vs. 6.3%, P=.134). The incidence of smoking was 29.4% (95%CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P<.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in groupi, 69.9% in groupii, 10.4% in groupiii and 3.3% in groupiv. 71.6% of the subjects were underdiagnosed and 63.5% undertreated. CONCLUSIONS Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.

Long-term inhaled nitric oxide plus dipyridamole for pulmonary arterial hypertension.

Inhaled nitric oxide (iNO) has been shown to be a potent and selective vasodilator in pulmonary arterial hypertension (PAH). However, the clinical experience in prolonged treatment is limited. We assess the safety and effectiveness of long-term administration of iNO in severe PAH. Two female patients were admitted to our hospital because of severe dyspnea (World Health Organization functional class IV) and hypoxemia. They were diagnosed with PAH (primary and secondary to congenital heart disease) and treated with iNO for 2 years. The delivery system consisted of an NO tank of 800 ppm, a modified gas-pulsing device, and nasal cannulas. On iNO treatment the patients showed remarkable improvement of symptoms, oxygenation and 6-min walk distance. After 16 months the patients began to experience a progressive rebound of symptoms. A phosphodiesterase type 5 inhibitor (dipyridamole) was added to iNO. This intervention proved useful in improving clinical deterioration and hemodynamics. This is the first study reporting 2-year iNO therapy in 2 patients with primary and secondary pulmonary hypertension. The combination of dipyridamole with iNO augments the pulmonary vasodilatation and may be useful in managing PAH.

Long-term cardiopulmonary function after thoracic sympathectomy: Comparison between the conventional and simplified techniques

OBJECTIVE We sought to compare the long-term effects of conventional and simplified thoracic sympathectomy on cardiopulmonary function. METHODS We performed a prospective and randomized study of 32 patients with diagnoses of primary hyperhidrosis who were candidates for either conventional or simplified thoracic sympathectomy. Patients were randomized according to the type of procedure: conventional thoracic sympathectomy (18 patients) and simplified thoracic sympathectomy (14 patients). Before surgical intervention, forced spirometry, body plethysmography, measurement of the diffusing capacity of the lung for carbon monoxide (DLCO), and exercise tests were carried out in all patients. These evaluations were performed again 1 year after the procedure to assess the long-term effects of sympathectomy. RESULTS Lung function tests revealed a significant decrease in forced expiratory volume in 1 second (FEV(1)) and forced expiratory flow between 25% and 75% of vital capacity (FEF(25%-75%)) in both groups (FEV(1) of -6.3% and FEF(25%-75%) of -9.1% in the conventional thoracic sympathectomy group and FEV(1) of -3.5% and FEF(25%-75%) of -12.3% in the simplified thoracic sympathectomy group). DLCO and heart rate at rest and maximal values after exercise were also significantly reduced in both groups (DLCO of -4.2%, DLCO corrected by alveolar volume of -6.1%, resting heart rate of -11.8 beats/min, and maximal heart rate of -9.5 beats/min in the conventional thoracic sympathectomy group and DLCO of -3.9%, DLCO corrected by alveolar volume of -5.2%, resting heart rate of -10.7 beats/min, and maximal heart rate of -17.6 beats/min in the simplified thoracic sympathectomy group). Airway resistance increased significantly in the group of patients undergoing conventional thoracic sympathectomy (+13%). Despite all these changes, the patients remained asymptomatic. No significant differences were found between the conventional and simplified thoracic sympathectomy groups. CONCLUSIONS Simplified and conventional thoracic sympathectomy resulted in a long-term reduction in FEV(1), FEF(25%-75%), DLCO, and resting and maximal heart rate, as well as a mild but significant increase in airway resistance in the conventional thoracic sympathectomy group, without any clinical consequence to the patient. These changes were unrelated to the level of transection of the thoracic sympathetic chain.

Pulmonary Cavities after Diagnostic Transbronchial Cryobiopsy in a Lung Transplantation Patient

bacteria identified as Pseudomonas aeruginosa were isolated from bronchial aspirate. All microbiological tests on peripheral blood and BAL were negative. Histologically, the findings revealed bronchiolitis obliterans confirming the suspected diagnosis of chronic lung transplant rejection. Our patient received high-dose systemic steroid therapy with a good response. Nineteen days following the technique, a HRCT showed almost complete resolution of both lesions (Fig. 1d). As far as we know, there is no report on the literature describing such images after a cryobiopsy. These changes in the lung parenchyma might occur in all patients and we might not have seen them yet as it is not a common practice to perform a CT after a cryobiopsy. We find the conjunction of the laceration itself, the local effects of congelation around the freezing point and a feasible valve mechanism due to the presence of bronchiolitis obliterans in our patient more suitable for explanation. Pulmonary cavities may be the visible expression of different infectious and noninfectious processes; therefore, to be aware that this procedure may cause cavities in the lung parenchyma may be clinically relevant. Lack of knowledge of these transient injuries might lead to an incorrect diagnosis and delayed steroid treatment in these patients. Over the last few years, cryobiopsy has been accepted as a safe and useful technique in the differential diagnosis of diffuse interstitial lung disease [1]. It has also been successfully used to identify lung transplant rejection with a low complication rate [2]. A 46-year-old woman with a history of primary ciliary dyskinesia and lung transplantation 14 years ago was admitted to the hospital due to lung function decline and a 10-day symptomatology of dyspnea. Physical examination, initial routine laboratory tests and chest radiograph were unremarkable (Fig. 1a). Bronchoalveolar lavage (BAL) was performed during flexible bronchoscopy at the time of admission and prophylactic antimicrobial treatment was started according to protocol while awaiting results. Forty-eight hours after admission, a transbronchial cryobiopsy was carried out via a flexible bronchoscope, under general anesthesia with a laryngeal mask, using fluoroscopy and the Arndt endobronchial blocker. Two samples were obtained from different segments (anterior and lateral) of the left lower lobe with minimal self-limited bleeding without major complications (Fig. 1b). Six days after the procedure, a chest high-resolution computed tomography (HRCT) showed two small cavitary lesions in the left lower lobe surrounded by a halo of ground-glass opacity (Fig. 1c) and air-trapping on expiratory sections. Gram-negative Published online: September 5, 2017