Introducción

Impact of the iCODEX tool in routine clinical practice in Spain

INTRODUCTION

The prognosis of COPD patients can be calculated using multidimensional indexes that improve the predictive capacity of the individual variables. The CODEX index can be calculated using iCODEX, a digital support tool available on the web and in an app. The aim of this study was to evaluate how the usefulness and applicability of iCODEX and its recommendations in routine clinical practice are perceived by specialists in internal medicine, pneumology, and primary care.

METHODS

A cross-sectional study was conducted from November 2019 to February 2020 with the participation of specialists in internal medicine, primary care, and pneumology. All respondents completed a survey consisting of 104 questions on their perception of the iCODEX tool.

RESULTS

Overall, 335 physicians responded. Of these, 95.2% had no difficulty accessing the tool and 83.1% were quite or very satisfied with it. Regarding the applicability and implementation of iCODEX recommendations in routine clinical practice, respondents reported that the recommendations were generally applicable: most questions obtained a median score of ≥ 4 out of 5. The recommendations with the greatest expected clinical benefit are listed.

CONCLUSIONS

Our study shows that the iCODEX tool is easy for participating specialists to use and identifies the recommendations that have the greatest clinical impact in areas such as lung obstruction, severe exacerbations, exercise, smoking, and patient follow-up.

Residential radon and characteristics of chronic obstructive pulmonary disease

It is not known whether residential radon exposure may be linked to the development of chronic obstructive pulmonary disease (COPD) and/or have an influence on the functional characteristics or exacerbations of COPD. The aim of this study was therefore to ascertain whether there might be an association between residential radon concentrations and certain characteristics of COPD. We analyzed COPD cases drawn from a case-control study conducted in an area of high radon exposure. Data were collected on spirometric pulmonary function variables, hospital admissions, and smoking. Radon measurements were taken using alpha-track-type CR-39 detectors individually placed in patients' homes. All statistical analyses were performed using the IBM SPSS v22 computer software program. The study included 189 COPD cases (79.4% men; median age 64 years). The median radon concentration was 157 Bq/m3. No differences were found between radon concentration and sex, age or severity of breathing obstruction as measured by FEV1%. It should be noted, however, that 48.1% of patients with FEV1% < 50 had radon concentrations below 100 Bq/m3, as compared to 35.6% with the same severity of obstruction who had over 300 Bq/m3. COPD cases with radon concentrations higher than > 600 Bq/m3 exhibited no different characteristics in lung function. Exposure to radon does not appear to have an influence on the clinical characteristics of smokers and ex-smokers with COPD. As exposure to residential radon increases, there is no trend towards a worsening of FEV1%. Further studies are thus needed to analyze this possible association in never-smokers with COPD.

Impact of patients' attitudes and dynamics in needs and life experiences during their journey in COPD: an ethnographic study

OBJECTIVES

Despite its importance in determining coping behaviors, few studies have assessed the reality of chronic obstructive pulmonary disease (COPD) and its management perceived by patients. This study aimed at an in-depth understanding of this reality to identify COPD patients' attitudes, COPD-shaped experiences, and overlooked needs during their journey.

METHODS

Qualitative ethnographic study including 28 adult patients with moderate and severe COPD and 20 healthcare professionals. Study phases were (1) in-depth individual and (2) ethnographic interviews (qualitative), and (3) online questionnaires (quantitative), including 400 patients. Qualitative data were collected using audio, video, and observation notes. Three ethnographers analyzed data using a template covering different themes: attitudes of COPD patients, COPD-shaped experiences, and overlooked needs.

RESULTS

We identified four attitudinal profiles of COPD patients: 'active controller,' 'naïve minimizer,' 'defeated sufferer,' and 'struggling bon vivant,' which were validated in 400 COPD patients, as well as five stages in the COPD patient journey and overlookedneeds. The 'active controller' profile was associated with slower disease progression compared with the 'defeated sufferer' and 'struggling bon vivant' profiles.

CONCLUSION

Four attitudinal profiles were distinguished and validated in a large sample of COPD patients. Patients' attitudes impacted in COPD-associated experiences, limitations, and unmet needs, which differed among profiles.

Inflammatory biomarkers in the pathogenesis of respiratory dysfunction in people living with HIV

BACKGROUND

Although the association between HIV infection and airway obstruction is well known, its etiopathogenesis is not clear.

OBJECTIVES

Our aim was to analyze the association between biomarkers of systemic inflammation and bacterial translocation and pulmonary function tests in HIV-infected patients and compare the results between smokers and non-smokers.

METHOD

It was a cross-sectional, observational study. The inclusion criterion of the study was people living with HIV with undetectable plasma viral load. The exclusion criterion was other comorbidities associated with systemic inflammation. Outcome variables were spirometry and diffusing capacity for carbon monoxide; explanatory variables were inflammatory biomarkers (interleukin-6, tumor necrosis factor-alpha), bacterial translocation (soluble CD14 [sCD14] and bacterial 16S rDNA), and variables related to HIV infection. Associations were tested using the Pearson/Spearman correlation tests, the Student t-test, and multivariable linear regression.

RESULTS

We included 71 patients (54.9% smokers). We did not observe significant differences in pulmonary function tests according to biomarkers of inflammation or bacterial translocation. In non-smokers (n=32), sCD14 was negatively correlated with forced expiratory volume in 1 second (R = -0.35, P = 0.048) and forced vital capacity (R= -0.40, P=0.023). Age, time since HIV diagnosis, and CD4+ nadir were associated with alterations in PFTs. In smokers, the only association observed was between the pack-years and pulmonary obstruction.

CONCLUSION

In non-smokers, HIV patients' lung dysfunction can be, at least partially, related to bacterial translocation (sCD14), CD4+ nadir, and time since HIV diagnosis.

Efecto de una actividad grupal educativa en la calidad de vida de la persona con EPOC

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC), es un importante problema de salud pública que repercute sobre la calidad de vida. Se requieren intervenciones que reduzcan su impacto. Objetivo: Determinar el efecto de una actividad educativa grupal sobre la calidad de vida de personas con EPOC, que asisten a una institución de cuarto nivel durante septiembre-2017 y junio-2018, en Bogotá, Colombia. Métodos: Diseño cuasi-experimental. La variable independiente fue la actividad educativa grupal y la variable dependiente la calidad de vida, medida con el Cuestionario Respiratorio de Saint George (SGRQ). Los pacientes se aleatorizaron con una tabla generada por computador. El grupo control (n=30) recibió la intervención usual y el grupo experimental (n=30) una actividad educativa grupal diseñada bajo recomendaciones internacionales, impartida por el personal de enfermería. Se excluyeron pacientes con asistencia a actividades grupales durante los últimos dos meses. Resultados: La media de la calidad de vida pos-intervención fue 41% y 32% para el grupo control y experimental, respectivamente, se redujeron dos puntos con respecto a la medición inicial. La dimensión de actividad fue la más comprometida. No se encontraron diferencias estadísticamente significativas en el análisis intragrupal ni intergrupal. Discusión: La leve mejoría pos-intervención en las dimensiones de actividad e impacto, así como las variables sociodemográficas son congruentes con otros estudios. Los resultados pueden guardar relación con la cantidad de actividades desarrolladas. Conclusiones: La actividad grupal no genera mejoría estadísticamente significativa en la calidad de vida de las personas con EPOC. Se identificó una mejoría clínica en las dimensiones de actividad e impacto, así como en la puntuación global.