Pedro Landete - Academia.edu (original) (raw)

Papers by Pedro Landete

Advances in Therapy, Sep 17, 2022

Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly u... more Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis, followup visits and treatment modifications during the COVID-19 pandemic. The present study describes the management of patients with COPD and asthma, and their treatments during the pandemic from the pulmonologist's perspective. Methods: NEUMOBIAL was an ecological study with aggregated data. A total of 279 Spanish pulmonologists answered a 60-question survey about their last 10 patients, focused on the characterisation and changes in visits and treatments during the pandemic. Results: Most pulmonologists (72.0%) considered that the pandemic negatively altered the diagnosis and follow-up of patients with asthma or COPD. Diagnostic tests were reduced during the pandemic, mainly because they were not recommended by pulmonologists (68.1% and 72.7% in the case of COPD and asthma tests, respectively). Moreover, 17.3% of the COPD and 19.1% of the asthma visits were remote visits. According to pulmonologists, low adherence to treatment was mainly due to a lack of patient knowledge about their disease (75.3% and 81.7% in COPD and asthma, respectively). Other factors that also influenced adherence were inadequate use of the inhaler (59.5% for COPD and 57.7% for asthma) and a lack of knowledge about the device (57.3% for COPD and 57.7% for asthma). Pulmonologists chose Zonda Ò for COPD because of the ease of use of the device (73.1%) and the ability to check whether the entire dose was inhaled (69.5%). For asthma, Spiromax Ò was chosen because of the ease of use of the device (85.7%) and the possibility of using a single device for maintenance and reliever treatment (82.4%). Conclusion: According to pulmonologists, during the pandemic, treatments for COPD and asthma were mainly chosen on the basis of their ease of use; treatment adherence was good; and the number of remote visits increased.

Advances in Therapy

Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly u... more Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis, followup visits and treatment modifications during the COVID-19 pandemic. The present study describes the management of patients with COPD and asthma, and their treatments during the pandemic from the pulmonologist's perspective. Methods: NEUMOBIAL was an ecological study with aggregated data. A total of 279 Spanish pulmonologists answered a 60-question survey about their last 10 patients, focused on the characterisation and changes in visits and treatments during the pandemic. Results: Most pulmonologists (72.0%) considered that the pandemic negatively altered the diagnosis and follow-up of patients with asthma or COPD. Diagnostic tests were reduced during the pandemic, mainly because they were not recommended by pulmonologists (68.1% and 72.7% in the case of COPD and asthma tests, respectively). Moreover, 17.3% of the COPD and 19.1% of the asthma visits were remote visits. According to pulmonologists, low adherence to treatment was mainly due to a lack of patient knowledge about their disease (75.3% and 81.7% in COPD and asthma, respectively). Other factors that also influenced adherence were inadequate use of the inhaler (59.5% for COPD and 57.7% for asthma) and a lack of knowledge about the device (57.3% for COPD and 57.7% for asthma). Pulmonologists chose Zonda Ò for COPD because of the ease of use of the device (73.1%) and the ability to check whether the entire dose was inhaled (69.5%). For asthma, Spiromax Ò was chosen because of the ease of use of the device (85.7%) and the possibility of using a single device for maintenance and reliever treatment (82.4%). Conclusion: According to pulmonologists, during the pandemic, treatments for COPD and asthma were mainly chosen on the basis of their ease of use; treatment adherence was good; and the number of remote visits increased.

Respiratory Medicine, 2019

European Journal of Heart Failure, 2013

Anales de Pediatría, 2009

Journal of Sleep Disorders & Therapy, 2014

Archivos de Bronconeumología, 2016

Objectives: To compare clinical outcomes and costs between two administration strategies of omali... more Objectives: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. Method: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. Results: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50±15 years, FEV1% 67±22%, body mass index (BMI) 28±6 kg/m 2 , 639±747 UI IgE/mL, followed for 24±11 months (12-45), Asthma Control Test (ACT) score 12±4 and Asthma Control Questionnaire (ACQ) 3±2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<.001), ACQ (P<.001), improvement in FEV1% (P<.001), reduction in total admissions (P<.001), days of hospitalization (P<.001), emergency room visits (P<.001), cycles and doses of oral steroids (P<.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. Conclusion: The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

Revista Portuguesa de Pneumologia, 2013

Figura 1 Requisição de provas funcionais respiratórias a um doente com DPOC. O doente quase fumou... more Figura 1 Requisição de provas funcionais respiratórias a um doente com DPOC. O doente quase fumou o papel da requisição.. .

Archivos de Bronconeumología, 2015

Archivos de Bronconeumología, 2013

Archivos de Bronconeumología, 2014

We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena ... more We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena cava syndrome (SVCS). Physical examination showed collar of Stokes and extensive collateral circulation in the neck and anterosuperior thoracic region, as well as a large testicular mass. Fibrobronchoscopy revealed an endobronchial tumor, histopathologically diagnosed as seminoma, with the same characteristics as the testicular biopsy. Treatment was initiated with surgery, chemotherapy and radiotherapy, resulting in a major clinical improvement. We indicate the importance of considering SVCS as an entity related with less common neoplasms such as germ cell tumors.

International Journal of Chronic Obstructive Pulmonary Disease, Jun 1, 2017

Current recommendations to consider initiation of palliative care (PC) in COPD patients are often... more Current recommendations to consider initiation of palliative care (PC) in COPD patients are often based on an expected poor prognosis. However, this approach is not evidence-based, and which and when COPD patients should start PC is controversial. We aimed to assess whether current suggested recommendations for initiating PC were sufficiently reliable. We identified prognostic variables proposed in the literature for initiating PC; then, we ascertained their relationship with 1-year mortality, and finally, we validated their utility in our cohort of 697 patients hospitalized for COPD exacerbation. From 24 articles of 499 screened, we selected 20 variables and retrieved 48 original articles in which we were able to calculate the relationship between each of them and 1-year mortality. The number of studies where 1-year mortality was detailed for these variables ranged from 9 for previous hospitalizations or FEV 1 #30% to none for albumin #25 mg/dL. The percentage of 1-year mortality in the literature for these variables ranged from 5% to 60%. In the validation cohort study, the prevalence of these proposed variables ranged from 8% to 64%; only 10 of the 18 variables analyzed in our cohort reached statistical significance with Cox regression analysis, and none overcame an area under the curve $0.7. We conclude that none of the suggested criteria for initiating PC based on an expected poor vital prognosis in COPD patients in the short or medium term offers sufficient reliability, and consequently, they should be avoided as exclusive criteria for considering PC or at least critically appraised.

Frontiers in Cardiovascular Medicine, Mar 21, 2023

Background: Little is known about whether the overlap syndrome (OS) combining features of chronic... more Background: Little is known about whether the overlap syndrome (OS) combining features of chronic obstructive pulmonary disease (COPD) and sleep apneahypopnea syndrome increases the risk of stroke associated with COPD itself. Methods: We prospectively studied 74 COPD patients and 32 subjects without lung disease. Spirometry and cardiorespiratory polygraphy were used to assess the pulmonary function of the study population and ultrasound measurements of intima media thickness (IMT) as well as the volume of plaques in both carotid arteries were also evaluated. Results: Polygraphic criteria of OS were met in 51% of COPD patients. We found that 79% of patients with OS and 50% of COPD patients without OS had atherosclerotic plaques in the left carotid artery (p = 0.0509). Interestingly, the mean volume of atherosclerotic plaques was significantly higher in the left carotid artery of COPD patients with OS (0.07 ± 0.02 ml) than in those without OS (0.04 ± 0.02 ml, p = 0.0305). However, regardless of the presence of OS, no significant differences were observed in both presence and volume of atherosclerotic plaques in the right carotid artery of COPD patients. Adjustedmultivariate linear regression revealed age, current smoking and the apnea/ hypopnea index (OR = 4.54, p = 0.012) as independent predictors of left carotid atherosclerotic plaques in COPD patients. Conclusions: This study suggests that the presence of OS in COPD patients is associated with larger left carotid atherosclerotic plaques, indicating that OS might be screened in all COPD patients to identify those with higher risk of stroke.

Archivos De Bronconeumologia, Sep 1, 2015

Archivos De Bronconeumologia, May 1, 2014

We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena ... more We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena cava syndrome (SVCS). Physical examination showed collar of Stokes and extensive collateral circulation in the neck and anterosuperior thoracic region, as well as a large testicular mass. Fibrobronchoscopy revealed an endobronchial tumor, histopathologically diagnosed as seminoma, with the same characteristics as the testicular biopsy. Treatment was initiated with surgery, chemotherapy and radiotherapy, resulting in a major clinical improvement. We indicate the importance of considering SVCS as an entity related with less common neoplasms such as germ cell tumors.

European Respiratory Journal, Sep 1, 2013

Body: Background. Recent studies in humans have shown an association between sleep-disordered bre... more Body: Background. Recent studies in humans have shown an association between sleep-disordered breathing (SDB), including overnight hypoxia, and the incidence and mortality of cancer, but no study has focused on a specific type of cancer. The objective of this study was to analyze the relationship between some markers of cutaneous malignant melanoma (CMM) aggressiveness and the severity of SDB. Methods. We performed a prospective, multicenter observational study in 56 consecutive patients diagnosed with CMM. Measurements of CMM aggressiveness included: number of mitosis/mm 2 , Breslow Index, presence of ulceration and growth rate of melanoma (GRM). Every participant underwent a diagnostic respiratory polygraphy. Multivariate analyses were used to investigate the independent relationship between SDB severity measured by the apnoea-hypopnoea index (AHI) and oxygen desaturation indexes (ODI3% and ODI4%) and markers of CMM aggressiveness. Results. The prevalence of SDB (AHI≥5) in the cohort was 60.7% and severe SDB (AHI≥30) was present in 14.3% of the patients. In fully adjusted multivariate analyses, AHI (OR 1.17; 95%CI 1.03-1.34), ODI3% (OR 1.14; 95%CI 1.03-1.26) and ODI4% (OR 1.3; 95%CI 1.04-1.45) were independently associated with an increased GRM. Furthermore, AHI, ODI4% and ODI3% correlated with other aggressiveness factors of CMM, such as the Breslow Index, presence of ulceration and mitotic index. Conclusion. SDB severity independently predicts aggressiveness of cutaneous malignant melanoma.

Archivos De Bronconeumologia, May 1, 2014

We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena ... more We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena cava syndrome (SVCS). Physical examination showed collar of Stokes and extensive collateral circulation in the neck and anterosuperior thoracic region, as well as a large testicular mass. Fibrobronchoscopy revealed an endobronchial tumor, histopathologically diagnosed as seminoma, with the same characteristics as the testicular biopsy. Treatment was initiated with surgery, chemotherapy and radiotherapy, resulting in a major clinical improvement. We indicate the importance of considering SVCS as an entity related with less common neoplasms such as germ cell tumors.

Archivos De Bronconeumologia, Apr 1, 2016

Objectives: To compare clinical outcomes and costs between two administration strategies of omali... more Objectives: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. Method: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. Results: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50±15 years, FEV1% 67±22%, body mass index (BMI) 28±6 kg/m 2 , 639±747 UI IgE/mL, followed for 24±11 months (12-45), Asthma Control Test (ACT) score 12±4 and Asthma Control Questionnaire (ACQ) 3±2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<.001), ACQ (P<.001), improvement in FEV1% (P<.001), reduction in total admissions (P<.001), days of hospitalization (P<.001), emergency room visits (P<.001), cycles and doses of oral steroids (P<.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. Conclusion: The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

American Journal of Medical Genetics, Sep 10, 2020

Patients with Down syndrome (DS) often have a high occurrence of obstructive sleep apnea-hypopnea... more Patients with Down syndrome (DS) often have a high occurrence of obstructive sleep apnea-hypopnea (OSA) syndrome. We studied a large cohort of adults with DS attended due to clinical suspicion of OSA. A standardized questionnaire and full medical assessment were conducted, including a sleep study. One hundred and fiftyseven DS individuals were studied, with a mean ± SD age of 36 ± 10 years, 40.7% women, BMI 29.4 ± 5.6 kg/m 2. The main clinical symptom was daytime sleepiness (64.9%). A sleep study was conducted in 114 patients. All 114 DS patients were diagnosed with OSA, with a predominance of obstructive and hypopnea events, (apneahypopnoea index, AHI, 35.0 ± 26.6), with an oxygen desaturation index of 32.9, and a Tc90% of 24.7%. Continuous positive airway pressure (CPAP) treatment was implemented in 75 (65.8%) of subjects. Tolerance was considered good in 75% of them, with a high compliance of 79.2% >4 hr/day (mean 7.1 hr/day), resulting in a symptomatic improvement in 58.7% of them. Obstructive sleep apnea is frequently confirmed in patients with DS when it clinically suspected.

Barcelona respiratory network reviews, Dec 28, 2022

The respiratory intermediate care unit (RICU) is logistically a «step up» or «step down» unit bet... more The respiratory intermediate care unit (RICU) is logistically a «step up» or «step down» unit between the intensive care unit (ICU) and general hospitalization. It is efficiency in terms of «avoided cost». During the pandemic, RICU increased exponentially with the aim of avoiding ICU congestion with coronavirus disease 2019 (COVID-19) patients. These units must be attended by a multidisciplinary professional team with presence and assistance 24 hours a day and must be prepared with adequate monitoring for a quick scale in case of deterioration. The high flow nasal cannula (HFNC) increases ventilator-free days and reduces hospital stays. Awake prone position significantly reduced the incidence of treatment failure. Conscious sedation is used to increase the tolerance to non-invasive ventilation (NIV). In the treatment with HFNC, obesity, immunosuppression and elevated inflammatory markers were associated with a higher failure rate. With everything learned so far, there should be no hospital without RICU.

Advances in Therapy, Sep 17, 2022

Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly u... more Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis, followup visits and treatment modifications during the COVID-19 pandemic. The present study describes the management of patients with COPD and asthma, and their treatments during the pandemic from the pulmonologist's perspective. Methods: NEUMOBIAL was an ecological study with aggregated data. A total of 279 Spanish pulmonologists answered a 60-question survey about their last 10 patients, focused on the characterisation and changes in visits and treatments during the pandemic. Results: Most pulmonologists (72.0%) considered that the pandemic negatively altered the diagnosis and follow-up of patients with asthma or COPD. Diagnostic tests were reduced during the pandemic, mainly because they were not recommended by pulmonologists (68.1% and 72.7% in the case of COPD and asthma tests, respectively). Moreover, 17.3% of the COPD and 19.1% of the asthma visits were remote visits. According to pulmonologists, low adherence to treatment was mainly due to a lack of patient knowledge about their disease (75.3% and 81.7% in COPD and asthma, respectively). Other factors that also influenced adherence were inadequate use of the inhaler (59.5% for COPD and 57.7% for asthma) and a lack of knowledge about the device (57.3% for COPD and 57.7% for asthma). Pulmonologists chose Zonda Ò for COPD because of the ease of use of the device (73.1%) and the ability to check whether the entire dose was inhaled (69.5%). For asthma, Spiromax Ò was chosen because of the ease of use of the device (85.7%) and the possibility of using a single device for maintenance and reliever treatment (82.4%). Conclusion: According to pulmonologists, during the pandemic, treatments for COPD and asthma were mainly chosen on the basis of their ease of use; treatment adherence was good; and the number of remote visits increased.

Advances in Therapy

Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly u... more Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis, followup visits and treatment modifications during the COVID-19 pandemic. The present study describes the management of patients with COPD and asthma, and their treatments during the pandemic from the pulmonologist's perspective. Methods: NEUMOBIAL was an ecological study with aggregated data. A total of 279 Spanish pulmonologists answered a 60-question survey about their last 10 patients, focused on the characterisation and changes in visits and treatments during the pandemic. Results: Most pulmonologists (72.0%) considered that the pandemic negatively altered the diagnosis and follow-up of patients with asthma or COPD. Diagnostic tests were reduced during the pandemic, mainly because they were not recommended by pulmonologists (68.1% and 72.7% in the case of COPD and asthma tests, respectively). Moreover, 17.3% of the COPD and 19.1% of the asthma visits were remote visits. According to pulmonologists, low adherence to treatment was mainly due to a lack of patient knowledge about their disease (75.3% and 81.7% in COPD and asthma, respectively). Other factors that also influenced adherence were inadequate use of the inhaler (59.5% for COPD and 57.7% for asthma) and a lack of knowledge about the device (57.3% for COPD and 57.7% for asthma). Pulmonologists chose Zonda Ò for COPD because of the ease of use of the device (73.1%) and the ability to check whether the entire dose was inhaled (69.5%). For asthma, Spiromax Ò was chosen because of the ease of use of the device (85.7%) and the possibility of using a single device for maintenance and reliever treatment (82.4%). Conclusion: According to pulmonologists, during the pandemic, treatments for COPD and asthma were mainly chosen on the basis of their ease of use; treatment adherence was good; and the number of remote visits increased.

Respiratory Medicine, 2019

European Journal of Heart Failure, 2013

Anales de Pediatría, 2009

Journal of Sleep Disorders & Therapy, 2014

Archivos de Bronconeumología, 2016

Objectives: To compare clinical outcomes and costs between two administration strategies of omali... more Objectives: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. Method: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. Results: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50±15 years, FEV1% 67±22%, body mass index (BMI) 28±6 kg/m 2 , 639±747 UI IgE/mL, followed for 24±11 months (12-45), Asthma Control Test (ACT) score 12±4 and Asthma Control Questionnaire (ACQ) 3±2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<.001), ACQ (P<.001), improvement in FEV1% (P<.001), reduction in total admissions (P<.001), days of hospitalization (P<.001), emergency room visits (P<.001), cycles and doses of oral steroids (P<.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. Conclusion: The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

Revista Portuguesa de Pneumologia, 2013

Figura 1 Requisição de provas funcionais respiratórias a um doente com DPOC. O doente quase fumou... more Figura 1 Requisição de provas funcionais respiratórias a um doente com DPOC. O doente quase fumou o papel da requisição.. .

Archivos de Bronconeumología, 2015

Archivos de Bronconeumología, 2013

Archivos de Bronconeumología, 2014

We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena ... more We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena cava syndrome (SVCS). Physical examination showed collar of Stokes and extensive collateral circulation in the neck and anterosuperior thoracic region, as well as a large testicular mass. Fibrobronchoscopy revealed an endobronchial tumor, histopathologically diagnosed as seminoma, with the same characteristics as the testicular biopsy. Treatment was initiated with surgery, chemotherapy and radiotherapy, resulting in a major clinical improvement. We indicate the importance of considering SVCS as an entity related with less common neoplasms such as germ cell tumors.

International Journal of Chronic Obstructive Pulmonary Disease, Jun 1, 2017

Current recommendations to consider initiation of palliative care (PC) in COPD patients are often... more Current recommendations to consider initiation of palliative care (PC) in COPD patients are often based on an expected poor prognosis. However, this approach is not evidence-based, and which and when COPD patients should start PC is controversial. We aimed to assess whether current suggested recommendations for initiating PC were sufficiently reliable. We identified prognostic variables proposed in the literature for initiating PC; then, we ascertained their relationship with 1-year mortality, and finally, we validated their utility in our cohort of 697 patients hospitalized for COPD exacerbation. From 24 articles of 499 screened, we selected 20 variables and retrieved 48 original articles in which we were able to calculate the relationship between each of them and 1-year mortality. The number of studies where 1-year mortality was detailed for these variables ranged from 9 for previous hospitalizations or FEV 1 #30% to none for albumin #25 mg/dL. The percentage of 1-year mortality in the literature for these variables ranged from 5% to 60%. In the validation cohort study, the prevalence of these proposed variables ranged from 8% to 64%; only 10 of the 18 variables analyzed in our cohort reached statistical significance with Cox regression analysis, and none overcame an area under the curve $0.7. We conclude that none of the suggested criteria for initiating PC based on an expected poor vital prognosis in COPD patients in the short or medium term offers sufficient reliability, and consequently, they should be avoided as exclusive criteria for considering PC or at least critically appraised.

Frontiers in Cardiovascular Medicine, Mar 21, 2023

Background: Little is known about whether the overlap syndrome (OS) combining features of chronic... more Background: Little is known about whether the overlap syndrome (OS) combining features of chronic obstructive pulmonary disease (COPD) and sleep apneahypopnea syndrome increases the risk of stroke associated with COPD itself. Methods: We prospectively studied 74 COPD patients and 32 subjects without lung disease. Spirometry and cardiorespiratory polygraphy were used to assess the pulmonary function of the study population and ultrasound measurements of intima media thickness (IMT) as well as the volume of plaques in both carotid arteries were also evaluated. Results: Polygraphic criteria of OS were met in 51% of COPD patients. We found that 79% of patients with OS and 50% of COPD patients without OS had atherosclerotic plaques in the left carotid artery (p = 0.0509). Interestingly, the mean volume of atherosclerotic plaques was significantly higher in the left carotid artery of COPD patients with OS (0.07 ± 0.02 ml) than in those without OS (0.04 ± 0.02 ml, p = 0.0305). However, regardless of the presence of OS, no significant differences were observed in both presence and volume of atherosclerotic plaques in the right carotid artery of COPD patients. Adjustedmultivariate linear regression revealed age, current smoking and the apnea/ hypopnea index (OR = 4.54, p = 0.012) as independent predictors of left carotid atherosclerotic plaques in COPD patients. Conclusions: This study suggests that the presence of OS in COPD patients is associated with larger left carotid atherosclerotic plaques, indicating that OS might be screened in all COPD patients to identify those with higher risk of stroke.

Archivos De Bronconeumologia, Sep 1, 2015

Archivos De Bronconeumologia, May 1, 2014

We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena ... more We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena cava syndrome (SVCS). Physical examination showed collar of Stokes and extensive collateral circulation in the neck and anterosuperior thoracic region, as well as a large testicular mass. Fibrobronchoscopy revealed an endobronchial tumor, histopathologically diagnosed as seminoma, with the same characteristics as the testicular biopsy. Treatment was initiated with surgery, chemotherapy and radiotherapy, resulting in a major clinical improvement. We indicate the importance of considering SVCS as an entity related with less common neoplasms such as germ cell tumors.

European Respiratory Journal, Sep 1, 2013

Body: Background. Recent studies in humans have shown an association between sleep-disordered bre... more Body: Background. Recent studies in humans have shown an association between sleep-disordered breathing (SDB), including overnight hypoxia, and the incidence and mortality of cancer, but no study has focused on a specific type of cancer. The objective of this study was to analyze the relationship between some markers of cutaneous malignant melanoma (CMM) aggressiveness and the severity of SDB. Methods. We performed a prospective, multicenter observational study in 56 consecutive patients diagnosed with CMM. Measurements of CMM aggressiveness included: number of mitosis/mm 2 , Breslow Index, presence of ulceration and growth rate of melanoma (GRM). Every participant underwent a diagnostic respiratory polygraphy. Multivariate analyses were used to investigate the independent relationship between SDB severity measured by the apnoea-hypopnoea index (AHI) and oxygen desaturation indexes (ODI3% and ODI4%) and markers of CMM aggressiveness. Results. The prevalence of SDB (AHI≥5) in the cohort was 60.7% and severe SDB (AHI≥30) was present in 14.3% of the patients. In fully adjusted multivariate analyses, AHI (OR 1.17; 95%CI 1.03-1.34), ODI3% (OR 1.14; 95%CI 1.03-1.26) and ODI4% (OR 1.3; 95%CI 1.04-1.45) were independently associated with an increased GRM. Furthermore, AHI, ODI4% and ODI3% correlated with other aggressiveness factors of CMM, such as the Breslow Index, presence of ulceration and mitotic index. Conclusion. SDB severity independently predicts aggressiveness of cutaneous malignant melanoma.

Archivos De Bronconeumologia, May 1, 2014

We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena ... more We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena cava syndrome (SVCS). Physical examination showed collar of Stokes and extensive collateral circulation in the neck and anterosuperior thoracic region, as well as a large testicular mass. Fibrobronchoscopy revealed an endobronchial tumor, histopathologically diagnosed as seminoma, with the same characteristics as the testicular biopsy. Treatment was initiated with surgery, chemotherapy and radiotherapy, resulting in a major clinical improvement. We indicate the importance of considering SVCS as an entity related with less common neoplasms such as germ cell tumors.

Archivos De Bronconeumologia, Apr 1, 2016

Objectives: To compare clinical outcomes and costs between two administration strategies of omali... more Objectives: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. Method: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. Results: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50±15 years, FEV1% 67±22%, body mass index (BMI) 28±6 kg/m 2 , 639±747 UI IgE/mL, followed for 24±11 months (12-45), Asthma Control Test (ACT) score 12±4 and Asthma Control Questionnaire (ACQ) 3±2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<.001), ACQ (P<.001), improvement in FEV1% (P<.001), reduction in total admissions (P<.001), days of hospitalization (P<.001), emergency room visits (P<.001), cycles and doses of oral steroids (P<.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. Conclusion: The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

American Journal of Medical Genetics, Sep 10, 2020

Patients with Down syndrome (DS) often have a high occurrence of obstructive sleep apnea-hypopnea... more Patients with Down syndrome (DS) often have a high occurrence of obstructive sleep apnea-hypopnea (OSA) syndrome. We studied a large cohort of adults with DS attended due to clinical suspicion of OSA. A standardized questionnaire and full medical assessment were conducted, including a sleep study. One hundred and fiftyseven DS individuals were studied, with a mean ± SD age of 36 ± 10 years, 40.7% women, BMI 29.4 ± 5.6 kg/m 2. The main clinical symptom was daytime sleepiness (64.9%). A sleep study was conducted in 114 patients. All 114 DS patients were diagnosed with OSA, with a predominance of obstructive and hypopnea events, (apneahypopnoea index, AHI, 35.0 ± 26.6), with an oxygen desaturation index of 32.9, and a Tc90% of 24.7%. Continuous positive airway pressure (CPAP) treatment was implemented in 75 (65.8%) of subjects. Tolerance was considered good in 75% of them, with a high compliance of 79.2% >4 hr/day (mean 7.1 hr/day), resulting in a symptomatic improvement in 58.7% of them. Obstructive sleep apnea is frequently confirmed in patients with DS when it clinically suspected.

Barcelona respiratory network reviews, Dec 28, 2022

The respiratory intermediate care unit (RICU) is logistically a «step up» or «step down» unit bet... more The respiratory intermediate care unit (RICU) is logistically a «step up» or «step down» unit between the intensive care unit (ICU) and general hospitalization. It is efficiency in terms of «avoided cost». During the pandemic, RICU increased exponentially with the aim of avoiding ICU congestion with coronavirus disease 2019 (COVID-19) patients. These units must be attended by a multidisciplinary professional team with presence and assistance 24 hours a day and must be prepared with adequate monitoring for a quick scale in case of deterioration. The high flow nasal cannula (HFNC) increases ventilator-free days and reduces hospital stays. Awake prone position significantly reduced the incidence of treatment failure. Conscious sedation is used to increase the tolerance to non-invasive ventilation (NIV). In the treatment with HFNC, obesity, immunosuppression and elevated inflammatory markers were associated with a higher failure rate. With everything learned so far, there should be no hospital without RICU.