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Introduction: ILD compose a heterogeneous group of conditions demanding a multidisciplinary approach. However, a significant number of ILD cases must be labelled as ‘unclassifiable ILD’,common in fibrotic ILD Objective: To describe our patients showing unclassifiable ILD and the basis for diagnosis Methods: Retrospective descriptive study based on a database of patients assessed in ILD Specialized Unit and diagnosed with unclassifiable ILD (clinical, radiological and pathological findings did not suggest a specific diagnosis after assessment by an ILD multidisciplinary team) Results: 640 patients: 88 (14%), 55 ♂, 33 ♀, were diagnosed with unclassifiable ILD. Mean age: 70.85 ± 15.40 and 75.54 ± 10.36 in unclassifiable ILD cases. HRCT patterns:41 alternative diagnosis, 4 probable UIP, 11 indeterminate, 8 UIP, 11 NSIP, 13 other. 27 patients underwent bronchoalveolar lavage, 16 transbronchial biopsy and 1 surgical lung biopsy. Reasons for an unclassifiable ILD: old age (47), comorbidities (11), mild or stable disease (14), severe disease (4), patient declining surgical lung biopsy (2), and major discrepancies between clinical, radiological and pathological findings (10) Conclusions: A significant number of ILD cases are diagnosed as unclassifiable ILD, thus hindering pharmacological treatment. Survival is similar in patients with IPF or unclassifiable ILD. A greater use of antifibrotic therapy is advisable because most HRCT patterns present pulmonary fibrosis

Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease whose main extra-articular organ affected is the lung, sometimes in the form of diffuse interstitial lung disease (ILD) and conditions the prognosis. Methods: A multicenter, observational, descriptive and cross-sectional study of consecutive patients diagnosed with RA-ILD between 2013 and 2018. Demographic, analytical, respiratory functional and evolution characteristics were analyzed to evaluate the predictors of progression and mortality. Results: 106 patients were included. The mean age was 70.2±19.8 years and 51.9% of the patients presented UIP pattern. In the multivariate Cox analysis the age (HR 1.33, 95% CI 1.09-1.62, p=0.0045), the DLCO (%) (HR 0.85, 95% CI 0.73-0.98, p=0.0246), and the final SatO2 (%) in the 6MWT (HR 0.62, 95% CI 0.39-0.99, p=0.0465) were independent predictor variables of mortality, as well as the GAP index (HR 4.65, 95% CI 1.59 - 13.54, p=0.0051) and the CPI index (HR 1.12, 95% CI 1.03 - 1.22, p=0.0092). Also highlight that the diagnostic delay was an independent predictor of mortality (HR 1.11, CI 1.01-1.23, p = 0.035). Conclusions: This is the first study where it is objectified that the diagnostic delay in RA-ILD is associated with an increased mortality just like happens in IPF.

The convergence of tuberculosis and diabetes represents a co-epidemic that threatens progress against tuberculosis. We have investigated type 2 diabetes as a risk factor for tuberculosis susceptibility, and have used as experimental model whole blood infected in vitro with Mycobacterium tuberculosis. Blood samples from diabetic patients were found to have a higher absolute neutrophil count that non-diabetic controls, but their immune functionality seemed impaired because they displayed a lower capacity to phagocytose M. tuberculosis, a finding that had been previously reported only for monocytes. In contrast, an increased production of TNFα was detected in infected blood from diabetic patients. Despite the altered phagocytic capacity showed by cells from these patients, the antimicrobial activity measured in both whole blood and monocyte derived macrophages was similar to that of controls. This unexpected result prompts further improvements in the whole blood model to analyze the immune response of diabetes patients to tuberculosis.

Introduction: SRIF was described as changes in lung parenchyma (hyalinized interstitial fibrosis, alveolar septal thickening, emphysema and respiratory bronchiolitis-RB) in lobectomy specimens from smokers with cancer and eventually by HRCT (ground-glass attenuation, reticulation and thick-walled cysts without traction bronchiectasis or parenchymal distortion) Objectives: To describe a group of SRIF patients as associated with interstitial lung disease (ILD) and/or emphysema Methods: Retrospective study on SRIF patients diagnosed in ILD consult since 2016 by HRCT. The variables included:age, sex, smoking habit, HRCT findings, spirometry, DLCO, pulmonary biopsy and diagnosis Results: 30 patients (28 ♂,2 ♀); mean age 69; 80% ex-smokers, 20% current smokers. All underwent HRTC with findings of SRIF and another ILD in most cases (Table 1). Spirometry pattern was obstructive in 11, non-obstructive in 3 and normal in 14. DLCO was low in 26 (mild 9, moderate 13, severe 4). Out of 4 pulmonary biopsies (1 transbronchial and 3 surgical) SRIF was found in the surgical ones. Final diagnoses: ILD 19 (Table 2), COPD and/or emphysema 17. In 17 patients SRIF was associated with other smoking related-ILD:9 CPFE, 5 RB-ILD, 2 pulmonary LCH, 1 RA-ILD. 21 patients were evaluated in ILD multidisciplinary meeting Conclusions: 1-Radiologists must consider SRIF on performing HRCT on smokers or ex-smokers. 2-SRIF may coexist with multiple HRCT patterns of smoking-related ILD

Part of the susceptibility to tuberculosis has a genetic basis, which is clear in primary immunodeficiencies, but is less evident in apparently immunocompetent subjects. Immune responses were analysed in blood samples from tuberculosis patients and their healthy first-degree relatives who were infected in vitro with mycobacteria (either Mycobacterium tuberculosis or M. bovis BCG). The antimicrobial activity against M. tuberculosis in blood from relatives was significantly lower than that observed in healthy controls. Tuberculosis patients exhibited a higher number of neutrophils, and monocyte phagocytosis was inhibited in both relatives and tuberculosis patients. A remarkable finding was that the production of reactive oxygen species by infected neutrophils was higher in relatives than in healthy controls. A higher production of TNFα in infected blood from relatives was also observed. These results may indicate that relatives display a stronger inflammatory response and that their immune response to M. tuberculosis is different from those of unrelated controls. First-degree relatives may represent a highly informative group for the analysis of tuberculosis susceptibility.

Resumen: Objetivo: El objetivo de este estudio ha sido conocer las características de los pacientes EPOC por fenotipos y según la GOLD 2011-ABCD y el grado de concordancia de los tratamientos farmacológicos. Diseño: Estudio transversal de observación y descriptivo. Emplazamiento: Pacientes EPOC entre 40 y 85 años pertenecientes al Ãrea de León que figuran en la base de datos MEDORA de Atención Primaria. Participantes: De los 5.522 pacientes recogidos en la base de datos de MEDORA con los criterios de selección descritos, se calculó un tamaño muestral de 734 sujetos, de los cuales se estudiaron finalmente 577 enfermos. Mediciones principales: Se diseñó un cuestionario estructurado para recoger la información sociodemográfica, clínica, tratamientos y calidad de vida. Se incluía realización de espirometría y prueba broncodilatadora. Resultados: De los 734 enfermos muestreados se ha conseguido estudiar al 78,6% (577). En 166 pacientes (28,7%), el diagnóstico había sido realizado exclusivamente por la clínica, sin constancia de espirometría en el MEDORA. En 123 (21,3%) el índice FEV1/FVC fue superior a 0,7, por lo que se descartó el diagnóstico de EPOC. Con respecto a los tratamientos prescritos según fenotipos, observamos que en el fenotipo no agudizador existe una sobreprescripción de corticoides inhalados. Lo mismo sucede en los grupos A y B. Conclusiones: A pesar de las guías clínicas, el manejo de los pacientes con EPOC en la vida real sigue siendo mejorable, tanto en el aspecto diagnóstico como de medidas terapéuticas. Abstract: Objective: The purpose of this study was to evaluate different characteristics of COPD patients according to phenotypes and GOLD guidelines.according to GesEPOC phenotypes and GOLD 2011 ABCD guidelines and pharmacological treatment agreement. Design: Cross-sectional survey. Location: COPD patients aged 40-85 from León were randomly selected from Primary Care database, MEDORA. Participants: 5222 eligible COPD patients were collected from MEDORA database. We calculated a sample size of 734 patients and finally studied 577 of them. Main measurements: PatientsÌ clinical, functional and health related quality of life information were collected. Spirometry and postbroncodilator test were performed. Results: A total of 577 patients were included in this study. 28.7% of them did not have a spirometry recorded in their files. 123 patients had a normal or non-obstructive spirometry pattern, so they were excluded from a COPD diagnostic. With regard to treatments, there was an overprescribing of inhaled steroids in patients from GOLD A and B groups, and also in patients with the called exacerbator phenotype (GesEPOC). Conclusion: Although there have been several published guidelines, management of COPD patients in real life should be improved. Palabras clave: Enfermedad pulmonar obstructiva crónica, Espirometría, Diagnóstico, Tratamiento, Keywords: Chronic obstructive pulmonary desease, Spirometry, Diagnostic, Treatment

INTRODUCTION The GOLD guidelines, include in the COPD definition a obstruction to the airflow, define as a ratio FEV1/FVC METHODS There was selected, between 5522 cases diagnosed of COPD in accordance to the data base of the medical history of primary attention, 577 patients, between 40 and 85 years old. Spirometry were performed. The correctly performed test were evaluated by the GOLD, NICE and LLN criteria, according to age range. Kappa concordance coefficient was used to evaluate the results. RESULTS The spirometries of 469 patients were evaluated. 368 had an obstructive disease according to GOLD; 277 according to NICE and 244 according to LLN. Stratified by age The Kappa coefficient between the GOLD and LLN was 0.572 for the interval from 40 to 55 years old; 0.437 between 55 to 70 and 0.301 from 70 to 85 years old. Between the NICE and LLN criteria were 0.576; 0.559 and 0.436 for the same intervals. CONCLUSIONS As the age increases a mayor discrepancy is observed between the different criteria used to evaluate the obstruction of the airflow in the COPD, losing concordance among them.

As previous studies have shown Interstitial lung diseases(ILD)would be a risk factor for lung cancer(LC)development OBJECTIVES: Describing our population of patients with concomitant ILD and LC as well as knowing their survival MATERIAL AND METHODS: Prospective study started in 2012 comprising 41 patients with ILD and LC revised in ILD consult(25%)or LC consult(75%).The variables included were age,sex,smoking habit,radiological ILD pattern,FVC,DLCO,histology,tumor localization,stage,treatment and time until death RESULTS: The average age was 71.9±8.4;95% were male.70% ex-smokers and 30% smokers.The radiological patterns were:20 UIP,8 possible UIP,8 inconsistent UIP,4 NSIP and 1 LCH.The average FVC was 94±19 and DLCO 50±16.Most tumors(61%)were located in the upper lobes.3 patients were not biopsy-proven,16 squamous cell carcinoma,11 ADC,8 SCLC and 3 NOS carcinoma.20 patients were diagnosed in stages I and II and 21 in stages III and IV.Only 4 patients underwent surgery,5 chemotherapy,5 radiotherapy,16 combined treatment and 11 palliative treatment.There were 23 deaths(average time to death 5.3 months±4.5).No statistically significant differences in mean time to death between different radiological patterns of ILD were shown. CONCLUSIONS: LC represents a major comorbidity in ILD patients,mainly in those with UIP pattern Concomitance of ILD and LC has an adverse impact on survival.There was no difference in mean survival between the different radiological patterns of ILD.