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Biomedical subjects

M Perpiñá

Publications and source records attributed to M Perpiñá.

At least 19 recordsLinked to original sources
PubMed2006

[Evolution over time in over perceivers of dyspnea in asthma].

OBJECTIVE: In previous studies we identified a subgroup of patients whose perception of breathlessness was exaggerated during acute bronchoconstriction and who were termed "over perceivers" or "hyperperceivers". In this study we aimed to determine whether such over perception is sporadic or stable over time. We also examined whether there is an association between over perception of dyspnea and hyperventilation syndrome. PATIENTS AND METHODS: The subjects were 22 stable asthmatics (11 men, 11 women) who had been over perceivers of dyspnea in a study 9 years earlier. After a medical history was taken, a patient performed forced spirometry and a severity classification was made according to the criteria of the Global Initiative for Asthma (GINA). A bronchial histamine challenge was then administered to measure dose-related perception of dyspnea on a Borg scale, according to a procedure that was similar to the one used 9 years earlier by the same investigator. The patients were also asked for a subjective assessment of the severity of their asthma (scale, 0-10) and to respond to items on the Nijmegen hyperventilation questionnaire and the trait form of the State-Trait Anxiety Inventory. RESULTS: The overall perception of severity of disease, level of anxiety, and perception of dyspnea at rest were lower after 9 years (P<.001). No change was observed in bronchial hyperresponsiveness (dose of inhaled histamine required to provoke a 20% decline in forced expiratory volume in the first second [FEV1]-PD20) or objective parameters of severity (FEV1 and GINA classification). Fourteen asthmatics (64%) were still over perceivers and the other patients had changed: 6 were normal perceivers and 2 were "poor perceivers". Only subjective perception of disease severity improved for the patients who were still over perceivers; the other patients, on the other hand, showed improvements in subjective assessments, objective ones (except PD20), and anxiety. Finally, those who remained over perceivers had higher scores for anxiety (24 vs 15; P<.05) and hyperventilation (18 vs 13; P= not significant). CONCLUSIONS: Most over perceivers of dyspnea remain so over the years and this trait is related to anxiety. We have been unable to demonstrate an association with hyperventilation syndrome.

Adult↗
PubMed2006

[Does experience influence perception of dyspnea?].

OBJECTIVE: The perception of somatic sensations like dyspnea can be influenced by such factors as an individual s personality, experiences, or ability to adapt to stimuli. Our aim was to determine whether the perception of acute bronchoconstriction is different for patients with asthma and patients who have never experienced an episode of airway obstruction. PATIENTS AND METHOD: We studied 2 groups of patients. The first consisted of 24 subjects with intermittent rhinitis and asthma (10 females and 14 males) with a mean (SD) age of 25 (7) years. All reported not feeling dyspnea at rest on a Borg scale. The second group consisted of 24 subjects who only had rhinitis but no lung disease (no episode of asthma) or dyspnea at rest (12 females and 12 males) with a mean age of 27 (6) years. There were no significant differences between the groups with regard to sex, smoking, economic or educational level, anxiety (determined by the trait portion of the State-Trait Anxiety Inventory), depression (Beck Depression Inventory), or spirometric parameters. All took a histamine bronchial provocation test in which the patient assessed dyspnea on a modified Borg scale after each histamine dose. The provocation dose needed to produce a 20% decrease (PD20) in forced expiratory volume in the first second (FEV1) was calculated. We also recorded dyspnea perception score when FEV1 fell 5%, 10%, 15%, and 20%. RESULTS: No dyspnea was perceived at PS20 by 12.5% of the asthmatics and by 45% of nonasthmatics (P< .0001). The mean PS20 was 2.4 (2.1) (range, 0-7) in the first group and 0.37 (0.48) (range, 0-3) in the second (P< .0001). More asthma patients than nonasthmatics perceived dyspnea at all degrees of bronchial obstruction. PD20 was different in the 2 groups (1.6 [2] vs 6.03 [5] for the first and second groups, respectively; P< .003), but there was no significant relation between PD20 and PS20 (Spearman s correlation coefficient, 0.19; P= .221). CONCLUSION: Our findings support the hypothesis that appropriate perception of dyspnea is grounded in prior experience and learning.

Adult↗
PubMed2005

[Prevalence of hyperventilation syndrome in patients treated for asthma in a pulmonology clinic].

OBJECTIVE: Although the presence of hyperventilation syndrome can affect the symptoms of patients with asthma, there is very little information available regarding its frequency in Spain. The aim of this study was to investigate the prevalence of hyperventilation syndrome in the asthmatic population treated as outpatients and establish its relationship with anxiety disorders. PATIENTS AND METHOD: We studied 157 consecutive asthmatic patients (61 men and 96 women; mean [SD] age, 45 [17] years; forced expiratory volume in the first second, 84% [21%] of the predicted value) treated in our outpatients clinic. The patients had stable disease with varying degrees of severity. After collecting demographic data and medical histories, we asked the patients to complete the Spanish versions of the Anxiety Sensitivity Index, the Asthma Symptom Checklist, and the Nijmegen questionnaire; in the latter test, a score of 23 or over was considered diagnostic for hyperventilation syndrome. Finally, patients were evaluated to determine whether they had suffered from panic disorder in the last 6 months (according to the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders). RESULTS: Hyperventilation syndrome was present in 57 asthmatic patients (36%) and panic disorder in 4 patients (2%). The majority of patients with hyperventilation syndrome were women (78% vs 51%; P=.001) and were older (49 vs 42; P=.01); they displayed more basal dyspnea (1.26 vs 0.89 on the Medical Research Council scale; P=.01), greater sensitivity to anxiety (P=.001), and went to the emergency room more often for exacerbations (P=.002). Patients with hyperventilation syndrome scored significantly higher on all subscales of the Asthma Symptoms Checklist. Finally, the variables introduced in the regression analysis (stepwise) to explain the score on the Nijmegen questionnaire (r(2)=0.57) were basal dyspnea and sensitivity to anxiety. CONCLUSIONS: Approximately one third of the asthmatic patients treated in a pulmonology clinic also present hyperventilation syndrome. This cannot be explained by comorbidity of asthma with panic disorder, and is only partly linked to the symptoms associated with hyperventilation that appear during an asthma attack.

Adult↗
PubMed2005

[Agreement in asthmatics' perception of dyspnea during acute and chronic obstruction].

OBJECTIVE: Three types of asthmatic patients can be identified during periods of clinical stability: "poor perceivers," "normal perceivers," and "over perceivers." When asthmatics undergo bronchial challenge in the laboratory, the same distinctions in type of perception can be observed. The aim of the present study was to determine the level of agreement between the 2 situations. PATIENTS AND METHODS: A total of 93 patients with persistent moderate asthma (36 men and 57 women; mean age 40 years) were studied. We asked them to assess their dyspnea on a modified Borg scale when stable and after each histamine dose in a bronchial provocation test. When a patient's Borg scale assessment in stable situation was below the 25th percentile, that patient was classified as a poor perceiver. Patients were considered over perceivers if their score in stable situation was in the 75th percentile. Others were labeled normal perceivers. Type of perception during acute bronchoconstriction was defined in function of the change in Borg assessment once forced expiratory volume in the first second had decreased 20%: poor perceivers were those whose change in Borg assessment was in the 25th percentile, over perceivers were in the 75th percentile, and normal perceivers in the middle percentiles. RESULTS: In stable situation, 23 patients were poor perceivers, 58 were normal perceivers, and 12 were over perceivers. During bronchoconstriction, there were 23 poor perceivers, 47 normal perceivers, and 23 over perceivers. Agreement was estimated by a kappa index of 0.0574 for poor perception, 0.1521 for over perception, and 0.3980 for normal perception. CONCLUSIONS: Asthmatics' perception of dyspnea during periods of stability and during acute bronchoconstriction are independent phenomena. It is therefore not possible to infer how a patient will perceive an asthmatic attack by evaluating only how he or she perceives breathlessness during stable periods.

Acute Disease↗
PubMed2005

Airway inflammation and cough sensitivity in cough-variant asthma.

BACKGROUND: Mechanisms underlying cough and bronchoconstriction in patients with cough-variant asthma (CVA) are not well established. Differences in location or degree of activation of eosinophils and allergic cytokines have been suggested as the likely causes. To address this issue, we have carried out a comparative study of airway inflammatory markers between patients with CVA and classic asthma (CA). The relationship between these markers with airway hyperresponsiveness (AHR) and cough sensitivity has also been studied. METHODS: Twenty-seven non-smokers and steroid-naive patients with CVA (12) and CA (15) were examined. Capsaicin challenge, histamine bronchoprovocation test, nitric oxide levels in exhaled air and sputum induction were performed in all of them. Differential cell sputum recount and supernatant concentrations of eosinophil granule-derived cationic proteins (ECP), interleukin (IL)5, IL8 and tumour necrosis factor (TNF)-alpha were also measured. RESULTS: There were no significant differences in either the inflammatory pattern of soluble markers or differential cell counts between CA and CVA. Histamine PC20 was correlated with IL-5 in CVA, whereas it was associated with sputum eosinophilia in CA. Cough sensitivity (log C5) and histamine PC20 were inversely related in CA. CONCLUSIONS: Although the pattern of inflammatory sputum markers in patients with asthma and cough-variant asthma is similar, its relation with bronchial hyperreactivity and cough sensitivity is different in each group.

Adult↗
PubMed2004

[Prevalence of malnutrition in outpatients with stable chronic obstructive pulmonary disease].

OBJECTIVE: To determine the prevalence of malnutrition in outpatients with stable chronic obstructive pulmonary disease (COPD) followed at a respiratory clinic. MATERIAL AND METHOD: In this prospective study, we assessed the nutritional status of consecutive outpatients with stable COPD by investigating various anthropometric parameters. Patients were malnourished (low body weight) if their body mass index was within the bottom quartile of a reference population. Muscle mass was determined from the midarm muscle area and if this mass was at or within the bottom quartile, muscle wasting was present. Albumin and transferrin plasma concentrations were used as a measure of visceral protein stores. Fat stores were assessed from body fat and if this value was at or within the bottom quartile, calorific malnutrition was present. All patients underwent arterial blood gas sampling at rest and spirometry. RESULTS: A total of 178 patients--one woman (0.6%) and 177 men (99.4%)--were enrolled in the study, with a mean (SD) age of 69 (9) years. We found low body weight in 19.1% of the patients, muscle wasting in 47.2%, visceral protein depletion in 17.4%, and fat depletion in 19.1%. Of the patients with normal weight, 62.9% showed muscle wasting. The proportion of patients with a body mass index or midarm muscle area at or within the bottom quartile increased significantly with increased bronchial obstruction (P<.001 and P=.015, respectively), though 35.7% of the patients showed muscle wasting even when COPD was mild. CONCLUSIONS: Many patients with stable COPD suffer malnutrition. Nutritional state is worse with more severe COPD. Depletion involves both fat stores and muscle and visceral protein stores, but the greatest effect is seen in muscle wasting. A significant number of patients with normal weight also suffer muscle wasting. Although changes in body composition were common in our patients, low body weight was less prevalent than has been reported for populations in countries that are socially and economically similar to Spain.

Aged↗
PubMed2003

[Asthma patients' perception of dyspnea during acute bronchoconstriction].

The aim of this study was to analyze variations in the perception of acute bronchial obstruction among asthmatics in our practice and to try to define the variables that influence inter-individual differences. We studied 153 asthmatics in stable condition, using a Borg scale to measure dyspnea perceived during a histamine bronchial challenge test. To study individual perception we analyzed both absolute magnitude of perception of dyspnea on the Borg scale when forced expiratory volume in 1 second (FEV1) fell 20% (perception score 20-PS20) and the mathematical difference between PS20 and baseline dyspnea (change in Borg, CB). The results were as follows. 1) The factors that affected PS20 according to multiple linear regression were anxiety, baseline dyspnea and the provocative concentration required to produce a 20% fall in FEV1 (PC20). 2) Within each level of asthma severity, there were differences in dyspnea perception when FEV1 fell 20% (analysis of variance of repeated measures), such that patients with mild asthma and no bronchial obstruction perceived more change in dyspnea. 3) CB during the bronchial challenge test distinguished four ways of perceiving dyspnea: 15% were dysperceivers, 13% were hypoperceivers, 48% were normoperceivers and 24% were hyperperceivers. 4) Hypoperceivers and dysperceivers were at greater risk of severe exacerbation whereas hyperperceivers requested unnecessary medical consultations. 5) Subjects with poorer quality of life were usually dysperceivers; hyperperceivers were the second most common type among those with poorer quality of life. In conclusion, a large percentage of asthmatics do not appropriately perceive acute bronchial obstruction, and the simplest way to evaluate their perception is to calculate the change in dyspnea (on a Borg scale) during the bronchial challenge test. The manner of perceiving dyspnea can not be predicted beforehand, yet it has a significant impact on the use of medical resources and patient quality of life, among other aspects.

Acute Disease↗
PubMed2003

[Efficacy of an antibacterial filter for preventing contamination of respiratory function diagnostic equipment].

OBJECTIVES: Devices to assess lung function are a potential source of nosocomial infection. Our aims in this study were: 1) to determine the efficacy of an antimicrobial filter to prevent contamination of a multifunctional device; 2) to assess the ability of the filter to prevent cross contamination of individuals being tested; and 3) to evaluate the efficacy of the recommendations of the Spanish Society of Respiratory Diseases and Thoracic Surgery for disinfecting lung function equipment. DESIGN: In this prospective, randomized study in two phases we used filters in phase 1 but not in phase 2. A pharyngeal swab culture was started within 7 days of a patient's lung function test. Swab samples for culturing were taken from three different places in the equipment at the beginning and end of each working day. PATIENTS: Sixty-five patients (31 in phase 1 and 34 in phase 2) were studied. Thirty-two (49.2%) were men and the mean age was 49.4 15.7 years. RESULTS: Significantly less equipment contamination was found in phase 1 (4.2%) than in phase 2 (21%). We detected no cases of cross contamination using the criteria in this study. No cultures from any of the samples taken before exploration were positive. CONCLUSIONS: a) The antimicrobial filter used is effective for preventing the contamination of lung function testing equipment, b) throughout both phases of the study, we observed no cross contamination of patients tested, such that we cannot conclude that the antimicrobial filter is effective for preventing possible nosocomial infections, c) the recommendations of SEPAR for disinfecting lung function equipment are effective.

Cross Infection↗
PubMed2003

Cough reflex testing with inhaled capsaicin in the study of chronic cough.

OBJECTIVES: To assess the utility of capsaicin test in the differential diagnosis of non-productive causes of chronic cough and to examine the effects of treatment on this reflex. PARTICIPANTS: 86 healthy volunteers and 101 patients with chronic cough: asthma (n: 54) gastroesophageal reflux (n: 35) and post-nasal drip syndrome (n: 12). DESIGN: Prospective intervention trial. Spirometry, bronchoprovocation test with histamine (PC20), and cough challenge with ascending concentrations of capsaicin (0.49-500 microM) were initially performed in all subjects. Patients were treated for 3 months according to the origin of the cough. Concentrations that elicited two (C2) and five or more coughs (C5) were determined before and after treatment. RESULTS: In healthy subjects, cough sensitivity to capsaicin was not influenced by gender or smoking status; however, women with chronic cough were more sensitive to cough challenge than men. C2 and C5 were significantly lower in patients with asthma or gastroesophageal reflux than in post-nasal drip syndrome. No significant correlation was observed between the capsaicin cough threshold and PC20. Cough sensitivity did not improve significantly in most patients with asthma or gastroesophageal reflux despite adequate medical treatment during 3 months. Discriminative value of capsaicin test to differentiate healthy subjects from patients with asthma or reflux was poor. CONCLUSIONS: Cough sensitivity to inhaled capsaicin is a safe and reproducible tool in the study of chronic cough. However, its usefulness for the management and differential diagnosis is limited.

Administration, Inhalation↗
PubMed2003

Duration of length of stay in pneumonia: influence of clinical factors and hospital type.

Length of stay (LOS) in hospital for community-acquired pneumonia depends on the characteristics of the patient and hospital. The present study sought to identify these variables within the first 24 h of hospitalisation. Patients hospitalised for pneumonia in four hospitals (one teaching and three general hospitals) had their data analysed by univariate and multivariate statististics. The variables entered were LOS, demographical characteristics, referral source, comorbidity, initial severity of illness, laboratory analyses, initial radiograph findings and antibiotic treatment regimens. The study sample included 425 patients. The overall mortality was 8.2% and the median LOS was 9 days. Using LOS as a dependent variable, three multivariate linear regression analyses were performed with: 1) the whole cohort; 2) the low-risk classes (categories I and II of Fine); and 3) the high-risk classes (categories III, IV and V of Fine). The mathematical model identified hypoxemia, low diastolic pressure, pleural effusion, multi-lobe involvement and hypoalbuminaemia as associated with longer stays in risk classes III-V, while in the low-risk patients (I-II) only hypoxemia and pleural effusion appeared in the equation. Following adjustment for these clinical variables, the LOS remained lower in some hospitals. Several independent clinical factors increased the pneumonia-associated length of stay with significant differences between hospitals. Hypoxemia and pleural effusions were the predictive variables of length of stay in low-risk patients and, additionally, diastolic blood pressure, multi-lobe involvement and hypoalbuminaemia were significant in the higher-risk classes III-V.

Aged↗
PubMed2002

[Perception of improvement in asthma patients].

The objective of this study was to investigate the ability of patients with stable asthma to recognize improvement in bronchial obstruction with treatment. We enrolled 75 stable asthmatics (44 women and 31 men, mean age 43 17 years) who reported baseline dyspnea on a modified Borg scale. Acute bronchodilation of 15% was provoked in the laboratory, after which the patients were asked if there was a change in dyspnea. Our results were as follows. 1) Overall, 19 asthmatics (25%) failed to perceive improvement in dyspnea with bronchodilation. 2) The mean change in dyspnea was 1.17 1.11, although the change was greater in patients with more severe asthma (0.60 0.5 for mild asthmatics, 1.05 1.07 for moderate asthmatics and 1.93 1.4 for severe asthmatics; p < 0.0001). 3) Perception of improvement was significantly related to level of the patient's emotional balance (anxiety-depression), quality of life, education, socioeconomic level, age, age of onset, severity, baseline dyspnea and obstruction, thoracic pressure and number of visits to the doctor in the preceding year. 4) The variables entered into the stepwise regression model were baseline dyspnea, depression, thoracic pressure and age. 5) Generally, young asthmatics whose disease appeared at a younger age and who also had less ventilatory obstruction and greater quality of life, showed a tendency to underestimate the beneficial effect of bronchodilator treatment. Moreover, when asthma was severe, non-perceptive individuals had significantly more admissions to intensive care units due to asthma exacerbation.In conclusion, 25% of our asthmatics are unable to recognize whether their bronchia dilate as a result of treatment, meaning that they would delay the start of rescue medication during an exacerbation. Such patients should be identified in order to establish therapeutic guidelines in function of objective home criteria (peak-flow monitoring).

Adolescent↗
PubMed2002

Noninvasive positive pressure home ventilation in restrictive disorders: outcome and impact on health-related quality of life.

Noninvasive positive-pressure home ventilation (NIPPHV) improves arterial blood gases, dyspnea and health-related quality of life (HRQL) in patients with restrictive thoracic diseases. Whether these changes persist during the follow-up remains unclear. The aim of this study was to investigate the long-term effects of NIPPHV upon dyspnea, HRQL, lung function and hospitalization rate in 35 patients with kyphoscoliosis and 27 individuals with several neuromuscular disorders. So, we measured dyspnea, HRQL, lung function and nocturnal oxygen saturation (SaO2) before and after 3, 6, 9, 12 and 18 months after NIPPHV. Dyspnea was assessed with the Borg scale and HRQL was measured using the Spanish validated version of the SF-36 questionnaire. The kyphoscoliosis group showed significant improvement of PaCO2 and SaO2 at 3 months and minor dyspnea changes at 6 months after NIPPHV had been started. These patients also showed improved health status in the following categories: "physical role" and "emotional role" at 3 months and in the categories "social functioning", "vitality" and "mental health" at 6 months after NIPPHV; some of these changes persisted at 9, 12 and 18 months. In the neuromuscular group, a significant improvement of SaO2 was observed at 3 months and this persisted for 18 months. Changes of HRQL in this group included a significant improvement in "physical role" at 3 months, "emotional role" and "social functioning" at 6 months and "physical functioning" at 9 months. The hospitalization rate decreased significantly in all patients from a mean annual admission rate of 1.1 (1.4) before NIPPHV to 0.6 (1.1) after 12 months of ventilatory support (P<0.005). We conclude that: (a) NIPPHV had a higher impact on arterial blood gases, dyspnea and health-related quality of life in patients with kyphoscoliosis than in those with neuromuscular disorders; (b) most clinical and functional changes persisted at long term and (c) a significant decrease in the hospitalization rate after NIPPHV occurred in both groups.

Adult↗
PubMed2001

[Clinical manifestations and prevalence of hypercoagulable states in patients with venous thromboembolic disease].

BACKGROUND: Blood flow stasis, an alteration in the coagulation process or endothelium injury the most common mechanisms involved in venous thromboembolic diseases (TED) and constitute the so-called hypercoagulable states (HS). The HS have been classified into two groups: primary and secondary and several of them can be measured. Our purpose was to investigate the prevalence in Spain of measurable HS in patients with venous TED and to know the clinical picture of pulmonary embolism in these patients. PATIENTS AND METHOD: Sixty of 175 consecutive patients diagnosed with deep venous thrombosis and pulmonary embolism fulfilled criteria to study a HS. The study was performed 1 month after anticoagulant therapy was finished. RESULTS: Seventeen (28%) of the 60 patients had one HS that was a primary disorder in 14 and a secondary one in 3. The increase of PAI-1 level was the most common; recurrence of thrombotic events and familial history were frequent in these selected patients. CONCLUSIONS: The prevalence of hypercoagulable states in venous thromboembolic disease was high in this series. The clinical picture was similar to those to be expected and PAI-1 was the most frequent marker of hypercoagulable states.

Adult↗
PubMed2001

[Gain, loss and agreement between respiratory specialists and generalists in the diagnosis of asthma].

OBJECTIVE: To determine and analyze the degree of agreement and disagreement in the diagnosis of bronchial asthma (BA) by respiratory disease specialists and generalists in regional hospital and primary care settings. MATERIAL AND METHODS: Ninety-six outpatients (16 to 70 years of age) were studied; all had been assigned a diagnosis of BA by the referring physician or by the respiratory disease specialist. We recorded 1) clinical symptoms, determining the initial probability of a diagnosis (IPD)of BA to be high, medium or low; 2) results of spirometry and bronchodilator testing (BDT), peak flow variability and methacholine challenge testing; 3) prick test results, eosinophil levels and total serum IgE levels. Three diagnoses were recorded: the initial diagnosis (ID) by the referring physician to whom follow-up data were unavailable; diagnosis by the respiratory disease specialist based only on clinical symptoms (RSS); and the final diagnosis(FD). To arrive at a FD of BA, it was necessary to have a high or medium IPD and a positive BDT. A Kappa test was used to analyze the degree of agreement among the three diagnoses. Group features associated with greater or lesser agreement were analyzed by chi-square tests and analysis of variance. RESULTS: Agreement was acceptable between RSS and FD (K = 0.63) but very low between ID and RSS and between ID and FD. In the latter two cases, agreement was greatest for patients diagnosed in hospital and for those with high IgE levels (p < 0.05), with high IPD, longer course of disease and a history of asthma (p < 0.01) (odds ratio =59.8). Diagnostic disagreement occurred mainly for patients for whom a BA diagnosis was gained later, the of under-diagnosis being 39%. The patients involved visited the physician only because they had observed an isolated symptom related to asthma (odds ratio = 119) and to arrive at a diagnosis bronchomotor tests other than BDT were required (p < 0.01). CONCLUSIONS: a) The degree of agreement for a diagnosis of BA is low. b)The functional profile of patients for whom diagnostic agreement exists differs from that of patients for whom diagnosis is gained through testing. c) In the context of this study, a high rate of under-diagnosis is evident.

Adolescent↗
PubMed2001

[Analysis of the impact of Archivos de Bronconeumología through the Science Citation Index].

OBJECTIVE: To describe the impact factor of Archivos de Bronconeumología from 1997 until 2000 and to identify the patterns of citation of the journal and topics having the greatest impact. METHOD: SCISEARCH was used to locate citations of articles published by Archivos de Bronconeumología between 1995 and 1999. The following data were collected for each article: year of publication, authors, journal, country of publication, language, specialty or specialties, institution(s), residence of the first author and topic. The impact factor was calculated as the ratio of citations received in one year by articles published in Archivos de Bronconeumología during the two previous years and the total number of articles published by Archivos de Bronconeumología over the two years under study. RESULTS: The impact factor of Archivos de Bronconeumología was 0.107 in 1997, 0.089 in 1998, 0.105 in 1999 and 0.119 in 2000. Citations were found in a wide range of source journals, with respiratory system publications having little weight. Citations were made mainly by Spanish authors (75%) and self-citation was restrained (21.1%). Topics related to tuberculosis and respiratory infections (23.6% of the citations received) and chronic obstructive pulmonary disease (12.5%) made the greatest impact. CONCLUSION: The impact factor of Archivos de Bronconeumología is modest, although higher than those of some other publications included in Journal Citation Reports.

Databases, Bibliographic↗
PubMed2001

[The impact of COPD on hospital resources: the specific burden of COPD patients with high rates of hospitalization].

OBJECTIVES: 1) To know the impact of chronic obstructive pulmonary disease (COPD) on hospital care (visits to the emergency room and admission); and 2) to identify and describe COPD patients whose use of health care is high (COPD-HC), also assessing the costs generated by such patients. METHOD: We reviewed the files of all patients with COPD receiving care at our hospital in 1998, looking at age, sex, smoking, simple spirometry, arterial gases at rest, number of admissions, duration of hospital stay, and number of visits to the emergency room. After describing the sample, patients were stratified in three groups by use of hospital care: group A, patients not requiring hospital care; group B, patients requiring less care than the COPD-HC group; and group C, COPD-HC. The criteria used to define the COPD-HC group were 1) >= 2 admissions in one year, 2) >= 3 visits to the emergency room, without admission in one year, or 3) 1 admission and 2 visits to the emergency room for COPD exacerbation in one year. RESULTS: Three hundred twenty cases were studied, 3 women (0.9%) and 317 men (99.1%), mean age 71 9 years. One hundred twenty-six patients (39.4%) made 263 visits in 1998, accounting for 1.1% of all emergencies (n = 23,750) and 4.05% of all medical emergencies (n = 6,489). Ninety-two patients (28.7%) were admitted for exacerbation of COPD. One hundred twenty-six admissions were made over the course of the year, accounting for 9.6% of all admissions to the internal medicine wards (n = 1,309). The 39 patients (12.2%) who were classified COPD-HC generated 160 emergency visits (60.8%) and 72 admissions due to COPD (57.1%). The analysis of variation revealed statistically significant differences among the 3 groups for age, FEV1, FVC and PaO2, but not for PaCO2. COPD-HC patients had the lowest values for FEV1, FVC and PaO2 and were older. CONCLUSIONS: COPD generates high demand for hospital care. A small group of COPD patients (12.2%) accounts for nearly 60% of hospital visits for this disease. The group requiring greater care generally has more severe disease (older, more severe bronchial obstruction and hypoxemia).

Adult↗
PubMed2001

Improved asthma control with budesonide/formoterol in a single inhaler, compared with budesonide alone.

Budesonide/formoterol in a single inhaler was compared with budesonide alone, and with concurrent administration of budesonide and formoterol from separate inhalers, in patients with asthma, not controlled with inhaled glucocorticosteroids alone. In this 12-week, double-blind, randomized, double-dummy study, 362 adult asthmatics (forced expiratory volume in one second 73.8% of predicted, inhaled glucocorticosteroid dose 960 microg x day(-1)) received single inhaler budesonide/formoterol (Symbicort Turbuhaler) 160/4.5 microg, two inhalations b.i.d., or corresponding treatment with budesonide, or budesonide plus formoterol via separate inhalers. There was a greater increase in morning peak expiratory flow (PEF) with single-inhaler (35.7 L x min(-1)) and separate-inhaler (32.0 L x min(-1)) budesonide and formoterol, compared with budesonide alone (0.2 L x min(-1); p<0.001, both comparisons); the effect was apparent after 1 day (p<0.001 versus budesonide, both comparisons). Similarly, evening PEF, use of rescue medication, total asthma symptom scores and percentage of symptom-free days improved more with both single inhaler and separate inhaler therapy than with budesonide alone, as did asthma control days (approximately 15% more, p<0.001 versus budesonide, both comparisons, with a marked increase in the first week). All treatments were well tolerated and the adverse event profile was similar in all three treatment groups. It is concluded that single inhaler therapy with budesonide and formoterol is a clinically effective and well-tolerated treatment for patients with asthma that is not fully controlled by inhaled glucocorticosteroids alone.

Administration, Inhalation↗
PubMed2001

Initial risk class and length of hospital stay in community-acquired pneumonia.

The total medical costs of community-acquired pneumonia are directly related to the costs of hospital admission and length of stay. The aim of the present study was to evaluate the reasons for prolonged duration of stay in patients stratified in five risk classes for death, and to identify factors associated with prolonged stay. The study population consisted of 295 patients. According to lower (classes I, II, III) or to higher (classes IV, V) risk, the target duration of hospitalization was set at 5 and 7 days, respectively. The causes of prolonged hospitalization were classified as pneumonia-related, complications, unstable comorbid diseases and nonclinical factors. The overall percentage of patients with appropriate duration of hospitalization was 32%. Causes of prolonged hospitalization were related mainly to pneumonia (32%) from all risk classes. Morbid complications and instability of the underlying illness were greater in class V patients. Nonclinical factors were present in 29.5% of cases. Hypoxaemia, anaemia, hypoalbuminaemia, and complications appearing before 72 h were associated with prolonged hospitalization. The cause of prolonged hospitalization of patients with community-acquired pneumonia is multifactorial, depending mainly on pneumonia and comorbid conditions but there is a large number of unnecessary hospitalization days that could be reduced by improving the efficiency of hospital care.

Adolescent↗