BACKGROUND:Community pharmacies (CP) have access to subjects at high-risk of suffering Chronic Obstructive Pulmonary Disease (COPD). We investigated if a COPD case finding program in CP could be a new strategy to reduce COPD underdiagnosis. METHODS:Prospective, cross-sectional, descriptive, uncontrolled, remotely supported study in 100 CP in Barcelona, Spain. Pharmacists were trained in a four-day workshop on spirometry and COPD, and each was provided with a spirometer for 12 weeks. The program included questionnaires and forced spirometry measurements, whose quality was controlled and monitored by web-assistance. FINDINGS:Overall 2295 (73.5%), of 3121 CP customers invited to participate in the program accepted, and 1.456 (63.4%) were identified as "high risk" for COPD using the GOLD questionnaire. Only 33 could not conduct spirometry, and a pre-bronchodilator airflow limitation (FEV1/FVC ratio <0.7) was confirmed in 282 (19.8%); 244 of these were referred to their primary care (PC) physician for further diagnostic and therapeutic work-up, but only 39 of them (16%) fed-back this information to the pharmacist. Clinically acceptable quality spirometries (grade A or B) were obtained in 69.4% of the cases. CONCLUSION:This study shows that adequately trained and supported community pharmacists can effectively identify individuals at high risk of having COPD and can thus contribute to ameliorate underdiagnosis in this disease. Links between PC and CP should be improved to achieve a useful program.

A 75 year-old female was referred to the Central University Hospital of Asturias, Oviedo, in March 2000, because of an abnormal chest X-ray (CXR) as a casual finding. The patient at this time was asymptomatic (no chest pain, night sweats or fever). She had no known toxic habits nor surgical or medical background of interest. The chest X-ray showed a left lower lobe (LLL) alveolar infiltrate. She was diagnosed with community acquired pneumonia and received antibiotic treatment for 10 days. In her follow-up visit, she remained asymptomatic, but due to the persistence of the lesion 2 months after the pneumonia diagnosis, a computed tomography (CT) scan of the chest was performed. The CT scan revealed a LLL alveolar consolidation and associated bronchiectasis. On january 10, 2001, a bronchoscopy was conducted and no endobronchial lesions were found, being the bronchial aspirate (BAS) and brushing technique negative for malignancy and infection. With the diagnosis of bronchiectasis in the LLL, follow up visits continued for a period of 3 years, in which the patient was clinically stable and the initial lesion in the LLL remained unchanged.

A three-dimensional, computational fluid dynamics model of the human respiratory system is put forward for consideration. This in silico model is based on existing state-of-the-art geometric approximations. As a complete simulation of the geometry would have unaffordable high computational costs, the model is composed of a single path of air from the mouth to the 16th bronchial generation, truncating the symmetrical branches that were not included. The innovation housed in this model is the development of a function that is applied to the truncated branches, which contemplates the behavior of the airflow within those branches, by copying cell by cell the velocity vectors existing in the symmetrical face of the developed branch. This model can reproduce the complete airflow process: inspiration and expiration cycles, through simulation in unsteady flow conditions. In normal breathing the air velocity varies within a narrow range, with steady changes. Therefore the model has been validated simulating a spirometry maneuver, in which an inspiration and expiration are performed in the most demanding conditions in order to obtain a wide speed range with faster variations.

Objectives: Assessment of demographic and clinical factors that have an impact on the quality of life (QoL) of patients with asthma in Spain.Patients and methods: Multicenter, prospective, observational, cohort study, conducted in 40 Spanish Pneumology Units during a 12-month period. Data on sociodemographic, clinical variables, asthma treatment and QoL were collected in a case report form.Results: 536 patients (64.6% women, mean age: 54) were recruited. Reported QoL was better for patients from Northern and Central Spain as compared with those from the South and the East (p < 0.001), students and employed patients as compared with housewives and unemployed (p < 0.01), for those who had received asthma information (p < 0.01), for those with milder daytime symptoms (p < 0.01) and for patients with higher level of education (p < 0.05).Conclusions: Among the factors that have a significant effect on patients' QoL only symptom control and patient education on asthma control are modifiable. Therefore, all the strategies should be tailored to improve such factors when managing asthma patients. (C) 2013 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved.

Suspended particles can cause a wide range of chronic respiratory illnesses such as asthma and chronic obstructive pulmonary diseases, as well as worsening heart conditions and other conditions. To know the particle depositions in realistic models of the human respiratory system is fundamental to prevent these diseases. The main objective of this work is to study the lung deposition of inhaled particles through a numerical model using UDF (User Defined Function) to impose the boundary conditions in the truncated airways. For each generation, this UDF puts the values of velocity profile of the flow path to symmetrical truncated outlet. The flow rates tested were 10, 30 and 60 ℓ/min, with a range of particles between 0.1 µm and 20 µm.

Background: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain.Objective: To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment.Methods: Retrospective, multicentre study, recording the data on patients of either sex and >= 12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit.Results: 214 patients were evaluable (mean age = 48.2 +/- 17.7 years; mean age at the time of diagnosis = 26.6 +/- 16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273 +/- 205.4IU/ml. The mean monthly dose was 380.5 +/- 185.4 mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7 +/- 15.9% vs. 70.8 +/- 18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC).Conclusions: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies. (C) 2012 SEICAP. Published by Elsevier Espana, S.L. All rights reserved.

a Servicio de Medicina Intensiva, Hospital Universitario Vall d’Hebron, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain b Centre de Recerca en Enginyeria Biomedica, Departament d’Enginyeria Electronica, Universitat Politecnica de Catalunya, Barcelona, Spain c Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Facultad de Medicina y Ciencias de la Salud de la Universidad de Oviedo, Oviedo, Spain

Study objectives: The process of intermittent hypoxia-reoxygenation produces airway inflammation and endothelial dysfunction that favors the development of cardiovascular disorders in obstructive sleep apnea syndrome (OSAS). Nitric oxide (NO) is an important mediator in airway inflammation and the regulation of endothelium-dependent vasodilation.Design: This study compared airway NO (FENO) and alveolar NO (CA(NO)) measurements in exhaled breath in 30 OSAS patients to those of 30 healthy (non-OSAS) individuals and determined the relationship between NO levels and OSAS severity. Additionally, NO measurements were analyzed after 3 months of CPAP treatment.Measurements and results: The mean (+/- SD) FEN level in the OSAS group (27.2 +/- 18 ppb) was higher than in the healthy non-OSAS group (p = 0.006). The mean CAN level was 1.65 +/- 0.90 ppb, lower than in the non-OSAS group (p = 0.001). A significant correlation was found between FENO and CA(NO) levels and the apnea hypopnea index (AHI) in the OSAS group (r = 0.8, p < 0.05; r = -0.9, p = 0.01, respectively). FENO levels decreased and CA(NO) levels increased significantly after CPAP treatment.Conclusions: Severe OSAS patients have higher FENO and lower CA(NO) levels and these are restored to normal after CPAP treatment, reflecting the correction of local upper airway inflammation and endothelial dysfunction present in OSAS patients. Exhaled breath techniques can be useful to identify airway inflammation and endothelial dysfunction in severe OSAS patients. (c) 2010 Elsevier Ltd. All rights reserved.

The main objective of this work is the analysis of the fluid dynamic characteristics of the obstructive pulmonary diseases (Cronic Obstructive Pulmonary Disease, COPD, bronchitis and emphysema). Its obstructive pattern can be easily detected in the spirometry, but they usually need more complex tests to distinguish between them. However, their fluid dynamic features are quite different. A 3D numerical model of the bronchial tree has been developed, from the trachea to the seventh level bronchioles, following the model developed by Weibel and Kitaoka . The main innovation in the numerical model is the unsteady boundary conditions applied and an adaptive time step, using two User Defined Function (UDF). The analysis of the results obtained varying the geometry and the unsteady boundary conditions, allows the characterization of the particular fluid dynamic phenomenon of each disease and how it is perceived in the tests.

BackgroundCOPD case finding is currently recommended at primary and tertiary care levels only.AimTo evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry.MethodsPilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV1/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry.ResultsOf the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV1/FVC ratio<0.7. When these subjects with airflow limitation were offered referral to a hospital respiratory function laboratory for further assessments, 11 (52%) attended the appointment. Over 70% of spirometries were rated as being of acceptable quality. No significant differences were observed in lung function parameters between the pharmacy and hospital measurements.ConclusionsCOPD case finding by spirometry in high-risk customers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.

Equations used to estimate ventilation out of EIT images, validated on healthy volunteers show a significant bias and a larger variance when applied to COPD patients. The differences in estimation values were found to be highly correlated to anthropometric parameters and CO exchange (DL,CO) in a previous group of COPD patients. A new group of 13 COPD male patients (FEV1/FVC<70% and FVC ≥ 80%) was used in this study, with stricter inclusion criteria than in the previous one. Anthropometric parameters (age, weight, height, skinfolds) and values of several pulmonary function tests, such as spirometry (FVC, FEV1 and FEV1/FVC), static volumes (RV and TLC) and pulmonary diffusion (DL,CO and DL,CO /VA) were recorded. The EIT system (TIE4sys) and a pneumotach were simultaneously connected to monitor tidal volume. The anthropometric main values of COPD patients were: Age 67±9 years; height 1.65±0.05 m; weight 72±11 kg; BMI 26.4±3.3 kg/m2; Subscapular skinfold 23±9 mm. The mean values of pulmonary function test were: Spyrometry FVC 83±13, FEV1 47±15% of reference value and FEV1/FVC 40±9%. Static Volume test RV 168±43% and TLC 119±12% of reference value. Pulmonary diffusion test DL,CO 56±15%, DL,CO,ADJ 57±15% and DL,CO /VA 68±13% of reference value. The mean tidal volumes estimated with TIE4sys and the pneumotach were: 0.544±0.196 L and 0.763±0.168 L r = 0.861 (p<0.01). The mean difference was 0.218±0.100 L (p<0.01). The differences show a strong correlation with the subscapular and rear skinfold; and the pulmonary diffusion values. The correction equation was: Difference=0.09-0.005 ⋆ (DL,CO,ADJ) +0.028 ⋆ (rear_skinfold)-0.01 ⋆ (subscapular skinfold) (R2=0.899; p<0.01). The differences of determinations estimated with pneumotach and TIE4sys can be attributed to changes in lung internal anatomy (DL,CO, DL,CO,adj Hb, DL,CO/VA) and also anthropometric characteristics like subscapular skinfold.

Background: The prevalence of asthma and bronchial hyper-responsiveness is greater in elite athletes than in the general population, and its association with mild airway inflammation has recently been reported. Objective: To study the relationship between the type of sport practised at the highest levels of competition (on land or in water) and sputum induction cell counts in a group of healthy people and people with asthma. Material and methods: In total, 50 athletes were enrolled. Medical history, results of methacholine challenge tests and sputum induced by hypertonic saline were analysed Results: Full results were available for 43 athletes, who were classified by asthma diagnosis and type of sport (land or water sports). Nineteen were healthy (10 land and 9 water athletes) and 24 had asthma (13 land and 11 water athletes). Although the eosinophil counts of healthy people and people with asthma were significantly different (mean difference 3.1%, 95% CI 0.4 to 6.2, p = 0.008), analysis of variance showed no effect on eosinophil count for either diagnosis of asthma or type of sport. However, an effect was found for neutrophil counts (analysis of variance: F = 2.87, p = 0.04). There was also a significant correlation between neutrophil counts and both duration of training and bronchial hyper-responsiveness among athletes exposed to water (Spearman’s rank correlations, 0.36 and 0.47, p = 0.04 and 0.04, respectively). Conclusions: Elite athletes who practice water sports have mild neutrophilic inflammation, whether or not asthma is present, related to the degree of bronchial hyper-reactivity and the duration of training in pool water.

BACKGROUND AND AIM:Carbon dioxide (CO2) rebreathing is a complication of non-invasive ventilation (NIV). Our objectives were to evaluate the ability of masks with exhaust vents (EV) to avoid rebreathing while using positive pressure (PP) NIV with different levels of expiratory pressure (EPAP). Concerning volume-cycled NIV, we aimed to determine whether cylindrical spacers located in the circuit generate rebreathing.MATERIALS AND METHODS:5 healthy volunteers were evaluated. Bi-level PP was used with 3 nasal and 2 facial masks with and without EV. Spacers of increasing volume attached to nasal hermetic masks were evaluated with volume NIV. Inspired CO2 fraction was analyzed.RESULTS:Rebreathing was zero with all nasal masks and EPAP levels. Using facial masks 1 volunteer showed rebreathing. There was no rebreathing while using all the spacers.CONCLUSIONS:In healthy volunteers, nasal and facial masks with EV prevent rebreathing. In addition, the use of spacers did not generate this undesirable phenomenon.