Laura Vigil

Condensado de aire espirado: estandarización de la recogida de muestras en voluntarios sanos

El condensado de aire espirado (CAE) es una tecnica no invasiva que permite la obtencion de un conjunto de sustancias que expresan el estado funcional del pulmon y otros tejidos. A 20 voluntarios sanos se les realizo un total de 3 pruebas a cada uno: una primera recogida, seguida de otra a los 20 min y la ultima a las 48 h de la inicial. Al final de la prueba se estimaron el volumen de muestra de condensado obtenida y el volumen de aire movilizado. La media (± desviacion estandar) del volumen de muestra de CAE recolectado en 15 min fue de 1,8 ± 0,5 ml, con un intervalo de confianza (IC) del 95% de 1,5 a 2 ml y un coeficiente de variacion del 29%. El analisis de la variancia entre las 3 muestras analizadas no mostro diferencias estadisticamente significativas. La media del volumen de aire inspirado en los 15 min fue de 119 ± 25 l, con un IC del 95% de 112 a 125 l. Nuestros resultados indican que para obtener un volumen de muestra superior a 1,5 ml son necesarios al menos 15 min de recogida y haber movilizado unos 120 l de aire, lo que permite la distribucion en alicuotas para analizar los componentes fisicos y quimicos basicos (conductividad, pH) y ciertos biomarcadores de interes.

Exhaled Breath Condensate: Standardized Collection of Samples From Healthy Volunteers

Expired breath condensate collection is a noninvasive technique for obtaining a sample in which to analyze substances that reflect the functional status of the lung and other tissues. Twenty healthy volunteers provided 3 expired breath samples: the second was collected 20 minutes after the first and the third 48 hours after the first. The air and condensate volumes were assessed. The mean (SD) volume of condensate in exhaled air over a period of 15 minutes was 1.8 (0.5) mL (95% confidence interval [CI], 1.5-2 mL) and the coefficient of variation was 29%. Analysis of variance in the 3 samples demonstrated no significant differences. The mean volume of air inhaled over 15 minutes was 119 (25) L (95% CI, 112-125 L). These results indicate that it takes at least 15 minutes and the inhalation of some 120 L of air to collect a condensate volume that exceeds 1.5 mL, sufficient to allow distribution in aliquots to analyze fundamental physical and chemical properties (conductivity, pH) and certain relevant biomarkers.

Validez y sensibilidad al cambio de la versión española autoadministrada del cuestionario de la enfermedad respiratoria crónica (CRQ-SAS)

INTRODUCTION The interviewer-administered chronic respiratory questionnaire (CRQ-IA) is widely used and has demonstrated excellent properties for measuring health-related quality of life (HRQL) in patients with chronic obstructive pulmonary disease (COPD). However, the self-administered version (CRQ-SAS) in Spanish has not been validated. The aim of this trial was to evaluate the validity and the sensitivity of the Spanish version of the CRQ-SAS in patients with COPD. MATERIAL AND METHODS We randomized 40 patients with COPD (33 treated with pulmonary rehabilitation and 7 with liquid oxygen therapy) to one of the two methods of administration of CRQ (SAS vs. IA) both before and 8 weeks after the treatment. In addition, patients completed the SF-36 questionnaire, pulmonary function tests, and six-minute walk test. RESULTS The CRQ-SAS demonstrated good longitudinal construct validity on all domains with a range of correlations, for the change scores, between 0.46 (P=.05) and 0.71 (P=.01). Regarding sensitivity to change, we observed a minimal clinically significant change in most domains (fatigue 0.71 [P=.02], emotional factor 0.62 [P=.04], control of the disease 0.83 [P=.06]). CONCLUSIONS The Spanish version of CRQ-SAS is valid for evaluating HRQL in COPD patients. The correlations of the CRQ-SAS with other tools provide construct validity and show good sensitivity to change.

Sleep biosignature of Type 2 diabetes: a case–control study

To determine whether or not the sleep disturbances associated with Type 2 diabetes affect the structure of sleep.

Maximal oxygen uptake cannot be estimated from resting lung function and submaximal exercise in patients with chronic obstructive pulmonary disease.

BACKGROUND: Maximal oxygen uptake (VO2max) obtained from incremental exercise testing is a useful indicator of limited exercise capacity. Several prediction equations have been developed to estimate VO2max in patients with chronic obstructive pulmonary disease (COPD), but agreement studies between estimated and measured VO2max are lacking. This study aims to assess agreement between the 6 estimated VO2max equations and direct measures of VO2max evaluated during maximal incremental exercise testing in male COPD patients. METHODS: Patients with stable COPD, in accordance with GOLD guidelines, were included in the study. Agreement between VO2max obtained during incremental exercise testing and VO2max obtained from 6 prediction equations were studied. To estimate VO2max from anthropometric prediction equations, lung function variables and submaximal exercise testing were used. RESULTS: Of the 60 male patients in the study, 12 were GOLD stage II, 24 GOLD stage III, and 24 GOLD stage IV. Five prediction equations underestimated the value of VO2max in relation to measured VO2max: equations 1, 2, 3, 4, and 6, by 14%, 66%, 42.2%, 35%, and 23.3%, respectively. Conversely, prediction equation 5 overestimated measured VO2max by 76.9%. Agreement between all VO2max prediction equations and measured VO2max was poor. Discrepancy between VO2max prediction equations and measured VO2max varied from 20.857 to 0.736 L/min. CONCLUSIONS: The use of lung function at rest and submaximal exercise testing is inaccurate for determining VO2max, which cannot be estimated by prediction equations in patients with stable COPD.

Simpatectomía dorsal bilateral en el tratamiento de la hiperhidrosis esencial: efectos a los 3 años sobre la función pulmonar

INTRODUCTION Primary hyperhidrosis is characterized by excessive sweating of the palms, soles, and axillae due to overactivity of the sympathetic nervous system at the level of the second and third sympathetic thoracic ganglia. The treatment of choice is bilateral dorsal sympathectomy performed using video-assisted thoracic surgery (VATS). The objective of our study was to determine whether lung function changes observed in a group of patients prior to bilateral dorsal sympathectomy performed using VATS were still evident 3 years after surgery. PATIENTS AND METHODS Of the 20 patients studied at baseline, we were able to obtain data for 18 (3 men and 15 women; mean age, 35 y). They underwent spirometry and a bronchial challenge test with methacholine, and the fraction of exhaled nitric oxide (FE(NO)) was measured. The results were compared with those of the tests performed before surgery. RESULTS At 3 years from baseline, we detected a statistically significant increase in forced vital capacity from a mean (SD) of 96% (10%) to 101% (11%) (P=.008), and a statistically significant decrease in midexpiratory flow rate from 3.8 (0.9)L/s to 3.5 (0.9)L/s (P=.01). The results of the bronchial challenge test with methacholine and the FE(NO) remained unchanged. CONCLUSIONS The lung function changes detected point toward minimal, clinically insignificant small airway alterations due to sympathetic denervation following bilateral dorsal sympathectomy performed 3 years earlier.

Bilateral Dorsal Sympathectomy for the Treatment of Primary Hyperhidrosis: Effects on Lung Function at 3 Years

Abstract Introduction Primary hyperhidrosis is characterized by excessive sweating of the palms, soles, and axillae due to overactivity of the sympathetic nervous system at the level of the second and third sympathetic thoracic ganglia. The treatment of choice is bilateral dorsal sympathectomy performed using video-assisted thoracic surgery (VATS). The objective of our study was to determine whether lung function changes observed in a group of patients prior to bilateral dorsal sympathectomy performed using VATS were still evident 3 years after surgery. Patients and methods Of the 20 patients studied at baseline, we were able to obtain data for 18 (3 men and 15 women; mean age, 35 y). They underwent spirometry and a bronchial challenge test with methacholine, and the fraction of exhaled nitric oxide (FENO) was measured. The results were compared with those of the tests performed before surgery. Results At 3 years from baseline, we detected a statistically significant increase in forced vital capacity from a mean (SD) of 96% (10%) to 101% (11%) (P=.008), and a statistically significant decrease in midexpiratory flow rate from 3.8 (0.9) L/s to 3.5 (0.9) L/s (P=.01). The results of the bronchial challenge test with methacholine and the FENO remained unchanged. Conclusions The lung function changes detected point toward minimal, clinically insignificant small airway alterations due to sympathetic denervation following bilateral dorsal sympathectomy performed 3 years earlier.

Optimal Clinical Time for Reliable Measurement of Transcutaneous CO2 with Ear Probes: Counterbalancing Overshoot and the Vasodilatation Effect

OBJECTIVES: To determine the optimal clinical reading time for the transcutaneous measurement of oxygen saturation (SpO2) and transcutaneous CO2 (TcPCO2) in awake spontaneously breathing individuals, considering the overshoot phenomenon (transient overestimation of arterial PaCO2). EXPERIMENTAL SECTION: Observational study of 91 (75 men) individuals undergoing forced spirometry, measurement of SpO2 and TcPCO2 with the SenTec monitor every two minutes until minute 20 and arterial blood gas (ABG) analysis. Overshoot severity: (a) mild (0.1–1.9 mm Hg); (b) moderate (2–4.9 mm Hg); (c) severe: (>5 mm Hg). The mean difference was calculated for SpO2 and TcPCO2 and arterial values of PaCO2 and SpO2. The intraclass correlation coefficient (ICC) between monitor readings and blood values was calculated as a measure of agreement. RESULTS: The mean age was 63.1 ± 11.8 years. Spirometric values: FVC: 75.4 ± 6.2%; FEV1: 72.9 ± 23.9%; FEV1/FVC: 70 ± 15.5%. ABG: PaO2: 82.6 ± 13.2; PaCO2: 39.9.1 ± 4.8 mmHg; SaO2: 95.3 ± 4.4%. Overshoot analysis: overshoot was mild in 33 (36.3%) patients, moderate in 20 (22%) and severe in nine (10%); no overshoot was observed in 29 (31%) patients. The lowest mean differences between arterial blood gas and TcPCO2 was −0.57 mmHg at minute 10, although the highest ICC was obtained at minutes 12 and 14 (>0.8). The overshoot lost its influence after minute 12. For SpO2, measurements were reliable at minute 2. CONCLUSIONS: The optimal clinical reading measurement recommended for the ear lobe TcPCO2 measurement ranges between minute 12 and 14. The SpO2 measurement can be performed at minute 2.

Traqueobroncopatía osteocondroplásica, un hallazgo casual

Please cite this article as: Sota Yoldi LA, Fernández Mellado R, Vigil Vigil L. Traqueobroncopatía osteocondroplásica, un hallazgo casual. Arch Bronconeumol. 2018;54:280. ∗ Corresponding author. E-mail address: lsotayol@hotmail.com (L.A. Sota Yoldi). irregular nodular involvement of the anterolateral wall of the trachea and main bronchi, with a stony consistency, not impinging on the pars membranosa in any way (Fig. 1). Given these characteristic findings, tracheobronchopathia osteochondroplastica was diagnosed. Tracheobronchopathia osteochondroplastica is a rare benign disease of unknown etiology that affects the trachea and, to a lesser extent, the main bronchi. It is caused by the formation of cartilaginous or bony submucous nodules that project into the lumen of the airway, with no involvement of the posterior wall.2 Visualization of these lesions on bronchoscopy is sufficient to confirm diagnosis, without the need for a histology study.1,2 However, biopsies are performed if bone or calcification of the submucosa is seen. The disease course is benign and slow, and complications are unusual.

Hipoplasia pulmonar en un adulto joven

A 27-year-old Moroccan man, living in Spain for 9 years, with no known toxic habits or significant medical history. He was diagnosed incidentally with left pulmonary hypoplasia after consulting for non-specific chest pain. A marked reduction in the volume of the left hemithorax was observed in the tomographic images of the chest, with varicose and cystic bronchiectasis in the small portion of parenchyma present, and compensatory hyperinflation of the right lung (Fig. 1). Unilateral pulmonary hypoplasia is very uncommon. According to the literature, very few cases go unnoticed until adulthood,1 as occurred in our patient. The left lung is most frequently affected, although the cause or causes for this propensity are unknown. The production and retention of secretions in the rudimentary lung tissue predispose these patients to repeated respiratory infections, and bronchiectasis may be the cause or the result of these infections. A definitive diagnosis is reached with imaging techniques such as computed axial tomography.2 It is remarkable in our case that the patient did not report any previous or current history of infections.