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The ventilatory mechanics of patients with COPD and obesity-hypoventilation syndrome (OHS) are changed when there is air trapping and auto-PEEP, which increase respiratory effort. PWith a prospective design, subjects with COPD and OHS were studied in whom positive airway pressure was applied in their treatment. PA total of 88 subjects were analyzed: 56% were males, and the mean age of 65 ± 9 y old. Fifty-four (61%) had OHS, and 34 (39%) had COPD. Fifty (56%) had air trapping, with an initial PCOPD and air trapping were associated with greater P

The cardiopulmonary exercise (CPET) test is an essential tool to determine the severity, prognosis, and need for invasive treatments in heart failure with reduced ejection fraction (HFrEF) but disregards the exercise modality. The present study aimed at analyzing the differences between treadmill and cycle-ergometer exercises. This was a prospective study, involving 65 patients with HfrEF who performed treadmill exercise followed by cycle-ergometer exercise 72 h later. We enrolled 65 patients, aged 58 ± 9 years, with an ejection fraction of 29 ± 9%. Peak VO2 was 20% greater (95% CI: 18–21%; p < 0.000) on the treadmill, and the ventilatory efficiency estimated by the VE/VCO2 slope (32 ± 8 vs. 34 ± 9; p < 0.05). The ventilatory response was greater on the treadmill: maximum ventilation (55 ± 16 vs. 46 ± 11 L/min; p < 0.000) and ventilatory reserve at the maximum effort (28 ± 17 vs. 41 ± 15%; p < 0.000). These values led to a change in the functional class of 23 (51%) patients and ventilatory class of 28 (47%) patients. Differences in the main parameters, including peak VO2 and VE/VCO2, impact prognostic scales and possible advanced treatments; therefore, the results should be interpreted in accordance with the exercise modality.

Introduction Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV. Patients and methods Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30 min at baseline and another 30 min on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥100% of LLN) and patients with HF and low CO ( Results The final sample comprised 36 patients, aged 66 (±8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO 4.5 l/min (77%), P=.009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P=.2. Conclusion A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO.

The collapsibility of the upper airway is a key factor in the pathogenesis of obstructive sleep apnea (OSA). The exact measurement of this parameter, typically performed by obtaining the critical pressure (Pcrit), has not been introduced into clinical practice. The techniques that are used to measure the upper airway resistance could provide information on its the collapsibility of the airway. The aim of this study was to associate resistance in the upper airway with the presence of OSA. Using a cross-sectional design with a control group, consecutive cases that were seen in the Chest Diseases Sleep Unit were recruited after undergoing nocturnal polysomnography. The upper airway collapsibility was determined based on the change in its resistance from the standing position to the supine position with a flow interruption (Rint) device by measuring the angle formed between the pressure/flow lines (PF angle) between the two positions. The PF angle was greater in the OSA group than in the controls: 7.5° (4) vs. 4° (2) (P

Objective: The aim of our study was to determine the tomographic findings and prevalence of bronchiectasis in our population of patients with severe asthma, and to identify factors associated with the presence of bronchiectasis in these patients. Materials and methods: We retrospectively collected data from the medical histories of patients referred to the asthma unit of our hospital, with a diagnosis of severe asthma between 2015 and 2017. Patients with ABPA, cystic fibrosis, immunodeficiency or systemic disease were excluded. High-resolution thorax-computed tomodensitography (HRCT) was performed in all patients. A standardized protocol was applied in data collection. Results: A total of 108 patients comprising 50 men (46%) and 58 women (54%) were included in the study. Of the 108 patients, 59 (55%) had at least one abnormality detected by HRCT, the most commonly reported abnormalities being bronchiectasis (35%), bronchial wall thickening (33%), emphysema (7%), atelectasis area (6%), mosaic attenuation due to air trapping (4%), and "tree in bud" image (2%). Subjects with bronchiectasis were older (p = 0.001), had a longer asthma history (p = 0.048), had poorer pulmonary function tests with lower FVC (p = 0.031), had more severe bronchial obstruction with lower FEV1 (p = 0.008) and had lower FEV1/FVC (p = 0.003). They also experienced more frequent hospitalizations in the previous year (p = 0.019) and received treatment with omalizumab more frequently (p = 0.049). Plasma eosinophil count and IgE levels were comparable in both groups. In the multivariate analysis, the presence of bronchiectasis was associated with ages older than 40 (OR: 8.3; 95% CI: 1.7-41.2) and chronic airflow obstruction (OR: 5.4; 95% CI: 1.9-15.3). Conclusions: We found that in patients with severe asthma, the prevalence of bronchiectasis is high and that bronchiectasis is associated with a longer asthma history, greater severity and, more importantly, chronic airflow obstruction. These findings are still insufficient evidence to considere features of asthma-bronchiectasis overlap syndrome, a distinct phenotype of severe asthma, but bronchiectasis is a frequent phenomenon leading to a more severe disease with frequent exacerbations. The performance of thorax HRCT on patients with severe asthma can help to evaluate management strategies for the disease in order to improve treatment and prognosis.

To analyse the accuracy of commonly used risk scores (PSI and CURB-65) in predicting mortality and need for ICU admission in Covid-19.Prospective study of patients diagnosed with Covid-19 pneumonia. Patients were followed until home discharge or death. PSI, CURB-65, SMART-COP and MuLBSTA severity scores were assessed on admission. Risk scores were related to mortality and ICU admission.About 249 patients, 143 males (57.4%) were included. The mean age was 65.6 + 16.1 years. Factors associates with mortality in the multivariate analysis were age 80 years (OR: 13.9; 95% CI 3.8-51.1) (P = .000), lymphocytes 800 (OR: 2.9; CI 95% 1.1-7-9) (P = .040), confusion (OR: 6.3; 95% CI 1.6-24.7) (P = .008) and NT-proBNP 500 pg/mL (OR: 10.1; 95% CI 1.1-63.1) (P = .039). In predicting mortality, the PSI score: AUC 0.874 (95% CI 0.808-0.939) and the CURB-65 score: AUC 0.852 (95% CI 0.794-0.909) were the ones that obtained the best results. In the need for ICU admission, the SMART-COP score: AUC 0.749 (95% CI 0.695-0.820) and the MuLBSTA score: AUC 0.777 (95% CI 0.713-0.840) were the ones that obtained better results, with significant differences with PSI and CURB-65. The scores with the lowest value for ICU admission prediction were PSI with AUC of 0.620 (95% CI 0.549-0.690) and CURB-65 with AUC of 0.604 (95% CI 0.528-0.680).Prognosis scores routinely used for CAP (PSI and CURB-65) were good predictors for mortality in patients with Covid-19 CAP but not for need of hospitalisation or ICU admission. In the evaluation of Covid-19 pneumonia, we need scores that allow to decide the appropriate level of care.

Resumen Introduccion En la patogenia del sindrome de obesidad-hipoventilacion (SOH) se ha postulado una disfuncion del centro respiratorio, que muchas veces precisa la utilizacion de ventilacion no invasiva (VNI) en domicilio para el tratamiento. Nuestro objetivo fue medir el efecto de la VNI en la funcion del CR en pacientes con SOH y los factores que lo determinan. Metodos Con un diseno prospectivo de mediciones repetidas se estudio la respuesta a la hipercapnia (RHC) midiendo la pendiente de la relacion p01/pEtCO2 en situacion basal y tras 6 meses de tratamiento con VNI en un grupo de pacientes con SOH. Previamente en un grupo control se establecio un umbral en 0,22 cmH2O/mmHg para diferenciar la respuesta optima (RO) de la respuesta suboptima (RSO) del CR. Resultados Se incluyeron 36 casos, 19 varones (52%), de 65 (DE: 9) anos de edad; un 63% de ellos tenian un p01/pEtCO2 por debajo del valor de referencia. El valor basal de p01/pEtCO2 fue de 0,17 (DE: 0,14) cmH2O/mmHg y tras 6 meses de VNI fue de 0,30 (DE: 0,22) cmH2O/mmHg (p = 0,011). Tras 6 meses de tratamiento con VNI, 12 casos (33%) mantienen una funcion deprimida de su CR. Conclusion Un 63% de los pacientes con SOH mostraron disfuncion de su CR. La aplicacion de VNI mejora la funcion del CR, aunque no en todos los casos.

Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV.Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30minutes at baseline and another 30minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P.05.The final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P=.009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P=.2.A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO.

Introduction Respiratory center (RC) dysfunction has been implicated in the pathogenesis of obesity-hypoventilation syndrome (OHS), and often requires treatment with home non-invasive ventilation (NIV). Our objective was to measure the effect of NIV on RC function in patients with OHS, and the factors that determine such an effect. Methods We performed a prospective, repeated measures study to evaluate hypercapnia response (HR) by determining the p01/pEtCO 2 ratio slope at baseline and after 6 months of treatment with NIV in a group of OHS patients. A threshold of 0.22 cmH 2 O/mmHg had previously been established in a control group, in order to differentiate optimal RC response from suboptimal RC response. Results A total of 36 cases were included, 19 men (52%) aged 65 (SD 9) years, 63% of whom had p01/pEtCO 2 below the reference value. Baseline p01/pEtCO 2 was 0.17 (SD: 0.14) cmH 2 O/mmHg and, after 6 months of NIV, 0.30 (SD: 0.22) cm H 2 O/mmHg ( P =0.011). After 6 months of treatment with NIV, depressed RC function persisted in 12 cases (33%). Conclusion In total, 63% of OHS patients had RC dysfunction. The application of NIV improves RC function but not in all cases.

Introduction: Alveolar ventilation is under the control of the respiratory center (RC). In the Obesity Hipoventilation Syndrome (OHS) a malfuction of the RC is postulated. We hypothesized that RC function would improve after treatment with non invasive ventilation (NIV). Our objetive is to analize the changes in RC function after NIV treatment in patients with OHS. Material and methods: Thirty four patients with OHS treated with NIV for at least 3 months were included, of them twenty nine cases with pCO2 Results: Age of 62 (11) years old, 62% males. The HRT basal value was 0,17 (0,14) cmH2O/mmHg and after NIV 0,27 (0,19) cmH2O/mmHg (p=0,033). Before NIV 24 cases (85%) showed SOHRT and after NIV 11 cases (37%) didn’t show changes sin the RC function. Conclusions: - An improvement in the function of the RC was found in patients with higher BMI and AHI. - The parameters chosen for the NIV treatment (especially RF) could influence in the response of RC to NIV. - Althoug the improvement in PCO2 was equally achieved in both groups in 37% of the patients no changes were detected.

Objetive To analyze alterations in pulmonary fuction observed by Cardiopulmonary Exercise Testing (CPET) in patients with cystic fibrosis (CF) and relate them with resting lung fuction tests and radiological parameters. Methods This is a prospective study including patients attending at our hospital. Patients included had performed resting fuctional tests and a treadmill ergospirometry, using a multi-breath gas analyzer and collecting flow-volume curves during exertion. These data was correlated with the resting tests, radiological parameters (Bhalla scale) and quality of life. Results Twenty three patients were included, 10 (43%) male and 13 (57%) female with a mean age of 32 + 18 (18-62) years. Static hyperinflation was observed in 5 patients (22%) and 17 patients (74%) presented dynamic hyperinflation (DH). Patients with DH showed the lowest values in FVC%, FEV1%, FEV1/FVC, MEF% and IC%. Also, they had a significantly lower punctuation on Bhalla scale (13.9 + 4.1 vs 17.8 + 0.8)(p=0.002). Data did not report any relation amongst DH and age, gender, age at diagnosis, genetic mutation type, presence of bacterial colonization, hepatic or pancreatic insufficiency or cystic fibrosis -related diabetes. We found no relationship between DH and BMI, percentage of lean body mass or dynamometry. DH influences negatively in quality of life demonstrated by CFQR questionnaire punctuation. Conclusions - CPET showed the presence of DH in 74% patients. - Neather the resting fuctional tests nor the stuctural damage measure by Bhalla scale are capable of predicting the existance of DH. - CPET on the follow-up of patients with cystic fibrosis could detect promptly exertional limitation and its ethiological mechanisms.

In obstructive sleep apnea–hypopnea syndrome (OSAS), airway collapses and vibrations cause local and systemic inflammatory response and oxidative stress (OS). Our objective was to determine the presence of OS in the airway of patients with OSAS compared with controls without OSAS and determine its relation to treatment with CPAP and other clinical variables. We performed a prospective observational case–control study with repeated measures. We recruited consecutive patients with SAHS diagnosed using complete polysomnography, and a parallel control group. We collected a sample of exhaled breath condensate (EBC) prior to nasal continuous positive airway pressure (CPAP) treatment and again after 4 months. The marker of OS used was 8-isoprostane (8-IPN). The variables analyzed were age, sex, anthropometric variables, apnea–hypopnea index (AHI), snoring, oxygenation, and polysomnographic variables. The study included 20 patients and 10 controls. In cases, the initial value of 8-IPN was 6.8 (1.9), and after nasal CPAP, it was 5.3 (1.2) pg/ml (p = 0.02). In controls, the value of 8-IPN was 5.6 (1.1) pg/ml (p = 0.04 compared to initial values). 8-IPN showed significant correlation with snoring, AHI, BMI, nocturnal desaturation index, and non-REM sleep. On multivariate analysis, only snoring was a significant predictor of 8-IPN. Snoring, and not OSAS severity, could be the phenomenon underlying the presence of local OS measured in the airway of patients with OSAS.