C Villasante

Hospital Universitario La Paz, Madrid, Madrid, Spain

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Publications (90)350.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Asthma PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: to compare the perception of dyspnea (POD) during cycle exercise testing and airway challenge to adenosine in non-asmathic (group 1) fictitious asthmatic (group 2), and asthmatic (group 3) obese subjects. fictitious asthma was considered when patients have used bronchodilator or corticoid inhaler medication during the last year despite not having a positive bronchial responsiveness testing or elevation of exhaled nitric oxide (NO). Anxiety and depression questionnaires (State-Trait Anxiety Inventory for Adults [STAI] and Beck Depression Inventory [Beck], respectively), body impedance assessment, exhaled NO, spirometry and body plethysmography measurements were performed in all patients. POD was measured in both, adenosine challenge and cycle ergometer testing, using the modified 10-point Borg scale. Finally, incremental exercise testing was conducted on an electronically cycle ergometer (Oxycon Alpha, Viasys). we included 73 patients (group 1=27, group 2=22, group 3=24). Groups were not different by demographic (age, sex, smoking habit) and anthropometric variables. Group 2 had higher Trait anxiety scoring than group 1 (30.9±13.8 vs.19.1±13.4, p<0.05). Pulmonary function testing were similar between groups 1 and 2. During adenosine challenge, POD assessed by the rate of change in Borg score was greater in group 2 than in group 1 (1.95±1.66 vs. 0.57±1.12, p<0.05). Also, relationship between adenosine concentration and changes of the Borg score was greater in group 2 than in group 1 (p=0,051). Likewise, in the exercise testing, the intercept (but not the slope) for work intensity-Borg ratings was significantly lower in group 2 and 3 than in group 1 (13.7±11.6; 12.5±6.7; 30.6±10.8, p<0.001, respectively). Finally, fictitious asthmatic patients had lower intercept and higher slope for oxygen uptake-Borg rating than non-asthmatic patients (p<0.001). in obese patients, POD during exercise testing is greater in fictitious asthmatic than in non-asthmatic subjects but similar to asthmatic patients. Also, perceptual response to bronchoconstriction is higher in fictitious asthma than in non-asthma patients. overdiagnosis of asthma in obese subjects could be due to a greater PODDISCLOSURE: The following authors have nothing to disclose: Carlos Carpio, Francisco García-Río, David Romero, Isabel Fernández, Raul Galera, Carlos Villasante, Rodolfo Álvarez-SalaNo Product/Research Disclosure Information.
    Chest 03/2014; 145(3 Suppl):13A. · 7.13 Impact Factor
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    ABSTRACT: Subjective measurement of physical activity using questionnaires has prognostic value in COPD. However, their lack of accuracy and large individual variability limit their use for evaluation on an individual basis. We evaluated the capacity of the objective measurement of daily physical activity in patients with COPD using accelerometers to estimate their prognostic value. In 173 consecutive subjects with moderate to very severe COPD, daily physical activity was measured using a triaxial accelerometer providing a mean of 1-min movement epochs as vector magnitude units (VMUs). Patients were evaluated by lung function testing and 6-min walk, incremental exercise, and constant work rate tests. Patients were followed for 5 to 8 years, and the end points were all-cause mortality, hospitalization for COPD exacerbation, and annual declining FEV(1). After adjusting for relevant confounders, a high VMU decreased the mortality risk (adjusted hazard ratio [HR], 0.986; 95% CI, 0.981-0.992), and in a multivariate model, comorbidity, endurance time, and VMU were retained as independent predictors of mortality. The time until first admission due to COPD exacerbation was shorter for the patients with lower levels of VMU (adjusted HR, 0.989; 95% CI, 0.983-0.995). Moreover, patients with higher VMU had a lower hospitalization risk than those with a low VMU (adjusted incidence rate ratio, 0.099; 95% CI, 0.033-0.293). In contrast, VMU was not identified as an independent predictor of the annual FEV(1) decline. The objective measurement of the daily physical activity in patients with COPD using an accelerometer constitutes an independent prognostic factor for mortality and hospitalization due to severe exacerbation.
    Chest 01/2012; 142(2):338-46. · 7.13 Impact Factor
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    ABSTRACT: Although asthma is one of the most prevalent chronic respiratory diseases, the participation of Spanish pulmonology units in the management of asthma may have room for improvement. To determine the degree of involvement of the Spanish pulmonology services in the patient care, education and research related with asthma disease and especially in difficult-to-control asthma. A survey made up of 75 questions was sent to the heads of several pulmonology departments. The survey asked questions pertaining to respiratory disease care in general, and in asthma in particular, as well as the educational activities and research in asthma during the previous five years. Out of the 107 surveys sent, 69 (645%) centers filled them out and returned them. Forty-seven (681%) met the criteria for an important level of health-care activity in asthma. However, only 29 (42%) had a monographic consultation for difficult-to-control asthma and 37 (536%) used an education program. As for postgraduate education, only 31 (449%) provided their resident physicians with specific asthma training. And in the research field, 12 (174%) reported having projects funded by SEPAR and 25 (362%) had published studies in journals with an impact factor. Although the majority of the pulmonology centers interviewed report a notable activity in asthma patient care, their involvement in the specialized approach for difficult-to-control asthma is insufficient. Likewise, participation in educational activities and research related with the disease is inconsistent and limited to few centers.
    Archivos de Bronconeumología 01/2012; 48(4):114-9. · 2.17 Impact Factor
  • Sleep Medicine 09/2011; 12:S104. · 3.49 Impact Factor
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    ABSTRACT: A very weak relationship has been reported between the health-related quality of life (HRQL) of patients with asthma and their degree of airway hyper-responsiveness (AHR), evaluated in terms of sensitivity. However, this relationship still has not been sufficiently explored for bronchial reactivity indices. To analyse the relationship between bronchial reactivity and sensitivity with the HRQL of patients with stable asthma, identifying the functional parameters that determine HRQL. In 103 consecutive patients with stable asthma, HRQL was evaluated using the Asthma Quality of Life Questionnaire (AQLQ). Patients underwent spirometry and non-specific bronchial provocation with methacoline. Sensitivity (PD(20)) and reactivity (dose-response slope (DRS), continuous index of responsiveness (CIR) and bronchial reactivity index (BRI)) of the dose-response curve were analysed. BRI presented significant differences with different degrees of asthma severity. Although patients with AHR showed poorer quality of life than patients without AHR, the AQLQ total score was not related to PD(20) but rather to DRS (r=-0.784), CIR (r=-0.712) and BRI (r=-0.776). The indices of bronchial reactivity reached a negative correlation with all the domains of the AQLQ. In a multiple linear regression model, BRI, DRS, FIV(1) (forced inspiratory volume in 1 s) and VCIN (inspiratory vital capacity) were identified as independent predictors of the AQLQ total score (r(2)=0.742, p<0.001). In patients with stable asthma, bronchial reactivity is associated with HRQL. This could justify incorporating bronchial reactivity indices in bronchial provocation analyses.
    Thorax 09/2010; 65(9):795-800. · 8.38 Impact Factor
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    ABSTRACT: We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n = 4,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n = 3,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1-10.2%) in 1997 to 4.5% (95% CI 2.4-6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40-69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p<0.05) within this 10-yr frame. The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.
    European Respiratory Journal 12/2009; 36(4):758-65. · 6.36 Impact Factor
  • Chest 11/2009; 136(5 Suppl):e30. · 7.13 Impact Factor
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    ABSTRACT: In elderly subjects, static lung volumes are interpreted using prediction equations derived from primarily younger adult populations. To provide reference equations for static lung volumes for European adults 65 to 85 years of age and to compare the predicted values of this sample with those from other studies including middle-aged adults. We compare the lung volumes by plethysmography and helium dilution in elderly subjects. Reference equations were derived from a randomly selected sample from the general population of 321 healthy never-smoker subjects 65 to 85 years of age. Spirometry and lung volume determinations by plethysmography and multibreath helium equilibration method were performed following the American Thoracic Society/European Respiratory Society recommendations. Reference values and lower and upper limits of normal were derived using a piecewise polynomial model. Plethysmography provided higher values than the dilutional method for all lung volumes, with wide limits of agreement. In addition to height, our reference equations confirm the age- and body size dependence of lung volumes in older subjects. Practically all the estimations performed by extrapolating reference equations of middle-aged adults overpredicted the true lung volumes of our healthy elderly volunteers. Middle-aged reference equations classify subjects as being below the total lung capacity lower limit of normal between 17.9 and 62.5% of the women and between 12.5 and 42.2% of the men of the current study. These results underscore the importance of using prediction equations appropriate to the origin, age, and height characteristics of the subjects being studied.
    American Journal of Respiratory and Critical Care Medicine 10/2009; 180(11):1083-91. · 11.04 Impact Factor
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    ABSTRACT: Data on the relationship between exercise-induced bronchoconstriction (EIB) and exhaled nitric oxide (NO) in adult patients with asthma are controversial. It is unclear whether endogenous NO may act as either a protective or stimulatory factor in the airway response to exercise or whether changes in exhaled NO simply reflect acute narrowing of the airway. The aim of this study was to assess the changes in the fraction of exhaled nitric oxide (FE(NO)) before and after exercise challenge in patients with asthma and to analyze the relationship between FE(NO) and airway obstruction. Twenty-five non-smoking, steroid-naïve, atopic, adult patients with mild persistent asthma and 12 non-smoking, nonatopic, healthy subjects (control group) performed an exercise challenge on a cycloergometer, with monitored ventilation. FEV1 and FE(NO) were measured at baseline and 1, 5, 10, 15 and 20 minutes after the exercise challenge. Eleven of the asthmatic patients had exercise-induced bronchoconstriction (EIB group) and the remaining 14 did not (non-EIB group). Baseline FE(NO) was higher in the EIB and non-EIB asthmatic groups than in the control group. In the EIB group, FE(NO) was significantly lower 5, 10 and 15 minutes after exercise, and the changes in FE(NO) correlated with variation in FEV1 10 and 15 min after exercise. A significant correlation between baseline FE(NO) and maximal post-exercise decrease in FEV1 was found in asthmatic patients (EIB group). In conclusion, exhaled nitric oxide levels transiently decrease during exercise-induced bronchoconstriction in adult patients with asthma. Baseline FE(NO) might predict the airway obstruction resulting after exercise.
    International Journal of Sports Medicine 12/2006; 27(11):905-10. · 2.27 Impact Factor
  • O Mediano, F García-Río, C Villasante
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    ABSTRACT: A comparison is made between the end-tidal fractional concentration of carbon dioxide (FETCO2) obtained during application of varying levels of continuous positive airway pressure (CPAP) with a prototype mask (from Carburos Metálicos) and FETCO2 obtained with 2 commonly used nasal masks (Profile Lite and ComfortClassic from Respironics). The nasal FETCO2 was measured on 3 consecutive days in 11 healthy volunteers, 12 patients with severe obstructive sleep apnea-hypopnea syndrome, and 12 hypercapnic patients. A different mask was randomly assigned on each day and the FETCO2 was measured after 3 minutes of CPAP at 4, 5, 6, 8, 10, 15, and 20 cm H2O. Although in all cases a progressive reduction in FETCO2 was observed with increasing CPAP, the effect was greatest with the prototype mask at all pressures. In the 3 different study groups the pressures obtained with the prototype mask were similar to those generated by the CPAP machine. In conclusion, the lower concentration of nasal CO2 obtained using the prototype mask suggests that it causes less rebreathing.
    Archivos de Bronconeumología 05/2006; 42(4):189-93. · 1.37 Impact Factor
  • O. Mediano, F. García-Río, C. Villasante
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    ABSTRACT: A comparison is made between the end-tidal fractional concentration of carbon dioxide (FETCO2) obtained during application of varying levels of continuous positive airway pressure (CPAP) with a prototype mask (from Carburos Metálicos) and FETCO2 obtained with 2 commonly used nasal masks (Profile Lite and ComfortClassic from Respironics). The nasal FETCO2 was measured on 3 consecutive days in 11 healthy volunteers, 12 patients with severe obstructive sleep apnea-hypopnea syndrome, and 12 hypercapnic patients. A different mask was randomly assigned on each day and the FETCO2 was measured after 3 minutes of CPAP at 4, 5, 6, 8, 10, 15, and 20 cm H2O. Although in all cases a progressive reduction in FETCO2 was observed with increasing CPAP, the effect was greatest with the prototype mask at all pressures. In the 3 different study groups the pressures obtained with the prototype mask were similar to those generated by the CPAP machine. In conclusion, the lower concentration of nasal CO2 obtained using the prototype mask suggests that it causes less rebreathing.
    Archivos de Bronconeumología. 04/2006; 42(4):189–193.
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    ABSTRACT: To identify factors associated with diagnosis and health-related quality of life (HRQL) impairment in chronic obstructive pulmonary disease (COPD) patients from a population-based epidemiological study. This was an epidemiologic, multicenter, population-based study. Three hundred and sixty-three individuals diagnosed with COPD from a randomly general population sample of 4035 individuals aged 40-69 were included in the analyses. Forced spirometry was performed on eligible subjects, and the European Commission for Steel and Coal (ECSC) and the St. George's Respiratory Questionnaires (SGRQ) were completed. Logistic regression models were constructed to identify variables associated with the previous diagnosis of COPD and with COPD in never smokers. A multiple linear regression model attempted to identify variables influencing HRQL impairment. Only 79 (21.7%) COPD patients had been previously diagnosed. Disease severity based on FEV(1), worse SGRQ score, previous respiratory disease, as well as the presence of wheezing were significantly associated with previous diagnosis. Being a woman, older than 55, with previous respiratory disease and without expectoration or wheezing characterized COPD in never smokers. A worse HRQL was associated with chronic symptoms, especially dyspnea; and with older age, cardiac comorbidity and impairment in lung function. Diagnosis of COPD in the community is more likely in patients with worse lung function and HRQL, and wheezing is the symptom most strongly associated with a diagnosis of COPD. Women older than 55, with previous respiratory diseases, without respiratory symptoms and mild airflow obstruction constitute the majority of individuals with COPD who have never smoked. Chronic respiratory symptoms are strongly associated with impairment in HRQL.
    Respiratory Medicine 09/2005; 99(8):985-95. · 2.59 Impact Factor
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    ABSTRACT: Between 15% and 20% of smokers develop chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine which characteristics of smoking, particularly the Fagerström Test for Nicotine Dependence (FTND) score, were associated with the risk of developing COPD. Data from the IBERPOC epidemiological study were analyzed. IBERPOC was a multicenter epidemiological study including 4035 individuals aged 40-69 years, 1023 (25%) of whom were active smokers. We analyzed the association between smoking characteristics--such as the cumulative consumption of tobacco, FTND score, and expired-air carbon monoxide levels--and the diagnosis of COPD. Among the smokers, 153 (15%) were diagnosed with COPD. A cumulative tobacco consumption of more than 30 pack-years (OR=4.24, 95% CI=2.83-6.36) and the FTND score (OR=1.11, 95% CI=1.02-1.21, for each point increase) were significantly associated with the diagnosis of COPD in the model obtained by logistic regression analysis with the full sample of smokers. Cumulative consumption of tobacco was associated with the diagnosis of COPD. For each point increase in the FTND score, the probability of a smoker developing COPD increased by 11%.
    Nicotine & Tobacco Research 09/2004; 6(4):649-53. · 2.48 Impact Factor
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    ABSTRACT: In the studies carried out to date, the cost of chronic obstructive pulmonary disease (COPD) may have been overestimated due to the inclusion of previously diagnosed patients seeking medical attention for their symptoms. As a result, the severity of the cases included in these studies may have been greater than in an unselected sample of the general population. The aim of the present study was to estimate the direct cost of COPD on the basis of a representative sample of the overall Spanish population between 40 and 69 years of age (from the IBERPOC study). The cost was evaluated retrospectively by means of a questionnaire completed by the 363 patients with COPD from the IBERPOC study with questions referring to the previous year. Standardized spirometry was performed on all the patients by a pneumologist in each of the 7 geographical areas in which the study was carried out. Hospitalization accounted for the greatest expenditure (41% of total), followed by drug therapy (37%). The cost was euro;98.39 per patient, and euro;909.50 per previously diagnosed patient. The cost per person of severe COPD was more than 3 times that of moderate COPD and more than 7 times that of mild COPD. The estimated annual cost of COPD in Spain was euro;238.82 million (for 1997). The present study, which was the first to estimate the cost of COPD in a representative sample of the general population, found the cost to be lower than in studies analyzing samples of patients with previous diagnoses of COPD. The cost distribution is not in line with recommended health care practices, underlining the need to optimize resources used to monitor and treat the disease, with an emphasis on early diagnosis.
    Archivos de Bronconeumología 03/2004; 40(2):72-9. · 1.37 Impact Factor
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    ABSTRACT: ObjectiveIn the studies carried out to date, the cost of chronic obstructive pulmonary disease (COPD) may have been overestimated due to the inclusion of previously diagnosed patients seeking medical attention for their symptoms. As a result, the severity of the cases included in these studies may have been greater than in an unselected sample of the general population. The aim of the present study was to estimate the direct cost of COPD on the basis of a representative sample of the overall Spanish population between 40 and 69 years of age (from the IBERPOC study).MethodThe cost was evaluated retrospectively by means of a questionnaire completed by the 363 patients with COPD from the IBERPOC study with questions referring to the previous year. Standardized spirometry was performed on all the patients by a pneumologist in each of the 7 geographical areas in which the study was carried out.ResultsHospitalization accounted for the greatest expenditure (41% of total), followed by drug therapy (37%). The cost was €98.39 per patient, and €909.50 per previously diagnosed patient. The cost per person of severe COPD was more than 3 times that of moderate COPD and more than 7 times that of mild COPD. The estimated annual cost of COPD in Spain was €238.82 million (for 1997).ConclusionThe present study, which was the first to estimate the cost of COPD in a representative sample of the general population, found the cost to be lower than in studies analyzing samples of patients with previous diagnoses of COPD. The cost distribution is not in line with recommended health care practices, underlining the need to optimize resources used to monitor and treat the disease, with an emphasis on early diagnosis.ObjetivoEn los estudios realizados hasta ahora, el coste de la enfermedad pulmonar obstructiva crónica (EPOC) puede estar sobrestimado porque han incluido a pacientes previamente diagnosticados que consultaron por sus síntomas, por lo que la gravedad puede ser superior a la que realmente tendría una población no seleccionada obtenida de la población general. El propósito del presente estudio fue estimar el coste directo de la EPOC basándose en una muestra representativa del conjunto de la población española de entre 40 y 69 años (estudio IBERPOC).MétodoEl coste se evaluó retrospectivamente a través de un cuestionario referido al último año en los 363 pacientes con EPOC del estudio IBERPOC. Un neumólogo realizó a todos ellos una espirometría estandarizada en cada una de las 7 áreas geográficas en las que se llevó a cabo el estudio.ResultadosLa asistencia hospitalaria fue el coste más elevado (41% del coste total), seguido del tratamiento farma-cológico (37%). El coste por paciente fue de 98,39 €, y por paciente previamente diagnosticado, de 909,5 €. El coste de la EPOC grave por persona fue más de tres veces el coste de la EPOC moderada y más de 7 veces el coste de la EPOC leve. El coste anual estimado de la EPOC en España fue de 238,82 millones de euros (información referida a 1997).ConclusiónÉste es el primer estudio que estima el coste de la EPOC en una muestra representativa de la población general, que es inferior al calculado por los estudios que han analizado una muestra seleccionada con diagnóstico previo de EPOC. La distribución del gasto no se ajusta a las prácticas asistenciales recomendables, por lo que son necesarias actuaciones que optimicen los recursos empleados en el seguimiento y en el tratamiento de la enfermedad, prestando especial atención a su diagnóstico temprano.
    Archivos de Bronconeumología 02/2004; · 2.17 Impact Factor
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    ABSTRACT: Proinflammatory leukotrienes, which are not completely inhibited by inhaled corticosteroids, may contribute to asthmatic problems [corrected]. A 16 week multicentre, randomised, double blind, controlled study was undertaken to study the efficacy of adding oral montelukast, a leukotriene receptor antagonist, to a constant dose of inhaled budesonide. A total of 639 patients aged 18-70 years with forced expiratory volume in 1 second (FEV(1)) > or =55% predicted and a minimum predefined level of asthma symptoms during a 2 week placebo run in period were randomised to receive montelukast 10 mg (n=326) or placebo (n=313) once daily for 16 weeks. All patients received a constant dose of budesonide (400-1600 microg/day) by Turbuhaler throughout the study. Mean FEV(1) at baseline was 81% predicted. The median percentage of asthma exacerbation days was 35% lower (3.1% v 4.8%; p=0.03) and the median percentage of asthma free days was 56% higher (66.1% v 42.3%; p=0.001) in the montelukast group than in the placebo group. Patients receiving concomitant treatment with montelukast had significantly (p<0.05) fewer nocturnal awakenings and significantly (p<0.05) greater improvements in beta agonist use and morning peak expiratory flow rate (PEFR). For patients with mild airway obstruction and persistent asthma symptoms despite budesonide treatment, concomitant treatment with montelukast significantly improves asthma control.
    Thorax 03/2003; 58(3):204-10. · 8.38 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the sociodemographic characteristics, smoking habits, the prevalence of respiratory symptoms and chronic obstructive pulmonary disease (COPD) in four groups of smokers: of cigarettes (SCt), of cigars (SCigar), of both (SB), of cigars currently but of cigarettes in the past (SCigarExCt) and of cigarettes currently but of cigars in the past (SCtExCigar). A multicenter epidemiological study enrolling 4,035 subjects aged between 40 and 69 years. One thousand nine hundred sixty-three were non-smokers and 1,146 were current smokers. Among the smokers, 869 were SCt, 37 were SCigar, 97 were SB, 86 were SCigarExCt and 57 were SCtExCigar. We analyzed sociodemographic characteristics, smoking and the prevalence of respiratory symptoms and COPD. Cigar smokers were usually men, of lower socioeconomic status (p < 0.001) and older than cigarette smokers (p < 0.001), but CO concentrations in expired air were lower in the SCigar group than in the SCt group (5 ppm vs 15.7; p < 0.001). Informants who believed their smoking was not detrimental to their health or to that of second-hand smokers made up 86.5% of the SCigar group and 79.1% of the SCigarExCt group. COPD was diagnosed in 13.2% of the SCt group, in 24.7% of the SB group, and in 12.8% of the SCigarExCt group, in comparison with 4% of the non-smokers (p < 0.001 for all comparisons). SCigar are mainly older men with lower educational levels. Their concentrations of CO in expired air are low and they have little awareness of the health risks posed by their habit. SCigar who were once smokers of cigarettes have a higher prevalence of respiratory symptoms and COPD than non-smokers and the same prevalence of COPD as SCt.
    Archivos de Bronconeumología 11/2002; 38(11):530-5. · 1.37 Impact Factor
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    ABSTRACT: The aim of the present study was to examine the relationships between the responses to progressive isocapnic hypoxia and hypoxic withdrawal test in patients with obstructive sleep apnoea-hypopnoea syndrome (OSAHS) and to analyse the determinants of carotid body sensitivity in OSAHS. Nineteen consecutive OSAHS patients and 13 healthy subjects were selected. Ventilatory (delta V'I/Sa,O2/BSA) and inspiratory neural drive (delta P0.1/Sa,O2) responses to progressive isocapnic hypoxia were determined. Peripheral chemosensitivity was evaluated by the hypoxic withdrawal test, which measures the decrease in ventilation caused by two breaths of 100% oxygen (%delta V'I). Withdrawal response and ventilatory and inspiratory neural drive responses to hypoxia were lower in OSAHS patients than in control subjects. In patients with OSAHS, %delta V'I correlated significantly with delta V'I/Sa,O2/BSA and with delta P0.1/Sa,O2. On stepwise multiple linear regression analysis, a strong correlation between %delta V'I and delta P0.1/Sa,O2 was found. Moreover, %delta V'I, delta V'I/Sa,O2/BSA and delta P0.1/Sa,O2 were significantly correlated with minimum arterial oxygen saturation and with arousal index. Obstructive sleep apnoea-hypopnoea syndrome patients have a strong relationship between peripheral chemosensitivity and respiratory response to hypoxia, suggesting that hypoxic stimulation of central chemoreceptors is minimally relevant in obstructive sleep apnoea-hypopnoea syndrome. Moreover, sensitivity of the carotid body in patients with obstructive sleep apnoea-hypopnoea syndrome is related to sleep disruption and to nocturnal hypoxia.
    European Respiratory Journal 10/2002; 20(3):724-32. · 6.36 Impact Factor
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    ABSTRACT: The aim of the study was to obtain the general population norms for the St. George's Respiratory Questionnaire (SGRQ), a specific questionnaire for respiratory diseases. The IBERPOC project was a cross-sectional study of representative samples of the general population aged between 40-69 yrs. The study sample was composed of 862 individuals. All participants considered as "probable cases" of chronic obstructive pulmonary disease (COPD) (n=460) were eligible to complete the SGRQ and among the rest of the nonprobable COPD participants (n=3,571), 10 individuals from each defined age and sex group were eligible (n=402). Weights were applied to restore general population representativity of the sample. Mean forced expiratory volume in one second (FEV1) predicted was 89.4% (SD=16.5%; range: 16-131%). Chronbach's alpha coefficients were >0.7 in the symptoms, activity and impact scales, and >0.9 in the overall scale. Symptom scale score was significantly higher among males (11.6 versus 7.8; p<0.01) and activity scale score was significantly higher among females (12.2 versus 14.6; p=0.04). In a multiple linear regression model, respiratory diseases (asthma and COPD) and FEV1 % over pred showed the strongest association with the SGRQ total score. Smoking, sex, age and education were independently associated with the total SGRQ score. These results indicate that individuals from the general population presented some of the problems that are important when measuring health-related quality of life in respiratory patients, and provide St George's Respiratory Questionnaire norms, a useful method for interpreting the St George's Respiratory Questionnaire score in a given patient or study samples.
    European Respiratory Journal 03/2002; 19(3):405-13. · 6.36 Impact Factor
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    ABSTRACT: Whether the growth of the lungs in acromegaly is due to alveolar hypertrophy or alveolar hyperplasia is a subject of debate. To discriminate these hypotheses, we compared pulmonary distensibility and diffusing capacity among 11 patients with active acromegaly and 11 matched control subjects, evaluating the response of pulmonary distensibility and diffusing capacity to suppression of growth hormone (GH) hypersecretion. We performed lineal and exponential analyses of quasistatic pressure-volume curves. Patients with active acromegaly had a greater TLC, lung compliance, and shape constant, K, than did normal subjects. We found no significant differences between the study groups in carbon monoxide diffusing capacity or diffusing capacity per unit of alveolar volume. After treatment, patients with inactive acromegaly showed a reduced TLC (6.95 +/- 1.40 [mean +/- SD] L versus 6.35 +/- 1.23 L), reduced lung compliance (3.61 +/- 0.90 L/kPa versus 2.36 +/- 0.79 L/ kPa), reduced K coefficient (2.62 +/- 0.65 kPa(-)(1) versus 1.35 +/- 0.40 kPa(-)(1)), and increased maximal recoil pressure (1.74 +/- 0.38 kPa versus 2.28 +/- 0.25 kPa). We conclude that the increased lung distensibility with normal diffusion capacity demonstrated in patients with active acromegaly, which was partly reversible after suppression of GH hypersecretion, suggests that lung growth in acromegaly may result from an increase in alveolar size.
    American Journal of Respiratory and Critical Care Medicine 10/2001; 164(5):852-7. · 11.04 Impact Factor

Publication Stats

970 Citations
350.63 Total Impact Points

Institutions

  • 1992–2012
    • Hospital Universitario La Paz
      • Servicio de Neumología
      Madrid, Madrid, Spain
  • 2004
    • Instituto Nacional de Salud Pública
      Cuernavaca, Morelos, Mexico
  • 2002
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 1999–2000
    • Hospital Universitario Cruces
      Bilbo, Basque Country, Spain
    • Hospital Universitari i Politècnic la Fe
      • Servicio de Neumología
      Valenza, Valencia, Spain
  • 1991–1995
    • Universidad Autónoma de Madrid
      • Facultad de Medicina
      Madrid, Madrid, Spain