28 de septiembre de 2015
Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial
https://www.dovepress.com/efficacy-of-a-respiratory-rehabilitation-exercise-training-package-in--peer-reviewed-article-COPD
Conclusion: Results of this study suggest that the respiratory rehabilitation exercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD.
17 de septiembre de 2015
Hospitalizaciones potencialmente evitables por descompensación de EPOC
http://www.atlasvpm.org/documents/10157/0e89ca32-b9f5-431c-b7e3-4a09dbc7f05d
Las hospitalizaciones evitables son un indicador indirecto de la capacidad de resolución de la Atención Primaria y directo del
volumen de actividad hospitalaria potencialmente prevenible mediante cuidados oportunos y efectivos en el primer nivel
asistencial. La hipótesis de partida es que, la correcta aplicación de intervenciones habitualmente proporcionadas por Atención
Primaria – prevención primaria, diagnóstico y tratamiento temprano y/o seguimiento y control adecuados-, los cuidados
ambulatorios especializados y la cooperación entre niveles asistenciales supondría una importante reducción de las tasas de
este tipo de hospitalizaciones.
Las hospitalizaciones por descompensación de Enfermedad Pulmonar Obstructiva Crónica (EPOC) están incluidas entre las
“hospitalizaciones potencialmente evitables” y se utilizan como indicador de la calidad y coordinación de la atención a los
pacientes frágiles o con enfermedades crónicas.
- El Atlas VPM (Variaciones en la Práctica Médica) evalúa la asistencia sanitaria recibida por más de 45 millones de españoles en 203 áreas sanitarias de las 17 Comunidades Autónomas.
16 de septiembre de 2015
14 de septiembre de 2015
4 de agosto de 2015
Cómo realizar una espirometría de calidad
https://www.youtube.com/watch?v=6KIPK92OYnE&index=15&list=PLX8gn9E0dsu5j3Jb_rg4nUDOEeUHi2oTF
Un video de P2P FEGAS
"P2P: del Profesional para el Profesional" es un programa formativo de la Fundación Pública Escuela Gallega de Administración Sanitaria (FEGAS) basado en la gestión del conocimiento a través de píldoras formativas que responden a necesidades formativas básicas en el ámbito clínico con contenidos breves y directos.
Un video de P2P FEGAS
"P2P: del Profesional para el Profesional" es un programa formativo de la Fundación Pública Escuela Gallega de Administración Sanitaria (FEGAS) basado en la gestión del conocimiento a través de píldoras formativas que responden a necesidades formativas básicas en el ámbito clínico con contenidos breves y directos.
Ejercicio aeróbico y asma
Aerobic training decreases bronchial hyperresponsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial
Conclusions Aerobic training reduced bronchial hyperresponsiveness and serum proinflammatory cytokines and improved quality of life and asthma exacerbation in patients with moderate or severe asthma. These results suggest that adding exercise as an adjunct therapy to pharmacological treatment could improve the main features of asthma.
(COCHRANE): En un paciente con asma bien controlado con LABA + Corticoides inhalados ¿se debe suspender el LABA?
(COCHRANE) En un paciente con asma bien controlado con LABA + Corticoide inhalado ¿se debe suspender el LABA?
Stopping long-acting beta2-agonists (LABA) for adults with asthma well controlled by LABA and inhaled corticosteroids
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011306.pub2/abstract
Authors' conclusions
This review suggests that stopping LABA in adults who have stable asthma while they are taking a combination of LABA and ICS inhalers may increase the likelihood of asthma exacerbations that require treatment with oral corticosteroids, but this is not certain. Stopping LABA may slightly reduce asthma control and quality of life, but evidence was insufficient to show whether this had an effect on important outcomes such as serious adverse events and exacerbations requiring hospital admission, and longer trials are warranted. Trialists should include patient-important outcomes such as asthma control and quality of life and should use validated measurement tools. Definitions of exacerbations should be provided.
Sensitivity of different spirometric tests for detecting airway obstruction in childhood asthma
http://informahealthcare.com/doi/abs/10.3109/02770903.2014.984842
Conclusions:
(1) Tests at low lung volumes (small airway tests) are more sensitive than large airway tests;
(2) Within groups, the FEV1 is better than PEFR and FEF75 is better than FEF25–75 or FEF50.
Conclusions:
(1) Tests at low lung volumes (small airway tests) are more sensitive than large airway tests;
(2) Within groups, the FEV1 is better than PEFR and FEF75 is better than FEF25–75 or FEF50.
REVIEW - Diagnosis And Monitoring Of Chronic Obstructive Pulmonary Disease
http://www.hsric.nihr.ac.uk/topics/review-diagnosis-and-monitoring-of-chronic-obstructive-pulmonary-disease/
Currently, the diagnosis of COPD is often delayed, meaning that patients miss out on appropriate care in the early stages of their disease. In addition, COPD exacerbations are usually treated without knowing the specific cause of the exacerbation, which exposes some patients to unnecessary treatments, a particular concern given the increasing development of antibiotic resistance and the potentially significant side effects of corticosteroids. In this review, we sought to determine whether any technologies currently in development could address these issues. We identified technologies by searching a wide range of online sources, and then asked clinical experts and patients with COPD to comment on each technology’s level of innovation, likely impact on patients and health services, acceptability to users, and likelihood of adoption by the NHS.
Horizon Scanning Research & Intelligence Centre
What does the future hold for COPD diagnostic and monitoring technologies?
Chronic obstructive pulmonary disease (COPD) is a lifelong, progressive and incurable disease of the airways that affects more than 1.5 million people in England and Wales. Patients experience shortness of breath and cough, which restricts their daily life, and many also suffer periods when their symptoms get rapidly worse. These ‘exacerbations’ are often due to infection and usually require treatment with antibiotics and corticosteroids, often in hospital. COPD is therefore a significant burden on patients, carers and the NHS.
Currently, the diagnosis of COPD is often delayed, meaning that patients miss out on appropriate care in the early stages of their disease. In addition, COPD exacerbations are usually treated without knowing the specific cause of the exacerbation, which exposes some patients to unnecessary treatments, a particular concern given the increasing development of antibiotic resistance and the potentially significant side effects of corticosteroids. In this review, we sought to determine whether any technologies currently in development could address these issues. We identified technologies by searching a wide range of online sources, and then asked clinical experts and patients with COPD to comment on each technology’s level of innovation, likely impact on patients and health services, acceptability to users, and likelihood of adoption by the NHS.
15 de julio de 2015
Using a mobile health application to support self-management in chronic obstructive pulmonary disease: a six-month cohort study
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4472616/
Conclusions
Home based, unassisted, daily use of the mHealth platform is feasible and acceptable to people with COPD for reporting daily symptoms and medicine use, and to measure physiological variables such as pulse rate and oxygen saturation. These findings provide evidence for integrating telehealth interventions with clinical care pathways to support self-management in COPD.
26 de junio de 2015
18 de junio de 2015
Hablemos sobre EPOC: ¿La conocías?
Sesión clínica del centro de salud San Blas de Alicante :
http://sesionessanblas.blogspot.com.es/2015/06/hablemos-sobre-epoc-la-conocias.html
http://sesionessanblas.blogspot.com.es/2015/06/hablemos-sobre-epoc-la-conocias.html
10 de junio de 2015
EUROPEAN MEDICINES AGENCY (EMA) : inicio de la revisión de los corticoides inhalados en la EPOC
http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Inhaled_corticosteroids_for_chronic_obstructive_pulmonary_disease/human_referral_prac_000050.jsp&mid=WC0b01ac05805c516f
The European Medicines Agency (EMA) has started a review of inhaled corticosteroid-containing medicines used to treat chronic obstructive pulmonary disease (COPD). COPD is a long-term inflammatory disease of the lungs in which the airways and air sacs in the lungs become damaged or blocked. Corticosteroids are widely used in the European Union (EU) to treat COPD and are usually taken by inhalation using an inhaler device.
The review of inhaled corticosteroid-containing medicines has been requested by the European Commission to evaluate the risk of pneumonia (inflammation of the lungs) when these medicines are used for COPD. The risk of pneumonia with these medicines is known and was first identified in 2007 when a study showed that patients treated with an inhaled corticosteroid, fluticasone, were at higher risk of developing pneumonia than those given placebo (dummy treatment)*. Since then, new studies of individual inhaled corticosteroids and combined study results (meta-analyses) on the class of inhaled corticosteroids have provided further data on the risk of pneumonia and it was considered necessary that a thorough review be performed to further characterise this risk.
EMA will now review all available data on the risk of pneumonia with inhaled corticosteroids for COPD and consider the need to update the existing prescribing advice across the EU.
'iCoach' : una 'App' para dejar de fumar
http://www.infosalus.com/salud-investigacion/noticia-mas-442000-europeos-utilizan-icoach-app-dejar-fumar-20150529141102.html?utm_content=bufferba585&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
¿ Cuándo prescribir azitromicina ?
http://www.australianprescriber.com/magazine/38/3/87/9
Azithromycin is a broad-spectrum macrolide antibiotic with a long half-life and excellent tissue penetration.
It is primarily used for the treatment of respiratory, enteric and genitourinary infections and may be used in preference to other macrolides for some sexually transmitted and enteric infections.
Azithromycin has additional immunomodulatory effects and has been used in chronic respiratory inflammatory diseases for this purpose.
Potential major adverse effects include cardiovascular arrhythmias and hearing loss. Macrolide resistance is also a problem, as are interactions with commonly prescribed drugs.
Andalucía sin tabaco
http://livestream.com/easptv/AndaluciaSinTabaco/videos/88953036?t=1433160675
Nueva edición de “Diálogos EASP”, centrada esta vez en la lucha contra el tabaquismo en la comunidad autónoma andaluza.
El director del Plan Integral de Tabaquismo de Andalucía (PITA), Daniel Jesús López Vega y el director de la Unidad de Gestión Clínica Rodríguez Arias de San Fernando (Cádiz), Vidal Samuel Barchillón nos hablan del trabajo que se ha desarrollado por parte de profesionales y administración para ayudar a miles de personas a dejar de fumar y establecer hábitos de vida más saludables.
Nueva edición de “Diálogos EASP”, centrada esta vez en la lucha contra el tabaquismo en la comunidad autónoma andaluza.
El director del Plan Integral de Tabaquismo de Andalucía (PITA), Daniel Jesús López Vega y el director de la Unidad de Gestión Clínica Rodríguez Arias de San Fernando (Cádiz), Vidal Samuel Barchillón nos hablan del trabajo que se ha desarrollado por parte de profesionales y administración para ayudar a miles de personas a dejar de fumar y establecer hábitos de vida más saludables.
Broncodilatadores para la EPOC : cuadro resumen
https://mileon.wordpress.com/2015/05/28/broncodilatadores-para-la-epoc-cuadro-resumen/
El Dr. Borrego, adjunto del servicio de Medicina Interna del Hospital de León, ha realizado una actualización sobre el anterior cuadro de broncodilatadores, incluyendo los nuevos productos que se han comercializado en los últimos meses.
Actividad física en pacientes con EPOC : The PROactive instruments
http://erj.ersjournals.com/content/early/2015/05/28/09031936.00183014.long
Daily and clinical visit “PROactive physical activity in COPD” instruments are hybrid tools combining a short patient-reported outcome questionnaire and two activity monitor variables which provide simple, valid and reliable measures of physical activity in COPD patients.
Daily and clinical visit “PROactive physical activity in COPD” instruments are hybrid tools combining a short patient-reported outcome questionnaire and two activity monitor variables which provide simple, valid and reliable measures of physical activity in COPD patients.
Rinitis alérgica : guía de práctica clínica
http://oto.sagepub.com/content/152/1_suppl/S1.long
This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options.
This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options.
18 de mayo de 2015
Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications
http://thorax.bmj.com/content/68/1/114.full?utm_content=HT_A6&utm_medium=Link6&utm_medium=email&utm_campaign=ATS&utm_campaign=Thorax_ATS&utm_source=landingpage&utm_source=marketing_email&keytype=ref&siteid=bmjjournals&utm_term=&ijkey=rx9mxHs129chk
Conclusions
The inhaled anticholinergic agents ipratropium and tiotropium have the potential to increase the risk of serious cardiovascular events, including mortality, when used in the treatment of COPD.
The authors urge caution in prescribing inhaled anticholinergics for patients with pre-existing arrhythmias or cardiac disorders.
Blood fibrinogen as a biomarker of chronic obstructive pulmonary disease
http://thorax.bmj.com/content/68/7/670.full?utm_source=landingpage&utm_medium=Link4&utm_campaign=ATS&utm_source=marketing_email&utm_medium=email&utm_campaign=Thorax_ATS&utm_content=HT_A4&utm_term=
Conclusions Fibrinogen is likely to be a useful biomarker to stratify individuals with COPD into those with a high or low risk of future exacerbations and may identify those with a higher risk of mortality.
Conclusions Fibrinogen is likely to be a useful biomarker to stratify individuals with COPD into those with a high or low risk of future exacerbations and may identify those with a higher risk of mortality.
21 de abril de 2015
Efficacy of 13-valent polysaccharide conjugate vaccine (PCV13) against Pneumococcal Pneumonia in Adults
http://www.nejm.org/doi/full/10.1056/NEJMoa1408544
CONCLUSIONS
Among older adults, PCV13 was effective in preventing vaccine-type pneumococcal, bacteremic, and nonbacteremic community-acquired pneumonia and vaccine-type invasive pneumococcal disease but not in preventing community-acquired pneumonia from any cause.
12 de abril de 2015
Actualización 2015 de la guía de asma GINA
The 2015 update of the Global Strategy for Asthma Management and Prevention incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. It is the first annual update of the document since a major revision was launched on World Asthma Day, May 6, 2014. This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.
http://www.ginasthma.org/documents/4
9 de abril de 2015
Toma de decisiones compartida y medicina mínimamente impertinente en pacientes con EPOC
Shared decision making and minimally disruptive medicine for COPD patients
Sobre la medicina mímimamente impertinente :
Interpretación de las pruebas funcionales respiratorias
A Stepwise Approach to the Interpretation of Pulmonary Function Tests
Atorvastatina en bronquiectasias
http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70050-5/abstract?cc=y
6 months of atorvastatin improved cough on a quality-of-life scale in patients with bronchiectasis. Multicentre studies are now needed to assess whether long-term statin treatment can reduce exacerbations.
6 months of atorvastatin improved cough on a quality-of-life scale in patients with bronchiectasis. Multicentre studies are now needed to assess whether long-term statin treatment can reduce exacerbations.
18 de marzo de 2015
11 de marzo de 2015
Indacaterol/glicopirronio frente a Tiotropio/formoterol en EPOC moderada-grave : Estudio QUANTIFY
http://thorax.bmj.com/content/early/2015/02/12/thoraxjnl-2014-206345.full.pdf+html
Conclusions:
Indacaterol/glycopyrronium is non-inferior to TIO+FOR in improving HRQoL, with clinically meaningful and significant improvements in breathlessness and lung function in patients with COPD.
Azitromicina en infecciones respiratorias de vías bajas: una revisión Cochrane
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001954.pub4/abstract
Authors' conclusions
There is unclear evidence that azithromycin is superior to amoxycillin or amoxyclav in treating acute LRTI. In patients with acute bronchitis of a suspected bacterial cause, azithromycin tends to be more effective in terms of lower incidence of treatment failure and adverse events than amoxycillin or amoxyclav. However, most studies were of unclear methodological quality and had small sample sizes; future trials of high methodological quality and adequate sizes are needed.
9 de marzo de 2015
Atención continuada e ingresos hospitalarios evitables en pacientes con EPOC
http://www.jabfm.org/content/28/2/222.abstract?etoc
Conclusions: Patients with COPD with higher continuity of care had a significantly lower likelihood of avoidable hospitalization. To prevent future hospitalizations, health policy stakeholders should encourage physicians and patients to develop long-term relationships to further improve their health outcomes.
Conclusions: Patients with COPD with higher continuity of care had a significantly lower likelihood of avoidable hospitalization. To prevent future hospitalizations, health policy stakeholders should encourage physicians and patients to develop long-term relationships to further improve their health outcomes.
4 de marzo de 2015
3 de marzo de 2015
El BasicEPOC llega a los centros de salud
Hoy, he impartido el primer módulo de la versión del programa de formación BasicEPOC para centros de salud en el Polígono Sur de Sevilla. Ha sido una sesión intensa con una gran asistencia de unos magníficos profesionales que trabajan en la zona más deprimida de la ciudad.
Muchas gracias por vuestra participación activa.
La próxima semana, volveré con el segundo módulo.
Muchas gracias por vuestra participación activa.
La próxima semana, volveré con el segundo módulo.
18 de febrero de 2015
Impacto de un paquete de recomendaciones al alta tras reingreso por una exacerbación de la EPOC
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116187#sec009
Contenidos del paquete de recomendaciones:
The care bundle recommendations are that all patients admitted with an AECOPD receive the following interventions from staff who have the appropriate competencies, most often delivered by one or more clinicians who are members of a respiratory team;
Care bundles aim both to improve quality of care, and to standardise delivery, so that all of the included elements are delivered routinely.
Contenidos del paquete de recomendaciones:
The care bundle recommendations are that all patients admitted with an AECOPD receive the following interventions from staff who have the appropriate competencies, most often delivered by one or more clinicians who are members of a respiratory team;
- (1) Evidence-based smoking cessation interventions (support and pharmacotherapy) and offer of referral to smoking cessation service if a current smoker;
- (2) Assessment for, explanation of, and referral to, a pulmonary rehabilitation programme;
- (3) Appropriate education, written personalised information including information about patient support groups (British Lung Foundation (BLF) Breathe Easy Groups), self-management plans (for example, BLF self-management booklet), and, if appropriate, rescue packs for future exacerbations and an oxygen alert card or equivalent;
- (4) Assessment of patient understanding and use of medications with focus on enabling effective inhaler technique;
- (5) Leave hospital with booked review once discharged from hospital.
Care bundles aim both to improve quality of care, and to standardise delivery, so that all of the included elements are delivered routinely.
Conclusions
The COPD discharge care bundle appeared to be associated with a reduction in readmission rate among hospitals using it. The significance of this is unclear because of changes to background trends in London and nationally.
Uso de la vacuna antineumocócica en adultos
http://jama.jamanetwork.com/article.aspx?articleid=2110955
Major recommendations
- Pneumococcal vaccine–naive adults aged 65 years or older (or adults ≥65 years whose pneumococcal vaccine history is unknown) should receive 1 dose of 13-valent pneumococcal conjugate vaccine (PCV13) followed by a dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) 6 to 12 months later (minimum duration between PCV13 and PPSV23, 8 weeks).
- Adults aged 65 years or older who have previously received 1 or more doses of PPSV23 should receive 1 dose of PCV13 1 year or longer after the most recent PPSV23 dose.
- In adults who received PPSV23 before age 65 years, PCV13 should be given after age 65 years (and ≥1 year after the PPSV23 was given). PPSV23 should then be repeated 6 to 12 months later (and ≥5 years since the initial PPSV23 injection).
15 de febrero de 2015
Efecto de la vacuna antineumocócica 13-valente sobre la enfermedad neumocócica invasiva en niños y adultos de USA
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)71081-3/abstract
PCV13 reduced invasive pneumococcal disease across all age groups when used routinely in children in the USA. These findings provide reassurance that, similar to PCV7, PCVs with additional serotypes can also prevent transmission to unvaccinated populations.
PCV13 reduced invasive pneumococcal disease across all age groups when used routinely in children in the USA. These findings provide reassurance that, similar to PCV7, PCVs with additional serotypes can also prevent transmission to unvaccinated populations.
Documento de consenso SEPAR-ALAT sobre vacunación antineumocócica en fumadores
https://www.alatorax.org/tabaquismo/biblioteca-tabaquismo/guias-tabaquismo/documento-de-consenso-separ-alat-sobre-vacunacion-antineumococica-en-fumadores
Streptococcus pneumoniae es causante de diversos cuadros clínicos: neumonía adquirida en la comunidad,
sinusitis, otitis media, etc. Sin duda, la forma clínica más grave ocasionada por este germen es la enfermedad
neumocócica invasiva. Se sabe que determinados factores, entre los que destaca el consumo de
tabaco, y el padecimiento de enfermedades subyacentes concomitantes aumentan el riesgo de padecer
estos procesos. Este artículo muestra un documento de consenso sobre vacunación antineumocócica en
fumadores que ha sido realizado por un grupo de expertos en tabaquismo de la Sociedad Española de
Neumología y Cirugía Torácica y de la Asociación Latinoamericana del Tórax.
Mejora de la adherencia al tratamiento con corticoides inhalados en niños con asma mediante un recordatorio electrónico
http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(15)00008-9/abstract
The use of an electronic monitoring device with an audiovisual reminder led to significant improvements in adherence to inhaled corticosteroids in school-aged children with asthma. This intervention could be beneficial for the improvement of asthma control in patients for whom poor asthma control is related to poor adherence.
The use of an electronic monitoring device with an audiovisual reminder led to significant improvements in adherence to inhaled corticosteroids in school-aged children with asthma. This intervention could be beneficial for the improvement of asthma control in patients for whom poor asthma control is related to poor adherence.
4 de febrero de 2015
28 de enero de 2015
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