Juan Bautista Galdiz Iturri

Oxigenoterapia continua domiciliaria

Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.

Normativa del asma ocupacional

El asma ocupacional (AO) es la enfermedad ocupacional más frecuente en los países industrializados y se estima que aproximadamente un 15% de todas las asmas del adulto pueden ser de origen ocupacional. Un diagnóstico correcto y un temprano manejo son puntos clave para el pronóstico de la enfermedad y sus consecuencias socioeconómicas. La repercusión de estas actuaciones no sólo afecta a la persona implicada, sino que en ocasiones la modificación de las condiciones de trabajo y de otros ámbitos laborales similares puede llevar a evitar otros muchos casos. Los beneficios, así, son importantes para la salud de la población trabajadora, y también para la economía de las empresas y de la sociedad en general. Valorando la trascendencia de esta enfermedad, el comité científico de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha encargado al Dr. Orriols Martínez la coordinación de un grupo de excelentes profesionales, pertenecientes a las áreas de Enfermedades Respiratorias de Origen Laboral (EROL) y Asma de SEPAR, para la redacción de esta normativa, que pretende proporcionar una ayuda clara y concisa en el diagnóstico y posterior manejo del paciente en el que se sospecha AO.

Clinical Application of the COPD Assessment Test: Longitudinal Data From the COPD History Assessment in Spain (CHAIN) Cohort

OBJECTIVE The COPD Assessment Test (CAT) has been proposed for assessing health status in COPD, but little is known about its longitudinal changes. The objective of this study was to evaluate 1-year CAT variability in patients with stable COPD and to relate its variations to changes in other disease markers. METHODS We evaluated the following variables in smokers with and without COPD at baseline and after 1 year: CAT score, age, sex, smoking status, pack-year history, BMI, modified Medical Research Council (mMRC) scale, 6-min walk distance (6MWD), lung function, BODE (BMI, obstruction, dyspnea, exercise capacity) index, hospital admissions, Hospital and Depression Scale, and the Charlson comorbidity index. In patients with COPD, we explored the association of CAT scores and 1-year changes in the studied parameters. RESULTS A total of 824 smokers with COPD and 126 without COPD were evaluated at baseline and 441 smokers with COPD and 66 without COPD 1 year later. At 1 year, CAT scores for patients with COPD were similar (± 4 points) in 56%, higher in 27%, and lower in 17%. Of note, mMRC scale scores were similar (± 1 point) in 46% of patients, worse in 36%, and better in 18% at 1 year. One-year CAT changes were best predicted by changes in mMRC scale scores (β-coefficient, 0.47; P < .001). Similar results were found for CAT and mMRC scale score in smokers without COPD. CONCLUSIONS One-year longitudinal data show variability in CAT scores among patients with stable COPD similar to mMRC scale score, which is the best predictor of 1-year CAT changes. Further longitudinal studies should confirm long-term CAT variability and its clinical applicability. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.

Magnetic Stimulation of the Quadriceps: Analysis of 2 Stimulators Used for Diagnostic and Therapeutic Applications

Compromised muscle function can be evaluated in respiratory disease patients by supramaximal magnetic stimulation (isometric twitch) of the quadriceps, a technique that is reproducible and objective. We validated the technique, comparing a device used in our laboratory with another reference electromagnet. We also assessed whether the technique could potentially be used to train the muscle by repetitive stimulation. The Medtronic Magpro (MED) device with a circular coil and the Magstim 200 device (MAG) with a figure-of-eight coil (reference device) were used to stimulate the femoral nerve of 6 volunteers at different percentages of maximal output. MED stimulation was also applied on the quadriceps muscle. We measured voluntary contractions, comparing measurements from the 2 devices and on different days. The stimulation achieved with MED was lower than with MAG, showed greater day-to-day variability, and was not clearly supramaximal. MED quadriceps stimulation was 80.7% of MAG stimulation. In conclusion, supramaximal stimulation of the quadriceps cannot be guaranteed with MED and the circular coil. However, this device generates sufficient contraction when applied to the muscle to be used for repetitive stimulation.

Comparison of 2 methods for inspiratory muscle training in patients with chronic obstructive pulmonary disease

OBJECTIVE The aim of this study was to compare the use of threshold and resistive load devices for inspiratory muscle training in patients with chronic obstructive pulmonary disease (COPD). A randomized prospective trial was designed to compare use of the 2 devices under training or control conditions. PATIENTS AND METHODS Thirty-three patients with moderate or severe COPD were randomly assigned to home treatment with a threshold device, a resistive load device, or a control situation in which either of those devices was maintained at a minimum load throughout the study. Training was performed daily in 2 sessions of 15 minutes each for 6 weeks. In the patients who underwent training with threshold (n=12) and resistive load (n=11) devices, the loads used were adjusted weekly until the maximum tolerated load was reached to ensure that the interventions were as equivalent as possible. Respiratory function, respiratory muscle function, and quality of life were assessed before and after training and the different inspiratory pressure profiles were compared between training groups. RESULTS Both peak inspiratory pressure and scores on the Chronic Respiratory Questionnaire (CRQ) improved in the groups that received inspiratory muscle training compared with control subjects: maximal static inspiratory pressure increased from 86 cmH2O to 104.25 cmH2O (P< .01) in the threshold device group and from 91.36 cm H2O to 105.7 cmH2O (P< .01) in the resistive load device group. The resistive load group showed the largest increase in CRQ quality-of-life scores. Differences between the dyspnea score on the CRQ at the beginning and end of the training period were as follows: 3 points in the resistive load group, 2.58 in the threshold group, and 2.5 in the control group. Significant differences in duty cycle measured during training sessions were observed between groups at the end of training (0.31 in the threshold group and 0.557 in the resistive load group), but the mean pressure-time index was similar (0.11) in both groups because of the greater peak and mean inspiratory pressures in the threshold device group. CONCLUSIONS Load readjustment allowed equivalent training intensities to be achieved with different inspiratory pressure profiles. Our study demonstrated the effectiveness of inspiratory muscle training without control of breathing pattern but showed no superiority of one training method over another.

Estimulación magnética del cuádriceps. Análisis de 2 estimuladores de uso diagnóstico y terapéutico

La estimulacion supramaxima o twitch magnetico isometrico del cuadriceps es una tecnica reproducible y objetiva que nos informa sobre la funcion muscular, que se encuentra comprometida en las enfermedades respiratorias. Hemos validado la tecnica estandar y comparado un equipo utilizado en nuestro laboratorio con otro electroiman de referencia. Tambien evaluamos el potencial de la tecnica para entrenamiento muscular mediante estimulacion repetitiva. Los equipos Magstim 200 con pala en mariposa (MAG, equipo de referencia) y Medtronic Magpro con pala circular (MED) se aplicaron sobre el nervio femoral de 6 voluntarios, a diferentes porcentajes del estimulo maximo. El MED se aplico tambien sobre el musculo cuadriceps (MED-Q). Se realizaron medidas voluntarias y comparaciones entre equipos y dias diferentes. El MED alcanzo valores menores que el MAG, con mayor variabilidad entre dias y sin clara supramaximalidad. La estimulacion MED-Q fue equivalente al 80,7% del MAG. En conclusion, no puede garantizarse un estimulo supramaximo del cuadriceps con el MED y pala redonda, aunque esta, aplicada sobre el musculo, genera una contraccion que avala este abordaje para la estimulacion repetitiva.

Telerrehabilitación, ¿una estrategia eficaz en programas de rehabilitación respiratoria?

La rehabilitación respiratoria (RR) ha demostrado proporcionar beneficios en pacientes con EPOC con un grado máximo de evidencia. Estos beneficios se centran principalmente en un aumento en la capacidad de esfuerzo para las actividades de la vida diaria y una mejora en la calidad de vida relacionada con la salud. Una crítica constante a la RR es el hecho de que los beneficios logrados con los programas se pierden de forma progresiva y constante una vez que el paciente ha finalizado la fase intensiva y pierde el contacto con el equipo. Esta limitación hace que diferentes normativas insistan en la necesidad de encontrar nuevas estrategias que intenten resolver esta limitación1,2. Desde un punto de vista teórico, si en pacientes con EPOC un programa de RR utilizando la telemedicina fuera capaz de mantener los beneficios logrados por la RR tras un periodo de entrenamiento intensivo, esta estrategia podría ser considerara como un enfoque útil para llevar a cabo programas de mantenimiento de RR que pudieran incluir un mayor número de pacientes. Algunos programas han sido capaces de mantener los beneficios iniciales utilizando estrategias que consistían en la prolongación del programa habitual durante un periodo de 6 meses, en contraste con la duración de los programas habituales de 8 semanas. En un estudio clásico, Troosters et al.3, en pacientes ambulatorios y con un programa de 6 meses de duración obtuvieron un mantenimiento de los beneficios tras 18 meses de seguimiento. Wilson et al.4 con un diseño de mantenimiento de baja intensidad, controles cada 3 meses, tras el programa intensivo inicial de RR, observaron que a pesar de los esfuerzos para motivar a los pacientes en sesiones muy seguidas en el tiempo no consiguieron aumentar la actividad física, perdiéndose los efectos beneficiosos antes del primer control realizado a los 3 meses. Son numerosos los estudios que han demostrado las dificultades de mantener los beneficios tras un programa intensivo de RR.

Normativa SEPAROxigenoterapia continua domiciliariaContinuous Home Oxygen Therapy

Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.