Miguel Perpiñá-Tordera

Factors Associated With Bronchiectasis in Patients With COPD

BACKGROUND Previous studies have shown a high prevalence of bronchiectasis in patients with moderate to severe COPD. However, the factors associated with bronchiectasis remain unknown in these patients. The objective of this study is to identify the factors associated with bronchiectasis in patients with moderate to severe COPD. METHODS Consecutive patients with moderate (50% < FEV(1) ≤ 70%) or severe (FEV(1) ≤ 50%) COPD were included prospectively. All subjects filled out a clinical questionnaire, including information about exacerbations. Peripheral blood samples were obtained, and lung function tests were performed in all patients. Sputum samples were provided for monthly microbiologic analysis for 6 months. All the tests were performed in a stable phase for at least 6 weeks. High-resolution CT scans of the chest were used to diagnose bronchiectasis. RESULTS Ninety-two patients, 51 with severe COPD, were included. Bronchiectasis was present in 53 patients (57.6%). The variables independently associated with the presence of bronchiectasis were severe airflow obstruction (OR, 3.87; 95% CI, 1.38-10.5; P = .001), isolation of a potentially pathogenic microorganism (PPM) (OR, 3.59; 95% CI, 1.3-9.9; P = .014), and at least one hospital admission due to COPD exacerbations in the previous year (OR, 3.07; 95% CI, 1.07-8.77; P = .037). CONCLUSION We found an elevated prevalence of bronchiectasis in patients with moderate to severe COPD, and this was associated with severe airflow obstruction, isolation of a PPM from sputum, and at least one hospital admission for exacerbations in the previous year.

Cambios espirométricos y en la saturación arterial de oxígeno durante la ascensión a una montaña de más de 3.000 metros

Objetivo: Averiguar si en la ascension a una montana de mas de 3.000 m se produce alguna alteracion ventilatoria, si esta se modifica por la aclimatacion y si se relaciona con los cambios en la saturacion arterial de oxigeno (SaO2) o con la aparicion de sintomas de mal de montana agudo (MAM). Sujetos y metodos: En 8 montaneros no aclimatados que ascendieron a la cumbre del Aneto (3.404 m) y permanecieron 3 dias en ella medimos: la capacidad vital forzada (FVC), el volumen espiratorio forzado en el primer segundo (FEV1), la respuesta a la inhalacion de terbutalina, la SaO2 y los sintomas de MAM. Resultados: Al llegar a la cumbre disminuyeron el FEV1 (12,3 ± 5,7%) y la FVC (7,6 ± 6,7%) con la relacion FEV1/FVC% normal. Al dia siguiente aumentaron ambos parametros. No hubo respuesta al tratamiento broncodilatador. La restriccion se corrigio totalmente al descender. La SaO2 en la cumbre aumento progresivamente con la aclimatacion. Durante la ascension el FEV1 se correlaciono con la SaO2 (r = 0,79). Un participante con MAM presento FEV1/FVC menor del 70% y la peor SaO2 durante la estancia en la cima. Esta obstruccion precedio a los sintomas, no cedio con tratamiento broncodilatador y se corrigio con el descenso. Conclusiones: Los montaneros que ascienden a montanas de mas de 3.000 m presentan una restriccion que se correlaciona con la hipoxemia, no mejora con el tratamiento broncodilatador, se alivia con la aclimatacion y desaparece con el descenso. Un sujeto con MAM sufrio una obstruccion que no respondio a la terbutalina y desaparecio con el descenso.

Changes in Spirometric Parameters and Arterial Oxygen Saturation During a Mountain Ascent to Over 3000 Meters

OBJECTIVE To ascertain whether climbing a mountain over 3000 meters high produces any alterations in ventilation, whether such alterations are modified by acclimatization, and whether they correlate with changes in arterial oxygen saturation (SaO2) or the development of acute mountain sickness (AMS). SUBJECTS AND METHODS The following parameters were measured in 8 unacclimatized mountaineers who climbed Aneto (3404 m) and spent 3 days at the summit: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), airway response to inhaled terbutaline, SaO2, and the symptoms of AMS. RESULTS At the summit, mean (SD) FEV1 declined by 12.3% (5.7%) and mean FVC by 7.6% (6.7%) while the ratio of FEV1 to FVC remained normal. The means for both parameters were higher on the following day. No airway response to bronchodilator treatment was observed. The restriction disappeared entirely on descent. At the peak, SaO2 increased progressively as the climbers became acclimatized. During the ascent, FEV1 correlated with SaO2 (r=0.79). One participant who suffered from AMS had a ratio of FEV1 to FVC less than 70% and the worst SaO2 during the 3 days on the summit. Obstruction preceded the AMS symptoms, did not respond to bronchodilator treatment, and disappeared when the climber descended. CONCLUSIONS The mountaineers who climbed over 3000 meters presented restriction that correlated with hypoxemia. This restriction did not respond to bronchodilator treatment, improved with acclimatization, and disappeared on descent. One person with AMS presented obstruction that did not respond to terbutaline and disappeared on descent.

Bronquiectasias en pacientes mayores de 65 años. Estudio de los valores séricos de las subclases de inmunoglobulina G

Fundamento y objetivo: Analizar los valores sericos de las subclases de inmunoglobulina G (IgG) en un amplio numero de pacientes mayores de 65 anos con bronquiectasias. Pacientes y metodo: De todos los pacientes mayores de 65 anos diagnosticados en nuestro centro de bronquiectasias mediante tomografia computarizada de alta resolucion de torax, se recogieron de forma prospectiva datos relativos a la historia clinica, sintomas, espirometria forzada, estudio analitico, determinacion de la concentracion de inmunoglobulinas, incluidas las subclases de IgG, Mantoux, tincion y cultivo de esputo, radiografia/tomografia computarizada de senos paranasales y estudio etiologico especifico segun sospecha clinica. Resultados: Se incluyo en el estudio a 128 pacientes, con una edad media (desviacion estandar) de 71,6 (5,1) anos (extremos: 65-88 anos); un 44,5% eran varones. El 20,3% presento colonizacion cronica por Pseudomonas aeruginosa. La causa conocida mas frecuente de bronquiectasias fue la infecciosa (28,1%), si bien el 40,6% permanecio con etiologia desconocida. Dieciseis pacientes (12,5%) presentaron alguna disminucion de los valores sericos de las subclases de IgG respecto a los valores de normalidad, siendo la mas frecuente la disminucion de los valores de IgG2. Estos pacientes mostraron un perfil de bronquiectasias peculiar: de forma significativa, presentaron una mayor extension pulmonar (p = 0,02), mayor porcentaje de formas difusas y cilindricas (p = 0,02 y 0,01, respectivamente), mayor porcentaje de formas con etiologia no conocida (p = 0,004), mayor afectacion de los senos paranasales (p = 0,004) y mayor prevalencia pasada de infecciones respiratorias de las vias altas de repeticion (p = 0,03). Conclusiones: La disminucion de los valores sericos de las subclases de IgG podria asociarse a la aparicion de bronquiectasias con un perfil peculiar en pacientes mayores de 65 anos en los que se ha descartado otra posible causa.