Roberto Rodríguez-Roisin

Publications (7)73.59 Total impact

• Article: Chronic obstructive pulmonary disease overview: epidemiology, risk factors, and clinical presentation.

  Joan B Soriano, Roberto Rodríguez-Roisin
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  ABSTRACT: Chronic obstructive pulmonary disease (COPD) has been a major public health problem during the 20th century, and will remain a challenge for the foreseeable future. Worldwide, COPD is in the spotlight, because its high prevalence, morbidity, and mortality create formidable challenges for healthcare systems. However, there remain many ongoing, contentious issues in COPD, including the definition and staging of COPD itself. Similarly, it appears that there is no consensus as yet on how, when, and where spirometry and other tools (symptoms assessment, imaging, biomarkers, and so on) should be conducted and implemented to screen, label, and treat for COPD, if any. Our current knowledge on the epidemiology, risk factors, and clinical presentation of COPD has been reasonably well documented in several previous reviews. We aim to summarize new developments surrounding the epidemiology of COPD, both at the population and at the clinical level, in comparison with other major burden contributors, while debating old and novel risk factors. Cigarette smoking is the principal causal factor, but other factors play a role in causing and triggering COPD. Likely, the clinical presentation of COPD and its contributing phenotypes within the remainder of the 21st century will be different than the "blue bloaters" and "pink puffers" observed one or two generations ago. Hopefully, the COPD clinical course will shift to better outcomes and prognosis than in the past.
  Proceedings of the American Thoracic Society 08/2011; 8(4):363-7.
• Article: Below what FEV1 should arterial blood be routinely taken to detect chronic respiratory failure in COPD?

  Diego A Rodríguez, Lluis Jover, Mitra B Drakulovic, Federico P Gómez, Josep Roca, Joan Albert Barberà, Peter D Wagner, Roberto Rodríguez-Roisin
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  ABSTRACT: To diagnose and assess chronic respiratory failure in stable chronic obstructive pulmonary disease (COPD) the measurement of arterial blood gases (ABG) is required. It has been suggested that ABG be determined for this purpose when FEV1 ranges between 50% and 30% predicted, but these thresholds are not evidence-based. To identify the post-bronchodilator (BD) FEV₁ and arterial oxygen saturation (SaO(2)) values that provide the best sensitivity, specificity, and likelihood ratio (LR) for the diagnosis of hypoxaemic and/or hypercapnic chronic respiratory failure in stable COPD. A total of 150 patients were included (39 with PaO₂ < 60 mmHg [8 kPa], 14 of them with a PaCO₂ ≥ 50 mmHg [6.7 kPa]). The best post-BD FEV(1) and SaO(2) cut-off points to predict chronic respiratory failure were selected using the PC and the Receiver Operating Characteristics (ROC) curves. A post-BD FEV(1) equal to 36% and an SaO(2) of 90% were the best predictive values for hypoxaemic respiratory failure and a post-BD FEV(1) equal to 33% for the hypercapnic variant. An FEV(1) ≥ 45% ruled out hypoxaemic respiratory failure. A post-BD FEV(1) of 36% is the best cut-off point to adequately predict both hypoxaemic and hypercapnic respiratory failure in the patient with stable COPD. For its part, an SaO(2) of 90% is the best value for isolated hypoxaemic failure. These values could be considered for future clinical recommendations/guidelines for COPD.
  Archivos de Bronconeumología 07/2011; 47(7):325-9. · 2.17 Impact Factor
• Article: Chronic obstructive pulmonary disease with lung cancer and/or cardiovascular disease.

  Roberto Rodríguez-Roisin, Joan B Soriano
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  ABSTRACT: Chronic obstructive pulmonary disease (COPD) has been identified as an enormous growing worldwide health problem associated with long-term exposure to toxic gases and particles, most often related to cigarette smoking, heavily challenging our current millennium. The present article briefly reviews the evidence of the causes of death in COPD, while focusing on the impact of two of their most common and characteristic systemic effects, also named comorbidities-namely, lung cancer and cardiovascular disease-and drawing the attention to a new field of growing interest, namely the metabolic syndrome, and its potential interplay with the natural course of COPD. A comorbidity is defined as one or more distinct disorders (or diseases) in addition to COPD, regardless of whether this condition is or is not directly related to COPD, and irrespective of whether it is or is not part of the spectrum of the natural history of COPD.
  Proceedings of the American Thoracic Society 01/2009; 5(8):842-7.
• Source

  Available from: upenn.edu

  Article: Hepatopulmonary syndrome--a liver-induced lung vascular disorder.

  Roberto Rodríguez-Roisin, Michael J Krowka
  New England Journal of Medicine 06/2008; 358(22):2378-87. · 53.30 Impact Factor
• Article: Safety of long-acting beta-agonists in stable COPD: a systematic review.

  Gustavo J Rodrigo, Luís J Nannini, Roberto Rodríguez-Roisin
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  ABSTRACT: Some studies have suggested that use of long-acting beta(2)-agonists (LABAs) leads to an increased risk for adverse events in patients with stable COPD. The purpose of this review was to assess the safety, and secondarily the efficacy of LABAs. The authors conducted a systematic review with metaanalysis of randomized clinical trials (> or = 1 month in duration) in the published literature that have compared LABAs with placebo or anticholinergics in stable poorly reversible and reversible COPD. MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register were searched to identify 27 studies. LABAs reduced severe exacerbations compared with placebo (relative risk [RR], 0.78; 95% confidence interval [CI], 0.67 to 0.91). There was no significant difference between LABA and placebo groups in terms of respiratory deaths (RR, 1.09; 95% CI, 0.45 to 2.64). Use of LABAs with inhaled corticosteroids reduced the risk of respiratory death compared with LABAs alone (RR, 0.35; 95% CI, 0.14 to 0.93). Patients receiving LABAs showed significant benefits in airflow limitation measures, health-related quality of life, and use of rescue medication. Finally, tiotropium decreased the incidence of severe COPD exacerbations compared with LABAs (RR, 0.52; 95% CI, 0.31 to 0.87). This review supports the beneficial effects of the use of LABAs in patients with stable moderate-to-severe COPD, and did not confirm previous data about an increased risk for respiratory deaths. Also, our analysis suggests the superiority of tiotropium over LABAs for the treatment of stable COPD patients.
  Chest 05/2008; 133(5):1079-87. · 5.25 Impact Factor
• Article: Gas exchange response to short-acting beta2-agonists in chronic obstructive pulmonary disease severe exacerbations.

  Eva Polverino, Federico P Gómez, Hernán Manrique, Néstor Soler, Josep Roca, Joan Albert Barberà, Roberto Rodríguez-Roisin
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  ABSTRACT: Short-acting beta(2)-agonists are one of the mainstays of bronchodilator strategy for exacerbations of chronic obstructive pulmonary disease (COPD). The assessment of pulmonary gas exchange after salbutamol in COPD severe exacerbations remains unknown. We investigated whether the effects of nebulized salbutamol during COPD severe exacerbations are associated with further deterioration of pulmonary gas exchange. We examined patients with severe COPD when hospitalized for exacerbation (n = 9), and while in stable convalescence. We assessed spirometry, arterial blood gases, systemic hemodynamics, and V/Q relationships 30 and 90 minutes after administration of 5.0 mg salbutamol. At exacerbation, compared with baseline, 30 minutes after salbutamol administration, cardiac output (Q) increased (from 6.5 +/- [SEM] 0.4 to 7.3 +/- 0.5 L . min(-1)) (p < 0.03) alone, without inducing changes in gas exchange indices. When in convalescence, compared with baseline, 30 minutes after salbutamol, there was an increase in Q (from 5.7 +/- 0.5 to 7.0 +/- 0.6 L . min(-1)) and Vo(2) (from 211 +/- 12 to 232 +/- 11 ml . min(-1)) (p < 0.002 each), whereas Pa(O(2)) decreased (from 71 +/- 4 to 63 +/- 3 mm Hg) and alveolar-arterial Po(2) difference increased due to increased perfusion of low-V/Q-ratio regions (from 4.5 +/- 2.6 to 9.6 +/- 4.1% of Q) (p < 0.05); Sa(O(2)) (93 +/- 2%) and Pa(CO(2)) (43 +/- 2 mm Hg) remained unchanged. This deleterious gas exchange response persisted at 90 minutes. At exacerbation, salbutamol does not aggravate pulmonary gas exchange abnormalities. When in convalescence, however, baseline lung function improvement was associated with a detrimental gas exchange response to salbutamol, resulting in further V/Q imbalance and small decreases in Pa(O(2)) compounded by small increases in Q and Vo(2).
  American Journal of Respiratory and Critical Care Medicine 08/2007; 176(4):350-5. · 11.08 Impact Factor
• Article: The airway pathophysiology of COPD: implications for treatment.

  Roberto Rodríguez-Roisin
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  ABSTRACT: The pathophysiology of chronic obstructive pulmonary disease (COPD) is complex and can be attributed to multiple components: mucociliary dysfunction, airway inflammation and structural changes, all contributing to the development of airflow limitation, as well as an important systemic component. Current pharmacotherapies vary in their ability to address the underlying multi-component nature of COPD. Long-acting anticholinergics and long-acting beta2-agonists (LABAs) can both provide effective and convenient bronchodilation in moderate COPD (Stage II-GOLD) and are recommended as regular therapy in global treatment guidelines. However, there is evidence to suggest that LABAs can mediate additional benefits independent of their bronchodilatory effects and may help address the multi-component nature of COPD. Effects on mucociliary dysfunction and reduced bacterial-induced damage have been experimentally proven with LABAs, and anti-inflammatory activity and structural effects have also been suggested. The use of inhaled corticosteroids (ICSs) is now recommended for the treatment of COPD patients with frequent exacerbations. In addition, ICSs provide a range of anti-inflammatory effects in COPD and thus have effects that are complementary to those of LABAs. Recent data indicate that LABA/ICS combinations produce wide-ranging clinical benefits that are greater than with either agent alone. Other new strategies include selective phosphodiesterase 4 (PDE4) inhibitors, which in addition to anti-inflammatory activity, have been shown to provide bronchodilation in COPD. In summary, the potential to address the multicomponent nature of COPD with strategies such as LABA/ICS combination therapy, and the development of new treatments directed at novel targets means that the future for sufferers of COPD can be more optimistic.
  COPD Journal of Chronic Obstructive Pulmonary Disease 07/2005; 2(2):253-62. · 1.79 Impact Factor