Maria Montes de Oca

Central University of Venezuela, Caracas, Distrito Federal, Venezuela

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Publications (81)354.15 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients < 65 years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.
    Archivos de Bronconeumología. 01/2015;
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    ABSTRACT: Spirometry is the gold standard for diagnosing chronic obstructive pulmonary disease (COPD). Although there are a number of different guideline criteria for deciding who should be selected for spirometric screening, to date it is not known which criteria are the best based on sensitivity and specificity.
    NPJ primary care respiratory medicine. 10/2014; 24:14075.
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    ABSTRACT: To determine whether the presence of chronic obstructive lung disease (COPD) and reduction of lung function parameters were predictors of mortality in a cohort.
    PLoS ONE 10/2014; 9(10):e109732. · 3.53 Impact Factor
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    ABSTRACT: Antecedentes El estudio basal del PLATINO, llevado a cabo entre 2003 y 2005 en 5 ciudades latinoamericanas (São Paulo, Ciudad de México, Montevideo, Santiago, Caracas), mostró una prevalencia elevada de la enfermedad pulmonar obstructiva crónica (EPOC). Métodos/diseño Se llevó a cabo un estudio de seguimiento en 3 de los 5 centros (Montevideo, Santiago y São Paulo) después de un periodo de 5, 6 y 9 años, respectivamente, con el objetivo de verificar la estabilidad del diagnóstico de EPOC a lo largo del tiempo, la evolución de la enfermedad en cuanto a supervivencia, morbilidad y función respiratoria, y análisis de los biomarcadores genéticos e inflamatorios en sangre. Se añadieron algunas preguntas adicionales al cuestionario original y se obtuvieron los certificados de defunción a partir de los registros oficiales nacionales. Resultados El trabajo de campo se ha completado en los 3 centros. De las muestras originales de la fase i del PLATINO pudimos localizar y entrevistar al 85,6% en Montevideo, al 84,7% en Santiago y al 77,7% en São Paulo. Los individuos no localizados se caracterizaban por un mayor nivel de estudios en Brasil y era más probable que fueran fumadores actuales en Santiago y São Paulo que en Montevideo. La calidad global de las espirometrías fue ≥ 80% según los criterios de la American Thoracic Society. El número de muertes fue de 71 (Montevideo), 95 (Santiago) y 135 (São Paulo), y se obtuvieron los certificados de defunción a partir de los registros de mortalidad nacionales del 76,1, del 88,3 y del 91,8% de los casos en Montevideo, Santiago y São Paulo, respectivamente. Conclusiones Este estudio muestra que es posible realizar estudios longitudinales de base poblacional en Latinoamérica, con tasas de seguimiento elevadas y una alta calidad de los datos de espirometría. La idoneidad de los registros de mortalidad nacionales varía en los distintos centros de Latinoamérica.
    Archivos de Bronconeumología 01/2014; · 2.17 Impact Factor
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    ABSTRACT: Introducción La enfermedad pulmonar obstructiva crónica (EPOC) se asocia a comorbilidades que influyen en el estado de salud y en el pronóstico de los pacientes. El estudio PLATINO aporta datos sobre comorbilidades autorreportadas y percepción del estado general de salud (EGS) en la EPOC. Métodos PLATINO es un estudio poblacional, sobre prevalencia de EPOC en 5 ciudades de Latinoamérica. El diagnóstico de EPOC se realizó según el criterio de GOLD (FEV1/FVC < 0,70 post-broncodilatador). Se recogió información sobre las siguientes comorbilidades: cardíaca, hipertensión, diabetes, accidente cerebrovascular (ACV), úlcera y asma. El EGS se evaluó mediante el cuestionario SF-12, con la pregunta: «En general ¿diría usted que su salud es: excelente, muy buena, buena, regular o pobre?». Sumando las comorbilidades, se elaboró un índice de comorbilidad. Resultados Sobre una población total de 5.314 individuos se realizó diagnóstico de EPOC en 759. Las comorbilidades reportadas en orden decreciente fueron: cualquier tipo de enfermedad cardiovascular, hipertensión, úlcera péptica, enfermedad cardíaca, diabetes, ACV, asma y cáncer de pulmón. Los sujetos con EPOC tuvieron mayor índice de comorbilidad, prevalencia de cáncer de pulmón (p < 0,0001) y asma (p < 0,0001), así como mayor tendencia a hipertensión (p = 0,0652) y ACV (p = 0,0750). Los factores asociados a comorbilidad en EPOC fueron la edad, el índice de masa corporal (IMC) y el género femenino. Con el deterioro del EGS aumenta el número de comorbilidades. Conclusiones En población no seleccionada los individuos con EPOC presentan más comorbilidades. La edad, el sexo femenino y mayor IMC son los principales factores asociados a comorbilidad en estos pacientes. Independientemente de la condición de EPOC, un mayor número de comorbilidades se asocia a peor EGS.
    Archivos de Bronconeumología 11/2013; 49(11):468–474. · 2.17 Impact Factor
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    ABSTRACT: Introduction Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD), and have a significant impact on health status and prognosis. The PLATINO study provides data on self-reported comorbidities and perceived health status in COPD subjects. Methods PLATINO is a population-based study on COPD prevalence in five Latin American cities. COPD diagnosis was defined by GOLD criteria (FEV1/FVC < .70 post-bronchodilator). Information was collected on the following comorbidities: heart disease, hypertension, diabetes, cerebrovascular disease, peptic ulcer and asthma. Health status was evaluated using the SF-12 questionnaire, derived from the question: «In general, would you say your health is excellent, very good, good, fair or poor?». A simple comorbidity score was calculated by adding the total number of comorbid conditions. Results Of a total population of 5314 individuals, 759 had COPD. Reported comorbidities by decreasing frequency were: any cardiovascular disease, hypertension, peptic ulcer, heart disease, diabetes, cerebrovascular disease, asthma and lung cancer. COPD patients had a higher comorbidity score and prevalence of lung cancer (P < .0001) and asthma (P < .0001), as well as a higher tendency to have hypertension (P = .0652) and cerebrovascular disease (P = .0750). Factors associated with comorbidities were age, body mass index (BMI) and female gender. The number of comorbidities increased as the health status deteriorated. Conclusions In the PLATINO population-based study, COPD individuals had an increased number of comorbidities. Age, female gender and higher BMI were the factors associated with comorbidity in these patients. Comorbid conditions were associated with impaired health status, independently of the COPD status.
    Archivos de Bronconeumología 11/2013; 49(11):468–474. · 1.82 Impact Factor
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    ABSTRACT: Several COPD phenotypes have been described; the COPD-Asthma overlap is one of the most recognized. Aim: to evaluate the prevalence of three subgroups (asthma, COPD and COPD-Asthma overlap) in the PLATINO study population, to describe their main characteristics and to determine the association of the COPD-Asthma overlap group with exacerbations, hospitalizations, limitations due to physical health and perception of general health status (GHS). The PLATINO study is a multicenter population-based survey carried out in five Latin American cities. Outcomes were self-reported exacerbations (defined by deterioration of breathing symptoms that affected usual daily activities or caused missed work), hospitalizations due to exacerbations, physical health limitations and patients' perception of their GHS obtained by questionnaire. Subjects were classified in three specific groups: COPD - a post-bronchodilator (BD) FEV1/FVC ratio of < 0.70; asthma - presence of wheezing in the last year and a minimum post-BD increase in FEV1 or FVC of 12% and 200 ml; overlap COPD-Asthma - the combination of the two. Out of 5,044 subjects, 767 were classified as COPD (12%), asthma (1.7%) and COPD-Asthma overlap (1.8%). Subjects with COPD-Asthma overlap had more respiratory symptoms, worse lung function, used more respiratory medication, more hospitalization and exacerbations, and worse GHS. After adjusting for confounders, the COPD-Asthma overlap was associated with higher risks for exacerbations (PR 2.11; 95%CI 1.08-4.12), hospitalizations (PR 4.11; 95%CI 1.45-11.67) and worse GHS (PR 1.47; 95%CI 1.18-1.85), compared to those with COPD. The coexisting COPD-Asthma phenotype is possibly associated with increased disease severity.
    Chest 10/2013; · 7.13 Impact Factor
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    ABSTRACT: Latin America is made up of a number of developing countries. Demographic changes are occurring in the close to 600million inhabitants, in whom a significant growth in population is combined with the progressive ageing of the population. This part of the world poses great challenges for general and respiratory health. Most of the countries have significant, or even greater, rates of chronic respiratory diseases or exposure to risk. Human resources in healthcare are not readily available, particularly in the area of respiratory disease specialists. Academic training centers are few and even non-existent in the majority of the countries. The detailed analysis of these conditions provides a basis for reflection on the main challenges and proposals for the management and training of better human resources in this specialist area.
    Archivos de Bronconeumología 10/2013; · 2.17 Impact Factor
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    ABSTRACT: A 6-second spirometry test is easier than full exhalations. We compared the reliability of the ratio of the Forced expiratory volume in 1 second/Forced expiratory volume in 6 seconds (FEV1/FEV6) to the ratio of the FEV1/Forced vital capacity (FEV1/FVC) for the detection of airway obstruction. The PLATINO population-based survey in individuals aged 40 years and over designed to estimate the prevalence of post-Bronchodilator airway obstruction repeated for the same study participants after 5-9 years in three Latin-American cities. Using the FEV1/FVC<Lower limit of normal (LLN) index, COPD prevalence apparently changed from 9.8 to 13.2% in Montevideo, from 9.7 to 6.0% in São Paulo and from 8.5 to 6.6% in Santiago, despite only slight declines in smoking prevalence (from 30.8% to 24.3%). These changes were associated with differences in Forced expiratory time (FET) between the two surveys. In contrast, by using the FEV1/FEV6 to define airway obstruction, the changes in prevalence were smaller: 9.7 to 10.6% in Montevideo, 8.6 to 9.0% in São Paulo, and 7.5 to 7.9% in Santiago. Changes in the prevalence of COPD with criteria based on FEV1/FVC correlated strongly with changes in the FET of the tests (R(2) 0.92) unlike the prevalence based on a low FEV1/FEV6 (R(2) = 0.40). The FEV1/FEV6 is a more reliable index than FEV1/FVC because FVC varies with the duration of the forced exhalation. Reporting FET and FEV1/FEV6<LLN helps to understand differences in prevalence of COPD obtained from FEV1/FVC-derived indices.
    PLoS ONE 08/2013; 8(8):67960-. · 3.53 Impact Factor
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    ABSTRACT: We aimed to describe the distribution of self-reported sleep duration in adults over the age of 40years and to analyze the associated risk factors, comorbid conditions, and quality of life (QoL). Our study was constructed as a cross-sectional population-based study and is part of the PLATINO (Spanish acronym for the Latin American Project for Research in Pulmonary Obstruction) study. It includes data from Mexico City (Mexico), Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). Data from 4533 individuals were analyzed using a single questionnaire entitled, PLATINO, which was designed to collect data on self-reported sleep symptoms. Spirometry also was performed in accordance with international standards. All statistical analyses took the study design into consideration with adjustments for each city. The prevalence of subjects who reported sleeping <7h was 38.4%, ⩾7 to <9h was 51.4%, and ⩾9h was 10.2%. In the multivariate analysis, individuals with shorter sleep duration had higher frequencies of insomnia, increased forced expiratory volume in one second in liters and percentage/forced vital capacity in liters (FEV1/FVC) of predicted ratios, and a higher presence of coughing and phlegm. The main risk factor associated with longer duration of sleep was the number of comorbidities. Self-reported sleep duration discriminated among groups that differed in sleep-related symptoms, respiratory symptoms, QoL and comorbid conditions.
    Sleep Medicine 07/2013; · 3.10 Impact Factor
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    ABSTRACT: Background The PLATINO baseline study, conducted from 2003-2005 in five Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, Caracas), showed a high prevalence of chronic obstructive pulmonary disease (COPD). Methods/design A follow-up study was conducted in three out of the five centers (Montevideo, Santiago, and São Paulo) after a period of 5, 6 and 9 years, respectively, aimed at verifying the stability of the COPD diagnosis over time, the evolution of the disease in terms of survival, morbidity and respiratory function, and the analyses of inflammatory and genetic biomarkers in the blood. Some questions were added to the original questionnaire and death certificates were obtained from the national official registries. Results The fieldwork has been concluded in the three centers. From the original samples in the PLATINO study phase i, we were able to locate and interview 85.6% of patients in Montevideo, 84.7% in Santiago and 77.7% in São Paulo. Individuals who could not be located had higher education levels in Brazil, and were more likely to be current smokers in Santiago and São Paulo than in Montevideo. The overall quality of spirometries was ≥ 80% according to American Thoracic Society criteria. The number of deaths was 71 (Montevideo), 95 (Santiago) and 135 (São Paulo), with death certificates obtained from the national mortality registries for 76.1%, 88.3% and 91.8% of cases in Montevideo, Santiago and São Paulo, respectively. Conclusions This study shows that is possible to perform population-based longitudinal studies in Latin American with high follow-up rates and high-quality spirometry data. The adequacy of national mortality registries varies among centers in Latin America.
    Archivos de Bronconeumología 01/2013; · 1.82 Impact Factor
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    ABSTRACT: Latin America is made up of a number of developing countries. Demographic changes are occurring in the close to 600 million inhabitants, in whom a significant growth in population is combined with the progressive ageing of the population. This part of the world poses great challenges for general and respiratory health. Most of the countries have significant, or even greater, rates of chronic respiratory diseases or exposure to risk. Human resources in healthcare are not readily available, particularly in the area of respiratory disease specialists. Academic training centers are few and even non-existent in the majority of the countries. The detailed analysis of these conditions provides a basis for reflection on the main challenges and proposals for the management and training of better human resources in this specialist area.
    Archivos de Bronconeumología. 01/2013;
  • María Montes de Oca, Maria Victorina Lopez
    European Respiratory Journal 11/2012; 40(5):1305-6. · 7.13 Impact Factor
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
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    ABSTRACT: Although chronic obstructive pulmonary disease (COPD) is mostly related to tobacco smoking, a variable proportion of COPD occurs in never smokers. We investigated differences between COPD in never smokers compared with smokers and subjects without COPD. PLATINO is a cross-sectional population-based study of five Latin American cities. COPD was defined as postbronchodilator FEV(1)/FVC <0.70 and FEV(1) <80% of predicted values. Among 5,315 subjects studied, 2278 were never smokers and 3036 were ever smokers. COPD was observed in 3.5% of never smokers and in 7.5% of ever smokers. Never smokers with COPD were most likely older and reported a medical diagnosis of asthma or previous tuberculosis. Underdiagnosis was as common in obstructed patients who never smoked as in ever smokers. Never smokers comprised 26% of all individuals with airflow obstruction. Obstruction was associated with female gender, older age and a diagnosis of asthma or tuberculosis.
    Archives of medical research 04/2012; 43(2):159-65. · 1.88 Impact Factor
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    María Victorina LÓPEZ VARELA, María MONTES DE OCA
    Archivos de Bronconeumología 04/2012; · 1.82 Impact Factor
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    ABSTRACT: Little information exists regarding the epidemiology of the chronic bronchitis phenotype in unselected chronic obstructive pulmonary disease (COPD) populations. We examined the prevalence of the chronic bronchitis phenotype in COPD and non-COPD subjects from the PLATINO study, and investigated how it is associated with important outcomes. Post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <0.70 was used to define COPD. Chronic bronchitis was defined as phlegm on most days, at least 3 months per year for ≥ 2 yrs. We also analysed another definition: cough and phlegm on most days, at least 3 months per year for ≥ 2 yrs. Spirometry was performed in 5,314 subjects (759 with and 4,554 without COPD). The proportion of subjects with and without COPD with chronic bronchitis defined as phlegm on most days, at least 3 months per year for ≥ 2 yrs was 14.4 and 6.2%, respectively. Using the other definition the prevalence was lower: 7.4% with and 2.5% without COPD. Among subjects with COPD, those with chronic bronchitis had worse lung function and general health status, and had more respiratory symptoms, physical activity limitation and exacerbations. Our study helps to understand the prevalence of the chronic bronchitis phenotype in an unselected COPD population at a particular time-point and suggests that chronic bronchitis in COPD is possibly associated with worse outcomes.
    European Respiratory Journal 01/2012; 40(1):28-36. · 7.13 Impact Factor
  • María Victorina López Varela, María Montes de Oca
    Archivos de Bronconeumología 12/2011; 48(4):105-6. · 2.17 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a costly condition that frequently causes permanent work disabilities. Little information exists regarding the impact of COPD on work force participation and the indirect costs of the disease in developing countries. To examine the frequency of paid employment and factors influencing it in a Latin-American population-based study. Post-bronchodilator FEV(1)/FVC < 0.70 (forced expiratory volume in 1 s/forced vital capacity) was used to define COPD. Information regarding paid work was assessed by the question 'At any time in the past year, have you worked for payment?' Interviews were conducted with 5571 subjects; 5314 (759 COPD and 4554 non-COPD) subjects underwent spirometry. Among the COPD subjects, 41.8% reported having paid work vs. 57.1% of non-COPD (P < 0.0001). The number of months with paid work was reduced in COPD patients (10.5 ± 0.17 vs. 10.9 ± 0.06, P < 0.05). The main factors associated with having paid work in COPD patients were male sex (OR 0.33, 95%CI 0.23-0.47), higher education level (OR 1.05, 95%CI 1.01-1.09) and younger age (OR 0.90, 95%CI 0.88-0.92). COPD was not a significant contributor to employment (OR 0.83, 95%CI 0.69-1.00, P = 0.054) in the entire population. Although the proportion of persons with paid work is lower in COPD, having COPD appears not to have a significant impact on obtaining paid employment in the overall population of developing countries.
    The International Journal of Tuberculosis and Lung Disease 09/2011; 15(9):1259-64, i-iii. · 2.76 Impact Factor
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    ABSTRACT: The 6-minute walk distance (6MWD) has been useful in the evaluation of men with COPD. Little is known about 6MWD in women with the disease. Using healthy women as a reference, to evaluate the factors that help determine 6MWD in women with COPD. To explore if the 350 meters threshold differentiates survival in women as it does in men. Healthy women (n = 164) and with COPD (n = 223) were included in the study. Age, pack-years history, smoking status, comorbidities (Charlson Index), BMI, MRC dyspnea, spirometry and 6MWD were recorded in all participants and PaO(2) and IC/TLC in COPD women. The patients were prospectively followed and deaths registered. Factors predicting 6MWD were determined by multiple regression analysis. ROC analysis was used to calculate the best threshold value for the 6MWD with mortality as gold standard. Kaplan-Meier curves compared survival of patients that walked more or less than 350 m by age categories. The 6MWD is decreased in women with COPD. Values decrease with age and GOLD stages. Age, BMI, smoking status, comorbidities, MRC and FEV(1%) are statistical significant predictors of 6MWD. A 350 m cut-off value has a good sensitivity and specificity to predict (73% and 80% respectively) and differentiate survival (p < 0.001 for log rank comparisons) in these patients. In women with COPD, the 6MWD decreases with age and GOLD stages. A 350 m distance is a valid threshold to differentiate survival. Further studies in different settings should confirm our findings.
    COPD Journal of Chronic Obstructive Pulmonary Disease 08/2011; 8(4):300-5. · 2.73 Impact Factor

Publication Stats

3k Citations
354.15 Total Impact Points

Institutions

  • 1997–2014
    • Central University of Venezuela
      • • Facultad de Medicina
      • • Instituto de Medicina Experimental
      Caracas, Distrito Federal, Venezuela
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2013
    • Hospital Maciel
      Ciudad de Montevideo, Montevideo, Uruguay
  • 2006–2013
    • Instituto Nacional de Enfermedades Respiratorias
      Ciudad de México, The Federal District, Mexico
  • 2011
    • Universidad de Montevideo
      Ciudad de Montevideo, Montevideo, Uruguay
  • 2010
    • University of the Republic, Uruguay
      • Facultad de Medicina
      Montevideo, Departamento de Montevideo, Uruguay
  • 2008–2009
    • Universidade Federal de Pelotas
      • Faculty of Medicine (FM)
      Pelotas, Estado do Rio Grande do Sul, Brazil
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
  • 2005–2009
    • Hospital Universitario de Caracas
      Caracas, Distrito Federal, Venezuela
  • 2007
    • Universidad Nacional Autónoma de México
      Ciudad de México, Mexico City, Mexico
    • Pontifical Catholic University of Chile
      CiudadSantiago, Santiago Metropolitan, Chile
  • 1999–2000
    • Tufts University
      • Division of Pulmonary, Critical Care and Sleep Medicine
      Boston, GA, United States
  • 1996
    • Boston Medical Center
      Boston, Massachusetts, United States