Mechanisms underlying gas exchange alterations in an experimental model of pulmonary embolism

The aim of the present study was to determine the ventilation/perfusion ratio that contributes to hypoxemia in pulmonary embolism by analyzing blood gases and volumetric capnography in a model of experimental acute pulmonary embolism. Pulmonary embolization with autologous blood clots was induced in seven pigs weighing 24.00 �� 0.6 kg, anesthetized and mechanically ventilated. Significant changes occurred from baseline to 20 min after embolization, such as reduction in oxygen partial pressures in arterial blood (from 87.71 �� 8.64 to 39.14 �� 6.77 mmHg) and alveolar air (from 92.97 �� 2.14 to 63.91 �� 8.27 mmHg). The effective alveolar ventilation exhibited a significant reduction (from 199.62 �� 42.01 to 84.34 �� 44.13) consistent with the fall in alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V Aeff/Q ratio) also presented a significant reduction after embolization (from 0.96 �� 0.34 to 0.33 �� 0.17 fraction). The carbon dioxide partial pressure increased significantly in arterial blood (from 37.51 �� 1.71 to 60.76 �� 6.62 mmHg), but decreased significantly in exhaled air at the end of the respiratory cycle (from 35.57 �� 1.22 to 23.15 �� 8.24 mmHg). Exhaled air at the end of the respiratory cycle returned to baseline values 40 min after embolism. The arterial to alveolar carbon dioxide gradient increased significantly (from 1.94 �� 1.36 to 37.61 �� 12.79 mmHg), as also did the calculated alveolar (from 56.38 �� 22.47 to 178.09 �� 37.46 mL) and physiological (from 0.37 �� 0.05 to 0.75 �� 0.10 fraction) dead spaces. Based on our data, we conclude that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the V Aeff/Q ratio. We were also able to demonstrate that V Aeff/Q progressively improves after embolization, a fact attributed to the alveolar ventilation redistribution induced by hypocapnic bronchoconstriction.

Chronic obstructive pulmonary disease is underdiagnosed and undertreated in S��o Paulo (Brazil): results of the PLATINO study

Chronic obstructive pulmonary disease (COPD) is a common disease in adults over 40 years of age and has a great social and economic impact. It remains little recognized and undertreated even in developed countries. However, there are no data about its diagnosis and treatment in Brazil. The objectives of the present study were to evaluate the proportion of COPD patients who had never been diagnosed and to determine if the COPD patients who had been identified were receiving appropriate treatment. The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was a randomized epidemiological study of adults over 40 years living in five metropolitan areas, including S��o Paulo. The studied sample was randomly selected from the population after a division of the metropolitan area of S��o Paulo in clusters according to social characteristics. All subjects answered a standardized questionnaire on respiratory symptoms, history of smoking, previous diagnosis of lung disease, and treatments. All subjects performed spirometry. The criterion for the diagnosis of COPD was defined by a post-bronchodilator FEV1/FVC ratio lower than 0.7. A total of 918 subjects were evaluated and 144 (15.8%) met the diagnostic criterion for COPD. However, 126 individuals (87.5%) had never been diagnosed. This undiagnosed group of COPD patients had a lower proportion of subjects with respiratory symptoms than the previously diagnosed patients (88.9 vs 54.8%) and showed better lung function with greater FEV1 (86.8 �� 20.8 vs 68.5 �� 23.6% predicted) and FVC (106.6 �� 22.4 vs 92.0 �� 24.1% predicted). Among the COPD patients, only 57.3% were advised to stop smoking and 30.6% received the influenza vaccine. In addition, 82.3% did not receive any pharmacological treatment. In conclusion, COPD is underdiagnosed and a large number of COPD patients are not treated appropriately.

Effect of three exercise programs on patients with chronic obstructive pulmonary disease

We compared the effect of three different exercise programs on patients with chronic obstructive pulmonary disease including strength training at 50_80% of one-repetition maximum (1-RM) (ST; N = 11), low-intensity general training (LGT; N = 13), or combined training groups (CT; N = 11). Body composition, muscle strength, treadmill endurance test (TEnd), 6-min walk test (6MWT), Saint George's Respiratory Questionnaire (SGRQ), and baseline dyspnea (BDI) were assessed prior to and after the training programs (12 weeks). The training modalities showed similar improvements (P > 0.05) in SGRQ-total (ST = 13 �� 14%; CT = 12 �� 14%; LGT = 11 �� 10%), BDI (ST = 1.8 �� 4; CT = 1.8 �� 3; LGT = 1 �� 2), 6MWT (ST = 43 �� 51 m; CT = 48 �� 50 m; LGT = 31 �� 75 m), and TEnd (ST = 11 �� 20 min; CT = 11 �� 11 min; LGT = 7 �� 5 min). In the ST and CT groups, an additional improvement in 1-RM values was shown (P < 0.05) compared to the LGT group (ST = 10 �� 6 to 57 �� 36 kg; CT = 6 �� 2 to 38 �� 16 kg; LGT = 1 �� 2 to 16 �� 12 kg). The addition of strength training to our current training program increased muscle strength; however, it produced no additional improvement in walking endurance, dyspnea or quality of life. A simple combined training program provides benefits without increasing the duration of the training sessions.

Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease

Few studies show patient outcomes over time in chronic obstructive pulmonary disease (COPD). In the present study, we monitored forced expiratory volume in the first second (FEV1) and other manifestations of the disease over 3 years in 133 COPD patients (69% males, age = 65 �� 9 years, FEV1 = 59 �� 25%) evaluated at baseline. During follow-up, 15 patients (11%) died and 23 (17%) dropped out. Measurements for 95 (72%) COPD patients alive after 3 years were analyzed. FEV1, body mass index (BMI), 6-min walking distance (6MWD), Medical Research Council scale (MRC), Saint George��s Respiratory Questionnaire (SGRQ), Charlson Comorbidity index, and BODE index were obtained at baseline and after 3 years. At baseline, 17 patients (18%) presented mild, 39% moderate, 19% severe, and 24% very severe COPD. Predicted FEV1 % and BMI did not change over the period (P &gt; 0.05). FEV1 in liters [1.25 (0.96-1.72) vs 1.26 (0.88-1.60) L; P < 0.001], 6MWD (438 �� 86 vs 412 �� 100 m; P < 0.001), MRC [1 (1-2) vs 2 (1-3); P = 0.002], Charlson index [3 (3-4) vs4 (3-5); P = 0.009], BODE index (2.2 �� 1.8 vs 2.6 �� 2.3; P = 0.008), and total SGRQ (42 �� 19 vs 44 �� 19%; P = 0.041) worsened after 3 years compared to baseline measurements. These data show that COPD patients deteriorated during the 3-year follow-up despite the fact that they had only minor modifications in airway obstruction and body composition. They support the need for comprehensive patient assessment to better identify disease progression.

Anthropometric midarm measurements can detect systemic fat-free mass depletion in patients with chronic obstructive pulmonary disease

Our objective was to determine whether anthropometric measurements of the midarm (MA) could identify subjects with whole body fat-free mass (FFM) depletion. Fifty-five patients (31% females; age: 64.6 �� 9.3 years) with mild/very severe chronic obstructive pulmonary disease (COPD), 18 smokers without COPD (39% females; age: 49.0 �� 7.3 years) and 23 never smoked controls (57% females; age: 48.2 �� 9.6 years) were evaluated. Spirometry, muscle strength and MA circumference were measured. MA muscle area was estimated by anthropometry and MA cross-sectional area by computerized tomography (CT) scan. Bioelectrical impedance was used as the reference method for FFM. MA circumference and MA muscle area correlated with FFM and biceps and triceps strength. Receiver operating characteristic curve analysis showed that MA circumference and MA muscle area cut-off points presented sensitivity and specificity &gt;82% to discriminate FFM-depleted subjects. CT scan measurements did not provide improved sensitivity or specificity. For all groups, there was no significant statistical difference between MA muscle area [35.2 (29.3-45.0) cm��] and MA cross-sectional area values [36.4 (28.5-43.3) cm��] and the linear correlation coefficient between tests was r = 0.77 (P < 0.001). However, Bland-Altman plots revealed wide 95% limits of agreement (-14.7 to 15.0 cm��) between anthropometric and CT scan measurements. Anthropometric MA measurements may provide useful information for identifying subjects with whole body FFM depletion. This is a low-cost technique and can be used in a wider patient population to identify those likely to benefit from a complete body composition evaluation.

Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass

Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 �� 9 years. The PaO2/FiO2 ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31% postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19% (P < 0.001). Non-aerated lung increased by 253 �� 97 g (P < 0.001), from 3 to 27%, after surgery and poorly aerated lung by 72 �� 68 g (P < 0.001), from 24 to 27%, while normally aerated lung was reduced by 147 �� 119 g (P < 0.001), from 72 to 46%. No correlations (Pearson) were observed between PaO2/FiO2 ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone.

Effect of methylprednisolone on perivascular pulmonary edema, inflammatory infiltrate, VEGF and TGF-beta immunoexpression in the remaining lungs of rats after left pneumonectomy

Pneumonectomy is associated with high rates of morbimortality, with postpneumonectomy pulmonary edema being one of the leading causes. An intrinsic inflammatory process following the operation has been considered in its physiopathology. The use of corticosteroids is related to prevention of this edema, but no experimental data are available to support this hypothesis. We evaluated the effect of methylprednisolone on the remaining lungs of rats submitted to left pneumonectomy concerning edema and inflammatory markers. Forty male Wistar rats weighing 300 g underwent left pneumonectomy and were randomized to receive corticosteroids or not. Methylprednisolone at a dose of 10 mg/kg was given before the surgery. After recovery, the animals were sacrificed at 48 and 72 h, when the pO2/FiO2 ratio was determined. Right lung perivascular edema was measured by the index between perivascular and vascular area and neutrophil density by manual count. Tissue expression of vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-&#946;) were evaluated by immunohistochemistry light microscopy. There was perivascular edema formation after 72 h in both groups (P = 0.0031). No difference was observed between operated animals that received corticosteroids and those that did not concerning the pO2/FiO2 ratio, neutrophil density or TGF-&#946; expression. The tissue expression of VEGF was elevated in the animals that received methylprednisolone both 48 and 72 h after surgery (P = 0.0243). Methylprednisolone was unable to enhance gas exchange and avoid an inflammatory infiltrate and TGF-&#946; expression also showed that the inflammatory process was not correlated with pulmonary edema formation. However, the overexpression of VEGF in this group showed that methylprednisolone is related to this elevation.

Morphometric evaluation of nitric oxide synthase isoforms and their cytokine regulators predict pulmonary dysfunction and survival in systemic sclerosis

Because histopathological changes in the lungs of patients with systemic sclerosis (SSc) are consistent with alveolar and vessel cell damage, we presume that this interaction can be characterized by analyzing the expression of proteins regulating nitric oxide (NO) and plasminogen activator inhibitor-1 (PAI-1) synthesis. To validate the importance of alveolar-vascular interactions and to explore the quantitative relationship between these factors and other clinical data, we studied these markers in 23 cases of SSc nonspecific interstitial pneumonia (SSc-NSIP). We used immunohistochemistry and morphometry to evaluate the amount of cells in alveolar septa and vessels staining for NO synthase (NOS) and PAI-1, and the outcomes of our study were cellular and fibrotic NSIP, pulmonary function tests, and survival time until death. General linear model analysis demonstrated that staining for septal inducible NOS (iNOS) related significantly to staining of septal cells for interleukin (IL)-4 and to septal IL-13. In univariate analysis, higher levels of septal and vascular cells staining for iNOS were associated with a smaller percentage of septal and vascular cells expressing fibroblast growth factor and myofibroblast proliferation, respectively. Multivariate Cox model analysis demonstrated that, after controlling for SSc-NSIP histological patterns, just three variables were significantly associated with survival time: septal iNOS (P=0.04), septal IL-13 (P=0.03), and septal basic fibroblast growth factor (bFGF; P=0.02). Augmented NOS, IL-13, and bFGF in SSc-NSIP histological patterns suggest a possible functional role for iNOS in SSc. In addition, the extent of iNOS, PAI-1, and IL-4 staining in alveolar septa and vessels provides a possible independent diagnostic measure for the degree of pulmonary dysfunction and fibrosis with an impact on the survival of patients with SSc.

Correlations between forced oscillation technique parameters and pulmonary densitovolumetry values in patients with acromegaly

The aims of this study were to evaluate the forced oscillation technique (FOT) and pulmonary densitovolumetry in acromegalic patients and to examine the correlations between these findings. In this cross-sectional study, 29 non-smoking acromegalic patients and 17 paired controls were subjected to the FOT and quantification of lung volume using multidetector computed tomography (Q-MDCT). Compared with the controls, the acromegalic patients had a higher value for resonance frequency [15.3 (10.9-19.7) vs 11.4 (9.05-17.6) Hz, P=0.023] and a lower value for mean reactance [0.32 (0.21-0.64) vs 0.49 (0.34-0.96) cm H2O/L/s2, P=0.005]. In inspiratory Q-MDCT, the acromegalic patients had higher percentages of total lung volume (TLV) for nonaerated and poorly aerated areas [0.42% (0.30-0.51%) vs 0.25% (0.20-0.32%), P=0.039 and 3.25% (2.48-3.46%) vs 1.70% (1.45-2.15%), P=0.001, respectively]. Furthermore, the acromegalic patients had higher values for total lung mass in both inspiratory and expiratory Q-MDCT [821 (635-923) vs 696 (599-769) g, P=0.021 and 844 (650-945) vs 637 (536-736) g, P=0.009, respectively]. In inspiratory Q-MDCT, TLV showed significant correlations with all FOT parameters. The TLV of hyperaerated areas showed significant correlations with intercept resistance (rs=&#8722;0.602, P<0.001) and mean resistance (rs=&#8722;0.580, P<0.001). These data showed that acromegalic patients have increased amounts of lung tissue as well as nonaerated and poorly aerated areas. Functionally, there was a loss of homogeneity of the respiratory system. Moreover, there were correlations between the structural and functional findings of the respiratory system, consistent with the pathophysiology of the disease.

Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis

We investigated the risk factors for pulmonary hypertension (PH) in patients receiving maintenance peritoneal dialysis (MPD). A group of 180 end-stage renal disease patients (124 men and 56 women; mean age: 56.43��8.36) were enrolled in our study, which was conducted between January 2009 and June 2014. All of the patients received MPD treatment in the Dialysis Center of the Second Affiliated Hospital of Soochow University. Clinical data, laboratory indices, and echocardiographic data from these patients were collected, and follow-ups were scheduled bi-monthly. The incidence and relevant risk factors of PH were analyzed. The differences in measurement data were compared by t-test and enumeration data were compared with the &#967;2 test. Among the 180 patients receiving MPD, 60 were diagnosed with PH. The remaining 120 were regarded as the non-PH group. Significant differences were observed in the clinical data, laboratory indices, and echocardiographic data between the PH and non-PH patients (all P<0.05). Furthermore, hypertensive nephropathy patients on MPD showed a significantly higher incidence of PH compared with non-hypertensive nephropathy patients (P<0.05). Logistic regression analysis showed that the proportion of internal arteriovenous fistula, C-reactive protein levels, and ejection fraction were the highest risk factors for PH in patients receiving MPD. Our study shows that there is a high incidence of PH in patients receiving MPD and hypertensive nephropathy patients have an increased susceptibility to PH.

Socio-demographic factors, smoking, symptoms, morbidities and pulmonary function and quality of life in individuals with a heavy smoking history

Objective: To determine which socio-demographic, exposure, morbidity and symptom variables are associated with health-related quality of life among former and current heavy smokers. Methods: Cross sectional data from 2537 participants were studied. All participants were at ���2% risk of developing lung cancer within 6 years. Linear and logistic regression models utilizing a multivariable fractional polynomial selection process identified variables associated with health-related quality of life, measured by the EQ-5D. Results: Upstream and downstream associations between smoking cessation and higher health-related quality of life were evident. Significant upstream associations, such as education level and current working status and were explained by the addition of morbidities and symptoms to regression models. Having arthritis, decreased forced expiratory volume in one second, fatigue, poor appetite or dyspnea were most highly and commonly associated with decreased HRQoL. Discussion: Upstream factors such as educational attainment, employment status and smoking cessation should be targeted to prevent decreased health-related quality of life. Practitioners should focus treatment on downstream factors, especially symptoms, to improve health-related quality of life.

Intra- and inter-hemispheric interactions in somatosensory processing of pain : dynamical causal modeling analysis of fMRI data

La douleur est une exp��rience perceptive comportant de nombreuses dimensions. Ces dimensions de douleur sont inter-reli��es et recrutent des r��seaux neuronaux qui traitent les informations correspondantes. L�����lucidation de l'architecture fonctionnelle qui supporte les diff��rents aspects perceptifs de l'exp��rience est donc une ��tape fondamentale pour notre compr��hension du r��le fonctionnel des diff��rentes r��gions de la matrice c��r��brale de la douleur dans les circuits corticaux qui sous tendent l'exp��rience subjective de la douleur. Parmi les diverses r��gions du cerveau impliqu��es dans le traitement de l'information nociceptive, le cortex somatosensoriel primaire et secondaire (S1 et S2) sont les principales r��gions g��n��ralement associ��es au traitement de l'aspect sensori-discriminatif de la douleur. Toutefois, l'organisation fonctionnelle dans ces r��gions somato-sensorielles n���est pas compl��tement claire et relativement peu d'��tudes ont examin�� directement l'int��gration de l'information entre les r��gions somatiques sensorielles. Ainsi, plusieurs questions demeurent concernant la relation hi��rarchique entre S1 et S2, ainsi que le r��le fonctionnel des connexions inter-h��misph��riques des r��gions somatiques sensorielles homologues. De m��me, le traitement en s��rie ou en parall��le au sein du syst��me somatosensoriel constitue un autre ��l��ment de questionnement qui n��cessite un examen plus approfondi. Le but de la pr��sente ��tude ��tait de tester un certain nombre d'hypoth��ses sur la causalit�� dans les interactions fonctionnelle entre S1 et S2, alors que les sujets recevaient des chocs ��lectriques douloureux. Nous avons mis en place une m��thode de mod��lisation de la connectivit��, qui utilise une description de causalit�� de la dynamique du syst��me, afin d'��tudier les interactions entre les sites d'activation d��finie par un ensemble de donn��es provenant d'une ��tude d'imagerie fonctionnelle. Notre paradigme est constitu�� de 3 session exp��rimentales en utilisant des chocs ��lectriques �� trois diff��rents niveaux d���intensit��, soit mod��r��ment douloureux (niveau 3), soit l��g��rement douloureux (niveau 2), soit compl��tement non douloureux (niveau 1). Par cons��quent, notre paradigme nous a permis d'��tudier comment l'intensit�� du stimulus est cod�� dans notre r��seau d'int��r��t, et comment la connectivit�� des diff��rentes r��gions est modul��e dans les conditions de stimulation diff��rentes. Nos r��sultats sont en faveur du mode s��riel de traitement de l���information somatosensorielle nociceptive avec un apport pr��dominant de la voie thalamocorticale vers S1 controlat��rale au site de stimulation. Nos r��sultats impliquent que l'information se propage de S1 controlat��ral �� travers notre r��seau d'int��r��t compos�� des cortex S1 bilat��raux et S2. Notre analyse indique que la connexion S1���S2 est renforc��e par la douleur, ce qui sugg��re que S2 est plus ��lev�� dans la hi��rarchie du traitement de la douleur que S1, conform��ment aux conclusions pr��c��dentes neurophysiologiques et de magn��toenc��phalographie. Enfin, notre analyse fournit des preuves de l'entr��e de l'information somatosensorielle dans l'h��misph��re controlat��ral au c��t�� de stimulation, avec des connexions inter-h��misph��riques responsable du transfert de l'information �� l'h��misph��re ipsilat��ral.

Comparaci��n entre los pacientes con diagn��stico cl��nico de EPOC vs los confirmados por Espirometr��a en un hospital de segundo nivel en Bogot�� DC, 2011

Introducci��n: La enfermedad pulmonar obstructiva cr��nica (EPOC), est�� caracterizada por la limitaci��n del flujo a��reo, de forma progresiva y casi irreversible, asociada a la reacci��n inflamatoria atribuida a diferentes factores, principalmente a la exposici��n al humo de tabaco. Es considerada un problema de salud p��blica en Colombia y en el mundo, con un aumento acelerado de la condici��n cr��nica en la actualidad. Objetivo: Identificar las diferencias sociodemogr��ficas, cl��nicas y de tratamiento, entre los pacientes con diagn��stico cl��nico y espirom��tricos de EPOC vs los pacientes con diagn��stico cl��nico y descartados por espirometr��a en el Hospital de Suba. Material y M��todos: Estudio observacional, descriptivo, retrospectivo como un componente exploratorio para comparar los grupos con diagn��stico de EPOC cl��nico y confirmado o descartado por espirometr��a, entre Enero y Agosto del 2011. Se utiliz�� estad��stica descriptiva para calcular las medidas de tendencia central, los datos cuantitativos se expresaron como la media de la variable �� desviaci��n est��ndar, y los cualitativos como porcentaje, la t de Student para analizar diferencia de las variables cuantitativas de medias entre grupos y la prueba de Pearson para analizar la relaci��n entre los datos cualitativos para aquellos con valores esperados menores a 5 se aplic�� test exacto de Fisher, tuvimos en cuenta un �� de 0.05 para el an��lisis bivariado y medidas de asociaci��n. Todos los an��lisis se realizaron con el paquete estad��stico SPSS 19,0 Versi��n corporativa. Resultados: De los 398 pacientes, solo 287 cumpl��an con criterios de inclusi��n. El promedio de edad del total de los pacientes fue de 70,29 + 11,18 a��os, y 59,5% de la poblaci��n fue de sexo femenino. Del total de pacientes evaluados, 171 pacientes (59.6%) se descart�� el diagn��stico de EPOC (VEF1/ VEC > 0,70). Al comparar los grupos de pacientes a los que se les confirmo el diagn��stico de EPOC contras los descartados por espirometr��a se encontr�� que no hay diferencias estad��sticamente significativas entre la edad; en los pacientes con EPOC predomino el sexo femenino (p 0.02); en los factores de riesgo existe clara asociaci��n entre EPOC y la exposici��n a humo de le��a (p <0.001), y en cuanto al tabaquismo solo se encontr�� asociaci��n con ex fumador (p 0,011). Para analizar las diferencias en el tratamiento se estratifico por las posible combinaciones de inhaladores con o sin teofilina, encontrando una diferencia estad��sticamente significativa para los tratamientos de tres inhaladores (p 0,015), dos inhaladores + teofilina (p 0,05), tres inhaladores + teofilina (p <0.001), y en los pacientes no tratados (p <0,001).

Quality of life and Chronic Obstructive Pulmonary Disease

The Chronic Obstructive Pulmonary Disease (COPD) has a progressive and irreversible character and it���s associated to the triad of dyspnea, exercise limitation and the evident deterioration of quality of life. In the United States the prevalence of COPD in adult population is approximately of 6% in men, and 1 to 3% in women and it���s the fourth cause of mortality by no transmissible chronic diseases. In 1993, the National Health Interview Surgery considered that 12 millions of Americans suffer from chronic bronchitis and 2 million had emphysema. These two affections are responsible for more than 13% of the hospitalizations. As this affection progresses, patients experience a diminution in quality of life related to health (CVRS), their capacity to work get worse and their participation in physical and social activities reduces. Nevertheless, it has been confirmed that the isolated evaluation of COPD seriousness, defined by the reduction of the Forced Expiratory Volume in the First Second (FEV1), does not provide enough information to know the health state perceived by the patients. The fact that the CVRS is the result of the interaction of multiple physical, psychological and social factors, unique for each individual, can explain this finding. This paper is a general and updated approach to the integral handling of patients with COPD, and it discusses the concept of quality of life, related to health improvement.

S��ntomas respiratorios y neumoconiosis por polvo de carb��n diagnosticada radiol��gicamente, en los trabajadores de miner��a subterr��nea en Boyac�� en el a��o 2014

Introducci��n Las neumoconiosis son un grupo de enfermedades respiratorias ocupacionales, debidas a la acumulaci��n de polvo en los pulmones. Colombia pese a ser un pa��s minero, no cuenta con datos oficiales sobre la prevalencia de la neumoconiosis que permitan implementar medidas preventivas para evitar el desarrollo de enfermedades asociadas a la explotaci��n minera y que disminuyan la incidencia y prevalencia de la neumoconiosis. Objetivos Determinar la prevalencia de neumoconiosis a partir del diagn��stico radiol��gico y describir s��ntomas respiratorios referidos por los trabajadores de las minas subterr��neas de carb��n en el departamento de Boyac��. Materiales y m��todos Se realiz�� un estudio descriptivo de corte transversal en 232 trabajadores de miner��a subterr��nea del departamento de Boyac��; teniendo como fuente de informaci��n los datos obtenidos en el proyecto ���Evaluaci��n de la exposici��n a polvo de carb��n en tres departamentos de Colombia, 2012-2015���, financiado por el Instituto Nacional de Salud, Universidad de Los Andes, la Universidad del Rosario, Positiva ARL y Colciencias. El an��lisis de los datos del estudio se realiz�� a trav��s del software Stata versi��n 11. Resultados El 100% de la poblaci��n estudio fueron de sexo masculino. La mediana para la edad fue de 40.5 a��os (20 ��� 73). La labor m��s com��nmente desempa��ada por los mineros fue: picadores 168 (72,41%). Los s��ntomas respiratorios m��s frecuentemente encontrados en este estudio fueron expectoraci��n y tos. En cuanto a expectoraci��n fue m��s frecuente en la ma��ana durante el invierno: 66.38% (154) y la tos de d��a o de noche durante el invierno: 53.88% (125). Para el h��bito de fumar el 17.67% fumaba al momento del estudio. En 69 mineros (29.74%) se encontraron anormalidades parenquimatosas en la Radiograf��a de T��rax.