Ramon Coll

Diagnóstico y tratamiento de las bronquiectasias

Bronchiectasis is the end result of several different diseases that share principles of management. The clinical course usually involves chronic bronchial infection and inflammation, which are associated with progression. The cause of bronchiectasis should always be investigated, particularly when it can be treated. We recommend evaluating etiology, symptoms, bronchial colonization and infection, respiratory function, inflammation, structural damage, nutritional status, and quality of life in order to assess severity and to monitor clinical course. Care should be supervised by specialized units, at least in cases of chronic bronchial infection, recurrent exacerbations, or when there is a cause that is likely to respond to treatment. Improving symptoms and halting progression are the goals of management, which is based on treatment of the underlying cause and of acute or chronic infections and on the drainage of secretions. Complications that arise must also be treated. Antibiotic prescription is guided by how well infection is being controlled, and this is indicated by the color of sputum and a reduction in the number of exacerbations. We recommend inhaled antibiotics in cases of chronic bronchial infection that does not respond to oral antibiotics, when these cause side effects, or when the cause is Pseudomonas species or other bacteria resistant to oral antibiotics. Inhaled administration is also advisable to treat initial colonization by Pseudomonas species.

Spanish guideline for COPD (GesEPOC). Update 2014.

aServicio de Neumologia, Hospital Universitari Vall d’Hebron, Barcelona, Spain bCIBER de Enfermedades Respiratorias (CIBERES), Spain cUnidad de Neumologia, Servicio de Medicina Interna, Hospital de Requena, Valencia, Spain dServicio de Neumologia, Hospital Clinico San Carlos, Madrid, Spain eCentro de Salud Francia, Direccion Asistencial Oeste, Madrid, Spain fServicio de Medicina Interna, Hospital Universitari Mutua de Terrassa, Terrasa, Barcelona, Spain gCentro de Salud Lucena I, Lucena, Cordoba, Spain hServicio de Neumologia, Hospital San Pedro de Alcantara, Caceres, Spain iCentro de Salud Menasalbas, Toledo, Spain jServicio de Urgencias, Hospital General Universitario Reina Sofia, Murcia, Spain kServicio de Urgencias, Hospital General Yague, Burgos, Spain lMedicina Fisica y Rehabilitacion, Parc de Salut Mar, Grupo de Investigacion en Rehabilitacion, Institut Hospital del Mar d’Investigacions Mediques, Universitat Autonoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain mUnidad de Fisioterapia Respiratoria, Hospital Universitario de Gran Canaria Dr. Negrin, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Spain nServicio de Medicina Fisica y Rehabilitacion, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Barcelona, Spain nServicio de Medicina Fisica y Rehabilitacion, Hospital Parc Tauli, Universitat Autonoma de Barcelona, Sabadell, Barcelona, Spain oCentro de Salud Gandhi, Madrid, Spain pServicio de Medicina Interna, Hospital Royo Vilanova, Zaragoza, Spain qFundacion Caubet-Cimera FISIB Illes Balears, Bunyola, Baleares, Spain rServicio de Neumologia, Hospital Universitario de la Princesa, Instituto de Investigacion Sanitaria Princesa (IP), Madrid, Spain

Increased Exercise Capacity after Surgically Induced Weight Loss in Morbid Obesity

Objective: To investigate the effects of surgically induced weight loss on exercise capacity in patients with morbid obesity (MO).

Diagnosis and Treatment of Bronchiectasis

Bronchiectasis is the end result of several different diseases that share principles of management. The clinical course usually involves chronic bronchial infection and inflammation, which are associated with progression. The cause of bronchiectasis should always be investigated, particularly when it can be treated. We recommend evaluating etiology, symptoms, bronchial colonization and infection, respiratory function, inflammation, structural damage, nutritional status, and quality of life in order to assess severity and to monitor clinical course. Care should be supervised by specialized units, at least when there is a history of chronic bronchial infection, recurrent exacerbations, or a cause that is likely to respond to treatment. Improving symptoms and halting progression are the goals of management, which is based on treatment of the underlying cause and of acute or chronic infections and on the drainage of secretions. Complications that arise must also be treated. Antibiotic prescription is guided by monitoring how well infection is being controlled, and this is indicated by the color of sputum and a reduction in the number of exacerbations. We recommend inhaled antibiotics when bronchial infection is chronic and does not respond to oral antibiotics or when these cause side effects, or when the cause is Pseudomonas species or other bacteria resistant to oral antibiotics. Inhaled administration is also advisable to treat initial colonization by Pseudomonas species.

Guía española de la EPOC (GesEPOC). Actualización 2014

Servicio de Neumología, Hospital Universitari Vall d’Hebron, Barcelona, Spain CIBER de Enfermedades Respiratorias (CIBERES), Spain Unidad de Neumología, Servicio de Medicina Interna, Hospital de Requena, Valencia, Spain Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, Spain Servicio de Medicina Interna, Hospital Universitari Mútua de Terrassa, Terrasa, Barcelona, Spain Centro de Salud Lucena I, Lucena, Córdoba, Spain Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain Centro de Salud Menasalbas, Toledo, Spain Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain Servicio de Urgencias, Hospital General Yagüe, Burgos, Spain Medicina Física y Rehabilitación, Parc de Salut Mar, Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain Unidad de Fisioterapia Respiratoria, Hospital Universitario de Gran Canaria Dr. Negrín, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Spain Servicio de Medicina Física y Rehabilitación, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain Servicio de Medicina Física y Rehabilitación, Hospital Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain Centro de Salud Gandhi, Madrid, Spain Servicio de Medicina Interna, Hospital Royo Vilanova, Zaragoza, Spain Fundación Caubet-Cimera FISIB Illes Balears, Bunyola, Baleares, Spain Servicio de Neumología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, SpainServicio de Neumología, Hospital Universitari Vall d’Hebron, Barcelona, España CIBER de Enfermedades Respiratorias (CIBERES), España Unidad de Neumología, Servicio de Medicina Interna, Hospital de Requena, Valencia, España Servicio de Neumología, Hospital Clínico San Carlos, Madrid, España Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, España Servicio de Medicina Interna, Hospital Universitari Mútua de Terrassa, Terrasa, Barcelona, España Centro de Salud Lucena I, Lucena, Córdoba, España Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, España Centro de Salud Menasalbas, Toledo, España Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España Servicio de Urgencias, Hospital General Yagüe, Burgos, España Medicina Física y Rehabilitación, Parc de Salut Mar, Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, España Unidad de Fisioterapia Respiratoria, Hospital Universitario de Gran Canaria Dr. Negrín, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, España Servicio de Medicina Física y Rehabilitación, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España Servicio de Medicina Física y Rehabilitación, Hospital Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España Centro de Salud Gandhi, Madrid, España Servicio de Medicina Interna, Hospital Royo Vilanova, Zaragoza, España Fundación Caubet-Cimera FISIB Illes Balears, Bunyola, Baleares, España Servicio de Neumología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, España

Sex and age differences in fragility in a heart failure population.

Heart failure (HF) patients have a high degree of fragility and dependence from physical, cognitive and psychological points of view, and are a mainly geriatric population.

Statins in Heart Failure: The Paradox Between Large Randomized Clinical Trials and Real Life

OBJECTIVE To assess the relationship between statins and prognosis in ischemic and nonischemic patients with heart failure (HF) in a real-life cohort followed up for a long period. PATIENTS AND METHODS This prospective study included 960 patients with HF with preserved or depressed left ventricular ejection fraction (LVEF), irrespective of HF etiology, who were referred to the HF clinic of a university hospital between August 1, 2001, and December 31, 2008. The patients were followed up for a maximum of 9.1 years (median, 3.7 years), and survival in ischemic and nonischemic patients was determined. RESULTS Median age was 69 years, and median LVEF was 31%. Of the 960 patients, 532 (55.4%) had ischemic HF etiology, and most received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (846; 88.1%) and β-blockers (776; 80.8%). Patients with HF of ischemic origin were more often treated with statins (P<.001). During follow-up, 440 patients (45.8%) died. Statin therapy was associated with significantly improved survival (hazard ratio, 0.45 [95% confidence interval, 0.37-0.54]; P<.001). After adjustment for HF prognostic factors (age, sex, cholesterol level, New York Heart Association class, HF etiology, LVEF, body mass index, HF duration, atrial fibrillation, implantable cardioverter-defibrillator therapy, and medicines), statins remained significantly associated with lower mortality risk in both ischemic (P=.007) and nonischemic (P=.002) patients. CONCLUSION In contrast to results of large randomized trials, statins were independently and significantly associated with lower mortality risk in our real-life HF cohort, including patients with nonischemic HF etiology.

Significado pronóstico de los valores de hemoglobina en pacientes con insuficiencia cardíaca

Introduccion y objetivos Evaluar el valor pronostico de las concentraciones de hemoglobina (Hb) en relacion con la mortalidad y con los ingresos hospitalarios por insuficiencia cardiaca (IC) al ano de la primera visita a la Unidad de IC. Pacientes y metodo Conocemos la situacion vital y los ingresos por IC al ano en 337 pacientes admitidos entre agosto de 2001 y marzo de 2003. Las concentraciones de Hb se recogieron en la primera visita. Resultados Fallecieron 28 (8%) pacientes y hubo 158 ingresos por IC en 66 pacientes. Los valores de Hb se asociaron con la mortalidad a 1 ano (pacientes vivos, 13,0 ± 1,7 g/dl; pacientes fallecidos, 11,6 ± 1,7 g/dl; p Conclusiones Los valores de Hb se asocian inversamente con la mortalidad y los ingresos por IC en el primer ano de seguimiento. La prevalencia de anemia en nuestra poblacion con IC es elevada y tiene valor pronostico independiente.

Patient's education by nurse: what we really do achieve?

Aim: To evaluate what is really achieved with nurse education in an outpatient heart failure population. Method: The answers obtained in a nurse questionnaire performed at the first visit to the Unit and at 1 year of follow-up were compared. The questionnaire was addressed to know how compliant patients were and how much they knew about their disease and their treatment. Results: Two hundred and ninety eight patients (219 men and 79 women) were evaluated. Baseline mean age was 65 years (35–86). At first visit only 30% knew and understood the performance of the heart; 56% at 1 year (p < 0.001). Only 28% initially understood the disease; 55% at follow-up (p < 0.001). Awareness of more than 3 worsening signs increased from 66.5% to 86.5% (p < 0.001). Knowledge of the names of all the pills they were receiving increased from 33% to 44% (p < 0.001), of the action of these pills from 24% to 44% (p < 0.001), and of how to use nitroglycerine among patients with ischemic heart disease from 87% to 96% (p < 0.001). Initially 63% monitored their weight only at the medical visit and 21% monitored it at least once a week; at 1 year these percentages were 16% and 39% respectively (p < 0.001). At baseline 45% checked blood pressure only at the medical visit and 28.5% checked it at least once a week; at 1 year these percentages were 12% and 43% (p < 0.001). Whereas no significant differences were found in sodium restricted diet compliance, exercise performance increased slightly although statistically significantly (p = 0.01). The great majority of patients never or only very rarely smoked or drunk alcoholic beverages, both at first visit and at 1 year, although both habits increased slightly during follow-up. No significant differences in treatment compliance (92% vs. 88% were taking all the medications prescribed) were found. Conclusion: Nurse-guided education has changed self-care behaviour of patients with heart failure in several important aspects, as weight and blood monitoring, and has increased their knowledge and understanding of the disease and treatment. However, these improvements have not been reflected in a better compliance of treatment and sodium restricted diet. Such aspects need more and more work to obtain better results.

Nurse evaluation of patients in a new multidisciplinary Heart Failure Unit in Spain.

Aim: To know how compliant patients are, how much they know about their disease and treatment, and how their level of self-care is. Methods: We performed a short nurse questionnaire during the first visit to a new Heart Failure Unit. Results: Three hundred and twenty-four patients have been evaluated, with a mean age of 65.4 years. Ninety-eight patients (30%) knew and understood the performance of the heart and 85 (29%) understood the disease. Two-hundred and nineteen (67%) knew more than three signs of worsening symptoms. One-hundred and five (32%) knew all the names of the medication they were taking and 74 (23%) knew the action of these medications. Two-hundred and ninety-four (91%) said they were taking all the medication prescribed and 229 (71%) carried on always their written prescription. Sixty-two percent of patients controlled weight only at the medical visit and only 14% controlled weight more than once a week. Fifty-nine (18%) controlled blood pressure more than once a week, while 45% controlled it only at the medical visit. Only 33% of patients were said always to follow sodium restricted diet. The great majority (93%) never smoked and only very rarely took alcohol (83%). While only 18 (6%) performed some kind of physical exercise, the majority (83%) did walking and daily living activities. The 85% of patients with ischemic heart disease knew how to use sublingual nitro-glycerine. When subgroups were analysed, we found significant differences by age, gender and previous specialist management. Younger patients, men and patients referred from the Cardiology outpatient clinic showed a higher level of knowledge and understanding of several aspects of disease and treatment, and performed more physical activities, compared to older patients, women and patients referred from other departments. On the contrary, older patients showed better adherence with sodium restriction, and, as women, better smoking and drinking habits. Conclusion: There is a lot of work to do in nurse-guided education of patients with heart failure, although treatment compliance, use of nitro-glycerine and abstinence of smoking and alcohol intake seem to be quite assumed by the majority of our patients. Significant differences in knowledge and behaviour were evident between younger and older patients, between men and women, and relating to previous specialist management. In spite of that, we found no differences in treatment compliance.