E Ballester

Southern Medical Clinic, San Fernando, City of San Fernando, Trinidad and Tobago

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Publications (54)359.56 Total impact

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    ABSTRACT: To analyse the prevalence and clinical significance of bronchiectasis in a large series of patients with primary Sjögren's syndrome (SS) and evaluate its impact on disease expression and outcomes. The study cohort included 507 patients with primary SS. Bronchiectasis were diagnosed according to pulmonary computed tomography (CT). As a control group, we included 37 consecutive SS patients evaluated by pulmonary CT during the same study period without pulmonary involvement. Fifty primary SS patients had bronchiectasis according to the pulmonary CT. Nine patients were excluded due to non-autoimmune processes and 41 were classified as bronchiectasis associated with primary SS (40 women, mean age of 64 years). All cases of bronchiectasis were of the cylindrical type and were located in the inferior lobes in 29 cases (71%). Patients with bronchiectasis were older at diagnosis of SS (60.39 vs. 52.54 years, p=0.022) and had a higher frequency of hiatus hernia (41% vs. 16%, p=0.024) in comparison with controls. Immunologically, patients with bronchiectasis had a lower frequency of anti-Ro/SS-A antibodies (27% vs. 54%, p=0.022) but a higher frequency of anti-smooth muscle--SMAantibodies (82% vs. 60%, p=0.043). During follow-up, patients with bronchiectasis had a higher frequency of respiratory infections (56% vs. 3%, p<0.001) and pneumonia (29% vs. 3%, p=0.002) in comparison with those without. Patients with primary SS and bronchiectasis are characterised by an older age, a high frequency of hiatus hernia, a specific immunologic pattern (low frequency of anti-Ro/SS-A and high frequency of anti-SMA) and during follow-up a much higher frequency of respiratory infections and pneumonia.
    Clinical and experimental rheumatology 09/2010; 28(5):647-53. · 2.66 Impact Factor
  • American Thoracic International Conference; 05/2010
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    ABSTRACT: AIMS: To evaluate the validity of Apnea-LinkTM (at home and in the hospital) for diagnosis of patients with suspected Obstructive Sleep Apnea-Hypopnoea (OSAH). METHODS: Prospective, randomised, crossover multicentre study. RESULTS: A total of 679 patients completed the study (49.6 +/- 13.1 yr; 72% men; BMI 30.8 +/- 7.3; Epworth 10.8 +/- 5.6; AHI 40.4 +/- 30.0). We compared the results of AHI obtained with the polysomnography -PSG- (AHI-PSG) with the AHI obtained with Apnea-LinkTM (AHI-Link) analysed with visual and automatic scoring, carried out in the hospital and at home. The table represents the validity analysis obtained with Apnea-Link vs. the AHI obtained with the PSG with a cut-of point of AHI <30 / > 30. SENSIBILITY SPECIFICITY (+) PREDICT. V (-) PREDICT. V HOME AHI-LINK (V) 0.75 (0.70-0.79) 0.84 (0.80-0.88) 0.85 (0.81-0.89) 0.73 (0.69-0.78) AHI-LINK (A) 0.78 (0.74-0.82) 0.80 (0.75-0.84) 0.83 (0.79-0.86) 0.74 (0.70-0.79) HOSPITAL AHI-LINK (V) 0.82 (0.78-0.86) 0.85 (0.81-0.89) 0.87 (0.84-0.90) 0.79 (0.74-0.83) AHI-LINK (A) 0.82 (0.78-0.85) 0.80 (0.75-0.84) 0.83 (0.80-0.87) 0.78 (0.73-0.82) AHI-LINK: Apnoea-hypopnoea Index per hour of recording according to the results of visual (V) or automatic (A) scoring. CONCLUSIONS: 1. TheApneaLinkTM is a useful device for diagnosis of OSAH. 2. Visual scoring is slightly better compared to automatic scoring but both shown good results.
    2010 European Respiratory Congress; 01/2010
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    ABSTRACT: Changes in management of COPD in primary care were studied following a training exercise among Spanish general practitioners (GPs). The exercise involved dissemination of the Spanish Society for Pulmonology and Thoracic Surgery (SEPAR) guidelines. The use of a portable device to perform spirometry tests was evaluated to adequately categorize COPD and reduce other diagnostic interventions. A representative sample of GPs from general practices in Spain was recruited for the study. In phase I, GPs performed an initial evaluation of 5 patients with COPD. In phase II, GPs were randomly allocated to the following groups: 1) control group-G1 (GPs managing COPD according to usual clinical practice); 2) training group-G2 (dissemination of SEPAR guidelines); and 3) training group-G3 (dissemination of SEPAR guidelines and distribution of the Koko Peak Pro to measure FEV(1), FEV(6), and FEV(1)/FEV(6)). Phase-I included 3254 physicians, who selected 16,024 patients. In phase II, 301 physicians in G1, 1182 in G2, and 1141 in G3 selected 1481, 5798, and 5556 patients respectively. Evaluation of the changes in COPD stratification according to the SEPAR guidelines showed that physicians in G1 adequately classified 60% of patients, compared to 69% in G2 and 88.5% in G3 (p<0.0001). On comparing groups G1 and G3, a significant reduction was seen in chest X-rays (from 42% to 32%, p=0.0002) and arterial blood gas studies performed (from 34% to 22%, p<0.0001). The dissemination of the SEPAR guidelines and the utilization of the portable device for spirometry may improve management of COPD in primary care.
    Respiratory medicine 01/2010; 104(1):67-75. · 2.33 Impact Factor
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    ABSTRACT: To assess the effect of continuous positive airway pressure (CPAP) on 24 hour ambulatory blood pressure monitoring values in a large number of patients with untreated systemic hypertension of new onset and obstructive sleep apnoea. Multicentre, double blind, randomised, placebo controlled trial. Eleven general hospitals in Spain between 2004 and 2007. 340 patients recently diagnosed as having systemic hypertension by a general practitioner (systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or both) and an apnoea-hypopnoea index per hour of sleep of >15 events/hour. Patients were assigned to CPAP (n=169) or sham CPAP (n=171) for three months. Main outcome measurements Net changes in the different 24 hour ambulatory blood pressure monitoring values from baseline to three months of optimal or sham CPAP. 277 (81%) of the 340 patients randomised were men; the patients had a mean age of 52.4 (SD 10.5) years, a body mass index of 31.9 (5.7), an Epworth sleepiness scale score of 10.1 (4.3), an apnoea-hypopnoea index of 43.5 (24.5). No differences between groups were seen at baseline. Compared with placebo and analysed by intention to treat, the mean 24 hour ambulatory blood pressure of the CPAP group decreased by 1.5 (95% confidence interval: 0.4 to 2.7) mm Hg (P=0.01). The mean 24 hour ambulatory blood pressure monitoring measures decreased by 2.1 mm Hg (0.4 to 3.7) mm Hg (P=0.01) for systolic pressure and 1.3 (0.2 to 2.3) mm Hg (P=0.02) for diastolic blood pressure. Mean nocturnal blood pressure decreased by 2.1 (0.5 to 3.6) mm Hg (P=0.01). CPAP produced a statistically significant reduction in blood pressure in patients with systemic hypertension and obstructive sleep apnoea. This reduction is small and did not achieve the 3 mm Hg drop in mean 24 hour ambulatory blood pressure that the trial was powered to detect. Consequently, these results may have uncertain clinical relevance. However, taking into account the prevalence of hypertension and the likelihood of comorbidities, the decrease in blood pressure, although minimal, may be beneficial. Clinical trials NCT00202527.
    BMJ (online) 01/2010; 341:c5991. · 17.22 Impact Factor
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    ABSTRACT: When a disorder is as prevalent as sleep apnea-hypopnea syndrome (SAHS), different medical levels and approaches should be involved in facilitating the diagnosis, at least, of patients with symptoms that disrupt social or working life, and of risk groups such as professional drivers. We sought to analyze the degree of concordance between management and treatment decisions for SAHS patients at sleep reference centers (RCs) and at non-RCs (NRCs). Eighty-eight consecutive patients with suspected SAHS were referred by family doctors to the NRC. The patients were studied randomly at the RC, using full polysomnography, and at the NRC, employing respiratory polygraphy. The concordance in the therapeutic approach between both centers was analyzed via the outcomes, and the physiologic variables of the sleep studies were also evaluated. The concordance in the final clinical decision was substantial. There was a good agreement with respect to apnea-hypopnea index as a categoric variable and as a continuous variable. These results suggest that respiratory physicians with simple sleep studies are able to manage a large number of patients with SAHS. Trial registration: Clinicaltrials.gov Identifier: NCT 00424658.
    Chest 01/2008; 132(6):1853-7. · 7.13 Impact Factor
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    ABSTRACT: Continuous positive airway pressure (CPAP) is an effective treatment for sleep apnea (SA), although the evidence for improving chronic heart failure (CHF) is inconclusive. Our aim was to evaluate the effect of CPAP treatment on the left ventricle ejection fraction (LVEF) among other cardiological variables in a randomized, multicenter, placebo (sham-CPAP)-controlled study. After the selection procedure, 60 patients with CHF with LVEF<45% and SA with an apnea-hypopnea index (AHI)>10/h were evaluated at baseline, and after 3 months of treatment with optimal CPAP or sham-CPAP. The assessment was based on the LVEF, hypertension, daytime sleepiness (Epworth sleepiness scale [ESS]), quality of life (SF-36), New York Heart Scale (NYHA score), dyspnea (by using the Borg scale) and exercise tolerance (6-min walk test). The mean AHI was normalized in the optimal CPAP group but not in the sham-CPAP group. The LVEF showed a significant improvement in the group of patients treated with CPAP (2.5; 95% CI: 0.6 to 4.3), which was not observed in the sham-CPAP group (0.0; 95% CI: -2.1 to 2.1). However, the change in the LVEF from baseline to 3 months was not significantly greater in the whole group (obstructive and Cheyne-Stokes events) treated with CPAP than in the control group (p: 0.07). In patients with only obstructive sleep apnea (OSA), who account for 83% of the total population, there was a significant improvement in the LVEF in the group of patients treated with CPAP but no such improvement in the sham-CPAP group. In this OSA group, the change in the LVEF from baseline to 3 months was significantly greater in the group treated with CPAP than in the sham-CPAP group (p: 0.03). The other variables studied were not modified. When the patients were divided according to the severity of the LVEF (a LVEF cut-off of 30%), improvement was observed in those with a LVEF>30. No changes were found in the other cardiological variables. CPAP therapy proved to be useful in patients with associated sleep-disordered breathing and CHF. The improvement was more marked in patients with a LVEF>30%. However, the increased LVEF in the CPAP group was not accompanied by changes in the other cardiological variables.
    Sleep Medicine 10/2007; 9(6):660-6. · 3.49 Impact Factor
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    ABSTRACT: Flow limitation during sleep occurs when the rise in esophageal pressure is not accompanied by a flow increase which results in a non-rounded inspiratory flow shape. Short periods of flow limitation ending in an arousal or in a fall in SaO2 (hypopnea or upper airway resistance syndrome) are detrimental but the role of prolonged periods of flow limitation (PPFL) has not yet been clarified. This is important not only for diagnosis but also for nasal continuous positive airway pressure (CPAP) titration, especially for the automatic devices that need to be setup. The aim of this study was to analyze the effects of PPFL. We compared the behavior of the mean end-expiratory systemic blood pressure (SBP), end-tidal CO2, esophageal pressure and the pattern of breathing during a period of normal breathing at optimal (CPAP) and during PPFL at suboptimal CPAP in 14 patients with sleep apnea/hypopnea syndrome during a full polysomnography CPAP titration. The mean values of the parameters studied, at optimal and suboptimal CPAP were (1) SBP 92+/-13 vs. 91+/-15 mmHg (P: ns). At suboptimal CPAP, swings of blood pressure were associated with changes in pleural pressure; (2) SaO2 97.5+/-1.2 vs. 96.5+/-1.6 (P: 0.03), (3) end-tidal CO2 43.5+/-4 vs. 49.5+/-4 (P:0.001); (4) oesophageal pressure, 10.5+/-4 vs. 37.6+/-15 cmH2O (P:0.001) and (5) pattern of breathing: minute ventilation 6.6+/-1.4 vs. 6.1+/-1.2L/min (P: ns) and inspiratory time 1.24+/-0.3 vs. 1.66+/-0.4s (P:0.001). It can be concluded that PPFL induces significant physiological changes. Nevertheless, given the scant literature, clinical studies are warranted to elucidate the clinical role of these physiological changes.
    Respiratory Medicine 06/2006; 100(5):813-7. · 2.59 Impact Factor
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    ABSTRACT: Pulmonary varices are uncommon vascular abnormalities that are usually asymptomatic and so they are normally diagnosed by chance from a chest x-ray. They often present as a pulmonary nodule and can be either congenital or acquired. If acquired, they are associated with pulmonary venous hypertension, usually as a result of mitral valve disease. Pulmonary arteriography provides a definitive diagnosis, although the use of new noninvasive imaging techniques is spreading. Treatment is not normally required unless serious complications arise. We present the case of a pulmonary varix located within a pulmonary bulla. This form of presentation has not been previously reported.
    Archivos de Bronconeumología 02/2006; 42(1):39-41. · 1.37 Impact Factor
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    ABSTRACT: Pulmonary varices are uncommon vascular abnormalities that are usually asymptomatic and so they are normally diagnosed by chance from a chest x-ray. They often present as a pulmonary nodule and can be either congenital or acquired. If acquired, they are associated with pulmonary venous hypertension, usually as a result of mitral valve disease. Pulmonary arteriography provides a definitive diagnosis, although the use of new noninvasive imaging techniques is spreading. Treatment is not normally required unless serious complications arise. We present the case of a pulmonary varix located within a pulmonary bulla. This form of presentation has not been previously reported.Las varices pulmonares son anomalías vasculares pulmo-nares infrecuentes. Suelen ser asintomáticas, por lo que nor-malmente se diagnostican como hallazgo casual en la radio-grafía de tórax, y con frecuencia se presentan como un nódulo pulmonar. Su origen puede ser congénito o adquirido; en este último caso se relaciona con una hipertensión pulmonar venosa, frecuentemente asociada a valvulopatía mitral. Su diagnóstico definitivo se realiza mediante arteriografía pulmonar, aunque cada vez más se están usando nuevas téc-nicas de imagen no invasivas. Normalmente no requieren tra-tamiento, a menos que presenten complicaciones graves. Ex-ponemos un caso con una forma de presentación de variz pulmonar no descrita con anterioridad, ya que dicha anoma-lía se encontraba en el interior de una bulla pulmonar.
    Archivos de Bronconeumología ((English Edition)). 01/2006;
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    ABSTRACT: Pulmonary varices are uncommon vascular abnormalities that are usually asymptomatic and so they are normally diagnosed by chance from a chest x-ray. They often present as a pulmonary nodule and can be either congenital or acquired. If acquired, they are associated with pulmonary venous hypertension, usually as a result of mitral valve disease. Pulmonary arteriography provides a definitive diagnosis, although the use of new noninvasive imaging techniques is spreading. Treatment is not normally required unless serious complications arise. We present the case of a pulmonary varix located within a pulmonary bulla. This form of presentation has not been previously reported.
    Archivos de Bronconeumología. 01/2006; 42(1):39–41.
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    ABSTRACT: To assess whether the measurement of breathing reduction during obstructive sleep events depends on using the flow or the volume signals recorded with a pneumotachograph. Prospective observational study. Sleep laboratory in a University Hospital. Data from 10 male patients with sleep apnea (54 +/- 11 years, apnea-hypopnea index: 43 +/- 21 events/hour, body mass index: 30 +/- 2 kg/m2). Slow modification of continuous positive airway pressure was performed during full-polysomnography continuous positive airway pressure titration. Air flow was measured by a pneumotachograph, and volume was computed by numerical integration. Obstructive events of different magnitude were selected. In 500 breathing cycles analyzed, the reduction in tidal volume was greater than the reduction in the flow amplitude: mean difference of 0.091 (i.e., 9.1% amplitude) and limits of agreement of 0.095 and -0.277 (i.e., 9.5% and -27.7% amplitude). In 14% of the cycles, the reduction in flow was < 50%, whereas the reduction in volume was > 50%, resulting in discordant event classification. The quantification of breathing reduction depends on whether the flow or the volume signal is used to assess breathing during sleep.
    Sleep 08/2005; 28(8):990-2. · 5.10 Impact Factor
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    ABSTRACT: NTRODUCTION:CPAP has shown improvement of left ventricular ejection fraction (EF) in patients with chronic heart failure (CHF) in non controlled studies.AIM:We performed a multicenter randomized parallel placebo controlled study, to evaluate the efficacy of CPAP in CHF patients with sleep apnoea (SA).METHODS:We have studied 245 patients with CHF and EF<42%. We excluded 118 with COPD and unstable CHF.Therefore, we studied 127 patients by polygraphy or polysomnography (PSG).73 patients had an apnoea-hypopnoea index (AHI)>10 by PSG and were randomized for CPAP or shamCPAP for three months. The main outcome was the difference between basal and final EF by isotopic ventriculography. CPAP Placebo P EF% 28.1 28.5 0.84 AHI 40.3 41.5 0.85 Age 62.5 64 0.53 CS% 19 11 0.50 Baseline characteristics RESULTS:There were no differences between the mean EF improvement in the CPAP group (2.4;95%CI 0.5-4.3) compared to shamCPAP (0.0;95%CI-2.1+2.1).Among those with an EF at baseline ≥30%, the mean change of EF with CPAP was +2.9%, while in the shamCPAP was -2.2% (difference 5.1%;95%CI:0.5-9.8;P=0.03).There was no effect among those with an EF<30%.CONCLUSIONS:The prevalence of SA is high (57.5%), but the prevalence of Cheynes Stokes (CS) is less than expected (15%).CPAP treatment only improved the EF for patients having a basal EF≥30%. Funded by Health Research Funds of the Health Ministry (01/0109) and Vasco-Navarra Respiratory Society 2001.
    2004 European Respiratory congress; 09/2004
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    ABSTRACT: The high prevalence of habitual snoring (35% of the general population) and the increasing demand for an effective treatment have led, in the last decade, to the generalisation of laser-assisted uvulopalatoplasty (LAUP). However, acceptable studies on its effectiveness are lacking. The present randomised, placebo-controlled study included 25 nonapnoeic and mild obstructive sleep apnoea snorers to evaluate LAUP effectiveness for snoring. Group I received a one-stage LAUP treatment and group II a placebo (simulated snore surgery followed by an oral placebo). Before each treatment and 3 months after, the variables and procedures assessed were: body weight; sleepiness (Epworth sleepiness scale); quality of life (SF-36); subjective snoring intensity (0-10 analogue scale); objective snoring intensity (average decibel intensity); snoring index (number of snores per hour); and apnoea/hypopnea index. No differences were observed in body weight, sleepiness, quality of life, subjective and objective intensity, and frequency of snoring, and apnoea/hypopnea index between the groups before and 3 months after treatment. In conclusion, this study provides evidence of the lack of effectiveness of one-stage laser-assisted uvulopalatoplasty for snoring in nonapnoeic and mild obstructive sleep apnoea patients, with the result that it does not meet the expectations generated by the procedure.
    European Respiratory Journal 08/2004; 24(1):66-70. · 6.36 Impact Factor
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    ABSTRACT: Increased upper airway collapsibility in the sleep apnea/hypopnea syndrome (SAHS) is usually interpreted by a collapsible resistor model characterized by a critical pressure (Pcrit) and an upstream resistance (Rup). To investigate the role played by the upstream segment of the upper airway, we tested the hypothesis that breathing different gases would modify Rup but not Pcrit. The study was performed on 10 patients with severe SAHS (apnea-hypopnea index: 59 +/- 14 events/hour) when breathing air and helium-oxygen (He-O2) during non-REM sleep. The continuous positive airway pressure that normalized flow (CPAPopt) was measured. Rup and Pcrit were determined from the linear relationship between maximal inspiratory flow VImax and nasal pressure (PN):VImax = (PN - Pcrit)/Rup. Changing the breathing gas selectively modified the severity of dynamic (CPAPopt, Rup) and static (Pcrit) obstructions. CPAPopt was significantly (p = 0.0013) lower when breathing He-O2 (8.44 +/- 1.66 cm H2O; mean +/- SD) than air (10.18 +/- 2.34 cm H2O). Rup was markedly lower (p = 0.0001) when breathing He-O2 (9.21 +/- 3.93 cm H2O x s/L) than air (15.92 +/- 6.27 cm H2O x s/L). Pcrit was similar (p = 0.039) when breathing He-O2 (4.89 +/- 2.37 cm H2O) and air (4.19 +/- 2.93 cm H2O). The data demonstrate the role played by the upstream segment of the upper airway and suggest that different mechanisms determine static (Pcrit) and dynamic (Rup) upper airway obstructions in SAHS.
    American Journal of Respiratory and Critical Care Medicine 10/2003; 168(6):659-63. · 11.04 Impact Factor
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    ABSTRACT: Exacerbation of chronic obstructive pulmonary disease (COPD) is one of the most frequent causes of hospital admission. We examined the results and feasibility of two programs conducted by a hospital respiratory unit aimed to reduce both the length of hospital stay and the number of hospital admissions for COPD acute exacerbation. a) Assisted hospital discharge program: Patients admitted for acute exacerbation who met our criteria for early discharge were sent home with the support of a respiratory nurse. Home visits were carried out and direct phone contact with the nurse and physician was provided during a limited period of 6 weeks. Outcome variables studied were length of hospital admission and need for hospital reentry. b) Exacerbation prevention program: A group of patients with severe COPD and at least 3 hospital admissions for exacerbation during the previous year were included. These patients underwent an educational program and were given unlimited direct phone access to the respiratory nurse and physician. When necessary, home visits were carried out. The main outcome variable of this program was the number of hospital admissions. a) Assisted hospital discharge program: A total of 97 patients were included. The mean length of hospital stay was 5.4 1.7 days, which was significantly shorter than the previous average length of stay in our respiratory unit for a diagnosis of COPD exacerbation (8.52 days). The rate of hospital reentry was 17% (within the first 3 months). b) Exacerbation prevention program: 23 patients were enrolled. In this group, the number of hospital admissions decreased significantly from 5.0 1.8 to 1.7 2.4 per year (p = 0.001). Visits to the emergency department were also decreased, from 1.2 1.6 to 0.4 1.6 per patient (p = 0.05). Finally, the length of hospital stay decreased from 38 17 to 16 20 days (p = 0.0001). A combined use of hospital resources and home care programs which are specifically addressed to severe COPD patients can reduce the need for hospital admission.
    Medicina Clínica 04/2003; 120(11):408-11. · 1.25 Impact Factor
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    ABSTRACT: Background and objective Exacerbation of chronic obstructive pulmonary disease (COPD) is oneof the most frequent causes of hospital admission. We examined the results and feasibility oftwo programs conducted by a hospital respiratory unit aimed to reduce both the length of hospitalstay and the number of hospital admissions for COPD acute exacerbation. Patients and method a) Assisted hospital discharge program: Patients admitted for acute exacerbationwho met our criteria for early discharge were sent home with the support of a respiratorynurse. Home visits were carried out and direct phone contact with the nurse and physician wasprovided during a limited period of 6 weeks. Outcome variables studied were length of hospitaladmission and need for hospital reentry. b) Exacerbation prevention program: A group of patientswith severe COPD and at least 3 hospital admissions for exacerbation during the previous yearwere included. These patients underwent an educational program and were given unlimited directphone access to the respiratory nurse and physician. When necessary, home visits were carriedout. The main outcome variable of this program was the number of hospital admissions. Results a) Assisted hospital discharge program: A total of 97 patients were included. Themean length of hospital stay was 5.4 ± 1.7 days, which was significantly shorter than the previousaverage length of stay in our respiratory unit for a diagnosis of COPD exacerbation (8.52days). The rate of hospital reentry was 17% (within the first 3 months). b) Exacerbation preventionprogram: 23 patients were enrolled. In this group, the number of hospital admissions decreasedsignificantly from 5.0 ± 1.8 to 1.7 ± 2.4 per year (p = 0.001). Visits to the emergencydepartment were also decreased, from 1.2 ± 1.6 to 0.4 ± 1.6 per patient (p = 0.05). Finally,the length of hospital stay decreased from 38 ± 17 to 16 ± 20 days (p = 0.0001). Conclusions A combined use of hospital resources and home care programs which are specificallyaddressed to severe COPD patients can reduce the need for hospital admission.
    Medicina Clínica 01/2003; 120(11):408-411. · 1.25 Impact Factor
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    ABSTRACT: Continuous positive airway pressure (CPAP) is widely applied as a home treatment during sleep. Conventional CPAP devices are based on a blower to generate nasal pressure and to maintain air washout from the circuit. Because common CPAP systems do not incorporate alarms, failure in the device or in the electric supply could result in rebreathing. To assess the potential rebreathing to which a patient could be subjected after CPAP failure. Four conventional CPAP devices, PV100 (Breas Medica; Molnlycke, Sweden), CP90 (Taema; Antony, France), and SoloPlus and BiPAP (Respironics, Murrysville, PA), and three common exhalation ports (Whisper Swivel [Respironics], Plateau [Respironics], and 4-mm orifice) were tested in a bench study. Rebreathing after failure was assessed by measuring the resistance of the exhalation port (REP) and the resistance of the tubing plus CPAP device (RTUB), and by measuring O(2) and CO(2) concentrations in the nasal mask in a subject breathing through a CPAP system. REP was much higher (approximately 30 cm H(2)O x s/L) than RTUB (approximately 1 cm H(2)O x s/L). Most (approximately 90%) of the breathing tidal volume would flow from/to the tubing plus CPAP device, which represents a dead space (> or = 0.5 L) similar to the patient's tidal volume. After CPAP failure, end-tidal O(2) in the mask changed from 16.8 to 9.2% and end-tidal CO(2) in the mask changed from 4.2 to 6.2%. By contrast, O(2) and CO(2) did not change when a nonrebreathing valve was placed in the mask. Common CPAP systems run a risk of inducing rebreathing in case of failure. This risk could be easily avoided by including a passive valve in the apparatus.
    Chest 01/2002; 121(1):196-200. · 7.13 Impact Factor
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    ABSTRACT: Application of continuous positive airway pressure (CPAP) as the standard treatment for sleep apnea/hypopnea syndrome (SAHS) is a moot point. Studies on the effectiveness of this treatment have been challenged because of the lack of a suitable placebo. The recent description of a true placebo (sham CPAP) prompted us to conduct a randomized trial of CPAP or placebo to assess the effectiveness of CPAP in improving SAHS-related symptoms and daytime function in patients with moderate to severe SAHS. Forty-eight patients, stratified in four groups according to severity, were randomly allocated into two treatment groups (optimal and sham CPAP) for a 6-wk period. Of these, 45 completed follow-up (91% males; age: 54 +/- 10 yr; body mass index [BMI]: 32 +/- 6 kg/m(2); apnea-hypopnea index [AHI]: 54 +/- 19 events/h; and Epworth Sleepiness Scale [ESS]: 16 +/- 5). The ESS, a questionnaire on SAHS-related symptoms, Functional Outcomes Sleep Questionnaire (FOSQ), and the Short Form Health Survey (SF-36) were completed at inclusion and after treatment. After 10 d of washout, the placebo group was treated with optimal CPAP and reassessed before and after optimal CPAP. The group receiving optimal CPAP when compared with the group with sham CPAP showed considerably greater improvement in the relief of sleepiness (-9.5 versus -2.3, p < 0.001), other SAHS-related symptoms (-18.5 versus -4.5, p < 0.001), vigilance (+8.5 versus +3.4, p = 0.009), and general productivity (+4.0 versus +0.5, p = 0.04) FOSQ scales. Both groups used a similar number of hours for the optimal and the sham CPAP (4.3 versus 4.5, (p = NS). The patients initially treated with placebo CPAP improved significantly more when optimal CPAP was applied for ESS (-2.3 versus -6.7, p < 0.001) and other sleep apnea syndrome (SAS)-related symptoms (-4.5 versus -11.2, p = 0.02). Our study provides strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe SAHS.
    American Journal of Respiratory and Critical Care Medicine 09/2001; 164(4):608-13. · 11.04 Impact Factor
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    ABSTRACT: The forced oscillation technique (FOT) is a noninvasive method that is useful for assessing airway obstruction and for titrating continuous positive airway pressure (CPAP) in patients with sleep apnoea. The aim was to evaluate the routine applicability of a simplified FOT set-up based on recording pressure and flow at the level of the CPAP device, i.e. obviating the need for connecting the transducers to the nasal mask. A correction to account for the tubing and the exhaust port was applied. This simplified FOT was evaluated on nine patients with moderate or severe sleep apnoea during routine CPAP titration. Patient impedance measured by the simplified FOT ([Z]) was compared with actual patient impedance ([Zrs]) measured simultaneously with a reference FOT based on recording pressure and flow at the nasal mask. An excellent agreement was found between [Z] and [Zrs] over the wide range of airway obstruction explored (4.8-72.1 cmH2O x s x L(-1)): [Z] = [Zrs] x 0.86 + 1.3 cmH2O x s x L(-1) (r = 0.99). Moreover, the simplified and the conventional FOT settings detected the same respiratory events during sleep. These results demonstrate that this simplified FOT is applicable for measuring airway obstruction during routine sleep studies in patients with sleep apnoea.
    European Respiratory Journal 04/2001; 17(3):456-61. · 6.36 Impact Factor

Publication Stats

1k Citations
359.56 Total Impact Points

Institutions

  • 1986–2008
    • Southern Medical Clinic
      San Fernando, City of San Fernando, Trinidad and Tobago
  • 1993–2007
    • Hospital Clínic de Barcelona
      • Servicio de Neumología
      Barcino, Catalonia, Spain
  • 1990–2004
    • University of Barcelona
      • • Unitat de Biofísica i Bioenginyeria
      • • Departament de Medicina
      • • Departament d'Anatomia Patològica, Farmacologia i Microbiologia
      Barcino, Catalonia, Spain
  • 1999–2001
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1997
    • Parc de Salut Mar
      Barcino, Catalonia, Spain