Javier Hueto

Spirometry in Primary Care in Navarre, Spain

OBJECTIVE To analyze the use and quality of spirometry in primary care settings in Navarre, Spain. PATIENTS AND METHODS A questionnaire was completed simultaneously by professionals responsible for spirometry in all of the primary health care centers in Navarre. Data were collected on availability, model of spirometer, frequency of use, calibration, methods, personnel responsible for testing, and training of personnel. Then, baseline spirometry without a bronchodilator test was performed in 171 patients in their primary health care center and then the test was repeated on the same day in a hospital pneumology department. Spirometry was supervised by 2 pneumologists who jointly assessed the acceptability of the flow-volume curves. The quality of spirometry was assessed according to the recommendations of the American Thoracic Society and the interpretation of spirometry results according to the criteria of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). RESULTS A total of 90.9% of primary health care centers in Navarre have a spirometer, although 22% of those spirometers have never been used. Only 2 centers performed between 10 and 20 spirometry tests per week and none performed more than 20. In 96% of primary health care centers the spirometers were not regularly calibrated. The professionals who performed spirometry were not dedicated for that task in 51.2% of cases, and the mean period of supervised training was 10 hours. When comparisons were made between the mean values obtained in the primary care centers and the pneumology department, statistically significant differences were detected for forced vital capacity (P < .0001) and forced expiratory volume in the first second (P = .0002). Significant differences were also found between the flow-volume curves performed in the 2 different care settings for the initial and end portions of the curve as well as for the slope. The criteria for reproducibility recommended by the American Thoracic Society were not met in 76% of cases for forced vital capacity and 39.7% of cases for forced expiratory volume in the first second. Incorrect functional diagnosis occurred in 39.7% of spirometry tests and there was a tendency in the primary care settings to falsely diagnose patterns as restrictive and to inadequately classify the severity of obstruction. CONCLUSIONS Despite the fact that spirometers are available in the majority of primary health care centers in Navarre, we found a marked underuse of these devices and little compliance with recommendations for the use of spirometry. Furthermore, the quality of the measurements performed in this care setting was very low.

Effects of Combined Resistance and Endurance Training Versus Resistance Training Alone on Strength, Exercise Capacity, and Quality of Life in Patients With COPD.

PURPOSE: To compare the effects of 12-week training periods (2 d·wk−1) involving resistance training only with the effects of 12-week training periods involving combined resistance (once weekly) and endurance (once weekly) training on strength, endurance performance, and quality of life. METHODS: Thirty-six patients with moderate-to-severe chronic obstructive pulmonary disease were randomized to combined training (REG), resistance training alone (RG), or control (CG) groups. Patients were tested for maximal strength of the upper and lower extremities, power output of the lower extremities, maximal (W max) and submaximal exercise capacity, performance on a 6-minute walk test (6MWT), and quality of life. RESULTS: REG and RG induced similar maximal strength gains. Muscle power increased 19% (P ⩽ .01) and W max improved 13% (P < .05) in REG. Reductions (P < .05) in the heart rate and blood lactate at a given submaximal workload were observed in REG. Improvements in 6MWT and quality of life were similar in both training groups. CONCLUSIONS: Compared with a twice-weekly resistance training program, the combination of once-weekly resistance and once-weekly endurance training not only produced similar gains in maximal strength, 6MWT performance, and quality of life but also produced improvements in muscle power and endurance performance. These findings may have implications for the prescription of resistance and endurance exercise for patients with chronic obstructive pulmonary disease.

Transbronchial Cryobiopsy in Interstitial Lung Disease: Are We on the Right Path?

Background:A definitive and specific diagnosis of interstitial lung disease (ILD) often requires a histologic analysis of the lung parenchyma. A transbronchial biopsy with forceps has a limited diagnostic yield for idiopathic interstitial pneumonias. The incorporation of a transbronchial lung cryobiopsy for diagnosing ILD appears to be very promising, although there are only a few published studies in this regard. Our paper shows the results of using this technique in our center. Methods:This was a prospective study including 55 patients with ILD diagnosed from January 2012 to January 2015. The methodology used, the overall diagnostic yield, and the number and the location of samples, in addition to complications, have been reported. Results:In 38 (69%), 10 (20.8%), and 7 (12.7%) cases, we obtained a certain, highly likely, and unclassifiable diagnosis of interstitial pneumonia, respectively. With 18 cases, usual interstitial pneumonia was the most common diagnosis. The most common complication was a pneumothorax in 8 patients (14.5%). Conclusions:A transbronchial lung cryobiopsy using a flexible cryoprobe has a good diagnostic yield and might be an alternative to consider in cases of diffuse ILD in which a histologic sample is required for diagnosis. This technique could avoid a large number of surgical biopsies.

The Relationships Between Muscle Power and Physical Activity in Older Men With Chronic Obstructive Pulmonary Disease

The purpose of this study was to determine the potential relationship between muscle power of the lower extremities and the physical activity in older men with chronic obstructive pulmonary disease (COPD). Forty-four men (70.3 ± 6.7 years old) with moderate-to-severe COPD completed the 6-min walk test (6MWT), BODE (body mass index, obstruction, dyspnea, and exercise), a one-repetition maximum strength of the quadriceps femoris (1RMQF), and muscle power at 50% and 70% 1RMQF. Physical activity was measured using an accelerometer. The 6MWT was associated with muscle power at 50% 1RMQF (r = .40; P = .013) but not muscle power at 70% 1RMQF (r = .24; P = .15) or 1RMQF (r = .13; P = .44). Light-intensity activity was positively correlated with muscle power at 50% 1RMQF (r = .52; P = .001). Lower limb muscle power is associated with the 6MWT and light-intensity activities in older men with COPD.

Situación en Navarra del diagnóstico y tratamiento en el síndrome de apneas-hipopneas obstructivas durante el sueño

Objetivo Evaluar la situacion del diagnostico y tratamiento en el sindrome de apneas-hipopneas obstructivas durante el sueno (SAHS) y conocer algunas caracteristicas de los pacientes tratados con presion nasal positiva continua en la via aerea (n-CPAP) en nuestra comunidad. Metodologia Se incluyo en el estudio a todos los pacientes que en julio de 2000 recibian tratamiento con n-CPAP a cargo del Servicio Navarro de Salud. Una enfermera realizo una visita a cada paciente en la que rellenaba un formulario con datos epidemiologicos, antropometricos y clinicos; posteriormente llevaba a cabo las siguientes exploraciones: medicion del CO en el aire espirado, determinacion de la presion de n-CPAP utilizada y lectura del contador horario de la n-CPAP. Entre uno y 2 meses despues, y sin previo aviso, se ponia de nuevo en contacto con el usuario y se procedia a una segunda visita en la que realizaba una segunda determinacion de CO en el aire espirado y nueva lectura del contador. Resultados La tasa de prevalencia de tratamientos con n-CPAP en nuestra comunidad fue de 125 por 100.000 habitantes, y se comprobo un progresivo incremento de las prescripciones anuales. Se visito en el domicilio a 535 pacientes (el 80,7% del total). El 83,5% de las indicaciones fueron realizadas por neumologos; la media de horas/dia reales de utilizacion de n-CPAP fue de 6,1 y existio una correlacion estadisticamente significativa entre las horas de uso de n-CPAP declaradas y las reales; el indice de apneas-hipopneas (IAH) medio fue de 51,5 y este indice no se determino en el 4,2% de los casos. Un 83,7% de los pacientes declaraban tener una tolerancia del tratamiento muy buena o buena y el 24,8% llevaba mas de 4 anos con esta terapia. La enfermedad asociada con el SAHS mas frecuente fue la obesidad, presente en el 73,4% de las personas, seguida de la hipertension arterial en el 40%; 299 enfermos (55,8%) padecian dos o mas enfermedades asociadas y 54 (9,7%) no tenian ninguna. El 45,9% de los casos disponia de polisomnografia convencional como metodo diagnostico y un 49,7% de poligrafia respiratoria; en el 19,4% la nivelacion de la presion se realizo con polisomnografia y el 32,1% no disponia de ningun estudio para este fin. Un 50,8% de las personas referian presentar algun efecto secundario al tratamiento. Conclusiones Elevada tasa de prevalencia de tratamientos con n-CPAP en Navarra y progresivo incremento de prescripciones. Buena tolerancia y cumplimiento de la terapia por parte de los pacientes. Disponibilidad en la mayoria de los casos de polisomnografia o poligrafia respiratoria como metodos diagnosticos de SAHS y alto porcentaje de titulaciones de n-CPAP sin haberse realizado los estudios recomendados.

Are Training Programs Efficient Enough to Improve Spirometry Quality in Primary Care

Objective: To analyse the spirometry situation in primary care (PC), in terms of its use as well as its quality, one decade after our first analysis and to evaluate the effectiveness of the plans instituted since then. Methodology: In the first phase, a survey of all health centres (centros de salud, CSs, in Spanish), similar to the one used in 2005, was conducted in which information was requested regarding spirometric equipment, frequency of use, calibration, and personnel training. Subsequently, 96 patients were referred from PC after having a baseline spirometry conducted at a CS. The spirometry was repeated the same morning with a similar spirometer in the pneumology laboratory. Two expert pneumologists in functionalism analysed the quality of the tests according to the ATS/ERS and SEPAR regulations and compared the results with these obtained in 2005. Results: A spirometer is available in 100% of the CSs (90.9% in 2005). Spirometries are performed in 91.8%, and in 80.3%, daily calibration is performed (4% in 2005). However, the number of spirometries remains similar to that found in our previous study and lower than desired. With respect to their quality, only 40.5% of the 96 tests analysed had sufficient quality (A, B or C in a scale from A to F). The spirometric diagnosis was wrong in 43.7% of the cases (39.7% in 2005), corresponding to an absence of agreement in 29.1% and a discrepancy in the severity in 13.5%. Conclusions: Spirometry in PC continues to be an unresolved problem in our area, and we have ascertained that exclusively training and non-continuing programmes yield insufficient results. Given the magnitude of the problem and knowledge of the existence of projects that have demonstrated their effectiveness, we believe there should be no further delay in implementing any of these strategies adapted to each area.

Muscle power output in older adults with COPD

Introduction: Skeletal muscle power of the lower extremities decreases earlier than muscle strength with advancing age and is more strongly associated with functional performance of activities of daily living (e.g. rising from a chair, walking speed, and climb stairs) than maximal strength in the elderly population. In addition, increasing skeletal muscle power has been associated with a reduction in falls in older adults. It was hypothesized that skeletal muscle power would more strongly associated with functional exercise capacity than maximal strength in older men with chronic obstructive pulmonary disease (COPD). Objective: To determine the relationship between lower extremity skeletal muscle power and functional exercise capacity. Methods: Thirty-five men (aged 70 ± 5) with moderate to severe COPD were tested for thigh muscle mass, maximal strength (1RM), power output of the lower extremities at 50% and 70% 1RM, six minute walking (6MW) distance, and peak oxygen uptake. Results: The 6MW distance was positively associated with power output at 50% 1RM (r= 0.64; p Conclusions: Muscle power output is strongly associated with the 6MW distance than maximal strength. Furthermore, pulmonary rehabilitation programs that include lower extremity muscle power training should be prescribed to older adults with COPD. Support by of the Spanish Ministry of Education and Science DEP2011-30042-C02-01; DEP2011-30042-C01-02.