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J L Izquierdo Alonso

Publications and source records attributed to J L Izquierdo Alonso.

At least 19 recordsLinked to original sources
PubMed2005

[Factors affecting drug prescription in patients with stable COPD: results from a multicenter Spanish study (IDENTEPOC)].

OBJECTIVE: To determine what factors are associated with prescription of drugs to patients with stable chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We studied 568 patients with stable COPD. Assessments included determination of the severity of dyspnea, body mass index, health-related quality of life, and spirometry testing. RESULTS: The forced expiratory volume in 1 second was significantly associated with prescription of long-acting beta2-adrenergic agonists (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.96-1) and inhaled corticosteroids (OR=0.98; 95% CI, 0.96-1). Quality of life was related to administration of short-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), long-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), ipratropium bromide (OR=1.03; 95% CI, 1-1.04), theophylline drugs (OR=1.02; 95% CI, 1-1.03), and inhaled corticosteroids (OR=1.02; 95% CI, 1-1.03). The severity of dyspnea was significantly associated with prescription of oral corticosteroids (for grade IV dyspnea, OR=15.25; 95% CI, 2.40-97.02). Body mass index was not related to drug administration. CONCLUSIONS: Drug prescription in patients with stable COPD correlates not only with forced expiratory volume in 1 second but also with other parameters such as health-related quality of life and dyspnea.

Aged↗
PubMed2004

[Bacterial colonization and home mechanical ventilation: prevalence and risk factors].

OBJECTIVE: To investigate the prevalence of bacterial contamination of ventilators and colonization of patients, the bacteria implicated, and predisposing factors in noninvasive home ventilation. MATERIAL AND METHODS: Forty patients on a home noninvasive ventilation program (mean [SD] age: 63.1 [12] years; time on ventilation: 30.7 [25] months; daily use: 8.1 [2] hours) were enrolled in this descriptive cross-sectional study. Microbiological samples for semiquantitative cultures were swabbed from the ventilator (mask and tubing) and the nostrils. A questionnaire was completed on the underlying disease, time on the ventilation program, type of ventilator, presence of a humidifier, and attention to ventilator cleanliness and maintenance. We defined "colonization" as the presence of microorganisms in the nostrils without evidence of a host immune response, and "contamination" as the presence of surface microorganisms (on tubing or the nasal mask). RESULTS: Potentially pathogenic bacteria were isolated from 6 ventilators (15%) and the nasal swabs of 10 patients (25%). Staphylococcus aureus was the most frequently isolated one (in 5 ventilators and 6 patients--contamination coinciding with colonization in 3 cases). Other potentially pathogenic bacteria isolated were Proteus species (from the nostrils of 2 patients) and an unidentified gram-negative bacillus from the ventilator. On analysis by underlying disease, 60% of the patients with obesity had been colonized. No other findings of note were obtained for other diseases. Contamination and colonization correlated with attention to cleanliness and maintenance of the ventilator but not with type of ventilator, time on the ventilation program, or use of a humidifier. CONCLUSIONS: Home mechanical ventilators are a potential source of nasal colonization. The most frequently encountered microorganism was S. aureus. The degree of ventilator cleaning and disinfection seems to affect contamination; thus it is necessary to impress on patients the need for adequate maintenance of their ventilators.

Adult↗
PubMed2004

[Quality of life with chronic obstructive pulmonary disease: the influence of level of patient care].

OBJECTIVE: The aim of the study was to determine the factors related to the health-related quality of life (HRQL) of patients with stable chronic obstructive pulmonary disease (COPD) and to assess the degree of influence of level of patient care (primary or specialized). MATERIAL AND METHOD: An observational descriptive, cross-sectional, multicenter study was carried out. The study sample was a randomized selection taken from a stratified sample of patients treated by primary care physicians and pneumologists from each Spanish region. Only those patients whose level of health care was indicated and whose diagnosis of COPD was confirmed by spirometry were enrolled in the study. RESULTS: Five hundred sixty patients were assessed, 100 from primary health care and 460 from pneumology practices. No significant differences between the 2 levels of care were found in the scores on the HRQL questionnaire (Spanish version of the St George's Respiratory Questionnaire). There was a weak correlation between patients' perception of health and lung function parameters. Factors related to HRQL in the multivariate analysis were dyspnea, the presence of COPD exacerbations in the previous year, consequent visits to the emergency department, age, and degree of airflow restriction, but not level of patient care. CONCLUSIONS: Stable COPD patients' HRQL is not related to their level of care, be it primary or specialized, but is related to other factors such as dyspnea, presence of exacerbations or consequent visits to the emergency department, age, and degree of airflow restriction.

Adult↗
PubMed2003

[Drug treatment of chronic obstructive pulmonary disease on two levels of patient care: degree of compliance with recommended protocols].

OBJECTIVE: The aims of this study were to identify the drug treatment protocols applied by primary care physicians or pneumologists for patients with stable chronic obstructive pulmonary disease (COPD) in Spain, to determine the agreement between prescription practices and current recommendations and to assess differences between the two levels of patient care. PATIENTS AND METHODS: The study was observational, descriptive and multicenter. A stratified random sample of patients treated by family physicians or pneumologists was taken for every region in Spain. RESULTS: Five hundred sixty-eight (63.2%) of the 898 subjects fulfilled COPD diagnostic criteria; 100 were treated by primary care physicians and 460 by pneumologists. In 8 cases the caregiver was unknown. Obstruction was mild-to-moderate in 144 cases and severe in 416. The drugs most commonly prescribed were ipratropium bromide (77.8%), inhaled short-acting beta(2) agonists (65.8%), inhaled corticosteroids (61.0%), long-acting beta(2) agonists (46.4%) and theophyllines (41.3%). Primary care physicians prescribed inhaled short-acting beta 2-agonists most often, whereas pneumologists prescribed anticholinergics most often. In the primary care setting, no differences in treatment protocols were observed based on severity of COPD, degree of dyspnea or quality of life. More consistent differences were seen in treatment by pneumologists. In both settings, prescription was more frequently given when COPD was severe. The most commonly prescribed inhalation device was the Turbuhaler in primary care and the pressurized canister in pneumology. CONCLUSIONS: Treatments prescribed for COPD patients do not follow current guidelines strictly, particularly in the primary care setting. Different prescription protocols are used at the different levels of patient care.

Aged↗
PubMed2003

[Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors].

OBJECTIVE: The aims of this study were to assess the methods used by primary care physicians and pneumologists to diagnose chronic obstructive pulmonary disease (COPD) in Spain, and to analyze the factors affecting correct diagnosis of the disease. MATERIAL AND METHODS: This observational, descriptive, cross-sectional and multicenter study enrolled a stratified randomized sample from each Spanish region from the practices of primary care physicians and pneumologists. RESULTS: Five hundred sixty-eight (63.2%) of the 898 subjects enrolled had airway obstruction, 92 (10.3%) did not fulfill functional criteria for COPD and 238 (26.5%) did not perform spirometric tests to confirm the diagnosis and establish severity of disease. Primary care physicians classified 29.3% of the patients correctly, whereas pneumologists diagnosed 84.8% correctly. Clinical and/or radiologic criteria were the basis for correct diagnosis in 38.6% of the cases managed by primary care physicians and 10.2% of those treated by pneumologists. Spirometry was available to 49.1% of the primary care physicians and 97.8% of the pneumologists' cases (p < 0.001). Moreover, only 29.9% of the primary care settings had a technician in charge of performing the study, in comparison with 97.8% of the specialized pneumology settings (p < 0.001). The use of spirometry in diagnosing COPD was related to level of patient care (primary or specialized), availability of the test in the primary care setting, place of residence and a patient's situation of temporary absence from work due to COPD. CONCLUSIONS: Many COPD patients are incorrectly diagnosed, particularly in primary care. There are differences in diagnostic procedures at the different levels of patient care. The availability of spirometry is an important factor for correctly diagnosing COPD.

Aged↗
PubMed2002

[Chronic cough].

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Adult↗
PubMed2002

[Clinical benefits of tiotropium, a new anticholinergic bronchodilator].

Bronchodilators are, at the present time, the mainstay of symptomatic therapy in patients with chronic obstructive pulmonary disease (COPD). Anticholinergics are the first steep in the clinical management of these patients although its short half life constitutes a serious limitation in patients with persistent symptoms. However, there have been some important developments on this area. Tiotropium bromide, used once daily shows several clinical advantages when it is compared with ipratropium bromide or with long acting beta-2 agonists. This suggests than tiotropium bromide could be in coming years one of the first options for the treatment of COPD.

Administration, Inhalation↗
PubMed1996

[The utility of the flow-volume curve in detecting fixed extrathoracic stenoses in patients with chronic obstructive pulmonary disease].

The flow-volume curve is the usual noninvasive diagnostic test for upper airways obstruction. In order to assess its usefulness for the detection of fixed upper airways obstruction in chronic obstructive pulmonary disease (COPD), we plotted flow-volume curves using maximum inspiratory and expiratory maneuvers in 60 COPD patients and in 15 healthy controls. Baseline readings were taken, followed by readings after random application of fixed external resistances with diameters of 4, 6, 8 and 10 mm in all cases. Although PEF and FIF50 decreased significantly with resistance of 10 mm, even in the group with the most severe ventilatory limitation it was necessary to reduce the internal diameter to 6 mm to detect changes in FEV1. In patients with baseline values under 50% of theoretical values, 4 mm stenosis was required to provoke changes in FEV1. The fall in FEV1 and PEF was less evident as the severity of COPD increased, with both parameters correlating with percent baseline FEV1 only at diameters of 6 mm (p < 0.01) and 4 mm (p < 0.001). The sensitivities of the usual indices for detecting upper airways obstruction, such as FEV1/PEF and FEV1/FEV0-5, were low (below 50%) in all groups at diameters over 6 mm, and in the most severe cases of COPD, even with stenosis of 4 mm. Nor did other indices, such as FEF50/FIF50 and FEV1/FIV1,, give better diagnostic yield. We conclude that the flow-volume curve may not detect the existence of upper airways obstruction in COPD, and that in the most severely affected patients alternative diagnostic methods should therefore be considered.

Aged↗
PubMed1996

[Usefulness of the visual analysis of night oximetry as a screening method in patients with suspected clinical obstructive sleep apnea syndrome].

Conventional polysomnography (CPS) is a complex, costly procedure that is not widely available, meaning that it is difficult to apply it in patients suspected of having obstructive sleep apnea syndrome (OSAS). Various procedures have therefore been proposed for screening candidates for CPS. We studied the usefulness of visual analysis of nocturnal oximetry in 96 patients suspected of having OSAS. The OSAS diagnosis was confirmed by CPS in 67 (69.8%). Oximetry was positive in 70 cases. Sixty-one patients were positive by both oximetry and CPS, while 9 and positive oximetry results and a negative CPS. We conclude that nocturnal oximetry has a 91% sensitivity and 69% specificity for OSAS, with a positive predictive value of 87% and a negative predictive value of 77%. We believe that nocturnal oximetry may be a useful way of screening for OSAS, in order to decrease the number of CPS performed on patients without the disease.

Adult↗