Search

Background We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment. Methods Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. Primary outcome: COPD exacerbations. Secondary outcomes: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication. Results Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1 = 43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (−33.3%; P Conclusions In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.

Introduction NECPAL is a tool for identification of patients with advanced chronic disease in need of palliative care. The main objective of the study is to know the prevalence of patients with palliative needs in an acute respiratory ward in a Spanish tertiary hospital using NECPAL. A second objective of the study is to know the annual mortality rate of these patients. Materials and methods Cross sectional study and prospective monitoring of a cohort identified as palliative patients with the NECPAL tool for 12 months. Patient identification was performed in patients admitted to the respiratory ward of our hospital for longer than 3 days. We have assessed the annual vital status (deceased or not deceased) of patients and have recorded demographics, clinical and functional data, as well as the use of healthcare resources. Results We monitored a cohort of 363 patients. Of them, 87 patients (24.3%) (IC 95% 19–30) were identified as NECPAL positive. 60% of patients (n = 64) died within 12 months of their admission. There was no significant difference in the mortality ratio of oncologic versus non oncologic patients. In a multivariable analysis, mortality was associated with demand by patients or relatives for palliative care and with the presence of specific disease progression markers or indicators. Conclusions prevalence of patients with palliative needs in acute respiratory wards is high (one out of four patients). 60% of the patients identified as NECPAL positive in our cohort died in the first 12 months. Training of healthcare professionals as well as availability of appropriate resources are indispensable factors to improve care of this population.

Resumen Introduccion El instrumento NECPAL es una herramienta para la identificacion de personas en situacion de enfermedad cronica avanzada con necesidades paliativas. El objetivo del estudio es conocer la prevalencia de pacientes con necesidades paliativas en un Servicio de Neumologia de un hospital terciario mediante la herramienta NECPAL. Como objetivo secundario se plantea conocer la mortalidad al ano de estos pacientes. Material y metodos Estudio trasversal y seguimiento prospectivo de la cohorte de los pacientes identificados como paliativos con la herramienta NECPAL durante 12 meses. La identificacion se realiza en pacientes ingresados > 3 dias en una planta de Neumologia. Hemos evaluado el estatus vital (fallecido o no fallecido) al ano, asi como datos demograficos clinicos, funcionales y uso de recursos sanitarios. Resultados Se analizaron 363 pacientes. De ellos, 87 (24,3%) (IC 95%, 19-30) fueron identificados como NECPAL positivos. En el seguimiento durante un ano fallecieron 54 pacientes, un 60%. No hubo diferencias en mortalidad entre diagnosticos oncologicos y no oncologicos. En el analisis multivariante, la mortalidad se asocio a la demanda de paciente o familiares de atencion paliativa y a la presencia de indicadores especificos de progresion de la enfermedad. Conclusiones La prevalencia de pacientes con necesidades paliativas en una planta de hospitalizacion de agudos de Neumologia es alta (uno de cada cuatro pacientes). El 60% de los identificados como NECPAL positivos en nuestra serie fallece en los primeros 12 meses. Son necesarios formacion y recursos para atender a estos pacientes.

Resumen A pesar de que es conocido que la presencia cronica de microorganismos en las vias aereas de pacientes con enfermedad pulmonar obstructiva cronica (EPOC) en fase de estabilidad conlleva una evolucion desfavorable, ninguna guia de manejo de la enfermedad establece pautas sobre como diagnosticar y tratar este tipo de casos. Con la intencion de orientar a los profesionales, desde la Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) se ha elaborado un documento que pretende aportar respuestas clinicas sobre el manejo de pacientes con EPOC en los que se aislan microorganismos de forma puntual o persistente. Dado que la heterogeneidad de las evidencias cientificas disponibles no permite crear una Guia de Practica Clinica, se ha elaborado un documento basado en la literatura cientifica existente y/o en la propia experiencia clinica que aborda tanto la definicion de las diferentes situaciones clinicas como su diagnostico y manejo. El texto ha sido consensuado entre un amplio numero de neumologos con gran experiencia clinica y cientifica en este ambito. Este documento cuenta con el aval del Comite Cientifico de SEPAR.

Little is known about the relationship between the COVID-19 and tuberculosis (TB). The aim of this study is to describe a group of patients who died with TB (active disease or sequelae) and COVID-19 in two cohorts. Data from 49 consecutive cases in 8 countries (cohort A) and 20 hospitalised patients with TB and COVID-19 (cohort B) were analysed and patients who died were described. Demographic and clinical variables were retrospectively collected, including co-morbidities and risk factors for TB and COVID-19 mortality. Overall, 8 out of 69 (11.6%) patients died, 7 from cohort A (14.3%) and one from cohort B (5%). Out of 69 patients 43 were migrants, 26/49 (53.1%) in cohort A and 17/20 (85.0%) in cohort B. Migrants: (1) were younger than natives; in cohort A the median (IQR) age was 40 (27–49) VS. 66 (46–70) years, whereas in cohort B 37 (27–46) VS. 48 (47–60) years; (2) had a lower mortality rate than natives (1/43, 2.3% versus 7/26, 26.9%; p-value: 0.002); (3) had fewer co-morbidities than natives (23/43, 53.5% versus 5/26–19.2%) natives; p-value: 0.005). The study findings show that: (1) mortality is likely to occur in elderly patients with co-morbidities; (2) TB might not be a major determinant of mortality and (3) migrants had lower mortality, probably because of their younger age and lower number of co-morbidities. However, in settings where advanced forms of TB frequently occur and are caused by drug-resistant strains of M. tuberculosis, higher mortality rates can be expected in young individuals.

SLICE Trial Group., [Importance] Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD)., [Objective] To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation., [Design, Setting, and Participants] Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020)., [Interventions] Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367)., [Main Outcomes and Measures] The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected., [Results] Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, −6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, −2.0% [95% CI, −4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, −3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, −1.7% [95% CI, −5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, −1.9% to 1.8%]; P = .99)., [Conclusions and Relevance] Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome., [Trial Registration] ClinicalTrials.gov Identifier: NCT02238639.

Young and middle-aged adults are the largest group of patients infected with SARS-CoV-2 and some of them develop severe disease. Objective: To investigate clinical manifestations in adults aged 18-65 years hospitalized for COVID-19 and identify predictors of poor outcome. Secondary objectives: to explore potential differences compared to the disease in elderly patients and the suitability of the commonly used community-acquired pneumonia prognostic scales in younger populations. Methods: Multicenter prospective registry of consecutive patients hospitalized for COVID-19 pneumonia aged 18-65 years between March and May 2020. We considered a composite outcome of “poor outcome” including intensive care unit admission and/or use of noninvasive ventilation, continuous positive airway pressure or high flow nasal cannula oxygen therapies and/or death. Results: We identified 513 patients

Introduction: Forced spirometry (FS) is essential for diagnosis and control of respiratory diseases. The aim is to analyze demographic, clinical and spirometric variables by age groups. Method: Retrospective study including all high quality FS (according to clinical guidelines) performed in 140 primary care centers from Sep 2011 to Feb 2019. Variables were divided by age ranges (≤14, 14-65, 65-80 and >80 years). Results: 56,515 FS were performed: 6,149 in ≤14 years (y), 36,732 in 14-65y, 11,662 in 65-80y and 1,972 in >80y. Asthma was the main previous diagnosis in the 0-65y group and COPD in the 65-95y group. In 14-65y group most of the tests are done for diagnosis and in the rest of ranges for control. In the FS performed for diagnosis, positive Post-Bronchodilator test (PBD) was detected in 2.4% of patients ≤14y, 22.1% in 14-65y, 17.4% in 65-80y and 11.7% in >80y. FEV1/FVC PBD 80y (45.3% smoking history). Tables 1 and 2 show spirometric data classified by age groups and subclassified by previous diagnoses of asthma and COPD. Conclusions: The main pre-diagnosis 80y. Considerable number of patients had previous COPD diagnosed without obstruction in PDB spirometry.

Aims: to evaluate the outcomes of NTM pulmonary disease treatment in real life practice Methods: retrospective study. All respiratory NTM isolations from 5 hospitals in northern Spain between 2012 and 2017 were analyzed. Microbiology, demographic data, radiologic features, treatment and outcome variables (cure, death, therapeutic failure) were collected Results: 395 patients has at least one NTM isolation, 147 met 2007 ATS disease criteria and / or received treatment for NTM pulmonary disease. 34 patients did not receive treatment despite meeting ATS criteria. Main results are shown in the attached tables. Multivariate analysis showed that only age> 75, the diagnosis of neoplasia and COPD were significant associated to all-cause mortality. Conclusions: Mortality in patients with NTM pulmonary disease is high but mainly related to the underlying comorbidities of the patients. Therapeutic failure is associated with the presence of M abcessus and bronchiectasis-nodular pattern in the CT scan.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has attracted interest because of its global rapid spread, clinical severity, high mortality rate, and capacity to overwhelm healthcare systems [1, 2]. SARS-CoV-2 transmission occurs mainly through droplets, although surface contamination contributes and debate continues on aerosol transmission [3–5].

Resumen El fracaso ventilatorio agudo, especialmente en la enfermedad pulmonar obstructiva cronica, es una causa frecuente de ingreso en pacientes ancianos con pluripatologia y limitacion de esfuerzo terapeutico. Cada vez hay mas datos de la utilidad de la ventilacion mecanica no invasiva (VMNI) en este contexto. Nuestro centro desarrollo en 2010 una via clinica integrada urgencias-hospitalizacion para el uso de la VMNI en el fracaso ventilatorio agudo. El objetivo de este trabajo fue evaluar el resultado de la VMNI en el fracaso ventilatorio agudo en pacientes con orden de no intubar en un hospital de subagudos. Material y metodo Estudio observacional, con un ano de seguimiento. Las variables principales son la mortalidad al ingreso y al ano. Se recogen todos los casos que reciben VMNI, a traves de un registro especifico. Otras variables recogidas son: datos demograficos, clinicos y funcionales, enfermedad de base, situacion funcional basal, gasometria, estancia y reingresos. Resultados Se incluyeron 102 pacientes con una edad media de 81 anos, un indice de Charlson de 3,7 y un indice de Barthel de 54, estando el 22% institucionalizados. La mortalidad durante el ingreso fue del 33%. Entre los pacientes sin indicacion ajustada a protocolo, la mortalidad fue del 71%. La supervivencia global al ano fue del 46%, resultando asociada en el analisis estadistico multivariante a obesidad-hipoventilacion e indice de Barthel > 50. Conclusiones La VMNI es una tecnica de utilidad en pacientes ancianos con limitacion de esfuerzo terapeutico. A pesar de la severidad y la comorbilidad, se obtienen tasas aceptables de supervivencia. Los pacientes con mejor situacion funcional basal y obesidad-hipoventilacion tienen mayor supervivencia.

Aim: Analyze clinical-radiological features and clinical course of M.kansasii pulmonary disease compared to other NTMs Methods: Retrospective, descriptive study of NTM pulmonary disease from 1997 to 2016. 2007 ATS criteria were fulfilled. We evaluated:demographic data, risk factors, symptomatology, radiology, coinfection, recurrence and overall mortality per year Results: 327cases of NTM lung disease:274(83.7%)M. Kansasii and 53(16.3%)other NTM. Comparison between them are seen in figure1.M. Kansasii group, patients were younger, males, smokers and with cancer. No differences were found in symptoms.M. kansasii was associated with more cavitation, unilaterality and upper lobes predominance. Other NTMs infections were associated with bronchiectasis, nodules or “tree in bud” infiltrates with middle lobes predominance and more coinfection. Rates of recurrence were similar in both groups and the overall-1year mortality rate, including NTMosis-related mortality and other causes mortality. Sputum conversion was maintained in 85.8% of M.kansasii vs 75.5% in other NTM and radiological resolution in 60%vs39% Conclusions: There are relevant differences between M. Kansasii lung infections and those caused by other NTMs:1. They appear to occur more in male smokers, in the fifth decade and with a history of neoplasia 2. They are associated with cavitation, unilaterality and upper lobe predominance 3. Sputum conversion and radiological resolution rates are higher

Recent studies suggest an increasing prevalence of nontuberculous mycobacteria (NTM) lung disease. The aim of the present study was to describe incidence rates of NTM lung disease and trends therein in our area over a 20-year period. This was a retrospective study of all cases of NTM lung disease between 1997 and 2016 that met the 2007 American Thoracic Society criteria. We analysed the annual incidence rates, species of mycobacteria isolated, trends over time and annual mortality in 327 patients. Mycobacterium kansasii was the most common mycobacterium isolated (84%), followed by Mycobacterium avium complex (MAC) (13%). We compared two periods: 1997–2006 (257 cases, 79%) and 2007–2016 (70 cases, 21%). The incidence rates tended to decrease across these years, with a peak of incidence in 2000 with 10.6 cases per 100 000. There was a clearly decreasing trend in M. kansasii infection, not only in the first period (incident rate ratio (IRR) 0.915, 95% CI 0.88–0.90; p, This epidemiological study shows a clear decrease in the incidence of nontuberculous mycobacterial lung disease, unlike other studies that have described an overall increase http://bit.ly/2ZH46nv

Resumen Introduccion Las bronquiectasias son una causa frecuente de ingreso en ancianos. Aunque algunas guias recomiendan el uso de antibiotico inhalado a largo plazo en bronquiectasias sin fibrosis quistica falta evidencia que avale el uso de estos tratamientos en esta poblacion. El objetivo de nuestro trabajo es evaluar la efectividad y tolerancia del tratamiento inhalado con colistina a largo plazo en pacientes ancianos con bronquiectasias sin fibrosis quistica e infeccion cronica por P aeruginosa para reducir las exacerbaciones graves que precisan ingreso. Material y metodos Estudio cuasi experimental, prospectivo, controlado, abierto. Incluimos pacientes con bronquiectasias diagnosticadas por TAC y persistencia de Pseudomonas aeruginosa en esputo despues de tratamiento apropiado. Todos los pacientes recibieron educacion y fisioterapia respiratoria. El grupo de intervencion recibio ademas colistina inhalada 1 millon UI dos veces al dia. Se recogieron datos demograficos, caracteristicas clinicas y funcionales, ingresos y visitas a urgencias en el ano previo. Los pacientes fueron seguidos durante un ano recogiendo cada 2 meses cultivo de esputo, datos clinicos funcionales, y uso de recursos sanitarios. Resultados Se incluyeron 39 pacientes, 20 en el grupo con colistina y 19 en el grupo de tratamiento convencional. No hubo diferencias significativas entre los 2 grupos en las caracteristicas basales. La edad media fue de 77,7 +/- 5, y el FEV1 41 %. Cinco pacientes (25 %) interrumpieron el tratamiento por efectos secundarios. Pseudomonas aeruginosa desaparecio del esputo en 9 pacientes del grupo de tratamiento (45 %) y solo en uno del grupo control, con significacion estadistica, sin embargo, al final del ano de estudio no hubo diferencias en el numero de ingresos (grupo control 1,6 +/- 1,7 and 2,7 +/- 3 grupo con colistina) ni en dias ingresados (19 +/- 31 and 23 +/- 20). Tampoco se detectaron diferencias entre los dos grupos en resultados funcionales o sintomas clinicos. No hubo cambios en la flora ni en la sensibilidad antibiotica. Conclusiones El tratamiento inhalado con colistina a largo plazo en pacientes ancianos colonizados por Pseudomonas hizo que disminuyera la presencia de Pseudomonas aeruginosa en esputo, pero esto no se tradujo en una disminucion en el uso de recursos sanitarios, ni en mejoria clinica o funcional. Los efectos secundarios fueron frecuentes. Son necesarios mas estudios para identificar subgrupos de pacientes que se beneficien de estos tratamientos a largo plazo.

Elderly patients with multiple morbidity and do not intubate (DNI) orders frequently present with acute respiratory failure. There are data supporting the effectiveness of non-invasive ventilation (NIV) in this context. Our chronic disease hospital developed an integrated care clinical pathway for the use of NIV in acute respiratory failure in the emergency room and wards in 2010. The aim of this study was to assess the outcome of NIV in patients with acute respiratory failure who had a DNI order in a sub-acute care hospital.Observational, one year-follow up study. The main variables were in-hospital mortality and one year mortality. Other variables recorded were: demographics, clinical data, functional data, performance of daily life activities, dementia, arterial blood gases and re-admissions.The study included a total of 102 patients, of which 22% were in institutions. The mean age 81±7.47% males, with a Charlson index 3.7±1, and Barthel index 54±31. The overall mortality during the admission was 33% (34 patients). Among those patients ventilated outside the protocol indication, the mortality was significantly greater, at 71% (P.05). Overall one-year survival rate was 46%. This survival rate was statistically higher in patients with obesity hypoventilation syndrome and a Barthel50.NIV is a useful technique in a hospital for chronic patients in an elderly population with a therapeutic ceiling. Despite their disease severity and comorbidity, acceptable survival rates are achieved. A correct case selection is needed. Obesity hypoventilation syndrome and those with Barthel index50 have a better prognosis.

Bronchiectasis is a frequent cause of admission for elderly patients and chronic respiratory diseases. Although some guidelines recommend long-term treatment with inhaled antibiotics in non-cystic fibrosis bronchiectasis with chronic Pseudomonas aeruginosa (P. aeruginosa) infection, there is limited evidence supporting these prolonged antibiotic treatments in this population. The aim of this study was to assess the effectiveness of inhaled colistin in elderly patients with bronchiectasis and chronic bronchial P. aeruginosa infection in reducing hospital readmissions.A prospective, controlled and open label study was conducted on patients with bronchiectasis diagnosed by computed tomography and persistence of P. aeruginosa in sputum after appropriate antimicrobial therapy. All patients received education, and physiotherapy training. The intervention group also received nebulized colistin 1 million IU twice a day for one year. Data were collected on the demographics, clinical and functional characteristics, admissions in previous year, and sputum microbiology. Patients were followed up every two months for one year, with readmissions, microbiological results, functional tests, and deaths being evaluated.The study included 39 patients, of whom 20 received nebulized colistin and 19 conventional therapy. There were no differences between the two groups in baseline clinical and functional characteristics or previous hospital stay. The mean age was 77.7+/-5, Charlson index 2.85, and FEV1% 41.3+/-15. Five patients (25%) stopped the nebulized treatment because of adverse effects. P. aeruginosa was eradicated in 45% of the colistin treated patients, and in only one of the control group (statistically significant), but at the end of the study year, there were no differences in the number of hospital admissions (control group 1.6+/-1.7 and 2.7+/-3 colistin group), or days of stay (19+/-31 and 23+/-20). There were no differences in lung function or clinical symptoms between the two groups No significant changes were observed in P. aeruginosa A antibiotic sensitivity or in sputum flora.More patients in the treatment group achieved Pseudomonas eradication, but benefits in clinical symptoms, lung function or use of healthcare resources in our elderly patients, could not be demonstrated. Adverse effects were common. Further studies are needed in order to identify factors associated with response, or subgroups of patients with bronchiectasis and chronic infection with P. aeruginosa, who benefit from (expensive) long term treatments with inhaled antibiotics.