The prevalence and clinical implications of colonization with nontuberculous mycobacteria were pr... more The prevalence and clinical implications of colonization with nontuberculous mycobacteria were prospectively studied in 37 patients who had cystic fibrosis. Sputum samples were cultured on Coletsos and Löwenstein-Jensen selective media after decontamination with sodium hydroxide and oxalic acid. Oxalic acid-decontaminated fractions were also cultured in selective liquid medium. Nontuberculous mycobacteria were isolated from 6 patients (16.1%). Mycobacterium chelonae and Mycobacterium avium-intracellulare complex were the most common species. Three patients with positive results of culture had at least 1 positive result by acid-fast smear. Oxalic acid decontamination and culture in liquid medium had the lowest contamination rate (6.7%). Colonization with nontuberculous mycobacteria was associated with humoral response to mycobacteria (immunoglobulin G titers against antigen A60) in patients with samples that tested positive by acid-fast smear. An improvement in pulmonary function was observed in 2 patients after they received a course of antimycobacterial therapy. Screening for nontuberculous mycobacteria in patients with cystic fibrosis will contribute to understanding the relevance of these pathogens with regard to deterioration of pulmonary function in patients with cystic fibrosis.
Progressive lung disease, caused by chronic endobronchial colonization, is the major cause of mor... more Progressive lung disease, caused by chronic endobronchial colonization, is the major cause of morbidity and mortality in patients with cystic fibrosis (CF). Several pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa are responsible for this effect. The steadily improving prognosis of CF has been attributed to the use of antibiotics with activity against these organisms. Despite a significant increase in the amount of published material demonstrating the potential role of macrolide antibiotics as antiinflammatory agents and their effects on bacterial virulence, their mechanism of action in CF patients is still unknown. Although there is a limited number of clinical trials assessing the efficacy and safety of azithromycin (AZM) in CF, increasing evidence suggests that 3 to 6-month AZM treatment in CF patients is safe and well tolerated. This treatment results in clinical improvement, decreasing the number of pulmonary exacerbations and increasing pulmonary function. Therefore, chronic treatment with AZM should be considered in CF patients added to conventional therapy. Clinical experience with macrolides other than AZM in CF patients is very limited.
A descriptive study of the home intravenous antibiotic treatment (HIVAT) course in cystic fibrosi... more A descriptive study of the home intravenous antibiotic treatment (HIVAT) course in cystic fibrosis (CF) units of Madrid in an 18 month period. Different patient features were recorded, antibiotherapy, intravenous access, complications and their resolutions. We accessed the improvement of the pulmonary function, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) at the end of the treatment. For an 18 months period (January 2002-June 2003) the patients with CF who received HIVAT and fulfilled the previously fixed criteria were included. The next clinic variables were collected: age, sex, bacterial colonization of respiratory tree, pancreatic function and pulmonary function in steady phase, before and after HIAT. 56 patients, 31 male and 25 female, were given 90 courses of HIAT (34 patients received only one course). Mean age was 20.06 (8.07) years. 57.1% of the patients were colonized by Pseudomonas aeruginosa. The most frequently used antibiotics were ceftazidime and tobramycin. Courses of treatment lasted a mean of 4.08 (5.09) days inpatient and 11.89 (4.96) at home. In 87.7% of the course were used the intravenous cannulae, Port-a-cath in 6.7% and Venocath in 7.8%. The intravenous access was replaced, in the 64.4% of the cases, by the nurse of the CF Unit, in the 21.4% in the emergency room of the nearest hospital and in 11.9% in primary care center. Three occasions skin reactions were reported. The parameters of pulmonary function improved significatively after HIVAT. The HIVAT is a therapeutic option that, following predetermined inclusion criteria, has a low complication rate and improves pulmonary function.
Fourteen cases are revised of bronchiolalveolar carcinoma (BAC) diagnosed in our institution from... more Fourteen cases are revised of bronchiolalveolar carcinoma (BAC) diagnosed in our institution from 1980 to 1992. The time interval from clinical manifestations to diagnosis was 5.13 +/- 6.01 months. The incidence of smokers in the population was 42.8%. Clinical findings were non-specific, except in three cases, consisting in bronchorrhea with more than 100 ml. The most frequent site of the tumor was bilateral and diffuse (71%), mainly in nonsmokers. Endoscopic findings suggested a likely malignancy in 21% of cases. Transbronchial biopsy was the most sensitive diagnostic method. Histological confirmation was obtained in 85% of cases. To note the possible association with Epstein-Barr virus (EBV), as demonstrated by the findings of EBV genome in the cases when this study was performed.
Most pneumologists assume that chronic asthma and emphysema associated with smoking differ both i... more Most pneumologists assume that chronic asthma and emphysema associated with smoking differ both in their etiology and type of inflammation. However, it is difficult to study subjects who have both diseases simultaneously. We designed a prospective study to determine whether or not some advanced emphysema patients who are smokers have an asthmatic profile suggesting the two diseases overlap. Twenty-three smokers with moderate to severe obstruction and radiologic signs of advanced emphysema were studied. The following signs of asthma were analyzed for all patients: positive acute response to bronchodilators, eosinophilia in peripheral blood, significant eosinophilia in sputum, significant total serum immunoglobulin E (IgE) and specific IgE positive for common allergens and fungi. An asthmatic profile was defined as the presence of 3 or more of the aforementioned signs. Statistical analysis was by calculation of the confidence interval on the total number of positive cases to estimate ...
ABSTRACT BACKGROUND: Nutritional status is a prognostic factor in cystic fibrosis. Prevention of ... more ABSTRACT BACKGROUND: Nutritional status is a prognostic factor in cystic fibrosis. Prevention of nutritional impairment and weigh loss are major clinical objectives because they are associated with worsening of lung function and increased mortality. OBJECTIVE: To identify a potential relationship of clinical nutrition parameters, and their relative changes, with lung function (FEV1%) in a cohort of adolescent and adult patients with CF. METHODS: A retrospective analysis of 64 patients older than 14years. Weight, height, BMI, and lung function data were collected at a period of disease stability, both in the year of the first abnormal oral glucose tolerance test (OGTT) and in the previous year. Relative changes in weight and BMI, and their relationship with FEV1%, were determined by linear regression and ANOVA tests; influence of gender and diabetes was also assessed. RESULTS: Mean age of the series (28 females and 36 males) was 26.8years. Normal glucose tolerance (NGT) was found in 26.7%, while 18.3% had diabetes without impaired fasting glucose (CFRD without FPG). Mean BMI was 20.32, with a mean weight of 53.53kg; 32.8% had BMI<18.5, and only 4.7% were overweight. Overall, a positive relative change in weight (≥6%) was associated with an increase in FEV1% (9.31%), as compared to those with a greater weight loss (at least 2%), who had a 12.09% fall in FEV1. Patients with CFRD without FPG had poorer lung function if they had a negative relative change in weight by at least 2% as compared to NGT. CONCLUSIONS: In patients with CF, a relative weight gain is positively associated to FEV1%, while a relative weight loss of at least 2% has a significant negative impact on lung function
... Este círculo vicioso de obstrucción-infec-ción-inflamación daña el pulmón, produciendo bron-q... more ... Este círculo vicioso de obstrucción-infec-ción-inflamación daña el pulmón, produciendo bron-quiectasias quísticas y fibrosis pulmonar. ... Hospitals Vall d'Hebron. Informaciones e inscripciones: Sras. Rosa Llòria y Montse Murillo. Servei de Pneumologia. ...
dilator forced expiratory volume in the first second (FEV 1 ), more frequent cystic bronchiectasi... more dilator forced expiratory volume in the first second (FEV 1 ), more frequent cystic bronchiectasis, and more hospitaltreated exacerbations. They were also more frequently treated with long-term antibiotics. Multivariate analysis showed that daily purulent sputum (OR = 3.75, p = 0.045) and longterm antibiotics (OR = 2.37, p = 0.005) were independently associated with persistence of Aspergillus spp. and C. albicans , respectively. Conclusions: Isolation and persistence of Aspergillus spp. and C. albicans are frequent in patients with non-CF bronchiectasis. Daily purulent sputum and chronic antibiotic treatment were associated with persistence of Aspergillus spp. and C. albicans , respectively.
La fibrosis quística (FQ) es una enfermedad autosómica recesiva causada por mutaciones en el gen ... more La fibrosis quística (FQ) es una enfermedad autosómica recesiva causada por mutaciones en el gen localizado en el brazo largo del cromosoma 7 que codifica la proteína reguladora de la conductancia transmembrana (RTFQ). En realidad se considera una patología también de la edad adulta por la mayor supervivencia y el incremento de los diagnósticos en la edad adulta. Se caracteriza por una gran variabilidad tanto en la clínica como en las mutaciones genéticas, y aunque pueden afectarse diferentes órganos, la enfermedad pulmonar es la principal causa de morbilidad y mortalidad. El diagnóstico no es fácil y sigue siendo un tema de actualidad, motivo de diversas publicaciones de consenso y razón de ser de esta Normativa. Durante los últimos años se han modificado los criterios de diagnóstico, tanto los clínicos, incorporando el cribado neonatal o la ausencia bilateral de conductos deferentes, como los de laboratorio, incorporando nuevas pruebas diagnósticas y modificando el significado de las ya utilizadas (prueba del sudor) 1-3 .
The prevalence and clinical implications of colonization with nontuberculous mycobacteria were pr... more The prevalence and clinical implications of colonization with nontuberculous mycobacteria were prospectively studied in 37 patients who had cystic fibrosis. Sputum samples were cultured on Coletsos and Löwenstein-Jensen selective media after decontamination with sodium hydroxide and oxalic acid. Oxalic acid-decontaminated fractions were also cultured in selective liquid medium. Nontuberculous mycobacteria were isolated from 6 patients (16.1%). Mycobacterium chelonae and Mycobacterium avium-intracellulare complex were the most common species. Three patients with positive results of culture had at least 1 positive result by acid-fast smear. Oxalic acid decontamination and culture in liquid medium had the lowest contamination rate (6.7%). Colonization with nontuberculous mycobacteria was associated with humoral response to mycobacteria (immunoglobulin G titers against antigen A60) in patients with samples that tested positive by acid-fast smear. An improvement in pulmonary function was observed in 2 patients after they received a course of antimycobacterial therapy. Screening for nontuberculous mycobacteria in patients with cystic fibrosis will contribute to understanding the relevance of these pathogens with regard to deterioration of pulmonary function in patients with cystic fibrosis.
Progressive lung disease, caused by chronic endobronchial colonization, is the major cause of mor... more Progressive lung disease, caused by chronic endobronchial colonization, is the major cause of morbidity and mortality in patients with cystic fibrosis (CF). Several pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa are responsible for this effect. The steadily improving prognosis of CF has been attributed to the use of antibiotics with activity against these organisms. Despite a significant increase in the amount of published material demonstrating the potential role of macrolide antibiotics as antiinflammatory agents and their effects on bacterial virulence, their mechanism of action in CF patients is still unknown. Although there is a limited number of clinical trials assessing the efficacy and safety of azithromycin (AZM) in CF, increasing evidence suggests that 3 to 6-month AZM treatment in CF patients is safe and well tolerated. This treatment results in clinical improvement, decreasing the number of pulmonary exacerbations and increasing pulmonary function. Therefore, chronic treatment with AZM should be considered in CF patients added to conventional therapy. Clinical experience with macrolides other than AZM in CF patients is very limited.
A descriptive study of the home intravenous antibiotic treatment (HIVAT) course in cystic fibrosi... more A descriptive study of the home intravenous antibiotic treatment (HIVAT) course in cystic fibrosis (CF) units of Madrid in an 18 month period. Different patient features were recorded, antibiotherapy, intravenous access, complications and their resolutions. We accessed the improvement of the pulmonary function, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) at the end of the treatment. For an 18 months period (January 2002-June 2003) the patients with CF who received HIVAT and fulfilled the previously fixed criteria were included. The next clinic variables were collected: age, sex, bacterial colonization of respiratory tree, pancreatic function and pulmonary function in steady phase, before and after HIAT. 56 patients, 31 male and 25 female, were given 90 courses of HIAT (34 patients received only one course). Mean age was 20.06 (8.07) years. 57.1% of the patients were colonized by Pseudomonas aeruginosa. The most frequently used antibiotics were ceftazidime and tobramycin. Courses of treatment lasted a mean of 4.08 (5.09) days inpatient and 11.89 (4.96) at home. In 87.7% of the course were used the intravenous cannulae, Port-a-cath in 6.7% and Venocath in 7.8%. The intravenous access was replaced, in the 64.4% of the cases, by the nurse of the CF Unit, in the 21.4% in the emergency room of the nearest hospital and in 11.9% in primary care center. Three occasions skin reactions were reported. The parameters of pulmonary function improved significatively after HIVAT. The HIVAT is a therapeutic option that, following predetermined inclusion criteria, has a low complication rate and improves pulmonary function.
Fourteen cases are revised of bronchiolalveolar carcinoma (BAC) diagnosed in our institution from... more Fourteen cases are revised of bronchiolalveolar carcinoma (BAC) diagnosed in our institution from 1980 to 1992. The time interval from clinical manifestations to diagnosis was 5.13 +/- 6.01 months. The incidence of smokers in the population was 42.8%. Clinical findings were non-specific, except in three cases, consisting in bronchorrhea with more than 100 ml. The most frequent site of the tumor was bilateral and diffuse (71%), mainly in nonsmokers. Endoscopic findings suggested a likely malignancy in 21% of cases. Transbronchial biopsy was the most sensitive diagnostic method. Histological confirmation was obtained in 85% of cases. To note the possible association with Epstein-Barr virus (EBV), as demonstrated by the findings of EBV genome in the cases when this study was performed.
Most pneumologists assume that chronic asthma and emphysema associated with smoking differ both i... more Most pneumologists assume that chronic asthma and emphysema associated with smoking differ both in their etiology and type of inflammation. However, it is difficult to study subjects who have both diseases simultaneously. We designed a prospective study to determine whether or not some advanced emphysema patients who are smokers have an asthmatic profile suggesting the two diseases overlap. Twenty-three smokers with moderate to severe obstruction and radiologic signs of advanced emphysema were studied. The following signs of asthma were analyzed for all patients: positive acute response to bronchodilators, eosinophilia in peripheral blood, significant eosinophilia in sputum, significant total serum immunoglobulin E (IgE) and specific IgE positive for common allergens and fungi. An asthmatic profile was defined as the presence of 3 or more of the aforementioned signs. Statistical analysis was by calculation of the confidence interval on the total number of positive cases to estimate ...
ABSTRACT BACKGROUND: Nutritional status is a prognostic factor in cystic fibrosis. Prevention of ... more ABSTRACT BACKGROUND: Nutritional status is a prognostic factor in cystic fibrosis. Prevention of nutritional impairment and weigh loss are major clinical objectives because they are associated with worsening of lung function and increased mortality. OBJECTIVE: To identify a potential relationship of clinical nutrition parameters, and their relative changes, with lung function (FEV1%) in a cohort of adolescent and adult patients with CF. METHODS: A retrospective analysis of 64 patients older than 14years. Weight, height, BMI, and lung function data were collected at a period of disease stability, both in the year of the first abnormal oral glucose tolerance test (OGTT) and in the previous year. Relative changes in weight and BMI, and their relationship with FEV1%, were determined by linear regression and ANOVA tests; influence of gender and diabetes was also assessed. RESULTS: Mean age of the series (28 females and 36 males) was 26.8years. Normal glucose tolerance (NGT) was found in 26.7%, while 18.3% had diabetes without impaired fasting glucose (CFRD without FPG). Mean BMI was 20.32, with a mean weight of 53.53kg; 32.8% had BMI<18.5, and only 4.7% were overweight. Overall, a positive relative change in weight (≥6%) was associated with an increase in FEV1% (9.31%), as compared to those with a greater weight loss (at least 2%), who had a 12.09% fall in FEV1. Patients with CFRD without FPG had poorer lung function if they had a negative relative change in weight by at least 2% as compared to NGT. CONCLUSIONS: In patients with CF, a relative weight gain is positively associated to FEV1%, while a relative weight loss of at least 2% has a significant negative impact on lung function
... Este círculo vicioso de obstrucción-infec-ción-inflamación daña el pulmón, produciendo bron-q... more ... Este círculo vicioso de obstrucción-infec-ción-inflamación daña el pulmón, produciendo bron-quiectasias quísticas y fibrosis pulmonar. ... Hospitals Vall d'Hebron. Informaciones e inscripciones: Sras. Rosa Llòria y Montse Murillo. Servei de Pneumologia. ...
dilator forced expiratory volume in the first second (FEV 1 ), more frequent cystic bronchiectasi... more dilator forced expiratory volume in the first second (FEV 1 ), more frequent cystic bronchiectasis, and more hospitaltreated exacerbations. They were also more frequently treated with long-term antibiotics. Multivariate analysis showed that daily purulent sputum (OR = 3.75, p = 0.045) and longterm antibiotics (OR = 2.37, p = 0.005) were independently associated with persistence of Aspergillus spp. and C. albicans , respectively. Conclusions: Isolation and persistence of Aspergillus spp. and C. albicans are frequent in patients with non-CF bronchiectasis. Daily purulent sputum and chronic antibiotic treatment were associated with persistence of Aspergillus spp. and C. albicans , respectively.
La fibrosis quística (FQ) es una enfermedad autosómica recesiva causada por mutaciones en el gen ... more La fibrosis quística (FQ) es una enfermedad autosómica recesiva causada por mutaciones en el gen localizado en el brazo largo del cromosoma 7 que codifica la proteína reguladora de la conductancia transmembrana (RTFQ). En realidad se considera una patología también de la edad adulta por la mayor supervivencia y el incremento de los diagnósticos en la edad adulta. Se caracteriza por una gran variabilidad tanto en la clínica como en las mutaciones genéticas, y aunque pueden afectarse diferentes órganos, la enfermedad pulmonar es la principal causa de morbilidad y mortalidad. El diagnóstico no es fácil y sigue siendo un tema de actualidad, motivo de diversas publicaciones de consenso y razón de ser de esta Normativa. Durante los últimos años se han modificado los criterios de diagnóstico, tanto los clínicos, incorporando el cribado neonatal o la ausencia bilateral de conductos deferentes, como los de laboratorio, incorporando nuevas pruebas diagnósticas y modificando el significado de las ya utilizadas (prueba del sudor) 1-3 .
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