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The high prevalence and chronicity of chronic obstructive pulmonary disease (COPD) imply that many of these patients are treated and controlled in primary-care centres, often without contact with specialized pneumologist care. We conducted the present study to evaluate the treatment administered in stable and exacerbated COPD in GP-setting clinics and to investigate which factors could be associated with the different prescriptions. This is a cross-sectional observational study of ambulatory COPD patients. General practitioners (n = 201) were selected throughout Spain by regionally stratified sampling. We recorded the physician-reported prescription drug use in ambulatory treatment of stable COPD and acute exacerbations of COPD through a standard questionnaire. Factors independently associated with the prescription of drugs were ascertained by multiple logistic regression analysis. Of 1078 questionnaires reviewed, 1001 fulfilled quality criteria. There were 878 men (88%) and 123 women (12%); 777 (78%) were smokers or ex-smokers with a mean age of 68 years. Mean FEV1 was 47% predicted (% pred.) (SD = 13%). The median number of exacerbations was two per year (range = 0-16). Regular treatment for COPD was received by 878 (88%): the most commonly used drugs were inhaled beta 2-agonists (71%), theophyllines (53%) and inhaled corticosteroids (ICs) (50%), followed by mucolytics (25%), ipratropium bromide (23%), and oral corticosteroids (OCs) (4%). Treatment for exacerbations included inhaled bronchodilators (90%), antibiotics (89%), ICs (71%) and OCs (43%). Impairment of FEV1 was the factor most strongly associated in multiple regression analysis with increasing drug prescription in stable COPD, except for mucolytics, while the number of previous acute exacerbations was the main factor associated with exacerbation treatment except for OCs, the use of which was associated with more impaired pulmonary function. A significant number of the treatments prescribed in primary care for stable and exacerbated COPD do not follow current recommendations. Impairment in FEV1 is the factor most strongly associated with increasing prescription in stable COPD and the number of previous exacerbations is the main factor associated with exacerbation treatment.

Smoking and depression are related. Bupropion, the first non-nicotinic drug that is an effective treatment in smoking cessation, is a tricyclic antidepressant that inhibits neuronal uptake of serotonin, dopamine and norepinephrine in the thalamic nuclei.To assess if certain personality factors (anxiety or depression) might predict the efficacy of bupropion for smoking cessation.The study was carried out in two smoking cessation clinics in Madrid and Barcelona. Fifty patients (21 men) declaring the desire to quit smoking were enrolled. Their mean age was 43.6 years (SD 8.75). The patients were treated with 300 mg of bupropion per day for one month and expired CO was monitored for 6 months. Personality factors were assessed on a hospital anxiety and depression scale (HADS). We evaluated whether there was a significant difference in HADS scores for patients who were still not smoking after 6 months and those who had not managed to quit.The 50 patients were smokers of a mean 39 packs per year (SD 17.82) and had mean scores of 7.4 (SD 4.15) for anxiety and 5.8 (SD 3.93) for depression. Four patients (8%) were unable to complete the study. After one month, 28% of the patients smoked, after 3 months 56% smoked and after 6 months 58% still smoked. The patients who smoked during the first month had higher depression scores than did the non-smokers (p = 0.03). After 3 and 6 months the patients who had managed to continue not smoking were those who had higher anxiety scores than did those who still smoked (p = 0.0052 at 3 months and p = 0.017 at 6 months).Patients who responded better to treatment with bupropion after 6 months of follow-up were those with higher anxiety scores on the HADS. Depression levels influenced outcome only during the first month.

To determine the prevalence and attitudes in a group of medical students between the fourth and sixth years of their studies.

Objectives: To determine the prevalence of smoking in a group of pregnant women and to evaluate changes in tobacco habits and the response to medical advice during pregnancy.

To determine the prevalence and attitudes of fourth-year medical students towards tobacco and to sensitize future health professionals to the importance of being a non-smoker.

This study was designed to evaluate the gasometric and functional respiratory responses in chronic bronchitic patients with chronic respiratory insufficiency (CRI) under ambulatory oxygen therapy (AOT) with almitrine bismesylate (AB). It was a double-blind, placebo-controlled, randomized, prospective study which lasted three months and with a dosage regime of 50-100 mg/day of AB. Fiftyfour patients completed the study (28 in AB and 24 in the placebo (P) groups, respectively). All patients were males, with a mean age or 65 +/- 6.1 years. In the study of pulmonary function only airway resistance (Raw) was changed, with a significant decrease at the third month in the AB group compared with the P group (0.83 +/- 0.31 vs. 1.07 +/- 0.46 kpa/L.S), with a p value of 0.05 (mean +/- SD) and PaO2 which improved from 8.15 +/- 0.88 to 8.81 +/- 2.3 kpa (61.17 +/- 6.6 to 66.10 +/- 10 mmHg), with a p value of 0.05. AB therapy was well tolerated.

A myopathy basically involving proximal respiratory muscles can develop in uremia. To evaluate respiratory muscle force in uremia, maximal inspiratory pressure (MIP) was measured in 27 patients with renal failure. MIP was very limited in patients with a creatinine clearance (Crc) lower than 10/ml/min 1.73 m2 not treated with hemodialysis (HD) and in patients on HD who were not treated with 1.25 (OH)2D3 (45 +/- 9 and 43 +/- 5 cm H2O, respectively), moderately reduced in patients on HD treated with 1.25 (OH)2D3 (58 +/- 5 cmH2O) and normal in patients with Crc higher than 10 ml/min 1.73 m2 (86 +/- 6 cmH2O). The treatment with 1.25 (OH)2D3 during 3 months promoted a significant increase in MIP and serum calcium level and a reduction in parathyroid hormone in patients with Crc lower than 10 ml/min. It was concluded that, in uremia, a respiratory muscle weakness partially reversible with vitamin D therapy may be found.

Se presentan tres casos de proteinosis alveolar (PA), enfermedad pulmonar infrecuente cuya etiopatogenia permanece aun sin aclarar y que se caracteriza por el deposito en los espacios aereos pulmonares de una sustancia lipidoproteica semejante al surfactante pulmonar. Se senala que si bien la clinica y la radiologia no son caracteristicas, deben hacernos sospechar que se trate de esta entidad. La fibrobroncoscopia es una tecnica auxiliar importante mediante la cual podemos realizar lavados brocoalveolares y biopsia transbronquial, permitiendonos en algunos casos obviar la necesidad de llegar a la biopsia pulmonar abierta para establecer el diagnostico de certeza. El lavado broncopulmonar es en la actualidad el tratamiento de mayor validez para la PA; sin embargo, es una tecnica compleja no exenta de riesgos, lo que unido a que mas de la mitad de los casos de esta enfermedad no cursan con gravedad, hace que haya que valorar adecuadamente la indicacion del mismo para cada caso en particular.

Resumen Se estudiaron 31 enfermos con bronconeumopatia obstructiva cronica, separados tipologicamente segun sus caracteristicas clinicas, desde un punto de vista funcional en busca de los criterios con mayor capacidad diferencial. Los Grupos A («enfisema») y B («bronquitis cronica») mantuvieron un comportamiento funcional claramente distinto. Los indices estaticos de elasticidad utilizados (compliance estatica, resorte elastico e indice de retraccion) y en menor cuantia los gases arteriales, fueron los parametros mas utiles en esta diferenciacion. Los pacientes con caracteristicas clinicas mezcla de los anteriores (Grupo C ) no solo se diferenciaron de forma mas pobre sino que mostraron un comportamiento menos coherente que pudiera achacarse a los criterios empleados para su seleccion.

Resumen Se revisa la rentabilidad diagnostica de la broncoscopia y broncografia en una serie de 196 enfermos de Hidatidosis Pulmonar. Se clasificaron los enfermos en dos grupos: Hidatidosis Pulmonar integra, 125 casos, e Hidatidosis Pulmonar complicada, 71 casos. Las exploraciones broncologicas no fueron diagnosticas cuando el quiste hidatidico estaba integro. La broncoscopia fue diagnostica de Hidatidosis Pulmonar complicada en 14 de 44 enfermos, 32%. El broncoscopio flexible permitio la visualizacion

The increasingly frequent use of continuous ambulatory peritoneal dialysis (CAPD) as substitutive therapy in terminal renal failure has induced the investigation of the advantages and disadvantages of this therapeutic modality. The effects of CAPD on pulmonary function are one of the aspects currently under study. Based on previous data suggesting the existence of extrapulmonary ventilatory restriction in uremic patients under CAPD, we have studied in these patients the respiratory muscle function as expressed in the maximal inspiratory pressure (MIP) and assessed the impact of the infusion of 2 liters of dialysis fluid into the peritoneal cavity on both MIP and the pulmonary volumes. Uremic patients evidenced significantly lower MIP values as compared with healthy controls. The filling of the peritoneal cavity induced, both in the supine and in the sitting position, a restrictive effect and an increase in the inspiratory capacity. We conclude that uremic patients under CAPD evidence a respiratory muscle dysfunction of as yet unclear cause. Our findings further suggest that the infusion of 2 liters of dialysis fluid into the peritoneal cavity induces not only a restrictive effect, but also an increase in the strength of the respiratory muscles, the latter effect being probably due to increased diaphragmatic contractility.